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Intravenöse Thrombolyse mit Alteplase beim akuten ischämischen Schlaganfall

Anwendung in einem Krankenhaus ohne spezielle Stroke Unit?

Intravenous thrombolysis with alteplase for acute ischaemic stroke

Application in a hospital without a specialised stroke unit?

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Zusammenfassung

Hintergrund

Ziel der vorliegenden Studie war es, die ersten Erfahrungen mit der intravenösen Thrombolyse mit Alteplase (rt-PA) beim akuten ischämischen Schlaganfall (IS) in unserem Krankenhaus ohne spezielle Stroke Unit bezüglich Sicherheit und Effektivität zu analysieren.

Patienten und Methoden

Für diese retrospektive Untersuchung konnten die Daten von 177 der 182 konsekutiven Patienten, die von September 2004 bis Juni 2006 auf unserer „Intermediate Care Station“ wegen eines IS behandelt worden waren, ausgewertet werden.

Ergebnisse

Von den 177 Patienten mit IS wurden 10,7% (19/177; 10 Frauen; mittleres Alter: 74,7±10,1 Jahre [Spannbreite: 54–92 Jahre]) mit rt-PA behandelt. Der mittlere „National Institute of Health“ (NIH-) Schlaganfall-Score fiel dabei von 15,2±5,1 bei Aufnahme auf 8,7±6,1 vor Entlassung (p<0,01) ab. Die Hospitalmortalität war bei den lysierten tendenziell niedriger als bei den konventionell behandelten Patienten (0% vs. 12,6%; p=0,09).

Schlussfolgerung

Die intravenöse Thrombolyse kann auch in einem Krankenhaus ohne spezielle Stroke Unit eine sichere und effektive Therapieoption beim akuten IS sein, sofern ein kranielles Computertomogramm 24 h verfügbar ist.

Abstract

Background

The aim of the present investigation was to analyse the first experience of thrombolysis with intravenous alteplase (rt-PA) for ischaemic stroke (IS) in our hospital without a specialised stroke unit in terms of safety and effectiveness.

Patients and methods

For this retrospective study, the data of 177 out of 182 consecutive patients who had been treated for IS in our intermediate care unit between September 2004, and June 2006, could be evaluated.

Results

Of the 177 patients with IS 10.7% (19/177; 10 women, mean age: 74.7±10.1 years, range 54–92 years) were treated with rt-PA. Thereby, the mean National Institute of Health Stroke Scale Score decreased from 15.2±5.1 on admission to 8.7±6.1 before discharge (p<0.01). Patients with thrombolysis showed a trend towards a lower in-hospital mortality compared to those patients treated conventionally (0% vs. 12.6%; p=0.09).

Conclusion

Intravenous thrombolysis may be a safe and an effective treatment option for acute IS also in a hospital without a specialised stroke unit, if a cerebral CT scan is available for 24 h per day.

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Danksagung

Wir danken Frau Birgit Lotze für die engagierte Unterstützung bei der Fertigstellung des Manuskripts.

Interessenkonflikt

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Authors and Affiliations

  1. Medizinische Klinik I, Krankenhaus Waltershausen-Friedrichroda GmbH, Friedrichroda, Deutschland

    U. Lotze Chefarzt, K. Neubauer & J. Liebetrau

  2. Klinik für Innere Medizin, Saale-Unstrut-Klinikum Naumburg, Humboldtstr. 31, 06618, Naumburg, Deutschland

    U. Lotze Chefarzt

  3. Abteilung für Röntgendiagnostik, Krankenhaus Waltershausen-Friedrichroda GmbH, Friedrichroda, Deutschland

    M. Zivcec

  4. Medizinische Klinik II, Krankenhaus Waltershausen-Friedrichroda GmbH, Friedrichroda, Deutschland

    C.U. Günther

  5. Institut für bildgebende Diagnostik, Zentralklinik Bad Berka GmbH, Bad Berka, Deutschland

    J. Leonhardi

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  1. U. Lotze Chefarzt
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  2. K. Neubauer
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  6. J. Leonhardi
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Correspondence to U. Lotze Chefarzt.

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Lotze, U., Neubauer, K., Zivcec, M. et al. Intravenöse Thrombolyse mit Alteplase beim akuten ischämischen Schlaganfall. Notfall Rettungsmed 11, 407–414 (2008). https://doi.org/10.1007/s10049-008-1079-8

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  • DOI: https://doi.org/10.1007/s10049-008-1079-8

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