Ischemic stroke in Uruguay
First 34 cases of thrombolized patients at the Clinicas Hospital
Abstract
Introduction: ischemic stroke is a health issue of paramount importance in Uruguay and the world. It has been proved that intravenous thrombolysis reduces morbi-mortality and sequels in patients with severe ischemic strokes (evidence level: severe ischemic stroke).
Objectives: to analyse the cases of thrombolized ischemic strokes at the Clinicas Hospital and to assess the usefulness of the risk score to predict symptomatic intracranial hemorrhage in this population.
Method: descriptive, observational and prospective study. Population: thrombolized patients at the Clinicas Hospital during the 2010-2013 period of time. A risk score to predict symptomatic intracranial hemorrhage was applied to the entire thrombolized population. Statistical tests: chi-square test, student test and Wilcoxon test. The study considered p < 0,05 reflected statistically significant differences.
Results: thirty four thrombolized patients, average age was 67 years old, most of them were women, high percentage of severe ischemic strokes, average National Institute of Health Stroke Scale value upon admittance was 11, with statistically significant improvement trends. Main etiology: cardioembolism. Average symptom-to-needle time: 170 minutes. Intracranial Hemorrhage: eight patients (23.5%), four of which died. The risk score failed to predict the intracranial hemorrhage.
Conclusions: the percentage of thrombolized ischemic strokes has been gradually increasing at the Clinicas Hospital since the Ischemic Stroke Department was open, and current national figures match the international ones. Thrombolysis resulted in a statistically significant benefit in the NIHSS scale. The hemorrhage was similar to that described in international literature.
References
(2) Castillo J, Zarranz JJ, Larracoechea J. Enfermedades vasculares cerebrales. En: Zarranz JJ. Neurología. 3 ed. Madrid: Elsevier Science, 2004:357-435.
(3) Govan L, Langhorne P, Weir CJ; Stroke Unit Trialists Collaboration. Does the prevention of complications explain the survival benefit of organized inpatient (stroke unit) care?: further analysis of a systematic review. Stroke 2007; 38(9):2536-40.
(4) The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995; 333(24):1581-7.
(5) Hacke W, Kaste M, Fieschi C, Toni D, Lesaffre E, von Kummer R, et al. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. The European Cooperative Acute Stroke Study (ECASS). JAMA 1995; 274(13):1017-25.
(6) Hacke W, Kaste M, Fieschi C, von Kummer R, Davalos A, Meier D, et al. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators. Lancet 1998; 352(9136):1245-51.
(7) Hacke W, Donnan G, Fieschi C, Kaste M, von Kummer R, Broderick JP, et al; ATLANTIS Trials Investigators; ECASS Trials Investigators; NINDS rt-PA Study Group Investigators. Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet 2004; 363(9411):768-74.
(8) Lees KR, Bluhmki E, von Kummer R, Brott TG, Toni D, Grotta JC, et al; ECASS, ATLANTIS, NINDS and EPITHET rt-PA Study Group. Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Lancet 2010; 375(9727):1695-703.
(9) Del Zoppo GJ, Saver JL, Jauch EC, Adams HP Jr; American Heart Association Stroke Council. Expansion of the time window for treatment of acute ischemic stroke with intravenous tissue plasminogen activator: a science advisory from the American Heart Association/American Stroke Association. Stroke 2009; 40(8):2945-8.
(10) Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D, et al; ECASS Investigators. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 2008; 359(13):1317-29.
(11) Mazya M, Egido JA, Ford GA, Lees KR, Mikulik R, Toni D, et al; SITS Investigators. Predicting the risk of symptomatic intracerebral hemorrhage in ischemic stroke treated with intravenous alteplase: safe Implementation of Treatments in Stroke (SITS) symptomatic intracerebral hemorrhage risk score. Stroke 2012; 43(6):1524-31.
(12) Wardlaw JM, Dennis MS, Lindley RI, Sellar RJ, Warlow CP. The validity of a simple clinical classification of acute ischaemic stroke. J Neurol 1996; 243(3):274-9.
(13) Adams HP Jr, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, 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(1):35-41.
(14) Wahlgren N, Ahmed N, Dávalos A, Ford GA, Grond M, Hacke W, et al; SITS-MOST investigators. 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(9558):275-82.
(15) Figueroa Reyes T, Sáez D, Mansilla E, Sánchez R, Nogales Gaete J, Delgado I. Experiencia de trombolisis sistematizada en infarto cerebral agudo en un hospital público de Chile. Rev Méd Chile 2011; 139(9):1118-27.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
