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Thrombolytic therapy

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https://www.readbyqxmd.com/read/28428435/bet-1-a-glass-half-full-thrombolysis-for-the-treatment-of-submassive-pulmonary-embolism
#1
Liam Barrett, Dan Horner
A short-cut review was carried out to establish whether thrombolysis in addition to therapeutic anticoagulation could be of benefit in submassive (intermediate risk) pulmonary embolism (PE). 64 directly relevant papers were found using the reported search strategy. Of these, three presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. It is concluded that there is insufficient evidence to support the routine use of adjuvant thrombolytic therapy at any dose for patients with submassive PE...
May 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28417608/comparison-of-antithrombotic-agents-during-urgent-percutaneous-coronary-intervention-following-thrombolytic-therapy-a-retrospective-cohort-study
#2
Jaya R Mallidi, Peter Robinson, Paul F Visintainer, Amir S Lotfi, Scott Mulvey, Gregory R Giugliano
BACKGROUND: The optimal antithrombotic regimen for urgent percutaneous coronary interventions (PCI) following thrombolytic therapy for ST segment myocardial infarction (STEMI) is currently unknown. METHODS: We performed a retrospective analysis of all patients referred to our institution from January 2005 to July 2014 who underwent urgent PCI within 24 hr after receiving thrombolytic therapy. The patients were divided into three cohorts based on the anticoagulation strategy during PCI-bivalirudin, heparin alone or heparin plus Glycoprotein IIb/IIIa inhibitor (GPI)...
April 18, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28417266/guided-longer-pulses-from-a-diagnostic-ultrasound-and-intraclot-microbubble-enhanced-catheter-directed-thrombolysis-in-vivo
#3
Shunji Gao, Qiong Zhu, Xiaoxiao Dong, Zhong Chen, Zheng Liu, Feng Xie
The mechanism of ultrasound thrombolysis (UT) is generally attributed to cavitation. The insufficiency of microbubbles (MB) to serve as cavitation nuclei in the vessel-obstructing thrombi significantly reduces the effectiveness of UT. Taking advantage of the widely performed catheter-directed therapy (CDT), in a thrombo-embolized rabbit IVC model with a simultaneous catheter directed rt-PA thrombolysis procedure, guided moderate mechanical index longer pulses from a modified diagnostic ultrasound transducer, combined with an intraclot infusion of MB, significantly accelerated the thrombolysis process...
April 17, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28414895/the-impact-of-ct-perfusion-threshold-on-predicted-viable-and-nonviable-tissue-volumes-in-acute-ischemic-stroke
#4
Xuya Huang, Dheeraj Kalladka, Bharath Kumar Cheripelli, Fiona Catherine Moreton, Keith W Muir
BACKGROUND AND PURPOSE: Perfusion imaging is used for patient selection in clinical practice and trials. Postprocessing and definitions of tissue viability are nevertheless not standardized. We compared the lesion volumes generated with two well-recognized perfusion tissue definitions in a single-center phase 2 thrombolysis study. METHODS: We analyzed perfusion imaging data from the Alteplase-Tenecteplase Trial Evaluation for Stroke Thrombolysis (ATTEST) study using two popular tissue viability thresholds (ischemic core definition: (1) cerebral blood volume < 2...
April 17, 2017: Journal of Neuroimaging: Official Journal of the American Society of Neuroimaging
https://www.readbyqxmd.com/read/28414658/septic-cerebral-venosinus-thrombosis-secondary-to-an-odontogenic-infection
#5
Hongvan Le, Shane Prejean, Madeleine Heck
BACKGROUND: Cerebral venosinus thrombosis (CVT); is an uncommon, potentially fatal disease that is more common in young adults and children. Thrombophilia, elevated estrogenic states, and infections are the most common risk factors in patients who develop CVT. CASE: A 69-year-old man with a right-sided odontogenic infection presented with fever, headache, opthalmoplegia, and periorbital swelling. Imaging revealed evidence of meningitis and thrombosis of bilateral ophthalmic veins, the cavernous sinus, right internal jugular vein, and sigmoid sinus...
