Acil Trombolitik Uygulama İlkeleri
Özet
Fibrinolitik ajanlar; akut iskemik inme, akut pulmoner emboli, akut miyokard infarktüsü, periferik arter tıkanıklıkları, venöz tromboembolizm (derin ven trombozu), kalıcı santral intravenöz kateter ve kalp kapak protezlerinde oluşan pıhtıların eritilmesinde yaygın olarak kullanılmaktadır. Fakat her endikasyonda, trombolitik tedavinin yeri ve etkinliği aynı kanıt ve öneri düzeyinde değildir. Özellikle bilinmesi gereken nokta şudur; hangi endikasyonla hangi trombolitik ajan kullanılırsa kullanılsın asıl faydanın, ilacın erken verilmesine bağlı olduğudur. Dünyada olduğu gibi ülkemizde de klinik pratikte trombolitik uygulamasının yeteri kadar yaygınlaşamamasında en büyük payı, potansiyel risklerin varlığı ve bu durumlarda klinisyenin yaklaşım algoritmalarına yeterince hakim olmaması oluşturmaktadır. Bu yazıda trombolitik ajanların genel özelliklerinin yanı sıra, kullanımı konusunda sıkça merak edilen sorulara verilecek yanıtlar güncel kılavuzlar ışığında tartışılmıştır.
Referanslar
Zoghi M. Akut Miyokard İnfarktüsü ve Trombolitik Tedavi. Yoğun Bakım Hemşireliği Dergisi. 2000; 4(1): 29-34.
Sayhan MB, Salt O (2021). Kanama Bozuklukları Ve Kanamalı Hastaya Yaklaşım. Editörler Özgür Karcıoğlu, Selman Yeniocak. 1. Baskı. İstanbul. 2021.
Cesarman-Maus G, Hajjar KA. Molecular mechanisms of f ibrinolysis. Br J Haematol. 2005; 129: 307-21
Kearon C, Kahn SR, Agnelli K, et al.; Antithrombotic therapy for venous thromboembolic disease. ACCP evidence based clinical practice guidelines (8th Edition). Chest 2008;133:454545.
Menon BK, Al-Ajlan FS, Najm M, et al.; Association of clinical, imaging, and thrombus characteristics with recanalization of visible intracranial occlusion in patients with acute ischemic stroke. JAMA. 2018;320:1017-1026.
Berge E, Whiteley W, Audebert H, et al. European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke. Eur Stroke J. 2021;6:I-LXII.
Powers WJ, Rabinstein AA, Ackerson T, 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 Association. Stroke. 2019;50:e344-e418.
Mkoma GF, Norredam M, Iversen HK, et al.; Use of reperfusion therapy and time delay in patients with ischaemic stroke by immigration status: A register-based cohort study in Denmark. Eur J Neurol. 2022 ;29(7):1952-1962.
Jeon SB, Ryoo SM, Lee DH, et al.; Multidisciplinary Approach to Decrease In-Hospital Delay for Stroke Thrombolysis. J Stroke. 2017;19(2):196-204.
Thomalla G, Boutitie F, Ma H, et al.; Intravenous alteplase for stroke with unknown time of onset guided by advanced imaging: systematic review and meta-analysis of individual patient data. Lancet. 2020;396(10262):1574-1584.
Zhu A, Rajendram P, Tseng E, et al.; Alteplase or tenecteplase for thrombolysis in ischemic stroke: An illustrated review. Res Pract Thromb Haemost. 2022;6:e12795.
Topçuoğlu MA, Arsava EM, Özdemir AÖ ve ark. Akut İnme Tedavisinde İntravenöz Trombolitik Tedavi: Sık Görülen Sistemik Sorunlar ve Çözümleri. Turk J Neurol 2018;24:13-25.
Saposnik G, Fang J, Kapral MK, et al.; Investigators of the Registry of the Canadian Stroke Network (RCSN); Stroke Outcomes Research Canada (SORCan) Working Group. The iScore predicts effectiveness of thrombolytic therapy for acute ischemic stroke. Stroke 2012;43:1315-1322.
Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D, Larrue V, Lees KR, Medeghri Z, Machnig T, Schneider D, von Kummer R, Wahlgren N, Toni D; ECASS Investigators. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 2008; 359:1317-1329.
Mazya M, Egido JA, Ford GA, Lees KR, Mikulik R, Toni D, Wahlgren N, Ahmed N; SITS Investigators. Predicting the risk of symptomatic intracerebral hemorrhage in ischemic stroke treated with intravenous alteplase: safe Implementation of Treatments in Stroke (SITS) symptomatic intracerebral hemorrhage risk score. Stroke 2012;43:1524-1531.
Cucchiara BL, Jackson B, Weiner M, et al.; Usefulness of checking platelet count before thrombolysis in acute ischemic stroke.Stroke. 2007;38(5):1639-40.
