Intavenous thrombolytic therapy in acute ischemic stroke, the experience of the Neurology Department of Karadeniz Technical University

Objective: Stroke is the third most common cause of death after coronary arter disease and cancer, takes the first place among the leading causes of disability. 80% of strokes are ischemic. The treatment of acute ischemic stroke with intravenous trombolytic therapy is one of the most effective approved methods of treatment. Our results are compared with the results of other studies in the world, short-term and long-term effectiveness and the side effects of the treatment are planned to be analyzed. Materials and methods: 44 patients were evaluated retrospectively from the hospital records who were assessed for ischemic stroke by physicians and trombolytic therapy was given between April 2007 and March 2013 at KTU, Faculty of Medicine, Farabi Hospital. The patients found to be suitable for the treatment was applied within 3 hours of the onset of symptoms until the year 2012, after the indication for the drug was taken for the first 4,5 hours was applied within 4,5 hours to the treatment of intravenous alteplase 0.9 mg/kg (maximum 90 mg). The efficacy of the treatment, is evaluated with NIHSS and mRS scores and, reliability of the treatment was considered intracranial hemorrhage and side effects after thrombolitic therapy. The relationship between demographic characteristics of the patients, stroke risc factors, initial clinical status (stroke severity), the presence of early infarct and the start of treatment period, the efficacy and safety of the treatment are also examined. Findings: Total 44 patients (20 female and 24 male) received thrombolytic therapy, of whom mean age was 65.09±13.82. Of patients, hypertension in 31 (70.45 %), diabetes mellitus in 9 (20.45 %), hyperlipidemia in 15 (34.09 %), atrial fibrilation in 12 (27.27 %), use of ASA in 21 (47.33 %) and CT or MRI findings of early infarct in 12 (27.27 %) were found. Pre-treatment values of mean NIHSS and mRS was 10.64±5.30 and 3.34±1.18 consequently. Average of symptom-to-door time, door-to-needle time and symptom-to-needle time were 75.02±38.13, 68.84±28.96 and 142.95±39.74 minutes respectively. The number of the patients that have 2 points and below mRS scores was 12 (27.27 %). In terms of short-term efficacy after treatment at 24. Hour who more than 4 points decrease at NIHSS values were observed in 21 patients (48 %). For long-term efficacy, 22 patients (50 %) mRS values were 2 and below (indipendently sustain of activities of daily living). 12 patients (27.27 %) died. 3. month efficacy of the treatment was 71.43 % on the patients that was treated in 90 minutes and was 45.94 % on patients that was treated after 90 minutes. This difference was not statistically significant. The effectiveness of the treatment in patients that have early infarct signs on neuroimaging was less at the 3. month (16.7 % versus 62.5 %, p=0.018). There was no relationship between age, gender, hypertention, diabetes mellitus, hyperlipidemi, atrial fibrillation, pre-treatment ASA use, treatment starting time and admission NIHSS values and, the patients that sustain daily living activities independently. It was found that 10 patients (22,73 %) had intracranial hemorrhage after the treatment and 3 of them (6.82 %) had an increase of 4 points and above NIHSS values with neurological deterioration (symptomatic hemorrhage). One patient with symptomatic hemorrhage was died. Intracranial hemorrhage was more at patients with atrial fibrillation (50 % versus 12.5 %, p=0.015). There was no relationship between intracranial hemorrhage and, age, gender, hypertention, diabetes mellitus, hyperlipidemi, pre-treatment ASA use, treatment starting time and admission NIHSS values of the patients. However, there was no intracranial hemorrhage in patients that was treated in 90 minutes. Results: Our results suggest that trombolytic therapy is an efficient and reliable method in acute ischemic stroke. Patients with acute ischemic stroke symptoms should be evaluated without delay, intravenous trombolytic therapy should be applied in appropriate patients and should be closely monitored. Key words: Thrombolytic therapy, Tissue plasminogen activator, Acute ischemic stroke