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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.
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OBJECTIVE To systematically evaluate the efficacy and safety of intravenous bolus of tenecteplase in the treatment of acute ischemic stroke （AIS）， in order to provide evidence-based support for the clinic’s choice of intravenous thrombolytic drugs. METHODS Randomized controlled trials （RCTs） about the efficacy and safety of tenecteplase versus alteplase （control） in the treatment of AIS were collected from PubMed， Embase， the Cochrane Library， Web of Science， Sinomed， CNKI， Wanfang Data， and VIP during the inception to June 2022. Two evaluators independently screened the literature， extracted data from the literature， assessed the bias risk of included study， and then conduct meta-analysis by using Stata 15 software. RESULTS A total of 8 literature were included， involving 2 129 patients. Meta-analysis results showed that the early improvement rate of neurological function [OR（95%CI）＝2.44（1.09，5.46），P＝0.030] and the good rate of neurological function recovery （modified Rankin scale score 0-2 after 90 days of intravenous thrombolysis treatment） [OR（95%CI）＝1.54（1.00，2.36），P＝0.048] were higher in 0.25 mg/kg tenecteplase group （medium dose） than alteplase group. According to meta-analysis of other outcome indicators （including recanalization rate， percentage of reperfusion lesions， excellent rate of neurological function recovery， the incidence rate of bleeding， the incidence rate of symptomatic intraventricular hemorrhage and all-cause mortality rate within 90 d）， the tenecteplase group had no statistically significant difference with alteplase group （P＞0.05）. CONCLUSIONS Compared with alteplase， medium dose of tenecteplase has some advantages in terms of early neurological function improvement and neurological function recovery， and it does not increase the risk of adverse events.
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Objective:To investigate the efficacy and safety of thrombolytic therapy with intravenous alteplase(rt-PA)for elderly acute ischemic stroke patients on maintenance hemodialysis.Methods:In this retrospective study, data of 165 elderly patients with acute cerebral infarction on maintenance dialysis, aged 65-85, treated at the Stroke Center of the Fourth Central Hospital Affiliated to Nankai University between May 2018 and March 2021, were collected.Based on whether intravenous thrombolysis with alteplase(rt-PA)was used and differences in thrombolytic schemes, patients were divided into a conservative treatment group( n=58, receiving only standardized secondary stroke prevention), a low-dose rt-PA group( n=57, receiving rt-PA intravenous thrombolysis, 0.6 mg/kg)and a standard-dose rt-PA group( n=50, receiving rt-PA intravenous thrombolysis, 0.9 mg/kg). The safety and efficacy of rt-PA treatment were assessed. Results:The rate of effectiveness at 24 h and the rate of good prognosis at 7 d were 64.9%(37/57)and 70.2%(40/57)for the low-dose rt-PA group and 68.0%(34/50)and 74.0%(37/50)for the standard dose group, respectively.There was no significant difference between the two groups( χ2=0.417, P=0.518; χ2=0.636, P=0.425), but these rates were better than 29.3%(17/58)and 41.4%(24/58)for the conservative treatment group( χ2=10.583、16.714, P<0.001). The good prognosis rate at 90 days were 73.7%(42/57), 78.0%(39/50)and 69.0%(40/58)for the three groups, respectively, with no significant difference( χ2=1.126, P=0.569), but the fatality rate for the low-dose rt-PA group was 7.0%(4/57), lower than 18.0%(9/50)( χ2=5.420, P=0.020)for the standard dose rt-PA group and 20.0%(8/58)for the conservative treatment group( χ2=5.048, P=0.025). The incidence of intracranial hemorrhage was 8.8%(5/57)for the low-dose rt-PA group, lower than 24.0%(12/50)for the standard-dose rt-PA group( P=0.032). The incidence of extracranial complications was 15.8%(9/57)for the low-dose rt-PA group, lower than 36.0%(18/50)for the standard-dose group( P=0.017). Conclusions:For elderly patients with acute cerebral infarction on maintenance hemodialysis, intravenous thrombolytic therapy with low dose rt-PA should be considered with caution.
