Experience of Intravenous Thrombolytic Treatment in Sanliurfa: A Prospective Study
Yıl: 2019 Cilt: 25 Sayı: 1 Sayfa Aralığı: 19 - 25 Metin Dili: İngilizce DOI: 10.4274/tnd.galenos.2018.69335 İndeks Tarihi: 01-05-2020
Experience of Intravenous Thrombolytic Treatment in Sanliurfa: A Prospective Study
Öz: Objective: Stroke ranks second among the diseases that cause death and third among the causes of disability in Turkey. An average of 1.9 million neurons dieevery minute due to acute ischemic stroke and therefore ‘time is brain’. Intravenous thrombolytic treatment (ITT) and, if possible, endovascular treatment shouldbe initiated quickly. We aimed to share our ITT experience in Sanliurfa with this study.Materials and Methods: We recorded the clinical and demographic characteristics, risk factors, and three-month follow-up of 21 patients with acute ischemicstroke who were given ITT between June 2015 and July 2017.Results: Of the 21 patients, nine were male and 12 were female, and the mean age was 72.1±11.8 (range, 48-87) years. Large vessel occlusion was found in five(23.8%) patients, cardioembolism in 9 (42.9%), and small vessel occlusion in 2 (9.5%) patients; etiology was not determined in five (23.8%) patients. Atrialfibrillation was found in 38.1%, hypertension in 57.1%, diabetes mellitus in 23.8%, coronary artery disease in 33.3%, hyperlipidemia in 19%, and smokingin 33.3% of the patients.The NIHSS score was 11.7±6.7 (range, 2-24) prior to treatment. The symptom-onset to needle time was 185±55.8 minutes when 19patients were evaluated. Intracerebral hemorrhage was observed in two (9.5%) patients after treatment. One patient was asymptomatic and the symptomaticpatient (4.75%) died despite decompression surgery. Ten patients died and the mortality rate was 47.6% at the end of the three-month follow-up period. Themodified Rankin scale score was 0-2 in eight patients (38.1%) and was 0-1 in seven patients (33.3%). ITT was given to seven patients aged ≥80 years, five patientswith NIHSS <5, and two patients in whom the treatment window was exceeded, which was non-adherent to the label.Conclusion: ITT is effective and safe. It increases the number of independent living patients. We must strive to perform this treatment all over Turkey andencourage our colleagues.
Anahtar Kelime: Konular:
Şanlıurfa’da İntravenöz Trombolitik Tedavi Deneyimi: Prospektif Bir Çalışma
Öz: Amaç: İnme, Türkiye’de ölüme neden olan hastalıklar içerisinde ikinci sırada ve özürlülüğe yol açan nedenler içerisinde üçüncü sıradadır. Akut iskemik inmeye (Aİİ) bağlı her geçen dakikada ortalama 1,9 milyon nöron ölmektedir ve bu nedenle “zaman beyindir”. Hızlı bir şekilde intravenöz trombolitik tedaviye (İTT) ve mümkünse endovasküler tedaviye başlanmalıdır. Biz bu çalışma ile Şanlıurfa’daki İTT deneyimimizi paylaşmayı amaçladık. Gereç ve Yöntem: Haziran 2015 ve Temmuz 2017 arasında başvuran, Aİİ tanısı konarak İTT verilen 21 hastanın klinik ve demografik özelliklerini, risk faktörlerini ve 3 aylık izlemlerini kaydettik. Bulgular: Çalışmaya dahil edilen 21 hastanın 12’si kadın, 9’u erkekti ve yaş ortalamaları 72,1±11,8 (48-87) idi. Etiyolojik incelemede hastaların beşinde (%23,8) büyük damar hastalığı, dokuzunda (%42,9) kardiyoembolizm, ikisinde (%9,5) küçük damar hastalığı saptanırken, beşinde (23,8%) neden