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RESUMEN Introducción: El síndrome de Nicolau (SN), conocido como embolia cutis medicamentosa o dermatitis livedoide es un acontecimiento adverso debido a la administración de inyecciones intramusculares, intraarteriales, subcutánea e incluso intraarticulares asociado a diversos fármacos1. Se desconoce toda la patogenia de este síndrome, pero se ha asociado a lesión vascular, trombosis arterial, espasmo reflejo de las arterias, oclusión vascular por microembolia e inflamación. Caso clínico: Paciente masculino de 32 años de edad, luego de inyección intramuscular de penicilina benzatínica presenta dolor intenso en área de inyección que se acompaña de lesiones eritematosas a nivel de abdomen, escroto y miembro inferior derecho además de presentar dolor, pareste-sia, palidez moteado eritematoso (livedo) y disminución de pulsos en dicha extremidad por lo que se diagnostica isquemia aguda (IA) que requirió tratamien-to fibrinolitico, entre otros fármacos. Conclusión: El síndrome de Nicolau es una condición iatrogénica que puede ser producida por inyección de múltiples medicamentos, puede presentar diferentes síntomas y signos como lesión neurológica, necrosis en área de irrigación de vasos afectados e incluso isquemia aguda. En este caso el manejo con rt-PA fue efectivo en tratar la isquemia. El conocimiento de este síndrome y sus complicaciones facilitaría su manejo2.Palabras claves: Síndrome Nicolau, bencilpenicilina, anticoagulante, rt-PA
ABSTRACT Introduction: Nicolau syndrome (NS), known as cutaneous embolism or livedoid dermatitis, is an adverse event due to the administration of intramuscular, intraarterial, subcutaneous and intraarticular injections associated with various drugs1. The entire pathogenesis of this syndrome is unknown, but it has been associated with vascular injury, arterial thrombosis, reflex spasm of the arteries, vascular occlusion due to microemboli, and inflammation. Clinical case: 32-year-old male. After an intramuscular injection of benzathine penicillin, the patient presented severe pain in the injection area accompanied by erythem-atous lesions at the level of the abdomen, scrotum, and right lower limb. In addition to that, the patient presented pain, paresthesia, and mottled paleness erythema (livedo). Moreover, the patient had a decreased pulse in the right limb, acute ischemia was diagnosed and required fibrinolitic treatment, among other drugs. Conclusion: Nicolau Syndrome, is an iatrogenic condition that is produced by injection of multiple drugs. It can produce different symptoms and signs from neurological injury, necrosis in the irrigation area of affected vessels and acute ischemia. rt-PA management in this case was effective in treating ischemia. It is essential to know about this syndrome and its complications. This would facilitate its management2.Keywords: Nicolau syndrome, benzylpenicillin, anticoagulant, rt-PA.
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Humans , Male , Adult , Penicillin G Benzathine , Therapeutics , Nicolau Syndrome , Anticoagulants , Thrombosis , Wounds and InjuriesABSTRACT
Objective: Herein, we report a patient with acute cerebral infarction with a favorable prognosis after being managed by a general physician with support from the telestroke program.Patient and Methods: An 85-year-old man was transferred to a regional hospital due to sudden onset of dysarthria and left hemiparesis. As no neurosurgeons or neurologists were available in that hospital or area, the patient was examined by a general physician who diagnosed him with cardioembolic stroke on the left middle cerebral artery territory. The physician consulted a stroke specialist using the telestroke system; with the support from the telestroke program, the physician administered thrombolytic therapy 4 hours and 10 minutes after the onset of symptoms.Results: The patient’s National Institutes of Health Stroke Scale score improved from 9 to 3 and he was subsequently transferred to the stroke center. However, the occluded left middle cerebral artery had already re-canalized. His hemiparesis completely improved one week after the onset.Conclusion: A telemedicine system for general physicians is indispensable in areas without accessible stroke specialists as it provides access to a standard of care for hyper-acute stroke patient assessment and management, and helps improve neuroprognosis.
