Clinical Analysis and Literature Review of Intravenous Thrombolysis in Acute Ischemic Stroke with Active Malignancy

doi:10.3969/j.issn.1673-5765.2021.02.004

Abstract

Abstract:

Objective To investigate the therapeutic efficacy and safety of intravenous thrombolysis with rt-PA for acute ischemic stroke (AIS) with active malignancy. Methods The clinical data of AIS patients with active malignancy who underwent intravenous thrombolysis in Stroke Unit of Beijing Shijingshan Hospital from April 2017 to April 2020 were retrospectively analyzed. The analyzed data included neurological function improvement (NIHSS score decrease ≥2) at 7 days, 90-day good prognosis (mRS score ≤2), thrombolysis-related intracranial hemorrhage and severe systemic hemorrhage. A pooled analysis was performed to evaluate the efficacy and safety of intravenous thrombolysis with rt-PA in AIS patients with active malignancy based on the data from the published literature and this study. Results A total of 6 patients were included in this study, with an average age of 80.2 ±5.6 years. There were 5 cases (83.3%) with neurological function improvement at 7 days after thrombolysis, 4 cases (66.7%) with good prognosis at 90 days, 1 case (16.7%) with intracranial hemorrhage and no serious systemic hemorrhage. The pooled analysis included 77 cases from the previous literature and 6 cases in this study, of the total 83 cases, 44 cases (53.0%) had good prognosis at 90 days, 9 cases (10.8%) developed intracranial hemorrhage, 1 case (1.2%) developed severe systemic hemorrhage, 16 cases (19.3%) died within 90 days, and there was no death caused by thrombolysis-related intracranial hemorrhage or severe systemic hemorrhage. Conclusions For AIS patients with active malignancy, intravenous thrombolysis may be effective and safe after excluding intracranial metastases and cancer-related active bleeding.

Key words: Acute ischemic stroke; Active malignancy; Intravenous thrombolysis

摘要：

目的探讨伴有活动性恶性肿瘤的急性缺血性卒中应用rt-PA进行静脉溶栓的有效性及安全性。方法回顾性连续收集2017年4月-2020年4月在北京市石景山医院卒中单元进行静脉溶栓的伴有活动性恶性肿瘤的急性缺血性卒中患者的临床资料，统计溶栓后7 d神经功能好转率（NIHSS评分下降≥2分）、90 d良好预后率（mRS评分≤2分）、溶栓相关的颅内出血转化率及严重系统性出血发生率；通过文献回顾，汇总既往报道的伴有活动性恶性肿瘤的急性缺血性卒中患者溶栓治疗的研究数据，评价此类患者rt-PA静脉溶栓的有效性及安全性。结果本研究共纳入6例患者，平均年龄80.2±5.6岁，溶栓后7 d N I HS S评分下降≥2分者5例（83.3%），90 d mRS评分≤2分者4例（66.7%），发生颅内出血转化1例（16.7%），无严重的系统性出血。通过文献回顾，收集病例77例，与本研究合并分析共83例。90 d mRS评分≤2分患者44例（53.0%），发生颅内出血转化9例（10.8%），严重系统性出血1例（1.2%），90 d内死亡16例（19.3%），无溶栓相关颅内出血转化或严重系统性出血而导致死亡的病例。结论对于伴有活动性恶性肿瘤的急性缺血性卒中患者，在排除颅内转移瘤及肿瘤本身的活动性出血的前提下，进行rt-PA静脉溶栓可能是有效且安全的。

关键词: 急性缺血性卒中; 恶性肿瘤; 静脉溶栓

CHEN Ying, GAO Ya-Li, LIN Fang-Ju, JIA Wei-Hua. Clinical Analysis and Literature Review of Intravenous Thrombolysis in Acute Ischemic Stroke with Active Malignancy[J]. Chinese Journal of Stroke, 2021, 16(02): 130-135.

陈英，高亚丽，蔺芳菊，贾伟华. 伴活动性恶性肿瘤的急性缺血性卒中患者静脉溶栓的临床分析及文献回顾[J]. 中国卒中杂志, 2021, 16(02): 130-135.

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