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Alteplase

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https://www.readbyqxmd.com/read/28100764/drip-n-ship-versus-mothership-for-endovascular-treatment-modeling-the-best-transportation-options-for-optimal-outcomes
#1
Matthew S W Milne, Jessalyn K Holodinsky, Michael D Hill, Anders Nygren, Chao Qiu, Mayank Goyal, Noreen Kamal
BACKGROUND AND PURPOSE: There is uncertainty regarding the best way for patients outside of endovascular-capable or Comprehensive Stroke Centers (CSC) to access endovascular treatment for acute ischemic stroke. The role of the nonendovascular-capable Primary Stroke Centers (PSC) that can offer thrombolysis with alteplase but not endovascular treatment is unclear. A key question is whether average benefit is greater with early thrombolysis at the closest PSC before transportation to the CSC (Drip 'n Ship) or with PSC bypass and direct transport to the CSC (Mothership)...
January 18, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28096208/improving-door-to-needle-times-for-acute-ischemic-stroke-effect-of-rapid-patient-registration-moving-directly-to-computed-tomography-and-giving-alteplase-at-the-computed-tomography-scanner
#2
Noreen Kamal, Jessalyn K Holodinsky, Caroline Stephenson, Devika Kashayp, Andrew M Demchuk, Michael D Hill, Renee L Vilneff, Erin Bugbee, Charlotte Zerna, Nancy Newcommon, Eddy Lang, Darren Knox, Eric E Smith
BACKGROUND: The effectiveness of specific systems changes to reduce DTN (door-to-needle) time has not been fully evaluated. We analyzed the impact of 4 specific DTN time reduction strategies implemented prospectively in a staggered fashion. METHODS AND RESULTS: The HASTE (Hurry Acute Stroke Treatment and Evaluation) project was implemented in 3 phases at a single academic medical center. In HASTE I (June 6, 2012 to June 5, 2013), baseline performance was analyzed...
January 2017: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/28089562/sequential-multiple-assignment-randomized-trials-an-opportunity-for-improved-design-of-stroke-reperfusion-trials
#3
William J Meurer, Nicholas J Seewald, Kelley Kidwell
BACKGROUND: Modern clinical trials in stroke reperfusion fall into 2 categories: alternative systemic pharmacological regimens to alteplase and "rescue" endovascular approaches using targeted thrombectomy devices and/or medications delivered directly for persistently occluded vessels. Clinical trials in stroke have not evaluated how initial pharmacological thrombolytic management might influence subsequent rescue strategy. A sequential multiple assignment randomized trial (SMART) is a novel trial design that can test these dynamic treatment regimens and lead to treatment guidelines that more closely mimic practice...
January 12, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28070820/development-of-a-new-catheter-prototype-for-laser-thrombolysis-under-guidance-of-optical-coherence-tomography-oct-validation-of-feasibility-and-efficacy-in-a-preclinical-model
#4
Rouven Berndt, Rene Rusch, Lars Hummitzsch, Matthias Lutz, Katharina Heß, Katharina Huenges, Bernd Panholzer, Christoph Otte, Assad Haneya, Georg Lutter, Alexander Schlaefer, Jochen Cremer, Justus Groß
In this feasibility study, a novel catheter prototype for laser thrombolysis under the guidance of optical coherence tomography (OCT) was designed and evaluated in a preclinical model. Human arteries and veins were integrated into a physiological flow model and occluded with thrombi made from the Chandler Loop. There were four experimental groups: placebo, 20 mg alteplase, laser, 20 mg alteplase + laser. The extent of thrombolysis was analyzed by weighing, OCT imaging and relative thrombus size. In the alteplase group, thrombus size decreased to 0...
