scholarly journals Comparative study of intravenous thrombolysis with rt-PA and urokinase for patients with acute cerebral infarction

2020 ◽  
Vol 48 (5) ◽  
pp. 030006051989535
Author(s):  
Fan Sun ◽  
Heng Liu ◽  
Hui-xiao Fu ◽  
Shuo Zhang ◽  
Xu-dong Qian ◽  
...  
Keyword(s):  
Cerebral Infarction ◽  
Time Window ◽  
Intravenous Thrombolysis ◽  
Cerebral Haemorrhage ◽  
Recombinant Tissue Plasminogen Activator ◽  
Serum Levels ◽  
Acute Cerebral Infarction ◽  
Bleeding Complications ◽  
Therapeutic Effects ◽  
Clinical Trial Evidence

Objective Cerebral infarction has a poor prognosis and causes a serious burden on families and society. Recombinant tissue plasminogen activator (rt-PA) and urokinase (UK) are commonly used thrombolytic agents in the clinic. However, direct and powerful clinical trial evidence to determine the therapeutic effect of rt-PA and UK on intravenous thrombolysis is lacking. Methods In this study, 180 patients with acute cerebral infarction were treated with rt-PA or UK. The National Institutes of Health Stroke Scale (NIHSS) scores, Barthel index, bleeding complications, and biomarkers were evaluated. Results No significant differences in NIHSS or Barthel scores were found between the groups. However, UK increased the risk of intracranial haemorrhage compared with rt-PA. rt-PA had increased activity in reducing serum levels of MMP-9 than UK. Conclusion Intravenous thrombolysis with rt-PA and UK in the time window of acute cerebral infarction can achieve similar therapeutic effects, but rt-PA can further reduce the risk of cerebral haemorrhage and is relatively safer than UK.

scholarly journals The relationship of leukoaraiosis, haemorrhagic transformation and prognosis at 3 months after intravenous thrombolysis in elderly patients aged ≥ 60 years with acute cerebral infarction

2020 ◽  
Vol 41 (11) ◽  
pp. 3195-3200
Author(s):  
Xiaowei Liu ◽  
Jiatang Zhang ◽  
Chenglin Tian ◽  
Jun Wang
Keyword(s):  
Elderly Patients ◽  
Cerebral Infarction ◽  
Intravenous Thrombolysis ◽  
Recombinant Tissue Plasminogen Activator ◽  
The Elderly ◽  
Acute Cerebral Infarction ◽  
Bleeding Events ◽  
Clinical Prognosis ◽  
Haemorrhagic Transformation ◽  
The Relationship

Abstract Backgroud As the elderly stroke population continues to increase, we will have to confront greater challenges regarding how to choose suitable patients to reduce thrombolysis-related bleeding events and accurately judge their prognosis. Therefore, we evaluated the relationship among leukoaraiosis (LA), haemorrhagic transformation (HT) and the prognosis at 3 months after intravenous (IV) thrombolysis in elderly patients aged ≥ 60 years with acute cerebral infarction (ACI). Methods We prospectively and consecutively chose 125 elderly patients aged ≥ 60 years with ACI who could accept and be suitable for IV recombinant tissue plasminogen activator (rtPA) after excluding 6 cases. Brain computed tomography(CT) was used to assess LA by using the modified Van Swieten scale (mVSS) before treatment and the modified Rankin scale (mRS) to appraise prognosis at 3 months after IV rtPA. Binary logistic regression was used to analyse the predictors of HT and the prognosis of ACI. Results Our data indicated that by brain CT, 26.4% of all patients showed severe LA, and the rate of HT and symptomatic intracranial haemorrhage (sICH) were 12.0% and 9.6%, respectively. Severe LA was evidently associated with HT (odds ratio [OR] 3.272, 95% confidence interval [CI] 1.010–10.598, P = 0.048) rather sICH (P > 0.05). Moreover, we also found that severe LA was associated with poor functional prognosis (OR 5.266, 95% CI 1.592–17.419, P = 0.006). Conclusion Our results showed that LA was associated with HT and adverse clinical prognosis rather sICH after IV rtPA in elderly patients aged ≥60 years with ACI. Although LA may increase the risk of bleeding but not fatal haemorrhage after IV thrombolysis, therefore, we should actively select an appropriate elderly population for thrombolytic treatment and have reasonable judgments on the outcomes.

