Early outcomes of thrombolysis for acute ischaemic stroke in a South African tertiary care centre

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dc.contributor.advisorBryer, Alanen_ZA
dc.contributor.authorWasserman, Seanen_ZA
dc.date.accessioned2014-07-29T09:16:43Z
dc.date.available2014-07-29T09:16:43Z
dc.date.issued2012en_ZA
dc.descriptionIncludes abstract.
dc.descriptionIncludes bibliographical references.
dc.description.abstractStroke is an important cause of death and disability in sub-Saharan Africa. Recombinant tissue plasminogen activator (tPA) thrombolysis is effective in treating acute ischaemic stroke, but may not be a viable option in developing countries. This prospective observational study was designed to assess the short-termoutcomes and safety of tPA for the treatment of stroke at Groote Schuur Hospital.Data was collected from January 2000 to February 2012, and included patients witha clinical diagnosis of acute stroke with onset of stroke symptoms within 4.5 hours ofreceiving thrombolysis. Exclusion criteria were based on the National Institute ofNeurological Disorders and Stroke (NINDS) rt-PA trial protocol (upper age limit was 75 years). Primary outcomes were the proportion of patients achieving significant early neurological recovery defined as an improvement of 4 or more points on the National Institutes of Health stroke scale (NIHSS) score and functional independence defined as a modified Rankin score of 2 or less at discharge. The primary safety measures were the rates of symptomatic intracranial haemorrhage (SICH) and death. From January 2000 to February 2011 42 patients were thrombolysed, with a mean time to tPA infusion of 160 minutes (standard deviation (SD) 50; range 60 - 270). By discharge the median NIHSS score fell from 14 (interquartile range (IQR) 10.5 - 17) to 7.5 (IQR 1 - 15); 28 (66.7%) achieved significant neurological improvement, and 17 (40.5%) were functionally independent. Two patients (4.8%) suffered SICH and there were 3 (7.1%) deaths. Thrombolysis in routine clinical practice in a South African setting has similar safety and early efficacy outcomes to controlled trials and open-label studies in developing and developed countries.en_ZA
dc.identifier.apacitationWasserman, S. (2012). <i>Early outcomes of thrombolysis for acute ischaemic stroke in a South African tertiary care centre</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Department of Medicine. Retrieved from http://hdl.handle.net/11427/3493en_ZA
dc.identifier.chicagocitationWasserman, Sean. <i>"Early outcomes of thrombolysis for acute ischaemic stroke in a South African tertiary care centre."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Department of Medicine, 2012. http://hdl.handle.net/11427/3493en_ZA
dc.identifier.citationWasserman, S. 2012. Early outcomes of thrombolysis for acute ischaemic stroke in a South African tertiary care centre. University of Cape Town.en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Wasserman, Sean AB - Stroke is an important cause of death and disability in sub-Saharan Africa. Recombinant tissue plasminogen activator (tPA) thrombolysis is effective in treating acute ischaemic stroke, but may not be a viable option in developing countries. This prospective observational study was designed to assess the short-termoutcomes and safety of tPA for the treatment of stroke at Groote Schuur Hospital.Data was collected from January 2000 to February 2012, and included patients witha clinical diagnosis of acute stroke with onset of stroke symptoms within 4.5 hours ofreceiving thrombolysis. Exclusion criteria were based on the National Institute ofNeurological Disorders and Stroke (NINDS) rt-PA trial protocol (upper age limit was 75 years). Primary outcomes were the proportion of patients achieving significant early neurological recovery defined as an improvement of 4 or more points on the National Institutes of Health stroke scale (NIHSS) score and functional independence defined as a modified Rankin score of 2 or less at discharge. The primary safety measures were the rates of symptomatic intracranial haemorrhage (SICH) and death. From January 2000 to February 2011 42 patients were thrombolysed, with a mean time to tPA infusion of 160 minutes (standard deviation (SD) 50; range 60 - 270). By discharge the median NIHSS score fell from 14 (interquartile range (IQR) 10.5 - 17) to 7.5 (IQR 1 - 15); 28 (66.7%) achieved significant neurological improvement, and 17 (40.5%) were functionally independent. Two patients (4.8%) suffered SICH and there were 3 (7.1%) deaths. Thrombolysis in routine clinical practice in a South African setting has similar safety and early efficacy outcomes to controlled trials and open-label studies in developing and developed countries. DA - 2012 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2012 T1 - Early outcomes of thrombolysis for acute ischaemic stroke in a South African tertiary care centre TI - Early outcomes of thrombolysis for acute ischaemic stroke in a South African tertiary care centre UR - http://hdl.handle.net/11427/3493 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/3493
dc.identifier.vancouvercitationWasserman S. Early outcomes of thrombolysis for acute ischaemic stroke in a South African tertiary care centre. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Department of Medicine, 2012 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/3493en_ZA
dc.language.isoengen_ZA
dc.publisher.departmentDepartment of Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.subject.otherInternal Medicineen_ZA
dc.titleEarly outcomes of thrombolysis for acute ischaemic stroke in a South African tertiary care centreen_ZA
dc.typeMaster Thesis
dc.type.qualificationlevelMasters
dc.type.qualificationnameMMeden_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceThesisen_ZA
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