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1.
Acta neurol. colomb ; 38(1): 12-22, ene.-mar. 2022. tab
Article in Spanish | LILACS | ID: biblio-1374127

ABSTRACT

RESUMEN INTRODUCCION: El ataque cerebrovascular (ACV) de etiología isquémica es una patología cuya incidencia y mortalidad aumentaron en la última década. Cuando se maneja oportunamente, mediante trombólisis como terapia inicial, mejora su desenlace y funcionalidad. En el departamento del Tolima (Colombia) no hay registros de esta patología y en el país la bibliografía al respecto es limitada. El objetivo de este estudio es evaluar los desenlaces clínicos del manejo agudo con r-tPA en los pacientes que presentaron ACV isquémico en dos instituciones de la ciudad de Ibagué, capital de dicho departamento, entre junio del 2019 y junio del 2020, e identificar los tiempos de atención hospitalaria y las principales variables asociadas con el grupo de pacientes que fallecieron. MATERIALES Y METODOS: Estudio descriptivo de corte transversal del manejo del ACV isquémico con r-tPA, en el que se describen las variables sociodemográficas, la escala NIHSS como evaluación neurológica inicial, los tiempos de atención (inicio-aguja, puerta-tac y puerta-aguja), los desenlaces postoperatorios y el Rankin modificado al egreso. RESULTADOS: Se incluyeron 38 pacientes con una media de 67,37 años, el 60,53 % fueron mujeres. La escala NIHSS al ingreso fue 13,47 puntos (DE 5,24). Los tiempos de atención fueron 183 minutos (DE 72,63) inicio-aguja, 41 minutos (RIQ 17-72) puerta-TAC y 101,50 minutos (RIQ 77 - 137,25) puerta-aguja. La mortalidad fue del 23,68 %. CONCLUSION: La mortalidad y el desenlace funcional del ACV en nuestra población fueron similares a los reportados en la literatura nacional e internacional, sin embargo, es preciso implementar protocolos de atención del infarto cerebral para incrementar el número de pacientes con desenlace favorable, acortando los tiempos de atención en toda la cadena del tratamiento adecuado del infarto cerebral.


ABSTRACT INTRODUCTION: Ischemic stroke is a growing disease in the last decade, increasing both its incidence and its mortality. However, timely thrombolysis management as initial therapy can improve both disease progression as well as an individual's functionality. In Tolima, there are no registries of this disease and in Colombia in general, the literature is limited. The objective of this study is to investigate the clinical outcomes of the acute management of ischemic stroke using r-tPA as well as identifying in-hospital treatment times, at two institutions in Ibague between 2019 and 2020. METHODS AND MATERIALS: Using a cross-sectional descriptive study, we describe the management of ischemic stroke using r-tPA, describing sociodemographic variables, NIHSS scale as the initial neurological evaluation, in-hospital treatment times (symptoms-to-needle, door-to-TAC, door-to-needle), the clinical outcomes, and lastly the modified Rankin score upon discharge. RESULTS: We included 38 patients with median age of 67,37 years, 60,53 % were females. The initial average NIHSS scale upon admission was 13,47 (DE 5,24). In-hospital attention time averages were: symptoms-to-needle 183 minutes (DE 72,63), door-to-CAT 41 minutes (RIQ 17-72), and door-to-needle 101,50 minutes (RIQ 77-137,25). Overall the rate of mortality was 23,68 %. CONCLUSIONS: Mortality and functionality outcomes of the stroke population observed was similar to previously reported, both nationally and internationally. However, protocols should be implemented for the timely ischemic stroke management to improve the number of patients with favorable outcomes, by reducing the in-hospital attention times in all areas of the management chain.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Thrombolytic Therapy , Tissue Plasminogen Activator/therapeutic use , Ischemic Stroke/drug therapy , Time Factors , Tertiary Healthcare , Cross-Sectional Studies , Colombia/epidemiology , Ischemic Stroke/mortality , Octogenarians
2.
Acta neurol. colomb ; 38(1): 2-11, ene.-mar. 2022. tab, graf
Article in Spanish | LILACS | ID: biblio-1374126

ABSTRACT

RESUMEN INTRODUCCIÓN: La evaluación de la calidad de la atención del ataque cerebrovascular (ACV) es una prioridad para los sistemas de salud, debido a su relación con la disminución de la discapacidad y la muerte. En este estudio se analizan los marcadores de calidad en ACV en un hospital de referencia en Nariño, Colombia. OBJETIVO: Evaluar los marcadores de calidad de atención en ACV en el Hospital Universitario Departamental de Nariño E. S. E., entre junio del 2018 y diciembre del 2019. Como referencia se comparó con los registros de Colombia en la plataforma RES-Q. MATERIALES Y MÉTODOS: Estudio descriptivo retrospectivo de pacientes con ACV atendidos intrahospitalariamente. La recolección de datos se realizó mediante la plataforma RES-Q, en tanto que el análisis se efectuó por medio de estadísticos descriptivos y frecuencias absolutas y relativas y las diferencias con pruebas analíticas. RESULTADOS: Se evaluaron 457 pacientes con predominio de ACV isquémico y se llevó a cabo trombólisis endovenosa al 7,2% en el 2018 y al 9,2 % en el 2019, el 27,7 % con tiempo puerta aguja menor a 60 minutos en el 2018 y el 42,8 % en el 2019. Entre los marcadores de calidad, se encontró mejoría en realización de NIHSS, evaluación de disfagia en las primeras 24 horas, realización de doppler carotideo en los primeros siete días. En comparación con Colombia, se encontró un porcentaje inferior en trombólisis endovenosa y trombectomía. La mayoría de los indicadores de atención en ACV es similar al promedio nacional. CONCLUSIONES: La mejoría en el cumplimiento de marcadores de calidad en ACV refleja el impacto de programas de atención en ACV. El monitoreo de los parámetros de calidad permite generar programas para fortalecer la atención integral del ataque cerebrovascular en la región.


ABSTRACT INTRODUCTION: The evaluation of the quality of care for Stroke is a priority for health systems, given its relationship with disability and death. In this study, Stroke quality markers are analyzed in stroke in a referral hospital in Narino, Colombia. OBJECTIVE: To evaluate the markers of quality of care in stroke in the Hospital Departamental Universitario de Narino E.S.E between June 2018 and December 2019. As a reference, the outcomes were compared with the Colombian registries on RES-Q platform. MATERIALS AND METHODS: A retrospective descriptive study of patients treated in-hospital with stroke, data collection was performed using the RES-Q platform. The analysis was carried out using descriptive statistics and absolute and relative frequencies and the differences with analytical tests. RESULTS: 457patients were evaluated, with ischemic stroke predominance, endovenous thrombolysis was performed in 7.2 % in 2018, and 9.2 % in 2019, 27.7 % of patients had door to needle time less than 60 minutes in 2018 and 42.8 % in 2019. Among the quality markers evaluated, an improvement was found in the performance of NIHSS, dysphagia evaluation, and carotid doppler performance in ischemic stroke. Compared with Colombian registry, a lower percentage was found in endovenous thrombolysis and thrombectomy. Most of Stroke Care Markers are similar to national average. CONCLUSIONS: The improvement in compliance of standard of Stroke Care Quality Markers reflects the impact of stroke care programs. The monitoring of quality parameters allows the generation of comprehensivestroke care programs in the region.


