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https://www.readbyqxmd.com/read/29140185/thrombolysis-improving-door-to-needle-times-for-ischemic-stroke-treatment-a-narrative-review
#1
Noreen Kamal, Eric E Smith, Thomas Jeerakathil, Michael D Hill
Background The effectiveness of thrombolysis is highly time dependent. For this reason, short target times have been set to reduce time to treatment from hospital arrival, which is called door-to-needle time. Summary of review There has been considerable work done at single centers and across multiple hospitals to improve door-to-needle time. There have been reductions of 8 to 47 min when applying one or more improvement strategies at single centers, and there have been many multi-hospital initiatives. The delays to treatment have been attributed to both patient and hospital factors, and strategies to address these delays have been proven to reduce door-to-needle time...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/29135819/prophylactic-rtpa-in-the-prevention-of-line-associated-thrombosis-and-infection-in-short-bowel-syndrome
#2
Lynn M Malec, James Cooper, Jeffrey Rudolph, Marian G Michaels, Margaret V Ragni
BACKGROUND: Central venous access devices (CVADs) are essential for total parenteral nutrition administration in patients with short bowel syndrome (SBS). However, they are fraught with complications including infection and venous thromboembolism (VTE), which increases associated morbidity and mortality in this population. There is evidence linking the development of CVAD-associated thrombosis and line-related infection. Thus, it has been postulated that prevention of catheter-related clot formation could minimize the risk of infection originating from the catheter...
November 10, 2017: Journal of Pediatric Gastroenterology and Nutrition
https://www.readbyqxmd.com/read/29106711/interventions-for-treating-central-venous-haemodialysis-catheter-malfunction
#3
REVIEW
Alice L Kennard, Giles D Walters, Simon H Jiang, Girish S Talaulikar
BACKGROUND: Adequate haemodialysis (HD) in people with end-stage kidney disease (ESKD) is reliant upon establishment of vascular access, which may consist of arteriovenous fistula, arteriovenous graft, or central venous catheters (CVC). Although discouraged due to high rates of infectious and thrombotic complications as well as technical issues that limit their life span, CVC have the significant advantage of being immediately usable and are the only means of vascular access in a significant number of patients...
October 26, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29105904/predictors-of-symptomatic-intracranial-hemorrhage-in-off-label-thrombolysis-an-analysis-of-the-sits-registry
#4
Sibu Mundiyanapurath, Katharina Hees, Niaz Ahmed, Nils Wahlgren, Lorenz Uhlmann, Meinhard Kieser, Peter Arthur Ringleb, Werner Hacke, Simon Nagel
BACKGROUND: Intravenous thrombolysis is the only approved pharmacological treatment for acute ischemic stroke. Off-label intravenous thrombolysis for ischemic stroke is common. We aimed to analyse its safety in a large database. METHODS: Retrospective analysis of the SITS thrombolysis registry regarding 11 off-label criteria according to the European license for alteplase. Symptomatic intracranial haemorrhage (SICH) according to SITS was defined as primary safety endpoint and SICH according to the ECASS II definition and the NINDS definition as secondary safety endpoints...
November 6, 2017: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/29100859/safety-of-intravenous-thrombolysis-in-chronic-intracranial-hemorrhage-a-five-year-multicenter-study
#5
Ramin Zand, Georgios Tsivgoulis, Alireza Sadighi, Mantinderpreet Singh, Michael McCormack, Shima Shahjouei, Nitin Goyal, Nariman Noorbakhsh-Sabet, Anne W Alexandrov, Andrei V Alexandrov
INTRODUCTION: Although the recently updated U.S. alteplase label removed "history of intracranial hemorrhage (ICH)" as a contraindication, there are very limited data on the safety of intravenous thrombolysis (IVT) in acute ischemic stroke (AIS) patients with chronic ICH. We sought to evaluate IVT safety in AIS patients with a history of ICH. METHODS: We analyzed consecutive AIS patients treated with IVT at 3 tertiary stroke centers during a 5-year period. We identified AIS treated with IVT with clinical history and neuroimaging confirmation of prior ICH...
