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在发作后长达24小时内进行中风的基血栓溶解与输血成像选择:CHABLIS-T II随机临床试验
Xin Cheng1, Lan Hong1, Longting Lin2
1Department of Neurology, National Center for Neurological Disorders, National Clinical Research Centre for Aging and Medicine, Huashan Hospital, Fudan University, Shanghai, China (X.C., L.H., Y.L., Yiran Zhang, X.L., S.L., L.Y., Q.D.).
Stroke
|January 2, 2025
概括
在24小时窗口内,tenecteplase显著改善了急性缺血性中风患者的再输液. 然而,这并没有转化为90天后改善的临床结果,尽管这是安全的.
科学领域:
- 神经学 神经学
- 心血管医学 心血管医学
- 紧急医疗 紧急医疗
背景情况:
- 在急性缺血性中风中,延长静脉血栓溶解超过4.5小时的疗效和安全性尚不清楚.
- 大/中型血管封闭性创伤对延长的治疗窗口构成独特的挑战.
研究的目的:
- 评价中国急性缺血性中风患者中甲的有效性和安全性.
- 为了在延长的时间窗口内 (长达24小时) 评估 tenecteplase,大/中血管封闭.
主要方法:
- 随机试验比较tenecteplase (0.25 mg/kg) 与最佳医疗治疗在患者呈现4.5-24小时中风后.
- 根据有利的半阴影成像形状和大/中血管封闭情况选择的患者.
- 主要结局:没有症状的内出血的主要再输血;次要结局:再通道化,90天后的临床结果.
主要成果:
- 与最好的医疗治疗相比,丁替显著增加了主要转血率 (33.3%与10.8%) 和再通道 (35.8%与14.3%).
- 两组之间在临床疗效结果或出血转变率方面没有发现显著差异.
- 这项研究包括224名患者,其中111人接受了基和113人接受了最佳医疗治疗.
结论:
- 乙甲,当静脉注射0.25毫克/千克时,在选择的急性缺血性中风患者中,在较晚的时间窗口内增强了再输液.
- 虽然提升了再输和再通道化,但在90天后,tenecteplase并没有显著改变临床结果.
- 该疗法在症状性内出血和全身出血方面显示出安全性.
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