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INTRODUCTION@#Intravenous (IV) thrombolysis with alteplase (rt-PA) is effective in ischaemic stroke. The primary objective was to evaluate predictors of functional outcome in acute ischaemic stroke (AIS) patients treated with IV rt-PA. The secondary objective was to assess the outcome with the modified Rankin scale (mRS). We also examined the predictive value of the Totaled Health Risks in Vascular Events (THRIVE) score.@*METHODS@#AIS patients treated with IV rt-PA from February 2012 to August 2016 were recruited. Demographic data, National Institutes of Health Stroke Scale (NIHSS) scores, timing and neuroradiological findings were recorded. Patients received a dose of 0.9 mg/kg IV rt-PA within 4.5 hours of symptom onset. mRS score was evaluated at discharge and three months, and good and poor clinical outcomes were defined as scores of 0-2 and 3-6, respectively. Baseline THRIVE scores were assessed.@*RESULTS@#36 patients received IV rt-PA. 20 (55.6%) patients had an mRS score of 0-2 at three months. Based on THRIVE score, 86.1% had a good or moderately good prognosis. On univariate analysis, poor outcome was associated with NIHSS score before rt-PA (p = 0.03), THRIVE score (p = 0.02), stroke subtype (p = 0.049) and diabetes mellitus (DM; p = 0.06). Multiple logistic regression showed that outcome was significantly associated with NIHSS score before rt-PA (p = 0.032) and DM (p = 0.010).@*CONCLUSION@#Our newly developed Malaysian IV rt-PA service is safe, with similar outcomes to the published literature. Functional outcome after thrombolysis was associated with baseline NIHSS score and DM.
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Objective To compare the safety and clinical efficacy of recombinant human tissue plasminogen activator (rt-PA) and urokinase(UK)in catheter-directed thrombolysis(CDT)for the treatment of subacute iliofemoral deep venous thrombosis(DVT). Methods From June 2013 to June 2017, a total of 116 subacute DVT patients underwent consistent CDT with either rt-PA or urokinase, or simple anticoagulation treatment in this study.The patients were divided into three groups for comparison:rt-PA-CDT group(n=43), UK-CDT group(n=39)and anticoagulation group(n=34). The baseline data, thrombolysis duration, rt-PA or UK dosages, thrombolytic rate and clinical efficacy rate were compared among the three groups. Independent t-test(accorded to normal distribution)was used to analyze the thrombolysis duration.The quantitative data were analyzed with analysis of varianc and the qualitative data were compared by the chi-square test. Results There was no significant difference in general clinical features among the three groups(P>0.05). The thrombolysis duration, total dosages and thrombolytic rate (≥50)were(5.8±1.3)d,(49.7±16.1)mg,86.0% for rt-PA-CDT group,and(6.3±1.5)d,(440±99)×104 U, 66.7% for UK-CDT group.The difference of thrombolysis duration was not statistically significant between the rt-PA-CDT group and UK-CDT group(t=-1.868, P>0.05). The thrombolysis rate of rt-PA-CDT group was significantly higher than that of UK-CDT group(χ2=4.315, P<0.05). The time of obtaining grade Ⅲthrombosis rate was shorter for rt-PA-CDT group(4.7±0.9)d compared with UK-CDT group(6.0±1.2 d) (t=-2.343,P<0.05).The clinical efficacy rates of the rt-PA-CDT group[88.4%(38/43)]and UK-CDT group [76.9%(30/39)]were significantly higher than that of anticoagulation group[26.5%(9/34)](P<0.05).There was no statistical difference between the rt-PA-CDT group and UK-CDT group(χ2=1.893, P>0.05). No severe complications were found in all groups. The incidence rates of mild complication of the rt-PA-CDT group, UK-CDT group and anticoagulation group were 16.3%(7/43), 17.9%(7/39)and 8.8%(3/34), respectively, and there were no significant differences among the three groups(χ2=1.396, P>0.05). Conclusion The clinical efficacy of CDT using rt-PA and UK for subacute DVT is better than simple anticoagulation treatment.Thrombolytic rate of rt-PA is superior to UK.
