{"id":9674,"date":"2024-10-09T10:35:03","date_gmt":"2024-10-09T07:35:03","guid":{"rendered":"https:\/\/ozgurkilickesmez.com\/?p=9674"},"modified":"2025-09-04T21:02:43","modified_gmt":"2025-09-04T18:02:43","slug":"tromboliza","status":"publish","type":"post","link":"https:\/\/ozgurkilickesmez.com\/ro\/tromboliza\/","title":{"rendered":"Tromboliza"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">Tromboliza este o procedur\u0103 medical\u0103 utilizat\u0103 pentru dizolvarea cheagurilor de s\u00e2nge care obstruc\u021bioneaz\u0103 vasele. Tratamentul se aplic\u0103 \u00een accidente vasculare cerebrale, infarct miocardic sau tromboze periferice, av\u00e2nd ca scop restabilirea fluxului sanguin \u0219i prevenirea complica\u021biilor severe.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Terapia trombolitic\u0103 se realizeaz\u0103 prin administrarea intravenoas\u0103 sau intraarterial\u0103 a agen\u021bilor fibrinolitici. Ace\u0219tia ac\u021bioneaz\u0103 asupra fibrinei din structura cheagului, favoriz\u00e2nd dizolvarea rapid\u0103 \u0219i reducerea ischemiei tisulare.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Un avantaj major al trombolizei este eficien\u021ba crescut\u0103 \u00een primele ore de la debutul simptomelor. Cu c\u00e2t procedura este efectuat\u0103 mai precoce, cu at\u00e2t \u0219ansele de recuperare complet\u0103 \u0219i reducerea sechelelor sunt mai mari.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Tromboliza este realizat\u0103 sub supraveghere strict\u0103 medical\u0103, fiind necesar\u0103 monitorizarea atent\u0103 a pacientului. Riscul de hemoragii exist\u0103, dar este controlat prin criterii stricte de selec\u021bie a cazurilor eligibile pentru tratament.<\/span><\/p>\n<table>\n<tbody>\n<tr>\n<td>Metod\u0103 de tratament<\/td>\n<td>Tromboliz\u0103<\/td>\n<\/tr>\n<tr>\n<td>Defini\u021bie<\/td>\n<td>O metod\u0103 de tratament, aplicat\u0103 \u00een general intravenos, care vizeaz\u0103 dizolvarea cheagurilor de s\u00e2nge formate \u00een vase \u0219i restabilirea fluxului sanguin.<\/td>\n<\/tr>\n<tr>\n<td>Zone de utilizare<\/td>\n<td>AVC ischemic acut, embolie pulmonar\u0103, tromboz\u0103 venoas\u0103 profund\u0103 (TVP), infarct miocardic (atac de cord) cauzate de blocaje prin cheaguri.<\/td>\n<\/tr>\n<tr>\n<td>Avantaje<\/td>\n<td>Prin tratamentul precoce, blocajul poate fi \u00eendep\u0103rtat, \u021besutul afectat poate fi salvat \u0219i se poate preveni pierderea func\u021biei; d\u0103 rezultate mai ales \u00een cazul AVC-ului \u0219i al atacului de cord.<\/td>\n<\/tr>\n<tr>\n<td>Proces de aplicare<\/td>\n<td>De regul\u0103, medicamentele trombolitice (precum tPA) administrate pe cale intravenoas\u0103 dizolv\u0103 cheagul, redeschiz\u00e2nd vasul; \u00een unele cazuri se ajunge la zona blocat\u0103 prin cateter.<\/td>\n<\/tr>\n<tr>\n<td>Efecte secundare<\/td>\n<td>Risc de s\u00e2ngerare (\u00een special la nivel cerebral \u0219i gastrointestinal), reac\u021bii alergice, tensiune arterial\u0103 sc\u0103zut\u0103, rareori apari\u021bia unei embolii.<\/td>\n<\/tr>\n<tr>\n<td>Rat\u0103 de succes<\/td>\n<td>Aplicat\u0103 devreme \u00een AVC \u0219i infarct miocardic, are o rat\u0103 \u00eenalt\u0103 de succes; depinde de m\u0103rimea cheagului \u0219i de momentul \u00eenceperii tratamentului.<\/td>\n<\/tr>\n<tr>\n<td>Monitorizare \u0219i urm\u0103rire<\/td>\n<td>Dup\u0103 tratament este important s\u0103 se urm\u0103reasc\u0103 semnele de s\u00e2ngerare \u0219i parametrii vitali; dac\u0103 este nevoie, starea cheagului este evaluat\u0103 prin RMN, CT sau angiografie.