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Intravenous thrombolytic therapy in acute ischemic stroke: A single center experience

INTRODUCTION: Intravenous (iv) thrombolytic therapy is used in the acute phase of stroke to recanalize the occluded vessel and provide reperfusion.The aim of this study is to determine the frequency of side effects and prognosis and the affecting factors in the patients who received iv thrombolytic therapy with the diagnosis of acute ischemic stroke in the neurology clinic of a state hospital between December 2016 and December 2019. METHODS: After obtaining the necessary ethical and institutional permissions, 181 patients who were diagnosed with acute ischemic stroke and received iv thrombolytic therapy in the Neurology Clinic of Denizli State Hospital between December 2016 and December 2019 were analyzed. In this retrospective cohort type study, data were collected with a standart form. Intracranial hemorrhages occurring within the first 36 hours after the treatment were considered as complications of the treatment. The 6th month modified Rankin Stroke Scale (mRS) data of the patients were calculated. RESULTS: The mean age of the patient was 67.8 (±12.7) years and 72 (39.8%) were female. Over the years, the number of treatments increased from 29 to 71. There was a history of recurrent CVO in 39 (21.0%) patients. Mean symptom/door time 86±50 min, door/needle time 93±47 min, and symptom/needle time 179±56 min. Only 34 (18.8%) patients were given normal dose of r-tPA. Intracranial hemorrhage was observed in 24 (13.3%) of the patients after treatment. Factors affecting intracranial hemorrhage after treatment were ASPECT score (26.9% in patients with ≤7, 7.8% in patients with ≥8, p<0.001), infarct type (35.3% in TACI+PACI, 0% in LACI patients), p=0.002) and NIHSS 24-hour value (0% in mild cases, 32.3% in severe cases, p<0.001). Factors that affecting the prognosis at the 6th month after treatment were ASPECT score, type of infarct, NIHSS level at admission, 24-hour NIHSS level, mRS at discharge level and mRS level at 1 month. DISCUSSION AND CONCLUSION: Our results were generally found to be compatible with similar studies published in Turkey and the number of patients receiving iv thrombolytics has been increasing over the years. However, it is noteworthy that iv thrombolytics were used at low doses in this study. This suggests that there may be a need for in-service training on iv thrombolytics.