Safety Of Intravenous Thrombolysis Research Articles

Endovascular thrombectomy with versus without intravenous thrombolysis in patients with acute basilar artery occlusion: a systematic review and meta-analysis.

The benefit and safety of intravenous thrombolysis before endovascular thrombectomy in patients with acute ischemic stroke caused by basilar artery occlusion (BAO) remains unclear. This article aims to investigate the clinical outcomes and safety of endovascular thrombectomy with versus without intravenous thrombolysis in acute BAO stroke patients. We conducted a comprehensive search of PubMed, Embase, Cochrane, and Web of Science databases to identify relevant literature pertaining to patients with acute BAO who underwent endovascular thrombectomy alone or intravenous thrombolysis bridging with endovascular thrombectomy (bridging therapy), until January 10, 2024. The primary outcome was functional independence, defined as a score of 0-2 on the modified Rankin Scale at 90days. The safety outcome was mortality at 90days and symptomatic intracranial hemorrhage within 48h. Effect sizes were computed as risk ratio (RR) with random-effect models. This study was registered in PROSPERO (CRD42023462293). A total of 528 articles were obtained through the search and articles that did not meet the inclusion criteria were excluded. Finally, 2 RCTs and 10 cohort studies met the inclusion criteria. The findings revealed that the endovascular thrombectomy alone group had a lower rate of functional independence compared to the bridging therapy group (29% vs 38%; RR 0.78, 95% CI 0.68-0.88, p < 0.001), lower independent ambulation (39% vs 45%; RR 0.89, 95% CI 0.82-0.98, p = 0.01), and higher mortality (36% vs 28%, RR 1.22, 95% CI 1.08-1.37, p = 0.001). However, no differences were detected in symptomatic intracranial hemorrhage between the two groups (6% vs 4%; RR 1.12, 95% CI 0.74-1.71, p = 0.58). Intravenous thrombolysis plus endovascular thrombectomy seemed to led to better functional independence, independent ambulation, and lower risk of mortality without increasing the incidence of intracranial hemorrhage compared to endovascular thrombectomy alone. However, given the non-randomized nature of this study, further studies are needed to confirm these findings.

Thrombolysis for Wake-Up Stroke Versus Non-Wake-Up Unwitnessed Stroke: EOS Individual Patient Data Meta-Analysis.

Stroke with unknown time of onset can be categorized into 2 groups; wake-up stroke (WUS) and unwitnessed stroke with an onset time unavailable for reasons other than wake-up (non-wake-up unwitnessed stroke, non-WUS). We aimed to assess potential differences in the efficacy and safety of intravenous thrombolysis (IVT) between these subgroups. Patients with an unknown-onset stroke were evaluated using individual patient-level data of 2 randomized controlled trials (WAKE-UP [Efficacy and Safety of MRI-Based Thrombolysis in Wake-Up Stroke], THAWS [Thrombolysis for Acute Wake-Up and Unclear-Onset Strokes With Alteplase at 0.6 mg/kg]) comparing IVT with placebo or standard treatment from the EOS (Evaluation of Unknown-Onset Stroke Thrombolysis trial) data set. A favorable outcome was prespecified as a modified Rankin Scale score of 0 to 1 at 90 days. Safety outcomes included symptomatic intracranial hemorrhage at 22 to 36 hours and 90-day mortality. The IVT effect was compared between the treatment groups in the WUS and non-WUS with multivariable logistic regression analysis. Six hundred thirty-four patients from 2 trials were analyzed; 542 had WUS (191 women, 272 receiving alteplase), and 92 had non-WUS (42 women, 43 receiving alteplase). Overall, no significant interaction was noted between the mode of onset and treatment effect (P value for interaction=0.796). In patients with WUS, the frequencies of favorable outcomes were 54.8% and 45.5% in the IVT and control groups, respectively (adjusted odds ratio, 1.47 [95% CI, 1.01-2.16]). Death occurred in 4.0% and 1.9%, respectively (P=0.162), and symptomatic intracranial hemorrhage in 1.8% and 0.3%, respectively (P=0.194). In patients with non-WUS, no significant difference was observed in favorable outcomes relative to the control (37.2% versus 29.2%; adjusted odds ratio, 1.76 [0.58-5.37]). One death and one symptomatic intracranial hemorrhage were reported in the IVT group, but none in the control. There was no difference in the effect of IVT between patients with WUS and non-WUS. IVT showed a significant benefit in patients with WUS, while there was insufficient statistical power to detect a substantial benefit in the non-WUS subgroup. URL: https://www.clinicaltrials.gov; Unique identifier: CRD42020166903.

