[thorn]

Сообщение от ErickRed

Соглашусь, что принципы ЕВМ в пользу лизиса. Но попасть на "красный" тромб, при котором лизис эффективен - тоже лотерея! Поэтому, на мой взгляд, для того, чтобы лизировать ИИ, стоит учитывать две вещи: доказанность тромбоэмболического характера ИИ и отсутствие окклюзирующего процесса в МАГ, ИМХО.

...И все-таки, если бы была река алтеплазы, круглосуточное КТ и больных везли в первые 3 часа - благословили бы у себя в клинике тромболизис? Как отнесется начальство к 6% симптоматического геморража при тромболизисе, полученного в первые 36 часов, а лучшему функциональному исходу через 3 месяца?
Пока у нас дальше разговоров дело не идет, канадцы, например, и у пациентов старше 80 лет тромболизис проводят... Ужос ...

TPA Is Safe in Elderly Patients With Acute Ischemic Stroke

By Michelle Rizzo

NEW YORK (Reuters Health) Jul 28 - Results of a study published in the July issue of the Journal of Neurology, Neurosurgery, and Psychiatry suggest that thrombolysis can be safely applied in carefully selected elderly patients with acute ischemic stroke.
"Ischemic stroke patients over 80 can be successfully and safely treated with tPA," lead author Dr. Michael D. Hill, of the University of Calgary, Alberta, Canada, told Reuters Health. "Hopefully...practitioners will be less 'afraid' of the older age group and treat them just as aggressively with thrombolysis as they treat younger patients."
The researchers reviewed data prospectively collected from the Canadian Alteplase for Stroke Effectiveness Study (n = 1135). Two hundred seventy patients at least 80 years of age who were treated with tPA for acute ischemic stroke were compared with 865 patients younger than 80 years.
No significant differences were observed in the risk of symptomatic intracerebral hemorrhage between patients aged 80 years and older and those younger than 80 years (4.4% versus 4.6%).
Forty percent of patients younger than 80 years of age had a favorable outcome (defined as a modified Rankin Score of 0 to 1) at 90 days, compared to 25% of those 80 years and older (p < 0.001). At 3 months' follow-up, 35% of patients older than 80 were dead, compared with 18% of those younger than 80 years (p = 0.001).
Patients 80 years of age and older were more likely than those younger than 80 years to have atrial fibrillation (37% versus 18%, p < 0.001), congestive heart failure (11% versus 6%, p = 0 .004), hypertension (59% versus 48%, p = 0.002), and ischemic heart disease (30% versus 23%, p = 0.05).
The older patients were also more likely to have greater stroke severity than the younger patients. In patients 80 years and older, predictors of death included baseline serum glucose level and congestive heart failure.
"In carefully selected elderly patients, the use of intravenous tPA was not found to be associated with an increased risk of symptomatic intracerebral hemorrhage," the authors conclude.

J Neurol Neurosurg Psychiatry 2006;77:826-829.

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