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Background: Although acute pancreatitis is listed among the exclusion criteria for the administration of recombinant tissue plasminogen activator according to the Japanese Guideline for the Management of Stroke, the co-occurrence of acute pancreatitis and acute ischemic stroke has not been investigated. The present study aimed to assess the incidence rate of acute pancreatitis in patients with acute ischemic stroke.Methods: This study consecutively enrolled all patients with ischemic stroke admitted to the Department of Neurology, JA Toride Medical Center between April 2014 and March 2016. Diagnosis of acute pancreatitis was made according to the revised Atlanta Classification of Acute Pancreatitis. We retrospectively analyzed serum amylase activity and the frequency of acute pancreatitis as a comorbidity of ischemic stroke.Results: A total of 411 ischemic stroke patients were included. Serum amylase activity was measured for 364 patients, 27 of whom presented with amylase activity exceeding the upper limit of normal. In two patients with serum amylase activity greater than three times-fold the upper limit of normal, computed tomography or transabdominal ultrasonography showed no characteristic findings of acute pancreatitis. No patient in the cohort met the diagnostic criteria for acute pancreatitis.Conclusions: Acute pancreatitis is a very rare comorbidity of acute ischemic stroke.
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RESUMEN El tratamiento con activador recombinante del plasminógeno tisular (sigla en inglés rt-PA), aplicado por vía intravenosa (VIV) es el procedimiento de primera línea en casos de ataque cerebrovascular agudo (ACVA) en una ventana de 4,5 horas. En Colombia hay una experiencia publicada del uso exitoso de este medicamento. En el número actual se publica una nueva experiencia del uso de rt-PA en el caribe colombiano, de gran utilidad para reseñar los artículos publicados en Colombia acerca del tema.
ABSTRACT Treatment with intravenous recombinant tissue plasminogen activator (rt-PA) for acute stroke (AS) is the first line procedure for patients in 4,5 hours window. In Colombia there is a published experience about the successful use of this medication. In the currently issue a new experience from Colombian Caribbean is presented, which it is taken in advantage for briefly reviewing the published papers about the theme in our country.
Subject(s)
Tissue Plasminogen Activator , Colombia , StrokeABSTRACT
Objective To investigate the clinical effect of of rt-Pa Early Thrombolytic Therapy on the Patients with Acute Cerebral Infarction (ACI). Methods 40 patients with acute cerebral infarction were randomly divided into rt-PA group and control group, 20 cases in each group. The treatment time window was less than 3 hours. On the basis of the routine medication of cerebral infarction, rt-PA group was given rt-PA intravenous thrombolytic therapy, the control group was treated with sodium ozagrel. The National Institutes of Health Stroke Scale (NIHSS) and Barthel index (BI) were used to evaluate the efficacy and safety. Results The NIHSS scores of two groups after treatment were significantly improved compared with before treatment, rt-PA group improved significantly better than the control group (P<0.05); At 21 days of treatment, the excellence rate of rt-PA group was 80% and the ratio of BI≥95 was 40.00%, the excellence rate of control group was 25.0% and the ratio of BI≥95 was 20.00%, the rt-PA group was significantly higher than the control Group (P<0.01); there was no significant difference between the two groups in the mortality rate, the incidence of secondary cerebral hemorrhage and vascular restenosis in the two groups. Conclusion Within 3 hours of onset of ACI, compared with the sodium ozagrel therapy, the rt-PA intravenous thrombolytic therapy is more safe and effective in the treatment of ACI patients, and it is worthy to be widely used in clinical treatment.
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Objective To assess the efficacy and safety of thrombolysis therapy for hyperglycemic patients suffering from minor stroke. Methods Intravenous thrombolysis by rtPA was given to hyperglycemic patients suffering from minor stroke. The recovery of neurological deficits and other clinical parameters were recorded 24 hours ,7 days and 90 days after treatment in randomized thrombolytic group and non-thrombolytic group. Results Neurological recovery rate of minor stroke patients with diabetes in thrombolytic group was higher than that in non-thrombolytic group 24 hours,7 days and 90 days after the treatment(P < 0.05)and the incidence of aggravation or worsening of clinical symptoms in thrombolytic group was lower than that of non-thrombolytic group(P < 0.05). There was no significant difference in the recovery rate of neurological deficits and the incidence of exacerbation or deterioration of clinical symptoms in hyperglycemic patients suffering from minor stroke. No intra-cranial hemorrhage occurred in both groups. Conclusion It is of great significance for minor stroke patients with diabetes to receive intravenous thrombolysis ,which is a safer clinical alternative.