Comparison of the Efficacy and Safety Between Intravenous Thrombolysis, Direct Endovascular Therapy, and Bridging Therapy for Acute Basilar Artery Occlusion in Cerebral Infarction Patients

ObjectiveTo compare the efficacy and safety of intravenous thrombolysis (IVT), direct endovascular therapy (EVT), and bridging therapy (BT=IVT+EVT) for acute basilar artery occlusion cerebral infarction. MethodsOne hundred and fourteen patients with acute basilar artery occlusion cerebral infarctions admitted between January 2020 and August 2023 were selected. Differences in the reperfusion rate, prognosis, incidence of stroke-associated pneumonia, and mortality rate were compared among the three groups. ResultsThere was no statistically significant difference in the percentage of patients who achieved successful reperfusion (86.8% vs. 84.2%) or complete reperfusion (72.1% vs. 68.4%) between the direct EVT and BT groups (both P>0.05). There were no statistically significant differences in the rates of symptomatic intracranial haemorrhage (3.7% vs. 10.3% vs. 10.5%, P=0.763). There were statistically significant differences in the rates of good prognosis (mRS score 0-2) (59.3% vs. 30.9% vs. 26.3%, P=0.021), stroke-related pneumonia (29.6% vs. 66.2% vs. 36.8%, P=0.002), and mortality (14.8% vs. 48.5% vs. 42.1%, P=0.010) among the three treatment groups. According to the binary logistic regression analysis, a good prognosis was independently associated with a baseline National Institutes of Health Stroke Scale (NIHSS) score <=10 (odds ratio [OR], 3.714; 95% confidence interval [CI], 1.207-11.430; P =0.022) and the incidence of stroke-associated pneumonia (OR, 0.640; 95% CI, 0.484-0.845; P=0.002). ConclusionAlthough there were differences in prognosis, mortality, and incidence of complications among the three treatment groups, after adjusting for confounding factors, prognosis was independently correlated only with the baseline NIHSS score and stroke-associated pneumonia but not with treatment methods.

Thrombectomy versus combined thrombolysis and thrombectomy in patients with large vessel occlusion and chronic kidney disease

BackgroundWhether intravenous thrombolysis (IVT) should be bridged before mechanical thrombectomy (MT) remains uncertain in patients with large vessel occlusion (LVO) and chronic kidney disease (CKD). MethodsThis research systematically enrolled every patient with both acute ischemic stroke (AIS) and CKD who received MT and fulfilled the criteria for IVT from January 2015 to December 2022. According to whether they underwent IVT, the patients were categorized into two cohorts: MT and combined IVT + MT. A binary logistic regression model was used to adjust for potential confounders, and propensity score matching analysis was used to assess the efficacy and safety of IVT in AIS patients with CKD who underwent MT. ResultsA total number of 406 patients were ultimately included in this study, with 236 patients in the MT group and 170 in the combined group. After PSM, there were 170 patients in the MT group and 170 in the combined group, and the clinical characteristics between the two groups were well balanced. The MT + IVT group had better long-term functional outcomes than the MT group (35.9% versus 21.2%, P = 0.003) and more modified thrombolysis in cerebral infarction (mTICI) (2b-3) (94.1% versus 87.6%, P = 0.038), while no significant difference was found regarding symptomatic intracranial hemorrhage (sICH). In line with the results observed in the in the postmatched population, the logistic regression revealed that patients in the IVT + MT group demonstrated superior clinical outcomes (adjusted OR 0.440 [95% CI (0.267–0.726)], P = 0.001) in the prematched population. ConclusionFor LVO patients with CKD and indications for IVT, IVT bridging MT improves their prognosis compared with direct MT.

Intravenous tenecteplase compared with alteplase for minor ischaemic stroke: a secondary analysis of the AcT randomised clinical trial

BackgroundIn ischaemic stroke, minor deficits (National Institutes of Health Stroke Scale (NIHSS) ≤5) at presentation are common but often progress, leaving patients with significant disability. We compared the efficacy and...