bulunamadı. Hastaların %38,1’inde atrial fibrilasyon, %57,1’inde hipertansiyon, %23,8’inde diabetes mellitus, %33,3’ünde koroner arter hastalığı, %19’unda hiperlipidemi ve %33,3’ünde sigara kullanımı mevcuttu. Hastaların tedavi öncesi National Institutes of Health Stroke Scale (NIHSS) skoru 11,7±6,7 (2-24) idi. Semptom başlangıcından tedaviye başlanana kadar geçen süre 19 hasta değerlendirildiğinde 185±55,8 dakika idi. İki hastada (%9,5) tedavi sonrası intraserebral kanama gözlendi. Birisi asemptomatikti, semptomatik (%4,75) olan bir hasta ise dekompresif cerrahi uygulanmasına rağmen kaybedildi. Üç aylık takipte on hasta kaybedildi ve mortalite oranı (%47,6) olarak hesaplandı. Üçüncü ay modifiye Rankin skalası skoru, sekiz hastada (%38,1) 0-2, yedi hastada (%33,3) 0-1 idi. Yedi hastada ≥80 yaş, beş hastada NIHSS <5 ve iki hastada 4,5 saatlik tedavi penceresi aşılmış olmasına rağmen, ruhsatlandırma dışı olarak İTT uygulanmıştır. Sonuç: İTT etkili ve güvenlidir. Bağımsız yaşayan hasta sayısını anlamlı olarak arttırır. Bu tedavinin Türkiye’nin her yerinde uygulanmasına gayret göstermeli ve meslektaşlarımızı cesaretlendirmeliyiz.
Anahtar Kelime: Konular:
Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
- 1. Saver JL. Time is brain--quantified. Stroke 2006;37:263-266.
- 2. Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380:2095-2128.
- 3. Murray CJ, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380:2197-2223.
- 4. Ozturk S. Epidemiology and the global burden of stroke--situation in Turkey. World Neurosurg 2014;81:e35-36.
- 5. Kutluk K, Kaya D, Afsar N, et al. Analyses of the Turkish National Intravenous Thrombolysis Registry. J Stroke Cerebrovasc Dis 2016;25:1041- 1047.
- 6. Adams HP Jr, Bendixen BH, Kappelle LJ, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke 1993;24:35- 41.
- 7. Hacke W, Kaste M, Fieschi C, et al. Randomised double-blind placebocontrolled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators. Lancet 1998;352:1245-1251.
- 8. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995;333:1581-1587.
- 9. Hacke W, Kaste M, Bluhmki E, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 2008;359:1317-1329.
- 10. Amiri H, Bluhmki E, Bendszus M, et al. European Cooperative Acute Stroke Study-4: Extending the time for thrombolysis in emergency neurological deficits ECASS-4: ExTEND. Int J Stroke 2016;11:260-267.
- 11. Ahmed N, Wahlgren N, Grond M, et al.: Implementation and outcome of thrombolysis with alteplase 3-4.5 h after an acute stroke: an updated analysis from SITS-ISTR. Lancet Neurol 2010;9:866-874.
- 12. Wahlgren N, Ahmed N, Davalos A, et al. Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST): an observational study. Lancet 2007;369:275-282.
- 13. Wardlaw JM, Murray V, Berge E, et al. Recombinant tissue plasminogen activator for acute ischaemic stroke: an updated systematic review and metaanalysis. Lancet 2012;379:2364-2372.
- 14. Messe SR, Khatri P, Reeves MJ, et al. Why are acute ischemic stroke patients not receiving IV tPA? Results from a national registry. Neurology 2016;87:1565-1574.
- 15. Nasr DM, Brinjikji W, Cloft HJ, Rabinstein AA. Utilization of intravenous thrombolysis is increasing in the United States. Int J Stroke 2013;8:681-688.
- 16. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis 2008;25:457-507.
