Study on the efficacy and safety of aspirin combined with clopidogrel pretreatment before rt⁃PA intravenous thrombolysis in patients with cardioembolism

Abstract

Objective To investigate the efficacy and safety of aspirin combined with clopidogrel pretreatment before intravenous thrombolysis with rt ⁃ PA in patients with cardioembolism (CE). Methods Three hundred and thirteen patients with CE treated with rt ⁃ PA intravenous thrombolysis from July 2018 to July 2019 were admitted. Among them, 167 patients were pretreated with aspirin combined with clopidogrel before thrombolysis (pretreatment group), and 146 patients were not (control group). The short ⁃ term improvement of neurological function (1 h, 24 h and 7 d after thrombolysis) was evaluated by National Institutes of Health Stroke Scale (NIHSS). The long ⁃ term prognosis (90 d after onset) was evaluated by modified Rankin Scale (mRS), and mortality and the incidence of intracranial hemorrhage (ICH) within 90 d after onset were recorded. Results The neurological function improvement rates in the pretreatment group at 1h, 24 h and 7 d after intravenous thrombolysis were higher than those in control group [48.50% (81 / 167) vs. 32.19% (47/146), χ2 = 8.574, P = 0.003; 57.49% (96/167) vs. 45.21%  (66/146), χ2 = 4.704, P = 0.030; 77.25% (129/167) vs. 63.01% (92/146), χ2 = 7.602, P = 0.006]. The incidence of ICH after thrombolysis [3.59% (6/167) vs. 3.42% (5/146); χ2 = 0.006,  P = 0.936], mortality [0.60% (1/167) vs. 0.68% (1/146); Fisher's exact probability: P =1.000] and the rate of good prognosis within 90 d after onset [80.84% (135/167) vs. 74.66% (109/146); χ2 = 1.732, P = 0.188] between 2 groups were no significant difference. Conclusions Aspirin combined with clopidogrel pretreatment before intravenous thrombolysis can improveearly neurological function in patients with CE, and does not increase the risk of ICH. It is safe and effective for clinical application.DOI：10.3969/j.issn.1672⁃6731.2020.05.010