Clinical efficacy and safety of intravenous thrombolysis with recombinant human TNK tissue-type plasminogen activator and reteplase plasminogen activator in patients with acute ischemic stroke
10.3969/j.issn.1008-9691.2024.05.007
- VernacularTitle:急性缺血性脑卒中患者应用替奈普酶和瑞替普酶静脉溶栓的临床有效性及安全性差异分析
- Author:
Feng GAO
1
;
Xulei WANG
;
Zhengcui LIU
Author Information
1. 渭南市中心医院急诊科,陕西渭南 714000
- Publication Type:Journal Article
- Keywords:
Acute ischemic stroke;
Intravenous thrombolysis;
Recombinant human TNK tissue-type plasminogen activator;
Reteplase plasminogen activator
- From:
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
2024;31(5):561-565
- CountryChina
- Language:Chinese
-
Abstract:
Objective To compare the clinical efficacy and safety of intravenous thrombolytic therapy with recombinant human TNK tissue-type plasminogen activator (rhTNK-tPA) and reteplase plasminogen activator (r-PA) in patients with acute ischemic stroke (AIS). Methods A total of 108 AIS patients admitted to the department of emergency of Pucheng County Hospital from January 2018 to December 2020 were selected as research objects. According to different intravenous thrombolytic drugs,the patients were divided into rhTNK-tPA group (60 cases) and r-PA group (48 cases). The rhTNK-tPA group was treated with 0.25 mg/kg rhTNK-tPA,which was dissolved in 3 mL sterile water for injection and rapidly injected intravenously within 5-10 s. In the r-PA group,18 mg r-PA was dissolved in 100 mL normal saline,10 mL was injected intravenously within 3 minutes,and the remaining 90 mL was infused intravenously within 1 hour. The National Institute of Health Stroke Scale (NIHSS) score was used to evaluate the changes in the degree of neurological deficit in the two groups before treatment and 24 hours,7 days and 14 days after treatment. Barthel index (BI) score was used to evaluate the changes in the activities of daily living (ADL) of the two groups. The coagulation function indicators,differences in clinical efficacy and the incidence of symptomatic intracranial hemorrhage (sICH) between the two groups were observed. Results Activated partial thromboplastin time (APTT) and prothrombin time (PT) after thrombolytic treatment in rhTNK-tPA group were significantly longer than those before treatment[APTT (s):34.20±7.62 vs. 29.73±5.76,PT (s):13.98±3.15 vs. 10.16±1.92,both P<0.05],the international normalized ratio (INR) was significantly higher than that before treatment (1.21±0.31 vs. 1.06±0.12,P<0.05),and the fibrinogen (Fib) was significantly lower than that before treatment (g/L:2.45±1.03 vs. 3.35±1.31,P<0.05). In the r-PA group,only Fib was significantly decreased after treatment (g/L:2.28±0.98 vs. 3.40±1.37,P<0.05). PT in rhTNK-tPA group was significantly higher than that in r-PA group (s:13.98±3.15 vs. 11.23±2.43,P<0.05). The NIHSS scores at each time point after thrombolysis were significantly lower than those before thrombolysis in both groups and the NIHSS scores at 24 hours and 7 days after thrombolysis in rhTNK-tPA group were significantly lower than those in r-PA group (24 hours after treatment:5.96±1.54 vs. 7.55±2.16,7 days after treatment:2.48±0.75 vs. 3.29±0.88,both P<0.05). BI scores at 24 hours,7 days and 14 days after thrombolytic therapy were significantly higher than those before thrombolytic therapy in both groups (rhTNK-tPA group:78.92±9.68、85.66±9.79、92.63±9.98 vs. 66.46±8.83,r-PA group:77.87±9.70、83.49±9.68、91.36±9.80 vs. 67.45±9.16,all P<0.05),but there was no significant difference in BI scores between the two groups at each time point. The total effective rate of thrombolysis in rhTNK-tPA group was significantly higher than that in r-PA group[93.3％ (57/60) vs. 85.4％ (41/48),P<0.05]. In terms of safety outcomes,the incidence of sICH within 36 hours after thrombolysis in rhTNK-tPA group was significantly lower than that in r-PA group[6.67％ (4/60) vs. 10.42％ (5/48),P<0.05]. Conclusions The use of rhTNK-tPA or r-PA intravenous thrombolytic drugs in the treatment of AIS is safe and effective. Compared with r-PA,rhTNK-tPA can improve the symptoms of neurological deficit faster,with higher safety and total effective rate.