March 2017: Journal of the Louisiana State Medical Society: Official Organ of the Louisiana State Medical Society
https://www.readbyqxmd.com/read/28405804/cytoprotective-drug-tissue-plasminogen-activator-protease-interaction-assays-screening-of-two-novel-cytoprotective-chromones
#6
Paul A Lapchak, Jacqueline M Lara, Paul D Boitano
Tissue plasminogen activator (tPA) is currently used in combination with endovascular procedures to enhance recanalization and cerebral reperfusion and is also currently administered as standard-of-care thrombolytic therapy to patients within 3-4.5 h of an ischemic stroke. Since tPA is not neuroprotective or cytoprotective, adjuvant therapy with a neuroprotective or an optimized cytoprotective compound is required to provide the best care to stroke victims to maximally promote clinical recovery. In this article, we describe the use of a sensitive standardized protease assay with CH3SO2-D-hexahydrotyrosine-Gly-Arg-p-nitroanilide•AcOH, a chromogenic protease substrate that is cleaved to 4-nitroaniline (p-nitroaniline) and measured spectrophotometrically at 405 nm (OD405 nm), and how the assay can be used as an effective screening assay to study drug-tPA interactions...
April 12, 2017: Translational Stroke Research
https://www.readbyqxmd.com/read/28400035/percutaneous-closure-of-post-myocardial-infarction-ventricular-septal-rupture-a-single-centre-experience
#7
Rajendra Kumar Premchand, Ravikanth Garipalli, T N C Padmanabhan, Geetesh Manik
BACKGROUND: Post-infarction ventricular septal rupture (VSR) is a rare but lethal mechanical complication of an acute myocardial infarction (AMI). Survival to 1 month without intervention is 6%. Given high surgical mortality, transcatheter closure has emerged as a potential strategy in selected cases. Indian data on percutaneous device closure of post AMI-VSR is scarce hence we report our single-centre experience with ASD occluder device (Amplatzer and lifetech) for closure of post-AMI VSR...
April 2017: Indian Heart Journal
https://www.readbyqxmd.com/read/28395964/inertial-cavitation-ultrasound-with-microbubbles-improves-reperfusion-efficacy-when-combined-with-tissue-plasminogen-activator-in-an-in%C3%A2-vitro-model-of-microvascular-obstruction
#8
Akash Goyal, Francois T H Yu, Mathea G Tenwalde, Xucai Chen, Andrew Althouse, Flordeliza S Villanueva, John J Pacella
We have previously reported that long-tone-burst, high-mechanical-index ultrasound (US) and microbubble (MB) therapy can restore perfusion in both in vitro and in vivo models of microvascular obstruction (MVO). Addition of MBs to US has been found to potentiate the efficacy of thrombolytics on large venous thrombi; however, the optimal US parameters for achieving microvascular reperfusion of MVO caused by microthrombi, when combined with tissue plasminogen activator (tPA), are unknown. We sought to elucidate the specific effects of US, with and without tPA, for effective reperfusion of MVO in an in vitro model using both venous and arterial microthrombi...
April 7, 2017: Ultrasound in Medicine & Biology
https://www.readbyqxmd.com/read/28395416/-application-of-percutaneous-angiojet-thrombectomy-in-patients-with-acute-symptomatic-portal-and-superior-mesenteric-venous-thrombosis
#9
J H Song, X He, W S Lou, L Chen, G P Chen, H B Su, W Y Shi, T Wang, B X Zhao, J P Gu
Objective: To evaluate the clinical value of percutaneous AngioJet thrombectomy in treatment of acute symptomatic portal and superior mesenteric venous thrombosis venous thrombosis (PVMVT) . Method: From January 2014 to January 2016, a total of 8 patients in Nanjing First Hospital with PVMVT verified by color Doppler ultrasound and computed tomographic angiography (CTA) were analyzed retrospectively. Under ultrasound guidance , the branch of the right portal vein(PV) was punctured with a micropuncture set and a 4-F infusion catheter was advanced to the superior mesenteric vein(SMV)...
April 4, 2017: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/28393971/-mechanical-and-pharmacomechanical-trombolysis-in-deep-venous-thrombosis-with-no-clinical-response-to-conventional-treatment
#10
Leopoldo Marine, Jesús Urbina, Michel Bergoeing, Francisco Valdés, Renato Mertens, Albrecht Kramer
BACKGROUND: Conventional treatment of deep vein thrombosis (DVT) is anticoagulation, bed rest and limb elevation. Proximal DVT patients with persisting edema, pain and cyanosis of extremities despite of conventional therapy may develop ischemia. Direct treatment of thrombosis becomes necessary. AIM: To report our experience with mechanical trombolysis of proximal lower extremity DVT. MATERIAL AND METHODS: Retrospective review of medical records of proximal DVT patients treated with thrombolysis between March 2012 and August 2015...
