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Resumen: Introducción: El uso de activador tisular del plasminógeno (rt-PA) a dosis bajas fue propuesto inicialmente en países asiáticos en atención a particularidades raciales relacionadas con la funcionalidad del fibrinógeno y factores de coagulación que contribuyen al riesgo de hemorragias intracerebrales, así como a la intención de ahorrar costos. Ante la controversia sobre el uso de rt-PA por debajo de la dosis estándar, realizamos una revisión de la literatura sobre los estudios que motivaron su uso y aquellos dirigidos a comparar diferentes dosis de rt-PA. Desarrollo: Se revisaron 198 resúmenes relacionados con los términos de búsqueda. Se revisaron 52 publicaciones de texto completo de los últimos 30 años. Se incluyeron 13 ensayos clínicos aleatorizados dirigidos a determinar la eficacia y seguridad del uso de rt-PA a diferentes dosis en el ictus agudo, 14 estudios de cohorte observacionales, 5 metaanálisis y 3 revisiones sistemáticas. Conclusiones: No se cuenta con evidencia suficiente para catalogar la dosis baja de alteplase como superior o al menos no inferior que el tratamiento estándar en el manejo del ictus agudo en población occidental. Se requieren más ensayos clínicos para determinar, si el uso de dosis bajas es beneficioso en pacientes con contraindicaciones relativas de terapia trombolítica u otras circunstancias particulares que eleven el riesgo de hemorragias intracerebrales. Abstract: Introduction: The use of low doses of recombinant tissue plasminogen activator (rt-PA) was initially proposed in Asian countries in response to racial peculiarities related to the functionality of fibrinogen and coagulation factors that potentially increased the risk of intracerebral haemorrhage, and with a view to saving costs. In view of the controversy over the use of rt-PA below the standard dose, we conducted a literature review of studies promoting the use of low doses or comparing different doses of rt-PA. Development: We reviewed 198 abstracts related to the search terms and the full texts of 52 studies published in the last 30 years. We finally included 13 randomised clinical trials aiming to determine the efficacy and safety of the use of rt-PA at different doses in acute stroke, 14 observational cohort studies, 5 meta-analyses, and 3 systematic reviews. Conclusions: There is insufficient evidence to classify low doses of rt-PA as superior or at least not inferior to the standard treatment in the management of acute stroke in western populations. More clinical trials are required to determine whether the use of low doses is beneficial in patients with relative contraindications for thrombolytic therapy or other particular circumstances that may increase the risk of intracerebral haemorrhage.

Pulmonary embolism (PE) is the leading cause of hospital death and the third most frequent cause of cardiovascular mortality. Traditionally, treatment options have included anticoagulation, thrombolysis, or surgery; however, catheter-directed interventions (CDI), including catheter-directed thrombolysis and aspiration thrombectomy, have been developed for patients with intermediate- or high-risk PE. These techniques can rapidly improve right ventricular function, hemodynamic status, and mortality in some patients, although there is a lack of evidence from randomized controlled trials. This document, prepared by the Interventional Cardiology Association, the Association of Ischemic Heart Disease and Acute Cardiovascular Care, and the Working Group on Pulmonary Hypertension of the Spanish Society of Cardiology (SEC), reviews the current recommendations and available evidence on the management of PE. It emphasizes the importance of rapid response teams, risk stratification, and early patient monitoring in identifying candidates for reperfusion. Based on existing clinical evidence on CDI, the document discusses various clinical scenarios and provides guidance on patient selection, particularly in situations of uncertainty due to insufficient evidence. Lastly, it describes periprocedural support, highlighting the necessary multidisciplinary approach to improve outcomes and reduce morbidity and mortality in patients with PE. Full English text available from: www.revespcardiol.org/en., (Copyright © 2024 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Thromboembolic events incidence is low in pediatrics; high suspicion and explicit management algorithms are essential. We present a 12-year-old female patient with two weeks of dyspnea, orthopnea, and ankle edema. Tests showed metabolic acidosis, hyperlactatemia, elevated D-dimer, and positive SARS-CoV-2 CRP. The echocardiogram showed severe right ventricular dysfunction and supra-systemic pulmonary hypertension. Chest CT angiography showed extensive bilateral pulmonary thromboembolism. Anticoagulant therapy was started. She presented with hemodynamic instability. Adrenaline, norepinephrine, milrinone, and nitric oxide were started. The clinical picture was extremely severe in the first 24 hours. It was decided to perform systemic thrombolysis with alteplase, which led to an improvement. Cardiorespiratory stabilization and anticoagulation are the mainstays of therapy in massive pulmonary thromboembolism. Fibrinolytic therapy is used in selected high-risk cases. In this patient, systemic reperfusion therapy with alteplase was performed with no significant complications., (Sociedad Argentina de Pediatría.)

