In Vitro Examination of the Thrombolytic Efficacy of Desmoteplase and Therapeutic Ultrasound Compared with rt-PA

The aim of the study described here was to evaluate the thrombolytic efficacy of combined treatment with the fibrin-selective plasminogen activator desmoteplase (DSPA) and therapeutic ultrasound (sonothrombolysis [STL]) compared with conventional rt-PA (recombinant tissue plasminogen activator) treatment in vitro. Lysis rates were determined by the weight loss of platelet-rich plasma (PRP) clots treated with rt-PA (60 kU/mL) or DSPA (2 μg/mL) combined with pulsed wave ultrasound (2 MHz, 0.179 W/cm²). To reveal the individual effects of medication and ultrasound, lysis rates were also determined for DSPA monotherapy and for combined treatment with rt-PA and ultrasound. Clots solely placed in plasma served as the control group. Lysis increased significantly with rt-PA (26.5 ± 7.8%) and DSPA (30.5 ± 6%) compared with the control group (18.2 ± 5.9%) (each p < 0.001). DSPA lysis was more effective than rt-PA lysis (without STL: p = 0.015, with STL: p = 0.01). Combined treatment with DSPA and 2-MHz STL significantly exceeded rt-PA lysis (32.8% vs. 26.5%, p < 0.001).     

Comparison of thrombolytic agents in treatment of patients with acute ischemic stroke; findings from a single centre follow up study in real-life settings.

Background and objectivesHealth outcome data of thrombolysis in patients with acute ischemic stroke in real life-settings in India are scarce. We studied the clinical profile, risk factors and functional outcome of patients with acute ischemic stroke (AIS) who were thrombolysed.MethodsIn a single centre retrospective study from January 2017 to June 2020, we analysed the data of adult patients with AIS presented within 4.5 h of symptom onset. We included patients if they had NIHSS score ≥4, modified Rankin score of 2 or less before the stroke onset and without evidence of haemorrhage. Modified Rankin score of two or less at the end of three months was defined as the primary efficacy outcome. The development of symptomatic intracerebral haemorrhage was considered as the primary safety outcome. We tried to analyse the primary safety and efficacy outcomes between two thrombolytic agents.ResultsNinety patients (Tenecteplase = 61; Alteplase, n = 29) underwent stroke thrombolysis during the study period. The mean age was 64.3 years in Tenecteplase group and 63.2 years in Alteplase group. Twenty patients were aged more than 75 years. Hypertension was the most common comorbidity in both the groups (72% and 72.4%). Median mRS score at 3-months was 1 in Tenecteplase group and 0.5 in Alteplase group (p < 0.001), however there was no statistically significant difference between both treatment groups in terms of NIHS score at 24 h (70.4% vs 51.7%, p = 0.08), functional recovery calculated with mRS at 3-month (83.6% vs 79.3%, p = 0.62) or in terms of symptomatic ICH (9.8% and 17.2% p = 0.36).ConclusionTenecteplase appears to have similar clinical outcomes as Alteplase for stroke thrombolysis. Given the relatively low-cost and ease of administration, Tenecteplase may be better than Alteplase for management of acute ischemic stroke.     

脑苷肌肽联合阿替普酶治疗急性脑梗死的临床研究

目的探讨脑苷肌肽注射液联合注射用阿替普酶治疗急性脑梗死的临床疗效。方法选取2015年8月—2017年10月海安市人民医院收治的90例急性脑梗死患者为研究对象。根据入院编号将所有患者分为对照组和治疗组,每组各45例。对照组给予注射用阿替普酶,0.9 mg/(kg·d),总剂量的10%于短时间内静脉推注,剩余90%在1 h内静脉滴注。治疗组在对照组治疗的基础上静脉滴注脑苷肌肽注射液,20 mL加入0.9%氯化钠注射液250 mL中,1次/d。两组均连续治疗14 d。观察两组临床疗效,比较两组患者的美国国立卫生院脑卒中量表(NIHSS)评分、Barthel指数、血液流变学指标和血清学指标。结果治疗后,对照组和治疗组的总有效率分别为82.2%、95.6%,两组比较差异具有统计学意义(P0.05)。治疗7、14d后,两组NIHSS评分显著降低,Barthel指数显著升高,同组治疗前后比较差异具有统计学意义(P0.05)。治疗7、14d后,治疗组NIHSS评分、Barthel指数显著优于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组全血高切黏度、全血低切黏度、血浆黏度和红细胞压积水平均显著降低,同组治疗前后比较差异具有统计学意义(P0.05)。治疗后,治疗组血液流变学指标显著低于对照组,两组比较差异具有统计学意义(P0.05)。治疗后,两组S100β蛋白、基质金属蛋白酶-9(MMP-9)、肿瘤坏死因子-α(TNF-α)和白细胞介素1β(IL-1β)水平均显著降低,同组治疗前后比较差异具有统计学意义(P0.05)。治疗后,治疗组血清指标水平显著低于对照组,两组比较差异具有统计学意义(P0.05)。治疗期间,治疗组不良反应发生率为6.7%,显著低于对照组的15.6%,两组比较差异具有统计学意义(P0.05)。结论脑苷肌肽注射液联合注射用阿替普酶治疗急性脑梗死具有较好的临床疗效,可显著改善患者的神经功能评分和生活质量,降低炎性指标和血液黏度,具有一定的临床推广应用价值。     

