RESUMO
BACKGROUND: Intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) reduces disability in patients with ischemic stroke. However, its implementation in Chilean public general hospitals has been slow and faces some difficulties. AIM: To analyze the results of an intravenous thrombolysis protocol implementation in a public general hospital. MATERIAL AND METHODS: During a lapse of 28 months a standardized protocol for intravenous thrombolysis implemented in the emergency room of a public hospital, was prospectively evaluated. Fifty four patients with ischemic stroke were treated and assessed three months later as outpatients. RESULTS: At three months of follow-up, 66.4% of patients subjected to thrombolysis had a favorable evolution, defined as having 0 to 1 points in the modified Rankin scale. Intracerebral hemorrhage rate was 11.1%, including 5.5% of symptomatic intracerebral hemorrhage. Four percent of patients had systemic bleeding complications after thrombolysis. The mortality rate was 14.8%. CONCLUSIONS: The success rates, mortality, and complications rate were comparable to the results obtained in international studies, despite of the absence of a stroke unit to manage stroke and its complications.
Assuntos
Isquemia Encefálica/tratamento farmacológico , Fibrinolíticos/uso terapêutico , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica/métodos , Ativador de Plasminogênio Tecidual/uso terapêutico , Adulto , Idoso , Encéfalo/diagnóstico por imagem , Isquemia Encefálica/complicações , Hemorragia Cerebral/etiologia , Hemorragia Cerebral/prevenção & controle , Progressão da Doença , Feminino , Hospitais Públicos , Humanos , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Acidente Vascular Cerebral/complicações , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Background: Intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) reduces disability in patients with ischemic stroke. However, its implementation in Chilean public general hospitals has been slow and faces some difficulties. Aim: To analyze the results of an intravenous thrombolysis protocol implementation in a public general hospital. Material and Methods: During a lapse of 28 months a standardized protocol for intravenous thrombolysis implemented in the emergency room of a public hospital, was prospectively evaluated. Fifty four patients with ischemic stroke were treated and assessed three months later as outpatients. Results: At three months of follow-up, 66.4% of patients subjected to thrombolysis had a favorable evolution, defined as having 0 to 1 points in the modified Rankin scale. Intracerebral hemorrhage rate was 11.1%, including 5.5% of symptomatic intracerebral hemorrhage. Four percent of patients had systemic bleeding complications after thrombolysis. The mortality rate was 14.8%. Conclusions: The success rates, mortality, and complications rate were comparable to the results obtained in international studies, despite of the absence of a stroke unit to manage stroke and its complications.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Ativadores de Plasminogênio/uso terapêutico , Terapia Trombolítica/métodos , Isquemia Encefálica/tratamento farmacológico , Acidente Vascular Cerebral/tratamento farmacológico , Fibrinolíticos/uso terapêutico , Fatores de Tempo , Índice de Gravidade de Doença , Infusões Intravenosas , Encéfalo/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Hemorragia Cerebral/etiologia , Hemorragia Cerebral/prevenção & controle , Isquemia Encefálica/complicações , Estudos Prospectivos , Reprodutibilidade dos Testes , Resultado do Tratamento , Progressão da Doença , Acidente Vascular Cerebral/complicações , Hospitais PúblicosRESUMO
The origin of 20% of ischemic strokes is a left ventricular thrombus. We report two patients with strokes originating from cardiac thrombi, treated in two different ways. A 42-year-old diabetic man admitted with a left parietal and occipital stroke. An echocardiogram showed a left ventricular thrombus. The patient was subjected to a surgical cardiac revascularization procedure and left ventricular thrombectomy. The postoperative evolution was uneventful and the patient was discharged on oral anticoagulation. On ambulatory follow up, no neurological deterioration was evidenced. A 38-year-old male admitted with an acute ischemic stroke, was subjected to thrombolysis with human plasminogen activator. An echocardiogram showed a left ventricular thrombus, considered the cause of the stroke. The patient was anticoagulated with heparin and discharged ten days after admission with oral anticoagulation. A new echocardiogram performed one month later, did not show the left ventricular thrombus.
Assuntos
Cardiopatias/complicações , Acidente Vascular Cerebral/terapia , Trombose/complicações , Adulto , Ecocardiografia , Ventrículos do Coração , Humanos , Masculino , Acidente Vascular Cerebral/etiologia , Terapia Trombolítica , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
The origin of 20% of ischemic strokes is a left ventricular thrombus. We report two patients with strokes originating from cardiac thrombi, treated in two different ways. A 42-year-old diabetic man admitted with a left parietal and occipital stroke. An echocardiogram showed a left ventricular thrombus. The patient was subjected to a surgical cardiac revascularization procedure and left ventricular thrombectomy. The postoperative evolution was uneventful and the patient was discharged on oral anticoagulation. On ambulatory follow up, no neurological deterioration was evidenced. A 38-year-old male admitted with an acute ischemic stroke, was subjected to thrombolysis with human plasminogen activator. An echocardiogram showed a left ventricular thrombus, considered the cause of the stroke. The patient was anticoagulated with heparin and discharged ten days after admission with oral anticoagulation. A new echocardiogram performed one month later, did not show the left ventricular thrombus.