Safety And Efficacy Analysis Of Intravenous Heparin For Acute Ischemic Stroke After Thrombolysis With Altepase

Objectives : Bridging therapy with antithrombotic agent after intravenous tissue plasminogen activator(TPA)is promising by augmenting the thrombolytic effect.However,its benefit may not outweigh the risk of hemorrhagic transformation.We aimed to explore the benefit and risk of intravenous TPA(IVT)followed by intravenous heparin(IVH)in patients with acute ischemic stroke(AIS).Methods: From the Tangshan Stroke Thrombolysis Registry(TSTR)database,allpatientswere reviewed for this study.Based on the antithrombotictreatment regimens after thrombolysis,the eligible patients were divided into two groups: those received IVH immediately after IVT(heparin group)or those received antithrombotic therapy 24 hours after IVT(control group).The safety outcomes included symptomatic intracranial hemorrhage(sICH)and all intracranial hemorrhage(aICH)within 7 days and mortality within 90 days.The efficacy outcomes included neurological improvement at 24 hours and 7 days,excellent recovery and functional independence at 90 days.The two yuan logistics regression analysis method was used to compare all the results and analyze the discussion.Results: We studied 116 early IV heparin treatment cases and 116 controls.No statistically significant differences in the baseline characteristics were observed for patients in heparin group versus those in the control group.Compared with the control group,the heparin group had higher rates of neurological improvement at 24 hours(53.4% vs 32.8%,OR=2.36,95% CI=1.38-4.01;7 days: 62.9% vs 48.3%,OR=1.82,95% CI=1.08-3.07)and 90 days good outcome(good recovery: 44% vs 30.4%,OR=1.79,95% CI=1.04-3.08;life self-care(56.0% vs 41.7%,OR=1.78,95%CI=1.06-3.00)were significantly higher than those in the control group.The NIHSS score of the two groups was compared,the NIHSS score of the heparin group was 14.12±1.845 in the admission group,the NIHSS score of the control group was 14.13 ± 2.147,and the P>0.05 had no significant difference.The NIHSS score of the heparin group was 7.267±1.132 after 7 days treatment,the NIHSS score of the control group was 13.07±2.628,and the P <0.05 was significantly different;the liver was treated after 7 days.The NIHSS score of the patients in the treatment group was 4.650±0.9467,while the NIHSS score in the control group was 9.895±2.394,and there was a significant difference in P<0.05.The mRS score of the two groups was compared,the mRS score of the heparin group was4.471±0.2443,the mRS score of the control group was 4.333±0.2315,and the P>0.05 had no significant difference.The mRS score of the heparin group was 3.619 + 0.3272 after 7 days treatment,the mRS score of the control group was 2.500±0.3727,and the P< 0.05 was significantly different;the heparin was treated after 7 days.The mRS score of the group was 0.3200 ± 0.1381,while the mRS score of the control group was 0.981±0.1086,and the difference between P<0.05 was significant.At the same time,the results of the bleeding risk(symptomatic intracranial hemorrhage: 5.2% vs 6.9%,OR=0.74,95% CI=0.25-2.19;cerebral hemorrhage: 22.4% vs 13.8%,OR=1.81,95% CI=0.91-3.58)and mortality(8.6% vs 13.9%,OR=0.58,95% CI=0.25-1.35)were not significantly different between the two groups.Conclusions : Our study showed that after IV r-tPA thrombolysis for acute ischemic stroke patients,early IV heparin treatment started within 24 hours improved the 90 day clinical outcome and did not increase the risk of symptomatic or any intracranial hemorrhage compared to standard antithrombotic treatment.Early IV heparin treatment may be helpful for a subset of patients with acute ischemic stroke after IV rtPA thrombolysis.