Sağlık Bakanlığı Sağlık Hizmetleri Genel Müdürlüğü Araştırma, Geliştirme ve Sağlık Teknolojisi Değerlendirme Dairesi Başkanlığı Akut İskemik İnme Tanı ve Tedavi Rehberi 2022. Erişim:(https://shgmargestddb.saglik.gov.tr/Eklenti/36615/0/akutiskemikinmetanitedavirehberi20200226pdf.pdf)
Cucchiara B, Jackson B, Weiner M, et al.; Usefulness of checking platelet count before thrombolysis in acute ischemic stroke. Stroke 2007;38:1639-1640.
Breuer L, Huttner HB, Kiphuth IC, et al.; Waiting for platelet counts causes unsubstantiated delay of thrombolysis therapy. Eur Neurol 2013;69:317-320.
Jauch EC, Saver J, Adams HP, et al.; American Heart Association Stroke Council; Council on Cardiovascular Nursing; Council on Peripheral Vascular Disease; Council on Clinical Cardiology. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013;44:870-947.
Desilles JP, Meseguer E, Labreuche J, et al.; Diabetes mellitus, admission glucose, and outcomes after stroke thrombolysis: a registry and systematic review. Stroke 2013;44:1915-1923.
Anderson CS, Huang Y, Lindley RI, et al.; ENCHANTED Investigators and Coordinators. 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;393:877–888.
Yaghi S, Willey JZ, Cucchiara B, et al.; Treatment and outcome of hemorrhagic transformation after intravenous alteplase in acute ischemic stroke: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2017;48:e343-e361.
Pahs L, Droege C, Kneale H, Pancioli A. A novel approach to the treatment of orolingual angioedema after tissue plasminogen activator administration. Ann Emerg Med. 2016;68(3):345-348.
Türk Toraks Derneği Pulmoner Tromboembolizm Tanı ve Tedavi Uzlaşı Raporu. Reperfüzyon Tedavisi 2021.62-66.
Yamamoto T. Management of patients with high-risk pulmonary embolism: a narrative review. J Intensive Care 2018; 6: 16.
Hasanoğlu C. Trombolitik Tedavi: Kime, Ne Zaman, Nasıl? Güncel Göğüs Hastalıkları Serisi 2015; 3 (1): 34-44.
Meyer G, Vicaut E, Danays T, et al.; PEITHO Investigators. Fibrinolysis for patients with intermediate-risk pulmonary embolism. N Engl J Med 2014;370:1402-11.
Konstantinides SV, Meyer G, Becattini C, et al.; ESC Scientific Document Group. 2019 ESC guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with European Respiratory Society (ERS). Eur Heart J 2020;41:543-603.
İpekci A. Pulmoner Emboli 2019. Phnx Med J. 2019;1(1):51-63.
O'Connor RE, Brady W, Brooks SC, et al.; Part 10: acute coronary syndromes: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation . 2010; 122(18 Suppl 3):787-817.
Referanslar
Zoghi M. Akut Miyokard İnfarktüsü ve Trombolitik Tedavi. Yoğun Bakım Hemşireliği Dergisi. 2000; 4(1): 29-34.
Sayhan MB, Salt O (2021). Kanama Bozuklukları Ve Kanamalı Hastaya Yaklaşım. Editörler Özgür Karcıoğlu, Selman Yeniocak. 1. Baskı. İstanbul. 2021.
Cesarman-Maus G, Hajjar KA. Molecular mechanisms of f ibrinolysis. Br J Haematol. 2005; 129: 307-21
Kearon C, Kahn SR, Agnelli K, et al.; Antithrombotic therapy for venous thromboembolic disease. ACCP evidence based clinical practice guidelines (8th Edition). Chest 2008;133:454545.
Menon BK, Al-Ajlan FS, Najm M, et al.; Association of clinical, imaging, and thrombus characteristics with recanalization of visible intracranial occlusion in patients with acute ischemic stroke. JAMA. 2018;320:1017-1026.
Berge E, Whiteley W, Audebert H, et al. European Stroke Organisation (ESO) guidelines on intravenous thrombolysis for acute ischaemic stroke. Eur Stroke J. 2021;6:I-LXII.
Powers WJ, Rabinstein AA, Ackerson T, 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 Association. Stroke. 2019;50:e344-e418.
Mkoma GF, Norredam M, Iversen HK, et al.; Use of reperfusion therapy and time delay in patients with ischaemic stroke by immigration status: A register-based cohort study in Denmark. Eur J Neurol. 2022 ;29(7):1952-1962.
Jeon SB, Ryoo SM, Lee DH, et al.; Multidisciplinary Approach to Decrease In-Hospital Delay for Stroke Thrombolysis. J Stroke. 2017;19(2):196-204.
