MedWorm: Thrombolytic Therapy

Interventional approaches to deep vein thrombosis

American Journal of Hematology — Wed, 08 Feb 2012 05:00:00 +0100

AbstractThe last decade has seen increased use of aggressive, catheter‐based methods of treating venous thromboembolism (DVT). In this article, we outline the risks, benefits, and uncertainties surrounding endovascular DVT therapies, describe clinical situations in which endovascular treatment options should reasonably be considered, and update the reader on new outcomes data that pertains to catheter‐based DVT interventions. Endovascular thrombolytic therapy is reasonable to perform for selected patients with DVT causing acute limb‐threatening circulatory compromise, acute IVC occlusion, or acute iliofemoral DVT for the purposes of limb salvage and relief of presenting DVT symptoms, and appears likely to prevent post‐thrombotic syndrome (PTS) in patients with proximal DVT. A multi...

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Is asymptomatic hemorrhagic transformation really innocuous?

Neurology — Mon, 06 Feb 2012 05:00:00 +0100

Conclusions: Our study shows that the odds of a worse outcome are increased by a factor of 2 in patients with asymptomatic HT compared with those without HT after acute ischemic stroke. (Source: Neurology)

Stereotactic Surgery Plus tPA Shrinks Clots in Stroke (CME/CE)

MedPage Today Meeting Coverage — Sun, 05 Feb 2012 20:19:06 +0100

NEW ORLEANS (MedPage Today) -- Reducing the size of an intracerebral hemorrhage through a minimally invasive surgical technique and thrombolytic therapy may help improve clinical outcomes, a phase II trial showed. (Source: MedPage Today Meeting Coverage)

Stroke Score May Predict if Clot Busters Will Work (CME/CE)

MedPage Today Cardiovascular — Sun, 05 Feb 2012 12:13:00 +0100

(MedPage Today) -- NEW ORLEANS — A tool used to predict outcomes in patients with acute ischemic strokes also may help predict the clinical response to IV thrombolytic therapy, researchers found. (Source: MedPage Today Cardiovascular)

Forearm Compartment Syndrome following Thrombolytic Therapy for Massive Pulmonary Embolism: A Case Report and Review of Literature

Advances in Pharmacological Sciences — Mon, 23 Jan 2012 18:36:31 +0100

In this report, we present a case of acute compartment syndrome of the right forearm in a 78 years old male patient following repeated attempts to secure an arterial line for initiating the thrombolytic therapy for the management of massive pulmonary embolism. The patient underwent urgent surgical decompression of the forearm compartments and thus managed to save his limb. (Source: Advances in Pharmacological Sciences)

Severe ischemia of lower limbs due to arteritis caused by HIV infection

Jornal Vascular Brasileiro — Wed, 18 Jan 2012 12:07:02 +0100

A isquemia aguda de membros pode se manifestar, embora de forma incomum, como consequência à vasculite associada ao vírus da imunodeficiência humana (HIV). O presente caso descreve a evolução de uma paciente soropositiva para o HIV, que apresentou quadro de isquemia distal bilateral, com diminuição da temperatura de terço distal das pernas e pés, dor intensa, cianose fixa de pododátilos e ausência de pulsos distais. Submetida ao tratamento com terapia trombolítica, apresentou sinais de lesões decorrentes da isquemia e lesão tecidual de reperfusão com perda tecidual em regiões distais dos dedos, porém com melhora dos sinais e sintomas dos membros inferiores. Trata-se de um caso raro na literatura em função da associação da vasculite com o HIV e do acometimento dos vaso...

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Fistula between right coronary artery vein graft and right atrium as an immediate complication of percutaneous coronary intervention

Catheterization and Cardiovascular Interventions — Tue, 10 Jan 2012 05:00:00 +0100

We report the first case of a fistula between SVG and the right atrium (RA) as an immediate complication after a percutaneous coronary intervention (PCI) in an 86‐year‐old female. She presented with inferior ST‐elevation myocardial infarction (STEMI) and was treated with thrombolytic therapy in a peripheral hospital, which was unsuccessful. PCI to SVG to the right coronary (RCA) was complicated by a fistula to RA. Cardiac magnetic resonance (CMR) confirmed the site of the fistula and also presence of a significant arteriovenous (AV) shunt. Reversal of anticoagulation had no effect on fistula closure. Therefore, a covered stent was deployed for closure of the fistula to avoid long‐term complications of the significant AV shunt. In summary, the diagnosis and appropriate management of...

