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Intravenous tissue plasminogen activator

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https://www.readbyqxmd.com/read/28211169/a-first-in-human-study-of-ds-1040-an-inhibitor-of-the-activated-form-of-thrombin-activatable-fibrinolysis-inhibitor-in-healthy-subjects
#1
Jin Zhou, Jarema Kochan, Ophelia Yin, Vance Warren, Cynthia Zamora, George Atiee, Joseph Pav, Yasushi Orihashi, Vijay Vashi, Victor Dishy
BACKGROUND: Current treatments for acute ischemic stroke and venous thromboembolism, such as recombinant tissue plasminogen activator and thrombectomy, are limited by a narrow time window and the risk of bleeding. DS-1040 is a novel low-molecular weight compound inhibiting the activated form of thrombin-activatable fibrinolysis inhibitor (TAFIa), developed as a fibrinolysis enhancer for treatment of thromboembolic diseases. OBJECTIVES: This first-in-human, randomized, placebo-controlled, three-part, phase 1 study was conducted to evaluate the safety, pharmacokinetics (PK), and pharmacodynamics (PD) of DS-1040 in healthy subjects...
February 17, 2017: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/28202820/-clinical-manifestations-of-spinal-epidural-hematoma-stroke-mimic-and-pitfalls-in-diagnosis
#2
Masaru Kuriyama
Clinical manifestations of spinal epidural hematoma are presented, and the cases mimicking acute ischemic stroke have been reviewed from the literature. Many reports described the cases of spinal epidural hematoma with acute hemiparesis mimicking ischemic stroke in which intravenous thrombolytic treatment with recombinant tissue plasminogen activator was considered. A correct diagnosis of acute ischemic stroke must be made within 4.5 hours from the onset of symptoms, a relatively short window period. A spinal epidural hematoma is a potentially important stroke mimic in a wide variety of conditions that mimic a stroke...
February 2017: Brain and Nerve, Shinkei Kenkyū No Shinpo
https://www.readbyqxmd.com/read/28202431/thrombus-migration-in-the-middle-cerebral-artery-incidence-imaging-signs-and-impact-on-success-of-endovascular-thrombectomy
#3
Johannes Kaesmacher, Christian Maegerlein, Mirjam Kaesmacher, Claus Zimmer, Holger Poppert, Benjamin Friedrich, Tobias Boeckh-Behrens, Justus F Kleine
BACKGROUND: Thrombus migration (TM) in intracranial vessels during ischemic stroke has been reported in the form of case reports, but its incidence, impact on the technical success of subsequent endovascular thrombectomy and patients' outcome have never been studied systematically. METHODS AND RESULTS: Retrospective analysis was done of 409 patients with isolated middle cerebral artery occlusions treated with endovascular thrombectomy. TM was observed (1) by analyzing discrepancies between computed tomographic angiography and digital subtraction angiography and (2) by comparing infarct pattern in the striatocapsular region with exact, angiographically assessed thrombus location within the M1-segment and the involvement of the middle cerebral artery perforators...
February 15, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28196814/racial-ethnic-disparities-in-acute-stroke-care-in-the-florida-puerto-rico-collaboration-to-reduce-stroke-disparities-study
#4
Ralph L Sacco, Hannah Gardener, Kefeng Wang, Chuanhui Dong, Maria A Ciliberti-Vargas, Carolina M Gutierrez, Negar Asdaghi, W Scott Burgin, Olveen Carrasquillo, Enid J Garcia-Rivera, Ulises Nobo, Sofia Oluwole, David Z Rose, Michael F Waters, Juan Carlos Zevallos, Mary Robichaux, Salina P Waddy, Jose G Romano, Tatjana Rundek
BACKGROUND: Racial-ethnic disparities in acute stroke care can contribute to inequality in stroke outcomes. We examined race-ethnic disparities in acute stroke performance metrics in a voluntary stroke registry among Florida and Puerto Rico Get With the Guidelines-Stroke hospitals. METHODS AND RESULTS: Seventy-five sites in the Florida Puerto Rico Stroke Registry (66 Florida and 9 Puerto Rico) recorded 58 864 ischemic stroke cases (2010-2014). Logistic regression models examined racial-ethnic differences in acute stroke performance measures and defect-free care (intravenous tissue plasminogen activator treatment, in-hospital antithrombotic therapy, deep vein thrombosis prophylaxis, discharge antithrombotic therapy, appropriate anticoagulation therapy, statin use, smoking cessation counseling) and temporal trends...
