Current state of treatment research on promoting neurological function improvement after intravenous thrombolysis in patients with acute ischemic stroke_West China Medical Journal

Authors：

WANG Lulu ¹ , ZHANG Canfei ² ,  FU Qizhi ³

1. College of Clinical Medicine, Henan University of Science and Technolog, Luoyang, Henan 471003, P. R. China;
2. Department of Neurology, the First Affiliated Hospital of Henan University of Science and Technology, Luoyang, Henan 471003, P. R. China;
3. Department of Intensive Care Medicine, the First Affiliated Hospital of Henan University of Science and Technology, Luoyang, Henan 471003, P. R. China;

Corresponding author：

FU Qizhi, Email: fuqizhi33@sina.com

Keywords：

Ischemic stroke; neurological function improvement; intravenous thrombolysis; treatment

DOI：

10.7507/1002-0179.202504207

Video：

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Acute ischemic stroke (AIS) is a clinical syndrome caused by blood supply disorder of brain tissue, which has the characteristics of high incidence rate and high disability rate, and seriously affects the quality of life of patients. Intravenous thrombolysis is currently an important treatment for AIS, with alteplase being the only thrombolytic drug recommended by all guidelines. However, some patients did not experience improvement or even experienced deterioration in their neurological function after undergoing thrombolysis. Therefore, this article reviews the current status of treatment research on promoting neurological function in patients with AIS after intravenous thrombolysis, in order to explore the importance of combined treatment strategies on further promoting neurological function improvement.

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2. Chugh C. Acute ischemic stroke: management approach. Indian J Crit Care Med, 2019, 23(Suppl 2): S140-S146.
3. 中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国急性缺血性卒中诊治指南 2023. 中华神经科杂志, 2024, 57(6): 523-559.
4. Berge E, Whiteley W, Audebert H, et al. European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke. Eur Stroke J, 2021, 6(1): I-LXII.
5. Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2019, 50(12): e344-e418.
6. Yu J, Lee HS, Lee SM, et al. Aggravation of post-ischemic liver injury by overexpression of A20, an NF-κB suppressor. J Hepatol, 2011, 55(2): 328-336.
7. Seners P, Turc G, Maïer B, et al. Incidence and predictors of early recanalization after intravenous thrombolysis: a systematic review and meta-analysis. Stroke, 2016, 47(9): 2409-2412.
8. Hacke W, Kaste M, Bluhmki E, et al. Thrombolysis with alteplase 3 to 4. 5 hours after acute ischemic stroke. N Engl J Med, 2008, 359(13): 1317-1329.
9. Yang M, Huo X, Miao Z, et al. Platelet glycoprotein Ⅱb/Ⅲa receptor inhibitor tirofiban in acute ischemic stroke. Drugs, 2019, 79(5): 515-529.
10. Shi H, Hou MM, Ren G, et al. Tirofiban for acute ischemic stroke patients receiving intravenous thrombolysis: a systematic review and Meta-analysis. Cerebrovasc Dis, 2023, 52(5): 587-596.
11. Li W, Lin L, Zhang M, et al. Safety and preliminary efficacy of early tirofiban treatment after alteplase in acute ischemic stroke patients. Stroke, 2016, 47(10): 2649-2651.
12. 樊琼, 闵宁, 张文娟, 等. 替罗非班注射液联合阿替普酶静脉溶栓治疗急性脑梗死的效果及对神经因子、脑血管循环的影响. 临床医学研究与实践, 2023, 8(11): 30-33.
13. Jeong HG, Kim BJ, Yang MH, et al. Stroke outcomes with use of antithrombotics within 24 hours after recanalization treatment. Neurology, 2016, 87(10): 996-1002.
14. 吕洋, 柳燕, 李宏伟, 等. 阿替普酶静脉溶栓后早期联合替罗非班治疗轻中度急性缺血性卒中及各 TOAST 亚型的效果研究. 实用心脑肺血管病杂志, 2023, 31(1): 112-118.
15. Liang Z, Zhang J, Huang S, et al. Safety and efficacy of low-dose rt-PA with tirofiban to treat acute non-cardiogenic stroke: a single-center randomized controlled study. BMC Neurol, 2022, 22(1): 280.
16. Barreto AD, Alexandrov AV, Lyden P, et al. The argatroban and tissue-type plasminogen activator stroke study: final results of a pilot safety study. Stroke, 2012, 43(3): 770-775.
17. 北京神经科学学会血管神经病学专业委员会, 阿加曲班治疗急性缺血性卒中中国专家共识组. 阿加曲班治疗急性缺血性卒中中国专家共识 2021. 中国卒中杂志, 2021, 16(9): 946-953.
18. Al-Salihi MM, Saha R, Ayyad A, et al. Efficacy and safety of argatroban in the management of acute ischemic stroke: a systematic literature review and meta-analysis. Clin Neurol Neurosurg, 2024, 236: 108097.
19. 刘晓虎, 王新波, 王茹, 等. 阿加曲班联合 rt-PA 静脉溶栓治疗急性后循环缺血性脑卒中的效果及对脑氧代谢指标的影响. 临床医学研究与实践, 2024, 9(7): 65-68.
20. 褚春沐. 阿加曲班联合阿替普酶静脉溶栓治疗急性脑梗死的效果及对脑血管储备功能的影响. 医学信息, 2022, 35(13): 133-135.
21. 赵东慧, 王楠, 杨思远. 阿加曲班联合阿替普酶静脉溶栓治疗急性脑梗死的疗效及对脑血管储备功能的影响. 医学信息, 2023, 36(13): 151-154.
22. 郭承承, 汪志云. 急性缺血性脑卒中老年患者溶栓后联合阿加曲班治疗的临床研究. 中华老年心脑血管病杂志, 2021, 23(8): 854-856.
23. Chen HS, Cui Y, Zhou ZH, et al. Effect of argatroban plus intravenous alteplase vs intravenous alteplase alone on neurologic function in patients with acute ischemic stroke: the ARAIS randomized clinical trial. JAMA, 2023, 329(8): 640-650.
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Latest ArticlesCurrent state of treatment research on promoting neurological function improvement after intravenous thrombolysis in patients with acute ischemic stroke

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