| ?Objective?Through studing the efficacy,prognosis,and safety of rt-PA intravenous thrombolysis in patients with both AIS and atrial fibrillation,and investigating whether there are difference in efficacy,prognosis,and safety of intravenous thrombolysis in patients with both AIS and atrial fibrillation in different time windows,aim to provide reference for the treatment of patients with both AIS and atrial fibrillation.?Methods and groups?1.240 patients with AIS and onset time<4.5h were continuously collected in our hospital from January 2012 to November 2017,all of them were treated with rt-PA intravenous thrombolysis in inclusion criteria.They are divided into atrial fibrillation thrombolytic group(patients with both AIS and atrial fibrillation treated with intravenous thrombolysis)84 cases and non-atrial fibrillation thrombolytic group(patients with AIS but without atrial fibrillation treated with intravenous thrombolysis)156 cases according to the presence or absence of combined atrial fibrillation.In addition,158 patients with both AIS and atrial fibrillation and onset time<4.5h but without intravenous thrombolysis(atrial fibrillation non-thrombolytic group)were continuously collected during the same time period.Compared the efficacy,and prognosis indicators(the NIHSS score?cerebral blood flow?90d mRS score)and safety indicators(the incidence of cerebral hemorrhage and other complications?the death rate after 90 days)within and between groups(atrial fibrillation thrombolytic group vs atrial fibrillation non-thrombolytic group?atrial fibrillation thrombolytic group vs non-atrial fibrillation thrombolytic group).2.Subgroup analysis:We divide the patients with both AIS and atrial fibrillation treated with intravenous thrombolysis(the atrial fibrillation thrombolytic group 84 cases)into 0-3h thrombolysis group and 3-4.5h thrombolysis group according to time window.Compared the efficacy,prognosis,and safety indicators same as above within and between two groups.?Result?1?Analysis of the efficacy,prognosis and safety of rt-PA intravenous thrombolysis in patients with both AIS and atrial fibrillation(1)Comparison of efficacy:(1)The NIHSS scores:There were no significant difference in the NIHSS scores before treatment in three groups(including atrial fibrillation thrombolytic group,non-atrial fibrillation thrombolytic group and atrial fibrillation non-thrombolytic group)(P>0.05);The NIHSS score of 1h,24 h,7d after thrombolysis of atrial fibrillation thrombolytic group was significantly decreased compared with the score before treament(P<0.05)and the score of atrial fibrillation non-thrombolytic group(P<0.05)but similar to non-atrial fibrillation thrombolytic group(P>0.05).(2)Cerebral blood flow:The Vm of 7d after thrombolysis of atrial fibrillation thrombolytic group was significantly increased compared with the Vm of 1h after thrombolysis(P<0.05),the PI of 7d after thrombolysis was significantly decreased compared with the PI of 1h after thrombolysis(P<0.05);Both the Vm of 1h and 7d after thrombolysis of atrial fibrillation thrombolytic group were obviously higher than atrial fibrillation non-thrombolytic group(P<0.05),both the PI of 1h and 7d after thrombolysis were obviously lower than atrial fibrillation non-thrombolytic group(P<0.05);Both the Vm,PI of 1h and 7d after thrombolysis of atrial fibrillation thrombolytic group were similar to non-atrial fibrillation thrombolytic group(P>0.05).(2)Comparison of prognosis:The rate of good prognosis at 90 d of atrial fibrillation thrombolytic group(25.0%)was obviously higher than atrial fibrillation non-thrombolytic group(11.4%)(P<0.0125),but similar to non-atrial fibrillation thrombolytic group(28.8%)(P>0.0125).(3)Comparison of safety:(1)Comparison of complications:The cerebral hemorrhage rate of atrial fibrillation thrombolytic group(31.0%)was higher than atrial fibrillation non-thrombolytic group(12.7%)and non-atrial fibrillation thrombolytic group(13.5%)(P<0.0125);The incidence of symptomatic cerebral hemorrhage,gastrointestinal hemorrhage,oral gingival bleeding and cerebral hernia of atrial fibrillation thrombolytic group were similar to atrial fibrillation non-thrombolytic group and non-atrial fibrillation thrombolytic group(P>0.05).(2)Comparison of the total mortality rate of 90d:The total mortality rate of 90 d of atrial fibrillation thrombolytic group(13.1%)was similar to atrial fibrillation non-thrombolytic group(7.6%)(P>0.05)and non-atrial fibrillation thrombolytic group(8.3%)(P>0.05).2?Analysis of the efficacy,prognosis and safety of rt-PA intravenous thrombolysis in patients with both AIS and atrial fibrillation in different time windows(1)Comparison of efficacy:(1)The NIHSS scores:There were no significant difference in the NIHSS scores before treament in two groups(including 0-3h thrombolysis group and 3-4.5h thrombolysis group)(P>0.05);The NIHSS score of 1h,24 h,7d after thrombolysis of two groups were significantly decreased compared with the score before treament(P<0.05);The NIHSS score of 1h,24 h,7d after thrombolysis of two groups was not obviously different(P>0.05).(2)Cerebral blood flow:The Vm of 7d after thrombolysis of 0-3h thrombolysis group and 3-4.5h thrombolysis group were both significantly increased compared with the Vm of 1h after thrombolysis(P<0.05),the PI of 7d after thrombolysis were both significantly decreased compared with the PI of 1h after thrombolysis(P<0.05);Both the Vm,PI of 1h and 7d after thrombolysis of two groups were similar to each other(P>0.05).(2)Comparison of prognosis:The rate of good prognosis at 90 d of 0-3h thrombolysis group(27.3%)was similar to 3-4.5h thrombolytic group(22.5%)(P>0.05).(3)Comparison of safety:(1)Comparison of complications:The incidence of cerebral hemorrhage,symptomatic cerebral hemorrhage,cerebral hernia,gastrointestinal hemorrhage,oral gingival bleeding of 0-3h thrombolytic group and 3-4.5h thrombolytic group were similar to each other(P>0.05).(2)Comparison of the total mortality rate of 90d:The total mortality rate of 90 d of 0-3h thrombolytic group(15.9%)was similar to 3-4.5h thrombolytic group(10.0%)(P>0.05).?Conclusion?1.The rt-PA intravenous thrombolysis in patients with both AIS and atrial fibrillation can still obtain remarkable efficacy and prognosis,which is similar to non-atrial fibrillation thrombolytic group.2.The rt-PA intravenous thrombolysis in patients with both AIS and atrial fibrillation can increase cerebral hemorrhage rate,however,does not increase the incidence of symptomatic cerebral hemorrhage and the total mortality rate.3.Compare with the patients with both AIS and atrial fibrillation treated with intravenous thrombolysis in the time window of 0-3h,extending the time window(to 3-4.5h)can still obtain remarkable efficacy and prognosis,which is similar to 0-3h thrombolysis group.4.Compare with the patients with both AIS and atrial fibrillation treated with intravenous thrombolysis in the time window of 0-3h,extending the time window(to 3-4.5h)does not increase the incidence of cerebral hemorrhage,symptomatic cerebral hemorrhage and the total mortality rate. |
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