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Thrombolytic therapy

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https://www.readbyqxmd.com/read/28103118/park2-dependent-mitophagy-induced-by-acidic-postconditioning-protects-against-focal-cerebral-ischemia-and-extends-the-reperfusion-window
#1
Zhe Shen, Yanrong Zheng, Jiaying Wu, Ying Chen, Xiaoli Wu, Yiting Zhou, Yang Yuan, Shousheng Lu, Lei Jiang, Zhenghong Qin, Zhong Chen, Weiwei Hu, Xiangnan Zhang
Prompt reperfusion after cerebral ischemia is critical for neuronal survival. Any strategies that extend the limited reperfusion window will be of great importance. Acidic postconditioning (APC) is a mild acidosis treatment that involves inhaling CO2 during reperfusion following ischemia. APC attenuates ischemic brain injury although the underlying mechanisms have not been elucidated. Here we report that APC reinforces ischemia-reperfusion-induced mitophagy in middle cortical artery occlusion (MCAO)-treated mice, and in oxygen-glucose deprivation (OGD)-treated brain slices and neurons...
January 19, 2017: Autophagy
https://www.readbyqxmd.com/read/28094079/a-stroke-mimic-methotrexate-induced-neurotoxicity-in-the-emergency-department
#2
Patrick Rogers, Wilbur J Pan, Richard A Drachtman, Christopher Haines
BACKGROUND: Acute lymphoblastic leukemia (ALL) is the most common form of childhood leukemia. The treatment of ALL involves multimodality therapy, and methotrexate (MTX) remains a mainstay of treatment. A complication of MTX therapy includes acute, subacute, and chronic neurotoxocity. Signs and symptoms may range from headaches, dizziness, and mood disorders to seizures and stroke-like symptoms. CASE REPORT: An 18-year-old woman with a history of ALL presented to the emergency department with acute onset of right-sided facial paralysis, right upper extremity flaccid paralysis, and right lower extremity weakness after receiving MTX therapy 3 days earlier...
January 13, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28090232/efficacy-and-safety-of-thrombolytic-therapy-in-acute-submassive-pulmonary-embolism-follow-up-study
#3
Santosh Kumar Sinha, Mohit Sachan, Amit Goel, Karandeep Singh, Vikas Mishra, Mukesh Jitendra Jha, Ashutosh Kumar, Nasar Abdali, Mohammad Asif, Mahamdula Razi, Umeshwar Pandey, Ramesh Thakur, Chandra Mohan Varma, Vinay Krishna
BACKGROUND: Thrombolysis in acute submassive pulmonary embolism (PE) remains controversial. So we studied impact of thrombolytic therapy in acute submassive PE in terms of mortality, hemodynamic status, improvement in right ventricular function, and safety in terms of major and minor bleeding. METHOD: A single-center, prospective, randomized study of 86 patients was conducted at LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, India. Patients received thrombolysis (single bolus of tenecteplase) with unfractionated heparin (UFH, group I) or placebo with UFH (group II)...
February 2017: Journal of Clinical Medicine Research
https://www.readbyqxmd.com/read/28089562/sequential-multiple-assignment-randomized-trials-an-opportunity-for-improved-design-of-stroke-reperfusion-trials
#4
William J Meurer, Nicholas J Seewald, Kelley Kidwell
BACKGROUND: Modern clinical trials in stroke reperfusion fall into 2 categories: alternative systemic pharmacological regimens to alteplase and "rescue" endovascular approaches using targeted thrombectomy devices and/or medications delivered directly for persistently occluded vessels. Clinical trials in stroke have not evaluated how initial pharmacological thrombolytic management might influence subsequent rescue strategy. A sequential multiple assignment randomized trial (SMART) is a novel trial design that can test these dynamic treatment regimens and lead to treatment guidelines that more closely mimic practice...
January 12, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28075424/managing-challenging-patients-with-venous-thromboembolism-a-practical-case-based-approach
#5
James Douketis, Walter Ageno, Marc Carrier, Clive Kearon
The management of patients with venous thromboembolism is a common clinical scenario that, for the most part, involves well-established, evidence-based treatment pathways. However, important unanswered clinical questions remain that are the focus of ongoing research. The aim of this narrative review is to provide a practical, case-based approach to the following clinical scenarios in which therapeutic management pathways are less well established: How long to anticoagulated patients with a first unprovoked venous thromboembolism? How to manage complex patients with cancer-associated venous thromboembolism? When and how to treat patients with splanchnic vein thrombosis? When to use thrombolytic therapy for deep vein thrombosis?...
