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thrombolytics in stroke

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https://www.readbyqxmd.com/read/28935502/outcomes-of-nonagenarians-with-acute-ischemic-stroke-treated-with-intravenous-thrombolytics
#1
Réza Behrouz, Jaime Masjuán-Vallejo, Rocío Vera, Joshua Z Willey, Mickael Zedet, Solène Moulin, Charlotte Cordonnier, Catharina J M Klijn, Karin Kanselaar, Maaike Dirks, Brian Silver, Muhib Khan, Mahmoud R Azarpazhooh, Daniel A Godoy, Christine Roffe, Lizz Paley, Benjamin D Bray, Craig J Smith, Mario Di Napoli
BACKGROUND: Nonagenarians are under-represented in thrombolytic trials for acute ischemic stroke (AIS). The effectiveness of intravenous thrombolytics in nonagenarians in terms of safety and outcome is not well established. MATERIALS AND METHODS: We used a multinational registry to identify patients aged 90 years or older with good baseline functional status who presented with AIS. Differences in outcomes-disability level at 90 days, frequency of symptomatic intracerebral hemorrhage (sICH), and mortality-between patients who did and did not receive thrombolytics were assessed using multivariable logistic regression, adjusted for prespecified prognostic factors...
September 18, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28934363/sex-related-differences-in-the-risk-factors-for-in-hospital-mortality-and-outcomes-of-ischemic-stroke-patients-in-rural-areas-of-taiwan
#2
Cheung-Ter Ong, Yi-Sin Wong, Sheng-Feng Sung, Chi-Shun Wu, Yung-Chu Hsu, Yu-Hsiang Su, Ling-Chien Hung
BACKGROUND AND PURPOSE: Sex-related differences in the clinical presentation and outcomes of stroke patients are issues that have attracted increased interest from the scientific community. The present study aimed to investigate sex-related differences in the risk factors for in-hospital mortality and outcome in ischemic stroke patients. METHODS: A total of 4278 acute ischemic stroke patients admitted to a stroke unit between January 1, 2007 and December 31, 2014 were included in the study...
2017: PloS One
https://www.readbyqxmd.com/read/28929979/pharmacists-as-care-providers-for-stroke-patients-a-systematic-review
#3
Jade E Basaraba, Michelle Picard, Kirsten George-Phillips, Tania Mysak
BACKGROUND: Pharmacists have become an integral member of the multidisciplinary team providing clinical patient care in various healthcare settings. Although evidence supporting their role in the care of patients with other disease states is well-established, minimal literature has been published evaluating pharmacist interventions in stroke patients. The purpose of this systematic review is to summarize the evidence evaluating the impact of pharmacist interventions on stroke patient outcomes...
September 20, 2017: Canadian Journal of Neurological Sciences. le Journal Canadien des Sciences Neurologiques
https://www.readbyqxmd.com/read/28926782/enterprise-stent-in-recanalizing-non-acute-atherosclerotic-intracranial-internal-carotid-artery-occlusion
#4
Xiaofei Wang, Zhigang Wang, Yong Ji, Xuan Ding, Yizheng Zang, Chengwei Wang
OBJECTIVE: To investigate the safety and effectiveness of recanalization in non-acute occlusion of intracranial internal carotid arteries using the flexible Enterprise self-expanding stent. PATIENTS AND METHODS: From June 2014 to June 2016, 12 consecutive patients with non-acute occlusion of intracranial internal carotid arteries received endovascular recanalization with Enterprise stenting. All patients received medication for anti-platelet aggregation therapy before and after the operation...
June 27, 2017: Clinical Neurology and Neurosurgery
https://www.readbyqxmd.com/read/28925023/fibrinolysis-from-blood-to-the-brain
#5
Robert L Medcalf
We all know about classical fibrinolysis, how plasminogen activation by either tissue-type plasminogen activator (t-PA) or urokinase-type plasminogen activator (u-PA) promotes fibrin breakdown, and how this process was harnessed for the therapeutic removal of blood clots. While this is still perfectly true and still applicable to thromboembolic conditions today, another dimension to this system came to light over two decades ago that implicated the plasminogen activating system in a context far removed from the dissolution of blood clots...