January 9, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28067616/management-of-acute-central-retinal-artery-occlusion-intravenous-thrombolysis-is-feasible-and-safe
#5
Cécile Préterre, Gaelle Godeneche, Xavier Vandamme, Thomas Ronzière, Matthias Lamy, Christophe Breuilly, Cédric Urbanczyk, Valérie Wolff, Pierre Lebranchu, Mathieu Sevin-Allouet, Benoit Guillon
Background Although acute central retinal artery occlusion is as a stroke in the carotid territory (retinal artery), its management remains controversial. The aim of this study was to assess the feasibility and safety of intravenous thrombolysis delivered within 6 h of central retinal artery occlusion in French stroke units. Methods We performed a retrospective analysis of patients treated with intravenous alteplase (recombinant tissue-plasminogen activator), based on stroke units thrombolysis registers from June 2005 to June 2015, and we selected those who had acute central retinal artery occlusion...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28045369/carotid-endarterectomy-following-thrombolysis-for-acute-ischaemic-stroke
#6
Naz Ahmed, Damian Kelleher, Manmohan Madan, Sarita Sochart, George A Antoniou
BACKGROUND: Insufficient evidence exists to support the safety of carotid endarterectomy (CEA) following intravenous thrombolysis (IVT) for acute ischaemic stroke. Our study aimed to report a single-centre experience of patients treated over a five-year period. PATIENTS AND METHODS: Departmental computerised databases were interrogated to identify patients who suffered an ischaemic stroke and subsequently underwent thrombolysis followed by CEA. Mortality and stroke within 30 days of surgery were defined as the primary outcome end points...
January 3, 2017: VASA. Zeitschrift Für Gefässkrankheiten
https://www.readbyqxmd.com/read/28040669/perfusion-computed-tomography-in-patients-with-stroke-thrombolysis
#7
Hiroyuki Kawano, Andrew Bivard, Longting Lin, Henry Ma, Xin Cheng, Richard Aviv, Billy O'Brien, Kenneth Butcher, Min Lou, Jingfen Zhang, Jim Jannes, Qiang Dong, Christopher R Levi, Mark W Parsons
Stroke shortens an individual's disability-free life. We aimed to assess the relative prognostic influence of pre- and post-treatment perfusion computed tomography imaging variables (e.g. ischaemic core and penumbral volumes) compared to standard clinical predictors (such as onset-to-treatment time) on long-term stroke disability in patients undergoing thrombolysis. We used data from a prospectively collected international, multicentre, observational registry of acute ischaemic stroke patients who had perfusion computed tomography and computed tomography angiography before treatment with intravenous alteplase...
December 31, 2016: Brain: a Journal of Neurology
https://www.readbyqxmd.com/read/28040384/circulatory-collapse-right-ventricular-dilatation-and-alveolar-dead-space-a-triad-for-the-rapid-diagnosis-of-massive-pulmonary-embolism
#8
Raúl J Gazmuri, Dimple J Patel, Rom Stevens, Shani Smith
A triad of circulatory collapse, right ventricular dilatation, and large alveolar dead space is proposed for the rapid diagnosis and treatment of massive pulmonary embolism. A 17year-old female on oral contraceptives collapsed at home becoming incoherent with shallow breathing. Paramedics initiated mechanical chest compression and transported the patient to our emergency department, arriving minimally responsive with undetectable blood pressure but having positive corneal reflexes and bradycardia with wide QRS...
December 16, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28008093/arterial-obstruction-on-computed-tomographic-or-magnetic-resonance-angiography-and-response-to-intravenous-thrombolytics-in-ischemic-stroke
#9
Grant Mair, Rüdiger von Kummer, Alessandro Adami, Philip M White, Matthew E Adams, Bernard Yan, Andrew M Demchuk, Andrew J Farrall, Robin J Sellar, Eleni Sakka, Jeb Palmer, David Perry, Richard I Lindley, Peter A G Sandercock, Joanna M Wardlaw
BACKGROUND AND PURPOSE: Computed tomographic angiography and magnetic resonance angiography are used increasingly to assess arterial patency in patients with ischemic stroke. We determined which baseline angiography features predict response to intravenous thrombolytics in ischemic stroke using randomized controlled trial data. METHODS: We analyzed angiograms from the IST-3 (Third International Stroke Trial), an international, multicenter, prospective, randomized controlled trial of intravenous alteplase...