October 31, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29097489/treatment-and-outcome-of-hemorrhagic-transformation-after-intravenous-alteplase-in-acute-ischemic-stroke-a-scientific-statement-for-healthcare-professionals-from-the-american-heart-association-american-stroke-association
#6
REVIEW
Shadi Yaghi, Joshua Z Willey, Brett Cucchiara, Joshua N Goldstein, Nicole R Gonzales, Pooja Khatri, Louis J Kim, Stephan A Mayer, Kevin N Sheth, Lee H Schwamm
PURPOSE: Symptomatic intracranial hemorrhage (sICH) is the most feared complication of intravenous thrombolytic therapy in acute ischemic stroke. Treatment of sICH is based on expert opinion and small case series, with the efficacy of such treatments not well established. This document aims to provide an overview of sICH with a focus on pathophysiology and treatment. METHODS: A literature review was performed for randomized trials, prospective and retrospective studies, opinion papers, case series, and case reports on the definitions, epidemiology, risk factors, pathophysiology, treatment, and outcome of sICH...
November 2, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29097062/icatibant-as-a-potential-treatment-of-life-threatening-alteplase-induced-angioedema
#7
Edmund Cheong, Lizzie Dodd, William Smith, Timothy Kleinig
Severe orolingual angioedema is a life-threatening complication of alteplase treatment for acute ischemic stroke that occurs during alteplase infusion or in the first 2 hours afterward. Currently, there are no proven therapies, although glucocorticoids, antihistamines, and adrenaline are sometimes used. Intubation is required if significant airway compromise supervenes. The incidence is .2%-5.1%, and risk factors include treatment with angiotensin-converting enzyme inhibitors and total insular infarcts. Here we report a case of alteplase-induced severe angioedema, which resolved briskly following icatibant treatment...
October 30, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/29096678/minimal-sufficient-balance-randomization-for-sequential-randomized-controlled-trial-designs-results-from-the-escape-trial
#8
Tolulope T Sajobi, Gurbakhshash Singh, Mark W Lowerison, Jordan Engbers, Bijoy K Menon, Andrew M Demchuk, Mayank Goyal, Michael D Hill
BACKGROUND: We describe the implementation of minimal sufficient balance randomization, a covariate-adaptive randomization technique, used for the "Endovascular treatment for Small Core and Anterior circulation Proximal occlusion with Emphasis on minimizing CT to recanalization times" (ESCAPE) trial. METHODS: The ESCAPE trial is a prospective, multicenter, randomized clinical trial that enrolled subjects with the following main inclusion criteria: less than 12 h from symptom onset, age 18 years or older, baseline NIHSS score > 5, ASPECTS score > 5 and computed tomography angiography (CTA) evidence of carotid T/L or M1-segment middle cerebral artery (MCA) occlusion, and at least moderate collaterals by CTA...
November 2, 2017: Trials
https://www.readbyqxmd.com/read/29092734/predictors-of-functional-outcome-and-hemorrhagic-complications-in-acute-ischemic-stroke-patients-treated-with-intravenous-thrombolysis-a-retrospective-analysis%C3%A2
#9
Qinqin Zhao, Wenya Shan, Li Liu, Xuchun Fu, Ping Liu, Yunzhen Hu
Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (rt-PA) within 4.5 hours is an effective and routine therapy for acute ischemic stroke (AIS). The purpose of the study was to identify predictors of functional outcome at 3 months and hemorrhagic complications after IVT. A total of 123 AIS patients treated with intravenous alteplase within 4.5 hours after stroke were enrolled. Baseline clinical characteristics, medication and disease history, radiographic and laboratory data were collected...
October 26, 2017: International Journal of Clinical Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/29073536/intensive-care-unit-drug-costs-in-the-context-of-total-hospital-drug-expenditures-with-suggestions-for-targeted-cost-containment-efforts
#10
Shoroq M Altawalbeh, Melissa I Saul, Amy L Seybert, Joshua M Thorpe, Sandra L Kane-Gill
PURPOSE: To assess costs of intensive care unit (ICU) related pharmacotherapy relative to hospital drug expenditures, and to identify potential targets for cost-effectiveness investigations. We offer the unique advantage of comparing ICU drug costs with previously published data a decade earlier to describe changes over time. MATERIALS AND METHODS: Financial transactions for all ICU patients during fiscal years (FY) 2009-2012 were retrieved from the hospital's data repository...
