Letter to the editor Intravenous thrombolytic therapy for acute ischemic stroke in Tuzla Canton, Bosnia and Herzegovina Dear Editor, It is well known that thrombolysis with intravenous recombinant tissue plasminogen activator (rt-PA) is the first evidence-based treatment for acute ischemic stroke. In the European Union (EU),
Table 1 Baseline characteristics of the patients treated with thrombolytic therapy Characteristic Gender Female, n (%) Male, n (%) Age (y), mean ± SD Stroke risk factors, n (%) Hypertension Diabetes mellitus Atrial fibrillation Heart failure Hyperlipidemia Current smoking Previous stroke Baseline NIHSS, n (%) 0–7 8–14 ≥ 15 NIHSS, mean ± SD Stroke etiology, n (%) Large artery arteriosclerosis Cardiac embolism Lacunar stroke Undetermined Door-to-needle time (mean) Onset-to-needle time (mean) Significant ICH, n (%)
26 (36) 46 (64) 64 ± 10 53 (74) 22 (31) 20 (28) 12 (17) 16 (22) 25 (35) 6 (8) 13 (18) 37 (52) 22 (30) 12 ± 4·5 33 (46) 14 (19) 15 (21) 10 (14) 74 min. 154 min. 4 (5·5)
NIHSS, National Institute of Health Stroke Scale; ICH, intracerebral hemorrhage; SD, standard deviation.
Correspondence: Denisa Salihovic´*, Department of Neurology, University Clinical Centre Tuzla, Trnovac bb, 75000 Tuzla. E-mail:
[email protected];
[email protected] Conflincts of interest: None declared. DOI: 10.1111/ijs.12106
E48
Vol 8, October 2013, E48
rt-PA was approved in 2002 and has been used widely since then. Bosnia and Herzegovina is one of the few European countries not yet part of the EU, and approval for rt-PA in acute ischemic stroke was granted in 2007 under the same conditions as in other European countries. We presented our results with the use of intravenous thrombolytic therapy in patients with acute ischemic stroke in Tuzla Canton, Bosnia and Herzegovina. Between April 2008 and December 2011, intravenous rt-PA was administered to 72 patients with acute ischemic stroke, which represents 3·5% of patients with acute ischemic stroke admitted to the Department of Neurology Tuzla in that period (2067 patients). Baseline characteristics of the patients treated with thrombolytic therapy are provided in Table 1. Figure 1 illustrates the three-month outcome of our patients treated with thrombolytic therapy in comparison with the results of the neighboring countries: Sestre milosrdnice University Hospital Zagreb, Croatia (1) and Institute of Neurology Belgrade, Serbia (2). We wish to emphasize that these are only the results from our department, not at the national level. Bosnia and Herzegovina is one of the few countries in Europe that does not have an official
20
National Stroke register, primarily because of the political situation. Therefore, our participation in multicenter studies is limited. With this article we want to demonstrate that we are working in line with the established protocols and show that our results are approximate to the results of other countries, despite the aforementioned shortcomings. These are small steps for world’s neurology but big ones for neurology in Bosnia and Herzegovina.
Dževdet Smajlovic´, Denisa Salihovic´*, Leila Avdic´, Zikrija Dostovic´, Omer C´. Ibrahimagic´, and Mirjana Vidovic´ Department of Neurology, University Clinical Centre Tuzla, Medical Faculty, University of Tuzla, Tuzla, Bosnia and Herzegovina
References 1 Roje-Bedekovic M, Vargek-Solter V, Coric L et al. Thrombolysis for acute ischemic stroke – our experiences as part of SITS-MOST. Acta Clin Croat 2009; 48:287–93. 2 Bogosavljevic V, Bodenant M, BeslacBumbasirevic LJ et al. Intravenous thrombolysis for acute cerebral ischemia in Belgrade, Serbia: comparison with Lille, France. Eur Neurol 2011; 66:30–6.
41
31
49.5
47
28
18
8
11
15.5
11.5
19.5
patients (%) Fig. 1 Three-month outcome of the patients treated with thrombolytic therapy mRS, modified Rankin Score.
© 2013 The Authors. International Journal of Stroke © 2013 World Stroke Organization
