Pharmacotherapeutic characterization in patients with ischemic stroke in a hospital in Soledad, Atlántico

Caracterización farmacoterapéutica en pacientes con accidente cerebrovascular isquémico en un hospital de Soledad, Atlántico

Objective: to characterize the pharmacotherapy of patients with acute ischemic stroke (ACVi) treated with recombinant tissue plasminogen activator (rt-PA) in a hospital in Soledad - Atlántico in the period 2015-2020. Materials and methods: a retrospective descriptive observational study was carried out, for the quantitative variables the Kolmogórov – Smirnov normality test was applied. The data that complied with the assumption of normality (p>0.05) were presented as means ± standard deviation, those that did not comply were presented as medians. Categorical variables were shown as frequencies or percentages. Results: 72 patients with a median age of 74 years were studied, 52.2% of the population were men, 69.4% suffered from arterial hypertension, 26.4% received platelet aggregation inhibitors, excluding heparin, and 23, 6% were administered drugs belonging to the therapeutic group of heparins. Twenty-five percent of the population developed hemorrhage: 19.4% had intracerebral hemorrhage, 4.2% developed subarachnoid hemorrhage, and 1.4% had gastrointestinal hemorrhage. Conclusion: it was possible to identify opportunities for improvement in the management of patients with stroke and in the use of alteplase. A higher percentage of bleeding complications was found compared to studies previously conducted in Colombia. Further investigations are required to corroborate the results, due to the limited number of participants and scarce data related to clinical histories.

