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).
CONCLUSIONS: 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.
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).
CONCLUSIONS: 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：通常应在重组组织纤溶酶原激活剂（rt-PA）治疗后24小时内避免抗血栓治疗（AT），但对于合并急诊血管内治疗（EVT）的大动脉粥样硬化（LAA）患者应考虑。本研究的目的是评估合并EVT的LAA导致的超急性缺血性卒中患者在rt-PA治疗后24小时内AT的安全性。
方法：从2013年1月至2019年7月，招募症状发作后6小时内收治的LAA所致急性缺血性脑血管病患者。根据再灌注治疗和rt-PA治疗的早期(24小时内)AT将患者分为6组。比较各组的安全性结果。
结果：共155名患者（35名女性[23%]，中位年龄74[IQR66-79]岁;NIHSS评分3[1-10])纳入本研究。其中,73人（47%）未接受再灌注治疗，24（15%）接受rt-PA治疗和早期AT，七个（6%）在没有提前AT的情况下接受了rt-PA，26（17%）只接受EVT，6人(4%)同时接受rt-PA和EVT，没有早期AT，19人(12%)接受rt-PA和EVT治疗，早期AT。在rt-PA+EVT合并早期AT的患者中,在rt-PA后中位3.9(1.6-8.0)小时给予AT。在rt-PA和EVT治疗后24小时内AT没有增加出血性并发症(均p>0.05)。
结论：在本回顾性分析中，对于接受rt-PA加EVT治疗的LAA导致的超急性卒中患者,早期AT治疗不会增加出血性事件.
方法：从2013年1月至2019年7月，招募症状发作后6小时内收治的LAA所致急性缺血性脑血管病患者。根据再灌注治疗和rt-PA治疗的早期(24小时内)AT将患者分为6组。比较各组的安全性结果。
结果：共155名患者（35名女性[23%]，中位年龄74[IQR66-79]岁;NIHSS评分3[1-10])纳入本研究。其中,73人（47%）未接受再灌注治疗，24（15%）接受rt-PA治疗和早期AT，七个（6%）在没有提前AT的情况下接受了rt-PA，26（17%）只接受EVT，6人(4%)同时接受rt-PA和EVT，没有早期AT，19人(12%)接受rt-PA和EVT治疗，早期AT。在rt-PA+EVT合并早期AT的患者中,在rt-PA后中位3.9(1.6-8.0)小时给予AT。在rt-PA和EVT治疗后24小时内AT没有增加出血性并发症(均p>0.05)。
结论：在本回顾性分析中，对于接受rt-PA加EVT治疗的LAA导致的超急性卒中患者,早期AT治疗不会增加出血性事件.
