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T-pa hemorrhage

Ichiro Deguchi, Takeshi Hayashi, Hiroaki Neki, Fumitaka Yamane, Shoichiro Ishihara, Norio Tanahashi, Masaki Takao
We herein report three ischemic stroke patients who underwent emergency carotid artery stenting after receiving intravenous tissue plasminogen activator (t-PA) treatment. All patients received antiplatelet medications immediately before stent placement for loading as well as dual antiplatelet therapy after stenting. Under high-dose and dual antiplatelet therapy, none of the three patients showed symptomatic intracranial hemorrhaging. However, one case showed reocclusion of the placed stent after acute thrombosis...
2016: Internal Medicine
Yogender Pal Khasa
Cardiovascular disorders are on the rise worldwide due to alcohol abuse, obesity, hypertension, raised blood lipids, diabetes and age-related risks. The use of classical antiplatelet and anticoagulant therapies combined with surgical intervention helped to clear blood clots during the inceptive years. However, the discovery of streptokinase and urokinase ushered the way of using these enzymes as thrombolytic agents to degrade the fibrin network with an issue of systemic hemorrhage. The development of second generation plasminogen activators like anistreplase and tissue plasminogen activator partially controlled this problem...
October 3, 2016: Bioengineered
Han-Sen Chen, Su-Hua Qi, Jian-Gang Shen
Tissue plasminogen activator (t-PA) is the only FDA approved drug for acute ischemic stroke treatment, but its clinical use is limited due to the narrow therapeutic time window and severe adverse effects, including hemorrhagic transformation (HT) and neurotoxicity. One of the potential resolutions is to use adjunct therapies to reduce the side effects and extend t-PA's therapeutic time window. However, therapies modulating single target seems not satisfying, and a multi-target strategy is warranted to resolve such complex disease...
June 19, 2016: Current Neuropharmacology
Jillian Plonsker, Lee A Tan, Lorenzo F Munoz
Heparin and thrombolytic agents such as tissue plasminogen activator (t-PA) are frequently used to prevent and treat occluded hemodialysis (HD) catheters. Thrombolytic agents have not been well studied for systemic effects. We present a post-operative neurosurgical patient who experienced a symptomatic intracranial hemorrhage (ICH) after t-PA was used to treat an occluded HD catheter. This case highlights that using t-PA to treat dysfunctional catheters may be associated with ICH in neurosurgical patients. Management strategies are discussed with a review of pertinent literature...
October 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Cathy Sila
No abstract text is available yet for this article.
June 16, 2016: New England Journal of Medicine
David Asuzu, Karin Nystrӧm, Hardik Amin, Joseph Schindler, Charles Wira, David Greer, Nai Fang Chi, Janet Halliday, Kevin N Sheth
OBJECTIVE: We recently described TURN (Thrombolysis risk Using mRS and NIHSS), a computationally simple tool for predicting symptomatic intracerebral hemorrhage (sICH) after IV thrombolysis (rt-PA). Our objective was to compare TURN to existing scores for predicting sICH. METHODS: Our internal dataset consisted of 210 ischemic stroke patients receiving IV rt-PA from January 2009 until July 2013 at Yale New Haven Hospital. Our external dataset included 303 patients who received IV rt-PA during the NINDS rt-PA trial...
July 2016: Clinical Neurology and Neurosurgery
Saim Sag, Omer Fatih Nas, Aysel Aydin Kaderli, Bulent Ozdemir, İbrahim Baran, Cuneyt Erdoğan, Sumeyye Gullulu, Bahattin Hakyemez, Ali Aydinlar
The treatment options for high risk acute pulmonary embolism (PE) patients with failed systemic thrombolytic treatment (STT) is limited. The clinical use of catheter directed thrombolysis with the EkoSonic Endovascular System (EKOS) in this population has not been evaluated before. Catheter directed thrombolysis is an effective treatment modality for high risk PE patients with failed STT. Thirteen consecutive patients with failed STT were included in the study. EKOS catheters were placed and tissue plasminogen activator (t-PA) in combination with unfractionated heparin were given...
October 2016: Journal of Thrombosis and Thrombolysis
Ju-Mi Lee, Juned Siddique, Hyeon Chang Kim, David Green, Linda Van Horn, Matthew Allison, Sylvia Wassertheil-Smoller, Philip Greenland
BACKGROUND: Known risk factors for intracerebral hemorrhage (ICH) include age, hypertension, smoking, alcohol intake, and anticoagulant use. Some previous reports have indicated that hemostatic factors measured many years before the onset of ICH might predict the later occurrence of ICH. The objective of this analysis was to test whether selected hemostatic factors measured years before the onset of ICH could identify patients at higher risk for future ICH. METHODS: We performed a nested case-control study within the Women's Health Initiative (WHI) cohort...