September 19, 2017: Journal of Thrombosis and Haemostasis: JTH
https://www.readbyqxmd.com/read/28905212/hub-and-spoke-stroke-network-in-the-veneto-region-a-retrospective-study-investigating-the-effectiveness-of-the-stroke-pathway-and-trends-over-time
#6
L Nardetto, B Giometto, G Moretto, D Mantoan, M Saia
After recognizing the pivotal role played by stroke unit (SU) admission in reducing mortality and dependency in stroke patients, the need to organize and monitor stroke networks has become an increasingly essential aspect of stroke care. We conducted a retrospective study of stroke patients admitted to hospitals in the Veneto region from 2007 to 2015 in order to evaluate the effectiveness of the stroke pathway and trends over time. Between 2007 and 2015, 61,062 stroke patients were discharged from Veneto hospitals: they were more frequently female, females were older than males, and had higher intrahospital mortality and a lower probability of undergoing systemic thrombolysis...
September 13, 2017: Neurological Sciences
https://www.readbyqxmd.com/read/28900446/endothelial-progenitor-cells-for-ischemic-stroke-update-on-basic-research-and-application
#7
REVIEW
Shaohua Liao, Chunxia Luo, Bingzhen Cao, Huaiqiang Hu, Suxia Wang, Huili Yue, Lin Chen, Zhenhua Zhou
Ischemic stroke is one of the leading causes of human death and disability worldwide. So far, ultra-early thrombolytic therapy is the most effective treatment. However, most patients still live with varying degrees of neurological dysfunction due to its narrow therapeutic time window. It has been confirmed in many studies that endothelial progenitor cells (EPCs), as a kind of adult stem cells, can protect the neurovascular unit by repairing the vascular endothelium and its secretory function, which contribute to the recovery of neurological function after an ischemic stroke...
2017: Stem Cells International
https://www.readbyqxmd.com/read/28886856/outcome-of-patients-receiving-thrombolytic-therapy-while-on-rivaroxaban-for-nonvalvular-atrial-fibrillation-from-rivaroxaban-once-daily-oral-direct-factor-xa-inhibition-compared-with-vitamin-k-antagonism-for-prevention-of-stroke-and-embolism-trial-in-atrial
#8
Sean T Chen, Anne S Hellkamp, Richard C Becker, Scott D Berkowitz, Günter Breithardt, Keith A A Fox, Werner Hacke, Jonathan L Halperin, Graeme J Hankey, Kenneth W Mahaffey, Christopher C Nessel, Jonathan P Piccini, Daniel E Singer, Manesh R Patel
The safety of intravenous thrombolysis in patients taking rivaroxaban has not been well established. We retrospectively analyzed the outcomes of all patients who received thrombolytic therapy in the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF). A review of medical and adverse event records for patients receiving thrombolytic therapy while enrolled in ROCKET AF was performed to determine their baseline characteristics, indications for thrombolysis, and type of agent used...
August 7, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28881141/elongated-plant-virus-based-nanoparticles-for-enhanced-delivery-of-thrombolytic-therapies
#9
Andrzej Stanislaw Pitek, Yunmei Wang, Sahil Gulati, Huiyun Gao, Phoebe L Stewart, Daniel I Simon, Nicole F Steinmetz
Thrombotic cardiovascular disease, including acute myocardial infarction, ischemic stroke, and venous thromboembolic disease, is the leading cause of morbidity and mortality worldwide. While reperfusion therapy with thrombolytic agents reduces mortality from acute myocardial infarction and disability from stroke, thrombolysis is generally less effective than mechanical reperfusion and is associated with fatal intra-cerebral hemorrhage in up to 2-4% of patients. To address these limitations, we propose the tobacco mosaic virus (TMV)-based platform technology for targeted delivery of thrombolytic therapies...
September 7, 2017: Molecular Pharmaceutics
https://www.readbyqxmd.com/read/28873991/thrombolytic-removal-of-intraventricular-hemorrhage-in-treatment-of-severe-stroke-results-of-the-clot-lysis-evaluating-accelerated-resolution-of-intraventricular-hemorrhage-phase-iii-trial
#10
Carlos M Alvarez, Robert M Starke, Ricardo J Komotar, E Sander Connolly
No abstract text is available yet for this article.