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Objective:To explore the effects of Zhenfang Baiwanzi Decoction combined with alteplase injection on serum inflammatory factors and vascular endothelial active substances in patients with acute ischemic stroke (AIS).Methods:Randomized controlled trial. A total of 87 patients with AIS admitted to Mengcheng County Hospital of Traditional Chinese Medicine between June 2019 and July 2022 were selected as the observation subjects by prospective cohort study, and they were divided into treatment group (44 cases) and control group (43 cases) according to the last number of medical records. The control group was given thrombolytic therapy with alteplase injection on the basis of routine therapy, and the treatment group was given Zhenfang Baiwanzi Decoction on the basis of the control group. Both groups were treated for 2 weeks. TCM symptoms were scored before and after treatment, and National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the degree of neurological deficit, and Activity of Daily Living Scale (ADL) was applied to evaluate the quality of life. The levels of serum IL-6, CRP, TNF-α, monocyte chemoattractant protein-1 (MCP-1), VEGF, NOS and endothelin-1 (ET-1) were detected by ELISA. The adverse reactions were recorded and the clinical efficacy was evaluated.Results:The total effective rate was 93.18% (41/44) in treatment group and 76.74% (33/43) in control group ( χ2=4.62, P=0.032). After treatment, the scores of hemiparalysis, skin insensitivity, deviated mouth and eye, inhibited speech and headache and dizziness in treatment group were significantly lower than those in the control group ( t=3.38, 3.77, 2.69, 2.60, 2.36, P<0.01 or P<0.05). The NIHSS score was significantly lower than that of the control group ( t=7.53, P<0.01) while the ADL score was significantly higher than that of the control group ( t=2.99, P<0.01). After treatment, the levels of serum IL-6, CRP, TNF-α and MCP-1 in treatment group were significantly lower than those in the control group ( t=6.07, 5.70, 5.30, 3.36, P<0.01), and the levels of VEGF [(364.54±33.04)ng/L vs. (346.86±29.63)ng/L, t=2.63] was significantly lower than that of the control group ( P<0.05), NOS [(20.77±3.12) μmol/L vs. (29.46±5.36) μmol/L, t=9.27] and ET-1 [(85.41±7.09) ng/L vs. (94.11±9.38) ng/L, t=4.89] were significantly lower than those in the control group ( P<0.01). Conclusion:Zhenfang Baiwanzi Decoction combined with alteplase injection can improve the clinical symptoms, reduce levels of inflammatory factors, protect the vascular endothelial function, and enhance the efficacy of patients with AIS.
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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.
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Humanos , Femenino , Adulto , Embolia Pulmonar , Terapia Trombolítica , Activador de Tejido Plasminógeno , SARS-CoV-2 , COVID-19RESUMEN
Objective:To study the clinical efficacy and prognostic quality of neurointervention combined with alteplase in the treatment of acute ischemic stroke.Methods:Ninety-two patients with acute ischemic stroke admitted to the First People's Hospital of Bijie City from February 2019 to December 2020 were selected and divided into the control group and the observation group using the random number method, with 46 cases in each group. Patients in both groups received conventional treatment with intravenous thrombolytic therapy with alteplase, and on this basis, patients in the observation group received neurointerventional treatment. The overall efficiency, national institutes of health stroke scale (NIHSS) score, modified Thrombolysis in cerebral infarction classification (mTICI) score, modified rankin scale (mRS) score, complication rate, and prognostic indexes of patients in both groups were compared after the treatment.Results:The total treatment efficiency of patients in the observation group was 93.48%, which was significantly higher than that of 76.09% in the control group ( P<0.05). The NIHSS scores of both groups were significantly lower than those of the same period before treatment at 1 and 7 days and 1 and 3 months after the treatment (all P<0.05), and the NIHSS scores of the observation group were significantly lower than those of the control group at the same period ( P<0.01). The proportions of mTICI grades < grade 2 and mRS scores in the observation group were significantly lower than those in the control group after treatment(all P<0.05). The overall complication rate of patients in the observation group was significantly lower than that of the control group( P<0.05), and the re-infarction rate of patients in the observation group was significantly lower than that of the control group ( P<0.05). Conclusions:For acute ischemic stroke, neurointervention combined with alteplase is effective, can reduce the risk of complications, and improve the quality of the patient's prognosis, and therefore deserves to be promoted in clinical practice.
