2026美国心脏学会/美国卒中学会急性缺血性卒中患者早期管理指南静脉溶栓要点与解读

doi:10.3969/j.issn.1673-5765.2026.02.010

中国卒中杂志 ›› 2026, Vol. 21 ›› Issue (2): 226-233.DOI: 10.3969/j.issn.1673-5765.2026.02.010

2026美国心脏学会/美国卒中学会急性缺血性卒中患者早期管理指南静脉溶栓要点与解读

杜万良^1，2

1北京 100070 首都医科大学附属北京天坛医院急诊科
2北京 100070 神经系统疾病国家临床医学研究中心

收稿日期:2026-01-29 修回日期:2026-02-10 接受日期:2026-02-15 出版日期:2026-02-20 发布日期:2026-02-20
通讯作者: 杜万良 duwanliang@ncrcnd.org.cn

Interpretation of the Key Updates on Intravenous Thrombolysis in the 2026 Guideline for the Early Management of Patients with Acute Ischemic Stroke: A Guideline from the American Heart Association/American Stroke Association

DU Wanliang^1,2

1Department of Emergency, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
2China National Clinical Research Center for Neurological Diseases, Beijing 100070, China

Received:2026-01-29 Revised:2026-02-10 Accepted:2026-02-15 Online:2026-02-20 Published:2026-02-20
Contact: DU Wanliang, E-mail: duwanliang@ncrcnd.org.cn

摘要/Abstract

摘要： 2026美国心脏学会/美国卒中学会急性缺血性卒中患者早期管理指南于2026年1月发布，其在静脉溶栓方面的推荐有大量更新，内容涵盖药物选择、儿童患者筛选、时间窗延长、禁忌证减少，以及轻型非致残性卒中不建议静脉溶栓等。本文对2026版指南静脉溶栓方面的更新要点进行总结和解读，以期为国内急性缺血性卒中静脉溶栓临床实践提供参考。

关键词: 卒中; 静脉溶栓; 替奈普酶; 儿童; 时间窗

Abstract: The ‌2026 Guideline for the Early Management of Patients with Acute Ischemic Stroke: A Guideline from the American Heart Association/American Stroke Association was released in January 2026. It contains substantial updates to the recommendations on intravenous thrombolysis, covering agent selection, screening of pediatric patients, extended therapeutic time windows, reduced contraindications, and that intravenous thrombolysis is not recommended for mild non-disabling stroke. This article summarizes and interprets these key updates, aiming to provide a reference for the clinical practice of intravenous thrombolysis among patients with acute ischemic stroke in China.

Key words: Stroke; Intravenous thrombolysis; Tenecteplase; Child; Time window

中图分类号:

杜万良. 2026美国心脏学会/美国卒中学会急性缺血性卒中患者早期管理指南静脉溶栓要点与解读[J]. 中国卒中杂志, 2026, 21(2): 226-233.

DU Wanliang. Interpretation of the Key Updates on Intravenous Thrombolysis in the 2026 Guideline for the Early Management of Patients with Acute Ischemic Stroke: A Guideline from the American Heart Association/American Stroke Association[J]. Chinese Journal of Stroke, 2026, 21(2): 226-233.