<\/td>\n<\/tr>\n<tr>\n<td>Metode alternative<\/td>\n<td>Trombectomie (\u00eendep\u0103rtarea chirurgical\u0103 a cheagului), terapie anticoagulant\u0103 (medicamente pentru sub\u021bierea s\u00e2ngelui), tratament endovascular.<\/td>\n<\/tr>\n<tr>\n<td>Boli asociate<\/td>\n<td>AVC ischemic acut, embolie pulmonar\u0103, tromboz\u0103 venoas\u0103 profund\u0103, infarct miocardic (atac de cord).<\/td>\n<\/tr>\n<tr>\n<td>Preven\u021bie \u0219i preg\u0103tire<\/td>\n<td>Utilizarea medicamentelor anticoagulante, tulbur\u0103ri de coagulare, situa\u021biile de s\u00e2ngerare activ\u0103 reprezint\u0103 contraindica\u021bii pentru tromboliz\u0103; evaluarea riscului de s\u00e2ngerare \u00eenainte de procedur\u0103 este esen\u021bial\u0103.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><span data-sheets-root=\"1\">\n\t<section class=\"section\" id=\"section_734425020\">\n\t\t<div class=\"section-bg fill\" >\n\t\t\t\t\t\t\t\t\t\n\t\t\t\n\n\t\t<\/div>\n\n\t\t\n\n\t\t<div 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class=\"col-inner dark\"  >\n\t\t\t\n\t\t\t\n\n\t<div id=\"text-3455476437\" class=\"text\">\n\t\t\n\n<p><strong>Prof. Dr. \u00d6zg\u00fcr KILI\u00c7KESMEZ<br \/><\/strong><span style=\"font-size: 65%;\"><em>Radiologie Interven\u021bional\u0103 \/ Neuroradiologie Interven\u021bional\u0103<\/em><\/span><\/p>\n\t\t\n<style>\n#text-3455476437 {\n  font-size: 1.25rem;\n}\n@media (min-width:550px) {\n  #text-3455476437 {\n    font-size: 2rem;\n  }\n}\n<\/style>\n\t<\/div>\n\t\n<p>Prof. Dr. K\u0131l\u0131\u00e7kesmez de\u021bine Certificatul de Competen\u021b\u0103 \u00een Radiologie din Turcia, Certificatul de Competen\u021b\u0103 \u00een Radiologie Interven\u021bional\u0103 din Turcia, Certificarea pentru tratamentul accidentului vascular cerebral \u0219i Certificatul European de Radiologie Interven\u021bional\u0103 (EBIR). \u00cen cariera sa academic\u0103, a c\u00e2\u0219tigat Premiul I Siemens pentru Radiologie \u00een 2008.<\/p>\n\n<a href=\"https:\/\/ozgurkilickesmez.com\/kimdir\/\" 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class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/ozgurkilickesmez.com\/ro\/tromboliza\/#Ce_este_tromboliza_si_cum_functioneaza\" >Ce este tromboliza \u0219i cum func\u021bioneaz\u0103?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/ozgurkilickesmez.com\/ro\/tromboliza\/#In_ce_situatii_se_aplica_tromboliza_la_pacientii_cu_AVC\" >\u00cen ce situa\u021bii se aplic\u0103 tromboliza la pacien\u021bii cu AVC?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/ozgurkilickesmez.com\/ro\/tromboliza\/#Care_sunt_riscurile_si_complicatiile_trombolizei\" >Care sunt riscurile \u0219i complica\u021biile trombolizei?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/ozgurkilickesmez.com\/ro\/tromboliza\/#Cele_mai_recente_progrese_in_studiile_privind_tromboliza\" >Cele mai recente progrese \u00een studiile privind tromboliza<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/ozgurkilickesmez.com\/ro\/tromboliza\/#Intrebari_frecvente\" >\u00centreb\u0103ri frecvente<\/a><\/li><\/ul><\/nav><\/div>\n<h2><span class=\"ez-toc-section\" id=\"Ce_este_tromboliza_si_cum_functioneaza\"><\/span>Ce este tromboliza \u0219i cum func\u021bioneaz\u0103?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Tromboliza include medicamente speciale care dizolv\u0103 cheagurile de s\u00e2nge din vasele cerebrale, restabilind astfel fluxul sanguin. Cele mai frecvent utilizate medicamente trombolitice sunt alteplaza \u0219i tenecteplaza. Alteplaza descompune cheagul prin activarea plasminogenului, care distruge fibrina \u0219i trebuie administrat\u0103 \u00een decurs de 4,5 ore.