Effect of Huoxiang Zhengqi Pill on Early Neurological Deterioration in Patients with Acute Ischemic Stroke Undergoing Recanalization Therapy and Predictive Effect of Essen Score.

Jianguo Lin,Zhi-Xin Huang,Ying-Yi Dai,Xintong Liu,Songbin Lin,Cheng Zhang

doi:10.1155/2020/6912015

Abstract

Early neurologic deterioration (END) in the acute phase of ischemic stroke is a serious clinical event, which is closely related to poor prognosis. Therefore, it is important to identify presentation features that predict END and take relevant treatment measures, as they could help to prevent the deterioration of high-risk patients. The prospective intervention study was carried out from January 2018 to December 2019. We included consecutive patients hospitalized for acute ischemic stroke (AIS) within 6 hours of onset. Patients were randomly assigned (1 : 1) to recanalization therapy plus Huoxiang Zhengqi Pill (HXZQ) (intervention group) or standard recanalization therapy alone (control group). The primary outcome was the development of END according to predefined criteria within the first 1 week of stroke onset. Poisson regression was used to identify predictors for END. Of the 155 patients enrolled in the study (age, 63 ± 11 years; 28.4% female), 20 (12.9%) developed END. Univariate analysis showed that the use of HXZQ and Essen stroke risk score (ESRS) (low risk group) were protective factors for END, while advanced age was a risk factor for END. However, in multivariate analysis, only ESRS (OR, 0.232; 95%CI, 0.058–0.928; P=0.039) and the use of HXZQ (OR, 0.297; 95%CI, 0.096–0.917; P=0.035) were statistically significant. ESRS can be used as the prediction factor of END. HXZQ has small side effects and wide indication. It could be used in the treatment of AIS.

Highlights

Stroke is a leading cause of long-term disability and death in China, of which about 70% are ischemic stroke [1]
Intravenous thrombolysis with recombinant tissue plasminogen activator within 4.5 hours after onset has been proved to be effective against acute ischemic stroke (AIS) and can reduce mortality
Our findings indicated that patients with low-risk Essen scores have a low incidence of early neurologic deterioration (END), and oral administration of Huoxiang Zhengqi Pill (HXZQ) may reduce the incidence of END

Summary

Introduction

Stroke is a leading cause of long-term disability and death in China, of which about 70% are ischemic stroke [1]. Intravenous thrombolysis with recombinant tissue plasminogen activator within 4.5 hours after onset has been proved to be effective against acute ischemic stroke (AIS) and can reduce mortality. END is one of the most common complications of AIS, affecting about a third of ischemic stroke patients and increasing the risk of adverse functional outcomes and death [3,4,5]. Previous studies have found that coronary artery disease is usually associated with severe intracranial and extracranial atherosclerosis and that progressive neurological deterioration is more common in patients with coronary artery. Is finding suggests that patients with extensive atherosclerosis are more likely to develop cerebrovascular disease and are more likely to have progressive stroke [6, 7]. It is necessary to explore whether the Essen stroke risk score (ESRS) (including atherosclerotic risk factors, such as hypertension, diabetes, and smoking) can be used to predict END

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