BACKGROUND Aspirin is a widely used antiplatelet agent that reduces the risk of recurrent ischemic stroke and other vascular events.However,the optimal timing and dose of aspirin initiation after an acute stroke remai...BACKGROUND Aspirin is a widely used antiplatelet agent that reduces the risk of recurrent ischemic stroke and other vascular events.However,the optimal timing and dose of aspirin initiation after an acute stroke remain controversial.AIM To evaluate the efficacy and safety of aspirin antiplatelet therapy within 48 h of symptom onset in patients with acute stroke.METHODS We conducted a randomized,open-label,controlled trial in 60 patients with acute ischemic or hemorrhagic stroke who were admitted to our hospital within 24 h of symptom onset.Patients were randomly assigned to receive either aspirin 300 mg daily or no aspirin within 48 h of stroke onset.The primary outcome was the occurrence of recurrent stroke,myocardial infarction,or vascular death within 90 d.The secondary outcomes were functional outcomes at 90 d measured using the modified Rankin Scale(mRS),incidence of bleeding complications,and mortality rate.RESULTS The mean age of the patients was 67.8 years and 55%of them were male.The median time from stroke onset to randomization was 12 h.The baseline characteristics were well balanced between the two groups.The primary outcome occurred in 6.7%of patients in the aspirin group and 16.7%of patients in the no aspirin group(relative risk=0.40,95%confidence interval:0.12-1.31,P=0.13).The mRS score at 90 d was significantly lower in the aspirin group than in the no aspirin group(median,2 vs 3,respectively;P=0.04).The incidence of bleeding complications was similar between the groups(6.7%vs 6.7%,P=1.00).The mortality rates were also comparable between the two groups(10%vs 13.3%,P=0.69).CONCLUSION Aspirin use is associated with favorable functional outcomes but does not significantly reduce the risk of recurrent vascular events.Its acceptable safety profile is comparable to that of no aspirin.Further studies with larger sample sizes and longer follow-up periods are needed to confirm these findings.展开更多
Objective.To examine the procoagulant effects of thrombolytic agent on hemostasis and study the role of hemostatic markers as predictors of clinical outcomes.Methods.In the present study,eighteen patients with acute m...Objective.To examine the procoagulant effects of thrombolytic agent on hemostasis and study the role of hemostatic markers as predictors of clinical outcomes.Methods.In the present study,eighteen patients with acute myocardial infarction(AMI) received 1.5 or 2.0 mulliou U nonspecific urokinase(UK),or 70-80 mg fibrin-specific fecombinant tissue plasminogen activator(rt-PA) and did not use heparin until 8 hours after intravenous injection of the above agents.Eight patients with AMI an without thrombolytic therapy were enrolled as controls.Coagulant and thrombolytic activity markers included thrombin-antithrombin Ⅲ comlex(TAT),D-dimer,fibrinogen(Fg) ,FMPV/Amax.All markers were determined before,immediately,1,2,4 and 8 hours after the administration of thrombolytic agents respectively.Results.Molecular marker of thrombin generation-TAT showed an activated coagulant state immediately after thrombolytic therapy.Level of TAT showed no significant changes between every two osbserved phases in controls.Howver,level of TAT increased significantly from 4.95±1.75μg/L(4.63±1.37μg/L) to 14.71±3.31μg/L(14.25±2.53μg/L) before and immediately after administration of thrombolytic agents UK(or rt-PA).There was significant difference between level of serum TAT of patients with and without thrombolytic therapy,and higher EMPV/Amax level than controls.D-dimer,a surrogate of thrombolytic activity increased markedly and Fg significantly declined after thrombolytic therap(P<0.05).Couclusions.Thrombin generation occurred in plasma in response to excess fibrinolysis induced by thrombolytic therapy.Both urokinase and rt-PA had procoagulant action.This transient activation of the coagulant system might contribute to early reocclusion.These data provided the theoretical support for simultaneous administration of anticoagulant therapy with thrombolytic agents.These data provided the theoretical support for simultaneous administration of anticoagulant therapy with thrombolytic agents.These results also suggested that TAT might be useful in predicting clinical outcomes of patients treated with thrombolytic therapy for AMI.展开更多