<\/p>\n<p>Tenecteplaza este o form\u0103 modificat\u0103 genetic, av\u00e2nd acela\u0219i efect, \u00eens\u0103 cu o specificitate mai mare fa\u021b\u0103 de fibrin\u0103 \u0219i se administreaz\u0103 \u00eentr-o singur\u0103 doz\u0103 bolus. Are un timp de \u00eenjum\u0103t\u0103\u021bire mai lung dec\u00e2t alteplaza. Aceste medicamente aduc avantaje importante \u00een tratamentul AVC-ului ischemic deoarece:<\/p>\n<ul>\n<li aria-level=\"1\">Reduc afectarea cerebral\u0103 \u0219i accelereaz\u0103 procesul de recuperare.<\/li>\n<li aria-level=\"1\">Tenecteplaza ofer\u0103 posibilitatea unei administr\u0103ri mai simple.<\/li>\n<li aria-level=\"1\">Asigur\u0103 rezultate bune \u00een ceea ce prive\u0219te eficacitatea \u0219i siguran\u021ba.<\/li>\n<li aria-level=\"1\">Astfel, tenecteplaza c\u00e2\u0219tig\u0103 din ce \u00een ce mai mult\u0103 popularitate \u00een tratamentul trombolitic.<\/li>\n<\/ul>\n<h2><span class=\"ez-toc-section\" id=\"In_ce_situatii_se_aplica_tromboliza_la_pacientii_cu_AVC\"><\/span>\u00cen ce situa\u021bii se aplic\u0103 tromboliza la pacien\u021bii cu AVC?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Tromboliza se aplic\u0103 \u00een cazurile de AVC ischemic acut cu scopul de a dizolva cheagul, fiind destinat\u0103 pacien\u021bilor ce \u00eendeplinesc anumite criterii. Intervalul standard de aplicare este de 4,5 ore de la debutul simptomelor. Tratamentul administrat rapid \u00een acest interval ofer\u0103 cele mai bune rezultate. Totu\u0219i, pentru a efectua tromboliza, trebuie \u00eendeplinite anumite criterii de baz\u0103:<\/p>\n<ul>\n<li aria-level=\"1\">Diagnosticul de AVC ischemic trebuie confirmat prin evaluarea clinic\u0103.<\/li>\n<li aria-level=\"1\">Nu trebuie s\u0103 existe contraindica\u021bii majore, precum s\u00e2nger\u0103ri active, interven\u021bii chirurgicale recente sau hipertensiune necontrolat\u0103.<\/li>\n<li aria-level=\"1\">La tomografia computerizat\u0103 (CT) cerebral\u0103, f\u0103r\u0103 substan\u021b\u0103 de contrast, nu trebuie s\u0103 existe hipodensit\u0103\u021bi extinse.<\/li>\n<\/ul>\n<p>\u00cen unele situa\u021bii, folosind metode avansate de imagistic\u0103, perioada de tratament poate fi extins\u0103 peste 4,5 ore. \u00cen special p\u00e2n\u0103 la 9 ore sau, \u00een anumite cazuri speciale, p\u00e2n\u0103 la 24 de ore. \u00cen acest context extins, prin CT de perfuzie sau RMN de difuziune se identific\u0103 zonele de \u021besut cerebral \u00eenc\u0103 viabil. Aceste tehnici permit aplicarea tratamentului f\u0103r\u0103 restric\u021bii stricte de timp.<\/p>\n<ul>\n<li>Tehnicile de perfuzie permit evaluarea raportului dintre nucleul ischemic \u0219i penumbra ischemic\u0103.<\/li>\n<li>Studiile EXTEND, DAWN \u0219i DEFUSE 3 au ar\u0103tat c\u0103 folosirea tehnicilor avansate de imagistic\u0103 poate extinde tromboliza p\u00e2n\u0103 la 24 de ore.<\/li>\n<\/ul>\n<p><span data-sheets-root=\"1\">\n\t<section class=\"section\" id=\"section_514164071\">\n\t\t<div class=\"section-bg fill\" >\n\t\t\t\t\t\t\t\t\t\n\t\t\t\n\n\t\t<\/div>\n\n\t\t\n\n\t\t<div class=\"section-content relative\">\n\t\t\t\n\n<div class=\"row\"  id=\"row-1010389243\">\n\n\n\t<div id=\"col-1605390137\" class=\"col small-12 large-12\"  >\n\t\t\t\t<div class=\"col-inner box-shadow-2\"  >\n\t\t\t\n\t\t\t\n\n<div class=\"row\"  id=\"row-1769900009\">\n\n\n\t<div id=\"col-719102055\" class=\"col whatsapp-alani hide-for-small medium-3 small-12 large-3\"  >\n\t\t\t\t<div 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>\n\t\t\t\n\t\t\t\n\n\t<div id=\"text-1294732525\" class=\"text\">\n\t\t\n\n<p><span style=\"color: #ffffff;\"><a style=\"color: #ffffff;\" href=\"https:\/\/api.whatsapp.com\/send\/?phone=905405032303&amp;text=Bun\u0103%2C+v\u0103+contactez+de+pe+https%3A%2F%2Fozgurkilickesmez.com%2F&amp;type=phone_number&amp;app_absent=0\">Apas\u0103 aici pentru suport WhatsApp 24\/7!