Comparative study of intravenous thrombolysis with rt-PA and urokinase for patients with acute cerebral infarction

Sun, Fan; Liu, Heng; Fu, Hui-Xiao; Zhang, Shuo; Qian, Xudong; Li, Jiajia; Zhu, Yun-Bo; Zhang, Xiaoxuan; Zhang, Jiän; Qiu, Hai-Peng; Ling-ling, Kang; Zhao, Liang; Mi, Yan-Juan; Gao, Yanjun; Dou, Zulin; Ma, Zheng

doi:10.1177/0300060519895352

Cited by 17 publications

(11 citation statements)

References 19 publications

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“…Recently, several comparative studies on the efficacy and safety of alteplase and urokinase for treating acute ischemic stroke have been conducted (13)(14)(15). These studies all demonstrated that urokinase and alteplase have similar therapeutic effects.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes and Treatment Complications of Intravenous Urokinase Thrombolysis in Acute Ischemic Stroke in China

et al. 2021

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Background: Intravenous thrombolysis with alteplase benefits eligible patients with acute ischemic stroke. However, in some countries such as China, alteplase may be too expensive for low-income patients, and also for regions with low economic development. Urokinase is much less expensive than alteplase. This study aimed to assess the outcomes and treatment complications of urokinase in acute ischemic stroke patients, which are poorly understood.Methods: This multicenter retrospective study included acute ischemic stroke patients who received intravenous urokinase or alteplase from January 2014 to January 2018 at 21 centers in China. Outcomes and treatment complications were analyzed by univariate and multivariate analyses.Results: Among the 618 patients included in this study, 489 were treated with urokinase and 129 were treated with alteplase. Functional independence, no/minimal disability, mortality, intracranial hemorrhage (ICH), and symptomatic ICH did not significantly differ between the urokinase and alteplase groups in the univariate and multivariate analyses. However, the patients who received alteplase had a lower odds ratio (OR) of extracranial bleeding in the univariate analysis and a lower adjusted OR (aOR) in the multivariate analysis than the patients who received urokinase (OR = 0.410 [95% CI, 0.172–0.977], p = 0.038; aOR = 0.350 [95% CI, 0.144–0.854], p = 0.021). Furthermore, in patients treated with urokinase, the patients who received high-dose urokinase had a higher OR of extracranial bleeding in the univariate analysis and a higher aOR of extracranial bleeding in the multivariate analysis than patients who received low-dose urokinase (OR = 3.046 [95% CI, 1.696–5.470], p < 0.001; aOR = 3.074 [95% CI, 1.627–5.807], p = 0.001). Moreover, patients who received low-dose urokinase had similar outcomes and complications compared to patients treated with alteplase.Conclusions: Patients treated with urokinase had similar outcomes but a higher risk of extracranial bleeding compared to patients treated with alteplase. The risk of extracranial bleeding was higher in the patients treated with high-dose urokinase than in the patients treated with low-dose urokinase. Patients who received low-dose urokinase had similar outcomes and complications compared to patients treated with alteplase. In countries such as China where some acute ischemic stroke patients cannot afford alteplase, urokinase may be a good alternative to alteplase for intravenous thrombolysis.

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Section: Discussionmentioning

confidence: 99%

“…However, the bleeding risks were different. Sun et al reported that the ICH risk of alteplase was lower than urokinase ( 14 ). Bao et al found that patients treated with urokinase had a lower frequency of bleeding ( 13 ).…”

Section: Discussionmentioning

confidence: 99%

Outcomes and Treatment Complications of Intravenous Urokinase Thrombolysis in Acute Ischemic Stroke in China

et al. 2021

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“…The inclusion criteria were: patients suffered from ACI without coma within 6 hours [ 9 – 12 ] ; age range between 18 and 85 years old; low density ischemic lesions were not observed via head CT scanning with cerebral hemorrhage eliminated; not pregnant; and patient or family members sign informed consent form.…”

Section: Methodsmentioning

confidence: 99%

Predictors of hemorrhagic complications after intravenous thrombolysis in acute cerebral infarction patients

