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1.
Rev. méd. Urug ; 40(2): e202, 2024.
Article in Spanish | LILACS, BNUY | ID: biblio-1560256

ABSTRACT

Introducción: la trombolisis intravenosa es parte fundamental del tratamiento agudo de los pacientes que sufren un ataque cerebrovascular (ACV) isquémico. Existe un interés creciente en la utilización de tenecteplase como alternativa trombolítica a alteplase. El objetivo del presente trabajo es comparar la efectividad clínica de tenecteplase respecto a alteplase en la trombolisis intravenosa del ACV isquémico. Método: estudio de cohorte, bispectivo y unicéntrico, de todos los pacientes ingresados con ACV isquémico y que recibieron trombolíticos intravenosos, desde 2019 a 2022. Se compararon prospectivamente los pacientes tratados con tenecteplase con aquellos tratados con alteplase como control histórico. Se realizó test de chi cuadrado o exacto de Fisher para la asociación de variables categóricas y prueba de Wilcoxon para la comparación de medianas. Se consideró significativo un valor p menor de 0,05. Resultados: se incluyeron 69 pacientes (33 recibieron alteplase y 36 tenecteplase). La mediana de la escala de NIHSS fue de 11 (RIC 8-18) y del tiempo inicio de síntomas-aguja de 160 minutos (RIC 120-208). No se hallaron diferencias estadísticamente significatvas entre los puntajes de las escalas de coma de Glasgow y NIHSS al egreso hospitalario, así como en la escala de Rankin modificada (mRS) 0-2 y mortalidad a los seis meses, entre los dos grupos de pacientes. Tampoco hubo diferencias en las complicaciones hemorrágicas intracraneanas entre ambos grupos (13,9% para tenecteplase y 12,1% para alteplase). Conclusiones: se presenta el primer estudio acerca del tema en nuestro medio. En concordancia con los recientes ensayos internacionales, el presente trabajo no mostró diferencias significativas en los resultados clínicos de los pacientes tratados con tenecteplase o alteplase. El tenecteplase podría ser una alternativa razonable a alteplase como terapia trombolítica en el ACV isquémico, con una buena relación costo-beneficio y forma de implementación más sencilla. Se necesitan estudios aleatorizados y con un mayor número de pacientes.


Introduction: intravenous thrombolysis is a key part of the acute treatment of patients with ischemic stroke. There is a growing interest in the use of tenecteplase as a thrombolytic alternative to alteplase. The aim of this study is to compare the clinical effectiveness of tenecteplase versus alteplase in intravenous thrombolysis for ischemic stroke. Method: a single-center, bispective cohort study of all patients admitted with ischemic stroke who received intravenous thrombolytics from 2019 to 2022. Patients treated with tenecteplase were prospectively compared with those treated with alteplase as a historical control. Chi-square or Fisher's exact test was used for the association of categorical variables, and the Wilcoxon test was used for median comparison A p-value of less than 0.05 was considered significant. Results: a total of 69 patients were included in the study (33 received alteplase and 36 received tenecteplase). The median NIHSS scale score was 11 (IQR 8-18), and the median time from symptom onset to needle was 160 minutes (IQR 120-208). No statistically significant differences were found between Glasgow Coma Scale and NIHSS scores at hospital discharge, as well as in modified Rankin Scale (mRS) 0-2 and mortality at 6 months, between the two groups of patients. There were also no differences in intracranial hemorrhagic complications between both groups (13.9% for tenecteplase and 12.1% for alteplase). Conclusions: This is the first study on the topic in our setting. In line with recent international trials, our study did not show significant differences in clinical outcomes of patients treated with tenecteplase or alteplase. Tenecteplase could be a reasonable alternative to alteplase as thrombolytic therapy in ischemic stroke, with a good cost-benefit ratio and simpler implementation. Randomized studies with a larger number of patients are needed.