October 19, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/29068112/use-of-systemic-bivalirudin-with-catheter-directed-thrombolysis-in-a-patient-with-heparin-induced-thrombocytopenia-a-case-report
#11
Hisham A Badreldin, Jessica Rimsans, Jean M Connors, Stephen D Wiviott
In patients with submassive pulmonary embolism, the use of catheter-directed thrombolysis (CDT), using low-dose alteplase is associated with improvement in overall hemodynamics. The data for use of CDT in patients with heparin-induced thrombocytopenia are limited. We report a case of CDT in a patient with HIT using bivalirudin anticoagulation. Data of the use of bivalirudin and argatroban for systemic anticoagulation with CDT are limited.
October 25, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/29037436/which-imaging-before-reperfusion-strategy
#12
REVIEW
J M Olivot
The ischemic penumbra is a transient and potentially reversible condition. Therefore, infarct progression and its counterpart penumbral salvage are highly variable and result from the interaction of 3 major factors: collateral flow, revascularization delay and success. Multimodal brain imaging now offers in clinical practice an exhaustive characterization of the acute ischemic injury: vessel site occlusion, infarction/critical hypoperfusion volume, and collateral flow. From 1995 to 2015, IV alteplase administered within 4...
November 2017: Revue Neurologique
https://www.readbyqxmd.com/read/28974997/the-door-to-needle-time-metric-can-be-achieved-via-telestroke
#13
Ganesh Asaithambi, Amy L Castle, Michael A Sperl, Jayashree Ravichandran, Aditi Gupta, Bridget M Ho, Sandra K Hanson
The administration of intravenous (IV) alteplase to patients with stroke via telestroke (TS) can be safe and effective. It remains unclear how quickly IV alteplase occurs during TS evaluations. We sought to compare door to needle times (DNTs) between patients receiving IV alteplase who present directly to our comprehensive stroke center (CSC) and those presenting to community hospitals in our TS network. Consecutive patients with acute ischemic stroke (AIS) who presented to emergency departments and received IV alteplase between August 2014 and June 2015 were identified at our CSC and TS network...
October 2017: Neurohospitalist
https://www.readbyqxmd.com/read/28973174/low-dose-vs-standard-dose-alteplase-for-patients-with-acute-ischemic-stroke-secondary-analysis-of-the-enchanted-randomized-clinical-trial
#14
Xia Wang, Thompson G Robinson, Tsong-Hai Lee, Qiang Li, Hisatomi Arima, Philip M Bath, Laurent Billot, Joseph Broderick, Andrew M Demchuk, Geoffrey Donnan, Jong S Kim, Pablo Lavados, Richard I Lindley, Sheila O Martins, Veronica V Olavarria, Jeyaraj D Pandian, Mark W Parsons, Octavio M Pontes-Neto, Stefano Ricci, Vijay K Sharma, Nguyen H Thang, Ji-Guang Wang, Mark Woodward, Craig S Anderson, John Chalmers
Importance: A lower dose of intravenous alteplase appears to be a safer treatment option than the standard dose, reducing the risk of symptomatic intracerebral hemorrhage. There is uncertainty, however, over how this effect translates into an overall clinical benefit for patients with acute ischemic stroke (AIS). Objective: To assess whether older, Asian, or severely affected patients with AIS who are considered at high risk of thrombolysis may benefit more from low-dose rather than standard-dose alteplase treatment...
November 1, 2017: JAMA Neurology
https://www.readbyqxmd.com/read/28959492/characteristics-management-and-response-to-alteplase-in-china-versus-non-china-participants-of-the-enchanted-trial
#15
Lily Song, Xia Wang, Thompson Robinson, Richard I Lindley, Hisatomi Arima, Pablo M Lavados, Xiaoying Chen, John Chalmers, Craig S Anderson
BACKGROUND: The characteristics of patients with acute ischaemic stroke (AIS) and their management vary across regions, which may influence outcomes. We examined for differential patterns of outcome between China and non-China participants of the ENhanced Control of Hypertension And Thrombolysis strokE stuDy (ENCHANTED), which tested different alteplase doses in AIS. METHODS: ENCHANTED was an international, multicentre, open, blinded-endpoint trial of the effects of low-dose (0...