El tromboembolismo pulmonar es la manifestación más grave de la enfermedad tromboembólica venosa y la tercera causa de mortalidad cardiovascular. Su sintomatología puede ir desde un cuadro asintomático o con síntomas leves, hasta el paro cardiaco. Dentro del enfoque de esta patología es importante tener en cuenta escalas que permiten estimar la probabilidad de que determinado paciente con ciertos signos, síntomas y factores de riesgo presente un tromboembolismo pulmonar, así como escalas diseñadas para valorar el riesgo de morir, en pacientes en los que ya se estableció este diagnóstico. Los pilares del tratamiento son la anticoagulación y la trombólisis, sin embargo, esta última está indicada únicamente en algunos casos. La presente revisión tiene como objetivo presentar una actualización de la evidencia sobre el enfoque diagnóstico y terapéutico del tromboembolismo pulmonar agudo, desde el ingreso del paciente al servicio de urgencias.

Background: acute myocardial infarction is a health problem with high morbidity and mortality rates.Objective: to characterize patients with ST-elevation acute myocardial infarction (STEMI), treated with thrombolytic therapy at the "Guillermo Domínguez López" General Teaching Hospital of the municipality of Puerto Padre, province of Las Tunas, from June 2018 through June 2020.Methods: a descriptive cross-sectional research was carried out with patients of the aforementioned institution and during the period herein declared. The sample was made up of 103 patients older than 19 years of age. The following variables were studied: age, sex, presence of associated risk factors, window time, complications, adverse reactions related to thrombolytic treatment, and status at discharge.Results: the 60 to 79 age group (68,9 %) and the male sex (58,3 %) predominated; as an associated comorbidity, diabetes mellitus was the highest one (33,9 %). Arterial hypotension was the most frequent adverse reaction (52,4 %). As complications, cardiogenic shock (10,7 %), ventricular dysfunction (9,7 %) and serious arrhythmias (8,7 %) had a higher number of occurrences. Live patients at discharge predominated.Conclusions: patients with ST-elevation acute myocardial infarction who underwent thrombolytic therapy at the intensive care unit of the hospital were characterized. Most of them were alive when discharged.

In this letter to the editor are highlighted the results of the article "Clinical characteristics of patients with acute myocardial infarction treated with thrombolysis". To this, it was carried out a comparative analysis between genders using the data reported by the authors and the finding was that mortality in women is higher. It was used Pearson's chi-square, and the results were statistically significant: p = 0.038, corrected chi-square p = 0.07. Given that the proportion of women is typically lower in reported series in the literature, these data are relevant despite the small sample size., (Licencia CC 4.0 (BY-NC-ND) © 2024 Revista Médica del Instituto Mexicano del Seguro Social.)

Introduction and Objectives: Catheter-directed therapy (CDT) for acute pulmonary embolism (PE) is an emerging therapy that combines heterogeneous techniques. The aim of the study was to provide a nationwide contemporary snapshot of clinical practice and CDT-related outcomes., Methods: This Investigator-initiated multicenter registry aimed to include consecutive patients with intermediate-high risk (IHR) or high-risk (HR), acute PE eligible for CDT. The primary outcome of the study was in-hospital all-cause death., Results: A total of 253 patients were included, of whom 93 (36.8%) had HR-PE, and 160 (63.2%) had IHR-PE with a mean age of 62.3±15.1 years. Local thrombolysis was performed in 70.8% and aspiration thrombectomy in 51.8%, with 23.3% of patients receiving both. However, aspiration thrombectomy was favored in the HR-PE cohort (80.6% vs 35%; P<.001). Only 51 patients (20.2%) underwent CDT with specific PE devices. The success rate for CDT was 90.9% (98.1% of IHR-PE patients vs 78.5% of HR-PE patients, P<.001). In-hospital mortality was 15.5%, and was highly concentrated in the HR-PE patients (37.6%) and significantly lower in IHR-PE patients (2.5%), P<.001. Long-term (24-month) mortality was 40.2% in HR-PE patients vs 8.2% in IHR-PE patients (P<.001)., Conclusions: Despite the high success rate for CDT, in-hospital mortality in HR-PE is still high (37.6%) compared with very low IHR-PE mortality (2.5%)., (Copyright © 2023 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Objective: To quantify by cardiovascular magnetic resonance the salvaged myocardium in the myocardium supplied by the infarct-related artery in reperfused and non-reperfused patients with a first ST-segment elevation myocardial infarction (STEMI)., Patients and Method: Twenty-five patients with a first STEMI (non-reperfused, ten patients; thrombolysis, ten patients; primary angioplasty, five patients) underwent cardiac magnetic resonance imaging 3 to 6 days after coronary angiography. Myocardial salvage and myocardial salvage index were quantified., Results: Peak troponin values were lower in patients with primary angioplasty than in thrombolysis and non-reperfused patients (14,1 ng/ mL versus 515,4 ng/mL and 123,1 ng/mL, respectively; p < 0,007) and smaller infarct size (14,1 g versus 31,2 g and 31,5 g, respectively; p < 0,003). Myocardial salvage mass and myocardial salvage index were higher in patients with primary angioplasty than in thrombolysis and non-reperfused patients (27,4 g versus 4,7 g and 2,1 g, respectively; p < 0,003) and (65,2% versus 14,9% and 6,6%, respectively; p < 0,0001)., Conclusions: The results of this study indicate the need to reassess the performance of coronary angioplasty and stent implantation in patients with a first STEMI, thrombolysis, and non-thrombolysis without prior myocardial viability studies. Cardiac magnetic resonance allows the quantification of salvaged myocardium and could be considered an emerging clinical application for the early evaluation of myocardial viability.

