急性缺血性卒中静脉溶栓后早期抗血小板治疗的研究现状与展望

doi:10.3969/j.issn.1673-5765.2025.08.014

摘要/Abstract

摘要： 静脉溶栓治疗是急性缺血性卒中患者恢复脑血流灌注最主要的措施之一，目前急性缺血性卒中相关诊疗指南多建议在静脉溶栓后24 h后启动抗血小板治疗。然而，研究显示急性缺血性卒中患者静脉溶栓后至启动二级预防前，仍有症状加重和病情反复的风险。针对静脉溶栓后仍然呈现病情进展的急性缺血性卒中患者，若早期启动包括抗血小板治疗在内的二级预防，有望改善其预后。本文对近年来有关急性缺血性卒中患者静脉溶栓后24 h内启用抗血小板治疗的相关研究进行综述，以期为缺血性卒中患者溶栓后的治疗策略提供参考。

文章导读： 本文论述了急性缺血性卒中患者静脉溶栓后早期抗血小板治疗的可行性、安全性与有效性，并将其归纳为具体意见，以期为临床实践提供参考。

关键词: 急性缺血性卒中; 静脉溶栓治疗; 阿替普酶; 早期抗血小板治疗; 替罗非班

Abstract: Intravenous thrombolytic therapy has become the primary measure for restoring cerebral blood perfusion in patients with acute cerebral infarction. Guidelines recommend the use of antiplatelet drugs 24 hours after the end of intravenous thrombolytic therapy in patients with acute cerebral infarction. However, studies indicate that patients with acute cerebral infarction remain at risk of symptom aggravation and disease recurrence between intravenous thrombolysis and secondary prevention initiation. For patients with acute cerebral infarction who still show disease progression after intravenous thrombolysis, early initiation of secondary prevention, including antiplatelet therapy, is expected to improve their prognosis. This article reviews the relevant studies on antiplatelet therapy initiation within 24 hours after intravenous thrombolysis in patients with acute cerebral infarction in recent years, aiming to provide a reference for the treatment of patients with cerebral infarction after thrombolysis.

Key words: Acute cerebral infarction; Intravenous thrombolytic therapy; Alteplase; Early antiplatelet therapy; Tirofiban

中图分类号:

李子恒, 刘毅. 急性缺血性卒中静脉溶栓后早期抗血小板治疗的研究现状与展望[J]. 中国卒中杂志, 2025, 20(8): 1042-1050.

LI Ziheng, LIU Yi. Current Status and Prospects of Early Antiplatelet Therapy after Intravenous Thrombolysis in Acute Ischemic Stroke[J]. Chinese Journal of Stroke, 2025, 20(8): 1042-1050.

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链接本文: https://www.chinastroke.org.cn/CN/10.3969/j.issn.1673-5765.2025.08.014

https://www.chinastroke.org.cn/CN/Y2025/V20/I8/1042

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