Objective: To investigate the different effects on evacuation of hematoma, the severity of nerve injury, inflammatory reaction and oxidative stress response in the treatment of acute intracerebral hemorrhage by using ...Objective: To investigate the different effects on evacuation of hematoma, the severity of nerve injury, inflammatory reaction and oxidative stress response in the treatment of acute intracerebral hemorrhage by using minimally invasive puncture and drainage assisted with alteplase or urokinase. <br> Methods:A total of 114 patients with acute intracerebral hemorrhage treated with minimally invasive puncture and drainage in our hospital from May 2012 to October 2015 were retrospectively analyzed and divided into alteplase group and urokinase group, which received adjuvant therapy with alteplase and urokinase, respectively. Before and after treatment, CT was used for scanning, and the volume of hematoma and edema and the distance of midline shift were examined. After treatment, serum was collected for detecting the contents of molecular markers of nerve injury, inflammatory reaction and oxidative stress response. <br> Results:On the 3rd day after treatment, the volume of hematoma and edema and the distance of midline shift in minimally invasive group were significantly lower than those of craniotomy group, and incidence of intracranial infection was lower than that of craniotomy group. There was no significant difference of rebleeding incidence compared to craniotomy group. The serum contents of osteopontin, S100β, glial fibrillary acidic protein, neuron-specific enolase, myelin basic protein, neuropeptide Y, ischemia modified albumin, tumor necrosis factor alpha, interleukin-1β, interleukin-6, interleukin-8, soluble intercellular adhesion molecule-1, high-mobility group protein 1, malonaldehyde, advanced oxidation protein products and 8-hydroxy-2'-deoxyguanosine urine of patients from alteplase group were significantly lower than those of urokinase group. The content of total antioxidant capacity was obviously higher than that of urokinase group. <br> Conclusions: As for the effect on evacuation of hematoma and also the ameliorative effect on nerve injury, inflammatory reaction and oxidative stress response in treatment of acute intracerebral hemorrhage, minimally invasive puncture and drainage assisted with alteplase was superior to adjuvant therapy with urokinase.展开更多
BACKGROUND: In recent years, thrombolytic therapy has become the main treatment of ischemic stroke. But the increasing use of alteplase in ischemic stroke has made some complications more evident. Angioedema is a rare...BACKGROUND: In recent years, thrombolytic therapy has become the main treatment of ischemic stroke. But the increasing use of alteplase in ischemic stroke has made some complications more evident. Angioedema is a rare but potentially life-threatening complication of alteplase treatment. Only a few studies have examined the incidence of angioedema after treatment with alteplase for stroke.METHODS: A 75-year-old man complaining of right hemiparesis was admitted to our emergency department. He was diagnosed as having acute ischemic stroke, and alteplase infusion was given two hours after the onset of stroke symptoms. Immediately after the completion of infusion he was noted to have a large swollen tongue.RESULTS: His neurological symptoms resolved gradually within 4 hours, whereas his upper extremity strength improved to 4/5 and lower extremity 5/5. Lingual edema resolved within 16 hours without any complication. He died from presumed nosocomial infection 5 days later.CONCLUSIONS: Lingual angioedema may appear as a possible complication in patients who were treated with alteplase. The management of these patients should be very careful.展开更多
Objective:To investigate the effects of intravenous thrombolysis therapy with alteplase on neurological function,coagulation function and serum inflammatory factors in patients with acute cerebral infarction.Methods:A...Objective:To investigate the effects of intravenous thrombolysis therapy with alteplase on neurological function,coagulation function and serum inflammatory factors in patients with acute cerebral infarction.Methods:A total of 96 patients with acute cerebral infarction admitted to our hospital from September 2017 to October 2019 were randomly divided into two groups,with 48 patients in each group.The control group(n=48)received routine treatment,and the observation group received intravenous thrombolysis therapy with alteplase on the basis of routine treatment.The neurological deficit score,prothrombin time(PT),activated partial thromboplastin time(APTT),tumor necrosis factor-a level(TNF-α),and high-sensitivity C-reactive protein(hs-CRP)were compared between the two groups after 15 days of treatment.Results:After treatment,NIHSS scores in both groups were lower than those before treatment;PT levels were increased,while APTT,TNF-αand hs-CRP levels were all decreased in both groups,and the changes in the observation group were greater than those in the control group,with statistically significant difference(P<0.05).Conclusions:Intravenous thrombolysis therapy with alteplase can improve the neurological function,coagulation function and serum levels of inflammatory factors in patients with acute cerebral infarction,which is worthy of clinical application.展开更多