Introdução: A trombólise intravenosa é uma parte essencial do tratamento agudo de pacientes que sofrem um acidente vascular cerebral isquêmico. Há um interesse crescente no uso da tenecteplase como uma alternativa trombolítica à alteplase. O objetivo deste estudo foi comparar a eficácia clínica da tenecteplase com a alteplase na trombólise intravenosa do AVC isquêmico. Métodos: estudo de coorte, bispectivo, em um único centro, de todos os pacientes admitidos com AVC isquêmico que receberam trombolíticos intravenosos de 2019 a 2022. Os pacientes tratados com tenecteplase foram comparados prospectivamente com aqueles tratados com alteplase como um controle histórico. O teste de qui-quadrado ou exato de Fisher foi realizado para a associação de variáveis categóricas e o teste de Wilcoxon para a comparação de medianas. Um valor de p inferior a 0,05 foi considerado significativo. Resultados: Foram incluídos 69 pacientes (33 receberam alteplase e 36 tenecteplase). A mediana do escore da escala NHISS foi de 11 (RIC 8-18) e a mediana do tempo de início dos sintomas foi de 160 minutos (RIC 120-208). Não foram encontradas diferenças estatisticamente significativas entre os escores de coma de Glasgow e NIHSS na alta hospitalar, bem como na Escala de Rankin modificada (MRS) 0-2 e na mortalidade em 6 meses, entre os dois grupos de pacientes. Também não houve diferenças nas complicações hemorrágicas intracranianas entre os dois grupos (13,9% para tenecteplase e 12,1% para alteplase). Conclusões: Este é o primeiro estudo sobre o assunto em nosso meio. De acordo com estudos internacionais recentes, nosso estudo não mostrou diferenças significativas nos resultados clínicos em pacientes tratados com tenecteplase ou alteplase. A tenecteplase poderia ser uma alternativa razoável à alteplase como terapia trombolítica no AVC isquêmico, com uma boa relação custo-benefício e implementação mais fácil. São necessários estudos randomizados com um número maior de pacientes.


Subject(s)
Thrombolytic Therapy , Tissue Plasminogen Activator/therapeutic use , Stroke/therapy , Tenecteplase/therapeutic use , Cohort Studies
2.
Rev. colomb. neumol ; 35(2): 45-50, 05/12/2023.
Article in Spanish | LILACS | ID: biblio-1584632

ABSTRACT

El tromboembolismo pulmonar masivo es una entidad potencialmente mortal si no es tratado de forma emergente. La trombólisis sistémica es una terapéutica adecuada para estos casos cuando se presenten con datos de shock obstructivo o fracaso respiratorio agudo severo. Presentamos el caso de un varón de 69 años con antecedente de reparación programada de una hernia inguinal diez días antes del evento que acude al servicio de urgencias y emergencias por síncope. A las cuatro horas de su estancia en el hospital sufre hipotensión y desaturación brusca y es diagnosticado de tromboembolismo pulmonar masivo requiriendo la administración de fármacos fibrinolíticos. En este caso, no hubo eventos adversos hemorrágicos y la reperfusión fue completa inmediatamente después a su administración. Se adjuntan imágenes del electrocardiograma (EKG) y la tomografía computarizada (CT) con contraste previo y posterior a la administración del fibrinolítico donde se objetivan reperfusión total de la arteria pulmonar y corrección de todos los cambios eléctricos secundarios a la sobrecargar del ventrículo derecho en un plazo menor a 24 horas. El paciente fue dado de alta a medicina interna a las 72 horas.


Massive pulmonary thromboembolism is a potentially fatal entity if it is not treated immediately. Systemic thrombolysis is an adequate therapy for these cases when they present with data of obstructive shock or severe acute respiratory failure. We present the case of a 69-year-old man with a history of scheduled inguinal hernia repair ten days before the event who attended the Emergency Department due to syncope. Four hours into his hospital stay, he suffered hypotension and sudden desaturation and diagnosed with massive pulmonary thromboembolism requiring the administration of fibrinolytic drugs. In this case, there were no hemorrhagic adverse events and reperfusion was complete at once after its administration. Electrocardiogram (EKG) and computed tomography (CT) images with contrast before and after the administration of the fibrinolytic are attached, showing total reperfusion of the pulmonary artery and correction of all electrical changes secondary to right ventricular overload in less than 24 hours. The patient was discharged to Internal Medicine at 72 hours.


