Abstract

MEZA BEJARANO, Yilber; RODRIGUEZ QUINTANA, Jesús Hernán; AMAYA GONZALEZ, Pablo  and  RESTREPO, Héctor Fabio. Contraindications for thrombolysis in patients with acute ischemic stroke. Acta Neurol Colomb. [online]. 2013, vol.29, n.1, pp.4-9. ISSN 0120-8748.

Introduction: stroke ranks first in frequency among all adult neurological diseases, and it is the third most frequent cause of death. In order to have an acute management, it was approved therapy with recombinant tissue plasminogen activator (rt-PA) in the first 4,5 hours after symptoms onset, showing a longer survival and lower level of disability. However only 5-10% of patients receive this management. These are the reasons why it is necessary to know which factors are associated with non-therapeutic intervention. Objective: to describe factors associated with non-thrombolysis in patients with stroke in a level IV hospital in Bogota, Colombia. Materials and methods: cross-sectional analytical study in a hospital in Bogota between January 2009 and January 2011. Results: we found 178 patients at an average age of 65.9 years (± 10 years) with a male to female ratio 1:1, the leading cause of non-thrombolysis was greater than window 4.5 hours, 33.7% (n = 60), 26.4% by changes in diagnostic image, and 14% for mild or sever scores on the scale National Institute of Health Stroke Scale (NIHSS), surgical history 7.3% and laboratory 4.5%. The average time of attention was 23 minutes (SD ± 21 min.) for the stroke code ACV activation, 39 minutes for evaluation of neurology (DE ± 25 min), 46 minutes (DE ± 19,1 min), for making paraclinical issues, 66 minutes for images shooting and 97 minutes for thrombolysis (SD ± 21 min, SD ± 17 min, respectively). Thrombolysis was performed in 17 patients, 9.6%. No significant association between organizational culture with thrombolysis or service time with thrombolysis was found. Conclusions: the main reason for not thrombolysis was the window increased to 4.5 hours, there was no relationship between institutional organizational culture with thrombolysis. The average time was 90 minutes thrombolysis. Measures should be in place to reduce the time of arrival at the hospital, and the times of emergency care. New assessments should be performed after stroke code improvement strategies.

Keywords : Stroke; Thrombolitic Thepaphy; door-to-needle time; Organizational Culture.

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