Objective:To study the differences in the effect of intravenous alteplase thrombolysis and non-thrombolytic therapy on the neurological function in patients with acute cerebral infarction as well as the specific molec...Objective:To study the differences in the effect of intravenous alteplase thrombolysis and non-thrombolytic therapy on the neurological function in patients with acute cerebral infarction as well as the specific molecular mechanism.Methods:Patients with acute cerebral infarction who were treated in our hospital between April 2013 and May 2016 were selected and randomly divided into two groups, thrombolysis group received intravenous alteplase thrombolysis and non-thrombolysis group received conventional treatment. After treatment, transcranial color Doppler ultrasound was used to assess intracranial blood flow, and serum was collected to detect blood coagulation function indexes, nerve injury indexes and inflammatory stress response indexes.Results:1 week and 2 weeks after treatment, middle cerebral artery Vs, Vd and Vm levels of thrombolysis group were significantly higher than those of non-thrombolysis group;2 weeks after treatment, serum FVIII, VWF, S100β, NSE, GFAP, MBP, UCH-L1, TNF-α, IL-1β, MDA, AOPP and 8-OHdG content of thrombolysis group were significantly lower than those of control group while PT, TT and APTT were significantly higher than those of control group.Conclusion: Intravenous alteplase thrombolysis can improve cerebral blood perfusion and alleviate nerve injury in patients with acute cerebral infarction, and inhibiting blood coagulation process as well as oxidizing and inflammatory reaction is the molecular mechanism for alteplase to achieve therapeutic action.展开更多
Objective:To study the effect of alteplase thrombolysis sequenced by low molecular heparin calcium antithrombosis on the neurological function and serum cytokines in patients with cerebral infarction.Methods:Patients ...Objective:To study the effect of alteplase thrombolysis sequenced by low molecular heparin calcium antithrombosis on the neurological function and serum cytokines in patients with cerebral infarction.Methods:Patients with acute cerebral infarction who received alteplase thrombolysis in Zigong Fourth People's Hospital between June 2014 and October 2016 were retrospectively analyzed and divided into the intervention group who received low molecular heparin calcium treatment and the control group who did not receive low molecular heparin calcium treatment. The serum was collected before and after treatment to determine the contents of platelet activation factors, nerve injury molecules, soluble apoptotic molecules and growth factors.Results: Serum CD62p, CD63, PAF, GMP-140, NSE, S100B, GFAP, sFas, sFasL, sTRAIL, IGF-1, VEGF, BDNF and bFGF levels of both groups of patients after treatment were lower than those before treatment, serum CD62p, CD63, PAF, GMP-140, NSE, S100B, GFAP, sFas, sFasL and sTRAIL levels of intervention group after treatment were lower than those of control group while IGF-1, VEGF, BDNF and bFGF levels were higher than those of control group.Conclusion: Alteplase thrombolysis sequenced by low molecular heparin calcium antithrombosis for acute cerebral infarction can inhibit platelet activation and cell apoptosis, alleviate nerve injury and improve neurotrophy status.展开更多
Objective:To study the effect of alteplase thrombolysis on nerve injury and serum cytokines in patients with cerebral infarction.Methods: Patients with acute cerebral infarction who received thrombolytic therapy in Do...Objective:To study the effect of alteplase thrombolysis on nerve injury and serum cytokines in patients with cerebral infarction.Methods: Patients with acute cerebral infarction who received thrombolytic therapy in Dongfang Hospital between May 2014 and October 2016 were retrospectively analyzed, and according to the different ways of thrombolysis, they were divided into rt-Pa group and UK group who accepted alteplase and urokinase thrombolysis respectively. Serum levels of nerve injury markers, nerve cytokines and inflammatory cytokines were detected before as well as 1 d and 7 d after thrombolytic therapy.Results:1 d and 7 d after thrombolysis, serum nerve injury markers NSE, S100B, MDA and 8-OHdG as well as inflammatory cytokines IL-1β, IL-18, TNF-α and sVCAM-1 levels of both groups of patients were significantly lower than those before treatment while nerve cytokines BDNF, NGF and VEGF levels were significantly higher than those before treatment, and serum nerve injury markers NSE, S100B, MDA and 8-OHdG as well as inflammatory cytokines IL-1β, IL-18, TNF-α and sVCAM-1 levels of rt-Pa group were significantly lower than those of UK group while nerve cytokines BDNF, NGF and VEGF levels were significantly higher than those of UK group. Conclusion: Alteplase thrombolysis for acute cerebral infarction can reduce nerve injury, improve neurotrophic state, and inhibit inflammatory response.展开更多
