Therapeutic effect of recombinant tissue plasminogen activator on acute cerebral infarction at different times

doi:10.5847/wjem.j.issn.1920-8642.2013.03.009

Abstract

Abstract:

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.

Key words: Acute cerebral infarction, Thrombolysis, Recombinant tissue type plasminogen activator

Ming Liu, Hai-rong Wang, Jia-fu Liu, Hao-jun Li, Shen-xing Chen, Sha Shen, Shu-ming Pan. Therapeutic effect of recombinant tissue plasminogen activator on acute cerebral infarction at different times[J]. World Journal of Emergency Medicine, 2013, 4(3): 205-209.

Figures/Tables 3

References 19

1	Johnston SC, Mendis S, Mathers CD. Global variation in stroke burden and mortality: estimates from monitoring, surveillance, and modelling. Lancet Neurol 2009; 8:345-354. pmid: 19233730
2	Liao XL, Wang CX, Wang YL, Wang CJ, Zhao XQ, Zhang LQ, et al. Implementation and outcome of thrombolysis with alteplase 3 to 4.5 h after acute stroke in Chinese patients. CNS Neurosci Ther 2013; 19:43-47.
3	Chen D, Román GC, Wu GX, Wu ZS, Yao CH, Zhang M, et al. Stroke in China (Sino-MONICA-Beijing Study) 1984-1986. Neuroepidemiology 1992; 13:15-23.
4	Sheth T, Nair C, Nargundkar M, Anand S, Yusuf S. Cardiovascular and cancer mortality among Canadians of European, south Asian and Chinese origin from 1979 to 1993: an analysis of 1.2 million deaths. CMAJ 1999; 13:132-138.
5	Adams HP Jr, del Zoppo G, Alberts MJ, Bhatt DL, Brass L, Furlan A, et al. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Stroke 2007; 38:1655-1711.
6	Wang Y, Wang GN, Sun H, Chen C, Xiao H, Zhang JS. Association of ALOX5AP with ischemic stroke in eastern Chinese. World J Emerg Med 2012; 3:108-113. pmid: 25215047
7	Schellinger PD, Fiebach JB, Mohr A, Ringleb PA, Jansen O, Hacke W. Thrombolytic therapy for ischemic stroke-a review. Part I-Intravenous thrombolysis. Crit Care Med 2001; 29:1812-1818. doi: 10.1097/00003246-200109000-00027 pmid: 11546993
8	Adams H, Adams R, Del Zoppo G, Goldstein LB; Stroke Council of the American Heart Association; American Stroke Association. Guidelines for the early management of patients with ischemic stroke: 2005 guidelines update a scientific statement from the Stroke Council of the American Heart Association/American Stroke Association. Stroke 2005; 36:916-923.
9	Zhu HC, Cao RL. The relationship between serum levels of uric acid and prognosis of infection in critically ill patients. World J Emerg Med 2012; 3:186-190. pmid: 25215061
10	van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Inter-observer agreement for the assessment of handicap in stroke patients. Stroke 1988; 19:604-607. doi: 10.1161/01.str.19.5.604 pmid: 3363593
11	Tilley BC, Lyden PD, Brott TG, Lu M, Levine SR, Welch KM. Total quality improvement method for reduction of delays between emergency department admission and treatment of acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Arch Neurol 1997; 54:1466-1474.
12	Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D,, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 2008; 359:1317-1329. pmid: 18815396
13	Tekle WG, Chaudhry SA, Fatima Z, Ahmed M, Khalil S, Hassan AE, et al. Intravenous thrombolysis in expanded time window (3-4.5 hours) in general practice with concurrent availability of endovascular treatment. J Vasc Interv Neurol 2012; 5:22-26. pmid: 22737262
14	Shobha N, Buchan AM, Hill MD, Canadian Alteplase for Stroke Effectiveness Study (CASES). Thrombolysis at 3-4.5 hours after acute ischemic stroke onset--evidence from the Canadian Alteplase for Stroke Effectiveness Study (CASES) registry. Cerebrovasc Dis 2011; 31:223-228. doi: 10.1159/000321893 pmid: 21178345
15	Li BH, Ding X, Yin YW, Liu Y, Gao CY, Zhang LL, et al. Meta-analysis of clinical outcomes of intravenous recombinant tissue plasminogen activator for acute ischemic stroke: within 3 hours versus 3-4.5 hours. Curr Med Res Opin 2013. [Epub ahead of print].
16	Zhang J, Wang Y, Wang GN, Sun H, Sun T, Jian-quan Shi JQ, et al. Clinical factors in patients with ischemic versus hemorrhagic stroke in East China. World J Emerg Med 2011; 2:18-23. doi: 10.5847/wjem.j.1920-8642.2011.01.003 pmid: 25214977
17	Hähnel S, Schellinger PD, Gutschalk A, Geletneky K, Hartmann M, Knauth M, et al. Local intra-arterial fibrinolysis of thromboemboli occurring during neuroendovascular procedures with recombinant tissue plasminogen activator. Stroke 2003; 34:1723-1728.
18	Liu M, Xie P, Cui LY. Neurology. Beijing: People's Medical Publishing House, 2008: 53.
19	García-Bermejo P, Calleja AI, Pérez-Fernández S, Cortijo E, del Monte JM, García-Porrero M, et al. Perfusion computed tomography-guided intravenous thrombolysis for acute ischemic stroke beyond 4.5 hours: a case-control study. Cerebrovasc Dis 2012; 34:31-37. pmid: 22759450

[1]	Tian Xu, Ya Li, Li-ding Zhao, Guo-sheng Fu, Wen-bin Zhang. Predictors of recurrent angina in patients with no need for secondary revascularization [J]. World Journal of Emergency Medicine, 2021, 12(1): 42-47.
[2]	Jian-ping Gao, Ke-jing Ying. Thrombolysis during extended cardiopulmonary resuscitation for autoimmune-related pulmonary embolism [J]. World Journal of Emergency Medicine, 2015, 6(2): 153-156.
[3]	Jing-xia Zhang, Yong-li Chen, Yu-ling Zhou, Qian-yu Guo, Xian-pei Wang. Expression of tissue factor in rabbit pulmonary artery in an acute pulmonary embolism model [J]. World Journal of Emergency Medicine, 2014, 5(2): 144-147.