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Objective To investigate the values of recombinant tissue type plasminogen activator (rt-PA)) in the treatment of acute cerebral infarction complicated with atrial fibrillation.Methods Used the prospective research methods,74 patients of acerebral infarction complicated with atrial fibrillation in Xi'an XD Group Hospital from February 2015 to August 2016 were selected and were equally divided into the observation group and the control group accorded to the principle of random envelope drawing.The control group was treated with urokinase intravenous thrombolytic therapy,the observation group was treated with rt-PA intravenous thrombolytic therapy,and the prognosis of the two groups were observed.Results There were no significant differences in gender,age,time window,disease,systolic blood pressure and diastolic blood pressure compared between the two groups.The treatment efficiency in the observation group and control group were 94.6％ and 75.7％,the observation group was significantly higher than that of the control group (P ＜ 0.05).After treatment,the mRS scores in the observation group and the control group were (5.22± 1.83) points and (7.29± 1.45) points,were significantly lower than those before treatment of (10.24± 1.31) points and (10.19 ± 1.52) points (P ＜ 0.05),and the observation group was significantly lower than the control group (P ＜ 0.05).In the observation group,the symptomatic intracerebral hemorrhage and non symptomatic cerebral hemorrhage were 5.4％ and 2.7％ respectively,so that were 18.9％ and 16.2％ in the control group that the observation group were significantly lower than those of the control group (P ＜ 0.05).Conclusion Intravenous thrombolysis with recombinant tissue type plasminogen activator of patients with acute cerebral infarction combined with atrial fibrillation is safe and effective,it can promote the improvement of neurological function,and has good application value.
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Objective:To observe the clinical efficacy of rt-PA in the treatment of patients with acute ischemic stroke ( CIS) and hyperdense middle cerebral artery sign ( HMCAS) . Methods:Totally 107 patients with CIS and HMCAS were randomly divided into the control group (n=54) and the treatment group (n=53). The control group was treated with urokinase, while the treatment group was treated with recombinant tissue type plasminogen activator ( rt-PA) . The treatment course was 14 days, and then the clinical effi-cacy and safety were evaluated. Results:Compared with that before the treatment, the score of national institute of health stroke scale ( NIHSS) in both groups was decreased after the treatment, and the decrease in the treatment group was more notable than that in the control group with statistically significant difference (P<0. 05). The clinical effective rate of the treatment group was 88. 68%, while that of the control group was 79. 63%, and there was statistically significant difference between the groups (P<0. 05). Compared with that before the treatment, BI index in both groups was increased after the treatment, and the increase in the treatment group was more significant than that in the control group with statistically significant difference (P<0. 05). Conclusion:rt-PA thrombolytic therapy in the patients with CIS and HMCAS has remarkable clinical efficacy, which can improve patients’ life quality and is worthy of promo-tion.
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BACKGROUND:The study aimed to compare the therapeutic effect of recombinant tissue plasminogen activator (rt-PA) on the onset of acute cerebral infarction (ACI) at different time points of the first 6 hours.METHODS:A retrospective analysis was conducted in 74 patients who received rt-PA thrombolysis treatment within 4.5 hours after ACI and another 15 patients who received rt-PA thrombolysis treatment between 4.5-6 hours after ACI.RESULTS:National Institute of Health Stroke Scale (NIHSS) scores were statistically decreased in both groups (P>0.05) at 24 hours and 7 days after ACI. There was no significant difference in modified ranking scores and mortality at 90 days after the treatment between the two groups (P>0.05).CONCLUSIONS:The therapeutic effect and mortality of rt-PA treatment in patients with ACI between 4.5-6 hours after the onset of the disease were similar to those in patients who received rt-PA within 4.5 hours after the onset of this disease. Therefore, intravenous thrombolytic therapy for ACI within 4.5-6 hours after ACI was effective and safe.
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Objective To explore the clinical effect and safety of using recombinant tissue type plasminogen activator (rt-PA) in early lower extremity deep venous thrombosis (DVT) after gynecological surgeries. Methods Twenty-five cases with early DVT after gynecological operation were enrolled and randomly divided into two groups,contorl group (n = 13) and the rt-PA therapy group (n = 12). The patients from contorl group were treated with Low-Molecular-Weight Heparins Calcium 0. 4 ml/d alone, and the rt-PA group accepted rt-PA 100 mg i. v in addition to the Low-Molecular-Weight Heparins Calcium. The recanalization rates of lamb veins,prothrombin time (PT) ,bleeding event and other adverse complications were observed and evaluated at day seven. Results The recanalization rates of lamb veins were 91. 7% (11/12) and 53. 8 % (7/13) in rtPA and the control group respectively,which showed significant difference between each other (x2 = 15. 68, P 0. 05). Two patients with vaginal stump bleeding were healed by local hemostasis. Conclusion The usage of rt-PA could improve the recanalization rate of DVT after gynecological surgery. The rates of adverse complications, including vaginal stump bleeding,were extremly low.