January 2017: Revista Médica de Chile
https://www.readbyqxmd.com/read/28393614/current-and-future-perspectives-on-the-treatment-of-cerebral-ischemia
#11
REVIEW
Brandon R Christophe, Shyle H Mehta, Andrew L A Garton, Jonathan Sisti, E Sander Connolly
After heart disease and combined forms of cancer, stroke is the leading cause of death in the United States. Currently, tissue-plasminogen activator (tPA) thrombolysis is the only thrombolytic therapy that has been shown to improve patient outcome. Presently, the only antithrombotic drug treatment that has proven effective at improving acute ischemic stroke patient outcome is aspirin administration. Despite these studies, no clinical trials have yet demonstrated a reliably effective pharmacological treatment...
April 2017: Expert Opinion on Pharmacotherapy
https://www.readbyqxmd.com/read/28386231/bifurcation-in-blood-oscillatory-rhythms-for-patients-with-ischemic-stroke-a-small-scale-clinical-trial-using-laser-doppler-flowmetry-and-computational-modeling-of-vasomotion
#12
Alexey Goltsov, Anastasia V Anisimova, Maria Zakharkina, Alexander I Krupatkin, Viktor V Sidorov, Sergei G Sokolovski, Edik Rafailov
We describe application of spectral analysis of laser Doppler flowmetry (LDF) signals to investigation of cerebrovascular haemodynamics in patients with post-acute ischemic stroke (AIS) and cerebrovascular insufficiency. LDF was performed from 3 to 7 days after the onset of AIS on forehead in the right and left supraorbital regions in patients. Analysis of LDF signals showed that perfusion in the microvasculature in AIS patients was lower than that in patients with cerebrovascular insufficiency. As a result of wavelet analysis of the LDF signals we obtained activation of the vasomotion in the frequency range of myogenic oscillation of 0...
2017: Frontiers in Physiology
https://www.readbyqxmd.com/read/28384594/vascular-closure-devices-in-stroke-patients-receiving-tissue-plasminogen-activator-a-retrospective-analysis-from-an-academic-tertiary-medical-center-and-a-teaching-community-hospital-stroke-database
#13
Mangaladevi S Patil, Mahesh V Jayaraman, Sun H Ahn
OBJECTIVES: To determine the safety and effectiveness of vascular closure devices in prevention of access site complications in acute stroke patient receiving intravenous (IV) and/or intra-arterial (IA) IV tissue plasminogen activator (tPA). PATIENTS AND METHODS: All patients with acute stroke onset treated with IV and/or IA tPA closed with vascular closure device and adult age (>18 years) were identified from an academic tertiary medical center and a teaching community hospital stroke database for 9 years (from March 2005 to June 2014)...
March 29, 2017: Clinical Neurology and Neurosurgery
https://www.readbyqxmd.com/read/28382611/parkinsonism-or-other-movement-disorders-presenting-as-stroke-mimics
#14
Cheng-Yang Hsieh, Chih-Hung Chen, Sheng-Feng Sung, Wen-Juh Hwang
PURPOSE: Patients with parkinsonism or other movement disorders may visit the emergency department due to acute deterioration of neurological status or consciousness disturbance. Under such circumstances, patients may be misdiagnosed as having a hyperacute stroke, i.e. stroke mimic. The purpose of the present study was to explore the clinical features and consequences of patients with parkinsonism or other movement disorders presenting as stroke mimics with activation of a stroke code...