Subject(s)
Humans , Male , Female , Aged , Quality Indicators, Health Care , Stroke , Thrombolytic Therapy , Cross-Sectional Studies , Retrospective Studies , Tissue Plasminogen Activator/therapeutic use , Colombia , Stroke/drug therapy
3.
J. Transcatheter Interv ; 3020220101. tab
Article in English, Portuguese | LILACS-Express | LILACS | ID: biblio-1399203

ABSTRACT

A embolia pulmonar, uma doença com risco de vida, é prevalente em todo o mundo, afetando grande porcentagem da população e representando uma das principais causas de morte cardiovascular. Para reduzir sua mortalidade e morbidade e melhorar os desfechos, é fundamental uma estratificação precoce do risco. Há uma ampla variação na gravidade de uma embolia pulmonar, desde leve até com risco de vida. Quando um paciente tem uma embolia pulmonar de alto risco e está em choque ou parada cardíaca, é razoável realizar trombólise sistêmica ou embolectomia de emergência, mas a anticoagulação isolada tem ótimos resultados na embolia pulmonar de baixo risco. Há várias estratégias para aproveitar os benefícios da trombólise e minimizar seus riscos, mas a experiência clínica com essas novas estratégias de intervenção é limitada. A equipe de resposta à embolia pulmonar, composta de cardiologista intervencionista, radiologista intervencionista, cirurgião cardíaco, radiologista especializado em imagem cardíaca e intensivista, pode ajudar a determinar o tipo de intervenção em um determinado paciente. Este artigo traz um esboço das terapias intervencionistas endovasculares atuais e seu contexto.


This life-threatening condition, known as pulmonary embolism, is prevalent throughout the world, affecting a large percentage of population and representing one of the leading causes of cardiovascular death. To reduce mortality and morbidity and improve outcomes, early risk stratification is critical. There is a wide range in the severity of a pulmonary embolism, from mild to life-threatening. When a patient has a high-risk pulmonary embolism and is in shock or cardiac arrest, emergency systemic thrombolysis or embolectomy is reasonable, but anticoagulation alone has great results in low-risk pulmonary embolism. Multiple strategies exist to capture the benefits of thrombolysis while minimizing its risks, but clinical experience with such novel intervention strategies is limited. The pulmonary embolism response team comprises interventional cardiologist, interventional radiologist, cardiac surgeon, cardiac radiologist, and critical care specialist, can help determine the type of intervention in a given patient. This article provides an outline of current endovascular interventional therapies and their context.

4.
Chinese Journal of Neurology ; (12): 210-215, 2022.
Article in Chinese | WPRIM | ID: wpr-933783

ABSTRACT

Objective:To investigate the efficacy and safety of intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) for acute ischemic stroke with stress hyperglycemia under the guidance of glycosylated hemoglobin A1c (GHbA1c).Methods:The clinical data of 195 patients of acute cerebral infarction with admission blood glucose over 22.2 mmol/L and GHbA1c less than 15.59% were collected in Nankai University Affiliated Tianjin Fourth Central Hospital from January 2018 to June 2021 and analyzed retrospectively. Patients were divided into control group (60 cases), rt-PA low-dose group (0.6 mg/kg, 70 cases) and rt-PA standard-dose group (0.9 mg/kg, 65 cases) to evaluate the guiding effect of GHbA1c and the efficacy and safety of rt-PA.Results:The effective rate at 24 hours and good rate at 7 days were 61.4% (43/70) and 72.9% (51/70) in the rt-PA low-dose group, 64.6% (42/65) and 69.2% (45/65) in the rt-PA standard-dose group, respectively, both better than the control group [30.0% (18/60); χ2=18.25, P<0.001 and 46.7% (28/60); χ2=13.65, P=0.001]. The good outcome rate at 90 days was 82.8% (58/70) in the rt-PA low-dose group, which was better than 63.3% (38/60) in the control group (χ2=6.38, P=0.016), but without statistically significant difference compared with the rt-PA standard-dose group [72.3% (47/65); χ2=2.17, P=0.153]. The case fatality rate at 90 days of the rt-PA low-dose group was 7.1% (5/70), which was lower than 20.0% (13/65) in the rt-PA standard-dose group (χ2=4.82, P=0.041) and 18.3% (11/60) in the control group (χ2=5.04, P=0.030). The incidence of intracranial hemorrhage and symptomatic intracranial hemorrhage was 8.5% (6/70) and 2.9% (2/70) in the rt-PA low-dose group, lower than 20.0% (13/65; P=0.048) and 13.8% (9/65; P=0.020) in the rt-PA standard-dose group. The incidence of extracranial hemorrhage was 7.1% (5/70) in the rt-PA low-dose group, lower than 18.9% (12/65) in the rt-PA standard-dose group ( P=0.042). Conclusion:Acute cerebral infarction patients with admission blood glucose over 22.2 mmol/L can receive rt-PA treatment when GHbA1c is less than 15.59%, and 0.6 mg/kg dosage is recommended.

5.
Article in Chinese | WPRIM | ID: wpr-931659

ABSTRACT

Objective:To investigate the clinical efficacy of alteplase combined with rosuvastatin calcium in the treatment of acute cerebral infarction.Methods:A total of 100 patients with acute cerebral infarction who received treatment in Zhejiang Xin'an International Hospital from October 2019 to October 2020 were included in this study. They were randomly assigned to undergo either rosuvastatin calcium (control group, n = 50) or alteplase combined with rosuvastatin calcium (study group, n = 50). The National Institute Health of Stroke Scale (NIHSS) score, serum viscosity, blood lipid change, and clinical efficacy were assessed before and after treatment. Results:Response rate was significantly higher in the study group than in the control group [90% (45/50) vs. 80% (40 /50), χ2 = 4.52, P < 0.05]. NIHSS score, soluble intercellular adhesion molecule-1 level, and soluble vascular cell adhesion molecule 1 level in the study group were (7.29 ± 1.46) points, (132.68 ± 15.20) μg/L, and (118.67 ± 112.60) μg/L, respectively, which were significantly lower than those in the control group [(11.47 ± 2.80) points, (189.22 ± 9.40) μg/L, (1 372.59±125.70) μg/L, t = 4.21, 3.21, 5.12, all P < 0.05]. Insulin-like growth factor 1 level was significantly higher in the study group than in the control group [(485.41 ± 51.30) μg/L vs. (364.23 ± 44.50) μg/L, t = 6.32, P < 0.05]. Total cholesterol and low density lipoprotein cholesterol levels in the study group were (3.29 ± 1.46) mmol/L and (3.04 ± 0.15) mmol/L, respectively, which were significantly lower than those in the control group [ (4.47 ± 2.80) mmol/L, (3.22 ± 0.41) mmol/L, t = 4.54, 3.87, both P < 0.05]. Conclusion:Alteplase combined with rosuvastatin calcium can greatly improve blood circulation, reduce blood viscosity, and restore neurological function in patients with acute cerebral infarction. This study is highly innovative and scientific.

