ABSTRACT
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Subject(s)
Male , Adult , Humans , Neurosyphilis/complications , Cerebral Palsy/etiology , Dementia/etiology , Neurosyphilis/diagnosis , Cerebral Palsy/diagnosis , Dementia/diagnosis , Cerebral Palsy/drug therapySubject(s)
Dementia/etiology , Neurosyphilis/complications , Humans , Male , Middle Aged , Neurosyphilis/diagnosisABSTRACT
BACKGROUND AND OBJECTIVE: Treatment of acute ischemic stroke within three hours with intravenous tissue-type plasminogen activator (t-PA) has been recently approved by the European Drug Agency. We present the development of an internal organization system that has permitted thrombolytic treatment in our center without previous experience as well as the results of the first year. PATIENTS AND METHOD: Development of the thrombolysis educational program for the staff informed, of the internal organization system, and combined care protocols among the participating services. Prospective registry of patients treated with t-PA within the period 1/2004-2/2006. We collected demographic data, stroke assessment scales score (NIHSS), time to treatment, seven day and three months mortality, symptomatic hemorrhagic transformation, systemic bleedings, functional independency at three months, early significant improvement and significant deterioration. RESULTS: Fifty-three patients were treated. Mean age: 65 +/- 13 years; 56% women. Mean NIHSS pre-treatment: 14 +/- 4.7. Mean time to hospital arrival: 62 +/- 40 minutes; door-to-treatment: 68 +/- 22 minutes, and mean time from stroke onset to treatment: 130 +/- 31 minutes. Symptomatic hemorrhagic transformation: 5.8%. Systemic bleeding: 3.8%. Seven day mortality: 5.6%; three months mortality: 15.1%. Early significant improvement: 51%. Significant neurological deterioration: 7.5%. Functional independency at three months: 51%. CONCLUSIONS: Treatment of acute ischemic stroke within three hours with intravenous t-PA is safe and is associated with a favourable outcome when it is applied by neurologists specifically trained in acute stroke management.
Subject(s)
Fibrinolytic Agents/therapeutic use , Outcome and Process Assessment, Health Care , Stroke/drug therapy , Thrombolytic Therapy , Aged , Emergency Service, Hospital , Female , Humans , Male , Middle Aged , Neurology , SpainABSTRACT
Introducción. El tratamiento del infarto cerebral agudo de menos de tres horas de evolución con activador del plasminógeno tisular (t-PA) ha sido recientemente aprobado por la Agencia Europea del Medicamento. Presentamos el desarrollo de una organización interna para el tratamiento trombolítico del ictus en un centro sin experiencia previa y los resultados de los dos primeros años. Pacientes y método. Desarrollo del programa de formación para el personal involucrado, del sistema de organización intrahospitalaria y de los protocolos de atención conjunta entre los servicios que intervienen. Registro prospectivo de todos los pacientes con ictus agudo tratados con t-PA en el período 1/2004-2/2006. Se recogen variables demográficas, escalas de evaluación del déficit neurológico (NIHSS), demora en la aplicación del tratamiento, mortalidad a los 7 días y tres meses, transformación hemorrágica sintomática, complicaciones hemorrágicas sistémicas, independencia funcional a los tres meses, mejoría significativa precoz y empeoramiento significativo. Resultados. Se trataron 53 pacientes. Edad media: 65 ± 13 años; 56% mujeres. NIHSS pretratamiento: 14 ± 4,7. Tiempo medio de llegada: 62 ± 40 minutos; tiempo puerta-aguja: 68 ± 22 minutos, y tiempo ictus-tratamiento: 130 ± 31 minutos. Transformación hemorrágica sintomática: 5,8%. Hemorragias sistémicas: 3,8%. Mortalidad a los 7 días: 5,6%; a los tres meses: 15,1%. Mejoría clínica significativa: 51%. Deterioro neurológico significativo: 7,5%. Independencia funcional a los tres meses: 51%. Conclusión. El tratamiento trombolítico del ictus agudo de menos de tres horas es seguro y eficaz cuando es administrado por neurólogos con formación específica en este tratamiento
Background and objective. Treatment of acute ischemic stroke within three hours with intravenous tissue-type plasminogen activator (t-PA) has been recently approved by the European Drug Agency. We present the development of an internal organization system that has permitted thrombolytic treatment in our center without previous experience as well as the results of the first year. Patients and method. Development of the thrombolysis educational program for the staff informed, of the internal organization system, and combined care protocols among the participating services. Prospective registry of patients treated with t-PA within the period 1/2004-2/2006. We collected demographic data, stroke assessment scales score (NIHSS), time to treatment, seven day and three months mortality, symptomatic hemorrhagic transformation, systemic bleedings, functional independency at three months, early significant improvement and significant deterioration. Results. Fifty-three patients were treated. Mean age: 65 ± 13 years; 56% women. Mean NIHSS pre-treatment: 14 ± 4.7. Mean time to hospital arrival: 62 ± 40 minutes; door-to-treatment: 68 ± 22 minutes, and mean time from stroke onset to treatment: 130 ± 31 minutes. Symptomatic hemorrhagic transformation: 5.8%. Systemic bleeding: 3.8%. Seven day mortality: 5.6%; three months mortality: 15.1%. Early significant improvement: 51%. Significant neurological deterioration: 7.5%. Functional independency at three months: 51%. Conclusions. Treatment of acute ischemic stroke within three hours with intravenous t-PA is safe and is associated with a favourable outcome when it is applied by neurologists specifically trained in acute stroke management
