Clinical Analysis Of Intravenous Thrombolysis In Patients With Atrial Fibrillation And Non-Atrial Fibrillation Cerebral Infarction

ObjectiveIntravenous thrombolysis within 4.5 hours can significantly improve the prognosis of patients with cerebral infarction.Patients with cardiogenic cerebral embolism also benefit from rt-PA intravenous thrombolysis,but there is a difference in the benefits of intravenous thrombolytic therapy between cardiogenic and non-cardiogenic stroke.So far,there has been no unanimous statement.The purpose of this study was to analyze the risk factors affecting the prognosis of intravenous thrombolytic therapy for cerebral infarction and to explore the safety and efficacy of intravenous thrombolytic therapy for cardiogenic and non-cardiogenic cerebral infarction.MethodsThis is a retrospective study.182 cases of acute cerebral infarction treated by intravenous thrombolysis within 4.5 hours of onset were collected and included in the study.The subjects who met the inclusion criteria were divided into two groups according to whether they were cardiogenic cerebral infarction or not:(1)cardiogenic group,This group was composed of 55 patients with cerebral infarction complicated with atrial fibrillation,cardiac valvular disease and other diseases that could produce emboli in endocardium and valve within 4.5 hours of onset;(2)non-cardiogenic group,This group consisted of 127 patients who were treated within 4.5 hours after the exclusion of CCE.The patients were treated with intravenous thrombolysis with a total dose of 0.9 mg/kg,a maximum of 90 mg,and 10% of the total amount was injected intravenously in 1 min,and the remaining 90% was added to saline 100 ml and injected intravenously at a uniform rate in 60 min.The basic information,past history,hematological examination,imaging examination,stroke severity,stroke classification and complications at admission and discharge were collected.NIHSS scale and modified Rankin scale were used to evaluate the recovery of neurological function.ResultsThe average age of patients with cardiogenic cerebral infarction was older than that of patients with non-cardiogenic cerebral infarction(P < 0.001),and the proportion of patients with previous history of valvular heart disease(P < 0.001)and heart failure(P = 0.001)in cardiogenic group was higher than that in patients with non-cardiogenic cerebral infarction.The proportion of male(P < 0.001)and smoking(P = 0.013)in cardiogenic group was lower than that in patients with non-cardiogenic cerebral infarction.The red blood cell count(P = 0.023),platelet count(P = 0.027)and low density lipoprotein(P = 0.016)were lower in cardiogenic patients at admission.Before treatment,NIHSS in cardiogenic group was significantly higher than that in non-cardiogenic group(P < 0.001).The difference of NIHSS score before treatment and 2 weeks after treatment was more significant in cardiogenic group than that in non-cardiogenic group(P = 0.044).The incidence of bleeding events(cerebral hemorrhage,SAH,gastrointestinal bleeding)within 7 days after intravenous thrombolysis in cardiogenic group was significantly higher than that in non-cardiogenic group(P = 0.024).The all-cause mortality in cardiogenic group was significantly higher than that in non-cardiogenic group within 3 months(P < 0.001).The rate of poor prognosis in cardiogenic group was significantly higher than that in non-cardiogenic group(P < 0.001).Logistic regression of bleeding events within 7 days showed that female patients(P=0.012)and history of heart failure(P=0.028)and atrial fibrillation history(P=0.041)were independent risk factors for bleeding events.The logistic regression of death events within 3 months showed that the age(P=0.043),the higher the initial NIHSS score(P=0.013)and atrial fibrillation(P=0.021)were independent risk factors for 3-month death.Combined with stroke history(P=0.011)was independent favorable factor to reduce the incidence of death.The mRS score ? 3 within 3 months was classified as poor prognosis.The logical regression analysis of showed that older age(P=0.008),high WBC count(P=0.029),high PLT count(P=0.043)and high initial NIHSS score(P=0.004)were independent risk factors for poor prognosis at 3 months.Conclusions1.The history of female,heart failure and atrial history of fibrillation were independent risk factors for bleeding transformation within 7 days after intravenous thrombolysis in patients with cerebral infarction.2.Advanced age,high initial NIHSS score and history of atrial fibrillation were independent risk factors for death within 3 months after intravenous thrombolysis in patients with cerebral infarction,but history of stroke was favorable independent factors.3.Advanced age,high initial NIHSS score and high white blood cell count were independent risk factors for poor prognosis 3 months after intravenous thrombolysis in cerebral infarction.4.Cardiogenic cerebral infarction can increase the risk of bleeding events within 7 days,poor prognosis at 3 months and death.