6.
Article in English | WPRIM | ID: wpr-928991

ABSTRACT

OBJECTIVES@#There is a high coagulation state in pregnant women, which is prone to coagulation and fibrinolysis system dysfunction. This study aims to explore the latest coagulation markers-thrombomodulin (TM), thrombin-antithrombin complex (TAT), plasmin-α2 plasmin inhibitor complex (PIC), and tissue plasminogen activator/plasminogen activator inhibitor compound (tPAI-C) in different stages of pregnancy, establish reference intervals (RIs) for healthy pregnant women of Chinese population, and to provide an effective and reliable reference for clinicians.@*METHODS@#A total of 492 healthy pregnant women, who underwent pregnancy examination and delivery in the Department of Obstetrics, Second Xiangya Hospital of Central South University from October 2019 to October 2020, were enrolled for this study. They were assigned into the first trimester group, the second trimester group, the third trimester group, and the puerperium group according to the pregnancy period, and 123 healthy non-pregnant women were selected as the controls. Plasma levels of TM, TAT, PIC and tPAI-C were analyzed by automatic chemiluminescence immunoassay analyzer. The RIs for TM, TAT, PIC, and tPAI-C were defined using non-parametric 95% intervals, determined following Clinical and Laboratory Standards Institute Document C28-A3c (CLSI C28-A3c), and Formulation of Reference Intervals for the Clinical Laboratory Test Items (WS/T402-2012).@*RESULTS@#TM and TAT levels increased gradually in the first, second, and third trimester women and decreased in the puerperium women (P<0.05 or P<0.01). PIC level of healthy non-pregnant women was lower than that of pregnant women (P<0.05 or P<0.01), but PIC level of pregnant and puerperium women did not differ significantly (P>0.05). tPAI-C level in healthy non-pregnant women was lower than that of pregnant women (P<0.05 or P<0.01), and tPAI-C level was significantly decreases in the puerperium women (P<0.01). The RIs for TM were as follows: Healthy non-pregnant women at 3.20-4.60 TU/mL, the first and second trimester at 3.12-7.90 TU/mL, the third trimester at 3.42-8.29 TU/mL, puerperium at 2.70-6.40 TU/mL. The RIs for TAT were as follows: Healthy non-pregnant women at 0.50-1.64 ng/mL, the first and second trimester at 0.52-6.91 ng/mL, the third trimester at 0.96-12.92 ng/mL, puerperium at 0.82-3.75 ng/mL. The RIs for PIC were as follows: Healthy non-pregnant women at 0.160-0.519 ng/mL, pregnant women at 0.162-0.770 μg/mL. The RIs for tPAI-C were as follows: Healthy non-pregnant women at 1.90-4.80 ng/mL, the first and second trimester at 2.03-9.33 ng/mL, the third trimester at 2.80-14.20 ng/mL, puerperium at 1.10-8.40 ng/mL.@*CONCLUSIONS@#The levels of 4 new coagulation markers TM, TAT, PIC, and tPAI-C in pregnant women are increased significantly during pregnancy and gradually return to normal after delivery. The RIs for TM, TAT, PIC, and tPAI-C in pregnant women by trimester are established according to CLSI C28-A3c, thus providing a clinical reference for clinician in judgement of thrombotic risk.


Subject(s)
Biomarkers/blood , Blood Coagulation , Female , Humans , Postpartum Period , Pregnancy , Reference Values
7.
Enferm. foco (Brasília) ; 13: 1-6, 2022. tab
Article in Portuguese | LILACS, BDENF | ID: biblio-1395266

ABSTRACT

Objetivo: Identificar os fatores de risco associados ao déficit neurológico em pessoas vítimas de acidente vascular cerebral isquêmico. Métodos: Trata-se de um estudo retrospectivo descritivo quantitativo realizado em um hospital no interior de Minas Gerais Brasil. Os dados foram coletados em 52 prontuários, através de um instrumento contendo variáveis sociodemográficas, clínicas e janelas de tempo de tratamento. Para avaliação do déficit neurológico utilizou-se National Institutes of Health Stroke Scale. Os testes de Shapiro-Wilk, Quiquadrado de Pearson, T Student e McNemar foram utilizados para a análise estatística. O nível de significância foi de 0,05. Resultados: Na admissão hospitalar houve prevalência do déficit neurológico moderado, e na alta hospitalar, o déficit neurológico leve. O valor do déficit neurológico na admissão hospitalar e alta hospitalar foram, respectivamente 13,10 (±7,2) e 7,58 (±8,3), p = (0,000). O período de internação foi de 7,78 dias para os indivíduos com déficit neurológico leve/moderado e 11,67 dias para déficit neurológico grave (p=0,044). O tempo de janela porta agulha foi 38 minutos nos pacientes com déficit neurológico leve/moderado e 55,3 minutos para o déficit neurológico grave (p=0,025). Conclusão: Destaca-se a influência da condição neurológica no tempo de internação e a importância do atendimento ágil por parte da equipe. (AU)


Objective: To identify the risk factors associated with neurological deficit in people who victims of ischemic stroke. Methods: This is a retrospective quantitative descriptive study carried out in a hospital in the interior of Minas Gerais Brazil. Data were collected from 52 medical records, using an instrument containing sociodemographic and clinical variables and treatment time windows. To assess neurological deficit, the National Institutes of Health Stroke Scale was used. The Shapiro-Wilk, Pearson Chi- square, T Student and McNemar testes were used for statistical analysis. The significance level was 0,05. Results: At hospital admission there was a prevalence of moderate neurological deficit, and at hospital discharge, mild neurological deficit. Neurological deficit values at hospital admission and discharge werw respectively 13,10 (±7,2) and 7,58 (±8,3), p = (0,000). The hospital stay was 7,78 days for individuals with mild/moderate neurological deficit and 11,67 days for severe neurological deficit (p=0,044). The needle door window time was 38 minutes for patients with mild/moderate neurological deficit and 55,3 minutes for severe neurological deficit (p=0,025). Conclusion: The influence of the neurological condition on the length of stay and the importance of prompt care by the team are highlighted. (AU)


