Year 2019, Volume 12, Issue 2, Pages 309 - 314 2019-05-28

İkinci basamak bir acil serviste trombolitik tedavi deneyimi
Thrombolytic therapy experience in an secondary care emergency department

Mehmet Ali Aslaner [1] , Necmi Baykan [2]

13 16

Amaç: Trombolitik tedavi, ülkemizde üniversite ve eğitim-araştırma hastanelerinde sıklıkla uygulanmakta ve kullanım oranları daha net olarak tanımlanmış olmasına rağmen, ulusal literatürde ikinci basamak acil servis kullanım oranları bilinmemektedir. Bu çalışma ile ülkemizde eksik olan, ikinci basamağa ait yeni bir veri seti oluşturmak amaçlanmıştır.

Yöntem: Çalışma 2006-2008 yılları arasında geriye dönük olarak, ........... ilinin en büyük hastanesinin ikinci basamak acil servisinde gerçekleştirildi. Veri seti; demografik özelliklerin yanı sıra, tanılar, kullanılan etken madde, komplikasyon durumu ve 3 aylık mortalite olarak belirlendi.

Bulgular: Çalışma periyodu boyunca 57 hastaya trombolitik tedavi verildi. Hastaların ortanca yaşı 68 (IQR 54-79) ve erkek cinsiyet oranı %70,2 idi. Tüm çalışma boyunca trombolitik tedavi kullanım sıklığı 1,8/10.000 acil servis başvurusu olarak saptandı. Trombolitik tedavi uygulanan tanılar içerisinde; iskemik inme %50,9 oranında, akut miyokard enfarktüsü %29,8, arrest etiyolojisi %10,5 ve pulmoner tromboemboli %8,8 oranındaydı. Kullanılan ajanlardan alteplaz %75,4 oranında ve tenekteplaz %24,6 oranında uygulandı. Tedavi uygulanan tüm hastaların 3 aylık mortalite oranı %57,9’ idi.

Sonuç: Çalışmada, trombolitik tedavi uygulamasının daha sıklıkla iskemik inme hastalarında uygulandığı görüldü. Alteplaz, geniş endikasyon spektrumu nedeniyle en sık kullanılan trombolitik ajandı. Çalışma sonucunda trombolitik kullanımının, özellikle ikinci basamak acil servislerde oldukça düşük oranda olduğu düşünüldü.

Purpose: Although thrombolytic therapy is frequently used and the usage rates are well defined in university and education-research hospitals in our country, secondary care emergency departments (ED) utilization rates in national literature are not known. With this study, it was aimed to create a new data set which is insufficient in our country.

Materials and Methods: The study was carried out retrospectively between 2006 and 2008 in the secondary care ED of the biggest hospital of ........... province. Data set were included diagnoses, active substance, complication status and 3-months mortality in addition to demographic characteristics.

Results: During the study period, 57 patients received thrombolytic therapy. The median age of the patients was 68 (IQR 54-79) and the male gender ratio was 70.2%. The frequency of thrombolytic therapy was 1.8 / 10.000 in all ED visits. Of all diagnoses; the incidence of ischemic stroke was 50.9%, acute myocardial infarction was 29.8%, arrest etiology was 10.5% and pulmonary thromboembolism was 8.8%. Alteplase was used in 75.4% of the cases and tenecteplase was used in 24.6%. The mortality rate was 57.9% in all patients.

Conclusion: Thrombolytic therapy was more frequently performed in patients with ischemic stroke. Alteplase was the most commonly used thrombolytic agent because of its wide spectrum of indications. It was thought that thrombolytic usage is very low in in the secondary care emergency departments.

