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Intravenous tissue plasminogen activator

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https://www.readbyqxmd.com/read/28644924/intravenous-thrombolysis-for-acute-ischemic-stroke-a-bridge-between-two-centuries
#1
Georgios Tsivgoulis, Odysseas Kargiotis, Andrei Alexandrov
Intravenous tissue-plasminogen activator (tPA) remains the only approved systemic reperfusion therapy suitable for most patients presenting timely with acute ischemic stroke. Accumulating real-word experience for over 20 years regarding tPA safety and effectiveness lead to re-appraisal of original contraindications for intravenous thrombolysis (IVT). Areas covered: This narrative review focuses on fast yet appropriate selection of patients for safe administration of tPA per recently expanded indications. Novel strategies for rapid patient assessment will be discussed...
June 23, 2017: Expert Review of Neurotherapeutics
https://www.readbyqxmd.com/read/28631345/advantages-and-disadvantages-of-using-intravenous-tissue-plasminogen-activator-as-salvage-therapy-for-inoperable-heartware-thrombosis
#2
Robyn Basken, Charles M Bazzell, Richard Smith, Rajesh Janardhanan, Zain Khalpey
Device thrombosis is a devastating complication of left ventricular assist devices. The definitive treatment has been device exchange or explant. Evidence of increasing morbidity and mortality with device exchange has shifted strategies toward conservative management. In this report, we detail the use of thrombolytics as salvage therapy in a patient with an occlusive HeartWare ventricular assist device (HeartWare Inc., Framingham, MA) thrombus, resulting in long-term survival without further intervention.
June 19, 2017: Journal of Cardiac Surgery
https://www.readbyqxmd.com/read/28611830/endovascular-therapy-demonstrates-benefit-over-intravenous-recombinant-tissue-plasminogen-activator-based-on-repeatedly-measured-national-institutes-of-health-stroke-scale
#3
Liqiong Fan, Sharon D Yeatts, Lydia D Foster, Pooja Khatri, Thomas Tomsick, Joseph P Broderick, Yuko Y Palesch
BACKGROUND AND PURPOSE: The Interventional Management of Stroke (IMS) III trial was a randomized controlled trial designed to compare the effect of endovascular therapy after intravenous recombinant tissue plasminogen activator (i.v. rt-PA) as compared to i.v. rt-PA alone. The primary outcome was modified Rankin Scale at 90 days. Secondary outcomes included National Institutes of Health Stroke Scale (NIHSS), which was assessed repeatedly through 90 days. The objective of this analysis is to evaluate the treatment effect of endovascular therapy over time on NIHSS...
March 2017: Interventional Neurology
https://www.readbyqxmd.com/read/28606123/preventing-graft-restenosis-after-coronary-artery-bypass-grafting-with-tissue-type-plasminogen-activator
#4
Ruixiong Li, Bin Lan, Tianxiang Zhu, Yanlong Yang, Muyan Cai, Zhongmin Fang, Chensheng Ma, Shu Chen
OBJECTIVE: To explore the feasibility and safety of using tissue-type plasminogen activator (t-PA) to prevent graft restenosis after coronary artery bypass grafting (CABG). METHODS: In this prospective observational study, 37 patients underwent CABG between June 2009 and May 2013. These patients were grouped according to the anti-coagulation strategy after surgery: t-PA (n = 12) and conventional treatments (n = 25). In the t-PA group, the patients received acetylsalicylic acid (ASA) and clopidogrel plus intravenous infusion of t-PA (0...
June 12, 2017: European Journal of Medical Research
https://www.readbyqxmd.com/read/28596447/impact-of-thrombus-length-on-outcomes-after-intra-arterial-aspiration-thrombectomy-in-the-therapy-trial
#5
Albert J Yoo, Pooja Khatri, J Mocco, Osama O Zaidat, Rishi Gupta, Donald Frei, Demetrius Lopes, Harish Shownkeen, Olvert A Berkhemer, Denise Meyer, Susana S Hak, Sophia S Kuo, Hope Buell, Arani Bose, Siu Po Sit, Rüdiger von Kummer
BACKGROUND AND PURPOSE: Increasing thrombus length (TL) impedes recanalization after intravenous (IV) thrombolysis. We sought to determine whether the clinical benefit of aspiration thrombectomy relative to IV r-tPA (recombinant tissue-type plasminogen activator) may be greater at longer TL. METHODS: THERAPY was a randomized trial of aspiration thrombectomy plus IV r-tPA versus IV r-tPA alone in large-vessel stroke patients with prospective TL measurement ≥8 mm...
