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Akut İskemik İnmede İntravenöz Trombolitik Tedavi Sonuçları

Year 2024, Volume: 8 Issue: 2, 151 - 156, 27.08.2024
https://doi.org/10.46332/aemj.1382834

Abstract

Amaç: Bu çalışmada inme ünitemizde intravenöz rekombinan doku plazminojen aktivatörü (iv rt-PA) uyguladığımız akut iskemik inme tanılı hastaların verilerini inceleyerek tedavinin etkinliği, komplikasyonları ve prognozları hakkında deneyimlerimizi paylaşmayı amaçladık.

Araçlar ve Yöntem: Eylül 2018 ve Aralık 2021 yılları arasında inme ünitemizde iv rt-PA uyguladığımız 39 hasta retrospektif olarak incelendi. Hastaların demografik özellikleri, inme risk faktörleri, semptom-kapı, semptom-iğne zamanı, NIHSS (National Institutes of Health Stroke Scale) ve MRS (Modified Rankin Scale) değerleri dosyalarından kaydedildi.

Bulgular: Hastaların 22’sikadın (% 56.4),17’si erkekti (%43.6). En sık görülen risk faktörü hipertansiyon (%56.4) ve hiperlipidemiydi (%46.2). Hastaların giriş, 24. saat ve 7. gününde bakılan NIHSS skorları sırasıyla 17.3±5.9, 13.4±8.7, 11.1±10.3’idi. Hastaların sadece 9‘unda (%23.1) serebral kanama saptanırken, 12’sinde (%30.8) ölüm olduğu saptandı.

Sonuç: Ivrt-PA tedavisi akut iskemik inmede etkili ve güvenli bir yöntemdir. İnme tedavisinde toplumsal farkındalığın artırılması, inme ünitesi ve merkezlerinin sayılarının artırılması ile başarı oranları çok daha iyi seviyelere yükselecektir.

References

  • 1. Tanrıverdi Z, Örken DN, Aksoy S, et al. Akut iskemik inmede intravenöz trombolitik tedavi: Şişli Etfal Eğitim ve Araştırma Hastanesi nöroloji kliniği deneyimi. Ş. EEAH Tıp Bülteni. 2012;46(4):165-169.
  • 2. Bahar S, Bakaç G. Beyin Kan Dolaşımının Anatomi ve Fizyolojisi. Nöroloji. 2015;2:239-245.
  • 3. Disorders NIoN, Group Sr-PSS. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333(24):1581-1588.
  • 4. 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(13):1317-1329.
  • 5. Field JM, Hazinski MF, Sayre MR, et al. Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(18 Suppl 3):640-656.
  • 6. Topçuoğlu MA, Arsava EM, Özdemir AÖ, Gürkaş E, Örken DN, Öztürk Ş. Akut inme tedavisinde intravenöz trombolitik tedavi: Sorunlar ve çözümler. Turk J Neurol. 2017;23(4):162-175.
  • 7. Çetiner M, Canbaz Kabay S, Aydın HE. Akut iskemik inmede intravenöz trombolitik tedavi: Kütahya deneyimleri. 2017.
  • 8. Oruc S, Demirbaş H, Yaman M, et al. Akut iskemik inmeli olgularda Kocatepe Üniversitesi Nöroloji Kliniği’nin intravenöz trombolitik tedavi deneyimleri. 2015.
  • 9. Çabalar M, Taşdemir N, Erdoğan HA, et al. Akut İskemik İnmede İntravenöz Trombolitik Tedavi Deneyimlerimiz. Med J Bakirkoy. 2018;14(1):71-75.
  • 10. Thomalla G, Simonsen CZ, Boutitie F, et al. MRI-guided thrombolysis for stroke with unknown time of onset. N Engl J Med. 2018;379(7):611-622.
  • 11. Group Nt-PSS. Intracerebral hemorrhage after intravenous t-PA therapy for ischemic stroke. Stroke. 1997;28(11):2109-2118.
  • 12. 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. The Lancet. 2014;384(9958):1929-1935.
  • 13. Casaubon LK, Boulanger J-M, Blacquiere D, et al. Canadian stroke best practice recommendations: hyperacute stroke care guidelines, update 2015. Int J Stroke. 2015;10(6):924-940.
  • 14. Demaerschalk B, Kleindorfer D, Adeoye O, et al. American Heart Association Stroke Council and Council on Epidemiology and Prevention. Scientific rationale for the inclusion and exclusion criteria for intravenous alteplase in acute ischemic stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2016;47(2):581-641.
  • 15. Kutluk K, Kaya D, Afsar N, et al. Analyses of the Turkish National Intravenous Thrombolysis Registry. J. Stroke Cerebrovasc. Dis. 2016;25(5):1041-1047.
  • 16. Arık A, Altun Y, Tak AZ, Altunışık E. Akut iskemik inmede intravenöz trombolitik tedavi: Adıyaman deneyimleri. Turk J Cereb Vasc Dis. 2020;26(3):262-268.
  • 17. Logallo N, Novotny V, Assmus J, et al. Tenecteplase versus alteplase for management of acute ischaemic stroke (NOR-TEST): a phase 3, randomised, open-label, blinded endpoint trial. Lancet Neurol. 2017;16(10):781-788.
  • 18. Kvistad CE, Næss H, Helleberg BH, et al. Tenecteplase versus alteplase for the management of acute ischaemic stroke in Norway (NOR-TEST 2, part A): a phase 3, randomised, open-label, blinded endpoint, non-inferiority trial. Lancet Neurol. 2022;21(6):511-519.
  • 19. Katsanos AH, Psychogios K, Turc G, et al. Off-Label Use of Tenecteplase for the Treatment of Acute Ischemic Stroke: A Systematic Review and Meta-analysis. JAMA Netw Open. 2022;5(3):e224506.
  • 20. Jolugbo P, Ariëns RAS. Thrombus Composition and Efficacy of Thrombolysis and Thrombectomy in Acute Ischemic Stroke. Stroke. 2021;52(3):1131-1142.
  • 21. Gong L, Zheng X, Feng L, et al. Bridging Therapy Versus Direct Mechanical Thrombectomy in Patients with Acute Ischemic Stroke due to Middle Cerebral Artery Occlusion: A Clinical- Histological Analysis of Retrieved Thrombi. Cell Transplant. 2019;28(6):684-690.