Intravenous Thrombolysis is Effective in Mild Stroke Patients with an Admission NIHSS Score of 3 to 5.

The role of intravenous thrombolysis in patients with acute mild ischemic stroke remains highly controversial. Therefore, this study aims to analyze the efficacy and safety of intravenous thrombolysis in patients with mild ischemic stroke based on admission National Institutes of Health Stroke Scale (NIHSS) score. The present study enrolled 507 patients with acute mild ischemic stroke admitted within 4.5 hours of symptom onset with an admission NIHSS score of 0 to 5. Patients were assigned to two groups based on admission NIHSS scores of 0 to 2 and 3 to 5, and subsequent analyses compared functional outcomes between thrombotic and non-thrombotic patients within these groups. The primary outcome was a modified Rankin score (mRS) of 0 or 1 at 90 days, representing functional independence. The safety outcomes were symptomatic intracranial hemorrhage (sICH), early neurological deterioration (END), and the rate of stroke recurrence within 90 days. Among the 267 patients with NIHSS scores of 0 to 2, 112 (41.9%) patients received intravenous thrombolysis. Overall, thrombolysis administration did not significantly improve the patient's functional prognoses at 90 days (adjusted OR=1.046, 95%CI=0.587-1.863, p = 0.878). However, there was a marked increase in the risk of sICH (p = 0.030). Of the 240 patients with NIHSS scores of 3 to 5, 155 (64.6%) patients received intravenous thrombolysis, resulting in a significant improvement in 90-day functional prognosis (adjusted OR=3.284, 95%CI=1.876- 5.749, p < 0.001) compared to those that did not receive thrombolysis intervention. Importantly, there was no significant increase in sICH incidence (adjusted OR=2.770, 95%CI=0.313-24.51, p = 0.360). There were no statistically significant differences in END or the rate of stroke recurrence within 90 days between thrombotic and non-thrombotic groups. Intravenous thrombolysis is safe and effective in patients with baseline NIHSS scores of 3 to 5. In contrast, it did not improve 90-day functional outcomes in patients with NIHSS scores of 0 to 2 and instead increased the risk of sICH.

Abstract 236: Effects of intravenous thrombolysis on thrombectomy outcomes: a systematic review and meta‐analysis

Introduction Efficacy and safety of intravenous thrombolysis (IVT) in patients undergoing mechanical thrombectomy (MT) is still debatable. However, IVT's efficacy on stent retriever (SR) and aspiration thrombectomy (ASP) outcomes specifically remain unclear. In our meta‐analysis, we aimed to explore the effects of IVT on SR and ASP thrombectomy outcomes. Methods A systematic literature review was steered using Medline, Embase, Scopus, Web of Science, and Cochrane Center of Clinical Trials databases, according to PRISMA guidelines. Outcomes of interest included successful recanalization (modified Thrombolysis In Cerebral Infarction (mTICI) ≥2b), functional independence (modified Rankin Scale (mRS) ≤2), modified first pass efficacy (mFPE), symptomatic intracranial hemorrhage (sICH), and embolization to new territories (ENT). Results We included four randomized controlled trials with 1176 patients. SR and ASP had similar mTICI ≥2b, mFPE, and mRS 0‐2 rates whether they received IVT or not. SR without IVT was associated with a lower rate of mFPE compared with the SR+IVT (RR 0.85, 95% CI 0.74 to 0.97). Additionally, ASP without IVT resulted in a lower rate of mRS 0‐2 than the ASP+IVT (RR 0.78, 95% CI 0.60 to 1.01). Finally, bridging therapy did not increase sICH and ENT rates after ASP or SR thrombectomy. Conclusion Our analysis suggests that SR and ASP thrombectomy have equivalent efficacy and safety outcomes regardless of prior IVT administration. Moreover, our results indicate that administration of IVT before MT may improve certain outcomes based on the used first‐line MT technique.

The efficacy and safety of intravenous thrombolysis with tenecteplase versus alteplase for acute ischemic stroke: a systematic review and meta-analysis.

