Investigating the Effect and Immunity of Tissue Plasminogen Activator in the Treatment of Acute Ischemic Stroke
DOI:
https://doi.org/10.6000/2292-2598.2020.08.02.2Keywords:
Acute ischemic stroke, Thrombolytic therapy, NIHSS, mRS.Abstract
Background and Objective: Although current evidence has demonstrated the efficacy and immunity of Alteplase, further studies are needed to evaluate its functioning in the therapeutic system. This study aims to assess the effect and immunity of tissue plasminogen activator (tPA) in the treatment of acute ischemic stroke (AIS).
Methods: This study was conducted as a retrospective observational study on patients with AIS referred to Ahvaz Golestan Hospital in 2017-2018. By using the hospital database, demographic information, the cause of lack of thrombolytic therapy, the onset of symptoms and admission were extracted. The National Institutes of Health Stroke Scale (NIHSS) at the time of referral, 24 hours after treatment, and at the time of discharge, the modified Rankin Scale (mRS) scores at discharge time and 3 months after discharge, complications and mortality at the time of admission and 3 months after discharge were recorded.
Results: The mean of the event to needle (hrs) was significantly lower in the tPA group (P <0.0001), and delay in visiting time and loss of golden time were of the main reasons for not receiving tPA in the control group. The mean difference and the decrease in NIHSS score 24 hours after admission and discharge in the tPA group was significantly higher (P <0.0001). At the time of discharge, the mean score of mRS in the two groups was not significantly different. Three months after treatment, the mean score of mRS in the tPA group was significantly lower than that in the control group (P <0.05). The percentage of patients with bleeding complications was higher in the tPA group (7.27%) than that in the control group (4.89%). The percentage of deaths during the hospital stay in the tPA group (3.64%) was higher than that in the control group (1.63%).
Conclusion: Patients with AIS under intravenous thrombolytic therapy with tPA showed improvement in functional measurements and neurological outcomes compared with the control group. Lack of significant difference in the rate of complications and mortality between the two groups indicated the safety and high efficacy of thrombolytic therapy in patients with AIS
References
Catanese L, Tarsia J, Fisher M. Acute ischemic stroke therapy overview. Circulation Research 2017; 120(3): 541-58. https://doi.org/10.1161/CIRCRESAHA.116.309278 DOI: https://doi.org/10.1161/CIRCRESAHA.116.309278
Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Executive summary: heart disease and stroke statistics-2016 update: a report from the American Heart Association. Circulation 2016; 133(4): 447-54. https://doi.org/10.1161/CIR.0000000000000366 DOI: https://doi.org/10.1161/CIR.0000000000000366
Kissela BM, Khoury JC, Alwell K, Moomaw CJ, Woo D, Adeoye O, et al. Age at stroke temporal trends in stroke incidence in a large, biracial population. Neurology 2012; 79(17): 1781-7. https://doi.org/10.1212/WNL.0b013e318270401d DOI: https://doi.org/10.1212/WNL.0b013e318270401d
Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, et al. Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) and the GBD Stroke Experts Group. Global and regional burden of stroke during 1990-2010: findings from the global burden of disease study 2010. Lancet 2014; 383(9913): 245-54. https://doi.org/10.1016/S0140-6736(13)61953-4 DOI: https://doi.org/10.1016/S0140-6736(13)61953-4
WHO. The global burden of disease: 2004 update. [10 June 2018]. Available from: http://www.who.int/healthinfo/ global_burden_disease/2004_report_update/en/.