<\/a><\/span><\/p>\n\t\t\n<style>\n#text-1294732525 {\n  font-size: 1.25rem;\n  text-align: center;\n  color: rgb(255,255,255);\n}\n#text-1294732525 > * {\n  color: rgb(255,255,255);\n}\n@media (min-width:550px) {\n  #text-1294732525 {\n    font-size: 1.5rem;\n  }\n}\n<\/style>\n\t<\/div>\n\t\n\n\t\t<\/div>\n\t\t\t\t\n<style>\n#col-350714581 > .col-inner {\n  padding: 20px 0px 1px 0px;\n  margin: 0px 0px 0px 0px;\n  border-radius: 100px;\n}\n@media (min-width:550px) {\n  #col-350714581 > .col-inner {\n    margin: 0px 0px -40px 0px;\n  }\n}\n<\/style>\n\t<\/div>\n\n\t\n\n\t<div id=\"col-462927580\" class=\"col medium-9 small-12 large-9\"  >\n\t\t\t\t<div class=\"col-inner text-left\"  >\n\t\t\t\n\t<div class=\"is-border\"\n\t\tstyle=\"border-width:0px 0px 0px 0px;margin:0px 0px 0px 0px;\">\n\t<\/div>\n\t\t\t\n\n<div class=\"row\"  id=\"row-139580610\">\n\n\n\t<div id=\"col-2031881849\" class=\"col small-12 large-12\"  >\n\t\t\t\t<div class=\"col-inner\"  >\n\t\t\t\n\t\t\t\n\n\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f8836-o1\" lang=\"tr-TR\" dir=\"ltr\" data-wpcf7-id=\"8836\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/ro\/wp-json\/wp\/v2\/posts\/9674#wpcf7-f8836-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"8836\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.2.3\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" 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placeholder=\"Telefon\" value=\"\" type=\"tel\" name=\"tel-10\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"col-quarter\">\n\t\t\t<p><span class=\"wpcf7-form-control-wrap\" data-name=\"email-563\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" autocomplete=\"name\" aria-required=\"true\" aria-invalid=\"false\" placeholder=\"E-mail\" value=\"\" type=\"email\" name=\"email-563\" \/><\/span>\n\t\t\t<\/p>\n\t\t<\/div>\n\t\t<div class=\"col-quarter\">\n\t\t\t<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"TRIMITE\" \/>\n\t\t\t<\/p>\n\t\t<\/div>\n\t<\/div>\n<\/div><p style=\"display: none !important;\" class=\"akismet-fields-container\" data-prefix=\"_wpcf7_ak_\"><label>&#916;<textarea name=\"_wpcf7_ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label><input type=\"hidden\" id=\"ak_js_1\" name=\"_wpcf7_ak_js\" value=\"203\"\/><script>\ndocument.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );\n<\/script>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n\n\n\t\t<\/div>\n\t\t\t\t\n<style>\n#col-2031881849 > .col-inner {\n  margin: 0px 0px -60px 0px;\n}\n<\/style>\n\t<\/div>\n\n\t\n\n\t<div id=\"col-407253923\" class=\"col small-12 large-12\"  >\n\t\t\t\t<div class=\"col-inner\"  >\n\t\t\t\n\t\t\t\n\n\t<div id=\"text-2266559477\" class=\"text\">\n\t\t\n\n<p>*V\u0103 recomand\u0103m s\u0103 completa\u021bi toate c\u00e2mpurile pentru a primi cel mai bun r\u0103spuns posibil.<\/p>\n\t\t\n<style>\n#text-2266559477 {\n  font-size: 0.85rem;\n  line-height: 1.5;\n}\n@media (min-width:550px) {\n  #text-2266559477 {\n    line-height: 0.75;\n  }\n}\n<\/style>\n\t<\/div>\n\t\n\n\t\t<\/div>\n\t\t\t\t\n<style>\n#col-407253923 > .col-inner {\n  margin: 0px 0px -40px 0px;\n}\n<\/style>\n\t<\/div>\n\n\t\n\n<\/div>\n\n\t\t<\/div>\n\t\t\t\t\n<style>\n#col-462927580 > .col-inner {\n  padding: 0px 0px 0px 0px;\n  margin: 0px 0px -20px 0px;\n}\n@media (min-width:550px) {\n  #col-462927580 > .col-inner {\n    padding: 20px 0px 0px 0px;\n    margin: 0px 0px -66px 0px;\n  }\n}\n<\/style>\n\t<\/div>\n\n\t\n\n<\/div>\n\n\t\t<\/div>\n\t\t\t\t\n<style>\n#col-1605390137 > .col-inner {\n  padding: 30px 10px 0px 10px;\n  border-radius: 30px;\n}\n@media (min-width:550px) {\n  #col-1605390137 > .col-inner {\n    padding: 0px 20px 0px 0px;\n  }\n}\n<\/style>\n\t<\/div>\n\n\t\n\n<\/div>\n\n\t\t<\/div>\n\n\t\t\n<style>\n#section_514164071 {\n  padding-top: 30px;\n  padding-bottom: 30px;\n}\n<\/style>\n\t<\/section>\n\t<\/span><\/p>\n<h2><span class=\"ez-toc-section\" id=\"Care_sunt_riscurile_si_complicatiile_trombolizei\"><\/span>Care sunt riscurile \u0219i complica\u021biile trombolizei?