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thrombolytics in stroke

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https://www.readbyqxmd.com/read/27932197/crucial-role-of-carotid-ultrasound-for-the-rapid-diagnosis-of-hyperacute-aortic-dissection-complicated-by-cerebral-infarction-a-case-report-and-literature-review
#1
Eglė Sukockienė, Kristina Laučkaitė, Antanas Jankauskas, Dalia Mickevičienė, Giedrė Jurkevičienė, Antanas Vaitkus, Edgaras Stankevičius, Kęstutis Petrikonis, Daiva Rastenytė
Aortic dissection is a life-threatening rare condition that may virtually present by any organ system dysfunction, the nervous system included. Acute cerebral infarction among multiple other neurological and non-neurological presentations is part of this acute aortic syndrome. Rapid and correct diagnosis is of extreme importance keeping in mind the possibility of thrombolytic treatment if a patient with a suspected ischemic stroke arrives to the Emergency Department within a 4.5-h window after symptom onset...
November 19, 2016: Medicina
https://www.readbyqxmd.com/read/27928063/could-advanced-drug-delivery-systems-be-the-future-in-cardiovascular-revascularization-medicine
#2
Marco Zuin, Gianluca Rigatelli, Giuseppe Faggian, Roberto L'Erario, Mauro Chinaglia, Loris Roncon
Acute myocardial infarction, stroke and pulmonary embolism required a prompt revascularization to restore the normal blood flow as soon as possible. Fibrinolytic treatment has gradually become both dated and underused in the treatment of acute myocardial infarction, after the wide diffusion of cathlab and percutaneous transluminal coronary angioplasty. Conversely, the use of systemic thrombolysis remained a benchmark in the treatment of both ischemic stroke and massive pulmonary embolism. In daily clinical practice, the use of thrombolytic agents is often limited by absolute and/or relative contraindications and possible adverse events after the drug administration, as intracranial and/or extracranial bleeding events...
December 6, 2016: Vascular
https://www.readbyqxmd.com/read/27924212/combined-administration-of-the-gpvi-fc-fusion-protein-revacept-with-low-dose-thrombolysis-in-the-treatment-of-stroke
#3
Andreas Reimann, Zhongmin Li, Silvia Goebel, Julia Fassbender, Hans-Peter Holthoff, Meinrad Gawaz, Götz Münch, Martin Ungerer
BACKGROUND: Thrombolytic therapy with recombinant tissue plasminogen activator (rtPA) remains the only approved medication for acute ischemic stroke, but incurs significant bleeding risks. Therefore, approaches to combine lower doses of thrombolytic therapy with other effective drugs aim at improving efficacy and reducing bleeding rates. We examined the safety and therapeutic effects of various dosings of rtPA, either alone or combined with glycoprotein VI-Fc fusion protein (GPVI-Fc, Revacept) on experimental stroke in mice...
January 2016: Heart International
https://www.readbyqxmd.com/read/27920715/intra-arterial-mechanical-thrombectomy-an-effective-treatment-for-ischemic-stroke-caused-by-endocarditis
#4
Olafur Sveinsson, Lars Herrman, Staffan Holmin
Patients with stroke secondary to infectious endocarditis have a high in-hospital morbidity and mortality, with only one-third becoming functionally independent. Infective endocarditis is usually considered a relative contraindication to thrombolytic therapy. We describe 3 consecutive cases of acute middle cerebral artery occlusion due to infective endocarditis, who were all successfully treated with intra-arterial mechanical thrombectomy using the Solitaire device. From this limited experience, mechanical thrombectomy could be used as an effective acute treatment for ischemic stroke in patients with infective endocarditis...
September 2016: Case Reports in Neurology
https://www.readbyqxmd.com/read/27905388/-prognostic-biochemical-markers-of-thrombolytic-therapy-in-ischemic-stroke
#5
O A Kicherova, L I Reikhert, V G Skorikova, S A Semeshko
AIM: To assess prognostic value of endothelial dysfunction, endogenous intoxication and oxidative stress in the acute period of ischemic stroke (II) at the stage of making a decision on using thrombolytic therapy (TLT) as well during the follow-up in order to personalize treatment. MATERIAL AND METHODS: The study included 57 patients stratified into control group 1 (n=29) and TLT group (n=28). Contents of C-reactive protein (Nsrb), matrixmetalloproteinase-9 (MMP-9) erythrocyte lipid peroxidation products were measured in the blood of patients...