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Objective To explore the safety and clinical efficacy of Ginkgo biloba lactone injection combined with Alteplase intravenous thrombolysis in treatment of acute ischemic stroke.Methods Totally 87 patients were recruited and divided into control group and test group.The,patients in control group (39 cases) were given Alteplase 0.9 mg/kg for injection,intravenous bolus total dose 10％ was given within 1 min,then intravenous infusion of the remaining 90％ was given in 1 h,and given basic therapy after 24 h.The 48 cases in test group,which were immediately iv Ginkgo biloba lactone injection after intravenous thrombolysis,6 mL added into 250 mL saline,once daily for 14 d,and also were given basic therapy after 24 h.All NIHSS scores were recorded before treatment,14 d and 90 d after treatment,and the adverse events were recorded.The modified Rankin scale (mRS) score and BI index were performed at 14 and 90 d after admission.Patients in two groups were classified according to the TOAST classification,and the patients with large-arteryatherosclerosis and small-artery occlusion were analyzed.Results No intracranial hemorrhage occurred in the two groups.The NIHSS score and mRS score of test group were significantly lower than that of control group,and BI index was significantly increased 90 d after treatment.The NIHSS score and mRS score of test group were significantly lower than that of control group,and BI index was significantly increased90 d after treatment of patients with large-artery atherosclerosis.But there was no significant difference between test group and control group of patients with small-artery occlusion.Conclusion Ginkgo biloba lactone injection combined with rt-PA intravenous thrombolysis in the treatment of acute ischemic stroke has high safety,and can improve the prognosis of patients.
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Objective To study the application of 99Tcm in rabbit cerebral thromboembolic stroke and thrombolysis effect of recombinant tissue plasminogen activator (rt-PA).Methods The 0.5 mL radioactive pertechnetate sodium (specification:5 mCi/2mL and radiation intensity 92.5 MBq/mL) was combined with 30 μL stannous chloride (5 mg/mL),and the 20 μL mixture was joined to whole blood,red blood cells,and plasma for labelling.Then 50 μL CaCl2 (0.5 mol/L) and bovine thrombin (50 IU/mL) were doped in mixture,and rapidly sucked into a polyethylene plastic pipe (PE80).Thrombus was formed for 2 h at 37 ℃ and cut into small pieces of 10 mm.Autologous blood clots combined with 99Tcm from external carotid artery were injected to internal carotid artery of rabbit,the radioactivity (counts per minute,CPM) was measured by gamma counting instrument,and the improvement of rt-PA 4.5 mg/kg (clinical equivalent dose) on this model was observed.Results After thromboembolism,CPM increased approximately by (5.1 ± 1.3) times,which suggested that the model was reliable.The rt-PA 4.5 mg/kg had significant progressive thrombolysis effect.Conclusion 99Tcm tracer technology could be applied to rabbit cerebral stroke model,which is stable and reliable
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Objective To investigate the clinical effect of of rt-Pa Early Thrombolytic Therapy on the Patients with Acute Cerebral Infarction (ACI). Methods 40 patients with acute cerebral infarction were randomly divided into rt-PA group and control group, 20 cases in each group. The treatment time window was less than 3 hours. On the basis of the routine medication of cerebral infarction, rt-PA group was given rt-PA intravenous thrombolytic therapy, the control group was treated with sodium ozagrel. The National Institutes of Health Stroke Scale (NIHSS) and Barthel index (BI) were used to evaluate the efficacy and safety. Results The NIHSS scores of two groups after treatment were significantly improved compared with before treatment, rt-PA group improved significantly better than the control group (P<0.05); At 21 days of treatment, the excellence rate of rt-PA group was 80% and the ratio of BI≥95 was 40.00%, the excellence rate of control group was 25.0% and the ratio of BI≥95 was 20.00%, the rt-PA group was significantly higher than the control Group (P<0.01); there was no significant difference between the two groups in the mortality rate, the incidence of secondary cerebral hemorrhage and vascular restenosis in the two groups. Conclusion Within 3 hours of onset of ACI, compared with the sodium ozagrel therapy, the rt-PA intravenous thrombolytic therapy is more safe and effective in the treatment of ACI patients, and it is worthy to be widely used in clinical treatment.