June 8, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28592785/multidisciplinary-approach-to-decrease-in-hospital-delay-for-stroke-thrombolysis
#6
Sang-Beom Jeon, Seung Mok Ryoo, Deok Hee Lee, Sun U Kwon, Seongsoo Jang, Eun-Jae Lee, Sang Hun Lee, Jung Hee Han, Mi Jeong Yoon, Soo Jeong, Young-Uk Cho, Sungyang Jo, Seung-Bok Lim, Joong-Goo Kim, Han-Bin Lee, Seung Chai Jung, Kye Won Park, Min-Hwan Lee, Dong-Wha Kang, Dae Chul Suh, Jong S Kim
BACKGROUND AND PURPOSE: Decreasing the time delay for thrombolysis, including intravenous thrombolysis (IVT) with tissue plasminogen activator and intra-arterial thrombectomy (IAT), is critical for decreasing the morbidity and mortality of patients experiencing acute stroke. We aimed to decrease the in-hospital delay for both IVT and IAT through a multidisciplinary approach that is feasible 24 h/day. METHODS: We implemented the Stroke Alert Team (SAT) on May 2, 2016, which introduced hospital-initiated ambulance prenotification and reorganized in-hospital processes...
May 2017: Journal of Stroke
https://www.readbyqxmd.com/read/28592784/nationwide-hospital-emergent-capability-accreditation-by-level-stroke-improves-stroke-treatment-in-taiwan
#7
Tain-Junn Cheng, Giia-Sheun Peng, Wei-Siang Jhao, Jiunn-Tay Lee, Tsung-Hsi Wang
BACKGROUND AND PURPOSE: Recombinant tissue plasminogen activator (rtPA) is one of the proven therapies that improve the outcome of patients with acute ischemic stroke (AIS). In 2009, the Ministry of Health and Welfare, Executive Yuan, Republic of China, launched the project "Hospital Emergent Capability Accreditation by Level-Stroke (HECAL-Stroke)" to improve AIS treatment in Taiwan. The current study was performed to determine whether the project launched by the government was effective in promoting rtPA therapy among AIS patients...
May 2017: Journal of Stroke
https://www.readbyqxmd.com/read/28572721/outcome-of-stroke-patients-receiving-different-doses-of-recombinant-tissue-plasminogen-activator
#8
Cheung-Ter Ong, Yi-Sin Wong, Chi-Shun Wu, Yu-Hsiang Su
BACKGROUND AND PURPOSE: Intravenous recombinant tissue plasminogen activator (tPA) at a dose of 0.9 mg/kg body weight is associated with a high hemorrhagic transformation (HT) rate. Low-dose tPA (0.6 mg/kg) may have a lower hemorrhage rate but the mortality and disability rates at 90 days cannot be confirmed as non-inferior to standard-dose tPA. Whether the doses 0.7 and 0.8 mg/kg have better efficacy and safety needs further investigation. Therefore, this study is to compare the efficacy and safety of each dose of tPA (0...
2017: Drug Design, Development and Therapy
https://www.readbyqxmd.com/read/28559833/acute-intravenous-calcium-antagonist-for-suspected-hemiplegic-migraine-a-case-story
#9
Charlotte Lützhøft Rath, Jun He, Mette Maria Nordling, Troels Wienecke
Stroke mimics, like attacks of hemiplegic migraine, are challenging in acute stroke evaluation. We present a 28-year-old woman with a suspected hemiplegic migraine attack with left-sided hemiparalysis. Brain CT with perfusion imaging 1 h 54 min after symptom onset revealed hypoperfusion in the right hemisphere. The patient was treated with intravenous recombinant tissue plasminogen activator (rtPA) with no effect. After a subsequent intravenous verapamil infusion, the patient gained full motor function within 10 min...
January 2017: Case Reports in Neurology
https://www.readbyqxmd.com/read/28558372/dosage-calculation-for-intravenous-thrombolysis-of-ischemic-stroke-to-weigh-or-to-estimate
#10
Andreas Ragoschke-Schumm, Asem Razouk, Martin Lesmeister, Stefan Helwig, Iris Q Grunwald, Klaus Fassbender
BACKGROUND: Estimation is a widely used method of assessing the weight of patients with acute stroke. Because the dosage of tissue plasminogen activator (tPA) is weight-dependent, errors in estimation lead to incorrect dosing. METHODS: We installed a ground-level scale in the computed tomography (CT) suite of our hospital and also integrated a scale into the CT table of our Mobile Stroke Unit in order to prospectively assess the differences between reported, estimated, and measured weights of acute stroke patients...