July 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Kevin Phan, Dong Fang Zhao, Steven Phan, Ya Ruth Huo, Ralph J Mobbs, Prashanth J Rao, Alex M Mortimer
One of the primary strategies for the management of acute ischemic stroke is intravenous (IV) thrombolysis with tissue plasminogen activator (t-PA). Over the past decade, endovascular therapies such as the use of stent retrievers to perform mechanical thrombectomy have been found to improve functional outcomes compared to t-PA alone. We aimed to reassess the functional outcomes and complications of IV thrombolysis with and without endovascular treatment for acute ischemic stroke using conventional meta-analysis and trial sequential analysis...
July 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
T Umazume, T Yamada, M Morikawa, S Ishikawa, T Kojima, K Cho, N Masauzi, H Minakami
AIM: Women with pre-eclampsia (PE), placenta previa (PP), placental abruption (PA), and placental mesenchymal dysplasia (PMD) have been described as having placental permeability dysfunction. This study was performed to determine whether occult fetomaternal hemorrhage (FMH) is common in women with such complications and in women with non-reassuring fetal status. METHODS: Forty-one antenatal and 39 postnatal blood samples were obtained from 46 women, including 11 with placental permeability dysfunction (5, 3, 2, and 1 with PE, PP, PA, and PMD, respectively) and 35 controls without such complications...
June 2016: Journal of Obstetrics and Gynaecology Research
Han-Sen Chen, Su-Hua Qi, Jian-Gang Shen
Tissue plasminogen activator (t-PA) is the only FDA approved drug for acute ischemic stroke treatment, but its clinical use is limited due to the narrow therapeutic time window and severe adverse effects, including hemorrhagic transformation (HT) and neurotoxicity. One of the potential resolutions is to use adjunct therapies to reduce the side effects and extend t-PA's therapeutic time window. However, therapies modulating single target seems not satisfying, and a multi-target strategy is warranted to resolve such complex disease...
December 7, 2015: Current Neuropharmacology
Yunus Gurbuz, Baris Ozturk, Emin Ediz Tutuncu, Irfan Sencan, Gonul Cicek Senturk, Fatma Aybala Altay
BACKGROUND: Crimean-Congo hemorrhagic fever (CCHF) is a widespread disease in Turkey, and was responsible for many deaths in endemic regions during the last decade. The pathogenesis of the disease is not fully understood yet. OBJECTIVES: In this study we aimed to determine the levels of tissue plasminogen activator (tPA) and Plasminogen activator inhibitor-1 (PAI-1) as predictors of prognosis in CCHF. PATIENTS AND METHODS: Patients who were diagnosed by the polymerase chain reaction (PCR) and IgM positivity in the reference laboratory were included in this study...
October 2015: Jundishapur Journal of Microbiology
Toshinori Takagi, Shinichi Yoshimura, Kazutaka Uchida, Yukiko Enomoto, Yusuke Egashira, Hiroshi Yamagami, Nobuyuki Sakai
INTRODUCTION: No previous study has investigated the relationship between intravenous tissue plasminogen activator (IV t-PA) and intracranial hemorrhage (ICH) according to the location of vessel occlusion. The aim of the present study was to investigate the relationship between preprocedural IV t-PA and endovascular treatment (EVT) and ICH according to the location of occlusion using data from the nationwide prospective registry of acute cerebral large vessel occlusion (LVO), the RESCUE-Japan Registry...
February 2016: Neuroradiology
Gregory Piazza, Benjamin Hohlfelder, Michael R Jaff, Kenneth Ouriel, Tod C Engelhardt, Keith M Sterling, Noah J Jones, John C Gurley, Rohit Bhatheja, Robert J Kennedy, Nilesh Goswami, Kannan Natarajan, John Rundback, Immad R Sadiq, Stephen K Liu, Narinder Bhalla, M Laiq Raja, Barry S Weinstock, Jacob Cynamon, Fakhir F Elmasri, Mark J Garcia, Mark Kumar, Juan Ayerdi, Peter Soukas, William Kuo, Ping-Yu Liu, Samuel Z Goldhaber
OBJECTIVES: This study conducted a prospective, single-arm, multicenter trial to evaluate the safety and efficacy of ultrasound-facilitated, catheter-directed, low-dose fibrinolysis, using the EkoSonic Endovascular System (EKOS, Bothell, Washington). BACKGROUND: Systemic fibrinolysis for acute pulmonary embolism (PE) reduces cardiovascular collapse but causes hemorrhagic stroke at a rate exceeding 2%. METHODS: Eligible patients had a proximal PE and a right ventricular (RV)-to-left ventricular (LV) diameter ratio ≥0...