1. Wing E; Schiffman F. Cerebrovascular Disease. In: Elsevier, editor. Cecil Essentials of Medicine. 10th ed. 2021. p. 1056.
2. Donkor ES. Stroke in the 21st Century: A Snapshot of the Burden, Epidemiology, and Quality of Life. Stroke Res Treat. 2018; 2018:1–10.
3. World Health Organization. Stroke, Cerebrovascular accident. 2023.
4. Phipps MS, Cronin CA. Management of acute ischemic stroke. BMJ. 2020; l6983.
5. Demaerschalk B, Kleindorfer D, Adeoye O, Demchuk A, Fugate J, Grotta J, et al. Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke A Statement for Healthcare Professionals from the American Heart Association/American Stroke Association. Stroke. 2016. 581–641 p.
6. Reed M, Kerndt C, Nicolas D. Alteplase. StatPearls. 2023.
7. García Alfonso C, Martínez Reyes AE, García V, Ricaurte Fajardo A, Torres I, Coral Casas J. Actualización en diagnóstico y tratamiento del ataque cerebrovascular isquémico agudo. Univ Médica. 2019;60(3):1–17.
8. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Grou. Tissue Plasminogen Activator for Acute Ischemic Stroke. N Engl J Med. 1995; 333(24):1581–8.
9. Wahlgren N, Ahmed N, Eriksson N, Aichner F, Bluhmki E, Dávalos A, et al. Multivariable Analysis of Outcome Predictors and Adjustment of Main Outcome Results to Baseline Data Profile in Randomized Controlled Trials. Stroke. 2008; 39(12):3316–22.
10. Whiteley WN, Thompson D, Murray G, Cohen G, Lindley RI, Wardlaw J, et al. Targeting Recombinant Tissue-Type Plasminogen Activator in Acute Ischemic Stroke Based on Risk of Intracranial Hemorrhage or Poor Functional Outcome. Stroke. 2014; 45(4):1000–6.
11. Pan X, Lu J, Cheng W, Yang Y, Zhu J, Jin M. Pulmonary static inflation with 50% xenon attenuates decline in tissue factor in patients undergoing Stanford type A acute aortic dissection repair. J Thorac Dis. 2018; 10(7):4368–76.
12. Organización Panamericana De la Salud. Elaboración y medición de indicadores de salud. Indicadores de salud. 2018. 1–83 p.
13. Spronk E, Sykes G, Falcione S, Munsterman D, Joy T, Kamtchum-Tatuene J, et al. Hemorrhagic Transformation in Ischemic Stroke and the Role of Inflammation. Front Neurol. 2021;12:1–15.
14. Boehringer Ingelheim Pharma GmbH & Co. KG. Actilyse. 2018;1–23. Available from: https://resources.boehringer-ingelheim.com/Prospectos_ROPU_SA/ACTILYSE/ACTILYSE_PY.pdf
15. Instituto Nacional de Salud, Observatorio Nacional de Salud. Carga de enfermedad por enfermedades crónicas no transmisibles y discapacidad en Colombia. Observatorio Nacional de Salud. 2015.
16. Tseng Y, Hu R, Lee S, Lin Y, Hsu C, Lin S, et al. Risk Factors Associated with Outcomes of Recombinant Tissue Plasminogen Activator Therapy in Patients with Acute Ischemic Stroke. Int J Environ Res Public Health. 2020; (2):618.
17. Soto V. Á, Morales I. G, Echeverría V. G, Belén Colinas G. M, Canales O. P, Contreras B. D. Factores asociados a llegada y evaluación precoz de pacientes con ataque cerebrovascular en un hospital regional de alta complejidad. Rev Chil Neuropsiquiatr. 2019; 57(2):158–66.
18. Mohamadpour M, Whitney K, Bergold PJ. The importance of therapeutic time window in the treatment of traumatic brain injury. Front Neurosci. 2019;13: 1–10.
19. Anderson CS, Huang Y, Lindley RI, Chen X, Arima H, Chen G, et al. Intensive blood pressure reduction with intravenous thrombolysis therapy for acute ischaemic stroke (ENCHANTED): an international, randomised, open-label, blinded-endpoint, phase 3 trial. Lancet. 2019; 393(10174):877–88.
20. Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke a guideline for healthcare professionals from the American Heart Association/American Stroke A. Stroke. 2019.
21. Harder S, Klinkhardt U. Thrombolytics. Drug Saf. 2000; 23(5): 391–9.
22. Berge E, Whiteley W, Audebert H, De Marchis G, Fonseca AC, Padiglioni C, et al. European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke. Eur Stroke J. 2021; (1):I–LXII.
23. Garg R, Biller J. Recent advances in spontaneous intracerebral hemorrhage. F1000Research. 2019;8.
24. Truc My Nguyen T, van de Stadt SIW, Groot AE, Wermer MJH, den Hertog HM, Droste HM, et al. Thrombolysis related symptomatic intracranial hemorrhage in estimated versus measured body weight. Int J Stroke. 2020;15(2):159–66.
25. Cheng CY, Chen SH, Chen HM, Li CJ, Liu TY, Tan TY. Impact of estimated-weight-base dose of alteplase in acute stroke treatment on clinical outcome. J Clin Neurosci. 2021;85:101–5.
26. Dancsecs KA, Nestor M, Bailey A, Hess E, Metts E, Cook AM. Identifying errors and safety considerations in patients undergoing thrombolysis for acute ischemic stroke. Am J Emerg Med. 2021; 47:90–4.
27. Pineda DA. Trombólisis con tratamiento con activador recombinante del plasminógeno tisular (rt-PA) para el ataque cerebro vascular agudo: la experiencia colombiana. Acta Neurológica Colomb. 2017; 33(1):1–2.
28. Martinez Rubio CF, Rodríguez Orozco JE. Trombólisis Endovenosa en ACV Isquémico: Experiencia en un Hospital de Popayán, Cauca. Acta Neurológica Colomb. 2020;36(3): 212–4.
29. Hernández Ruiz EA, Guarín Navas EG, Lora Acuña FJ, Acosta Reyes J, Beltrán Carrascal E, Meza Cely. N. Trombólisis intravenosa en pacientes con accidente cerebrovascular isquémico: Experiencia de un Hospital del Caribe Colombiano. Acta Neurológica Colomb. 2017; 33(1): 3–7.