Outcomes and Treatment Complications of Intravenous Urokinase Thrombolysis in Acute Ischemic Stroke in China.
Outcomes and Treatment Complications of Intravenous Urokinase Thrombolysis in Acute Ischemic Stroke in China.
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中国急性缺血性脑卒中静脉尿激酶溶栓治疗的结果和治疗并发症
DOI：
10.3389/fneur.2021.685454
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发表时间：
2021
影响因子：
3.4
通讯作者：
Qin X
中科院分区：
文献类型：
--
作者：
Zhang R;Wei H;Ren Y;Wu Y;Luo Y;Zhang L;Huo Y;Feng J;Monnier PP;Qin X
背景：阿替普酶静脉溶栓可使符合条件的急性缺血性卒中患者获益。然而，在中国等一些国家，阿替普酶对于低收入患者和经济发展水平较低的地区来说可能过于昂贵。尿激酶比阿替普酶便宜得多。本研究旨在评估尿激酶在急性缺血性卒中患者中的结局和治疗并发症，这一点目前尚不清楚。研究方法：这项多中心回顾性研究纳入了2014年1月至2018年1月在中国21家中心接受静脉尿激酶或阿替普酶治疗的急性缺血性卒中患者。结果和治疗并发症进行了单因素和多因素分析。结果：在纳入本研究的618例患者中，489例接受尿激酶治疗，129例接受阿替普酶治疗。在单变量和多变量分析中，尿激酶组和阿替普酶组之间的功能独立性、无/极轻微残疾、死亡率、颅内出血（ICH）和症状性ICH无显著差异。然而，与接受尿激酶治疗的患者相比，接受阿替普酶治疗的患者在单变量分析中颅外出血的比值比（OR）较低，在多变量分析中校正OR（aOR）较低（OR = 0.410 [95% CI，0.172-0.977]，p = 0.038; aOR = 0.350 [95% CI，0.144-0.854]，p = 0.021）。此外，在接受尿激酶治疗的患者中，与接受低剂量尿激酶的患者相比，接受高剂量尿激酶治疗的患者在单变量分析中颅外出血的OR较高，在多变量分析中颅外出血的aOR较高（OR = 3.046 [95%CI，1.696-5.470]，p < 0.001; aOR = 3.074 [95%CI，1.627-5.807]，p = 0.001）。此外，接受低剂量尿激酶治疗的患者与接受阿替普酶治疗的患者的结局和并发症相似。结论：与阿替普酶治疗的患者相比，尿激酶治疗的患者结局相似，但颅外出血风险较高。高剂量尿激酶治疗的患者发生颅外出血的风险高于低剂量尿激酶治疗的患者。接受低剂量尿激酶治疗的患者与接受阿替普酶治疗的患者结局和并发症相似。在中国等一些急性缺血性卒中患者无法负担阿替普酶的国家，尿激酶可能是阿替普酶静脉溶栓的良好替代品。
Background: Intravenous thrombolysis with alteplase benefits eligible patients with acute ischemic stroke. However, in some countries such as China, alteplase may be too expensive for low-income patients, and also for regions with low economic development. Urokinase is much less expensive than alteplase. This study aimed to assess the outcomes and treatment complications of urokinase in acute ischemic stroke patients, which are poorly understood. Methods: This multicenter retrospective study included acute ischemic stroke patients who received intravenous urokinase or alteplase from January 2014 to January 2018 at 21 centers in China. Outcomes and treatment complications were analyzed by univariate and multivariate analyses. Results: Among the 618 patients included in this study, 489 were treated with urokinase and 129 were treated with alteplase. Functional independence, no/minimal disability, mortality, intracranial hemorrhage (ICH), and symptomatic ICH did not significantly differ between the urokinase and alteplase groups in the univariate and multivariate analyses. However, the patients who received alteplase had a lower odds ratio (OR) of extracranial bleeding in the univariate analysis and a lower adjusted OR (aOR) in the multivariate analysis than the patients who received urokinase (OR = 0.410 [95% CI, 0.172–0.977], p = 0.038; aOR = 0.350 [95% CI, 0.144–0.854], p = 0.021). Furthermore, in patients treated with urokinase, the patients who received high-dose urokinase had a higher OR of extracranial bleeding in the univariate analysis and a higher aOR of extracranial bleeding in the multivariate analysis than patients who received low-dose urokinase (OR = 3.046 [95% CI, 1.696–5.470], p < 0.001; aOR = 3.074 [95% CI, 1.627–5.807], p = 0.001). Moreover, patients who received low-dose urokinase had similar outcomes and complications compared to patients treated with alteplase. Conclusions: Patients treated with urokinase had similar outcomes but a higher risk of extracranial bleeding compared to patients treated with alteplase. The risk of extracranial bleeding was higher in the patients treated with high-dose urokinase than in the patients treated with low-dose urokinase. Patients who received low-dose urokinase had similar outcomes and complications compared to patients treated with alteplase. In countries such as China where some acute ischemic stroke patients cannot afford alteplase, urokinase may be a good alternative to alteplase for intravenous thrombolysis.
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