We aimed to evaluate the available evidence on the efficacy and safety outcomes of intravenous tenecteplase (TNK) compared with intravenous alteplase(ALT) for patients with acute ischemic stroke (AIS) in randomized controlled trials (RCTs). The MEDLINE/PubMed, Embase, Springer, Web of Science, Cochrane Collaboration database, China National Knowledge Infrastructure (CNKI) database, and Wanfang database were comprehensively searched for RCTs regarding the effects of TNK versus ALT among AIS patients in these English and Chinese electronic databases from inception dates to August 1, 2022. This meta-analysis followed PRISMA guidelines. Two reviewers independently retrieved RCTs and extracted relevant information. The methodological quality of the included trials was estimated using the Cochrane risk of bias tool. The pooled analyses were performed using RevMan 5.3 software. The primary outcome was functional outcome on the modified Rankin Scale (mRS) (range 0 to 5) and mortality at 90days. The secondary outcomes included successful recanalization, early neurologic improvement < 48h, any intracranial hemorrhage (ICH), and symptomatic ICH. The follow-up time of all studies was at least 3months. A total of nine RCTs involving 1958 patients in TNK group and 1731 patients in ALT group were finally included. For the efficacy outcomes, there were no significant differences between the two groups in terms of mRS score 0 ~ 2 (RR 1.00; 95% CI 0.88-1.13; P = 0.96), mRS score 0 ~ 1 (RR 1.03; 95% CI 0.96-1.10; P = 0.36), successful recanalization (RR 1.25; 95% CI 0.88-1.76; P = 0.21), and early neurologic improvement < 48h (RR 1.08; 95% CI 0.92-1.26; P = 0.37). Similar results were seen for the safety outcomes, which have no statistical differences in terms of any ICH (RR 1.01; 95% CI 0.72-1.41; P = 0.96), symptomatic ICH (RR 1.19; 95% CI 0.81-1.76; P = 0.37), and mortality at 90days (RR 0.99; 95% CI 0.83-1.19; P = 0.94). Overall, the efficacy and safety outcomes of intravenous thrombolysis with TNK versus ALT for AIS were not statistically different. However, TNK at a dose of 0.25mg/kg may be a reasonable alternative to ALT for thrombolysis.

Sex Differences in Outcomes of Intravenous Thrombolysis in Acute Ischemic Stroke Patients with Preadmission Use of Antiplatelets.

To compare safety and functional outcomes of intravenous thrombolysis (IVT) between females and males with acute ischaemic stroke (AIS) in relation to preadmission use of antiplatelets. Multicentre cohort study of patients admitted from 1 January 2014 to 31 January 2020 to hospitals participating in the Swiss Stroke Registry, presenting with AIS and receiving IVT. Primary safety outcome was in-hospital symptomatic intracerebral haemorrhage (sICH). Primary functional outcome was functional independence at 3 months after discharge. Multivariable logistic regression models were fitted to assess the association between sex and each outcome according to preadmission use of antiplatelets. The study included 4996 patients (42.51 % females, older than males, median age 79 vs 71 years, p < 0.0001). Comparable proportions of females (39.92 %) and males (40.39 %) used antiplatelets before admission (p = 0.74). In total, 3.06 % females and 2.47 % males developed in-hospital sICH (p = 0.19), with similar odds (adjusted odds ratio, [AOR] 0.93, 95 % confidence interval, [CI] 0.63-1.39). No interaction was found between sex and preadmission use of either single or dual antiplatelets in relation to in-hospital sICH (p = 0.94 and p = 0.23). Males had higher odds of functional independence at 3 months (AOR 1.34, 95 % CI 1.09-1.65), regardless of preadmission use of antiplatelets (interaction between sex and preadmission use of either single or dual antiplatelets p = 0.41 and p = 0.58). No sex differences were observed in the safety of IVT regarding preadmission use of antiplatelets. Males showed more favourable 3-month functional independence than females; however, this sex difference was apparently not explained by a sex-specific mechanism related to preadmission use of antiplatelets.

Abstract TMP2: Intravenous Thrombolysis For Ischemic Stroke With Unknown Time Of Onset: Differences Between Wake-up Stroke And Non-wake-up Subtypes: EOS

