Araştırma Makalesi
BibTex RIS Kaynak Göster

Experiences of Intravenous Thrombolytic Therapy of Mugla in Acute Ischemic Stroke

Yıl 2023, Cilt: 10 Sayı: 2, 115 - 119, 21.08.2023
https://doi.org/10.47572/muskutd.1173741

Öz

Recombinant tissue plasminogen activator administered within the first 4.5 hours of acute ischemic stroke is a proven treatment method. In this study, we aimed to analyze the data of 71 patients with acute ischemic stroke who underwent thrombolytic therapy between 01.01.2018 and 01.12.2021 and to share the experience of our center. The neurological status of the patients was evaluated by the National Institutes of Health Stroke Scale (NIHSS) and their disability was evaluated by the Modified Rankin Scale (mRS). NIHSS score at the 24 hours and 7 days after administration of thrombolytic therapy was significantly lower than the initial NIHSS (p<0.001 for both). 3-month mRS score was significantly lower than the mRS score at 24 hours (p<0.001). No significant correlation was found between the door-to-needle time or the symptom-to-needle time and the initial NIHSS, 24-hour NIHSS, 7-day NIHSS, 24-hour mRS and 3-month mRS scores. The 3-month mRS score was strongly correlated with the 24-hour NIHSS, 24 hour-mRS and the 7-day NIHSS (r=0.770, 0.907 and 0.857, respectively, p<0.001). There was a moderate correlation between the NIHSS at the end of the administration of rt-PA and the 3-month mRS score (r=0.597, p<0.001). As a result, thrombolytic therapy positively contributes to the prognosis. In addition, clinical status at 24 hours and 7 days predicts 3-month prognosis and correlation coefficients between NIHSS and the final mRS increase over time.

Kaynakça

  • 1. Coupland AP, Thapar A, Qureshi MI, et al. The definition of stroke. J R Soc Med. 2017;110:9.
  • 2. Feigin VL, Krishnamurthi RV, Parmar P, et al. Update on the global burden of ischemic and hemorrhagic stroke in 1990-2013: The GBD 2013 Study. Neuroepidemiol. 2015;45:161–76.
  • 3. Arsava M. Beyin damar hastalıkları ve demans. Ulusal Hastalık Yükü Çalışması Sonuçları ve Çözümleri 2017;9.
  • 4. Bahar SZ, Bakaç G, Ekizoğlu E. Beyin kan dolaşımının anatomi ve fizyolojisi. İçinde: İstanbul Tıp Fakültesi Nöroloji Kitabı. Editörler: Öge AE, Betül B, Başar B. Nobel Tıp Kitabevleri, İstanbul, 2021. s: 301-302.
  • 5. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995;333:1581-8.
  • 6. Hacke W, Kaste M, Bluhmki E, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008;359:1317-29.
  • 7. Del Zoppo GJ, Saver JL, Jauch EC, et al. Expansion of the time window for treatment of acute ischemic stroke with intravenous tissue plasminogen activator: a science advisory from the American Heart Association/American Stroke Association. Stroke. 2009;40:2945–8.
  • 8. Powers WJ, Derdeyn CP, Biller J, et al. 2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment. Stroke. 2015;46(10):3020–35.
  • 9. Prabhakaran S, Ruff I, Bernstein RA. Acute stroke intervention: a systematic review. JAMA. 2015;313:1451-62.
  • 10. Lees KR, Emberson J, Blackwell L, et al. Effects of alteplase for acute stroke on the distribution of functional outcomes: A pooled analysis of 9 trials. Stroke. 2016;47:2373-9.
  • 11. Hart RG, Diener HC, Coutts SB, et al. Embolic strokes of undetermined source: the case for a new clinical construct. Lancet Neurol. 2014;13:429–38.
  • 12. Ceornodolea AD, Bal R, Severens JL. Epidemiology and management of atrial fibrillation and stroke: Review of data from four European countries. Stroke Res Treat. 2017;2017:8593207. 13. Kamel H, Healey JS. Cardioembolic stroke. Circ Res. 2017;120:514–26.
  • 14. Kutluk K, Kaya D, Afsar N, et al. Analyses of the Turkish National Intravenous Thrombolysis Registry. J Stroke Cerebrovasc Dis. 2016;25:1041–7.
  • 15. Goyal M, Almekhlafi M, Dippel DiW, et al. Rapid alteplase administration improves functional outcomes in patients with stroke due to large vessel occlusions. Stroke. 2019;50:645–51.
  • 16. Wardlaw JM, Murray V, Berge E, et al. Recombinant tissue plasminogen activator for acute ischaemic stroke: an updated systematic review and meta-analysis. Lancet. 2012;379:2364–72.
  • 17. Emberson J, Lees KR, Lyden P, et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet. 2014;384:1929–35.
  • 18. Saver JL, Fonarow GC, Smith EE, et al. Time to treatment with intravenous tissue plasminogen activator and outcome from acute ischemic stroke. JAMA. 2013;309:2480-8.
  • 19. Saver JL, Altman H. Relationship between neurologic deficit severity and final functional outcome shifts and strengthens during first hours after onset. Stroke. 2012;43:1537–41.

