2026/11/14 13:30-15:00 Room 401
- Precision Pharmacology in Stroke
- Time
- Topic
- Speaker
- Moderator
- 14:10-14:30
- Early antithrombotics after IVT
- SPEAKER:
Chih-Hao Chen
陳志昊
Taiwan (台灣)
- MODERATOR:
Po-Lin Chen
陳柏霖
Taiwan (台灣)
Li-Kai Tsai
蔡力凱
Taiwan (台灣)
- Chih-Hao Chen
- MD, PhD
-
Physician, Department of Neurology, National Taiwan University Hospital
Lecture Abstract：
For three decades, antiplatelet and anticoagulant agents have been withheld for 24 hours after intravenous thrombolysis (IVT). This convention originated as a safety provision in the NINDS protocol and has never been directly tested in a randomized trial, yet early reocclusion and early neurological deterioration occur most often within this interval. Alteplase has a plasma half-life of only a few minutes and tenecteplase is cleared within hours, so the rule is more conservative than the pharmacokinetics require.
The first generation of trials gave an antithrombotic agent while thrombolysis was still running, and consistently failed, with excess hemorrhage or mortality in some of them. Over the past two years, several large randomized trials have moved administration to after completion of thrombolysis and restricted enrollment to non-cardioembolic stroke, and a number of these have been positive. Two distinct strategies have emerged: treating every patient who meets the trial entry phenotype within the first hour, and a response-guided approach that treats only those who deteriorate or fail to improve between 4 and 24 hours. A recent meta-analysis restricted to randomized trials nevertheless remained neutral overall, and trial sequential analysis indicates that the evidence is still inconclusive.
This lecture will review these recent trials, the specific clinical settings in which each of them applies, and how the two strategies might be used in Taiwan.
For three decades, antiplatelet and anticoagulant agents have been withheld for 24 hours after intravenous thrombolysis (IVT). This convention originated as a safety provision in the NINDS protocol and has never been directly tested in a randomized trial, yet early reocclusion and early neurological deterioration occur most often within this interval. Alteplase has a plasma half-life of only a few minutes and tenecteplase is cleared within hours, so the rule is more conservative than the pharmacokinetics require.
The first generation of trials gave an antithrombotic agent while thrombolysis was still running, and consistently failed, with excess hemorrhage or mortality in some of them. Over the past two years, several large randomized trials have moved administration to after completion of thrombolysis and restricted enrollment to non-cardioembolic stroke, and a number of these have been positive. Two distinct strategies have emerged: treating every patient who meets the trial entry phenotype within the first hour, and a response-guided approach that treats only those who deteriorate or fail to improve between 4 and 24 hours. A recent meta-analysis restricted to randomized trials nevertheless remained neutral overall, and trial sequential analysis indicates that the evidence is still inconclusive.
This lecture will review these recent trials, the specific clinical settings in which each of them applies, and how the two strategies might be used in Taiwan.
