Short Term Outcome and Associated factor Among Stroke Patien Given Trombolysis

Authors

  • Florilyn Joyce C Bentrez Baguio General Hospital and Medical Center
    Philippines

DOI:

https://doi.org/10.23917/bik.v18i1.5547

Keywords:

thrombolysis, outcome, Stroke, rTPA, Philippines

Abstract

The study aimed to investigate the short-term outcome and associated factors among acute ischemic stroke patients given rTPA (Recombinant tissue plasminogen activator).  This is a hospital-based cross-sectional retrospective study among 107 acute stroke patients given rTPA for a span of 3 years.  A favorable outcome is defined as the modified Rankin Scale (MRS) 0 to 2, while a score > 2 is defined as a poor outcome.  Mortality and adverse events were also documented. The majority (57%) had favorable outcomes on discharge. Initial stroke severity, stroke etiology, and presence of symptomatic Intracerebral hemorrhage (ICH) were significant factors for discharge outcome.  There was no significance as to age group and as to needle time of 0-3 hours versus 3-4.5 hours. The symptomatic ICH rate is 5.6%.  The overall mortality rate is 15.88% (47% due to malignant infarction, 17.6% due to symptomatic intracerebral hemorrhage (sICH), 23.52% due to basilar artery occlusion (BAO), and 11.7% due to medical causes). With a dose of 0.6mg/kg, our data indicate favorable discharge outcomes of thrombolysis.  A high baseline NIHSS, cardioembolic stroke etiology, and the presence of sICH are seen in patients with poor outcomes.  The rate of sICH is consistent with other literature, however with high mortality (100%).  Overall mortality is high primarily due to malignant infarct.   Institutions must be capacitated to address outcomes and complications of thrombolysis.

Downloads

Download data is not yet available.

References

Anderson, C. S., Robinson, T., Lindley, R. I., Arima, H., Lavados, P. M., Lee, T.-H., Broderick, J. P., Chen, X., Chen, G., Sharma, V. K., Kim, J. S., Thang, N. H., Cao, Y., Parsons, M. W., Levi, C., Huang, Y., Olavarría, V. V, Demchuk, A. M., Bath, P. M., … Chalmers, J. (2016). Low-Dose versus Standard-Dose Intravenous Alteplase in Acute Ischemic Stroke. The New England Journal of Medicine, 374(24), 2313–2323. https://doi.org/10.1056/NEJMoa1515510 PubMed: PMID: 27161018

Demaerschalk, B. M., Kleindorfer, D. O., Adeoye, O. M., Demchuk, A. M., Fugate, J. E., Grotta, J. C., Khalessi, A. A., Levy, E. I., Palesch, Y. Y., Prabhakaran, S., Saposnik, G., Saver, J. L., & Smith, E. E. (2016). Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke, 47(2), 581–641. https://doi.org/10.1161/STR.0000000000000086 PubMed: PMID: 26696642

Ghandehari, K. (2011). Barriers of thrombolysis therapy in developing countries. Stroke Research and Treatment, 2011, 686797. https://doi.org/10.4061/2011/686797 PubMed: PMID: 21603174

Hacke, W., Kaste, M., Bluhmki, E., Brozman, M., Dávalos, A., Guidetti, D., Larrue, V., Lees, K. R., Medeghri, Z., Machnig, T., Schneider, D., von Kummer, R., Wahlgren, N., & Toni, D. (2008). Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. The New England Journal of Medicine, 359(13), 1317–1329. https://doi.org/10.1056/NEJMoa0804656 PubMed: PMID: 18815396

Ifejika-Jones, N. L., Harun, N., Mohammed-Rajput, N. A., Noser, E. A., & Grotta, J. C. (2011). Thrombolysis with intravenous tissue plasminogen activator predicts a favorable discharge disposition in patients with acute ischemic stroke. Stroke, 42(3), 700–704. https://doi.org/10.1161/STROKEAHA.110.604108 PubMed: PMID: 21293014

Lees, K. R., Emberson, J., Blackwell, L., Bluhmki, E., Davis, S. M., Donnan, G. A., Grotta, J. C., Kaste, M., von Kummer, R., Lansberg, M. G., Lindley, R. I., Lyden, P., Murray, G. D., Sandercock, P. A. G., Toni, D., Toyoda, K., Wardlaw, J. M., Whiteley, W. N., Baigent, C., … Howard, G. (2016). Effects of Alteplase for Acute Stroke on the Distribution of Functional Outcomes: A Pooled Analysis of 9 Trials. Stroke, 47(9), 2373–2379. https://doi.org/10.1161/STROKEAHA.116.013644 PubMed: PMID: 27507856

Morihara, R., Kono, S., Sato, K., Hishikawa, N., Ohta, Y., Yamashita, T., Deguchi, K., Manabe, Y., Takao, Y., Kashihara, K., Inoue, S., Kiriyama, H., & Abe, K. (2016). Thrombolysis with Low-Dose Tissue Plasminogen Activator 3-4.5 h After Acute Ischemic Stroke in Five Hospital Groups in Japan. Translational Stroke Research, 7(2), 111–119. https://doi.org/10.1007/s12975-016-0448-8

