Cohort study of the efficacy and safety of thrombolytic therapy of ischemic stroke in vascular centers of the Republic of Tatarstan


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Background. The frequency of thrombolytic therapy (TLT) is an important indicator of the work of a stroke service in any region. Identifying the reasons limiting the frequency of TLT use is extremely important. Objective. Assessment of the efficacy and safety of the intravenous thrombolysis in patients with ischemic stroke (IS) in the vascular centers of the Republic of Tatarstan. Identification of possible factors limiting the use of TLT in IS. Methods. Observational 12-year study of treatment outcomes for patients with IS in vascular centers based on hospital registry data. Results. The study included 124 891 IS patients; 101 551 patients were treated in vascular centers. TLT was performed in 4903 patients. The frequency of intravenous thrombolysis for the period from 2008 to 2019 increased from 2.87 to 7.83% (p<0.005); among patients with baseline NIHSS score of more than 15 points at admission, the frequency of thrombolysis decreased from 8.95 to 6.78% (p<0.05). Assessment of the outcomes by the 30th day from the onset of the disease revealed that the proportion of independent in everyday activities after thrombolysis was 54.95%; among patients who did not undergo TLT, the proportion of independent in everyday activities was 30.80%. Over 12 years, the incidence of symptomatic hemorrhagic transformations after thrombolysis decreased from 7.57 to 1.51% (p<0.001). The mortality rate among patients who did not undergo TLT was 9.72%. Mortality among patients who underwent TLT was 5.10%; over the period from 2008 to 2019, mortality in this category of patients decreased from 15.15 to 5.30% (p<0.005). Conclusion. In the clinical practice of vascular centers in the Republic of Tatarstan, TLT has demonstrated its safety and efficacy in patients with IS of varying severity. Analysis of the stroke register data allows concluding about the importance of the decision-making problem at the stage of selecting patient candidates for reperfusion therapy.

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作者简介

Timur Demin

Interregional Clinical and Diagnostic Center

Email: tdiemin@gmail.com
Neurologist of the highest qualification category, Head of the Neurological Department for Stroke Patients Kazan, Russia

D. Khasanova

Interregional Clinical and Diagnostic Center; Kazan State Medical University

Kazan, Russia

D. Nefedieva

Children's Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan; Kazan State Medical Academy - Branch Campus of RMACPE

Kazan, Russia

M. Volodyukhin

Interregional Clinical and Diagnostic Center

Kazan, Russia

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