Treatment analysis of intravenous thrombolysis in patients with mild ischemic stroke

Abstract

Objective To analysis the safety and outcome of intravenous thrombolysis with recombinant tissue plasminogen activator (rt⁃PA) in patients with acute mild ischemic stroke. Methods From November 2017 to October 2018, 252 patients with acute mild ischemic stroke who were admitted into our hospital within 4.50 h after onset (84 patients in intravenous thrombolysis group, 108 patients in aspirin and clopidogrel group, and 60 patients in aspirin or clopidogrel group). The general condition, the level of high⁃sensitivity C⁃reactive protein (hs⁃CRP) and erythrocyte sedimentation (ESR) were compared among 3 groups. The modified Rankin Scale (mRS) were evaluated on 7 d after admission or at earlier discharge, and 21 and 90 d. Symptomatic intracranial hemorrhage rates were compared among 3 groups. Results There were no significant difference in general clinical data, the initial level of hs⁃CRP and ESR between the intravenous thrombolytic group and the 2 non⁃thrombolysis groups. At 7 d after admission or earlier discharge, the descending range of hs⁃CRP and ESR in 3 groups were significant (P = 0.000, for all); there were significant differences among the 3 groups (P = 0.000, for all); pairwise comparison of 3 groups showed that the levels of hs⁃CRP and ESR in intravenous thrombolytic group at 7 d were significantly lower than aspirin and/or clopidogrel group (P = 0.000, 0.000; P = 0.000, 0.010). There was no significant difference in the rate of intracranial hemorrhage between thrombolytic group and other 2 groups at 24 h after treatment [1.19% (1/84) vs. 0 (0/168); χ 2discharge, the intravenous thrombolytic group had better prognosis than aspirin and/or dopidogrel group (P = 0.043, 0.012); At 21 and 90 d, the intravenous thrombolytic group had better prognosis than aspirin or clopidogrel group (P = 0.021, 0.037); but compared with aspirin and clopidogrel group, there was no significant difference (P = 0.070, 0.053). Conclusions Patients with mild ischemic stroke, especially that may induce disability should be treated with rt⁃PA intravenous thrombolysis timely. If it impossible by any causes, aspirin and clopidogrel should be given within 24 h after onset.

DOI：10.3969/j.issn.1672⁃6731.2019.12.012