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Analysis of factors influencing the early efficiency of systemic thrombolytic therapy for ischemic stroke

https://doi.org/10.14412/2074-2711-2013-2337

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Abstract

he paper shows the urgency of enhancing the efficiency of systemic thrombolytic therapy (TLT).
Objective: to study the impact of age, gender, smoking, atrial fibrillation, glucose levels at admission and the time of initiation of TLT after ischemic stroke onset on its early efficiency.
Patients and methods. The efficiency of TLT was analyzed in 44 patients with ischemic stroke. Their mean age was 59.5 (range 53.0–70.0) years; 43.2% were smokers; persistent and paroxysmal atrial fibrillation was seen in 27 and 7% of the patients, respectively. The interval between the onset of the disease onset and thrombolysis averaged 187.5 (range 152.5–217.5) min. The criterion for the early efficiency of TLT was a ≥4 score reduction in the severity of neurological deficit according to the National Institute of Health Stroke Scale (NIHSS) on day 7. The mean NIHSS score at admission was 11.5 (range 9–16.5%). Neurological deficit at hospital admission was higher in patients with cardioembolic stroke – 14.0 (range 12.0–18.0) scores.
Results. Improvement was observed in 66% of the patients on day 7. The mean NIHSS score on day 7 was 6.0 (range 4–12). There was a significant correlation between the high early efficiency of TLT, time to start thrombolysis, and baseline blood glucose level. The influence of other factors calls for further investigations in a larger patient sample.

About the Authors

Elena Vladimirovna Prazdnichkova
Sverdlovsk Regional Clinical Hospital One, Yekaterinburg
Russian Federation


A M Alasheev
Sverdlovsk Regional Clinical Hospital One, Yekaterinburg
Russian Federation


O A Shalagina
Demidov Hospital, Nizhny Tagil
Russian Federation


L I Volkova
Ural State Medical Academy, Ministry of Health of Russia, Yekaterinburg
Russian Federation


References

1. <div><p>Снижение заболеваемости, смертности и инвалидности от инсультов в Российской Федерации. Под ред. Скворцовой ВИ. Москва: Литерра; 2007. 192 с. [Snizhenie zabolevaemosti, smertnosti i invalidnosti ot insul'tov v Rossiyskoy Federatsii. Pod red. Skvortsovoy VI. Moscow: Literra; 2007. 192 s.]</p><p>Kufner A, Nolte CH, Galinovic I et al. Smoking-Thrombolysis Paradox : Recanalization and Reperfusion Rates After Intravenous Tissue Plasminogen Activator in Smokers With Ischemic Stroke. Stroke. 2013 Feb;44(2):407–13. DOI: 10.1161/STROKEAHA.112.662148. Epub 2013 Jan 3.</p><p>Doll R, Peto R. Mortality in relation to smoking: 20 years’ observations on male British doctors. Br Med J. 1976;2(6051):1525–36. DOI: 10.1136%2Fbmj.2.6051.1525.</p><p>Klein IF, Lavallée C, Amarenco P Outcomes of Intravenous Recombinant Tissue Plasminogen Activator Therapy According to Gender: A Clinical Registry Study and Systematic Review. Stroke. 2009;40(6):2104–10. DOI: 10.1161/STROKEAHA.108.546325. Epub 2009 Apr 16.</p><p>Di Legge S, Saposnik G, Nilanont Y, Hachinski V. Neglecting the difference: does right or left matter in stroke outcome after thrombolysis? Stroke. 2006;37(8):2066–9. Epub 2006 Jun 22.</p><p>Grines CL, Topol EJ, O’Neill WW et al. Effect of cigarette smoking on outcome after thrombolytic therapy for myocardial infarction. Circulation. 1995;91(2):298–303. DOI: 10.1161%2F01.CIR.91.2.298.</p><p>Kirtane AJ, Martinezclark P, Rahman AM et al. Association of smoking with improved myocardial perfusion and the angiographic characterization of myocardial tissue perfusion after fibrinolytic therapy for ST-segment elevation myocardial infarction. J Am Coll Cardiol. 2005;45(2):321–23. DOI: 10.1016%2Fj.jacc.2004.10.018.</p><p>Purcell IF, Newall N, Farrer M. Lower cardiac mortality in smokers following thrombolysis for acute myocardial infarction may be related to more effective fibrinolysis. QJM. 1999;92(6):327–33. DOI: 10.1093%2Fqjmed%2F92.6.327.</p><p>Barbash GI, White HD, Modan M et al. Significance of smoking in patients receiving thrombolytic therapy for acute myocardial infarction: experience gleaned from the International Tissue Plasminogen Activator/Streptokinase Mortality Trial. Circulation. 1993;87(1):53–8. DOI: 10.1161%2F01.CIR.87.1.53.</p><p>Newby DE, McLeod AL, Uren NG et al. Impaired coronary tissue plasminogen activator release is associated with coronary atherosclerosis and cigarette smoking: direct link between endothelial dysfunction and atherothrombosis. Circulation. 2001;103(15):1936–41. DOI: 10.1161%2F01.CIR.103.15.1936.</p><p>Zangerle A, Kiechl S, Spiegel M et al. Recanalization after thrombolysis in stroke patients: predictors and prognostic implications. Neurology. 2007;68(1):39–44. DOI: 10.1212%2F01.wnl.0000250341.38014.d2.</p><p>Vaidyula VR, Rao AK, Mozzoli M et al. Effects of hyperglycemia and hyperinsulinemia on circulating tissue factor procoagulant activity and platelet CD40 ligand. Diabetes. 2006;55(1):202–8. DOI: 10.2337%2Fdiabetes.55.01.06.db05-1026.</p><p>Lemkes BA, Hermanides J, Devries JH et al. Hyperglycemia: a prothrombotic factor? J ThrombHaemost. 2010;8(8):1663–9. DOI: 10.1111/j.1538-7836.2010.03910.x. Epub 2010 May 12.</p><p>Pandolfi A, Giaccari A, Cilli C et al. Acute hyperglycemia and acute hyperinsulinemia decrease plasma fibrinolytic activity and increase plasminogen activator inhibitor type 1 in the rat. Acta Diabetol. 2001;38(2):71–6. DOI: 10.1007%2Fs005920170016.</p><p>Парфенов ВА, Хасанова ДР. Ишемический инсульт. Москва: МИА; 2012. 288 с. [Parfenov VA, Khasanova DR. Ishemicheskiy insul't. Moskva: MIA; 2012. 288 p.]</p></div><br />


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For citations:


Prazdnichkova E.V., Alasheev A.M., Shalagina O.A., Volkova L.I. Analysis of factors influencing the early efficiency of systemic thrombolytic therapy for ischemic stroke. Neurology, Neuropsychiatry, Psychosomatics. 2013;5(3):32-35. (In Russ.) https://doi.org/10.14412/2074-2711-2013-2337

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ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)