ABSTRACT
Objective:To investigate the correlation between blood pressure changes within 24 h after intravenous thrombolysis and the outcome in patients with acute ischemic stroke.Methods:Patients with acute ischemic stroke treated with alteplase intravenous thrombolysis in the Department of Neurology, Anhui No. 2 Provincial People's Hospital from June 2018 to September 2020 were enrolled retrospectively. The patients who received antihypertensive therapy before and within 24 h after intravenous thrombolysis were excluded. The blood pressure before intravenous thrombolysis and the blood pressure drop within 24 h after intravenous thrombolysis were recorded. The modified Rankin Scale was used to evaluate the clinical outcome at 90 d after the onset. 0-2 was defined as good outcome, and >2 was defined as poor outcome. Multivariate logistic regression analysis was used to investigate the independent correlation between blood pressure changes within 24 h after intravenous thrombolysis and the clinical outcomes. Results:A total of 205 patients with acute ischemic stroke were enrolled, including 125 males (60.98%), 80 females (39.02%); aged 63.30±9.63 years; 124 (60.49%) had a good outcome, and 81 (39.51%) had a poor outcome. Univariate analysis showed that the proportion of diabetic patients as well as baseline systolic blood pressure, prethrombolytic blood glucose, baseline National Institutes of Health Stroke Scale score, and the incidence of symptomatic intracranial hemorrhage in the good outcome group were significantly lower than those in the poor outcome group, and the proportion of patients with small vessel occlusion and the decrease in systolic blood pressure within 24 h after thrombolytic therapy were significantly higher than those in the poor outcome group (all P<0.05). Multivariate logistic regression analysis showed that higher baseline systolic blood pressure was independently associated with the poor outcome at 90 d after intravenous thrombolysis (odds ratio 0.964, 95% confidence interval 0.942-0.987; P=0.002), and a greater decrease in systolic blood pressure within 24 h after intravenous thrombolysis was independently associated with a good outcome (odds ratio 1.134, 95% confidence interval 1.067-1.206; P<0.001). Conclusion:For patients with acute ischemic stroke who received intravenous thrombolysis, higher baseline blood pressure before intravenous thrombolysis was associated with the poor outcome, and greater decrease in systolic blood pressure within 24 h after intravenous thrombolysis was associated with the good outcome.
ABSTRACT
Objective To compare the efficacy and safety of low-dose and standard-dose alteplase intravenous thrombolytic therapy in patients with acute ischemic stroke and to investigate whether low-dose alteplase is more suitable for patients with acute ischemic stroke in China.Methods Patients with acute ischemic stroke treated with alteplase intravenous thrombolysis from July 2016 to December 2018 in Anhui No.2 Provincial People's Hospital were enrolled retrospectively.According to the dose of alteplase,they were divided into low-dose group (0.6 mg/kg,the total dose not exceeding 60 mg) and standard dose group (0.9 mg/kg,the total dose not exceeding 90 mg).The efficacy endpoint was the clinical outcome at 90 d after onset evaluated by the modified Rankin Scale (mRS).The mRS score 0-2 was defined as self-care in life,and 0-1 was defined as good outcome.The safety endpoints were the incidence of symptomatic intracerebral hemorrhage (sICH) within 24-48 h after thrombolytic therapy and the mortality at 3 months.Results A total of 103 patients were enrolled,including 45 in the low-dose group and 58 in the standard dose group.There were no significant differences in demography,baseline clinical data,as well as self-care and good outcome rates at 90 d between the 2 groups.The incidence of sICH in the low-dose group (National Institute of Neurological Disorders and Stroke criteria:2.22％ vs.17.24％;x2 =4.521,P=0.033) and mortality at 90 d (6.67％ vs.24.14％;x2 =4.417,P =0.036) were significantly lower than those in the standard dose group.Conclusion The efficacy of low-dose alteplase in the treatment of acute ischemic stroke was comparable to that of standard dose,but the incidence of sICH and mortality at 90 d were significantly reduced,which might be more suitable for Chinese patients.