NRS-490 Literature Review: Thrombolysis in Acute Ischemic Stroke

This literature review examines the effectiveness of tissue plasminogen activator (tPA) in treating acute ischemic stroke patients within 4.5 hours of symptom onset, focusing on improved neurological outcomes. It compares research questions, sample populations, and study limitations across multiple articles, highlighting the importance of timely tPA administration. The review concludes that early thrombolytic intervention can significantly reduce the severity of neurological deficits, emphasizing the need for proper patient monitoring and further research in this critical area of stroke management. Desklib offers a wealth of resources, including past papers and solved assignments, to support students in their academic endeavors.

Running head: LITERATURE REVIEW
PATIENTS WIH ACUTE ISCHEMIC STROKE THAT RECEIVE TISSUE PLASMINOGEN
ACTIVATOR VERSUS NOT RECEIVING THROMBOLYTIC AGENTS RESULT IN
BETTER NEUROLOGICAL OUTCOME WITHIN 4.5 HOURS FROM THE ONSET OF
SYMPTOMS
LITERATURE REVIEW
Name of the Student
Name of the University
Author note

1LITERATURE REVIEW
Table of Contents
Introduction......................................................................................................................................2
Comparison of the research questions.............................................................................................2
The comparison of the sample populations.....................................................................................3
The comparisons of the limitations of the study..............................................................................3
Conclusion.......................................................................................................................................4
Reference.........................................................................................................................................5

2LITERATURE REVIEW
Introduction
The disease ischemic stroke is determined or characterised by blood loss circulation suddenly to
an area of the brain which results in the loss of the neurologic functions of the corresponding
area. This is caused by the thrombotic occlusion of the functions of the nerves and this stroke is
more common than the hemorrhagic stroke (Babkair, 2017). The main purpose of this literature
review is determining that whether the patients who are suffering from ischemic stroke if treated
with the help of plasminogen activator gives better neurological outcomes or not. An example of
the thrombolytic agent is the alteplase (t-PA) along with reteplase. The other agents are the drugs
that dissolve any clots. This drugs are used to treat stroke, heart attack and thrombosis of brain
(Nascimento et al., 2016).
Comparison of the research questions
The different research questions that are put forward are – analyse the outcomes of the
experiment and the factors which are associated in ischemic stroke patients who are already
submitted to the thrombolytic therapy, does patients who receive the treatment of the
intravenous Tpa with ischemic stroke associated with improved long term survival?, to compare
the severity of the neurological deficit between patients suffering from acute ischemic stroke
receiving thrombolytic therapy and those patients who are not receiving, to describe the barriers
of the thrombolytic therapy in the cases of acute stroke care, the role of the nurses in screening,
preventing and educating patients with cardioembolic stroke and whether the increase in the use
of Tpa will improve the outcomes of the strokes. If all these research questions are compared,
the first question is only dealing with the factors associated with a patient who has received
thrombolytic therapy. The second research question is the most appropriate one as this is dealing

3LITERATURE REVIEW
with the intravenous treatment with alteplase and it is also measuring the whether this treatment
can provide survival for long term (Schmitz et al., 2014). The third one is dealing with the
neurological deficit in patients getting treatment and those who are not getting treatments. The
last one is completely irrelevant with this research topic as deals with the barriers of the
treatments (Hanauer et al., 2018).
The comparison of the sample populations
If the sample populations were compared, the number of samples in the second research
question is better than the other sample populations of the other research questions. This is
because the number of population in the topic of the second research question is very high as
compared to the other research questions. The actual number of the sample is mentioned but in
the sample populations the actual population of the sample are nor mentioned. In the other
sample populations only the number of the hospitals are mentioned, but not the number of
patients who are involved in the experiments. Also the study design of the experiment is the
randomised control trials, which is advantageous than the other study designs (McDermott,
Skolarus & Burke, 2016). This experiment did the comparison effectively as it involved huge
number if populations and it also reduced the chances of bias regarding the collection of the
results and also in assessing the performances of the experiment. The result obtained from this
experiment also provide a statistically significant result. The last research question also involved
large number of patients but it is a systematic analysis.
The comparisons of the limitations of the study
The limitations of most of the research articles are about the populations that are involved
in the experiments and the methods of conducting the experiments. Though the population size

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of the second research article was appropriate but the result obtained from the third research
question is appropriate as the result obtained from this experiment showed that for the purpose of
improving the neurological recovery, the patients should be treated with Tpa within 4.5 hours.
The limitation of this research work is the populations of the experiment. The limitation of the
second research question is that it did not mentioned the time interval within which the
medicines are needed to be provided (Meurer et al., 2011).
Conclusion
After completing this literature review this can be concluded that the patients suffering
from ischemic heart attacks if treated with plasminogen activator before 4.5 hours of the onset of
the symptoms of the diseases get reduced. The patients must be monitored as well as managed
properly. The nurses must regularly observe and monitor the patients for any alterations in the
functions of the nerves. Till now not much research work has been done on this topic of research
and thus a large future scope is there for doing much researches in this area.

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Reference
Babkair, L. A. (2017). Cardioembolic Stroke: A Case Study. Critical care nurse, 37(1), 27-39.
Hanauer, L., Schmidt, D., Miranda, R. E. D., & Borges, M. K. (2018). Comparison of the
neurological deficit severity in patients with acute ischemic stroke submitted or not to
thrombolytic therapy. Fisioterapia e Pesquisa, 25(2), 217-223.
McDermott, M., Skolarus, L. E., & Burke, J. F. (2016). A Systematic Review of Interventions to
Increase tPA Administration. Stroke, 47(suppl_1), A181-A181.
Meurer, W. J., Majersik, J. J., Frederiksen, S. M., Kade, A. M., Sandretto, A. M., & Scott, P. A.
(2011). Provider perceptions of barriers to the emergency use of tPA for acute ischemic
stroke: a qualitative study. BMC emergency medicine, 11(1), 5.
Nascimento, K. G. D., Chavaglia, S. R. R., Pires, P. D. S., Ribeiro, S. B. F., & Barbosa, M. H.
(2016). Clinical outcomes of ischemic stroke patients after thrombolytic therapy. Acta
Paulista de Enfermagem, 29(6), 650-657.
Schmitz, M. L., Simonsen, C. Z., Hundborg, H., Christensen, H., Ellemann, K., Geisler, K., ... &
Andersen, G. (2014). Acute ischemic stroke and long-term outcome after thrombolysis:
nationwide propensity score–matched follow-up study. Stroke, 45(10), 3070-3072.