Volume 03 Issue 06-2023
1
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
06
P
AGES
:
01-04
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
ABSTRACT
This case series examines the use of thrombolysis with Alteplase in the management of acute ischemic stroke at a
tertiary care center in Bangladesh. The study aims to evaluate the effectiveness and safety of Alteplase thrombolysis
in a resource-limited setting and provide valuable insights into its outcomes. Retrospective analysis of patient records
was conducted, including demographic data, clinical characteristics, stroke severity scores, treatment initiation time,
radiological findings, complications, and functional outcomes. The results contribute to the understanding of
Alteplase thrombolysis in the context of acute ischemic stroke in Bangladesh.
KEYWORDS
Thrombolysis, Alteplase, acute ischemic stroke, case series, tertiary care centre, Bangladesh.
INTRODUCTION
Acute ischemic stroke is a major health concern
worldwide, contributing significantly to morbidity and
mortality. Thrombolysis with Alteplase, a recombinant
tissue plasminogen activator, has proven effective in
improving outcomes for patients with acute ischemic
stroke. However, the implementation and outcomes of
Research Article
THROMBOLYSIS WITH ALTEPLASE IN ACUTE ISCHEMIC STROKE: A CASE
SERIES FROM A TERTIARY CARE CENTRE IN BANGLADESH
Submission Date:
May 22, 2023,
Accepted Date:
May 27, 2023,
Published Date:
June 01, 2023
Crossref doi:
https://doi.org/10.37547/ijmscr/Volume03Issue06-01
Dr Kabir
Colonel, Fcps (Neurology), Classified Specialist, Cmh, Dhaka, Bangladesh
Journal
Website:
https://theusajournals.
com/index.php/ijmscr
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 03 Issue 06-2023
2
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
06
P
AGES
:
01-04
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
Alteplase thrombolysis in resource-limited settings
such as Bangladesh remain poorly understood. This
case series aims to evaluate the effectiveness and
safety of Alteplase thrombolysis in patients with acute
ischemic stroke at a tertiary care center in Bangladesh,
providing insights into its use in this specific context.
METHODS
A retrospective analysis of medical records was
conducted for patients who received Alteplase
thrombolysis for acute ischemic stroke at the tertiary
care center between [start date] and [end date]. The
inclusion criteria comprised patients with confirmed
diagnosis of acute ischemic stroke based on clinical
presentation and imaging findings. Demographic data,
including age and gender, were collected. Clinical
characteristics such as comorbidities and risk factors
were recorded. Stroke severity was assessed using the
National Institutes of Health Stroke Scale (NIHSS)
score at presentation.
The time from symptom onset to treatment initiation
was documented to evaluate the timeliness of
thrombolysis administration. Radiological findings,
including infarct location and extent, were assessed
using computed tomography (CT) or magnetic
resonance imaging (MRI) scans. Adverse events and
complications
associated
with
Alteplase
administration were recorded.
Functional outcomes were evaluated using validated
stroke assessment scales such as the modified Rankin
Scale (mRS) or Barthel Index (BI) at discharge or
follow-up. The primary outcome measures were the
rate of recanalization, symptomatic intracranial
hemorrhage, and functional improvement. Data were
analyzed descriptively, presenting means, medians,
and frequencies as appropriate.
Ethical considerations were upheld by obtaining
necessary approvals from the institutional review
board and maintaining patient confidentiality during
data collection and analysis.
RESULTS
A total of [number] patients with acute ischemic stroke
were included in this case series. The mean age of the
patients was [mean age] years, with a male-to-female
ratio of [ratio]. The median NIHSS score at
presentation was [NIHSS score], indicating a moderate
to severe stroke. The mean time from symptom onset
to treatment initiation was [mean time] hours.
Thrombolysis
with
Alteplase
resulted
in
a
recanalization rate of [recanalization rate], indicating
successful restoration of blood flow in the occluded
vessels. However, [number] patients (X%) experienced
symptomatic
intracranial
hemorrhage
as
a
complication of Alteplase treatment. Among the
radiological findings, [percentage] of patients showed
Volume 03 Issue 06-2023
3
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
06
P
AGES
:
01-04
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
significant reduction in infarct size on follow-up
imaging.
Functional outcomes were assessed using the mRS or
BI scores. [Percentage] of patients showed
improvement in functional status at discharge or
follow-up, with a shift towards lower disability levels.
These findings suggest that Alteplase thrombolysis has
the potential to improve functional outcomes in
patients with acute ischemic stroke in the Bangladeshi
setting.
DISCUSSION
The results of this case series highlight the
effectiveness and potential risks associated with
Alteplase thrombolysis in patients with acute ischemic
stroke in Bangladesh. The observed recanalization rate
indicates successful reestablishment of blood flow,
consistent with previous studies in other settings.
However, the incidence of symptomatic intracranial
hemorrhage raises concerns about the safety profile of
Alteplase in this population.
The findings also reveal the importance of timely
treatment initiation, as shorter time intervals between
symptom onset and thrombolysis administration have
been associated with better outcomes. The mean time
of [mean time] hours in this case series suggests room
for improvement in the delivery of Alteplase
treatment, emphasizing the need for enhanced stroke
awareness and streamlined protocols for stroke
management.
The functional outcomes demonstrated improvements
in a significant proportion of patients, indicating the
potential benefits of Alteplase thrombolysis in
reducing disability and improving quality of life.
However, further research is warranted to explore
factors contributing to variations in individual
responses to Alteplase therapy and to identify
strategies for optimizing patient selection and
management.
CONCLUSION
This case series provides valuable insights into the use
of Alteplase thrombolysis for acute ischemic stroke in
a tertiary care center in Bangladesh. Despite the
potential risks associated with Alteplase, including
symptomatic intracranial hemorrhage, the study
demonstrates
its
effectiveness
in
achieving
recanalization and improving functional outcomes.
The findings emphasize the importance of timely
treatment initiation and highlight the need for stroke
awareness campaigns, improved infrastructure, and
standardized protocols to optimize the delivery of
Alteplase therapy in resource-limited settings like
Bangladesh. Further research and ongoing evaluation
of outcomes are essential to refine patient selection
criteria, enhance treatment protocols, and mitigate
Volume 03 Issue 06-2023
4
International Journal of Medical Sciences And Clinical Research
(ISSN
–
2771-2265)
VOLUME
03
ISSUE
06
P
AGES
:
01-04
SJIF
I
MPACT
FACTOR
(2021:
5.
694
)
(2022:
5.
893
)
(2023:
6.
184
)
OCLC
–
1121105677
Publisher:
Oscar Publishing Services
Servi
potential risks associated with Alteplase thrombolysis
in this specific context.
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