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Intravenous thrombolysis

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https://www.readbyqxmd.com/read/27907956/intensive-care-management-of-the-endovascular-stroke-patient
#1
Julian Bösel
Acute ischemic stroke caused by the occlusion of large brain vessels can be treated effectively by mechanical thrombectomy, as proved by recent strong and consistent evidence from high-quality randomized trials. This new era of endovascular stroke treatment, however, poses particular challenges that go far beyond the so far gold standard of intravenous thrombolysis alone. Because these stroke patients usually present with severe neurologic deficits, may be unstable from cardiac or pulmonary instability, have to endure an invasive intervention of sometimes long duration, may suffer complications and require close postinterventional follow-up, they often demand intensive care measures...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27904545/treatment-of-recurrent-prosthetic-mitral-valve-thrombosis-with-reteplase-a-report-of-four-cases
#2
Neda Behzadnia, Babak Sharif Kashani, Arda Kiani, Atefe Abedini, Seyed Reza Seyedi, Hossein Zargham Ahmadi, Farah Naghash Zadeh, Atefeh Fakharian
Thrombosis is a life threatening complications of prosthetic mitral valves and is associated with high morbidity and mortality. Even in presence of systemic anticoagulation prosthetic valve thrombosis has an incidence of 0.5% to 8%. Recurrent prosthetic valve thrombosis and the resulting thrombotic occlusion require re-establishment of blood flow across the valve. While surgical repair is considered the classic first line treatment option for prosthetic valve thrombosis, intravenous thrombolysis has emerged as an acceptable alternative for the first episode of prosthetic valve thrombosis...
2016: Tanaffos
https://www.readbyqxmd.com/read/27894313/identifying-the-barriers-and-enablers-for-a-triage-treatment-and-transfer-clinical-intervention-to-manage-acute-stroke-patients-in-the-emergency-department-a-systematic-review-using-the-theoretical-domains-framework-tdf
#3
REVIEW
Louise E Craig, Elizabeth McInnes, Natalie Taylor, Rohan Grimley, Dominique A Cadilhac, Julie Considine, Sandy Middleton
BACKGROUND: Clinical guidelines recommend that assessment and management of patients with stroke commences early including in emergency departments (ED). To inform the development of an implementation intervention targeted in ED, we conducted a systematic review of qualitative and quantitative studies to identify relevant barriers and enablers to six key clinical behaviours in acute stroke care: appropriate triage, thrombolysis administration, monitoring and management of temperature, blood glucose levels, and of swallowing difficulties and transfer of stroke patients in ED...
November 28, 2016: Implementation Science: IS
https://www.readbyqxmd.com/read/27889194/usefulness-of-thromboelastography-in-the-detection-and-management-of-tissue-plasminogen-activator-associated-hyperfibrinolysis
#4
Francesca Rosafio, Laura Vandelli, Guido Bigliardi, Francesco Cavallieri, Maria Luisa Dell'Acqua, Livio Picchetto, Andrea Zini
Rotation thromboelastometry is a viscoelastometric method that provides a rapid assessment of a patient's hemostatic processes in emergency settings, allowing prompt identification of specific coagulation abnormalities. Its results thus might guide targeted replacement therapy in hemorrhagic conditions, in case of platelet or coagulation factor deficiency, or hyperfibrinolysis, which is difficult to identify otherwise. Although currently used in emergency and traumatic surgery, there are limited data about thromboelastometry in ischemic stroke, particularly in monitoring the coagulative response to recombinant tissue plasminogen activator after intravenous thrombolysis (IVT)...
November 23, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/27885484/the-impact-of-cerebral-microbleeds-on-intracerebral-hemorrhage-and-poor-functional-outcome-of-acute-ischemic-stroke-patients-treated-with-intravenous-thrombolysis-a-systematic-review-and-meta-analysis
#5
REVIEW
Shuang Wang, Yan Lv, Xin Zheng, Jing Qiu, Hui-Sheng Chen
It is still controversial whether pre-existing cerebral microbleeds (CMBs) increase the risks of intracranial hemorrhage (ICH) and poor functional outcome (PFO) in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT). Therefore, we performed a systematic review and meta-analysis to determine the impact of CMBs on ICH and PFO of AIS patients with IVT. We searched PubMed, EMBASE and Web of Science from inception to August 3, 2016, with language restriction in English. We included studies that reported the relationship between CMBs and ICH or PFO after thrombolysis...