ResumenIntroducción y objetivos: Las enfermedades cardiovasculares constituyen la primera causa de muerte en los países desarrollados, y el infarto agudo de miocardio, es su expresión fundamental. El objetivo de esta investigación fue caracterizar el comportamiento y la evolución de los pacientes atendidos por esta enfermedad. Método: Se realizó un estudio observacional, transversal y multicéntrico con 31 pacientes que ingresaron a los Centro de Diagnóstico Integral con la sospecha de infarto agudo de miocardio, en el período comprendido entre octubre de 2005 a junio de 2007, en el Estado Trujillo, Venezuela. El diagnóstico de infarto se realizó mediante los métodos tradicionales. Las variables cualitativas fueron analizadas utilizando medidas de resumen, como el porcentaje. Para el análisis de las cuantitativas se utilizaron la media y la desviación estándar. Se consideró significativo una p < 0,05. Resultados: Predominó el sexo masculino con 24 pacientes (77,4 %), la hipertensión arterial estuvo presente en 19 de ellos (68,2 %), el mayor número de casos, 19 (61,2 %), presentó elevación del segmento ST y en 8 pacientes (25,8 %), hubo afectación de la cara inferior; 15 (48,4 %) recibieron tratamiento fibrinolítico y 11 (35,4 %) presentaron fallo de bomba. La estadía hospitalaria predominante fue entre 7 y 15 días (87 % de los pacientes). Conclusiones: El sexo masculino y el grupo de edad entre 60 y 70 años, fueron los de mayor representatividad; la hipertensión arterial, la dislipidemia y la diabetes mellitus fueron los principales factores de riesgo. La trombólisis le fue realizada a la mitad de los pacientes con criterios para ello, con beneficios clínicos, eléctricos y hemodinámicos óptimos.AbstractIntroduction and objectives: Cardiovascular diseases are the leading cause of death in developed countries, and myocardial infarction is the fundamental expression. The objective of this research was to characterize the behavior and evolution of the patients treated for this disease. Method: An observational, transversal, multicentre study was performed with 31 patients who were admitted to the Comprehensive Diagnostic Center with suspected acute myocardial infarction from October 2005 to June 2007, in Trujillo State, Venezuela. The diagnosis of infarction was performed using traditional methods. Qualitative variables were analyzed using summary measures, such as the percentage. For quantitative analysis, the mean and standard deviation were used. A p

ResumenIntroducción y objetivos: El infarto agudo de miocardio, en pacientes jóvenes (menores de 45 años), es una situación clínica con características específicas que difieren de los pacientes viejos. El objetivo de esta investigación fue caracterizar el comportamiento de esta enfermedad en pacientes jóvenes, identificar los principales factores de riesgo, las localizaciones topográficas más frecuentes, el tratamiento utilizado, y analizar la mortalidad. Método: Se realizó un estudio descriptivo, retrospectivo y longitudinal, en pacientes menores de 45 años con infarto agudo de miocardio, que ingresaron en las Unidades de Cuidados Intensivos de los Hospitales Universitarios "Celestino Hernández Robau" y “Arnaldo Milián Castro” de Santa Clara, Villa Clara, en el período comprendido entre enero de 1995 y diciembre de 2006. Resultados: Los 202 pacientes menores de 45 años de edad representaron el 4,6 % del total de casos, el 81,2 % se correspondió con el sexo masculino; el hábito de fumar fue el factor de riesgo más prevalente (68,8 %), seguido por la hipertensión arterial (56,4 %); la localización inferior del infarto se encontró en 85 pacientes (42,0 %), seguido por el anterior extenso y el ántero-septal con 49 (24,2 %) y 45 (22,3 %) casos, respectivamente. Recibieron tratamiento trombolítico 126 pacientes (62,4 %), solo 1 de ellos (0,8 %) falleció, los otros 4 fallecidos (5,3 %), no habían recibido ese tipo de tratamiento. Conclusiones: Predominaron el sexo masculino, el hábito de fumar, el infarto con supradesnivel del ST, la afectación de la cara inferior y la administración del tratamiento trombolítico.Abstract Introduction and objectives: Myocardial infarction in young patients (under 45 years of age) is a clinical condition with specific characteristics that differ from older patients. The objective of this research was to characterize the behavior of this disease in young patients, to identify the main risk factors, the most common topographic locations, treatment used, and to analyze mortality. Method: A descriptive, retrospective and longitudinal study was performed in patients under 45 years of age with acute myocardial infarction, admitted to the Intensive Care Units of "Celestino Hernández Robau" and "Arnaldo Milian Castro" University Hospitals in Santa Clara, Villa Clara, between January 1995 and December 2006. Results: 202 patients under 45 years of age accounted for 4,6 % of total cases, 81,2 % were male sex, smoking was the most prevalent risk factor (68,8 %), followed by hypertension (56,4 %). The inferior infarct location was found in 85 patients (42,0 %), followed by extensive anterior and antero-septal infarct location with 49 (24,2 %) and 45 (22,3 %) cases, respectively. 126 patients received thrombolytic therapy (62,4 %), only 1 of them (0,8 %) died, the other 4 dead (5,3 %) had not received such treatment. Conclusions: Male sex, smoking, myocardial infarction with ST elevation, inferior infarct location and the administration of thrombolytic therapy were predominant.