目的探讨替罗非班联合重组人尿激酶原(rhPro-UK)预处理逆行溶栓对急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入术(PCI)后冠脉无复流的影响研究。方法选择2021年5月~2023年2月间收治的行PCI治疗的STEMI患者86例。根据随机分组原...目的探讨替罗非班联合重组人尿激酶原(rhPro-UK)预处理逆行溶栓对急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入术(PCI)后冠脉无复流的影响研究。方法选择2021年5月~2023年2月间收治的行PCI治疗的STEMI患者86例。根据随机分组原则分为对照组和观察组,各组43例。两组均采取PCI治疗,术中给予普通肝素钠、替罗非班,对照组注入rhPro-UK进行常规溶栓。观察组由犯罪血管远端到近端注入rhPro-UK进行逆行溶栓。比较两组术后心肌梗死溶栓试验(TIMI)血流分级、2 h ST段回落率(STR)、冠脉无复流及慢血流(NR/SF)发生率,术后住院期间B型利钠肽(BNP)、肌钙蛋白(cTnI)、左室射血分数(LVEF),随访3个月,比较两组TIMI大出血事件及主要不良心血管事件(MACEs)发生率。结果观察组PCI术后TIMI血流分级优于对照组,STR回落率高于对照组,NR/SF发生率低于对照组(P<0.05);观察组术后住院期间BNP峰值、cTnI峰值均低于对照组,LVEF峰值高于对照组(P<0.05);两组随访期间均未发生TIMI大出血,观察组MACEs发生率(心衰再住院2例)低于对照组(心源性死亡1例,心衰再住院8例),差异有统计学意义(P<0.05)。结论替罗非班联合重组人尿激酶原预处理逆行溶栓可显著改善STEMI患者PCI术后血流复流情况及左室射血功能,降低冠脉无复流及慢血流与不良心血管事件等发生率,且不增加出血风险。展开更多
目的探讨尿激酶溶栓治疗急性心肌梗死患者的临床效果及安全性。方法选取天津市第四中心医院急诊内科2013年1月~2015年1月收治的100例符合急性心肌梗死静脉溶栓治疗条件的患者进行回顾性分析,其中起病至溶栓时间〈6 h 53例患者（早期组）...目的探讨尿激酶溶栓治疗急性心肌梗死患者的临床效果及安全性。方法选取天津市第四中心医院急诊内科2013年1月~2015年1月收治的100例符合急性心肌梗死静脉溶栓治疗条件的患者进行回顾性分析,其中起病至溶栓时间〈6 h 53例患者（早期组）、6~12 h 47例患者（晚期组）,2组患者均采用常规治疗＋尿激酶静脉溶栓治疗,对比2组患者的治疗效果差异。结果溶栓治疗2 h后,早期组患者的ST段回落≥50%率、ST段完全回落率及再通率均显著高于晚期组患者（P〈0.05）;溶栓治疗后,早期组患者的CK峰值、CK-MB峰值及达峰时间均显著小于或短于晚期组患者（P〈0.05）;溶栓治疗后,早期组的严重心律失常发生率显著低于晚期组患者（P〈0.05）,2组间发生出血事件及死亡率差异无统计学意义。结论尿激酶溶栓治疗急性心肌梗死患者的最佳时机是在起病后6h以内,早期溶栓治疗具有较高的再通率及治疗安全性。展开更多
基金This study has been registered at the Clinical Research Registry at www.researchregistry.com.The registration identification number is(researchregistry9015).
文摘BACKGROUND Aspirin is a widely used antiplatelet agent that reduces the risk of recurrent ischemic stroke and other vascular events.However,the optimal timing and dose of aspirin initiation after an acute stroke remain controversial.AIM To evaluate the efficacy and safety of aspirin antiplatelet therapy within 48 h of symptom onset in patients with acute stroke.METHODS We conducted a randomized,open-label,controlled trial in 60 patients with acute ischemic or hemorrhagic stroke who were admitted to our hospital within 24 h of symptom onset.Patients were randomly assigned to receive either aspirin 300 mg daily or no aspirin within 48 h of stroke onset.The primary outcome was the occurrence of recurrent stroke,myocardial infarction,or vascular death within 90 d.The secondary outcomes were functional outcomes at 90 d measured using the modified Rankin Scale(mRS),incidence of bleeding complications,and mortality rate.RESULTS The mean age of the patients was 67.8 years and 55%of them were male.The median time from stroke onset to randomization was 12 h.The baseline characteristics were well balanced between the two groups.The primary outcome occurred in 6.7%of patients in the aspirin group and 16.7%of patients in the no aspirin group(relative risk=0.40,95%confidence interval:0.12-1.31,P=0.13).The mRS score at 90 d was significantly lower in the aspirin group than in the no aspirin group(median,2 vs 3,respectively;P=0.04).The incidence of bleeding complications was similar between the groups(6.7%vs 6.7%,P=1.00).The mortality rates were also comparable between the two groups(10%vs 13.3%,P=0.69).CONCLUSION Aspirin use is associated with favorable functional outcomes but does not significantly reduce the risk of recurrent vascular events.Its acceptable safety profile is comparable to that of no aspirin.Further studies with larger sample sizes and longer follow-up periods are needed to confirm these findings.
