The Retrospective Study Of The Efficacy And Safety Of Thrombolysis In Acute Cerebral Infarction In Shanghai

Background:Acute cerebral infarction is a kind of disease with high prevalence,high morbidity and high mortality,and it is the second cause of death in the world,there is no other therapeutic ways which can dramatically changed the outcome except thrombolysis.It is controversial to identify the efficacy and safety of thrombolysis through the present data,especially for the evaluation of the risk factor which may have effect on the outcome or SICH(symptomatic intracerebral hemorrhage).Object:To identify the efficacy and safety of intravenous thrombolysis within 6 hours after the stroke onset,analyze the factors which can effect the outcome,find out the possible risk factors of SICH.Method:Retrospectively analyze the data of 152 patients who had taken thrombolysis therapy during Sep.1996 to Sep.2006 in Shanghai,collect the data of age,sex,weight,time from onset to treatment,blood pressure before admission and thrombolysis,the dosage of rt-PA,the ischemic change of cerebral CT before thrombolysis,the NIHSS of the patients before and after thrombolysis even 24 hours after the thrombolytic therapy,TOAST, antiplatelet agent and anticoagulation agent taken which followed thrombolytic therapy,90 days NIHSS,mRS and BI.We choose the placebo group in NINDS rt-PA stroke study as control.Early improvement was defined as complete resolution of the neurologic deficit or an improvement from base line in the score on the National Institutes of Health stroke scale(NIHSS) by 4 or more points 24 hours after the onset of stroke.Scores of 95 or 100 on the Barthel Index,and less than 1 on the NIHSS and the modified Rankin scale were considered to indicate a favorable outcome in 90 days.Chi-square Test was used to compare the differences of the efficacy and safety between the treatment group and the placebo group. Multivariable logistic regression was used to determine the characteristics which exist on the outcome and intracerebral hemorrhage risk.Result:Trombolysis within 6 hours is beneficial for the outcome of acute ischemic stroke.61.2%patients of the treatment group got early improvement,higher than the control group,and thrombolysis is trend to acquire more favorable outcome 90 days after onset.Immediately and early improvement along with the cerebral CT changes before thrombolysis are predict markers of outcome in 90 days after onset in the multivariable logistic regression model,Thrombolysis increased the risk of symptomatic intracerebral hemorrhage compared with the placebo,but there was no difference of mortality between the two group.The stroke subtype of TOAST was a predict marker of SICH(symptomatic intracerebral hemorrhage), patients who belonged to cardioembolic is more likely to suffer from SICH.Conclusion:Trombolysis within 6 hours is efficacious and safe.The more early improvement the patients get,the more favourable outcome one will acquire at day 90.As cardioemoblic is a risk factor of SICH,it is important for us to be careful when thrombolysis is given to the patients of such stroke subtype.