Background:The occurrence of early neurological deterioration following intravenous thrombolysis(IVT)is considered a particularly ominous clinical event and is strongly correlated with poor outcomes.Initiating tirofib...Background:The occurrence of early neurological deterioration following intravenous thrombolysis(IVT)is considered a particularly ominous clinical event and is strongly correlated with poor outcomes.Initiating tirofiban within 24 h after IVT has been suggested as a better treatment option to achieve long-term functional outcomes.However,the rationality of this remedy is a controversial.The purpose of the study was to evaluate the safety and efficacy of early intravenous tirofiban administration after IVT in patients with acute ischemic stroke(AIS).Methods:Databases including PubMed,EMBASE,Cochrane Library,and Web of Science were searched for clinical trials on early tirofiban implementation after IVT in patients with AIS from inception to September 2022.Odds ratios(ORs)were generated for dichotomous variants via meta-analysis using STATA 17.0 MP.Results:Five clinical trials with 725 patients were eligible.The study outcomes demonstrated that early tirofiban administration after IVT was not associated with symptomatic intracranial hemorrhage(OR,0.78;95%confidence interval(CI),0.22–2.74;P=0.70),asymptomatic intracranial hemorrhage(OR,1.11;95%CI,0.52–2.37;P=0.80),systemic bleeding(OR,0.97;95%CI,0.42–2.23;P=0.94),and death(OR,1.05;95%CI,0.47–2.31;P=0.91),but may reduce the incidence of early neurological deterioration(OR,0.09;95%CI,0.02–0.50;P=0.01),and was significantly associated with 90-day excellent(modified Rankin scale score 0–1)(OR,2.01;95%CI,1.35–3.02;P=0.00)and favorable(modified Rankin scale score 0–2)(OR,2.30;95%CI,1.63–3.23;P=0.00)functional outcomes.Conclusion:The early intravenous administration of tirofiban after IVT in patients with AIS may be a safe and effective treatment strategy that improves long-term neurological functional outcomes without increasing the risk of adverse events.展开更多
Objective: to investigate the clinical safety and efficacy of intravenous thrombolysis with alteplase in the treatment of acute mild ischemic stroke. Methods: a total of 92 patients with acute mild ischemic stroke adm...Objective: to investigate the clinical safety and efficacy of intravenous thrombolysis with alteplase in the treatment of acute mild ischemic stroke. Methods: a total of 92 patients with acute mild ischemic stroke admitted from September in 2019 to March in 2020 were selected and divided into control group and observation group, with 46 cases in each group. The control group received conventional treatment, and the observation group received intravenous thrombolytic therapy with alteplase. The neurological function deficit, therapeutic effect and safety of the two groups were compared. Results: Before treatment, there was no statistical difference in NIHSS scores between 2 groups (P > 0.05). After treatment, the scores of both groups decreased, and the NIHSS scores of the observation group at different stages decreased more than that of the control group, with statistical significance (P < 0.05). The effective rate of observation group was significantly higher than control group. The complication rate of the observation group was lower than that of the control group. Conclusion: intravenous thrombolysis with alteplase is effective in treating acute mild ischemic stroke. It can be seen that the neurological function deficit has been significantly improved, with fewer complications. It is a treatment method with guaranteed safety and effectiveness, which is worthy of clinical promotion.展开更多
Objective: The medical staff randomly selected two groups during the research to explore and analyze the control experiment with the control score, and to explore the effect of butylbenzene peptide in the treatment of...Objective: The medical staff randomly selected two groups during the research to explore and analyze the control experiment with the control score, and to explore the effect of butylbenzene peptide in the treatment of patients with acute ischemic stroke. Methods: 86 patients with acute ischemic stroke admitted to our hospital by medical staff were selected for comprehensive data analysis and discussion on the individual condition of the patients. The patients were selected from June 2020 to May 2022 for research. After analyzing the condition of the patients, the patients were randomly divided into two groups. All patients met the test requirements and were recorded as the control group (n43) and the experimental group (n43) according to the experimental habits. The patients in the control group were treated only with alteplase, while the patients in the experimental group were treated with butylphthalide. After the treatment, the medical staff assessed the neurological deficit of the patients based on the NIHSS Stroke Scale to confirm the rehabilitation status of the patients. Results: compared with the control group, the NIHSS score of the experimental group was significantly lower than that of the control group, and the FMA score of the experimental group was significantly higher than that of the control group (P < 0.05). The MoCA score and MMSE score of the experimental group were higher than those of the control group (P < 0.05), and the effect of the experimental group was better than that of the control group (P < 0.05). Conclusion: the condition of patients with acute ischemic stroke is very complicated, and researchers found that the combined use of drugs can improve the treatment effect of patients. The application of butylphthalide combined with alteplase in the treatment of patients can improve the individual condition of patients, which is very good for the subsequent treatment of patients and the recovery of patients condition.展开更多