Subject(s)
Pulmonary Embolism , Tissue Plasminogen Activator , Embolism
3.
Cambios rev. méd ; 22 (2), 2023;22(2): e929, 16 octubre 2023. tabs.
Article in Spanish | LILACS | ID: biblio-1516690

ABSTRACT

La Enfermedad Cerebrovascular Isquémica (ECV-Isquémica) provoca alteraciones neurológicas agudas, causadas por la dis-función del flujo sanguíneo cerebral, lo que determina la pre-sencia de injuria neuronal.1Los factores de riesgo se clasifican en modificables y no modi-ficables entre estos últimos, los más frecuentes son: la hiperten-sión arterial, diabetes mellitus, obesidad, tabaco y sedentarismo, y su frecuencia es notablemente mayor después de los 65 años de edad (Anexo 1).1La Enfermedad Cerebrovascular Isquémica se caracteriza por ser la segunda causa de mortalidad a nivel mundial, y la ter-cera en causar discapacidad. En 2019, según el reporte del Ins-tituto Nacional de Estadísticas y Censos (INEC), se registraron 4577 fallecimientos producto de esta patología; y se reportó como la tercera causa de fallecimiento en hombres y mujeres en Ecuador.2El impacto económico que genera la ECV-Isquémica es con-siderable, puesto que se ha evidenciado que aproximadamente supone un gasto promedio de 4330 dólares en los primeros 3 meses posterior a presentar esta patología, sin considerar otras consecuencias como la pérdida laboral.3


Ischemic Cerebrovascular Disease (Ischemic-CVD) causes acute neurological alterations, caused by cerebral blood flow dysfunction, which determines the presence of neuronal injury.1Risk factors are classified as modifiable and non-modifiable, among the latter, the most frequent are: arterial hypertension, diabetes mellitus, obesity, smoking and sedentary lifestyle, and their frequency is notably higher after 65 years of age (Anexo 1).1Ischemic Cerebrovascular Disease is characterized as the second leading cause of mortality worldwide, and the third leading cause of disability. In 2019, according to the report of the National Ins-titute of Statistics and Census (INEC), 4577 deaths were regis-tered as a result of this pathology; and it was reported as the third leading cause of death in men and women in Ecuador.2The economic impact of CVD-ischemic stroke is considerable, since it has been shown that approximately US$ 4330 is spent on average in the first 3 months after the onset of this pathology, without considering other consequences such as loss of work.3


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Tertiary Healthcare , Brain Ischemia , Brain Infarction , Critical Care , Ischemic Stroke , Neurology , Brain Diseases , Tissue Plasminogen Activator , Stroke , Ecuador
4.
Chinese Journal of Pediatrics ; (12): 222-227, 2023.
Article in Chinese | WPRIM | ID: wpr-970271

ABSTRACT

Objective: To evaluate the clinical value of new coagulation biomarkers including soluble thrombomodulin (sTM) and tissue plasminogen activator inhibitor complex (t-PAI·C) for the diagnosis and prognosis of sepsis in children. Methods: The prospective observational study enrolled 59 children who were diagnosed with sepsis including severe sepsis and septic shock in the Department of Pediatric Critical Care Medicine of Shanghai Children's Medical Center affiliated to the Medical College of Shanghai Jiao Tong University from June 2019 to June 2021. The sTM, t-PAI·C and conventional coagulation tests were detected on illness day one of sepsis. Twenty healthy children were selected as the control group, and the above parameters were detected on the day of inclusion. Children with sepsis were divided into survival group and non-survival group according to prognosis at discharge. Baseline comparisons between groups were performed using Mann-Whitney U test. Multivariate Logistic regression analysis was used to evaluate the risk factors for the diagnosis and prognosis of sepsis in children. Receiver operating characteristic (ROC) curve was conducted to evaluate the predictive values of above variables for the diagnosis and prognosis of sepsis in children. Results: The sepsis group included 59 patients (39 boys and 20 girls), aged 61(22, 136)months. There were 44 patients in the survival group and 15 patients in the non-survival group, respectively. The control group consisted of 20 boys, aged 107 (94,122) months. Patients in the sepsis group had higher sTM and t-PAI·C ((12 (9, 17)×103 vs. 9(8, 10)×103 TU/L, 10(6, 22) vs. 2 (1, 3) μg/L, Z=-2.15, -6.05, both P<0.05) compared with children in the control group. The t-PAI·C was superior to sTM for the diagnosis of sepsis. The areas under the curve (AUC) of t-PAI·C and sTM for the diagnosis of sepsis were 0.95 and 0.66, respectively, and the optimal cut-off value were 3 μg/L and 12×103 TU/L, respectively. Patients in the survival group had lower sTM (10 (8, 14)×103 vs. 17 (11, 36)×103 TU/L, Z=-2.73, P=0.006) than those in the non-survival group. Logistic regression analysis showed that sTM was a risk factor for death at discharge (OR=1.14, 95%CI 1.04-1.27, P=0.006). The AUC of sTM and t-PAI·C for predicting death at discharge were 0.74 and 0.62, respectively, and the optimal cut-off values were 13×103 TU/L and 6 μg/L, respectively. The AUC of sTM combined with platelet counts for predicting death at discharge was 0.89, which was superior to sTM and t-PAI·C. Conclusion: The sTM and t-PAI·C had clinical application values in diagnosing and predicting prognosis in pediatric sepsis.


