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Experience with non-immunogenic staphylokinase for intravenous thrombolysis in ischemic stroke: analysis of hospital registry data

https://doi.org/10.21518/ms2023-057

Abstract

Introduction. Intravenous thrombolysis (IT) is the primary method of reperfusion therapy for ischemic stroke. Over the past couple of years, there has been a global trend towards the predominant use of the bolus forms of thrombolytic drugs that is caused by necessity to increase the reperfusion therapy rate to achieve its best outcomes.

Aim. To evaluate the efficacy and safety of the use of non-immunogenic staphylokinase for IT in ischemic stroke in real-world clinical practice of the regional vascular center.

Materials and methods. The clinical outcomes of the cohort of 50 patients who underwent IT with non-immunogenic staphylokinase were analysed.

Results. The age of the patients ranged from 46 to 94 years and averaged 71.8 ± 10.0 years; 22% of patients were over 80 years of age. The NIHSS score at admission varied from 3 to 23 scores and averaged 11 (8-14) scores. 36% of patients had large artery occlusions. 14% of patients received a step-wise reperfusion therapy. The median door-to-needle time was 23 (18-26) minutes. 52% of patients didn’t develop any infarction area during control neuroimaging. 62% of patients required no further rehabilitation. Hospital mortality was 12%. 18% of patients developed hemorrhagic conversion mainly in the form of hemorrhagic infarction. 1 patient had a symptomatic hemorrhagic conversion. Major bleeding and angioedema were not observed.

Conclusion. The analysis of 50 consecutive cases of IT in ischemic stroke using non-immunogenic staphylokinase indicates the high efficiency and safety of this method of reperfusion therapy.

About the Authors

A. A. Kulesh
Vagner Perm State Medical University
Russian Federation

Aleksey A. Kulesh - Dr. Sci. (Med.), Professor of the Department of Neurology and Medical Genetics.

26, Petropavlovskaya St., Perm, 614990



L. I. Syromyatnikova
Vagner Perm State Medical University
Russian Federation

Lyudmila I. Syromyatnikova - Dr. Sci. (Med.), Professor of the Department of Propaedeutics of Internal Diseases No. 1.

26, Petropavlovskaya St., Perm, 614990



S. Krapivin
Vagner Perm State Medical University
Russian Federation

Sergey Krapivin - 5th Year Student of the Medicine Faculty.

26, Petropavlovskaya St., Perm, 614990



References

1. Pan Y., Shi G. Silver Jubilee of Stroke Thrombolysis With Alteplase: Evolution of the Therapeutic Window. Front Neurol. 2021;12:593887. https://doi.org/10.3389/fneur.2021.593887.

2. Jadhav A.P., Desai S.M., Jovin T.G. Indications for Mechanical Thrombectomy for Acute Ischemic Stroke: Current Guidelines and Beyond. Neurology. 2021;97(20 Suppl. 2):S126-S136. https://doi.org/10.1212/WNL.0000000000012801.

3. Spina E., Candelaresi P., Volpe G., D'Onofrio F., Spitaleri D., Martusciello G. et al. Trends of recanalization therapies and state of art for ischemic stroke treatment in Campania region, Italy. Neurol Sci. 2022;43(12):6865-6870. https://doi.org/10.1007/s10072-022-06321-3.

4. Richter D., Weber R., Eyding J., Bartig D., Misselwitz B., Grau A. et al. Acute ischemic stroke care in Germany further progress from 2016 to 2019. Neurol Res Pract. 2021;3(1):14. https://doi.org/10.1186/s42466-021-00115-2.

5. Alamowitch S., Turc G., Palaiodimou L., Bivard A., Cameron A., De Marchis G.M. et al. European Stroke Organisation (ESO) expedited recommendation on tenecteplase for acute ischaemic stroke. Eur Stroke J. 2023. https://doi.org/10.1177/23969873221150022.

6. Kulesh А.А., Demin D.A. Intravenous thrombolysis in ischemic stroke: 10 rules for the practical neurologist. Meditsinskiy Sovet. 2022;16(21):175-183. (In Russ.) https://doi.org/10.21518/2079-701X-2022-16-21-175-183.

7. Kulesh A.A. Difficult questions of intravenous thrombolytic therapy in ischemic stroke. Consilium Medicum. 2021;23(11):805-813. (In Russ.) https://doi.org/10.26442/20751753.2021.11.201143.

8. Kulesh A.A., Drobakha V.E., Kaileva N.A., Syromyatnikova L.I., Golosova Yu.A., Shestakov V.V. Capabilities of perfusion ASPECTS in predicting the efficiency of intravenous thrombolytic therapy. Neurology, Neuropsychiatry, Psychosomatics. 2017;9(3):10-17. https://doi.org/10.14412/2074-2711-2017-3-10-17.

9. Kulesh A.A., Syromyatnikova L.I., Golosova Yu.A., Shestakov V.V. The experience of using thrombolysis in patients with acute disturbances of cerebral circulation: efficacy, safety, predictors of outcome and hemorrhagic transformation. Zhurnal Nevrologii i Psikhiatrii imeni S.S. Korsakova. 2018;118(7):18-24. (In Russ.) https://doi.org/10.17116/jnevro20181187118.