2016: Zhurnal Nevrologii i Psikhiatrii Imeni S.S. Korsakova
https://www.readbyqxmd.com/read/27904619/modeling-of-in-hospital-mortality-determinants-in-myocardial-infarction-patients-with-and-without-stroke-a-national-study-in-iran
#6
Ali Ahmadi, Arsalan Khaledifar, Koorosh Etemad
BACKGROUND: The data and determinants of mortality due to stroke in myocardial infarction (MI) patients are unknown. This study was conducted to evaluate the differences in risk factors for hospital mortality among MI patients with and without stroke history. MATERIALS AND METHODS: This study was a retrospective, cohort study; 20,750 new patients with MI from April, 2012 to March, 2013 were followed up and their data were analyzed according to having or not having the stroke history...
2016: Journal of Research in Medical Sciences: the Official Journal of Isfahan University of Medical Sciences
https://www.readbyqxmd.com/read/27899756/coagulation-testing-in-acute-ischemic-stroke-patients-taking-non-vitamin-k-antagonist-oral-anticoagulants
#7
Jan C Purrucker, Kirsten Haas, Timolaos Rizos, Shujah Khan, Sven Poli, Peter Kraft, Christoph Kleinschnitz, Rainer Dziewas, Andreas Binder, Frederick Palm, Sebastian Jander, Hassan Soda, Peter U Heuschmann, Roland Veltkamp
BACKGROUND AND PURPOSE: In patients who present with acute ischemic stroke while on treatment with non-vitamin K antagonist oral anticoagulants (NOACs), coagulation testing is necessary to confirm the eligibility for thrombolytic therapy. We evaluated the current use of coagulation testing in routine clinical practice in patients who were on NOAC treatment at the time of acute ischemic stroke. METHODS: Prospective multicenter observational RASUNOA registry (Registry of Acute Stroke Under New Oral Anticoagulants; February 2012-2015)...
November 29, 2016: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/27898168/the-association-between-t-pa-administration-and-in-hospital-mortality-following-acute-ischemic-stroke-in-puerto-rican-patients
#8
Kevin Shah, Samuel Kohrman, Suehyb Alkhatib, Juan González, Fernando Santiago, Marcia Varella, Juan Zevallos
OBJECTIVE: Despite being the standard of care, thrombolytic therapy with tissue plasminogen activator (t-PA) is currently administered to only 5% of acute ischemic stroke (AIS) patients in the United States. Published scientific information regarding both the use of t-PA for AIS in Hispanic patients and its impact on short-term mortality is scarce. The objectives of this study are to investigate, among Puerto Rican patients hospitalized with AIS, the rate of t-PA administration, and the risk of in-hospital mortality in patients who received t-PA vs...
December 2016: Puerto Rico Health Sciences Journal
https://www.readbyqxmd.com/read/27890301/thrombolytic-therapy-associated-acute-myocardial-infarction-in-patients-with-acute-ischemic-stroke-a-treatment-dilemma
#9
Chih-Jen Yang, Po-Chuan Chen, Chin-Sheng Lin, Chia-Lin Tsai, Shih-Hung Tsai
Acute myocardial infarction (AMI) is uncommon in the acute phase of acute ischemic stroke (AIS) and occurs in approximately 1% of the population. Here, we report a paradoxical case of AMI during tissue plasminogen activator (t-PA) infusion for AIS. We review and analyze the previously reported cases. We found that only patients with AMI which occurred after thrombolytic therapy for AIS who received an adequate combination of anticoagulation plus percutaneous coronary intervention survived their events. Several mechanisms have been proposed for the development of AMI after thrombolytic therapy...
November 22, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27887976/the-establishment-of-a-telestroke-service-using-multimodal-ct-imaging-decision-assistance-turning-on-the-fog-lights
#10
REVIEW
Jelle Demeestere, Claire Sewell, Jennifer Rudd, Timothy Ang, Louise Jordan, James Wills, Carlos Garcia-Esperon, Ferdinand Miteff, Venkatesh Krishnamurthy, Neil Spratt, Longting Lin, Andrew Bivard, Mark Parsons, Christopher Levi
Telestroke services have been shown to increase stroke therapy access in rural areas. The implementation of advanced CT imaging for patient assessment may improve patient selection and detection of stroke mimics in conjunction with telestroke. We implemented a telestroke service supported by multimodal CT imaging in a rural hospital in Australia. Over 21months we conducted an evaluation of service activation, thrombolysis rates and use of multimodal imaging to assess the feasibility of the service. Rates of symptomatic intracranial haemorrhage and 90-day modified Rankin Score were used as safety outcomes...
