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thrombolytics in stroke

Yuji Shono, Hiroshi Sugimori, Ryu Matsuo, Yoshihisa Fukushima, Yoshinobu Wakisaka, Junya Kuroda, Tetsuro Ago, Masahiro Kamouchi, Takanari Kitazono
Background The safety of antithrombotic therapy for patients with acute ischemic stroke harboring unruptured intracranial aneurysms remains unclear. Aims This study was performed to determine whether treatment with antiplatelets, anticoagulants, or intravenous thrombolytic agents is safe for patients with acute ischemic stroke and unruptured intracranial aneurysms. Methods Among 9149 patients with acute ischemic stroke enrolled in the Fukuoka Stroke Registry from June 2007 to December 2014, 8857 patients with data on cerebrovascular imaging and three-month outcomes were included in this study...
January 1, 2018: International Journal of Stroke: Official Journal of the International Stroke Society
Mingli He, Jin'e Wang, Qing Dong, Niu Ji, Pin Meng, Na Liu, Shan Geng, Sizhou Qin, Wenyan Xu, Chuantong Zhang, Dabo Li, Huamin Zhang, Jinping Zhu, Hua Qin, Rutai Hui, Yibo Wang
BACKGROUND: Building effective and efficient stroke care systems is a key step in improving prevention, treatment and rehabilitation of stroke. The aim of this study was to evaluate the effectiveness of this stroke system of care on stroke management during a 2-year follow-up. METHODS: A stroke system of care was developed from November 2009 to November 2010 in three townships in Ganyu County. Additional three matched townships were invited as controls. We first investigated the stroke incidence of these populations...
March 7, 2018: Journal of Epidemiology and Community Health
Emine Sekerdag, Ihsan Solaroglu, Yasemin Gursoy-Ozdemir
As a result of ischemia or hemorrhage, blood supply to neurons is disrupted which subsequently promotes a cascade of pathophysiological responses resulting in cell loss. Many mechanisms are involved solely or in combination in this disorder including excitotoxicity, mitochondrial death pathways, and the release of free radicals, protein misfolding, apoptosis, necrosis, autophagy and inflammation. Besides neuronal cell loss, damage to and loss of astrocytes as well as injury to white matter contributes also to cerebral injury...
March 1, 2018: Current Neuropharmacology
Aimen Moussaddy, Andrew M Demchuk, Michael D Hill
Acute stroke therapy has significantly evolved over the last two decades. The two main advances have been the approval of intravenous chemical thrombolysis in 1995, and the approval of intra-arterial mechanical thrombectomy in 2015. This has lead to significant improvement of functional outcomes in a disease known to be the first cause of disability worldwide. Subsequent studies have focused on identifying pre-treatment predictors of good treatment candidates, by developing biochemical and imaging biomarkers...
March 2, 2018: Neuropharmacology
András Folyovich, Dávid Biczó, Katalin Anna Béres-Molnár, Gergely Toldi
BACKGROUND: The critical period of stroke management lies between the disease onset and the time of the emergency call, relying on stroke-related knowledge of the population. Public campaigns play a role in spreading relevant health information. Due to the substantial expenses of these campaigns, the assessment of their efficiency is reasonable. METHODS: We assessed the number of thrombolytic treatments performed in Hungary, subjected to national media coverage and in particular in Budapest, being the location of the Stroke Day campaign, in the period between 2008 and 2015...
March 1, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Sheng-Feng Sung, Kuanchin Chen, Darren Philbert Wu, Ling-Chien Hung, Yu-Hsiang Su, Ya-Han Hu
OBJECTIVE: To reduce errors in determining eligibility for intravenous thrombolytic therapy (IVT) in stroke patients through use of an enhanced task-specific electronic medical record (EMR) interface powered by natural language processing (NLP) techniques. MATERIALS AND METHODS: The information processing algorithm utilized MetaMap to extract medical concepts from IVT eligibility criteria and expanded the concepts using the Unified Medical Language System Metathesaurus...
April 2018: International Journal of Medical Informatics
Drayton A Hammond, Laura Baumgartner, Craig Cooper, Elisabeth Donahey, Serena A Harris, Jessica M Mercer, Mandy Morris, Mona K Patel, Angela M Plewa-Rusiecki, Alia A Poore, Ryan Szaniawski, Deanna Horner
PURPOSE: To summarize selected meta-analyses and trials related to critical care pharmacotherapy published in 2017. The Critical Care Pharmacotherapy Literature Update (CCPLU) Group screened 32 journals monthly for impactful articles and reviewed 115 during 2017. Two meta-analyses and eight original research trials were reviewed here from those included in the monthly CCPLU. Meta-analyses on early, goal-directed therapy for septic shock and statin therapy for acute respiratory distress syndrome were summarized...