Background Whether intravenous thrombolysis(IVT)should be administered prior to endovascular therapy(EVT)in patients with atherothrombotic stroke-related large vessel occlusion(AT-LVO)remains unclear.This study aimed ...Background Whether intravenous thrombolysis(IVT)should be administered prior to endovascular therapy(EVT)in patients with atherothrombotic stroke-related large vessel occlusion(AT-LVO)remains unclear.This study aimed to assess the efficacy and safety of IVT administered before EVT in this patient population.Methods We analysed the data from a multicentre registry of patients who underwent EVT for AT-LVO.Patients were categorised based on presumed mechanism of occlusion:in situ occlusion(intracranial group)or embolism from cervical artery occlusion/stenosis(tandem group).We compared the efficacy and safety of IVT before EVT in patients who received IVT(IVT stratum)and those who did not(non-IVT stratum).The primary outcome was a modified Rankin Scale score of 0-2 at 90 days.Results Among the 336 patients in the intracranial group,99 patients underwent IVT.The rate of favourable functional outcomes did not differ between IVT and non-IVT strata(51.1%vs 47.6%;adjusted ORs(aORs)(95%CI),1.18(0.66 to 2.09));whereas any intracranial haemorrhage(ICH)(10.1%vs 3.8%;aOR,2.98(1.01 to 9.26))and mortality at 90 days(6.4%vs 1.3%;aOR,4.66(1.02 to 26.73))were significantly higher in the IVT stratum.Among the 233 patients in the tandem group,88 patients underwent IVT,with no significant differences in efficacy or safety outcomes between the strata.Conclusion In patients with AT-LVO,IVT before EVT did not improve outcomes and was associated with increased risk of ICH and mortality in those with in situ intracranial occlusion.IVT before EVT may not be recommended in patients with atherosclerotic intracranial occlusions.展开更多
Objective The Antiplatelet versus R-tPA for Acute Mild Ischaemic Stroke trial has demonstrated the non-inferiority of dual antiplatelet therapy(DAPT)to alteplase in minor non-disabling stroke.This prespecified seconda...Objective The Antiplatelet versus R-tPA for Acute Mild Ischaemic Stroke trial has demonstrated the non-inferiority of dual antiplatelet therapy(DAPT)to alteplase in minor non-disabling stroke.This prespecified secondary analysis aimed to investigate whether the treatment effects were similar across stroke territories.Methods Participants were divided according to stroke territory,which were subdivided into DAPT and alteplase.An excellent functional outcome at 90 days defined as modified Rankin Scale scoring 0–1 was primary outcome.National Institutes of Health Stroke Scale(NIHSS)score change and early neurological improvement measured by a 2-point decline in NIHSS score at 24 hours were secondary outcomes.Symptomatic intracerebral haemorrhage(sICH)and bleeding events were safety outcomes.Primary analyses adjusted unbalanced baseline characteristics between treatments by multivariate logistic regression.Results A total of 719 patients were included:566 in anterior circulation stroke(ACS)and 153 in posterior circulation stroke(PCS).Primary outcome was 94.1%in DAPT and 91.7%in alteplase among ACS patients(adjusted risk difference(RD)and 95%CI,1.5%(−1.5%to 4.6%),p=0.32),while 91.2%in DAPT and 91.8%in alteplase among PCS patients(adjusted RD and 95%CI,−2.1%(−8.5%to 4.4%),p=0.53).Compared with alteplase,DAPT was associated with lower risk of sICH(p=0.03)and bleeding events(p<0.001)in ACS,but only lower risk of bleeding events(p=0.007)in PCS.Additionally,among ACS patients,the alteplase was superior to DAPT in terms of decrease in NIHSS score at 24 hours compared with admission(adjusted geometric mean ratio and 95%CI,−0.09(−0.16 to−0.03),p=0.005)and early neurological improvement(adjusted RD and 95%CI,−7.2%(−11.6%to−2.7%),p=0.001).Conclusion Among ischaemic stroke with minor non-disabling symptoms,DAPT was similar with intravenous alteplase regarding long-term functional outcome and better safety regardless of ACS or PCS.The potential benefit of intravenous alteplase regarding early neurological improvement in patients with ACS warrants further investigation.Trial registration number NCT03661411.展开更多
Background The benefit-risk profile of tenecteplase in the elderly patients with acute ischaemic stroke(AIS)is uncertain.We sought to investigate the efficacy and safety of 0.25 mg/kg tenecteplase compared with altepl...Background The benefit-risk profile of tenecteplase in the elderly patients with acute ischaemic stroke(AIS)is uncertain.We sought to investigate the efficacy and safety of 0.25 mg/kg tenecteplase compared with alteplase for AIS patients aged≥80 years.Methods We performed a post hoc analysis of the Tenecteplase Reperfusion Therapy in Acute Ischaemic Cerebrovascular Events-2 Trial,a randomised,phase 3,non-inferiority clinical trial.Disabling AIS patients aged≥80 years who initiated intravenous thrombolytics within 4.5 hours of symptom onset were enrolled from June 2021 to May 2022 across 53 centres in China and were randomly allocated to receive 0.25 mg/kg tenecteplase or 0.9 mg/kg alteplase.The primary efficacy outcome was the proportion of participants with a modified Rankin Scale(mRS)score of 0-1 at 90 days.Symptomatic intracranial haemorrhage(sICH)within 36 hours was the safety outcome.Results Of 137 participants,mRS 0-1 at 90 days occurred in 37(49.3%)of 75 in the tenecteplase group vs 20(33.9%)of 59 in the alteplase group(risk ratio(RR)1.47,95%CI 0.96 to 2.23).sICH within 36 hours was observed in 3(4.0%)of 76 in the tenecteplase group and two(3.3%)of 61 in the alteplase group(RR 1.30,95%CI 0.20 to 8.41).Conclusions The risk-benefit profile of tenecteplase thrombolysis was preserved in the elderly patients,which lends further support to intravenous 0.25 mg/kg tenecteplase as an alternative to alteplase in these patients.展开更多
