轻型缺血性卒中静脉溶栓后双重抗血小板治疗研究

目的 探讨轻型缺血性卒中重组组织型纤溶酶原激活剂(recombinant tissue plasminogen activator,rtPA)静脉溶栓治疗后3个月是否能够改善患者的预后,探索轻型缺血性卒中静脉溶栓后24小时,给予双重抗血小板药物治疗是否安全,能否降低患者的卒中复发率并改善预后.方法 传统静脉溶栓组22例,给予rt-PA静脉溶栓,24小时后复查头颅CT,排除脑出血转换后,给予阿司匹林100 mg,每日1次,口服治疗;联合静脉溶栓组23例,接受rt-PA静脉溶栓后24小时复查头颅CT,排除脑出血转换后,给予阿司匹林100 mg,每日1次,口服治疗,同时联合氯吡格雷75 mg,每日1次,口服治疗2周,然后继续单用阿司匹林药物治疗;未溶栓组25例,发病时间小于24小时,未接受rt-PA静脉溶栓的轻型卒中患者,常规予阿司匹林100mg,每日1次,口服治疗.3个月时评测美国国立卫生研究院卒中量表(NIHSS)评分、Barthel指数(BI)、改良Rankin量表评分(mRS),其中NIHSS评分0～1分、BI 95～100分、mRS为0～1分者定义为良好结局.评估3个月内脑出血率、病死率和脑梗死复发率.结果 3个月时,传统及联合静脉溶栓组良好结局的比例明显高于未溶栓组(P＜0.05,P＜0.01),传统静脉溶栓组和联合静脉溶栓组之间差异无统计学意义.未溶栓组脑梗死复发率明显高于溶栓组(P＜0.05).3组之间的脑出血率和病死率差异无统计学意义.结论 轻型缺血性卒中rt-PA静脉溶栓治疗可提高3个月内良好结局的比例、减少卒中的复发.轻型缺血性卒中rt-PA静脉溶栓后24小时,短期给予双重抗血小板治疗,不增加脑出血风险.

Dual antiplatelet treatment after intravenous thrombolysis for mild ischaemic stroke

Objective To explore whether treatment with recombinant tissue plasminogen activator（rt-PA） for mild ischaemic stroke can sustain its clinical benefit three months later and to evaluate the safety of dual antiplatelet treatment at 24 h after intravenous thrombolysis as well as its effect on reducing the recurrence of stroke and improving patients＂ outcome. Methods Forty-five patients with mild ischaemic stroke were enrolled in this study. All patients received traditional treatment with rt-PA. 24 h later, CT scan was performed on each patient to exclude cerebral hemorrhage transformation. Then, all patients received oral administration of aspirin 100 mg once daily. Among them, 23 patients also received oral administration of clopidogrel 75 mg once daily（combined treatment group） for 2 weeks, then aspirin alone. Another 25 patients with less than 24 h disease time and never received rt-PA thrombolytic therapy were enrolled as control group. Patients in the control group only received treatment with aspirin. At 3 months after treatment, all patients received NIHSS scoring, Barthel index（BI） and modified Rankin scale（mRS） rating. Patients getting NIHSS scores no more than 1, BI between 95 and 100 and mRS no more than 1 were considered to get a favorable outcome. Intracranial hemorrhage, fatality rate, and recurrence rate of stroke were also evaluated. Results At 3 months after treatment, the percentage of patients getting favorable outcome in the traditional and combined treatment groups were significantly higher than that in the control group（ P 〈0.05 and P 〈0.01, respectively）, but there was no significant difference between the traditional and combined treatment groups （ P 〉0.05）. The recurrence rate of stroke in the traditional and combined treatment groups were remarkably lower than that in the control group （ P 〈0.05）. However, the intracranial hemorrhage and fatality rate showed no significant difference among the three groups. Conclusion Intravenous thrombolysis for mil