苦碟子注射液联合阿替普酶治疗急性脑梗死的临床研究

目的 探讨苦碟子注射液联合阿替普酶治疗急性脑梗死临床疗效。方法 选取2020年7月—2022年7月郑州市第三人民医院收治的112例急性脑梗死患者,随机分为对照组和治疗组,每组各56例。对照组患者静脉注射注射用阿替普酶,0.9 mg/kg,最大剂量不超过90 mg,在1 min内静脉推注总药量的10%,剩下的90%在1 h内静脉泵入。在对照组基础上,治疗组静脉滴注苦碟子注射液,40 mL/次加入生理盐水300 mL,1次/d。两组治疗14 d。观察两组患者临床疗效,比较治疗前后两组患者症状改善时间、神经功能受损程度（NIHSS）评分、氧化应激水平,血清炎性因子白细胞介素-6（IL-6）、胱抑素C（CysC）、肿瘤坏死因子-α（TNF-α）和同型半胱氨酸（Hcy）水平,及不良反应情况。结果 治疗后,治疗组患者临床有效率为91.07%,明显高于对照组（71.43%,P＜0.05）。治疗后,治疗组症状改善时间均早于对照组（P＜0.05）。治疗后,两组患者NIHSS评分指标均明显下降（P＜0.05）,且治疗组NIHSS评分指标明显低于对照组（P＜0.05）。治疗后,两组患者超氧化物歧化酶（SOD）和谷胱甘肽过氧化物酶（CSH-Px）指标明显升高,而丙二醛（MDA）指标明显降低（P＜0.05）,且治疗组氧化应激水平明显好于对照组（P＜0.05）。治疗后,两组患者血清炎性因子IL-6、Cys-C、TNF-α、Hcy水平明显降低（P＜0.05）,且治疗组明显均低于对照组（P＜0.05）。治疗后,治疗组不良反应总发生率为5.36%,明显低于对照组（10.71%,P＜0.05）。结论 阿替普酶联合苦碟子注射液治疗急性脑梗死疗效确切,对脑神经功能损伤程度及氧化应激反应改善明显,并能降低机体炎性因子水平,且安全性良好。     

急性脑梗死患者经神经节苷脂治疗的临床疗效

〔摘 要〕 目的：研究神经节苷脂治疗急性脑梗死患者的临床疗效。方法：选取漯河市第二人民医院 2019 年 8 月 至 2021 年 8 月期间收治 146 例的急性脑梗死患者，根据治疗方法不同分为观察组（78 例，神经节苷脂联合阿替普酶 治疗）和对照组（68 例，阿替普酶治疗）。比较两组患者的临床疗效，不同时期神经功能以及治疗前后炎症因子水平。 结果：观察组患者治疗总有效率为 91.67 %，高于对照组的 80.00 %，差异具有统计学意义（P ＜ 0.05）。两组患者治 疗后全血黏度、血浆黏度、红细胞比容及红细胞聚集指数均显著降低，且治疗后观察组患者的全血黏度、血浆黏度、 红细胞比容及红细胞聚集指数水平均显著低于对照组，差异具有统计学意义（P ＜ 0.05）。治疗后两组患者的 C 反应 蛋白（CRP）、肿瘤坏死因子 –α（TNF–α）水平均有明显的下降，而治疗后观察组患者的 CRP、TNF–α 水平均明显 低于对照组，差异具有统计学意义（P ＜ 0.05）。治疗 1 周后、治疗 2 周后两组患者的美国国立卫生研究院卒中量表 （NIHSS）评分均有明显的下降，而治疗 1 周后、治疗 2 周后观察组患者的 NIHSS 评分显著低于对照组，差异具有 统计学意义（P ＜ 0.05）。两组患者不良反应发生率比较，差异无统计学意义（P ＞ 0.05）。结论：神经节苷脂联合 阿替普酶静脉溶栓治疗更有利于改善急性脑梗死患者的神经功能、血液流变学指标，且较单独使用阿替普酶治疗者可 更好的抑制患者炎症反应。     

Pharmacoeconomic impact of an alternative workflow process for stroke

Objective

The objective of this study was to evaluate a new multidisciplinary process in which intravenous alteplase (tPA) waste, used for acute ischemic stroke (AIS), was salvaged in an attempt to maximize cost effectiveness without impacting door-to-needle (DTN) administration times.