大动脉粥样硬化性卒中患者接受重组组织型纤溶酶原激活物治疗 24 小时内应用抗栓治疗的安全性：来自急诊 PTA/CAS 病例的启示。

Safety of Antithrombotic Therapy within 24 Hours after Recombinant Tissue-Plasminogen Activator Treatment for Large-Artery Atherosclerosis Stroke: Insights from Emergent PTA/CAS Cases.

机构信息

Department of Neurology, Graduate School of Medicine, Nippon Medical School.

Department of Neurology, Tokyo Rosai Hospital.

出版信息

J Nippon Med Sch. 2024;91(3):307-315. doi: 10.1272/jnms.JNMS.2024_91-309.

DOI:10.1272/jnms.JNMS.2024_91-309

PMID:38972743

Abstract

BACKGROUND

Antithrombotic therapy (AT) should generally be avoided within 24 hours after recombinant tissue-plasminogen activator (rt-PA) treatment but should be considered in patients with large-artery atherosclerosis (LAA) who undergo concomitant emergent endovascular treatment (EVT). The aim of the present study was to assess the safety of AT within 24 hours after rt-PA treatment in patients with hyperacute ischemic stroke due to LAA who received concomitant EVT.

METHODS

From January 2013 through July 2019, consecutive patients with acute ischemic cerebrovascular disease due to LAA who were admitted within 6 hours from symptom onset were recruited. The patients were classified into six groups based on the reperfusion treatment and early (within 24 hours) AT from rt-PA treatment. Safety outcomes were compared among the groups.

RESULTS

A total of 155 patients (35 women [23%], median age 74 [IQR 66-79] years; NIHSS score 3 [1-10]) were included in the present study. Of these, 73 (47%) received no reperfusion therapy, 24 (15%) received rt-PA treatment and early AT, seven (6%) received rt-PA without early AT, 26 (17%) received EVT only, six (4%) received both rt-PA and EVT without early AT, and 19 (12%) received rt-PA and EVT with early AT. AT was administered a median of 3.9 (1.6-8.0) hours after rt-PA in patients with rt-PA+EVT with early AT. AT within 24 hours after rt-PA and EVT treatment did not increase hemorrhagic complications (p > 0.05 for all).

CONCLUSION

In this retrospective analyses, early AT administration for patients with hyperacute stroke due to LAA treated with rt-PA plus EVT did not increase hemorrhagic events.

摘要

背景

重组组织型纤溶酶原激活剂（rt-PA）治疗后 24 小时内一般应避免抗血栓治疗，但接受同时进行的紧急血管内治疗（EVT）的大动脉粥样硬化（LAA）患者应考虑抗血栓治疗。本研究旨在评估 rt-PA 治疗后 24 小时内接受同时 EVT 的 LAA 所致超急性缺血性脑卒中患者进行抗血栓治疗的安全性。

方法

从 2013 年 1 月至 2019 年 7 月，连续招募发病 6 小时内的 LAA 导致的急性缺血性脑血管病患者。根据再灌注治疗和 rt-PA 治疗后早期（24 小时内）抗血栓治疗将患者分为六组。比较各组之间的安全性结果。

结果

本研究共纳入 155 例患者（35 例女性[23%]，中位年龄 74 [IQR 66-79]岁；NIHSS 评分 3 [1-10]）。其中，73 例（47%）未接受再灌注治疗，24 例（15%）接受 rt-PA 治疗和早期 AT，7 例（6%）接受 rt-PA 而无早期 AT，26 例（17%）接受 EVT 治疗，6 例（4%）接受 rt-PA 和 EVT 治疗但无早期 AT，19 例（12%）接受 rt-PA 和 EVT 治疗且早期 AT。rt-PA+EVT+早期 AT 患者 rt-PA 后中位 3.9（1.6-8.0）小时给予 AT。rt-PA 和 EVT 治疗后 24 小时内进行 AT 并未增加出血性并发症（所有 p 值均＞0.05）。