July 1, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28872451/incidence-of-seizure-in-stroke-patients-treated-with-recombinant-tissue-plasminogen-activator-a-systematic-review-and-meta-analysis
#11
Alain Lekoubou, Jean Joël Awoumou, André Pascal Kengne
Background Recombinant tissue plasminogen activator is the only FDA-approved thrombolytic agent for acute stroke treatment. However, there are concerns that recombinant tissue plasminogen activator may increase the risk of seizures (including early and late seizures). Aims We performed a systematic review to assess the incidence of seizures and the association of recombinant tissue plasminogen activator with seizure occurrence. Summary of review We searched major databases for articles published between 1995 and February 2016...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28867523/drip-and-ship-thrombolytic-therapy-for-acute-ischemic-stroke
#12
Ichiro Deguchi, Satoko Mizuno, Shinya Kohyama, Norio Tanahashi, Masaki Takao
BACKGROUND: Neuroendovascular therapy is a common treatment for patients with acute ischemic stroke of the anterior circulation who fail to respond to recombinant tissue plasminogen activator. However, although most hospitals can provide recombinant tissue plasminogen activator therapy, many cannot perform neuroendovascular therapy. Thus, use of a drip-and-ship treatment-liaison system allowing recombinant tissue plasminogen activator-treated patients to be transferred to facilities offering neuroendovascular therapy is important...
August 31, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28864991/evaluating-safety-of-thrombolysis-in-chronic-kidney-disease-patients-presenting-with-pulmonary-embolism-using-propensity-score-matching
#13
Brijesh Patel, Naveen Sablani, Mahek Shah, Lohit Garg, Manyoo Agarwal, Sahil Agrawal, Susan Steigerwalt, Raman Dusaj
To assess the safety of thrombolytic therapy in chronic kidney disease (CKD) patients who present with pulmonary embolism (PE). We used the Nationwide Inpatient Sample Database to identify patients who underwent thrombolysis for PE between 2010 and 2014. The patients were divided into two groups: (1) No CKD and (2) CKD. Patients with and without CKD were matched using 1:1 propensity score matching and a caliper width of 0.01. The primary outcomes were in-hospital mortality and hemorrhagic events. The secondary outcomes were blood transfusions, length of stay and total hospitalization charge...
September 1, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28855859/%C3%AE-2-adrenergic-receptor-mediated-hif-1%C3%AE-upregulation-mediates-blood-brain-barrier-damage-in-acute-cerebral-ischemia
#14
Yanyun Sun, Xi Chen, Xinyu Zhang, Xianzhi Shen, Mengwei Wang, Xiaona Wang, Wen-Cao Liu, Chun-Feng Liu, Jie Liu, Wenlan Liu, Xinchun Jin
Disruption of the blood brain barrier (BBB) within the thrombolytic time window is an antecedent event to intracerebral hemorrhage in ischemic stroke. Our recent studies showed that 2-h cerebral ischemia induced BBB damage in non-infarcted area and secreted matrix metalloproteinase-2 (MMP-2) accounted for this disruption. However, the factors that affect MMP-2 secretion and regulate BBB damage remains unknown. Since hypoxia-inducible factor-1 alpha (HIF-1α) was discovered as a mater regulator in hypoxia, we sought to investigate the roles of HIF-1α in BBB damage as well as the factors regulating HIF-1α expression in the ischemic brain...
2017: Frontiers in Molecular Neuroscience
https://www.readbyqxmd.com/read/28813741/a-case-of-an-acute-myocardial-infarction-post-thrombolytic-treatment-of-ischemic-stroke-a-management-dilemma
#15
Kalyan Wagle, Jimmy Yee, Vishesh Kumar, Amornpol Anuwatworn, Tomasz Stys, Adam Stys, Christopher Stanton
Acute ischemic stroke and myocardial infarction are emergency clinical events that require prompt intervention. Concurrent occurrence of both events magnifies the complexity of the clinical management. We present a case of a patient who presented with acute ischemic stroke, complicated by acute myocardial infarction shortly after thrombolytic was administered. This case highlights the importance of individualization of management especially in complex cases where there are no clear specific guidelines to follow...