Objetivo: Identificar los factores de riesgo asociados al déficit neurológico en personas víctimas de ictus isquémico. Métodos: Se trata de un estudio cuantitativo descriptivo retrospectivo realizado en un hospital del interior de Minas Gerais Brasil. Se recolectaron datos de 52 historias clínicas, utilizando un instrumento que contiene variables sociodemográficas y clínicas y ventanas de tiempo de tratamiento. Para evaluar el déficit neurológico, se utilizó la National Institutes of Health Stroke Scale. Para el análisis estadístico se utilizaron las pruebas de Shapiro-Wilk, Chi-cuadrado de Pearson, T de Student y McNemar. El nivel de significancia fue 0.05. Resultados: al ingreso hospitalario prevaleció déficit neurológico moderado y al alta hospitalaria déficit neurológico leve. Los valores de déficit neurológico al ingreso y al alta hospitalaria fueron respectivamente 13,10 (± 7,2) y 7,58 (± 8,3), p = (0,000). La estancia hospitalaria fue de 7,78 días para individuos con déficit neurológico leve / moderado y de 11,67 días para déficit neurológico severo (p = 0,044). El tiempo de ventana de la puerta de la aguja fue de 38 minutos para pacientes con déficit neurológico leve / moderado y de 55,3 minutos para déficit neurológico severo (p = 0,025). Conclusión: Se destaca la influencia de la afección neurológica en la duración de la estadía y la importancia de una atención inmediata por parte del equipo. (AU)


Subject(s)
Stroke , Thrombolytic Therapy , Risk Factors , Tissue Plasminogen Activator
8.
Braz. J. Pharm. Sci. (Online) ; 58: e19692, 2022. graf
Article in English | LILACS | ID: biblio-1384014

ABSTRACT

Abstract The development of stable cell lines producing recombinant proteins is very time-consuming and laborious. One of the practical approaches successfully performed is Fluorescence-Activated Cell Sorting (FACS). A mutated chimeric tissue plasminogen activator (mt-PA) was developed by removing the first three domains of t-PA, insertion of GHRP sequence and mutation toward resistance to plasminogen activator inhibitor-1 (PAI-1). In the current study, a new stable CHO-DG44 cell line producing mt-PA was developed by two sequential clonal selections: FACS and clonal-selection by limiting dilution. Furthermore, the expression was more evaluated using two different expression media. Finally, the high-producing clones were selected based on the dot blot and amidolytic activity test. The transfection efficiency of CHO-DG44 cells was 38% as measured by flow cytometry on green fluorescent protein (GFP). After performing FACS on stable cell pools, the expression yield was increased to fifty-fold. In terms of growth profile, CD-DG44 showed higher viability and cell density results than ProCHO5 medium. The expression of mt-PA was significantly higher in CD-DG44 than in ProCHO5, 765 and 280 IU/mL, respectively. Our data indicated that selection of an appropriate expression medium played a critical role in the development of potent producing stable cells by FACS.


Subject(s)
Tissue Plasminogen Activator , Process Optimization , Flow Cytometry/methods , Fluorescence , Cell Count/instrumentation , Clone Cells/classification , Plasminogen Activator Inhibitor 1/adverse effects , Green Fluorescent Proteins
9.
Article in Chinese | WPRIM | ID: wpr-929899

ABSTRACT

Objective:To investigate the efficacy and safety of intravenous thrombolysis based on diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) mismatch in patients with wake-up stroke (WUS).Methods:Patients with acute ischemic stroke received alteplase intravenous thrombolysis in the Stroke Center, the Second People's Hospital of Hefei from July 2019 to June 2021 were enrolled retrospectively. According to the time of finding the symptoms, they were divided into WUS group and non-WUS group. The demographic and baseline clinical data were documented and compared between the two groups. The efficacy endpoint was the clinical outcome assessed by the modified Rankin Scale (MRS) score at 90 d after onset. 0-2 was defined as a good outcome, and >2 were defined as a poor outcome. The primary safety endpoint was symptomatic intracranial hemorrhage (sICH); the secondary safety endpoint was death within 90 d after onset. Multivariate logistic regression analysis was used to determine the independent risk factors for poor outcome. Results:A total of 256 patients with acute ischemic stroke were enrolled, including 155 males (60.5%), aged 63.0±8.53 years. The median time from symptom onset to intravenous thrombolysis was 130.5 min, and the median baseline National Institutes of Health Stroke Scale (NIHSS) score was 7. Forty-eight patients (18.7%) were WUS and 208 (81.3%) were non-WUS; 186 (72.7%) had a good outcome and 70 (27.3%) had a poor outcome. There were no significant differences in 90 d good outcome rate (79.2% vs. 71.2%; χ2=1.260, P=0.262), sICH incidence (4.2% vs. 5.3%; χ2=0.102, P=0.750) and 90 d mortality (2.1% vs. 3.4%; χ2=0.000, P=1.000) between the WUS group and the non-WUS group. The baseline NIHSS score, the time from symptom onset to intravenous thrombolysis and the proportion of patients with cardiogenic embolism in the poor outcome group were significantly higher than those in the good outcome group (all P<0.05). Multivariate logistic regression analysis showed that the baseline NIHSS score (odds ratio 1.670, 95% confidence interval 1.453-1.919; P<0.001) and the time from symptom onset to intravenous thrombolysis (odds ratio 1.007, 95% confidence interval 1.000-1.015; P=0.043) were the independent risk factors for the poor outcome. Conclusion:The efficacy and safety of intravenous thrombolysis in DWI-FLAIR-mismatched wake-up stroke patients are comparable to those of acute ischemic stroke within the time window.

10.
Acta neurol. colomb ; 37(4): 189-196, oct.-dic. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1349890

ABSTRACT

RESUMEN INTRODUCCIÓN: El ataque cerebrovascular (ACV) es la segunda causa de muerte y tercera causa de discapacidad en el mundo. La trombólisis intravenosa, como tratamiento agudo del ACV isquémico ha demostrado reducir discapacidad y mortalidad; sin embargo, está directamente ligado al tiempo de administración y un adecuado programa hospitalario. Mediante este trabajo se evalúan los tiempos de atención en trombólisis intravenosa en el Hospital Universitario Departamental de Nariño E.S.E, como institución de referencia departamental en Colombia. MATERIALES Y MÉTODOS: Estudio descriptivo transversal retrospectivo, incluyó pacientes con ACV isquémico que recibieron trombólisis intravenosa entre 2014 y 2019. El análisis se realizó mediante estadísticos descriptivos, y frecuencias absolutas y relativas. Para evaluar las diferencias se dividió en tres periodos de atención. RESULTADOS: Se evaluaron 50 pacientes, con edad promedio 67,6 años, 58% hombres. En 70% se observó una disminución mayor a 3 puntos NIHSS post-trombólisis. El 58 % tuvo escala modificada Rankin (mRS) 0 a 1. Hubo una diferencia significativa entre las medianas del tiempo Puerta-TAC con 36,5 (n=10, 2014-2015 ), 34,5 (n=16, 2016-2017) y 16 minutos (n=24, 2018-2019). Y en el tiempo Puerta-Aguja fue de 154,8; 98,2 y 79,9 minutos en los mismos periodos. En 45,8% el tiempo Puerta-Aguja fue menor a 60 minutos en el tercer periodo. CONCLUSIONES: Se evidencia aumento del número de pacientes que reciben trombólisis intravenosa a través de los años evaluados, así como disminución en tiempo Puerta-TAC y Puerta-Aguja, como marcadores de mejoría en la atención clínica.