December 22, 2016: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27998323/short-and-long-term-reduction-of-door-to-needle-time-in-thrombolysis-for-acute-stroke
#10
Bing Yu Chen, Aimen Moussaddy, Mark R Keezer, Yan Deschaintre, Alexandre Y Poppe
BACKGROUND: More timely administration of tissue plasminogen activator (alteplase) for patients with acute ischemic stroke yields greater clinical benefits. We implemented door-to-needle (DTN) time reduction strategies at our center and evaluated their short- and long-term effects on in-hospital treatment delays and clinical outcomes. METHODS: Strategies, including stroke team prenotification, direct computed tomography transfer, not routinely waiting for laboratory results and alteplase delivery on the computed tomography table, were implemented in June 2013...
December 21, 2016: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
https://www.readbyqxmd.com/read/27978795/desmoteplase-for-acute-ischemic-stroke-a-systematic-review-and-meta-analysis-of-rcts
#11
Ahmed Elmaraezy, Abdelrahman Ibrahim Abushouk, Soha Saad, Moutaz Eltoomy, Osama Mahmoud, Hossam Mahmoud Hassan, Ahmed Aboelmakarem, Ahmed Aboel Fotoh, Farah Althaher, Nguyen Tien Huy, Kenji Hirayama
INTRODUCTION: There is an unmet need to develop better treatments for acute ischemic stroke (AIS). Desmoteplase is a vampire bat saliva-derived analogue of human tissue plasminogen activator. It has higher fibrin selectivity and a longer half-life, compared to alteplase. We performed this meta-analysis to synthesize evidence from published RCTs about the safety and efficacy of desmoteplase in AIS. METHODS: A computer literature search for (PubMed, EMBASE, CENTRAL, Scopus, Web of science, and clinicaltrials...
December 13, 2016: CNS & Neurological Disorders Drug Targets
https://www.readbyqxmd.com/read/27972016/effectiveness-and-safety-of-thrombolytic-agents-streptokinase-alteplase-and-tenecteplase-in-the-treatment-of-acute-myocardial-infarction
#12
B O Ascef, J B Izidoro, A M Almeida, A F Bahia Neto, A A Guerra Júnior, F A Acurcio
No abstract text is available yet for this article.
November 2016: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
https://www.readbyqxmd.com/read/27965285/the-impact-of-ct-perfusion-imaging-on-the-response-to-tenecteplase-in-ischemic-stroke-analysis-of-two-randomized-controlled-trials
#13
Andrew Bivard, Xuya Huang, Patrick McElduff, Christopher R Levi, Bruce C V Campbell, Bharath Kumar Cheripelli, Dheeraj Kalladka, Fiona C Moreton, Ian Ford, Christopher F Bladin, Stephen M Davis, Geoffrey A Donnan, Keith W Muir, Mark W Parsons
BACKGROUND: -We pooled two clinical trials of tenecteplase compared with alteplase for the treatment of acute ischemic stroke, one demonstrating superiority of tenecteplase, while the other showed no difference between the treatments on patient clinical outcomes. We tested the hypotheses that reperfusion therapy with tenecteplase would be superior to alteplase in improving functional outcome in the group of patients with target mismatch as identified with advanced imaging. METHODS: -We investigated if tenecteplase treated patients had a different 24h reduction in the National Institutes of Health Stroke Scale (NIHSS) and a favourable odds ratio of a modified Rankin scale (mRS) of 0-1vs 2-6 compared with alteplase treated patients using linear regression to generate odds ratios (OR)...
December 13, 2016: Circulation
https://www.readbyqxmd.com/read/27904506/safety-and-efficacy-of-tenecteplase-versus-alteplase-in-acute-coronary-syndrome-a-systematic-review-and-meta-analysis-of-randomized-trials
#14
REVIEW
Alexandre Guillermin, David Jun Yan, Arnaud Perrier, Christophe Marti
INTRODUCTION: Alteplase and tenecteplase are two widely used thrombolytic agents and are both approved for the treatment of acute myocardial infarction. These two molecules have increased fibrin specificity compared with older thrombolytics but distinct pharmacokinetic properties and may differ in terms of risks and benefits. We decided to review the available evidence comparing the safety and efficacy of these two molecules in acute coronary syndrome (ACS) or pulmonary embolism (PE)...