- 17. ESO Guideline Update (Abstract) - January 2009, European Stroke Organisation. Last accessed date: August 11, 2015. Available from: https:// congrex.com/
- 18. Anani N, Mazya MV, Bill O, et al. Changes in European Label and Guideline Adherence After Updated Recommendations for Stroke Thrombolysis: Results From the Safe Implementation of Treatments in Stroke Registry. Circ Cardiovasc Qual Outcomes 2015;8:S155-162.
- 19. Meretoja A, Putaala J, Tatlisumak T, et al. Off-label thrombolysis is not associated with poor outcome in patients with stroke. Stroke 2010;41:1450- 1458.
- 20. Powers WJ, Rabinstein AA, Ackerson T, et al. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2018;49:e46-e110.
- 21. Emberson J, Lees KR, Lyden P, et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet 2014;384:1929-1935.
- 22. Romano JG, Smith EE, Liang L, et al. Outcomes in mild acute ischemic stroke treated with intravenous thrombolysis: a retrospective analysis of the Get With the Guidelines-Stroke registry. JAMA Neurol 2015;72:423-431.
- 23. Wardlaw JM, Murray V, Berge E, del Zoppo GJ. Thrombolysis for acute ischaemic stroke. Cochrane Database Syst Rev 2014;CD000213.
- 24. Schwamm LH, Wu O, Song SS, et al. Intravenous thrombolysis in unwitnessed stroke onset: MR WITNESS trial results. Ann Neurol 2018.
- 25. Nogueira RG, Jadhav AP, Haussen DC, et al. Thrombectomy 6 to 24 Hours after Stroke with a Mismatch between Deficit and Infarct. N Engl J Med 2018;378:11-21.
- 26. Topcuoglu MA, Arsava EM, Ozdemir AO, et al.: Intravenous Thrombolytic Therapy in Acute Stroke: Problems and Solutions. Turk J Neurol 2017;23:162-175.
- 27. Hametner C, Kellert L, Veltkamp R, et al. Prolonged low-dose thrombolysis in posterior circulation stroke. Neurocrit Care 2014;21:114-118.
- 28. Topcuoglu MA, Arsava EM, Ozdemir AO, et al. Intravenous Thrombolytic Therapy in Acute Stroke: Frequent Systemic Problems and Solution. Turk J Neurol 2018;24:13-25.
| APA | Atmaca M, kocaturk o, MARUFOĞLU F, KÖYLÜOĞLU A, ÇOLAK ATMACA M, BALDUZ M, ÖNALAN A, KARGI E (2019). Experience of Intravenous Thrombolytic Treatment in Sanliurfa: A Prospective Study. , 19 - 25. 10.4274/tnd.galenos.2018.69335 |
| Chicago | Atmaca Murat Mert,kocaturk ozcan,MARUFOĞLU Fidan,KÖYLÜOĞLU Ahmet Candan,ÇOLAK ATMACA Melek,BALDUZ Metin,ÖNALAN AYŞENUR,KARGI Emine Experience of Intravenous Thrombolytic Treatment in Sanliurfa: A Prospective Study. (2019): 19 - 25. 10.4274/tnd.galenos.2018.69335 |
| MLA | Atmaca Murat Mert,kocaturk ozcan,MARUFOĞLU Fidan,KÖYLÜOĞLU Ahmet Candan,ÇOLAK ATMACA Melek,BALDUZ Metin,ÖNALAN AYŞENUR,KARGI Emine Experience of Intravenous Thrombolytic Treatment in Sanliurfa: A Prospective Study. , 2019, ss.19 - 25. 10.4274/tnd.galenos.2018.69335 |