La enfermedad renal crónica representa un problema de salud pública en todo el mundo. La hemodiálisis es la modalidad utilizada con mayor frecuencia en el tratamiento de estos pacientes en estadio terminal. La obtención de un buen acceso vascular es la clave para obtener unos buenos niveles de depuración renal. La trombosis de la fístula es la mayor complicación del acceso vascular. Restablecer la permeabilidad del acceso vascular trombozado consiguiendo un flujo adecuado para una hemodiálisis efectiva, detectar las posibles causas subyacentes de trombosis, fundamentalmente estenosis, y proceder a su corrección debe ser el objetivo fundamental del tratamiento de esta complicación. Se presentó un caso con disfunción aguda de la FAV para hemodiálisis en el Hospital General "Augusto César Sandino", se le realizó la trombolisis de rescate efectiva con estreptoquinasa recombinante; se explicó el tratamiento y dosis empleadas, el paciente no presentó complicaciones. Se llegó a la conclusión de que es de gran utilidad el hecho de realizar un rápido y adecuado diagnóstico para la realización de dicho proceder, donde es posible lograr resultados muy satisfactorios.Chronic renal failure represents a public health problem all over the world. Hemodialysis is the most frequent modality of treatment in terminal stage patients. The achievement of a good vascular approach is the key to obtain proper levels of renal clearance. The thrombosis of the fistula is the major complication of vascular access. Permeability recovery of thrombosed vascular access to obtain an adequate flow to an accurate Hemodialysis together with the detection of possible underlying causes of thrombosis, mainly stenosis, and then to correct it, should be the basic objective when treating this complication. A case presenting acute dysfunction of Arteriovenous Fistula to carry out Hemodialysis was reported at «Agusto Cesar Sandino» General Hospital. A successful rescue thrombolysis with recombinant streptokinase was performed, explaining the treatment and dosage used without complications. An adequate and rapid diagnosis is very useful to carry out the procedure in order to achieve satisfactory results.

OBJECTIVE: To identify factors that delay the onset of thrombolysis in patients with acute myocardial infarction (AMI). METHODS: A cohort study was carried out with 146 patients, each diagnosed with AMI and subjected to thrombolytic therapy. The data was extracted from medical records between January 2002 and December 2004. RESULTS: The average age of the studied population was 57.5 ± 9 years, 64.4% were male. The average time between the onset of pain and arrival at the hospital was 254.7 ± 126.6 minutes, 28.1% used an ambulance for the trip to the hospital, the door-to-electrocardiogram time averaged 19.4 ± 7.3 minutes and the door-to-needle time was 51.1 ± 14.9 minutes. There was no significant difference between the time of arrival to the hospital and the method of transportation used (P= 0.81), and those seen by cardiologists and during the nightshift had a reduction in the door-to-needle time, respectively (P=0.014) and (P=0.034). CONCLUSIONS: Study results show that the delay in the search for medical service, and the long time taken from door-to-electrocardiogram and to reach the AMI diagnosis were the factors involved in the delay of thrombolytic treatment.OBJETIVO: Identificar los factores que retardan el inicio de la trombolisis en pacientes con IAM. MÉTODOS: Estudio de coorte, en 146 pacientes, con diagnóstico de IAM sometidos a la terapéutica trombolitica. Los datos fueron extraídos de prontuarios, entre enero de 2002 y diciembre de 2004. RESULTADOS: El promedio de edad fue de 57,5 ± 9 años y 64% eran del sexo masculino. El tiempo promedio transcurrido entre el inicio del dolor y la entrada al hospital fue de 254,7 ± 126,6 minutos; 28% utilizaron la ambulancia como medio de transporte; el tiempo promedio porta ECG (tiempo porta ECG: intervalo entre el ingreso del paciente al hospital y la realización del electrocardiograma) fue de 19,4 ± 7,3 minutos y el tiempo porta aguja de 51,1 ± 14,9 minutos (tiempo porta aguja: intervalo entre la entrada del paciente al hospital y la administración del trombolítico). No hubo diferencia significativa entre el tiempo de ingreso al hospital y los medios de transporte utilizados. Los pacientes atendidos por un médico cardiólogo y durante el turno de la noche tuvieron una reducción en el tiempo porta aguja, respectivamente, de (P=0,014) y (P=0,034). CONCLUSIONES: Los resultados del estudio demuestran que la demora en el ingreso al servicio médico, el tiempo porta electrocardiograma y el tiempo para diagnosticar el IAM, fueron los factores que determinaron el retardo de la administración del trombolítico.OBJETIVO: Identificar fatores que retardam o início da trombólise em pacientes com IAM. MÉTODOS: Estudo de coorte , com 146 pacientes, com diagnóstico de IAM submetidos à terapêutica trombolítica. Os dados foram extraídos de prontuários, entre janeiro de 2002 e dezembro de 2004. RESULTADOS: A média de idade foi de 57,5 ± 9 anos, 64% sexo masculino. O tempo médio entre o início da dor e a chegada ao hospital foi de 254,7 ± 126,6 minutos, 28% utilizaram a ambulância para o deslocamento, o tempo porta-eletrocardiograma médio de 19,4 ± 7,3 minutos e tempo porta-agulha de 51,1 ± 14,9 minutos. Não houve diferença significativa entre o tempo de apresentação ao hospital e o meio de transporte utilizado. Os pacientes atendidos por cardiologistas e no turno da noite tiveram uma redução no tempo porta-agulha, respectivamente (P=0,014) e (P=0,034). CONCLUSÕES: Os resultados do estudo demonstram que a demora na chegada ao serviço médico, tempo porta-eletrocardiograma e tempo para diagnosticar o IAM, foram os fatores envolvidos no retardo da administração de trombolítico.

