recombinant tissue plasminogen activator rt - PA acute ischemic stroke AIS 1 AIS. 24 h 2. 3 h 4. 5 h AIS 20 AIS TIA AIS

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1 1371 AIS 20 AIS 5% ~ 10% 1. 9% AIS TIA R A doi /j. issn J www. chinagp. net Sun YF Zhang Q Li JM et al. Research progress in thrombolytic therapy in treatment of acute ischemic stroke J. Chinese General Practice Research Progress in Thrombolytic Therapy in Treatment of Acute Ischemic Stroke SUN Yu - fang ZHANG Qin LI Ji - mei et al. Department of Neurology Beijing Friendship Hospital Capital Medical University Beijing China Abstract There has been about 20 years since thrombolytic therapy was used in the treatment of acute ischemic stroke AIS. However thrombolysis rate is not satisfactory due to its indications contraindications and complications. Thrombolysis rate is 5% - 10% in the treatment of AIS in other countries but the rate is only about 1. 9% in China. It is an important issue for the clinicians to increase thrombolysis rate in the treatment of AIS. The article summarizes the extension of time window of thrombolytic therapy expansion of age range transient ischemic attack TIA thrombolytic therapy for minor stroke thrombolytic therapy with contraindications and optimal dose. Key words Stroke Tissue plasminogen activator Intravernous thrombolysis AIS recombinant tissue plasminogen activator rt - PA acute ischemic stroke AIS AIS h 2 AIS 3 h 4. 5 h E - mail ybzhangcn@ sina. com 2008 ECASS Ⅲ AIS 3. 0 ~ 4. 5 h

2 SITS 6 h 3. 0 ~ 4. 5 h 3. 0 h AIS 3. 0 ~ 4. 5 h EPITHET PWI DWI 3 ~ 6 h DIAS Desmoteplase in Acute Ischemic Stroke DEDAS Dose Escalation of Desmoteplase for Acute Ischemic Stroke 2005 Ⅱ ~ 9 h NINDS ECASS ATLANTIS Ⅲ 14 CT AIS 2009 DIAS 90 μg / rt - PA 4. 5 h kg 3 ~ 9 h IST h AIS % > % 4. 5 ~ rt - PA < 3. 0 h FAD 6. 0 h rt - PA 0. 9 mg /kg 4. 5 ~ 6. 0 h 0. 1 mg /kg mg /kg 6. 0 h AIS 16 7 d AIS 4. 5 h IST h AIS FAD rt - PA 9 Meta IST h 10 6 h Nagakane 11 PWI DWI 2 30% AIS 80 MRI 4. 5 h 18 ~ 80 Thomalla MRI DWI 2012 IST h FLAIR AIS rt - PA % > h Sztriha h CT ~ 6 h

3 1373 > 80 rt - PA < 3 h h rt - PA INR < h rt - PA INR < 1. 7 K Bhatnagar INR 1. 7 SICH Meta mrs 27 SICH AHA SICH Meta 6. 6% TIA 7. 7% AHA GWTG h % 1% 28. 3% NINDS National Institute of Neurological Disorders and Stroke 24 h 30 SICH 20 Greisenegger NIHSS rt - PA rt - PA 3 GWTG NIHSS < ~ 4. 5 h rt - PA Ⅱb /C SICH 22 AHA rt - PA 1 mm Hg = kpa 110 mm Hg 9 NHISS mm Hg 100 mm Hg NIHSS AHA AHA 185 /110 mm Hg /105 mm Hg 24 Mishra GWTG AHA / ASA GWTG INR < mrs mm Hg