January 4, 2017: Polskie Archiwum Medycyny Wewnętrznej
https://www.readbyqxmd.com/read/28069786/portomesenteric-vein-thrombosis-after-laparoscopic-sleeve-gastrectomy-for-morbid-obesity
#6
Leslie S Anewenah, Mohammed Asif, Richard Francesco, Prashanth Ramachandra
Portomesenteric vein thrombosis (PMVT) is a rare, life-threatening pathology associated with increased prevalence in laparoscopic sleeve gastrectomy (LSG) versus other gastric bypass procedures. Gaining popularity, LSG is becoming the first choice of patients and physicians alike due to its low complication profile compared to the gastric bypass procedure. We present the case of a 34-year-old woman who underwent an uncomplicated LSG for the treatment of morbid obesity, and presented on postoperative day 13 with PMVT...
January 9, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28063771/matrix-metalloproteinase-9-and-recovery-of-acute-ischemic-stroke
#7
Maged M Abdelnaseer, Nervana M Elfauomy, Eman H Esmail, Manal M Kamal, Enji H Elsawy
BACKGROUND: Stroke outcome can be predicted by clinical features, biochemical parameters, and some risk factors. Matrix metalloproteinase-9 (MMP-9) is involved in various stages of stroke pathology. MMP-9 inhibitors are potential stroke therapeutic agents. Little is known about the relation between MMP-9-after the acute stage-and clinical recovery. OBJECTIVE: The study aimed to investigate the serum level of MMP-9 at stroke onset as predictor of stroke outcome and the relation between the level of MMP-9 after 30 days and stroke recovery...
January 4, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28051251/observation-of-clinical-efficacy-of-rt-pa-intravenous-thrombolytic-treatment-for-patients-combined-with-grade-0-1-diabetic-foot-by-wagner-classification-and-acute-ischemic-stroke
#8
C-H Li, Y Chen, C-H Zhang, Z Dong, Z Wang, S-N Zhao, Y-X Wang, Z-Y Lv, P-L Zhang
OBJECTIVE: To evaluate the safety and efficacy of rt-PA intravenous thrombolytic treatment for patients with diabetic foot (DF) and acute ischemic stroke. PATIENTS AND METHODS: A retrospective analysis was performed on 76 patients admitted between June 2012 to December 2015 presenting with acute ischemic stroke and Grade 0-1 DF a (Wagner classification). The treatment group consisted of 44 patients who received rt-PA intravenous thrombolytic treatment, while 32 cases in the control group did not...
December 2016: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/28027191/intentional-intra-arterial-injection-of-heroin-a-case-report
#9
Joji Suzuki, Erin S Valenti
Intravenous injection of drugs is associated with a host of medical complications, notably soft-tissue infections. On the contrary, intra-arterial injections of drugs have also been reported, largely restricted to inadvertent injections. Here we describe a patient who engaged in repeated intra-arterial injections of heroin when she exhausted most of her venous access, and presented acutely with a radial artery occlusion requiring thrombolytic therapy. Clinicians should have a high index of suspicion for intra-arterial injection in injection drug users who present with limb pain, ischemia, and motor/sensory deficits...
December 23, 2016: Journal of Addiction Medicine
https://www.readbyqxmd.com/read/28025592/mortality-related-risk-factors-in-high-risk-pulmonary-embolism-in-the-icu
#10
Begüm Ergan, Recai Ergün, Taner Çalışkan, Kutlay Aydın, Murat Emre Tokur, Yusuf Savran, Uğur Koca, Bilgin Cömert, Necati Gökmen
Introduction. We sought to identify possible risk factors associated with mortality in patients with high-risk pulmonary embolism (PE) after intensive care unit (ICU) admission. Patients and Methods. PE patients, diagnosed with computer tomography pulmonary angiography, were included from two ICUs and were categorized into groups: group 1 high-risk patients and group 2 intermediate/low-risk patients. Results. Fifty-six patients were included. Of them, 41 (73.2%) were group 1 and 15 (26.7%) were group 2. When compared to group 2, need for vasopressor therapy (0 vs 68...
