Combined thrombolytic therapy with low-dose recombinant tissue plasminogen activator and urokinase for patients with acute cerebral infarction

Objective To observe the efficacy and safety of combined thrombolytic therapy with recombinant tissue plasminogen activator(rt-PA) and urokinase(UK) on patients with acute cerebral infarction.Method Eighty-one patients with acute cerebral infarction(6 hours from onset) were recruited and randomly allocated into four groups:combined thrombolysis group(n=20),rt-PA group(n=22),UK group(n=18),and control group(n=21).The patients in combined thrombolysis group received rt-PA 20 mg and UK 300 000-500 000 IU;the patients in rt-PA group received rt-PA 0.9 mg/kg intravenously;the patients in UK group received UK 10 000-20 000 IU/kg(patients with body weight 75 kg received the same dose of medication as 75 kg),and the maximum dose of UK was 1 500 000 IU;the patients in the control group received to no thrombolytic drugs.The outcome score were evaluated according to the National Institute of Health Stroke Scale(NIHSS) before treatment and four weeks after symptom onset,and to evaluate hemorrhagic transformation,recurrent infarction,and death as the safety indicators.Results ①Before treatment the NIHSS scores in the combined thrombolysis,rt-PA,UK,and control groups were 18.1±3.6,17.9±3.6,18.0±3.4,and 17.3±4.0,respectively,and after treatment they were 9.1±5.6,8.8±5.5,9.6±5.2,and 14.1±4.6,respectively.There were significant differences in each group before and after treatment(P0.01),and also between the 3 thrombolysis groups and the control group(P0.01);but there were no significant differences between each other of the 3 thrombolysis groups.②The total effective rates in the 4 groups but were 85.0%(17/20),86.4%(19/22),83.3%(15/18),and 42.9%(9/21),respectively.As compared between the 3 thrombolysis groups with the control group,there were significant differences(P0.05);and there were no significant differences among the 3 thrombolysis groups(P0.05).③One patient had new attack of cerebral infarction,and 1 patient had hemorrhagic transformation within 24 hours after thrombolytic therapy in the combined thrombolytic group;3 patients had hemorrhagic transformation in the rt-PA group;1 patient had new attack of cerebral infarction in the UK group;2 patients had hemorrhagic transformation,and 1 of them died.One patient had new attack of cerebral infarction,and 1 patient was died in the control group.Conclusion The combined thrombolytic therapy with low-dose rt-PA and UK for the treatment of acute cerebral infarction is safe and effective.