Acil Serviste Trombolitik Uygulanan Hastaların Özellikleri

Year 2023, Volume: 33 Issue: 1, 51 - 55, 28.02.2023

Ahmet Tolga Eraslan , Fatih Selvi , Cihan Bedel , Muhammed Baltacıoğlu , Günay Yıldız

https://doi.org/10.54005/geneltip.1200029

Abstract

Amaç: Arteriyel veya venöz tromboembolizm günümüzde sık görülen hastalıklardan birisi olup; iskemik inme, pulmoner emboli ve miyokart infarktüsü gibi mortalite ve morbiditesi yüksek patolojiler ile ilişkilidir. Fibrinolitik tedavi bu hastalıklarda hayat kurtarıcı en önemli tedavidir. Bu çalışmada fibrinolitik tedavi almış hastaların demografik verileri ile takip süreçlerini değerlendirmeyi amaçladık.
Gereç ve Yöntem: 1 Ocak 2018 – 1 Temmuz 2021 tarihleri arasında acil servise başvuran ve fibrinolitik tedavi alan hastalar geriye dönük olarak bu çalışmaya dahil edildi. Çalışma hastalarının yaş, cinsiyet, fibrinolitik uygulama nedeni, vital bulguları, laboratuvar tetkikleri, ek hastalıkları, kullandığı ilaçlar, hastalığa yönelik aldığı ek tedaviler, tedavilerin komplikasyonları, mortalite ve 6 aylık süreçte benzer tanılı başvuruları kaydedildi.
Bulgular: Toplamda 277 hasta çalışmaya dahil edildi. Çalışmada acil serviste en sık tPA uygulama nedeni iskemik inmeydi (n=252; %91). tPA uygulanan hastalarda en sık görülen komplikasyon %11,9 ile intrakraniyal kanama, en sık uygulanan kurtarıcı tedavi ise trombektomiydi (n=34, %12,4). Hastaların en sık kullandığı ilaç %56 (n=155) ile anti-hipertansifler olup, anti-hipertansifleri %36,5 (n=101) ile anti-agreganlar, %30 (n=83) ile anti-diyabetikler, %24,5 (n=68) ile anti-aritmik ilaçlar takip etmekteydi. Yapılan tek değişkenli analizde, tPA uygulaması sonrası kanama meydana gelen ve gelmeyen hastalar arasında anti-agregan kullanımı (n=21, %53,8 vs n=80, %33,6; p=0,01), sistolik kan basıncı (160 mmHg, IQR: 138-190 vs 150 mmHg 130-169; p=0,02) ve diyastolik kan basıncı (90 mmHg, IQR: 75-100 vs 83 mmHg, IQR: 72-94; p=0,03) açısından anlamlı fark vardı. Çok değişkenli analizde ise post-tPA kanama ile ilişkili bağımsız değişken olarak sadece anti-agregan kullanımı saptandı.
Sonuç: Bizim çalışmamızın sonuçlarına göre, acil servisimizde en sık tPA verilme endikasyonu iskemik inmedir. tPA verilen hastalarda en sık yandaş hastalık hipertansiyon olup, en sık kullanılan ilaç antihipertansifler ve antiagreganlardır. İntrakraniyal kanama tPA verilen hasta grubunda en sık görülen komplikasyon olup, sistolik ve diyastolik kan basıncı ile antiagregan kullanımı tPA kullanımı sonrası kanamalarla ilişkilidir.

Keywords

fibrinolitik tedavi, inme, pulmoner emboli, intrakaniyal kanama

Characteristics of Patients Administrated Thrombolytics in the Emergency Department

Abstract

Objective: Arterial and venous thromboembolism is one of the most prevalent diseases and related to ischemic stroke, pulmonary embolism, and myocardial infarction leading to mortality or morbidity. Fibrinolytic therapy is the most profound lifesaving therapy in these diseases. We aimed to evaluate the demographic features and post- tissue plasminogen activator (tPA) period of patients administered fibrinolytic in the emergency department (ED).
Materials and Methods: This retrospective study was conducted with patients instituted fibrinolytic therapy in the ED between January 2018 and July 2021. Age and gender of the patients, vital signs, laboratory tests, comorbidities, drugs used, lifesaving therapies secondary to the present pathology, tPA complications, mortality and similar presentations within the six months period were recorded to the study form.
Results: A total of 277 patients were included into the study. Ischemic stroke was the most prevalent disease entailing the institution of tPA (n=252; 91%). The study patients mostly used antihypertensives (n=155, 56%), followed by anti-aggregants (n=101, 36.5%). Intracranial hemorrhage (11.9%) was the most frequent complication secondary to tPA and the study patients had mostly undergone thrombectomy as a lifesaving therapy (n=34, 12.4%). The univariate analysis revealed that antiaggregant usage (n=21, 53.8% vs n=80, 33.6%; p=0.01), systolic blood pressure (160 mmHg, IQR: 138-190 vs 150 mmHg 130-169; p=0.02) and diastolic blood pressure (90 mmHg, IQR: 75-100 vs 83 mmHg, IQR: 72-94; p=0.03) differ between the patients with and without a post-tPA hemorrhage.
Conclusion: According to the results of this study, ischemic stroke is the main pathology related to tPA administration in ED. Hypertension was the most seen comorbidity in study patients, mostly using anti-hypertensive and anti-aggregants. Intracranial hemorrhage was the most prevalent complication owing to tPA use, and systolic and diastolic blood pressures and anti-aggregant use pertain to post-tPA hemorrhages.

Keywords

fibrinolytic therapy, stroke, pulmonary embolus, intracranial hemorrhage

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