Intravenous tenecteplase compared with alteplase for minor ischaemic stroke:a secondary analysis of the AcT randomised clinical trial  

作　　者：Radhika Nair Nishita Singh Mahesh Kate Negar Asdaghi Robert Sarmiento Fouzi Bala Shelagh B Coutts MacKenzie Horn Alexandre Y Poppe Heather Williams Ayoola Ademola Ibrahim Alhabli Faysal Benali Houman Khosravani Gary Hunter Aleksander Tkach Herbert Alejandro Manosalva Alzate Aleksandra Pikula Thalia Field Anurag Trivedi Dar Dowlatshahi Luciana Catanese Ashfaq Shuaib Andrew Demchuk Tolulope Sajobi Mohammed A Almekhlafi Richard H Swartz Bijoy Menon Brian H Buck 

机构地区：[1]Department of Medicine,Division of Neurology,University of Alberta,Edmonton,Alberta,Canada [2]Department of Internal Medicine,Division of Neurology,University of Manitoba,Winnipeg,Manitoba,Canada [3]Department of Clinical Neurosciences,University of Calgary,Calgary,Alberta,Canada [4]Department of Neurology,University of Miami Miller School of Medicine,Miami,Florida,USA [5]Department of Neurosciences,Radiology and Community Health Sciences,University of Calgary,Calgary,Alberta,Canada [6]Diagnostic and Interventional Neuroradiology,Tours University Hospital,Tours,France [7]Department of Clinical Neurosciences,University of Montreal,Montreal,Québec,Canada [8]Department of Medicine,Queen Elizabeth Health Sciences Centre,Charlottetown,Edward Island,Canada [9]Cumming School of Medicine,University of Calgary,Calgary,Alberta,Canada [10]Department of Medicne,Neurology Division,Sunnybrook Health Sciences Centre,Toronto,Ontario,Canada [11]Department of Medicine,University of Saskatchewan,Saskatoon,Saskatchewan,Canada [12]Kelowna General Hospital,Kelowna,British Columbia,Canada [13]Department of Medicine,Medicine Hat Regional Hospital,Medicine Hat,Alberta,Canada [14]Department of Neurology,University of Toronto,Toronto,Ontario,Canada [15]Department of Neurosciences,University of British Columbia,Vancouver,British Columbia,Canada [16]Department of Medicine,Neurology Division,University of Manitoba,Winnipeg,Manitoba,Canada [17]Department of Medicine,University of Ottawa,Ottawa,Ontario,Canada [18]Division of Neurology,McMaster University,Hamilton,Ontario,Canada [19]Division of Neurology,Sunnybrook Health Sciences Centre,Toronto,Ontario,Canada

出　　处：《Stroke & Vascular Neurology》2024年第6期604-612,共9页卒中与血管神经病学(英文)

摘　　要：Background In ischaemic stroke,minor deficits(National Institutes of Health Stroke Scale(NIHSS)≤5)at presentation are common but often progress,leaving patients with significant disability.We compared the efficacy and safety of intravenous thrombolysis with tenecteplase versus alteplase in patients who had a minor stroke enrolled in the Alteplase Compared to Tenecteplase in Patients With Acute Ischemic Stroke(AcT)trial.Methods The AcT trial included individuals with ischaemic stroke,aged>18 years,who were eligible for standard-of-care intravenous thrombolysis.Participants were randomly assigned 1:1 to intravenous tenecteplase(0.25 mg/kg)or alteplase(0.9 mg/kg).Patients with minor deficits pre-thrombolysis were included in this post-hoc exploratory analysis.The primary efficacy outcome was the proportion of patients with a modified Rankin Score(mRS)of 0–1 at 90–120 days.Safety outcomes included mortality and symptomatic intracranial haemorrhage(sICH).Results Of the 378 patients enrolled in AcT with an NIHSS of≤5,the median age was 71 years,39.7%were women;194(51.3%)received tenecteplase and 184(48.7%)alteplase.The primary outcome(mRS score 0–1)occurred in 100 participants(51.8%)in the tenecteplase group and 86(47.5%)in the alteplase group(adjusted risk ratio(RR)1.14(95%CI 0.92 to 1.40)).There were no significant differences in the rates of sICH(2.9%in tenecteplase vs 3.3%in alteplase group,unadjusted RR 0.79(0.24 to 2.54))and death within 90 days(5.5%in tenecteplase vs 11%in alteplase group,adjusted HR 0.99(95%CI 0.96 to 1.02)).Conclusion In this post-hoc analysis of patients with minor stroke enrolled in the AcT trial,safety and efficacy outcomes with tenecteplase 0.25 mg/kg were not different from alteplase 0.9 mg/kg.

关 键 词：ACUTE MINOR analysis 

分 类 号：R743.3[医药卫生—神经病学与精神病学]