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Neuroprotective effect of shenfu injection after intra-arterial thrombolysis

Neural Regeneration Research 2006年第5期1卷 428-431页

作者： Huaijun Liu Xiuchuan Jia Jiping Yang Zengpin Liu Guoshi Wang Linfang Li Department of Medical Imaging Second Hospital Hebei Medical University Shijiazhuang 050000 Hebei Province China

BACKGROUND： Within 3 hours after ischemic stroke, thrombolysis can improve prognosis of patients; however, cerebral edema and cerebral hemorrhage induced by vascular recanalization at an early phase can influence on therapeutic effect of thrombolysis; therefore, thrombolysis is combined with neuroprotective agent for recently clinical treatment. OBJECTIVE： To evaluate the neuroprotective effect of shenfu injection on patients with ischemic stroke after arterial thrombolysis and compare with the controls. DESIGN ： Case-controlled study. SETTING ： Department of Medical Image, Second Hospital of Hebei Medical University. PARTICIPANTS ： A total of 45 patients with acute stroke were selected from Emergency Department or Neurological Department of the Second Hospital of Hebei Medical University from August 2005 to May 2006. All patients were met the diagnosis criteria published by the Fourth National Stroke Conference and had middle cerebral arterial embolism with angiography. Attacked course was less than 6 hours. Patients did not have a history of stroke. Scores of the National Institutes of Health Stroke Scale （NIHSS） were not less than 4 points and patients were aged from 18 to 80 years. All subjects consented of the whole therapeutic process. METHODS ： ① Intermittent perfusion was used to treat intra-arterial thrombolysis. Thirty patients with vascular recanalization or partially vascular recanalization （18 males and 12 females） were randomly divided into treatment group and control group with 15 in each group. There was no significant difference of baseline data between the two groups. After recanalization, patients in treatment group were given 20 mL shenfu injection, which consisted of ginseng saponin and aconitine （Ya＇an Sanjiu Pharmaceutical Company, batch number： 041013, 10 mL/ampoule） and slowly injected into vein for longer than 5 minutes. And then, patients were intravenously dripped with 50 mL shenfu injection and 50 g/L 250 mL glucose solution once

关键词：输注动脉内纤维蛋白溶解药/治疗应用血栓溶解疗法卒中/治疗卒中/血液老年人人类

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低分子肝素钙配伍血塞通治疗急性脑梗死90例疗效观察

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陕西医学杂志 2007年第9期36卷 1261-1262页

作者：王成宏陈雁斌陕西省榆林市第二医院榆林719000

我院于2001年3月至2006年8月,采用低分子肝素钙配伍血塞通治疗急性脑梗死共180例,取得了较满意的疗效,现分析报告如下。[第一段]

关键词：脑梗死/诊断脑梗死/药物疗法替德肝素/治疗应用钙/治疗应用纤维蛋白溶解药/治疗应用

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Primary angioplasty with routine stenting compared with thrombolytic therapy in elderly patients with acute myocardial infarction

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AMERICAN HEART JOURNAL 2003年第5期145卷 862-867页

作者： Goldenberg, I Matetzky, S Halkin, A Roth, A Di Segni, E Freimark, D Elian, D Agranat, O Zahav, YH Guetta, V Hod, H Chaim Sheba Med Ctr Inst Heart Cardiac Intens Care Unit IL-52621 Tel Hashomer Israel Soraski Med Ctr Inst Heart Tel Aviv Israel Tel Aviv Univ Sackler Fac Med IL-69978 Tel Aviv Israel