November 24, 2016: Journal of Neurology
https://www.readbyqxmd.com/read/27881425/relationship-between-language-preference-and-intravenous-thrombolysis-among-acute-ischemic-stroke-patients
#6
Betty Luan Erfe, Khawja Ahmeruddin Siddiqui, Lee H Schwamm, Nicte I Mejia
BACKGROUND: Approximately 20% of the US population primarily speaks a language other than English at home. Yet the effect of language preference on treatment of acute ischemic stroke (AIS) patients remains unknown. We aimed to evaluate the influence of language preference on AIS patients' receipt of intravenous (IV) thrombolysis. METHODS AND RESULTS: We analyzed data from 3894 AIS patients who participated in the American Heart Association "Get With The Guidelines(®)-Stroke" program at our hospital from January 1, 2003 to April 30, 2014...
November 23, 2016: Journal of the American Heart Association
https://www.readbyqxmd.com/read/27871433/regional-variation-in-acute-stroke-care-organisation
#7
Paula Muñoz Venturelli, Thompson Robinson, Pablo M Lavados, Verónica V Olavarría, Hisatomi Arima, Laurent Billot, Maree L Hackett, Joyce Y Lim, Sandy Middleton, Octavio Pontes-Neto, Bin Peng, Liying Cui, Lily Song, Gillian Mead, Caroline Watkins, Ruey-Tay Lin, Tsong-Hai Lee, Jeyaraj Pandian, H Asita de Silva, Craig S Anderson
BACKGROUND: Few studies have assessed regional variation in the organisation of stroke services, particularly health care resourcing, presence of protocols and discharge planning. Our aim was to compare stroke care organisation within middle- (MIC) and high-income country (HIC) hospitals participating in the Head Position in Stroke Trial (HeadPoST). METHODS: HeadPoST is an on-going international multicenter crossover cluster-randomized trial of 'sitting-up' versus 'lying-flat' head positioning in acute stroke...
December 15, 2016: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/27866732/impact-of-a-direct-admission-stroke-pathway-on-delays-of-admission-care-and-rates-of-intravenous-thrombolysis
#8
REVIEW
C Mouthon-Reignier, I Bonnaud, M Gaudron, S Vannier-Bernard, J-F Bodin, J-P Cottier, B De Toffol, S Debiais
INTRODUCTION: This study examined the impact of a "direct potential thrombolysis" pathway with direct admission to a neurological stroke unit (SU) on delays of admission, stroke care and proportion of patients with ischemic stroke (IS) treated with intravenous (IV) rtPA. METHODS: This prospective study included all patients admitted in the intensive SU for potential thrombolysis over a 2-month period. Data collected included the time of symptom onset, mode of transport, National Institutes of Health Stroke Scale (NIHSS) score on arrival, delays of care, delays of imaging and modalities, diagnosis and therapeutic data...
November 17, 2016: Revue Neurologique
https://www.readbyqxmd.com/read/27865697/sulfonylurea-pretreatment-and-in-hospital-use-does-not-impact-acute-ischemic-strokes-ais-outcomes-following-intravenous-thrombolysis
#9
Georgios Tsivgoulis, Nitin Goyal, Sulaiman Iftikhar, Ramin Zand, Jason J Chang, Lucas Elijovich, Anne W Alexandrov, Marc D Malkoff, Andrei V Alexandrov
BACKGROUND AND PURPOSE: Preliminary studies have indicated that sulfonylurea drugs (SUD) may confer protection against cerebral swelling and hemorrhagic transformation in severe acute ischemic stroke (AIS). We sought to determine whether pretreatment and in-hospital use of SUD may be associated with better outcomes in diabetic AIS patients treated with intravenous thrombolysis (IVT). SUBJECTS AND METHODS: We analyzed consecutive diabetic AIS patients treated with IVT during a 3-year period...
November 16, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/27864581/prognostic-value-of-diffusion-weighted-imaging-dwi-apparent-diffusion-coefficient-adc-in-patients-with-hyperacute-cerebral-infarction-receiving-rt-pa-intravenous-thrombolytic-therapy
#10
Hai-Jing Sui, Cheng-Gong Yan, Zhen-Guo Zhao, Qing-Ke Bai
BACKGROUND The aim of this study was to investigate the potential value of apparent diffusion coefficient (ADC) of diffusion-weighted imaging (DWI) in the prognosis of patients with hyperacute cerebral infarction (HCI) receiving intravenous thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA). MATERIAL AND METHODS From June 2012 to June 2015, 58 cases of HCI (<6 h) undergoing rt-PA intravenous thrombolytic therapy (thrombolysis group) and 70 cases of HCI (<6 h) undergoing conventional antiplatelet and anticoagulant therapy (control group) in the same period were collected...