文摘Objective: To investigate the different effects on evacuation of hematoma, the severity of nerve injury, inflammatory reaction and oxidative stress response in the treatment of acute intracerebral hemorrhage by using minimally invasive puncture and drainage assisted with alteplase or urokinase. <br> Methods:A total of 114 patients with acute intracerebral hemorrhage treated with minimally invasive puncture and drainage in our hospital from May 2012 to October 2015 were retrospectively analyzed and divided into alteplase group and urokinase group, which received adjuvant therapy with alteplase and urokinase, respectively. Before and after treatment, CT was used for scanning, and the volume of hematoma and edema and the distance of midline shift were examined. After treatment, serum was collected for detecting the contents of molecular markers of nerve injury, inflammatory reaction and oxidative stress response. <br> Results:On the 3rd day after treatment, the volume of hematoma and edema and the distance of midline shift in minimally invasive group were significantly lower than those of craniotomy group, and incidence of intracranial infection was lower than that of craniotomy group. There was no significant difference of rebleeding incidence compared to craniotomy group. The serum contents of osteopontin, S100β, glial fibrillary acidic protein, neuron-specific enolase, myelin basic protein, neuropeptide Y, ischemia modified albumin, tumor necrosis factor alpha, interleukin-1β, interleukin-6, interleukin-8, soluble intercellular adhesion molecule-1, high-mobility group protein 1, malonaldehyde, advanced oxidation protein products and 8-hydroxy-2'-deoxyguanosine urine of patients from alteplase group were significantly lower than those of urokinase group. The content of total antioxidant capacity was obviously higher than that of urokinase group. <br> Conclusions: As for the effect on evacuation of hematoma and also the ameliorative effect on nerve injury, inflammatory reaction and oxidative stress response in treatment of acute intracerebral hemorrhage, minimally invasive puncture and drainage assisted with alteplase was superior to adjuvant therapy with urokinase.
文摘BACKGROUND: In recent years, thrombolytic therapy has become the main treatment of ischemic stroke. But the increasing use of alteplase in ischemic stroke has made some complications more evident. Angioedema is a rare but potentially life-threatening complication of alteplase treatment. Only a few studies have examined the incidence of angioedema after treatment with alteplase for stroke.METHODS: A 75-year-old man complaining of right hemiparesis was admitted to our emergency department. He was diagnosed as having acute ischemic stroke, and alteplase infusion was given two hours after the onset of stroke symptoms. Immediately after the completion of infusion he was noted to have a large swollen tongue.RESULTS: His neurological symptoms resolved gradually within 4 hours, whereas his upper extremity strength improved to 4/5 and lower extremity 5/5. Lingual edema resolved within 16 hours without any complication. He died from presumed nosocomial infection 5 days later.CONCLUSIONS: Lingual angioedema may appear as a possible complication in patients who were treated with alteplase. The management of these patients should be very careful.
文摘Objective:To investigate the effects of intravenous thrombolysis therapy with alteplase on neurological function,coagulation function and serum inflammatory factors in patients with acute cerebral infarction.Methods:A total of 96 patients with acute cerebral infarction admitted to our hospital from September 2017 to October 2019 were randomly divided into two groups,with 48 patients in each group.The control group(n=48)received routine treatment,and the observation group received intravenous thrombolysis therapy with alteplase on the basis of routine treatment.The neurological deficit score,prothrombin time(PT),activated partial thromboplastin time(APTT),tumor necrosis factor-a level(TNF-α),and high-sensitivity C-reactive protein(hs-CRP)were compared between the two groups after 15 days of treatment.Results:After treatment,NIHSS scores in both groups were lower than those before treatment;PT levels were increased,while APTT,TNF-αand hs-CRP levels were all decreased in both groups,and the changes in the observation group were greater than those in the control group,with statistically significant difference(P<0.05).Conclusions:Intravenous thrombolysis therapy with alteplase can improve the neurological function,coagulation function and serum levels of inflammatory factors in patients with acute cerebral infarction,which is worthy of clinical application.