Background Prior studies have yielded conflicting data on the advantage of primary angioplasty compared with thrombolysis in elderly patients with acute myocardial infarction (AMI). These studies, however, were performed before the contemporary widespread use of intracoronary stents and glycoprotien IIb/IIIa antagonists. Methods we prospectively compared the outcome of 130 consecutive elderly patients (aged greater than or equal to70 years) with ST-elevation AMI who were admitted to 2 similar neighboring medical centers. Patients were assigned to receive either thrombolytic therapy with accelerated tissue-type plasminogen activator (center 1) or primary angioplasty with routine stenting (center II). Results Of the patients assigned to receive primary angioplasty, 91% underwent stenting. At 6 months, patients treated with primary angioplasty, compared with those treated with thrombolytic therapy, had a lower incidence of reinfarction (2% vs 14%, P = .053) and revascularization for recurrent ischemia (9% vs 61%, P < .001) and a significant reduction in the prespecified combined end point of death, reinfarction, or revascularization for recurrent ischemia (29% vs 93%, P < .01). Primary angioplasiy remained an independent predictor of the triple combined end point after controlling for potential covariables (relative risk 0.63, 95% Cl 0.38-0.84.). Major bleeding complications were also significantly reduced in the primary angioplasty group (0% vs 17%, P = .03). Conclusions Compared with thrombolysis, primary angioplasty with routine stenting in elderly patients with AM is associated with better clinical outcomes and a lower risk of bleeding complications.

关键词：血管成形术经腔经皮冠状动脉/死亡率用药计划表纤维蛋白溶解药/治疗应用出血/化学诱导医院死亡率以色列/流行病学 Logistic模型心肌梗死/药物疗法心肌梗死/死亡率心肌梗死/治疗心肌缺血/病因学前瞻性研究复发支架组织型纤溶酶原激活物/治疗应用治疗结果老年人女(雌)性人类男(雄)性

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Angiographic and clinical characteristics associated with the development of Q-wave and non-Q-wave myocardial infarction in the Thrombolysis In Myocardial Infarction (TIMI) 14 trial

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AMERICAN HEART JOURNAL 2003年第1期146卷 42-47页

作者： Murphy, SA Dauterman, K de Lemos, JA Kermgard, S Antman, EM Braunwald, E Gibson, CM TIMI Study Grp Boston MA 02115 USA Brigham & Womens Hosp Dept Med Harvard Med Sch Boston MA 02115 USA Cleveland Clin Fdn Cleveland OH 44195 USA Univ Calif San Francisco Dept Med Div Cardiovasc San Francisco CA USA Univ Texas SW Med Ctr Dept Med Dallas TX USA

Background in the absence of thrombolytic therapy, patients with non-Q-wave myocardial infarction (MI) have previously been shown to have lower long-term mortality rates than patients with Q-wave MI. The goal of our study was to examine the angiographic and clinical differences between non-Q-wave MI and Q-wave MI in patients with ST elevation MI (STEMI) in the era of thrombolytic and combination therapy of thrombolytics plus glycoprotein IIb/IIIa inhibitors. Methods Angiography was performed 90 minutes after thrombolytic administration in the Thrombolysis in Myocardial Infarction (TIMI) 14 trial. The development of a non-Q-wave MI was assessed on electrocardiogram performed at the time of hospital discharge. Angiographic findings were assessed at an angiographic core: laboratory by blinded investigators. Results The qualifying episode of ST elevation developed into a non-Q-wave MI in 36% of patients (315/878) and into,a Q-wave MI in 64% of patients (563/878). In patients in whom non-Q-wave MI developed, the rate of TIMI grade 3 flow was higher, peak creatine kinase level was lower, mean left ventricular ejection fraction was greater, corrected TIMI frame counts (CTFCs) were lower (ie, faster blood flow), and chest pain duration after, thrombolytic administration was shorter. Patients in whom non-Q-wave MI developed less frequently underwent a percutaneous coronary intervention (PCI), and when they did, they had faster post-PCI CTFCs and higher rates of post-PCI TIMI grade 3 flow. Patients in whom a non-Q-wave MI developed had lower rates of severe recurrent ischemia. There were no differences in 30-day or in-hospital mortality rates or recurrent MI between patients with Q-wave MI and patients with non-Q-wave MI. Conclusion After thrombolytic therapy in STEMI with or without abciximab, ejection fractions were higher, the duration of ischemia was shorter, and coronary blood flow at both 90 minutes and after PCI was faster in patients who sustained non-Q-wave MI than i

