Vascular Neurology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
China National Clinical Research Center for Neurological Diseases, Beijing, China.
CNS Neurosci Ther. 2023 Jun;29(6):1615-1623. doi: 10.1111/cns.14124. Epub 2023 Mar 7.
Our study aimed to explore the effectiveness and safety of intravenous t-PA compared with dual antiplatelet therapy (DAPT) and aspirin alone for minor stroke with National Institutes of Health Stroke Scale (NIHSS) score ≤5 and large vessel occlusion (LVO).
Patients with minor stroke harboring LVO within 4.5-h time window were included from the Third China National Stroke Registry (CNSR-III) between August 2015 and March 2018 in China. Clinical outcomes including modified Rankin scale (mRS) score, recurrent stroke, and all-cause mortality at 90 days and 36-h symptomatic intracerebral hemorrhage (sICH) were collected. Multivariable logistic regression models and propensity score matching analyses were used to determine the association between treatment groups and clinical outcomes.
A total of 1401 minor stroke patients with LVO were included. Overall 251 patients (17.9%) received intravenous t-PA, 722 patients (51.5%) received DAPT, and 428 patients (30.5%) received aspirin alone. The intravenous t-PA was associated with greater proportions of mRS 0-1 (aspirin versus t-PA: adjusted odds ratio [aOR], 0.50; 95% confidence interval [CI], 0.32 to 0.80; p = 0.004; DAPT versus t-PA: aOR, 0.76; 95% CI, 0.49 to 1.19; p = 0.23). Using propensity score matching analyses, the results were similar. There was no difference in 90-day recurrent stroke among the groups. The rates of all-cause mortality in intravenous t-PA, DAPT, and aspirin groups were 0%, 0.55%, 2.34%, respectively. No patient developed sICH within 36 h of intravenous t-PA.
In patients with minor stroke harboring LVO within 4.5-h time window, intravenous t-PA was associated with higher odds for the excellent functional outcome, as compared with the aspirin alone. Further randomized controlled trials are warranted.
本研究旨在探讨与双联抗血小板治疗（DAPT）和单独应用阿司匹林相比，静脉注射组织型纤溶酶原激活剂（t-PA）治疗 NIHSS 评分≤5 分且伴有大血管闭塞（LVO）的轻型卒中的有效性和安全性。
本研究纳入了 2015 年 8 月至 2018 年 3 月期间中国第三次全国卒中登记研究（CNSR-III）中发病 4.5 小时内的轻型卒中伴 LVO 患者。收集了 90 天和 36 小时症状性颅内出血（sICH）时的改良 Rankin 量表（mRS）评分、复发卒中和全因死亡率等临床结局。采用多变量逻辑回归模型和倾向评分匹配分析来确定治疗组与临床结局之间的关系。
共纳入 1401 例 LVO 轻型卒中患者。其中，251 例（17.9%）接受了静脉 t-PA 治疗，722 例（51.5%）接受了 DAPT 治疗，428 例（30.5%）接受了单独应用阿司匹林治疗。静脉 t-PA 治疗组 mRS 0-1 评分的比例更高（阿司匹林组与 t-PA 组：调整后比值比[aOR]，0.50；95%置信区间[CI]，0.32 至 0.80；p=0.004；DAPT 组与 t-PA 组：aOR，0.76；95%CI，0.49 至 1.19；p=0.23）。采用倾向评分匹配分析后，结果相似。三组间 90 天内复发卒中的发生率无差异。静脉 t-PA、DAPT 和阿司匹林组的全因死亡率分别为 0%、0.55%和 2.34%。静脉 t-PA 治疗组在 36 小时内无一例发生 sICH。
在发病 4.5 小时内伴有 LVO 的轻型卒中患者中，与单独应用阿司匹林相比，静脉 t-PA 治疗可显著提高患者获得良好功能结局的几率。尚需开展更多的随机对照试验来验证。