February 26, 2018: Journal of Critical Care
Raviraj Vankayala, Samantha R Corber, Jenny T Mac, Masaru P Rao, Mohammad Shafie, Bahman Anvari
Ischemic stroke occurs when a blood clot obstructs or narrows the arteries that supply blood to the brain. Currently, tissue plasminogen activator (tPA), a thrombolytic agent, is the only United States Food and Drug Administration (FDA)-approved pharmacologic treatment for ischemic stroke. Despite its effective usage, the major limitation of tPA that stems from its short half-life in plasma (≈5 min) is the potential for increased risk of hemorrhagic complications. To circumvent these limitations, herein, the first proof-of-principle demonstration of a theranostic nanoconstruct system derived from erythrocytes doped with the FDA-approved near-infrared (NIR) imaging agent, indocyanine green, and surface-functionalized with tPA is reported...
February 26, 2018: Macromolecular Bioscience
Andrew Bivard, Neil Spratt, Ferdinand Miteff, Christopher Levi, Mark William Parsons
Aim: The relative prognostic importance of modern imaging profiles compared with standard clinical characteristics is uncertain in acute stroke patients. In this study, we aimed to compare baseline multimodal CT imaging measures with known clinical predictors of patient outcome at 3 months [modified Rankin scale (mRS)]. Methods: We collected baseline, 24 h, and day 90 clinical and imaging data from acute ischemic stroke patients being assessed for thrombolytic therapy between 2010 and 2015 at a single center as part of a retrospective analysis...
2018: Frontiers in Neurology
Federico Pappalardo, Anna Mara Scandroglio, Azeem Latib
Extracorporeal membrane oxygenation is used for acute respiratory distress syndrome, refractory cardiogenic shock, and out-of-hospital cardiac arrest with uncertain neurological status, and, until recently, it was the only minimally invasive option to achieve biventricular support. However, extracorporeal membrane oxygenation increases left ventricular afterload and requires systemic anticoagulation, which is a major contraindication in the context of thrombolytic therapy following an ischaemic stroke. Conversely, the Impella heart pumps by design unload the ventricle and require minimal anticoagulation...
February 21, 2018: ESC Heart Failure
Ilya Bragin, Justine M Chen
Thrombocytopenia (platelet count: < 100,000/mm3 ) is considered a contraindication in the use of intravenous thrombolysis for acute ischemic stroke. Little literature exists regarding tissue plasminogen activator (tPA) usage in thrombocytopenic patients, especially in older patients. Age and stroke severity are major prognostic indicators of the risk of hemorrhagic transformation. The Stroke Prognostication using Age and NIH Stroke Scale (SPAN) index estimates a patient's risk of intracerebral hemorrhage (ICH) and clinical response to thrombolysis by combining age in years with the National Institutes of Health Stroke Scale (NIHSS) scores...
December 11, 2017: Curēus
Negar Asdaghi, Kefeng Wang, Maria A Ciliberti-Vargas, Carolina Marinovic Gutierrez, Sebastian Koch, Hannah Gardener, Chuanhui Dong, David Z Rose, Enid J Garcia, W Scott Burgin, Juan Carlos Zevallos, Tatjana Rundek, Ralph L Sacco, Jose G Romano
BACKGROUND AND PURPOSE: Mild stroke is the most common cause for thrombolysis exclusion in patients acutely presenting to the hospital. Thrombolysis administration in this subgroup is highly variable among different clinicians and institutions. We aim to study the predictors of thrombolysis in patients with mild ischemic stroke in the FL-PR CReSD registry (Florida-Puerto Rico Collaboration to Reduce Stroke Disparities). METHODS: Among 73 712 prospectively enrolled patients with a final diagnosis of ischemic stroke or TIA from January 2010 to April 2015, we identified 7746 cases with persistent neurological symptoms and National Institutes of Health Stroke Scale ≤5 who arrived within 4 hours of symptom onset...
March 2018: Stroke; a Journal of Cerebral Circulation
Kashif Waqar Faiz, Antje Sundseth, Bente Thommessen, Ole Morten Rønning
Background: Public campaigns focus primarily on stroke symptom and risk factor knowledge, but patients who correctly recognize stroke symptoms do not necessarily know the reason for urgent hospitalization. The aim of this study was to explore knowledge on stroke risk factors, symptoms and treatment options among acute stroke and transient ischemic attack patients. Methods: This prospective study included patients admitted to the stroke unit at the Department of Neurology, Akershus University Hospital, Norway...
2018: Vascular Health and Risk Management
Naveed Kamal, Neil Majmundar, Nitesh Damadora, Mohammad El-Ghanem, Rolla Nuoman, Irwin A Keller, Steven Schonfeld, Igor Rybinnik, Gaurav Gupta, Sudipta Roychowdry, Fawaz Al-Mufti
PURPOSE: The purpose of this study is to review the history of treatments for acute ischemic stroke, examine developments in endovascular therapy, and discuss the future of the management of acute ischemic stroke. METHODS: A selective review of recent clinical trials for the treatment of acute ischemic stroke was conducted. RESULTS: We reviewed completed trials of the management of acute ischemic stroke including intravenous thrombolytics, intraarterial thrombolytics, and thrombectomy...