Se realizó una revisión bibliográfica de la conducta a seguir frente a la enfermedad cerebrovascular isquémica desde el momento de admisión en los servicios de urgencia. Se tuvo en cuenta el tratamiento general y el específico. Se aportaron datos de los diferentes estudios llevados a cabo al respecto. Se incluyeron los últimos avances en cuanto al tratamiento trombolítico y se ofrecieron escalas clínicas que permiten una valoración orientadora del paciente afecto. Se concluyó que el tratamiento con medicamentos antiagregantes y el tratamiento trombolítico son eficaces en la atención de dicha entidad.A bibliographic review was made on the behavior to be followed with ischaemic stroke, starting from the patients’ admission at the emergency services. The general and specific treatments were taken into account. Data taken from the different studies carried out on this topic were provided. The latest advances in relation to the thrombolytic therapy were included and clinical scales allowing to have a guiding assessment of the affected patient were shown. It was concluded that the treatment with antiaggregant drugs and the thrombolytic therapy are efficient to treat such entity.

El propósito de nuestra investigación fue estudiar los tiempos de demora en 119 pacientes infartados en 4 hospitales de Ciudad de La Habana, para lo cual se aplicó una encuesta y los datos obtenidos se procesaron en Excel. Se obtuvo como resultado que la cuarta parte de los infartados no conocían las características del dolor anginoso, que la mitad de ellos viven solos y que frente al dolor acuden directo al hospital sin pasar por la Atención Primaria de Salud (APS). Los tiempos-pacientes y los de atención prehospitalaria están prolongados en los hospitales "Hermanos Ameijeiras" y "Manuel Fajardo", respectivamente y el tiempo puerta-aguja más demorado fue el del hospital "Ameijeiras". El tiempo de demora global hasta la trombólisis (entre los 4 hospitales) fue 4 veces más prolongado que el recomendado por la literatura mundial. Por todo esto se sugiere elaborar pautas y estrategias para reducir estos tiempos y mejorar la calidad de la atención al paciente infartado.The aim of our research work is to study the delay times that occurred in 119 patients who had an infarction in four hospitals of the City of Havana. A survey was administered and obtained data were processed by Excel. The result was that 25% of patients with infarction did not know the characteristics of anginosis, half of them live alone and they go directly to the hospital without going first to the Primary Health Care when pain appears. Patient and pre-hospital care times were longer in "Hermanos Ameijeiras" and "Manuel Fajardo" hospitals and the longest door-needle time was that of the Ameijeiras hospital. The global delay time up to thrombolysis (of the four hospitals) was four times longer than the recommended time in the world literature. Therefore, we suggest that guidelines and strategies should be drawn up to reduce time and improve the quality of the care of patients with infarction.

Background: In those patients who do not have timely access to primary angioplasty, the pharmaco-invasive approach, that is, the use of thrombolysis as a bridging measure prior to the coronary angiography, is a safe alternative., Aim: To describe the features of patients with an acute ST-elevation myocardial infarction (STEMI) treated with a pharmaco-invasive strategy., Material and Methods: Descriptive observational study of 144 patients with mean age of 46 years with STEMI who received a dose of thrombolytic prior to their referral for primary angioplasty at a public hospital between 2018 and 2021., Results: There were no differences the clinical presentation according to the Killip score at admission between thrombolyzed and non-thrombolyzed patients (p = ns). Fifty-three percent of non-thrombolyzed patients were admitted with an occluded vessel (TIMI 0) compared with 27% of thrombolyzed patients (p < 0.001). The thrombolyzed group required significantly less use of thromboaspiration (3.5 and 8.4% respectively; p = 0.014). Despite this, 91 and 92% of non-thrombolyzed and thrombolyzed patients achieved a post-angioplasty TIMI 3 flow. Long-term survival was 91 and 86% in thrombolyzed and non-thrombolyzed patients, respectively (p = ns)., Conclusions: The pharmaco-invasive strategy is a safe alternative when compared to primary angioplasty in centers that don't have timely access to Interventional Cardiology.

