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Mohammed Owais, Ajay Panwar, Chandrasekhar Valupadas, Madhavarao Veeramalla
Objective: Outcome assessment of intravenous (IV) thrombolysis with tenecteplase in acute ischemic stroke. Materials and Methods: We consecutively enrolled acute ischemic stroke patients who underwent IV thrombolysis with tenecteplase from October 2016 to May 2017. Primary clinical efficacy outcome was defined as an improvement in the National Institute of Health Stroke Scale (NIHSS) score of ≥4 points at 24 h (h). Secondary clinical efficacy outcome was the favorable outcome on modified Rankin scale at 90 days defined as a score of 0 or 1...
April 2018: Annals of African Medicine
Aimen Moussaddy, Andrew M Demchuk, Michael D Hill
Acute stroke therapy has significantly evolved over the last two decades. The two main advances have been the approval of intravenous chemical thrombolysis in 1995, and the approval of intra-arterial mechanical thrombectomy in 2015. This has lead to significant improvement of functional outcomes in a disease known to be the first cause of disability worldwide. Subsequent studies have focused on identifying pre-treatment predictors of good treatment candidates, by developing biochemical and imaging biomarkers...
March 2, 2018: Neuropharmacology
Mahesh Kate, Robert Wannamaker, Harsha Kamble, Parnian Riaz, Laura C Gioia, Brian Buck, Thomas Jeerakathil, Penelope Smyth, Ashfaq Shuaib, Kenneth Butcher, Derek Emery
BACKGROUND AND PURPOSE: Thrombolysis >4.5 hours after ischemic stroke onset is unproven. We assessed the feasibility of tenecteplase (TNK) treatment in patients with evidence of an ischemic penumbra 4.5 to 24 hours after onset. METHODS: Acute ischemic stroke patients underwent perfusion computed tomography (CT)/magnetic resonance imaging. Patients with cerebral blood volume (CBV) or diffusion weighted imaging Alberta Stroke Program Early CT Scores (ASPECTS) >6 and mismatch score >2 (defined as >2 ASPECTS regions with delay on mean transit time maps and normal CBV) were eligible for treatment with TNK (0...
January 2018: Journal of Stroke
S S Iyengar, Tiny Nair, Jagdish Hiremath, Anjan Lal Dutta, Uday Jadhav, V K Katyal, Dayanand Kumbla, Immaneni Sathyamurthy, R K Jain, M Srinivasan, Prasant Kr Sahoo
Objective: This real-world, observational, prescription event monitoring study was conducted to evaluate safety and efficacy of indigenous tenecteplase (TNK-tPA) in Indian patients presenting with ST elevation myocardial infarction (STEMI). Methods: This is a multi-centric, observational, prescription event monitoring study. Data was collected for 7,668 patients from 1,307 investigator sites across India from January 2011 to February 2016. Results: Overall, 76...
September 2017: Journal of the Association of Physicians of India
Amal Paul, Paul V George
OBJECTIVE: Tenecteplase-based pharmacoinvasive percutaneous coronary intervention (PCI) has been shown to yield outcomes comparable to primary PCI in the setting of acute ST elevation myocardial infarction (STEMI). This study was designed to compare the efficacy of pharmacoinvasive PCI following successful thrombolysis with Streptokinase versus primary PCI in patients with STEMI. METHODOLOGY: We conducted a prospective single center observational study in 120 patients with STEMI who underwent primary PCI (n=60) and Streptokinase-based pharmacoinvasive PCI (n=60)...
November 2017: Indian Heart Journal
Andrew Yang, Quin Pon, Andrea Lavoie, Jennifer J Crawford, Sebastian Harenberg, Rodney H Zimmermann, Jeff Booker, Sheila Kelly, Shahar Lavi, Warren J Cantor, Shamir R Mehta, Akshay Bagai, Shaun G Goodman, Asim N Cheema, Payam Dehghani
The long-term pharmacodynamic effects of Ticagrelor versus Clopidogrel in patients undergoing early percutaneous coronary intervention (PCI) after fibrinolytic therapy is unknown. From May 2014 to August 2016, 212 patients undergoing PCI within 24 h of Tenecteplase (TNK), Aspirin, and Clopidogrel for ST-elevated myocardial infarction (STEMI) were randomized at four Canadian sites to receive additional Clopidogrel or Ticagrelor initiated prior to PCI. The platelet reactivity units (PRU) were measured with the VerifyNow Assay before study drug administration (baseline), at 4 and 24 h post PCI, and follow-up appointment...