November 19, 2016: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
https://www.readbyqxmd.com/read/27862667/prognostic-significance-of-proteinuria-in-stroke-patients-treated-with-intravenous-thrombolysis
#11
H Gensicke, A A Frih, D Strbian, A Zini, A Pezzini, V Padjen, M Haueter, D J Seiffge, L Mäkitie, C Traenka, L Poli, N Martinez-Majander, J Putaala, L H Bonati, G Sibolt, G Giovannini, S Curtze, L Beslac-Bumbasirevic, L Vandelli, P A Lyrer, P J Nederkoorn, T Tatlisumak, S T Engelter
BACKGROUND AND PURPOSE: Proteinuria and estimated glomerular filtration rate (eGFR) are indicators of renal function. Whether proteinuria better predicts outcome than eGFR in stroke patients treated with intravenous thrombolysis (IVT) remains to be determined. METHODS: In this explorative multicenter IVT register based study, the presence of urine dipstick proteinuria (yes/no), reduced eGFR (<60 ml/min/1.73 m(2) ) and the coexistence of both with regard to (i) poor 3-month outcome (modified Rankin Scale score 3-6), (ii) death within 3 months and (iii) symptomatic intracranial hemorrhage (ECASS-II criteria) were compared...
November 10, 2016: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/27862464/randomized-assessment-of-imatinib-in-patients-with-acute-ischaemic-stroke-treated-with-intravenous-thrombolysis
#12
N Wahlgren, M Thorén, B Höjeberg, T-B Käll, A-C Laska, C Sjöstrand, J Höijer, H Almqvist, S Holmin, A Lilja, L Fredriksson, D Lawrence, U Eriksson, N Ahmed
BACKGROUND: Imatinib, a tyrosine kinase inhibitor, has been shown to restore blood-brain barrier integrity and reduce infarct size, haemorrhagic transformation and cerebral oedema in stroke models treated with tissue plasminogen activator. We evaluated the safety of imatinib, based on clinical and neuroradiological data, and its potential influence on neurological and functional outcomes. METHODS: A phase II randomized trial was performed in patients with acute ischaemic stroke treated with intravenous thrombolysis...
November 14, 2016: Journal of Internal Medicine
https://www.readbyqxmd.com/read/27861540/thrombolysis-in-stroke-within-30-minutes-results-of-the-acute-brain-care-intervention-study
#13
Sanne M Zinkstok, Ludo F Beenen, Jan S Luitse, Charles B Majoie, Paul J Nederkoorn, Yvo B Roos
BACKGROUND AND PURPOSE: Time is brain: benefits of intravenous thrombolysis (IVT) in ischemic stroke last for 4.5 hours but rapidly decrease as time progresses following symptom onset. The goal of the Acute Brain Care (ABC) intervention study was to reduce the door-to-needle time (DNT) to ≤30 minutes by optimizing in-hospital stroke treatment. METHODS: We performed a single-centre before (pre-intervention period: 2000-2005) versus after (post-intervention period: 2006-2012) comparison in a cohort of consecutive patients treated with IVT...
2016: PloS One
https://www.readbyqxmd.com/read/27859971/frequency-and-outcome-of-total-anterior-circulation-strokes-without-intracranial-large-vessel-occlusion
#14
E Giralt-Steinhauer, A Ois, S Abilleira, X Urra, P Cardona-Portela, M Gomis, M Castellanos, C Molina, J Martí-Fàbregas, A Pellisé, D Cànovas, M Gómez-Choco, J Kuprinski, D Cocho, J Roquer
BACKGROUND AND PURPOSE: The percentage of patients with clinical total anterior circulation infarct (TACI) syndrome treated with reperfusion therapies in the absence of intracranial large-vessel occlusion (ILVO) was determined and their characteristics and outcome are described. METHODS: Data from a population-based, prospective, externally audited registry of all stroke patients treated with intravenous thrombolysis (IVT) and endovascular therapies in Catalonia from January 2011 to December 2013 were used...
November 10, 2016: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/27847771/emergent-double-barrel-bypass-shortly-after-intravenous-administration-of-recombinant-tissue-plasminogen-activator-for-acute-ischemic-stroke
#15
Joon-Ho Choi, Hyun-Seok Park
Although intravenous recombinant tissue plasminogen activator (IV rt-PA) is effective in many cases of acute ischemic stroke, the neurologic symptoms can worsen after IV rt-PA because of sustained vessel occlusion. For such cases, several reperfusion modalities are available, including intra-arterial thrombolysis (IAT), carotid endarterectomy, and superficial temporal artery-middle cerebral artery (STA-MCA) bypass. Invasive procedures, such as major surgery, should be generally avoided within 24 hours after the administration of IV rt-PA...
