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THROMBOLYSIS FOR ACUTE STROKE ON A LOCAL HOSPITAL IN COLOMBIA

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ESOC-2019

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Abstract

Background and Aims: The implementation of specific programs for early reperfusion therapies have been improving the stroke’s outcomes in the short and long term (1,2). The access to thrombolytic therapies for ischemic stroke is still very limited in countries such as Colombia. The Hospital Universitario Departamental de Nariño is located at south of Colombia and constitutes the main reference institution for predominantly rural and low-income 1.7 million inhabitants of the department of Nariño. The Stroke’s reperfusion program have been working since 2014, and with the help of Angels Initiative, has been improving the possibility of better stroke care for region. Methods: A retrospective study was conducted with all ischemic stroke patients who received intravenous thrombolysis under international criteria in the institution (3). Normality distribution was tested with Shapiro-Wilk’s test. Stadistic descriptives were used; Differences were analized with χ2 or Fishers exact test or U Mann Withney where appropriate. P Values <0,05 were considered statistically significant. Analyses were done with SPSS V.20.0 Results: Thirty-five patients were evaluated, the main risk factors founded were arterial hypertension (62,9%) and atrial fibrillation (37,1%). 82.9% of stroke occurred in territory of the middle cerebral artery. 57,1% of patients improves after successful thrombolysis. (Table 1). Three patients required additional mechanical thrombectomy. 7 patients had some grade of hemorrhage post-Thrombolysis (20%), and 4 died associated with larger lesions and higher severity. Between 2014 to 2016, tomography was performed within the first hour in 80% and in 85% in 2017 to 2018. Door-needle and Stroke-needle times have decreased significantly, which confirms improvement in attention times (Figure 1) Patients with better functionality at 3 months (mRS 0-2) had lower initial NIHSS and improved at least 3 points in NIHSS with r-TPA, and worst functionality (mRS 3-6) were associated with Hemorrhage Post-Thrombolysis (Table 2 ) Conclusions: The Stroke program has achieved better results over time, It is very important to continue supporting the creation of new stroke centers around the world that can offer a better quality of care. The implementation of a stroke care program, a network of attention, as well as ongoing training with medical staff and community have been improving the possibility of access to reperfusion therapies and better standards of stroke care in developing regions.

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