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>De\u0219i tromboliza este o metod\u0103 utilizat\u0103 \u00een tratamentul AVC-ului ischemic acut, aceasta implic\u0103 riscuri \u0219i complica\u021bii semnificative. Printre principalele complica\u021bii se num\u0103r\u0103 transformarea hemoragic\u0103 (HT), hemoragia intracerebral\u0103 (ICH) \u0219i s\u00e2nger\u0103rile sistemice. Transformarea hemoragic\u0103 este o complica\u021bie serioas\u0103 ce const\u0103 \u00een s\u00e2ngerarea \u021besutului cerebral. Apare la aproximativ 6% dintre pacien\u021bii care primesc tromboliz\u0103 \u0219i riscul cre\u0219te \u00een prezen\u021ba unor factori precum v\u00e2rsta \u00eenaintat\u0103, zona mare de infarct, scor NIHSS ridicat, hipertensiune, hiperglicemie \u0219i fibrila\u021bie atrial\u0103. Transformarea hemoragic\u0103 cre\u0219te mortalitatea \u0219i gradul de dizabilitate, afect\u00e2nd negativ rezultatul final al tratamentului.<\/p>\n<p>Hemoragia intracerebral\u0103 este o alt\u0103 complica\u021bie poten\u021bial fatal\u0103, mai frecvent\u0103 la persoanele cu antecedente de hipertensiune arterial\u0103. Dac\u0103 tensiunea arterial\u0103 dep\u0103\u0219e\u0219te 180\/105 mmHg, tromboliza nu este recomandat\u0103, deoarece riscul de s\u00e2ngerare cre\u0219te. De asemenea, persoanele care au suferit recent o interven\u021bie chirurgical\u0103 major\u0103 sau prezint\u0103 antecedente de AVC hemoragic au un risc mai mare.<\/p>\n<p>S\u00e2ngerarea sistemic\u0103 semnific\u0103 faptul c\u0103, pe l\u00e2ng\u0103 s\u00e2nger\u0103rile intracraniene, tromboliza poate cauza s\u00e2nger\u0103ri \u00een alte regiuni ale corpului. Apari\u021bia s\u00e2nger\u0103rilor gastrointestinale sau a celor \u00een zonele recent operate este un exemplu, motiv pentru care tromboliza este contraindicat\u0103 la pacien\u021bii care au suferit recent o opera\u021bie.<\/p>\n<p><strong>Criterii de excludere:<\/strong><\/p>\n<ul>\n<li><strong>Interven\u021bii chirurgicale recente:<\/strong> Pacien\u021bii care au suferit o opera\u021bie major\u0103 \u00een ultimele 14 zile.<\/li>\n<li><strong>Hipertensiune necontrolat\u0103:<\/strong> Tensiune arterial\u0103 peste 185\/110 mmHg.<\/li>\n<li><strong>Coagulopatie:<\/strong> Num\u0103r sc\u0103zut de trombocite sau INR &gt;1,7.<\/li>\n<\/ul>\n<p><span data-sheets-root=\"1\">\n\t<section class=\"section dark\" id=\"section_1914421359\">\n\t\t<div class=\"section-bg fill\" >\n\t\t\t\t\t\t\t\t\t\n\t\t\t\n\n\t\t<\/div>\n\n\t\t\n\n\t\t<div class=\"section-content relative\">\n\t\t\t\r\n\r\n\t<div id=\"gap-1699563847\" class=\"gap-element clearfix hide-for-medium\" style=\"display:block; height:auto;\">\n\t\t\n<style>\n#gap-1699563847 {\n  padding-top: 10px;\n}\n<\/style>\n\t<\/div>\n\t\r\n\r\n<div class=\"row align-middle\"  id=\"row-7798164\">\r\n\r\n\n\t<div id=\"col-218178864\" class=\"col medium-8 small-12 large-8\"  >\n\t\t\t\t<div class=\"col-inner\"  >\n\t\t\t\n\t\t\t\r\n\r\n\t<div id=\"text-622043768\" class=\"text\">\n\t\t\r\n\r\n<div><strong>Contacteaz\u0103-l acum pe Prof. Dr. \u00d6zg\u00fcr K\u0131l\u0131\u00e7kesmez pentru informa\u021bii detaliate \u0219i pentru a programa o consulta\u021bie!