December 15, 2016: Acta Neurologica Taiwanica
https://www.readbyqxmd.com/read/28380019/thromboelastometric-analysis-of-the-risk-factors-for-return-of-spontaneous-circulation-in-adult-patients-with-out-of-hospital-cardiac-arrest
#15
Hiroyuki Koami, Yuichiro Sakamoto, Ryota Sakurai, Miho Ohta, Hisashi Imahase, Mayuko Yahata, Mitsuru Umeka, Toru Miike, Futoshi Nagashima, Takashi Iwamura, Kosuke Chris Yamada, Satoshi Inoue
It is well known that coagulopathy is observed in patients with out-of-hospital cardiac arrest (OHCA). Thrombolytic therapy for those patients has been controversial until now. The purpose of this study was to identify a significant predictor for return of spontaneous circulation (ROSC) of OHCA patients in the emergency department (ED) using whole blood viscoelastic testing. Adult non-trauma OHCA patients transported to our hospital that underwent thromboelastometry (ROTEM) during cardiopulmonary resuscitation between January 2013 and December 2015 were enrolled in this study...
2017: PloS One
https://www.readbyqxmd.com/read/28372322/interactions-between-iodinated-contrast-media-and-tissue-plasminogen-activator-in-vitro-comparison-study
#16
Eszter Vörös, László Deres, Róbert Halmosi, Edit Váradi, Kálmán Tóth, István Battyáni
BACKGROUND AND PURPOSE: Iodinated contrast media (Xenetix®, Ultravist®, Omnipaque®, Visipaque® and Iomeron®) used for computed tomography (CT) may decrease fibrinolysis by recombinant tissue plasminogen activator (rt-PA). We hypothesized that receiving iodinated contrast media before rt-PA may impair thrombolysis as measured by a new model system. METHODS: Whole blood from Wistar Kyoto rats (n = 10) was obtained and allowed to form blood clots. Thrombolysis was performed by placing individually the prepared clots into 15 mL tubes and adding 5 mL saline buffer, 100μg rt-PA and a different contrast media; adjusting the quantity of iodine to either 30 mg or 60 mg...
March 30, 2017: Clinical Hemorheology and Microcirculation
https://www.readbyqxmd.com/read/28366066/neuroprotective-strategies-and-the-underlying-molecular-basis-of-cerebrovascular-stroke
#17
Michael Karsy, Andrea Brock, Jian Guan, Phillip Taussky, M Yashar S Kalani, Min S Park
Stroke is a leading cause of disability in the US. Although there has been significant progress in the area of medical and surgical thrombolytic technologies, neuroprotective agents to prevent secondary cerebral injury and to minimize disability remain limited. Only limited success has been reported in preclinical and clinical trials evaluating a variety of compounds. In this review, the authors discuss the most up-to-date information regarding the underlying molecular biology of stroke as well as strategies that aim to mitigate this complex signaling cascade...
April 2017: Neurosurgical Focus
https://www.readbyqxmd.com/read/28365630/thrombolysis-and-thrombectomy-for-acute-ischaemic-stroke
#18
Salwa El Tawil, Keith W Muir
The likelihood of disability-free recovery after acute ischemic stroke is significantly improved by reperfusion either by intravenous thrombolytic drug treatment or with endovascular mechanical thrombectomy in selected cases. The use of intravenous thrombolysis is limited by the short treatment window and you need to assess individual balance of benefit and risk of symptomatic intracranial haemorrhage. Benefit is greater for shorter onset-to-reperfusion time intervals, requiring optimisation of pre-hospital and in-hospital pathways...
April 2017: Clinical Medicine: Journal of the Royal College of Physicians of London
https://www.readbyqxmd.com/read/28356204/what-is-the-utility-of-thrombolytic-therapy-for-acute-deep-venous-thrombosis
#19
EDITORIAL
Michael Gottlieb, Thomas Alcorn
No abstract text is available yet for this article.
March 26, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28349275/the-100-most-influential-papers-in-the-field-of-thrombolytic-therapy-a-bibliometric-analysis
#20
Tariq Jamal Siddiqi, Muhammad Shariq Usman, Muhammad Shahzeb Khan, Kaneez Fatima, Alexander Norbash, Adnan Iqbal Qureshi, Abdur Rahman Khan, Faisal Khosa
BACKGROUND: Bibliometric analyses are used by researchers and research funding agencies to help determine areas of greatest interest, and consequently which topics and domains warrant increased research attention. Bibliometric analyses have similarly been published in a number of clinical subspecialties concerning areas of specific medical interest; however, a thorough literature search revealed that such a study has been absent in the field of thrombolytics to date. To bridge this gap, we conducted a citation analysis of the 100 most influential articles on thrombolytics...
March 27, 2017: American Journal of Cardiovascular Drugs: Drugs, Devices, and Other Interventions
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