RESUMEN
Currently, five oral anticoagulants have been shown to be effective in preventing recurrent ischemic stroke and/or systemic embolism in patients with non-valvular atrial fibrillation. However, 1.1-2.2% of patients taking oral anticoagulants develop ischemic strokes. The use of oral anticoagulants limits the possibility of systemic thrombolytic therapy, as this is associated with an increased risk of symptomatic hemorrhagic transformation. The exception is cases when, with the help of a specific antagonist, it is possible to neutralize the effect of the anticoagulant in the shortest possible time and achieve normocoagulation. Currently, the Russian Federation allows two drugs for systemic thrombolytic therapy in patients with ischemic stroke in the «therapeutic window¼ up to 4.5 hours from the onset of the disease - recombinant tissue plasminogen activator and non-immunogenic staphylokinase, which showed no less efficacy and safety in the FRIDA study compared to recombinant tissue plasminogen activator. This article describes a clinical case of the first systemic thrombolytic therapy with a non-immunogenic staphylokinase after the use of idarucizumab in a patient taking dabigatran etexilate, followed by thrombectomy.
Asunto(s)
Isquemia Encefálica , Accidente Cerebrovascular Isquémico , Accidente Cerebrovascular , Anticoagulantes/uso terapéutico , Isquemia Encefálica/complicaciones , Isquemia Encefálica/tratamiento farmacológico , Dabigatrán , Fibrinolíticos/uso terapéutico , Humanos , Metaloendopeptidasas , Accidente Cerebrovascular/tratamiento farmacológico , Accidente Cerebrovascular/etiología , Trombectomía , Terapia Trombolítica/efectos adversos , Activador de Tejido Plasminógeno/uso terapéutico , Resultado del TratamientoAsunto(s)
Potenciales Evocados Auditivos , Audición/fisiología , Discriminación de la Altura Tonal/fisiología , Estimulación Acústica/métodos , Pérdida Auditiva Sensorineural/fisiopatología , Pérdida Auditiva Sensorineural/psicología , Humanos , Psicofisiología , Tiempo de Reacción/fisiología , Valores de ReferenciaRESUMEN
Auditory evoked potentials (AEP) elicited by acoustic stimuli of various frequencies and intensities were studied in children aged from three to sixteen years. With age, peak latencies of the AEP components decrease on the average (taking into account the differences of such changes depending on the frequency and intensity of the stimuli presented) by 67.6 +/- +/- 13; 82.0 +/- 7.5; 65.6 +/- 7.2; 32.3 +/- 6.7 ms for components P1, N1, P2, N2 respectively. In 90% of the cases the thresholds of auditory sensations coincided with AEP thresholds; in 10% of the cases the thresholds of electrocortical reactions were by 5 dB lower than those of the auditory sensations. Enhancement of the stimulus to 80 dB lead to an increase of the AEP amplitude, while further augmentation of stimulus intensity in most cases resulted in a decrease of the AEP amplitude which was accompanied by unpleasant sensations or preceded their appearance. The frequency of this phenomenon drops with the age from 90% in 3-4 years old children, down to 30% in juveniles 15-16 years old.