1
|
Liu A, Sun J, Tiwari S, Wong J, Wang H, Tang D, Han Z. Effect of Chinese herbal formulae (BU-SHEN-YI-QI granule) treatment on thrombin expression after ischemia/reperfusion. ALL LIFE 2023. [DOI: 10.1080/26895293.2023.2173311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Affiliation(s)
- Aihua Liu
- Department of Integrative Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai, P.R. People’s Republic of China
| | - Jing Sun
- Department of Integrative Medicine, Huashan Hospital Affiliated to Fudan University, Shanghai, P.R. People’s Republic of China
| | - Sagun Tiwari
- Department of Neurology and Rehabilitation, Seventh People's Hospital of Shanghai University of TCM, Shanghai, P.R. People’s Republic of China
- International Education College, Shanghai University of TCM, Shanghai, P.R. People’s Republic of China
| | - John Wong
- School of Nursing and Department of Occupational Therapy, MGH Institute of Health Professions, Boston, MA, USA
| | - Honglin Wang
- Department of Neurology and Rehabilitation, Seventh People's Hospital of Shanghai University of TCM, Shanghai, P.R. People’s Republic of China
| | - Dongxu Tang
- Department of Neurology and Rehabilitation, Seventh People's Hospital of Shanghai University of TCM, Shanghai, P.R. People’s Republic of China
| | - Zhenxiang Han
- Department of Neurology and Rehabilitation, Seventh People's Hospital of Shanghai University of TCM, Shanghai, P.R. People’s Republic of China
| |
Collapse
|
2
|
Han X, Li Y, Chen X, Pan D, Mo J, Qiu J, Li Y, Chen Y, Huang Y, Shen Q, Tang Y. Platelet-activating factor antagonist-based intensive antiplatelet strategy in acute ischemic stroke: A propensity score matched with network pharmacology analysis. CNS Neurosci Ther 2023; 29:4082-4092. [PMID: 37435773 PMCID: PMC10651968 DOI: 10.1111/cns.14331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 05/25/2023] [Accepted: 06/20/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Diterpene ginkgolides meglumine injection (DGMI) is a platelet-activating factor receptor (PAFR) antagonist that can be used to treat acute ischemic stroke (AIS). This study evaluated the efficacy and safety of an intensive antiplatelet strategy based on PAFR antagonists and explored the underlying mechanisms of PAFR antagonists in AIS treatment. METHODS This is a retrospective study applying propensity score methods to match AIS patients treated with DGMI to nontreated patients. The primary outcome was functional independence (modified Rankin Scale [mRS] 0-2) at 90 days. The safety outcome was bleeding risk. We used McNemar test to compare the efficacy outcome. Subsequently, the network pharmacology analysis was performed. RESULTS 161 AIS patients treated with DGMI in the study were matched with 161 untreated patients. Compared with untreated patients, DGMI-treated patients had a significantly higher rate of mRS ranking 0-2 at 90 days (82.0% vs. 75.8%, p < 0.001), without increased risk of bleeding. The gene enrichment analysis showed that the overlap genes of DGMI targeted and AIS-related enriched in thrombosis and inflammatory-related signaling pathways. CONCLUSIONS An intensive antiplatelet strategy of DGMI plus traditional antiplatelet agents is effective in treating AIS and may work by mediating post-stroke inflammation and thrombosis.
Collapse
Affiliation(s)
- Xiaoyan Han
- Department of NeurologyFirst People's Hospital of ZhaoqingZhaoqingPeople's Republic of China
- Department of Neurology, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
| | - Youjia Li
- Department of NeurologyFirst People's Hospital of ZhaoqingZhaoqingPeople's Republic of China
| | - Xuemin Chen
- Guangdong Medical UniversityZhanjiangPeople's Republic of China
| | - Dong Pan
- Department of Neurology, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
| | - Junning Mo
- Department of NeurologyFirst People's Hospital of ZhaoqingZhaoqingPeople's Republic of China
| | - Jiaming Qiu
- Department of NeurologyFirst People's Hospital of ZhaoqingZhaoqingPeople's Republic of China
| | - Yi Li
- Department of Neurology, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
| | - Yan Chen
- Department of NeurologyFirst People's Hospital of ZhaoqingZhaoqingPeople's Republic of China
| | - Yan Huang
- Department of NeurologyFirst People's Hospital of ZhaoqingZhaoqingPeople's Republic of China
| | - Qingyu Shen
- Department of Neurology, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
| | - Yamei Tang
- Department of Neurology, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat‐sen Memorial HospitalSun Yat‐sen UniversityGuangzhouPeople's Republic of China
- Guangdong Province Key Laboratory of Brain Function and Disease, Zhongshan School of MedicineSun Yat‐Sen UniversityGuangzhouPeople's Republic of China
| |
Collapse
|
3
|
