Recombinant tissue-type plasminogen activator (rt-PA) effectively restores neurological function and improves prognosis in acute ischemic stroke

Shouyun Zhang; Dezhen Wang; Lin Li

Recombinant tissue-type plasminogen activator (rt-PA) effectively restores neurological function and improves prognosis in acute ischemic stroke

Am J Transl Res. 2023 May 15;15(5):3460-3467. eCollection 2023.

Authors

Shouyun Zhang¹, Dezhen Wang², Lin Li³

Affiliations

¹ The Encephalopathy Department, Zhecheng Hospital of Traditional Chinese Medicine Shangqiu, Henan, China.
² Emergency Department, Zhengzhou Central Hospital Affiliated to Zhengzhou University No. 16, Tongbai North Road, Zhongyuan District, Zhengzhou, Henan, China.
³ Internal Medicine-Neurology, Zhengzhou Central Hospital Affiliated to Zhengzhou University No. 16, Tongbai North Road, Zhongyuan District, Zhengzhou, Henan, China.

PMID: 37303683
PMCID: PMC10251022

Abstract

Objective: To evaluate the clinical efficacy of intravenous thrombolysis with recombinant tissue-type plasminogen activator (rt-PA) for acute ischemic stroke.

Methods: A total of 76 patients with acute ischemic stroke admitted to the Encephalopathy Dept. of Zhecheng Hospital of Traditional Chinese Medicine between February 2021 and June 2022 were recruited in this prospective trial (ClinicalTrials.gov, NCT03884410) and patients were randomized 1:1 to receive either aspirin plus clopidogrel (control group) or aspirin plus clopidogrel and rt-PA intravenous thrombolytic therapy (experimental group), with 38 cases in each group. The treatment efficiency, National Institute of Health stroke scale (NIHSS) scores, daily living ability, coagulation function, serum Lipoprotein-associated phospholipaseA2 (Lp-PLA2), homocysteine (HCY), hypersensitive C-reactive protein (hsCRP) levels, adverse events, and prognosis were evaluated and compared between the two groups.

Results: Intravenous thrombolysis with rt-PA resulted in a better treatment outcome of patients versus aspirin plus clopidogrel (P<0.05). Patients with rt-PA exhibited better improvement in neurological function than those with aspirin plus clopidogrel, as shown by the lower NIHSS scores (P<0.05). Intravenous thrombolysis with rt-PA resulted in a better quality of life of patients than aspirin plus clopidogrel, indicated by the higher Barthel Index (BI) levels (P<0.05). The lower von Willebrand factor (vWF) and Factor VIII (F) levels indicated better coagulation function of patients with rt-PA versus those with aspirin plus clopidogrel (P<0.05). The lower serum concentrations of Lp-PLA2, HCY, and hsCRP suggested patients with rt-PA had milder inflammatory responses versus those without rt-PA (P<0.05). There was no significant difference in the incidence of adverse events in the two groups (P>0.05). Intravenous thrombolytic therapy with rt-PA better enhanced the prognosis of patients than with aspirin plus clopidogrel (P<0.05).

Conclusion: Compared with conventional pharmacological regimens, additional rt-PA intravenous thrombolytic therapy improves the clinical outcome of patients with acute ischemic stroke, promotes neurological recovery, and enhances patient prognosis without increasing the risk of patient-related adverse events.

Keywords: Recombinant tissue-type fibrinogen activator; acute ischemic stroke; clinical efficacy; intravenous thrombolysis.