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Objective To assess the efficacy and safety of thrombolysis therapy for hyperglycemic patients suffering from minor stroke. Methods Intravenous thrombolysis by rtPA was given to hyperglycemic patients suffering from minor stroke. The recovery of neurological deficits and other clinical parameters were recorded 24 hours ,7 days and 90 days after treatment in randomized thrombolytic group and non-thrombolytic group. Results Neurological recovery rate of minor stroke patients with diabetes in thrombolytic group was higher than that in non-thrombolytic group 24 hours,7 days and 90 days after the treatment(P < 0.05)and the incidence of aggravation or worsening of clinical symptoms in thrombolytic group was lower than that of non-thrombolytic group(P < 0.05). There was no significant difference in the recovery rate of neurological deficits and the incidence of exacerbation or deterioration of clinical symptoms in hyperglycemic patients suffering from minor stroke. No intra-cranial hemorrhage occurred in both groups. Conclusion It is of great significance for minor stroke patients with diabetes to receive intravenous thrombolysis ,which is a safer clinical alternative.
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Objective To explore the Efficacy and safety of intravenous thrombolysis with different doses of rt-PA in the treatment of acute anterior circulation cerebral infarction with atrial fibrillation.Methods Retrospective analysis of 61 cases of patients with anterior circulation of cerebral infarction with atrial fibrillation from October 2009 to October 2014 in the First Affiliated Hospital of Xiamen University, the incidence within 4.5 hours of intravenous thrombolysis,and divided into two groups by rt-PA usage,19 cases in adequate group,received 0.9 mg/kg rt-PA intravenous thrombolytic therapy,42 cases in low dose group, received 0.6 mg/kg rt-PA intravenous thrombolysis.Before and after thrombolysis 1,7 and 30 days,NIHSS score was measured, the indexes of coagulation were observed at before thrombolysis and 1,7 days after thrombolysis,,CT scans were performed at 1, 7, and 14 days after thrombolysis,and Rankin (MRS) scores were compared at 90 days after thrombolysis.Results NIHSS 1,7,30 days scores of 2 groups were significantly decreased after thrombolysis(P<0.05),there was no statistically significant at at each time point after thrombolysis.Plasma prothrombin time increased significantly at 1 day and 7 days after thrombolysis,fibrinogen was significantly lower,compared with the low dose group, the difference was significant (P<0.05).There was no significant difference between the two groups in clinical outcome and mortality.The rate of mucosal bleeding in low dose group was lower than that in adequate group (P<0.05).Conclusion Low-dose rt-PA group intravenous thrombolysis with anterior circulation of atrial fibrillation is more safe,can reduce the risk of bleeding, reduce neurological deficits and improve the quality of life of patients.
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OBJECTIVE:To explore the prognosis effect of Shengmai injection to the rt-PA thrombolysis on broadened thera-peutic window patients of mild-to-moderate cerebral infarction under the guidance of computer tomography(CT). METHODS:168 patients with mild-to-moderate cerebral infarction were randomly divided into control group (84 cases) and observation group (84 cases). Control group received rt-PA(0.9 mg/kg),and 10% of the total rt-PA was mixed and injected into patients within 1 min, the rest 90% adding into 250 ml 0.9% Sodium chloride injection (no less than 1 h),CT was performed after 24 h thrombolytic therapy,and the patients with no intracerebral hemorrhage in re-examination received 300 mg/d aspirin for 10 d,then 100 mg/d for 90 d,and appropriate statins,calcium antagonists,β-blockers and nitrates;observation group additionally received 40 ml Sheng-mai injection,adding into 250 ml 5% Glucose injection,intravenous infusion,once a day,for 28 d. National Institutes of Health Stroke Scale (NIHSS) score,Rankin score,daily living-Barthel Index (Barthel) score,rate of symptomatic intracranial hemor-rhage,rate of secondary hemorrhage,hospitalization time,3-month postoperative mortality and incidence of adverse reactions in 2 groups were observed. RESULTS:Before treatment,there were no significant differences in the NIHSS score,Rankin score and Barthel score(P>0.05). The NIHSS score in 2 groups after 6 h,24 h and 7 d were significantly lower than before,and observa-tion group was lower than control group after 24 h and 7 d;Rankin score after 3 months was significantly lower than before,and observation group was lower than control group;Barthel score after 3 months was significantly higher than before,and observation group was higher than control group,The differences were statistically significant (P<0.05). The hospitalization time in observa-tion group was significantly shorter than in control group,and 3-month postoperative mortality was significantly lower than control group,the differences were statistically significant(P<0.05). There were no obvious adverse reactions during treatment. CONCLU-SIONS:Based on conventional treatment,Shengmai injection has improvement in the rt-PA intravenous thrombolysis on broadened therapeutic window patients of mild-to-moderate cerebral infarction under the guidance of CT,it can reduce NIHSS score and Rankin score,increase Barthel score,shorten hospitalization time and reduce the 3-month postoperative mortality,with good safety.