November 22, 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/27878926/the-effects-of-dwi-infarct-lesion-volume-on-dwi-flair-mismatch-is-there-a-need-for-size-stratification
#11
Seyedmehdi Payabvash, Shayandokht Taleb, John C Benson, Jeffrey B Rykken, Mark C Oswood, Alexander M McKinney, Benjamin Hoffman
BACKGROUND: The lack of fluid-attenuated inversion-recovery (FLAIR) hyperintensity in areas of diffusion-weighted imaging (DWI) high signal, or DWI-FLAIR mismatch, is a potential imaging biomarker for timing of stroke onset. We aimed to determine the effects of DWI infarct lesion volume on DWI-FLAIR mismatch and its accuracy for identification of strokes within intravenous (IV) the thrombolytic therapy window. METHODS: Acute ischemic stroke patients with magnetic resonance imaging scan within 12 hours of witnessed stroke were included...
November 23, 2016: Journal of Neuroimaging: Official Journal of the American Society of Neuroimaging
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
#12
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/27847681/language-barriers-between-physicians-and-patients-are-not-associated-with-thrombolysis-of-stroke-mimics
#13
Sara K Rostanski, Olajide Williams, Joshua I Stillman, Randolph S Marshall, Joshua Z Willey
BACKGROUND: Acute stroke is a time-sensitive condition in which rapid diagnosis must be made in order for thrombolytic treatment to be administered. A certain proportion of patients who receive thrombolysis will be found on further evaluation to have a diagnosis other than stroke, so-called "stroke mimics." Little is known about the role of language discordance in the emergency department diagnosis of acute ischemic stroke. METHODS: This is a retrospective analysis of all acute ischemic stroke patients who received IV tissue plasminogen activator (tPA) in our emergency department between July 2011 and December 2015...
October 2016: Neurology. Clinical Practice
https://www.readbyqxmd.com/read/27834297/identification-of-rate-limiting-steps-in-the-provision-of-thrombolytics-for-acute-ischemic-stroke
#14
Elise L Metts, Abby M Bailey, Kyle A Weant, Stephanie B Justice
BACKGROUND: Tissue plasminogen activator (tPA) is the only pharmacotherapy shown to improve outcomes in acute ischemic stroke. The American Heart Association (AHA) recommends a door-to-needle (DTN) time of <60 minutes in at least 50% of patients presenting with acute ischemic stroke. OBJECTIVE: The purpose of this study was to analyze the possible barriers that may delay tPA administration within the emergency department (ED) of an academic medical center. METHODS: A retrospective chart review was conducted from February 2011 to October 2013...
November 9, 2016: Journal of Pharmacy Practice
https://www.readbyqxmd.com/read/27830895/thrombolysis-for-acute-deep-vein-thrombosis
#15
REVIEW
Lorna Watson, Cathryn Broderick, Matthew P Armon
BACKGROUND: Standard treatment for deep vein thrombosis aims to reduce immediate complications. Use of thrombolysis or clot dissolving drugs could reduce the long-term complications of post-thrombotic syndrome (PTS) including pain, swelling, skin discolouration, or venous ulceration in the affected leg. This is the third update of a review first published in 2004. OBJECTIVES: To assess the effects of thrombolytic therapy and anticoagulation compared to anticoagulation alone for the management of people with acute deep vein thrombosis (DVT) of the lower limb as determined by the effects on pulmonary embolism, recurrent venous thromboembolism, major bleeding, post-thrombotic complications, venous patency and venous function...
November 10, 2016: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/27829963/are-there-disparities-in-thrombolytic-treatment-and-mortality-in-acute-ischemic-stroke-in-the-hispanic-population-living-in-border-states-versus-nonborder-states
#16
Ameer E Hassan, David H Kassel, Malik M Adil, Wondwossen G Tekle, Adnan I Qureshi
BACKGROUND: Recent studies have found an underutilization of hospital in-patient care for coronary artery disease in Hispanics living in border states. OBJECTIVE: To identify acute treatment disparities in acute ischemic stroke Hispanic patients and determine the effect of such disparity on patient outcomes. METHODS: We identified Hispanic and non-Hispanic acute ischemic stroke patients from the Nationwide Inpatient Sample-2011 data files...
