Demographic characteristics and recombinant tissue plasminogen activator treatment in patients with acute ischemic stroke

Year 2020, , 78 - 83, 01.03.2020

Muzaffer Güneş

https://doi.org/10.21601/ortadogutipdergisi.634446

Abstract

Aim: Intravenous recombinant tissue plasminogen activator (IV rt-PA) has revolutionized the treatment of acute ischemic stroke (AIS). The use of IV rt-PA in the treatment of AIS is still not at the expected level. Data regarding utilization rate in Turkey is inadequate. In this study, we aimed to present the clinical and demographic characteristics of AIS patients and to share IV rt-PA application data.
Material and Methods: 224 patients diagnosed with AIS between January 2017 and January 2019 were included in the study. Among these, 17 patients received IV rt-PA treatment after informed consent was obtained. Clinical and laboratory findings, risk factors and demographic characteristics of the patients were recorded from our database. Statistical significance level was accepted as p < 0.05.
Results: In this study, the rate of IV rt-PA administration was 7.6% (17 of 224 patients) among all AIS patients. However, in all AIS patients (n = 224), the rate of patients (n = 57) who could application IV rt-PA clinically (National Institutes of Health Stroke Scale [NIHSS] of ≥5 or aphasia or homonymous hemianopsia) was 25.4%. The most common reason for not applying IV rt-PA (72.5%) was that the onset of symptoms was uncertain or the therapeutic time was over 4.5 hours (3 hours in patients over 80 years of age and wide middle cerebral artery infarction).
Conclusion: There are many patients who can benefit from IV rt-PA, which has proven efficacy in the treatment of AIS. In order to increase the number of patients who can benefit from this treatment, multi-faceted studies are needed, including awareness raising activities for the population and training of emergency and ambulance health personnel.

Keywords

acute ischemic stroke, application rate, awareness, recombinant tissue plasminogen activator

Akut iskemik inme hastalarının demografik özellikleri ve rekombinant doku plazminojen aktivatörü tedavisi

Abstract

Amaç: İntravenöz rekombinant doku plazminojen aktivatörü (IV rt-PA), akut iskemik inme (Aİİ) tedavisinde çığır açmıştır. Aİİ tedavisinde IV rt-PA kullanımı hala beklenen düzeyde değildir. Türkiye’de ise kullanım oranlarına ilişkin veriler yetersizdir. Bu çalışmada, Aİİ hastalarının klinik ve demografik özelliklerini sunmak ve ek olarak IV rt-PA uygulama verilerini paylaşmak amaçlanmıştır.
Gereç ve Yöntemler: Ocak 2017 ile Ocak 2019 tarihleri arasında hastanemizde Aİİ tanısı konulan 224 hasta çalışmaya alındı. Bunlardan 17’si bilgilendirilmiş onam alındıktan sonra IV rt-PA tedavi uygulanmış hastalar idi. Hastaların klinik ve laboratuvar bulguları, risk faktörleri ve demografik özelliklerine ait bilgilere veri tabanımızdan ulaşılarak kaydedildi. İstatistiksel anlamlılık düzeyi p<0,05 olarak kabul edildi.
Bulgular: Bu çalışmada, tüm Aİİ hastaları içinde IV rt-PA uygulama oranı yaklaşık %7,6 (224 hastanın 17’si) idi. Oysa tüm Aİİ hastalarının içinde (n=224) klinik olarak (Ulusal Sağlık Enstitüsü İnme Ölçeği [National Institutes of Health Stroke Scale, NIHSS] 5 ve üstü veya afazi veya homonim hemianopsi) IV rt-PA uygulanabilecek hastaların (n=57) oranı %25,4’dir. En sık IV rt-PA uygulamama nedeni (%72,5), semptom başlama zamanının belirsiz olması ya da terapötik zamanın 4.5 saati (80 yaş üstü ve geniş orta serebral arter infarktında 3 saat) geçmiş olması idi.
Sonuç: Aİİ tedavisinde etkinliği kanıtlanmış olan IV rt-PA’dan faydalanabilecek çok sayıda hasta vardır. Bu tedaviden faydalanabilecek hastaların sayısını arttırmak için toplumu inme konusunda bilinçlendirme çalışmaları, acil ve ambulans sağlık personelinin eğitimi de dahil olmak üzere çok yönlü çalışmalara ihtiyaç vardır.

