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Akut iskemik inmede intravenöz trombolitik tedavi: Klinik değerlendirme

Yıl 2019, Cilt: 29 Sayı: 4, 169 - 174, 01.12.2019

Fettah Eren Gözde Öngün Aydın Talip Yıldoğan Melike Işık Şerefnur Öztürk

Öz

Amaç: İnme tedavisinde asıl amaç, oklüde vasküler yapının belirli süre içerisinde rekanalizasyonudur. Medikal tedavide rekombinant doku plazminojen aktivatörü tPA kullanılmaktadır. Bu çalışmada, tPA tedavisi verilen iskemik inme hastaları değerlendirilmiştir.Gereç ve Yöntem: Temmuz 2015-Ağustos 2017 arasında tPA tedavisi uygulanan 97 akut iskemik inme hastası retrospektif incelendi. Demografik veriler, başvuru semptomları ve tedavi saatleri kaydedildi. Klinik durum ve prognoz ‘National Institutes of Health Stroke Skalası’ NIHSS ve fonksiyonel durum ölçeği ile değerlendirildi. Hemorajik dönüşüm bilgisayarlı tomografi ile değerlendirildi.Bulgular: Çalışmaya 61 %62,8 erkek ve 36 %37,2 kadın hasta alındı. Yaş ortalamaları 60,29±12,62 idi. 7 %7,2 hastaya 1. saate, 5 %25,8 hastaya 1-2 saat arasında, 31 %32 hastaya 2-3 saat arasında, 34 %35,1 hastaya 3-4,5 saat arasında tPAbaşlandı. Başvuruda en sık semptom hemi/monoparezi idi %92,8 .%69,1 oranında parsiyel anterior, %16,5 total anterior, %15,8 posterior vasküler oklüzyon saptandı. NIHSS sonuçları 10,39±4,36 tedavi öncesi ve 6,63±3,76 taburculuk idi. Hastalartam bağımsız %20,6 , kısmi bağımlı %43,3 ve tam bağımlı %21,6 olarak taburcu edildi.Hastaların %12’sinde hemorajik dönüşüm izlendi.Platelet değeri düşük olan hastalarda hemorajik transformasyon daha fazlaydı P

Anahtar Kelimeler

İskemik inme trombolitik özürlülük hemorajik transformasyon

Kaynakça

  • Blackham KA, Meyers PM, Abruzzo TA, et al. Endovascu- lartherapy of acuteischemicstroke: report of thestandards of practicecommittee of thesociety of neurointerventionalsur- gey. J Neurointerv Surg 2012;4:87-93.
  • Kumral E, Balkır K. İnme epidemiyolojisi. In: Balkan S, ed. Serebrovasküler hastalıklar. 1. baskı, Ankara: Güneş Kita- pevi, 2002;38-40.
  • Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heartdiseasean- dstroke statistics-2017 update: a reportfromthe American Heart Association. Circulation 2017;135:146-603.
  • Heiss WD. Theischemic penumbra: correlates in imaging andimplications for treatment of ischemicstroke. Cerebro- vasc Dis 2011;32:307-20.
  • Wahlgren N, Ahmed N, Dávalos A, et al. Thromboly- siswithalteplase for acuteischaemicstroke in theSafeImp- lementation of Thrombolysis in Stroke-MonitoringS- tudy (SITS-MOST): an observationalstudy. The Lancet 2007;369:275-82.
  • Hacke W, Kaste M, Fieschi C, et al. Intravenoustromboly- siswithrecombinanttissueplasminogenactivator for acute- hemisphericstroke. JAMA 1995;274:1017-59.
  • Katzan IL, Hammer MD, Hixson ED, et al. Utilization of intravenoustissueplasminogenactivator for acuteischemi- cstroke. Arch Neurol 2004;61:346-50.
  • Hacke W, Kaste M, Bluhmki E, et al. Thrombolysiswithal- teplase 3 to 4.5 hoursafteracuteischemicstroke. N Engl J Med 2008;359:1317-29.
  • Kanazawa M, Takahashi T, Nishizawa M, Shimohata T. The- rapeutic strategies to attenuate hemorrhagic transformati- on after tissue plasminogen activator treatment for acute ischemic stroke. J AtherosclerThromb 2017;24:240-53.
  • Zhang Y, Yang H, Sun Y, Xing Y. Hemorrhagic transforma- tion after cerebral infarction: current concepts and challen- ges. Ann Transl Med 2014;2:81-8.
  • Sadeghi-Hokmabadi E, Farhoudi M, Taheraghdam A, et al. Intravenous recombinant tissue plasminogen activator for acute ischemic stroke: a feasibility and safety study. Int J Gen Med 2016;9:361-7.
  • Guo Y, Yang Y, Zhou M, He L. Risk factors of haemorrha- gic transformation for acute ischaemic stroke in Chinese patients receiving intravenous recombinant tissue plasmi- nogen activator: a systematic review and meta-analysis. Stroke VascNeurol2018;3:203-8.
  • 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.
  • Van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, vanGijn J. Inter observer agreement for the assessment of handicap in stroke patients. Stroke 1988;19:604-7.
  • National Institute of Neurological Disordersand Stroke rt- PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995;333:1581-7.
  • Wardlaw J, Berge E, Zoppo G, Yamaguchi T. Thrombolysis for acut ischemic stroke. Stroke 2004;35:2914-5.
  • Wardlaw JM, Warlow CP. Thrombolysis in acute ischemic stroke: Does it work?. Stroke 1992;23:1826-39.
  • Wahlgren N, Ahmed N, Davalos A, et al. Thrombolysis with alteplase for acute ischemic stroke in the safe implementati- on of thrombolysis in stroke monitoring study: an observa- tional study. Lancet 2007;369:275-82.
  • Hacke W, Donnan G, Fieschi C, et al. Association of out- come with early stroke treatment: pooledanalysis of AT- LANTIS, ECASS, and NINDS rt-PA stroketrials. Lancet 2004;363:768-74.
  • Saver JL. Number needed to treat estimates in corporating effects over the entire range of clinical outcomes: novel de- rivation method and application to thrombolytic therapy for acutes troke. ArchNeurol 2004;61:1066-70.
  • Saqqur M, Uchino K, Demchuk AM, et al. Site of arterial occlusion identified by transcranial doppler predicts the response to intravenous thrombolysis for stroke. Stroke 2007;38:948-54.
  • Kim DH, Lee DS, Nah HW, Cha JK. Clinicaland radiologi- cal factors associated with unfavorable outcome after intra- venous thrombolysis in patients with mild ischemic stroke. BMC Neurol 2018;18:30.
  • Marti-Fabregas J, Bravo Y, Cocho D, et al. Frequency and predictors of symptomatic intracerebralhemorrhage in pa- tients with ischemic stroke treated with recombinant tissue plasminogen activator outside clinical trials. Cerebrovasc- Dis 2007;23:85-90.
  • Yaghi S, Boehme AK, Dibu J, et al. Treatment and outcome of thrombolysis-related hemorrhage: A multicenter retros- pective study. JAMA Neurol 2015;72:1451-7.
  • Sadeghi-Hokmabadi E, Farhoudi M, Taheraghdam A, et al. Intravenous recombinant tissue plasminogen activator for acute ischemic stroke: a feasibility and safety study. Int J Gen Med 2016;9:361-7.

