Observation Of The Effect Of Urokinase And Alteplase In The Treatment Of Patients Aged Over 80 Years With Acute Ischemic Stroke

Objective: The present study aimed to explore the effectiveness and safety of intravenous thrombolysis with urokinase in patients aged over 80 years with acute ischemic stroke(AIS).Methods: A retrospective study of patients aged over 80 years who received intravenous thrombolysis in the comprehensive stroke center at Yongchuan Hospital of Chongqing Medical University between June 2017 and October 2020 was conducted.The patients were divided into two groups based on the use of thrombolytic agents.44 patients was in the urokinase group and 62 patients was in the alteplase group.Two subgroups were specified based on vessel condition(large vessel occlusion [LVO] or non-large vessel occlusion [non-LVO]).Patients in urokinase group and alteplase group were matched by using propensity score matching(PSM),and 29 pairs of patients were successfully matched.The effectiveness outcomes and safety outcomes were analyzed in alteplase group and urokinase group.Results: The rate of favorable outcome was 29.5% in the urokinase group and 43.5% in the alteplase group.The rates of death and intracerebral hemorrhage(ICH)in urokinase group were 40.9% and 9.1%,respectively.And the rates of death and ICH in alteplase group were 24.2%and 14.5%,respectively.After PSM,there were no significant differences in the effectiveness and safety outcomes between the alteplase group and urokinase group(P>0.05).In the LVO stroke patients,the urokinase group got a significantly lower rate of favorable outcome(5.9% vs 40.0%;P<0.05),higher modified Rankin Scale(m RS)score at 90 days(6[5-6] vs4[1-6];P<0.05)than the alteplase group.While in the non-LVO stroke patients,there were no significant difference in the favorable outcome(50.0% vs 66.7%;P>0.05),m RS score at 90 days(3[0-6] vs 1[0-5];P>0.05)between the two groups.Conclusions: Intravenous thrombolysis with urokinase is relatively effective and safe in AIS patients aged over 80 years.Urokinase is a potential thrombolytic agent in AIS patients aged over 80 years who are not eligible for intravenous thrombolysis with alteplase for economic reasons or within 4.5～6h of symptom onset.In addition,comparing with LVO stroke patients,intravenous thrombolysis with urokinase may be more suitable for non-LVO stroke patients aged over 80 years.