|
|
|
| Effectiveness of Urokinase and Alteplase in the treatment of super-aged patients with acute ischemic stroke#br# |
| ZHOU Ting1,2 LIAO Juan2,3 LIU Li4 ZHAO Libo1,2,3 YANG Yonghong1,2 LIU Qingjun1,2 LIU Shudong1,2 YANG Deyu1,2,3,5 |
1.Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing 402160, China;
2.Chongqing Key Laboratory of Cerebrovascular Disease Research, Chongqing 402160, China;
3.Central Laboratory, Yongchuan Hospital of Chongqing Medical University, Chongqing 402160, China;
4.Department of Health Management, Yongchuan Hospital of Chongqing Medical University, Chongqing 402160, China;
5.Department of Internal Medicine, Changdu People’s Hospital, Tibet Region, Changdu 854000, China |
|
|
|
|
Abstract Objective To explore the effectiveness of Urokinase and Alteplase in the treatment of super-aged patients with acute ischemic stroke (AIS). Methods The clinical data of 106 super-aged patients with AIS treated in Yongchuan Hospital of Chongqing Medical University from June 2017 to October 2020 was analyzed retrospectively. According to different thrombolytic drugs, they were divided into Urokinase group (44 cases) and Alteplase group (62 cases). Twenty-nine pairs of patients in two groups were screened by propensity score matching, including 17 patients with large vessel occlusion (LVO) and 12 patients with non-LVO in the Urokinase group, Alteplase group included 20 LVO patients and 9 non-LVO patients. The baseline characteristics and observation indexes (rate of favorable outcome, modified Rankin scale[mRS] score at 90 days, changes of the National Institutes of Health stroke scale score, death rate, rate of intracranial hemorrhage, rate of symptomatic intracranial hemorrhage, and rate of extracranial hemorrhage) were compared between the two groups. Results Before matching, the time from onset to thrombolysis in urokinase group was longer than that in Alteplase group, the difference was statistically significant (P ＜ 0.05), while there was no significant difference in other baseline data and observation indicators (P ＞ 0.05). After matching, there were no significant differences in baseline data and observation indicators between the two groups (P ＞ 0.05). In LVO patients, the rate of favorable outcome of Urokinase group was lower than that of alteplase group, and the mRS score at 90 days was higher than that of Alteplase group, with statistical significance (P ＜ 0.05). In non-LVO patients, there was no statistical significance between the two groups (P ＞ 0.05). Conclusion Intravenous Urokinase thrombolytic therapy for AIS in super-aged patients is relatively safe and effective. In super-aged patients with non-LVO stroke, the efficacy of Urokinase is comparable to that of Alteplase intravenous thrombolytic therapy, and it can be used as a substitute for Alteplase.
|
|
|
|
|
|
[1] 王拥军，李子孝，谷鸿秋，等.中国卒中报告2019（中文版）（1）[J].中国卒中杂志，2020，15（10）：1037-1043.
[2] Matuja SS，Munseri P，Khanbhai K. The burden and outcomes of stroke in young adults at a tertiary hospital in Tanzania：a comparison with older adults [J]. BMC Neurol，2020，20（1）：206.
[3] Carbajo-Garcia AM，Cortes J，Arboix A，et al. Predictive clinical features of cardioembolic infarction in patients aged 85 years and older [J]. J Geriatr Cardiol，2019，16（11）：793-799.
[4] Powers WJ，Rabinstein AA，Ackerson T，et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke：2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke：A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association [J]. Stroke，2019， 50（12）：e344-e418.
[5] Berge E，Whiteley W，Audebert H，et al. European Stroke Organisation（ESO）guidelines on intravenous thrombolysis for acute ischaemic stroke [J]. Eur Stroke J，2021，6（1）：Ⅰ-LⅫ.
[6] Dong Q，Dong Y，Liu L，et al. The Chinese Stroke Association scientific statement：intravenous thrombolysis in acute ischaemic stroke [J]. Stroke Vasc Neurol，2017，2（3）：147-159.
[7] Lee RS，Ok YC，Lim JS，et al. Outcome evaluation of intravenous infusion of urokinase for acute ischemic stroke [J]. Chonnam Med J，2012，48（1）：52-56.
[8] Misra V，El KR，Arora R，et al. Safety of high doses of urokinase and reteplase for acute ischemic stroke [J]. AJNR Am J Neuroradiol，2011，32（6）：998-1001.