  • 1. Rivera-Bou WL, Chersich A. The Role of Fibrinolytic Therapy in the Emergency Department. Boletin de la Asociacion Medica de Puerto Rico 2016;108:61-4.
  • 2. Hasanoğlu C. Trombolitik Tedavi: Kime, Ne zaman, Nasıl. Güncel Göğüs Hastalıkları Serisi 2015;3:34-44.
  • 3. Kunt R. Treatment with Intravenous Thrombolysis in Acute Ischemic Stroke Through the Perspective of a State Hospital. Türk Beyin Damar Hast Derg 2016;22:91-9.
  • 4. Duggal R, Harger N. The safe and appropriate use of thrombolytics in the emergency department. US Pharm 2011;36:11-6.
  • 5. Johnson M, Bakas T. A review of barriers to thrombolytic therapy: implications for nursing care in the emergency department. The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses 2010;42:88-94.
  • 6. Topçuoğlu MA, Arsava EM, Özdemir AÖ, Gürkaş E, Necioğlu Örken D, Öztürk Ş. Intravenous Thrombolytic Therapy in Acute Stroke: Problems and Solutions. Turk J Neurol 2017;23:162-75.
  • 7. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevationThe Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). European Heart Journal 2018;39:119-77.
  • 8. Karaarslan S, Alihanoglu YI, Yildiz BS, et al. Appropriateness of the current guidelines on reperfusion treatment for patients applying to our hospital with ST-segment elevation acute myocardial infarction. Turk Kardiyol Dern Ars 2012;40:493-8.
  • 9. Beton O, Zorlu A. Yoğun Bakımda Fibrinolitik Tedavi. Turkiye Klinikleri Journal of Cardiology Special Topics 2016;9:42-50.
  • 10. Erkan L, Fındık S, Öztürk A, et al. Masif pulmoner tromboembolide trombolitik tedavi. Solunum Hastalıkları 2002;13:163-71.
  • 11. Thrombolytic Therapy. 2017. (Accessed 08.12.2018, at https://emedicine.medscape.com/article/811234-overview.)
  • 12. Bottiger BW, Bode C, Kern S, et al. Efficacy and safety of thrombolytic therapy after initially unsuccessful cardiopulmonary resuscitation: a prospective clinical trial. Lancet (London, England) 2001;357:1583-5.
  • 13. Böttiger BW, Arntz H-R, Chamberlain DA, et al. Thrombolysis during Resuscitation for Out-of-Hospital Cardiac Arrest. New England Journal of Medicine 2008;359:2651-62.
  • 14. Spohr F, Arntz HR, Bluhmki E, et al. International multicentre trial protocol to assess the efficacy and safety of tenecteplase during cardiopulmonary resuscitation in patients with out-of-hospital cardiac arrest: the Thrombolysis in Cardiac Arrest (TROICA) Study. European journal of clinical investigation 2005;35:315-23.
  • 15. Abraham P, Arroyo DA, Giraud R, Bounameaux H, Bendjelid K. Understanding haemorrhagic risk following thrombolytic therapy in patients with intermediate-risk and high-risk pulmonary embolism: a hypothesis paper. Open Heart 2018;5:e000735.
  • 16. Davydov L, Cheng JW. Tenecteplase: a review. Clinical therapeutics 2001;23:982-97; discussion 1.
  • 17. Melandri G, Vagnarelli F, Calabrese D, Semprini F, Nanni S, Branzi A. Review of tenecteplase (TNKase) in the treatment of acute myocardial infarction. Vascular health and risk management 2009;5:249-56.
  • 18. Kline JA, Nordenholz KE, Courtney DM, et al. Treatment of submassive pulmonary embolism with tenecteplase or placebo: cardiopulmonary outcomes at 3 months: multicenter double-blind, placebo-controlled randomized trial. Journal of thrombosis and haemostasis : JTH 2014;12:459-68.
  • 19. Kline JA, Hernandez-Nino J, Jones AE. Tenecteplase to treat pulmonary embolism in the emergency department. Journal of thrombosis and thrombolysis 2007;23:101-5.
Primary Language tr
Subjects Emergency Medicine
Published Date Mayıs 2019
Journal Section Research Article
Authors

Orcid: 0000-0002-7851-7881
Author: Mehmet Ali Aslaner
Institution: Nevşehir Devlet Hastanesi, Acil Servis
Country: Turkey


Orcid: 0000-0002-6845-9550
Author: Necmi Baykan (Primary Author)
Institution: Nevşehir Devlet Hastanesi, Acil Servis
Country: Turkey


Bibtex @research article { patd515838, journal = {Pamukkale Tıp Dergisi}, issn = {}, eissn = {1308-0865}, address = {Pamukkale University}, year = {2019}, volume = {12}, pages = {309 - 314}, doi = {10.31362/patd.515838}, title = {İkinci basamak bir acil serviste trombolitik tedavi deneyimi}, key = {cite}, author = {Aslaner, Mehmet Ali and Baykan, Necmi} }
APA Aslaner, M , Baykan, N . (2019). İkinci basamak bir acil serviste trombolitik tedavi deneyimi. Pamukkale Tıp Dergisi, 12 (2), 309-314. DOI: 10.31362/patd.515838
MLA Aslaner, M , Baykan, N . "İkinci basamak bir acil serviste trombolitik tedavi deneyimi". Pamukkale Tıp Dergisi 12 (2019): 309-314 <http://dergipark.org.tr/patd/issue/45448/515838>
Chicago Aslaner, M , Baykan, N . "İkinci basamak bir acil serviste trombolitik tedavi deneyimi". Pamukkale Tıp Dergisi 12 (2019): 309-314
RIS TY - JOUR T1 - İkinci basamak bir acil serviste trombolitik tedavi deneyimi AU - Mehmet Ali Aslaner , Necmi Baykan Y1 - 2019 PY - 2019 N1 - doi: 10.31362/patd.515838 DO - 10.31362/patd.515838 T2 - Pamukkale Tıp Dergisi JF - Journal JO - JOR SP - 309 EP - 314 VL - 12 IS - 2 SN - -1308-0865 M3 - doi: 10.31362/patd.515838 UR - https://doi.org/10.31362/patd.515838 Y2 - 2019 ER -
EndNote %0 Pamukkale Tıp Dergisi İkinci basamak bir acil serviste trombolitik tedavi deneyimi %A Mehmet Ali Aslaner , Necmi Baykan %T İkinci basamak bir acil serviste trombolitik tedavi deneyimi %D 2019 %J Pamukkale Tıp Dergisi %P -1308-0865 %V 12 %N 2 %R doi: 10.31362/patd.515838 %U 10.31362/patd.515838
ISNAD Aslaner, Mehmet Ali , Baykan, Necmi . "İkinci basamak bir acil serviste trombolitik tedavi deneyimi". Pamukkale Tıp Dergisi 12 / 2 (May 2019): 309-314. https://doi.org/10.31362/patd.515838