Chen HS, Cui Y, Zhou ZH, Dai YJ, Li GH, Peng ZL, Zhang Y, Liu XD, Yuan ZM, Jiang CH, Yang QC, Duan YJ, Ma GB, Zhao LW, Wang RX, Sun YL, Shen L, Wang EQ, Wang LH, Feng YF, Wang FY, Zou RL, Yang HP, Wang K, Wang DL, Wang YL. Effect of Argatroban Plus Intravenous Alteplase vs Intravenous Alteplase Alone on Neurologic Function in Patients With Acute Ischemic Stroke: The ARAIS Randomized Clinical Trial. JAMA 2023; 329:640-650. [PMID: 36757755 PMCID: PMC9912168 DOI: 10.1001/jama.2023.0550] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 01/16/2023] [Indexed: 02/10/2023]
Abstract
IMPORTANCE Previous studies suggested a benefit of argatroban plus alteplase (recombinant tissue-type plasminogen activator) in patients with acute ischemic stroke (AIS). However, robust evidence in trials with large sample sizes is lacking. OBJECTIVE To assess the efficacy of argatroban plus alteplase for AIS. DESIGN, SETTING, AND PARTICIPANTS This multicenter, open-label, blinded end point randomized clinical trial including 808 patients with AIS was conducted at 50 hospitals in China with enrollment from January 18, 2019, through October 30, 2021, and final follow-up on January 24, 2022. INTERVENTIONS Eligible patients were randomly assigned within 4.5 hours of symptom onset to the argatroban plus alteplase group (n = 402), which received intravenous argatroban (100 μg/kg bolus over 3-5 minutes followed by an infusion of 1.0 μg/kg per minute for 48 hours) within 1 hour after alteplase (0.9 mg/kg; maximum dose, 90 mg; 10% administered as 1-minute bolus, remaining infused over 1 hour), or alteplase alone group (n = 415), which received intravenous alteplase alone. Both groups received guideline-based treatments. MAIN OUTCOMES AND MEASURES The primary end point was excellent functional outcome, defined as a modified Rankin Scale score (range, 0 [no symptoms] to 6 [death]) of 0 to 1 at 90 days. All end points had blinded assessment and were analyzed on a full analysis set. RESULTS Among 817 eligible patients with AIS who were randomized (median [IQR] age, 65 [57-71] years; 238 [29.1%] women; median [IQR] National Institutes of Health Stroke Scale score, 9 [7-12]), 760 (93.0%) completed the trial. At 90 days, 210 of 329 participants (63.8%) in the argatroban plus alteplase group vs 238 of 367 (64.9%) in the alteplase alone group had an excellent functional outcome (risk difference, -1.0% [95% CI, -8.1% to 6.1%]; risk ratio, 0.98 [95% CI, 0.88-1.10]; P = .78). The percentages of participants with symptomatic intracranial hemorrhage, parenchymal hematoma type 2, and major systemic bleeding were 2.1% (8/383), 2.3% (9/383), and 0.3% (1/383), respectively, in the argatroban plus alteplase group and 1.8% (7/397), 2.5% (10/397), and 0.5% (2/397), respectively, in the alteplase alone group. CONCLUSIONS AND RELEVANCE Among patients with acute ischemic stroke, treatment with argatroban plus intravenous alteplase compared with alteplase alone did not result in a significantly greater likelihood of excellent functional outcome at 90 days. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03740958.
Collapse
Affiliation(s)
- Hui-Sheng Chen
- Department of Neurology, General Hospital of Northern Theatre Command, Shenyang, China
| | - Yu Cui
- Department of Neurology, General Hospital of Northern Theatre Command, Shenyang, China
| | - Zhong-He Zhou
- Department of Neurology, General Hospital of Northern Theatre Command, Shenyang, China
| | - Ying-Jie Dai
- Department of Neurology, General Hospital of Northern Theatre Command, Shenyang, China
| | - Gao-Hua Li
- Department of Neurology, Liaoning Health Industry Group Fukuang General Hospital, Fushun, China
| | - Zhao-Long Peng
- Department of Neurology, The Affiliated Nanshi Hospital of Henan University, Nanyang, China
| | - Yi Zhang
- Department of Neurology, Tieling County Central Hospital, Tieling, China
| | - Xiao-Dong Liu
- Department of Neurology, Tonghua Vascular Disease Hospital, Tonghua, China
| | - Zhi-Mei Yuan
- Department of Neurology, Tonghua Vascular Disease Hospital, Tonghua, China
| | - Chang-Hao Jiang
- Department of Neurology, Lvshunkou Traditional Chinese Medicine Hospital, Dalian, China
| | - Qing-Cheng Yang
- Department of Neurology, Anyang People’s Hospital, Anyang, China
| | - Ying-Jie Duan
- Department of Neurology, Liaoning Health Industry Group Fuxinkuang General Hospital, Fuxin, China
| | - Guang-Bin Ma
- Department of Neurology, Haicheng Traditional Chinese Medicine Hospital, Haicheng, China
| | - Li-Wei Zhao
- Department of Neurology, Anshan Changda Hospital, Anshan, China
| | - Rui-Xian Wang
- Department of Neurology, Tianjin Beichen Traditional Chinese Hospital, Tianjin, China
| | - Yuan-Lin Sun
- Department of Neurology, Panjin Central Hospital, Panjin, China
| | - Lei Shen
- Department of Neurology, Nanyang Central Hospital, Nanyang, China
| | - Er-Qiang Wang
- Department of Neurology, Fuqing Hospital, Fuqing, China
| | - Li-Hua Wang
- Department of Neurology, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ye-Fang Feng
- Department of Neurology, Huludao Second People’s Hospital, Huludao, China
| | - Feng-Yun Wang
- Department of Neurology, Liaocheng Brain Hospital, Liaocheng, China
| | - Ren-Lin Zou
- Department of Neurology, Wafangdian Third Hospital, Dalian, China
| | - He-Ping Yang