Background: The unknown onset stroke can be categorized into two groups; wake-up stroke (WUS) and non-wake-up unwitnessed stroke with a time of onset unavailable due to aphasia, impaired consciousness, or cognitive impairment (non-wake-up unknown onset stroke, non-WUS). We aimed to assess the differences in efficacy and safety of intravenous thrombolysis (IVT) for these subgroups. Methods: Patients with an unknown onset stroke from the Evaluation of unknown Onset Stroke thrombolysis trials (EOS) collaboration were evaluated using an individual patient-level database of randomized controlled trials comparing IVT with placebo/standard treatment. A favorable outcome was defined as a modified Rankin Scale score 0-1 at 90 days. Safety outcomes included symptomatic intracranial hemorrhage (sICH) at 22-36 hours and 90-day mortality. The effect of IVT was compared between the treatment groups in the WUS and non-WUS with mixed-effect logistic-regression analysis. Results: A total of 634 patients (233 women [36.8%], median age 70 years [IQR 61-76]) were analyzed. In patients with non-WUS (n=92 [14%]), advanced age, atrial fibrillation, vessel occlusion on MRA and high NIHSS score were more prevalent (P&lt;0.01 for each) than those with WUS (n=542 [86%]). Overall, no significant interaction was noted between the mode of onset and treatment effect (Pinteraction=0.782). In patients with WUS, a favorable outcome was more common in the IVT group than the control (149 [54.8%] vs. 117 [45.5%], adjusted OR: 1.45, 95% CI 1.01-2.11), death occurred in 11 [4.0%] and 5 [1.9%] (p=0.099), and sICH occurred in 5 [1.8%] and 1 [0.3%] (p=0.142). In patients with non-WUS, no significant difference was observed for a favorable outcome (16 [37.2%] vs. 14 [29.2%], aOR 1.73 [0.60-4.98]). One death and one sICH were reported in the IVT group, but none in the controls. Conclusions: The benefit of IVT was significant in patients with WUS. Excellent outcome was also numerically more prevalent in non-WUS but this did not reach significance, probably due to the lack of statistical power.

Retracted: Meta-Analysis of the Effectiveness and Safety of Intravenous Thrombolysis in Patients with Acute Cerebral Infarction.

[This retracts the article DOI: 10.1155/2021/2833043.].

Intravenous thrombolytic therapies in the management of unknown onset and wakeup strokes: A scoping review

Background : The efficacy and safety of thrombolytic therapies for the management of unknown time onset stroke (UTOS) and wake-up stroke (WUS) are in a debate. &#x0D; Objective: The objective of this scoping review is to map the existing research literature to answer the research question: What is the efficacy and safety of intravenous thrombolysis in the management of unknown time onset stroke? &#x0D; Data Sources: The literature search was conducted using the search terms {(Intravenous thrombolysis)} AND {(Unknown time onset stroke)} in pub med and Intravenous thrombolysis *, Unknown time onset stroke *in Cochrane. The review was limited to articles written in the English language. Databases searched included MEDLINE, PubMed and Cochrane electronic databases complemented with a manual search.&#x0D; Study Selection and Data Extraction: 45 articles of potential relevance were selected. Out of them 14 were containing relevant information direct to the question. The analysis was conducted by charting descriptive numerical data and by content analysis of the narrative representations&#x0D; Results: From 14 relevant papers, 2 Retrospective observational, 2 case control, 1 pilot study, and 5 recent randomized control trials were included for critical appraisal and review writing.&#x0D; Conclusions: The penumbral mismatch in UTOS is a cogent method to recognize the patients for thrombolytic therapy without significant risk, but the appropriate imaging criteria to maximize the efficacy and minimize bleeding complications of thrombolytic treatment still has to be fully defined. Results from ongoing trials may be promising with the use of advanced imaging modalities in selected patients.

