The Efficacy And Safety Of Alteplase(rt-PA)Intravenous Thrombolysis In The Older Patients With Acute Ischemic Stroke

Objective:Objective to compare alteplase(recombinant tissue type plasminogen activator)between the younger group and the older group of patients with acute ischemic stroke by retrospective case study,Objective to investigate the efficacy and safety of alteplase in the treatment of older patients with acute ischemic stroke,and to provide guidance for clinical treatment.Method:a retrospective analysis of patients with acute ischemic stroke diagnosed in the Department of Neurology of Chongqing Dazu District People’s Hospital from May 2014 to December 2019 was conducted.All patients met the diagnostic criteria of American Heart / Stroke Association(AHA / ASA)for acute ischemic stroke in 2018.The onset time was less than 4.5 hours,and received intravenous thrombolytic therapy with alteplase.The patients were divided into age group(≥ 18 years old,< 80 years old)and older group(≥ 80 years old)according to their age.Several older patients with acute ischemic stroke(≥ 80 years old)were randomly selected for control analysis.At the same time,m RS score and Barthel score of daily life index were calculated after 90 days.The information of gender composition,low density lipoprotein abnormality,atrial fibrillation,hypertension,diabetes,coronary heart disease,onset start time and NIHSS score before treatment were collected.The main outcome measures of the three groups were as follows:(1)effectiveness indicators: NIHSS score of National Institutes of Health Stroke Scale(NIHSS)before treatment,NIHSS score of 1 and 14 days after treatment,and modified Rankin scale of 90 days,m RS);Barthel score of daily life index;(2)safety index: the rate of hemorrhagic transformation(HT),symptomatic intracranial hemorrhage(SICH)and bleeding in other non important parts such as gingiva,joints and skin within 7 days after treatment.Result:A total of 168 eligible patients were included in this study,including91 males(54.1%)and 77 females(45.9%).There were 42 older patients(≥80 years old)with acute ischemic stroke treated with alteplase intravenous thrombolytic therapy,66 age-matched patients with acute ischemic stroke,and 60 older patients(≥ 80 years old)with acute ischemic stroke treated without intravenous thrombolytic therapy.There was no significant difference in gender composition,onset time and main risk factors among the three groups except age factor There is no significant difference between them.Observation of effectiveness indicators: 1.There was no significant difference in the median nhiss score among the three groups before treatment(11,11.5,12.5).On the first day of treatment,there was no significant difference in the NIHSS score among the three groups(8.5,7.5,8).On the 14 th day of treatment,the NIHSS score of the older thrombolytic group was significantly higher than that of the age group,but there was no significant difference between the older thrombolytic group and the non thrombolytic group(6.5,3.6).2.The 90 day m RS score of the older thrombolytic group was higher than that of the non thrombolytic group(40.5% vs 32.2%).The average Barthel score of the 90 day older thrombolytic group was higher than that of the non thrombolytic group(P <0.05).Safety index observation: there was no significant difference in the incidence of HT and Sich among the three groups within 7 days after treatment(P > 0.05).There was no significant difference in bleeding of gingiva,joints,skin and other non important parts among the three groups within 7 days after treatment.Inter group analysis: 1.The long-term prognosis of the low NIHSS group(≤ 6 points)in the older thrombolysis group was better,and the good rate of m RS score at 90 days in different NIHSS score groups(≤ 6 points;7-15 points;≥ 16 points)were 83%,52%and 6% respectively.2.In the older thrombolysis group,the long-term recovery of patients with posterior circulation stroke was better than that of patients with anterior circulation stroke(80% vs 29.4%).3.Univariate regression analysis showed that high NIHSS score,time to start treatment,history of atrial fibrillation and diabetes mellitus were the main risk factors of thrombolytic bleeding in older patients.Conclusion:The short-term symptom improvement rate of intravenous thrombolytic therapy in older patients with acute ischemic stroke is similar to that of non thrombolytic therapy,but it may be beneficial to long-term functional recovery compared with non thrombolytic therapy,and there is no significant difference in safety.For patients with less bleeding risk factors and lower NIHSS score,it can be recommended in clinic.