Study On The Efficacy And Safety Of Low-dose Alteplase In The Treatment Of Elderly Patients With Acute Ischemic Stroke

Objective : To study the difference in efficacy and safety between low-dose(0.6mg / kg)and standard-dose(0.9mg / kg)alteplase intravenous thrombolysis in elderly(≥ 80 years)patients with acute ischemic stroke.Methods : A total of 139 patients with acute ischemic stroke who were treated in WUHAN NO.1 HOSPITAL from January 2017 to December 2022 were collected.According to the different doses of alteplase,they were divided into a standard dose(0.9mg / kg)group of 62 patients and a low dose(0.6mg / kg)group of 77 patients.The general data of the two groups of patients,the incidence of bleeding adverse events within 36 hours after thrombolysis,the NHISS score before treatment and 24 hours and 7 days after treatment,the mRS score before treatment and 3 months after treatment,and the mortality rate 3 months after treatment were collected.The short-term efficacy and neurological function improvement were evaluated by comparing the NHISS scores before and 7 days after treatment.The long-term good functional prognosis was evaluated by comparing the mRS scores and the ratio of patients with 0-1 points before and 3 months after treatment.The safety of different doses of treatment was evaluated by comparing 36 h symptomatic intracranial hemorrhage and mortality at 3 months after treatment.Results :1.There was no significant difference between the two groups in demographic data(age,gender),past history(hypertension,coronary heart disease,diabetes mellitus,atrial fibrillation 、 smoking history),laboratory examination(blood pressure,blood glucose,coagulation function,platelet count),TOAST classification,onset to needle time(ONT)and door to needle time(DNT)(P > 0.05).2.Early neurological function changes(24h,7d NHISS score compared with NHISS score before treatment)in both groups were significantly improved(P>0.05).3.There was no significant difference in the early efficacy between the two groups(71.43% vs 64.51%,P > 0.05).4.In terms of long-term good functional prognosis(mRS score at 3 months compared with mRS score before treatment),both groups could obtain good prognosis after treatment(P < 0.05);There was no significant difference in mRS score between the two groups before and after treatment(P > 0.05).5.There was no significant difference in the long-term prognosis between the two groups(the proportion of patients with mRS score 0-1 :40.26% vs 35.48%,P > 0.05).6.There was a statistically significant difference in symptomatic intracranial hemorrhage between the two groups after treatment(2.60% vs 12.90%,P < 0.05);there was significant difference in the total incidence of bleeding adverse events between the two groups after treatment(27.27% vs 45.16%,P < 0.05).There was no significant difference in3-month mortality between the two groups(10.39% vs 12.90%,P > 0.05).Conclusion :The efficacy of low-dose(0.6mg / kg)alteplase intravenous thrombolysis in the treatment of elderly patients(≥ 80 years old)with acute ischemic stroke is comparable to that of standard dose(0.9mg / kg).In terms of safety,it can significantly reduce the incidence of symptomatic intracranial hemorrhage and bleeding adverse events,which is generally better than standard measurement.