关键词：肾上腺素能β受体拮抗剂/治疗应用抗体单克隆/治疗应用心律失常心性/诊断显像心律失常心性/药物疗法心律失常心性/病理生理学冠状血管造影术纤维蛋白溶解药/治疗应用免疫球蛋白Fab片段/治疗应用心肌梗死/诊断显像心肌梗死/药物疗法心肌梗死/病理生理学血小板糖蛋白GPⅡb-Ⅲa复合物/拮抗剂和抑制剂统计学非参数血栓溶解疗法/方法组织型纤溶酶原激活物/治疗应用女(雌)性人类男(雄)性中年人

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Reappraising the role of immediate intervention following thrombolytic recanalization in acute myocardial infarction

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AMERICAN JOURNAL OF CARDIOLOGY 2000年第4期86卷 400-405页

作者： Grech, ED Sutton, AGC Campbell, PG Ashton, VJ Price, DJA Hall, JA de Belder, MA S Cleveland Hosp Cardiothorac Div Dept Cardiol Middlesbrough TS4 3BW Cleveland England Univ Teesside Ctr Hlth & Med Res Middlesbrough Cleveland England

Early studies indicated that after successful thrombolytic recanalization, adjunctive percutaneous transluminal coronary angioplasty (PTCA) was not appropriate, even when a significant residual stenosis was present. The aim of this study was to assess in-hospital clinical outcomes of patients with acute myocardial infarction (AMI) who underwent successful recanalization after thrombolytic therapy. The relation between repeat AMI/unstable angina and the severity of the stenosis, as well as other angiographic and clinical features was also examined. One hundred patients with AMI of <10 hours underwent coronary angiography 2 hours after receiving thrombolytic therapy. Salvage PTCA +/- stenting was performed if recanalization was unsuccessful (Thrombolysis In Myocardial Infarction [TIMI] trial grade 0 to 2), and no PTCA was undertaken if there was brisk anterograde flow (TIMI 3). Angiographic analysis was performed to assess the severity of the residual lesion, as well as the presence or absence of thrombus. Forty patients had unsuccessful recanalization, and of these, 36 underwent attempted PTCA. Of the 60 patients with TIMI 3 flow, 15 required repeat angiography and PTCA after repeat AMI (n = 13) or unstable angina (n = 2) within 5 days. Receiver-operating characteristic analysis indicated an optimum percent diameter stenosis predictor of 85% for repeat AMI/unstable angina. There was no additional relation to age, gender, time to thrombolysis, the infarct-related artery, or the presence of culprit lesion thrombus. After recanalization, a high-grade stenosis >85% is common (n = 25, 42.4%). This is associated with a 54% repeat AMI/unstable angina risk-a ninefold increase in the incidence of such events than in patients with lesions <85%. Thus, patients with narrowings >85% may benefit from early intervention rather than a conservative approach. Narrowings <85% have a 94% probability of no repeat AMI/unstable angina and do not require early intervention. (C)2000 by Excer

关键词：心绞痛不稳定型/病因学血管成形术经腔经皮冠状动脉综合疗法冠状血管造影术冠心病/分类冠心病/病理学纤维蛋白溶解药/治疗应用心肌梗死/药物疗法心肌梗死/治疗前瞻性研究 ROC曲线复发危险因素链激酶/治疗应用治疗结果成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Efficacy of a synthetic pentasaccharide, a pure factor Xa inhibitor, as an antithrombotic agent a pilot study in the setting of coronary angioplasty

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THROMBOSIS AND HAEMOSTASIS 1999年第2期81卷 214-220页

作者： Vuillemenot, A Schiele, F Meneveau, N Claudel, S Donat, F Fontecave, S Cariou, R Samama, MM Bassand, JP Hop Univ St Jacques Serv Cardiol F-25030 Besancon France Sanofi Rech F-34082 Montpellier France Hotel Dieu Paris France