Subject(s)
Child , Female , Humans , Male , Infant , Child, Preschool , Biomarkers , China , Sepsis/diagnosis , Shock, Septic , Tissue Plasminogen Activator
5.
Zhongguo zhenjiu ; (12): 733-738, 2023.
Article in Chinese | WPRIM | ID: wpr-980787

ABSTRACT

OBJECTIVE@#To observe the effects of the Xingnao Kaiqiao (regaining consciousness and opening orifices) acupuncture on hemorrhagic transformation and limb motor function after intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) in stroke patients.@*METHODS@#A total of 130 stroke patients after rt-PA thrombolytic were divided into an acupuncture group (58 cases, 1 case dropped off) and a non-acupuncture group (72 cases, 7 cases dropped off) according to whether they received acupuncture treatment. Propensity score matching (PSM) was used to match each group, with 38 patients in each group. The patients in the non-acupuncture group received rt-PA thrombolytic therapy and western medical basic treatment. In addition to the basic treatment, the patients in the acupuncture group received Xingnao Kaiqiao acupuncture at Shuigou (GV 26), bilateral Neiguan (PC 6), and ipsilateral Sanyinjiao (SP 6), Chize (LU 5), once a day for 14 days. The incidence of hemorrhagic transformation within 30 days after onset was compared between the two groups. The Fugl-Meyer assessment (FMA) score and activities of daily living (ADL) score were observed at baseline and 30 days, 6 months, 1 year after onset in the two groups. The disability rate at 6 months and 1 year after onset was recorded, and safety was evaluated in both groups.@*RESULTS@#The incidence of hemorrhagic transformation in the acupuncture group was 5.3% (2/38), which was lower than 21.1% (8/38) in the non-acupuncture group (P<0.05). At 30 days, 6 month, and 1 year after onset, the FMA and ADL scores of both groups were higher than those at baseline (P<0.01), and the scores in the acupuncture group were higher than those in the non-acupuncture group (P<0.01). The disability rate in the acupuncture group at 1 year after onset was 10.5% (4/38), which was lower than 28.9% (11/38) in the non-acupuncture group (P<0.05). There was no significant difference in the incidence of adverse events between the two groups (P>0.05).@*CONCLUSION@#The Xingnao Kaiqiao acupuncture method could reduce the incidence of hemorrhagic transformation in stroke patients after intravenous thrombolysis with rt-PA, improve their motor function and daily living ability, and reduce the long-term disability rate.


Subject(s)
Humans , Tissue Plasminogen Activator/adverse effects , Activities of Daily Living , Prospective Studies , Stroke , Acupuncture Therapy , Thrombolytic Therapy/adverse effects
6.
Chin. j. integr. med ; Chin. j. integr. med;(12): 1121-1132, 2023.
Article in English | WPRIM | ID: wpr-1010316

