The Effect of Homocysteine Levels on Thrombolytic Treatment in Acute Ischemic Stroke Akut İskemik İnmede Homosistein Düzeyinin Trombolitik Tedavi Üzerine Etkileri
Turk Noroloji Dergisi, cilt.28, sa.4, ss.242-247, 2022 (ESCI, Scopus, TRDizin)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 28 Sayı: 4
- Basım Tarihi: 2022
- Doi Numarası: 10.4274/tnd.2022.48030
- Dergi Adı: Turk Noroloji Dergisi
- Derginin Tarandığı İndeksler: Emerging Sources Citation Index (ESCI), Scopus, Academic Search Premier, CINAHL, EMBASE, Directory of Open Access Journals, TR DİZİN (ULAKBİM)
- Sayfa Sayıları: ss.242-247
- Anahtar Kelimeler: Homocysteine, tissue plasminogen activator, acute ischemic stroke
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Objective: Hyperhomocysteinemia is an independent risk factor for cardiovascular diseases. It has paradoxically both antifibrinolytic and pro-hemorrhagic effects. In the study, we investigated the effect of homocysteine (Hcy) levels on thrombolytic therapy in patients with acute ischemic stroke. Materials and Methods: Patients who received intravenous (iv) tissue plasminogen activator (tPA) between 2005 and 2021 and had Hcy levels measured within the first 3 days were reviewed in terms of tPA efficacy, prognosis and intracerebral hemorrhage. The efficacy of tPA treatment was categorized as effective response (decrease of at least 4 points or a decrease in score to zero) and dramatic response (decrease of at least 8 points or a decrease in score to either zero or one) according to NIHSS score at 24 hours. Scores of 0 and 1 were classified as “excellent outcome”, and scores of 0, 1, and 2 were classified as “good outcome” on the modified Rankin scale evaluated at 3 months. Hemorrhagic transformation was evaluated according to Fiorelli’s classification. Results: Effective response was observed in 46.7% of the 182 patients (mean age 71±14 years; 99 women) included in the study, and dramatic response in 31.3%. Excellent outcome was reported in 33% of the patients, and good outcome in 53.3%. Cerebral hemorrhage of any severity was detected in 15.9% of the patients, and parenchymal hematoma type 2 in 5.5%. In the analyses made for assessing iv tPA response and cerebral hemorrhage status, no difference was found in terms of Hcy level and between the subgroups formed with different cut-off values of Hcy level. Conclusion: In our study, hyperhomocysteinemia, which is known to have negative effects on fibrinolysis and vascular integrity, did not show a significant effect on iv tPA efficacy, prognosis and complications. Prospective and large-sample sized studies are needed to better demonstrate these effects.