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Stroke AND thrombolysis

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https://www.readbyqxmd.com/read/29933207/multi-targeting-effects-of-a-new-synthetic-molecule-jm-20-in-experimental-models-of-cerebral-ischemia
#1
REVIEW
Yanier Nuñez-Figueredo, Jeney Ramírez-Sánchez, Gilberto L Pardo Andreu, Estael Ochoa-Rodríguez, Yamila Verdecia-Reyes, Diogo O Souza
Ischemic stroke is a major cause of death and disability worldwide. Thrombolysis by tissue plasminogen activator is the only pharmacological treatment approved for clinical practice, but has a narrow therapeutic window and poor efficacy when the cell death cascade is activated. Numerous drugs that are thought to protect neurons against injury have previously failed in human trials despite showing efficacy in experimental models of stroke. Herein, we reviewed the main pre-clinical results of the neuroprotective effects of JM-20, a new hybrid molecule, against brain ischemia...
February 12, 2018: Pharmacological Reports: PR
https://www.readbyqxmd.com/read/29932011/20-years-of-researching-stroke-through-audit
#2
Anthony G Rudd, Alex Hoffman, Lizz Paley, Benjamin Bray
Over the last 20 years, England, Wales and Northern Ireland have developed an audit programme that now encompasses nearly all patients admitted to hospital with a stroke. This article records and reviews some questions that have been answered using data from the audit: Is the rate of institutional care after rehabilitation a possible measure of outcome? Does stroke unit care in routine practice give the benefits shown in randomized controlled trials? How is the quality of stroke care affected by a patient's age and the time of their stroke? Do patient-reported measures match those obtained from the professionals recording of processes of care? How do the processes of care after stroke affect mortality? Is thrombolysis safe to use in patients over the age of 80? Do staffing levels matter? Does assessing the safety of swallowing really make a difference? Do clinicians make rational decisions about end-of-life care in patients with haemorrhage? Does socioeconomic status influence the risk of stroke, outcome after stroke and the quality of stroke care? How much does stroke really cost in England, Wales and Northern Ireland? The article concludes that this national audit has improved stroke care across the United Kingdom, has given answers to important questions that could not be answered in any other way and has shown that benefits found in research do generalize into real clinical benefits in day-to-day practice...
June 1, 2018: Clinical Rehabilitation
https://www.readbyqxmd.com/read/29931649/one-year-efficacy-and-safety-of-routine-prasugrel-in-patients-with-acute-coronary-syndromes-treated-with-percutaneous-coronary-intervention-results-of-the-prospective-rijnmond-collective-cardiology-research-study
#3
T Yetgin, E Boersma, P C Smits, A G de Vries, E Huijskens, F Zijlstra, M M J M van der Linden, R J M van Geuns
OBJECTIVE: To investigate 1‑year outcomes with routine prasugrel treatment after acute coronary syndrome (ACS) in a large-scale registry. METHODS: The Rijnmond Collective Cardiology Research registry is a prospective, observational study that enrolled 4,258 consecutive ACS patients treated with percutaneous coronary intervention (PCI) with 1‑year follow-up. Patients received prasugrel as first-choice antiplatelet agent, except for increased bleeding risk patients in which clopidogrel was recommended...
June 21, 2018: Netherlands Heart Journal
https://www.readbyqxmd.com/read/29930530/phase-1-trial-of-amnion-cell-therapy-for-ischemic-stroke
#4
Thanh G Phan, Henry Ma, Rebecca Lim, Christopher G Sobey, Euan M Wallace
Background: There is increasing interest in stem cell therapy as another treatment modality in stroke, particularly for patients who are unable to receive endovascular clot retrieval or thrombolysis therapies, or for whom standard treatment has failed. We have recently shown that human amniotic epithelial cells (hAECs) are effective in reducing infarct volume in different animal models of ischemic stroke, including in non-human primates. hAEC therapy attenuated infarct growth and/or promoted functional recovery, even when administered 1-3 days after the onset of stroke...
2018: Frontiers in Neurology
https://www.readbyqxmd.com/read/29929523/a-novel-design-process-for-selection-of-attributes-for-inclusion-in-discrete-choice-experiments-case-study-exploring-variation-in-clinical-decision-making-about-thrombolysis-in-the-treatment-of-acute-ischaemic-stroke
#5
Aoife De Brún, Darren Flynn, Laura Ternent, Christopher I Price, Helen Rodgers, Gary A Ford, Matthew Rudd, Emily Lancsar, Stephen Simpson, John Teah, Richard G Thomson
BACKGROUND: A discrete choice experiment (DCE) is a method used to elicit participants' preferences and the relative importance of different attributes and levels within a decision-making process. DCEs have become popular in healthcare; however, approaches to identify the attributes/levels influencing a decision of interest and to selection methods for their inclusion in a DCE are under-reported. Our objectives were: to explore the development process used to select/present attributes/levels from the identified range that may be influential; to describe a systematic and rigorous development process for design of a DCE in the context of thrombolytic therapy for acute stroke; and, to discuss the advantages of our five-stage approach to enhance current guidance for developing DCEs...