参考文献

[1] PRABHAKARAN S，GONZALEZ N R，ZACHRISON K S，et al. 2026 guideline for the early management of patients with acute ischemic stroke：a guideline from the American Heart Association/American Stroke Association[J/OL]. Stroke，2026：e1-e119[2026-02-02]. https://doi.org/10.1161/STR.0000000000000513.
[2] POWERS W J，RABINSTEIN A A，ACKERSON T，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[J/OL]. Stroke，2019，50（12）：e344-e418[2026-02-02]. https://doi.org/10.1161/STR.0000000000000211.
[3] MUIR K W，FORD G A，FORD I，et al. Tenecteplase versus alteplase for acute stroke within 4.5 h of onset（ATTEST-2）：a randomised，parallel group，open-label trial[J]. Lancet Neurol，2024，23（11）：1087-1096.
[4] MENON B K，BUCK B H，SINGH N，et al. Intravenous tenecteplase compared with alteplase for acute ischaemic stroke in Canada（AcT）：a pragmatic，multicentre，open-label，registry-linked，randomised，controlled，non-inferiority trial[J]. Lancet，2022，400（10347）：161-169.
[5] WANG Y J，LI S Y，PAN Y S，et al. Tenecteplase versus alteplase in acute ischaemic cerebrovascular events（TRACE-2）：a phase 3，multicentre，open-label，randomised controlled，non-inferiority trial[J]. Lancet，2023，401（10377）：645-654.
[6] PARSONS M W，YOGENDRAKUMAR V，CHURILOV L，et al. Tenecteplase versus alteplase for thrombolysis in patients selected by use of perfusion imaging within 4.5 h of onset of ischaemic stroke（TASTE）：a multicentre，randomised，controlled，phase 3 non-inferiority trial[J]. Lancet Neurol，2024，23（8）：775-786.
[7] MENG X，LI S Y，DAI H G，et al. Tenecteplase vs. alteplase for patients with acute ischemic stroke：the ORIGINAL randomized clinical trial[J]. JAMA，2024，332（17）：1437-1445.
[8] LI S Y，GU H Q，LI H，et al. Reteplase versus alteplase for acute ischemic stroke[J]. N Engl J Med，2024，390（24）：2264-2273.
[9] LI S Y，GU H Q，FENG B Y，et al. Safety and efficacy of intravenous recombinant human prourokinase for acute ischaemic stroke within 4.5 h after stroke onset（PROST-2）：a phase 3，open-label，non-inferiority，randomised controlled trial[J]. Lancet Neurol，2025，24（1）：33-41.
[10] DAVERIO M，BRESSAN S，GREGORI D，et al. Patient and process factors associated with type of first neuroimaging and delayed diagnosis in childhood arterial ischemic stroke[J]. Acad Emerg Med，2016，23（9）：1040-1047.
[11] STRAUSS K J. Developing patient-specific dose protocols for a CT scanner and exam using diagnostic reference levels[J/OL]. Pediatr Radiol，2014，44（Suppl 3）：479-488[2026-02-02]. https://doi.org/10.1007/s00247-014-3088-8.
[12] LEVI C R，ATTIA J A，D’ESTE C，et al. Cluster-randomized trial of thrombolysis implementation support in metropolitan and regional Australian stroke centers：lessons for individual and systems behavior change[J/OL]. J Am Heart Assoc，2020，9（3）：e012732[2026-02-02]. https://doi.org/10.1161/JAHA.119.012732.
[13] National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke[J]. N Engl J Med，1995，333（24）：1581-1587.
[14] HACKE W，KASTE M，BLUHMKI E，et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke[J]. N Engl J Med，2008，359（13）：1317-1329.
[15] THOMALLA G，SIMONSEN C Z，BOUTITIE F，et al. MRI-guided thrombolysis for stroke with unknown time of onset[J]. N Engl J Med，2018，379（7）：611-622.
[16] KOGA M，YAMAMOTO H，INOUE M，et al. Thrombolysis with alteplase at 0.6 mg/kg for stroke with unknown time of onset：a randomized controlled trial[J]. Stroke，2020，51（5）：1530-1538.
[17] DAVIS S M，DONNAN G A，PARSONS M W，et al. Effects of alteplase beyond 3 h after stroke in the echoplanar imaging thrombolytic evaluation trial（EPITHET）：a placebo-controlled randomised trial[J]. Lancet Neurol，2008，7（4）：299-309.
[18] RINGLEB P，BENDSZUS M，BLUHMKI E，et al. Extending the time window for intravenous thrombolysis in acute ischemic stroke using magnetic resonance imaging-based patient selection[J]. Int J Stroke，2019，14（5）：483-490.
[19] MA H，CAMPBELL B C V，PARSONS M W，et al. Thrombolysis guided by perfusion imaging up to 9 hours after onset of stroke[J]. N Engl J Med，2019，380（19）：1795-1803.
[20] XIONG Y Y，CAMPBELL B C V，SCHWAMM L H，et al. Tenecteplase for ischemic stroke at 4.5 to 24 hours without thrombectomy[J]. N Engl J Med，2024，391（3）：203-212.
[21] ALBERS G W，JUMAA M，PURDON B，et al. Tenecteplase for stroke at 4.5 to 24 hours with perfusion-imaging selection[J]. N Engl J Med，2024，390（8）：701-711.
[22] KHATRI P，KLEINDORFER D O，DEVLIN T，et al. Effect of alteplase vs. aspirin on functional outcome for patients with acute ischemic stroke and minor nondisabling neurologic deficits：the PRISMS randomized clinical trial[J]. JAMA，2018，320（2）：156-166.
[23] MERLINO G，NESI L，VERGOBBI P，et al. The use of alteplase，although safe，does not offer clear clinical advantages when mild stroke is non-disabling[J/OL]. Front Neurol，2023，14：1212712[2026-02-02]. https://doi.org/10.3389/fneur.2023.1212712.
[24] CHEN H S，CUI Y，ZHOU Z H，et al. Dual antiplatelet therapy vs. alteplase for patients with minor nondisabling acute ischemic stroke：the ARAMIS randomized clinical trial[J]. JAMA，2023，329（24）：2135-2144.
[25] COUTTS S B，ANKOLEKAR S，APPIREDDY R，et al. Tenecteplase versus standard of care for minor ischaemic stroke with proven occlusion（TEMPO-2）：a randomised，open label，phase 3 superiority trial[J]. Lancet，2024，403（10444）：2597-2605.
[26] VIANA P，RELVAS J H，CABRAL T D D，et al. Dual antiplatelet therapy vs. alteplase in adult patients with acute minor ischemic stroke：a systematic review and meta-analysis[J]. J Thromb Thrombolysis，2024，57（6）：929-935.
[27] YEATTS S D，BRODERICK J P，CHATTERJEE A，et al. Alteplase for the treatment of acute ischemic stroke in patients with low National Institutes of Health stroke scale and not clearly disabling deficits（potential of rtPA for ischemic strokes with mild symptoms PRISMS）：rationale and design[J]. Int J Stroke，2018，13（6）：654-661.

2026美国心脏学会/美国卒中学会急性缺血性卒中患者早期管理指南静脉溶栓要点与解读

Interpretation of the Key Updates on Intravenous Thrombolysis in the 2026 Guideline for the Early Management of Patients with Acute Ischemic Stroke: A Guideline from the American Heart Association/American Stroke Association

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