TY - JOUR T1 - Retrospective evaluation of mortality among stroke patients receiving thrombolytic therapy in the emergency department TT - Retrospective evaluation of mortality among stroke patients receiving thrombolytic therapy in the emergency department AU - Yaman, Eda AU - Sancar, Emin AU - Yılmaz, Abdurrahman AU - Dağtekin, Gökçe AU - Avcı, Sema PY - 2025 DA - September Y2 - 2025 DO - 10.38053/acmj.1729053 JF - Anatolian Current Medical Journal JO - Anatolian Curr Med J / ACMJ / acmj PB - MediHealth Academy Yayıncılık WT - DergiPark SN - 2718-0115 SP - 589 EP - 596 VL - 7 IS - 5 LA - en AB - Aims: Since strokes are an important cause of morbidity and mortality all over the world, early diagnosis and treatment are extremely important for sequela-free recovery. The best treatment option for an ischemic stroke is intravenous thrombolytic therapy with recombinant tissue plasminogen activator. In this study, we aimed to determine the factors affecting in-hospital mortality among patients who presented to the emergency department due to an ischemic stroke and received thrombolytic therapy.Methods: This cross-sectional study reviewed the medical records of patients who presented to the emergency department with stroke symptoms between January 2018 and August 2022, were diagnosed with ischemic stroke, received thrombolytic treatment within the first 4.5 hours of symptom onset, and were subsequently hospitalized. Results: After excluding patients who did not meet the inclusion criteria, 184 patients were included in the study. It was found that 42 (22.8%) of the patients had an exitus in the follow-up. We determined that the mortality rate was higher in patients admitted to the emergency department with emergency health services compared to outpatients (p KW - Ischemic stroke KW - thrombolytic therapy KW - mortality N2 - Aims: Since strokes are an important cause of morbidity and mortality all over the world, early diagnosis and treatment are extremely important for sequela-free recovery. The best treatment option for an ischemic stroke is intravenous thrombolytic therapy with recombinant tissue plasminogen activator. In this study, we aimed to determine the factors affecting in-hospital mortality among patients who presented to the emergency department due to an ischemic stroke and received thrombolytic therapy.Methods: This cross-sectional study reviewed the medical records of patients who presented to the emergency department with stroke symptoms between January 2018 and August 2022, were diagnosed with ischemic stroke, received thrombolytic treatment within the first 4.5 hours of symptom onset, and were subsequently hospitalized. Results: After excluding patients who did not meet the inclusion criteria, 184 patients were included in the study. It was found that 42 (22.8%) of the patients had an exitus in the follow-up. We determined that the mortality rate was higher in patients admitted to the emergency department with emergency health services compared to outpatients (p CR - Campbell BCV, De Silva DA, Macleod MR, et al. Ischaemic stroke. Nat Rev Dis Primers. 2019;5(1):70. doi:10.1038/s41572-019-0118-8 CR - Tsao CW, Aday AW, Almarzooq ZI, et al. Heart disease and stroke statistics-2023 update: a report from the American Heart Association. Circulation. 2023;147(8):e93-e621. doi:10.1161/CIR.0000000000001123 CR - Feigin VL, Norrving B, Mensah GA. Global burden of stroke. Circ Res. 2017;120(3):439-448. doi:10.1161/CIRCRESAHA.116.308413 CR - Krishnamurthi RV, Ikeda T, Feigin VL. Global, regional and country-specific burden of ischaemic stroke, intracerebral haemorrhage and subarachnoid haemorrhage: a systematic analysis of the global burden of disease study 2017. Neuroepidemiology. 2020;54(2):171-179. doi:10. 1159/000506396 CR - Chandra A, Stone CR, Du X, et al. The cerebral circulation and cerebrovascular disease III: stroke. Brain Circ. 2017;3(2):66-77. doi:10. 4103/bc.bc_12_17 CR - Auer RN, Sommer CJ. Chapter 4: histopathology of brain tissue response to stroke and injury, stroke: pathophysiology, diagnosis, and management. Elsevier Inc; 2019. CR - Jolugbo P, Ariëns RAS. Thrombus composition and efficacy of thrombolysis and thrombectomy in acute ıschemic stroke. Stroke. 2021; 52(3):1131-1142. doi:10.1161/STROKEAHA.120.032810 CR - Herpich F, Rincon F. Management of acute ischemic stroke. Crit Care Med. 2020;48(11):1654-1663. doi:10.1097/CCM.0000000000004597 CR - Dillon GM, Stevens S, Dusenbury WL, Massaro L, Toy F, Purdon B. Choosing the correct "-ase" in acute ischemic stroke: alteplase, tenecteplase, and reteplase. Adv Emerg Nurs J. 2019;41(3):271-278. doi: 10.1097/TME.0000000000000254 CR - Warach SJ, Dula AN, Milling TJ Jr. Tenecteplase thrombolysis for acute ischemic stroke. Stroke. 