Akut İskemik İnmenin İntravenöz Trombolitik Tedavisinde Muğla Deneyimleri

Yıl 2023, Cilt: 10 Sayı: 2, 115 - 119, 21.08.2023
https://doi.org/10.47572/muskutd.1173741

Öz

Akut iskemik inmede ilk 4.5 saat içinde uygulanan rekombinan doku plazminojen aktivatörü etkinliği kanıtlanmış bir tedavi yöntemidir. Bu çalışmada 01.01.2018-01.12.2021 tarihleri arasında trombolitik tedavi uygulanan 71 akut iskemik inme hastasının verilerini analiz etmeyi ve merkezimizin deneyimlerini paylaşmayı amaçladık. Hastaların nörolojik durumları Ulusal Sağlık Enstitüleri İnme Skalası (NIHSS), engellilikleri ise Modifiye Rankin Skalası (mRS) ile değerlendirildi. Trombolitik tedavisinden 24 saat ve 7 gün sonraki NIHSS, geliş NIHSS’ye göre istatistiksel olarak anlamlı düşük saptandı (her ikisi için p<0,001). 3. ay mRS skoru, 24. saat mRS skorundan anlamlı düşüktü (p<0,001). Kapıdan-iğneye veya semptomdan-iğneye zamanı ile rt-PA bitiş NIHSS, 24. saat NIHSS, 7. gün NIHSS, 24. saat mRS ve 3. ay mRS skorları arasında anlamlı ilişki bulunmadı. 24. saat NIHSS, 24. saat mRS ve 7. gün NIHSS ile 3. ay mRS skoru arasında güçlü korelasyon saptandı (sırasıyla r=0.77, 0.907 ve 0.857, p<0.001). rt-PA bitiş NIHSS ile 3 aylık mRS skoru arasında orta düzeyde bir korelasyon vardı (r=0.597, p<0.001). Sonuç olarak trombolitik tedavi prognoza olumlu katkı sunmaktadır. Ayrıca 24. saat ve 7. gündeki klinik durum, 3. aydaki prognozu öngörmede önemlidir ve 3. ay mRS ile NIHSS arasındaki korelasyon zamanla artmaktadır.

Kaynakça

  • 1. Coupland AP, Thapar A, Qureshi MI, et al. The definition of stroke. J R Soc Med. 2017;110:9.
  • 2. Feigin VL, Krishnamurthi RV, Parmar P, et al. Update on the global burden of ischemic and hemorrhagic stroke in 1990-2013: The GBD 2013 Study. Neuroepidemiol. 2015;45:161–76.
  • 3. Arsava M. Beyin damar hastalıkları ve demans. Ulusal Hastalık Yükü Çalışması Sonuçları ve Çözümleri 2017;9.
  • 4. Bahar SZ, Bakaç G, Ekizoğlu E. Beyin kan dolaşımının anatomi ve fizyolojisi. İçinde: İstanbul Tıp Fakültesi Nöroloji Kitabı. Editörler: Öge AE, Betül B, Başar B. Nobel Tıp Kitabevleri, İstanbul, 2021. s: 301-302.
  • 5. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995;333:1581-8.
  • 6. Hacke W, Kaste M, Bluhmki E, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med. 2008;359:1317-29.
  • 7. Del Zoppo GJ, Saver JL, Jauch EC, et al. Expansion of the time window for treatment of acute ischemic stroke with intravenous tissue plasminogen activator: a science advisory from the American Heart Association/American Stroke Association. Stroke. 2009;40:2945–8.
  • 8. Powers WJ, Derdeyn CP, Biller J, et al. 2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the early management of patients with acute ischemic stroke regarding endovascular treatment. Stroke. 2015;46(10):3020–35.
  • 9. Prabhakaran S, Ruff I, Bernstein RA. Acute stroke intervention: a systematic review. JAMA. 2015;313:1451-62.
  • 10. Lees KR, Emberson J, Blackwell L, et al. Effects of alteplase for acute stroke on the distribution of functional outcomes: A pooled analysis of 9 trials. Stroke. 2016;47:2373-9.
  • 11. Hart RG, Diener HC, Coutts SB, et al. Embolic strokes of undetermined source: the case for a new clinical construct. Lancet Neurol. 2014;13:429–38.
  • 12. Ceornodolea AD, Bal R, Severens JL. Epidemiology and management of atrial fibrillation and stroke: Review of data from four European countries. Stroke Res Treat. 2017;2017:8593207. 13. Kamel H, Healey JS. Cardioembolic stroke. Circ Res. 2017;120:514–26.
  • 14. Kutluk K, Kaya D, Afsar N, et al. Analyses of the Turkish National Intravenous Thrombolysis Registry. J Stroke Cerebrovasc Dis. 2016;25:1041–7.
  • 15. Goyal M, Almekhlafi M, Dippel DiW, et al. Rapid alteplase administration improves functional outcomes in patients with stroke due to large vessel occlusions. Stroke. 2019;50:645–51.
  • 16. Wardlaw JM, Murray V, Berge E, et al. Recombinant tissue plasminogen activator for acute ischaemic stroke: an updated systematic review and meta-analysis. Lancet. 2012;379:2364–72.
  • 17. Emberson J, Lees KR, Lyden P, et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet. 2014;384:1929–35.
  • 18. Saver JL, Fonarow GC, Smith EE, et al. Time to treatment with intravenous tissue plasminogen activator and outcome from acute ischemic stroke. JAMA. 2013;309:2480-8.
  • 19. Saver JL, Altman H. Relationship between neurologic deficit severity and final functional outcome shifts and strengthens during first hours after onset. Stroke. 2012;43:1537–41.
Toplam 18 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular İç Hastalıkları
Bölüm Araştırma Makalesi
Yazarlar