10. Shamalov N.A., Khasanova D.R., Stakhovskaya L.V., Voznyuk I.A., Yanishevsky S.N., Vinogradov O.I. Reperfusion therapy of ischemic stroke: clinical protocol. Moscow: MEDpress; 2019. 80 p. (In Russ.) Available at: https://medknigaservis.ru/wp-content/uploads/2019/06/NF0014418.pdf.

11. Ay H., Benner T., Arsava E.M., Furie K.L., Singhal A.B., Jensen M.B. et al. A computerized algorithm for etiologic classification of ischemic stroke: the Causative Classification of Stroke System. Stroke. 2007;38(11):2979-2984. https://doi.org/10.1161/STROKEAHA.107.490896.

12. Meretoja A., Keshtkaran M., Saver J.L., Tatlisumak T., Parsons M.W., Kaste M. et al. Stroke thrombolysis: save a minute, save a day. Stroke. 2014;45(4):1053-1058. https://doi.org/10.1161/STROKEAHA.113.002910.

13. Fonarow G.C., Zhao X., Smith E.E., Saver J.L., Reeves MJ., Bhatt D.L. et al. Door-to-needle times for tissue plasminogen activator administration and clinical outcomes in acute ischemic stroke before and after a quality improvement initiative. JAMA. 2014;311(16):1632-1640. https://doi.org/10.1001/jama.2014.3203.

14. Shamalov N.A., Khasanova D.R., Stakhovskaya L.V., Voznyuk I.A., Yanishevsky S.N., Vinogradov O.I. et al. Protocol for thrombolytic therapy of acute ischemic stroke. 2019. 39 p. (In Russ.) Available at: https://rehabrus.ru/Docs/2020/protokol_14_12_18_isprav.pdf.

15. Campbell B.C.V., Mitchell PJ., Churilov L., Yassi N., Kleinig TJ., Dowling RJ. et al. Tenecteplase versus Alteplase before Thrombectomy for Ischemic Stroke. N Engl J Med. 2018;378(17):1573-1582. https://doi.org/10.1056/NEJMoa1716405.

16. Mahawish K., Gommans J., Kleinig T., Lallu B., Tyson A., Ranta A. Switching to Tenecteplase for Stroke Thrombolysis: Real-World Experience and Outcomes in a Regional Stroke Network. Stroke. 2021;52(10):e590-e593. https://doi.org/10.1161/STROKEAHA.121.035931.

17. Zhong C.S., Beharry J., Salazar D., Smith K., Withington S., Campbell B.C.V. et al. Routine Use of Tenecteplase for Thrombolysis in Acute Ischemic Stroke. Stroke. 2021;52(3):1087-1090. https://doi.org/10.1161/STROKEAHA.120.030859.

18. Warach SJ., Dula A.N., Milling TJ., Miller S., Allen L., Zuck N.D. et al. Prospective Observational Cohort Study of Tenecteplase Versus Alteplase in Routine Clinical Practice. Stroke. 2022;53(12):3583-3593. https://doi.org/10.1161/STROKEAHA.122.038950.

19. Gusev E.I., Martynov M.Yu., Nikonov A.A., Shamalov N.A., Semenov M.P, Gerasimets E.A. et al. Non-immunogenic recombinant staphylokinase versus alteplase for patients with acute ischaemic stroke 4-5 h after symptom onset in Russia (FRIDA): a randomised, open label, multicentre, parallel-group, non-inferiority trial. Lancet Neurol. 2021;20(9):721-728. https://doi.org/10.1016/S1474-4422(21)00210-6.

20. Gusev E.I., Martynov M.Yu., Shamalov N.A., Yarovaya E.B., Semenov M.P., Semenov A.M. et al. Nonimmunogenic staphylokinase in the treatment of acute ischemic stroke (FRIDA trial results). Zhurnal Nevrologii i Psikhiatrii imeni SS. Korsakova. 2022;122(7):56-65. https://doi.org/10.17116/jnevro202212207156.

21. Yogendrakumar V., Churilov L., Guha P, Beharry J., Mitchell PJ., Kleinig TJ. et al. Tenecteplase Treatment and Thrombus Characteristics Associated With Early Reperfusion: An EXTEND-IA TNK Trials Analysis. Stroke. 2023;54(3):706-714. https://doi.org/10.1161/STR0KEAHA.122.041061.

22. Charbonnier G., Bonnet L., Biondi A., Moulin T. Intracranial Bleeding After Reperfusion Therapy in Acute Ischemic Stroke. Front Neurol. 2021;11:629920. https://doi.org/10.3389/fneur.2020.629920.

23. Whiteley W.N., Emberson J., Lees K.R., Blackwell L., Albers G., Bluhmki E. et al. Risk of intracerebral haemorrhage with alteplase after acute ischaemic stroke: a secondary analysis of an individual patient data meta analysis. Lancet Neurol. 2016;15(9):925-933. https://doi.org/10.1016/S1474-4422(16)30076-X.


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For citations:


Kulesh AA, Syromyatnikova LI, Krapivin S. Experience with non-immunogenic staphylokinase for intravenous thrombolysis in ischemic stroke: analysis of hospital registry data. Meditsinskiy sovet = Medical Council. 2023;(3):24-29. (In Russ.) https://doi.org/10.21518/ms2023-057

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ISSN 2079-701X (Print)
ISSN 2658-5790 (Online)