ABSTRACT INTRODUCTION: Stroke is the second leading cause of death and third of disability in the world. Intravenous Thrombolysis as a treatment for acute ischemic stroke has been shown to reduce disability and mortality; however, it is directly linked to administration time and adequate stroke care attention. Through this work, the times of attention in thrombolysis are evaluated at the Hospital Universitario Departamental de Narino E.S.E, as a local reference institution in Colombia. METHODS: A retrospective descriptive study included patients with ischemic stroke who received intravenous thrombolysis between 2014 and 2019. The analysis was performed using descriptive statistics and absolute and relative frequencies. To assess the differences, it was divided into three attention periods. RESULTS: 50 patients were evaluated, with an average age of 67.6 years, 58% men. In 70% a decrease greater than 3 NIHSS points was observed post-thrombolysis. The 58% had mRS 0-1. There was a difference between the medians in the Door-CT time with 36.5 (n = 10, 2014-2015), 34.5 (n = 16, 2016-2017) and 16 minutes (n = 24, 2018-2019). And in the Door-Needle time was 154.8; 98.2 and 79.9 minutes in the same periods. In 45.8%, the Door-Needle time was less than 60 minutes in the third period. CONCLUSIONS: There is evidence of an increase in the number of patients receiving intravenous thrombolysis throughout the years evaluated, as well as a decrease in Door-CT and Door-Needle times, as markers of improvement in clinical care.


Subject(s)
Thrombolytic Therapy , Tissue Plasminogen Activator , Quality Indicators, Health Care , Stroke , Developing Countries
11.
Rev. enferm. neurol ; 20(2): 115-125, may.-ago. 2021.
Article in Spanish | LILACS | ID: biblio-1368337

ABSTRACT

Introducción: el tratamiento con activador recombinante del plasminógeno tisular (siglas en inglés rt-PA), aplicado vía intravenosa (IV) es el procedimiento de primera línea en casos de evento vascular cerebral (EVC) en una ventana de 4,5 horas a partir del inicio de los síntomas y con bajo riesgo de transformación hemorrágica del infarto cerebral. El personal de enfermería es un elemento clave para el tratamiento de las personas que han padecido un EVC y se encuentra en su etapa aguda. La fibrinólisis con alteplasa (rt-PA) se ha establecido como tratamiento de primera línea para los casos de ictus isquémico, la administración de este fármaco, control y seguimiento de estos pacientes idealmente debe realizarse por el personal de enfermería en las unidades de ictus. Objetivo: investigar el nivel de conocimiento del personal de enfermería en la administración del activador recombinante del plasminógeno tisular (rt-PA) en el servicio de urgencias en una institución de tercer nivel. Material y métodos: se realizó un estudio descriptivo y transversal en el Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez de la Ciudad de México, con un muestreo por conveniencia, participaron 33 profesionales de enfermería que laboran en el servicio de urgencias, se observaron las 24 horas del día. Se tomó en cuenta a enfermeras de todas las categorías, excluyendo a personal médico, camilleros y enfermeras suplentes. Se aplicó un instrumento para evaluar el conocimiento sobre enfermedad vascular isquémica e intervenciones de enfermería en el cuidado inmediato y mediato en la administración del fármaco activador tisular de plasminógeno (rt-PA). Resultados: llama la atención que sólo 58 % del personal de enfermería conozca el tiempo vital para recuperar al cerebro, otro dato que alarma es que el 30 % no tiene claro el concepto de ictus y al ser una institución de especialidad neurológica de debe establecer un programa de capacitación para establecer intervenciones oportunas con (rt-PA) para reducir secuelas o daño neurológico. Discusión: el papel del personal de enfermería en unidades especializadas en afecciones neurológicas a los pacientes con ictus es proporcionar un cuidado de calidad, eficaz y eficiente, además de participar en la valoración integral del paciente y en la administración del actilyse cuando se trata de una terapia fibrinolítica. En consecuencia, la enfermera debe estar formada sobre los cuidados que requiere este tipo de pacientes, las complicaciones propias de la patología, tratamiento y efectos secundarios del mismo. Proponer un plan de cuidados integral, porque ya el personal tiene conocimientos al respecto de la enfermedad y la aplicación del activador tisular, pero sería interesante implementar para los profesionales en formación, sin olvidar la elaboración de una propuesta como guía de actuación. Conclusión: los cuidados que el personal de enfermería lleva a cabo deben ser especializados en constante actualización y capacitación para ser capaces de detectar y prevenir las complicaciones del proceso patológico y tratamiento.


Introduction: recombinant tissue plasminogen activator (rt-PA) therapy, given intravenously (IV), is the first-line procedure in cases of cerebral vascular event (CVE) within 4.5 hours of symptom onset and with low risk of haemorrhagic transformation of cerebral infarction. Nurses are a key element in the management of people who have suffered a stroke and are in the acute stage. Fibrinolysis with alteplase (rt-PA) has been established as the first-line treatment for ischaemic stroke, and the administration of this drug, control and follow-up of these patients should ideally be carried out by nurses in stroke units. Objective: to investigate the level of nursing staff knowledge in the administration of recombinant tissue plasminogen activator (rt-PA) in the emergency department of a tertiary care institution. Material and methods: a descriptive, cross-sectional study was carried out at the Manuel Velasco Suárez National Institute of Neurology and Neurosurgery in Mexico City, with convenience sampling. 33 nursing professionals working in the emergency department participated, and 24 hours a day were observed. All categories of nurses were considered, excluding medical staff, orderlies and substitute nurses. An instrument was used to assess knowledge of ischaemic vascular disease and nursing interventions in immediate and intermediate care in the administration of tissue plasminogen activator (rt-PA). Results: It is striking that only 58 % of nursing staff are aware of the vital time to recover the brain, another alarming fact is that 30 % are not clear about the concept of stroke and, being a neurological speciality institution, a training programme should be established to establish timely interventions with (rt-PA) to reduce sequelae or neurological damage. Discussion: the role of nurses in units specialising in neurological disorders in stroke patients is to provide quality, effective and efficient care, in addition to participating in the comprehensive assessment of the patient and in the administration of actilyse in the case of fibrinolytic therapy. Consequently, the nurse must be trained in the care required by this type of patient, the complications of the pathology, treatment and its side effects. Propose a comprehensive care plan, because the staff already has knowledge of the disease and the application of the tissue activator, but it would be interesting to implement it for professionals in training, without forgetting the development of a proposal as a guide for action. Conclusion: the care carried out by nursing staff must be specialised and constantly updated and trained in order to be able to detect and prevent complications of the pathological process and treatment.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Young Adult , Thrombolytic Therapy , Stroke , Tissue Plasminogen Activator , Nursing Care
12.
Article in Chinese | WPRIM | ID: wpr-909213