Efficacy and safety of intravenous thrombolysis in mild ischemic stroke

Background: Intravenous thrombolysis is the preferred clinical treatment for ultra-early (&lt;4.5 h) ischemic stroke. However, whether intravenous thrombolysis should be used in patients with mild stroke remains controversial. This study reports a systematic review and meta-analysis of the efficacy and safety of intravenous thrombolysis in acute mild stroke. Methods: The PubMed, Cochrane Library, MEDLINE, Embase and CBM disc databases were searched for studies on intravenous thrombolysis versus nonthrombolysis in acute mild stroke. All studies published in English prior to March 2022 were retrieved. The studies were screened and selected based on the inclusion and exclusion criteria. Then, the data were extracted and recorded by trained researchers. RevMan 5.4 statistical software was used to analyze the data on the efficacy (mRS score, stroke recurrence rate and mortality at 90 days) and safety (intracranial hemorrhage, symptomatic intracranial hemorrhage) of the patients with acute mild stroke in the intravenous thrombolysis and nonthrombolysis groups. Results: A total of 14 high-quality studies containing 86,063 patients with acute mild stroke (8,824 in the intravenous thrombolysis group; 77,239 in the nonthrombolysis group) were included in this meta-analysis. The meta-analysis results were as follows: (1) Efficacy: There were significant differences in mRS scores of 0~1 and 0~2 between the intravenous thrombolysis and nonthrombolysis groups (mRS 0-1, OR= 1.53, 95% CI: 1.31~1.79, Z=5.40, P &lt;0.00001; mRS 0-2, OR= 1.33, 95% CI: 1.07~1.65, Z=2.59, P =0.01). (2) Safety: There was no significant difference in the recurrence rate of stroke or mortality between the two groups ( recurrence rate, OR= 0.62, 95% CI: 0.35~1.08, Z=1.68, P =0.09; mortality, OR=0.89, 95% CI: 0.45~1.77, Z=0.33, P =0.74). There were more patients with intracranial hemorrhage in intravenous thrombolysis group than in nonthrombolysis group (asymptomatic intracranial hemorrhage, OR= 2.39, 95% CI:1.19~4.80, Z=2.45, P =0.01; symptomatic intracranial hemorrhage, OR= 7.65, 95% CI:3.07~19.05, Z=4.37, P &lt;0.0001). Conclusion: Intravenous thrombolysis significantly improved the functional outcomes but did not reduce mortality at 90 days in patients with acute mild stroke and had a higher risk of intracranial hemorrhage.

Thrombolysis in central retinal artery occlusion: a retrospective observational study

BackgroundThere is no evidence-based therapy for non-arteritic central retinal artery occlusion (NA-CRAO). Intravenous thrombolysis (IVT) with alteplase in a time window < 4.5 h may lead to a favorable outcome. Purpose of this study was to investigate the feasibility, efficacy and safety of IVT in patients classified as functionally blind.MethodsWe conducted a retrospective observational study of NA-CRAO-patients. All patients underwent an ophthalmological and neurological examination including cerebral magnetic resonance imaging (MRI) for assessment of additional stroke lesions. Patients were treated either conservatively or with IVT within 4.5 h. Visual acuity (VA) was evaluated in logMAR and a categorical analysis was performed.ResultsThirty-seven patients were included in the study, 21 patients in the conservative treatment group (CTG) and 16 patients in the IVT group. The median logMAR visual acuity at admission and discharge was similar in both groups. The medium symptom to treatment time in the IVT group was 158.0 min. 3 patients (19%) of the IVT group showed a favorable outcome, all CTG patients remained at the level of functional blindness. No serious adverse events were observed after IVT. MRI showed additional acute stroke in over one-third of the patients (n = 14).ConclusionsEarly intravenous thrombolysis therapy according to the current stroke protocol n a time window up to 4.5 h after the onset of symptoms was feasible and might be a potential treatment option for NA-CRAO. Patients with NA-CRAO are at very high risk of ischemic stroke and MRI should be done in all patients for optimized treatment and secondary stroke prevention. A prospective randomized study is required.

Effect of Xingnao Kaiqiao acupuncture on safety of rt-PA intravenous thrombolysis in patients with cerebral infarction: a randomized controlled trial

To assess the effect of Xingnao Kaiqiao (regaining consciousness and opening orifices) acupuncture on the efficacy and safety of intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in patients with cerebral infarction. A total number of 142 patients of cerebral infarction undergoing rt-PA intravenous thrombolysis were randomized into an acupuncture-medication group (71 cases) and a western medication group (71 cases, 1 case dropped off). In the western medication group, rt-PA intravenous thrombolysis was given. In the acupuncture-medication group, besides the intervention as the control group, Xingnao Kaiqiao acupuncture was provided at Shuigou (GV 26), Neiguan (PC 6), Sanyinjiao (SP 6), Jiquan (HT 1), etc. once daily. One treatment session contained 6 treatments and 1 session was required. Before and after treatment, the score of the National Institute of Health stroke scale (NIHSS), the levels of the relevant indexes of symptomatic intracerebral hemorrhage (sICH) (platelet [PLT], D-dimer and fibrinogen), the incidences of sICH and adverse effect were compared between groups. The efficacy was assessed in two groups. After treatment, NIHSS scores and the levels of D-dimer were reduced compared with those before treatment in both groups (P<0.05), and those in the acupuncture-medication group were lower than the western medication group (P<0.05). The level of fibrinogen in the acupuncture-medication group was increased in comparison with that before treatment (P<0.05), and also higher than the western medication group (P<0.05). The incidence of sICH was 0% (0/71) in the acupuncture-medication group, lower than 8.6% (6/70) in the western medication group (P<0.05). The effective rate was 97.2% (69/71) in the acupuncture-medication group, higher than 87.1% (61/70) in the western medication group (P<0.05). The incidence of adverse effect was 2.8% (2/71) in the acupuncture-medication group, lower than 12.9% (9/70) in the western medication group (P<0.05). Xingnao Kaiqiao acupuncture may improve the efficacy of rt-PA intravenous thrombolysis in the patients with cerebral infraction and decrease the incidences of sICH and adverse effect. The mechanism may be related to the regulation of fibrinogen and D-dimer levels.