Outcomes of Intravenous Thrombolytic Therapy in Acute Ischemic Stroke

Year 2024, Volume: 8 Issue: 2, 151 - 156, 27.08.2024
https://doi.org/10.46332/aemj.1382834

Abstract

Purpose: In this study, we aimed to share our experiences about the efficacy, complications and prognosis of intravenous recombinant tissue plasminogen activator (iv rt-PA) in patients with acute ischaemic stroke in our stroke unit.

Materials and Methods: Between September 2018 and December 2021, 39 patients who underwent iv rt-PA in our stroke unit were retrospectively analysed. Demographic characteristics, stroke risk factors, symptom-door, symptom-needle time, NIHSS (National Institutes of Health Stroke Scale) and MRS (Modified Rankin Scale) values of the patients were recorded from their files.

Results: Twenty-two patients were female (56.4%) and 17 were male (43.6%). The most common risk factors were hypertension (56.4%) and hyperlipidemia (46.2%). NIHSS scores at admission, 24 h and day 7 were 17.3±5.9, 13.4±8.7, 11.1±10.3, respectively. Cerebral haemorrhage was detected in only 9 (23.1%) of the patients and death was detected in 12 (30.8%).

Conclusion: Iv rt-PA treatment is an effective and safe method for acute ischemic stroke. Increasing public awareness and the number of stroke units and centers in stroke treatment will significantly improve success rates to much higher levels.

References

  • 1. Tanrıverdi Z, Örken DN, Aksoy S, et al. Akut iskemik inmede intravenöz trombolitik tedavi: Şişli Etfal Eğitim ve Araştırma Hastanesi nöroloji kliniği deneyimi. Ş. EEAH Tıp Bülteni. 2012;46(4):165-169.
  • 2. Bahar S, Bakaç G. Beyin Kan Dolaşımının Anatomi ve Fizyolojisi. Nöroloji. 2015;2:239-245.
  • 3. Disorders NIoN, Group Sr-PSS. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333(24):1581-1588.
  • 4. 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(13):1317-1329.
  • 5. Field JM, Hazinski MF, Sayre MR, et al. Part 1: executive summary: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(18 Suppl 3):640-656.
  • 6. Topçuoğlu MA, Arsava EM, Özdemir AÖ, Gürkaş E, Örken DN, Öztürk Ş. Akut inme tedavisinde intravenöz trombolitik tedavi: Sorunlar ve çözümler. Turk J Neurol. 2017;23(4):162-175.
  • 7. Çetiner M, Canbaz Kabay S, Aydın HE. Akut iskemik inmede intravenöz trombolitik tedavi: Kütahya deneyimleri. 2017.
  • 8. Oruc S, Demirbaş H, Yaman M, et al. Akut iskemik inmeli olgularda Kocatepe Üniversitesi Nöroloji Kliniği’nin intravenöz trombolitik tedavi deneyimleri. 2015.
  • 9. Çabalar M, Taşdemir N, Erdoğan HA, et al. Akut İskemik İnmede İntravenöz Trombolitik Tedavi Deneyimlerimiz. Med J Bakirkoy. 2018;14(1):71-75.
  • 10. Thomalla G, Simonsen CZ, Boutitie F, et al. MRI-guided thrombolysis for stroke with unknown time of onset. N Engl J Med. 2018;379(7):611-622.
  • 11. Group Nt-PSS. Intracerebral hemorrhage after intravenous t-PA therapy for ischemic stroke. Stroke. 1997;28(11):2109-2118.
  • 12. 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. The Lancet. 2014;384(9958):1929-1935.
  • 13. Casaubon LK, Boulanger J-M, Blacquiere D, et al. Canadian stroke best practice recommendations: hyperacute stroke care guidelines, update 2015. Int J Stroke. 2015;10(6):924-940.
  • 14. Demaerschalk B, Kleindorfer D, Adeoye O, et al. American Heart Association Stroke Council and Council on Epidemiology and Prevention. Scientific rationale for the inclusion and exclusion criteria for intravenous alteplase in acute ischemic stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2016;47(2):581-641.
  • 15. Kutluk K, Kaya D, Afsar N, et al. Analyses of the Turkish National Intravenous Thrombolysis Registry. J. Stroke Cerebrovasc. Dis. 2016;25(5):1041-1047.
  • 16. Arık A, Altun Y, Tak AZ, Altunışık E. Akut iskemik inmede intravenöz trombolitik tedavi: Adıyaman deneyimleri. Turk J Cereb Vasc Dis. 2020;26(3):262-268.
  • 17. Logallo N, Novotny V, Assmus J, et al. Tenecteplase versus alteplase for management of acute ischaemic stroke (NOR-TEST): a phase 3, randomised, open-label, blinded endpoint trial. Lancet Neurol. 2017;16(10):781-788.
  • 18. Kvistad CE, Næss H, Helleberg BH, et al. Tenecteplase versus alteplase for the management of acute ischaemic stroke in Norway (NOR-TEST 2, part A): a phase 3, randomised, open-label, blinded endpoint, non-inferiority trial. Lancet Neurol. 2022;21(6):511-519.
  • 19. Katsanos AH, Psychogios K, Turc G, et al. Off-Label Use of Tenecteplase for the Treatment of Acute Ischemic Stroke: A Systematic Review and Meta-analysis. JAMA Netw Open. 2022;5(3):e224506.
  • 20. Jolugbo P, Ariëns RAS. Thrombus Composition and Efficacy of Thrombolysis and Thrombectomy in Acute Ischemic Stroke. Stroke. 2021;52(3):1131-1142.
  • 21. Gong L, Zheng X, Feng L, et al. Bridging Therapy Versus Direct Mechanical Thrombectomy in Patients with Acute Ischemic Stroke due to Middle Cerebral Artery Occlusion: A Clinical- Histological Analysis of Retrieved Thrombi. Cell Transplant. 2019;28(6):684-690.
There are 21 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences (Other)
Journal Section Original Articles
Authors