Con el objetivo de reducir el tiempo "puerta-aguja" se trató a 110 pacientes con estreptoquinasa recombinante en el cuerpo de guardia del Instituto de Cardiología y Cirugía Cardiovascular. El tiempo desde el inicio de los síntomas hasta la llegada al cuerpo de guardia fue de 110 min (entre 10 y 420 min). El tiempo de demora para realizar la trombolisis fue de 53 min (entre 15 y 180 min). El tiempo desde el comienzo de los síntomas hasta el comienzo del tratamiento fue de 165 min (entre 30 y 440 min). Tras el tratamiento trombolítico los pacientes se dividieron en dos grupos. En el grupo en que se normalizó el segmento S-T, el tiempo entre el inicio de los síntomas-inicio del tratamiento fue en promedio 135,7 min, mientras que en el grupo sin normalización del segmento ST la media fue de 194,7 min, la diferencia fue significativa (p < 0,001). Se concluyó que la trombolisis en el cuerpo de guardia reduce significativamente el tiempo «puerta-aguja» y aumenta la probabilidad de éxito del tratamiento. 110 patients were treated with recombinant streptochinase by the medical tem on duty at the Institute of Cardiology and Cardiovascular Surgery aimed at reducing the «door-needle» time. The time elapsed from the onset of the symptons until the arrival of the patient to the Emergency Departament was 110 min (between 10 and 420 min). It took 53 min to carry out thrombolysis (from 15 to 180 min). The langh of time since the onset of the symptons until the beginning of the treatment was 165 min (between 30 and 440 min). After concluding the thrombolytic treatment patients were divided into 2 groups. In the group in which the S-T segment becams normal the average length of time from the onset of the symptoms to the beginning of the treatment was 135.7 min, whereas in the other group where the S-T segment was not normal the mean was 194.7 min. There was a significant difference (p < 0.001). It was concluded that thrombolysis at the Emergency Departament reduces the «door-needle» time remarkably and increases the possibility of success ot the treatment.

O tromboembolismo pulmonar (TEP) é uma importante causa de morbimortalidade nos pacientes submetidos a procedimentos neurocirúrgicos. O objetivo deste estudo foi apresentar um caso de trombólise intra-arterial pulmonar em pós-operatório recente de neurocirurgia. Paciente do sexo masculino, sendo submetido a clipagem de aneurisma de artéria comunicante anterior, apresentou como complicação no sétimo dia de pós-operatório, tromboembolismo pulmonar maciço, apresentando instabilidade hemodinâmica, sendo optado pela trombólise intra-arterial pulmonar com alteplase. Apresentou evolução satisfatória, sem complicações hemorrágicas, recebendo alta hospitalar. O tromboembolismo pulmonar é uma condição com alta morbi-mortalidade no pós-operatório de neurocirurgia, devendo ser a trombólise ser uma alternativa terapêutica nos casos refratários ao tratamento clínico.Pulmonary thromboembolism is a major cause of morbidity and mortality of patients undergoing neurosurgical procedures. The purpose of this study was to present a case of intra-arterial pulmonary thrombolysis in recent neurosurgery postoperative period. Male patient, undergoing neurosurgery, presented as a complication on the seventh day of postoperative massive pulmonary embolism with hemodynamic instability and intraarterial pulmonary thrombolysis with alteplase was indicated. Evolution was satisfactory without bleeding complications and patient was discharged. Pulmonary thromboembolism is a high morbidity and mortality condition at neurosurgical postoperative period and thrombolysis should be an alternative therapy in cases refractory to clinical treatment.

Background: Hospital on-call neurology shifts are frequently on-site, but some on-call services may be off-site or mixed. Intravenous tissue plasminogen activator (tPA) is one of the main reperfusion treatments for acute ischaemic stroke (AIS). This study assesses door-to-needle times (DNT) when the neurologist is on-site or off-site., Methods: We performed a prospective, observational study from 2012 to 2017, including patients with AIS and treated with tPA. Data were collected on sex, age, door-to-scan time, scan-to-needle time, and DNT. The on-duty neurologist was on-site from 08:00 to 20:00, and on call but off-site from 20:00 to 8:00. Three groups were formed: on-site, off-site, and off-site with resident present., Results: Our sample included 138 patients. The mean age was 69.7 years, and 45.7% of patients were women. Ninety-six patients were admitted during the on-site shift, 25 during the off-site shift, and 17 during the off-site-resident present shift. Patients admitted during the on-site and off-site shifts presented DNTs of 59 and 72minutes, respectively (P=.003). DNTs were 59, 74, and 68minutes (P=.001), respectively, for the on-site, off-site, and off-site-resident present shifts; the difference between DNTs for on-site and off-site shifts was statistically significant. No differences were observed between DNTs according to time of day (morning, afternoon, or night), or between weekdays and weekends., Conclusion: DNT is influenced by whether the on-duty neurologist is on- or off-site at the time of code stroke activation. The presence of a neurology resident can reduce DNT., (Copyright © 2019 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: The use of low doses of recombinant tissue plasminogen activator (rt-PA) was initially proposed in Asian countries in response to racial peculiarities related to the functionality of fibrinogen and coagulation factors that potentially increased the risk of intracerebral haemorrhage, and with a view to saving costs. In view of the controversy over the use of rt-PA below the standard dose, we conducted a literature review of studies promoting the use of low doses or comparing different doses of rt-PA., Development: We reviewed 198 abstracts related to the search terms and the full texts of 52 studies published in the last 30 years. We finally included 13 randomised clinical trials aiming to determine the efficacy and safety of the use of rt-PA at different doses in acute stroke, 14 observational cohort studies, 5 meta-analyses, and 3 systematic reviews., Conclusions: There is insufficient evidence to classify low doses of rt-PA as superior or at least not inferior to the standard treatment in the management of acute stroke in western populations. More clinical trials are required to determine whether the use of low doses is beneficial in patients with relative contraindications for thrombolytic therapy or other particular circumstances that may increase the risk of intracerebral haemorrhage., (Copyright © 2018 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.)

