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血栓溶解后轻微中风的早期抗血小板治疗:EAST试验
Hui-Sheng Chen1, Yu Cui1, Xiao-Qiu Li1
1Department of Neurology, General Hospital of Northern Theater Command, 83 Wenhua Rd, Shenyang 110016, China.
European heart journal
|September 19, 2025
概括
小型中风静脉血栓溶解后的早期抗血小板治疗是安全的,但不会改善功能结果. 这项随机试验在接受克洛皮多格雷尔加阿司匹林和安慰剂的患者中,在90天的优秀功能结果中没有显著差异.
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:
- 静脉内血栓溶解是急性缺血性中风的关键治疗方法.
- 延迟抗血小板启动 (24小时血栓溶解后) 是标准的,因为人们担心出血转化.
- 在接受血栓溶解的轻微中风患者中,早期抗血小板治疗的有效性仍在研究中.
研究的目的:
- 评估早期抗血小板治疗 (克洛皮多格雷尔加阿司匹林) 的有效性和安全性,在静脉输血栓溶解后6小时内开始,在轻度急性缺血性中风患者中.
- 为了确定早期抗血小板治疗是否与安慰剂相比,在90天后改善功能结果.
主要方法:
- 一个多中心,双盲,随机对照试验在中国进行.
- 1022名患有轻度神经缺陷的患者 (NIHSS 0-5) 接受静脉输血栓溶解被随机分组.
- 患者在血栓溶解后6小时内接受了克洛皮多格雷尔加阿司匹林或安慰剂.
- 主要终点:在90天后表现出色的功能性结果 (修改的兰金尺度得分0-1).
- 安全终点包括有症状的内出血和严重的全身出血.
主要成果:
- 主要终点没有达到;在组之间没有观察到卓越的功能结果的显著差异.
- 接受早期抗血小板治疗的89.7%的患者实现了0-1的mRS得分,而安慰剂组的89.6% (OR 1.00,P = .99).
- 早期的抗血小板治疗显示出与安慰剂相似的安全性,出血事件的发生率相似.
结论:
- 在接受静脉输血栓溶解治疗的中国急性轻度缺血性中风患者中,早期服用克洛皮多格雷尔加阿司匹林是安全的.
- 在这种患者群体中,早期的抗血小板疗法在90天后不会显著改善功能结果.
- 这些发现表明,目前推推迟抗血小板启动的建议可能适用于小型中风患者的血栓溶解后.
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