[9] 彭斌，吴波.中国急性缺血性脑卒中诊治指南2018[J].中华神经科杂志，2018，51（9）：666-682.
[10] World Health Organization. ICD-11 for mortality and morbidity statistics（2021）. 8B11 Cerebral ischaemic stroke. [2021-6-21]. https://icd.who.int/browse11/l-m/en.
[11] Wilson JT，Hareendran A，Grant M，et al. Improving the assessment of outcomes in stroke：use of a structured interview to assign grades on the modified Rankin Scale [J]. Stroke，2002，33（9）：2243-2246.
[12] 中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志，2015，48（4）：246-257.
[13] Heldner MR，Zubler C，Mattle HP，et al. National Institutes of Health stroke scale score and vessel occlusion in 2152 patients with acute ischemic stroke [J]. Stroke，2013，44（4）：1153-1157.
[14] Adams HJ，Bendixen BH，Kappelle LJ，et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment [J]. Stroke，1993，24（1）：35-41.
[15] Rennert RC，Wali AR，Steinberg JA，et al. Epidemiology，Natural History，and Clinical Presentation of Large Vessel Ischemic Stroke [J]. Neurosurgery，2019，85（suppl 1）：S4-S8.
[16] von Kummer R，Broderick JP，Campbell BC，et al. The Heidelberg Bleeding Classification：Classification of Bleeding Events After Ischemic Stroke and Reperfusion Therapy [J]. Stroke，2015，46（10）：2981-2986.
[17] Mishra NK，Ahmed N，Andersen G，et al. Thrombolysis in very elderly people：controlled comparison of SITS International Stroke Thrombolysis Registry and Virtual International Stroke Trials Archive [J]. BMJ，2010，341：c6046.
[18] Chen Y，Li CH，Wang YX，et al. Safety and Effectiveness of Intravenous Thrombolysis with Recombinant Tissue Plasminogen Activator in 80 Years and Older Acute Ischemic Stroke Patients [J]. Cell Biochem Biophys，2015， 72（3）：883-888.
[19] Ford GA，Ahmed N，Azevedo E，et al. Intravenous alteplase for stroke in those older than 80 years old [J]. Stroke，2010，41（11）：2568-2574.
[20] Lorenzano S，Vestri A，Lancia U，et al. Thrombolysis in elderly stroke patients in Italy（TESPI）trial and updated meta-analysis of randomized controlled trials [J]. Int J Stroke，2021，16（1）：43-54.
[21] Pego PM，Nunes AP，Ferreira P，et al. Thrombolysis in Patients Aged over 80 Years Is Equally Effective and Safe [J]. J Stroke Cerebrovasc Dis，2016，25（6）：1532-1538.
[22] 余练，严洪新，罗建华.超高龄脑梗死患者超早期应用尿激酶静脉溶栓的效果及安全性[J].血栓与止血学，2017，23（6）：915-917.
[23] 于丽波，王帅，姜瀛，等.尿激酶静脉溶栓与超选择性动脉溶栓治疗急性大脑中动脉脑梗死的效果[J].中国医药导报，2019，16（4）：100-103，111.
[24] Bluhmki E，Danays T，Biegert G，et al. Alteplase for Acute Ischemic Stroke in Patients Aged ＞ 80 Years：Pooled Analyses of Individual Patient Data [J]. Stroke，2020，51（8）：2322-2331.
[25] Uyttenboogaart M，Schrijvers EM，Vroomen PC，et al. Routine thrombolysis with intravenous tissue plasminogen activator in acute ischaemic stroke patients aged 80 years or older： a single centre experience [J]. Age Ageing，2007，36（5）：577-579.
[26] Song K，Guan M，Li W，et al. Acute ischemic stroke patients with diffusion-weighted imaging-Alberta Stroke Program Early Computed Tomography Score ≤ 5 can benefit from endovascular treatment：a single-center experience and literature review [J]. Neuroradiology，2019， 61（4）：451-459.
[27] 陈培材，饶俊平，廖伟锋.阿替普酶与尿激酶溶栓对超早期急性脑梗死患者神经功能的影响[J].中国当代医药，2019，26（13）：84-87.
[28] 薛桦.尿激酶与阿替普酶治疗急性脑梗死的疗效对比[J].药物评价研究，2016，39（5）：828-831. |
|
|
|