February 14, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28185970/risk-factors-for-hemorrhagic-transformation-following-intravenous-thrombolysis-in-acute-cerebral-infarction-a-retrospective-single-center-study
#5
Xiahong Xu, Changsong Li, Ting Wan, Xiaobo Gu, Wenxia Zhu, Junjie Hao, Huan Bao, Lian Zuo, Hui Hu, Gang Li
OBJECTIVE: To investigate the risk factors for the hemorrhagic transformation (HT) following intravenous thrombolysis using a recombinant tissue plasminogen activator (r-tPA) in acute cerebral infarction. METHODS: Acute cerebral infarction patients receiving r-tPA thrombolysis in Shanghai Eastern Hospital were retrospectively studied. Based upon the cranial CT or MRI examination, after the intravenous thrombolysis, the patients were divided into two groups: HT group and non-HT group...
February 6, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28174326/intravenous-thrombolysis-in-unknown-onset-stroke-results-from-the-safe-implementation-of-treatment-in-stroke-international-stroke-thrombolysis-registry
#6
Laura Dorado, Niaz Ahmed, Götz Thomalla, Manuel Lozano, Branko Malojcic, Mushtaq Wani, Mònica Millán, Ales Tomek, Antoni Dávalos
BACKGROUND AND PURPOSE: Stroke patients with unknown onset (UKO) are excluded from thrombolytic therapy. We aim to study the safety and efficacy of intravenous alteplase in ischemic stroke patients with UKO of symptoms compared with those treated within 4.5 hours in a large cohort. METHODS: Data were analyzed from 47 237 patients with acute ischemic stroke receiving intravenous tissue-type plasminogen activator in hospitals participating in the Safe Implementation of Treatment in Stroke-International Stroke Thrombolysis Registry between 2010 and 2014...
February 7, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28162169/-efficacy-of-intravenous-thrombolysis-in-acute-ischemic-stroke-with-hyperdense-middle-cerebral-artery-sign
#7
L Peng, Y Guo, Y Wang, Y N Lin, C H Zhang, H Y Wang, R M Yu, X P Sun
Objective: To observe the efficacy and safety of recombinant tissue-type plasminogen activator (rtPA) intravenous thrombolysis (IVT) in the treatment of acute cerebral infarction with hyperdense middle cerebral artery sign (HMCAS). Methods: Acute cerebral infarction patients with HMCAS from July 2010 to November 2015 at the First Affiliated Hospital of Dalian Medical University were collected.These patients were divided into two groups depending on whether they received IVT or not.The Nation Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) were used to evaluate early and long-time therapeutic effects...
January 17, 2017: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/28154103/acute-ischemic-stroke-therapy-overview
#8
Luciana Catanese, Joseph Tarsia, Marc Fisher
The treatment of acute ischemic stroke has undergone dramatic changes recently subsequent to the demonstrated efficacy of intra-arterial (IA) device-based therapy in multiple trials. The selection of patients for both intravenous and IA therapy is based on timely imaging with either computed tomography or magnetic resonance imaging, and if IA therapy is considered noninvasive, angiography with one of these modalities is necessary to document a large-vessel occlusion amenable for intervention. More advanced computed tomography and magnetic resonance imaging studies are available that can be used to identify a small ischemic core and ischemic penumbra, and this information will contribute increasingly in treatment decisions as the therapeutic time window is lengthened...
