Intravenous Thrombolytic Therapy with Recombinant Tissue Plasminogen Activator rt-PA (Actilyse^®) – Our First Experience from Practice

Czech version

Authors: J. Pribula ¹; P. Grajcar ²; A. Pribulová ³
Authors‘ workplace: neurologické oddělení, Městská nemocnice, Litoměřice ¹; kardiovaskulární JIP, Městská nemocnice, Litoměřice ²; rehabilitační oddělení, Městská nemocnice, Litoměřice ³
Published in: Cesk Slov Neurol N 2007; 70/103(1): 57-61
Category: Short Communication

Motto: „ … nejvyšší prioritou je léčit všechny pacienty bezodkladně. To znamená, že týmy specializované na léčbu akutních ischemických iktů by měly zaměřit celé své úsilí na redukci času od příjezdu pacienta do nemocnice po zahájení léčby rt-PA za účelem zlepšit možnosti na příznivější uzdravení“ [1].
Profesor Werner Hacke, přednosta Neurologické kliniky, Univerzita v Heidelbergu, Německo, předseda vědecké komise studie ECASS II

Overview

The report has analysed the first experience with intravenous thrombolytic therapy using recombinant plasminogen activator (rt-PA) in patients suffering from acute ischemic cerebrovascular accident (aiCV A) at the therapeutical interval by 3 hours since the development of the ictus symptomatology. Its course, results and safety in local conditions have been assessed retrospectively. Within January 2005 – June 2006, 203 patients with aiCVA were treated in our centre. Systemic intravenous thrombolytic therapy with rt-PA was applied in 8 of them (3.94 %). The indication criteria were identical with the recommendations issued by the Česká lékařská komora (ČLK). Thrombolytic therapy was given to five men and three women with the average age of 57 years. Mean period between developing the first signs of aiCVA and i.v. application of rt-PA was 107 minutes, and that elapsed between the patient´s admission to an emergency department and initiating i.v. rt-PA was 65 minutes. Clinically insignificant small intracerebral haemorrhage was observed in two cases with input hypertension. aiCVA relapsed in one case after successful thrombolysis carried out in the interval of 50 hours. No fatal complication was seen in the periprocedural course. A microset of eight patients evaluated retrospectively showed early improvement of their general conditions assessed as a reduction of clinical neurological deficit minimally by 4 points according to the NIHSS scale in the course of the first 24 hours after thrombolysis. The effects of thrombolytic therapy are evident even in the picture of ADL (Activity of Daily Living) scoring 90 days after the ictus development.

Key-words:
recombinant tissue plasminogen activator, rt-PA, therapy for acute ischemic ictus

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