Background

Ticagrelor is a novel antiplatelet agent that is frequently used for secondary prevention in coronary artery disease and has emerging evidence in stroke after the recent results of SOCRATES and THALES trials. The use of intravenous thrombolysis with alteplase in acute ischemic stroke (AIS) patients on ticagrelor is a topic of debate as the safety profile of ticagrelor in this setting is not well established.

Methods

We identified consecutive AIS patients taking ticagrelor who received intravenous alteplase at a comprehensive stroke center from January 2016 to December 2019. We then performed a literature search to capture all known published cases of intravenous thrombolysis in stroke patients on ticagrelor.

Results

Of the 3896 patients who were treated for AIS at our local comprehensive stroke center during this time period, two patients received intravenous alteplase while on ticagrelor. Both patients had posterior circulation acute strokes and were successfully treated with intravenous alteplase without a systemic or intracranial bleeding event. Only five other cases of intravenous thrombolysis in AIS patients on ticagrelor have been reported in the literature. Among these cases, four of the five cases had a hemorrhagic complication.

Conclusion

Despite prior reports of hemorrhagic complications with use of IV alteplase in setting of pre-treatment with ticagrelor, we report the safe use of intravenous thrombolysis in two cases presenting with acute ischemic stroke. Until safety is established in large studies, decision for thrombolysis should be made on case-by-case basis.

中文翻译：

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服用替加格雷洛的患者中风溶栓—两例成功病例及文献复习

背景

替卡格雷（Ticagrelor）是一种新型抗血小板药，通常用于冠状动脉疾病的二级预防，并且在最近进行的SOCRATES和THALES试验结果后，在卒中方面已出现新证据。在替卡格雷的急性缺血性卒中（AIS）患者中使用阿替普酶静脉溶栓治疗是一个争论的话题，因为在这种情况下，替卡格雷的安全性尚不明确。

方法

我们确定了从2016年1月至2019年12月在综合性卒中中心接受替卡格雷治疗的连续AIS患者接受静脉阿替普酶治疗的情况。然后，我们进行了文献检索，以收集所有已知的替卡格雷治疗中风患者静脉溶栓的已知病例。

结果

在此期间，在我们当地的综合性卒中中心接受AIS治疗的3896例患者中，有2例在替卡格雷时接受了静脉阿替普酶治疗。两名患者均患有后循环急性中风，并成功接受静脉内阿替普酶治疗，无全身或颅内出血事件。文献中仅报道了替卡格雷对AIS患者进行静脉溶栓的其他五例病例。在这些病例中，五例中有四例有出血并发症。

结论

尽管先前有报道报道在使用替卡格雷治疗前使用IV阿替普酶进行出血并发症的报道，但我们报告了在两名急性缺血性卒中患者中安全使用静脉溶栓治疗的情况。在大型研究中确定安全性之前，应根据具体情况决定溶栓的情况。