Intravenous recombinant tissue plasminogen activator for acute ischemic stroke ——a single center retrospective study

Abstract

Objective To assess the clinical efficacy and safety of intravenous recombinant tissue plasminogen activator （rtPA） in the treatment of acute ischemic stroke and to investigate the thrombolytic time window and the related factors affecting the prognosis of thrombolysis. Melahods Ninety-four patients with acute ischemic stroke （40 patients in the rtPA group, 54 patients in the control group）were alyzed retrospectively. The National Institute of Health Stroke Scale （NIHSS） was used to assess neurological function at 24 hours after onset. Early neurological improvement was defined as NIHSS improvement ≥4 or the neurological function recovered completely 24 hours after admission, The patients were assessed by the modified Ranldn Scale （mRS）, and the clinical efficacy was assessed by the Barthel Index 03I） and NIHSS. Good outcome was defined as BI ≥95, mRS ≤1 or NIHSS ≤1. In addition, the incidence and mortality of the symptomatic ilm~rmial hemorrhage （slCH） were assessed. Results The rate of early neurological improuercent at 24 hours in the rtPA group was significantly higher than that in the control group （37. 5% vs. 13.0%, OR = 3.900; P = 0. 007）. The rate of good outcorne at day 14 after admission in the rtPA group was significantly higher than that in the control group （OR =2. 654, 95% CI 1.089-7. 235, P =0. 035）. The incidence of slCH in the rtPA group during the hospitalization was significantly higher than that in the control group （15.00% vs. 1.85%, P =0. 033）, howe~r, there was no significant difference in mortality （17. 50% vs. 9. 36%, P =0. 054）. The multivariate regression analysis indicated that the senan glucose ≥ 8 mmol/L, basilar artery occlusion, NIHSS score ≥ 20, and an early sign of infarction on CT were the independent predicting factors for poor outcome; the rate of good outcome of intrauenous thrombolysis within 3 h was significantly higher than that in the 4. 5 to 6 h thrombolytic group （47. 1% vs. 16. 7%, P = 0. 034）. Conclusions q-hrombolysis treatment with intrauenous rtPA within 6 h after the onset was safe and effective for patients with acute ischemic stroke, in which the efficacy of intrvnous thrombolysis was better within 3 h. qhe serum glucose ≥8 mmol/L, basilar artery occlusion, NIHSS score ≥20, and an early sign of infarction on cr were the independent predicting factors for poor outcome. Key words: Tissue plasminogen activator; Thrombolytic therapy; Stroke; Brain ischemia; Intracranial hemorrhage