June 2017: Stroke and Vascular Neurology
https://www.readbyqxmd.com/read/28952914/tenecteplase-versus-alteplase-before-endovascular-thrombectomy-extend-ia-tnk-a-multicenter-randomized-controlled-study
#16
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
https://www.readbyqxmd.com/read/28948451/a-diagnostic-approach-to-stroke-in-young-adults
#17
REVIEW
Christopher A Stack, John W Cole
Optimal diagnosis and management of stroke in young adults benefit from a multidisciplinary team, including a vascular neurology specialist. In addition to the "standard" vascular risk factors including smoking, hypertension, diabetes, and hyperlipidemia, one needs to consider alternative etiologies including substance abuse, carotid/vertebral artery dissections, and rare genetic conditions among others. Once a young patient is determined to have had a stroke, the next question a clinician should ask is why did this patient have a stroke? A "heart to head" diagnostic approach is recommended...
September 25, 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28944741/the-application-of-nanoparticles-for-neuroprotection-in-acute-ischemic-stroke
#18
Lepei Chen, Xiaoling Gao
Stroke still represents one of the most common causes of death and disability worldwide. Acute ischemic stroke (AIS), caused by brain arterial occlusion resulting from a thrombus or embolus, is the most common form of stroke. However, current therapies in AIS are inadequate, and the only US FDA approved treatment is the thrombolytic drug Alteplase. Therefore, establishing effective therapeutic strategies for AIS is urgently needed. Using nanoparticle-based technologies to deliver neuroprotective agents to the ischemic area has attracted increasing attention of late...
October 2017: Therapeutic Delivery
https://www.readbyqxmd.com/read/28928186/recombinant-human-tnk-tissue-type-plasminogen-activator-rhtnk-tpa-versus-alteplase-rt-pa-as-fibrinolytic-therapy-for-acute-st-segment-elevation-myocardial-infarction-china-tnk-stemi-protocol-for-a-randomised-controlled-non-inferiority-trial
#19
Hai-Bo Wang, Ping Ji, Xing-Shan Zhao, Haiyan Xu, Xiao-Yan Yan, Qin Yang, Chen Yao, Run-Lin Gao, Yang-Feng Wu, Shu-Bin Qiao
AIM: To evaluate the efficacy and safety of recombinant human TNK tissue-type plasminogen activator (rhTNK-tPA) in lowering major adverse cardiovascular and cerebrovascular events (MACCEs) in Chinese acute ST-segment elevation myocardial infarction (STEMI) patients. METHODS AND ANALYSIS: The study is designed as a multicentre, randomised, controlled non-inferiority phase IV trial with balanced randomisation (1:1) in patients with STEMI. The planned sample size is 6200 participants (or 3100 per arm)...
September 18, 2017: BMJ Open
https://www.readbyqxmd.com/read/28919568/robotic-stereotactic-assistance-rosa-utilization-for-minimally-invasive-placement-of-intraparenchymal-hematoma-and-intraventricular-catheters-case-report
#20
Nima Alan, Phillip Lee, Alp Ozpinar, Bradley A Gross, Brian T Jankowitz
BACKGROUND: In patients with supratentorial spontaneous intracerebral hemorrhage, intrahematomal catheter placement may allow for intra-clot thrombolysis and drainage. Robotic assistance may be used for the stereotactic placement of catheters. CASE DESCRIPTION: A 76-year-old male presented with altered mental status and left-sided weakness. Non-contrast CT head showed a right ganglionic intraparenchymal hemorrhage with resultant entrapment of the temporal horn. Using Robotic Stereotactic Assistance (ROSA), an intrahematomal and an intraventricular catheter were placed...
September 14, 2017: World Neurosurgery
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