The Retrospective Study Of Traditional Chinese Medicine Injections Of Activating Blood Circulation And Removing Blood Stasis Combined With Intravenous Thrombolysis Or Endovascular Treatment Treating Acute Ischemic Stroke

ObjectiveAcute ischemic stroke(AIS)is a major cause of morbidity and mortality in China,bringing a heavy burden to society.Currently,recanalization therapy including intravenous thrombolysis and endovascular treatment is the most effective way to save damaged brain tissue.However,hemorrhagic transformation(HT)and symptomatic intracranial hemorrhage(SICH)are the main complications of the early treatment,resulting in unfavorable clinical outcomes.Therefore,we are looking for ideal therapy which might help to reducehemorrhagic event.Previous studies have shown traditional Chinses medicine(TCM)injection with the efficacy of activating blood circulation and removing blood stasis have the ability to improve clinical functional outcome and reduce the risk of hemorrhage.Based on these,our study retrospectively assessed the effect of recanalization therapy combined with traditional Chinses medicine(TCM)injections with the efficacy of activating blood circulation and removing blood stasis of AIS patients.MethodsWe retrospectively collected consecutive AIS patients from January 1,2018 to April 30,2020 of the encephalopathy center of the Second Clinical Affiliated Hospital of Chinese Medicine.We divided all 266 patients into group A(treated with TCM injections with the efficacy of activating blood circulation and removing blood stasis within 24h after recanalization therapy,n=107)and group B(non-treated with TCM injections with the efficacy of activating blood circulation and removing blood stasis within 24h after recanalization therapy,n=159).The primary outcome was sICH and the second outcome included death,favorable functional outcome(mRS≤2)at discharge,and neurologic improvement at 7±2 days(NIHSS scores decreased by more than 4 points from baseline NIHSS scores).ResultsCompared to group B,group A had fewer patients with previous history of atrial fibrillation,fewer patients with history of anticoagulant drugs,lower stroke severity(lower NIHSS score before treatment),more patients with non-disabling stroke(NIHSS≤5),shorter prothrombin time(PT),higher levels of prothrombin activity(AT)and international standardized ratio(INR).In terms of the outcome of intracranial hemorrhage,7 cases of intracranial hemorrhage in group A(6.5%)were lower than 23 cases(14.5%)in group B(P=0.045).Univariate analysis found that higher pretreatment NIHSS score,disabling stroke,lower RBC level,higher PT level,endovascular treatment,and no use of lipid-lowering drugs within 24h were associated with intracranial hemorrhage outcome.Multivariate analysis indicated that female,endovascular treatment,and no use of lipid-lowering drugs within 24h were independent risk factors for the outcome of intracranial hemorrhage,while the effect of TCM injections for promoting blood circulation and removing blood stasis on the outcome of intracranial hemorrhage was no longer significant.In terms of death outcome,8 patients(7.5%)died in group A and 11 patients(6.9%)died in group B(P>0.05).In multivariate analysis,female,NIHSS score before treatment,and mechanical thrombectomy were positively correlated with the outcome of death.In terms of favorable functional outcome,59 patients(56.2%)in group A and 75 patients(48.4%)in group B had favorable functional outcome(P>0.05).Multivariate analysis showed that systolic blood pressure at admission,NIHSS score before treatment,and mechanical thrombectomy were negatively correlated with good functional outcomes,while lipid-lowering drugs within 24h were positively correlated with good functional outcomes.In terms of neurologic improvement,there were 38 cases(43.7%)of effective improvement in group A and 49 cases(56.3%)of effective improvement in group B(P>0.05).Multivariate analysis showed that NIHSS score before treatment,prothrombin time(PT),and lipid-lowering drugs within 24h were positively correlated with the improvement of neurological function.The higher the level of random blood glucose(GLU),the worse the improvement of neurological function deficit.ConclusionIn our study,the use of T TCM injections with the efficacy of activating blood circulation and removing blood stasis within 24h after recanalization therapy had potential benefit for decreased risk of SICH,though there was no significant in multivariate analysis.To further estimate the association,we need more prospective and large sample trials.