Yıl 2019, Cilt: 29 Sayı: 4, 169 - 174, 01.12.2019

Fettah Eren Gözde Öngün Aydın Talip Yıldoğan Melike Işık Şerefnur Öztürk

Öz

Objective: The main purpose of treatment in stroke is recanalization of occluded vascular structure within a certain time period. Recombinant tissue plasminogen activator tPA is used for medical treatment. In this study, patients with ischemic stroke treated with tPA were evaluated.Material and Methods: Between July 2015 and August 2017, 97 patients with acute ischemic stroke who were treated with tPA reviewed retrospectively. Demographic data, presentation symptoms and treatment times were recorded. Clinical status and prognosis were evaluated with National Institutes of Health Stroke Scale NIHSS and functional status scale. Hemorrhagic transformation was evaluated with computed tomography.Results: 61 62.8% male and 36 37.2% female patients were included to study. The mean age was 60.29±12.62. tPA was started to 7 7.2% patients in 1 hour, 25 25.8% patients in 1-2 hours, 31 32% patients in 2-3 hours, 34 35.1% patients in 3-4.5 hours. The most common symptom was hemi/monoparesis 92.8% . 69.1% partial anterior, 16.5% total anterior and 15.8% posterior vascular occlusion were detected. NIHSS results were 10.39±4.36 pre-treatment and 6.63±3.76 discharged . Patients were discharged with not disabilty 20.6% , partial disabilty 43.3% and major disabilty 21.6% . Hemorrhagic transformation was detected in 12% of patients. Hemorrhagic transformation was higher in patients with low platelets P