Zeng

Chen

et al. 2021

Medicine

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For patients with ischemic stroke, intravenous (IV) thrombolysis with Urokinase within 6 hours has been accepted as beneficial, but its application is limited by high risk of hemorrhagic complications after thrombolysis. This study aimed to analyze the risk factors of hemorrhagic complications after intravenous thrombolysis using Urokinase in acute cerebral infarction (ACI) patients. Total 391 consecutive ACI patients were enrolled and divided into 2 groups: the hemorrhagic complications group and the non-hemorrhagic complications group. The related data were collected and analyzed. Univariate analysis showed significant differences in prothrombin time, atrial fibrillation (AF), Mean platelet volume, large platelet ratio (L-PLR), triglyceride (TG), Lactate dehydrogenase, alanine aminotransferase (ALT), high-density lipoprotein, and baseline National Institute of Health Stroke Scale score between the hemorrhagic complications and the non-hemorrhagic complications group ( P < .1). Multivariate logistic regression analysis indicated that AF (odds ratio [OR] = 2.91, 95% confidence interval [CI] = 1.06–7.99 P = .039) was the risk factor of hemorrhagic complications, while ALT (OR = 0.27, 95% CI = 0.10–0.72 P = .009) and TG (OR = 0.16, 95% CI = 0.06–0.45 P = .000) were protective factors of hemorrhagic complications. For patients with AF and lower levels of ALT or TG, the risk of hemorrhagic complications might increase after ACI.

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“…ACI is a disease with high morbidity, disability, and mortality, with a 19.04% incidence and 62.15% recurrence rate in China, ranking the top in the world. The world community has gradually recognized the severity of the disease and paid great attention [ 2 ]. At the onset of ACI, irreversible necrosis occurs in the ischemic core area, and the ischemic periphery is the ischemic penumbra with damaged neurological function but the neurons are still alive, so effective evacuation of the blocked blood vessels is the key to rescuing the ischemic penumbra [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Correlation between Selection of Time Window for Acute Cerebral Infarction and Efficacy of Intravascular Stent Implantation

Feng

Gong²

2022

Journal of Healthcare Engineering

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Objective. To explore the correlation between selection of time window for acute cerebral infarction (ACI) and efficacy of intravascular stent implantation. Methods. The clinical data of 84 ACI patients treated in our hospital from March 2019 to March 2020 were selected for the retrospective analysis, all study subjects received intravascular stent implantation, and after discharge, patients were assessed by the Modified Rankin Scale (mRS) and divided into the good prognosis group (n = 46, mRS score ≤2 points) and poor prognosis group (n = 38, mRS score >2 points). The clinical data of patients in the two groups at admission underwent univariate analysis, the indicators presenting P < 0.05 were included in the logistic regression model, and the correlation between patients’ treatment time window and clinical effect was analyzed by multivariate logistic regression analysis and linear fitting analysis. Results. According to the multivariate logistic regression analysis, low-density lipoprotein (LDL), time window, and blood glucose level before treatment were the independent factors affecting patients’ treatment effect and were associated with the efficacy of intravascular stent implantation (r was 0.790, 0.889, and 0.672, respectively). Conclusion. LDL, time window, and blood glucose level before treatment are the important factors affecting the efficacy of intravascular stent implantation for ACI patients, among which the time window is most significantly associated with the clinical effect. Therefore, ACI patients should accept clinical treatment as early as possible.

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Comparative study of intravenous thrombolysis with rt-PA and urokinase for patients with acute cerebral infarction

Cited by 17 publications

References 19 publications

Outcomes and Treatment Complications of Intravenous Urokinase Thrombolysis in Acute Ischemic Stroke in China

Outcomes and Treatment Complications of Intravenous Urokinase Thrombolysis in Acute Ischemic Stroke in China

Predictors of hemorrhagic complications after intravenous thrombolysis in acute cerebral infarction patients

Correlation between Selection of Time Window for Acute Cerebral Infarction and Efficacy of Intravascular Stent Implantation

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