辅助静脉注射阿尔加特罗班或提巴提德用于缺血性中风
Opeolu Adeoye1, Joseph Broderick1, Colin P Derdeyn1
1From the Department of Emergency Medicine, Washington University, St. Louis (O.A., P.P., S.P.); the Departments of Neurology and Rehabilitation Medicine (J.B., I.D., S.D., M.H., P.K.), Emergency Medicine (A.P.), and Radiology (A.V.), University of Cincinnati, and the Department of Pharmacy, University of Cincinnati Medical Center (N.S.) - both in Cincinnati; the Department of Radiology, University of Virginia, Charlottesville (C.P.D.); the Clinical Institute for Research and Innovation, Memorial Hermann Hospital (J.C.G.), the Department of Neuroradiology, University of Texas M.D. Anderson Cancer Center (M.W.), and the Department of Neurology, University of Texas Health Science Center (A.D.B.), Houston, Berry Consultants, Austin (S.B., T.G.), and the Texas Stroke Institute, Medical City Healthcare, Dallas (A.J.Y.) - all in Texas; the Department of Emergency Medicine, University of Michigan, Ann Arbor (W.B.), and the Department of Neurology, McLaren Flint, Flint (A.M.) - both in Michigan; the Department of Neurology, University of Minnesota, Minneapolis (O.B., C.S.); the Department of Neurology, Sarasota Memorial Hospital, Intercoastal Medical Group, Sarasota (M.C.), and the Department of Neurology, Mayo Clinic, Jacksonville (J.H.) - both in Florida; the Department of Public Health Sciences, Medical University of South Carolina, Charleston (J.E., J.I.), and the Department of Medicine (Neurology), Prisma Health-Upstate, University of South Carolina Greenville School of Medicine, Greenville (S.S.); the Department of Emergency Medicine, Temple University, Philadelphia (N.G.); the National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (S.J.); the Department of Neurology, Yale University, New Haven, CT (A.S.J.); the Departments of Neurology and Emergency Medicine, State University of New York, New York (S.R.L.); the Department of Neurology, Wake Forest University, Winston-Salem, NC (T.R.); and the Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (A.W.).
在急性缺血性中风的静脉血栓溶解中添加阿斯拉夫罗班或埃皮菲巴提德并没有改善结局和增加死亡率. 对于接受标准中风护理的患者,不建议使用这些辅助治疗.
科学领域:
- 神经学 神经学
- 心血管医学 心血管医学
- 临床试验 临床试验
背景情况:
- 内静脉血栓溶解是急性缺血性中风的标准治疗方法.
- 血栓溶解与阿格拉特罗班或提巴提德的联合疗效和安全性仍然不清楚.
研究的目的:
- 评估在急性缺血性中风中治疗血栓溶解的患者中辅助静脉注射阿格拉夫罗班或埃皮菲巴提德的疗效和安全性.
- 为了比较使用实用权重90天修改的Rankin规模得分的结果.
主要方法:
- 第三阶段,随机化,受控试验涉及514名患者在57个美国地点.
- 患者在症状出现后3小时内接受静脉血栓溶解,随后接受了阿斯拉夫罗班,埃普蒂菲巴提德或安慰剂.
- 主要结局包括功能性残疾 (修改的兰金尺度) 和症状性内出血.
主要成果:
- 与安慰剂相比,辅助的阿斯罗班或提巴提德并没有改善90天的功能结果.
- 在90天的死亡率高于阿斯拉特罗班 (24%) 和eptifibatide (12%) 与安慰剂 (8%) 相比.
- 在所有组中,症状性内出血的发病率都相似.
结论:
- 在急性缺血性中风中,作为血栓溶解的辅助疗法,静脉输入的 argatroban 或 eptifibatide 并没有减少残疾.
- 这些治疗与死亡率的增加有关,这表明它们不是标准护理的有益补充.
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