Efficacy and Safety of Intravenous Urokinase and Sodium Ozagrel in Acute Ischemic Stroke

Yuan Nong

doi:10.11648/j.ajpn.20180602.14

Abstract

Urokinase and sodium ozagrel are widely used in patients with acute ischemic stroke (AIS) in China. But the effectiveness and safety of the two combinations are not yet clear. A total of 129 AIS patients who were treated with combined intravenous (IV) urokinase and sodium ozagrel within 6 hours of onset were included in this study. All the patients were assessed with the National Institute of Health Stroke Scale (NIHSS) score at baseline, 6 hours, at hospital discharge, and 1 month after AIS. All the patients were characterized into two groups based on early response (decrease in NIHSS score≥4 points at 6 hours) and good outcome (NIHSS score ≤ 1 at 1 month), and assessed treatment safety by evaluating intracranial hemorrhage and mortality. There were 54 patients in the good outcome group and 74 in the bad outcome group at the end. Multivariate analysis showed that shorter onset to treatment time, a lower baseline NIHSS score, and lack of large artery stenosis or occlusion werel associated with good outcome at 1 month. This study suggested that combined IV urokinase and sodium ozagrel therapy was effective and safe in treating patient with AIS within a 6-hour time window. With lower cost and a longer time window, it can be used as an alternative intravenous thrombolytic therapy in patients with AIS except rt-PA.

Highlights

The effectiveness of intravenous thrombolysis for the treatment of cerebral infarction in the acute stage has been widely confirmed [1,2,3,4]
Recombinant tissue plasminogen activator is the only thrombolytic agent approved by the Food and Drug Administration (FDA), and has been widely used in treating acute ischemic stroke within 4.5 hours of onset [5,6,7]
We found that intravenous (IV) sodium ozagrel and urokinase enhanced the thrombolytic effect of urokinase, increased the recanalization rate, and resulted in a low incidence of bleeding

Summary

Introduction

The effectiveness of intravenous thrombolysis for the treatment of cerebral infarction in the acute stage has been widely confirmed [1,2,3,4]. Recombinant tissue plasminogen activator (rt-PA) is the only thrombolytic agent approved by the Food and Drug Administration (FDA), and has been widely used in treating acute ischemic stroke within 4.5 hours of onset [5,6,7]. In China, the use of urokinase, an alternative thrombolysis agent, is common given its cheaper cost (about 7 dollars/0.1 million U in China) and longer window time (within 6 hours of onset). Urokinase is an enzyme isolated from healthy human urine and acts directly on the endogenous fibrinolytic system. It catalyzes plasminogen into its active form, plasmin, a fibrinolytic enzyme that degrades fibrin clots, and cleaves and inactivates the coagulation factors V and factor VIII, achieving a thrombolytic effect. Single agent treatment with urokinase is not an ideal effective treatment

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