Angela has received the bolus of Alteplase and the infusion is running. She is transferred to the acute stroke unit for monitoring.
Listed below are a number of potential things that might happen after a stroke patient has been thrombolysed. How frequently do you believe each occurs? Find the correct %.
References:
Michael D Hill, Alastair M Buchan 2005. Thrombolysis for acute ischaemic stroke: results of the Canadian alteplase for stroke effectiveness study. Canadian Medical Association Journal 172 (10) 1307-1312
Thrombolysis with alteplase for acute ischaemic stroke in the Safe Implementation of Thrombolysis in Stroke Monitoring Study (SITS MOST): An Abbreviated Study. The Lancet, Vol 369 Jan 27 2007 275-282
Symptomatic intracranial haemorrhage which is fatal: The SITS-MOST study reported a rate of 0.28%
Major systemic bleeding: A large study of 1135 patients who were thrombolysed in Canada found that 0.4% of them experienced major systemic bleeding. They defined this as a bleeding episode (other than intracranial haemorrhage) that was considered life-threatening or resulted in a large drop in haemoglobin of 50g/l or more or required a transfusion of two or more units of blood. One patient had bleeding from a femoral artery puncture site (for angiography) and 3 from the oropharynx.
Angio-oedema – swelling of tongue and lips (reaction to the drug): Of the 1135 patients in a large study in Canada 1.3% developed some swelling of the tongue and lips. Of these 15 patients 13 responded to medical treatment and two required emergency airway management.
Symptomatic intracranial haemorrhage: A very large registry in the European Union designed to assess safety and efficacy of thrombolysis (SITS-MOST) reported a rate of 1.7% in the first 24 hours and 2.2% in the first 7 days.
