Outcome in Acute Ischemic Stroke Patient Treated with intravenous recombinant tissue Plasminogen Activator in Chonburi Hospital
Abstract
Introduction Intravenous recombinant tissue Plasminogen Activator (rt-PA) is standard treatment for the acute ischemic stroke patients that come to hospital within 4.5 hours since the symptoms occur (if no contraindication). Chonburi Hospital has had care system for these patients for several years. So, treatment outcomes and mortality in acute ischemic stroke patient treated with intravenous recombinant tissue Plasminogen Activator in Chonburi Hospital are studied.
Methods The study was descriptive study. Population were acute ischemic stroke patients treated with intravenous recombinant tissue Plasminogen Activator in Chonburi Hospital from January 2018 to December 2019. Main outcomes of this study were short-term outcome by using NIHSS score, long-term outcome and mortality by using mRS score at 90 days after fibrinolysis in acute ischemic stroke patient treated with intravenous recombinant tissue Plasminogen Activator in Chonburi Hospital. Secondary outcome was association between patient factors and long-term outcomes of treatment.
Results In 2018-2019, There were 294 patients (12.9% of acute ischemic stroke patients) treated with IV rt-PA in Chonburi Hospital. Improved short-term outcome was about 24.8%. Long-term outcome at 90 days after IV rt-PA had 32.4% for good outcome (mRS score 0-1) and 17.2% for mortality. Factors associated to good outcome at 90 days were age below 60-year-old (RR=1.51, 95%CI=1.03-2.21), age below 45-year-old (RR=2.01, 95%CI=1.29-3.13) and atrial fibrillation (RR=0.37, 95%CI=0.22-0.62). Factors associated to mortality at 90 days were atrial fibrillation (RR=2.70, 95%CI=1.63-4.45), door-to-needle time more than 45 minutes (RR=1.86, 95%CI=1.09-3.18) and more than 60 minutes (RR=2.35, 95%CI=1.43-3.88).
Conclusion The treatment outcomes and moortality in acute ischemic stroke patient treated with intravenous recombinant tissue Plasminogen Activator in Chonburi Hospital do not distinctively different compared with other studies. However, further study is needed to improve efficacy of acute ischemic stroke management.
References
Kongbunkiat K, Kasemsap N, Thepsuthammarat K, Tiamkao S, Sawanyawisuth K. National data on stroke outcomes in Thailand. J Clin Neurosci 2015;22:493-7.
Jeyaraj D, Vasantha P, Pamidimukkala V, Sylaja P, Jagaralpudi M. Stroke and thrombolysis in developing countries. Int J Stroke 2007;2:17-26.
Lindsay MP, Norrving B, Sacco RL, Brainin M, Hacke W, Martins S, et al. World Stroke Organization (WSO): Global Stroke Fact Sheet 2019. Int J Stroke 2019;14(8):806-17.
Suwanwela NC. Stroke epidemiology in Thailand. J Stroke 2014;16(1):1-7.
Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. 2018 Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2018;49(3):e46-e110.
Dharmasaroja P, Ratanakorn D, Nidhinandana S, Singhara Na Ayudhaya S, Churojana A, Suwatcharangkoon S, et al. 2019 Thai guidelines of endovascular treatment in patients with acute ischemic stroke. J Thai Stroke Soc 2019;18:52-75.
Weisscher N, Vermeulen M, Roos YB, de Haan RJ. What should be defined as good outcome in stroke trials; a modified Rankin score of 0-1 or 0-2? J Neurol 2008;255(6):867-74.
McArthur K, Fan Y, Pei Z, Quinn T. Optimising outcome assessment to improve quality and efficiency of stroke trials. Expert Rev Pharmacoecon Outcomes Res 2014;14(1):101-11.
Muruet W, Rudd A, Wolfe CDA, Douiri A. Long-term survival after intravenous thrombolysis for ischemic stroke: A propensity score-matched cohort with up to 10-year follow-up. Stroke 2018;49(3):607-13.
Schmitz ML, Simonsen CZ, Hundborg H, Christensen H, Ellemann K, Geisler K, et al. Acute ischemic stroke and long-term outcome after thrombolysis: nationwide propensity score-matched follow-up study. Stroke 2014;45(10):3070-2.
Stefanovic Budimkic M, Pekmezovic T, Beslac-Bumbasirevic L, Ercegovac M, Berisavac I, Stanarcevic P, et al. Long-term prognosis in ischemic stroke patients treated with intravenous thrombolytic therapy. J Stroke Cerebrovasc Dis 2017;26(1):196-203.