Amount of ST wave resolution in patients with and without spontaneous coronary reperfusion in the infarct -related artery after primary PCI: an observational study.

Anadolu Kardiyol Der... — Wed, 04 Jan 2012 05:00:00 +0100

CONCLUSION: Mean ST wave resolution was lower in patients with spontaneous coronary reperfusion who were treated with primary PCI compared to their counterparts who did not have spontaneous coronary reperfusion on initial coronary angiography. PMID: 22214740 [PubMed - as supplied by publisher] (Source: Anadolu Kardiyol Der...)

Diabetics Benefit From Thrombolytic Therapy for Acute StrokeDiabetics Benefit From Thrombolytic Therapy for Acute Stroke

Medscape Today Headlines — Mon, 02 Jan 2012 04:00:00 +0100

Concomitant diabetes mellitus and prior stroke was thought to contraindicate thrombolytic therapy for acute stroke, but this study indicates otherwise, and should expand eligibility for thrombolysis. Journal Watch (Source: Medscape Today Headlines)

Successful intra‐arterial thrombolytic therapy for a right middle cerebral artery stroke in a 2‐year‐old supported by a ventricular assist device

Transplant International — Tue, 27 Dec 2011 05:00:00 +0100

We present a case of a fully anti‐coagulated 29‐month‐old supported on a Berlin EXCOR LVAD (Berlin, Germany) with embolic stroke which was treated successfully with direct thrombolysis with recombinant tissue plasminogen activator. This is the first report which uses intra‐arterial thrombolytics while on a ventricular assist device in a pediatric patient. (Source: Transplant International)

Early computed tomography signs as early predictors of hemorrhagic transformation under heparinization in patients with cardiogenic embolism

Geriatrics and Gerontology International — Fri, 23 Dec 2011 05:00:00 +0100

Conclusions: Presence of early CT signs correlated more strongly with HT than with the interval from symptom onset to hospital arrival. We might extend the therapeutic time for thrombolytic therapy, only if the early CT sign does not appear. Geriatr Gerontol Int 2011; ••: ••–••. (Source: Geriatrics and Gerontology International)

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Basic Data Related to Thrombolytic Therapy for Acute Arterial Thrombosis

Annals of Vascular Surgery — Wed, 21 Dec 2011 05:00:00 +0100

The treatment approach to acute limb ischemia depends on the severity of the ischemic presentation and duration of symptoms. Urgent angiographic evaluation of the patient with an ischemic limb provides the option of ancillary treatment by catheter-directed thrombolysis (CDT). CDT with intra-arterial tissue plasminogen activators in the appropriate clinical setting has been shown to minimize the therapeutic intervention required and lead to an increase in short- and long-term amputation-free survival. (Source: Annals of Vascular Surgery)

Strategy of Thrombus Removal For Extensive DVT of Pregnancy

Journal of Vascular Surgery — Mon, 19 Dec 2011 23:06:58 +0100

Extensive deep vein thrombosis (DVT) is associated with severe postthrombotic morbidity when treated with anticoagulation alone. Extensive DVT during pregnancy is usually treated with anticoagulation alone, risking significant postthrombotic morbidity. Thrombolytic therapy and operative venous thrombectomy have been safely and effectively used in selected pregnant patients. The purpose of this report is to review the short and long-term outcomes of eleven patients with extensive DVT of pregnancy treated with a strategy of thrombus removal. (Source: Journal of Vascular Surgery)

Thrombolytic Therapy For Significant Pulmonary Emboli

Journal of Vascular Surgery — Mon, 19 Dec 2011 23:06:58 +0100

This study is a retrospective review of the treatment of patients with significant pulmonary emboli (PE) with thrombolytic therapy in a rural setting hospital. Significant PE is defined as a patient with hypoxemia ± right ventricular strain ± hemodynamic compromise. Long-term studies with emphasis on recurrent deep vein thrombosis was assessed as well. Patients studied were in the interval of 2000-2010. Records prior to 2000 were not available. (Source: Journal of Vascular Surgery)

Thrombolytic therapy for central venous catheter occlusion.