4 1374 benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke the third international stroke trial IST - 3 a randomised controlled trial J. Lancet Jaueh EC Saver JL Adams HP et al. Guidelines for the early 2009 ESO rt - PA 0. 9 mg /kg 90 mg AIS 4. 5 h 32 American Stroke Association J. Stroke rt - PA mg /kg 90 mg 10 Wardlaw JM Murray V Berge E et al. Recombinant tissue plasminogen activator for acute ischaemic stroke an updated 0. 6 mg /kg AIS systematic review and meta - analysis J. Lancet rt - PA 0. 9 mg /kg 11 Nagakane Y Christensen S Brekenfeld C et al. EPITHET 0. 6 mg /kg positive result after reanalysis using baseline diffusion - weighted 0. 9 imaging /perfusion - weighted imaging co - registration J. mg /kg 6 for the identification of patients with acute ischaemic stroke within 4. 5 AIS 3 h of symptom onset PRE - FLAIR a multicentre observational study J. Lancet Neurol Sztriha LK Manawadu D Jarosz J et al. Safety and clinical AIS outcome of thrombolysis in ischaemic stroke using a perfusion CT mismatch between 3 and 6 hours J. PLoS One e Hacke W Albers G Al - Rawi Y et al. The Desmoteplase in Acute Ischemic Stroke Trial DIAS a phase Ⅱ MRI - based 9 - hour window acute stroke thrombolysis trial with intravenous 1 Bandem E Botteri M Minelli C et al. Cerebral blood flow threshold desmoteplase J. Stroke of ischemic penumbra and infarct core in acute ischemic stroke a systematic review J. Stroke Donnan GA Baron JC Ma H et al. Penumbral selection of patients for trials of acute stroke therapy J. Lancet Neurol Macleod MR Petersson J Norrving B et al. Hypothermia for Stroke call to action 2010 J. Int J Stroke Lees KR Bluhmki E von Kummer R et al. Time to treatment with intravenous alteplase and outcome in stroke an updated pooled analysis of ECASS ATLANTIS NINDS and EPITHET trials J. Lancet Hacke W Kaste M Bluhmki E el al. Thrombolysis with alteplase 3 to 4. 5 hours after acute ischemic stroke J. New Engl J Med Wahlgren N Ahmed N Davalos A et al. Thrombolysis with alteplase h after acute ischemic stroke SITS - ISTR an observational study J. Lancet Davis SM Donnan GA Parsons MW et al. Effects of alteplase beyond 3 h after stroke in the Echoplanar Imaging Thrombolytic Evaluation Trial EPITHET a placebo - controlled randomised trial J. Lancet Neurol IST - 3 collaborative group Sandercock P Wardlaw JM et al. The management of patients with acute ischemie stroke a guideline for healthcare professionals from the American Heart Association / Stroke Thomalla G Cheng B Ebinger M et al. DWI - FLAIR mismatch 15 Albers GW von Kummer R DIAS - 3 and DIAS - 4 Study Group. The desmoteplase DIAS - 3 and DIAS - 4 clinical trials an important milestone passed J /OL http / /kenes. com/stroke2012/abstractcd/pdf /1463. pdf. 16 Parsons M Spratt N Bivard A et al. A randomized trial of tenecteplase versus alteplase for acute ischemic stroke J. N Engl J Med The Consensus of Expert Group of rt - PA Intravenous Thrombolytic Therapy for Ischemic Stroke. China expert consensus of rt - PA intravenous thrombolytic therapy for ischemic stroke 2012 J. Chinese Journal of Internal Medicine in Chinese rt - PA. rt - PA 2012 J Bhatnagar P Sinha D Parker RA et al. Intravenous thrombolysis in acute ischaemic stroke a systematic review and meta - analysis to aid decision making in patients over 80 years of age J. J Neurol Neurosurg Psychiatry Smith EE Fonarow GC Reeves MJ et al. Outcomes in mild or rapidly improving stroke not treated with intravenous recombinant tissue - type plasminogen activator findings from Get With The Guidelines - Stroke J. Stroke

5 Re - examining Acute Eligibility for Thrombolysis TREAT Task Force Khatrip L Broderick JP et al. NINDS rt - PA stroke trial investigators Review historical context and clarifications of the NINDS rt - PA stroke trial exclusion criteria part Ⅰ rapidly improving stroke symptoms J. Stroke Greisenegger S Seyfang L Kiechl S et al. Thrombolysis in patients with mild stroke results from the Austrian Stroke Unit Registry J. Stroke Ahmed N Wahlgren N Grond M et al. Implementation and outcome of thrombolvsis with alteplase h after an acute stroke an updated analysis from SITS - ISTR J. Lancel Neurol Frank B Grotta JC Alexandrov AV et al. Thrombolysis in stroke despite contraindications or warnings J. Stroke Jaunch EC Saver JL Adams HP Jr et al. Guidelines for the early management of patients with acute ischemic stroke a guideline for healthcare professionals from the American Heart Association / American Stroke Association J. Stroke Vergouwen MD Casaubon LK Swantz RH et al. Subtherapeutic warfarin is not associated with increased hemorrhage rates in ischemic strokes treated with tissue plasminogen activato J. Stroke Xian Y Liang L Smith EE et al. Risks of introcranial hemorrhage among patients with acute ischemic stroke receiving warfarin and treated wilh intravenous tissue plasminogen activator J. JAMA Mazya MV Lees KR Markus R et al. Safety of intravenous thrombolysis for ischemic stroke in patients treated with warfarin J. Ann Neurol Diener HC Foerch C Riess H et al. Treatment of acute ischaemic stroke with thrombolysis or thrombectomy in patients receiving anti - thrombotic treatmen J. Lancet Neurol Miedema I Luijckx GJ De Keyser J et al. Thrombolytic therapy for ischaemic stroke in patients using warfarin a systematic review and meta - analysis J. J Neurol Neurosurg Psychiatry Whitely WN Slot KB Fernandes P et al. Risk factors for intracranial hemorrhage in acute ischemic stroke patients treated with recombinant tissue plasminogen activator a systematic review and meta - analysis of 55 studies J. Stroke Mishra NK Ahmed N Davalos A et al. Thrombolysis outcomes in acute ischemic stroke patients with prior stroke and diabetes mellitus J. Neurology Wahlgren N Ahmed A Eriksson N et al. Multivariable analysis of outcome predictors and adjustment of main outcome results to baseline data profile in randomized controlled trials safe implementation of thrombolysis in stroke monitoring study SITS - MOST J. Stroke Chinese Society of Neurology. Guidelines for the diagnosis and treatment of China ischemic stroke 2010 J. Chinese Journal of Neurology in Chinese J Nakagawara J Minematsu K 0kada Y et al. Thrombolysis with 0. 6 mg / kg intravenous alteplase for acute ischemic stroke in routine clinical practice the Japan post - Marketing Altplase Registration Study J - MARS J. Stroke Dharmasroja PA Pattaraarchachai J. Low vs standard dose of recombinant tissue plasminogen aclivator in treaing East Asian patienls with acute ischemic stroke J. Neurol India 欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍 ASCVD < mg /dl 3 70 ~ 189 mg /dl ASCVD 40 ~ ASCVD 7. 5% 4 ASCVD 70 ~ 189 mg /dl 10 ASCVD 7. 5% 1 ~ 4 C hs - CRP CAC ABI 欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍欍