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Maskuri, Fajar
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CASE SERIES: EFFICACY OF THROMBOLYSIS USING INTRAVENOUS ALTEPLASE IN ACUTE ISCHEMIC STROKE WITH ONSET LESS THAN 6 HOURS (CODE STROKE) Maskuri, Fajar; Ning Tyas, Humaera Elphananing; Evicennianing Tyas, Rosyida; Wiastuti, Arni; Akhsani, Fathiya; Yudo Pratama, Yanasta
MNJ (Malang Neurology Journal) Vol. 10 No. 2 (2024): July
Publisher : PERDOSSI (Perhimpunan Dokter Spesialis Saraf Indonesia Cabang Malang) - Indonesian Neurological Association Branch of Malang cooperated with Neurology Residency Program, Faculty of Medicine Brawijaya University, Malang, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.mnj.2024.010.02.22

Abstract

Background: The gold standard therapy for acute ischemic stroke is timely reperfusion of ischemic brain tissue. Intravenous thrombolysis with tPA is the only proven medical therapy for acute ischemic stroke within 4.5 hours of symptom onset using intravenous alteplase at a dose of 0.9 mg per kilogram of body weight. Hemorrhagic transformation is one of the complications of thrombolytic therapy and East Asian population having a higher prevalence of cerebral hemorrhage. This study will examine several cases of ischemic stroke that were treated with thrombolysis using a standard dose (0.9 mg/kg) of intravenous alteplase in acute ischemic stroke with an onset of less than 6 hours in the Special Region of Yogyakarta, especially at the UGM Academic Hospital. Objective: To determine the efficacy of standard dose thrombolysis using intravenous alteplase (rTPA-recombinant tissue plasminogen activator) in acute ischemic stroke with an onset of less than 6 hours through activation of the Code Stroke. Methods: Descriptive research design using a case series, the hyperacute stroke patients with an onset of less than 6 hours who received intravenous alteplase which were then assessed by the National Institutes of Health Stroke Scale (NIHSS) score at initial admission, 24 hours post-alteplase and 30 days post -alteplase. The study took place and was conducted from May to October 2022 by administering intravenous alteplase at a dose of 0.9 mg/kg body weight in acute ischemic stroke patients at UGM RSA who are eligible for thrombolysis therapy with a maximum administration time of 6 hours after stroke onset with the maximum dose of alteplase is 50 mg. Results: The study sample was 8 patients with acute ischemic stroke who were treated between May to October 2022. There were 2 patients who died before completing the 3-month follow-up. One of the patients died within the second week of treatment from sepsis which may have occurred from a pre-existing pneumonia. Another patient died from ileus that occurred 1 month after tissue plasminogen activator (tPA). However, the patient with this ileus showed clinical improvement at the 24-hour post-tPA follow-up, i.e. the initial NIHSS score of 12 improved to an NIHSS score of 6. Conclusion: The modified Alteplase dose, which is 0.9 mg/kg body weight with a maximum dose of 50 mg, at the onset of stroke less than 6 hours can be an option to maximize thrombolytic therapy while still considering the efficiency of treatment costs.
Cohort Study in Outcome and One-Year Mortality of Acute Stroke Patient in Academic Hospital Universitas Gadjah Mada Maskuri, Fajar; Tyas, Humaera Elphananing; Talirasa, Nimitta; Wiastuti, Arni; Akhsani, Fathiya; Pratama, Yanasta Yudo
Academic Hospital Journal Vol 6, No 1 (2024)
Publisher : Rumah Sakit Akademik Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/ahj.v6i1.94520

Abstract

Background: Stroke is still becoming one of the most common non-communicable diseases in Indonesia. Sample Registration System survey in 2016 showed that in Indonesia stroke has become the most common cause of death at all age, about 19.9%. 4 Research conducted by Novbakht found that age, sex, BMI, type of stroke, family history of stroke, hyperlipidaemia, diabetes, and severity of stroke was related and increased the mortality rate. 6 Academic Hospital Universitas Gadjah Mada had not conducted this type of research, so that researcher wanted to know the one-year mortality rate after stroke, factors that related to mortality, and to improve the quality of stroke treatment at Academic Hospital Universitas Gadjah Mada.Objective: To know one-year mortality rate in acute stroke patients in Academic Hospital Universitas Gadjah Mada by looking for the acute stroke characteristic, outcome of stroke patients, and risk factors that cause mortality in stroke patients.Method: This is an analytic research using retrospective cohort study through data collection of acute stroke patients (patients with <5 days stroke onset) during July 2019 until June 2022 then we followed up the condition in the first year after stroke by using medical records, direct examination, or via telephone or video call. Mortality rates were assessed one year after stroke and the predictors of death were evaluated using the cox proportional hazard model.Result: One-year mortality after stroke in our study were related to age (>67 years old) (OR=2,29; 95% CI 1,18-4,46; p=0,015) and the severity of stroke was related to higher NIHSS score (NIHSS score during admission 16-42, (OR=38,49; 95% CI 8,92-166,0; p<0,001)) and ICU admission ((OR=8,01; 95% CI 4,03-15,90; p<0,001)).  Conclusion: An association was found between stroke severity and one-year outcomes of acute stroke patients with old age (>67 years), high NIHSS scores, and ICU admissions
Co-Authors Akhsani, Fathiya Evicennianing Tyas, Rosyida Ning Tyas, Humaera Elphananing Talirasa, Nimitta Tyas, Humaera Elphananing Wiastuti, Arni Yanasta Yudo Pratama