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Introduction: Brachiocephalic artery stenosis rarely causes right hemispheric infarction with associated left hemiparesis. To date, there have been no reported cases of stroke associated with brachiocephalic artery stenosis that were successfully treated with recombinant tissue-type plasminogen activator (rt-PA), alteplase.Case Report: An 80-year-old woman presented with left hemiparesis. Brain computed tomography showed no hemorrhage, and computed tomography angiography demonstrated brachiocephalic artery stenosis. Alteplase was administered based on a diagnosis of ischemic stroke. Brain magnetic resonance imaging showed multiple acute infarctions. Thereafter, the blood pressure of the right arm was found to be lower than that of the left arm. The patient’s neurological deficits gradually improved; she was eventually able to walk again and was thus discharged home.Conclusion: While the combination of left hemiparesis and a decrease in blood pressure in the right arm are well known in patients with stroke associated with Stanford type A aortic dissections, it may also occur in patients with stroke due to brachiocephalic artery stenosis. Unlike stroke associated with Stanford type A aortic dissections, stroke due to brachiocephalic artery stenosis may be treated with alteplase.
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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.
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Sistema Único de Salud , Análisis Costo-Beneficio , Activador de Tejido Plasminógeno , Accidente CerebrovascularRESUMEN
ABSTRACT Introduction: Superior vena cava syndrome is described as the obstruction of blood flow through the superior vena cava. The literature reports that the incidence of this pathology varies from 1 case in every 650 inhabitants and 1 case in every 3 100 inhabitants. Since this condition is very rare in the pediatric population, no clear figure has been reported regarding its incidence in children. The use of a central venous catheter in newborns is a risk factor for this condition, as it may cause a thrombus due to the inflammatory reaction against the device. Therefore, it is necessary to initiate anticoagulation management and remove the catheter. Case presentation: Premature male newborn, (31.4 weeks gestation), with acute respiratory distress syndrome, early neonatal sepsis, pneumonia, necrotizing enterocolitis on 2 occasions, intestinal obstruction due to adhesions and intestinal volvulus. At 90 days of age, he presented thrombosis of the superior vena cava without involvement of the jugular and subclavian vein junction in the right atrium. Anticoagulant management was started, but given his unfavorable evolution, a multidisciplinary medical board was held to assess the risks, benefits, and treatment options in this age group. It was decided to start intracavitary tissue plasminogen activator treatment associated with mechanical thrombectomy and angioplasty of the superior vena cava. Due to the difficulty of conducting clinical trials in this population and the rates of major bleeding complications obtained with thrombolytic therapies, there is very little information available on the use of tissue plasminogen activator in newborns. For this reason, alteplase is seldom considered as the therapy of choice. However, in patients with life-threatening thrombosis, such as the present case, the results obtained in adults could be extrapolated in search of a favorable outcome. Conclusions: Fibrinolytic therapy is a way to reduce the size of the thrombus, but it dramatically increases the risk of bleeding; consequently, these patients must be strictly monitored. In pediatric populations, due to the diameter of the blood vessels, thrombectomy is difficult to perform; additionally, recurrent thrombosis and the need for transfusion of blood products are frequent.