<\/strong><\/div>\r\n\t\t\n<style>\n#text-622043768 {\n  font-size: 1.25rem;\n  text-align: center;\n}\n@media (min-width:550px) {\n  #text-622043768 {\n    font-size: 1.15rem;\n  }\n}\n@media (min-width:850px) {\n  #text-622043768 {\n    font-size: 1.5rem;\n    text-align: left;\n  }\n}\n<\/style>\n\t<\/div>\n\t\r\n\r\n\t\t<\/div>\n\t\t\t\t\n<style>\n#col-218178864 > .col-inner {\n  padding: 20px 0px 0px 0px;\n  margin: 0px 0px -10px 0px;\n}\n@media (min-width:550px) {\n  #col-218178864 > .col-inner {\n    padding: 0px 0px 0px 0px;\n  }\n}\n<\/style>\n\t<\/div>\n\n\t\r\n\n\t<div id=\"col-1561706994\" class=\"col medium-4 small-12 large-4\"  >\n\t\t\t\t<div class=\"col-inner text-center\"  >\n\t\t\t\n\t\t\t\r\n\r\n<a href=\"https:\/\/api.whatsapp.com\/send\/?phone=905405032303&#038;text=Bun\u0103%2C+v\u0103+contactez+de+pe+https%3A%2F%2Fozgurkilickesmez.com%2F&#038;type=phone_number&#038;app_absent=0\" target=\"_blank\" class=\"button alert is-small box-shadow-5\" rel=\"noopener\" style=\"border-radius:10px;padding:5px 20px 5px 20px;\">\n\t\t<span>Contact prin Whatsapp<\/span>\n\t<i class=\"icon-whatsapp\" aria-hidden=\"true\"><\/i><\/a>\n\r\n\r\n\t\t<\/div>\n\t\t\t\t\n<style>\n#col-1561706994 > .col-inner {\n  padding: 20px 0px 0px 0px;\n}\n<\/style>\n\t<\/div>\n\n\t\r\n\r\n<\/div>\r\n\r\n\t\t<\/div>\n\n\t\t\n<style>\n#section_1914421359 {\n  padding-top: 0px;\n  padding-bottom: 0px;\n  background-color: #396cf0;\n}\n<\/style>\n\t<\/section>\n\t\r\n\t<div id=\"gap-966302100\" class=\"gap-element clearfix\" style=\"display:block; height:auto;\">\n\t\t\n<style>\n#gap-966302100 {\n  padding-top: 20px;\n}\n<\/style>\n\t<\/div>\n\t\r\n<\/span><\/p>\n<h2><span class=\"ez-toc-section\" id=\"Cele_mai_recente_progrese_in_studiile_privind_tromboliza\"><\/span>Cele mai recente progrese \u00een studiile privind tromboliza<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Ultimele cercet\u0103ri \u00een domeniul tratamentului AVC-ului ischemic acut vizeaz\u0103 utilizarea tenecteplazei \u0219i alteplazei \u0219i impactul lor clinic. Tenecteplaza, o form\u0103 modificat\u0103 genetic a alteplazei, se remarc\u0103 printr-un timp de \u00eenjum\u0103t\u0103\u021bire mai lung \u0219i o specificitate mai mare fa\u021b\u0103 de fibrin\u0103. Studiile sugereaz\u0103 c\u0103 ar putea asigura o dizolvare mai rapid\u0103 a cheagului \u0219i o reperfuzie mai bun\u0103. Trialuri precum TASTE-A \u0219i EXTEND-IA TNK au eviden\u021biat c\u0103 tenecteplaza poate fi mai eficient\u0103 dec\u00e2t alteplaza la pacien\u021bii cu ocluzie de vas mare. \u00cen aceste studii, realizate inclusiv \u00een ambulan\u021be specializate pentru AVC, s-a raportat o \u00eembun\u0103t\u0103\u021bire neurologic\u0103 \u0219i func\u021bional\u0103 la 90 de zile.<\/p>\n<p>Profilul de siguran\u021b\u0103 al tenecteplazei nu prezint\u0103 diferen\u021be semnificative fa\u021b\u0103 de alteplaz\u0103, din punctul de vedere al hemoragiei intracraniene simptomatice \u0219i al mortalit\u0103\u021bii. Analizele \u0219i studiile de sintez\u0103 arat\u0103 c\u0103 ambele medicamente au rezultate comparabile \u00een ceea ce prive\u0219te starea func\u021bional\u0103 la 90 de zile, \u00eens\u0103 tenecteplaza pare s\u0103 ofere un avantaj u\u0219or \u00een stadiile timpurii.<\/p>\n<p>\u00cen studii, doza optim\u0103 de tenecteplaz\u0103 este considerat\u0103 a fi 0,25 mg\/kg:<\/p>\n<ul>\n<li aria-level=\"1\">Aceast\u0103 doz\u0103 este echilibrat\u0103 \u00een termeni de siguran\u021b\u0103 \u0219i eficacitate.<\/li>\n<li aria-level=\"1\">Dozele mai mari au fost asociate cu un risc sporit de s\u00e2ngerare.