الفهرس 
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Abstract
Stroke is a devastating disease with increasing incidence and prevalence due to population aging.
The most effective approach in acute stroke therapy is still under discussion, but it appears reasonable to get the vessel recanalized to save penumbra tissue.
Intravenous alteplase is FDA approved within 4.5 hours of acute ischemic stoke onset. Some studies extend the window to 6 hours.
Our study was a prospective open-label controlled clinical trial conducted on 60 patients with acute ischemic stroke (AIS); to compare safety and effectiveness of Alteplase given 3-6 hours versus 0-3 hours after acute ischemic stroke.
Patients were subjected to full medical history, general and neurological examinations using NIHSS on admission, after infusion, after 24 hours and on deterioration, along with Modified ran king score on admission and after 30 days by phone).
Investigations included; complete blood count, PT-PTT-INR, cardiac enzymes (troponin), fibrinogen, FDP, ECG, non-contrast head CT on admission, and 24 hours.
60 AIS patient males and females divided into 2 groups 30 patients each. Eligible patients was categorized as having treatment within 3 hours or from 3to 6 hours and was evaluated for the following: Neurological improvement is defined as a decrease of 4 points in the 24-hour NIHSS score compared to baseline or the resolution of neurological deficit within 24 hours. Disability as measured by the modified Rankin Scale, incidence of mortality, and parenchymal hemorrhages.
Patients were followed up for
• Any signs suggestive of bleeding or neurological deterioration to stop the infusion. Observe for angioedema (face, tongue, pharynx) at 30-45-60-75 minutes of administration (treatment with hydrocortisone 100 mg IV q 8 hours).
• Blood pressure monitoring every 15 minutes for 2 hours then every 30 minutes for 6 hours then every 4 hours for 16 hours following treatment. Aggressive blood pressure lowering if >180/105 mm Hg.
• NPO until dysphagia is properly assessed. Repeat CT brain after 24 following rtPA administration (detect symptomatic hemorrhage and decision to restore antiplatelet therapy)
Our study revealed Highly significant shorter time of onset of symptoms, in A group; compared to B group. Significant decrease in NIHSS score in A group; compared to B group; during the post-infusion measurements. Non-significant decrease in mRS score in A group; compared to B group; during the post-infusion measurements.
We found that, there is significant decrease in mortality in A group; compared to B group. We also found that, there is non-significant difference as regards parenchymal hemorrhages, between the 2 groups.
Alteplase infusion therapy within the first 3 hours of stroke onset, convey a great benefit regarding improvement of NIHSS and mRS scores, along with decreased mortality and intracranial hemorrhage rates, as compared with 3-6 hours Alteplase infusion. The 3-6 hours group can benefit from IV thrombolytic by proper selection of patients.