AVC Isquêmico na fase aguda: avaliação da terapêutica com trombolítico pré e pós unidade de AVC em hospital terciário

Abstract

The new treatment ofAcute Ischemic Stroke associated with adequate and imediate rehabilitation in the Stroke Unit provides improvement in patient´s clinical and morbidity outcomes. Objective: To describe the impact of Stroke Units on the acute treatment of Ischemic Stroke, improving the patient´s functionality and time of hospitalization. Casuistics and methods: A total of 142 patients with ischemic stroke were evaluated, retrospectively. They had undergone to thrombolytic therapy according to the established undergone criteria present on the ECAS III study, hospitalized into the Neurology service at Hospital de Base comprising the period prior to the stroke unit from May 2016 to April 2017, and the period after the Stroke Unit from May 2017 to April 2018. The patients were followed during the first 48 hours of treatment, being submitted daily to the NIHSS (National Institute of Health Stroke Scale) and Rankin mRS scales Results: Out of the 142 patients analyzed, 37 of them were during the pre-Stroke Unit period, and 105 were during the post-Stroke Unit period. The mean age was 66.10±11.53 at the pre-Stroke Unit period, and 63.29±15.53 at the post-Stroke Unit period. Regarding to sex, we observed 23 males (62.1%) at the pre-Stroke unit period, and 64 males (60.9%) at the post-Stroke Unit period; while we observed 14 females (37.9%) at the pre-Stroke Unit period, and 41 females (39.1%) in the post-Stroke Unit period, with a predominance of male gender in the pre and post-Stroke Unit samples. In regard to the patient´s attendance time, there was an improvement in the needle-holder variable, reducing from 71.52±29.25 minutes to 52.18±33.52 minutes. According to the hospitalization time, there was a significant reduction of 6.38±2.93 to 3.83±2.21 (p=0.003). There was an important reduction of NIHSS post thrombolysis and at discharge, when compared the pre-Stroke Unit and post-Stroke Unit periods with p=0.0029 and p=0.005 respectively, when the samples were paired according to the age in both groups. Conclusion: Stroke is a medical emergency and the thrombolytic therapy requires speed as well as specialized treatment. The establishment of the Stroke Unit showed an improvement on the medical care, needle-holder time and the patient’s functionality discharge.