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Alteplase

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https://www.readbyqxmd.com/read/29788951/managing-acute-ischaemic-stroke-in-a-small-island-developing-state-meeting-the-guidelines-in-barbados
#1
Asanchia S Harewood-Marshall, Leslie S Craig, Tanya P Martelly, David O C Corbin, Lauren Maul, Damani McIntosh-Clarke, Tracey Blackman, Kenneth S George, Anselm J M Hennis, Ian R Hambleton, Angela M C Rose
BACKGROUND: We describe hospital-based management of acute ischaemic stroke patients in 2010-2013 in Barbados, by comparing documented treatment given in the single tertiary public hospital with international guideline recommendations. METHODS: Evidence-based stroke management guidelines were identified through a systematic literature search. Comparisons were made between these guidelines and documented diagnostic practice (all strokes) and prescribed medication (ischaemic stroke only), using a combination of key informant interviews and national stroke registry data for 2010-2013...
May 22, 2018: BMC Public Health
https://www.readbyqxmd.com/read/29788198/venous-thromboembolism-after-intraventricular-hemorrhage-results-from-the-clear-iii-trial
#2
(no author information available yet)
BACKGROUND: Venous thromboembolism (VTE) after intracerebral hemorrhage is well studied, but data on patients with spontaneous intraventricular hemorrhage (IVH) are limited. OBJECTIVE: To study the factors associated with VTE, association between VTE and clinical outcomes in IVH, and safety of VTE chemoprophylaxis in IVH treated with intraventricular catheters and thrombolysis. METHODS: Retrospective cohort study of patients enrolled in the CLEAR III trial, a multicenter, randomized trial comparing external ventricular drainage, with administration of intraventricular alteplase vs placebo, for obstructive IVH...
May 21, 2018: Neurosurgery
https://www.readbyqxmd.com/read/29787575/safety-of-intravenous-alteplase-within-4-5-hours-for-patients-awakening-with-stroke-symptoms
#3
Victor C Urrutia, Roland Faigle, Steven R Zeiler, Elisabeth B Marsh, Mona Bahouth, Mario Cerdan Trevino, Jennifer Dearborn, Richard Leigh, Susan Rice, Karen Lane, Mustapha Saheed, Peter Hill, Rafael H Llinas
BACKGROUND: Up to 25% of acute stroke patients first note symptoms upon awakening. We hypothesized that patients awaking with stroke symptoms may be safely treated with intravenous alteplase (IV tPA) using non-contrast head CT (NCHCT), if they meet all other standard criteria. METHODS: The SAfety of Intravenous thromboLytics in stroke ON awakening (SAIL ON) was a prospective, open-label, single treatment arm, pilot safety trial of standard dose IV tPA in patients who presented with stroke symptoms within 0-4...
2018: PloS One
https://www.readbyqxmd.com/read/29777016/clinical-utility-of-electronic-alberta-stroke-program-early-computed-tomography-score-software-in-the-enchanted-trial-database
#4
Simon Nagel, Xia Wang, Cheryl Carcel, Thompson Robinson, Richard I Lindley, John Chalmers, Craig S Anderson
BACKGROUND AND PURPOSE: Clinical utility of electronic Alberta Stroke Program Early CT Score (e-ASPECTS), an automated system for quantifying signs of infarction, was evaluated in a large database of thrombolyzed patients with acute ischemic stroke. METHODS: All baseline noncontrast computed tomographic scans of patients with anterior circulation acute ischemic stroke who participated in the alteplase dose arm of the randomized controlled trial ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study) were reviewed; poor quality and large (>6 mm) slice thickness were excluded...
May 18, 2018: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29768935/catheter-directed-thrombolysis-with-a-continuous-infusion-of-low-dose-alteplase-for-subacute-proximal-venous-thrombosis-efficacy-and-safety-compared-to-urokinase
#5
Maofeng Gong, Xu He, Jinhua Song, Boxiang Zhao, Wanyin Shi, Guoping Chen, Jianping Gu
The purpose of this study was to compare the efficacy and safety associated with catheter-directed thrombolysis (CDT) using either recombinant tissue plasminogen activator (rt-PA) or urokinase (UK) for subacute deep venous thrombosis (DVT). From January 2014 to December 2016, we conducted a retrospective analysis on a total of 49 patients who underwent consistent CDT with either rt-PA (rt-PA-CDT group) or UK (UK-CDT group) treatment. The thrombolytic rate of the rt-PA-CDT group was significantly higher than that of the UK-CDT group (87...