February 2018: Journal of Thrombosis and Thrombolysis
Rajesh Kumar Jha, Sandeep Bansal, H S Issar, Mayuresh Chaudhary, Sonu Sharma
BACKGROUND: Prosthetic valve thrombosis (PVT) in metallic prosthetic cardiac valves is not an uncommon condition, and has high mortality and morbidity. Although surgery is the traditional choice for PVT therapy, thrombolysis with newer agents has achieved good success rates. Many studies described in the western literature have used tissue plasminogen activators, while studies from developing countries have been largely based on the use of streptokinase and urokinase. Data regarding the use of newer agents such as tenecteplase are scant...
May 2017: Journal of Heart Valve Disease
Lauren K Stewart, Kristen E Nordenholz, Mark Courtney, Christopher Kabrhel, Alan E Jones, Matthew T Rondina, Deborah B Diercks, James R Klinger, Jeffrey A Kline
: Previous studies have associated biomarkers indicative of acute inflammation with pulmonary embolism, which may amplify coagulation, inhibit fibrinolysis and increase risk of venous thromboembolism (VTE) recurrence. The aim of this study was to measure inflammatory and hemostatic biomarkers in acute submassive pulmonary embolism at diagnosis and 3-month follow-up and to test the impact of treatment with fibrinolysis. Secondary analysis of a multicenter, double-blinded, randomized controlled trial including patients with submassive pulmonary embolism...
December 2017: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
Bruce Cv Campbell, Peter J Mitchell, Leonid Churilov, Nawaf Yassi, Timothy J Kleinig, Bernard Yan, Richard J Dowling, Steven J Bush, Helen M Dewey, Vincent Thijs, Marion Simpson, Mark Brooks, Hamed Asadi, Teddy Y Wu, Darshan G Shah, Tissa Wijeratne, Timothy Ang, Ferdinand Miteff, Christopher Levi, Martin Krause, Timothy J Harrington, Kenneth C Faulder, Brendan S Steinfort, Peter Bailey, Henry Rice, Laetitia de Villiers, Rebecca Scroop, Wayne Collecutt, Andrew A Wong, Alan Coulthard, P A Barber, Ben McGuinness, Deborah Field, Henry Ma, Winston Chong, Ronil V Chandra, Christopher F Bladin, Helen Brown, Kendal Redmond, David Leggett, Geoffrey Cloud, Anoop Madan, Neil Mahant, Bill O'Brien, John Worthington, Geoffrey Parker, Patricia M Desmond, Mark W Parsons, Geoffrey A Donnan, Stephen M Davis
Background and hypothesis Intravenous thrombolysis with alteplase remains standard care prior to thrombectomy for eligible patients within 4.5 h of ischemic stroke onset. However, alteplase only succeeds in reperfusing large vessel arterial occlusion prior to thrombectomy in a minority of patients. We hypothesized that tenecteplase is non-inferior to alteplase in achieving reperfusion at initial angiogram, when administered within 4.5 h of ischemic stroke onset, in patients planned to undergo endovascular therapy...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
Payam Dehghani, Andrea Lavoie, Shahar Lavi, Jennifer J Crawford, Sebastian Harenberg, Rodney H Zimmermann, Jeff Booker, Sheila Kelly, Warren J Cantor, Shamir R Mehta, Akshay Bagai, Shaun G Goodman, Asim N Cheema
OBJECTIVES: Patients undergoing PCI early after fibrinolytic therapy are at high risk for both thrombotic and bleeding complications. We sought to assess the pharmacodynamic effects of ticagrelor versus clopidogrel in the fibrinolytic-treated STEMI patients undergoing early PCI. METHODS AND RESULTS: Patients undergoing PCI within 24 hours of tenecteplase (TNK), aspirin, and clopidogrel for STEMI were randomized to receive additional clopidogrel 300 mg followed by 75 mg daily or ticagrelor 180 mg followed by 90 mg twice daily...