2016: Canadian Respiratory Journal: Journal of the Canadian Thoracic Society
https://www.readbyqxmd.com/read/28011405/platelet-to-lymphocyte-ratio-as-a-novel-marker-of-in-hospital-and-long-term-adverse-outcomes-among-patients-with-acute-pulmonary-embolism-a-single-center-large-scale-study
#11
Elif Hande Ozcan Cetin, Mehmet Serkan Cetin, Ugur Canpolat, Ahmet Akdi, Dursun Aras, Ahmet Temizhan, Sinan Aydogdu
BACKGROUND: The interaction of platelets with leukocytes is a well-known process both in progression and prognosis of acute pulmonary embolism (PE). Recently, platelet to lymphocyte ratio (PLR) is emerged as an indirect inflammatory indicator which was shown to be associated with adverse cardiovascular events in various clinical conditions, including acute PE. However, the long-term prognostic value of PLR in acute PE has not been investigated thoroughly. Therefore, we aimed to assess the impact of PLR on both in-hospital and long-term adverse outcomes in acute PE...
December 10, 2016: Thrombosis Research
https://www.readbyqxmd.com/read/28005024/a-global-perspective-on-mechanical-prosthetic-heart-valve-thrombosis-diagnostic-and-therapeutic-challenges
#12
Mustafa Ozan Gürsoy, Macit Kalçık, Mahmut Yesin, Süleyman Karakoyun, Emrah Bayam, Sabahattin Gündüz, Mehmet Özkan
Prosthetic valve thrombosis is one of the major causes of primary valve failure, which can be life-threatening. Multimodality imaging is necessary for determination of leaflet immobilization, cause of underlying pathology (thrombus versus pannus or both), and whether thrombolytic therapy attempt in the patient would be successful or surgery is needed. Current guidelines for the management of prosthetic valve thrombosis lack definitive class I recommendations due to lack of randomized controlled trials, and usually leave the choice of treatment to the clinician's experience...
December 2016: Anatolian Journal of Cardiology
https://www.readbyqxmd.com/read/28000492/successful-thrombolytic-therapy-in-a-patient-with-congenital-corrected-transposition-of-the-great-arteries
#13
Selcuk Ozturk, Fatma Erdem, Serkan Ozturk, Selim Ayhan
OBJECTIVE: The aim of this report is to emphasize the importance of thrombolytic therapy in selected patients, such as those with congenital heart defects in whom a coronary artery anomaly can be observed. CASE REPORT: We present here a 63 year-old female patient who was admitted to our emergency department with ST segment elevation myocardial infarction and a history of a congenital heart defect. We treated the patient successfully with thrombolytic therapy instead of primary percutaneous intervention, because of the suspicion of a coronary artery anomaly...
November 2016: Acta Medica Academica
https://www.readbyqxmd.com/read/27991996/simple-prediction-model-for-unfavorable-outcome-in-ischemic-stroke-after-intravenous-thrombolytic-therapy
#14
Daniel Amitrano, Ivan Rocha Ferreira da Silva, Bernardo B Liberato, Valéria Batistella, Janaina Oliveira, Osvaldo J M Nascimento
Objective: We aimed to develop a model to predict unfavorable outcome in patients with acute ischemic stroke treated with intravenous thrombolytic therapy (IVT), based on simple variables present on admission. Methods: Retrospective analysis of acute ischemic stroke patients treated with IVT in a hospital in Rio de Janeiro. Clinical and radiographic variables were selected for analysis. Multivariate logistic regression was used to develop a predictive model. Results: We analyzed a total of 82 patients...
December 2016: Arquivos de Neuro-psiquiatria
https://www.readbyqxmd.com/read/27990080/systemic-thrombolysis-for-pulmonary-embolism-a-review
#15
Colleen Martin, Kristine Sobolewski, Patrick Bridgeman, Daniel Boutsikaris
The authors review the evidence behind the use of thrombolytic therapy in patients with massive or submassive pulmonary embolism. Concurrent heparin therapy and the management of bleeding episodes are also discussed.