文摘Objective:To study the differences in the effect of intravenous alteplase thrombolysis and non-thrombolytic therapy on the neurological function in patients with acute cerebral infarction as well as the specific molecular mechanism.Methods:Patients with acute cerebral infarction who were treated in our hospital between April 2013 and May 2016 were selected and randomly divided into two groups, thrombolysis group received intravenous alteplase thrombolysis and non-thrombolysis group received conventional treatment. After treatment, transcranial color Doppler ultrasound was used to assess intracranial blood flow, and serum was collected to detect blood coagulation function indexes, nerve injury indexes and inflammatory stress response indexes.Results:1 week and 2 weeks after treatment, middle cerebral artery Vs, Vd and Vm levels of thrombolysis group were significantly higher than those of non-thrombolysis group;2 weeks after treatment, serum FVIII, VWF, S100β, NSE, GFAP, MBP, UCH-L1, TNF-α, IL-1β, MDA, AOPP and 8-OHdG content of thrombolysis group were significantly lower than those of control group while PT, TT and APTT were significantly higher than those of control group.Conclusion: Intravenous alteplase thrombolysis can improve cerebral blood perfusion and alleviate nerve injury in patients with acute cerebral infarction, and inhibiting blood coagulation process as well as oxidizing and inflammatory reaction is the molecular mechanism for alteplase to achieve therapeutic action.
文摘Objective:To study the effect of alteplase thrombolysis sequenced by low molecular heparin calcium antithrombosis on the neurological function and serum cytokines in patients with cerebral infarction.Methods:Patients with acute cerebral infarction who received alteplase thrombolysis in Zigong Fourth People's Hospital between June 2014 and October 2016 were retrospectively analyzed and divided into the intervention group who received low molecular heparin calcium treatment and the control group who did not receive low molecular heparin calcium treatment. The serum was collected before and after treatment to determine the contents of platelet activation factors, nerve injury molecules, soluble apoptotic molecules and growth factors.Results: Serum CD62p, CD63, PAF, GMP-140, NSE, S100B, GFAP, sFas, sFasL, sTRAIL, IGF-1, VEGF, BDNF and bFGF levels of both groups of patients after treatment were lower than those before treatment, serum CD62p, CD63, PAF, GMP-140, NSE, S100B, GFAP, sFas, sFasL and sTRAIL levels of intervention group after treatment were lower than those of control group while IGF-1, VEGF, BDNF and bFGF levels were higher than those of control group.Conclusion: Alteplase thrombolysis sequenced by low molecular heparin calcium antithrombosis for acute cerebral infarction can inhibit platelet activation and cell apoptosis, alleviate nerve injury and improve neurotrophy status.
文摘Objective:To study the effect of alteplase thrombolysis on nerve injury and serum cytokines in patients with cerebral infarction.Methods: Patients with acute cerebral infarction who received thrombolytic therapy in Dongfang Hospital between May 2014 and October 2016 were retrospectively analyzed, and according to the different ways of thrombolysis, they were divided into rt-Pa group and UK group who accepted alteplase and urokinase thrombolysis respectively. Serum levels of nerve injury markers, nerve cytokines and inflammatory cytokines were detected before as well as 1 d and 7 d after thrombolytic therapy.Results:1 d and 7 d after thrombolysis, serum nerve injury markers NSE, S100B, MDA and 8-OHdG as well as inflammatory cytokines IL-1β, IL-18, TNF-α and sVCAM-1 levels of both groups of patients were significantly lower than those before treatment while nerve cytokines BDNF, NGF and VEGF levels were significantly higher than those before treatment, and serum nerve injury markers NSE, S100B, MDA and 8-OHdG as well as inflammatory cytokines IL-1β, IL-18, TNF-α and sVCAM-1 levels of rt-Pa group were significantly lower than those of UK group while nerve cytokines BDNF, NGF and VEGF levels were significantly higher than those of UK group. Conclusion: Alteplase thrombolysis for acute cerebral infarction can reduce nerve injury, improve neurotrophic state, and inhibit inflammatory response.
基金supported by the Natural Science Foundation of Inner Mongolia(No.2021MS08169)the Medical and health Science and Technology Project of Inner Mongolia(No.202201571).
