|
|
|
| Risk assessment and management of existing puncture bleeding complications in patients with intravenous thrombolysis and treatment experience in two cases |
| ZHOU Ting1 LIU Li2 TANG Ge1 LIU Shudong1 SHI Haiyang1 ZHAO Libo1 ZHANG Lili3 YANG Deyu1 |
1.Department of Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing 402160, China;
2.Department of Health Management, Yongchuan Hospital of Chongqing Medical University, Chongqing 402160, China;
3.Department of Neurology, Daping Hospital of Army Military Medical University, Chongqing 400042, China |
|
|
|
Abstract For patients with acute cerebral infarction with easily compressible arterial puncture points, how to prevent complications of puncture point bleeding before intravenous thrombolysis is not elaborated in the current guidelines, and relevant reports are rare. This article reported the two patients with acute cerebral infarction with existing puncture sites were treated pass with intravenous thrombolysis. In case one, right radial artery puncture was performed one week before intravenous thrombolysis, and left radial artery puncture was performed two hours before thrombolysis, after intravenous thrombolysis, subcutaneous hematoma was found at both radial artery puncture sites, and false aneurysm was complicated at the right radial artery puncture site. After comprehensive treatment, such as fresh frozen plasma infusion, cryoprecipitate, elastic bandage, and compression of the radial artery, bleeding complications at the artery puncture site were controlled. In case two, right radial artery puncture was performed 26 hours before intravenous thrombolysis, and the radial artery puncture site was compressed by a compressor before intravenous thrombolysis, and no bleeding complications occurred at the puncture site. Although it is not contraindicated to perform intravenous thrombolysis within the last one week, patients should be assessed for the risk of complications from bleeding at the puncture site after receiving intravenous thrombolysis. For patients at higher risk, compression of the puncture site before thrombolysis may be considered to prevent complications of puncture site bleeding.
|
|
|
|
|
|
[1] GBD 2019 Stroke Collaborators. Global，regional，and national burden of stroke and its risk factors，1990-2019：a systematic analysis for the Global Burden of Disease Study 2019 [J]. The Lancet Neurology，2021，20（10）：795-820.
[2] 王陇德，吉训明，康德智，等.《中国卒中中心报告2020》概要[J].中国脑血管病杂志，2021，18（11）：737-743.
[3] 王拥军，李子孝，谷鸿秋，等.中国卒中报告2019（中文版）（1）[J].中国卒中杂志，2020，15（10）：1037-1043.
[4] Wang W，Jiang B，Sun H，et al. Prevalence，Incidence，and Mortality of Stroke in China：Results from a Nationwide Population-Based Survey of 480 687 Adults [J]. Circulation，2017，135（8）：759-771.
[5] Powers WJ，Rabinstein AA，Ackerson T，et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke：2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke：A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association [J]. Stroke，2019，50（12）：e344-e418.
[6] Demaerschalk BM，Kleindorfer DO，Adeoye OM，et al. Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke：A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association [J]. Stroke，2016，47（2）：581-641.
[7] 彭斌，吴波.中国急性缺血性脑卒中诊治指南2018[J].中华神经科杂志，2018，51（9）：666-682.
[8] Berge E，Whiteley W，Audebert H，et al. European Stroke Organisation （ESO） guidelines on intravenous thrombolysis for acute ischaemic stroke [J]. Eur Stroke J，2021，6（1）：Ⅰ-LⅫ.
[9] Lou M，Safdar A，Mehdiratta M，et al. The HAT Score：a simple grading scale for predicting hemorrhage after thrombolysis [J]. Neurology，2008，71（18）：1417-1423.
[10] Cucchiara B，Tanne D，Levine SR，et al. A risk score to predict intracranial hemorrhage after recombinant tissue plasminogen activator for acute ischemic stroke [J]. J Stroke Cerebrovasc Dis，2008，17（6）：331-333.
[11] Mazya M，Egido JA，Ford GA，et al. Predicting the risk of symptomatic intracerebral hemorrhage in ischemic stroke treated with intravenous alteplase：safe Implementation of Treatments in Stroke （SITS） symptomatic intracerebral hemorrhage risk score [J]. Stroke，2012，43（6）：1524-1531.
[12] Strbian D，Engelter S，Michel P，et al. Symptomatic intracranial hemorrhage after stroke thrombolysis：the SEDAN score [J]. Ann Neurol，2012，71（5）：634-641.
[13] Flint AC，Faigeles BS，Cullen SP，et al. THRIVE score predicts ischemic stroke outcomes and thrombolytic hemorrhage risk in VISTA [J]. Stroke，2013，44（12）：3365-3369.
[14] Saposnik G，Guzik AK，Reeves M，et al. Stroke Prognostication using Age and NIH Stroke Scale：SPAN-100 [J]. Neurology，2013，80（1）：21-28.
[15] Menon BK，Saver JL，Prabhakaran S，et al. Risk score for intracranial hemorrhage in patients with acute ischemic stroke treated with intravenous tissue-type plasminogen activator [J]. Stroke，2012，43（9）：2293-2299.
[16] 冀书娟，康康，柴源，等.急性脑梗死病人rt-PA静脉溶栓后出血转化风险评估量表的预测价值[J].中西医结合心脑血管病杂志，2022，20（6）：1114-1118.
[17] 刘琪，张玉梅.溶栓后出血评分的临床应用及进展[J].中国卒中杂志，2019，14（7）：727-732.
[18] 杨洁，谢小华，连万成，等.急性缺血性脑梗死静脉溶栓后出血转化风险预测模型的构建[J].疑难病杂志，2022，21（4）：371-376.
[19] Yaghi S，Willey JZ，Cucchiara B，et al. Treatment and Outcome of Hemorrhagic Transformation After Intravenous Alteplase in Acute Ischemic Stroke：A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association [J]. Stroke，2017，48（12）：e343-e361.
[20] 王玮娜，王志伟，郑俊江，等.急性脑梗死患者溶栓后出血性转化发生情况及危险因素分析[J].现代中西医结合杂志，2019，28（1）：60-62.
[21] 樊玉香，郭电渠，王满利.急性脑梗死患者采用阿替普酶溶栓出血不良反应及影响因素分析[J].中国药物滥用防治杂志，2022，28（1）：86-90.
[22] 凌雪辉，秦勇，许文杰. 急性脑梗死静脉溶栓后脑出血转化影响因素及影响因素对其预测价值分析[J].临床误诊误治，2021，34（7）：90-95.
[23] Pisters R，Lane DA，Nieuwlaat R，et al. A novel user- friendly score （HAS-BLED） to assess 1-year risk of major bleeding in patients with atrial fibrillation：the Euro Heart Survey [J]. Chest，2010，138（5）：1093-1100.
[24] 刘新峰，朱武生，孙文，等.中国缺血性脑血管病血管内介入诊疗指南2015[J].中华神经科杂志，2015，48（10）：830-837.
[25] 张云洪，智亚伟. 桡动脉穿刺后出现假性动脉瘤怎么处理[J].医师在线，2021，11（7）：24.
[26] 张杨，李谈，廖传军，等.医源性股动脉假性动脉瘤的血管外科处理[J].中华普通外科杂志，2020（1）：75-76. |
|
|
|