El presente caso plantea la utilidad de la estreptoquinasa en el manejo del tromboembolismo pulmonar, con gran repercusión hemodinámica. De mayor relevancia el hecho de tratarse de un paciente postoperatorio, período en el cual el riesgo de tromboembolismo pulmonar es más alto, y el temor de sangrado motiva al cirujano a ser reacio a la anticoagulación. Se presentó una revisión actualizada del tema y la experiencia de un paciente con tromboembolismo pulmonar tratado con estreptoquinasa en el Hospital Provincial Docente Clínico Quirúrgico José Ramón López Tabrane, de Matanzas, monitorizado con catéter de arteria pulmonar, lo cual evidenció una disociación entre la presión distólica pulmonar y la presión en cuña. Se le aplicó estreptoquinasa por infusión continua, con respuesta clínica y hemodinámica satisfactoria.The current case states the utility of the streptokinase in the pulmonary thromboembolism, with a great hemodynamic repercussion. Of greatest relevance is the fact of being a post-surgery patient, period in which post-surgery pulmonary thromboembolism risk is higher, and fearing bleeding motivates surgeon to refuse anticoagulation. We presented an updated review of the theme and the experience of a patient with post-surgery pulmonary thromboembolism treated with streptokinase in the Clinical Teaching Provincial Hospital José Ramón Lopez Tabrane, of Matanzas , monitored with a catheter of pulmonary artery, evidencing a dissociation between pulmonary diastolic pressure and wedge pressure. He received streptokinase via continuous infusion, with a satisfactory clinical and hemodynamic answer.

Se efectuó un estudio analítico y retrospectivo de los factores asociados a estadía hospitalaria, estado al egreso y mortalidad en 32 personas ancianas que recibieron tratamiento trombolítico por infarto miocárdico agudo con elevación del segmento ST, ingresadas en el Hospital provincial docente "Dr. Joaquín Castillo Duany" de santiago de cuba durante el quinquenio 2004 -2008 a causa de esa miocardiopatía. En la casuística predominaron los pacientes del sexo masculino menores de 75 años y del femenino mayores de esa edad; el cuadro clínico y enzimático fue generalmente típico de la afección, en tanto la prescripción de aspirina y heparina por vía endovenosa se relacionó con la estadía hospitalaria, considerada como aceptable en esta serie. Fallecieron 6 ancianas y ningún hombre, para 18,8 % del total.ABSTRACT An analytical and retrospective study of factors associated with hospital stay, state at discharge and mortality was conducted in 32 elderly patients who received thrombolytic therapy for heart attack with ST segment elevation, admitted to "Dr. Joaquín Castillo Duany" Provincial Teaching Hospital of Santiago de Cuba during 2004-2008 because of this cardiomyopathy. Male patients younger than 75 years and older women predominated in the case material. The enzymatic and clinical pattern was generally typical of the condition, while the prescription of aspirin and heparin intravenously was associated with hospital stay, considered acceptable in this series. Six women and no man died, for 18,8 % of the total.

Se realizó un estudio analítico transversal de los pacientes con Infarto Agudo del Miocardio ingresados en la Unidad de Cuidados Intensivos del Hospital Militar Dr. Mario Muñoz Monroy durante el período 2005-2007, con el objetivo fundamental de describir el comportamiento de la letalidad del Infarto Agudo del Miocardio en estos pacientes y su relación con los factores de riesgo más frecuentes y determinar la utilización y eficacia de la trombolisis y las complicaciones presentadas. El sexo más afectado fue el masculino con un 74,6% (53). La mayor incidencia de infarto fue de pacientes con edades entre los 59-68 años para un 32,33%. El factor de riesgo más frecuente fue la Hipertensión Arterial con un 70,4%, sin embargo el antecedente de Cardiopatía Isquémica fue el que mostró diferencia estadísticamente significativa. Hubo 45 pacientes complicados lo que representó el 63.4%. Se trombolizaron 31 pacientes que representaron el 48,4%, de ellos fallecieron el 22,5%. El estudio de la evolución de pacientes con infarto continúa siendo un arma de irrenunciable valor para el mejoramiento de la calidad médica.It was developed an analytic transversal study of the patients with acute myocardial infarct entering the Intensive Care Unit of the Military Hospital Mario Muñoz Monroy during the period 2005-2007, with the main objective of describing lethality behavior of Acute Myocardial Infarct in these patients and its relation with the most frequent risk facts, and determining thrombolysis usage and efficacy and presented complications. The most affected sex was the male sex with 74.6 % (53). The highest infarct incidence was in patients with ages between 59-68 years old (32.33 %). The most frequent risk fact was arterial hypertension with 70.4 %, but the antecedent of ischemic heart disease was the fact that showed a significant statistical difference. There were 45 patients with complications, representing a 63.4 %. 31 patients were thrombolysed, representing the 48.4 %; 22.5 % of them died. Studying the evolution of the patients with infarct is still a valuable weapon to improve medical quality.