文摘Background:The occurrence of early neurological deterioration following intravenous thrombolysis(IVT)is considered a particularly ominous clinical event and is strongly correlated with poor outcomes.Initiating tirofiban within 24 h after IVT has been suggested as a better treatment option to achieve long-term functional outcomes.However,the rationality of this remedy is a controversial.The purpose of the study was to evaluate the safety and efficacy of early intravenous tirofiban administration after IVT in patients with acute ischemic stroke(AIS).Methods:Databases including PubMed,EMBASE,Cochrane Library,and Web of Science were searched for clinical trials on early tirofiban implementation after IVT in patients with AIS from inception to September 2022.Odds ratios(ORs)were generated for dichotomous variants via meta-analysis using STATA 17.0 MP.Results:Five clinical trials with 725 patients were eligible.The study outcomes demonstrated that early tirofiban administration after IVT was not associated with symptomatic intracranial hemorrhage(OR,0.78;95%confidence interval(CI),0.22–2.74;P=0.70),asymptomatic intracranial hemorrhage(OR,1.11;95%CI,0.52–2.37;P=0.80),systemic bleeding(OR,0.97;95%CI,0.42–2.23;P=0.94),and death(OR,1.05;95%CI,0.47–2.31;P=0.91),but may reduce the incidence of early neurological deterioration(OR,0.09;95%CI,0.02–0.50;P=0.01),and was significantly associated with 90-day excellent(modified Rankin scale score 0–1)(OR,2.01;95%CI,1.35–3.02;P=0.00)and favorable(modified Rankin scale score 0–2)(OR,2.30;95%CI,1.63–3.23;P=0.00)functional outcomes.Conclusion:The early intravenous administration of tirofiban after IVT in patients with AIS may be a safe and effective treatment strategy that improves long-term neurological functional outcomes without increasing the risk of adverse events.
文摘Objective: to investigate the clinical safety and efficacy of intravenous thrombolysis with alteplase in the treatment of acute mild ischemic stroke. Methods: a total of 92 patients with acute mild ischemic stroke admitted from September in 2019 to March in 2020 were selected and divided into control group and observation group, with 46 cases in each group. The control group received conventional treatment, and the observation group received intravenous thrombolytic therapy with alteplase. The neurological function deficit, therapeutic effect and safety of the two groups were compared. Results: Before treatment, there was no statistical difference in NIHSS scores between 2 groups (P > 0.05). After treatment, the scores of both groups decreased, and the NIHSS scores of the observation group at different stages decreased more than that of the control group, with statistical significance (P < 0.05). The effective rate of observation group was significantly higher than control group. The complication rate of the observation group was lower than that of the control group. Conclusion: intravenous thrombolysis with alteplase is effective in treating acute mild ischemic stroke. It can be seen that the neurological function deficit has been significantly improved, with fewer complications. It is a treatment method with guaranteed safety and effectiveness, which is worthy of clinical promotion.
文摘Objective: The medical staff randomly selected two groups during the research to explore and analyze the control experiment with the control score, and to explore the effect of butylbenzene peptide in the treatment of patients with acute ischemic stroke. Methods: 86 patients with acute ischemic stroke admitted to our hospital by medical staff were selected for comprehensive data analysis and discussion on the individual condition of the patients. The patients were selected from June 2020 to May 2022 for research. After analyzing the condition of the patients, the patients were randomly divided into two groups. All patients met the test requirements and were recorded as the control group (n43) and the experimental group (n43) according to the experimental habits. The patients in the control group were treated only with alteplase, while the patients in the experimental group were treated with butylphthalide. After the treatment, the medical staff assessed the neurological deficit of the patients based on the NIHSS Stroke Scale to confirm the rehabilitation status of the patients. Results: compared with the control group, the NIHSS score of the experimental group was significantly lower than that of the control group, and the FMA score of the experimental group was significantly higher than that of the control group (P < 0.05). The MoCA score and MMSE score of the experimental group were higher than those of the control group (P < 0.05), and the effect of the experimental group was better than that of the control group (P < 0.05). Conclusion: the condition of patients with acute ischemic stroke is very complicated, and researchers found that the combined use of drugs can improve the treatment effect of patients. The application of butylphthalide combined with alteplase in the treatment of patients can improve the individual condition of patients, which is very good for the subsequent treatment of patients and the recovery of patients condition.
文摘Background Whether intravenous thrombolysis(IVT)should be administered prior to endovascular therapy(EVT)in patients with atherothrombotic stroke-related large vessel occlusion(AT-LVO)remains unclear.This study aimed to assess the efficacy and safety of IVT administered before EVT in this patient population.Methods We analysed the data from a multicentre registry of patients who underwent EVT for AT-LVO.Patients were categorised based on presumed mechanism of occlusion:in situ occlusion(intracranial group)or embolism from cervical artery occlusion/stenosis(tandem group).We compared the efficacy and safety of IVT before EVT in patients who received IVT(IVT stratum)and those who did not(non-IVT stratum).The primary outcome was a modified Rankin Scale score of 0-2 at 90 days.Results Among the 336 patients in the intracranial group,99 patients underwent IVT.The rate of favourable functional outcomes did not differ between IVT and non-IVT strata(51.1%vs 47.6%;adjusted ORs(aORs)(95%CI),1.18(0.66 to 2.09));whereas any intracranial haemorrhage(ICH)(10.1%vs 3.8%;aOR,2.98(1.01 to 9.26))and mortality at 90 days(6.4%vs 1.3%;aOR,4.66(1.02 to 26.73))were significantly higher in the IVT stratum.Among the 233 patients in the tandem group,88 patients underwent IVT,with no significant differences in efficacy or safety outcomes between the strata.Conclusion In patients with AT-LVO,IVT before EVT did not improve outcomes and was associated with increased risk of ICH and mortality in those with in situ intracranial occlusion.IVT before EVT may not be recommended in patients with atherosclerotic intracranial occlusions.
