Thrombolytic therapy for acute ischemic stroke

Thrombolytic therapy for acute ischemic stroke

Thrombolysis: thrombolytic therapy is the most important measure to restore blood flow at present, recombinant tissue plasminogen activator (rt-PA) and urokinase are the main thrombolytic drugs currently used in
China, and it is now believed that the time window for effectively rescuing semi-dark band tissue is within 4.

(1) Intravenous thrombolysis: including the application of rt-PA and urokinase
.

1) rt-PA: There have been several clinical trials evaluating the efficacy and safety of rt-PA intravenous thrombolysis in patients with acute cerebral infarction
.

For patients with mild or rapid improvement in stroke symptoms, major surgery in the last 3 months, and recent myocardial infarction, the risk-to-benefit ratio of venous thrombolysis needs to be weighed and further studied
。 RT-PA venous or arterial thrombolysis may be unfavorable in patients taking direct thrombin inhibitors or direct factor Xa inhibitors unless sensitive laboratory tests such as APTT, INR, platelet count, and serpentine venous enzyme coagulation time (ECT), thrombin time (TT), or appropriate direct test of factor Xa activity are normal, or have not been taken for more than 2 days (assuming normal renal function).

Multimodal MRI or CT to help select patients older than 4.

2) Urokinase: China's 9th Five-Year Plan research topic "Intravenous thrombolytic therapy of urokinase within 6 hours of acute ischemic stroke" test is divided into 2 stages
.

3) Indications, contraindications and monitoring of venous thrombolysis: indications, contraindications and relative contraindications of venous thrombolysis within 3 h are shown in Table 2
.

Indications and contraindications for intravenous thrombolysis of urokinase within 6 h are shown in Table 4
.

Recommendations: (1) For patients with ischemic stroke within 3 h (grade I recommendation, grade A evidence) and 3-4.

(2) Endovascular interventional therapy: including arterial thrombolysis, bridging, mechanical thromboplasty, angioplasty and stenting
.

1) Arterial thrombolysis: arterial thrombolysis allows thrombolytic drugs to reach the thrombotic site directly, and the re-passage rate of blood vessels should theoretically be higher than that of venous thrombolysis, and the risk of bleeding is reduced
.

At present, there are only a small number of small samples of studies
on the time window, safety and efficacy of thrombolytic therapy for vertebrobasilar artery infarction.

2) Research progress on bridging, mechanical thromboplasty, angioplasty and stenting can be found in the Interventional Guidelines
for Acute Cerebral Infarction.

Recommendations: (1) Intravenous thrombolysis is the preferred method of recirculation (grade I recommended, grade A evidence).