Efficacy And Safety Of Intravenous Thrombolysis In Patients With Acute Mild Non-disabling Ischemic Stroke

Objective:The purpose of this study was to compare the efficacy and safety of intravenous thrombolysis and antiplatelet therapy in patients with mild non-disabling ischemic stroke within 4.5 h of onset,as well as the risk factors affecting the prognosis at 90 days.Methods:A total of 197 patients with mild non-disabled stroke who were hospitalized into SuBei Hospital within 4.5 hours of onset from January 2018 to December 2019 were selected.They were divided into the intravenous thrombolysis group(83 patients),the non-intravenous thrombolysis group(114 patients)according to whether they had intravenous thrombolysis or not.The non-intravenous thrombolysis group included double antiplatelet therapy group(38 patients)and the single antiplatelet therapy group(76 patients).Baseline data of patients were collected(including sex,age,baseline NIHSS score,systolic blood pressure,diastolic blood pressure,history of smoking and drinking,past hypertension,diabetes mellitus,hyperlipidemia,atrial fibrillation,history of cerebral infarction)and related auxiliary examinations.Nerve function defect degree of the patients was evaluated by the National Institute of Health stroke scale(NIHSS)score.Short-term therapeutic effect,neurologic deterioration,symptomatic intracranial hemorrhage(s ICH)and the prognosis of 90 days between the groups were compared.Based on the Trial of Org 10172 in Acute Stroke Treatment(TOAST)classification,we to evaluate the efficacy,safety and prognosis of each type.Finally,the risk factors affecting the prognosis of patients at 90 days were analyzed.SPSS22.0statistical software was used for data analysis and processing.Results:1.1 The baseline data of the intravenous thrombolysis group and the non-intravenous thrombolysis group were compared,and the difference was not statistically significant(P>0.05).1.2 Comparison of the effective rate between the intravenous thrombolysis group and the non-intravenous thrombolysis group showed that there were 29 effective cases(34.94%)in the intravenous thrombolysis group and 39 effective cases(34.21%)in the non-intravenous thrombolysis group,and the difference was not statistically significant(P>0.05).Neurological deterioration occurred in 8 patients(9.64%)in the intravenous thrombolysis group and 10(8.77%)in the non-intravenous thrombolysis group,and the difference was not statistically significant(P=0.835).One case of symptomatic intracranial hemorrhage and 1 case of non-symptomatic intracranial hemorrhage were detected in the intravenous thrombolysis group and 0 case was detected in the non-intravenous thrombolysis group.There was no statistically significant difference between these two groups.There were 65 patients(78.31%)with favourable prognosis in the intravenous thrombolysis group,and 103 patients(90.35%)in the non-intravenous thrombolysis group.The difference was statistically significant(P=0.019).2.1 Efficacy rate,neurological deterioration rate,bleeding rate and favourable prognosis rate were compared between the intravenous thrombolysis group and the dual antiplatelet therapy group.Among them,83 cases were found in the intravenous thrombolysis group and 38 cases in the double-antibody group.There was no statistical difference in baseline data.The rate of favourable prognosis was 38(100%)in the dual antiplatelet therapy group and 65(78.31%)in the intravenous thrombolysis group,with statistically significant difference,while there was no statistically significant difference in other indicators.3.1 Efficacy rate,neurological deterioration rate,bleeding rate and favourable prognosis rate were compared between the dual antiplatelet therapy group and the single antiplatelet therapy group.The favourable prognosis rate was 38(100%)in the dual antiplatelet therapy group and 65(85.53%)in the single antiplatelet therapy group.The difference was statistically significant(P=0.015).There was no statistical difference in the rest.4.1 Patients were classified according to TOAST classification,and there was no statistical difference in baseline data between groups.The effective rate,deterioration rate of neurological function,bleeding rate and favourable prognosis rate were compared.The results showed that the deterioration rate of neurological function was 9(36%),and the favourable prognosis was 13(52%)in the Large Artery Atherosclerosis(LAA).The difference was statistically significant.There was no statistical difference in the rest.5.1 Patients were divided into the favourable prognosis group and the unfavourable prognosis group.Univariate analysis showed that the baseline NIHSS score,intravenous thrombolysis,and Hb A1 c in the unfavourable prognosis group were higher than those in the favourable prognosis group.Further logistic regression analysis showed that the baseline NIHSS score(OR value 0.723,95% confidence interval 0.534-0.926,P value0.010)was likely to be an independent risk factor for unfavourable 90-day prognosis.Conclusion:1.Mild non-disabling ischemic stroke patients treated with dual antiplatelet therapy within 4.5 h from onset have better 90-day prognosis than that treated with intravenous thrombolytic therapy and the single antiplatelet therapy.Intravenous thrombolysis did not increase the incidence of symptomatic intracranial hemorrhage.2.Large artery atherosclerosis cerebral infarction has a higher rate of neurological deterioration and a worse 90-day prognosis than other types of cerebral infarction.3.A higher baseline NIHSS score is an independent risk factor for prognosis in unfavourable patients with mild non-disabling ischemic stroke.