Objective To observe the efficacy and safety of rt-PA intravenous thrombolysis combined with
dual antiplatelet therapy in patients with mild ischemic stroke.
Methods Patients with mild ischemic stroke who were admitted in Department of Neurology, the
First Hospital of Shijiazhuang from December 2013 to December 2016 were prospectively enrolled
in this study, and all subjects were randomly divided into three groups: control group, thrombolysis +
mono antiplatelet therapy group (observation group A), and thrombolysis + dual antiplatelet therapy group (observation group B). The control group didn’t receive intravenous thrombolysis and were given long-term oral aspirin (100 mg/d), the observation group A was given long-term aspirin
therapy (100 mg/d) after rt-PA intravenous thrombolysis (0.9 mg/kg, the maximum dose of 90 mg).
The observation group B was given clopidogrel (75 mg/d) and aspirin (100 mg/d) for 21 days after
intravenous thrombolysis, and then dual antiplatelet therapy was changed to long-term mono aspirin
therapy. The follow-up time was 3 months. The efficacy indexes included the proportion of NIHSS
score 0-1, Barthel index (BI) score 95-100, mRS score 0-1 at 3 months. The safety indexes included
the incidence of 24-hour hemorrhagic transformation and symptomatic hemorrhagic transformation.
In addition, the levels of serum hs-CRP and IL-6 at the baseline and 3 months were compared in the
three groups.
Results A total of 85 patients were included in the study, including 28 cases in control group, 28 in
observation group A and 29 in observation group B. All patients were followed up for 3 months and
there was no death. The proportion of NIHSS score 0-1 in control group, observation group A and
B were 46.43%, 78.57% and 93.10%, respectively, and that of BI score 95-100 for 53.57%, 82.14%
and 89.66%, respectively, and that of mRS score 0-1 for 50.00%, 82.14% and 93.10%, respectively,
and all the above differences among the three groups were statistically significant. The pairwise
comparison of the above indexes showed that that of the observation group B was higher than that
of observation group A and control group, and that of observation group A was higher than that of
control group, and the differences were statistically significant. The incidence of recurrent ischemic
stroke in the control group, observation group A and B were 32.14%, 7.14% and 3.45%, respectively,
and the difference was statistically significant. There was no hemorrhagic transformation event in
the three groups. In addition, the level of hs-CRP in the control group, observation group A and B
were 11.92±3.58 mg/L, 9.04±2.85 mg/L and 6.04±2.65 mg/L, respectively, and the level of IL-6 for
26.18±4.65 ng/L, 16.11±6.93 ng/L and 12.84±2.57 ng/L, respectively, and the above differences
in inflammatory factors among the three groups were statistically significant, and the pairwise
comparison showed that that of observation group B was lower than that of observation group A
and control group, and that of observation group A was lower than that of control group.
Conclusions For patients with mild ischemic stroke, short-term dual antiplatelet therapy after
intravenous thrombolysis with rt-PA can significantly improve neurological function, reduce the
levels of inflammatory factors and stroke recurrence, without increasing the risk of bleeding.