Turgay Dölek 0000-0003-2124-2968

Utku Cenilki 0000-0001-8433-5657

Vedat Semai Bek 0000-0003-4913-976X

Gülnihal Kutlu 0000-0002-9325-4151

Yayımlanma Tarihi 21 Ağustos 2023
Gönderilme Tarihi 11 Eylül 2022
Yayımlandığı Sayı Yıl 2023 Cilt: 10 Sayı: 2

Kaynak Göster

APA Dölek, T., Cenilki, U., Bek, V. S., Kutlu, G. (2023). Akut İskemik İnmenin İntravenöz Trombolitik Tedavisinde Muğla Deneyimleri. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi, 10(2), 115-119. https://doi.org/10.47572/muskutd.1173741
AMA Dölek T, Cenilki U, Bek VS, Kutlu G. Akut İskemik İnmenin İntravenöz Trombolitik Tedavisinde Muğla Deneyimleri. MMJ. Ağustos 2023;10(2):115-119. doi:10.47572/muskutd.1173741
Chicago Dölek, Turgay, Utku Cenilki, Vedat Semai Bek, ve Gülnihal Kutlu. “Akut İskemik İnmenin İntravenöz Trombolitik Tedavisinde Muğla Deneyimleri”. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi 10, sy. 2 (Ağustos 2023): 115-19. https://doi.org/10.47572/muskutd.1173741.
EndNote Dölek T, Cenilki U, Bek VS, Kutlu G (01 Ağustos 2023) Akut İskemik İnmenin İntravenöz Trombolitik Tedavisinde Muğla Deneyimleri. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi 10 2 115–119.
IEEE T. Dölek, U. Cenilki, V. S. Bek, ve G. Kutlu, “Akut İskemik İnmenin İntravenöz Trombolitik Tedavisinde Muğla Deneyimleri”, MMJ, c. 10, sy. 2, ss. 115–119, 2023, doi: 10.47572/muskutd.1173741.
ISNAD Dölek, Turgay vd. “Akut İskemik İnmenin İntravenöz Trombolitik Tedavisinde Muğla Deneyimleri”. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi 10/2 (Ağustos 2023), 115-119. https://doi.org/10.47572/muskutd.1173741.
JAMA Dölek T, Cenilki U, Bek VS, Kutlu G. Akut İskemik İnmenin İntravenöz Trombolitik Tedavisinde Muğla Deneyimleri. MMJ. 2023;10:115–119.
MLA Dölek, Turgay vd. “Akut İskemik İnmenin İntravenöz Trombolitik Tedavisinde Muğla Deneyimleri”. Muğla Sıtkı Koçman Üniversitesi Tıp Dergisi, c. 10, sy. 2, 2023, ss. 115-9, doi:10.47572/muskutd.1173741.
Vancouver Dölek T, Cenilki U, Bek VS, Kutlu G. Akut İskemik İnmenin İntravenöz Trombolitik Tedavisinde Muğla Deneyimleri. MMJ. 2023;10(2):115-9.