*仅供医学专业人士阅读参考

■ 本期要点:

➤ 基于阿替普酶桥接取栓治疗急性大血管闭塞性缺血性卒中的研究结果,对于没有静脉溶栓禁忌证且有资格接受机械取栓的患者,直接取栓未能证实非劣于桥接取栓。因此,当患者同时符合静脉溶栓和机械取栓指征时,应进行桥接取栓。

➤ 替奈普酶作为一种新型纤溶酶原激活物,具有操作简便(单次推注)、半衰期长(约22 min)、纤维蛋白特异性高等优势,ORIGINAL研究证实了原研替奈普酶在急性缺血性卒中发病4.5h内溶栓治疗与阿替普酶相比的非劣效性。因此,原研替奈普酶被视为静脉溶栓治疗的新选择。


➤ 本期内容将对原研替奈普酶桥接机械取栓在急性缺血性卒中领域的指南 推荐和重要的临床研究进展进行回顾和梳理,以飨读者。

*以下内容仅供医疗卫生专业人士浏览。

调研问题

参考文献:

[1]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组. 中国急性缺血性卒中诊治指南2023. 中华神经科杂志,2024,57(06):523-559.

[2]Majoie CB, et al. Value of intravenous thrombolysis in endovascular treatment for large-vessel anterior circulation stroke: individual participant data meta-analysis of six randomised trials. Lancet. 2023;402(10406):965-974.

[3]Tanswell P, et al. Pharmacokinetics and pharmacodynamics of tenecteplase in fibrinolytic therapy of acute myocardial infarction. Clin Pharmacokinet. 2002;41(15):1229-45.

[4]Warach SJ, et al. Prospective Observational Cohort Study of Tenecteplase Versus Alteplase in Routine Clinical Practice. Stroke. 2022;53(12):3583-3593.

[5]Powers WJ, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019;50(12):e344-e418.

[6]Alamowitch S, et al. European Stroke Organisation (ESO) expedited recommendation on tenecteplase for acute ischaemic stroke. Eur Stroke J. 2023;8(1):8-54.

[7]中国卒中学会,《中国卒中学会急性缺血性卒中再灌注治疗指南2024》编写组,王拥军. 中国卒中学会急性缺血性卒中再灌注治疗指南2024. 中国卒中杂志,2024,19(12):1460-1478.

[8]Campbell BCV, et al. Tenecteplase versus Alteplase before Thrombectomy for Ischemic Stroke. N Engl J Med. 2018;378(17):1573-1582.

[9]Altersberger VL,et al. Bridging thrombolysis with tenecteplase versus endovascular thrombectomy alone for large-vessel anterior circulation stroke: a target trial emulation analysis. J Neurol Neurosurg Psychiatry. 2025 Jan 22:jnnp-2024-335325.

[10]Meng X, et al. Tenecteplase vs Alteplase for Patients With Acute Ischemic Stroke: The ORIGINAL Randomized Clinical Trial. JAMA. 2024;332(17):1437-1445.

[11]卓琳,等. 模拟目标试验概念及其关键要素. 中华儿科杂志,2024,62(08):751-751.

[12]Matthews AA, et al. Target trial emulation: applying principles of randomised trials to observational studies. BMJ. 2022;378:e071108.

审批编号:SC-CN-16714

有效期至:5/7/2026

*此文仅用于向医学人士提供科学信息,不代表本平台观点