Aim of the study. To assess the antithrombotic properties of SR90107/ORG31540, a sulfated pentasaccharide, which enhances specifically antithrombin In: mediated inactivation of factor-Xa, in a clinical setting known to promote arterial thrombosis, i.e. coronary angioplasty. Methods and results. Percutaneous transluminal coronary angioplasty (PTCA) was carried our with conventional balloons with a single 5 min intravenous infusion of 12 mg pentasaccharide, and 500 mg intravenous aspirin. Heparin was nor allowed before, during PTCA, and within 24 h after PTCA. The primary end point was the rate of abrupt vessel closure during and within 24 h after the procedure. The sample size was set at 60 evaluable patients, in order to be able to conclude with a good level of confidence (>95%) that the abrupt vessel closure rate was less than 10%, ii less than 3 abrupt vessel closures were observed. Seventy-one patients were included in the study, of whom 10 needed elective stenting, and were not considered as evaluable for efficacy. Two out of the 61 remaining evaluable patients experienced acute vessel closure during the study period [3.28%, 95% confidence interval (0.4%;11.4%)]. No major bleeding occurred. The drug plasma concentrations reached 1.91 +/- 0.39 mg/l, 10 min after pentasaccharide injection, and decreased on average to 1.18 +/- 0.27 mg/l at 2 h, and to 0.36 +/- 0.11 mg/l at 23 h after administration of pentasaccharide. Activated clotting time (ACT) and activated partial thromboplastin (aPTT) time remained within normal range. Thrombin-antithrombin complex levels fell from 22 +/- 17.1 to 4.5 +/- 3.4 mu g/ml, prothrombin fragment 1+2 levels decreased from 2.15 +/- 1.01 to 1.73 +/- 0.87, and activated factor Vn levels decreased from 43.4 +/- 16.8 mU/ml to 18.9 +/- 7.3 mU/ml respectively from baseline to 2 h following injection of the tested drug. Conclusions. Administration of pentasaccharide led to the inhibition of thrombin generation without modification of aPTT and

关键词：阿司匹林/治疗应用冠状血管造影术冠心病/放射摄影术冠心病/治疗冠状动脉血栓形成/预防和控制药物疗法联合纤维蛋白溶解药/治疗应用寡糖类/治疗应用试点项目血小板聚集抑制剂/治疗应用术前用药法治疗结果青少年成年人老年人女(雌)性人类男(雄)性中年人

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Pravastatin therapy in hyperlipidemia: Effects on thrombus formation and the systemic hemostatic profile

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第5期33卷 1294-1304页

作者： Dangas, G Badimon, JJ Smith, DA Unger, AH Levine, D Shao, JH Meraj, P Fier, C Fallon, JT Ambrose, JA Mt Sinai Sch Med Dept Med New York NY 10029 USA Mt Sinai Sch Med Dept Pathol New York NY 10029 USA Cornell Univ Coll Med Rogosin Inst New York NY USA

OBJECTIVES The study sought to determine the effects of lipid-lowering with pravastatin on the systemic fibrinolytic profile and on thrombus formation under dynamic flow conditions. BACKGROUND Lowering cholesterol (C) decreases clinical events in coronary artery disease (CAD) patients, but an analysis of the effects of lipid-lowering on the entire hemostatic and thrombotic profile has not been conducted. METHODS We prospectively studied 93 stable patients with untreated low-density lipoprotein cholesterol (LDL-C) >145 mg/dl. The CAD patients received pravastatin, and non-CAD patients were randomized to pravastatin versus placebo (double-blind). Thrombus formation upon an injured vascular surface was assessed in a substudy of 40 patients with a previously validated ex vivo perfusion chamber system. Systemic hemostatic markers and thrombus formation were evaluated at baseline, three and six months. RESULTS Placebo produced no changes in either the lipid profile, any of the hemostatic markers, or the ex vivo thrombus formation. Both pravastatin groups (CAD and non-CAD) showed decreased LDL-C by 30% within 6 weeks (188 to 126 mg/dl, p < 0.001 vs. baseline), and decreased plasminogen activator inhibitor-1 at 3- and 6-month follow-up compared to baseline (15% to 18% decrease at 3 months and 21% to 23% at 6 months). For the tissue plasminogen activator antigen, CAD and non-CAD groups showed significant decreases at 6 months compared to baseline (10% and 13%, respectively). No significant changes were observed with treatment in d-dimer, fibrinopeptide A, prothrombin fragment F-1.2, factor Wa, von Willebrand factor, or C-reactive protein. Fibrinogen levels were significantly increased at 6 months compared to baseline, though still below the upper normal limit. In the perfusion chamber substudy, there was a decrease in thrombus area in non-CAD patients treated with pravastatin at both 3 and 6 months compared to baseline (by 21% and 34%, respectively). The CAD patients showed

