Systemic Thrombolytic Therapy for Ischemic Stroke: Experience of the Regional Vascular Center

INTRODUCTION: Systemic thrombolysis is an effective and safe method of reperfusion therapy in ischemic stroke. However, the effectiveness and safety of different thrombolytic drugs are not the same. It is relevant to analyze the use of systemic thrombolytics in real clinical practice of the Regional Vascular Center. AIM: To compare the effectiveness and safety of thrombolytic therapy (TLT) with non-immunogenic staphylokinase (forteplase) and tissue plasminogen activator (alteplase) in patients with acute ischemic stroke hospitalized in the Regional Vascular Center. MATERIALS AND METHODS: A retrospective analysis of medical histories of 60 patients of the Regional Vascular Center was conducted. Group 1 (33 patients) received non-immunogenic staphylokinase, group 2 (27 patients) — alteplase. The groups had no statistically significant differences except for a higher incidence of diabetes in group 1. Before TLT and on day 1 after, neurologic deficit was evaluated on NIHSS scale, and clinical outcomes on the modified Rankin scale; evaluation on rehabilitation routing scale (RRS) was conducted on day 10. Safety of systemic thrombolysis was assessed by the existence of hemorrhagic complications, the development of a fatal outcome. RESULTS: In group 1 a statistically significant positive dynamics was obtained on day 1 on NIHSS, Rankin scale and on day 10 on RRS. One case of hemorrhagic transformation with a fatal outcome was recorded. In group 2 no statistically significant dynamics in the above parameters was recorded. Intracerebral hematoma and hemorrhagic transformation in 2 patients (7.4%). Fatal outcome at the hospital stage was statistically significantly more frequent in group 2 — 11 patients (40.7%) versus 6 patients (18.1%). CONCLUSION: The conducted retrospective comparative analysis of TLT in the acute period of ischemic stroke showed a higher effectiveness compared to alteplase, no less safety of non-immunogenic staphylokinase in terms of hemorrhagic complications, and lower mortality in the staphylokinase group in the hospital observation period.