Introduction: Minor strokes are considered to be those that present with few symptoms, although up to 40% of them entail long-term disability. The rate of thrombolysis in these patients is also lower than in other strokes. The aim of this study is to explore whether there are any differences in intravenous thrombolysis care times in minor strokes., Patients and Methods: We conducted a retrospective review of strokes treated with intravenous thrombolysis at our centre and a comparative analysis of the care times in minor strokes and in the other types., Results: Longer times were found in minor strokes in terms of door-to-CT scan and door-to-needle time. This was not the case, however, for the time from the onset of symptoms to arrival at the hospital., Conclusions: The presence of few symptoms in minor strokes can make them difficult to recognise and could be a reason for delaying treatment. Training among staff caring for these patients is essential to improve this aspect.

Acute ischemic stroke (AIS) is a time-dependent emergency, since the greatest impact depends on the time elapsed to treatment. The objective of this work was to analyze door to needle (DTN) and start treatment (STT) times and the effect of pre-notification system (PNS) and the appropriate choice of the healthcare center on these variables. An observational study with data obtained from records of patients admitted to the Stroke Unit (SU) was conducted between August 2015 to December 2019. We analyzed the number of intravenous thrombolytic treatments (IVT), DTN and STT and compared them according to PNS use, direct arrival at the center with SU or arrival at another center for subsequent referral. An overall of 472 patients were hospitalized during the studied period and the treatment was performed in 143 out of 265 patients. One hundred thirty-seven patients arrived from another center, 70 received IVT. Average DNT with PNS and without PNS were 41 ± 23 and 81 ± 44 minutes, respectively (p = 0.001). STT on direct arrival to SU was 159 ± 59 minutes and to another center for referral was 199 ± 44 (p = 0.001). The use of a PNS and the direct choice of a center where IVT is performed significantly improve treatment.

We performed a single center retrospective study in patients wi th pulmonary embolism (PE) undergoing catheter directed thrombolysis (CDT) from 2014 to 2020. Efficacy was defined by mean pulmonary pressure drop, and safety was assessed by intracranial and severe bleeding (defined by GUSTO). Forty-three patients were included, aged 64 (56-79) years old, 5 (12%) with shock, most with right ventricle dilation (95%) and bilateral PE (95%) or unilateral (5%) in patients with only one functional lung. CDT was used as first treatment (53%), upscale after anticoagulation alone (42%), or after failed systemic thrombolytics (5%). Median recombinant tissue plasminogen activator (rtPA) dose was 30 (25-35) mg over 20 (20-20) hours, and rtPA bolus was used after catheter placement in 38 cases (89%), consisting of 5 mg (95%) or 1 mg (5%). Only one lung was treated for technical reasons, and 4 (9%) were repositioned in the same lung for continuation of infusion. A significant reduction in mean pulmonary pressure was observed (pre 35 [29-41] mmHg vs. post 24 [20-34] mmHg, p < 0.001) with no intracranial bleeding. One patient (2%) experienced severe bleeding, while 5 (12%) presented access site bleeding, and 3 (7%) required blood transfusions. In-hospital mortality was 12% but only one case (2%) due to PE. Our results are similar to previously reported studies.

Intravenous fibrinolysis with recombinant tissue plasminogen activator (rTPA) and use of stroke units improve morbidity and mortality in patients with acute ischemic stroke (AIS). However, data published in Argentina are scarce. We describe the experience in the use of fibrinolysis in patients with acute ischemic stroke (AIS) before and after the implementation of a stroke unit in a Comprehensive Stroke Center in Buenos Aires during the last 17 years. Retrospective analysis of consecutive patients treated with rTPA between January 2003 and December 2019. Treatment times, hospitalization time, post-treatment complications and disability at 3 months were evaluated. For the analysis, the pre and post opening periods of the stroke unit were evaluated, Period 1 (P1, from 2003 to 2011) and Period 2 (P2, from 2012 to 2019). Intravenous fibrinolysis was performed in 182 patients. Opening of the stroke unit resulted in an increase in the percentage of fibrinolysis over the total number of admitted strokes (4% in P1 vs. 10% in P2, p < 0.001), shortening of the door-to-needle time (75 minutes in P1 vs. 53 minutes in P2, p < 0.00001) and higher proportion of patients treated within 60 minutes of hospital admission (36% in P1 vs. 76% in P2, p < 0.00001). In addition, there was a reduction in the median hospital stay from 9 days in P1 to 5 days in P2 (p < 0.00001). In conclusion, stroke units seem to optimize the use of fibrinolysis in acute stroke, increasing the percentage of patients treated, reducing door-to-needle time, and reducing hospitalization time.