Navarro, J. C., Baroque, A. C. 2nd, Lokin, J. K., & Venketasubramanian, N. (2014). The real stroke burden in the Philippines. International Journal of Stroke : Official Journal of the International Stroke Society, 9(5), 640–641. https://doi.org/10.1111/ijs.12287 PubMed: PMID: 24844610

Navarro, J. C., San Jose, M. C., Collantes, E., Macrohon-Valdez, M. C., Roxas, A., Hiyadan, J., Surdilla, A., Kalbi, M., De Leon-Gacrama, F., Escabillas, C. G., & Reandelar, M. (2018). Stroke thrombolysis in the Philippines. Neurology Asia, 23(2), 115–120. https://www.neurology-asia.org/articles/neuroasia-2018-23(2)-115.pdf

Powers, W. J., Rabinstein, A. A., Ackerson, T., Adeoye, O. M., Bambakidis, N. C., Becker, K., Biller, J., Brown, M., Demaerschalk, B. M., Hoh, B., Jauch, E. C., Kidwell, C. S., Leslie-Mazwi, T. M., Ovbiagele, B., Scott, P. A., Sheth, K. N., Southerland, A. M., Summers, D. V, & Tirschwell, D. L. (2018). 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke, 49(3), e46–e110. https://doi.org/10.1161/STR.0000000000000158 PubMed: PMID: 29367334

Putaala, J., Metso, T. M., Metso, A. J., Mäkelä, E., Haapaniemi, E., Salonen, O., Kaste, M., & Tatlisumak, T. (2009). Thrombolysis in young adults with ischemic stroke. Stroke, 40(6), 2085–2091. https://doi.org/10.1161/STROKEAHA.108.541185 PubMed: PMID: 19372446

Sandercock, P., Wardlaw, J. M., Lindley, R. I., Dennis, M., Cohen, G., Murray, G., Innes, K., Venables, G., Czlonkowska, A., Kobayashi, A., Ricci, S., Murray, V., Berge, E., Slot, K. B., Hankey, G. J., Correia, M., Peeters, A., Matz, K., Lyrer, P., … Arauz, A. (2012). The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial. Lancet (London, England), 379(9834), 2352–2363. https://doi.org/10.1016/S0140-6736(12)60768-5 PubMed: PMID: 22632908

Saposnik, G., Gladstone, D., Raptis, R., Zhou, L., & Hart, R. G. (2013). Atrial fibrillation in ischemic stroke: predicting response to thrombolysis and clinical outcomes. Stroke, 44(1), 99–104. https://doi.org/10.1161/STROKEAHA.112.676551 PubMed: PMID: 23168456

Suwanwela, N. C., & Poungvarin, N. (2016). Stroke burden and stroke care system in Asia. Neurology India, 64 Suppl, S46-51. https://doi.org/10.4103/0028-3886.178042 PubMed: PMID: 26954968

Tissue plasminogen activator for acute ischemic stroke. (1995). The New England Journal of Medicine, 333(24), 1581–1587. https://doi.org/10.1056/NEJM199512143332401 PubMed: PMID: 7477192

Toni, D., Ahmed, N., Anzini, A., Lorenzano, S., Brozman, M., Kaste, M., Mikulik, R., Putaala, J., & Wahlgren, N. (2012). Intravenous thrombolysis in young stroke patients: results from the SITS-ISTR. Neurology, 78(12), 880–887. https://doi.org/10.1212/WNL.0b013e31824d966b PubMed: PMID: 22402853

Tsivgoulis, G., Katsanos, A. H., Zand, R., Sharma, V. K., Köhrmann, M., Giannopoulos, S., Dardiotis, E., Alexandrov, A. W., Mitsias, P. D., Schellinger, P. D., & Alexandrov, A. V. (2017). Antiplatelet pretreatment and outcomes in intravenous thrombolysis for stroke: a systematic review and meta-analysis. Journal of Neurology, 264(6), 1227–1235. https://doi.org/10.1007/s00415-017-8520-1 PubMed: PMID: 28550481

Wang, X.-G., Zhang, L.-Q., Liao, X.-L., Pan, Y.-S., Shi, Y.-Z., Wang, C.-J., Wang, Y.-L., Liu, L.-P., Zhao, X.-Q., Wang, Y.-J., Li, D., & Wang, C.-X. (2015). Unfavorable Outcome of Thrombolysis in Chinese Patients with Cardioembolic Stroke: a Prospective Cohort Study. CNS Neuroscience & Therapeutics, 21(8), 657–661. https://doi.org/10.1111/cns.12421

Yamaguchi, T., Mori, E., Minematsu, K., Nakagawara, J., Hashi, K., Saito, I., & Shinohara, Y. (2006). Alteplase at 0.6 mg/kg for acute ischemic stroke within 3 hours of onset: Japan Alteplase Clinical Trial (J-ACT). Stroke, 37(7), 1810–1815. https://doi.org/10.1161/01.STR.0000227191.01792.e3 PubMed: PMID: 16763187

Downloads

Submitted

2024-06-22

Accepted

2024-11-23

Published

2025-01-30

How to Cite

Bentrez, F. J. C. (2025). Short Term Outcome and Associated factor Among Stroke Patien Given Trombolysis. Jurnal Berita Ilmu Keperawatan, 18(1), 56–68. https://doi.org/10.23917/bik.v18i1.5547

Issue

Section

Articles