Primeiro consenso brasileiro para trombólise no acidente vascular cerebral isquêmico agudo

Patel, Sutchin R.; Hensle, Terry W.; Plante, Mark; Caldamone, Anthony A.

doi:10.1590/s0004-282x2002000400032

Cited by 15 publications

(7 citation statements)

References 31 publications

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“…Stroke management, including the standardized IVT, was based on current guidelines [12,13,14,15]. This study was approved by the local Ethics Committee.…”

Section: Methodsmentioning

confidence: 99%

Factors Related to Cardioembolism as Major Predictors of Poor Survival after First-Ever Middle Cerebral Artery Stroke Treated with Thrombolysis

et al. 2017

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Background and Purpose: Prognostic factors related to mortality rates after stroke have been reported; however, most studies included different treatments and did not focus solely on ischemic stroke. The study aimed to report the short- and long-term survival and predictors of death in patients with first-ever ischemic stroke in the middle cerebral artery (MCA) territory, submitted to intravenous thrombolysis (IVT). Methods: A prospective observational cohort study of patients with first-ever ischemic stroke in the MCA territory treated with IVT from March 2010 to February 2015 was conducted, and patients were followed up until May 2015. The Kaplan-Meier method was used to estimate the cumulative case fatality rates. The potential prognostic factors were identified using Cox proportional hazards regression analysis. Results: A total of 169 patients, 51% women of mean age of 64.1 ± 12.9 years were followed up for a median time of 23.6 (8.1-36.2) months. At the end of the study, 53 (31.4%) patients had died. The estimated cumulative case fatality rate was 41.8% for 5 years. Chronic heart failure (hazards ratio [HR] 2.89, 95% CI 1.43-5.84, p = 0.003), atrial fibrillation (HR 3.88, 95% CI 1.30-11.57, p = 0.015), and symptomatic intracerebral hemorrhage (SICH; HR 7.83, 95% CI 3.43-17.92, p < 0.001) were significant unfavorable independent outcome predictors. The most frequent cause of death was infection (46%). Conclusions: Stroke in the MCA territory has a high mortality rate, even in patients treated with IVT. SICH, atrial fibrillation, and chronic heart failure are modifiable factors related to cardioembolism that need to be aggressively targeted for improved outcomes after stroke.

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“…Stroke management, including the standardized IVT, was based on current guidelines [12,13,14,15]. This study was approved by the local Ethics Committee.…”

Section: Methodsmentioning

confidence: 99%

Factors Related to Cardioembolism as Major Predictors of Poor Survival after First-Ever Middle Cerebral Artery Stroke Treated with Thrombolysis

et al. 2017

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“…Atualmente, o Acidente Vascular Cerebral (AVC) é definido como uma injúria cerebral responsável por gerar uma súbita alteração neurológica de características focais e/ou difusas, com duração maior do que 24 horas 2 . Essa condição pode ser determinada por dois diferentes mecanismos: isquêmico -observado em 85% dos casosou hemorrágico 1,4 .…”

Section: Introductionunclassified

“…O tratamento do AVCi agudo pode ser feito com Trombólise Endovenosa (TE) com Alteplase, desde que respeitado o período de janela terapêutica do medicamento 3,4 . Tal terapia tem como objetivo reduzir as sequelas e incapacidades residuais do AVCi e, dessa forma, aumentar a qualidade de vida da pessoa acometida 1,8 .…”

Section: Introductionunclassified

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Trombólise Endovenosa em Acidente Vascular Cerebral isquêmico: uma revisão de literatura

Szymanski

Neto²,

Bitencourt³

et al. 2021

Rev Neurocienc

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Introdução. O Acidente Vascular Cerebral é uma doença altamente prevalente na população mundial e gera muita morbimortalidade. O subtipo isquêmico é o mais comum (85% de todos os casos) e, se não tratado de maneira rápida e eficaz, produz sequelas e incapacidades permanentes. A Trombólise Endovenosa é uma das modalidades de tratamento agudo mais eficaz se feita no tempo certo, e aprimora a qualidade de vida dos doentes. Método. Revisão de literatura feita nas bases de dados PubMed, SciELO, UpToDate, Biblioteca Nacional em Saúde e Ministério da Saúde, com artigos em inglês, português e espanhol, dos últimos 19 anos. Resultados. Um total de 29 artigos foram selecionados para compor essa revisão de literatura, e tiveram como critérios de seleção o ano de publicação, duplicação de informações e/ou informações incompletas. Conclusões. A Trombólise Endovenosa é um dos principais tratamentos do Acidente Vascular Cerebral isquêmico agudo, pois restaura as áreas de penumbra. Entretanto, deve ser feita em tempo hábil e, para isso, é essencial o atendimento imediato das pessoas com sinais e sintomas do Acidente Vascular Cerebral isquêmico.