<\/li>\n<\/ul>\n<p>Viitoarele cercet\u0103ri urm\u0103resc combinarea tratamentului trombolitic cu anticoagulante \u0219i alte interven\u021bii, pentru a dezvolta protocoale terapeutice mai eficiente.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Intrebari_frecvente\"><\/span>\u00centreb\u0103ri frecvente<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p><strong>\u00cen ce situa\u021bii se aplic\u0103 tromboliza?<\/strong><\/p>\n<p>Tromboliza este utilizat\u0103 \u00een cazul pacien\u021bilor cu AVC ischemic acut care se prezint\u0103 la spital \u00een primele 4,5 ore de la debutul simptomelor, cu confirmarea la CT c\u0103 nu exist\u0103 hemoragii intracraniene. Acest tratament cre\u0219te cu aproximativ o treime \u0219ansele de a r\u0103m\u00e2ne independent dup\u0103 un AVC, dac\u0103 este administrat rapid. Eficacitatea trombolizei este extrem de sensibil\u0103 la timp, iar beneficiile scad pe m\u0103sur\u0103 ce perioada p\u00e2n\u0103 la ini\u021bierea tratamentului se prelunge\u0219te. Din acest motiv, evaluarea rapid\u0103 \u0219i \u00eenceperea prompt\u0103 a tratamentului sunt esen\u021biale pentru a maximiza rezultatele.<\/p>\n<p><strong>Cum ac\u021bioneaz\u0103 medicamentele utilizate \u00een timpul procedurii?<\/strong><\/p>\n<p>Medicamentele trombolitice, precum alteplaza, reteplaza \u0219i tenecteplaza, ac\u021bioneaz\u0103 prin conversia proteinei plasminogen \u00een plasmine, care apoi descompune fibrina \u2014 componenta-cheie a cheagurilor de s\u00e2nge. Astfel, cheagul se dizolv\u0103 \u0219i se restabile\u0219te fluxul sanguin. Aceste medicamente sunt de importan\u021b\u0103 critic\u0103 \u00een tratamentul infarctului miocardic acut, emboliei pulmonare \u0219i AVC-ului ischemic. Totu\u0219i, riscurile de s\u00e2ngerare impun ca pacien\u021bii s\u0103 fie atent selecta\u021bi \u0219i monitoriza\u021bi pe toat\u0103 durata tratamentului.<\/p>\n<p><strong>Care sunt riscurile tratamentului de tromboliz\u0103?<\/strong><\/p>\n<p>Tromboliza, mai ales cu alteplaz\u0103, presupune un risc de s\u00e2ngerare intracranian\u0103. Conform datelor, la fiecare 1.000 de pacien\u021bi trata\u021bi apare un surplus de 58 de episoade hemoragice (95% CI, 49-68) \u0219i 25 de decese adi\u021bionale \u00een primele 7 zile (95% CI, 11-39). La pacien\u021bii cu AVC ischemic acut care au utilizat recent anticoagulante orale directe (DOAC), riscul de hemoragie intracranian\u0103 simptomatic\u0103 (sICH) este mai ridicat. Cu toate acestea, la pacien\u021bii v\u00e2rstnici (\u226580 de ani) cu AVC ischemic acut, administrarea intravenoas\u0103 de tromboliz\u0103 poate \u00eembun\u0103t\u0103\u021bi prognosticul pe termen scurt \u0219i lung, f\u0103r\u0103 o cre\u0219tere semnificativ\u0103 a riscului de transformare hemoragic\u0103 sau de mortalitate. Beneficiul IVT \u00eenainte de trombectomie scade odat\u0103 cu trecerea timpului de la debutul simptomelor, iar dup\u0103 aproximativ 2 ore \u0219i 20 de minute, aceast\u0103 corela\u021bie devine nesemnificativ\u0103. De\u0219i tromboliza poate fi benefic\u0103, mai ales la anumite categorii de pacien\u021bi, sau c\u00e2nd este administrat\u0103 timpuriu, ea cre\u0219te riscul de hemoragie intracranian\u0103 \u0219i deces timpuriu.<\/p>\n<p><strong>Dup\u0103 acest tratament, poate reap\u0103rea obstruc\u021bia vascular\u0103?