Dependence of the effectiveness of thrombolytic therapy at ischemic stroke from clinical and paraclinical predictors
DOI:
https://doi.org/10.15587/2313-8416.2015.56428Keywords:
Actilyse, alteplase, thrombolytic therapy, brain infraction, inshemic stroke, predictors of effectivenessAbstract
The aim of the work. The aim of the work is an assessment of informativeness of several clinical and paraclinical predictors in prognostics of the results of effectiveness of thrombolytic therapy at the most acute period of ishemic stroke with the further definition of the most significant ones for achieving the least neurologic deficiency.
Methods of research: There were retrospectively considered 61 patients 60,5±7,8 years old with ishemic stroket who sucsessfully underwent thrombolytic therapy as an intravenous administration of Actilyse. These patients demonstrated the next factors of gemostasis: prothrombin time, prothrombin index, fibrinogen. For the research there were also used the scales of neurological deficiency activisation (Rankin and NIHSS); ultrasound of the magistral arteries and extracranial CT of brain; methods of mathematical statistics (the definition of chances and confidence intervals ratio, Pirson and Student criteria, verification of hypothesis about the law of distribution and equality of the mean values in the both samplings.
Results. There were defined the most informative factors in prognostication of the good result after thrombolytic therapy. There was formed the list of output factors that the results of actilyse thrombolytic therapy effectiveness in Lviv region are depending on. There was grounded the necessity of laboratory data monitoring in patients with stroke for receiving the best results of thrombolytic therapy.
There was established that thrombolytic therapy of ishemic stroke must begin as early as possible (in computed tomography department if possible) for receiving the maximal effectiveness. There was detected that ultrasound of magistral vessels that supply brain with blood is necessary for all patients who are candidates for thrombolytic therapy because the stenosis of the vessel lumen more than 60 % significantly worsens an effectiveness of treatment
References
Kuznetsov, A. N. (2004). Tserebralnaia embolyia: proshloe, nastoiashchee, budushchee problemy. Nevroloh. Zhurnal, 5, 4–11.
Shulha, O. D. (2008). Faktory, shcho vplyvaiut na perebih ta rezultat ishemichnoho insultu. Mizhnarodnyi nevrolohichnyi zhurnal, 6, 27–30. Available at: http://www.mif-ua.com/archive/article/7513
Husev, E. Y., Skvortsova, V. Y. (2001). Ishemyia holovnoho mozgha. Moscow: Medytsyna, 325. Available at: https://vk.com/doc29370700_301660821?hash=48ef68632745343646&dl=f38ebe7db2d6f4c773
Vereshchahyn, N., Pyradov, M. (2007). Intensyvnaia terapyia ostrykh narushenyi mozghovoho krovoobrashchenyia. Medytsyna neotlozhnykh sostoianyi, 2, 92–97. Available at: http://www.emergencymed.org.ua/j_pdf/2007_2_92_97.pdf
Clark, W. M., Williams, B. J., Selzer, K. A., Zweifler, R. M., Sabounjian, L. A., Gammans, R. E. (1999). A Randomized Efficacy Trial of Citicoline in Patients With Acute Ischemic Stroke. Stroke, 30 (12), 2592–2597. doi: 10.1161/01.str.30.12.2592
Chaturvedi, S., Bertasio, B., Femino, L. (1998). Emergency physician attitudes toward thrombolytic therapy in acute stroke. Journal of Stroke and Cerebrovascular Diseases, 7 (6), 442–445. doi: 10.1016/s1052-3057(98)80129-8
Karger, S. (2008). Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovascular diseases, 25 (5), 457–507. doi: 10.1159/000131083
Yavorska, V. O., Bodnar, O. B., Hrebeniuk, A. V. et. al (2013). Suchasni pryntsypy diahnostyky ta likuvannia khvorykh iz hostrym ishemichnym insultom ta TIA. Novyny medytsyny i farmatsii, 438, 55–78.
Shkliaieva, O. P. (2013). Osoblyvosti perebihu arterialnoi hipertenzii v hostromu periodi ishemichnoho insultu u khvorykh z fibryliatsiieiu. Vol. 22. NMAPO im. P. L. Shupyka, 201–207. Available at: http://nbuv.gov.ua/j-pdf/Znpsnmapo_2013_22(2)__33.pdf
Zozulia, Y. S., Bobrova, V. Y. (2000). Osobennosty vosstanovlenyia narushennykh funktsyi u bolnykh mozghovymy insultamy. Ukrainskyi visnyk psykhonevrolohii, 8, 28–29.
Panteleienko, L. V., Sokolova, L. I. (2010) Funktsionalnyi vykhid i yakist zhyttia cherez 6 misiatsiv pislia podii u khvorykh, shcho perenesly ishemichnyi insult, zalezhno vid stati. Medytsyna, 34, 56–68.
Kozolkin, O. A., Kuznietsov, A. A., Ruban, K. S. (2012). Kliniko-paraklinichna kharakterystyka ta prohnozuvannia naslidku hostroho periodu mozkovoho ishemichnoho supratentorialnoho insultu za naiavnosti stresovoi hiperhlikemii bez tsukrovoho diabetu. Mizhnarodnyi nevrolohichnyi zhurnal, 5, 61–67.
Murashko, N. K., Shkliaieva, O. P. (2013). Kliniko-nevrolohichni osoblyvosti rozvytku ishemichnoho insultu u khvorykh z fibryliatsiieiu peredserd. Likar. Sprava, 1, 77–82.
Pashkovska, N. V., Pashkovskyi, V. M. (2012). Suchasni pidkhody do likuvannia ta profilaktyky ishemichnoho insultu u khvorykh na tsukrovyi diabet. Praktychna anhiolohiia, 3, 24–30.
Dziak, L. A., Tsurkalenko, E. S. (2009). Insult u molodykh patsyentov. Zdorovia Ukrainy, 5/1, 12–15. Available at: http://health-ua.com/article/3622.html
Ingalsbe, G. (2015). Effect of Treatment Delay, Age, and Stroke Severity on the Effects of Intravenous Thrombolysis with Alteplase for Acute Ischaemic Stroke: A Meta-analysis of Individual Patient Data from Randomized Trials. The Journal of Emergency Medicine, 48 (5), 650. doi: 10.1016/j.jemermed.2015.03.037
Hodgson, C. S. (2007). To FAST or Not to FAST? Stroke, 38 (10), 2631–2632. doi: 10.1161/strokeaha.107.488809
Ozdemir, O., Giray, S., Arlier, Z., Baş, D. F., Inanc, Y., Colak, E. (2015). Predictors of a Good Outcome after Endovascular Stroke Treatment with Stent Retrievers. The Scientific World Journal, 2015, 1–9. doi: 10.1155/2015/403726
Šaňák, D., Herzig, R., Zapletalová, J., Horák, D., Král, M., Školoudík, D. et. al (2011). Predictors of good clinical outcome in acute stroke patients treated with intravenous thrombolysis. Acta Neurologica Scandinavica, 123 (5), 339–344. doi: 10.1111/j.1600-0404.2010.01401.x
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