Haematologica — Fri, 16 Dec 2011 05:00:00 +0100

Conclusions:Thrombolytic agents successfully clear central venous catheter occlusions in most cases. Newer agents may act more rapidly and effectively than currently utilized therapies, but randomized studies with direct comparisons of these agents are needed to determine optimal management for catheter obstruction. PMID: 22180420 [PubMed - as supplied by publisher] (Source: Haematologica)

Catheter-Directed Thrombolytic Therapy for Massive and Submassive Pulmonary Embolus: A Community Hospital Experience

Journal of Vascular Surgery — Thu, 01 Dec 2011 05:00:00 +0100

Pulmonary embolism (PE) is responsible for 200,000 deaths in the United States annually. Catheter directed thrombolytic therapy (CDTT) is reserved for massive and submassive PE, and rarely practiced outside of tertiary care university settings. Here we present a series of nine consecutive patients with massive (on pressors with hemodynamic instability) or submassive PE (echocardiograms showing pulmonary artery pressure > 70 mm Hg, right heart strain, and continued need for supplemental oxygen ) treated with CDTT in a community vascular surgery practice. (Source: Journal of Vascular Surgery)

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Thrombolytic therapy is effective in paroxysmal nocturnal hemoglobinuria: a series of 9 patients and a review of the literature.

Haematologica — Thu, 01 Dec 2011 05:00:00 +0100

Conclusions. Although it is associated with a significant but manageable risk of bleeding, systemic thrombolysis is a highly effective treatment in order to reverse venous thromboses in patients with paroxysmal nocturnal hemoglobinuria. PMID: 22133780 [PubMed - as supplied by publisher] (Source: Haematologica)

Thrombolysis Benefits Patients With Prior Stroke, DiabetesThrombolysis Benefits Patients With Prior Stroke, Diabetes

Medscape Today Headlines — Mon, 28 Nov 2011 13:00:00 +0100

A new study is challenging these exclusion criteria for thrombolytic therapy in acute stroke patients, which would increase the proportion of patients treated by 15%. Medscape Medical News (Source: Medscape Today Headlines)

Prior anticoagulant therapy, subtherapeutic international normalized ratio and thrombolytic therapy in acute ischemic stroke

International Journal of Stroke — Fri, 25 Nov 2011 13:09:57 +0100

(Source: International Journal of Stroke)

Intracerebral Hemorrhage with Thrombolytic Therapy for Acute Pulmonary Embolism

The American Journal of Medicine — Fri, 25 Nov 2011 05:00:00 +0100

Abstract: Background: Intracranial hemorrhage is one of the dreaded complications of thrombolytic therapy for acute pulmonary embolism. We identified patients with pulmonary embolism who may be at relatively high risk of intracerebral hemorrhage from those selected for thrombolytic therapy by their physicians and presumably thought to be of reasonable risk. Methods: The number of patients discharged from short-stay hospitals in the United States from 1998 to 2008 with pulmonary embolism who received thrombolytic therapy and the proportion with intracerebral hemorrhage were determined from the Nationwide Inpatient Sample, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Results: From 1998 to 2008, 2,237,600 patients were discharged with a diagnosis ...

Analysis suggests stroke history or diabetes should not rule out thrombolysis for acute ischaemic stroke

NeLM - News — Wed, 23 Nov 2011 05:00:00 +0100

Source: Neurology Area: News According to the results of research published in the journal 'Neurology', patients with prior stroke, diabetes, or both should not be excluded from thrombolysis for acute ischemic stroke. The authors note that any history of prior stroke and concomitant diabetes is a contra-indication to the use of alteplase in the treatment of acute ischaemic stroke in the EU. In their study, they sought to examine the influence of diabetes and prior stroke on the outcomes of patients receiving thrombolytic therapy (using data from the SITS registry [Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis]) compared to those who did not receive thrombolysis (data from VISTA [the Virtual International Stroke Trials Archive]). &...