August 2017: South Dakota Medicine: the Journal of the South Dakota State Medical Association
https://www.readbyqxmd.com/read/28806993/successful-intravenous-thrombolysis-for-ischemic-stroke-after-reversal-of-dabigatran-anticoagulation-with-idarucizumab-a-case-report
#16
Sergio Agosti, Laura Casalino, Enrico Rocci, Gabriele Zaccone, Eugenia Rota
BACKGROUND: Non-vitamin K antagonist oral anticoagulants, including dabigatran, are currently widely used for the prevention of stroke and systemic embolism in patients with non-valvular atrial fibrillation. Recently, idarucizumab, a monoclonal antibody fragment for immediate reversal of dabigatran-induced anticoagulation, has been introduced into the market to be used in life-threatening bleeding or urgent surgery, allowing for rapid normalization of clotting parameters. The use of idarucizumab is not yet well established in patients presenting with acute ischemic stroke on dabigatran who are candidates for thrombolytic therapy...
August 15, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28802751/acute-management-of-hemostasis-in-patients-with-neurological-injury
#17
REVIEW
M Irem Baharoglu, Anneke Brand, Maria M Koopman, Marinus Vermeulen, Yvo B W E M Roos
Neurological injuries can be divided into those with traumatic and nontraumatic causes. The largest groups are traumatic brain injury (TBI) and nontraumatic stroke. TBI patients may present with intracranial hemorrhages (contusions, or subdural or epidural hematomas). Strokes are ischemic or hemorrhagic. In all these disorders, thrombosis and hemostasis play a major role. Treatment aims to either cease bleeding and/or restore perfusion. We reviewed hemostatic and thrombolytic therapies in patients with neurological injuries by MEDLINE and EMBASE search using various key words for neurological disorders and hemostatic therapies restricted to English language and human adults...
July 13, 2017: Transfusion Medicine Reviews
https://www.readbyqxmd.com/read/28802542/the-impact-of-intravenous-alteplase-on-long-term-patient-survival-the-georgia-coverdell-acute-stroke-registry-s-experience
#18
Moges S Ido, Michael R Frankel, Ike S Okosun, Richard B Rothenberg
INTRODUCTION: Intravenous alteplase reduces disability and improves functionality among acute ischemic stroke patients. Two decades after its approval, only a small fraction of patients get the treatment, and demonstrating its impact on mortality may make a strong case for its wider use. This study assessed the impact of thrombolytic treatment by alteplase on 1-year mortality and readmission among acute ischemic stroke patients. METHOD: The 2008-2013 Georgia Coverdell Acute Stroke Registry data were linked with the 2008-2013 hospital discharge and the 2008-2014 death data in Georgia...
July 31, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28798356/low-serum-albumin-level-as-a-predictor-of-hemorrhage-transformation-after-intravenous-thrombolysis-in-ischemic-stroke-patients
#19
Ruiwen Che, Xiaoqin Huang, Wenbo Zhao, Fang Jiang, Longfei Wu, Zhen Zhang, Tingting Bian, Qingfeng Ma, Zhipeng Yu, Qian Zhang, Kai Dong, Haiqing Song, Xunming Ji
Serum albumin levels has been shown to predict outcome in ischemic stroke patients. We aimed to investigate the relationship between serum albumin levels and hemorrhagic transformation (HT) after intravenous thrombolysis (IVT) in patients with acute stroke. 428 patients receiving intravenous rt-PA therapy were included from 2013 to 2016 and were categorized into two groups: low level (<35 mmol/L) and normal level (35-55 mmol/L) group. Demographic, clinical and laboratory information, HT and functional outcomes were analyzed...
August 10, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28796540/recent-advances-in-targeted-delivery-of-tissue-plasminogen-activator-for-enhanced-thrombolysis-in-ischemic-stroke
#20
Masumeh Zamanlu, Mehdi Farhoudi, Morteza Eskandani, Javad Mahmoudi, Jaleh Barar, Mohammad Rafi, Yadollah Omidi
Tissue plasminogen activator (tPA) is the only FDA approved medical treatment for the ischemic stroke. However, it associates with some inevitable limitations, including: short therapeutic window, extremely short half-life and low penetration in large clots. Systemic administration (i.v./i.a.) may lead to complications such as hemorrhagic conversion in the brain and relapse in the form of re-occlusion. Furthermore, ultrasound has been utilized in combination with contrast agents, echogenic liposome, microspheres or nanoparticles carrying tPA for improving thrombolysis - an approach that has resulted in slight improvement of tPA delivery and facilitated thrombolysis...
August 10, 2017: Journal of Drug Targeting
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