December 2016: P & T: a Peer-reviewed Journal for Formulary Management
https://www.readbyqxmd.com/read/27989078/intravenous-recombinant-tissue-plasminogen-activator-therapy-for-acute-basilar-artery-ischemic-stroke-following-transfemoral-transcatheter-aortic-valve-implantation
#16
Nicholas J Montarello, Adam J Nelson, Samuel L Sidharta, Stephen G Worthley
Transcatheter aortic valve implantation (TAVI) can now be considered a standard of care for inoperable and high-risk surgical patients with severe aortic stenosis, and its uptake worldwide is rapidly increasing. Indeed, many centers performing the procedure have now moved towards treating intermediate-risk patients with TAVI rather than referring them for surgical aortic valve replacement. Although the incidence of peri-procedural acute and subacute stroke following TAVI has fallen to 2-5%, its occurrence can be life-threatening and life-changing, and every effort must be made to improve patient outcome should stroke occur...
January 2016: Journal of Heart Valve Disease
https://www.readbyqxmd.com/read/27984314/medical-management-of-pump-related-thrombosis-in-patients-with-continuous-flow-left-ventricular-assist-devices-a-systematic-review-and-meta-analysis
#17
Geetanjali Dang, Narendranath Epperla, Vijayadershan Mupiddi, Natasha Sahr, Amy Pan, Pippa Simpson, Lisa Baumann Kreuziger
Pump thrombosis is a dreaded complication of left ventricular assist device (LVADs). We completed a systematic review to evaluate the efficacy and complications associated with medical management of LVAD thrombosis. Databases were searched using the terms "vad*" or "ventricular assist device" or "heart assist device" and "thrombus" or "thrombosis" or "thromboembolism". Of 2383 manuscripts, 49 articles met the inclusion criteria. The risk of partial or no resolution of LVAD thrombosis did not significantly differ between thrombolytic and non-thrombolytic regimens (OR 0...
December 13, 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
https://www.readbyqxmd.com/read/27984007/inferior-vena-cava-filters-in-elderly-patients-with-stable-acute-pulmonary-embolism
#18
Paul D Stein, Fadi Matta, Mary J Hughes
BACKGROUND: Patients aged >60 years with pulmonary embolism who were stable and did not require thrombolytic therapy were shown to have a somewhat lower in-hospital all-cause mortality with vena cava filters. In this investigation we further assess mortality with filters in stable elderly patients. METHODS: In-hospital all-cause mortality according to use of inferior vena cava filters was assessed from the National (Nationwide) Inpatient Sample, 2003-2012, in: 1) All patients with pulmonary embolism; 2) All with pulmonary embolism who had none of the comorbid conditions listed in the Charlson Comorbidity Index; 3) Patients with a primary (first-listed) diagnosis of pulmonary embolism, and 4) Patients with a primary diagnosis of pulmonary embolism and none of the comorbid conditions listed in the Charlson Comorbidity Index...
October 29, 2016: American Journal of Medicine
https://www.readbyqxmd.com/read/27974991/increased-blood-pressure-variability-is-associated-with-worse-neurologic-outcome-in-acute-anterior-circulation-ischemic-stroke
#19
Adam de Havenon, Alicia Bennett, Gregory J Stoddard, Gordon Smith, Haimei Wang, Jana Wold, Lee Chung, David L Tirschwell, Jennifer J Majersik
Background. Although research suggests that blood pressure variability (BPV) is detrimental in the weeks to months after acute ischemic stroke, it has not been adequately studied in the acute setting. Methods. We reviewed acute ischemic stroke patients from 2007 to 2014 with anterior circulation stroke. Mean blood pressure and three BPV indices (standard deviation, coefficient of variation, and successive variation) for the intervals 0-24, 0-72, and 0-120 hours after admission were correlated with follow-up modified Rankin Scale (mRS) in ordinal logistic regression models...
2016: Stroke Research and Treatment
https://www.readbyqxmd.com/read/27970168/tct-781-safety-and-outcomes-of-catheter-directed-thrombolytic-therapy-in-high-risk-pulmonary-embolism
#20
Tyler Bloomer, Pete Fong, Michael McDaniel, Breck Sandvall, Henry Liberman, Chandan Devireddy, Wissam Jaber
No abstract text is available yet for this article.
November 1, 2016: Journal of the American College of Cardiology
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