Murat YILMAZ, Handan TEKER, Merve ÖNERLİ YENER, Edip GÜLTEKİN, Muhammed Nur ÖGÜN

Intravenous Thrombolytic Therapy for Acute Ischemic Stroke: Experiences of a Tertiary Hospital in Turkey

Objective: The aim of this study is to retrospectively collect the data of 95 patients with ischemic stroke who received intravenous (IV) tissue plasminogen activator (tPA) therapy between 2015 and 2019 in our clinic, to present the experiences of our clinic. Method: The data of the patients, who applied to our clinic with the diagnosis of acute ischemic stroke between 2015 and 2019, who received thrombolytic therapy, were reviewed retrospectively. General socio-demographic data, clinical features, National Institute Health Scale Scores (NIHSS), Alberta Stroke Program Early Computed Tomography (ASPECT) scores, symptom-to-door, door-to-needle, and symptom-to-needle times, treatment-related complications and Modified Rankin Scores (mRS) at the third month after treatment were evaluated. Results: Procedure-related major or minor bleeding complications developed in 18% of our patients who received tPA therapy. The mortality rate was 15% and 6.3% of these were caused by cerebral hemorrhage due to treatment complications and 8.7% were due to other systemic complications. Logistic regression analysis revealed that only the ASPECT score from factors that we found to be effective on the risk of developing complications was a highly effective factor in the development of complications (p=0.034, OR: 2.131). Conclusions: This study has shown that our results are generally compatible with the literature. Although there is an increase in the number of patients receiving tPA in our clinic every year, we aim to increase awareness of this therapy clinically and to expand the use of IV thrombolytic therapy in selected patients.

Akut İskemik İnmede İntravenöz Trombolitik Tedavi: Türkiye'deki Üçüncü Basamak Bir Hastanenin Deneyimleri

Giriş: Bu çalışmanın amacı, kliniğimizde 2015-2019 yılları arasında intravenöz (IV) doku plazminojen aktivatör (tPA) tedavisi alan 95 iskemik inmeli hastanın verilerini retrospektif olarak toplamak ve kliniğimizin deneyimlerini sunmaktır. Yöntemler: 2015-2019 yılları arasında akut iskemik inme tanısı ile kliniğimize başvuran trombolitik tedavi alan hastaların verileri retrospektif olarak incelendi. Genel sosyo-demografik veriler, klinik özellikler, National Institute Health Scale Score (NIHSS), Alberta Stroke Program Early Computed Tomography (ASPECT) skorları, kapı-iğne zamanı, semptom-iğne zamanı, tedaviye bağlı komplikasyonlar ve tedaviden sonraki üçüncü aydaki Modifiye Rankin Skoru (mRS) değerlendirildi. Bulgular: tPA tedavisi alan hastalarımızın %18'inde işleme bağlı majör veya minör kanama komplikasyonları gelişti. Mortalite oranı %15 idi ve bunların %6,3'ü tedavi komplikasyonlarına bağlı beyin kanamasından ve %8,7'si diğer sistemik komplikasyonlardan kaynaklanıyordu. Lojistik regresyon analizi, komplikasyon gelişme riski üzerinde etkili bulduğumuz faktörlerden sadece ASPECT skorunun komplikasyon gelişiminde oldukça etkili bir faktör olduğunu ortaya koymuştur (p = 0,034, OR: 2,131). Sonuç: Bu çalışma, sonuçlarımızın genel olarak literatür ile uyumlu olduğunu göstermiştir. Kliniğimizde her yıl tPA alan hasta sayısında artış olmasına rağmen, klinik olarak bu tedavinin farkındalığını artırmayı ve seçilmiş hastalarda IV trombolitik tedavi kullanımını yaygınlaştırmayı hedefliyoruz.

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