The efficacy and safety of intravenous thrombolysis in elderly patients with mild ischemic stroke
10.3760/cma.j.issn.0254-9026.2019.12.006
- VernacularTitle: 老年轻型急性缺血性脑卒中患者早期静脉溶栓治疗的疗效及安全性评估
- Author:
Lidong DING
1
;
Zhanghong XIAO
1
;
Huawu MAO
1
;
Xiaofang HANG
1
;
Xiaobo LU
1
;
Yuqing SHEN
1
;
Qi FANG
2
;
Jue CHEN
1
Author Information
1. Department of Neurology, the Second People’s Hospital of Taizhou Affiliated to Yangzhou University, Taizhou 225500, China
2. Department of Neurology, the First Affiliated Hospital of Suzhou University, Suzhou 215000, China
- Publication Type:Journal Article
- Keywords:
Stroke;
Brain Ischemia;
Thrombolytic therapy
- From:
Chinese Journal of Geriatrics
2019;38(12):1344-1347
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To evaluate the efficacy and safety of intravenous thrombolysis with recombinant tissue-plasminogen activator (rt-PA) in elderly patients with early-stage mild ischemic stroke (IS).
Methods:This was a prospective, open-label, controlled study.Ninety-four elderly patients with mild IS admitted to our hospital from January 2014 to December 2017 were randomized into a thrombolysis arm (TA, n=46) and a control arm (CA, n=48). The short-term endpoints were the National Institutes of Health stroke scale (NIHSS) scores on 3rd, 7th, 14thday after admission and the secondary endpoints were the modified Rankin Scale (mRS) score and the morbidity of recurrence IS within 90 days.Safety was evaluated by the incidence of intracranial hemorrhage (IH) and early neurological deterioration (END) during hospitalization.
Results:The baseline NIHSS scores of patients in the TA and CA groups were similar [(4.1±0.7) vs.(4.1±0.7)]. However, there were significant differences in the NIHSS score on 3rd [(3.4±1.2) vs.(4.2±1.4)], 7th[(3.0±1.8) vs.(4.1±1.6)] and 14thday [(2.5±2.0) vs.(3.4±1.6)], respectively, between the TA group and the CA group.Furthermore, the TA group was associated with a significantly higher proportion of patients with good prognosis (mRS, 0-2), compared with the CA group (71.7% vs.35.4%, P<0.01). Receiver operating characteristic curve analysis showed that patients with baseline NIHSS>3 could benefit from thrombolytic therapy.There were 1 case of symptomatic IH and 1 case of progressive stroke in the TA group, and 1 case of IH and 2 cases of progressive stroke in the control group.There were no significant differences in the rate of either END or IH between the two groups (P>0.05). Two patients in the TA group and three patients in the control group had recurrent IS within 90 days and the recurrence rate of IS was also similar within 90 days (P>0.05).
Conclusions:Intravenous thrombolytic therapy with rt-PA can improve the prognosis of elderly patients with mild stroke without increased risk of END, IH, or recurrence of IS.