RESUMEN Introducción. El síndrome de vena cava superior es la obstrucción del flujo sanguíneo a través de la misma. La incidencia de esta patología varía entre 1 caso por cada 650 habitantes y 1 caso por cada 3 100 habitantes. Al ser una condición de muy baja frecuencia en población pediátrica, no se ha reportado una cifra clara con respecto a la incidencia en niños. El uso de catéter venoso central en recién nacidos es un factor de riesgo para esta condición, ya que puede causar un trombo originado por la reacción inflamatoria al dispositivo, por lo que es necesario iniciar manejo anticoagulante y retirar el catéter. Presentación del caso. Paciente masculino prematuro (31 semanas y 4 días de gestación) con síndrome de dificultad respiratoria aguda, sepsis neonatal temprana, neumonía, enterocolitis necrotizante en 2 ocasiones, obstrucción intestinal por bridas y vólvulo intestinal. A los 90 días de vida presentó trombosis de la vena cava superior sin compromiso del confluente yugulosubclavio de la aurícula derecha. Se inició manejo anticoagulante, pero dada la evolución desfavorable se realizó junta médica multidisciplinaria donde se evaluaron los riesgos, beneficios y opciones de tratamiento en este grupo etario y se decidió realizar trombectomía mecánica y angioplastia de la vena cava superior. Debido a la dificultad para realizar ensayos clínicos en recién nacidos y las tasas de complicaciones hemorrágicas mayores obtenidas con las terapias trombolíticas, es muy poca la información disponible sobre el uso del activador tisular de plasminógeno en esta población; por esto también es muy inusual que se considere a la alteplasa como terapia de elección. Sin embargo, en pacientes con trombosis potencialmente mortales, como el del caso presentado, se podrían extrapolar los resultados obtenidos en los adultos en búsqueda de una evolución favorable. Conclusiones. El manejo fibrinolítico es una opción para reducir el tamaño del trombo, pero aumenta notoriamente el riesgo de sangrado, por lo que se necesita vigilancia estricta del paciente. En población pediátrica, debido al diámetro de los vasos sanguíneos, es complejo realizar trombectomía mecánica; adicionalmente, es frecuente que se presente trombosis recurrente y se necesite trasfundir hemoderivados.
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Objetivo: avaliar as habilidades dos enfermeiros, no uso terapêutico do Alteplase, como terapia fibrinolítica, em pacientes com diagnóstico de infarto agudo do miocárdio. Método: A pesquisa foi realizada por meio de um estudo descritivo transversal, quantitativo, realizado por meio de questionário como instrumento de coleta, contendo 10 questões de múltipla escolha elaboradas pelo autor. A amostra foi constituída por 24 enfermeiros. A coleta de dados foi realizada em julho de 2019, com CAAE n° 13159219.7.0000.5493. Os dados foram analisados e tratados por meio da análise descritiva. Resultado: Os resultados mostraram que os participantes da pesquisa possuem habilidades para o manuseio e aplicabilidade da terapia fibrinolítica, Alteplase, em pacientes acometidos por infarto agudo do miocárdio. Conclusão:Os resultados obtidos demonstram que os enfermeiros possuem habilidade para o manuseio, administração, aplicabilidade do Alteplase, bem como na avaliação dos sintomas e contraindicações do medicamento em pacientes acometidos por Infarto Agudo do Miocárdio. Entretanto, foi identificado uma porcentagem que apresentam dificuldades na execução de todas as atividades. Portanto, o estudo contribuirá na elaboração de protocolos aos profissionais da área da saúde envolvidos de modo direto ou indireto aos cuidados aos pacientes que necessitam desta intervenção farmacológica como tratamento.(AU)
Objective: to evaluate the abilities of nurses in the therapeutic use of Alteplase, as fibrinolytic therapy, in patients diagnosed with acute myocardial infarction. Method: The research was carried out by means of a transversal, quantitative descriptive study, carried out by means of a questionnaire as a collection instrument, containing 10 multiple choice questions elaborated by the author. The sample consisted of 24 nurses. The data collection was carried out in July 2019, with CAAE No. 13159219.7.0000.5493. The data were analyzed and treated through descriptive analysis. Result: The results showed that the research participants have skills for the handling and applicability of fibrinolytic therapy, Alteplase, in patients affected by acute myocardial infarction. Conclusion: The results show that the nurses have skills in the handling, administration and applicability of Alteplase, as well as in the evaluation of the symptoms and contraindications of the drug in patients affected by Acute Myocardial Infarction. However, it was identified a percentage that present difficulties in performing all activities. Therefore, the study will contribute in the elaboration of protocols to the professionals of the health area involved in a direct or indirect way to the care of patients who need this pharmacological intervention as treatment.(AU)
