Factors affecting the early efficacy of intravenous thrombolysis using alteplase in acute ischemic stroke: A retrospective analysis of 255 cases

The early efficacy of thrombolysis within 24 hours can accurately reflect its effectiveness, as it is less influenced by other factors. This study aimed to analyze the factors influencing the early efficacy of intravenous thrombolysis using recombinant tissue plasminogen activator (IV-rtPA). The clinical data of 225 acute ischemic stroke patients treated with IV-rtPA from December 2018 to June 2023 were analyzed retrospectively. Univariate analysis and multivariate logistic regression analysis were used to compare data between 2 groups. The effective group included 127 patients (49.8%), while the noneffective group had 128 patients (50.2%). Patients with a baseline National Institute of Health Stroke Scale (NIHSS) score below 10 and those who received IV-rtPA within 3 hours of acute ischemic stroke onset-to-treatment time (OTT) showed greater benefits (NIHSS, χ² = 110.434, P < .001; OTT, χ² = 23.196, P < .001). Univariate analysis revealed significant differences between the groups in gender (P = .030), age (P < .001), AF history (P = .024), drinking history (P = .026), FIB level (P = .012), SBP level (P = .046), OTT time (P < .001), baseline NIHSS (P < .001), and rtPA dose (P = .012). Multivariate logistic regression analysis identified male gender (OR: 3.986, 95% CI: 1.727-9.201, P < .001), drinking history (OR: 0.253, 95% CI: 0.124-0.671, P = .004), OTT (OR: 0.958, 95% CI: 0.948-0.969, P < .001), baseline NIHSS scores (OR: 0.838, 95% CI: 0.785-0.895, P < .001), and rtPA dose (OR: 385.527, 95% CI: 16.725-8886.741, P < .001) as independent factors influencing early efficacy. Male gender, drinking history, baseline NIHSS score, OTT, and rtPA dose are independent factors affecting early thrombolysis efficacy. Age, AF history, high FIB level, and high SBP may also be potential risk factors.