2020;51(11):3440-3451. doi:10.1161/STROKEAHA.120.029749 CR - El Husseini N, Shea KJ, Goldstein LB. Concerns for the reliability and validity of the national stroke project stroke severity scale. Cerebrovasc Dis. 2011;32(5):426-430.doi:10.1159/000331476 CR - TR. Ministry of Health, General Directorate of Health Services. Acute ischemic stroke diagnosis and treatment guideline. Ankara; 2020. CR - Öztürk B, Özön AÖ. Ischaemic stroke and gender. Akd Med J. 2020;6(1): 59-65. doi:10.17954/amj.2019.1579 CR - Ji R, Schwamm LH, Pervez MA, Singhal AB. Ischemic stroke and transient ischemic attack in young adults: risk factors, diagnostic yield, neuroimaging, and thrombolysis. JAMA Neurol. 2013;70(1):51-57. doi: 10.1001/jamaneurol.2013.575 CR - Thrift AG, Howard G, Cadilhac DA, et al. Global stroke statistics: an update of mortality data from countries using a broad code of "cerebrovascular diseases". Int J Stroke. 2017;12(8):796-801. doi:10.1177/ 1747493017730782 CR - Chantkran W, Chaisakul J, Rangsin R, Mungthin M, Sakboonyarat B. Prevalence of and factors associated with stroke in hypertensive patients in Thailand from 2014 to 2018: a nationwide cross-sectional study. Sci Rep. 2021;11(1):17614. doi:10.1038/s41598-021-96878-4 CR - Kiyan S, Ozsarac M, Ersel M, et al. Retrospective analysis of 124 acute ischemic stroke patients who attended to the emergency department in one year period. JAEM. 2009;8:3. doi:10.4170/JAEM.2009.46330 CR - Dolek T, Cenikli U, Bek S, Kutlu Gunergin G. Experiences of intravenous thrombolytic therapy of Muğla in acute ischemic stroke. Med J Mugla Sitki Kocman University. 2023;10(2):115-119. doi:10.47572/muskutd. 1173741 CR - Demirci Sahin A, Ustu Y, Isik D, Oztas D, Karatas Eray I, Ugurlu M. Demographic characteristics of patients with cerebrovascular disease and evaluation of preventable risk factors in primary care centers. Ankara Med J. 2015;15(4):196-208. doi:10.17098/amj.79435 CR - Gokmen EO. Factors affecting ischemia recurrence in patients presenting to the emergency department with recurrent ischemic stroke under antiembolicor antithrombotic treatment. 2023. Access address: https://acikerisim.erbakan.edu.tr/xmlui/handle/20.500.12452/10261 CR - Vahdati SS, Ala A, Hejazian S, et al. Factors affecting complications and mortality of stroke patients in stroke care unit. Erciyes Med J. 2022;44(2): 138-142. doi:10.14744/etd.2021.71430 CR - Lau LH, Lew J, Borschmann K, Thijs V, Ekinci EI. Prevalence of diabetes and its effects on stroke outcomes: a meta-analysis and literature review. J Diabetes Investig. 2019;10(3):780-792. doi:10.1111/jdi.12932 CR - De Stefano F, Mayo T, Covarrubias C, Fiani B, Musch B. Effect of comorbidities on ischemic stroke mortality: an analysis of the National inpatient sample (NIS) database. Surg Neurol Int. 2021;12:268. doi:10. 25259/SNI_415_2021 CR - Yoshida T, Uchino S, Yokota T, Fujii T, Uezono S, Takinami M. The impact of sustained new-onset atrial fibrillation on mortality and stroke incidence in critically ill patients: a retrospective cohort study. J Crit Care. 2018;44:267-272. doi:10.1016/j.jcrc.2017.11.040 CR - Schrock JW, Glasenapp M, Drogell K. Elevated blood urea nitrogen/creatinine ratio is associated with poor outcome in patients with ischemic stroke. Clin Neurol Neurosurg. 2012;114(7):881-884. doi:10. 1016/j.clineuro.2012.01.031 CR - Watso JC, Farquhar WB. Hydration status and cardiovascular function. Nutrients. 2019;11(8):1866. doi:10.3390/nu11081866 CR - Crary MA, Humphrey JL, Carnaby-Mann G, Sambandam R, Miller L, Silliman S. Dysphagia, nutrition, and hydration in ischemic stroke patients at admission and discharge from acute care. Dysphagia. 2013; 28(1):69-76. doi:10.1007/s00455-012-9414-0 CR - Cortés-Vicente E, Guisado-Alonso D, Delgado-Mederos R, et al. Frequency, risk factors, and prognosis of dehydration in acute stroke. Front Neurol. 2019;10:305. doi:10.3389/fneur.2019.00305 CR - Rowat A, Graham C, Dennis M. Dehydration in hospital-admitted stroke patients: detection, frequency, and association. Stroke. 2012;43(3):857-859. doi:10.1161/STROKEAHA.111.640821 CR - Fonarow GC, Saver JL, Smith EE, et al. Relationship of NIHSS to 30-day mortality in medicare beneficiaries with acute ischemic stroke. J Am Heart Assoc. 2012;1(1):42-50. doi:10.1161/JAHA.111.000034 CR - De Havenon A, Abbasi M, Yaghi S, et al. Effect of alteplase on ischemic stroke mortality is dependent on stroke severity. Ann Neurol. 2023;93(6): 1106-1116. doi:10.1002/ana.26621 CR - Olum S, Muyingo A, Wilson TL, et al. Stroke mortality outcomes in Uganda. J Stroke Cerebrovasc Dis. 2021;30(5):105661. doi:10.1016/j.jstrokecerebrovasdis.2021.105661 CR - Ongun N. Intravenous thrombolytic therapy in acute ischemic stroke: a public hospital experience, analysis of 87 cases. Turkish J Cerebrovasc Dis. 2021;27(2):139-44. doi:10.5505/tbdhd.2021.2499 CR - Heuschmann PU, Kolominsky-Rabas PL, Misselwitz B, et al. Predictors of in-hospital mortality and attributable risks of death after ischemic stroke: the German Stroke Registers study group. Arch Intern Med. 2004;164(16):1761-1768. doi:10.1001/archinte.164.16.1761 CR - Kalra L, Yu G, Wilson K, Roots P. Medical complications during stroke rehabilitation. Stroke. 1995;26:990-994. doi:10.1161/01.str.26.6.990 UR - https://doi.org/10.38053/acmj.1729053 L1 - https://dergipark.org.tr/tr/download/article-file/4998666 ER -