Combined thrombolytic therapy with low-dose recombinant tissue plasminogen activator and urokinase for patients with acute cerebral infarction within 6 hours of onset

Objective To evaluate the efficacy and safety of combined thrombolytic therapy with recombinant tissue plasminogen activator(rt-PA) and urokinase(UK) of patients with acute cerebral infarction within 6 hours of onset. Methods One hundred and sixty-one patients with acute cerebral infarction (6 hours from onset) were recruited and randomly allocated into 4 groups:combined thrombolysis group (A group)which included 44 patients,the rt-PA group (B group) included 37 patients,the UK group (C group)included 32 patients,and control group (D group)included 48 subjects. The outcome scores were evaluated according to the National Institute of Heath Stroke Scale (NIHSS) and Barthel index before treatment and 28 days after symptom onset,and the hemorrhagic transformation,recurrent infarction and death as the safety indicators were evaluated. Results There were significant differences in efficacy and satisfactory outcome rate between 3 thrombolysis groups and control group at 28 days (P 0.01). There were no significant differences in the efficacy and satisfactory outcome rate in 3 thrombolysis groups among the 28 days (P 0.05). There were no significant differences in stroke recurrence rate, mortality and non-symptomatic intracerebral hemorrhage rate (P 0.05) in 4 groups. The incidence of cerebral hemorrhage (symptomatic and non-symptomatic intracerebral hemorrhage) in each group was 9.0%, 27.0%, 28.1%, 4.2% respectively. There were no significant differences between A and D group (P 0.05). There were significant differences compared with A and B, A and C, B and D, C and D (P 0.05). Conclusions The efficacy of combined thrombolytic therapy is noninferior to rt-PA alone or urokinase alone for the treatment of acute cerebral infarction, but the incidence of cerebral hemorrhage is lower than that of the other two groups, so the combined thrombolytic therapy is safe and effective.