RESUMO
BACKGROUND AND PURPOSE: We present the early experience in thrombolysis in three major centers of Ho Chi Minh city, namely 115 People Hospital, Gia Dinh Hospital, and An Binh Hospital. METHODS: A prospective study of consecutive patients treated with intravenous tPA with a treatment protocol similar to that of the National Institute of Neurological Disorders and Stroke (NINDS) trial. National Institutes of Health Stroke Scale (NIHSS) scores on admission and Modified Rankin Scale (MRS) scores at 3 months were measured for all patients. Intracranial and systemic hemorrhagic complications were recorded. RESULT: A total of 121 of 6171 (2%) patients with acute IS received thrombolysis over 3 years. Mean age was 57 years (range 18-78) and initial median NIHSS score was 12 (range 5-23). The mean delay between symptom onset and treatment was 143 min (range 50-210). Seventy-three (60.3%) patients received the standard dose with the remaining 48 patients (36.9%) treated with a lower dose, a mean calculated dose of 0.62 mg/kg (range, 0.6-0.86 mg/kg). Over half (56.3%) of the patients receiving low dose achieved functional independence (mRS score 0-1) at 3 months compared with 34.2% in the standard-dose group (P = 0.01). The 3-month mortality rate was also higher in the standard-dose group (2.1% vs. 12.5% with standard-dose tPA; P = 0.04). Symptomatic intracranial hemorrhage was noted in four patients of standard-dose group and one patient of low-dose group (P = 0.36). CONCLUSION: Intravenous thrombolysis, particularly in a lower dose, is safe and feasible in the treatment of acute IS in our selected Vietnamese population.
Assuntos
Fibrinolíticos/uso terapêutico , Trombose Intracraniana/tratamento farmacológico , Avaliação de Resultados em Cuidados de Saúde/métodos , Sistema de Registros , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica/métodos , Terapia Trombolítica/estatística & dados numéricos , Adolescente , Adulto , Idoso , Relação Dose-Resposta a Droga , Serviços Médicos de Emergência/métodos , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Trombose Intracraniana/mortalidade , Trombose Intracraniana/prevenção & controle , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/prevenção & controle , Terapia Trombolítica/efeitos adversos , Resultado do Tratamento , Vietnã/epidemiologia , Adulto JovemRESUMO
BACKGROUND AND PURPOSE: We report a case of intravenous thrombolysis in a patient with early recurrent stroke. A 62-year-old man recovered nearly completely after a lacunar infarct of the left putamen. He suffered stroke recurrence 7 days later due to a new infarct in the left internal capsule. Intravenous alteplase 0.9 mg/kg was administered 40 min after the symptom onset resulting in significant neurologic improvement. CONCLUSION: Intravenous thrombolysis may be safe for early recurrent lacunar stroke in patients with relatively small risk of hemorrhage.