October 2017: American Heart Journal
Peerawat Jinatongthai, Junporn Kongwatcharapong, Chee Yoong Foo, Arintaya Phrommintikul, Surakit Nathisuwan, Ammarin Thakkinstian, Christopher M Reid, Nathorn Chaiyakunapruk
BACKGROUND: Fibrinolytic therapy offers an alternative to mechanical reperfusion for ST-segment elevation myocardial infarction (STEMI) in settings where health-care resources are scarce. Comprehensive evidence comparing different agents is still unavailable. In this study, we examined the effects of various fibrinolytic drugs on clinical outcomes. METHODS: We did a network meta-analysis based on a systematic review of randomised controlled trials comparing fibrinolytic drugs in patients with STEMI...
August 19, 2017: Lancet
Craig S Anderson
No abstract text is available yet for this article.
October 2017: Lancet Neurology
Nicola Logallo, Vojtech Novotny, Jörg Assmus, Christopher E Kvistad, Lars Alteheld, Ole Morten Rønning, Bente Thommessen, Karl-Friedrich Amthor, Hege Ihle-Hansen, Martin Kurz, Håkon Tobro, Kamaljit Kaur, Magdalena Stankiewicz, Maria Carlsson, Åse Morsund, Titto Idicula, Anne Hege Aamodt, Christian Lund, Halvor Næss, Ulrike Waje-Andreassen, Lars Thomassen
BACKGROUND: Tenecteplase is a newer thrombolytic agent with some pharmacological advantages over alteplase. Previous phase 2 trials of tenecteplase in acute ischaemic stroke have shown promising results. We aimed to investigate the safety and efficacy of tenecteplase versus alteplase in patients with acute stroke who were eligible for intravenous thrombolysis. METHODS: This phase 3, randomised, open-label, blinded endpoint, superiority trial was done in 13 stroke units in Norway...
October 2017: Lancet Neurology
Salim Arous, Meryem Haboub, Mohamed El Ghali Benouna, Tarik Bentaoune, Rachida Habbal
BACKGROUND: Hemorrhagic complications are quite common in the rare cases where thrombolysis is performed. Ischemic stroke in the aftermath of thrombolysis for a ST elevation myocardial infarction is a very rare and paradoxical complication. With these observations in mind we report two interesting cases of ischemic stroke which occurred after fibrinolytic therapy with tenecteplase for a ST elevation myocardial infarction. CASE PRESENTATION: The first case was a 56-year-old African man who presented with an acute infero-basal ST elevation myocardial infarction 6 hours after chest pain onset...
June 11, 2017: Journal of Medical Case Reports
Andrew Bivard, Xuya Huang, Christopher R Levi, Neil Spratt, Bruce C V Campbell, Bharath Kumar Cheripelli, Dheeraj Kalladka, Fiona Catherine Moreton, Ian Ford, Christopher F Bladin, Stephen M Davis, Geoffrey A Donnan, Keith W Muir, Mark W Parsons
OBJECTIVE: To test whether patients with complete vessel occlusion show greater recanalization at 24 hours and have improved clinical outcomes at 24 hours and 90 days when treated with tenecteplase compared to alteplase. METHODS: Pooled clinical and imaging data from 2 phase 2 randomized trials comparing tenecteplase with alteplase allowed CT angiography (CTA) scans to be assessed centrally for occlusion status at baseline and at 24 hours post thrombolysis using the modified thrombolysis in cerebral infarction (TICI) scale...