June 22, 2018: BMC Health Services Research
https://www.readbyqxmd.com/read/29929036/evaluation-of-common-housekeeping-proteins-under-ischemic-conditions-and-or-rt-pa-treatment-in-bend-3-cells
#6
Pau Comajoan, Carme Gubern, Gemma Huguet, Joaquín Serena, Elisabet Kádár, Mar Castellanos
Thrombolysis with recombinant tissue plasminogen activator (rt-PA) is the only pharmacological approved treatment for ischemic stroke, despite its associated increasing risk of hemorrhagic transformation. Since many of rt-PA effects in blood-brain barrier (BBB) are not well characterized, the study of protein changes in BBB cells after rt-PA administration may help to understand its adverse effects. Our aim was to analyze protein levels of four commonly used housekeeping proteins: β-Actin, α-Tubulin, GAPDH and HPRT in bEnd...
June 18, 2018: Journal of Proteomics
https://www.readbyqxmd.com/read/29928251/intravenous-thrombolysis-may-not-improve-clinical-outcome-of-acute-ischemic-stroke-patients-without-a-baseline-vessel-occlusion
#7
Huiqiao Tian, Mark W Parsons, Christopher R Levi, Xin Cheng, Richard I Aviv, Neil J Spratt, Timothy J Kleinig, Billy O'Brien, Kenneth S Butcher, Longting Lin, Jingfen Zhang, Qiang Dong, Chushuang Chen, Andrew Bivard
Background and Purpose: The benefit of thrombolysis in ischemic stroke patients without a visible vessel occlusion still requires investigation. This study tested the hypothesis that non-lacunar stroke patients with no visible vessel occlusion on baseline imaging would have a favorable outcome regardless of treatment with alteplase. Methods: We utilized a prospectively collected registry of ischemic stroke patients [the International Stroke Perfusion Imaging Registry (INSPIRE)] who had baseline computed tomographic perfusion and computed tomographic angiography...
2018: Frontiers in Neurology
https://www.readbyqxmd.com/read/29926575/-clinical-management-of-acute-stroke
#8
J Ly, P Maquet
Stroke management dramatically changed during the last decades. Evidence shows that an early admission in a stroke unit offers the best chance of recovery to the stroke patient. The most spectacular aspect of the stroke unit activity consists of the hyperacute diagnostic and therapeutic stroke procedures, including prompt neuroimaging, intravenous thrombolysis and mechanical thrombectomy.
May 2018: Revue Médicale de Liège
https://www.readbyqxmd.com/read/29925149/-combined-application-of-multi-parameter-semiquantitative-alberta-stroke-program-early-ct-score-to-assess-infarction-severity-in-acute-ischemic-stroke
#9
Z W Liu, Y Jiang, R Wang, J Lu, P Qi, R Y Cao, L Zhang, Z Y Shen, J Chen
Objective: To explore the significance of multi-parameter semiquantitative Alberta Stroke Program Early CT Score (ASPECTS) in detecting core infarction in acute ischemic stroke (AIS) patients. Methods: Twenty-one consecutive AIS patients from Beijing Hospital were retrospectively reviewed in this study from August 2016 to August 2017. All the patients presented within 6 hours since symptom onset.All the patients underwent one-stop dynamic whole brain 4D CTA-CTP scan before treatments (intravenous thrombolysis, mechanical thrombectomy, or other endovascular recanalization)...
June 5, 2018: Zhonghua Yi Xue za Zhi [Chinese medical journal]
https://www.readbyqxmd.com/read/29924046/generalization-of-the-right-acute-stroke-promotive-strategies-in-reducing-delays-of-intravenous-thrombolysis-for-acute-ischemic-stroke-a-meta-analysis
#10
Qiang Huang, Jing-Ze Zhang, Wen-Deng Xu, Jian Wu
The generalization of successful efforts for reducing time delays in intravenous thrombolysis (IVT) could help facilitate its utility and benefits in acute ischemic stroke (AIS) patients.We searched the PubMed and Embase databases for articles reporting interventions to reduce time delays in IVT, published between January 1995 and September 2017. The IVT rate was chosen as the primary outcome, while the compliance rates of onset-to-door time (prehospital delay) and door-to-needle time (in-hospital delay) within the targeted time frame were the secondary outcomes...