Moskowitz MA, Lo EH, Iadecola C. The science of stroke: mechanisms in search of treatments. Neuron 2010; 67(2): 181-98. https://doi.org/10.1016/j.neuron.2010.07.002 DOI: https://doi.org/10.1016/j.neuron.2010.07.002
Fisher M, Albers GW. Advanced imaging to extend the therapeutic time window of acute ischemic stroke. Annals of Neurology 2013; 73(1): 4-9. https://doi.org/10.1002/ana.23744 DOI: https://doi.org/10.1002/ana.23744
Heiss W-D. The ischemic penumbra: how does tissue injury evolve? Annals of the New York Academy of Sciences 2012; 1268(1): 26-34. https://doi.org/10.1111/j.1749-6632.2012.06668.x DOI: https://doi.org/10.1111/j.1749-6632.2012.06668.x
Jauch EC, Cucchiara B, Adeoye O, Meurer W, Brice J, Gentile N, et al. Part 11: Adult Stroke. Circulation 2010; 122(18 suppl 3): S818-S28. https://doi.org/10.1161/CIRCULATIONAHA.110.971044 DOI: https://doi.org/10.1161/CIRCULATIONAHA.110.971044
Hacke W, Donnan G, Fieschi C, Kaste M, von Kummer R, Broderick JP, et al. Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. The Lancet 2004; 363(9411): 768-74. https://doi.org/10.1016/S0140-6736(04)15692-4 DOI: https://doi.org/10.1016/S0140-6736(04)15692-4
Lees KR, Bluhmki E, Von Kummer R, Brott TG, Toni D, Grotta JC, et al. Time to treatment with intravenous alteplase and outcome in stroke: an updated pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. The Lancet 2010; 375(9727): 1695-703. https://doi.org/10.1016/S0140-6736(10)60491-6 DOI: https://doi.org/10.1016/S0140-6736(10)60491-6
National Institute of Neurological Disorders Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. New England Journal of Medicine 1995; 333(24): 1581-8. https://doi.org/10.1056/NEJM199512143332401
Boudreau DM, Guzauskas GF, Chen E, Lalla D, Tayama D, Fagan SC, et al. Cost-effectiveness of recombinant tissue-type plasminogen activator within 3 hours of acute ischemic stroke: current evidence. Stroke 2014; 45(10): 3032-9. https://doi.org/10.1161/STROKEAHA.114.005852 DOI: https://doi.org/10.1161/STROKEAHA.114.005852
Wasay M, Barohi H, Malik A, Yousuf A, Awan S, Kamal AK. Utilization and outcome of thrombolytic therapy for acute stroke in Pakistan. Neurological Sciences 2010; 31(2): 223-5. https://doi.org/10.1007/s10072-009-0159-y DOI: https://doi.org/10.1007/s10072-009-0159-y
Meretoja A, Roine RO, Kaste M, Linna M, Roine S, Juntunen M, et al. Effectiveness of primary and comprehensive stroke centers: PERFECT stroke: a nationwide observational study from Finland. Stroke 2010; 41(6): 1102-7. https://doi.org/10.1161/STROKEAHA.109.577718 DOI: https://doi.org/10.1161/STROKEAHA.109.577718
Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJ. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. The Lancet 2006; 367(9524): 1747-57. https://doi.org/10.1016/S0140-6736(06)68770-9 DOI: https://doi.org/10.1016/S0140-6736(06)68770-9
Suwanwela NC, Phanthumchinda K, Likitjaroen Y. Thrombolytic therapy in acute ischemic stroke in Asia: the first prospective evaluation. Clinical Neurology and Neurosurgery 2006; 108(6): 549-52. https://doi.org/10.1016/j.clineuro.2005.09.008 DOI: https://doi.org/10.1016/j.clineuro.2005.09.008
De Silva DA, Yassin N, Toh AJ, Lim DJ, Wong WX, Woon FP, et al. Timing of Arrival to a Tertiary Hospital after Acute Ischaemic Stroke—A Follow-up Survey 5 Years Later. Annals Academy of Medicine, Singapore 2010; 39(7): 513. DOI: https://doi.org/10.47102/annals-acadmedsg.V39N7p513
Durai Pandian J, Padma V, Vijaya P, Sylaja P, Murthy JM. Stroke and thrombolysis in developing countries. International Journal of Stroke 2007; 2(1): 17-26. https://doi.org/10.1111/j.1747-4949.2007.00089.x DOI: https://doi.org/10.1111/j.1747-4949.2007.00089.x
Bryer A, Wasserman S. Thrombolysis for acute ischemic stroke in South Africa. International Journal of Stroke 2013; 8(SA100): 112-3. https://doi.org/10.1111/ijs.12059 DOI: https://doi.org/10.1111/ijs.12059
