Thromboxane A2 synthetase inhibitor plus low dose aspirin : can it be a salvage treatment in acute stroke beyond thrombolytic time window

Abstract

Objective: There is no proven regimen to reduce the severity of stroke in patients with acute cerebral infarction presenting beyond the thrombolytic time window. Ozagrel sodium, a selective thromboxane A2 synthetase inhibitor, has been known to suppress the development of infarction. The antiplatelet effect is improved when aspirin is used together with a thromboxane synthetase inhibitor.

Methods: Patients with non-cardiogenic acute ischemic stroke who were not eligible for thrombolysis were randomly assigned to two groups; one group received ozagrel sodium plus 100 mg of aspirin (group 1, n=43) and the other 100 mg of aspirin alone (group 2, n=43). Demographic data, cardiovascular risk factors, initial stroke severity [National Institute of Health Stroke Scale (NIHSS) and motor strength scale] and stroke subtypes were analyzed in each group. Clinical outcomes were analyzed by NIHSS and motor strength scale at 14 days after the onset of stroke.

Results: There were no significant differences in the mean age, gender proportion, the prevalence of cardiovascular risk factors, stroke subtypes, and baseline neurological severity between the two groups. However, the clinical outcome for group 1 was much better at 14 days after the onset of stroke compared to group 2 (NIHSS score, p=0.007, Motor strength scale score, p<0.001). There was one case of hemorrhagic transformation in group 1, but there was no statistically significant difference in bleeding tendency between two groups.

Conclusion: In this preliminary study, thromboxane A2 synthetase inhibitor plus a low dose of aspirin seems to be safe and has a favorable outcome compared to aspirin alone in patients with acute ischemic stroke who presented beyond the thrombolytic time window.

Keywords: Aspirin; Stroke; Thromboxane A2 synthetase; Tissue Plasminogen activator.

Fig. 1

Comparison of mean NIHSS scores between treatment with thromboxane A2 synthetase inhibitor with a low dose of aspirin (group 1) and aspirin alone (group 2). pre : initial NIHSS score, post : NIHSS score at 14 days after onset of symptoms, p<0.007. NIHSS : National Institute of Health Stroke Scale.

Fig. 2

Comparison of mean motor power score between treatment with thromboxane A2 synthetase inhibitor with a low dose of aspirin (group 1) and aspirin alone (group 2). pre : initial NIHSS score, post : NIHSS score at 14 days after onset of symptoms, p<0.001. NIHSS : National Institute of Health Stroke Scale.