Early Low-dose ASpirin Use After Intravenous Thrombolysis for Acute Ischemic Cerebral Infarction（ELASTIC）

Condition(s) studied

Investigational drug(s) / intervention(s)

Aspirin (Early, 2h): Aspirin 100mg orally, administered once daily. The first dose is given at 2 hours after rt-PA thrombolysis, conditional on a follow-up CT scan at 2 hours excluding intracranial hemorrhage. Treatment continues for 3 months.

Aspirin (Standard, 24h): Aspirin 100mg orally, administered once daily. The first dose is given at 24 hours after rt-PA thrombolysis, conditional on a follow-up CT scan at 24 hours confirming no intracranial hemorrhage. Treatment continues for 3 months.

Study summary

This study evaluates whether early administration of low-dose aspirin (100mg) at 2 hours post-intravenous thrombolysis, compared to the standard timing of 24 hours, improves functional outcomes in patients with acute ischemic stroke. Intravenous thrombolysis is effective for very early treatment of acute ischemic stroke. However, current guidelines recommend starting antiplatelet therapy 24 hours after thrombolysis to avoid symptomatic intracranial hemorrhage (SICH), a recommendation not based on prospective clinical studies. Early re-occlusion of recanalized arteries due to platelet aggregation occurs in 14-34% of cases and is associated with poor prognosis. The average incidence of SICH is 2.4%, with fatal SICH occurring in only 0.28%. Thus, the impact of re-occlusion on poor prognosis may outweigh the risk of SICH. In this prospective, randomized, open-label trial with blinded endpoint evaluation, participants are assigned to receive aspirin 100mg either at 2 hours (early group) or at 24 hours (standard group) after thrombolysis. The primary outcome is the proportion of patients with a favorable functional outcome, defined as a modified Rankin Scale (mRS) score of 0-2 at 3 months. Safety outcomes include the incidence of SICH and all-cause mortality at 3 months. This study will provide clinical evidence regarding the optimal timing for initiating antiplatelet therapy after thrombolysis in acute ischemic stroke.

Eligibility

Primary outcome measure(s)

• Proportion of Patients with Favorable Functional Outcome at 3 Months — 3 months
  Favorable functional outcome is defined as a score of 0 to 2 on the modified Rankin Scale (mRS). The mRS score will be assessed by a blinded endpoint assessor at 3 months post-stroke via a structured telephone interview or during a clinic visit.

Trial sites (1)

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