基金Science and Technology Project Plan of Liaoning Province(2023-MSLH-348,2022JH2/101500020)。
文摘Objective The Antiplatelet versus R-tPA for Acute Mild Ischaemic Stroke trial has demonstrated the non-inferiority of dual antiplatelet therapy(DAPT)to alteplase in minor non-disabling stroke.This prespecified secondary analysis aimed to investigate whether the treatment effects were similar across stroke territories.Methods Participants were divided according to stroke territory,which were subdivided into DAPT and alteplase.An excellent functional outcome at 90 days defined as modified Rankin Scale scoring 0–1 was primary outcome.National Institutes of Health Stroke Scale(NIHSS)score change and early neurological improvement measured by a 2-point decline in NIHSS score at 24 hours were secondary outcomes.Symptomatic intracerebral haemorrhage(sICH)and bleeding events were safety outcomes.Primary analyses adjusted unbalanced baseline characteristics between treatments by multivariate logistic regression.Results A total of 719 patients were included:566 in anterior circulation stroke(ACS)and 153 in posterior circulation stroke(PCS).Primary outcome was 94.1%in DAPT and 91.7%in alteplase among ACS patients(adjusted risk difference(RD)and 95%CI,1.5%(−1.5%to 4.6%),p=0.32),while 91.2%in DAPT and 91.8%in alteplase among PCS patients(adjusted RD and 95%CI,−2.1%(−8.5%to 4.4%),p=0.53).Compared with alteplase,DAPT was associated with lower risk of sICH(p=0.03)and bleeding events(p<0.001)in ACS,but only lower risk of bleeding events(p=0.007)in PCS.Additionally,among ACS patients,the alteplase was superior to DAPT in terms of decrease in NIHSS score at 24 hours compared with admission(adjusted geometric mean ratio and 95%CI,−0.09(−0.16 to−0.03),p=0.005)and early neurological improvement(adjusted RD and 95%CI,−7.2%(−11.6%to−2.7%),p=0.001).Conclusion Among ischaemic stroke with minor non-disabling symptoms,DAPT was similar with intravenous alteplase regarding long-term functional outcome and better safety regardless of ACS or PCS.The potential benefit of intravenous alteplase regarding early neurological improvement in patients with ACS warrants further investigation.Trial registration number NCT03661411.
基金funded by Beijing Municipal Science&Technology Committee(Z211100003521019)China Shijiazhuang Pharmaceutical Company Recomgen Pharmaceutical(Guangzhou)Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(2019-I2M 5-029)National Natural Science Foundation(82111530203,82171272).
文摘Background The benefit-risk profile of tenecteplase in the elderly patients with acute ischaemic stroke(AIS)is uncertain.We sought to investigate the efficacy and safety of 0.25 mg/kg tenecteplase compared with alteplase for AIS patients aged≥80 years.Methods We performed a post hoc analysis of the Tenecteplase Reperfusion Therapy in Acute Ischaemic Cerebrovascular Events-2 Trial,a randomised,phase 3,non-inferiority clinical trial.Disabling AIS patients aged≥80 years who initiated intravenous thrombolytics within 4.5 hours of symptom onset were enrolled from June 2021 to May 2022 across 53 centres in China and were randomly allocated to receive 0.25 mg/kg tenecteplase or 0.9 mg/kg alteplase.The primary efficacy outcome was the proportion of participants with a modified Rankin Scale(mRS)score of 0-1 at 90 days.Symptomatic intracranial haemorrhage(sICH)within 36 hours was the safety outcome.Results Of 137 participants,mRS 0-1 at 90 days occurred in 37(49.3%)of 75 in the tenecteplase group vs 20(33.9%)of 59 in the alteplase group(risk ratio(RR)1.47,95%CI 0.96 to 2.23).sICH within 36 hours was observed in 3(4.0%)of 76 in the tenecteplase group and two(3.3%)of 61 in the alteplase group(RR 1.30,95%CI 0.20 to 8.41).Conclusions The risk-benefit profile of tenecteplase thrombolysis was preserved in the elderly patients,which lends further support to intravenous 0.25 mg/kg tenecteplase as an alternative to alteplase in these patients.
