Efficacy and safety of two different thrombolytic therapies for patients with hyperacute ischemic stroke_West China Medical Journal

Authors：

WANG Yan ¹ , LI Yanfang ¹ , ZHEN Zuorui ¹ , YANG Kemin ¹ , ZHANG Wenping ¹ ,  SHEN Ying ² ,  ZHU Dekun ¹

1. Department of Neurology, Shihezi People’s Hospital, Xinjiang, Shihezi 832000, P. R. China;
2. Department of Traditional Chinese Medicine, Xuanwu Hospital Affiliated to Capital Medical University, Beijing 100000, P. R. China;

Corresponding author：

SHEN Ying, Email: cshenying@163.com; ZHU Dekun, Email: 351714293@qq.com

Keywords：

Around time window; Urokinase; Alteplase; Intravenous thrombolysis; Hyperacute ischemic stroke

DOI：

10.7507/1002-0179.202103289

Video：

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Objective To observe and compare the efficacy and safety of intravenous thrombolysis with alteplase or urokinase in the first-ever acute ischemic stroke patients arriving at the hospital 3.5-4.5 h after onset.Methods Clinical data of patients with acute ischemic stroke treated in Shihezi People’s Hospital between January 2019 and October 2020 were prospectively collected. The National Insititutes of Health Stroke Scale (NIHSS) score on the 7th day and the 90th day, the modified Rankin Scale (mRS) score and the Blessed Behavior Scale (BBS) score on the 90th day, and symptomatic bleeding within 36 h after thrombolysis were analyzed and compared between the patients receiving alteplase threatment (the alteplase group) and the ones receiving urokinase treatment (the urokinase group).Results Totally 96 patients were treated with intravenous thrombolysis. Among them, 58 patients received alteplase threatment and 38 received urokinase treatment. The difference in NIHSS, mRS, or BBS scores between the two groups before treatment was not statistically significant (P>0.05). On the 90th day after treatment, the NIHSS, mRS, and BBS scores of the alteplase group were 3.59±3.73, 2.26±1.26, and 15.33±8.28, respectively, and those of the urokinase group were 5.95±4.88, 3.00±0.87, and 20.37±11.80, respectively; the differences between the two groups were all statistically significant (P<0.05). There was no significant difference in the rate of symptomatic intracerebral hemorrhage between the two groups within 36 h after treatment (P>0.05). Multiple linear regression analyses showed that the treatment method was related to the NIHSS score on the 7th day, the NIHSS score on the 90th day, the mRS score on the 90th day, and the BBS score on the 90th day (P<0.05), the history of heart disease was related to the mRS score on the 90th day (P<0.05), and the income was related to the BBS score on the 90th day (P<0.05).Conclusion For the hyperactue ischemic stroke, the overall effect of alteplase treatment may be better than that of urokinase treatment.

Citation： WANG Yan, LI Yanfang, ZHEN Zuorui, YANG Kemin, ZHANG Wenping, SHEN Ying, ZHU Dekun. Efficacy and safety of two different thrombolytic therapies for patients with hyperacute ischemic stroke. West China Medical Journal, 2021, 36(6): 753-757. doi: 10.7507/1002-0179.202103289 Copy

1.	Sharma VK, Ng KW, Venketasubramanian N, et al. Current status of intravenous thrombolysis for acute ischemic stroke in Asia. Int J Stroke, 2011, 6(6): 523-530.
2.	陈清棠, 贺茂林, 徐忠宝, 等. 急性脑梗死(6 h 以内)静脉溶栓治疗. 中风与神经疾病杂志, 2001, 18(5): 259-261.
3.	国家“九五”攻关课题协作组. 急性脑梗死六小时以内的静脉溶栓治疗. 中华神经科杂志, 2002, 35(4): 210-213.
4.	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2018. 中华神经科杂志, 2018, 51(9): 666-682.
5.	Fischer U, Arnold M, Nedeltchev K, et al. NIHSS score and arteriographic findings in acute ischemic stroke. Stroke, 2005, 36(10): 2121-2125.
6.	Savitz SI, Lew R, Bluhmki E, et al. Shift analysis versus dichotomization of the modified Rankin scale outcome scores in the NINDS and ECASS-II trials. Stroke, 2008, 38(12): 3205-3212.
7.	张文超, 孙昭胜, 刘洪博. 3 种认知功能障碍评定量表在中、重型颅脑损伤后患者 120 例的应用研究. 重庆医学, 2013, 42(9): 988-989.
8.	Wahlgren N, Ahmed N, Davalos A, et al. Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST): an observational study. Lancet, 2007, 369(9558): 275-282.
9.	国家统计局. 中国统计年鉴. 北京: 中国统计出版社, 2019: 83-84.
10.	Benedict CR, Refino CJ, Keyt BA, et al. New variant of human tissue plasminogen activator (TPA) with enhanced efficacy and lower incidence of bleeding compared with recombinant human TPA. Circulation, 1995, 92(10): 3032-3040.
11.	Parsons M, Spratt N, Bivard A, et al. A randomized trial of tenecteplase versus alteplase for acute ischemic stroke. N Engl J Med, 2012, 366(12): 1099-1107.
12.	楼敏, 王伊龙, 李子孝, 等. 中国卒中中心建设指南. 中国卒中杂志, 2015, 10(6): 499-507.
13.	Yang FC, Lin CC, Hsueh CJ, et al. Local intra-arterial thrombolysis with urokinase for acute ischemic stroke before and after the approval of intravenous tissue plasminogen activator treatment in Taiwan. Ann Vasc Surg, 2010, 24: 1117-1124.
14.	Teng Y, Jin H, Nan D, et al. In vivo evaluation of urokinase-loaded hollow nanogels for sonothrombolysis on suture embolization-induced acute ischemic stroke rat model. Bioact Mater, 2018, 3(1): 102-109.
15.	Merino P, Diaz A, Yepes M. Urokinase-type plasminogen activator (uPA) and its receptor (uPAR) promote neurorepair in the ischemic brain. Receptors Clin Investig, 2017, 4(2): e1552.201.
16.	Akutagawa N, Sadashima S, Nakagaki H, et al. Intracerebral hemorrhage after intravenous recombinant tissue plasminogen activator (rt-PA) therapy for acute cerebral infarction in a patient with ANCA-associated vasculitis. Rinsho Shinkeigaku, 2017, 57(8): 454-456.
17.	Onatsu J, Taina M, Mustonen P, et al. Soluble urokinase-type plasminogen activator receptor predicts all-cause 5-year mortality in ischemic stroke and TIA. In Vivo, 2017, 31(3): 381-386.
18.	Simats A, Garce ıa-Berrocoso T, Montaner J. Neuroinflammatory biomarkers: from stroke diagnosis and prognosis to therapy. Biochim Biophys Acta, 2016, 1862: 411-424.
19.	王金标. 急诊阿替普酶静脉溶栓治疗急性脑梗死的效果探讨. 中国现代药物应用, 2020, 14(12): 120-122.
20.	Dong Q, Dong Y, Liu L, et al. The Chinese stroke association scientific statement: intravenous thrombolysis in acute ischaemic stroke. Stroke Vasc Neurol, 2017, 2(3): 147-159.