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Effects of low frequency ultrasound on some properties of fibrinogen and its plasminolysis

BMC Biochemistry — Wed, 23 Nov 2011 05:00:00 +0100

Conclusions: The data presented here suggest that among proteins of fibrinolytic systems, the fibrinogen is one of the most sensitive proteins to the action of ultrasound. It has been shown in vitro that ultrasound induced fibrinogen aggregates formation, characterized by the loss of clotting ability and a greater rate of plasminolysis than native fibrinogen in different model systems and under different mode of ultrasound treatment. Under ultrasound treatment of plasminogen and/or t-PA in the presence of fibrin(ogen) the stabilizing effect fibrin(ogen) on given proteins was shown. On the other hand, an increase in the rate of fibrin(ogen) lysis was observed due to both the change in the substrate structure and promoting of the protein-protein complexes formation. (Source: BMC Biochemistry...

Intracoronary thrombolytic therapy: Aa treatment option for failed mechanical thrombectomy

Catheterization and Cardiovascular Interventions — Tue, 22 Nov 2011 05:00:00 +0100

We report a the case of a failed aspiration thrombectomy in a 66 year old woman who was admitted to our institution with chest pain associated with inferior ST segment elevation. Coronary angiography showed a thrombotic occlusion of the right coronary artery. Aspiration thrombectomy did little to reduce thrombus load and so the patient was treated with intracoronary tenectaplase. Repeat coronary angiography 18 hours later revealed marked thrombus resolution with TIMI 3 anterograde flow and patency of the infarct‐related artery was maintained at two month follow up. This case demonstrates the potential for intracoronary thrombolytic therapy as a treatment option for the management of patients following failed thrombectomy in primary PCI. © 2011 Wiley‐Liss, Inc. (Source: Catheterization...

Intracoronary thrombolytic therapy

Catheterization and Cardiovascular Interventions — Tue, 22 Nov 2011 05:00:00 +0100

We report a case of failed aspiration thrombectomy in a 66‐year‐old woman who was admitted to our institution with chest pain associated with inferior ST segment elevation. Coronary angiography showed a thrombotic occlusion of the right coronary artery. Aspiration thrombectomy did little to reduce thrombus load and so the patient was treated with intracoronary tenecteplase. Repeat coronary angiography 18 hr later revealed marked thrombus resolution with thrombolysis in myocardial infarction (TIMI) grade 3 anterograde flow and patency of the infarct‐related artery was maintained at 2‐month follow up. This case demonstrates the potential for intracoronary thrombolytic therapy as a treatment option for the management of patients following failed thrombectomy in PPCI. © 2011 Wiley Per...

Thrombolysis outcomes in acute ischemic stroke patients with prior stroke and diabetes mellitus

Neurology — Mon, 21 Nov 2011 05:00:00 +0100

Conclusions: Outcomes from thrombolysis are better than the controls among patients with DM, PS, or both. We find no statistical justification for the exclusion of these patients from receiving thrombolytic therapy. (Source: Neurology)

People With Stroke History Who Receive Clot-Busting Therapy Fare Better

Health News from Medical News Today — Thu, 17 Nov 2011 10:00:00 +0100

People with a history of stroke or diabetes who were given clot-busting drugs to break up blood clots after stroke fared better than those who did not receive the drugs, according to a study published in the November 16, 2011, online issue of Neurology®, the medical journal of the American Academy of Neurology. "The use of these drugs, called thrombolytic therapy, can limit damage and disability due to blood clots," said study author Kennedy R. Lees, MD, of the University of Glasgow in Scotland... (Source: Health News from Medical News Today)

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Risk stratification in pulmonary embolism: an algorithmic tool approach

