Intravenous recombinant tissue plasminogen activator for acute ischemic stroke: a feasibility and safety study

Abstract

BackgroundIn developing countries, intravenous thrombolysis (IVT) is available at a limited number of centers. This study aimed to assess the feasibility and safety of IVT at Tabriz Imam Reza Hospital.MethodsIn a prospective study, over a 55-month period, any patient at the hospital for whom stroke code had been activated was enrolled in the study. Data on demographic characteristics, stroke risk factors, admission blood pressure, blood tests, findings of brain computed tomography (CT) scans, time of symtom onset, time of arrival to the emergency department, time of stroke code activation, time of CT scan examination, and the time of recombinant tissue plasminogen activator administration were recorded. National Institutes of Health Stroke Scale assessments were performed before IVT bolus, at 36 hours, at either 7 days or discharge (which ever one was earlier), and at 3-month follow-up. Brain CT scans were done for all patients before and 24 hours after the treatment.ResultsStroke code was activated for 407 patients and IVT was done in 168 patients. The rate of functional independence (modified Rankin Scale [mRS] 0–1) at 3 months was 39.2% (62/158). The mortality rate at day 7 was 6% (10/168). Hemorrhagic transformation was noted in 16 patients (9.5%). Symptomatic intracranial hemorrhage occurred in 5 (3%), all of which were fatal. One case of severe urinary bleeding and one other fatal case of severe angioedema were observed.ConclusionDuring the first 4–5 years of administration of IVT in the hospital, it was found to be feasible and safe, but to increase the efficacy, poststroke care should be more organized and a stroke center should be established.

Efficacy and Safety of Intravenous Urokinase and Sodium Ozagrel in Acute Ischemic Stroke

“…Combined IV urokinase and sodium ozagrel therapy is reported to increase the chances of hemorrhage. However, in this study, only 2.3% patients developed SICH, a rate similar to or less than other studies that examined the efficacy of rt-PA [1,2,5,10,11]. Additionally, only 2.3% mortality was observed in this study, which is low [1,2,9,12].…”

Prehospital Notification can Effectively Reduce In-Hospital Delay for Thrombolysis in Acute Stroke

“…Although implementation of the stroke code system and PHN are important interventions to reduce onset to treatment time, the severe lack of public awareness to recognize stroke symptoms is the reason why thrombolysis rate does not rise effectively. In a recent report, the rate of thrombolysis for acute stroke patients was less than 5% at this center [27]; therefore, public education is crucial to reach a higher rate of thrombolysis.…”

Akut İskemik İnmede İntravenöz Trombolitik Tedavi: Klinik Değerlendirme

“…Sıklığı çalışmalar arasında farklılık göstermektedir. %3-43 gibi geniş bir aralıkta olabileceği gösterilmiştir (8,10,11,15). Hemoraji sonrası mortalite oranıyükselmektedir.…”

“…Bu duruma hidrostatik hasarlanma, immünolojik mekanizmalar, peroksinitrit ve eksitotoksisite sebep olmaktadır (9). Tedavi sonrasında hemorajik dönüşüm %3-43 oranında görülmektedir (10,11). İleri yaş, düşük trombosit sayısı, yüksek kan şekeri, geniş iskemi hacmi, zayıf kollateral damarlanma, yüksek kan basıncı, tedavide gecikme ve ağır dizabilite en önemli risk faktörleridir (12).…”