Anahtar Kelimeler

Ischemic stroke thrombolytic disability hemorrhagic transformation

Kaynakça

  • Blackham KA, Meyers PM, Abruzzo TA, et al. Endovascu- lartherapy of acuteischemicstroke: report of thestandards of practicecommittee of thesociety of neurointerventionalsur- gey. J Neurointerv Surg 2012;4:87-93.
  • Kumral E, Balkır K. İnme epidemiyolojisi. In: Balkan S, ed. Serebrovasküler hastalıklar. 1. baskı, Ankara: Güneş Kita- pevi, 2002;38-40.
  • Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heartdiseasean- dstroke statistics-2017 update: a reportfromthe American Heart Association. Circulation 2017;135:146-603.
  • Heiss WD. Theischemic penumbra: correlates in imaging andimplications for treatment of ischemicstroke. Cerebro- vasc Dis 2011;32:307-20.
  • Wahlgren N, Ahmed N, Dávalos A, et al. Thromboly- siswithalteplase for acuteischaemicstroke in theSafeImp- lementation of Thrombolysis in Stroke-MonitoringS- tudy (SITS-MOST): an observationalstudy. The Lancet 2007;369:275-82.
  • Hacke W, Kaste M, Fieschi C, et al. Intravenoustromboly- siswithrecombinanttissueplasminogenactivator for acute- hemisphericstroke. JAMA 1995;274:1017-59.
  • Katzan IL, Hammer MD, Hixson ED, et al. Utilization of intravenoustissueplasminogenactivator for acuteischemi- cstroke. Arch Neurol 2004;61:346-50.
  • Hacke W, Kaste M, Bluhmki E, et al. Thrombolysiswithal- teplase 3 to 4.5 hoursafteracuteischemicstroke. N Engl J Med 2008;359:1317-29.
  • Kanazawa M, Takahashi T, Nishizawa M, Shimohata T. The- rapeutic strategies to attenuate hemorrhagic transformati- on after tissue plasminogen activator treatment for acute ischemic stroke. J AtherosclerThromb 2017;24:240-53.
  • Zhang Y, Yang H, Sun Y, Xing Y. Hemorrhagic transforma- tion after cerebral infarction: current concepts and challen- ges. Ann Transl Med 2014;2:81-8.
  • Sadeghi-Hokmabadi E, Farhoudi M, Taheraghdam A, et al. Intravenous recombinant tissue plasminogen activator for acute ischemic stroke: a feasibility and safety study. Int J Gen Med 2016;9:361-7.
  • Guo Y, Yang Y, Zhou M, He L. Risk factors of haemorrha- gic transformation for acute ischaemic stroke in Chinese patients receiving intravenous recombinant tissue plasmi- nogen activator: a systematic review and meta-analysis. Stroke VascNeurol2018;3:203-8.
  • 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.
  • Van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, vanGijn J. Inter observer agreement for the assessment of handicap in stroke patients. Stroke 1988;19:604-7.
  • National Institute of Neurological Disordersand Stroke rt- PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995;333:1581-7.
  • Wardlaw J, Berge E, Zoppo G, Yamaguchi T. Thrombolysis for acut ischemic stroke. Stroke 2004;35:2914-5.
  • Wardlaw JM, Warlow CP. Thrombolysis in acute ischemic stroke: Does it work?. Stroke 1992;23:1826-39.
  • Wahlgren N, Ahmed N, Davalos A, et al. Thrombolysis with alteplase for acute ischemic stroke in the safe implementati- on of thrombolysis in stroke monitoring study: an observa- tional study. Lancet 2007;369:275-82.
  • Hacke W, Donnan G, Fieschi C, et al. Association of out- come with early stroke treatment: pooledanalysis of AT- LANTIS, ECASS, and NINDS rt-PA stroketrials. Lancet 2004;363:768-74.
  • Saver JL. Number needed to treat estimates in corporating effects over the entire range of clinical outcomes: novel de- rivation method and application to thrombolytic therapy for acutes troke. ArchNeurol 2004;61:1066-70.
  • Saqqur M, Uchino K, Demchuk AM, et al. Site of arterial occlusion identified by transcranial doppler predicts the response to intravenous thrombolysis for stroke. Stroke 2007;38:948-54.
  • Kim DH, Lee DS, Nah HW, Cha JK. Clinicaland radiologi- cal factors associated with unfavorable outcome after intra- venous thrombolysis in patients with mild ischemic stroke. BMC Neurol 2018;18:30.
  • Marti-Fabregas J, Bravo Y, Cocho D, et al. Frequency and predictors of symptomatic intracerebralhemorrhage in pa- tients with ischemic stroke treated with recombinant tissue plasminogen activator outside clinical trials. Cerebrovasc- Dis 2007;23:85-90.
  • Yaghi S, Boehme AK, Dibu J, et al. Treatment and outcome of thrombolysis-related hemorrhage: A multicenter retros- pective study. JAMA Neurol 2015;72:1451-7.
  • Sadeghi-Hokmabadi E, Farhoudi M, Taheraghdam A, et al. Intravenous recombinant tissue plasminogen activator for acute ischemic stroke: a feasibility and safety study. Int J Gen Med 2016;9:361-7.
Toplam 25 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Original Article
Yazarlar

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Yayımlanma Tarihi 1 Aralık 2019
Yayımlandığı Sayı Yıl 2019 Cilt: 29 Sayı: 4

Kaynak Göster

Vancouver Eren F, Öngün G, Yıldoğan AT, Işık M, Öztürk Ş. Akut iskemik inmede intravenöz trombolitik tedavi: Klinik değerlendirme. Genel Tıp Derg. 2019;29(4):169-74.

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