Clinical Effect Of Intravenous Thrombolysis With Different Doses Of Alteplase In The Treatment Of Mild Ischemic Stroke

Objective: To study the clinical efficacy and safety of intravenous thrombolysis with different doses of alteplase(RT-PA)in the treatment of mild ischemic stroke.Methods: A total of 170 patients with mild ischemic stroke(NIHSS score ≤5 points)in the Third People’s Hospital of Hubei Province from January 2017 to December 2020 were enrolled and divided into low-dose and standard dose groups,with 85 patients in each group receiving 0.6mg/kg alteplase and 0.9mg/kg alteplase,respectively.The general information,effective rate after treatment,NIHSS score at 24 h,7 and 14 days after intravenous thrombolysis,prognosis and adverse reactions after treatment were compared between the low-dose and standard dose groups.Results:(1)After the comparison of the basic information of the two groups,such as gender characteristics,age,past medical history,smoking,drinking,duration from onset to thrombolysis and NIHSS score before intravenous thrombolysis,there was no statistical significance(P>0.05).(2)Comparison of early effects between the two groups: after 24 hours of treatment,the effective rate of the low-dose group was 58.82%(50/85),and the effective rate of the standard dose group was 55.29%(47/85).After 7 days of treatment,the effective rate was 69.41%(59/85)in the low-dose group and 64.71%(55/85)in the standard-dose group.After 14 days of treatment,the effective rate of the low-dose group was 78.82%(67/85),and that of the standard dose group was 72.94%(62/85),and there was no statistical significance between the two groups(P>0.05).(3)Comparison of NIHSS evaluation: After intravenous thrombolysis,NIHSS score of the two groups decreased significantly compared with that before intravenous thrombolysis(P < 0.05);NIHSS scores at 24 h,7 d and 14 d after intravenous thrombolysis were similar between the two groups,and there was no statistical significance(P>0.05).(4)Comparison of early neurological deterioration: the rate of neurological deterioration after 24 hours was 4.71%(4/85)in the low-dose group and 7.06%(6/85)in the standard dose group,and the difference was not statistically significant(P>0.05).(5)Comparison of adverse reactions to bleeding: The serious adverse reactions to bleeding were 9.41%(8/85)in the low-dose group and 21.18%(18/85)in the standard dose group,showing a difference(2 =4.54,P=0.03).(6)Comparison of good prognosis at 30 days: The good prognosis rate(m RS < 2points)at 30 days in the low-dose group was 89.41%(76/85),The good prognosis rate(m RS< 2 points)at 30 days in standard dose group was 88.24%(75/85),and the difference was not statistically significant(P>0.05).Conclusion:(1)In the time window,alteplase(RT-PA)had obvious effect in the treatment of mild ischemic stroke,and the effect of the low-dose group was similar to that of the standard dose group.(2)Alteplase(RT-PA)can improve nerve defect function,reduce disability rate and improve prognosis,but there was no significant difference between the low-dose group and the standard dose group.(3)Compared with the standard dose of alteplase(RT-PA),the low dose alteplase has less adverse bleeding reactions and higher safety.