ABSTRACT

OBJECTIVE@#To interpret the pharmacology of quercetin in treatment of atherosclerosis (AS).@*METHODS@#Fourteen apolipoprotein E-deficient (ApoE-/-) mice were divided into 2 groups by a random number table: an AS model (ApoE-/-) group and a quercetin treatment group (7 in each). Seven age-matched C57 mice were used as controls (n=7). Quercetin [20 mg/(kg·d)] was administered to the quercetin group intragastrically for 8 weeks for pharmacodynamic evaluation. Besides morphological observation, the distribution of CD11b, F4/80, sirtuin 1 (Sirt1) and P21 was assayed by immunohistochemistry and immunofluorescence to evaluate macrophage infiltration and tissue senescence. Ultra-performance liquid chromatography/tandem mass spectrometry (UPLC-MSC/MS) was performed to study the pharmacology of quercetin against AS. Then, simultaneous administration of an apelin receptor antagonist (ML221) with quercetin was conducted to verify the possible targets of quercetin. Key proteins in apelin signaling pathway, such as angiotensin domain type 1 receptor-associated proteins (APJ), AMP-activated protein kinase (AMPK), peroxisome proliferator-activated receptor-γ coactivator-1α (PGC-1α), tissue plasminogen activator (TPA), uncoupling protein 1 (UCP1) and angiotensin II receptor 1 (AT1R), were assayed by Western blot.@*RESULTS@#Quercetin administration decreased lipid deposition in arterial lumen and improved the morphology of ApoE-/- aortas in vivo. Quercetin decreased the densities of CD11b, F4/80 and P21 in the aorta and increased the level of serum apelin and the densities of APJ and Sirt1 in the aorta in ApoE-/- mice (all P<0.05). Plasma metabolite profiling identified 118 differential metabolites and showed that quercetin affected mainly glycerophospholipids and fatty acyls. Bioinformatics analysis suggested that the apelin signaling pathway was one of the main pathways. Quercetin treatment increased the protein expressions of APJ, AMPK, PGC-1α, TPA and UCP1, while decreased the AT1R level (all P<0.05). After the apelin pathway was blocked by ML221, the effect of quercetin was abated significantly, confirming that quercetin attenuated AS by modulating the apelin signaling pathway (all P<0.05).@*CONCLUSION@#Quercetin alleviated AS lesions by up-regulation the apelin signaling pathway.


Subject(s)
Mice , Animals , Apelin , Tissue Plasminogen Activator/metabolism , Quercetin/therapeutic use , AMP-Activated Protein Kinases/metabolism , Sirtuin 1/metabolism , Signal Transduction/physiology , Atherosclerosis/metabolism , Apolipoproteins E
7.
Chinese Critical Care Medicine ; (12): 945-950, 2023.
Article in Chinese | WPRIM | ID: wpr-1010889

ABSTRACT

OBJECTIVE@#To establish a machine learning model to predict the risk of early neurological deterioration (END) based on the clinical and laboratory data of patients with acute ischemic stroke (AIS) before intravenous thrombolysis.@*METHODS@#The clinical data of AIS patients who received intravenous thrombolytic with recombinant tissue plasminogen activator (rt-PA) at the Stroke Center of the First Hospital of Qinhuangdao City from January 2019 to July 2022 were retrospectively analyzed. Patients were divided into END group and non-END group according to whether END appeared after intravenous thrombolytic. Clinical data of patients at admission were collected, including demographic characteristics, clinical evaluation, comorbidification, drug use history, laboratory tests, etc. Univariate and multivariate Logistic regression analysis were performed to screen out the independent predictors of the END of AIS patients after intravenous thrombolytic. The study subjects were randomly divided into a training set and a test set in a 7 : 3 ratio. Four machine learning prediction models, including Logistic regression (LR), K-nearest neighbor (KNN), support vector machine (SVM) and random forest (RF), were established based on independent predictors. The receiver operator characteristic curve (ROC curve) was used to evaluate the predictive ability of each model in END.@*RESULTS@#A total of 704 patients were enrolled, of whom 99 were identified as END and 605 as non-END. Univariate and multivariate Logistic regression analysis was used to screen out the National Institutes of Health stroke scale [NIHSS, odds ratio (OR) = 1.049, 95% confidence interval (95%CI) was 1.015-1.082, P = 0.004], systolic blood pressure (OR = 1.013, 95%CI was 1.004-1.022, P = 0.004), lymphocyte percentage (LYM%, OR = 0.903, 95%CI was 0.853-0.953, P < 0.001), platelet to lymphocyte ratio (PLR, OR = 1.007, 95%CI was 1.002-1.014, P = 0.013) were the independent predictors of END in AIS patients after intravenous thrombolysis. The area under the curve (AUC) of LR, KNN, SVM, and RF machine learning models in the test dataset were 0.789 (95%CI was 0.675-0.902), 0.797 (95%CI was 0.685-0.910), 0.851 (95%CI was 0.751-0.952) and 0.809 (95%CI was 0.699-0.919), respectively. The RF model had the highest sensitivity (95.7%). The accuracy (0.736), specificity (72.0%) and AUC of SVM model were the highest, and its overall prediction ability was better than the other three models.@*CONCLUSIONS@#Machine learning models have a potential role in early predicting the risk of END after intravenous thrombolysis in AIS patients, and can provide help in clinical decision-making for intravenous thrombolysis.


