| PurposeTo explore the safety and effectiveness of intravenous thrombolysis(IVT)in patients with acute ischemic stroke(AIS)who have been taking antiplatelet(AP)drugs for a long time before intravenous thrombolysis.Methods1.This study retrospectively analyzed the emergency department visits to the fifth affiliated hospital of Zhengzhou University from June 2017 to July 2019,and was evaluated by a specialist in green channel neurology at the emergency department of Zhengda Fifth Affiliated Hospital for urgent examination of blood routine,liver function,Renal function,coagulation function,blood glucose,brain CT examination to exclude intracranial hemorrhage,other contraindications,and fully communicate with the patient's family of the benefits of recombinant tissue plasminogen activator(rt-PA)intravenous thrombolysis And risk,family members signed the rt-PA intravenous thrombolytic informed consent,a total of 230 patients were randomly included,according to whether long-term(? 3 days)taking AP group before IVT.AP group:110 cases.As an observation group,70 cases of patients taking aspirin alone(aspirin,100mg,aspirin group),and 18 cases of patients taking clopidogrel for a long time(clopidogrel,75mg,clopidogrel)Group),there were 22 patients with aspirin combined with clopidogrel(aspirin 100mg+clopidogrel 75mg,double antibody group);120 patients without AP group were used as control group.Part of the data was obtained from the follow-up follow-up of the Research Office of the Stroke Center of our hospital.Compare general clinical data of all enrolled patients:age,gender,weight,AP,onset to treatment time(OTT),NIHSS score before thrombolysis(National Institutes of Health Stroke Scale,National Institutes of Health Stroke Scale(NIHSS),random blood glucose;risk factors(hypertension,diabetes,coronary heart disease,hyperlipidemia,atrial fibrillation,previous stroke history,TIA,smoking,alcohol abuse);NIHSS score 24 hours after thrombolytic therapy,NIHSS scores at 7 days and 2 weeks.The functional outcome of independent living after 90 days was evaluated by mRS,with a good prognosis:(mRS score of 0-2),poor prognosis(mRS score of 3-6 points),and the mRS score of patients after 90 days of follow-up were recorded.The adverse function prognosis mainly collected the number of intracerebral hemorrhagic transformation(HT),symptomatic intracranial hemorrhage(SICH),asymptomatic intracranial hemorrhage(ASICH)and deaths within 2 weeks.The NIHSS score and mRS score were obtained by a stroke green channel neurologist.Results1.Age,gender,weight,OTT,NIHSS score before thrombolysis,random blood glucose,hypertension,diabetes,coronary heart disease,hyperlipidemia,atrial fibrillation Compared with previous stroke history,TIA,smoking,alcoholism,TOAST classification,P>0.05,the difference was not statistically significant.2.Compared with the unused AP group,the short-term efficacy of the monoclonal antibody group and the unused AP(control group)group was longer than the unused AP group:(NIHSS score 4.54±3.54 vs 6.43±3.6 at 24 hours after IVT,P=0.044<0.05;NIHSS score 3.04±2.8 vs 4.58±2.6 after 7 days,P=0.032<0.05;NIHSS score 2.47±1.2 vs 3.53±1.7 after 2 weeks,P=0.048<0.05);long-term of monoclonal antibody group The prognosis is better than the unused AP group(mRS score 1.71±1.2 vs 2.35±1.2,P=0.043<0.05 after 3 months);there is no significant difference in the incidence of HT between the monoclonal antibody group and the unused AP group(3.4%vs 2.5%,P=1.000>0.05);the mortality rate of the two groups was 0,no significant difference.3.Compared with the unused AP group,the long-term efficacy of the double-antibody group before the onset was better than the unused AP group:(NIHSS score 5.37 ± 3.42 vs 6.63±3.6 24 hours after IVT,P=0.046<0.05;NIHSS score 3.03±2.4 vs 4.58 ± 2.6 after 7d,P=0.042<0.05;NIHSS score 2.12 ± 1.5 vs 3.53 ±1.7,P=0.034<0.05 after 2w;the long-term prognosis of the double antibody group is better than that of unused AP Group(mRS score 1.65±1.3 vs 2.35±1.2 after 3 months,P=0.038<0.05);there was no significant difference in the incidence of HT between the two groups(9.1%vs 2.5%,P=0.217>0.05),but the double antibody group The incidence of ASICH was significantly higher than that of the group without AP,with a significant difference(9.1%vs 0.83%,P=0.013<0.05);the mortality rate of the two groups was 0,and there was no significant difference.4.Compared with the long-term use of the double-antibody group and the monoclonal antibody group before the onset,there was no significant difference in the short-term efficacy of the double-antibody group and the monoclonal antibody group(NIHSS scores at 24h after IVT treatment were 5.17 ± 3.42 vs 5.14±3.54,P=0.894>0.05;7d NIHSS score 3.03±2.4 vs 3.04±2.8,P=0.932>0.05;2-week NIHSS scores were 2.12±1.5 and 2.47±1.2,P=0.448>0.05);there was no significant difference in long-term prognosis between the two groups(After 3 months of IVT treatment,the mRS score was 1.65±1.3 vs 1.71±1.2,P=0.743>0.05);there was no significant difference in the incidence of HT between the two groups(9.1%vs 2.3%,P=0.127>0.05),but the double antibody The incidence of ASICH in the group was significantly higher than that in the monoclonal antibody group,and there was a significant difference(9.1%vs 1.1%,P=0.04<0.05);the mortality rate of the two groups was 0,no significant difference.5.Compared with the long-term aspirin and clopidogrel groups before treatment,there was no significant difference in short-term efficacy after IVT between the two groups(NIHSS 5.08±3.52 vs 6.43±3.6 24 hours after IVT treatment,P=0.244>0.05;after 7 days NIHSS score 2.96 ± 2.9 vs 3.412 ± 2.6,P=0.232>0.05;2 weeks later NIHSS score 2.32 ± 1.1 vs 3.53± 1.7,P=0.348>0.05);there was no significant difference in long-term prognosis between the two groups(3 in IVT treatment)Months later,mRS score 1.65 ± 1.3 vs 2.15±1.0,P=0.243>0.05);there was no significant difference in the incidence of HT(1.4%vs 5.6%,P=0.369>0.05),and there was no significant difference in the incidence of ASICH(0 vs 5.6%,P=0.205>0.05);the mortality rate of the two groups was 0,no significant difference.Conclusion1.Patients with AIS who have been taking a single AP(aspirin or clopidogrel)for a long time before onset of IVT are safe and effective without significant increase in the incidence and mortality of SICH.2.The short-term efficacy and long-term prognosis of IVT for AIS patients taking dual AP(aspirin combined with clopidogrel)for a long time before the onset are better than those without AP.Although dual AP increases the risk of ASICH,it does not.Causes severe symptoms,does not affect patients' long-term functional prognosis,and does not increase patient mortality. |
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