Dual antiplatelet versus alteplase in anterior and posterior circulation minor stroke.

IF 2.6 1区 医学
Yu Cui, Hui-Sheng Chen
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引用次数: 0

Abstract

Objective: The Antiplatelet versus R-tPA for Acute Mild Ischaemic Stroke trial has demonstrated the non-inferiority of dual antiplatelet therapy (DAPT) to alteplase in minor non-disabling stroke. This prespecified secondary analysis aimed to investigate whether the treatment effects were similar across stroke territories.

Methods: Participants were divided according to stroke territory, which were subdivided into DAPT and alteplase. An excellent functional outcome at 90 days defined as modified Rankin Scale scoring 0-1 was primary outcome. National Institutes of Health Stroke Scale (NIHSS) score change and early neurological improvement measured by a 2-point decline in NIHSS score at 24 hours were secondary outcomes. Symptomatic intracerebral haemorrhage (sICH) and bleeding events were safety outcomes. Primary analyses adjusted unbalanced baseline characteristics between treatments by multivariate logistic regression.

Results: A total of 719 patients were included: 566 in anterior circulation stroke (ACS) and 153 in posterior circulation stroke (PCS). Primary outcome was 94.1% in DAPT and 91.7% in alteplase among ACS patients (adjusted risk difference (RD) and 95% CI, 1.5% (-1.5% to 4.6%), p=0.32), while 91.2% in DAPT and 91.8% in alteplase among PCS patients (adjusted RD and 95% CI, -2.1% (-8.5% to 4.4%), p=0.53). Compared with alteplase, DAPT was associated with lower risk of sICH (p=0.03) and bleeding events (p<0.001) in ACS, but only lower risk of bleeding events (p=0.007) in PCS. Additionally, among ACS patients, the alteplase was superior to DAPT in terms of decrease in NIHSS score at 24 hours compared with admission (adjusted geometric mean ratio and 95% CI, -0.09 (-0.16 to -0.03), p=0.005) and early neurological improvement (adjusted RD and 95% CI, -7.2% (-11.6% to -2.7%), p=0.001).

Conclusion: Among ischaemic stroke with minor non-disabling symptoms, DAPT was similar with intravenous alteplase regarding long-term functional outcome and better safety regardless of ACS or PCS. The potential benefit of intravenous alteplase regarding early neurological improvement in patients with ACS warrants further investigation.

Trial registration number: NCT03661411.

双重抗血小板与阿替普酶在轻度卒中前后循环中的作用。
目的:抗血小板与R-tPA治疗急性轻度缺血性卒中的试验表明,双重抗血小板治疗(DAPT)在轻度非致残性卒中中的效果优于阿替普酶。这项预先指定的二次分析旨在调查治疗效果在卒中区域是否相似。方法:根据脑卒中范围对受试者进行分组,再细分为DAPT和阿替普酶。90天的良好功能结局(修改Rankin量表评分0-1分)是主要结局。美国国立卫生研究院卒中量表(NIHSS)评分变化和早期神经系统改善(24小时时NIHSS评分下降2分)是次要结果。症状性脑出血(siich)和出血事件是安全结局。初步分析通过多变量逻辑回归调整治疗间不平衡的基线特征。结果:共纳入719例患者,其中前循环卒中566例,后循环卒中153例。ACS患者DAPT的主要结局为94.1%,阿替普酶为91.7%(调整后的风险差异(RD)和95% CI, 1.5%(-1.5%至4.6%),p=0.32), PCS患者DAPT的主要结局为91.2%,阿替普酶为91.8%(调整后的RD和95% CI, -2.1%(-8.5%至4.4%),p=0.53)。与阿替普酶相比,DAPT与较低的sICH风险(p=0.03)和出血事件相关(p结论:在轻度非致残性症状的缺血性卒中中,DAPT与静脉注射阿替普酶在长期功能结局方面相似,无论ACS还是PCS都具有更好的安全性。静脉注射阿替普酶对ACS患者早期神经系统改善的潜在益处值得进一步研究。试验注册号:NCT03661411。
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来源期刊
Journal of Investigative Medicine
Journal of Investigative Medicine MEDICINE, GENERAL & INTERNALMEDICINE, RESE-MEDICINE, RESEARCH & EXPERIMENTAL
自引率
0.00%
发文量
111
期刊介绍: Journal of Investigative Medicine (JIM) is the official publication of the American Federation for Medical Research. The journal is peer-reviewed and publishes high-quality original articles and reviews in the areas of basic, clinical, and translational medical research. JIM publishes on all topics and specialty areas that are critical to the conduct of the entire spectrum of biomedical research: from the translation of clinical observations at the bedside, to basic and animal research to clinical research and the implementation of innovative medical care.
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