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Trombolitička terapija akutnog ishemijskog moždanog udara Thrombolytic therapy for acute ishemic stroke
Oblast: resuscitaciona medicina Opis: acute; ischemic stroke; therapy; recombinant tissue plasminogen activator Sazetak: Intravenska primena rekombinovanog tkivnog aktivator plazminogena je trenutno jedino priznati postupak u lečenju akutnog ishemijskog moždanog udara (AIMU)od strane FDA. Intravenska primena tPA je bazirana na Nacional Institute of neurological Disorders and Stroke (NINDS) studiji kojom je postignut revolucionarni preokret u lečenju AIMU. Već u prvoj etapi studije, dokazana je efikasnost i bezbednost primene tPA. Pacijenti lečeni sa 0.9 mg/kg IV tPA IV, unutar tri sata od pojave inicijalnih simptoma AIMU imali su signifikantno niži NIHS skor unutar 24 h i 30% veće šanse da se u toku tri naredna meseca oporave bez, ili sa minimalnim funkcionalnim deficitom. Simptomatske intrakranijalne hemoragije značajno su rasle sa tretmanom, mada je ukupan procenat (6,4%) bio manji nego u drugim studijama. Mnoge zajednice i akademski centri imali su slična iskustva u lečenju AIMU primenom tPA, korišćenjem inkluzionih/eksluzionih kriterijuma NINDS studije. --------- Intravenous (IV) recombinant tissue plasminogen activator (tPA, alteplase) is currently the only treatment for acute ischemic stroke approved by the FDA. The use of IV tPA is based on the National Institutes of Neurological Disorders and Stroke (NINDS) studies that revolutionized the treatment of acute ischemic stroke. For the first time an effective and safe therapy for stroke was demonstrated. Patients treated with 0.9 mg/kg IV tPA within three hours of the onset of stroke had significantly lower NIHSS at 24 hours and were 30% more likely than placebo to have minimal or no disability at three months. Symptomatic hemorrhage was 6% in the tPA treated group compared to 0.6% in placebo but there was a non-significant reduction in mortality in the tPA treated group. Numerous community and academic centers have reported similar experience with the use of t-PA for acute ischemic stroke using the NINDS study inclusion/exclusion criteria.
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