| PartⅠ: Efficacy and safety of bridging treatment of trofiban after intravenous thrombolysis in mild ischemic strokeBackground:Intravenous thrombolytic therapy is an important measure to restore cerebral blood flow in the ultra-early stage of ischemic stroke.However,anticoagulant and antiplatelet aggregation drugs should not be used within 24 hours after thrombolysis,leading to the formation of a blind spot in antithrombolytic therapy after thrombolysis "within 24 hours after thrombolysis".Some patients with ischemic stroke have recurrent or worsening conditions during this period.It is a clinical research hotspot to explore the use of drugs in the blind area to avoid the progression of patients’ conditions.Based on the mature and widespread application of tirofiban in the treatment of coronary heart disease and the consensus of domestic experts on the recommendation of bridging to replace rofiban after intravenous thrombolysis for acute ischemic stroke,we assumed that bridging to replace rofiban after intravenous thrombolysis for patients with mild ischemic stroke would have good efficacy and safety.Objective:To evaluate the efficacy and safety of bridge replacement rofiban after intravenous thrombolysis in patients with mild ischemic stroke.Methods:This study was a prospective randomized controlled trial.A total of 120 patients with acute mild ischemic stroke who received intravenous alteplase thrombolysis within 4.5h of onset and admitted to Chengde Central Hospital from January 2019 to September 2020 were prospectively enrolled.They were divided into trial group and control group by random number table method: the experimental group received alteplase thrombolysis after bridge replacement rofiban maintenance therapy;The control group was treated with routine fluid rehydration after thrombolysis with alteplase.24 h later,head CT was reexamined,and after cerebral hemorrhage transformation was excluded,both groups were given aspirin 100mg+ clopidogrel 75 mg combined with antiplatelet aggregation therapy for 3 weeks,among which tirofeban was required to be treated with aspirin and clopidogrel overlapped for 4h in the experimental group.The NIHSS score decreased > by 18% or more at 24 h after thrombolysis.By comparing the modified Rankin score(m RS)24h and90 d after thrombolysis,the effectiveness of replacing rofiban with bridge after thrombolysis was evaluated to understand whether the disability rate could be significantly reduced and the prognosis of patients could be improved.In order to further evaluate the safety of rofiban replacement after thrombolysis,the percentage of cerebral hemorrhage conversion,adverse events,recurrence of cerebral infarction within 90 days and death in 2 groups were compared during treatment.Data processing methods: Measurement data were expressed as mean ± standard deviation,and independent sample t test was used for comparison between the two groups.Enumeration data were expressed as percentage,and χ2 test was used for comparison between the two groups.The test standard P=0.05,and P<0.05 indicated statistical significance.Results:1.The total effective rate 24 hours after thrombolysis in the experimental group was 91.7%,which was significantly higher than that in the control group(78.3%),the difference being statistically significant(P<0.05).2.The experimental group before thrombolysis baseline NIHSS score(3.83±1.34),1 h after thrombolysis NIHSS score(2.48±1.73),24 h after thrombolysis NIHSS score(1.67±1.37);Control group before thrombolysis baseline NIHSS score(3.27±1.40),1 h after thrombolysis NIHSS score(2.38±2.46),24 h after thrombolysis NIHSS score(2.38±3.67);There were no significant differences in NIHSS scores between the experimental group and the control group before and after thrombolysis(P>0.05).NIHSS scores in experimental group at 24 h after thrombolysis were significantly lower than those in control group,and the difference was statistically significant(P<0.05).3.The experimental group 24 h after thrombolysis m RS score(1.55±1.11),the 90 d m RS score(0.63±0.83);Control group 24 h after thrombolysis m RS score(2.30±1.41),the 90 d m RS score(1.12 ± 1.27);After thrombolysis,the m RS score of experimental group was significantly lower than that of control group at 24 h and 90 d,with statistical significance(P<0.05).4.The conversion rate of intracerebral hemorrhage(0),the incidence of adverse events(8.3%),the recurrence rate of cerebral infarction within 90days(5.0%),and the mortality rate(1.7%)in experimental group;In the control group,the conversion rate of cerebral hemorrhage(3.3%),the incidence of adverse events(100%),the recurrence rate of cerebral infarction within 90 days(8.3%),and the mortality rate(3.3%)were observed.Compared with the control group,there was no increase in cerebral hemorrhage transformation,adverse events,recurrence of cerebral infarction and death at 90 days in the experimental group,and there was no statistical significance(P>0.05).Conclusion:Subsequent rofiban therapy after intravenous thrombolysis in mild ischemic stroke can achieve more obvious clinical efficacy,improve neurological impairment,reduce disability rate and improve short-term prognosis.The conclusions of this study have certain guiding value in the clinical treatment of bridge replacement of rofiban after intravenous thrombolysis for mild ischemic stroke.However,due to the fact that this study was a single center with a small sample size and fewer cases of bleeding conversion,the conclusions of this study may be biased to a certain extent.PartⅡ: Analysis of risk factors affecting the prognosis of intravenous thrombolysis in mild ischemic strokeBackground:The occurrence and development of ischemic stroke are related to the changes of various physical and chemical factors in cerebral artery wall and lumen.At present,intravenous thrombolysis is the preferred treatment for hyperacute cerebral infarction,and the prognosis of thrombolysis varies among patients with different Mild Ischemic Stroke(MIS).The search for independent prognostic risk factors can help predict and evaluate the benefits and risks of intravenous thrombolytic therapy in MIS patients,so as to help clinicians to develop appropriate treatment measures for patients.Objective:To analyze the prognostic factors of thrombolytic therapy in patients with MIS by univariate and multivariate Logistic regression.Methods:In the first part of this study was the control group(plain)in patients with venous thrombolysis treatment based on clinical data continue to collect during the period of 2019-01 to 2020-09 in chengde city central hospital,160 cases with acute light ischemic stroke patients treated as the research object,the thrombolysis time window(< 4.5 h)give rt-PA intravenous thrombolysis treatment,24 h after thrombolysis review head CT ruled out after cerebral hemorrhage transformation,75 mg to 100 mg of aspirin + clopidogrel combined therapy with platelet aggregation in 3 weeks,the patient’s general demographic information collection,hematology indexes were compared,with 90 days of follow-up;To further analyze the risk factors affecting the prognosis of intravenous thrombolytic therapy for mild ischemic stroke.Data processing methods: enumeration data was expressed as percentage,and χ2 test was used for comparison.Multivariate analysis was conducted by Logistic regression analysis.The test standard was P=0.05,and P<0.05 indicated statistically significant difference.Results:1.A total of 29 patients(18.12%)with poor prognosis(MRS: 3-5)were confirmed by follow-up.2.On a variety of related factors affecting the prognosis study object respectively through single factor and multiple factors Logistic regression analysis showed that: before the onset of antithrombotic drugs,thrombolysis time window of 3-4.5h,baseline NIHSS score≥3,Glu >6.1 mmol/L,the influence of prognosis after thrombolysis in patients with MIS was statistically significant,P< 0.05,explain such indicators are light intravenous thrombolysis in patients with ischemic stroke in the independent risk factors of prognosis.Conclusion:no history of antithrombolytic drugs,thrombolytic time window of 3-4.5h,baseline NIHSS score ≥3,Glu>6.1mmol/L,independent risk factors affecting the prognosis of patients with mild ischemic stroke.This study may suggest that clinicians may be able to develop appropriate treatment and health education based on independent risk factors to maximize the prognosis of patients with mild ischemic stroke. |
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