Bosphorus Med J. 2023; 10(1): 45-50 | DOI: 10.14744/bmj.2022.58070

Repeated Intravenous Thrombolytic Treatment Experience with Tissue Plasminogen Activator in Patients with Acute Ischemic Stroke: Case series

Kadriye Güleda Keskin, Çisil Ýrem Özgenç Biçer, Iþýl Kalyoncu Aslan, Pelin Doðan, Irmak Salt, Eren Gozke
Department of Neurology, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Ýstanbul, Türkiye

Ischemic stroke treatment has been changing in recent years and these procedures have positive effects on patients’ prognosis, morbidity, and mortality. Intravenous Treatment with Recombinant Tissue-Type Plasminogen Activator (iv r-tPA) is one of the most efficient approaches in ischemic stroke patients. When administered in the first 4.5 h from symptom onset, it has been proven to be effective in functional improvement. However, physicians may feel hesitant about administering these treatments regarding the possible complications,especially the patients with recurrent stroke. The aim of this article is to contribute to the literature on the efficacy and safety of recur-rent iv r-tPA therapy in patients with recurrent stroke. We present seven patients who underwent thrombolytic treatment more than one time between September 2017 and September 2020 and recorded the patients’ gender, risk factors, age, initial/final National Institutes of Health Stroke Scale (NIHSS), and hemorrhagic transformation rates. Mean interval of iv r-TPA treatment was 244.7 days (minimum 58 days, maximum 1 year 9 months 10 days). Average of NIHSS calculated as 7.57 before the first and 8.26 before the second iv r-tPA treatment; at the time of discharge mean of NIHSS was 1.57 and 2.8 respectively for five patients. Five of the patients have been identified as cardioembolic in aetiology. In two of our cases, clinical worsening was observed in the follow-ups after iv r-tPA. Our symptomatic intracranial hemorrhage rates were similar to the literature seen in one patient. Rates of bleeding were directly proportional with calculated HAS-BLED scores in patients who were started anticoagulation. Our complication rates were similar with literature and the prognosis of recurrent r-tPA was discovered to have a good prognosis in the first 3 months.

Keywords: HAS-BLED, Hemorrhagic transformation, Ischemic stroke, iv tpa.

---

Akut Ýskemik Ýnme Hastalarýnda Doku Plazminojen Aktivatörü ile Tekrarlayan Ýntravenöz Trombolitik Tedavi Deneyimleri: Olgu Serisi

Kadriye Güleda Keskin, Çisil Ýrem Özgenç Biçer, Iþýl Kalyoncu Aslan, Pelin Doðan, Irmak Salt, Eren Gozke
Saðlýk Bilimleri Üniversitesi Fatih Sultan Mehmet Eðitim ve Araþtýrma Hastanesi, Nöroloji Kliniði, Ýstanbul, Türkiye

Ýskemik inme konusunda tedavi yöntemleri son yýllarda deðiþime uðramakta ve bu yöntemler hastalarýn prognoz ve saðkalýmý üzerinde olumlu etki göstermektedir. Rekombinant doku plazminojen aktivatörü alteplazýn (r-tPA) kullanýldýðý intravenöz trombolitik tedavi bu yaklaþýmlardan biridir. Semptom baþlangýcýndan itibaren ilk 4,5 saatte uygulandýðýnda hastalarýn fonksiyonel sonuçlarýnýn iyileþmesinde etkili olduðu kanýtlanmýþtýr. Fakat hekimler bazý durumlarda geliþebilecek komplikasyonlar nedeniyle tereddütte kalabilmektedir. Tekrarlayan inme hastalarýnda bu komplikasyonlarýn geliþme olasýlýðýnýn yüksek olma düþüncesi, intravenöz r-tPA uygulamasý konusunda þüphede býrakmaktadýr. Bu yazýnýn amacý, tekrarlayan iskemik inmelerde uygulanan intravenöz trombolitik tedavinin etkinliði ve güvenirliliðine dair literatüre katký saðlamaktýr. Çalýþmada, Eylül 2017-Eylül 2020 tarihleri arasýnda yedi tane birden fazla r-tPA tedavisi uygulanan hasta sunuldu. Hastalarýn yaþ, cinsiyet, inme risk faktörleri, baþvuru/final “National Institutes of Health (NIH)” inme skorlarý ve hemorajik transformasyon oranlarý deðerlendirildi. Trombolitik tedaviler arasýnda ortalama süre 244,7 gün (en az 58 gün, en fazla 1 yýl 9 ay 10 gün); baþvurudaki ortalama NIH inme skoru ilk r-tPA öncesi 7,57, ikincisi öncesi 8,26 idi. Taburculuktaki ortalama NIH inme skoru ilk tPA sonrasý 1,57, ikincisi sonrasý 2,8 idi. Beþ hastada inme etiyolojisinde kardiyoembolik olay saptandý. Ýki hastamýzda klinik kötüleþme izlendi. Semptomatik hemorajik transformasyon oranýmýz literatüre benzerdi, bir hastada görüldü. Kanama oranlarý, antikoagülan baþlanan hastalarda hesaplanan HAS-BLED ile doðru orantýlýydý. Hastalarýmýzda komplikasyon oranlarý literatüre benzer görüldü ve ilk üç ayda tekrarlayan trombolitik tedavilerin prognozlarý iyiydi.

Anahtar Kelimeler: Ýskemik inme, intravenöz tPA, HAS-BLED, hemorajik transformasyon.

---

CITE