| AMA | Atmaca M,kocaturk o,MARUFOĞLU F,KÖYLÜOĞLU A,ÇOLAK ATMACA M,BALDUZ M,ÖNALAN A,KARGI E Experience of Intravenous Thrombolytic Treatment in Sanliurfa: A Prospective Study. . 2019; 19 - 25. 10.4274/tnd.galenos.2018.69335 |
| Vancouver | Atmaca M,kocaturk o,MARUFOĞLU F,KÖYLÜOĞLU A,ÇOLAK ATMACA M,BALDUZ M,ÖNALAN A,KARGI E Experience of Intravenous Thrombolytic Treatment in Sanliurfa: A Prospective Study. . 2019; 19 - 25. 10.4274/tnd.galenos.2018.69335 |
| IEEE | Atmaca M,kocaturk o,MARUFOĞLU F,KÖYLÜOĞLU A,ÇOLAK ATMACA M,BALDUZ M,ÖNALAN A,KARGI E "Experience of Intravenous Thrombolytic Treatment in Sanliurfa: A Prospective Study." , ss.19 - 25, 2019. 10.4274/tnd.galenos.2018.69335 |
| ISNAD | Atmaca, Murat Mert vd. "Experience of Intravenous Thrombolytic Treatment in Sanliurfa: A Prospective Study". (2019), 19-25. https://doi.org/10.4274/tnd.galenos.2018.69335 |
| APA | Atmaca M, kocaturk o, MARUFOĞLU F, KÖYLÜOĞLU A, ÇOLAK ATMACA M, BALDUZ M, ÖNALAN A, KARGI E (2019). Experience of Intravenous Thrombolytic Treatment in Sanliurfa: A Prospective Study. Türk Nöroloji Dergisi, 25(1), 19 - 25. 10.4274/tnd.galenos.2018.69335 |
| Chicago | Atmaca Murat Mert,kocaturk ozcan,MARUFOĞLU Fidan,KÖYLÜOĞLU Ahmet Candan,ÇOLAK ATMACA Melek,BALDUZ Metin,ÖNALAN AYŞENUR,KARGI Emine Experience of Intravenous Thrombolytic Treatment in Sanliurfa: A Prospective Study. Türk Nöroloji Dergisi 25, no.1 (2019): 19 - 25. 10.4274/tnd.galenos.2018.69335 |
| MLA | Atmaca Murat Mert,kocaturk ozcan,MARUFOĞLU Fidan,KÖYLÜOĞLU Ahmet Candan,ÇOLAK ATMACA Melek,BALDUZ Metin,ÖNALAN AYŞENUR,KARGI Emine Experience of Intravenous Thrombolytic Treatment in Sanliurfa: A Prospective Study. Türk Nöroloji Dergisi, vol.25, no.1, 2019, ss.19 - 25. 10.4274/tnd.galenos.2018.69335 |
| AMA | Atmaca M,kocaturk o,MARUFOĞLU F,KÖYLÜOĞLU A,ÇOLAK ATMACA M,BALDUZ M,ÖNALAN A,KARGI E Experience of Intravenous Thrombolytic Treatment in Sanliurfa: A Prospective Study. Türk Nöroloji Dergisi. 2019; 25(1): 19 - 25. 10.4274/tnd.galenos.2018.69335 |
| Vancouver | Atmaca M,kocaturk o,MARUFOĞLU F,KÖYLÜOĞLU A,ÇOLAK ATMACA M,BALDUZ M,ÖNALAN A,KARGI E Experience of Intravenous Thrombolytic Treatment in Sanliurfa: A Prospective Study. Türk Nöroloji Dergisi. 2019; 25(1): 19 - 25. 10.4274/tnd.galenos.2018.69335 |
| IEEE | Atmaca M,kocaturk o,MARUFOĞLU F,KÖYLÜOĞLU A,ÇOLAK ATMACA M,BALDUZ M,ÖNALAN A,KARGI E "Experience of Intravenous Thrombolytic Treatment in Sanliurfa: A Prospective Study." Türk Nöroloji Dergisi, 25, ss.19 - 25, 2019. 10.4274/tnd.galenos.2018.69335 |
| ISNAD | Atmaca, Murat Mert vd. "Experience of Intravenous Thrombolytic Treatment in Sanliurfa: A Prospective Study". Türk Nöroloji Dergisi 25/1 (2019), 19-25. https://doi.org/10.4274/tnd.galenos.2018.69335 |