Retinal Infarction: A Pilot Study on the Efficacy and Safety of Intravenous Thrombolysis and Underlying Aetiologies.

Background: Treatment of non-arteritic central retinal artery occlusion is still inconsistent. Therefore, the current study aimed to evaluate the efficacy of intravenous thrombolysis (IVT) and describe the prevalence of co-occurring ischemic brain lesions in patients with acute visual loss due to ischemia. Methods: We analysed 38 consecutive patients with acute visual loss between January 2015 and June 2020. Patients presenting within 4.5 h of symptom onset without any contraindication were treated with IVT. Patients underwent neurologic and ophthalmologic examination and diagnostic workup for the underlying aetiology. Follow-up was performed after 3 and 12 months. Results: Patients treated with IVT had a significantly better functional outcome at discharge compared to patients treated conservatively. No additional ischemic brain lesions were detected (0 of 38). Three patients had extracranial carotid artery stenosis ≥50%. Atrial fibrillation was present in four patients, three of whom already received oral anticoagulation. In the remaining 31 patients no embolic source was detected. However, the number of plaques were rated mild to moderate. Within three months, one patient developed transient visual loss while another suffered a contralateral transient ischemic attack. Conclusions: IVT may represent a safe and effective treatment option in patients with isolated visual loss due to ischemia. The aetiology was atherosclerotic burden rather than embolism caused by carotid stenosis or atrial fibrillation, bringing the current diagnostic procedure and therapy into question. Randomized trials are necessary to evaluate the efficacy and safety of IV thrombolysis and clarify the aetiology of isolated visual loss due to ischemia.

Patterns and outcomes of stroke thrombolysis in a tertiary care hospital in North East India

Introduction: Intravenous thrombolysis with alteplase (tissue plasminogen activator -tPA) has been approved as the standard of care for the treatment of acute ischemic stroke (AIS) since 1995. Although there have been sporadic reports of hyperacute stroke thrombolysis coming from North-East India, a well-structured study from this resource poor area is lacking in this regard. Objective:To study the efficacy and safety of intravenous thrombolysis with tPA in AIS. Materials and methods: All patients of acute Ischemic stroke who were thrombolysed using the 4.5 hour window period, between Dec 2017 to April 2021 were enrolled and studied. We analyzed differences in age, gender, time from onset to start IVT, door to needle time (DNT), pretreatment NIHSS score, postoperative NIHSS score, and so on. They were followed up for a period of 3 months for the determination of outcome. The death rate at 90 days and incidence of SICH were used for assessment of safety. Results:A total of 30 patients were thrombolysed. 37% of patients were thrombolysed during the covid-19 pandemic. Hypertension was the most common risk factor. The mean Door to needle(DTN) time was 74.1 minutes with the shortest being 25 minutes. The mean NIHSS score at the point of hospitalization was 12.42 and after 24 hours was 9.27. In 57.69% of patients, the primary outcome (≥4 increment in NIHSS score) was achieved. 14.8% of patients suffered from adverse outcomes (death and SICH). Conclusion: This study re-affirms the safety and efficacy of IV tPA for hyperacute stroke thrombolysis in our set-up.