1. Sharma VK, Ng KW, Venketasubramanian N, et al. Current status of intravenous thrombolysis for acute ischemic stroke in Asia. Int J Stroke, 2011, 6(6): 523-530.
2. 陈清棠, 贺茂林, 徐忠宝, 等. 急性脑梗死(6 h 以内)静脉溶栓治疗. 中风与神经疾病杂志, 2001, 18(5): 259-261.
3. 国家“九五”攻关课题协作组. 急性脑梗死六小时以内的静脉溶栓治疗. 中华神经科杂志, 2002, 35(4): 210-213.
4. 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2018. 中华神经科杂志, 2018, 51(9): 666-682.
5. Fischer U, Arnold M, Nedeltchev K, et al. NIHSS score and arteriographic findings in acute ischemic stroke. Stroke, 2005, 36(10): 2121-2125.
6. Savitz SI, Lew R, Bluhmki E, et al. Shift analysis versus dichotomization of the modified Rankin scale outcome scores in the NINDS and ECASS-II trials. Stroke, 2008, 38(12): 3205-3212.
7. 张文超, 孙昭胜, 刘洪博. 3 种认知功能障碍评定量表在中、重型颅脑损伤后患者 120 例的应用研究. 重庆医学, 2013, 42(9): 988-989.
8. Wahlgren N, Ahmed N, Davalos A, et al. Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST): an observational study. Lancet, 2007, 369(9558): 275-282.
9. 国家统计局. 中国统计年鉴. 北京: 中国统计出版社, 2019: 83-84.
10. Benedict CR, Refino CJ, Keyt BA, et al. New variant of human tissue plasminogen activator (TPA) with enhanced efficacy and lower incidence of bleeding compared with recombinant human TPA. Circulation, 1995, 92(10): 3032-3040.
11. Parsons M, Spratt N, Bivard A, et al. A randomized trial of tenecteplase versus alteplase for acute ischemic stroke. N Engl J Med, 2012, 366(12): 1099-1107.
12. 楼敏, 王伊龙, 李子孝, 等. 中国卒中中心建设指南. 中国卒中杂志, 2015, 10(6): 499-507.
13. Yang FC, Lin CC, Hsueh CJ, et al. Local intra-arterial thrombolysis with urokinase for acute ischemic stroke before and after the approval of intravenous tissue plasminogen activator treatment in Taiwan. Ann Vasc Surg, 2010, 24: 1117-1124.
14. Teng Y, Jin H, Nan D, et al. In vivo evaluation of urokinase-loaded hollow nanogels for sonothrombolysis on suture embolization-induced acute ischemic stroke rat model. Bioact Mater, 2018, 3(1): 102-109.
15. Merino P, Diaz A, Yepes M. Urokinase-type plasminogen activator (uPA) and its receptor (uPAR) promote neurorepair in the ischemic brain. Receptors Clin Investig, 2017, 4(2): e1552.201.
16. Akutagawa N, Sadashima S, Nakagaki H, et al. Intracerebral hemorrhage after intravenous recombinant tissue plasminogen activator (rt-PA) therapy for acute cerebral infarction in a patient with ANCA-associated vasculitis. Rinsho Shinkeigaku, 2017, 57(8): 454-456.
17. Onatsu J, Taina M, Mustonen P, et al. Soluble urokinase-type plasminogen activator receptor predicts all-cause 5-year mortality in ischemic stroke and TIA. In Vivo, 2017, 31(3): 381-386.
18. Simats A, Garce ıa-Berrocoso T, Montaner J. Neuroinflammatory biomarkers: from stroke diagnosis and prognosis to therapy. Biochim Biophys Acta, 2016, 1862: 411-424.
19. 王金标. 急诊阿替普酶静脉溶栓治疗急性脑梗死的效果探讨. 中国现代药物应用, 2020, 14(12): 120-122.
20. Dong Q, Dong Y, Liu L, et al. The Chinese stroke association scientific statement: intravenous thrombolysis in acute ischaemic stroke. Stroke Vasc Neurol, 2017, 2(3): 147-159.

West China Medical Journal

Efficacy and safety of two different thrombolytic therapies for patients with hyperacute ischemic stroke

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