Susanne S, Martin G, Jobst R, Wolf-Dieter H. One-year follow-up in acute stroke patients treated with rtPA in clinical routine. Stroke 2000;31:1552-4.
Mouradian M, Senthilselvan A, Jickling G, McCombe J, Emery D, Dean N, et al. Intravenous rt-PA for acute stroke: comparing its effectiveness in younger and older patients. J Neurol Neurosurg Psychiatry 1995;76:1234-7.
Hill MD, Buchan AM, Canadian Alteplase for Stroke Effectiveness Study I. Thrombolysis for acute ischemic stroke: results of the Canadian alteplase for stroke effectiveness study. CMAJ 2005;172(10):1307-12.
Sharma VK, Ng KW, Venketasubramanian N, Saqqur M, Teoh HL, Kaul S, et al. Current status of intravenous thrombolysis for acute ischemic stroke in Asia. Int J Stroke 2011;6(6):523-30.
Betts KA, Hurley D, Song J, Sajeev G, Guo J, Du EX, et al. Real-world outcomes of acute ischemic stroke treatment with intravenous recombinant tissue plasminogen activator. J Stroke Cerebrovasc Dis 2017;26(9):1996-2003.
Jonathan E, Kennedy R, Patrick L, Lisa B, Gregory A, Erich B, et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet 2014;384:1929-35.
Turc G, Isabel C, Calvet D. Intravenous thrombolysis for acute ischemic stroke. Diagn Interv Imaging 2014;95(12):1129-33.
Nilanont Y, Nidhinandana S, Suwanwela NC, Hanchaiphiboolkul S, Pimpak T, Tatsanavivat P, et al. Quality of acute ischemic stroke care in Thailand: a prospective multicenter countrywide cohort study. J Stroke Cerebrovasc Dis 2014;23(2):213-9.
Suwanwela NC, Phanthumchinda K, Likitjaroen Y. Thrombolytic therapy in acute ischemic stroke in Asia: the first prospective evaluation. Clin Neurol Neurosurg 2006;108(6):549-52.
ทัศนีย์ จินตกานนท์. ประสิทธิภาพและความปลอดภัยของการรักษาผู้ป่วยโรคหลอดเลือดสมองตีบเฉียบพลันด้วย Recombinant Tissue-type Plasminogen Activator. วารสารศูนย์การศึกษาแพทยศาสตร์คลินิก โรงพยาบาลพระปกเกล้า 2019;36(3):227-35.
Dharmasaroja PA, Dharmasaroja P, Muengtaweepongsa S. Outcomes of Thai patients with acute ischemic stroke after intravenous thrombolysis. J Neurol Sci 2011;300(1-2):74-7.
Muengtaweepongsa S, Dharmasaroja P, Kummark U. Outcomes of intravenous thrombolytic therapy for acute ischemic stroke with an integrated acute stroke referral network: initial experience of a community-based hospital in a developing country. J Stroke Cerebrovasc Dis 2012;21(1):42-6.
Dharmasaroja PA, Muengtaweepongsa S, Pattaraarchachai J, Dharmasaroja P. Intracerebral hemorrhage following intravenous thrombolysis in Thai patients with acute ischemic stroke. J Clin Neurosci 2012;19(6):799-803.
Chao A, Hsu H, Chung C, Liu C, Chen C, Teng M, et al. Outcomes of thrombolytic therapy for acute ischemic stroke in Chinese patients, The Taiwan thrombolytic therapy for acute ischemic stroke (TTT-AIS) Study. Stroke 2010;41:885-90.
Mouradian MS, Senthilselvan A, Jickling G, McCombe JA, Emery DJ, Dean N, et al. Intravenous rt-PA for acute stroke: comparing its effectiveness in younger and older patients. J Neurol Neurosurg Psychiatry 2005;76(9):1234-7.
Demchuk A, Tanne DH, MD, Kasner S, Hanson S, Grond M, Levine S. Predictors of good outcome after intravenous tPA for acute ischemic stroke. Neurology 2001;57:474-80.
Man S, Xian Y, Holmes DN, Matsouaka RA, Saver JL, Smith EE, et al. Association between thrombolytic door-to-needle time and 1-year mortality and readmission in patients with acute ischemic stroke. JAMA 2020;323(21):2170-84.
ทิพย์มาศ พบสุข. ปัจจัยที่มีผลต่อระยะเวลาการให้ยาละลายลิ่มเลือดในผู้ป่วยโรคหลอดเลือดสมองตีบเฉียบพลันในโรงพยาบาลชลบุรี.วารสารโรงพยาบาลชลบุรี 2020;45(3):191-8.
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