Keywords

akut iskemik inme, uygulama oranı, farkındalık, rekombinant doku plazminojen aktivatörü

References

• Ozturk S. Epidemiology of cerebrovascular diseases and risk factors. Perspective of the world and Turkey. Turk J Geriatr 2009;13(1):51-8.
• Radisauskas R, Tamosiunas A, Kranciukaite-Butylkiniene D, Milinaviciene E, ve ark. Long-term survival after stroke in Lithuania: Data from Kaunas population-based stroke registry. PLoS One. 2019;14(7):e0219392. (doi: 10.1371/ journal.pone.0219392).
• Bogousslavsky J, Van Melle G, Regli F. The Lausanne Stroke Registry: Analysis of 1000 consecutive patients with first stroke. Stroke. 1998;19:1083-92.
• Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, ve ark. American Heart Association Stroke Council. 2018 Guidelines for the Early Management of Patients with Acute Ischemic Stroke: A Guideline for Healthcare Professionals from the American Heart Association / American Stroke Association. Stroke. 2018;49(3):e46-e99. (doi: 10.1161/STR.0000000000000158).
• Kleindorfer D, Lindsell CJ, Brass L, Koroshetz W, Broderick JP. National US estimates of recombinant tissue plasminogen activator use: ICD-9 codes substantially underestimate. Stroke. 2008;39(3):924-8. (doi: 10.1161/STROKEAHA.107.490375).
• Skolarus LE, Meurer WJ, Shanmugasundaram K, ve ark. Marked Regional Variation in Acute Stroke Treatment Among Medicare Beneficiaries. Stroke. 2015;46(7):1890-6. (doi: 10.1161/STROKEAHA.115.009163).
• McDermott M, Skolarus LE, Burke JF. A systematic review and meta-analysis of interventions to increase stroke thrombolysis. BMC Neurol. 2019;19(1):86. (doi: 10.1186/s12883-019-1298-2).
• Eissa A, Krass I, Levi C, Sturm J, Ibrahim R, Bajorek B. Understanding the reasons behind the low utilisation of thrombolysis in stroke. Australas Med J. 2013;6:152–167. (doi: 10.4066/AMJ.2013.1607).
• Rudd AG, Hoffman A, Grant R, Campbell JT, Lowe D; Intercollegiate Working Party for Stroke. Stroke thrombolysis in England, Wales and Northern Ireland: how much do we do and how much do we need? J Neurol Neurosurg Psychiatry. 2011;82:14–19. (doi: 10.1136/ jnnp.2009.203174).
• Hess DC, Wang S, Hamilton W, Lee S, ve ark. REACH: clinical feasibility of a rural telestroke network. Stroke. 2005;36(9):2018-20. (doi: 10.1161/01.STR.0000177534.02969.e4)
• CASPR. Prioritizing interventions to improve rates of thrombolysis for ischemic stroke. Neurology. 2005;64:654-9. (doi: 10.1212/01.WNL.0000151850.39648.51).
• Dirks M, Niessen LW, van Wijngaarden JD, ve ark. Promoting thrombolysis in acute ischemic stroke. Stroke. 2011;42(5):1325-30. (doi: 10.1161/STROKE.AHA.110.596940).
• Huang Q, Zhang JZ, Xu WD, Wu J. Generalization of the right acute stroke promotive strategies in reducing delays of intravenous thrombolysis for acute ischemic stroke: A meta-analysis. Medicine (Baltimore). 2018;97(25):e11205. (doi: 10.1097/MD.0000000000011205).
• Kamal N, Smith EE, Jeerakathil T, Hill MD. Thrombolysis: Improving door-to-needle times for ischemic stroke treatment - A narrative review. Int J Stroke. 2018;13(3):268-76. (doi: 10.1177/1747493017743060).
• Luan X, Qiu H, Hong X, Wu C, Zhao K, Chen H, ve ark. High serum nerve growth factor concentrations are associated with good functional outcome at 3 months following acute ischemic stroke. Clin Chim Acta. 2019;488:20-4. (doi: 10.1016/j.cca.2018.10.030).
• Charipar R, Charipar E. Administration of tissue plasminogen activator for acute ischemic stroke in a rural Wisconsin hospital. WMJ. 2008;107(4):176-80.
• Teuschl Y, Brainin M. Stroke education: discrepancies among factors influencing prehospital delay and stroke knowledge. Int J Stroke. 2010;5(3):187-208. (doi: 10.1111/j.1747-4949.2010.00428.x).