Seitz Rüdiger J, Hamzavi Magnolia, Junghans Ulrich, Ringleb Peter A, Schranz Corinna, Siebler Mario
Department of Neurology, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
Stroke. 2003 Aug;34(8):1932-5. doi: 10.1161/01.STR.0000080535.61188.A6. Epub 2003 Jun 26.
We sought to investigate the feasibility of the combined use of low-dose recombinant tissue plasminogen activator (rtPA) and tirofiban, a glycoprotein IIb/IIIa (GPIIb/IIIa) receptor antagonist, for systemic thrombolysis in acute stroke.
Consecutive patients who were treated with systemic application of low-dose rtPA and body weight-adjusted tirofiban (rtPA+T group; n=37) were evaluated retrospectively during 1999-2001. Patients in the rtPA+T group were compared with a group of patients treated with a dose of 0.9 mg/kg body weight in a different center (rtPA group; n=119). The 41 patients with infarctions of the middle cerebral artery territory who were not eligible for thrombolytic treatment because of medical contraindications or arrival in the hospital >3 hours after stroke onset served as controls. For matched comparisons, the National Institutes of Health Stroke Scale on admission and the Rankin Scale on discharge 5 days after stroke were used.
The patients treated with rtPA+T or rtPA improved (P<0.05) compared with the controls at discharge; patients in the rtPA+T and rtPA groups reached a Rankin Scale score of 0 to 2 in 63% and 55%, respectively, while only 16% of the controls achieved this score. Death rates (8% in rtPA+T group and 5% in rtPA group) were similar among the 2 treatment groups. They included 1 fatal hemorrhage in the rtPA+T group and 4 fatal hemorrhages in the rtPA group. Five percent of the untreated patients developed symptomatic, nonfatal cerebral hemorrhage.
Systemic combined thrombolysis with rtPA+T seems to be a feasible treatment in acute stroke.
我们旨在研究低剂量重组组织型纤溶酶原激活剂（rtPA）与糖蛋白IIb/IIIa（GPIIb/IIIa）受体拮抗剂替罗非班联合用于急性卒中全身溶栓的可行性。
回顾性评估1999年至2001年期间连续接受低剂量rtPA全身应用及根据体重调整剂量的替罗非班治疗的患者（rtPA + T组；n = 37）。将rtPA + T组患者与另一中心接受0.9 mg/kg体重剂量治疗的患者组（rtPA组；n = 119）进行比较。41例因医学禁忌或卒中发作后超过3小时入院而不符合溶栓治疗条件的大脑中动脉区域梗死患者作为对照。为进行匹配比较，使用了美国国立卫生研究院卒中量表入院时评分及卒中后5天出院时的Rankin量表评分。
与对照组相比，接受rtPA + T或rtPA治疗的患者出院时病情改善（P < 0.05）；rtPA + T组和rtPA组患者分别有63%和55%达到Rankin量表评分0至2，而对照组仅有16%达到该评分。两个治疗组的死亡率相似（rtPA + T组为8%，rtPA组为5%）。rtPA + T组有1例致命性出血，rtPA组有4例致命性出血。5%的未治疗患者发生有症状的非致命性脑出血。
rtPA + T全身联合溶栓似乎是急性卒中的一种可行治疗方法。