September 2016: Journal of Cerebrovascular and Endovascular Neurosurgery
https://www.readbyqxmd.com/read/27844035/intravenous-thrombolysis-in-acute-ischemic-stroke-after-dabigatran-reversal-with-idarucizumab-a-case-report
#16
Johannes Sebastian Mutzenbach, Slaven Pikija, Ferdinand Otto, Ursula Halwachs, Friedrich Weymayr, Johann Sellner
Much excitement has been generated with the approval of idarucizumab, a humanized monoclonal antigen-binding antibody fragment that is capable of reversing the anticoagulant activity of dabigatran. Here, we describe our initial experience of using tissue plasminogen activator (tPA) in an acute posterior circulation ischemic stroke after dabigatran reversal with idarucizumab. Both treatments were well tolerated and no hemorrhagic or procoagulatory complications were observed. We propose that the option of dabigatran reversal needs to be considered for contemporary treatment concepts of acute ischemic stroke...
November 2016: Annals of Clinical and Translational Neurology
https://www.readbyqxmd.com/read/27834751/stroke-thrombolysis-in-a-centralized-and-a-decentralized-system-helsinki-and-telemedical-project-for-integrative-stroke-care-network
#17
Gordian J Hubert, Atte Meretoja, Heinrich J Audebert, Turgut Tatlisumak, Florian Zeman, Sandra Boy, Roman L Haberl, Markku Kaste, Peter Müller-Barna
BACKGROUND AND PURPOSE: Intravenous thrombolysis with tissue-type plasminogen activator (tPA) for acute ischemic stroke is more effective when delivered early. Timely delivery is challenging particularly in rural areas with long distances. We compared delays and treatment rates of a large, decentralized telemedicine-based system and a well-organized, large, centralized single-hospital system. METHODS: We analyzed the centralized system of the Helsinki University Central Hospital (Helsinki and Province of Uusimaa, Finland, 1...
November 10, 2016: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27834750/baseline-predictors-of-poor-outcome-in-patients-too-good-to-treat-with-intravenous-thrombolysis
#18
Syed F Ali, Khawja Siddiqui, Hakan Ay, Scott Silverman, Aneesh Singhal, Anand Viswanathan, Natalia Rost, Michael Lev, Lee H Schwamm
BACKGROUND AND PURPOSE: Several studies have reported poor outcomes in patients too good to treat with intravenous thrombolysis because of mild or rapidly improving symptoms. We sought to determine baseline clinical and imaging predictors of poor outcome in these patients. METHODS: Among 3950 consecutive stroke admissions (2009-2015) in our local Get With the Guidelines-Stroke database, 632 patients presented ≤4.5 hours and did not receive tissue-type plasminogen activator, with 380 of 632 (60...
November 10, 2016: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27822079/intravenous-recombinant-tissue-plasminogen-activator-for-acute-ischemic-stroke-a-feasibility-and-safety-study
#19
Elyar Sadeghi-Hokmabadi, Mehdi Farhoudi, Aliakbar Taheraghdam, Mazyar Hashemilar, Daryous Savadi-Osguei, Reza Rikhtegar, Kaveh Mehrvar, Ehsan Sharifipour, Parisa Youhanaee, Reshad Mirnour
BACKGROUND: In developing countries, intravenous thrombolysis (IVT) is available at a limited number of centers. This study aimed to assess the feasibility and safety of IVT at Tabriz Imam Reza Hospital. METHODS: In a prospective study, over a 55-month period, any patient at the hospital for whom stroke code had been activated was enrolled in the study. Data on demographic characteristics, stroke risk factors, admission blood pressure, blood tests, findings of brain computed tomography (CT) scans, time of symtom onset, time of arrival to the emergency department, time of stroke code activation, time of CT scan examination, and the time of recombinant tissue plasminogen activator administration were recorded...
2016: International Journal of General Medicine
https://www.readbyqxmd.com/read/27821473/mechanical-thrombectomy-in-patients-with-medical-contraindications-for-intravenous-thrombolysis-a-prospective-observational-study
#20
María Alonso de Leciñana, Patricia Martínez-Sánchez, Andrés García-Pastor, Michal M Kawiorski, Patricia Calleja, Borja E Sanz-Cuesta, Fernando Díaz-Otero, Remedios Frutos, Fernando Sierra-Hidalgo, Gerardo Ruiz-Ares, Eduardo Fandiño, Exuperio Díez-Tejedor, Antonio Gil-Nuñez, Blanca Fuentes
BACKGROUND AND PURPOSE: The present study was conducted with the objective of evaluating the safety of primary mechanical thrombectomy (MT) in patients with large vessel occlusion (LVO) stroke and comorbidities that preclude treatment with IV thrombolysis (IVT), compared with patients who received standard IVT treatment followed by MT. Secondary objectives were to analyse the recanalization rate and outcomes. METHODS: A prospective observational multicenter study (FUN-TPA) that recruited patients treated within 4...
November 7, 2016: Journal of Neurointerventional Surgery
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