Meza CME, Meza MA, Ramón MH

Language: Spanish
References: 16
Page: 49-58
PDF size: 152.42 Kb.

ABSTRACT

Introduction: Intravenous thrombolysis has been extended from 3 to 4.5 h from the stroke symtoms. However, this indication has not been approved by all regulatory agencies in the world, due to the lack of scientific experience.
Objective: To determine the efficacy of thrombolytic therapy with alteplase in adult patients diagnosed With Acute Ischemic Cerebral Vascular Event (AICVE) in window period, which underwent intravenous thrombolysis in the period of 3 to 4.5 hours of onset of neurological symptoms.
Methods: A cross-sectional retrospective study was conducted by reviewing records of patients initially diagnosed with Acute Ischemic Cerebral Vascular Events in the Hospital San José in Monterrey, Hospital Zambrano Hellion and Hospital Metropolitano, who met the criteria specified in a period from January 2005 to June 2015. Independent variables such as age, previous functionality, presence of systemic arterial hypertension (SAH), diabetes mellitus (DM), dyslipidemia, active or inactive use of tobacco, atrial fibrillation, failure heart and aspirin use prior to stroke were analyzed. The outcome was measured by the Modified Rankin Scale (mRS) at 3 months by a telephone survey. Likewise, the presence of secondary complications to thrombolysis, specifically intracranial hemorrhage, symptomatic and fatal bleeding were analyzed too.
Results: Patients were divided into 2 groups: Early fibrinolytic therapy (less than 3 hours) and late fibrinolytic therapy (back to 3 hours, 3 to 4.5 hours). For both groups For the value of NIHSS income in the group early thrombolysis was 10.7 points (SD 4.18, p = 0.925) and 24 hours Post thrombolysis was 6.15 (5.09, p = 0.18) for the late thrombolysis group initial NIHSS was 11.3 (4.67) and post thrombolysis was 8.4 (6.07). In both groups, the majority of patients presented with Moderate AICVE , in the early thrombolysis group 18 patients (90%) were located in moderate AICVE (p = 0.40, ODD 3 CI 0.50-17.74), and the late Thrombolysis Group just 8 patients (75%) were placed in the same category (ODD 0.33, CI 0.05-1.97). As for the incidence of complications in the early thrombolysis group the incidence of intracranial hemorrhage was 4 cases (20%) (p = 0.71 ODD 0.58, CI 0.13-2.49) and in late thrombolysis Group were 6 cases ( 30%) (p = 0.71, ODD 1.71, CI 0.40-7.34). Likewise, for the NIHSS scale after 24 hours there is a distribution to lower values in the early Thrombolysis Group and a lowering effect complications presentation rates, although this effect was not significantly observed. For the severity of stroke, early thrombolysis patients were grouped into the mild NIHSS categories and in the lowest Rankin scores at 3 months.
Conclusion: Although the results are not significant, the trend seems to point back to that early thrombolysis is more effective than late thrombolysis, but a multicenter study should be done for increase the sample size and thus eliminate the bias caused by the low incidence of patients undergoing thrombolysis and then obtain statistically significant results and confirm the results that were observed in this study.

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