Thorax — Thu, 17 Nov 2011 05:00:00 +0100

It is with much interest we read the article by Jiménez et al1 and the accompanying editorial2 Focusing investigation on patients with symptomatic pulmonary thromboembolism (PTE) but who are normotensive at presentation, it reminds us that work still needs to be undertaken for the 95% of patients (including the 15% with submassive disease) who remain haemodynamically stable and excluded from thrombolysis, if current guidelines are followed.3 Anecdotally, with the increased use of CT pulmonary angiography, clinicians more readily visualise thrombus burden and, despite the lack of scientific evidence, consider thrombolytic therapy ahead of heparin even with submassive PTE. Although the mortality benefits from thrombolysis in this group are debatable, it does help improve the right ven...

Obesity and pulmonary embolism: The mounting evidence of risk and the mortality paradox

Thrombosis Research — Mon, 14 Nov 2011 05:00:00 +0100

Conclusions: The prevalence of pulmonary embolism in hospitalized patients was higher in obese patients than in non-obese patients. Mortality in patients with pulmonary embolism was lower in obese patients than in non-obese patients, with the greatest effects in women, older patients and stable patients. (Source: Thrombosis Research)

Preoperative Evaluation and Clearance for Surgery (Joshua Steinberg MD)

Family Medicine Digital Resources Library (FMDRL) Recently Uploaded — Thu, 10 Nov 2011 05:00:00 +0100

Hi Folks, This is my first stab at a formal teaching presentation for students and residents on performing preoperative evaluation and clearance for patients heading to surgery. It brings together information from the ACC/AHA preop guideline, the ICSI preop guideline, the ACCP Antithrombotic and Thrombolytic Therapy guideline, and more. It is much more didactic than I usually like, but it's just a first approach to the topic. I hope to make the session more interactive in the future. I'd be happy to receive feedback and suggestions on how to do so. Not surprisingly, this presentation covers similar material found in the iPhone app where even more details can be found. I think they'll work well together and I'll finish this powerpoint presentation with a little demo of the app so that fol...

Current Status and Trends in the Treatment of Acute Pulmonary Thromboembolism.

Circulation Journal — Thu, 10 Nov 2011 05:00:00 +0100

Authors: Yamada N, Nakamura M, Ito M Abstract Untreated acute pulmonary thromboembolism (APTE) is associated with high mortality, which is reduced by prompt treatment. Anticoagulation is fundamental in the treatment of APTE and should be initiated from suspicion. The efficacy and safety of novel anticoagulant drugs, such as oral anti-Xa and anti-IIa inhibitors, are topics in the treatment of APTE and are now under investigation. Thrombolytic therapy is a widely accepted treatment strategy for massive APTE, but its use for submassive APTE is controversial. Catheter intervention, percutaneous cardiopulmonary support and surgical embolectomy are also necessary and effective for some patients with APTE. A retrievable inferior vena cava filter is preferred for transient protection again...

Intravenous thrombolysis for acute stroke in patients with cancer

Journal of Neurology, Neurosurgery and Psychiatry — Mon, 07 Nov 2011 05:00:00 +0100

Introduction Current clinical guidelines recommend intravenous tissue plasminogen activator (tPA) as a specific treatment of ischaemic stroke up to 4.5 h of evolution in selected patients, according to eligibility criteria established in clinical trials in order to minimise the risk of major bleeding complications.1 These limitations on the use of tPA, which differ in European and American licences, are being overcome in clinical practice, having communicated their use in situations such as pregnancy, menstruation, recent surgery, previous stroke and others.2 Patients with malignant diseases were excluded not only from large trials of tPA but also from observational studies designed to evaluate the safety of treatment in daily practice.3 However, patients with cancer have an elevated ...

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Ninety-Day Outcome Rates of a Prospective Cohort of Consecutive Patients With Mild Ischemic Stroke.