文摘Objective.To examine the procoagulant effects of thrombolytic agent on hemostasis and study the role of hemostatic markers as predictors of clinical outcomes.Methods.In the present study,eighteen patients with acute myocardial infarction(AMI) received 1.5 or 2.0 mulliou U nonspecific urokinase(UK),or 70-80 mg fibrin-specific fecombinant tissue plasminogen activator(rt-PA) and did not use heparin until 8 hours after intravenous injection of the above agents.Eight patients with AMI an without thrombolytic therapy were enrolled as controls.Coagulant and thrombolytic activity markers included thrombin-antithrombin Ⅲ comlex(TAT),D-dimer,fibrinogen(Fg) ,FMPV/Amax.All markers were determined before,immediately,1,2,4 and 8 hours after the administration of thrombolytic agents respectively.Results.Molecular marker of thrombin generation-TAT showed an activated coagulant state immediately after thrombolytic therapy.Level of TAT showed no significant changes between every two osbserved phases in controls.Howver,level of TAT increased significantly from 4.95±1.75μg/L(4.63±1.37μg/L) to 14.71±3.31μg/L(14.25±2.53μg/L) before and immediately after administration of thrombolytic agents UK(or rt-PA).There was significant difference between level of serum TAT of patients with and without thrombolytic therapy,and higher EMPV/Amax level than controls.D-dimer,a surrogate of thrombolytic activity increased markedly and Fg significantly declined after thrombolytic therap(P<0.05).Couclusions.Thrombin generation occurred in plasma in response to excess fibrinolysis induced by thrombolytic therapy.Both urokinase and rt-PA had procoagulant action.This transient activation of the coagulant system might contribute to early reocclusion.These data provided the theoretical support for simultaneous administration of anticoagulant therapy with thrombolytic agents.These data provided the theoretical support for simultaneous administration of anticoagulant therapy with thrombolytic agents.These results also suggested that TAT might be useful in predicting clinical outcomes of patients treated with thrombolytic therapy for AMI.
文摘目的探讨替罗非班联合重组人尿激酶原(rhPro-UK)预处理逆行溶栓对急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入术(PCI)后冠脉无复流的影响研究。方法选择2021年5月~2023年2月间收治的行PCI治疗的STEMI患者86例。根据随机分组原则分为对照组和观察组,各组43例。两组均采取PCI治疗,术中给予普通肝素钠、替罗非班,对照组注入rhPro-UK进行常规溶栓。观察组由犯罪血管远端到近端注入rhPro-UK进行逆行溶栓。比较两组术后心肌梗死溶栓试验(TIMI)血流分级、2 h ST段回落率(STR)、冠脉无复流及慢血流(NR/SF)发生率,术后住院期间B型利钠肽(BNP)、肌钙蛋白(cTnI)、左室射血分数(LVEF),随访3个月,比较两组TIMI大出血事件及主要不良心血管事件(MACEs)发生率。结果观察组PCI术后TIMI血流分级优于对照组,STR回落率高于对照组,NR/SF发生率低于对照组(P<0.05);观察组术后住院期间BNP峰值、cTnI峰值均低于对照组,LVEF峰值高于对照组(P<0.05);两组随访期间均未发生TIMI大出血,观察组MACEs发生率(心衰再住院2例)低于对照组(心源性死亡1例,心衰再住院8例),差异有统计学意义(P<0.05)。结论替罗非班联合重组人尿激酶原预处理逆行溶栓可显著改善STEMI患者PCI术后血流复流情况及左室射血功能,降低冠脉无复流及慢血流与不良心血管事件等发生率,且不增加出血风险。
文摘目的探讨尿激酶溶栓治疗急性心肌梗死患者的临床效果及安全性。方法选取天津市第四中心医院急诊内科2013年1月~2015年1月收治的100例符合急性心肌梗死静脉溶栓治疗条件的患者进行回顾性分析,其中起病至溶栓时间〈6 h 53例患者（早期组）、6~12 h 47例患者（晚期组）,2组患者均采用常规治疗＋尿激酶静脉溶栓治疗,对比2组患者的治疗效果差异。结果溶栓治疗2 h后,早期组患者的ST段回落≥50%率、ST段完全回落率及再通率均显著高于晚期组患者（P〈0.05）;溶栓治疗后,早期组患者的CK峰值、CK-MB峰值及达峰时间均显著小于或短于晚期组患者（P〈0.05）;溶栓治疗后,早期组的严重心律失常发生率显著低于晚期组患者（P〈0.05）,2组间发生出血事件及死亡率差异无统计学意义。结论尿激酶溶栓治疗急性心肌梗死患者的最佳时机是在起病后6h以内,早期溶栓治疗具有较高的再通率及治疗安全性。
