Abstract
Background: Stroke has been a major concern worldwide. Thrombolysis has brought a new direction for management in acute ischemic stroke. It has served as a catalyst for major changes in the management of acute stroke. It is at the forefront with good evidence of its efficacy within 4.5 hours of symptom onset.
Aim: To study the outcome of thrombolysis of acute ischemic stroke with alteplase after 3 months. We also assessed associated complications of alteplase.
Methods: We have taken data of acute ischemic stroke patients who underwent thrombolysis with alteplase. Data collection was retrospective and analysed from January 2010 to April 2015.Primary outcome was measured with NIH Stroke Scale (NIHSS) at admission and at discharge; and secondary outcome was measured with modified Rankin score (mRS) and NIHSS at three months.
Results: We collected data of consecutive 64 patients who received alteplase for thrombolysis. Mean age was 59.05 years with a standard deviation (SD) of 12.7 with majority of them being males. Mean duration of hospital stay was eight days. Mean time of onset of symptoms to arrival to ED was 2 hours (SD-1.0) and onset to window period were 4.1 hours. Complications were noted in 19 patients (29.7%) and more common noted one was asymptomatic haemorrhagic transformation.
Conclusions: Stroke thrombolysis is a safe and effective therapy in actual practice. Its role has helped in reduction of morbidity and mortality associated with acute ischemic stroke.
Keywords: Alteplase, Thrombolysis, Acute ischemic stroke, Complications, NIHSS, mRS
References
- Johnston SC, Mendis S, Mathers CD. Global variation in stroke burden and mortality: estimates from monitoring, surveillance, and modelling. Lancet Neurol. 2009.
- Hill MD, Buchan AM. Thrombolysis for acute ischemic stroke: Results of the Canadian Alteplase for Stroke Effectiveness Study. Cmaj. 2005;172(10):1307-1312.
- Röther J, Ford GA, Thijs VNS. Thrombolytics in acute ischaemic stroke: Historical perspective and future opportunities. Cerebrovasc Dis. 2013.
- Grinnon ST, Miller K, Marler JR, et al. National Institute of Neurological Disorders and Stroke Common Data Element Project - approach and methods. Clin Trials. 2012;9(3):322-329.
- Albers GW, Olivot JM. Intravenous alteplase for ischaemic stroke. Lancet. 2007.
- Toni D, Ahmed N, Anzini A, et al. Intravenous thrombolysis in young stroke patients results from the SITS-ISTR. Neurology. 2012.
- Volans AP. An analysis of outcomes of emergency physician/department-based thrombolysis for stroke. Emerg Med J. 2012;29(8):640-643.
- Lees KR, von Kummer R, Bluhmki E, et al. Thrombolysis with Alteplase 3 to 4.5 Hours after Acute Ischemic Stroke. N Engl J Med. 2008.
- Schmülling S, Grond M, Rudolf J, Heiss WD. One-year follow-up in acute stroke patients treated with rtPA in clinical routine. Stroke. 2000.
- Hacke W, Albers G, Al-Rawi Y, et al. The Desmoteplase in Acute Ischemic Stroke Trial (DIAS): A phase II MRI-based 9-hour window acute stroke thrombolysis trial with intravenous desmoteplase. Stroke. 2005.
- Terkelsen T, Schmitz ML, Simonsen CZ, et al. Thrombolysis in acute ischemic stroke is associated with lower long-term hospital bed day use: A nationwide propensity score-matched follow-up study. Int J Stroke. 2016.
- W, A. P, M. K, et al. Quality indicators of intravenous thrombolysis from North India. Ann Indian Acad Neurol. 2017.
- Urrutia VC, Faigle R, Zeiler SR, et al. Safety of intravenous alteplase within 4.5 hours for patients awakening with stroke symptoms. PLoS One. 2018.
- Prasad Jagini S, I. S. Clinical profile of patients with acute ischemic stroke receiving intravenous thrombolysis (rtPA-alteplase). Int J Adv Med. 2018.
- Huded V, R DS, Nagarajaiah R, Zafer S, Nair R, Acharya H. Thrombolysis in acute ischemic stroke: Experience from a tertiary care centre in India. J Neurosci Rural Pract. 2014.
- Padma M, Singh M, Bhatia R, et al. Hyperacute thrombolysis with IV rtPA of acute ischemic stroke: Efficacy and safety profile of 54 patients at a tertiary referral center in a developing country. Neurol India. 2007.
- Sobesky J, Frackowiak M, Zaro Weber O, et al. The cologne stroke experience: Safety and outcome in 450 patients treated with intravenous thrombolysis. Cerebrovasc Dis. 2007.
- Thomalla G, Schwark C, Sobesky J, et al. Outcome and symptomatic bleeding complications of intravenous thrombolysis within 6 hours in MRI-selected stroke patients: Comparison of a German multicenter study with the pooled data of ATLANTIS, ECASS, and NINDS tPA trials. Stroke. 2006.
- Schaad H, Zwahlen M, Fischer U, et al. Impact of Thrombolysis on Stroke Outcome at 12 Months in a Population. Stroke. 2012;43(4):1039-1045.
Corresponding Author
Balakrishnan Ramasamy
Department of Neurology, PSG Institute of Medical Sciences and Research, Tamil Nadu – 641004, INDIA,
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v7i3.91
