Prognostic Analysis of Different Therapeutic Regimens in Patients With Acute Cardiogenic Cerebral Embolism
Abstract Background Intravenous rt-PA within 4.5h can reduce the degree of disability of acute ischemic stroke at 3 months, it is limited by the time of onset, the financial burden, or the risk of bleeding that the patient and his or her family consider, rt-PA is available to a very small number of patients.In practical clinical work, anticoagulant therapy and antiplatelet therapy within the 4.5h period of acute cardiogenic cerebral embolism (CCE) are more common. Few previous studies have observed and analyzed the functional outcomes at 3-month after receiving intravenous thrombolysis, or anticoagulation, or antiplatelet therapy within 4.5h from onset of cardiogenic cerebral embolism subtype. Methods The purpose of our study was to analyze clinical baseline data of patients with acute cardiogenic cerebral embolism and compare 3-month prognosis after different antithrombotic therapies administered within 4.5h from event onset. Our retrospective study cohort consisted of 335 patients with CCE hospitalized at the Second Affiliated Hospital of Soochow University in China from December 2011 to December 2016. Patients were assigned to a group according to early-acute treatment therapy. Baseline, clinical, and laboratory data, and 3-month prognosis were analyzed. Results We found that the most common cause of CCE was non-valvular atrial fibrillation (96.2%, 85.2%, and 95.3%) and the most common concomitant disease was hypertension (88.5%, 70.5%, and 78.7%) in the thrombolytic-, anticoagulant-, and antiplatelet-treated group, respectively. The overall intracranial hemorrhagic conversion rate hemorrhage in the acute phase of CCE (during hospitalization) in our cohort was high (26 cases, 7.8%), with the highest incidence in the thrombolytic group (13 cases, 16.7%),4 cases experienced extracranial (1.2%, P = 0.316).; further, 164 cases showed good prognosis at 3 months as measured using the modified Rankin Scale (mRS ≤ 2), with the majority of cases in the anticoagulant group (P = 0.018). Conclusions Anticoagulant therapy may be a safe and effective treatment option for patients with cardiac stroke subtype who fail to receive intravenous rtPA thrombolysis within the thrombolytic time window.