Effect of intravenous thrombolysis with recombinant tissue type plasminogen activator (rt-PA) in different time windows on acute cerebral infarction patients with atrial fibrillation

Abstract

To observe the intravenous thrombolysis effect of rt-PA in different time windows of acute cerebral infarction with atrial fibrillation(AF). Acute cerebral infarction patients who accepted the intravenous thrombolysis treatment with AF from January 2012 to December 2015 were included.According to the time from onset to intravenous thrombolysis, patients were divided into two groups: thrombolysis within 3 h and thrombolysis between 3-4.5 h. The Nation Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) were used to evaluate early and long-time therapeutic effects. The incidence of hemorrhagic infarction(HI), parenchymal hemorrhage(PH) and symptomatic intracranial hemorrhage(sICH) after thrombolysis within 24 hours were observed in the two groups. A total of 103 patients were included in the study, with 48 cases in thrombolysis within 3 h group and 55 cases in thrombolysis between 3-4.5 h group. After thrombolysis treatment, the 24-hour and 7-day NIHSS score of the two groups were significant lower than before treatment, and the difference was statistically significant(P<0.05). Compared between groups, 24-hour clinical efficacy of thrombolysis within 3 h group was better than that of thrombolysis between 3-4.5 h group, and the difference was statistically significant(P<0.05). There were no statistically significant differences between these two groups about 7-day and 90-day prognosis(P<0.05). The rate of PH in thrombolysis within 3 h group and thrombolysis between 3-4.5 h group is 6.3%(3/48) and 21.8%(12/55) individually, and the difference was statistically significant(P<0.05). While no statistically significant differences was found about the rate of HI(18.8% vs 32.7%, P>0.05) and sICH(8.3% vs 14.5%, P>0.05) between these two groups. For patients of acute cerebral infarction with AF, intravenous thrombolytic therapy by rt-PA within 3 h may contribute to a greatly improvement in a short time. Thrombolysis between 3-4.5 h increase the incidence of PH, but do not increase the incidence of sICH. There are no statistically significant differences between these two groups about 90-day favorable prognosis, indicating that thrombolysis between 3-4.5 h is safe and effective for acute cerebral infarction patients with AF.