Subject(s)
Humans , Tissue Plasminogen Activator/therapeutic use , Ischemic Stroke/drug therapy , Brain Ischemia , Retrospective Studies , Thrombolytic Therapy , Stroke , Fibrinolytic Agents/therapeutic use
8.
Beijing Da Xue Xue Bao ; (6): 1033-1038, 2023.
Article in Chinese | WPRIM | ID: wpr-1010164

ABSTRACT

OBJECTIVE@#To explore the predictive value of four items of new thrombus markers combined with conventional coagulation tests for thrombosis in antiphospholipid syndrome.@*METHODS@#A total of 121 antiphospholipid syndrome (APS) patients who hospitalized at Peking University People's Hospital from March 2022 to January 2023 were selected and divided into thrombus group (50 cases) and nonthrombus group (71 cases) according to whether thrombosis occurred. The differences of laboratory characteristics including antiphospholipid antibodies were compared between the thrombotic and non-thrombotic groups. Chemiluminescent immunoassay was used to detect thrombomodulin (TM), thrombin-antithrombin complex (TAT), Plasmin-α2 plasmin inhibitor complex (PIC), and tissue plasminogen activator inhibitor complex (t-PAIC) in plasma from venous. The independent risk factors of thrombosis in patients with APS were determined using binary Logistic regression. Receiver operating characteristic (ROC) curve analysis was applied to evaluate the efficacy of each index on the prediction of thrombosis.@*RESULTS@#Compared with the patients without thrombosis, the patients with thrombosis were older [49 (32, 64) years vs. 36 (32, 39) years, P < 0.05]. The percentages of male, smoking, hypertension, and global antiphospholipid syndrome score (GAPSS)≥10 in the patients with thrombosis were significantly higher than those in the patients without thrombosis (P < 0.05). The positive rates of anticardiolipin antibody (aCL) and lupus anticoagulant (LA) in the thrombotic group were significantly higher than those in the non-thrombotic group (P < 0.05), and the levels of prothrombin time, activated partial thromboplastin time, fibrinogen, fibrin degradation product in the thrombotic group were significantly higher than those in the non-thrombotic group (P < 0.05).Among the thrombosis group, venous thrombosis accounted for 19 (38.00%), including deep vein thrombosis (16, 84.21%) and pulmonary embolism accounted (5, 26.32%); Arterial thrombosis accounted for 35 (70.00%), including myocardial infarction (6, 17.14%) cerebral infarction (30, 85.71%). The patients in the thrombotic group had significantly greater TM levels than those in the non-thrombotic group (P < 0.05).There were no significant dif-ferences between the two groups in TAT (Z=-1.420, P=0.156), PIC (Z=-0.064, P=0.949), and t-PAIC (Z=-1.487, P=0.137). Univariate and binary Logistic regression analysis of relevant variables showed that advanced age [OR=1.126, P=0.002], elevated TM [OR=1.325, P=0.048], prolonged prothrombin time (PT) [OR=4.127, P=0.008] were independent risk factors for thrombosis in the patients with APS. ROC curve analysis of the above three independent risk factors showed that the combined detection of age, PT and TM had the highest Yoden index (0.727) and sensitivity (83.0%), with a specificity of 89.7%.@*CONCLUSION@#TAT, PIC, TM, and t-PAIC may reflect thrombus formation from the coagulation system, fibrinolysis system, and endothelial system. The combined of age TM and PT is superior to the application of a single marker, which has diagnostic value for the early identification of APS thrombosis.


Subject(s)
Humans , Male , Antiphospholipid Syndrome/diagnosis , Tissue Plasminogen Activator , Thrombosis/etiology , Antibodies, Antiphospholipid/analysis , Blood Coagulation Tests/adverse effects
9.
Zhonghua Yu Fang Yi Xue Za Zhi ; (12): 1693-1703, 2023.
Article in Chinese | WPRIM | ID: wpr-1045925

ABSTRACT

Thromboembolism is a crucial part of the global disease burden. It has high incidence, high mortality and disability rates, and the mechanism of occurrence and development is extremely complex. It is difficult to detect the disease in the early stage so that we have trouble with clinical prevention and treatment in general. At present, four items of blood coagulation and D-dimer have been widely used in the evaluation and auxiliary diagnosis of thromboembolism, the monitoring of effect for antithrombotic drugs and other fields. The thrombus biomarkers including thrombin-antithrombin complex (TAT), thrombomodulin (TM), tissue plasminogen activator-inhibitor complex (t-PAIC) and α2-plasmin inhibitor-plasmin complex (PIC) fill the gap of laboratory diagnosis before clinical symptoms appear in some degree. This article aims to explain the current application status of TAT, TM, t-PAIC and PIC in thromboembolism and explore their potential application value, so as to provide a reference for selecting appropriate early monitoring indicators for high-risk population of thromboembolism.


