Serie de casos sobre la mortalidad a 30 días tras trombectomía o fibrinólisis.El reto de la dispersión demográfica

  1. Alba García Moreira 1
  2. Lurdes González Blanco 1
  3. Carmen Rodríguez Jiménez 2
  4. Susana Álvarez Fernández 3
  1. 1 Servicio de Urgencias Hospitalarias. Complexo Hospitalario Universitario de Ourense. Ourense (España)
  2. 2 Centro de Salud de Moguer. Distrito Gerencia de Atención Primaria Huelva. Distrito Condado-Campiña. Huelva (España)
  3. 3 Servicio de Urgencias Hospitalarias. Hospital Álvaro Cunqueiro. Vigo (España)
Revista:
Revista Clínica de Medicina de Familia

ISSN: 2386-8201

Ano de publicación: 2023

Volume: 16

Número: 2

Páxinas: 88-93

Tipo: Artigo

DOI: 10.55783/RCMF.160205 DIALNET GOOGLE SCHOLAR lock_openAcceso aberto editor

Outras publicacións en: Revista Clínica de Medicina de Familia

Obxectivos de Desenvolvemento Sustentable

Resumo

Purpose: this study aims to analyze the survival and mortality rate after 30 days in patients with stroke code and fibrinolysis/thrombectomy. In addition, it is proposed to observe whether the demographic dispersion by the hospital’s location has any impact on this relationship for the patient. Method: longitudinal, retrospective and observational study. Patients with stroke code in the province of Ourense, Galicia. Subjects are 153 patients with a mean age of 76±12 years (83 women), recruited over 17 months. The variables to consider included the affected artery, fibrinolysis/thrombectomy intervention, mortality after 30 days, application of computerized tomography angiography, changes in the NIHSS (National Institutes Stroke Scale) and times in the casualty department in three hospitals in the province (Ourense, O Barco and Verín). Results: 12.9% of patients died within 30 days of the event. At least 54.2% of patients (84) received fibrinolysis, 19.4% underwent thrombectomy and at least 40 patients (26.0%) underwent a combined intervention (fibrinolysis + thrombectomy). A total of 13.1% of patients with fibrinolysis reached exitus letalis after 30 days. Logistic analysis determined that performing a thrombectomy reduces the probability of death, but not significantly. Conclusions: no statistically significant relationship was detected between the application of a specific treatment (thrombectomy/fibrinolysis) or its combination with the mortality rate of patients after 30 days. Ourense hospital that is closest to the thrombectomy referral centres shows P.

Información de financiamento

Referencias bibliográficas

  • Bagoly Z, Szegedi I, Kálmándi R, Tóth NK, Csiba L. Markers of coagulation and fibrinolysis predicting the outcome of acute ischemic stroke thrombolysis treatment: A review of the literature. Front Neurol. 2019;10:513.
  • Barker AB, Wagener BM. An ounce of prevention may prevent hospitalization. Physiol Rev. 2020;100(3):1.347-8. doi:10.1152/physrev.00017.2020.
  • Desilles JP, Consoli A, Redjem H, Coskun O, Ciccio G, Smaida S, et al. Successful Reperfusion with Mechanical Thrombectomy Is Associated with Reduced Disability and Mortality in Patients with Pretreatment Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Score ≤6. Stroke. 2017;48(4):963-9.
  • Dwivedi A, Glynn A, Johnson S, Duffy S, Fereidoonnezhad B, McGarry P, et al. Measuring the effect of thrombosis, thrombus maturation and thrombolysis on clot mechanical properties in an in-vitro model. J Biomech. 2021:129:110731
  • He Y De, Guo ZN, Qin C, Hin H, Zhang P, Abuduxukuer R, et al. Remote ischemic conditioning combined with intravenous thrombolysis for acute ischemic stroke. Ann Clin Transl Neurol. 2020;7(6):972-979.
  • Henderson SJ, Weitz JI, Kim PY. Fibrinolysis: strategies to enhance the treatment of acute ischemic stroke. J Thromb Haemost. 2018;16(10):1932-40.
  • Kai B, Bogorad Y, Nguyen LAN, Yang SJ, Chen W, Spencer HT, et al. Warfarin use and the risk of mortality, stroke, and bleeding in hemodialysis patients with atrial fibrillation. Heart Rhythm. 2017;14(5):645-51. doi:10.1016/j.hrthm.2017.01.047.
  • Katsanos AH, Malhotra K, Goyal N, Palaiodimou L, Schellinger P, Caso V, et al. Mortality Risk in Acute Ischemic Stroke Patients with Large Vessel Occlusion Treated With Mechanical Thrombectomy. J Am Heart Assoc. 2019;8(21):e014425.
  • Lovrencic-Huzjan A, Rundek T, Katsnelson M. Recommendations for management of patients with carotid stenosis. Stroke Res Treat. 2012:175869.
  • Man S, Schold JD, Uchino K. Impact of Stroke Center Certification on Mortality after Ischemic Stroke: The Medicare Cohort from 2009 to 2013. Stroke. 2017;48(9):2.527-33.
  • Mi D, Wang P, Yang B, Pu Y, Yang Z, Liu L. Correlation of hyperglycemia with mortality after acute ischemic stroke. Ther Adv Neurol Discord. 2018;11:1-5.
  • Muntner P, Whittle J, Lynch AI, Colontino L, Simpson L, Einhor P, et al. Visit-to-visit variability of blood pressure and coronary heart disease, stroke, heart failure, and mortality a cohort study. Ann Intern Med. 2015;163(5):329-38. doi:10.7326/M14-2803.
  • Panni P, Gory B, Xie Y, Consoli A, Desilles JP, Mazhigi M, et al. Acute Stroke With Large Ischemic Core Treated by Thrombectomy: Predictors of Good Outcome and Mortality. Stroke. 2019;50(5):1.164-71.
  • Pineda DA. Trombólisis con tratamiento con activador recombinante del plasminógeno tisular (rt-PA) para el ataque cerebro vascular agudo: la experiencia colombiana. Acta Neurol Colomb. Doi: https://dx.doi.org/10.22379/issn.2422-4022.
  • Romero C, Gaviria M, Mutis JA. Trombólisis intravenosa exitosa en infarto cerebral agudo en paciente con historia de macroadenoma y apoplejía hipofisaria. Rev Neurol Neurocir y Psiquiat. 2021;49(1):19-22.
  • Thrift AG, Thayabaranathan T, Howard G, Howard V, Rothwell P, Feignet V, et al. Global stroke statistics. Int J Stroke. 2017;12(1):13-32.
  • Villwock MR, Padalino DJ, Deshaies EM. Trends in mortality following mechanical thrombectomy for the treatment of acute ischemic stroke in the USA. J Neurointerv Surg. 2016;8(5):457-60.
  • Yang P, Zhang Y, Zhang L, Zhang Y, Treurniet KM, Chen W, et al. Endovascular Thrombectomy with or without Intravenous Alteplase in Acute Stroke. N Engl J Med. 2020;382(21):1981-93.