Abstract
INTRODUCTION:The ischemic stroke guidelines establish within the management algorithm the implementation of intravenous thrombolytic therapy as one of the strategies to approach the acute event that has been shown to reduce levels of disability in patients.
OBJECTIVE:To describe the impact of intravenous thrombolysis performed on patients with ischemic stroke, taking into account functionality and prognosis measuring scales.
MATERIALS AND METHODS:We conducted a descriptive longitudinal study on patients to whom intravenous thrombolysis were performed at the Fundación Hospital Universidad del Norte ( October 2011 - March 2016) taking into account the demographics aspects as well as risk factors including a 30 and 90 day follow up to determine prognosis and mortality using the modified Rankin scale.
RESULTS:The study consisted of 27 patients whose average age was 65 years, finding a higher prevalence within female patients and A frequent risk factor of hypertension (19/27). Initial management was performed according to the institutional protocol from the stroke unit. Average times were shown at each stage of care, from the onset of symptoms to thrombolysis. During the intervention, some complications were documented which justified the suspension of the treatment. There was hemorrhagic transformation of stroke reported leading to secondary death. Functionality was assessed with the NIHSS scale at patient's admission and discharge, prognosis and mortality were assessed with a modified Rankin scale, which showed that more than 50% of the patients scored between 0 and 1 at 90 days post-thrombolysis.
CONCLUSION:The study has limitations in order to establish conclusions statistically significant, but it does reflect the experience of a university center with an effective therapeutic intervention and looks to create a database in the region that can be use like a reference for other studies.
References
Aho K, Harmsem P, Hatano H, Marquardsen J, Smirnov V. E, Strasser T. Cerebrovascular diseases in the community: results of a WHO collaborative study. WHO.1980;58:113-30.
Chan Y, Gentile N, Hazinski M, et al. Adult Stroke: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010;122(18 suppl 3);S818-S828.
Lees KR, Bluhmki E, Von Kumme R, Brott TG, Toni D, Grotta JC, et al. Time to treatment with intravenous Alteplase and out-come in stroke an updated pooled analysis of ECASS,ATLANTIS, NIND and EPITHET trials. Lancet. 2010;375(9227):1695-703.
Sila C. Finding the right t-PA dose for Asians with acute ischemic stroke. N Engl J Med. 2016; 374: 2389-2390. Doi:10.1056/NEJMe1605228.
Domínguez A, Nuñez R, García S, Gómez I, López S, Ramos N. Inclusión de la escala neurológica del National Institute of Health (NIHSS) en la clínica de la unidad de Ictus del Hospital del Mar. Rev Cient Soc Enfer Neurol. 2009; 30: 15-21.
Latour-Pérez J, Galdos Anuncibay P. Trombolisis en el ictus isquémico agudo en centros sin unidad de ictus: ¿derivación a centro de referencia o tratamiento in situ?. Med Intensiva. 2012;26(5):324-28
Edward C. Jauch, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: Guideline for Healthcare Professionals From the American Heart Association/American Stroke. Association. Stroke. 2013;44(3):870-947.
Sanclemente C, Valdez F, et al. Accidentes vasculares cerebrales en la comarca de Osona. Factores de riesgo cardiovascular. An Med Interna. 2004;21(4):161-65
Silva F, Quintero C, Zarruck J. Comportamiento epidemiológico de la enfermedad cerebrovascular en la población colombiana. Rev Col Cardiol. 2006;13(2):85-9.
Uribe CS, Jiménez I, Mora MO, Arana A, Sánchez JL, Zuluaga L, et al. Epidemiología de las enfermedades cerebrovasculares en Sabaneta, Colombia (1992-1993). Rev Neurol.1997;25 (5 Suppl 4):1008-12.
Zarco L.A., González F., Coral J., Tratamiento actual del ataque cerebrovascular isquémico (ACV) agudo. Univ. Méd. 2008;49(4):467-98.
Alcaldía de Soledad - Atlántico [Internet]. Bogotá, Colombia: Alcaldía de Soledad [citado el 21 sep. de 2016]. Disponible en: Disponible en: http://www.soledad-atlantico.gov.co/indicadores.shtml#poblacion
Castañeda C, Coral J, Rueda M, Díaz D, Ruiz A. Experiencia de Trombólisis intravenosa en el manejo del ataque cerebro vascular en el Hospital Universitario. San Ignacio 2011-2013 (EXTRO HUSI). Acta Neurol Colomb. 2014;30(1):16-21.
Licona T, Aguilera M. Sandoval. Perfil clínico epidemiológico de pacientes con accidente cerebrovascular en el instituto hondu-reño de seguridad social. Rev Med Hondur. 2009;77(3):99-152.
Figueroa Reyes T, et al. Experiencia de trombolisis sistematizada en infarto cerebral agudo en un hospital público de Chile. Rev Med Chile. 2011;139(9): 1118-1127.
Clementti, P, et al. Tratamiento con Alteplase en infarto cerebral en la unidad de Stroke (Registro TAICUS). Rev Fed Arg Cardiol. 2008;37(1):41-47.
Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D, et al. For the ECASS Investigators Thrombolysis with Alteplase 3 to 4*5 hours after acute ischemic stroke. N Engl J Med 2008;359(13):1317-29.
Lyden P. Thrombolytic Therapy for Acute Stroke - Not a Moment to Lose. N Engl J Med;2008;359:1393-95.
Frey JL. Recombinant Tissue Plasminogen Activator (rt-PA) for Stroke The Perspective at 8 Years. The Neurologist 2005;11:123-133.
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