Tissue plasminogen activator for acute ischemic stroke: calculation of dose based on estimated patient weight can increase the risk of cerebral bleeding.

A dose of 0.9 mg/kg of intravenous tissue plasminogen activator (t-PA) has proven to be beneficial in the treatment of acute ischemic stroke (AIS). Dosing of t-PA based on estimated patient weight (PW) increases the likelihood of errors. Our objectives were to evaluate the accuracy of estimated PW and assess the effectiveness and safety of the actual applied dose (AAD) of t-PA. We performed a prospective single-center study of AIS patients treated with t-PA from May 2010 to December 2011. Dose was calculated according to estimated PW. Patients were weighed during the 24 h following treatment with t-PA. Estimation errors and AAD were calculated. Actual PW was measured in 97 of the 108 included patients. PW estimation errors were recorded in 22.7 % and were more frequent when weight was estimated by stroke unit staff (44 %). Only 11 % of patients misreported their own weight. Mean AAD was significantly higher in patients who had intracerebral hemorrhage (ICH) after t-PA than in patients who did not (0.96 vs. 0.92 mg/kg; p = 0.02). Multivariate analysis showed an increased risk of ICH for each 10 % increase in t-PA dose above the optimal dose of 0.90 mg/kg (OR 3.10; 95 % CI 1.14-8.39; p = 0.026). No effects of t-PA misdosing were observed on symptomatic ICH, functional outcome or mortality. Estimated PW is frequently inaccurate and leads to t-PA dosing errors. Increasing doses of t-PA above 0.90 mg/kg may increase the risk of ICH. Standardized weighing methods before t-PA is administered should be considered.

Perfil actual del paciente en diálisis y HIV+: nuevo reto para la enfermería / Current profile of patients under haemodyalisis and HIV: a new challenge for nursing

En nuestra Unidad de Diálisis hemos comprobado el aumento de pacientes con IRC y HIV+ en los últimos 5 años. Basándonos en un trabajo que realizamos en el año 1987 sobre los pacientes en diálisis con HIV+, hemos comparado a estos pacientes con los actuales en cuanto a origen del contagio, sexo, supervivencia, estado nutricional, corrección de la anemia y aspectos sociales.En el primer grupo (5 mujeres y 3 hombres) el origen del contagio era fundamentalmente las transfusiones y en el grupo actual (8 hombres y 1 mujer) es por adicción a drogas vía parenteral (ADVP). La supervivencia, el estado nutricional y adecuada corrección de la anemia son mejores en el segundo grupo.Una vez realizado este estudio hemos elaborado un plan de cuidados de enfermería para pacientes HIV+ en diálisis, revisando las técnicas de diálisis, cuidados del acceso vascular, nutrición y aspectos psicológicos y sociales. (AU)