June 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29916129/depressive-symptoms-in-stroke-patients-treated-and-non-treated-with-intravenous-thrombolytic-therapy-a-1-year-follow-up-study
#11
Barbara Grabowska-Fudala, Krystyna Jaracz, Krystyna Górna, Izabela Miechowicz, Izabela Wojtasz, Jan Jaracz, Radosław Kaźmierski
INTRODUCTION: This is a prospective study, first to compare the frequency of depressive symptoms in stroke survivors treated, and non-treated, with intravenous thrombolysis and second, to explore relationships between post-stroke depression (PSD) and stroke treatment modalities, taking into account other possible determinants of PSD, including post-traumatic stress symptoms. METHODS: Groups of 73 thrombolysed and 73 non-thrombolysed patients matched for age and gender were examined at 3 and 12 months after discharge...
June 18, 2018: Journal of Neurology
https://www.readbyqxmd.com/read/29914709/sex-differences-in-the-evaluation-and-treatment-of-acute-ischaemic-stroke
#12
REVIEW
Cheryl Bushnell, Virginia J Howard, Lynda Lisabeth, Valeria Caso, Seana Gall, Dawn Kleindorfer, Seemant Chaturvedi, Tracy E Madsen, Stacie L Demel, Seung-Jae Lee, Mathew Reeves
With the greater availability of treatments for acute ischaemic stroke, including advances in endovascular therapy, personalised assessment of patients before treatment is more important than ever. Women have a higher lifetime risk of stroke; therefore, reducing potential sex differences in the acute stroke setting is crucial for the provision of equitable and fast treatment. Evidence indicates sex differences in prevalence and types of non-traditional stroke symptoms or signs, prevalence of stroke mimics, and door-to-imaging times, but no substantial differences in use of emergency medical services, stroke knowledge, eligibility for or access to thrombolysis or thrombectomy, or outcomes after either therapy...
July 2018: Lancet Neurology
https://www.readbyqxmd.com/read/29908420/ticagrelor-versus-clopidogrel-after-fibrinolytic-therapy-in-patients-with-st-elevation-myocardial-infarction-rationale-and-design-of-the-ticagrelor-in-patients-with-st-elevation-myocardial-infarction-treated-with-thrombolysis-treat-trial
#13
Otavio Berwanger, Jose C Nicolau, Antonio C Carvalho, Lixin Jiang, Shaun Goodman, Stephen J Nicholls, Alexander Parkhomenko, Oleg Averkov, Carlos Tajer, Germán Malaga, Jose F Kerr Saraiva, Francisco Fonseca, Helio P Guimaraes, Pedro G M de Barros E Silva, Lucas P Damiani, Denise M Paisani, Camila M R Lasagno, Carolina T Candido, Nanci Valeis, Diogo D F Moia, Leopoldo S Piegas, Christopher B Granger, Harvey White, Renato D Lopes
BACKGROUND: The safety and efficacy of ticagrelor in patients with ST-elevation myocardial infarction (STEMI) treated with fibrinolytic therapy remain uncertain. OBJECTIVES: The primary objective of the TicagRElor in pAtients with ST elevation myocardial infarction treated with Thrombolysis (TREAT) trial is to evaluate the short-term safety of ticagrelor when compared with clopidogrel in STEMI patients treated with fibrinolytic therapy. Key secondary objectives are to assess the safety and efficacy of ticagrelor compared with clopidogrel at 12-months...
March 3, 2018: American Heart Journal
https://www.readbyqxmd.com/read/29907609/effects-of-centralizing-acute-stroke-services-a-prospective-cohort-study
#14
Sidsel Hastrup, Soren P Johnsen, Thorkild Terkelsen, Heidi H Hundborg, Paul von Weitzel-Mudersbach, Claus Z Simonsen, Niels Hjort, Anette T Møller, Thomas Harbo, Marika S Poulsen, Noella Ruiz de Morales Ayudarte, Dorte Damgaard, Grethe Andersen
OBJECTIVE: To investigate the effects of centralizing the acute stroke services in the Central Denmark Region (CDR). METHODS: The CDR (1.3 million inhabitants) centralized acute stroke care from 6 to 2 designated acute stroke units with 7-day outpatient clinics. We performed a prospective "before-and-after" cohort study comparing all strokes from the CDR with strokes in the rest of Denmark to discover underlying general trends, adopting a difference-in-differences approach...
June 15, 2018: Neurology
https://www.readbyqxmd.com/read/29904443/critical-event-intervals-in-determining-candidacy-for-intravenous-thrombolysis-in-acute-stroke
#15
John S Garrett, Steven Sonnamaker, Yahya Daoud, Hao Wang, Dion Graybeal
Background: The aim of the study was to determine the optimal set point for the critical event benchmarks described in stroke guidelines and validate the ability of these goals to predict successful administration of intravenous thrombolysis within 60 min of hospital arrival. Methods: This was a retrospective cohort analysis of patients with acute ischemic stroke who received intravenous thrombolysis following presentation to the emergency department. The national benchmarks for time intervals associated with the completion of critical events required to determine candidacy for thrombolysis were evaluated for the ability to predict successful administration of thrombolysis within 60 min of hospital arrival...
