ISC 2025 | Early antiplatelet therapy following intravenous thrombolysis for acute ischemic stroke: TREND-IVT

The TREND-IVT trial is a multi-center randomized clinical trial performed in China to investigate the safety and efficacy of early antiplatelet therapy with aspirin following intravenous thrombolysis within three hours in patients with acute ischemic stroke. And we all know that also the intravenous thrombolysis is effective in improving the functional outcome of patients with acute ischemic stroke. And there is also a very common clinical question is that we may encounter patients with neurological deterioration after intravenous thrombolysis. And the current guidelines recommend that the antiplatelet therapy can only be used 24 hours after thrombolysis therapy. And larger patients may experience the neurological deterioration within 24 hours of following thrombolysis. So, a lot of therapy has been investigated to prevent or to treat neurological deterioration after thrombolysis in patients with acute ischemic stroke. And the most promising therapy is about how to use antiplatelet therapy in these patients. And we all know that it’s about in 2012, the ARTIS trial published in the Lancet and showed that it may be harmful to use aspirin-following intravenous thrombolysis in patients with acute ischemic stroke, as it can increase the risk of symptomatic intracerebral hemorrhage. And now in recent years, a lot of study investigated the safety and efficacy of intravenous tirofiban for prevention and for the treatment of acute ischemic stroke patients who received intravenous thrombolysis. But from our research group we found that the patient who received aspirin, if the aspirin was used in a high dose and it’s antiplatelet therapy can be effectively within 15 to 30 minutes and it can play a very important role in the prevention of neurological deterioration after thrombolysis. And the main question is how we select the patients with high risk of neurological deterioration and with a small risk of intracerebral hemorrhage and from our from our previous studies that performed based on observational study and we found that patients who didn’t receive the antiplatelet therapy before the intravenous thrombolysis and patients who have [inaudible] vessel stenosis maybe have a high risk of deterioration with a small risk of intracerebral hemorrhage. So against these backgrounds we launched a milestone in china it is the TREND-IVT and the TREND-IVT was to use the 300 aspirin of the intravenous thrombolysis within three hours and we will evaluate whether it could improve the excellent functional outcome, defined as a modified Rankin score of 0 to 1 at 90 days. And now this study has also been begun in China and we will include, we will recruit about 1,180 patients. And we also hope that in the following one or three years we will complete our recruitment and we hope that this trial can provide the evidence about the early antiplatelet therapy following intravenous thrombolysis in patients with acute ischemic stroke. And so finally we also hope that the guidelines may change based on this evidence.

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