Dados do Trabalho

Título

Thrombolysis performance in a Brazilian public service

RESUMO

Introduction: Stroke is the second most common cause of morbimortality worldwide and one of the most important causes of death in Brazil. The ischemic stroke is the most common type and its treatment in the acute phase aims to restore the cerebral blood supply. This treatment can be performed by intravenous thrombolysis with alteplase and/or mechanical thrombectomy, the latter not being available in most of Brazilian public hospitals. Thrombolysis is currently one of the first line treatments in patients with acute ischemic stroke within 4,5 hours of symptom onset. Available data shows functional improvement of patients 3 to 6 months after treatment. The most dreaded complication of thrombolytic therapy is symptomatic intracerebral hemorrhage which is associated with risk factors such as high blood pressure, diabetes mellitus, advanced age, microangiopathy, atrial fibrillation and stroke severity. Objective: Reveal data about the benefits and possible complications of the patients treated with IV thrombolysis in a real life scenario in a Brazilian public hospital, in comparison with the data in the literature, focusing on hemorrhagic complications. Method: A prospective observational study was conduted between November/2019 and April/2020. The sample was calculated to compare outcomes with the studied population and the data of the available RCTs. The study included 53 sequential patients diagnosed with acute stroke treated with thrombolytic therapy. Results: Most of the patients were female and the mean age was 70 years old. The symptomatic hemorrhagic transformation rate was slightly higher in our study, as was the rate of worsened NIHSS after 24h of treatment, compared with data from the RCTs ECASS II and ECASS III. Moreover, 24,5% of the patients had other complications such as angioedema, hypertension and seizures and 15,09% of the patients died. Conclusion: It was observed that the population in our study was older and had at baseline more comorbidities, which are probably the features associated with higher odds of complications. In addition, despite the higher rates of hemorrhagic transformation, the patients in the study had an improvement in the functional status similar to the comparative studies. All in all, although in real life settings the rate of complications appears to be higher than that of RCTs, thrombolysis still leads to better outcomes, and therefore should be performed following proper protocols.

Palavras Chave

Stroke; intravenous thrombolysis; hemorrhagic complications

Área

Doença Cerebrovascular