February 3, 2017: Circulation Research
https://www.readbyqxmd.com/read/28149081/not-only-the-sugar-early-infarct-sign-hyperdense-middle-cerebral-artery-age-neurologic-deficit-score-but-also-atrial-fibrillation-is-predictive-for-symptomatic-intracranial-hemorrhage-after-intravenous-recombinant-tissue-plasminogen-activator
#9
Sombat Muengtaweepongsa, Pornpoj Prapa-Anantachai, Pornpat A Dharmasaroja
BACKGROUND: Symptomatic intracranial hemorrhage (sICH) is the most unwanted adverse event in patients with acute ischemic stroke who received intravenous recombinant tissue plasminogen activator (i.v. rt-PA). Many tool scores are available to predict the probability of sICH. Among those scores, the Sugar, Early infarct sign, hyperDense middle cerebral artery, Age, Neurologic deficit (SEDAN) gives the highest area under the curve-receiver operating characteristic value. OBJECTIVE: We aimed to examine any factors other than the SEDAN score to predict the probability of sICH...
January 2017: Journal of Neurosciences in Rural Practice
https://www.readbyqxmd.com/read/28149079/intravenous-thrombolysis-for-acute-ischemic-stroke-review-of-97-patients
#10
Anish Mehta, Rohan Mahale, Kiran Buddaraju, Anas Majeed, Suryanarayana Sharma, Mahendra Javali, Purushottam Acharya, Rangasetty Srinivasa
BACKGROUND: Intravenous thrombolysis (IVT) has now become a standard treatment in eligible patients with acute ischemic stroke (AIS) who present within 4.5 h of symptom onset. OBJECTIVE: To determine the usefulness of IVT and the subset of patients who will benefit from IVT in AIS within 4.5 h. MATERIALS AND METHODS: Patients with AIS within 4.5 h of symptom onset who underwent IVT were studied prospectively. The study period was from October 2011 to October 2015...
January 2017: Journal of Neurosciences in Rural Practice
https://www.readbyqxmd.com/read/28132961/does-reducing-the-duration-from-symptom-onset-to-recanalization-improve-the-results-of-intracranial-mechanical-thrombectomy-in-the-elderly
#11
Koichiro Komatsubara, Tomohisa Dembo, Eishi Sato, Hiroki Sasamori, Masataka Torii, Yoshiaki Shiokawa, Teruyuki Hirano
Endovascular recanalization for acute major cerebral artery occlusion is effective within a short time after symptom onset. However, its efficacy in the elderly remains unknown. We assessed the efficacy of our comprehensive stroke center's reduction of this time in 28 consecutive patients for elderly patients (defined as patients aged ≥75 years) with acute major cerebral artery occlusion treated with intravenous injection of tissue plasminogen activator, followed by thrombus retrieval by endovascular therapy...
January 27, 2017: Neurologia Medico-chirurgica
https://www.readbyqxmd.com/read/28131535/results-of-a-1-year-quality-improvement-process-to-reduce-door-to-needle-time-in-acute-ischemic-stroke-with-mri-screening
#12
D Sablot, N Gaillard, C Colas, P Smadja, C Gely, A Dutray, J-M Bonnec, S Jurici, G Farouil, A Ferraro-Allou, M Jantac, T Allou, C Pujol, N Olivier, A Laverdure, B Fadat, J Mas, A Dumitrana, Y Garcia, H Touzani, P Perucho, T Moulin, C Richard, C Heroum, S Bouly, C Sagnes-Raffy, D Heve
OBJECTIVE: To determine the effects of a 1-year quality-improvement (QI) process to reduce door-to-needle (DTN) time in a secondary general hospital in which multimodal MRI screening is used before tissue plasminogen activator (tPA) administration in patients with acute ischemic stroke (AIS). METHODS: The QI process was initiated in January 2015. Patients who received intravenous (iv) tPA<4.5h after AIS onset between 26 February 2015 to 25 February 2016 (during implementation of the QI process; the "2015 cohort") were identified (n=130), and their demographic and clinical characteristics and timing metrics compared with those of patients treated by iv tPA in 2014 (the "2014 cohort", n=135)...
