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("Thrombolysis" OR "Thrombolytic") AND "Emergency"

Hisham A Badreldin, Ghada Albassam, Maha Aldoughaim, Majed Alyami
BACKGROUND: Catheter-directed thrombolysis (CDT) is one of the emerging venous thromboembolism management modalities. There are fairly limited data regarding the use of direct-thrombin inhibitors (DTIs) in patients with heparin-induced thrombocytopenia and undergoing CDT. OBJECTIVES: The aim of this study was to provide a summary of the available evidence supporting the use of DTIs in patients undergoing CDT. METHODS AND RESULTS: We included 6 case reports in our analysis after searching for peer-reviewed articles and case reports in multiple research engines...
December 11, 2018: Journal of Cardiovascular Nursing
Jiri Polivka, Jiri Polivka, Vladimir Rohan
The model of centralized stroke care in the Czech Republic was created in 2010-2012 by Ministry of Health (MH) in cooperation with professional organization-Cerebrovascular Section of the Czech Neurological Society (CSCNS). It defines priorities of stroke care, stroke centers, triage of suspected stroke patients, stroke care quality indicators, their monitoring, and reporting. Thirteen complex cerebrovascular centers (CCC) provide sophisticated stroke care, including intravenous thrombolysis (IVT), mechanical thrombectomy (MTE), as well as other endovascular (stenting, coiling) and neurosurgical procedures...
December 2018: EPMA Journal
Johannes M Weller, Elke Hattingen, Gabor C Petzold, Felix J Bode
BACKGROUND: Intravenous thrombolysis and mechanical thrombectomy are the standard of care for patients with acute ischemic stroke with large vessel occlusion. Intracerebral hemorrhage is a main complication of intravenous thrombolysis, however, no data are available on the efficacy and safety of mechanical thrombectomy in patients with thrombolysis-associated intracerebral hemorrhage. This constellation is expected to become more frequent as increasing numbers of patients are treated under the drip-and-ship paradigm...
October 24, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Philipp Bücke, Marta Aguilar Pérez, Muhammad AlMatter, Victoria Hellstern, Hansjörg Bäzner, Hans Henkes
Background and Purpose: Various endovascular approaches to treat acute ischemic stroke caused by extra- intracranial tandem occlusions (TO) exist: percutaneous transluminal angioplasty with or without emergent extracranial carotid stenting (ECS) due to high-grade stenosis preceded or followed by intracranial mechanical and/or aspiration thrombectomy (MT). Which treatment strategy to use is still a matter of debate. Methods: From our ongoing prospective stroke registry we retrospectively analyzed 1,071 patients with anterior circulation stroke getting endovascular treatment within 6 h of symptom onset...
2018: Frontiers in Neurology
Leonid Churilov, Henry Ma, Bruce Cv Campbell, Stephen M Davis, Geoffrey A Donnan
BACKGROUND: EXtending the time for Thrombolysis in Emergency Neurological Deficits (EXTEND) is a randomized, multicenter, double-blinded, placebo-controlled phase 3 trial to test the hypothesis of extending the thrombolysis time window to 9 h from stroke onset and in wake-up stroke (WUS) patients. OBJECTIVE: To formulate the detailed statistical analysis plan for the EXTEND trial prior to database lock. This statistical analysis plan is based on the published and registered EXTEND trial protocol and is developed by the blinded steering committee and management team...
December 7, 2018: International Journal of Stroke: Official Journal of the International Stroke Society
Mojtaba Ziaee, Sina Mashayekhi, Samad Ghaffari, Javad Mahmoudi, Parvin Sarbakhsh, Alireza Garjani
We assessed the prognostic value of serum levels of endocan in patients with the acute coronary syndrome (ACS) through its correlation with the Thrombolysis in Myocardial Infarction (TIMI) risk score and compared the possible association with clinical outcomes. In this prospective cross-sectional study, we enrolled 320 patients with documented ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), or unstable angina (UA) who underwent diagnostic coronary angiography. Endocan was measured soon after admission in the emergency department...
December 4, 2018: Angiology
Reza Rikhtegar, Mehdi Yousefi, Sanam Dolati, Hosein Delavar Kasmaei, Saeid Charsouei, Mohammad Nouri, Seyed Kazem Shakouri
Neurological disorders, such as stroke, are triggered by a loss of neurons and glial cells. Ischemic stroke remains a substantial problem for industrialized countries. Over the previous few decades our understanding about the pathophysiology of stroke has enhanced, nevertheless, more awareness is required to advance the field of stroke recovery. Existing therapies are incapable to adequately relief the disease outcome and are not appropriate to all patients. Meanwhile, the majority of patients continue to show neurological deficits even subsequent effective thrombolysis, recuperative therapies are immediately required that stimulate brain remodeling and repair once stroke damage has happened...