Objetivo: evaluar las capacidades de las enfermeras en el uso terapéutico de la Alteplasa, como terapia fibrinolítica, en pacientes diagnosticados con infarto agudo de miocardio. Material y método: La investigación se realizó mediante un estudio descriptivo cuantitativo transversal, realizado mediante un cuestionario como instrumento de recopilación, que contenía 10 preguntas de opción múltiple preparadas por el autor. La muestra constaba de 24 enfermeras. La recopilación de datos se llevó a cabo en julio de 2019, con el CAAE Nº 13159219.7.0000.5493. Los datos fueron analizados y tratados mediante un análisis descriptivo. Resultado: Los resultados mostraron que los participantes en la investigación tienen habilidades en el manejo y la aplicabilidad del tratamiento fibrinolítico, Alteplase, en pacientes afectados por un infarto agudo de miocardio. Conclusión: Los resultados muestran que las enfermeras tienen aptitudes para el manejo, la administración y la aplicabilidad del Alteplase, así como para la evaluación de los síntomas y las contraindicaciones del fármaco en los pacientes afectados por un infarto agudo de miocardio. Sin embargo, se identificó un porcentaje que presenta dificultades para realizar todas las actividades. Por lo tanto, el estudio contribuirá a la elaboración de protocolos para los profesionales de la salud que participan directa o indirectamente en la atención de los pacientes que necesitan esta intervención farmacológica como tratamiento.(AU)
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Humanos , Terapéutica , Terapia Trombolítica/enfermería , Activador de Tejido Plasminógeno , Infarto del Miocardio , Enfermería de Urgencia , Servicios Médicos de UrgenciaRESUMEN
Objective: This study evaluated the efficacy of thrombolysis with 0.6 mg/kg intravenous alteplase for acute ischemic stroke patients within 6 h of stroke onset. Methods: This cross-sectional study collected data of patients with ischemic stroke received intravenous thrombolytic therapy with 0.6 mg/kg alteplase within 6 h of onset in Cipto Mangunkusumo General Hospital (Rumah Sakit Cipto Mangunkusumo [RSCM]) between November 2014 and August 2017. Efficacy of the thrombolytic therapy was evaluated using the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS). NIHSS evaluated on 24 h and 7 d post thrombolytic therapy portrayed clinical outcomes of patients while mRS evaluated on day 30 post-thrombolysis portrayed the functional outcome of patients. Results: The median NIHSS score decreased on 24 h and 7 d post-thrombolysis. 33.3% patients experienced a reduction of NIHSS score ≥4 on 24 h post thrombolytic therapy. On day 7 following thrombolysis, 57.4% patients had a good clinical outcome. On day 30 follow-up, 55.6% patients had a good functional outcome. Conclusion: Thrombolysis using 0.6 mg/kg intravenous alteplase within 6 h of onset is effective for acute ischemic stroke patients.
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@#The Indian data comparing the efficacy and safety outcomes of tenecteplase and alteplase in acute ischemic stroke is scarce. We aimed to compare the outcomes of two agents in an Indian population. Methods: TENVALT study was a single centre, retrospective study. Patients aged 18 years or older with acute ischemic stroke were included in this study if they presented within 3 hours of symptom onset and had a deficit with National Institute of Health Stroke Scale (NIHSS) score > 4, had a modified Rankin score (mRS) of 2 or less before the stroke onset and had no evidence of hemorrhage on non-contrast computed tomography of brain. A good functional recovery (mRS score of 0-2) at the end of three months was defined as the primary efficacy outcome. The development of symptomatic intracerebral hemorrhage was considered as the primary safety outcome. Results: A total of 120 patients (alteplase, n=65; tenecteplase, n=55) underwent stroke thrombolysis during this study. The mean age of the presentation in tenecteplase group was 66.6 years and in alteplase group was 62.5 years. Most of the study subjects were males in both the groups (tenecteplase, 78.2%; alteplase, 61.5%). Hypertension was the most common comorbidity in both the groups (tenecteplase, 67.3%; alteplase, 76.9%). Median mRS score at 3 months of follow up was 2 in tenecteplase and 1 in alteplase group; however, the difference between the total number of patients having good functional recovery (mRS 0-2) in the two groups was not statistically significant (tenecteplase 74.5 vs alteplase 87.7%, P=0.09). The total number of patients who had symptomatic intracranial hemorrhage was comparable between the two groups (tenecteplase, 5.5%; alteplase, 6.2%).