August 24, 2015: JACC. Cardiovascular Interventions
Ryan J Felling, Roland Faigle, Cheng-Ying Ho, Rafael H Llinas, Victor C Urrutia
Recombinant tissue plasminogen activator (t-PA) is the only FDA approved therapy for acute ischemic stroke. Cerebral microbleeds (CMBs) or cerebral amyloid angiopathy (CAA) are currently not contraindications, however, data regarding this complex issue are limited. We report 2 cases of fatal intracerebral hemorrhage (sICH) after IV t-PA, each with evidence of CAA. Patients with CAA may have increased risk for IV thrombolysis-associated sICH. We highlight the severe and catastrophic pattern of ICH, which may be a defining characteristic, and discuss the limitations of our current understanding of the risk of thrombolysis-associated ICH in patients with CAA and/or CMBs...
2014: Journal of Neurology & Translational Neuroscience
Joonsang Yoo, Dongbeom Song, Kijeong Lee, Young Dae Kim, Hyo Suk Nam, Ji Hoe Heo
BACKGROUND: Patients may experience stroke while being admitted to the hospital (in-hospital stroke (IHS)) and they may be important candidates for reperfusion therapy. IHS patients may have various comorbidities and show worse outcomes compared with patients with an out-of-hospital stroke (OHS). On the other hand, the time from onset to treatment may be shorter in IHS patients than OHS patients. Most outcome studies of reperfusion therapy have been based on findings in OHS patients, and little information is currently available regarding outcomes of IHS, whether the outcomes differ between patients with IHS and those with OHS who receive reperfusion therapy...
2015: Cerebrovascular Diseases
M Al-Khaled, B Langner, T Brüning
BACKGROUND AND PURPOSE: The most feared complication after treatment with recombinant tissue-plasminogen activator (rt-PA) is the occurrence of symptomatic intracerebral hemorrhage (sICH). The aims of the study were to predict the risk of sICH (ECASS II definition) after a therapy with rt-PA and to examine whether associations exist between SEDAN score and the early mortality in patients with acute ischemic stroke in a monocenter study. METHODS: During a 6-year period (2008-2013), 542 consecutive stroke patients (mean age, 73 ± 3 years; 51...
April 2016: Acta Neurologica Scandinavica
Han-Sen Chen, Xing-Miao Chen, Jing-Han Feng, Ke-Jian Liu, Su-Hua Qi, Jian-Gang Shen
AIM: Hemorrhagic transformation (HT) is a major complication of delayed tissue plasminogen activator (t-PA) treatment in ischemic stroke. We aimed to explore whether peroxynitrite decomposition catalyst (PDC) could prevent such complication. METHODS: Male Sprague-Dawley (SD) rats were subjected to middle cerebral artery occlusion (MCAO) with t-PA (10 mg/kg) or t-PA plus FeTMPyP (3 mg/kg, a representative PDC) at MCAO for 2 or 5 h and reperfusion for 22 or 19 h, respectively...
July 2015: CNS Neuroscience & Therapeutics
Andrés García-Pastor, Fernando Díaz-Otero, Carmen Funes-Molina, Beatriz Benito-Conde, Sandra Grandes-Velasco, Pilar Sobrino-García, Pilar Vázquez-Alén, Yolanda Fernández-Bullido, Jose Antonio Villanueva-Osorio, Antonio Gil-Núñez
A dose of 0.9 mg/kg of intravenous tissue plasminogen activator (t-PA) has proven to be beneficial in the treatment of acute ischemic stroke (AIS). Dosing of t-PA based on estimated patient weight (PW) increases the likelihood of errors. Our objectives were to evaluate the accuracy of estimated PW and assess the effectiveness and safety of the actual applied dose (AAD) of t-PA. We performed a prospective single-center study of AIS patients treated with t-PA from May 2010 to December 2011. Dose was calculated according to estimated PW...
October 2015: Journal of Thrombosis and Thrombolysis
Jeffrey L Saver, Mayank Goyal, Alain Bonafe, Hans-Christoph Diener, Elad I Levy, Vitor M Pereira, Gregory W Albers, Christophe Cognard, David J Cohen, Werner Hacke, Olav Jansen, Tudor G Jovin, Heinrich P Mattle, Raul G Nogueira, Adnan H Siddiqui, Dileep R Yavagal, Blaise W Baxter, Thomas G Devlin, Demetrius K Lopes, Vivek K Reddy, Richard du Mesnil de Rochemont, Oliver C Singer, Reza Jahan
BACKGROUND: Among patients with acute ischemic stroke due to occlusions in the proximal anterior intracranial circulation, less than 40% regain functional independence when treated with intravenous tissue plasminogen activator (t-PA) alone. Thrombectomy with the use of a stent retriever, in addition to intravenous t-PA, increases reperfusion rates and may improve long-term functional outcome. METHODS: We randomly assigned eligible patients with stroke who were receiving or had received intravenous t-PA to continue with t-PA alone (control group) or to undergo endovascular thrombectomy with the use of a stent retriever within 6 hours after symptom onset (intervention group)...
June 11, 2015: New England Journal of Medicine
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