Adding anticoagulation to thrombolytics for acute ischemic stroke (MOST trial)
There were lingering hopes that for patients with ischemic stroke, adding parenteral anticoagulation after thrombolytic therapy might improve outcomes. That line of inquiry might be at an end after the Multi-arm Optimization of Stroke Thrombolysis (MOST trial) reported phase 3 findings at the International Stroke Conference of the American Stroke Association.
Patients who had ischemic stroke and had received alteplase (tPA) or tenecteplase (TNK) within a few hours of symptom onset were randomized to receive placebo, argatroban (a direct thrombin inhibitor) or eptifibatide (a glycoprotein IIb/IIIa class platelet inhibitor). The trial enrolled patients with the most severe strokes, with severe disability at the time of presentation (potentially making a benefit easier to detect).
Patients also underwent mechanical thrombectomy when appropriate. Anticoagulants were started soon after thrombolytics were completed. But patients were not helped, and may have been harmed by adding blood thinn…
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