Stroke — Thu, 03 Nov 2011 04:00:00 +0100

CONCLUSIONS: Patients with mild ischemic stroke have substantial rates (29%) of disability at 90 days. PMID: 22052513 [PubMed - as supplied by publisher] (Source: Stroke)

Mechanical Embolectomy and Recanalization of Superior Mesenteric Artery Embolism Using the MERCI Retrieval Device

Journal of Vascular and Interventional Radiology : JVIR — Thu, 27 Oct 2011 08:56:23 +0100

We present a case of mesenteric ischemia successfully treated with the MERCI retrieval device. Submission of this case report does not require permission of the institutional review board of our hospital. (Source: Journal of Vascular and Interventional Radiology : JVIR)

Systemic Thrombolysis in Patients With Acute Ischemic Stroke and Internal Carotid ARtery Occlusion: The ICARO Study.

Stroke — Thu, 27 Oct 2011 04:00:00 +0100

ConclusionsIn patients with stroke attributable to ICA occlusion, thrombolytic therapy results in a significant reduction in the proportion of patients dependent in activities of daily living. Increases in death and any intracranial bleeding were the trade-offs for this clinical benefit. PMID: 22034003 [PubMed - as supplied by publisher] (Source: Stroke)

Cilostazol Reduces the Risk of Hemorrhagic Infarction After Administration of Tissue-Type Plasminogen Activator in a Murine Stroke Model.

Stroke — Thu, 27 Oct 2011 04:00:00 +0100

CONCLUSIONS: Our results suggest that patients treated with cilostazol before onset of stroke could have a lower risk of cerebral hemorrhage after thrombolytic therapy and might also have a longer therapeutic time window for thrombolysis. Furthermore, the risk of cerebral hemorrhage can be significantly altered by prestroke therapies, and analysis of the effects of multiple drugs on tissue-type plasminogen activator-induced cerebral hemorrhage in animal models is essential for the extending safe and effective thrombolytic therapy to a wider group of patients. PMID: 22033992 [PubMed - as supplied by publisher] (Source: Stroke)

Ischemic Stroke: Emergencies and Management

Neurologic Clinics — Mon, 24 Oct 2011 04:00:00 +0100

The past 40 years have seen the evolution of acute ischemic stroke management from unproven therapies du jour, such as steroids, heparin for stroke in evolution, and hypervolemic-hemodilution, to more of a scientific basis for our decision-making process. This evolution is directly related to the advancements in imaging of stroke. It is also related to carefully designed, controlled clinical trials of potential therapies, which have led to the recognition of the benefits of thrombolytic therapy in the acute setting but have also caused confusion and frustration over the lack of benefit for potential neuroprotective agents that once seemed promising. (Source: Neurologic Clinics)

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[Comment] Stroke on awakening and the tissue window for thrombolysis

Lancet Neurology — Tue, 18 Oct 2011 23:32:33 +0100

Ischaemic stroke occurs unwitnessed or in sleep in as many as a quarter of cases. Because stroke onset is defined by the time at which a patient is last seen well and because guidelines recommend thrombolytic therapy within 4·5 h of symptom onset, an unknown time of stroke onset can preclude the decision to begin treatment. Identification of a surrogate marker of time from stroke onset is therefore important because patients with an unknown time of symptom onset might still benefit from thrombolysis. (Source: Lancet Neurology)

Venous thromboembolism in cystic fibrosis

Pediatric Pulmonology — Mon, 17 Oct 2011 04:00:00 +0100

AbstractThe incidence of venous thromboembolism (VTE) is increasing in the pediatric population. Individuals with cystic fibrosis (CF) have an increased risk of thrombosis due to central venous catheters (CVCs), as well as acquired thrombophilia secondary to inflammation, or deficiencies of anticoagulant proteins due to vitamin K deficiency and/or liver dysfunction. CVC‐associated thrombosis commonly results in line occlusion, but may develop into serious life‐threatening conditions such as deep venous thrombosis (DVT), superior vena cava syndrome or pulmonary embolism (PE). Post‐thrombotic syndrome (PTS) may be a long complication. Local occlusion of the catheter tip may be managed with instillation of thrombolytics (such as tPA) within the lumen of the catheter; however, CVC‐asso...

Improved Prediction of Poor Outcome After Thrombolysis Using Conservative Definitions of Symptomatic Hemorrhage.