December 2, 2018: Journal of Cellular Biochemistry
Helena Estirado-Fugarolas, Maribel Maldonado-Meléndez
Stroke is a cerebrovascular disease caused by a decrease or abrupt obstruction of blood flow to the brain. Nerve cells do not receive oxygen and there is a transient or permanent alteration of the function of a certain region of the brain. It causes high morbidity and mortality resulting in disabilities with a large economic cost to society. The Stroke Code was established at the Mollet Hospital in 2015. A protocol, action guideline and registry were created. The Mollet Hospital does not have a specialist unit so people who suffer thrombolysis and / or who require specific care are transferred to the referral centre...
November 28, 2018: Enfermería Clínica
Karl Heinrich Scholz, Tim Friede, Thomas Meyer, Claudius Jacobshagen, Björn Lengenfelder, Jens Jung, Claus Fleischmann, Hiller Moehlis, Hans G Olbrich, Rainer Ott, Albrecht Elsässer, Stephen Schröder, Christian Thilo, Werner Raut, Andreas Franke, Lars S Maier, Sebastian Kg Maier
BACKGROUND: In ST-segment elevation myocardial infarction (STEMI) patients treated with percutaneous coronary intervention, direct transport from the scene to the catheterisation laboratory bypassing the emergency department has been shown to shorten times to reperfusion. The aim of this study was to investigate the effects of emergency department bypass on mortality in both haemodynamically stable and unstable STEMI patients. METHODS: The analysis is based on a large cohort of STEMI patients prospectively included in the German multicentre Feedback Intervention and Treatment Times in ST-Elevation Myocardial Infarction (FITT-STEMI) trial...
November 27, 2018: European Heart Journal. Acute Cardiovascular Care
Hyuksool Kwon, Kyuseok Kim, You Hwan Jo, Min Ji Park, Sang-Bae Ko, Tae Jung Kim, Jihoon Kang, Hyeon-Min Bae, Ji Eun Lee
Background: NIRSIT, a functional near-infrared spectroscopy (fNIRS) device with 204 channels, can measure oxyhemoglobin (HbO2) and deoxyhemoglobin (HbR) in non-pulsatile blood flow non-invasively using the absorption difference between HbO2 and HbR at a wavelength of 700-1,000 nm and can display the perfusion status in real time. Objective: We applied NIRSIT to patients with stroke to evaluate the usefulness of NIRSIT as an fNIRS device for the early detection of stroke. Methods: We performed a prospective pilot study in an emergency department (ED)...
2018: Frontiers in Neurology
Rahul A Sharma, Nancy J Newman, Valerie Biousse
PURPOSE OF REVIEW: To review recent advances in the management of acute ocular ischemic events, including: transient monocular vision loss, central and branch retinal artery occlusions, and nonarteritic anterior ischemic optic neuropathy. RECENT FINDINGS: Transient monocular vision loss and acute retinal arterial occlusions require immediate diagnosis and management, with recognition of these events as transient ischemic attack or stroke equivalents, respectively...
November 15, 2018: Current Opinion in Neurology
Mohammed A Almekhlafi, Jessalyn K Holodinsky, Michael D Hill, Noreen Kamal, Mayank Goyal
The dawn of endovascular stroke therapy has reshaped stroke care. Eligible patients need to be rushed to capable centers for intervention. This may entail bypassing closer hospitals that could confirm the diagnosis, administer thrombolytic therapy, then transfer patients for intervention. This has created a set of challenges: identifying endovascular candidates in the field, determining the best transport destination, and getting patients there quickly. Areas covered: This review provides a context for these emerging challenges...
November 19, 2018: Expert Review of Cardiovascular Therapy
Benjamin A Mazer, Patrick G Hughes
Phlegmasia cerulea dolens (PCD) is a rare and severe form of deep venous thrombosis that is classically associated with the lower extremities. We report a case of upper extremity PCD developing abruptly in a 37-year-old female with an indwelling cardiac pacemaker who presented to the emergency department complaining of pain and paresthesias in her left arm, adjoining left chest wall, and inferior neck. Her condition was promptly diagnosed and successfully treated with intravenous unfractionated heparin and balloon venoplasty with catheter-directed thrombolysis without any known residual signs or symptoms at hospital discharge...
