Clinical Efficacy Of Low-dose Rt-PA Combined With Tirofiban In The Treatment Of Acute Non-cardiogenic Cerebral Infarction

Objective: To explore the clinical efficacy and safety of early combination of rt-PA intravenous thrombolysis with the antiplatelet drug tirofiban in the treatment of acute ischemic stroke.To seek the best drug treatment for non-cardiogenic ischemic stroke,improve the vascular recanalization rate,reduce the bleeding rate after thrombolysis,reduce the early deterioration of neurological function after thrombolysis,and thereby improve the treatment for patients with non-cardiogenic ischemic stroke in the acute phase.Methods:From January 2018 to October 2018,60 patients with non-cardiogenic ischemic stroke who were hospitalized in the comprehensive stroke center of the Affiliated Yantai Yuhuangding Hospital of Qingdao University Hospital within 4.5 hours of onset were selected as the study subjects.The patients were randomly divided into experimental group and control group.The experimental group(n=30)was treated with low dose rt-PA(0.6mg/kg)combined with tirofiban.The control group(n=30)was treated with standard dose rt-PA(0.9mg/kg).Intracranial hemorrhage was excluded by brain CT24 hours after thrombolysis,and if there were no symptoms of systemic hemorrhage,patients in the two groups were also given standard secondary prevention treatment in the acute stage of ischemic stroke,such as anti-platelet aggregation and lipid-regulating statin to stable plaque,and then improved the relevant serological and imaging examinations.The safety of the experimental group was mainly observed.The safety indicators were neurological deterioration(>NIHSS score increased by >4),symptomatic hemorrhage,non-symptomatic hemorrhage,bleeding in other sites and death,in order to judge the safety of rt-PA combined with tirofiban.The neurological deficits of patients in the two groups were assessed with the National Institutes of Health Stroke Scale(NIHSS)score before thrombolysis,24 hours and 7 days after thrombolysis respectively,and then assessed by the modified RANKIN scale(mRS)at 3 months after thrombolysis,and the results of NIHSS score and mRS score were analyzed statistically.The therapeutic effect,namely NIHSS score,was compared between the two groups at 24 h after treatment and 7days after treatment.After 3 months of treatment,the prognosis of the two groups was compared.The mRS<2 was judged as the group with good long-term prognosis of ischemic stroke,and the mRS>2 was judged as the group with poor prognosis of ischemic stroke(the death cases were counted to the group with poor prognosis).Results:1.Ther was no significant difference between the experimental group and the control group of basic characterics,past and personal history,vital signs at admission and laboratory investigative results.2.The NIHSS scores of the experimental group and the control group were(7.53 ±3.44)and(7.37 ±3.88)before thrombolytic therapy,respectively,and there was no significant difference between the two groups(P > 0.05).The NIHSS scores of the experimental group and the control group were(5.57 ±3.05)and(6.57 ±4.41)at 24 hours after thrombolytic therapy,respectively,and there was no significant difference between the two groups(P > 0.05).The NIHSS scores of the experimental group and the control group were(3 ±2.27),(4.8±4.02)at 7 d after thrombolytic therapy,respectively,the difference between the two groups was significant(P < 0.05).3.Compared with the control group,the good prognosis rate was 83.3% in the experimental group and 60% in the control group after 3 months of treatment.There was significant difference between the two groups by Chi-square test(P < 0.05).4.Compared with the control group,the aggravation rate of symptoms was 0% in the experimental group and 6.6% in the control group,and the asymptomatic bleeding rate was 3.3% in the experimental group and 10% in the control group.The symptomatic bleeding rate and mortality rate were both 0.Chi-square test showed that there was no significant difference between the two groups(P > 0.05).Conclusions: Low dose rt-PA combined with tirofiban is effective and relatively safe compared with standard dose rt-PA in acute stage of non-cardiogenic ischemic stroke.