Outcomes of intravenous thrombolytic therapy for acute ischemic stroke in sichon hospital

Abstract

Background : Acute ischemic stroke is the most common problem in both Thailand and around the world and the second leading cause of death in the world.Incidence of acute ischemic stroke has increased in 2010 in Thailand. Thrombolysis with the intravenous recombinant  tissue plasminogen activator (rt-PA) is now the standard treatment for acute ischemic stroke patients  who have onset of stroke less than 4.5 hours. This FDA-approved treatment has been shown to reduce long term disability, reduce mortality rate and complication in acute ischemic stroke patients.Side effects of rt-PA was intracerebral hemorrhage (6%). Sichon hospital has introduced thrombolysis  with the intravenous recombinant  tissue plasminogen activator (rt-PA) to develop a modern treatment system and standardized treatment .

Objective : To study the outcomes of intravenous thrombolytic therapy in acute ischemic stroke patients at sichon hospital.

Methods : A retrospective review was performed on acute ischemic stroke patients  who arrived at sichon hospital within 4.5 hours of symptom onset  and entered the stroke fast tract program from 1 January 2012 to 31 December 2016 .Medical records of eligible patients  were studied. Baseline characteristics,Initial National Institute Health Stroke Scale (NIHSS) score,Initial systolic and diastolic blood pressures  were recorded.The main outcomes  were identified about thrombolysis time (door to needle time, onset to needle time, door to CT brain time and door to lab time), the NIHSS score before and after treatment, Barthel index,clinical outcome and complication after therapy.Quanlity indicators for treatment  were intravenous thrombolytic therapy rate and stroke fast tract program access rate.

Results : AII 1,473 acute stroke patients presented to emergency room at sichon hospital from 1January 2012 to

31 December 2016. There were 446 acute ischemic stroke patients.There  were 171 acute ischemic stroke patients who arrived at the hospital within 4.5 hours from the onset of symtoms and  42 patients were eligible for intravenous rt-PA therapy. The median NIHSS score before thrombolysis was 10.Median initial systolic and diastolic blood pressures before thrombolysis  were 153/87 mmHg. Median time to intravenous thrombolysis in 5 years were studied.The median door to needle time was 59 minutes, the median onset to needle time was 120 minutes, the median door to computerized tomography brain time was 20 minutes and the median door to lab time was 45 minutes.The NIHSS score  was dramatically improved (78.6%),worsed (11.9%),and stable (9.5%) after thrombolytic therapy.Outcome Barthel  ADL index  was good (increased  score) in 61.9%,poor (decreased score) in 7.1%,stable (same score) in 23.9%.Severe case could not be evaluated Barthel  ADL index (7.1%).

Clinical outcome (discharged) was improved (88.1%),worsed (7.1%),stable (2.4%)and died (2.4%).One patient died after thrombolytic therapy in 2014 due to intracerebral hemorrhage. No complication after treatment  was

33 patients (78.6%). Complication due to thrombolytic therapy and hospital admission  were intracerebral hemorrhage 3 patients (7.1%), brain edema 3 patients (7.1%), pneumonia 3 patients (7.1%),bed sore 1 patient (2.4%) and failing bed 1 patient (2.4%) in 5 years. Quanlity indicators for treatment  were intravenous thrombolytic therapy rate (9.42%) and stroke fast tract program access rate (38.34%) in 5 years.

Conclusions :  The standard treatment for acute ischemic stroke patients is thrombolysis  with the intravenous recombinant  tissue plasminogen activator (rt-PA) in whom who have onset of stroke less than 4.5 hours. Stroke fast tract program is the most important. Although the number of patients with acute ischemic stroke receiving

rt-PA in this study was small, thrombolytic therapy can be performed safety and effectively by physicians in the community hospital setting.