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Adjuvant radiotherapy (RT) can improve the rate of loco-regional control for patients with gastric cancer (GC),while the selection of patients plays a key role.As the research moves along,several relatively comprehensive molecular classifications emerged such as the TCGA classification and the ACRG classification.Studies have demonstrated that molecular classifications are closely related to the clinicopathologic characteristics,prognosis and treatment response.However,there is not recognized molecular classification of GC presently.It is a great challenge for radiation oncologists to make use of the individual bioinformation and accurately select patients who would benefit from RT.Meanwhile,precision RT could also be achieved with the prediction of radiosensitivity,combination of RT with targeted therapy and the application of ctDNA within the field of RT.
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Objective To evaluate the effect and mechanism of rt-PA combined with high pressure oxygen (HPO)on cerebral ischemia-reperfusion injury in rats.Methods The model of cerebral ischemia-reperfusion injury was constructed by using middle cerebral artery occlusion.The neurological function score;brain index,water content and infarction volume;SOD;LDH;NOS;MDA;LD;NO and NOS were measured.The protein and mRNA expressions of iNOS,BDNF,p75NTR and TrkB were also detected by RT-PCR and Western blot to evaluate and compare the protective effect of rt-PA combined HPO therapy. Results rt-PA combined HPO could significantly decrease the neurological function score;brain index,water content,and infarction volume;SOD;NOS;MDA;LD;NO and NOS but increase LDH content and the weight of rats,compared with rt-PA.In addition,rt-PA combined HPO could increase BNDF and TrKB expressions and downregulate the expressions of iNOS and p75NTR,compared with rt-PA (P<0.05).Conclusion The rt-PA combined HPO therapy has a greater protective effect than rt-PA therapy and its mechanism might be related to having antioxidant effects, increasing the expressions of BDNF and TrKB,and decreasing the expressions of iNOS and p75NTR.
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Objective To analyse effect of rt-PA intravenous thrombolytic therapy on serum levels of neuro-specific endolase, C-reactive protein and fatty acid binding protein in patients with early cerebral infarction.Methods 54 patients who were diagnosed with early acute cerebral infarction in Dalian Municipal Central Hospital were collected.All patients were randomly divided into experimental group and control group,27 cases in each group.Two groups were given conventional treatment,such as reduction of intracranial pressure,improve circulation and nutrition brain cells.Control group was given low molecular weight heparin calcium injection 5000U, one times per 12 h for 7 consecutive days, and experimental group was given rt-PA intravenous thrombolytic therapy on the basis of the control group for 7 consecutive days, post-treatment,the serum levels of NSE, CRP and FABP were detected in all patients.Results Compared with control group post-treatment, the serum CRP,NSE and FABP level was lower in experimental group ( P<0.05).Conclusions The rt-PA intravenous thrombolytic therapy can significantly reduce the serum CRP, NSE and FABP levels in the patients with early cerebral infarction, improve the prognosis of patients.
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Objective To evaluate the efficacy and safety of intermittent use of low-dose urokinase in the treatment of pulmonary embolism. Methods Forty-two patients with acute pulmonary embolism were divided into UK group with UK 10 000 U/(kg·d),7 days and rt-PA group with rt-PA 50 mg/2 h randomly. The efficacy was determined by the improvement of right heart dysfunction and perfusion defect 8 d and 14 d after the treatment. The bleeding incidence, death rate and PE recurrence were also evaluated. Results Differences of right heart dysfunction and perfusion defect between UK group and rt-PA group indicated no statistical significance (P >0.05).The rate of bleeding in UK group was lower than that of rt-PA group. Conclution The intermittent use of low-dose urokinase in the treatment of pulmonary embolism exhibits similar efficacy as rt-PA.
