| PurposeTo analyze the effects of different doses of aspirin and clopidogrel pretreatment combined with low-dose rt-PA intravenous thrombolytic therapy on neurological function,symptomatic intracranial hemorrhage and 90d death in patients with acute ischemic cerebrovascular disease,and find the best anti-platelet pretreatment program.At the same time,the effect of the treatment on recanalization and prognosis of acute ischemic stroke patients with M1 segment occlusion of middle cerebral artery was analyzed.MethodsThis study included 522 patients with acute ischemic cerebrovascular disease who received intravenous thrombolytic therapy from January 2019 to June 2020 in department of Neurology,Tianjin Huhu Hospital,and 158 patients with acute ischemic stroke complicated with M1 segment occlusion of the middle cerebral artery.All patients met the criteria for RT-PA intravenous thrombolysis as set out in the 2018 American Stroke Association/American Heart Association Guidelines for The Early Management of Patients with Acute Ischemic Stroke,were able to accept the treatment regimen,understood the associated risks,and signed the informed consent form.The first part was divided into standard dose group:rt-PA intravenous thrombolysis,pretreatment group 1:aspirin 300mg and clopidogrel 75mg pretreatment combined with low dose(0.6mg/Kg)rt-PA intravenous thrombolysis,pretreatment group 2:Aspirin 300mg and clopidogrel 150mg pretreatment combined with low dose intravenous thrombolysis of rt-PA,pretreatment group 3:aspirin300mg and clopidogrel 225mg pretreatment combined with low dose intravenous thrombolysis of rt-PA,pretreatment group 4:aspirin 300mg and clopidogrel 300mg pretreatment combined with low dose intravenous thrombolysis of rt-PA;The second part was divided into pretreatment group and standard dose group.Baseline data,imaging data before and after thrombolytic therapy,24h,7d NIHSS score(see appendix 1)and 90d modified Rankin Scale(m RS)score(see appendix 2)after intravenous thrombolytic therapy were collected from all patients.Symptomatic intracranial hemorrhage(s ICH)and death within 90 days after thrombolytic therapy were recorded.Thex~2 test or T test was used for comparison between groups,and analysis of variance was used for comparison between three groups or more.The effects of different pretreatment regimens on neurological prognosis were compared to find the optimal dosage of antiplatelet drugs.To further evaluate the effect of optimal treatment on recanalization of occluded vessels in MI segment of MCA.ResultsCompared with the standard dose group,pretreatment group 2,pretreatment group 3,pretreatment group 4 had better short-term and long-term neurological prognosis(p<0.05);Compared with pretreatment group 1,pretreatment group 2,pretreatment group 3,pretreatment group 4 had better neurological prognosis(p<0.05);Compared with pretreatment group 2,pretreatment group 3 and pretreatment group 4 had better prognosis of neurological function(p<0.05);The good prognosis rate of pretreated group 3 was similar to that of pretreated group 4(p>0.05).In terms of s ICH,pretreatment group 1,pretreatment group 2,pretreatment group 3 were significantly reduced compared with standard dose group(p<0.05),pretreatment group 4 was similar to standard dose group(p>0.05);Pretreatment group 3 was significantly lower than pretreatment group 1(p<0.05);Compared with pretreatment group 3,pretreatment group 4 significantly increased(p<0.05).Death within 90 days:compared with standard dose group,pretreatment group 2 and pretreatment group 3 were significantly reduced(p<0.05),pretreatment group 1 and pretreatment group 4 were similar(p>0.05);The death rate of pretreated group 3 was significantly lower than that of pretreated group 4(p<0.05).For acute ischemic stroke patients with middle cerebral artery occlusion of M1 segment,the vascular recanalization rate and neurological function improvement rate in the pretreatment group were significantly higher than those in the standard dose group(p<0.05),while there was no significant difference in s ICH and death(p>0.05).ConclusionFor ultra-early intravenous thrombolytic therapy of acute ischemic cerebrovascular disease,compared with standard dose of intravenous thrombolytic therapy of rt-PA,pretreatment with different doses of aspirin and clopidogrel combined with low dose of intravenous thrombolytic therapy of rt-PA can significantly improve short-term and long-term neurological function in patients with acute ischemic cerebrovascular disease.Among them,the pretreatment group with aspirin 300mg and clopidogrel 225mg had the greatest benefit and reduced the risk of s ICH and death.When clopidogrel increased to 300mg,the benefit of patients did not increase,but the risk of s ICH and death went up.In acute ischemic stroke patients with occlusion of the M1 segment of the middle cerebral artery,the pretreatment group increased vascular recanalization and improved neurological function without increasing the risk of bleeding or death. |
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