Stroke — Thu, 13 Oct 2011 04:00:00 +0100

CONCLUSIONS: None of the different definitions contains an optimal combination of prediction of mortality and outcome and a high interrater agreement rate. For the clinical evaluation of mortality, we recommend using the SITS definition; for studies needing a high interrater agreement rate, we recommend using the ECASS 2 definition. Due to the lack of 1 single optimal definition, future thrombolytic trials should preferably use different definitions. PMID: 21998049 [PubMed - as supplied by publisher] (Source: Stroke)

Deep Vein Thrombosis/Pulmonary Embolism: Prophylaxis, Diagnosis, and Management

Thoracic Surgery Clinics — Mon, 10 Oct 2011 04:00:00 +0100

Thoracic surgery patients should be regarded at high risk for postoperative venous thromboembolism (VTE). VTE mechanical and pharmacologic prophylaxis with low molecular weight heparin, or low-dose unfractionated heparin or fondaparinux (Arixtra) is therefore strongly recommended. Pharmacologic prophylaxis should be extended to 4 weeks after major cancer surgery. Pulmonary embolism should be always managed with anticoagulation, in addition to thrombolytic therapy, in patients presenting with cardiogenic shock or persistent arterial hypotension. (Source: Thoracic Surgery Clinics)

Expression of recombinant staphylokinase, a fibrin-specific plasminogen activator of bacterial origin, in potato (Solanum tuberosum L.) plants

World Journal of Microbiology and Biotechnology — Sat, 08 Oct 2011 15:44:12 +0100

In this study, transgenic Solanum tuberosum plants expressing a CaMV::sak-mgpf-gusA gene fusion, were obtained. AGL1 A. tumefaciens strain was used in the process of transformation. The presence of the staphylokinase gene was confirmed by PCR in 22.5% of the investigated plants. The expression of the fusion transgene was detected using the β-glucuronidase activity assay in 32 putative transgenic plants. Furthermore, on the basis of the GUS histochemical reaction, the transgene expression pattern had a strong, constitutive character in seven of the transformants. The polyacrylamide gel electrophoresis of a protein extract from the SAK/PCR-positive plants, revealed the presence of a119 kDa protein that corresponds to that of the fusion protein SAK-mGFP-GUSA. Western blot analysis, ...

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Thrombolytic Therapy Rates and Stroke Severity: An Analysis of Data From the Swedish Stroke Register (Riks-Stroke) 2007-2010.

Stroke — Thu, 06 Oct 2011 04:00:00 +0100

CONCLUSIONS: In recent years, an increase in the proportion of patients with minor stroke treated with thrombolysis has contributed to rising overall thrombolysis rates in Sweden. At the hospital level, high rates of thrombolysis are associated with a high proportion of minor stroke being treated. PMID: 21980204 [PubMed - as supplied by publisher] (Source: Stroke)

MRI Mismatch May Aid Stroke Treatment (CME/CE)

MedPage Today Cardiovascular — Wed, 05 Oct 2011 19:51:17 +0100

(MedPage Today) -- Assessment with two types of MRI techniques showed potential for identifying stroke patients who are within the time window for thrombolytic therapy, data from a multicenter study showed. (Source: MedPage Today Cardiovascular)

[Thrombolytic therapy using a low dose of tissue plasminogen activator in children.]

Anales de Pediatria — Wed, 05 Oct 2011 04:00:00 +0100

CONCLUSIONS: Thrombolytic therapy with low doses of t-PA (0.01-0.05mg/kg/h) is effective in a high percentage of children with acute arterial and/or venous thrombosis and produces a relatively low frequency of side effects. PMID: 21982548 [PubMed - as supplied by publisher] (Source: Anales de Pediatria)

Bleeding and Stroke Risk in a Real-world Prospective Primary Prevention Cohort of Patients With Atrial Fibrillation.