Subject(s)
Humans , Tissue Plasminogen Activator , Plasminogen Inactivators , Thrombomodulin , Thromboembolism , Biomarkers
10.
Zhonghua Yu Fang Yi Xue Za Zhi ; (12): 1693-1703, 2023.
Article in Chinese | WPRIM | ID: wpr-1046248

ABSTRACT

Thromboembolism is a crucial part of the global disease burden. It has high incidence, high mortality and disability rates, and the mechanism of occurrence and development is extremely complex. It is difficult to detect the disease in the early stage so that we have trouble with clinical prevention and treatment in general. At present, four items of blood coagulation and D-dimer have been widely used in the evaluation and auxiliary diagnosis of thromboembolism, the monitoring of effect for antithrombotic drugs and other fields. The thrombus biomarkers including thrombin-antithrombin complex (TAT), thrombomodulin (TM), tissue plasminogen activator-inhibitor complex (t-PAIC) and α2-plasmin inhibitor-plasmin complex (PIC) fill the gap of laboratory diagnosis before clinical symptoms appear in some degree. This article aims to explain the current application status of TAT, TM, t-PAIC and PIC in thromboembolism and explore their potential application value, so as to provide a reference for selecting appropriate early monitoring indicators for high-risk population of thromboembolism.


Subject(s)
Humans , Tissue Plasminogen Activator , Plasminogen Inactivators , Thrombomodulin , Thromboembolism , Biomarkers
11.
Rev. chil. neuro-psiquiatr ; Rev. chil. neuro-psiquiatr;61(3): 363-370, 2023.
Article in Spanish | LILACS | ID: biblio-1515161

ABSTRACT

Introducción: La trombólisis intravenosa con Alteplase (ALT) se recomienda como tratamiento estándar siendo el único agente trombolítico aprobado por la FDA, en infarto cerebral. La Tenecteplase (TNK), un activador tisular del plasminógeno modificado, surge como agente antitrombótico alternativo. Esta revisión narrativa evalúa la evidencia actual y aborda los problemas prácticos sobre la eficacia y seguridad de tenecteplase en comparación con alteplase. Metodología: Se realizó una búsqueda sistemática y analítica de la literatura, y se proporcionó una síntesis cualitativa de metaanálisis y ensayos clínicos concluidos, que compararon la efectividad y seguridad de la tenecteplase con alteplase en el AIS, utilizando artículos indexados en MEDLINE, Cochrane Library y Scopus. Resultados: Los ensayos clínicos aleatorizados en su mayoría coinciden al encontrar que TNK es al menos tan o más efectiva que la ALT para mejoría neurológica después del AIS; mientras los metaanálisis coinciden en que los pacientes que recibieron TNK presentaron una mayor recanalización exitosa, pero difieren en cuanto a los hallazgos de mejoría neurológica temprana, resultado funcional a los 90 días y mortalidad a los 90 días. Conclusión: La tenecteplase es al menos tan eficaz como la Alteplase con respecto a la mejoría neurológica después del tratamiento del accidente cerebrovascular isquémico agudo.


Introduction: Intravenous thrombolysis with alteplase (ALT) is recommended as standard treatment, being the only thrombolytic agent approved by the FDA. Tenecteplase (TNK), a modified tissue plasminogen activator, is emerging as an alternative antithrombotic agent. This narrative review assesses the current evidence and addresses practical issues regarding the efficacy and safety of tenecteplase compared to alteplase. Methodology: A systematic and analytical search of the literature was performed, providing a qualitative synthesis of meta-analyses and completed clinical trials comparing the effectiveness and safety of tenecteplase with alteplase in AIS, using articles indexed in MEDLINE, the Cochrane Library, and Scopus. Results: Randomized clinical trials mostly agree in finding TNK to be at least as or more effective than ALT for neurological improvement after AIS; while the meta-analyses agree that patients who received TNK had more successful recanalization, they differ in terms of the findings of early neurological improvement, functional outcome at 90 days, and mortality at 90 days. Conclusion: Tenecteplase is at least as effective as alteplase with regard to neurological improvement after treatment of acute ischemic stroke.


