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Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
[The efficacy of systemic thrombolysis in patients with cardioembolic stroke]
S V Kotov1, E V Isakova1, Yu A Belova1
1Vladimirsky Moscow Regional Scientific Research Clinical Institute, Moscow, Russia.
Insights
Systemic thrombolytic therapy (STLT) is effective for cardioembolic stroke (CE) and other ischemic stroke (IS) subtypes. This treatment improves patient outcomes and functional recovery, with comparable safety across different IS types.
Area of Science:
- Neurology
- Cardiology
- Internal Medicine
Background:
- Ischemic stroke (IS) encompasses various subtypes, with cardioembolic stroke (CE) posing unique challenges.
- Systemic thrombolytic therapy (STLT) is a critical treatment for acute IS, but its efficacy across different subtypes requires further investigation.
Purpose of the Study:
- To compare the efficacy and safety of STLT in patients with CE IS versus other IS pathogenic subtypes.
- To evaluate the impact of STLT on neurological status and functional recovery in different IS groups.
Main Methods:
- A cohort of 147 patients (37 with CE IS, 110 with other IS subtypes) received STLT.
- Neurological status was assessed using the National Institutes of Health Stroke Scale (NIHSS) and Rankin scale.
Main Results:
- Overall mortality was 14.3%, with no significant difference in lethality or STLT tolerability between CE IS and other IS subtypes.
- Survivors showed significant improvement in NIHSS scores, indicating better neurological function post-treatment, even with initially higher scores in the CE IS group.
- Symptomatic hemorrhagic transformation (SHT) was the cause of death in 11 patients.
Conclusions:
- STLT is effective in treating patients with CE IS, comparable to other IS subtypes.
- The study indicates an increased frequency of favorable functional recovery in CE IS patients treated with STLT.
- STLT demonstrates a favorable safety and efficacy profile across diverse ischemic stroke etiologies.
Aim:
To compare the efficacy and safety of systemic thrombolytic therapy (STLT) in patients with cardioembolic stroke (CE) versus other pathogenic subtypes of ischemic stroke (IS).
Material And Methods:
The study included 147 patients, 62 women and 85 men (mean age - 62.9±0.8 years) including 37 patients (25.2%) with CE subtype of IS (group 1) and 110 patients with other pathogenetic subtypes of IS (group 2). NIHSS and Rankin scale were used to assess patient's neurological status.
Results:
One hundred and twenty-six patients were discharged, 21 (14.3%) died. In 11 patients, the cause of death was the development of symptomatic hemorrhagic transformation (SHT). There were no significant differences in the lethality between groups 1 and 2. Tolerability to STLT in these groups did not differ as well. As a result of treatment, the condition of patients surviving to the end of the hospital stay improved, which was reflected in a significant decrease in the NIHSS scores, despite the higher NIHSS scores in group 1.
Conclusion:
The results confirm the efficacy of STLT in patients with CE IS and indicate the increase in the frequency of favorable functional recovery in these patients.
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