Efficacy, Influencing Factors, and Safety of Alteplase Intravenous Thrombolysis in Patients with Acute Ischemic Stroke Combined with Atrial Fibrillation

Ischemic stroke is the most common type of stroke. Intravenous thrombolytic therapy with alteplase is currently the most effective method to improve the prognosis of patients with acute cerebral infarction. The purpose of this study was to investigate the efficacy and safety of intravenous thrombolysis with alteplase in patients with acute ischemic stroke combined with atrial fibrillation and to analyze the related influencing factors. It turns out, alteplase intravenous thrombolysis is effective for patients with ICS combined with atrial fibrillation, and the incidence of sICH are lower than those without alteplase intravenous thrombolysis, but the efficacy is worse than that of patients without atrial fibrillation. At the same time, the baseline NHISS score and systolic pressure before the thrombolytic were independent risk factors affecting the efficacy of intravenous thrombolysis with alteplase in ICS patients with atrial fibrillation. This study has provided a scientific basis for making an active decision to perform ultraearly intravenous thrombolysis in our hospital to reduce the mortality and disability rate of stroke in the region.

Intravenous thrombolysis with alteplase in the treatment of acute cerebral infarction.

Objectives:To compare the efficacy and safety of intravenous thrombolysis with alteplase and intravenous thrombolysis with urokinase for patients with acute cerebral infarction.Methods:This prospective study included 140 patients with acute cerebral infarction who were admitted to our hospital between June 2018 and June 2019. They were randomly divided into two groups. The control group (70 cases) was treated with urokinase intravenous thrombolysis, and the observation group (70 cases) was given alteplase intravenous thrombolytic therapy. The treatment efficacy and safety of the two groups were compared.Results:The total effective rate of the observation group was 95.7%, and that of the control group was 78.6%, i.e., the total effective rate of the observation group was significantly superior to the that of the control group (P < 0.05). After treatment, the observation group had significantly lower National Institutes of Health Stroke Scale (NIHSS) score and significantly higher mini-mental state examination (MMSE) score than the control group; the difference was statistically significant (P<0.05). After treatment, the levels of inflammatory factors of both groups significantly decreased compared to before treatment, and the decrease in the observation group was larger than that in the control group (P<0.05). The levels of serum homocysteine (Hcy) and monocyte chemoattractant protein-1 (MCP-1) in the observation group were significantly lower than those in the control group after treatment, and the differences were statistically significant (P<0.05). The incidence of hemorrhagic adverse reaction in the observation group was lower than that in the control group (P<0.05).Conclusion:In the treatment of acute cerebral infarction, ccompared with urokinase, alteplase can further relieve cognitive impairment and promote the recovery of nerve function through inhibiting levels of inflammatory factors and levels of serum Hcy and MCP-1.

Meta-Analysis of the Effectiveness and Safety of Intravenous Thrombolysis in Patients with Acute Cerebral Infarction.

In this paper, a meta-analysis of the effectiveness and safety of intravenous thrombolysis in patients with acute cerebral infarction was carried out, the original literature inclusion criteria and retrieval strategies were developed, and the collection deadline was about new oral anticoagulants and other methods for the antithrombotic intravenous thrombolytic treatment of patients with acute cerebral infarction for the relevant literature on the safety and effectiveness comparison. First, the quality of the literature is evaluated according to whether the included studies are randomized controlled trials, whether there is randomized concealment, whether blinding is used, and whether they are withdrawn or lost to follow-up, and the RevMan 5.2 software is used for meta-analysis. At the same time, grey literature databases such as dissertations were experimentally searched, and all randomized controlled studies (RCT), nonrandomized controlled studies, case-controlled studies, cohort studies, case series reports, etc. of Wingspan in the treatment of intracranial atherosclerotic stenosis were collected. In the prevention of myocardial infarction in patients with acute cerebral infarction, the difference between the two was not statistically significant (RR = 0.82, 95% CI (0.57, 1.17), P = 0.27). Compared with other methods, it can significantly reduce the all-cause mortality of patients with nonvalvular venous thrombolysis, and the difference is statistically significant (RR = 0.90, 95% CI (0.85, 0.96), P = 0.001). Experimental results show that in terms of safety, the new oral anticoagulant is better than other methods in reducing minor bleeding in patients with acute cerebral infarction, and the difference is statistically significant (RR = 0.87, 95% CI (0.76, 0 99), P = 0.03); the effect is better than other methods in reducing the incidence of serious bleeding events, and the difference is statistically significant (RR = 0.79, 95% CI (0.74, 0.85), P < 0.00001).