Guidelines on intravenous thrombolysis in the treatment of acute cerebral infarction – 2021 version

2021 ◽  
Vol 84/117 (4) ◽  
Author(s):  
Jiří Neumann ◽  
Daniel Šaňák ◽  
Aleš Tomek ◽  
Michal Bar ◽  
Roman Herzig ◽  
...  
Keyword(s):  
Cerebral Infarction ◽  
Intravenous Thrombolysis ◽  
Acute Cerebral Infarction

Comparative study on the efficacy and safety of alteplase and urokinase in the treatment of acute cerebral infarction

2020 ◽  
pp. 1-6
Author(s):  
Hua Bao ◽  
Hao-Ran Gao ◽  
Min-Lu Pan ◽  
Lei Zhao ◽  
Hai-Bin Sun
Keyword(s):  
Treatment Group ◽  
Cerebral Infarction ◽  
Early Stage ◽  
Intravenous Thrombolysis ◽  
Acute Cerebral Infarction ◽  
Neurological Injury ◽  
Control Group ◽  
Efficacy And Safety ◽  
Time Period ◽  
And Control

BACKGROUND: Acute cerebral infarction (ACI) is a common cerebrovascular disease in clinical practice. OBJECTIVE: The present study aims to investigate the efficacy and safety of alteplase and urokinase in treating ACI. METHODS: A total of 96 patients with ACI, who were treated with alteplase and urokinase, were selected as the main subjects. Among these patients, 45 patients with ultra-early acute cerebral infarction, who received intravenous thrombolysis with RT-PA (alteplase), were included in the treatment group, while 51 patients with acute cerebral infarction, who were treated with urokinase in the same time period, were included in the control group. RESULTS: The National Institute of Health Stroke Scale (NIHSS) scores were significantly lower in the treatment group and control group (P< 0.05) at two hours, seven days and 14 days after thrombolysis, when compared to those before thrombolysis. The bleeding rate was significantly lower in the control group, when compared to the treatment group (P< 0.05). CONCLUSION: The intravenous thrombolysis with urokinase or alteplase in the ultra-early stage of acute cerebral infarction can reduce the neurological injury symptoms and effectively improve the prognosis of patients with stroke. Urokinase is lower in risk of bleeding, but better in safety, when compared to alteplase.

scholarly journals Correlation Between Serum C-Reactive Protein And Cystatin C In Patients With Acute Cerebral Infarction And Carotid Artery Stenosis

2018 ◽  
Vol 7 (1) ◽  
Author(s):  
Tao Zhang ◽  
Xiaowen Yang ◽  
Hui Wang ◽  
Jie Luo ◽  
Anrong Li ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Cerebral Infarction ◽  
Carotid Artery Stenosis ◽  
Serum Levels ◽  
Artery Stenosis ◽  
Acute Cerebral Infarction ◽  
Control Group ◽  
Case Group ◽  
Reactive Protein ◽  
Serum Crp

<p><em>To investigate the correlation between serum C-reactive protein (CRP) and serum cystatin C (Cys-C) levels in patients with acute cerebral infarction and carotid artery stenosis. Methods: From January 2015 to December 2016 admitted to our hospital new acute cerebral infarction parallel neck vascular color Doppler ultrasound examination showed 121 cases of carotid stenosis as the case group; select the same period of hospitalized patients with non-cerebrovascular disease in 50 cases As a control group. Fasting venous blood was collected on the third day after onset of the disease and serum levels of CRP and Cys-C were measured and compared. Results: Serum levels of CRP and Cys-C in case group were significantly higher than those in control group (P &lt;0.05). The correlation between serum CRP and Cys-C was found in any pairwise comparison (r = 0.4732). The level of CRP and Cys-C were closely related to the degree of carotid artery stenosis (P &lt;0.05). Conclusion: The combined detection of serum CRP and Cys-C levels can be used to evaluate the degree of carotid artery stenosis in patients with acute cerebral infarction and provide a reference for the next carotid endarterectomy.</em><em></em></p>

scholarly journals Patient Selection For Acute Stroke Intravenous Thrombolysis

2017 ◽  
pp. 50
Author(s):  
Mehdi Farhoudi
Keyword(s):  
Time Window ◽  
Intravenous Thrombolysis ◽  
Recombinant Tissue Plasminogen Activator ◽  
Exclusion Criteria ◽  
Level Of Evidence ◽  
Analysis Of Results ◽  
Scientific Statement ◽  
Selection For ◽  
In The Beginning ◽  
Related Level

Stroke is a leading cause of mortality worldwide. Unfortunately its incidence is more and the age of occurrence is one decade earlier in our country, Iran. About 75-90 percent of stroke etiology is ischemic. The only approved drug treatment for eligible acute ischemic stroke (AIS) patients is thrombolytic therapy by recombinant tissue plasminogen activator (tPA). Related level of evidence is the highest (1a) and it has been approved by FDA following NINDS study since 1996. First golden time for use of tPA was less than 3 hours but later it has extended to 4.5 hours following re-analysis of the data since 2009. In the beginning, related exclusion criteria was strict considering many absolute items, however, some of them changed or removed as relative exclusion criteria by practicing and performing researches and analysis of results and it is going to be more simplified. For example, in 2013 there were 15 absolute and 10 relative exclusion criteria for intravenous thrombolysis in AIS in less than 4.5 hours period from onset of symptoms but in 2016 following publishing American heart and Stroke Association (AHA/ASA) scientific statement this criteria was more clarified and some of relative exclusion criteria removed. And finally new published researches extended this therapeutic time window to 6 hours by using mechanical thrombectomy in defined patients not responding to IV thrombolysis. In the ninth national Iranian Stroke Congress this updated criteria will be discussed.                

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