May 30, 2017: Cerebrovascular Diseases Extra
https://www.readbyqxmd.com/read/28546326/regional-pediatric-acute-stroke-protocol-initial-experience-during-3-years-and-13-recanalization-treatments-in-children
#11
Laurence Tabone, Nicolas Mediamolle, Celine Bellesme, Fabrice Lesage, David Grevent, Augustin Ozanne, Olivier Naggara, Beatrice Husson, Isabelle Desguerre, Catherine Lamy, Christian Denier, Manoelle Kossorotoff
BACKGROUND AND PURPOSE: To evaluate hyperacute management of pediatric arterial ischemic stroke, setting up dedicated management pathways is the first recommended step to prove the feasibility and safety of such treatments. A regional pediatric stroke alert protocol including 2 centers in the Paris-Ile-de-France area, France, was established. METHODS: Consecutive pediatric patients (28 days-18 years) with confirmed arterial ischemic stroke who had acute recanalization treatment (intravenous r-tPA [recombinant tissue-type plasminogen activator], endovascular procedure, or both) according to the regional pediatric stroke alert were retrospectively reviewed during a 40-month period...
May 25, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28536176/cost-of-alteplase-has-more-than-doubled-over-the-past-decade
#12
Dawn Kleindorfer, Joseph Broderick, Bart Demaerschalk, Jeffrey Saver
BACKGROUND AND PURPOSE: Intravenous alteplase (tissue-type plasminogen activator) has been shown to be cost-effective because of savings in long-term disability. In October of 2005, an increased DRG payment to hospitals for alteplase-treated stroke patients was introduced. We sought to describe the trends in the cost of alteplase over time, in comparison to trends in hospital reimbursement in the United States. METHODS: Using publicly available information on the Centers for Medicare and Medicaid Services (CMS) website (www...
May 23, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28536170/door-to-needle-delays-in-minor-stroke-a-causal-inference-approach
#13
Sara K Rostanski, Zachary Shahn, Mitchell S V Elkind, Ava L Liberman, Randolph S Marshall, Joshua I Stillman, Olajide Williams, Joshua Z Willey
BACKGROUND AND PURPOSE: Thrombolysis rates among minor stroke (MS) patients are increasing because of increased recognition of disability in this group and guideline changes regarding treatment indications. We examined the association of delays in door-to-needle (DTN) time with stroke severity. METHODS: We performed a retrospective analysis of all stroke patients who received intravenous tissue-type plasminogen activator in our emergency department between July 1, 2011, and February 29, 2016...
May 23, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28535201/regulatory-t-cells-ameliorate-tissue-plasminogen-activator-induced-brain-haemorrhage-after-stroke
#14
Leilei Mao, Peiying Li, Wen Zhu, Wei Cai, Zongjian Liu, Yanling Wang, Wenli Luo, Ruth A Stetler, Rehana K Leak, Weifeng Yu, Yanqin Gao, Jun Chen, Gang Chen, Xiaoming Hu
Delayed thrombolytic treatment with recombinant tissue plasminogen activator (tPA) may exacerbate blood-brain barrier breakdown after ischaemic stroke and lead to lethal haemorrhagic transformation. The immune system is a dynamic modulator of stroke response, and excessive immune cell accumulation in the cerebral vasculature is associated with compromised integrity of the blood-brain barrier. We previously reported that regulatory T cells, which function to suppress excessive immune responses, ameliorated blood-brain barrier damage after cerebral ischaemia...
May 22, 2017: Brain: a Journal of Neurology
https://www.readbyqxmd.com/read/28531828/ct-and-mri-based-door-needle-times-for-acute-stroke-patients-a-quasi-randomized-clinical-trial
#15
Christine Krarup Hansen, Anders Christensen, Helen Rodgers, Inger Havsteen, Christina Kruuse, Janus Nybing, Mari-Anne Kaasbøl, Hanne Christensen
Door-Needle-times (DNT) of 20min are feasible when Computer Tomography (CT) is used for first-line brain-imaging to assess stroke-patients' eligibility for intravenous-tissue-Plasminogen-Activator (iv-tPA), but the more time-consuming Magnetic Resonance Imaging (MRI)-based-evaluation is superior in detecting acute ischaemia.
