Engin ÖZAKIN, Atilla ÖZCAN ÖZDEMİR, Deniz Gören ŞAHİN, Olga Meltem AKAY, Yasemin DİNÇ, Arif Alper CEVİK, Nurdan ACAR, Filiz Baloğlu KAYA, Muzaffer BİLGİN

Trombolitik Tedavi Alan Akut Inmeli Hastalarda Tromboleastografi ile Klinik Sonlanım Arasındaki Ilişkinin Araştırılması

Tromboelastografi (TEG), pıhtı oluşumunun elastikiyetini ve dinamiklerini ve oluşan pıhtıların gücünü ve stabilitesini ölçen hemostatik bir testtir. Trombolitik tedavi alan akut iskemik inmede TEG hakkında sınırlı veri vardır. Bu çalışmada, trombolitik tedavi alan akut inmeli hastalarda rotasyonel trombelastografi (ROTEM) yöntemi ile elde edilen pıhtılaşma parametrelerinin klinik sonuç ve intraserebral kanama üzerine etkisi araştırıldı. Çalışma, Haziran 2013-Mart 2014 tarihleri arasında rtPA tedavisi alan akut inmeli 29 hasta içermiştir. Hastalardan trombolitik tedaviye başlamadan önce kan örnekleri alındı. ROTEM® ile; INTEM ve EXTEM analizi, CT (pıhtılaşma süresi = sn), CFT (pıhtı oluşum süresi = sn) ve MCF (maksimum pıhtı sertliği = mm) parametreleri test edildi. Hastaların demografik bilgileri, başvuru sırasındaki ve 24 saat sonra NIHSS skorları, 3.ay mRs ve beyin tomografi sonuçları kaydedildi. Ayrıca ROTEM yöntemiyle elde edilen veriler kontrol grup ile karşılaştırıldı.Sağlıklı gruba göre iskemik inme hastalarında düşük intemCT (p <0.05), extemCT (p = 0.01) ve extemCFT (p <0.05) ve daha yüksek extemMCF (p <0.05) vardı. Bu sonuçlar hiper pıhtılaşabilirlik ile tutarlıydı. TEG parametreleri, trombolitik tedavi alan hastalarda semptomatik kanama, mortalite ve 3 ay sonraki kötü klinik ile korele değildi. Trombelastografi, iskemik inmeli hastaların hiper pıhtılaşma durumunda olduğunu gösterir. Bu gözlemi ve klinik sonlanım ile ilişkisinin incelenmesi için daha ileri çalışmalar gereklidir.

Anahtar Kelimeler:

Tromboelastografi, inme, mortalite, intraserebral kanama

The Relationship Between Thromboelastography and Clinical Outcome in Acute Stroke Patients Receiving Thrombolytic Therapy

Thromboelastography (TEG) is a hemostatic test that measures the shear elasticity and the dynamics of clot formation and the strength and stability of formed clot. There are limited data about TEG in acute ischemic stroke who receives thrombolytic therapies. This study aimed to investigate the impact of coagulation parameters obtained by rotational thrombelastography (ROTEM) method on clinical outcome and intracerebral hemoorage in acute stroke patients receiving thrombolytic treatment. The study included 29 patients with acute stroke who received rtPA treatment between June 2013 and March 2014. Blood samples were taken from the patients before starting thrombolytic therapy. By ROTEM®; INTEM and EXTEM analysis, the parameters of CT (clotting time=sec), CFT (clot formation time=sec) and MCF (maximum clot firmness=mm) were tested. The demographic information of patients, NIHSS scores at the time and 24 hours after the admission and brain tomography results were recorded. In addition, the data obtained by ROTEM method were compared with the normal group.Compared to healthy group, ischemic stroke patients had lower intemCT (p<0.05), extemCT (p=0.01) and extemCFT (p<0.05) and higher extemMCF (p<0.05). These results were consistent with hypercoagulability. TEG parameters were not correlated with symptomatic hemorrhage, mortality and poor outcome in patients who receive trombolytic treatment.Thrombelastography shows that patients with ischemic stroke are in hypercoagulable state. Further studies are needed to examine this observation and its relationship with clinical outcome

Keywords:

thromboelastography, stroke, mortality, hemorrhage,

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