Retrospective Analysis Of 42 Patients With Recurrent Transient Ischemic Attack

Transient ischemic attack (TIA) is a common disease of neurology, most times it is the precursor to cerebral infarction, control TIA has great significance to the prevention of cerebral infarction. The symptom of recurrent transient ischemic attack is more frequent and it is more difficult to control, the risk of cerebral infarction is greater. The treatment to recurrent TIA is an effective and important measure to prevent cerebral infarction. In the recent years there are more and more researches on TIA, but research on recurrent TIA lacks. The reason of recurrency is not clear. There are researches shows the combination of antithrombotic drugs of different mechanisms have better result in control TIA, and the risk of bleeding is lower. this study analyzed the reasons and the treatment of recurrent TIA retrospectively.This study is retrospective analysis about the reasons of the TIA frequency and the combination treatment with antithrombotic drug.studied the different risk factors, clinical and imaging performance and the relationship between the frequency of TIA, and treated with defibrase anticoagulant therapy in different groups, in order to find prevention and treatment of recurrent TIA.We collected 90 patients treated in the neurology department of China-Japan Union Hospital of Jilin University from January 2007 to December 2007 retrospectively,with 42 recurrent TIA and 48 non-recurrent TIA studied with risk factors,clinical manifestations and imaging examinations.Then divided 38 recurrent TIA into four groups: Groupâ… has 7 people, treated with Die mailing and Ozagrel ;â…¡4 cases treated with Die mailing,Ozagrel and low molecular heparin;â…¢12 cases, treated with Die mailing,Ozagrel and DF-521; â…£15cases, combined with Die mailing and Ozagrel low molecular heparin and DF-521 treatment. The application of ozagrel is intravenous drip with ozagrel 80mg + normal saline 100ml 2 times per day. The application of DF-521 is normal saline 250ml+DF-521 10u the first time, then at the 3rd and the 5th day use normal saline 250ml+DF-521 5u. The application of low molecular heparin is 5000U 1/d for a week. The treatment last 2 weeks.Observe the time of the symptom controlled. Measurement data using t-test, count data with the x2 test, P <0.05 means significant difference.The evaluation standard is: obvious effect: the symptom controlled in 3 days; effective: the symptom controlled in 3~14 days; ineffective: the symptome didn't controlled after 14 days or come to stroke.The 90 cases all have one or more following risk factors: blood pressure, smoking, heart disease, excessive drinking, dyslipidemia, diabetes,history of cerebrovascular diseases the 2 groups has no different in these risk factor(p>0.05).But the incidence of atrial fibrillation and heart valve disease are different in the 2 groups(p<0.05),and coagulation function between the two groups had no significant difference(p>0.05).Recurrent TIA happened in carotid artery system(CAS) more,69(76.67%)in CAS, and 21 (23.33%)in vertebral basilar system (VBS),but there are no difference between the 2 groups.The symptom lasted severol second at least,and no more than severol hours, most lasted 5~30 minites. Head CT or magnetic resonance imaging(MRI) scan and diffusion-weighted imaging showed old infarction or basal ganglia lacuna infarction, 6 of the 42 recurrent TIA patients did MRI test, and 5 of them found old infarction or basal ganglia lacuna infarction; while 2 of the 48 TIA did MRI and 1case found old infarction. There are no difference between the 2 groups(p>0.05). But more than one hour cases showed no fresh focus in CT or MRI.66 cases with vascular color doppler found that the arteriosclerosis is more in the recurrent group. The carotid endarterium - middle thickened,atherosclerotic plaque and vascular stenosis between the 2 groups are differrent(p<0.05). Atherosclerotic plaque, most foud in the proximal part of internal carotid artery and the carotid artery bifurcation. And the soft plaques,the blood flow velocity change between the 2 groups has no difference(p>0.05).The obvious effective rate of four different treatment groups are 57.14%,25.00%,58.33%,66.67%. The effect has no significant difference between the four treatment groups (p>0.05). Fibrinogen before and after treatment were significantly different (p <0.05). Only 1 case in low-molecular-weight heparin group foud bleed when brush teeth and soon resume, four groups of patients with no other adverse reactions such as bleeding, patients are well tolerated, liver and kidney function before and after treatment and the general state has no significant changes.So, through the compare of the recurrent TIA and non-frequent TIA patients and comparative analysis of the defibrase anticoagulant therapy ,we can concluded: The risk factors of TIA such as hypertension, coronary heart disease, smoking, drinking, diabetes, past cerebrovascular disease, dyslipidemia, changes in blood coagulation has nothing with the frequency of TIA, and atrial fibrillation and heart valve disease more common in non-frequent TIA. TIA attack more at the carotid artery system,the attack system,duration, CT and MRI has no relationship with the frequency. The atherosclerosis of recurrent TIA patients was significantly higher than that of non-frequent TIA patients, arteriosclerosis are related with the frequency of TIA. This study showed the united defibrase anticoagulant treatment to frequent TIA, the efficiency higher than defibrase or anticoagulant therapy, but there was no significant difference.