July 4, 2017: Neurology
U M Nagamalesh, V S Prakash, K C Karthik Naidu, S Sarthak, Anupama V Hegde, T Abhinay
INTRODUCTION: Acute pulmonary thromboembolism (PTE) is a life-threatening disease. Mortality in PTE still remains very high in spite of progress in diagnostic tools. Mortality rate is about 30% in patients with unrecognized acute PTE. METHODS: It is a single center observational study of 31 consecutive patients who were hospitalized in the Department of Cardiology at MS Ramaiah Memorial hospital between January 1, 2010 and June 2015. All the patients confirmed with diagnosis of acute PTE by CT scan (either HRCT or CTPA) were included in the study...
March 2017: Indian Heart Journal
Xuya Huang, Dheeraj Kalladka, Bharath Kumar Cheripelli, Fiona Catherine Moreton, Keith W Muir
BACKGROUND AND PURPOSE: Perfusion imaging is used for patient selection in clinical practice and trials. Postprocessing and definitions of tissue viability are nevertheless not standardized. We compared the lesion volumes generated with two well-recognized perfusion tissue definitions in a single-center phase 2 thrombolysis study. METHODS: We analyzed perfusion imaging data from the Alteplase-Tenecteplase Trial Evaluation for Stroke Thrombolysis (ATTEST) study using two popular tissue viability thresholds (ischemic core definition: (1) cerebral blood volume < 2...
November 2017: Journal of Neuroimaging: Official Journal of the American Society of Neuroimaging
Thomas Luiz, Alexander Wilhelms, Christian Madler, Gregor Pollach, Bernd Haaff, Joachim Grüttner, Tim Viergutz
Coronary occlusion and pulmonary embolism are responsible for the majority of cases of out-of-hospital cardiac arrest (OHCA). Despite previous favourable results of pre-hospital fibrinolysis in cases of OHCA, the benefit could not be confirmed in a large controlled study using the fibrinolytic tenecteplase. For reteplase (r-PA), there are hardly any data regarding pre-hospital fibrinolysis during ongoing resuscitation. The present study reported results using r-PA therapy in a German physician-supported Emergency Medical Services system...
April 2017: Experimental and Therapeutic Medicine
Stavros V Konstantinides, Eric Vicaut, Thierry Danays, Cecilia Becattini, Laurent Bertoletti, Jan Beyer-Westendorf, Helene Bouvaist, Francis Couturaud, Claudia Dellas, Daniel Duerschmied, Klaus Empen, Emile Ferrari, Nazzareno Galiè, David Jiménez, Maciej Kostrubiec, Matija Kozak, Christian Kupatt, Irene M Lang, Mareike Lankeit, Nicolas Meneveau, Massimiliano Palazzini, Piotr Pruszczyk, Matteo Rugolotto, Aldo Salvi, Olivier Sanchez, Sebastian Schellong, Bozena Sobkowicz, Guy Meyer
BACKGROUND: The long-term effect of thrombolytic treatment of pulmonary embolism (PE) is unknown. OBJECTIVES: This study investigated the long-term prognosis of patients with intermediate-risk PE and the effect of thrombolytic treatment on the persistence of symptoms or the development of late complications. METHODS: The PEITHO (Pulmonary Embolism Thrombolysis) trial was a randomized (1:1) comparison of thrombolysis with tenecteplase versus placebo in normotensive patients with acute PE, right ventricular (RV) dysfunction on imaging, and a positive cardiac troponin test result...
March 28, 2017: Journal of the American College of Cardiology
Nicos Papadopoulos, Christakis Damianou
BACKGROUND: The aim of the proposed study was to evaluate in an in vitro flow model the ability of small planar rectangular (2 × 10 mm(2)) ultrasonic transducer to enhance thrombolysis induced by the thrombolytic agent tenecteplase (TNK-tPA). METHODS: To provide a more realistic clinical environment of stroke, the study was conducted under realistic flow conditions and TNK-tPA concentrations. Fully retracted porcine blood clots were used to determine the thrombolytic efficacy of ultrasound (US) waves as an adjunct to TNK-tPA or in combination with microbubbles (MBs)...
February 21, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
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