Coagulation Risk Factors Of Hemorrhagic Transformation After Intravenous Thrombolysis With Rt-PA In Acute Cerebral Infarction

Background:In recent years,with the trend of population aging,the incidence of cerebrovascular disease is increasing,and the age of onset is becoming younger and younger.So cerebrovascular disease has become one of the major diseases endangering human health and life,as well as ischemic heart disease and malignant tumors and one of the main fatal diseases in China.According to statistics,cerebral infarction accounts for 70-80%of cerebrovascular diseases.One of the most effective treatments for patients with acute ischemic stroke(AIS)presenting in the appropriate time window is treated with intravenous thrombolysis(IVT).IVT is the most economical and effective treatment for patients with AIS within the time window of thrombolytic therapy,which is considered to be the most standard and rapid treatment for reperfusion therapy.Recombinant tissue plasminogen activator(rt-PA)is currently recognized as an important method for the recanalization of AIS.However,the hemorrhagic transformation(HT),especially cerebral HT,after thrombolysis conveys a high risk,which limits the application of IVT.Objective:To find out the relevant disease-causing factors of HT after IVT with rt-PA in cerebral infarction.Method:Patients with AIS receiving rt-PA thrombolysis in Neurology Department in the Affiliated Zhongshan Hospital,Xiamen University from February 2013 to January 2018 were retrospectively reviewed in the study.Based on the cranial computed tomography(CT)scanning after of 24 hours the IVT,the patients were divided into 2 groups:HT group and non-HT group.The information was collected before thrombolysis.Univariate analysis,subgroup analysis,stepwise logistic regression analysis and receiver operating characteristic were used for all the data.Results:A total of 403 patients were contained in the analysis.Using stepwise logistic regression analysis for analysis of risk of HT,we finally found that there was a significant difference between the HT and non-HT group(P<0.05)in the level of activated partial thromboplasmin time(APTT),fibrinogen(FIB),platelet(PLT)and smoking before thrombolysis.After thrombolytic therapy,the activated partial thromboplastin time(APTT)was higher than 36.30 s,and hemorrhagic transformation occurred.The results of statistical analysis before and after thrombolysis in non-hemorrhagic group and before and after thrombolysis in hemorrhagic group showed that the P values of APTT,FIB and PLT were less than 0.001,which showed that rt-PA might play an intravenous thrombolysis role in coagulation-fibrinolysis system through APTT,FIB and PLT in vivo.Conclusion:The levesl of APTT,FIB,PLT and smoking before thrombolysis are associated with the risk of HT.If APTT is higher than 36.30 s,hemorrhagic transformation will occurre.Rt-PA may play an intravenous thrombolytic role in coagulation-fibrinolysis system through APTT,FIB and PLT in vivo.