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Sun F, Liu H, Fu HX, Zhang S, Qian XD, Li JJ, Zhu YB, Zhang XX, Zhang J, Qiu HP, Kang LL, Hu YJ, Zhao L, Mi YJ, Gao YJ, Dou ZJ, Ma Z. Comparative study of intravenous thrombolysis with rt-PA and urokinase for patients with acute cerebral infarction. J Int Med Res 2021; 48:300060519895352. [PMID: 32357116 PMCID: PMC7221219 DOI: 10.1177/0300060519895352] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective Cerebral infarction has a poor prognosis and causes a serious burden on
families and society. Recombinant tissue plasminogen activator (rt-PA) and
urokinase (UK) are commonly used thrombolytic agents in the clinic. However,
direct and powerful clinical trial evidence to determine the therapeutic
effect of rt-PA and UK on intravenous thrombolysis is lacking. Methods In this study, 180 patients with acute cerebral infarction were treated with
rt-PA or UK. The National Institutes of Health Stroke Scale (NIHSS) scores,
Barthel index, bleeding complications, and biomarkers were evaluated. Results No significant differences in NIHSS or Barthel scores were found between the
groups. However, UK increased the risk of intracranial haemorrhage compared
with rt-PA. rt-PA had increased activity in reducing serum levels of MMP-9
than UK. Conclusion Intravenous thrombolysis with rt-PA and UK in the time window of acute
cerebral infarction can achieve similar therapeutic effects, but rt-PA can
further reduce the risk of cerebral haemorrhage and is relatively safer than
UK.
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Affiliation(s)
- Fan Sun
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Heng Liu
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Hui-Xiao Fu
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Shuo Zhang
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Xu-Dong Qian
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Jia-Jia Li
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Yun-Bo Zhu
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Xiao-Xuan Zhang
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Jian Zhang
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Hai-Peng Qiu
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Ling-Ling Kang
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Ya-Jun Hu
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Liang Zhao
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Yan-Juan Mi
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Yan-Jun Gao
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Zhi-Jie Dou
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Zheng Ma
- Neurology Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
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Xu X, Li C, Wan T, Gu X, Zhu W, Hao J, Bao H, Zuo L, Hu H, Li G. Risk Factors for Hemorrhagic Transformation After Intravenous Thrombolysis in Acute Cerebral Infarction: A Retrospective Single-Center Study. World Neurosurg 2017; 101:155-160. [PMID: 28185970 DOI: 10.1016/j.wneu.2017.01.091] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 01/20/2017] [Accepted: 01/25/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate the risk factors for hemorrhagic transformation (HT) after intravenous thrombolysis using a recombinant tissue plasminogen activator (r-tPA) in acute cerebral infarction. METHODS Patients with acute cerebral infarction receiving r-tPA thrombolysis in Shanghai Eastern Hospital were retrospectively studied. Based on the cranial computed tomography or magnetic resonance imaging examination, after the intravenous thrombolysis, the patients were divided into 2 groups: an HT group and a non-HT group. The information was collected before or after thrombolysis. RESULTS A total of 162 patients were included in the analysis. The age ranged from 25 to 86 years, with an average age of 65.6 ± 10.6 years. The average time from disease onset to thrombolysis was 188 ± 53.1 minutes. Cranial computed tomography or magnetic resonance imaging showed that 20 patients (12.3%) had HT after thrombolysis. Using univariate analysis, history of atrial fibrillation, positive expression of urinary protein, and high National Institutes of Health Stroke Scale (NIHSS) score before thrombolysis, we found that there was a significant difference between the HT and non-HT group (P < 0.05) in the level of mean systolic pressure (MSP) 24 hours after thrombolysis. Multivariate logistic regression analysis indicated that age ≥80 years, MSP ≥140 mm Hg, NIHSS score, and fibrinogen concentration before thrombolysis were risk factors for HT after thrombolysis in patients with acute cerebral infarction. CONCLUSIONS Age, MSP, NIHSS score, and fibrinogen concentration before thrombolysis are risk factors for HT after thrombolysis in acute cerebral infarction. These 4 factors should be carefully taken into account before thrombolysis.
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Affiliation(s)
- Xiahong Xu
- Department of Neurology, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Changsong Li
- Department of Neurology, Shanghai East Hospital, Dalian Medical University, Shanghai, China
| | - Ting Wan
- Department of Neurology, Shanghai East Hospital, Dalian Medical University, Shanghai, China
| | - Xiaobo Gu
- Department of Neurology, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wenxia Zhu
- Department of Neurology, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Junjie Hao
- Department of Neurology, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Huan Bao
- Department of Neurology, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Lian Zuo
- Department of Neurology, East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hui Hu
- Department of Neurology, East Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Gang Li
- Department of Neurology, East Hospital, Tongji University School of Medicine, Shanghai, China.
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Mandel RJ, Manfredsson FP, Foust KD, Rising A, Reimsnider S, Nash K, Burger C. Recombinant adeno-associated viral vectors as therapeutic agents to treat neurological disorders. Mol Ther 2006; 13:463-83. [PMID: 16412695 DOI: 10.1016/j.ymthe.2005.11.009] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2005] [Revised: 11/12/2005] [Accepted: 11/13/2005] [Indexed: 12/11/2022] Open
Abstract
Recombinant adeno-associated virus (rAAV) is derived from a small human parvovirus with an excellent safety profile. In addition, this viral vector efficiently transduces and supports long-term transgene expression in the nervous system. These properties make rAAV a reasonable candidate vector for treating neurological disorders. Indeed, rAAV is currently being used in five early stage clinical trials for various neurodegenerative disorders. Therefore, we will review the currently available preclinical data using rAAV in animal models of central nervous system (CNS) disorders. Moreover, potential caveats for rAAV-based gene therapy in the CNS are also presented.
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Affiliation(s)
- Ronald J Mandel
- Department of Neuroscience, and McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL 32610, USA.
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