Intravenous thrombolytic theraphy in acute stroke: the experience of the

neurology department of sisli etfal education and research hospital

Zeynep Tanrverdi, Dilek Neciolu rken, Selma Aksoy, Nihan Parasz Ykselen,
Emine ztrk Karg, Sibel Mumcu, Hulki Forta.

Abstract
Background: Stroke is the third leading cause of death and is a major cause of
disability in our country. Up to 80% of all strokes are of ischemic origin. It is a
clinical emergency requiring urgent medical intervention. Recombinant tissue
plasminogen activator (rt-PA) is the best treatment of acute ischemic stroke (AIS)
when given within three hours of symptom onset. The main aim of this study was
to review our thrombolithic treatment experience.

Methods: In our study, data of the 15 patients who were treated with intravenous
thrombolytic therapy in the Intensive Care Unit of the Neurology Department of
ili Etfal Research and Education Hospital between the years 2006 and 2012 were
evaluated prospectively within the context of database of Stroke Study Group of
Turkish Neurological Society. 0.9 mg/kg IV rt-PA had been administered to all of
the patients in first 3 hours.

Results: Fifteen patients with acute ischemic stroke received rt-PA. Mean age SD
of our patients was 66.213.8 years (range 3580). Eight of the patients (53.3%)
were female. Patients presented in 10-90 (mean: 50.1) minutes and they were
treated in 75- 205 ( mean 132.6) minutes after stroke onset. We observed clinical
improvement of > 25% in NIHSS points in 8 of the 15 (53.3%) patients within 24
hours of therapy. 5 patients were improved %100 at the and of the first week.

Conclusion: Our analysis suggests that administration of 0.9 mg/kg IV rt-PA is safe
and is associated with better functional outcome in the first 3-month- period.
Hospitals must have the ability to provide treatment with intravenous (IV) rt-PA 24
hours a day, 7 days a week and have to provide brain imaging facilities necessary
to perform before this therapy. Our hospital covers these requirements.
Nevertheless, it is necessary to provide coordination between the members of the
medical staff and a corporate organization scheme is required.

Key words: Thrombolytic therapy, tissue plasminogen activator, acute stroke

Akut iskemik inmede intravenz trombolitik tedavi: ili Etfal Eitim ve

Aratrma Hastanesi Nroloji Klinii deneyimi

zet
Ama: nme lkemizde lm nedenleri arasnda 3. sray almaktadr ve fonksiyon
kaybnn bata gelen nedenlerindendir. Tm inmelerin %80den fazlas iskemik
kkenlidir. Akut iskemik inme hzl tedavi gerektiren acil bir durumdur. lk 3 saatte
uygulanan rt-PA akut iskemik inmede en etkili tedavi yntemidir. almamzn
amac kliniimizin trombolitik tedavi deneyimini paylamaktr.

Yntem: almamzda 2006-2012 yllar arasnda hastanemiz Nroloji Klinii

Youn Bakm nitesinde intravenz trombolitik tedavi uygulanan 15 hastann Trk
Nroloji Dernei nme alma Grubu veri tabannda prospektif olarak biriktirilen
verileri deerlendirildi. Tm hastalara inme balangcndan itibaren ilk 3 saatte
intravenz 0.9 mg/kg rt-PA uyguland.

Bulgular: almaya ya ortalamas 66.213.8 olan 8i kadn (%53.3) toplam 15

akut iskemik inme tanl hasta alnd. Hastalarn semptom- kap zaman ortalama
50.1 dakika (10-90 dakika arasnda) ve semptom-ine zaman 132.6 dakika (75-205
dakika arasnda) idi. On be hastann 8inde (%53.3) tedaviden sonraki ilk 24 saat
ierisinde NIHSS deerlerinde %25 zerinde klinik iyileme gzlendi. Be hastada
da ilk haftann sonunda %100 klinik iyileme gzlendi.

Sonu: Bulgularmz, akut iskemik inme tedavisinde ilk 3 saatte kullanlan rt-
PAnn gvenli bir tedavi olduunu ve ilk 3 ayda fonksiyon kaybn azalttn
gstermektedir. Akut iskemik inme tedavisinin gvenli uygulanmas iin, o
kurumda inme konusunda eitimli ve iyi organize olmu ekiplerin bulunmas
gerekmektedir. Hastanemiz bu olanaklara sahiptir. Ancak ekipler arasnda
koordinasyon salanmas ve kurumsal bir organizasyon emas gerekmektedir.

Anahtar Kelimeler: Trombolitik tedavi, doku plazminojen aktivatr, akut

iskemik inme