Thomalla G, Boutitie F, Ma H, et al.; Intravenous alteplase for stroke with unknown time of onset guided by advanced imaging: systematic review and meta-analysis of individual patient data. Lancet. 2020;396(10262):1574-1584.
Zhu A, Rajendram P, Tseng E, et al.; Alteplase or tenecteplase for thrombolysis in ischemic stroke: An illustrated review. Res Pract Thromb Haemost. 2022;6:e12795.
Topçuoğlu MA, Arsava EM, Özdemir AÖ ve ark. Akut İnme Tedavisinde İntravenöz Trombolitik Tedavi: Sık Görülen Sistemik Sorunlar ve Çözümleri. Turk J Neurol 2018;24:13-25.
Saposnik G, Fang J, Kapral MK, et al.; Investigators of the Registry of the Canadian Stroke Network (RCSN); Stroke Outcomes Research Canada (SORCan) Working Group. The iScore predicts effectiveness of thrombolytic therapy for acute ischemic stroke. Stroke 2012;43:1315-1322.
Hacke W, Kaste M, Bluhmki E, Brozman M, Dávalos A, Guidetti D, Larrue V, Lees KR, Medeghri Z, Machnig T, Schneider D, von Kummer R, Wahlgren N, Toni D; ECASS Investigators. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 2008; 359:1317-1329.
Mazya M, Egido JA, Ford GA, Lees KR, Mikulik R, Toni D, Wahlgren N, Ahmed N; SITS Investigators. Predicting the risk of symptomatic intracerebral hemorrhage in ischemic stroke treated with intravenous alteplase: safe Implementation of Treatments in Stroke (SITS) symptomatic intracerebral hemorrhage risk score. Stroke 2012;43:1524-1531.
Cucchiara BL, Jackson B, Weiner M, et al.; Usefulness of checking platelet count before thrombolysis in acute ischemic stroke.Stroke. 2007;38(5):1639-40.
Sağlık Bakanlığı Sağlık Hizmetleri Genel Müdürlüğü Araştırma, Geliştirme ve Sağlık Teknolojisi Değerlendirme Dairesi Başkanlığı Akut İskemik İnme Tanı ve Tedavi Rehberi 2022. Erişim:(https://shgmargestddb.saglik.gov.tr/Eklenti/36615/0/akutiskemikinmetanitedavirehberi20200226pdf.pdf)
Cucchiara B, Jackson B, Weiner M, et al.; Usefulness of checking platelet count before thrombolysis in acute ischemic stroke. Stroke 2007;38:1639-1640.
Breuer L, Huttner HB, Kiphuth IC, et al.; Waiting for platelet counts causes unsubstantiated delay of thrombolysis therapy. Eur Neurol 2013;69:317-320.
Jauch EC, Saver J, Adams HP, et al.; American Heart Association Stroke Council; Council on Cardiovascular Nursing; Council on Peripheral Vascular Disease; Council on Clinical Cardiology. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013;44:870-947.
Desilles JP, Meseguer E, Labreuche J, et al.; Diabetes mellitus, admission glucose, and outcomes after stroke thrombolysis: a registry and systematic review. Stroke 2013;44:1915-1923.
Anderson CS, Huang Y, Lindley RI, et al.; ENCHANTED Investigators and Coordinators. 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;393:877–888.
Yaghi S, Willey JZ, Cucchiara B, et al.; Treatment and outcome of hemorrhagic transformation after intravenous alteplase in acute ischemic stroke: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2017;48:e343-e361.
Pahs L, Droege C, Kneale H, Pancioli A. A novel approach to the treatment of orolingual angioedema after tissue plasminogen activator administration. Ann Emerg Med. 2016;68(3):345-348.
Türk Toraks Derneği Pulmoner Tromboembolizm Tanı ve Tedavi Uzlaşı Raporu. Reperfüzyon Tedavisi 2021.62-66.
Yamamoto T. Management of patients with high-risk pulmonary embolism: a narrative review. J Intensive Care 2018; 6: 16.
Hasanoğlu C. Trombolitik Tedavi: Kime, Ne Zaman, Nasıl? Güncel Göğüs Hastalıkları Serisi 2015; 3 (1): 34-44.
Meyer G, Vicaut E, Danays T, et al.; PEITHO Investigators. Fibrinolysis for patients with intermediate-risk pulmonary embolism. N Engl J Med 2014;370:1402-11.
Konstantinides SV, Meyer G, Becattini C, et al.; ESC Scientific Document Group. 2019 ESC guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with European Respiratory Society (ERS). Eur Heart J 2020;41:543-603.
İpekci A. Pulmoner Emboli 2019. Phnx Med J. 2019;1(1):51-63.
O'Connor RE, Brady W, Brooks SC, et al.; Part 10: acute coronary syndromes: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation . 2010; 122(18 Suppl 3):787-817.
