Study On The Predictive Value Of Coagulation-Related Indicators For Vascular Reocclusion After Early Stage Of Intravenous Thrombolysis In Patients With Acute Cerebral Infarction

Objective: Although the intravenous thrombolysis is an important method for curing the acute cerebral infarction,the vascular reocclusion is usually one of the key reasons to result in the poor prognosis.In this study,we analyzed the predictive value of single-index and joint-index testings of fibrinogen(FIB),D-dimer(D-D),activated partial thromboplastin time(APTT),prothrombin time(PT),thrombin time(TT),mean platelet volume(MPV)and platelet distribution width(PDW)in predicting the vascular reocclusion of acute cerebral infarction patients after intravenous recombinant tissue plasminogen activator(IV rt-PA).Moreover,we compared the predictive value,to know which is more reliable between single-index testing and joint-index testing.Methods: This study collected the data of patients with acute cerebral infarction after the stroke and treated with intravenous recombinant tissue plasminogen activator from May 2019 to December2020 in the Department of Neurology of the First People’s Hospital of xx,and recorded the baseline scores of FIB,D-D,APTT,PT,TT,MPV,PDW,NIHSS(National Institute of Health Stroke Scale),and the NIHSS scores of multiple time points within 24 hours after the IV rt-PA treatment.All the patients were divided into recanalization group and reocclusion group according to the variations of their NIHSS scores.To determine the differences between the two groups by using single-variable analysis and multi-variable logistic regression analysis among the baseline scores of FIB,D-D,APTT,PT,TT,MPV and PDW.A prediction model was established to compare the predictive value of the prediction model and a single index for vascular reocclusion within 24 hours after intravenous thrombolysis with alteplase.Results: All 144 cases were diagnosed as acute cerebral infarction and were treated with intravenous recombinant tissue plasminogen activator,In these cases,4 patients with Symptomatic intracranial hemorrhage(s ICH),46 patients with persistent vascular reocclusion,the incidence of s ICH was 2.77% and the vascular recanalization rate was65.27%.According to the inclusion and exclusion criteria,the reocclusion rate is 23.40% by collecting the data of 94 enrolled patients,which included 72 cases in the recanalization group and 22 cases in the reocclusion group.According to the single-variable analysis,the differences of genders(p=0.031),age(p=0.002),PT(p< 0.001),FIB(p=0.013),D-D(p< 0.001),MPV(p< 0.001)of these two groups indicated statistical significances.The values of these indices in reocclusion group were higher than that of recanalization group.However,compared these two groups,TT in the reocclusion group at admission was less than that in the continuous improvement group(p=0.032).It means there was no statistical significance in other indicators between the two groups(p >0.05).In the multi-variable logistic regression analysis,the baseline scores of D-D(OR = 3.68,95%CI: 2.22 – 24.60)and MPV(OR = 3.21,95%CI: 1.67 – 7.66)are the predictive factors of vascular reocclusion,high D-D and high MPV are more likely to cause vascular reocclusion.Moreover,the area under the ROC curve of D-D,MPV and that of the prediction model were 0.893(0.811,0.974),0.783(0.671,0.896)and0.943(0.893,0.993),respectively.Among them,we found larger area under ROC curve in the prediction model,so it indicated the join-index testing is more suitable on predicting the vascular reocclusion within 24 hours after the intravenous thrombolysis with IV rt-PA treatment.Conclusions: 1.The relatively higher value of D-D and MPV at admission are predictive factors on the vascular reocclusion within 24 hours after the IV rt-PA treatment.2.Compared with the single-variable analysis of D-D or MPV baseline scores,the joint prediction model combining with D-D and MPV baseline scores is more suitable to predict the vascular reocclusion within24 hours after the IV rt-PA treatment.