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Objective To study and investigate the efficacy of alteplase combined with low molecular weight heparin sodium in the treatment of patients with submaximal pulmonary embolism and its influence on related indicators, and to guide clinical medication. Methods Eighty patients with large pulmonary embolism treated in our department from August 2013 to August 2017 were randomly divided into observation group and control group, with 40 cases in each group. The control group was treated with subcutaneous injection of low molecular weight heparin sodium. In combination with oral anticoagulation with warfarin, the observation group was treated with alteplase on the basis of the control group. After 1 week of continuous treatment, the clinical efficacy was compared between the 2 groups, and pulmonary function and arterial partial pressure of oxygen (PaO2) were compared before and after the treatment. The partial pressure of carbon dioxide (PaCO2) was used to compare the levels of serum B-type natriuretic peptide (BNP) , troponin Ⅰ (cTnⅠ) , homocysteine (Hey) , Ddimer (D-D) , and bleeding before and after the treatment in both groups. Results The total effective rate was97.50％ in the observation group, which was significantly higher than that in the control group of 75.00％ (P <0.05). There was no significant difference in terms of FEV1％, FEV1/FVC, PaO2 and PaCO2 between the two groups before the treatment (P> 0.05) , but FEV1％, FEV1/FVC, PaO2 in the observation group were significantly higher than those in the control group after the treatment, and PaCO2 was significantly lower (P <0.05); There was no significant difference regarding to serum BNP, cTnl, Hey and D-D levels between the two groups before the treatment (P> 0.05) , but after the treatment, the indexes of the observation group were significantly lower than those of the control group (P < 0.05). There was no statistical difference in the incidence of bleeding between the two groups (P> 0.05). Conclusion Alteplase combined with low-molecular-weight heparin sodium in the treatment of the next large-area pulmonary embolism can improve the efficiency of treatment, lung function and the prognosis, but will not inc-rease the risk of bleeding. It could be widely used in clinical practice.
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Objective@#To analyze related factors for early neurological improvement after intravenous thrombolysis with alteplase in elderly patients with acute ischemic stroke(AIS).@*Methods@#Clinical data of elderly AIS patients with intravenous thrombolytic therapy within 4.5 hours of symptom onset were retrospectively analyzed.The demographic and clonical data were compared between improvement group and non-improvement group.Relevant factors for early neurological improvement after thrombolysis with alteplase were analyzed by using multivariate logistic regression model.@*Results@#A total of 118 patients were included, of which 43 had early symptom improvement(36.44%). Multivariate logistic regression analysis showed that baseline NIHSS score(OR=1.098, 95%CI=1.002-1.202, P=0.045), admission blood glucose(OR=1.377, 95%CI=1.040-1.822, P=0.025), atrial fibrillation(OR=0.329, 95%CI=0.122-0.883, P=0.027)were significantly correlated with early symptom improvement after thrombolysis.@*Conclusions@#Baseline NIHSS score, admission blood glucose and atrial fibrillation are correlated with early neurological improvement after intravenous thrombolysis with alteptase in elderly AIS patients.