ABSTRACT

Objective:To investigate the effects of Danhong injection combined with intravenous recombinant tissue plasminogen activator (rt-PA) on cardiac function, myocardial zymogram and lipoprotein associated phospholipase A2 (Lp-PLA2) level in older adult patients with acute myocardial infarction (AMI). Methods:Eighty older adult patients with acute myocardial infarction who received treatment in Community-based General Hospital of Shaoxing Central Hospital, China between January 2017 and December 2019 were included in this study. They were randomly assigned to receive either intravenous thrombolysis with rt-PA (control group, n = 40) or Danhong injection combined with intravenous thrombolysis with rt-PA (observation group, n = 40). The changes in traditional Chinese medicine syndrome score, left ventricular ejection fraction, left ventricular end diastolic diameter, creatine kinase, creatine kinase-MB and lipoprotein associated phospholipase A2 level as well as adverse cardiovascular events were compared between the control and observation groups. Results:After treatment, the score of chest tightness, dark purple tongue, palpitation and shortness of breath in the two groups were decreased. After treatment, the score of chest tightness, dark purple tongue, palpitation and shortness of breath in the observation group was (2.13 ± 0.31) points, (1.98 ± 0.41) points, (1.77 ± 0.29) points, respectively, which was significantly lower than that in the control group [(2.98 ± 0.37) points, (2.52 ± 0.56) points, (2.13 ± 0.32) points, t = 11.137, 4.920, 5.272, all P < 0.001]. After treatment, left ventricular end diastolic diameter in each group was decreased compared with before treatment. After treatment, left ventricular end diastolic diameter in the observation group was significantly lower than that in the control group [(46.12 ± 4.11) mm vs. (49.74 ± 4.32) mm], and left ventricular ejection fraction in the observation group was significantly higher than that in the control group [(47.02 ± 3.55) % vs. (43.25 ± 4.10) %, t = 3.839, 4.396, both P < 0.001). After treatment, Lp-PLA2, creatine kinase, creatine kinase-MB levels in each group were decreased compared with before treatment. After treatment, Lp-PLA2, creatine kinase, creatine kinase-MB levels in the observation group were (171.02 ± 12.52) μg /L, (10.52 ± 2.11) U/L, (24.12 ± 3.52) U/L), respectively, which were significantly lower than those in the control group [(189.63 ± 11.98) μg/L, (14.71 ± 2.62) U/L, (32.79 ± 4.79) U/L), t = 6.792, 7.877, 9.224, all P < 0.001]. The incidence of adverse cardiovascular events in the observation group was significantly lower than that in the control group (5.00% vs. 22.50%, χ2 = 5.165, P < 0.05). Conclusion:Danhong injection combined with intravenous rt-PA for the treatment of acute myocardial infarction in older adult patients can greatly decrease traditional Chinese medicine syndrome score, improve cardiac function, regulate myocardial zymogram and Lp-PLA2 levels, and decrease the incidence of adverse cardiovascular events.

13.
Article in Chinese | WPRIM | ID: wpr-909162

ABSTRACT

Objective:To investigate the effects of intravenous thrombolysis with alteplase on immune function and quality of life in patients with cerebral infarction.Methods:Sixty-nine patients with cerebral infarction who received treatment in Rizhao Central Hospital, China between January 2014 and January 2019 were included in this study. They were randomly assigned to receive either intravenous thrombolysis with urokinase (control group, n = 34) or intravenous thrombolysis with alteplase (observation group, n = 35). Therapeutic efficacy and cerebral blood perfusion, immune function and quality of life before and after treatment were evaluated. Results:Effective rate in the observation group was significantly higher than that in the control group [82.86% (29/35) vs. 58.82% (20/34), χ2 = 4.840, P < 0.05]. After treatment, the transit time and peak time in the ischemic area in the observation group were (131.25 ± 25.41) seconds and (99.52 ± 17.50) seconds respectively, which were significantly shorter than those in the control group [(165.33 ± 31.05) seconds, (108.45 ± 12.52) seconds, t = 6.580, 3.215, both P < 0.05). The cerebral blood flow and cerebral blood volume in the observation group were (72.51 ± 21.35) mL/100 mg and (95.36 ± 31.25) mL/100 mg, respectively, which were significantly higher than those in the control group [(62.42 ± 19.35) mL/100 mg, (84.20 ± 28.05) mL/100 mg, t = 2.712, 2.243, both P < 0.05). After treatment, the proportion of CD 8+ cells in the observation group was significantly lower than that in the control group [(25.37 ± 3.73)% vs. (27.42 ± 3.25)%, t = 4.261, P < 0.05]. The proportions of CD 3+, CD 4+, CD 3-CD 16+CD 56+ cells in the observation group were (56.32 ± 6.57)%, (34.69 ± 3.44)%, (13.34 ± 3.75)%, respectively, which were significantly higher than those in the control group [(53.32 ± 4.05)%, (31.69 ± 3.72)%, (11.28 ± 3.06)%, t = 5.395, 3.694, 4.179, P < 0.05]. After treatment, the scores of all dimensions of Short Form 36 Health Status Questionnaire in the observation group were significantly higher than those in the control group (all P < 0.05). Conclusion:Intravenous thrombolysis with alteplase is superior to intravenous thrombolysis with urokinase in the treatment of cerebral infarction because it can better improve immune function and quality of life.

14.
Article in Chinese | WPRIM | ID: wpr-909155

ABSTRACT

Objective:To investigate the effects of blood pressure management on the prognosis of acute cerebral infarction after intravenous thrombolytic therapy.Methods:The clinical data of 60 patients with acute cerebral infarction who received intravenous thrombolytic therapy in The First People's Hospital of Fuyang District, Hangzhou, China between September 2017 and June 2019 were retrospectively analyzed. These 60 patients were divided into groups A and B according to different treatment methods ( n = 30/group). Patients in the group A received intravenous thrombolytic therapy with recombinant tissue plasminogen activator and those in the group B received intravenous thrombolysis with recombinant tissue plasminogen activator in combination with antihypertensive treatment. All patients were treated for 2 courses of treatment (14 days) and followed up for 3 months. Blood pressure, cerebral blood flow and prognosis were compared between groups A and B. Results:After 24 hours of treatment, there were no significant differences in blood pressure and cerebral blood flow between groups A and B (both P < 0.05). In the group B, modified Rankin Scale score ≥ 2 points was found in 1 (3.3%) patient and intracranial hemorrhage in 0 (0.0%) patient, which were significantly lower than 12 (40.0%) and 6 (20.0%) patients, respectively in the group A ( χ2 = 29.897, 19.573, both P < 0.05). Total effective rate in the group B was significantly higher than that in the group A [96.7% (29/30) vs. 86.67% (26/30), χ2 = 21.302, P < 0.05]. Conclusion:Blood pressure management highly affects the prognosis of cerebral infarction after intravenous thrombolytic therapy. The first 24 hours of intravenous thrombolytic therapy is the optimal time for blood pressure management.