February 8, 2018: British Journal of Neurosurgery
Benjamin R Kummer, Michael P Lerario, Babak B Navi, Adam C Ganzman, Daniel Ribaudo, Saad A Mir, Sammy Pishanidar, Tim Lekic, Olajide Williams, Hooman Kamel, Randolph S Marshall, George Hripcsak, Mitchell S V Elkind, Matthew E Fink
BACKGROUND:  Mobile stroke units (MSUs) reduce time to thrombolytic therapy in acute ischemic stroke. These units are widely used, but the clinical information systems underlying MSU operations are understudied. OBJECTIVE:  The first MSU on the East Coast of the United States was established at New York Presbyterian Hospital (NYP) in October 2016. We describe our program's 7-month pilot, focusing on the integration of our hospital's clinical information systems into our MSU to support patient care and research efforts...
January 2018: Applied Clinical Informatics
Nengpan Zhang, Chunlin Li, Dayong Zhou, Chen Ding, Yaqing Jin, Qingmei Tian, Xiangzhou Meng, Kefeng Pu, Yimin Zhu
Thrombosis, a critical event in blood vessels, not only is associated with myocardial infarction and stroke, but also accounts for considerable morbidity and mortality. Thrombolytic drugs are usually applied to the treatment of acute myocardial infarction, acute cerebral infarction and pulmonary embolism. However, thrombolytic drugs show limited efficacy in clinical practice because of the short half-life in plasma and systemic side effects. In this study, the cyclic RGD (cRGD) functionalized liposomes were prepared to encapsulate urokinase, a cheap and widely used thrombolytic drug in clinic and better thrombolysis efficacy was achieved...
February 9, 2018: Acta Biomaterialia
Rahsan Gocmen, Ethem Murat Arsava, Kader Karli Oguz, Mehmet Akif Topcuoglu
BACKGROUND AND AIMS: Intracranial internal carotid artery calcification (IICAC) is a frequent and readily available finding in acute stroke patients treated with intravenous (IV) tissue plasminogen activator (tPA). We aimed to investigate the effects of IICAC subtype (medial and intimal) on the response to IV tPA. METHODS: In this retrospective study, 91 (57% female, age 69 ± 13 years) consecutive acute anterior circulation stroke patients treated with IV tPA were included...
January 31, 2018: Atherosclerosis
Oluwaseun A Akinseye, Muhammad Shahreyar, Mark R Heckle, Rami N Khouzam
Acute ischemic stroke (AIS) and acute myocardial infarction (AMI) are both life-threatening medical conditions with narrow therapeutic time-window that carry grave prognosis if not addressed promptly. The acute management of both condition is well documented in the literature, however the management of a simultaneous presentation of both AIS and AMI is unclear. A delayed intervention of one infarcted territory for the other may result in permanent irreversible morbidity or disability, and even death. In addition, the use of antiplatelet and anticoagulants that are inherently part of an AMI management may increase the risk for hemorrhagic conversion associated with intravenous thrombolysis used in AIS, and the use of a thrombolytic in AIS increases the risk of cardiac wall rupture in the setting of an AMI...
January 2018: Annals of Translational Medicine
Alimu Wufuer, Atikaimu Wubuli, Peierdun Mijiti, Jun Zhou, Shabier Tuerxun, Jian Cai, Jianhua Ma, Xiaoning Zhang
Collateral circulation affects the prognosis of patients with acute ischemic stroke (AIS) treated by thrombolysis. The present study performed a systematic assessment of the impact of the collateral circulation status on the outcomes of patients receiving thrombolysis treatment. Relevant full-text articles from the Cochrane Library, Ovid, Medline, Embase and PubMed databases published from January 1, 2000 to November 1, 2016 were retrieved. The quality of the studies was assessed and data were extracted by 2 independent investigators...
January 2018: Experimental and Therapeutic Medicine
Hyun-Wook Nah, Dae-Hyun Kim, Myongjin Kang, Jae-Hyung Choi, Hyun-Seok Park, Jae-Kwan Cha
BACKGROUND: We sought to investigate whether early thrombolytic treatment can result in favorable functional outcome even in patients with large diffusion-weighted imaging (DWI) lesions. MATERIALS AND METHODS: We analyzed 566 patients who received intravenous alteplase within 4.5 hours from onset, initially underwent DWI and magnetic resonance angiography, and had acute infarction confined to anterior circulation. DWI lesion volumes were measured semiautomatically...
February 2, 2018: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
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