Aysu Yetiş 0000-0003-2139-0848

Burc Esra Sahin 0000-0003-1008-2743

Aydan Köysüren 0000-0001-8002-6208

Selcen Duran 0000-0001-7553-2034

Asuman Çelikbilek 0000-0002-2367-1128

Early Pub Date August 20, 2024
Publication Date August 27, 2024
Submission Date October 31, 2023
Acceptance Date February 26, 2024
Published in Issue Year 2024 Volume: 8 Issue: 2

Cite

APA Yetiş, A., Sahin, B. E., Köysüren, A., Duran, S., et al. (2024). Akut İskemik İnmede İntravenöz Trombolitik Tedavi Sonuçları. Ahi Evran Medical Journal, 8(2), 151-156. https://doi.org/10.46332/aemj.1382834
AMA Yetiş A, Sahin BE, Köysüren A, Duran S, Çelikbilek A. Akut İskemik İnmede İntravenöz Trombolitik Tedavi Sonuçları. Ahi Evran Med J. August 2024;8(2):151-156. doi:10.46332/aemj.1382834
Chicago Yetiş, Aysu, Burc Esra Sahin, Aydan Köysüren, Selcen Duran, and Asuman Çelikbilek. “Akut İskemik İnmede İntravenöz Trombolitik Tedavi Sonuçları”. Ahi Evran Medical Journal 8, no. 2 (August 2024): 151-56. https://doi.org/10.46332/aemj.1382834.
EndNote Yetiş A, Sahin BE, Köysüren A, Duran S, Çelikbilek A (August 1, 2024) Akut İskemik İnmede İntravenöz Trombolitik Tedavi Sonuçları. Ahi Evran Medical Journal 8 2 151–156.
IEEE A. Yetiş, B. E. Sahin, A. Köysüren, S. Duran, and A. Çelikbilek, “Akut İskemik İnmede İntravenöz Trombolitik Tedavi Sonuçları”, Ahi Evran Med J, vol. 8, no. 2, pp. 151–156, 2024, doi: 10.46332/aemj.1382834.
ISNAD Yetiş, Aysu et al. “Akut İskemik İnmede İntravenöz Trombolitik Tedavi Sonuçları”. Ahi Evran Medical Journal 8/2 (August 2024), 151-156. https://doi.org/10.46332/aemj.1382834.
JAMA Yetiş A, Sahin BE, Köysüren A, Duran S, Çelikbilek A. Akut İskemik İnmede İntravenöz Trombolitik Tedavi Sonuçları. Ahi Evran Med J. 2024;8:151–156.
MLA Yetiş, Aysu et al. “Akut İskemik İnmede İntravenöz Trombolitik Tedavi Sonuçları”. Ahi Evran Medical Journal, vol. 8, no. 2, 2024, pp. 151-6, doi:10.46332/aemj.1382834.
Vancouver Yetiş A, Sahin BE, Köysüren A, Duran S, Çelikbilek A. Akut İskemik İnmede İntravenöz Trombolitik Tedavi Sonuçları. Ahi Evran Med J. 2024;8(2):151-6.

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