15.
Acta Pharmaceutica Sinica B ; (6): 1341-1354, 2021.
Article in English | WPRIM | ID: wpr-881203

ABSTRACT

Breast cancer brain metastases (BCBMs) are one of the most difficult malignancies to treat due to the intracranial location and multifocal growth. Chemotherapy and molecular targeted therapy are extremely ineffective for BCBMs due to the inept brain accumulation because of the formidable blood‒brain barrier (BBB). Accumulation studies prove that low density lipoprotein receptor-related protein 1 (LRP1) is promising target for BBB transcytosis. However, as the primary clearance receptor for amyloid beta and tissue plasminogen activator, LRP1 at abluminal side of BBB can clear LRP1-targeting therapeutics. Matrix metalloproteinase-1 (MMP1) is highly enriched in metastatic niche to promote growth of BCBMs. Herein, it is reported that nanoparticles (NPs-K-s-A) tethered with MMP1-sensitive fusion peptide containing HER2-targeting K and LRP1-targeting angiopep-2 (A), can surmount the BBB and escape LRP1-mediated clearance in metastatic niche. NPs-K-s-A revealed infinitely superior brain accumulation to angiopep-2-decorated NPs-A in BCBMs bearing mice, while comparable brain accumulation in normal mice. The delivered doxorubicin and lapatinib synergistically inhibit BCBMs growth and prolongs survival of mice bearing BCBMs. Due to the efficient BBB penetration, special and remarkable clearance escape, and facilitated therapeutic outcome, the fusion peptide-based drug delivery strategy may serve as a potential approach for clinical management of BCBMs.

16.
Acta Pharmaceutica Sinica B ; (6): 2306-2325, 2021.
Article in English | WPRIM | ID: wpr-888864

ABSTRACT

Blood-brain barrier (BBB) strictly controls matter exchange between blood and brain, and severely limits brain penetration of systemically administered drugs, resulting in ineffective drug therapy of brain diseases. However, during the onset and progression of brain diseases, BBB alterations evolve inevitably. In this review, we focus on nanoscale brain-targeting drug delivery strategies designed based on BBB evolutions and related applications in various brain diseases including Alzheimer's disease, Parkinson's disease, epilepsy, stroke, traumatic brain injury and brain tumor. The advances on optimization of small molecules for BBB crossing and non-systemic administration routes (

17.
J. bras. econ. saúde (Impr.) ; 12(3): 241-254, Dezembro/2020.
Article in Portuguese | LILACS, ECOS | ID: biblio-1141314

ABSTRACT

Objetivo: Analisar o custo-efetividade da trombólise com alteplase no tratamento de acidente vascular isquêmico (AVCi) agudo em até 4,5 horas após início dos sintomas em comparação com tratamento clínico conservador, sob a perspectiva do Sistema Único de Saúde (SUS) no Brasil. Métodos: Construiu-se um modelo de Markov para simular o tratamento de AVCi agudo e suas consequências em curto e longo prazo. Foram conduzidas análises de custo-efetividade (anos de vida ganhos, AVG) e custo-utilidade (anos de vida ajustados pela qualidade de vida, QALY), considerando um horizonte temporal de tempo de vida. Parâmetros de eficácia e segurança foram obtidos em uma metanálise de dados individuais, considerando tratamento em até 3 horas e 3-4,5 horas. Os custos agudos e crônicos foram obtidos por análise secundária de dados de um hospital público brasileiro e expressos em reais (R$). Foram conduzidas análises de sensibilidade determinística e probabilística. Utilizou-se como limiar de disposição a pagar (LDP) 1 PIB (produto interno bruto) per capita para 2019 no Brasil (R$ 31.833,50). Resultados: O tratamento com alteplase vs. conservador resultou em incremento de 0,22 AVG, 0,32 QALY e R$ 4.320,12 em custo, com razão de custo-efetividade incremental (RCEI) estimada em R$ 19.996,43/AVG e R$ 13.383,64/QALY. Ambas as estimativas foram mais sensíveis a variações na efetividade e nos custos de tratamento agudo com alteplase. Para RCEI/AVG e RCEI/QALY, 70,7% e 93,1% das simulações na análise de sensibilidade probabilística estavam abaixo do LDP, respectivamente. Conclusões: O tratamento com alteplase até 4,5 horas após o início dos sintomas tem elevada probabilidade de ser custo-efetivo na perspectiva do SUS.


Objective: To assess the cost-effectiveness of thrombolysis with alteplase for the treatment of acute ischemic stroke up to 4.5 hours after the onset of symptoms as compared to conservative medical treatment from the perspective of the Brazilian Public Health System. Methods: A Markov model was used to simulate the treatment of acute stroke and the associated short- and long-term consequences. Cost-effectiveness (life-years gained, LYG) and cost-utility (quality-adjusted life years, QALY) analyses were performed considering a lifetime horizon. Efficacy and safety parameters were obtained from a meta-analysis of individual data, considering treatment within 3 hours and 3-4.5 hours after the onset of symptoms. Acute and chronic costs were derived from a secondary analysis of data obtained from a Brazilian public hospital and expressed in Brazilian reais (R$). Probabilistic and deterministic sensitivity analyses were performed. The willingness to pay threshold (WPT) was established as 1 GDP per capita for 2019 in Brazil (R$ 31,833.50). Results: Treatment with alteplase vs. conservative medical treatment was associated with an increase of 0.22 in LYG, 0.32 in QALY, and R$ 4,320.12 in cost. The incremental cost-effectiveness ratio (ICER) was estimated as R$ 19,996.43/LYG and R$ 13,383.64/QALY. Variations in effectiveness and costs of acute alteplase treatment had the greatest impact on sensitivity analyses. Considering ICER/LYG and ICER /QALY, 70.7% and 93.1% of the simulations in probabilistic sensitivity analysis were below the WPT, respectively. Conclusions: Treatment with alteplase up to 4.5 hours after the onset of symptoms has a high probability of being cost-effective from the perspective of the Brazilian Public Health System.


Subject(s)
Unified Health System , Cost-Benefit Analysis , Tissue Plasminogen Activator , Stroke
18.
Article | IMSEAR | ID: sea-213211

ABSTRACT

Despite a range of management options, pleural effusions and empyema continue to present therapeutic challenges in the clinical setting. With treatment options ranging from simple use of antibiotics to more complex surgical procedures, several important considerations need be made as to what type of treatment is best for each patient on a case by case basis. One treatment modality of increasing interest is the use of intrapleural fibrinolytics to facilitate drainage of effusions. This presents a viable option especially in patients in whom surgery is not preferred. But, as with many therapeutic approaches, the use of intrapleural fibrinolytics is laden with significant controversies and has been a subject of considerable debate over the last couple of years. With accruing evidence for and against this modality of treatment, the ensuing discussion has been whether or not it should be a routine treatment choice and which group of patients should this consideration be made for. This paper gives a background on the epidemiology and etiology of parapneumonic effusions and empyema and briefly outlines the available options of management. Furthermore, we extensively discuss available evidence on the use of intrapleural fibrinolytics as a management option for parapneumonic effusions and empyema, with particular emphasis on use of tissue plasminogen activator (tPA) and DNase.