Ghandehari K, Zahed AP, Taheri M, Abbasi M, Gorjestani S, Ahmadi AM, et al. Estimation of Iranian stroke patients eligible for intravenous thrombolysis with tPA. International Journal of Stroke 2009; 4(4): 236. https://doi.org/10.1111/j.1747-4949.2009.00273.x DOI: https://doi.org/10.1111/j.1747-4949.2009.00273.x
Ayromlou H, Soleimanpour H, Farhoudi M, Taheraghdam A, Hokmabadi ES, Ghafouri RR, et al. Eligibility assessment for intravenous thrombolytic therapy in acute ischemic stroke patients; evaluating barriers for implementation. Iranian Red Crescent Medical Journal 2014; 16(5). https://doi.org/10.5812/ircmj.11284 DOI: https://doi.org/10.5812/ircmj.11284
Azarpazhooh MR, Etemadi MM, Donnan GA, Mokhber N, Majdi MR, Ghayour-Mobarhan M, et al. Excessive incidence of stroke in Iran: evidence from the Mashhad Stroke Incidence Study (MSIS), a population-based study of stroke in the Middle East. Stroke 2010; 41(1): e3-e10. https://doi.org/10.1161/STROKEAHA.109.559708 DOI: https://doi.org/10.1161/STROKEAHA.109.559708
Sadeghi-Hokmabadi E, Farhoudi M, Taheraghdam A, Hashemilar M, Savadi-Osguei D, Rikhtegar R, et al. Intravenous recombinant tissue plasminogen activator for acute ischemic stroke: a feasibility and safety study. International Journal of General Medicine 2016; 9: 361. https://doi.org/10.2147/IJGM.S112430 DOI: https://doi.org/10.2147/IJGM.S112430
Mehrpour M, Aghaei M, Motamed MR. Safety and feasibility of intravenous thrombolytic therapy in Iranian patients with acute ischemic stroke. Medical journal of the Islamic Republic of Iran 2013; 27(3): 113.
Hatamabadi HR, Mansouri H, Asarzadegan F, Shojaee M. Barriers to On Time Delivery of Thrombolytic Therapy. Journal of Mazandaran University of Medical Sciences 2013; 23(102): 107-10.
Mojdehipanah H, Yazdi Z, Nasiri MS, Azizlo Z. Barriers to delivery of tissue plasminogen activator for patients with acute ischemic stroke. Feyz Journal of Kashan University of Medical Sciences 2015; 19(2): 169-76.
Nikkhah K, Avan A, Shoeibi A, Azarpazhooh A, Ghandehari K, Foerch C, et al. Gaps and hurdles deter against following stroke guidelines for thrombolytic therapy in Iran: exploring the problem. Journal of Stroke and Cerebrovascular Diseases 2015; 24(2): 408-15. https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.09.012 DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2014.09.012
Zarei E. Effects of rtPA (recombinant tissue plasminogen activator) in treatment of acute ischemic stroke.: Birjand University of Medical Sciences 2017.
Ghadimi Farah A. Determination of the efficacy of recombinant tissue plasminogen activator in improving clinical status in acute ischemic stroke: Hamadan University of Medical Sciences 2017.
Mahmoodi P. Comparison of recombinant tissue plasminogen activator therapy in short-term and mid-term prognosis of acute ischemic stroke patients and control group: Tabriz University of Medical Sciences 2015.
Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. New England Journal of Medicine 2008; 359(13): 1317-29. https://doi.org/10.1056/NEJMoa0804656 DOI: https://doi.org/10.1056/NEJMoa0804656
Marier J. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group Tissue plasminogen activator for acute ischemic stroke. New England Journal of Medicine 1995; 333(24): 1581-7. https://doi.org/10.1056/NEJM199512143332401 DOI: https://doi.org/10.1056/NEJM199512143332401
Clark WM, Wissman S, Albers GW, Jhamandas JH, Madden KP, Hamilton S, et al. Recombinant tissue-type plasminogen activator (alteplase) for ischemic stroke 3 to 5 hours after symptom onset: the ATLANTIS study: a randomized controlled trial. JAMA 1999; 282(21): 2019-26. https://doi.org/10.1001/jama.282.21.2019 DOI: https://doi.org/10.1001/jama.282.21.2019
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