October 2016: Journal of Vascular and Interventional Neurology
https://www.readbyqxmd.com/read/27821831/-delayed-diagnosis-of-aortic-dissection-following-thrombolytic-therapy-in-a-patient-with-acute-ischemic-stroke-report-of-a-case
#17
Yosuke Miyamoto, Zenichi Masuda, Yasuhiro Kotani, Suguru Tarui, Yosuke Kuroko, Yasuhiro Fujii, Susumu Ozawa, Shunji Sano
Diagnosis of aortic dissection complicating cerebral ischemic stroke is difficult. A 60-year-old patient presented at an emergency department of a hospital with a sudden development of left-sided weakness, but without chest pain. During administration of recombinant tissue plasminogen activator with diagnosis of cerebral infarction, he developed symptomatic hypotension and was transferred to our hospital. His chest computed tomography revealed Stanford type A aortic dissection. Replacement of the ascending aorta and aortic arch was successfully performed on the 4th day...
November 2016: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/27816964/therapeutic-effects-of-umbilical-cord-blood-plasma-in-a-rat-model-of-acute-ischemic-stroke
#18
Jongman Yoo, Han-Soo Kim, Jin-Ju Seo, Jang-Hyoun Eom, Seong-Mi Choi, Sanghyun Park, Dong-Wook Kim, Dong-Youn Hwang
Umbilical cord blood plasma (UCB-PL) contains various cytokines, growth factors, and immune modulatory factors that regulate the proliferation and function of immune cells and adult stem cells. Despite its therapeutic potential, the effects of UCB-PL treatment in conditions of ischemic brain injury have yet to be investigated. In this study, we demonstrated that both behavioral and structural impairments resulting from ischemic brain injury were significantly prevented/reversed after intravenous administration of UCB-PL relative to the vehicle control...
October 31, 2016: Oncotarget
https://www.readbyqxmd.com/read/27815374/treatment-with-tpa-in-the-golden-hour-and-the-shape-of-the-4-5-hour-time-benefit-curve-in-the-national-us-get-with-the-guidelines-stroke-population
#19
Joon-Tae Kim, Gregg C Fonarow, Eric E Smith, Mathew J Reeves, Digvijaya D Navalkele, James C Grotta, Maria V Grau-Sepulveda, Adrian F Hernandez, Eric D Peterson, Lee H Schwamm, Jeffrey L Saver
BACKGROUND: -Earlier tissue plasminogen activator (tPA) treatment improves ischemic stroke outcome, but aspects of the time-benefit relationship still not well delineated are: 1) the degree of additional benefit accrued with treatment in the first 60 minutes after onset, and 2) the shape of the time-benefit curve through 4.5 hours. METHODS: -We analyzed acute ischemic stroke patients treated with intravenous tPA within 4.5 hours of onset from the Get With The Guidelines-Stroke US national program...
November 4, 2016: Circulation
https://www.readbyqxmd.com/read/27813042/red-blood-cell-distribution-width-is-an-independent-predictor-of-outcome-in-patients-undergoing-thrombolysis-for-ischemic-stroke
#20
Gianni Turcato, Manuel Cappellari, Luca Follador, Alice Dilda, Antonio Bonora, Massimo Zannoni, Chiara Bovo, Giorgio Ricci, Paolo Bovi, Giuseppe Lippi
An appropriate and timely management, including early diagnosis and accurate prognostication, is the mainstay for managed care of patients with acute ischemic stroke. Since red blood cell distribution width (RDW) was found to be an independent predictor of clinical outcomes in patients with thrombotic disorders, we designed a retrospective observational study to investigate whether the RDW value may also retain predictive significance in stoke patients undergoing thrombolytic therapy. This retrospective study was based on all patients admitted to the Emergency Department (ED) of the University Hospital of Verona (Italy) with a diagnosis of ischemic stroke, who underwent systemic thrombolysis between January 2013 and June 2015...
November 3, 2016: Seminars in Thrombosis and Hemostasis
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