- Department of Neurology, Guangxi Zhuang Autonomous Region People’s Hospital, Nanning, China
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Duo-Lao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Yi-Long Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
4
|
Zhang D, Zhong W, Chen L, Xu C, Yan S, Zhou Y, Ma X, Lou M. Corticospinal Tract Hypoperfusion Associated With Unexplained Early Neurological Deterioration After Intravenous Thrombolysis. Front Neurol 2022; 13:854915. [PMID: 35418926 PMCID: PMC8996180 DOI: 10.3389/fneur.2022.854915] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose Early neurological deterioration (END) occurs in 10% among patients with acute ischemic stroke (AIS) who are receiving intravenous thrombolysis (IVT). Over half of them have no straightforward causes, which is referred to as unexplained END. We aimed to explore whether the presence of baseline corticospinal tract (CST) hypoperfusion could predict the development of unexplained END at 24 h in patients with AIS after receiving IVT. Methods We retrospectively analyzed the clinical and imaging data from patients with AIS who received IVT. Unexplained END was defined as ≥ 2-point increase of National Institutes of Health Stroke Scale (NIHSS) from baseline to 24 h without straightforward causes. Hypoperfusion lesions involving CST and other cerebral areas were identified on perfusion maps. Results Among 807 patients, CST hypoperfusion and non-CST hypoperfusion occurred in 488 (60.5%) and 319 (39.5%) patients, respectively. Patients with CST hypoperfusion were more likely to have unexplained END compared with patients with non-CST hypoperfusion (16.6 vs. 2.8%, P < 0.001). Binary logistics regression analysis showed that CST hypoperfusion was independently associated with unexplained END after IVT (OR = 5.64; 95% CI: 2.699–11.785; P < 0.001) after adjusting for baseline NIHSS, onset to needle time, baseline hypoperfusion volume, atrial fibrillation, and hypertension. Conclusions Patients with CST hypoperfusion were more likely to suffer from unexplained END after IVT, implying potential mechanisms and potential prevention of unexplained END.
Collapse
Affiliation(s)
- Danfeng Zhang
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.,Department of Neurology, Haiyan People's Hospital, Zhejiang, China
| | - Wansi Zhong
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Luowei Chen
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Chao Xu
- Department of Neurology, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Shenqiang Yan
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Ying Zhou
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| | - Xiaodong Ma
- Department of Neurology, Haiyan People's Hospital, Zhejiang, China
| | - Min Lou
- Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China
| |
Collapse
|
5
|
Lv B, Guo FF, Lin JC, Jing F. Efficacy and safety of argatroban in treatment of acute ischemic stroke: A meta-analysis. World J Clin Cases 2022; 10:585-593. [PMID: 35097084 PMCID: PMC8771382 DOI: 10.12998/wjcc.v10.i2.585] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/14/2021] [Accepted: 12/02/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Argatroban is a novel direct thrombin inhibitor that has been used for treatment of acute ischemic stroke (AIS). To our knowledge, no systematic analysis has assessed the efficacy and safety of argatroban for treatment of AIS.
AIM To evaluate the efficacy and safety of argatroban for treatment of AIS.
METHODS Cochrane Library, Medline, PubMed, and Web of Science were searched to retrieve all studies associated with argatroban and AIS. Effective rate, adverse events rate, and 95% confidence intervals were calculated and pooled using meta-analysis methodology.
RESULTS We only found four randomized controlled studies, comprising 354 cases with 213 in the argatroban group and 141 in the control group. Great heterogeneity was found in the four studies (c2 = 11.44, I2 = 74%, P = 0.01). Subgroup analysis could not be performed because of the absence of detailed data. The two most recent studies showed acceptable heterogeneity (c2 = 1.56, I2 = 36%, P = 0.21). Our analysis showed that argatroban was not more effective than the control therapy in the acute phase of ischemic stroke (Z = 0.01, P = 0.99). Argatroban did not increase the risk of bleeding compared with the control group (c2 = 0.37, I2 = 0%, P = 0.54, Z = 0.80, P = 0.42).
CONCLUSION Patients with AIS might not benefit from argatroban and combination therapy with argatroban does not increase bleeding tendency.
Collapse
Affiliation(s)
- Bin Lv
- Department of Neurology, Chinese PLA General Hospital, Beijing 100853, China
| | - Fang-Fang Guo
- Health Management Institute, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing 100853, China
| | - Jia-Cai Lin
- Department of Neurology, Hainan Hospital of Chinese PLA General Hospital, Sanya 572022, Hainan Province, China
| | - Feng Jing
- Department of Neurology, Chinese PLA General Hospital, Beijing 100853, China
| |
Collapse
|