July 2018: Journal of Clinical Medicine Research
https://www.readbyqxmd.com/read/29900414/development-and-validation-of-the-dutch-stroke-score-for-predicting-disability-and-functional-outcome-after-ischemic-stroke-a-tool-to-support-efficient-discharge-planning
#16
Inger R de Ridder, Simone A Dijkland, Maaike Scheele, Heleen M den Hertog, Maaike Dirks, Willeke F Westendorp, Paul J Nederkoorn, Diederik van de Beek, Gerard M Ribbers, Ewout W Steyerberg, Hester F Lingsma, Diederik Wj Dippel
Introduction: We aimed to develop and validate a prognostic score for disability at discharge and functional outcome at three months in patients with acute ischemic stroke based on clinical information available on admission. Patients and methods: The Dutch Stroke Score (DSS) was developed in 1227 patients with ischemic stroke included in the Paracetamol (Acetaminophen) In Stroke study. Predictors for Barthel Index (BI) at discharge ('DSS-discharge') and modified Rankin Scale (mRS) at three months ('DSS-3 months') were identified in multivariable ordinal regression...
June 2018: European stroke journal
https://www.readbyqxmd.com/read/29900412/the-economic-burden-of-stroke-care-in-england-wales-and-northern-ireland-using-a-national-stroke-register-to-estimate-and-report-patient-level-health-economic-outcomes-in-stroke
#17
Xiang-Ming Xu, Emma Vestesson, Lizz Paley, Anita Desikan, David Wonderling, Alex Hoffman, Charles DA Wolfe, Anthony G Rudd, Benjamin D Bray
Introduction: Stroke registries are used in many settings to measure stroke treatment and outcomes, but rarely include data on health economic outcomes. We aimed to extend the Sentinel Stroke National Audit Programme registry of England, Wales and Northern Ireland to derive and report patient-level estimates of the cost of stroke care. Methods: An individual patient simulation model was built to estimate health and social care costs at one and five years after stroke, and the cost-benefits of thrombolysis and early supported discharge...
March 2018: European stroke journal
https://www.readbyqxmd.com/read/29900409/estimating-the-number-of-uk-stroke-patients-eligible-for-endovascular-thrombectomy
#18
Peter McMeekin, Philip White, Martin A James, Christopher I Price, Darren Flynn, Gary A Ford
Introduction: Endovascular thrombectomy is a highly effective treatment for acute ischemic stroke due to large arterial occlusion. Routine provision will require major changes in service configuration and workforce. An important first step is to quantify the population of stroke patients that could benefit. We estimated the annual UK population suitable for endovascular thrombectomy using standard or advanced imaging for patient selection. Patients and methods: Evidence from randomised control trials and national registries was combined to estimate UK stroke incidence and define a decision-tree describing the endovascular thrombectomy eligible population...
December 2017: European stroke journal
https://www.readbyqxmd.com/read/29896430/prehospital-notification-procedure-improves-stroke-outcome-by-shortening-onset-to-needle-time-in-chinese-urban-area
#19
Sheng Zhang, Jungen Zhang, Meixia Zhang, Genlong Zhong, Zhicai Chen, Longting Lin, Min Lou
Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (rt-PA) can improve clinical outcome in eligible patients with acute ischemic stroke (AIS). However, its efficacy is strongly time-dependent. This study was aimed to examine whether prehospital notification by emergency medical service (EMS) providers could reduce onset to needle time (ONT) and improve neurological outcome in AIS patients who received IVT. We prospectively collected the consecutive clinical and time data of AIS patients who received IVT during one year after the initiation of prehospital notification procedure (PNP)...
June 2018: Aging and Disease
https://www.readbyqxmd.com/read/29896419/why-not-intravenous-thrombolysis-in-patients-with-recurrent-stroke-within-3-months
#20
REVIEW
Chuanjie Wu, Di Wu, Jian Chen, Chuanhui Li, Xunming Ji
Acute ischemic stroke continues to be a very severe disorder that has significant impact on human health. Its treatment options are limited and alteplase remains the only American Food and Drug Administration-approved drug for patients with acute ischemic stroke. Furthermore, intravenous thrombolysis remains substantially underutilized, because it has rigorous indications and contraindications. Most patients simply do not meet these criteria and cannot receive thrombolytic treatment. Guidelines in many countries currently include a history of stroke within months as one of the exclusion criteria for intravenous thrombolysis...
April 2018: Aging and Disease
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