January 1, 2018: Clinical and Applied Thrombosis/hemostasis
https://www.readbyqxmd.com/read/29766770/mri-guided-thrombolysis-for-stroke-with-unknown-time-of-onset
#6
Götz Thomalla, Claus Z Simonsen, Florent Boutitie, Grethe Andersen, Yves Berthezene, Bastian Cheng, Bharath Cheripelli, Tae-Hee Cho, Franz Fazekas, Jens Fiehler, Ian Ford, Ivana Galinovic, Susanne Gellissen, Amir Golsari, Johannes Gregori, Matthias Günther, Jorge Guibernau, Karl Georg Häusler, Michael Hennerici, André Kemmling, Jacob Marstrand, Boris Modrau, Lars Neeb, Natalia Perez de la Ossa, Josep Puig, Peter Ringleb, Pascal Roy, Enno Scheel, Wouter Schonewille, Joaquin Serena, Stefan Sunaert, Kersten Villringer, Anke Wouters, Vincent Thijs, Martin Ebinger, Matthias Endres, Jochen B Fiebach, Robin Lemmens, Keith W Muir, Norbert Nighoghossian, Salvador Pedraza, Christian Gerloff
Background Under current guidelines, intravenous thrombolysis is used to treat acute stroke only if it can be ascertained that the time since the onset of symptoms was less than 4.5 hours. We sought to determine whether patients with stroke with an unknown time of onset and features suggesting recent cerebral infarction on magnetic resonance imaging (MRI) would benefit from thrombolysis with the use of intravenous alteplase. Methods In a multicenter trial, we randomly assigned patients who had an unknown time of onset of stroke to receive either intravenous alteplase or placebo...
May 16, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/29766752/mri-guided-intravenous-alteplase-for-stroke-still-stuck-in-time
#7
Tudor G Jovin
No abstract text is available yet for this article.
May 16, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/29765393/support-of-new-triage-protocol-among-acute-stroke-care-providers
#8
Haitham M Hussein, David C Anderson
Objective: We conducted an online survey to gauge the acceptance of sending acute stroke patients with suspected large vessel occlusion (LVO) directly to an endovascular-capable hospital (ECH) even if that means bypassing a closer alteplase-capable hospital (ACH) without endovascular capability. Methods: The survey was composed of two cases of acute stroke, one with cortical symptoms suggestive of LVO and the other without. In each case, responders were asked to choose between triaging to a closer ACH or an ECH that is further away and to provide an opinion regarding the maximum extra travel time they would tolerate if they chose the ECH...
April 2018: Interventional Neurology
https://www.readbyqxmd.com/read/29760676/helsinki-stroke-model-is-transferrable-with-real-world-resources-and-reduced-stroke-thrombolysis-delay-to-34-min-in-christchurch
#9
Teddy Y Wu, Erin Coleman, Sarah L Wright, Deborah F Mason, Jon Reimers, Roderick Duncan, Mary Griffiths, Michael Hurrell, David Dixon, James Weaver, Atte Meretoja, John N Fink
Background: Christchurch hospital is a tertiary hospital in New Zealand supported by five general neurologists with after-hours services provided mainly by onsite non-neurology medical residents. We assessed the transferrability and impact of the Helsinki Stroke model on stroke thrombolysis door-to-needle time (DNT) in Christchurch hospital. Methods: Key components of the Helsinki Stroke model were implemented first in 2015 with introduction of patient pre-notification and thrombolysis by the computed tomography (CT) suite, followed by implementation of direct transfer to CT on ambulance stretcher in May 2017...
2018: Frontiers in Neurology
https://www.readbyqxmd.com/read/29755795/double-bolus-alteplase-therapy-during-cardiopulmonary-resuscitation-for-cardiac-arrest-due-to-massive-pulmonary-embolism-guided-by-focused-bedside-echocardiography
#10
Hafiz B Mahboob, Bruce W Denney
Massive pulmonary embolism (PE) frequently leads to cardiac arrest (CA) which carries an extremely high mortality rate. Although available, randomized trials have not shown survival benefits from thrombolytic use. Thrombolytics however have been used successfully during resuscitation in clinical practice in multiple case reports and in retrospective studies. Recent resuscitation guidelines recommend using alteplase for PE related CA; however they do not offer a standardized treatment regimen. The most consistently applied approach is an intravenous bolus of 50 mg tissue plasminogen activator (t-PA) early during cardiopulmonary resuscitation (CPR)...
2018: Case Reports in Critical Care
https://www.readbyqxmd.com/read/29754560/door-to-needle-time-and-functional-outcome-for-mild-ischemic-stroke-over-telestroke
#11
Jillian Harvey, Sami Al Kasab, Eyad Almalouhi, Waldo R Guerrero, Ellen Debenham, Nancy Turner, Patricia Aysse, Christine A Holmstedt
Introduction Faster intravenous alteplase (tPA) administration from time of symptom onset is associated with better functional outcome. Lack of recognition of mild ischemic stroke (MIS) might result in delay in treatment with tPA. We hypothesise that patients with MIS have a longer door to needle (DTN) time when compared to patients with severe stroke symptoms. Methods Data on all patients who received tPA at spoke hospitals through the Medical University of South Carolina (MUSC) telestroke network were analysed...
