경희대학교
의과대학 응급의학교실
김신칠·천일영·김명천·고영관
Evaluation
for Prognosis and Complication at Violation of Treatment with r-tTA in Acute lschemic
Stroke
Sin
Chul Kim, M.D., Yil Young Chen, M.D., Myung Chun Kim, M.D., and Young Gwan Ko, M.D.
Purpose:
In many other countries, based on research, recombinant tissue plasminogen activator(r-tPA)
has been approved for the treatment of acute ischemic strokes. However, in Korea,
little research has been done till now, in spite of using r-tPA widely. We sought
to assess the feasibility and the efficacy of treatment and to evaluate the prognosis
and complications at the violation of using r-tPA. Our study was compared with other
previous studies.
Methods:
A retrospective review is presented of 25 the cases of patients with acute ischemic
stroke treated with r-tPA according to the National institutes of Neurological Disorders
and Strokes (NINDS) protocol. We classified the groups by protocol violation (time,
blood pressure, and computed tomography). We then analyzed neurologic outcomes by
using the National institutes of Health Strokes Scale (NIHSS) and complications
based on whether or not intracerebra1 hemorrhage (ICH) had occurred.
Results:
Of the 25 patients (mean age: 57 males: 19), 6 had time violation (onset time >
180 min), 4 had blood-pressure violation (systolic BP > 185 mmHg), 5 had CT violation
(low density at initial CT). The NIHSS score improved ln 64% of all patients after
24 hours. However, improvement was lower in the case of deviation present than it
was in the case of deviation absent (time, blood pressure, and CT, respectively}
20%, 50%, and 40%; p-value respectively 0.0274, 0,8350, and 0.4125). ICH occurred
in 6 cases, but in cases of deviation present, ICH occurred at a greater frequency.
Conclusion:
Our safety and feasibility of outcome compared favorably with NINDS and other previous
studies. In addition, we confirmed that the presence of protocol deviation was associated
a poor outcome.
Key
Words: Ischemic stroke, Thrombolytic therapy, r-tPA, Protocol violation |
