Han Wei, Sakurada Tsutomu, Hachisuka Rina, Kuroya Sayaka, Sumi Hirofumi, Kojima Shigeki, Okamoto Takeshi, Shibagaki Yugo, Tsuchihashi Yoko, Isahaya Kenji, Sasaki Naoshi, Hasegawa Yasuhiro
Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao Miyamae-ku, Kawasaki, Kanagawa, Japan.
Division of Neurology, Department of Internal Medicine, St. Marianna University School of Medicine, 2-16-1 Sugao Miyamae-ku, Kawasaki, Kanagawa, Japan.
CEN Case Rep. 2018 Nov;7(2):282-287. doi: 10.1007/s13730-018-0343-0. Epub 2018 Jun 12.
Thrombolytic therapy is an effective treatment for acute ischemic stroke and provides benefits and improvements that lead to better neurological outcomes. However, thrombolytic therapy with recombinant tissue plasminogen activator (r-tPA) in hemodialysis (HD) patients is limited because HD patients have a higher risk of bleeding. We report a case of a 75-year-old HD patient who presented with sudden aphasia during HD treatment. She was brought to the hospital for treatment for infarction. Following thrombolytic therapy, we achieved re-opening without complications. To our knowledge, no report has been published describing the patients who had a stroke during a maintenance HD session and were treated with r-tPA successfully. Although the number of HD patients treated with r-tPA is small and requires further investigation, thrombolytic therapy can be an alternative option. After weighing the risks and benefits and assessing each patient carefully, the use of r-tPA should be considered, even in HD patients.
溶栓治疗是急性缺血性卒中的有效治疗方法，能带来益处并改善病情，从而实现更好的神经学转归。然而，在血液透析（HD）患者中使用重组组织型纤溶酶原激活剂（r-tPA）进行溶栓治疗受到限制，因为HD患者出血风险更高。我们报告一例75岁HD患者，在HD治疗期间突然出现失语。她被送往医院接受梗死治疗。经过溶栓治疗，我们实现了血管再通且无并发症。据我们所知，尚无已发表的报告描述在维持性HD期间发生卒中并成功接受r-tPA治疗的患者。尽管接受r-tPA治疗的HD患者数量较少且需要进一步研究，但溶栓治疗可以是一种替代选择。在仔细权衡风险和益处并对每位患者进行评估后，即使是HD患者，也应考虑使用r-tPA。