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“…The issue remains controversial in the literature 1,5,6,7 and warrants further analyses. Brain hemorrhage after thrombolysis is the most feared complication of the procedure 2,8 and studies analyzing possible predictors of risk are of great clinical interest.Sato et al …”

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confidence: 99%

Could side of middle cerebral artery obstruction be a prognostic factor for mortality in thrombolysed patients?

Gagliardi¹

2015

Arq. Neuro-Psiquiatr.

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T reatment with thrombolytic therapy in ischemic stroke is effective and safe but data on its safety and efficacy in different stroke subtypes and etiologies is lacking. Different parameters can influence the effectiveness and risk of thrombolysis in stroke patients and knowledge of these factors can be useful to inform therapeutic decisions, often involving actions outside the general consensus or decisions based on risk/benefit. This information may also be useful as a prognostic element and help guide rehabilitation conduct. Among the numerous parameters that can be analyzed, laterality of the arterial territory affected represents a favorable element which is readily and quickly assessed. Cerebrovascular events often cause neuropsychological deficits that are related to the side of the stroke, for example, aphasia in the left cerebral hemisphere (LCH) and neglect in the right cerebral hemisphere (RCH).RCH strokes are often underestimated by clinical rating scales 1,2 because deficits such as language disorders (typical of the LCH) are more easily recognized than neglect or agnosias, typical of the RCH 2,3 . Imaging studies show that RCH stroke patients can be rated lower by the NIH scale, despite having a large cerebral infarct area 3,4 . Stroke severity, as measured by the NIH scale, an internationally accepted instrument, is one of the criteria used for patient selection. The scale could be adjusted by hemisphere affected for a more accurate assessment of patient hemorrhage risk 1 , should the hypothesis of a relationship between laterality and severity be proven. These factors may contribute to less frequent thrombolysis of RCH stroke patients who consequently do not receive adequate treatment. Difficulties detecting symptoms of RCH stroke are challenges which must be overcome in order to optimize conduct, particularly during the acute phase of stroke.The topographic relationship regarding the side of the middle cerebral artery affected (right or left) can represent a further element contributing to risk assessment and quantification of prognosis. The issue remains controversial in the literature 1,5,6,7 and warrants further analyses. Brain hemorrhage after thrombolysis is the most feared complication of the procedure 2,8 and studies analyzing possible predictors of risk are of great clinical interest.Sato et al. 5, in a study analyzing a large casuistic (2708 patients with supratentorial hemorrhage) found a higher death rate in right-sided stroke but no effect of laterality on severity of sequelae among survivors. Audebert et al.1 stated that the higher hemorrhage rates in RCH stroke reported were due to bias introduced by the scales employed.Brott et al. 9 found a 15% higher incidence of silent infarction in RCH compared to LCH; patients with previous silent stroke may have poorer prognosis after thrombolysis, a finding which, if confirmed, can be used as an auxiliary criteria to guide patient conduct.The study of Ducci et al. 10, "Does the side of middle cerebral artery compromise matters in the mortal...

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Primeiro consenso brasileiro para trombólise no acidente vascular cerebral isquêmico agudo

Cited by 15 publications

References 31 publications

Factors Related to Cardioembolism as Major Predictors of Poor Survival after First-Ever Middle Cerebral Artery Stroke Treated with Thrombolysis

Factors Related to Cardioembolism as Major Predictors of Poor Survival after First-Ever Middle Cerebral Artery Stroke Treated with Thrombolysis

Trombólise Endovenosa em Acidente Vascular Cerebral isquêmico: uma revisão de literatura

Could side of middle cerebral artery obstruction be a prognostic factor for mortality in thrombolysed patients?

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