Efficacy Comparison Of Low-dose And Standard-dose Alteplase Intravenous Thrombolysis In Treating Acute Cerebral Infarction

Objective:To compare the efficacy of low-dose and standard-dose alteplase intravenous thrombolysis in treating acute cerebral infarction(ACI).Methods:The AC I patients who were hospitalized and received alteplase intravenous thrombolytic therapy in the Neurology Department of Sihong County People’s Hospital from May 2016 to September 2019 were included in this research.According to the dose of alteplase,the patients were randomly divided into low-dose group(group A and B)and standard-dose group(group C).Patients in group A and B were given 0.6mg/kg alteplase,with the maximum dose of 60mg.Patients in group A were intravenously injected with 15%of the total dose within 1min,and the rest 85%dose were pumped intravenously to the patients by an infusion pump within 60min.Patients in group B were intravenously injected with 10%of the total dose within 1 min,and the rest 90%dose were pumped intravenously to the patients in the same way as in group A.Patients in group C were given 0.9mg/kg alteplase,with the maximum dose of 90mg.The patients were intravenously injected with 10%of the total dose within 1min.The rest 90%were pumped intravenously to the patients in the same way as in group A.For all the patients included in the present research,their gender,age,personal history,past medical history,blood glucose level before thrombolysis,systolic pressure before thrombolysis,diastolic pressure before thrombolysis,thrombolysis time window,etc.were recorded after admission.Besides,their NIHSS score before thrombolysis and on the 1st,7th and 14th days after thrombolysis,as well as modified Rankin Scale score(mRS)before thrombolysis and on the 90th day after thrombolysis were recorded.The NIHSS score after thrombolysis decreased by no less than 18%than that before thrombolysis was set as effective therapy,and the rest situations were regarded as invalid.mRS score≤2 represents favourable prognosis;mRS score>2 represents poor prognosis;mRS score=6 represents death.SPSS 22.0 was applied to analyze and process the collected data.The effects of the two different doses of alteplase on early-neural functional recovery and long-term prognosis of ACI patients were compared.Results:A total of 155 patients treated by alteplase intravenous thrombolysis were included in this research,including 91 patients in low-dose group(38 in group A and 53 in group B)and 64 patients in standard-dose group(group C).No statistic difference was found in baseline information among the three groups(P>0.05).1.The NIHSS scores of the three groups were significantly lower than before thrombolysis,and the differences were statistically significant(P<0.05).There was no statistical significance in the NIHSS scores among the three groups on the 1st,7th and 14th days after therapy(P>0.05).After 1d of the therapy,the total effective rate in group A,group B and group C was respectively 55.26%(21/38),52.83%(28/53)and 57.81%(37/64),and the differences were not statistically significant(P>0.05);after 7d of the therapy,the total effective rate in group A,group B and group C was respectively 65.79%(25/38),66.04%(35/53)and 70.31%(45/64),and no statistically significant difference was found(P>0.05);after 14d of the therapy,the total effective rate in group A,group B and group C was respectively 71.05%(27/38),73.58%(39/53)and 75.00%(48/64),with no statistically significant difference(P>0.05).2.The difference in mRS score between the three groups before thrombolysis and 90d after thrombolysis was statistically significant(P<0.05).There were respectively 25,35 and 44 patients with favorable prognosis in group A(65.79%),group B(66.04%)and group C(68.75%),with no statistically significant difference(P>0.05).3.After thrombolysis,1 patient had gingival bleeding(2.63%),1 had alimentary tract hemorrhage(2.63%),2 had nasal hemorrhage(5.26%)and 1 had sub dermal ecchymosis(2.63%)in group A;1 patient had nasal hemorrhage(1.89%),1 had hematuria(1.89%)and 2 had sub dermal ecchymosis(3.77%)in group B;1 patient had intracranial bleeding(1.56%),2 had gingival bleeding(3.13%),1 had alimentary tract hemorrhage(1.56%),3 had nasal hemorrhage(4.69%),1 had hematuria(1.56%)and 2 had nasal hemorrhage(3.13%)in group C.The differences in intracranial hemorrhage,gingival bleeding,alimentary tract hemorrhage,nasal hemorrhage,hematuria,sub dermal ecchymosis and other bleeding status among the three groups were not statistically significant(P>0.05).4.After thrombolysis,3 patients died in group A(7.89%),3 in group B(5.66%)and 4 in group C(6.25%).There was no statistical significance in mortality among the three groups(P>0.05).Conclusion:1.The effect of alteplase intravenous thrombolysis in treating hyperacute cerebral infarction is highly significant,and low-dose(0.6mg/kg)intravenous thrombolysis has equivalent effect to that of standard dose(0.9mg/kg).2.Alteplase intravenous thrombolysis can significantly reduce the disability rate and improve prognosis of patients,but no significant difference was found between the standard dose and low dose.3.There was no significant difference in hemorrhage risk after intravenous thrombolysis of alteplase at low-dose and Standard-dose,and the overall mortality of standard dose is similar to that of low dose.