Effect of recombinant tissue-type fibrinolytic plasminogen activator intravenous thrombolysis followed by the addition of tirofiban at different times on neurovascular function in patients with acute ischemic stroke
Objective To investigate the effect of recombinant tissue-type fibrinolytic plasminogen activator(rt-PA)intravenous thrombolysis followed by the addition of tirofiban at different times on neurovascular function in patients with acute ischemic stroke(AIS).Methods A total of 120 patients with AIS admitted to the Neurology Department of Beijing Geriatric Hospital from March 2020 to March 2023 were selected as the research subjects,and all patients received intravenous throm-bolysis with rt-PA.According to the different times of adding tirofiban after intravenous thrombolysis treatment,the patients were divided into the early group(within 6 hours after thrombolysis,n=52),intermediate group(6-12 hours after thrombolysis,n=38)and late group(12-24 hours after thrombolysis,n=30).The neurological function[National Institutes of Health Stroke Scale(NIHSS)score,modified Rankin scale(mRS)score],vascular function[von Willebrand factor(vWF),vascular endothelial cell-calcineurin(VE-cadherin),thrombomodulin(TM)],inflammatory factors[high-sensitivity C-reactive protein(hs-CRP),homocysteine(Hey),interleukin-1 β(IL-1 β)]levels were compared among the three groups before and after treatment.The incidence of adverse events during treatment was recorded.Results Before treatment,there was no significant difference in NIHSS and mRS scores of patients among the three groups(P＞0.05);NIHSS and mRS scores of patients in the three groups after treatment were significantly lower than those before treatment(P＜0.05);after treatment,NIHSS and mRS scores of patients in the early group were significantly lower than those in the intermediate and late groups,and those in the intermediate group were significantly lower than those in the late group(P＜0.05).Before treatment,there was no statistically significant difference in vWF,VE-cadherin,and TM levels of patients among the three groups(P＞0.05);the levels of vWF,VE-cadherin and TM of patients in the three groups after treatment were significantly lower than those before treatment(P＜0.05);after treatment,the levels of vWF,VE-cadherin,and TM of patients in the early group were significantly lower than those in the intermediate and late groups(P＜0.05);after treatment,the levels of vWF of patients in the late group was significantly higher than that in the intermediate group(P＜0.05),and there was no statistically significant difference in the levels of VE-cadherin and TM of patients between the intermediate group and late group(P＞0.05).Before treatment,there was no significant difference in the levels of hs-CRP,Hcy,and IL-1 β of patients among the three groups(P＞0.05);the levels of hs-CRP,Hcy,and IL-1 β of patients in the three groups after treatment were significantly higher than those before treatment(P＜0.05);after treatment,the levels of hs-CRP,Hcy,and IL-1 β of patients in the early group were significantly lower than those in the intermediate and late groups,and the levels of hs-CRP,Hcy,and IL-1 β of patients in the intermediate group were significantly lower than those in the late group(P＜0.05).During the treatment period,there was no significant difference in the incidences of symptomatic cerebral hemorrhage of patients among the three groups(P＞0.05);the incidences of reocclusion and cardiopulmonary complications in the early group were significantly lower than those in the intermediate group and late group(P＜0.05);there was no significant difference in the incidence of reocclusion and cardiopulmonary complications of patients between the intermediate group and late group(P＞0.05).Conclusion The addition of tirofiban at different times after rt-PA intravenous thrombolysis can promote the recovery of neurological function and vascular function in AIS patients,and also can inhibit the inflammatory mediator response,of which the best effect is achieved by the addition of tirofiban at an early stage after rt-PA intravenous thrombolysis.
acute ischemic strokerecombinant tissue-type fibrinolytic plasminogen activatorintravenous thrombolysistirofibanneurovascular function
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