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Objective To evaluate the efficacy and safety of a novel mutated recombinant tissue-type plas-minogen activator (rt-Pam) in a rat model of acute cerebral thrombosis. Method Eighty-seven adult Wister rats were randomly divided into control group, recombinant tissue-type plasminogen activator (rt-PA) group, low dose of rt-Pam group and routine dose of rt-Pam group. The rats of different groups were treated for 3 hours after thrombosis of middle cerebral artery. The size of infarction, neurological scores and severity of hemorrhage were observed 24 hours after treatment. The protective role of rt-Pam in the brain tissue was evaluated as per the infiltration of neutrophils and the concentration of plasminogen activator receptor-1 (PAR-1). Results Compared with control group, the sizes of infarction in the low dose of rt-Pam group and routine dose of rt-Pam group were significantly smaller [(108.5 ±27.3) mm3 and (68.3 ±17.2) mm3 vs. (323.4 ±42.3) mm3]. The neurological scores were evidently correlated with the size of infarction (r = 0.613, P<0.001), while the liability of cerebral hemorrhage in low dose of rt-Pam group was not significantly increased. The rt-Pam also reduced the production of myeloperox-idase, as well as the production of PAR-1 in comparison with rt-PA group [(13.8 ± 3.1) vs. (28.3±4.5), P <0.00l]. Conclusions The novel rt-Pam could be a better thrombolytic agent than rt-PA in treating acute stroke.
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@#Objective To investigate the effects of recombinant tissue-type plasminogen activator (rt-PA) combined with mild hypothermia on the hemorrhagic transformation after cerebral ischemia-reperfusion within or out of the therapeutic time window in rats.Methods The focal cerebral ischemia-reperfusion 3 and 4 hours models of rats were established by middle cerebral artery occlusion (MCAO) 3 or 4 hours. The rats were randomly divided into the normal saline group (group NS), normothermia rt-PA group (group rt-PA), rt-PA combined with hypothermia group (group rt-PA +HT), and sham-operation group. Brain mild hypothermia was achieved after ischemia reperfusion and maintained 3 hours. Rats were sacrificed 24 h after ischemia reperfusion, and the amount of bleeding was measured.Results The amount of bleeding significantly reduced in the group rt-PA+HT compared with group rt-PA, which obviously increased in the group rt-PA compared with group NS ( P<0.05); there was a significant difference between rt-PA groups MCAO 3 hours and 4 hours ( P<0.05).Conclusion rt-PA can increase hemorrhagic transformation volume; hemorrhagic transformation volume is higher if treated by rt-PA within 3 h therapeutic time window than treated beyond the time window; mild hypothermia should possibly prevent the development of hemorrhagic transformation and prolong the therapeutic time window of thrombolytic intervention in ischemic stroke.
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@#ObjectiveTo study the efficacy and safety of intravenous recombinant tissue-type plasminogen activator (rt-PA) on hyperacute cerebral infarction. Methods41 patients with the supra-early acute cerebral infarction were divided into two groups: thrombolytic group (n=21) and control group (n=20). They were evaluated with European Stroke Scale (ESS) and Barthel Index before and 24 h, 21 d, 90 d after treatment. ResultsThe scores of the thrombolytic group showed more efficacious than that of the control groups (P<0.05). One patient suffered from cerebral hemorrhage in thrombolytic group, however his prognosis was good. There was no death in both groups. ConclusionThrombolytic therapy with rt-PA in the hyperacute cerebral infarction shows positive effect and safety.
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BACKGROUND: Previous studies indicated that there was important correlation between early patency of infarct-related artery, preservation of ventricular function, and improved survival after thrombolytic therapy for acute myocardial infarction. An increased infusion rate of rt-PA has been shown to result in faster thrombolysis and a high patency rate of occluded vessel in myocardial infarction. Therefore, we evaluated the effect of simplified triple bolus injection of rt-PA on early patency of infarct-related artery and evaluated safety and efficacy of triple bolus injection. METHOD: Patients with acute myocardial infarction presenting up to 6 hour from the onset of chest pain were recruited for the study. Aspring(100-200mg) was given immediately. Total dose for 1.5mg/kg of rt-PA(minimum 75mg, maximum 100mg) was administered as triple bolus intravenous injections. The half of total dose was injected initially, the quarter of total dose was injected at 10 minutes after 1st injection and the remainder was injected at 40 minutes after 1st injection. Five thousand units of heparin was given and 1,000-1,500unit/hr was given continuously. Coronary angiogram was performed at 60 minutes and 7-10 days after the first bolus injection. RESULTS: At 60 minutes, eleven of fourteen patients (78.6%) showed TMI grade-3 of patency in infarct-related coronary artery. There were two patients of hemorrhagic complications. One patient developed cerebellar hemorrhage at third day after rt-PA injection, and the other developed bleeding at femoral sheath site. There was no in-hospital mortality and reinfarction. CONCLUSION: In patients with acute myocardial infarction, the simplified triple bolus injection of rt-PA is associated with high early patency(TMI grade-3) in infarct-related coronary artery, with low risk of major bleeding comlications comparable to other studies.