19.
Rev. neuropsiquiatr ; 83(2): 79-86, abr-jun 2020. tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1144871

ABSTRACT

Resumen Objetivo: Describir el tratamiento del ictus isquémico agudo con reperfusión endovenosa y determinar los factores asociados al rendimiento funcional de pacientes sometidos a trombolisis en un hospital peruano. Material y Métodos: Estudio prospectivo y longitudinal de una cohorte de pacientes con ictus isquémico que recibieron rtPA en un periodo de 3 años. Se evaluó la relación entre datos demográficos y clínicos y el estado funcional a los 3 meses de la intervención. La asociación del pronóstico funcional se valoró mediante el modelo de regresión simple y multivariado de Poisson, y el Riesgo Relativo (RR) con un intervalo de confianza (IC) al 95%, como medida de asociación. Resultados: Durante el periodo del estudio, 74 pacientes (1.19% del total) recibieron el tratamiento. El 68,18% logró independencia funcional (mRS 0-2) a los 90 días. La mortalidad fue de 6 % y un 3% mostró hemorragia intracerebral (HIC). Glicemia >140 mg/dl (OR 5,12; 1,31-20,02; p=0,019) e infarto de tipo posterior (OR 7,47; 1,01-55,15; p =0,04) se asociaron a un mayor riesgo de dependencia funcional. Conclusiones: En la cohorte estudiada, la mayoría de los pacientes alcanzaron independencia funcional a los 3 meses de tratamiento trombolítico. La hiperglicemia (>140gr/dl) y el infarto vertebro-basilar se asociaron con un mayor riesgo de dependencia funcional.


SUMMARY Objective: To describe the treatment of acute ischemic strokes with intravenous rtPA and determine the factors associated with the functional outcomes of patients treated with thrombolysis in a Peruvian hospital. Material and Methods: A prospective, longitudinal cohort study of patients with ischemic stroke who received rtPA over a period of 3 years was performed. The association of demographic and clinical data with functional status was assessed 3 months after the intervention. Simple and multivariate Poisson regression models were performed to evaluate associations with functional prognosis, and Relative Risk (RR) with a 95% confidence interval (CI) was used as a measure of association. Results: During the study period, 74 patients (1.19% of the total) received IV thrombolysis, and 68.18% of them achieved functional independence (mRS 0-2) at 90 days. We found a mortality of 6%, an intracerebral hemorrhage (ICH) rate of 3%. Glycemia >140 mg/dl (OR 5.12; 1.31-20.02; p = 0.019), and posterior circulation infarcts (OR 7.47; 1.01-55.15; p = 0,04) were associated with an increased risk of functional dependency. Conclusions: In the studied cohort, most of the patients who underwent thrombolytic therapy achieved a functional independence at 3 months. Hyperglycemia (>140gr/dl) and vertebro-basilar infarcts were associated with an increased risk of functional dependence.

20.
Rev. Assoc. Med. Bras. (1992) ; 66(3): 263-267, Mar. 2020. tab, graf
Article in English | LILACS, SES-SP | ID: biblio-1136213

ABSTRACT

SUMMARY OBJECTIVES Acute pulmonary embolism (APE) is an important cause of cardiovascular mortality, due mainly to hemodynamic instability. In these cases, the recommendation is to perform some reperfusion procedure, with systemic thrombolysis being the main therapy used. However, national data evaluating the efficacy and safety of thrombolysis are scarce. METHODS Retrospective analysis of a case series. We included 13 patients diagnosed with high-risk APE and 4 patients with intermediate-high risk from a single-center, who were treated with alteplase 100mg. RESULTS The mean age of the patients was 55 years, most of them female (76.4%). Among the risk factors for VTE were immobilization (41.17%), contraceptive use (35.29%), cancer (17.63%), and previous history of DVT (11.76%). The most frequent clinical manifestations of APE were dyspnea (88.23%), hypoxia (82.35%), hypotension (82.35%), and tachycardia (64.70%). 82.35% of the patients had echocardiographic signs of right ventricular dysfunction, and 52.94% had increased troponin and BNP. Severe bleeding associated with thrombolysis occurred in 17.54% of cases. No patient died due to bleeding. There were 8 deaths from right ventricular failure (47%), 6 in the cases of patients presenting as high-risk APE (35.3%), and 2 in the cases of intermediate-high risk (11.8%). CONCLUSION Thrombolysis in patients with high-risk APE or intermediate-high risk had a severe bleeding rate of 17.6%. However, the high mortality of this population (47%) due to right ventricular failure justifies the use of this therapeutic modality.


RESUMO OBJETIVOS A embolia pulmonar aguda (EAP) é uma causa importante de mortalidade cardiovascular ao causar instabilidade hemodinâmica. Nesses casos, a recomendação é a realização de algum procedimento de reperfusão, sendo a trombólise sistêmica a principal terapia utilizada. No entanto, dados nacionais avaliando a eficácia e a segurança da trombólise são escassos. MÉTODO Análise retrospectiva de uma série de casos. Foram incluídos 13 pacientes com o diagnóstico de EAP de alto risco e quatro pacientes de risco intermediário-alto, de um único centro, e que foram tratados com alteplase 100 mg. RESULTADOS A média de idade dos pacientes foi 55 anos, sendo a maioria do gênero feminino (76,4%). Dos fatores de risco para TEV, estavam presentes a imobilização (41,17%), o uso de anticonceptivos (35,29%), câncer (17,63%) e história prévia de TVP (11,76%). As manifestações clínicas mais frequentes da EAP foram dispneia (88,23%), hipóxia (82,35%), hipotensão (82,35%) e taquicardia (64,70%); 82,35% dos pacientes apresentaram sinais ecocardiográficos de disfunção ventricular direita e 52,94% apresentaram aumento da troponina e BNP. Sangramento grave associado à trombólise ocorreu em 17,54% dos casos. Nenhum paciente faleceu em decorrência de sangramento. Houve oito mortes por insuficiência ventricular direita (47%): seis nos casos de paciente que se apresentaram como EAP de alto risco (35,3%) e duas nos casos de risco intermediário-alto (11,8%). CONCLUSÃO A trombólise nos pacientes com EAP de alto risco ou risco intermediário-alto apresentou uma taxa de sangramento grave de 17,6%. No entanto, a alta mortalidade dessa população (47%) por insuficiência ventricular direita justifica o uso desta modalidade terapêutica.


Subject(s)
Humans , Male , Female , Adult , Aged , Aged, 80 and over , Young Adult , Pulmonary Embolism/drug therapy , Thrombolytic Therapy/methods , Ventricular Dysfunction, Right/drug therapy , Fibrinolytic Agents/therapeutic use , Antifibrinolytic Agents/therapeutic use , Pulmonary Embolism/complications , Pulmonary Embolism/diagnostic imaging , Acute Disease , Retrospective Studies , Risk Factors , Treatment Outcome , Tissue Plasminogen Activator/therapeutic use , Ventricular Dysfunction, Right/complications , Ventricular Dysfunction, Right/etiology , Ventricular Dysfunction, Right/mortality , Risk Assessment , Fibrinolytic Agents/adverse effects , Hemorrhage/chemically induced , Middle Aged , Antifibrinolytic Agents/adverse effects
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