November 2018: Clinical practice and cases in emergency medicine
M Marshad, M Maresch, T Al Abbasi
INTRODUCTION AND CASE PRESENTATION: Acute portal and superior mesenteric vein thrombosis(SMV) is a rare but potentially lethal condition that is often characterized by generalized and non-specific symptoms. A high index of suspicion is warranted for early diagnosis and management. We present a case of 54 year old male who presented with generalized abdominal pain which was later accompanied by hemodynamic instability and radiological diagnosis of portal vein and superior mesenteric vein thrombosis...
October 5, 2018: International Journal of Surgery Case Reports
Karianne Larsen, Kristi G Bache, Eirik Franer, Lars H Tveit, Maren R Hov, Christian G Lund, Volker Solyga, Hans Morten Lossius
No abstract text is available yet for this article.
November 14, 2018: Acta Anaesthesiologica Scandinavica
Jiyang Liao, Fang Lai, Dongping Xie, Yun Han, Shutao Mai, Yanna Weng, Yan Zhang, Jiongdong Du, Gengbiao Zhou
RATIONAL: Thrombolysis in primigravida with hemodynamic instability is controversial, especially treatment with low-dosage recombinant tissue plasminogen activator (rtPA), and related studies are extremely rare. Here, we report the case of a 26-year-old primigravida diagnosed with an acute massive pulmonary embolism (PE) that prompted initiation of thrombolysis with low-dose alteplase. PATIENT CONCERNS: The patient was admitted to the Emergency Department with chief complaints of a sudden onset of extremely dyspnea, chest tightness, and confusion over a 6-hour period...
October 2018: Medicine (Baltimore)
Ronen R Leker, Jose E Cohen, David Tanne, David Orion, Gregory Telman, Guy Raphaeli, Jacob Amsalem, Jonathan Y Streifler, Hen Hallevi, Pavel Gavriliuc, Natan M Bornstein, Anat Horev, Nour Eddine Yaghmour
Background and Aims: Patients with emergent large-vessel occlusion (ELVO) that present earlier than 4 h from onset are usually treated with bridging systemic thrombolysis followed by endovascular thrombectomy (EVT). Whether direct EVT (dEVT) could improve the chances of favorable outcome remains unknown. Methods: Consecutively, prospectively enrolled patients with ELVO presenting within 4 h of onset were entered into a National Acute Stroke Registry of patients undergoing revascularization...
October 2018: Interventional Neurology
Victoria J Calderon, Brittany M Kasturiarachi, Eugene Lin, Vibhav Bansal, Osama O Zaidat
Background: The treatment of stroke is dependent on a narrow therapeutic time window that requires interventions to be emergently pursued. Despite recent "FAST" initiatives that have underscored "time is brain," many patients still fail to present within the narrow time window to receive maximum treatment benefit from advanced stroke therapies, including recombinant tissue plasminogen activator (tPA) and mechanical thrombectomy. The convergence of emergency medical services, telemedicine, and mobile technology, including transportable computed tomography scanners, has presented a unique opportunity to advance patient stroke care in the prehospital field by shortening time to hyperacute stroke treatment with a mobile stroke unit (MSU)...
October 2018: Interventional Neurology
Emrah Ermis, Serkan Kahraman, Hakan Ucar, Sinem Ozbay Ozyılmaz, Samir Allahverdiyev
Simultaneous multivessel epicardial coronary artery thrombosis is an uncommon finding in acute ST-segment elevation myocardial infarction (STEMI). It generally leads to cardiogenic shock and sudden cardiac death in the hospital. We report a 42-year-old male patient presenting with acute anterior STEMI with triple coronary artery thrombosis. An emergency coronary angiogram showed total occlusion of the left anterior descending artery (LAD) with thrombus formation. At the same time, thrombus formations were also seen in the circumflex artery (CXA), the second obtuse marginal (OM2) branch, and the distal right coronary artery (RCA)...
December 2018: International Journal of Angiology: Official Publication of the International College of Angiology, Inc
Stefano Barco, Stavros V Konstantinides
Pulmonary embolism (PE) contributes substantially to the global disease burden. A key determinant of early adverse outcomes is the presence (and severity) of right ventricular dysfunction. Consequently, risk-adapted management strategies continue to evolve, tailoring acute treatment to the patients' clinical presentation, hemodynamic status, imaging and biochemical markers, and comorbidity. For subjects with hemodynamic instability or 'high-risk' PE, immediate systemic reperfusion treatment with intravenous thrombolysis is indicated; emerging approaches such as catheter-directed pharmacomechanical reperfusion might help to minimize the bleeding risk...
September 25, 2018: Annals of Vascular Diseases
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