Efficacy And Safety Of Intravenous Thrombolysis In Young Patients With Acute Ischemic Stroke

ObjectiveTo explore the safety and efficacy of rt-PA intravenous thrombolysis in the treatment of acute ischemic stroke in young patients.Methods1. From October July 2014 to 2015 in Tianjin Huanhu Hospital Department of Neurology the fourth ward hospitalization given intravenous thrombolysis with rt-PA in 136 cases of patients with acute ischemic stroke in young adults, not given rt-PA intravenous thrombolysis in patients with acute ischemic stroke in young adults of 98 cases were retrospectively analyzed. All patients with intravenous thrombolysis were in accordance with the criteria of early treatment guidelines for AHA/ASA in 2013,and the time of onset was within 4.5 hours. Two groups of patients aged between18-45 years old.2. We recorded two groups of gender, age, risk factors, laboratory examination,all intravenous thrombolysis patients were informed consent and signed by family members, rt-PA by 0.90mg/kg dose to the medicine, the maximum dose of not more than 90 mg. Record the score of NIHSS after treatment 24 hours and 7 days, record the score of MRS after 3 months, Intracranial hemorrhage, symptomatic intracranial hemorrhage, and mortality were assessed within 3 months.3. Prognosis evaluation:(1) Prognostic evaluation: the NIHSS score after treatment 24 hours and 7 days of decline is more than or equal to 4 points or neurological symptoms completely disappeared, defined for the short-term outcome of good; NIHSS score after treatment 24 hours and 7 days fell 4 points, defined for poor short-term prognosis.(2) Long term prognosis evaluation: 3 months after treatment, the mRS score 0-2 score was defined as a good long-term prognosis; mRS score 3-6 score was defined as poor long-term prognosis. Symptomatic intracranial hemorrhage is defined as a poor prognosis.Results1. The gender, age, risk factors, laboratory examination and admission of baseline NIHSS score were not significantly differents between intravenousthrombolysis group and non intravenous thrombolysis group patients.2. Intravenous thrombolytic therapy group neural function defect in patients with good prognosis of 87 cases(63.9%) after 24 hours of treatment, control group has 38cases(38.8%),between the two groups exist significant difference(P=0.012);Intravenous thrombolytic therapy group of neural function defect 112 cases of patients(82.4%) with a good prognosis after 7 days of treatment, control group has61 cases(62.2%), between the two groups exist significant difference(P =0.005).3. Of 118 cases(86.7%) in intravenous thrombolysis group have good long-term prognosis after 3 months, control group has 63 cases(64.2%), there were statistically significant differences between the two groups(p=0.021).4. Of 3 cases(2.2%) in intravenous thrombolysis group have hemorrhagic transformation after 36 hours of treatment, control group has 1 cases(1.0%), all cases are asymptomatic intracranial hemorrhage, the difference between the two groups no statistical significance(p=0.087).5. The 3 months of stroke related mortality rate was 1.5% in the intravenous thrombolysis group and 2.0% in not intravenous thrombolytic therapy group, and there was no significant difference between the two groups(p=0.197).Conclusion1. There was no statistical significance between intravenous thrombolysis group and not intravenous thrombolysis group in young patients with acute ischemic stroke.2.The short-term effects and long-term prognosis in acute ischemic stroke patients were significantly better than without intravenous thrombolysis group.3.There was no difference of the risk of hemorrhagic transformation between intravenous thrombolysis treatment and not intravenous thrombolysis treatment in the young patients with acute ischemic stroke.4.There was no significant difference in stroke related mortality in the 3 months between the intravenous thrombolysis group and the non intravenous thrombolysis group of the young patients with acute ischemic stroke.