Akut iskemik inmede intravenöz trombolitik tedavi: farkındalık, hasta seçimi ve yönlendirilmesi

Yıl 2012, Cilt: 6 Sayı: 1, 28 - 32, 22.04.2012

Ersin Ulusoy

Öz

İnme önemli bir mortalite ve morbidite nedenidir. İnme sonrası hastaların bakıma muhtaç hale gelmeleri topluma hem ciddi bir ekonomik yük hem de hasta yakınlarına sürekli bakım
zorunluluğu getirmektedir. Bu nedenle akut iskemik inmeli vakalarda trombolitik tedavi adaylarının görüntüleme öncesinde seçilerek uygun merkezlere yönlendirilmesi ve merkezlerin tedavi hazırlığının sağlanması açısından, toplumun ve ilk müdahaleyi yapan hekimin bilinçliliğinin arttırılmasına giderek ayrı bir önem verilmektedir. Bu derlemenin amacı; bu farkındalığı artırarak tedaviden yararlanan hasta sayısını arttırmaktır.

ABSTRACT
Stroke is an important cause of mortality and morbidity. Most patients become dependent to caregivers after the stroke for long periods. Some become dependent until the end of their lives. It’s a serious economic burden on their relatives and on society. Because of this reality, it’s important to select thrombolytic treatment candidates in acute ischemic stroke cases and transfer patients to the appropriate centers prior to neuroimaging. The awareness and knowledge of the physicians who are the first to contact these patients and readyness of the health centers evaluating these patients must be increased. The aim of this review is to increase the number of patients who benefit from this treatment by increasing the awareness level.

Anahtar Kelimeler

İskemik inme, trombolitik tedavi, farkındalık

Kaynakça

• 1. Hankey GJ. Stroke. How large a public health problem and how can the neurologist help? Arch Neurol 1999;56:748-754.
• 2. Zuber M, Mas JL. Epidemiologie des accidents vasculires cerebraux. Rev Neurol 1992;148:245-255.
• 3. Rosamond W, Flegal K, Friday G, et al. Heart disease and stroke statistics–2007 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2007; 115: e69-172.
• 4. Balkan S. Serebrovasküler Hastalıklar.2. Baskı. Ankara: Güneş Kitabevi;2005.
• 5. Adams, HP Jr,del Zoppo G, Alberts MJ, et al. Guidelines for the early management of adults witk ischemic stroke. Stroke 2007;38:1655-1711.
• 6. EUSI writing committee. European Stroke Initiative recommendations for stroke center improve care for ischemic stroke? Neurology, 2005;64:422- 427.
• 7. Marler JR, Tilley BC, Lu et. Al. Early stroke treatment associated with better autcome. The NINDS rt-PA Stroke Study. Neurology 2000;55: 1649-1655.
• 8. Hacke W, Kaste M, Fieschi C, Toni D, Lasaffre E, von Kummer R, Boysen G, Bluhmki E, Hoxter G, Mahagne M, Hennerici M, İntravenous trombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke. JAMA 1995;274: 1017-1059.
• 9. Saver JL. Number needed to treat estimates incorporating effects over the entire range of clinical outcomes: novel derivation method and application to thrombolytic therapy for acute stroke. Arch Neurol. 2004;61:1066-1070.
• 10. Liebeskind DS. Reperfusion for acute ischemic stroke: arterial revascularization and collateral therapeutics. Curr Opin Neurol. 2010; 23 : 36–45.
• 11. Multicenter Acute Stroke Trial-Italy (MUST-I) Group. Randomized controlled trial of streptokinase, aspirin, and combination of both in treatment of acute ischemic stroke. Lancet1998; 346: 1509-1514.
• 12. Nogueira RG, Schwamm LH, Hirsch JA. Endovascular approaches to acute stroke, part 1: drugs, devices, and data. AJNR 2009; 30: 649-661.
• 13. The ATLANTIS, ECASS, and NINDS rt-PA Study Group Investigators. Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet. 2004;363:768-774.
• 14. Wahlgren N, Ahmed N, Davalos A, Ford GA, Grond M, Hacke W, Hennerici MG, Kaste M, Külkens S, Larrue V, Lees KR, Roine RO, Soinne L, Toni D, Vanhooren G: Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITSMOST): an observational study. Lancet 2007;369:275-282.
• 15. Hacke W, Kaste M, Bluhmki E, et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Medicine 2008; 359: 1317- 1329.
• 16. Katzan IL, Hammer MD, Hixson ED, Furlan AJ, Abou-Chebl A, Nadzam DM. Utilization of intravenous tissue plasminogen activator for acute ischemic stroke. Arch Neurol. 2004;61;346-350.
• 17. The European Stroke Organization (ESO) Executive Committee and the ESO Writing Committee 2008.
• 18. Ingall TJ, O’Fallon WM, Asplund K, Goldfrank LR, Hertzberg VS, Louis TA, Christianson TJH. Findings from the reanalysis of the NNDHS Tissue Plasminogen Activator for Acute Ischemic Stroke Treatment Trial. Stroke 2004;35:2418-2424.