关键词：阿司匹林/治疗应用血液凝固因子/代谢胆固醇 LDL/血液冠状动脉血栓形成/血液冠状动脉血栓形成/药物疗法冠状动脉血栓形成/病因学双盲法纤维蛋白溶解药/治疗应用随访研究止血/药物作用羟甲基戊二酰基CoA还原酶抑制剂/治疗应用高脂血症/血液高脂血症/并发症高脂血症/药物疗法脂蛋白(A)/血液普伐他丁/治疗应用前瞻性研究治疗结果老年人女(雌)性人类男(雄)性中年人

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Effect of delay on racial differences in thrombolysis for acute myocardial infarction

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AMERICAN HEART JOURNAL 2000年第4期140卷 643-650页

作者： Syed, M Khaja, F Rybicki, BA Wulbrecht, N Alam, M Sabbah, HN Goldstein, S Borzak, S Henry Ford Hosp Henry Ford Heart & Vasc Inst Detroit MI 48202 USA Henry Ford Hlth Syst Dept Biostat & Res Epidemiol Detroit MI USA

Objective To analyze the effect of delay times on racial differences in thrombolysis for acute myocardial infarction. Background Lower rates of thrombolytic therapy in blacks with acute myocardial infarction have recently been reported, but the reasons for this disparity are unknown. We hypothesized that lower rates of thrombolysis are caused by delay in presentation after symptom onset. Methods From November 1992 through November 1996, consecutive patients with a first acute myocardial infarction presenting to a large, urban teaching hospital were prospectively enrolled. Delay times were determined retrospectively from review of medical records. Patients were prospectively followed up for in-hospital cardiac events and death. A multivariable regression model was built to relate presentation times and other variables to thrombolysis administration. Results A total of 395 patients were included in the study, of which 33% were block. Symptom onset to emergency department presentation and door-to-needle times were significantly longer in blacks. Thrombolysis was administered significantly less often in blacks compared with whites (47% vs 68%, P = .001). Black race and age above 60 years were independently associated with delayed presentation and prolonged door-to-needle times. Black race, time to presentation, and non-Q-wave myocardial infarction were independently associated with not receiving thrombolysis. In-hospital mortality rates were similar in both groups. Conclusions Blacks presented later than whites for first acute myocardial infarction. late arrival strongly influenced the rate of thrombolysis administration, Lower rates of thrombolysis and prolonged door-to-needle times were apparent in blacks after adjustment for delay times and other clinical factors, a finding that merits further investigation.

关键词：非洲大陆世系人群欧洲大陆世系人群纤维蛋白溶解药/治疗应用医院死亡率心肌梗死/药物疗法心肌梗死/人种学心肌梗死/死亡率前瞻性研究存活率血栓溶解疗法/统计学和数值数据时间因素美国/流行病学市区人口成年人女(雌)性人类男(雄)性中年人

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Negative T waves shortly after ST-elevation acute myocardial infarction are a powerful marker for improved survival rate

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AMERICAN HEART JOURNAL 2000年第3期140卷 385-394页

作者： Sgarbossa, EB Meyer, PM Pinski, SL Pavlovic-Surjancev, B Barbagelata, A Goodman, SG Lum, AS Underwood, DA Gates, KB Califf, RM Topol, EJ Wagner, GS Fdn Favaloro Buenos Aires DF Argentina St Michaels Hosp Toronto ON M5B 1W8 Canada Cleveland Clin Fdn Cleveland OH 44195 USA Duke Clin Res Inst Durham NC USA