January 1, 2018: Journal of Telemedicine and Telecare
https://www.readbyqxmd.com/read/29728903/tenecteplase-versus-alteplase-in-acute-ischemic-stroke-systematic-review-and-meta-analysis
#12
A Thelengana, Divya M Radhakrishnan, Manya Prasad, Amit Kumar, Kameshwar Prasad
Tenecteplase is a product of genetic modification of recombinant tissue plasminogen activator with superior pharmacodynamic and pharmacokinetic properties. This meta-analysis was to determine whether intravenous thrombolysis with tenecteplase in patients with acute ischemic stroke has better efficacy and safety outcomes than with intravenous alteplase. PubMed, Cochrane Central Register of Controlled Trials, WHO International clinical trials registry platform (ICTRP), Australian New Zealand Clinical Trials Registry (ANZCTR), EU Clinical Trials Register (EU-CTR) and ClinicalTrials...
May 4, 2018: Acta Neurologica Belgica
https://www.readbyqxmd.com/read/29705803/lipid-lowering-pretreatment-and-outcome-following-intravenous-thrombolysis-for-acute-ischaemic-stroke-a-post-hoc-analysis-of-the-enhanced-control-of-hypertension-and-thrombolysis-stroke-study-trial
#13
Jatinder S Minhas, Xia Wang, Hisatomi Arima, Philip M Bath, Laurent Billot, Joseph P Broderick, Geoffrey A Donnan, Jong S Kim, Pablo M Lavados, Tsong-Hai Lee, Sheila Cristina Ouriques Martins, Verónica V Olavarría, Jeyaraj D Pandian, Octávio Marques Pontes-Neto, Stefano Ricci, Shoichiro Sato, Vijay K Sharma, Nguyen H Thang, Ji-Guang Wang, Mark Woodward, John Chalmers, Craig S Anderson, Thompson G Robinson
BACKGROUND: Debate exists as to whether statin pretreatment confers an increased risk of 90-day mortality and symptomatic intracranial haemorrhage (sICH) in acute ischaemic stroke (AIS) patients treated with intravenous thrombolysis. We assessed the effects of undifferentiated lipid-lowering pretreatment on outcomes and interaction with low-dose versus standard-dose alteplase in a post hoc subgroup -analysis of the Enhanced Control of Hypertension and Thrombolysis Stroke Study. METHODS: In all, 3,284 thrombolysis-eligible AIS patients (mean age 66...
April 27, 2018: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/29694815/tenecteplase-versus-alteplase-before-thrombectomy-for-ischemic-stroke
#14
RANDOMIZED CONTROLLED TRIAL
Bruce C V Campbell, Peter J Mitchell, Leonid Churilov, Nawaf Yassi, Timothy J Kleinig, Richard J Dowling, Bernard Yan, Steven J Bush, Helen M Dewey, Vincent Thijs, Rebecca Scroop, Marion Simpson, Mark Brooks, Hamed Asadi, Teddy Y Wu, Darshan G Shah, Tissa Wijeratne, Timothy Ang, Ferdinand Miteff, Christopher R Levi, Edrich Rodrigues, Henry Zhao, Patrick Salvaris, Carlos Garcia-Esperon, Peter Bailey, Henry Rice, Laetitia de Villiers, Helen Brown, Kendal Redmond, David Leggett, John N Fink, Wayne Collecutt, Andrew A Wong, Claire Muller, Alan Coulthard, Ken Mitchell, John Clouston, Kate Mahady, Deborah Field, Henry Ma, Thanh G Phan, Winston Chong, Ronil V Chandra, Lee-Anne Slater, Martin Krause, Timothy J Harrington, Kenneth C Faulder, Brendan S Steinfort, Christopher F Bladin, Gagan Sharma, Patricia M Desmond, Mark W Parsons, Geoffrey A Donnan, Stephen M Davis
BACKGROUND: Intravenous infusion of alteplase is used for thrombolysis before endovascular thrombectomy for ischemic stroke. Tenecteplase, which is more fibrin-specific and has longer activity than alteplase, is given as a bolus and may increase the incidence of vascular reperfusion. METHODS: We randomly assigned patients with ischemic stroke who had occlusion of the internal carotid, basilar, or middle cerebral artery and who were eligible to undergo thrombectomy to receive tenecteplase (at a dose of 0...
