Tiempo Puerta – Aguja en trombolisis con tPA en Stroke Isquémico

Parece ser que como sucede en los eventos isquémicos coronarios, la pronta intervención médica, administrando el tratamiento temprano es lo mejor que podemos hacer, una analogía a esta aseveración es la revisión de estudios de tratamiento del Infarto Agudo del Miocardio donde aprendimos que en orden de beneficios el mejor tratamiento que podemos instituir en el mismo es: Trombolisis/angioplastia-primaria antes en las primeras 6 horas, Angioplastia-primaria en las siguientes horas y si no tenemos disponible Angioplastia-primaria con un tiempo puerta-balón <90 minutos Trombolisis con medicamentos de 3a generación.

De forma que pareciera ser que el Stroke está migrando a tratamientos mas tempranos y rápidos para lograr mejores resultados sin mayores complicaciones como lo muestra el estudio del Dr. Gregg Fonarow presentado en el International Stroke Conference 2014 y comentado por Todd Neale en la pagina web: MEDPAGE TODAY.

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Improving Door-to-Needle Times in Acute Ischemic Stroke

Abstract
Background and Purpose—The benefits of intravenous tissue-type plasminogen activator (tPA) in acute ischemic stroke are time-dependent, and guidelines recommend a door-to-needle time of ≤60 minutes. However, fewer than one third of acute ischemic stroke patients who receive tPA are treated within guideline-recommended door-to-needle times. This article describes the design and rationale of Target: Stroke, a national initiative organized by the American Heart Association/American Stroke Association in partnership with other organizations to assist hospitals in increasing the proportion of tPA-treated patients who achieve guideline-recommended door-to-needle times.
Methods—The initial program goal is to achieve a door-to-needle time ≤60 minutes for at least 50% of acute ischemic stroke patients. Key best practice strategies previously associated with achieving faster door-to-needle times in acute ischemic stroke were identified.
Results—The 10 key strategies chosen by Target: Stroke include emergency medical service prenotification, activating the stroke team with a single call, rapid acquisition and interpretation of brain imaging, use of specific protocols and tools, premixing tPA, a team-based approach, and rapid data feedback. The program includes many approaches intended to promote hospital participation, implement effective strategies, share best practices, foster collaboration, and achieve stated goals. A detailed program evaluation is also included. In the first year, Target: Stroke has enrolled over 1200 United States hospitals.
Conclusions—Target: Stroke, a multidimensional initiative to improve the timeliness of tPA administration, aims to elevate clinical performance in the care of acute ischemic stroke, facilitate the more rapid integration of evidence into clinical practice, and improve outcomes.
Artículo en revista Stroke

Dr. Ismael Guzmán Melgar/Médico Internista – cardiólogo/Jefe de Servicio, Hospital Roosevelt, Guatemala.

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