May 10, 2017: Clinical Neurology and Neurosurgery
https://www.readbyqxmd.com/read/28513116/worse-outcome-in-patients-with-acute-stroke-and-atrial-fibrillation-following-thrombolysis
#16
Michael Findler, Jeremy Molad, Natan M Bornstein, Eitan Auriel
BACKGROUND: Atrial fibrillation (AF) is the most common arrhythmia and a common cause of ischemic stroke. Stroke patients with AF have been shown to have a poorer neurological outcome than stroke patients without AF. OBJECTIVES: To determine the impact of pre-existing AF on residual degree of disability in patients treated with IV thrombolysis. METHODS: In this case-control study, data of 214 stroke patients (63 with AF and 151 without AF) were collected from the National Acute Stroke Israeli Registry, a nationwide quadrennial stroke database...
May 2017: Israel Medical Association Journal: IMAJ
https://www.readbyqxmd.com/read/28502847/the-role-for-cardiologists-in-stroke-intervention
#17
REVIEW
Richard R Heuser
Even though cardiovascular disease (CVD) is still the leading cause of death in the United States, stroke is the second leading of global cause of death behind CVD . In the 21st Century, less than 40% of overall stroke patients are discharged to home and almost 25% of Medicare beneficiaries do not survive 90days. In spite of the fact that tissue plasminogen activator (TPA) has been approved for stroke care for 20years, only .75% of annual strokes are actually treated with intravenous (IV) TPA. Similar to how interventional cardiologists evolved from IV to catheter mechanical treatment for acute myocardial infarctions (AMI) over 30years ago, over the last few years, neurointerventionists now perform endovascular stroke therapy in many of these patients using stent retrievers...
May 11, 2017: Progress in Cardiovascular Diseases
https://www.readbyqxmd.com/read/28490161/endovascular-stroke-therapy-focused-on-stent-retriever-thrombectomy-and-direct-clot-aspiration-historical-review-and-modern-application
#18
REVIEW
Dong-Hun Kang, Jaechan Park
Intravenous recombinant tissue plasminogen activator had been the only approved treatment for acute ischemic stroke since its approval in 1995. However, the restrictive time window, numerous contraindications, and its low recanalization rate were all limitations of this modality. Under those circumstances, endovascular stroke therapy went through a great evolution during the past two decades of intravenous thrombolysis. The results of the 2013 randomized trials for endovascular stroke therapy were neutral, although they were limited by insufficient imaging screening at enrollment, early-generation devices with less efficacy, and treatment delays...
May 2017: Journal of Korean Neurosurgical Society
https://www.readbyqxmd.com/read/28487393/potent-thrombolytic-effect-of-n-acetylcysteine-on-arterial-thrombi
#19
Sara Martinez de Lizarrondo, Clément Gakuba, Bradley A Herbig, Yohann Repessé, Carine Ali, Cécile V Denis, Peter Lenting, Emmanuel Touzé, Scott L Diamond, Denis Vivien, Maxime Gauberti
Background -Platelet crosslinking during arterial thrombosis involves von Willebrand Factor (VWF) multimers. Therefore, proteolysis of VWF appears promising to disaggregate platelet-rich thrombi and restore vessel patency in acute thrombotic disorders such as ischemic stroke, acute coronary syndrome or acute limb ischemia. N-Acetylcysteine (NAC, a clinically approved mucolytic drug) can reduce intrachain disulfide bonds in large polymeric proteins. In the present study, we postulated that NAC might cleave the VWF multimers inside occlusive thrombi, thereby leading to their dissolution and arterial recanalization...
May 9, 2017: Circulation
https://www.readbyqxmd.com/read/28483774/observed-cost-and-variations-in-short-term-cost-effectiveness-of-therapy-for-ischemic-stroke-in-interventional-management-of-stroke-ims-iii
#20
Kit N Simpson, Annie N Simpson, Patrick D Mauldin, Yuko Y Palesch, Sharon D Yeatts, Dawn Kleindorfer, Thomas A Tomsick, Lydia D Foster, Andrew M Demchuk, Pooja Khatri, Michael D Hill, Edward C Jauch, Tudor G Jovin, Bernard Yan, Rüdiger von Kummer, Carlos A Molina, Mayank Goyal, Wouter J Schonewille, Mikael Mazighi, Stefan T Engelter, Craig Anderson, Judith Spilker, Janice Carrozzella, Karla J Ryckborst, L Scott Janis, Joseph P Broderick
BACKGROUND: Examination of linked data on patient outcomes and cost of care may help identify areas where stroke care can be improved. We report on the association between variations in stroke severity, patient outcomes, cost, and treatment patterns observed over the acute hospital stay and through the 12-month follow-up for subjects receiving endovascular therapy compared to intravenous tissue plasminogen activator alone in the IMS (Interventional Management of Stroke) III Trial. METHODS AND RESULTS: Prospective data collected for a prespecified economic analysis of the trial were used...
May 8, 2017: Journal of the American Heart Association
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