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Título

POST-STROKE DYSPHAGIA IN PATIENTS UNDERGOING THROMBOLYTIC TREATMENT: A RETROSPECTIVE COHORT

Resumo

INTRODUCTION: For the treatment of ischemic stroke in its acute phase, the use of intravenous thrombolysis with Alteplase (rt-PA) is currently recommended, as it is capable of reducing the functional deficits and the severity of the lesion. However, despite the advances in care and reduction of functional deficits in stroke patients, dysphagia is a common dysfunction. Nevertheless, there are few studies related to thrombolytic treatment and its effects on dysphagia, with divergent results regarding the benefits of this drug on the severity and incidence of dysphagia.
OBJECTIVE: To analyze dysphagia at hospital discharge after stroke in patients undergoing and not undergoing thrombolytic treatment. METHOD: A retrospective cohort was carried out in a stroke referral hospital in Salvador -BA, in which patients were divided into two groups: submitted and not submitted to thrombolytic treatment. This research was submitted to and approved by the Research Ethics Committee. The patient's sociodemographic and clinical characteristics were analyzed, and the incidence and severity of dysphagia between the groups were compared. The Dysphagia Outcome and Severity Scale (DOSS) was used to analyze dysphagia. Patients with some degree of dysphagia (DOSS ≤ 5) or no dysphagia (DOSS>5) were considered. Data were analyzed using descriptive statistics and compared by parametric or nonparametric tests, when appropriate. Moreover, a univariate analysis was performed for the outcome dysphagia at hospital discharge and the variables that were significant (p<0.05), were taken to logistic regression to assess whether the thrombolytic is an independent protective factor. RESULTS: A total of 120 thrombolyzed and 117 nonthrombolyzed patients were included in the final analysis. Dysphagia at hospital discharge affected 23(19.2%) thrombolyzed and 41(35%) nonthrombolyzed patients (p=0.006). There was no difference regarding the severity of dysphagia between the groups (p=0.158). For multivariate analysis, thrombolysis was an independent protective factor for dysphagia at hospital discharge [OR:0.29 (CI:0.08-0.95); p=0.042]. CONCLUSION: The incidence of dysphagia at hospital discharge was significantly higher in nonthrombolyzed patients, with no effect on dysphagia severity. Furthermore, thrombolysis was an independent protective factor for dysphagia at hospital discharge.

Palavras Chave

stroke; dysphagia; thrombolysis