Blood pressure trajectories after intravenous thrombolysis with alteplase and non-immunogenic recombinant staphylokinase in patients with acute ischemic stroke: a retrospective cohort study

Objective. To evaluate hemodynamic profiles of patients after intravenous thrombolysis with alteplase and non-immunogenic recombinant staphylokinase, as well as to identify associations between different hemodynamic profiles and intravenous thrombolysis outcomes. Material and methods. We analyzed local reperfusion intervention registry (patients older 18 years with ischemic stroke). Patients who underwent bridging reperfusion were excluded from the study. We defined primary endpoints as systolic blood pressure decrement within 1 and 3 hours after intravenous thrombolysis. We assessed NIHSS score increment ≥4 in 1 and 24 hours after intravenous thrombolysis as a safety criterion. Functional recovery was evaluated using the modified Rankin Scale at discharge. Results. A total of 218 cases were included. Intravenous thrombolysis with alteplase was performed in 114 cases, with non-immunogenic recombinant staphylokinase — in 104 cases. Systolic blood pressure decrement over the first 3 hours was significantly higher in the non-immunogenic staphylokinase group: B=6.8 [95% CI 1.0–12.6] (p=0.021). The incidence of neurological deterioration within 24 hours after intravenous thrombolysis did not differ between the groups: adjusted odds ratio 1.5 [95% CI 0.5–4.7] (p=0.529). No association was found between thrombolytic agent and achievement of good functional recovery (modified Rankin scale 0–2): adjusted odds ratio 1.3 [95% CI 0.6–2.6] (p=0.716). Conclusion. Non-immunogenic recombinant staphylokinase was associated with more effective correction of arterial hypertension within the first 3 hours after intravenous thrombolysis compared to alteplase. Appropriate hemodynamic trajectories were not accompanied by worse clinical outcomes.