Subject(s)
Humans , Tissue Plasminogen Activator , Intracranial Thrombosis , Tenecteplase , Ischemic Stroke/rehabilitation
13.
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
14.
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
15.
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
16.
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
17.
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
19.
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
20.
Medicina (B.Aires) ; Medicina (B.Aires);81(1): 6-10, mar. 2021. graf
Article in Spanish | LILACS | ID: biblio-1287234

ABSTRACT

Resumen La fibrinólisis intravenosa con activador del plasminógeno tisular recombinante (rTPA) y la utilización de unidades cerradas, demostraron disminuir sustancialmente la morbimortalidad en pacientes con accidente cerebrovascular isquémico (ACVi). Sin embargo, los datos publicados en Argentina son escasos. Describimos la experiencia en la utilización de fibrinólisis en pacientes con ACVi agudo antes y después de la implementación de una unidad cerebrovascular (UCV) en un Centro Integral de Neurología Vascular de la Ciudad de Buenos Aires durante 17 años. Se realizó un análisis retrospectivo de pacientes consecutivos tratados con rTPA entre enero 2003 y diciembre 2019. Se evaluaron tiempos de tratamiento, de internación, complicaciones post tratamiento y discapacidad a 3 meses. Para su análisis se evaluaron los períodos pre y post apertura de la UCV, período 1 (P1 de 2003-2011) y P2 (2012 -2019). Se realizó fibrinolisis intravenosa en 182 pacientes. La apertura de UCV resultó en aumento del porcentaje de fibrinólisis sobre el total de los ACVi ingresados (4% en P1 vs. 10% en P2, p < 0.001), acortamiento del tiempo puerta-aguja (75 minutos en P1 vs. 53 minutos en P2, p < 0.00001) y mayor proporción de pacientes tratados dentro de los 60 minutos del ingreso hospitalario (36% en P1 vs. 76% en P2, p < 0.00001). Además, hubo reducción de la mediana de internación de 9 días en P1 a 5 días en P2 (p < 0.00001). En conclusión, la UCV parece optimizar la utilización de fibrinólisis en el ACVi agudo, aumentando el porcentaje de pacientes tratados, reduciendo el tiempo puerta-aguja y disminuyendo el de internación.


Abstract Intravenous fibrinolysis with recombinant tissue plasminogen activator (rTPA) and use of stroke units improve morbidity and mortality in patients with acute ischemic stroke (AIS). However, data published in Argentina are scarce. We describe the experience in the use of fibrinolysis in patients with acute ischemic stroke (AIS) before and after the implementation of a stroke unit in a Comprehensive Stroke Center in Buenos Aires during the last 17 years. Retrospective analysis of consecutive patients treated with rTPA between January 2003 and December 2019. Treatment times, hospitalization time, post-treatment complications and disability at 3 months were evaluated. For the analysis, the pre and post opening periods of the stroke unit were evaluated, Period 1 (P1, from 2003 to 2011) and Period 2 (P2, from 2012 to 2019). Intravenous fibrinolysis was performed in 182 patients. Opening of the stroke unit resulted in an increase in the percentage of fibrinolysis over the total number of admitted strokes (4% in P1 vs. 10% in P2, p < 0.001), shortening of the door-to-needle time (75 minutes in P1 vs. 53 minutes in P2, p < 0.00001) and higher proportion of patients treated within 60 minutes of hospital admission (36% in P1 vs. 76% in P2, p < 0.00001). In addition, there was a reduction in the median hospital stay from 9 days in P1 to 5 days in P2 (p < 0.00001). In conclusion, stroke units seem to optimize the use of fibrinolysis in acute stroke, increasing the percentage of patients treated, reducing door-to-needle time, and reducing hospitalization time.


Subject(s)
Humans , Brain Ischemia/drug therapy , Stroke/drug therapy , Argentina , Thrombolytic Therapy , Retrospective Studies , Treatment Outcome , Tissue Plasminogen Activator/therapeutic use , Fibrinolysis , Fibrinolytic Agents/therapeutic use
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