Effect of panax notoginseng saponins on efficacy and hemorrhagic transformation of rt-PA intravenous thrombolysis in patients with acute ischemic stroke

Abstract

Objective To study the effect of panax notoginseng saponins (PNS) on the efficacy and hemorrhagic transformation (HT) of recombinant tissue-type plasminogen activator (rt-PA) intravenous thrombolysis in patients with acute ischemic stroke.  Methods A total of 200 patients with early acute ischemic stroke (the length of time between attack and hospital admission < 4.50 h) were divided into 2 groups according to random number table method: treatment group (N = 100) and control group (N = 100). The control group was treated with routine rt-PA intravenous thrombolysis treatment, and the treatment group was treated with rt-PA intravenous thrombolysis plus PNS injection. The ischemia-reperfusion injury index [malondialdehyde (MDA) and superoxide dismutase (SOD)], hemorrhagic transformation prediction index [matrix metalloproteinase-9 (MMP-9) and fibronectin (FN)] and nerve function index [National Institutes of Health Stroke Scale (NIHSS) and Barthel Index (BI)] were measured and compared before treatment, 24 h after thrombolysis and 14 d after thrombolysis. Adverse drug reactions and hemorrhagic transformation rate were observed 14 d after thrombolysis, and the prognosis (mortality and BI) was evaluated 12 months after thrombolysis.  Results Compared with control group, serum SOD (P = 0.000) and BI (P = 0.000) in treatment group were significantly higher, while serum MDA (P = 0.001), MMP-9 (P = 0.001), plasma FN (P = 0.000) and NIHSS score (P = 0.006) were significantly lower. In treatment group, 24 h after rt-PA intravenous thrombolysis plus PNS injection, serum MDA (P = 0.000), MMP-9 (P = 0.000) and BI (P = 0.000) were significantly increased, while NIHSS score (P = 0.000) was significantly decreased; 14 d after treatment, serum MDA (P = 0.000) and MMP-9 (P = 0.000) were decreased, serum SOD (P = 0.000) and BI (P = 0.000) were continuously increased, plasma FN (P = 0.000) and NIHSS score (P = 0.000) were continuously decreased. On the 14th day after thrombolysis, hemorrhagic transformation rate of treatment group was lower than that of control group [9 cases (9%) vs 19 cases (19%); χ² = 4.153, P = 0.042]. There was no significant difference in the incidence of adverse drug reactions between 2 groups [14 cases (14%) vs 11 cases (11%); χ² = 0.411, P = 0.521]. Twelve months after thrombolysis, there were 5 cases of death (5% ) in control group and one case (1% ) of death in treatment group. There was no significant difference in the incidence of mortality between 2 groups (χ² = 1.546, P = 0.241). The BI of treatment group was significantly higher than that of control group (88.51 ± 11.49 vs 84.47 ± 9.83; t = 2.451, P = 0.015).  Conclusions PNS reduces ischemia-reperfusion injury after rt-PA intravenous thrombolysis in patients with acute ischemic stroke. It can reduce the rate of hemorrhagic transformation after rt-PA intravenous thrombolysis and improve the prognosis with good safety.

DOI: 10.3969/j.issn.1672-6731.2016.11.012