Faisabilité et sécurité de la thrombolyse des accidents vasculaires cérébraux du Centre hospitalier de Pau

Autor: Daniel Bersani, Bruno Barroso, Alain Lippa, Philippe Carlier, Edouard Larribau, Jean-Marc Larrieu, Christophe Morisset, Alexandre Dakar, Hervé Mangon, Jean-François Lagabrielle, Nicole Montaut, François Rouanet
Rok vydání: 2007
Předmět:
Zdroj: La Presse Médicale. 36:859-866
ISSN: 0755-4982
Popis: Summary Background Stroke is the most common cause of permanent disability in Europe and is a major public health problem. A recent significant therapeutic advance is the administration of recombinant tissue plasminogen activator (rtPA) for cerebral infarcts within three hours of symptom onset. French guidelines limit its use to patients in specialized stroke units. There is only one stroke unit in the region of Aquitaine, in Bordeaux, 200 km from Pau and too far to transfer patients within the necessary time. With the collaboration of our colleagues in Bordeaux we decided to assess whether stroke thrombolysis could be feasibly and safely administered in our district general hospital. Design From September 2004 through August 2005, eligible patients received rtPA treatment in the emergency department. The National Institutes of Health Stroke Scale (NIHSS) was administered at admission, immediately after treatment, and 24 hours later. In January 2006, a prospective follow-up assessed the NIHSS, Modified Rankin Scale (MRS) and Barthel Index Score (BIS) for all subjects still alive and collected data about those who had died. Results In all, 553 patients were admitted for stroke: 306 had cerebral infarcts and 25 (8.1%) were treated by intravenous thrombolysis. The mean age of the patients who received thrombolysis was 67 years (range: 33-80), and the sex ratio was 4/1 (20 men and 5 women). Mean delay from symptom onset to treatment was 150 min (range 105-180). The median NIHSS score was 13 (range 8-22) at admission, 10 (range 0-22) after treatment, and 7 the next day (range 0-22). Two patients (8%) died during the acute phase. On January 2006, after a median follow-up of 11.6 months (range: 6-16), 18 (72%) patients were still alive: 13 (52%) with good outcomes (MRS, 0-1) and 3 severely disabled and institutionalized (BIS, 0-50). Conclusion Our results show that thrombolysis is possible in Pau. The population in our catchment area has a good proportion of stroke patients eligible for thrombolytic treatment. Outcomes and mortality rate are consistent with experience elsewhere. The creation of a stroke unit should help improve prognosis while complying with management guidelines.
Databáze: OpenAIRE
Externí odkaz: