Dados do Trabalho

Título

Causes for not performing intravenous thrombolysis for ischemic stroke patients in a hospital with a certified stroke program

Resumo

INTRODUCTION: Thrombolytic treatment (TT) reduces the morbidity and mortality of ischemic stroke when performed within 4.5 hours after stroke symptoms. Therefore, it is crucial to expand the performance of this treatment.
OBJECTIVE: To understand the reasons for not performing TT in ischemic stroke patients.
METHOD: We retrospectively evaluated the database of the stroke program of a private hospital in the city of SP over one year. All data from patients admitted to the program during this period were analyzed. Patients that were transferred from other services were excluded from this analysis. The percentage of patients undergoing TT and the exclusion reasons were analyzed, based on the criteria of non-eligibility for this treatment.
RESULTS: Data from 272 patients were analyzed. Of these, 137 (59%) were included in the protocol (ischemic and hemorrhage stroke, TIA, subarachnoid hemorrhage). Ninety-five patients (69%) were confirmed as having ischemic stroke (69%). Of these, 40 patients were excluded because they had been transferred from other services. Of the 55 patients included in the analysis, 8 (14%) were submitted to TT. Of the 47 (86%) who did not receive TT, the causes were: ischemic stroke occurring outside the therapeutic window (75%), large ischemic stroke area on arrival or previous stroke that occurred less than 3 months ago (2%), postoperative period of recent major surgery (5 %), use of oral anticoagulants (7%), and ischemic stroke with multiple comorbidities (12%).
Discussion: We found that the most important challenge to increase the percentage of cases treated with TT is to reduce the arrival time of patients to the health service. Educations actions for the population are crucial in this regard.

Palavras Chave

Stroke;Thrombolysis;