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OBJECTIVE： To evaluate therapeutic efficacy of reteplase versus alteplase in the treatment of acute myocardial infarction in China， and to provide evidence-based reference for clinical treatment. METHODS： Retrieved from Cochrane library， PubMed， Embase， Medline， CJFD， CSJD， Wanfang database by computor， etc.， also by manual search， RCTs about therapeutic efficacy （recanalization rate of thrombolysis） of reteplase （trial group） versus alteplase （control group） in the treatment of acute myocardial infarction in China were collected from Jan. 1995 to Sept. 2018. After data extraction and quality evaluation with Cochrane system evaluator manual 5.1.0， Meta-analysis was performed for recanalization rate of thrombolysis by using Rev Man 5.3 software. RESULTS： A total of 23 RCTs were included， involving 1 742 patients. Results of Meta-analysis showed that recanalization rate of thrombolysis in trial group was significantly higher than control group， with statistical significance [OR＝0.61，95％CI（0.50，0.73），P＜0.001]. Sub-group Meta-analysis was performed according to the successful time of thrombolysis. Results of Meta-analysis showed that recanalization rate of thrombolysis in trial group 1 h [OR＝0.38，95％CI（0.25，0.58），P＜0.001]， 1.5 h [OR＝0.44，95％CI（0.25，0.79），P＝0.006] and 2 h [OR＝0.62，95％CI（0.42，0.92），P＝0.02] after thrombolysis were significantly higher than control group， with statistical significance. CONCLUSIONS： The recanalization rate of thrombolysis by reteplase in Chinese patients with acute myocardial infarction in better than by alteplase.
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Objective To analyze related factors for early neurological improvement after intravenous thrombolysis with alteplase in elderly patients with acute ischemic stroke (AIS).Methods Clinical data of elderly AIS patients with intravenous thrombolytic therapy within 4.5 hours of symptom onset were retrospectively analyzed.The demographic and clonical data were compared between improvement group and non-improvement group.Relevant factors for early neurological improvement after thrombolysis with a[teplase were analyzed by using multivariate logistic regression model.Results A total of 118 patients were included,of which 43 had early symptom improvement (36.44％).Multivariate logistic regression analysis showed that baseline NIHSS score(OR =1.098,95％CI=1.002-1.202,P=0.045),admission blood glucose(OR =1.377,95％CI=1.040-1.822,P =0.025),atrial fibrillation(OR =0.329,95 ％ CI =0.122-0.883,P =0.027) were significantly correlated with early symptom improvement after thrombolysis.Conclusions Baseline NIHSS score,admission blood glucose and atrial fibrillation are correlated with early neurological improvement after intravenous thrombolysis with alteptase in elderly AIS patients.
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Background: Stroke patients are at highest risk death in the first few weeks after the event, and between 20-50% die within first month depending on type, severity, age, co-morbidities and effectiveness of treatment of complications. Objective of this study was to clinical profile of patients with acute ischemic stroke receiving intravenous thrombolysis (rtPA-alteplase).Methods: Prospective Observational study of 26 cases of acute ischemic stroke receiving IV thrombolysis using rtPA-alteplase at Kovai Medical Centre Hospital, Coimbatore over a period of 1 year 9 months.Results: 21 cases had NIHSS score of range 10 to 22. The mean NIHSS score at admission is 13.5. 15 subjects (57.7%) had achieved primary outcome in this study. MRS Score of 0 to 2 is considered as favorable outcome. In this study 20 subjects (76.92 %) had favorable outcome at the end of 3 months.Conclusions: Majority of the patients receiving rtPA-alteplase had favorable outcome
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Objective To compare the effect of different dosages of alteplase in the treatment of elderly patients with acute cerebral infarction,as well to evaluate the safety.Methods From January 2016 to June 2017,82 patients with acute cerebral infarction in the Hospital of Changping District were chosen in this study.The patients were randomly divided into 2 groups according to the digital table:41 patients in study group (0.6 mg/kg alteplase) and 41 patients in control group (0.9mg/kg alteplase).The effective rate and incidence of hemorrhage were compared between the two groups.Results The effective rate of the study group was 95.13％ (39/41),which of the control group was 100.00％ (41/41),the difference was not statistically significant (Z =4.982,P ＞ 0.05).The incidence rate of hemorrhage in the study group was 7.32％ (3/41),which in the control group was 24.39％ (10/41),the difference was statistically significant (x2 =6.248,P ＜ 0.05).Conclusion The effect of different dosages of alteplase demonstrates no significant difference in the treatment of elderly patients,and the safety of low dose is more reliable.