الفهرس 
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Abstract
In the present study the aim was to study the outcome and complications of IV rtPA treatment using both 0.9mg/kg and 0.6mg/kg doses of tPA in AIS patients at Alexandria University during one-year-period with follow-up 3 and 6 months after the recruitment.
To achieve this aim, patients were included and excluded according to the following criteria:
Inclusion Criteria:
All patients presented with AIS within 4.5 hours from the onset of symptoms with no contraindication to the rtPA and received rtPA at Alexandria University Hospital Stroke units at Elhadara and smouha hospitals during the one-year-period starting from February 2017 to February 2018.
Exclusion Criteria:
• All patients with absolute contraindication to rtPA were excluded.
• Patients with relative contraindications for rtPA were evaluated according to risk vs. benefit in every individual situation
All patients in this study were subjected to the following:
1. Ethical approval and written informed consent from all the subjects or their responsible relatives were obtained.
2. Rapid assessment on admission including complete history taking, neurological examination, assessment of stroke severity by NIHSS, RACE and FAST-ED, initial brain imaging (CT brain or MRI with DWI) and assessment of the CT brain by ASPECTS, assessment of vital signs and initial laboratory investigations (CBC, INR and random blood glucose).
3. After senior staff consultation about each individual patient for optimal medical care, patients were admitted to the stroke unit for the first 24-48 hours with estimation of rtPA dose (either 0.9 or 0.6mg/kg according to the anticipated risk of bleeding) and vital signs neurological assessment including NIHSS were monitored and checked at least every 15 min for first 2 hours, every 30 minutes for the next 6 hours, then every 1 hour for 24h after treatment.
4. Follow up CT brain 24 hours after treatment with IV rtPA.
5. Assessment by NIHSS and mRS 24 hour after tPA and upon discharge and the barthel index of activities of daily life upon discharge.
6. During admission or on outpatient follow-up visits: the studied patients underwent full routine laboratory investigations, cardiac assessment by ECG and echocardiography, carotid doppler or CT brain angiography, rehabilitation and use of antiplatelets or anticoagulants with or without statins post-stroke.
7. On follow-up visits scheduled three and six months after rtPA, the patient were assessmed by NIHSS, mRS, barthel index of activities of daily living and follow up CT brain.