Background Recent studies have reported that negative T waves in the setting of acute coronary events are associated with Thrombolysis In Myocardial Infarction flow grade 3 in the infarct-related artery and with improved parameters of ventricular function rather than with ischemia. Methods Patients enrolled in the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO-I) angiographic substudy (ie, patients with acute infarction randomly assigned to one of 4 thrombolytic regimens who then underwent coronary angiography) were included in this study if they survived at least 24 hours and had no confounding electrocardiographic factors (n = 1505). Results More patients had negative T waves develop (NT group, n = 938 [62%]) than not (PT group, n = 567 [38%]). Peak creatine kinase MB, time to thrombolysis, and randomization to accelerated alteplase were no different between the groups. Thirty days after admission, 12 patients in the NT group had died versus 25 patients in the PT group (1.3% vs. 4.4%;P < .001;odds ratio for negative T waves 0.28;95% confidence interval 0.14-0.56). The difference persisted when only patients who survived at least 3 days were analyzed. After adjusting for relevant covariates (including presence of new Q waves in the follow-up electrocardiogram), negative T waves were an independent predictor for survival (P = .007;odds ratio For negative T waves 0.38;95% confidence interval 0.18-0.78). Patients in the NT group were 35% more likely to have achieved patency of the infarct-related artery, although this difference was not statistically significant. Conclusions Negative T waves shortly after acute myocardial infarction treated with thrombolysis were markers for improved 30-day survival rate. This finding merits prospective testing.

关键词：生物学标记/分析冠状血管造影术心电描记术/分类纤维蛋白溶解药/治疗应用心肌梗死/诊断心肌梗死/药物疗法心肌梗死/死亡率预后前瞻性研究敏感性与特异性存活率成年人老年人女(雌)性人类男(雄)性中年人

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How long is too long? Association of time delay to successful reperfusion and ventricular function outcome in acute myocardial infarction: The case for thrombolytic therapy before planned angioplasty for acute myocardial infarction

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AMERICAN HEART JOURNAL 2002年第3期144卷 456-462页

作者： Lundergan, CF Reiner, JS Ross, AM George Washington Univ Cardiovasc Res Inst Washington DC 20037 USA George Washington Univ PACT Core Angiog Lab Washington DC 20037 USA

Objectives The purpose of this study was to quantify the effect of time delays to reperfusion on ventricular function after myocardial infarction. This allows one to identify a group of patients in whom a strategy using antecedent pharmacologic reperfusion therapy before planned direct angioplasty may offer significant benefit. Background Direct angioplasty for myocardial infarction is associated with a high rate of successful reperfusion compared with phormacologic reperfusion. However, there is an inherent time delay to treatment with angioplasty compared with pharmacologic therapy. There currently are insufficient data to determine the consequences of incremental time delays to reperfusion on ventricular function. Methods We determined, by logistic regression analysis, the probability of observing a decrement in postmyocardial infarction ventricular function as a function of incremental time delays to reperfusion. Results Time delays of 30, 60, 90, or 120 minutes to reperfusion increased the likelihood of a worse ventricular function outcome by 1.1-, 1.3-, 1.5-, and 1.7-fold, respectively (P < .02). The upper 95% confidence limits around these odds ratios are as high as 1.3 or 2.7 for 30- and 120-minute delays, respectively. Time from symptom onset to patency remained a significant determinant of ventricular function after adjustment for clinical and procedural factors. Conclusions Delay in time to reperfusion, measured in minutes, results in significant loss of ventricular function after myocardial infarction. Interventional strategies designed for treatment of myocardial infarction when "door-to-balloon" time is expected to exceed 60 minutes should strongly consider incorporation of pharmacologic reperfusion therapy into the therapeutic paradigm.

关键词：急性病血管成形术气囊/方法综合疗法恢复期冠状血管造影术双盲法纤维蛋白溶解药/治疗应用随访研究心肌梗死/诊断心肌梗死/药物疗法心肌梗死/外科学心肌血管重建术/方法结果评价(卫生保健) 安慰剂时间因素组织型纤溶酶原激活物/治疗应用治疗结果心室功能左/药物作用心室功能左/生理学人类

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