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Purpose: This paper presents the initial experience with thrombolysis for acute ischaemic stroke at Hospital de Base do Distrito Federal (HBDF), Brazil, and the difficulties associated with the implementation of this treatment. Method: A retrospective study was performed using the medical records of all patients with acute stroke who were treated with intravenous alteplase in our department, between May 2011 and April 2012. Results: The thrombolytic therapy was administered to 32 patients. The mean time between the ictus and the start of stroke therapy start was 195 (60-270) minutes. Sixteen patients demonstrated a significant clinical improvement (decrease in National Institute Health Stroke Scale [NIHSS] score≥4 points in 24 hours); 6 patients were discharged with an NIHSS score of 0 and 2 demonstrated haemorrhagic transformation. Conclusions: The results of our study are similar to those reported in the literature, although we have been dealing with difficulties, such as the lack of a stroke unit. .
Introdução: O objetivo deste trabalho é apresentar a experiência inicial em trombólise para o acidente vascular encefálico isquêmico (AVC) no Hospital de Base do Distrito Federal (HBDF) e as dificuldades encontradas na implementação do serviço. Método: Foi realizado estudo retrospectivo através da análise de prontuário de todos os pacientes submetidos à terapia trombolítica no período de maio de 2011 a abril de 2012. Resultados: A terapia trombolítica foi administrada a 32 pacientes. O tempo médio do ictus até o início da terapia foi de 195 (60-270) minutos. Dezesseis pacientes apresentaram uma melhora clínica significativa (queda do National Institute Health Stroke Scale [NIHSS] maior ou igual a 4 pontos em 24 horas). Seis pacientes receberam alta com NIHSS 0. Dois pacientes apresentaram transformação hemorrágica. Conclusão: Apesar das dificuldades encontradas, como a ausência de uma Unidade de AVC, o desfecho da nossa série é semelhante aos resultados descritos na literatura. .
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Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Brain Ischemia/drug therapy , Fibrinolytic Agents/therapeutic use , Stroke/drug therapy , Thrombolytic Therapy/methods , Tissue Plasminogen Activator/therapeutic use , Brazil , Medical Records , Retrospective Studies , Statistics, Nonparametric , Tertiary Care Centers , Time Factors , Treatment OutcomeABSTRACT
El tratamiento trombolítico ha producido un cambio positivo en la actitud de los clínicos ante los pacientes con ictus isquémico agudo. Un modesto beneficio de un 13% contrasta con un aumento del 10% en la ocurrencia de hemorragia intracerebral sintomática. Sin embargo, la mortalidad no es diferente entre los pacientes que reciben el agente trombolítico rt-PA y los que reciben placebo. Se continua estudiando la ventana terapéutica extendida actualmente hasta 4,5 horas de iniciado el evento y la organización de la atención que permita beneficiar a un mayor número de pacientes, pues por varias razones solo son elegibles en promedio 3%. Se revisan los estudios más relevantes sobre la trombólisis especialmente intravenosa: el NINDS, el ECAS III, el IST-3 y el DIDAS y DEDAS. Se describen las principales complicaciones de este tipo de terapia: la hemorragia intracerebral sintomática, otros tipos de hemorragias, angioedema y ruptura miocárdica
Thrombolytic therapy has positively changed the attitude of clinicians to treat patients with acute ischemic stroke. Treated patients were 13% more likely to achieve a recover with no significant disability after 3 month. This benefit was achieved at the cost of a 10% increase in the rate of symptomatic intracranial hemorrhage. However, this increase did not result in a higher rate of death or severe disability in the treated group. Intravenous rt-PA can be given with significant but decreasing benefit and an acceptable risk to benefit ratio up to 4,5 hours as therapeutic window. Thrombolytic therapy remains substantially underused. Most relevant trials which deal with thrombolytic therapy: NINDS, ECAS III, IST-3, DIDAS andDEDAS, are analyzed. The most frequent complications of this therapy are described