December 1, 2016: Archives of Medical Science: AMS
https://www.readbyqxmd.com/read/27900893/prompt-treatment-with-alteplase-is-essential-for-patients-with-severe-ischaemic-stroke
#15
(no author information available yet)
Thrombolysis with alteplase delivered within 4.5 hours of the onset of ischaemic stroke significantly improves the chances of good outcomes, but it also increases the risk of intracerebral haemorrhage, which can cause death or functional impairment.
November 30, 2016: Nursing Older People
https://www.readbyqxmd.com/read/27887792/edaravone-with-and-without-6%C3%A2-mg-kg-alteplase-within-4-5-hours-after-ischemic-stroke-a-prospective-cohort-study-protect4-5
#16
Takenori Yamaguchi, Hideto Awano, Hiroaki Matsuda, Norio Tanahashi
BACKGROUND: Edaravone is widely used to treat acute ischemic stroke (AIS) within 24 hours of onset. We aimed to evaluate current edaravone treatment practices and the efficacy and safety of edaravone used with recombinant tissue plasminogen activator (tPA) in AIS patients within 4.5 hours of onset. The results were compared with those of the Safe Implementation of Treatments in Stroke-International Stroke Thrombolysis Registry (SITS-ISTR) study. METHODS: PROTECT4...
November 22, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/27876561/tip-design-of-hemodialysis-catheters-influences-thrombotic-events-and-replacement-rate
#17
C Petridis, M Nitschke, W Lehne, E Smith, J P Goltz, H Lehnert, M Meier
OBJECTIVE/BACKGROUND: Central venous tunnelled hemodialysis catheters (CVTC) are used for initial vascular access in patients with renal failure. Tip design of the CVTC may play an important role in catheter function and complication rates, influencing adequate hemodialysis treatment of these patients. METHODS: This prospective, observational cohort study compared the function and complication rates of two CVTCs in patients with end stage renal disease (ESRD) within a follow-up period of 24 months...
November 19, 2016: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/27851466/1831-alteplase-for-ischemic-stroke-after-heparin-reversal-with-protamine
#18
Gabriel Fontaine, Shawn Smith
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27849730/50-evaluation-of-half-dose-versus-full-dose-alteplase-for-treatment-of-pulmonary-embolism
#19
Tyree Kiser, Ellen Burnham, Brendan Clark, Michael Ho, Marc Moss, R Vandivier
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27834743/infarct-in-a-new-territory-after-treatment-administration-in-the-escape-randomized-controlled-trial-endovascular-treatment-for-small-core-and-anterior-circulation-proximal-occlusion-with-emphasis-on-minimizing-ct-to-recanalization-times
#20
Aravind Ganesh, Fahad S Al-Ajlan, Farahna Sabiq, Zarina Assis, Jeremy L Rempel, Kenneth Butcher, John Thornton, Peter Kelly, Daniel Roy, Alexandre Y Poppe, Tudor G Jovin, Thomas Devlin, Blaise W Baxter, Timo Krings, Leanne K Casaubon, Donald F Frei, Hana Choe, Donatella Tampieri, Jeanne Teitelbaum, Cheemun Lum, Jennifer Mandzia, Stephen J Phillips, Oh Young Bang, Mohammed A Almekhlafi, Shelagh B Coutts, Philip A Barber, Tolulope Sajobi, Andrew M Demchuk, Muneer Eesa, Michael D Hill, Mayank Goyal, Bijoy K Menon
BACKGROUND AND PURPOSE: Infarct in a new previously unaffected territory (INT) is a potential complication of endovascular treatment. We applied a recently proposed methodology to identify and classify INTs in the ESCAPE randomized controlled trial (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times). METHODS: The core laboratory identified INTs on 24-hour follow-up imaging, blinded to treatment allocation, after assessing all baseline imaging...
December 2016: Stroke; a Journal of Cerebral Circulation
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