January 25, 2017: Revue Neurologique
https://www.readbyqxmd.com/read/28130211/plasma-kallikrein-mediates-brain-hemorrhage-and-edema-caused-by-tissue-plasminogen-activator-therapy-in-mice-after-stroke
#13
Fabrício Simão, Tuna Ustunkaya, Allen C Clermont, Edward P Feener
Thrombolytic therapy using tissue plasminogen activator (tPA) in acute stroke is associated with increased risks of cerebral hemorrhagic transformation and angioedema. While plasma kallikrein (PKal) has been implicated in contributing to both hematoma expansion and thrombosis in stroke, its role in the complications associated with the therapeutic use of tPA in stroke is not yet available. We investigated the effects of tPA on plasma prekallikrein (PPK) activation and the role of PKal on cerebral outcomes in a murine thrombotic stroke model treated with tPA...
January 27, 2017: Blood
https://www.readbyqxmd.com/read/28129994/impact-of-tissue-plasminogen-activator-dosing-on-patients-weighing-more-than-100%C3%A2-kg-on-3-month-outcomes-in-acute-ischemic-stroke
#14
Jeffrey Garavaglia, Jay Sherman, Hannah Yetzer, Michael Regier, Matthew Smith
BACKGROUND AND PURPOSE: The landmark National Institute of Neurological Disorders and Stroke (NINDS) tissue plasminogen activator (tPA) trial established the effectiveness and dosing of intravenous tPA for acute ischemic stroke (AIS) at .9 mg/kg with a maximum dose of 90 mg. Since the publication of the NINDS trial in 1995, there has been a drastic increase in the amount of obesity and the average weight of adults in the United States, which has caused an increase in the number of patients receiving 90 mg of alteplase for AIS...
January 24, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28119435/cervical-carotid-pseudo-occlusions-and-false-dissections-intracranial-occlusions-masquerading-as-extracranial-occlusions
#15
Jonathan A Grossberg, Diogo C Haussen, Fabricio B Cardoso, Leticia C Rebello, Mehdi Bouslama, Aaron M Anderson, Michael R Frankel, Raul G Nogueira
BACKGROUND AND PURPOSE: Pseudo-occlusion (PO) of the cervical internal carotid artery (ICA) refers to an isolated occlusion of the intracranial ICA that appears as an extracranial ICA occlusion on computed tomography angiography (CTA) or digital subtraction angiography because of blockage of distal contrast penetration by a stagnant column of unopacified blood. We aim to better characterize this poorly recognized entity. METHODS: Retrospective review of an endovascular database (2010-2015; n=898)...
January 24, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28119434/yamato-study-tissue-type-plasminogen-activator-and-edaravone-combination-therapy
#16
Junya Aoki, Kazumi Kimura, Naomi Morita, Masafumi Harada, Norifumi Metoki, Yohei Tateishi, Kenichi Todo, Hiroshi Yamagami, Kouji Hayashi, Yuka Terasawa, Koji Fujita, Nobuaki Yamamoto, Ichiro Deguchi, Norio Tanahashi, Takeshi Inoue, Takeshi Iwanaga, Nobuyuki Kaneko, Hidetaka Mitsumura, Yasuyuki Iguchi, Yasushi Ueno, Yoji Kuramoto, Toshiyasu Ogata, Shigeru Fujimoto, Mutsumi Yokoyama, Shinji Nagahiro
BACKGROUND AND PURPOSE: We investigated whether administration of edaravone, a free radical scavenger, before or during tissue-type plasminogen activator (tPA) can enhance early recanalization in a major arterial occlusion. METHODS: The YAMATO study (Tissue-Type Plasminogen Activator and Edaravone Combination Therapy) is an investigator-initiated, multicenter (17 hospitals in Japan), prospective, randomized, and open-label study. Patients with stroke secondary to occlusion of the M1 or M2 portion of the middle cerebral artery and within 4...
