Efficacy And Outcome Predictors Of Intravenous Thrombolysis Rt-PA For Patients With Acute Ischemic Stroke

Objective:Acute ischemic stroke(AIS)is the most common type of cerebrovascular disease with high mortality and morbidity,and is the leading cause of death in China.Recombinant tissue plasminogen activator(rt-PA)is currently the most effective drug treatment of acute ischemic stroke.Intravenous thrombolysis with rt-PA whithin the time window is drug treatment which is the only confirmed to reduce the disability rate of AIS.The world's indications and contraindications for rt-PA intravenous thrombolysis are different.The clinical prognosis of AIS patients with intravenous thrombolytic patients is a result of multi-factors.In this study,we use 29 factors including age,gender,incidence-thrombolytic time,baseline National Institutes of Health Stroke Scale(NIHSS)score,history of hypertension,history of diabetes,history of coronary heart disease,history of atrial fibrillation,history of prior stroke,history of hyperlipidemia,baseline blood pressure,baseline blood glucose,Baseline biochemical indexes such as baseline INR and baseline platelet count,NIHSS score at 24 h after thrombolysis,and modified Rankin scale(mRS)score at 3 months as observation indexes to determine factors associated with favorable clinical outcome in acute ischemic stroke patients who received intravenous thrombolysis to provide theoretical guide for reduction of unfavorable clinical outcome in acute ischemic stroke patients who received intravenous thrombolysis hope this study to reduce the clinical rt-PA.Materials and Methods:This study retrospectively analyzed the clinical data of patients with acute ischemic stroke who had received rt-PA thrombolytic therapy from January 2015 to June2016 in Qianfoshan Hospital of Shandong Province.According to the 3-month clinical outcome modified Rankin scale,patients were divided into two groups:those with good outcome(<2 points)and those with poor outcome(? 2 points).All patients were eligible for diagnostic criteria for ischemic stroke revised at the Fourth National Conference on Cerebrovascular Disease and confirmed by CT or MRl.Baseline and 24 hours neurological deficit were assessed using the NIHSS scale,thrombolysis after 3 months the degree of neurological deficits using mRS score evaluation.The influencing factors of clinical outcomes after thrombolysis were analyzed by single factor and multivariate analysis.Result:Among the 29 factors in the study,differences of 10 of them have statistically significance,which include Age,the history of diabetes,the history of hyperlipidemia,the history of atrial fibrillation,baseline blood glucose level,baseline hemoglobin level,baseline LDL level,incidence-thrombolysis time,baseline NIHSS score,and NIHSS score 24 h after thrombolytic therapy.Multi factor logistic regression analysis on these 10 factors showed that,4 indexes of them has statistically significance which are history of Hyperlipidemia,baseline LDL level,onset-thrombolytic time and 24hNIHSS score.Conclusion:History of Diabetes mellitus,history of hyperlipidemia,advanced age,baseline blood glucose,glycosylated hemoglobin,low density lipoprotein,baseline NIHSS score,onset-thrombolytic time are the risk factors of unfavorable clinical outcome of rt-PA thrombolysis.Hyperlipidemia,baseline LDL level,incidence-duration of thrombolysis and 24hNIHSS score were independent predictors of the efficacy of rt-PA intravenous thrombolysis.Baseline low-density lipoprotein levels,atrial fibrillation,and baseline NIHSS scores are factors that affect early symptoms of rt-PA intravenous thrombolysis.