在4.5至24小时内不进行血栓切除术时,用于治疗缺血性中风的 Tenecteplase
Yunyun Xiong1, Bruce C V Campbell1, Lee H Schwamm1
1From the Department of Neurology (Y. Xiong, Y.J., L. Zong, M.H., Z.C., Liyuan Wang, S.W., Z.L., X.Z., Y.W.), the China National Clinical Research Center for Neurologic Diseases (Y. Xiong, X.M., A.J., Y.J., Y.P., C.D., W.Y., H.L., Y.W.), and the Advanced Innovation Center for Human Brain Protection (Y.W.), the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, and the Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences (Y.W.), Beijing, the Department of Neurology, Linyi People's Hospital, Linyi (F.C., H.W., Z.W.), the Department of Neurology, Second Affiliated Hospital of Harbin Medical University, Harbin (Lihua Wang), the Department of Neurology, Weifang People's Hospital, Weifang (L. Zhou), the Department of Emergency Medicine, Linfen Central Hospital, Linfen (H.D.), the Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou (X.L.), the Department of Neurology, First Affiliated Hospital of Zhengzhou University, the National Health Commission Key Laboratory of Prevention and Treatment of Cerebrovascular Disease, Zhengzhou (Y. Xu), the Department of Neurology, First Affiliated Hospital of Jinan University, Guangzhou (A.X.), and the Department of Neurology, First People's Hospital of Foshan, Foshan (Z.T.) - all in China; the Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC (B.C.V.C), and the Department of Neurology, University of New South Wales South Western Sydney Clinical School, Liverpool (M.W.P.) - both in Australia; Yale New Haven Health System, Yale School of Medicine, New Haven, CT (L.H.S.); and the Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston (M.F.).
在4.5小时以后的缺血性中风中,用tenecteplase治疗改善了患者的治疗结果. 这项研究发现,与标准护理相比,甲导致残疾较少,存活率相似.
科学领域:
- 神经学 神经学
- 心血管医学 心血管医学
- 药理学 药理学是指药理学的学科.
背景情况:
- 丁氏甲是一种血栓缓解药物,在中风发作后4.5小时内有效.
- 有限的数据存在于tenecteplase在治疗中风患者的疗效超出这个4.5小时窗口.
研究的目的:
- 评估因大血管封闭而导致缺血性中风的患者在症状发作后4.5至24小时内使用特内克的有效性和安全性.
- 为了在没有接受内血管血栓切除术的人群中比较 tenecteplase 与标准的医疗治疗.
主要方法:
- 在中国的一项随机试验中,分配了516名患有大血管封闭和可挽救的大脑组织的患者,接受甲或标准医疗治疗.
- 治疗是在最后一个已知的井时间后4.5至24小时进行的.
- 主要结局是90天后没有残疾 (修改的兰金级评分为0或1).
主要成果:
- 在90天的时间里,基治疗导致功能独立率显著提高 (33.0%对24.2%,P=0.03).
- 在90天后的死亡率在丁氏甲基酶组 (13.3%) 和标准治疗组 (13.1%) 之间相似.
- 与标准治疗组 (0.8%) 相比,在基治疗组 (3.0%) 中,症状性内出血的发生率更高.
结论:
- 在患有大血管封闭症的患者中,在缺血性中风发作后4.5至24小时内服用tenecteplase导致残疾减少.
- 在基和标准医疗治疗之间,生存率是可比的.
- 这项研究表明,在这种延长的时间窗口中,用基剂可能会增加症状性内出血.