January 24, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28119380/use-of-intravenous-recombinant-tissue-plasminogen-activator-in-acute-ischemic-stroke-patients-taking-non-vitamin-k-antagonist-oral-anticoagulants-noacs-before-stroke
#17
Ying Xian, Jerome J Federspiel, Adrian F Hernandez, Daniel Laskowitz, Lee H Schwamm, Deepak L Bhatt, Eric E Smith, Gregg C Fonarow, Eric D Peterson
BACKGROUND: -Intravenous recombinant tissue plasminogen activator (rt-PA) is effective in improving outcomes in ischemic stroke; however, there are few data on use of rt-PA in patients who are receiving a non-vitamin K antagonist oral anticoagulant (NOAC). METHODS: -Using data from the American Heart Association Get With The Guidelines-Stroke Registry, we examined the outcomes of use of thrombolytic therapy in ischemic stroke patients receiving anticoagulation with NOACs versus those on warfarin (international normalized ratio <1...
January 24, 2017: Circulation
https://www.readbyqxmd.com/read/28110890/safety-of-endovascular-intervention-for-stroke-on-therapeutic-anticoagulation-multicenter-cohort-study-and-meta-analysis
#18
Donna Kurowski, Karin Jonczak, Qaisar Shah, Shadi Yaghi, Randolph S Marshall, Haroon Ahmad, James McKinney, Jose Torres, Koto Ishida, Brett Cucchiara
INTRODUCTION: Intravenous (IV) tissue plasminogen activator (tPA) is contraindicated in therapeutically anti-coagulated patients. Such patients may be considered for endovascular intervention. However, there are limited data on its safety. PATIENTS AND METHODS: We performed a multicenter retrospective study of patients undergoing endovascular intervention for acute ischemic stroke while on therapeutic anticoagulation. We compared the observed rate of National Institute of Neurological Disorders and Stroke defined symptomatic intracerebral hemorrhage (sICH) with risk-adjusted historical control rates of sICH after IV tPA using weighted averages of the hemorrhage after thrombolysis (HAT) and Multicenter Stroke Survey (MSS) prediction scores...
January 16, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28110588/neuroprotective-effects-of-adjunctive-treatments-for-acute-stroke-thrombolysis-a-review-of-clinical-evidence
#19
Hongxing Zhou, Suyun Huang, Gavin Sunnassee, Weiyu Guo, Jian Chen, Yang Guo, Sheng Tan
The narrow therapeutic time window and risk of intracranial hemorrhage largely restrict the clinical application of thrombolysis in acute ischemic stroke. Adjunctive treatments added to rt-PA may be beneficial to improve the capacity of neural cell to withstand ischemia, and to reduce the hemorrhage risk as well. This review aims to evaluate the neuroprotective effects of adjunctive treatments in combination with thrombolytic therapy for acute ischemic stroke. Relevant studies were searched in the PubMed, Web of Science, and EMBASE database...
January 23, 2017: International Journal of Neuroscience
https://www.readbyqxmd.com/read/28097310/combined-intravenous-thrombolysis-and-thrombectomy-vs-thrombectomy-alone-for-acute-ischemic-stroke-a-pooled-analysis-of-the-swift-and-star-studies
#20
Jonathan M Coutinho, David S Liebeskind, Lee-Anne Slater, Raul G Nogueira, Wayne Clark, Antoni Dávalos, Alain Bonafé, Reza Jahan, Urs Fischer, Jan Gralla, Jeffrey L Saver, Vitor M Pereira
Importance: Mechanical thrombectomy (MT) improves clinical outcomes in patients with acute ischemic stroke (AIS) caused by a large vessel occlusion. However, it is not known whether intravenous thrombolysis (IVT) is of added benefit in patients undergoing MT. Objective: To examine whether treatment with IVT before MT with a stent retriever is beneficial in patients undergoing MT. Design, Setting, and Participants: This post hoc analysis used data from 291 patients treated with MT included in 2 large, multicenter, prospective clinical trials that evaluated MT for AIS (Solitaire With the Intention for Thrombectomy performed from January 1, 2010, through December 31, 2011, and Solitaire Flow Restoration Thrombectomy for Acute Revascularization from January 1, 2010, through December 31, 2012)...
January 9, 2017: JAMA Neurology
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