April 26, 2018: New England Journal of Medicine
https://www.readbyqxmd.com/read/29689135/intravenous-thrombolysis-in-unwitnessed-stroke-onset-mr-witness-trial-results
#15
Lee H Schwamm, Ona Wu, Shlee S Song, Lawrence L Latour, Andria L Ford, Amie W Hsia, Alona Muzikansky, Rebecca A Betensky, Albert J Yoo, Michael H Lev, Gregoire Boulouis, Arne Lauer, Pedro Cougo, William A Copen, Gordon J Harris, Steven Warach
OBJECTIVE: Most acute ischemic stroke (AIS) patients with unwitnessed symptom onset are ineligible for intravenous thrombolysis due to timing alone. Lesion evolution on fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) correlates with stroke duration, and quantitative mismatch of diffusion-weighted MRI with FLAIR (qDFM) might indicate stroke duration within guideline-recommended thrombolysis. We tested whether intravenous thrombolysis ≤4.5 hours from the time of symptom discovery is safe in patients with qDFM in an open-label, phase 2a, prospective study (NCT01282242)...
April 24, 2018: Annals of Neurology
https://www.readbyqxmd.com/read/29685008/medicamentous-thrombolysis-disguises-pulmonary-thromboembolism-as-a-cause-of-death
#16
I Šoša, A Ferencic, V Stemberga, G Zamolo, S Arbanas, I Dasek, M Perkovic, D Cuculic
We report the case of a 31-year-old female who was admitted to the emergency department with symptoms of cardiac arrest and ultimately died in spite of enormous resuscitation efforts. During resuscitation, pulmonary embolism was considered as a possible non-cardiac cause of cardiac arrest, and following its extremely unfavorable prognosis, the fatal outcome was not so surprising. However, since acute pulmonary emboli obstructing blood flow to a lobe or multiple lung segments was suspected, alteplase was indicated and administered...
March 2018: Journal of Biological Regulators and Homeostatic Agents
https://www.readbyqxmd.com/read/29683786/real-world-treatment-of-large-vessel-occlusions-combined-outcomes-of-directly-presenting-and-transferred-in-patients-to-a-stroke-center
#17
Ganesh Asaithambi, Amy L Castle, Lana J Stein, Emily H Marino, Bridget M Ho, Andrew C Wallace-Jackson, Sandra K Hanson, Jeffrey P Lassig
Background Stroke patients transferred in for endovascular treatment (ET) may have lower chances for favorable outcomes compared to those who presented directly to a ET-capable hospital. We describe our real-world experience of ET in AIS, especially among patients transferred in. Materials and methods AIS patients receiving ET from January 2015 to November 2016 were reviewed. We calculated median onset to groin puncture (OTP) and groin puncture to recanalization times (PTR), location of target vessel treated, rate of concurrent intravenous (IV) alteplase use, and rate of successful recanalization as defined by TICI ≥ 2b...
April 23, 2018: Neurological Research
https://www.readbyqxmd.com/read/29673293/systemic-thrombolytic-therapy-for-massive-and-submassive-pulmonary-embolism
#18
Lauren A Igneri, John M Hammer
OBJECTIVE: To critically evaluate the published literature assessing the safety and efficacy of thrombolytic therapy for massive and submassive pulmonary embolism (PE). METHODS: A search of human trials in the English-language (September 2017) was conducted through the MEDLINE database using the following terms: PE, tissue plasminogen activator, tenecteplase, and alteplase. 67 unique articles were identified, of which 24 clinical trials discussing clinical outcomes related to administration of either intravenous tenecteplase or alteplase were included...
January 1, 2018: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/29666986/impaired-fasting-glucose-is-associated-with-unfavorable-outcome-in-ischemic-stroke-patients-treated-with-intravenous-alteplase
#19
E Osei, S Fonville, A A M Zandbergen, P J Koudstaal, D W J Dippel, H M den Hertog
OBJECTIVES: Hyperglycemia on admission and diabetes mellitus type II are associated with unfavorable outcome in stroke patients. We studied whether impaired fasting glucose (IFG) is associated with unfavorable outcome in ischemic stroke patients treated with intravenous alteplase as well and if IFG is a stronger prognostic factor than hyperglycemia on admission. METHODS: We studied 220 consecutive patients with ischemic stroke treated with intravenous alteplase...
April 17, 2018: Journal of Neurology
https://www.readbyqxmd.com/read/29651371/tenecteplase-versus-alteplase-for-the-management-of-acute-ischemic-stroke-in-a-low-income-country-nepal-cost-efficacy-and-safety
#20
REVIEW
Gaurav Nepal, Ghanshyam Kharel, Shaik Tanveer Ahamad, Babin Basnet
Intravenous alteplase is the only approved treatment for acute ischemic stroke. Tenecteplase, a genetically engineered, mutant tissue plasminogen activator, is an alternative thrombolytic agent. The economic feasibility of stroke treatment has been a matter of huge debate and discussion thus far. The use of thrombolytics for the management of ischemic stroke has recently begun in Nepal. In low-income countries like Nepal, where the per capita income falls at just $691.7 and 25.2% of the population are under the poverty line, stroke patients cannot meet treatment expenses...
February 9, 2018: Curēus
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