Efficacy, Influencing Factors, and Safety of Alteplase Intravenous Thrombolysis in Patients with Acute Ischemic Stroke Combined with Atrial Fibrillation

Abstract

Ischemic stroke is the most common type of stroke. Intravenous thrombolytic therapy with alteplase is currently the most effective method to improve the prognosis of patients with acute cerebral infarction. The purpose of this study was to investigate the efficacy and safety of intravenous thrombolysis with alteplase in patients with acute ischemic stroke combined with atrial fibrillation and to analyze the related influencing factors. It turns out, alteplase intravenous thrombolysis is effective for patients with ICS combined with atrial fibrillation, and the incidence of sICH are lower than those without alteplase intravenous thrombolysis, but the efficacy is worse than that of patients without atrial fibrillation. At the same time, the baseline NHISS score and systolic pressure before the thrombolytic were independent risk factors affecting the efficacy of intravenous thrombolysis with alteplase in ICS patients with atrial fibrillation. This study has provided a scientific basis for making an active decision to perform ultraearly intravenous thrombolysis in our hospital to reduce the mortality and disability rate of stroke in the region.

Recent Advances in Targeted Nanotherapies for Ischemic Stroke

“…IS caused by a blood vessel blockage, usually a blood clot, that reduces blood supply to an area of the brain and is the most prevalent form of stroke, accounting for approximately 87% of all strokes. , For patients with IS, time is of the essence in saving the brain. Intravenous thrombolysis is the standard resuscitation measure to minimize brain damage. , Although thrombolytic therapy is strictly time-limited, timely thrombolysis can be effective in relieving neurological damage. , The recombinant fibrinogen activator rtPA is the only effective thrombolytic agent approved by the FDA for clinical use in acute IS. , However, because of the short therapeutic window suitable for most patients (≤4.5 h), with the development of new thrombolytic agents and advanced imaging techniques that allow longer thrombolysis times based on advanced imaging, the concept of tissue time window has been proposed and the treatment time window has been extended to 6 h . Among other limitations, the therapeutic effect of rtPA is often unsatisfactory. , Additionally, a high risk of reperfusion injury and cerebral hemorrhage remain after thrombolysis .…”

“…7,8 Although thrombolytic therapy is strictly time-limited, timely thrombolysis can be effective in relieving neurological damage. 9,10 The recombinant fibrinogen activator rtPA is the only effective thrombolytic agent approved by the FDA for clinical use in acute IS. 11,12 However, because of the short therapeutic window suitable for most patients (≤4.5 h), with the development of new thrombolytic agents and advanced imaging techniques that allow longer thrombolysis times based on advanced imaging, the concept of tissue time window has been proposed and the treatment time window has been extended to 6 h. 13 Among other limitations, 14 the therapeutic effect of rtPA is often unsatisfactory.…”