<\/strong><\/p>\n<p>Da, este posibil ca vasul de s\u00e2nge s\u0103 se blocheze din nou dup\u0103 tromboliz\u0103. Studiile arat\u0103 c\u0103 pacien\u021bii care prezint\u0103 mai mult de 5% obstruc\u021bie vascular\u0103 pulmonar\u0103 rezidual\u0103 (RPVO) dup\u0103 tratamentul anticoagulant au un risc dublu de recidiv\u0103 a tromboembolismului venos (TEV) fa\u021b\u0103 de cei cu mai pu\u021bin de 5% RPVO; aceste valori sunt de 11,7% \u0219i, respectiv, 5,8% \u00een decurs de un an. \u00cen plus, \u00een cazul unor afec\u021biuni precum sindromul May-Thurner, poate exista un risc mai mare de recidiv\u0103 a trombozei venoase profunde (TVP) dup\u0103 tromboliza ghidat\u0103 prin cateter. De\u0219i tromboliza este eficient\u0103 \u00een dizolvarea cheagurilor existente, la pacien\u021bii cu factori predispozan\u021bi sau obstruc\u021bie vascular\u0103 rezidual\u0103 persist\u0103 \u00een continuare riscul de reapari\u021bie a cheagurilor.<\/p>\n<p><strong>C\u00e2t dureaz\u0103 procedura de tromboliz\u0103?<\/strong><\/p>\n<p>Durata procedurii de tromboliz\u0103 depinde de afec\u021biunea tratat\u0103 \u0219i de metoda de administrare a medicamentelor. Pentru un AVC ischemic acut, tromboliza intravenoas\u0103 trebuie ini\u021biat\u0103 \u00een primele 4,5 ore de la apari\u021bia simptomelor, iar intervalul \u201eu\u0219\u0103-ace\u201d (timpul de la sosirea la spital p\u00e2n\u0103 la administrarea trombolizei) ar trebui s\u0103 fie sub 60 de minute. De obicei, administrarea medicamentului const\u0103 \u00eentr-o doz\u0103 ini\u021bial\u0103 \u00een bolus, urmat\u0103 de o perfuzie pe durata a 60 de minute. Pentru tromboza venoas\u0103 profund\u0103, metoda ghidat\u0103 prin cateter poate dura de la c\u00e2teva ore p\u00e2n\u0103 la 48 de ore, \u00een func\u021bie de m\u0103rimea \u0219i localizarea cheagului. Durata exact\u0103 poate varia \u00een func\u021bie de situa\u021bia clinic\u0103 \u0219i de protocoalele de tratament.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Tromboliza este o procedur\u0103 medical\u0103 utilizat\u0103 pentru dizolvarea cheagurilor de s\u00e2nge care obstruc\u021bioneaz\u0103 vasele. Tratamentul se aplic\u0103 \u00een accidente vasculare cerebrale, infarct miocardic sau tromboze periferice, av\u00e2nd ca scop restabilirea fluxului sanguin \u0219i prevenirea complica\u021biilor severe. Terapia trombolitic\u0103 se realizeaz\u0103 prin administrarea intravenoas\u0103 sau intraarterial\u0103 a agen\u021bilor fibrinolitici. Ace\u0219tia ac\u021bioneaz\u0103 asupra fibrinei din structura cheagului, [&#8230;]\n","protected":false},"author":2,"featured_media":9677,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[321],"tags":[],"class_list":["post-9674","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-tratamente"],"_links":{"self":[{"href":"https:\/\/ozgurkilickesmez.com\/ro\/wp-json\/wp\/v2\/posts\/9674","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ozgurkilickesmez.com\/ro\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/ozgurkilickesmez.com\/ro\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/ozgurkilickesmez.com\/ro\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/ozgurkilickesmez.com\/ro\/wp-json\/wp\/v2\/comments?post=9674"}],"version-history":[{"count":2,"href":"https:\/\/ozgurkilickesmez.com\/ro\/wp-json\/wp\/v2\/posts\/9674\/revisions"}],"predecessor-version":[{"id":12081,"href":"https:\/\/ozgurkilickesmez.com\/ro\/wp-json\/wp\/v2\/posts\/9674\/revisions\/12081"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/ozgurkilickesmez.com\/ro\/wp-json\/wp\/v2\/media\/9677"}],"wp:attachment":[{"href":"https:\/\/ozgurkilickesmez.com\/ro\/wp-json\/wp\/v2\/media?parent=9674"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ozgurkilickesmez.com\/ro\/wp-json\/wp\/v2\/categories?post=9674"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ozgurkilickesmez.com\/ro\/wp-json\/wp\/v2\/tags?post=9674"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}