Chest — Sat, 01 Oct 2011 04:00:00 +0100

CONCLUSIONS: Stroke risk stratification models differed widely when categorizing subjects into the moderate- and high-stroke-risk categories. Bleeding and stroke risk were closely correlated and both were low among low-risk patients and were similarly high among moderate/high-risk groups. PMID: 21511826 [PubMed - in process] (Source: Chest)

Thrombolytic therapy for acute ischemic stroke after recent transient ischemic attack

International Journal of Stroke — Sat, 01 Oct 2011 04:00:00 +0100

ConclusionsTransient ischemic attack preceding ischemic stroke does not appear to have a major influence on outcomes following thrombolysis. Patients with prior ipsilateral transient ischemic attack appear not to be at higher risk of bleeding complications. (Source: International Journal of Stroke)

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Major Pulmonary Embolism

Critical Care Clinics — Sat, 01 Oct 2011 04:00:00 +0100

This article will review a structured pathophysiologic approach to the diagnostic, resuscitative and management strategies related to PE in the ICU. (Source: Critical Care Clinics)

Treatment of Pulmonary Embolism: Anticoagulation, Thrombolytic Therapy, and Complications of Therapy

Critical Care Clinics — Fri, 30 Sep 2011 04:00:00 +0100

During the last two decades, considerable progress in technology and clinical research methods have led to advances in the approach to the diagnosis, prevention, and treatment of acute venous thromboembolism (VTE). Despite this, however, the diagnosis is often delayed and preventive methods are often ignored. Thus, the morbidity and mortality associated with VTE remain high. The therapeutic approach to acute VTE is discussed, with a particular focus on the intensive care unit (ICU) setting. (Source: Critical Care Clinics)

Intervention in acute cerebral ischaemic stroke: a review of the role of pharmacological therapies and intra-arterial mechanical thrombectomy devices

Postgraduate Medical Journal — Tue, 27 Sep 2011 04:00:00 +0100

Acute ischaemic stroke (AIS) is the leading cause of death and disability in developed nations. In the past decade pharmacologic and endovascular therapy has been approved for use in treatment of patients presenting with AIS. The time window from symptom onset to be eligible for treatment is narrow, allowing for only a small proportion of these patients to be treated. Currently the established method of treatment is intravenous thrombolytic therapy for patients without contraindication, presenting within the time window of 4.5 h from the onset of symptoms. The improvement in patient outcome with this therapy is poor. This has led to exploration of intra-arterial mechanical thrombectomy devices to both increase the time window and also attempt to improve patient outcome with and withou...

Directed evolution improves the fibrinolytic activity of Nattokinase from Bacillus natto

FEMS Microbiology Letters — Tue, 27 Sep 2011 04:00:00 +0100

AbstractNattokinase (subtilisin NAT, NK) is a relatively effective microbial fibrinolytic enzyme that has been identified and characterised from Bacillus natto. In the current report, DNA family shuffling was applied to improve the fibrinolytic activity of nattokinase. Three homologous genes from Bacillus nattoAS 1.107, Bacillus amyloliquefaciensCICC20164 and Bacillus licheniformisCICC 10092 were shuffled to generate a mutant library. A plate‐based method was used to screen the mutant libraries for improved activity. After three rounds of DNA shuffling, one desirable mutant with sixteen amino acid substitutions was obtained. The mutant enzyme was purified and characterised. The kinetic measurements showed that the catalytic efficiency of the mutant NK was approximately 2.3 times higher t...

Observational Study of Need for Thrombolytic Therapy and Incidence of Bacteremia using Taurolidine‐Citrate‐Heparin, Taurolidine‐Citrate and Heparin Catheter Locks in Patients Treated with Hemodialysis

Seminars In Dialysis — Thu, 15 Sep 2011 04:00:00 +0100

AbstractCatheter‐related blood stream infections may be reduced by interdialytic locking with Taurolidine, a nontoxic antimicrobial agent. A formulation of 1.35% Taurolidine in 4% citrate (TC) is associated with a greater need for thrombolysis to maintain catheter patency than 5000 U/ml heparin. Our aim was to determine whether addition of 500 Units/ml of heparin to TC reduces the need for thrombolysis. TCH (1.35% taurolidine, 4% citrate and 500 U/ml heparin) was compared to TC and Heparin 5000 U/ml using retrospective data. Hundred and six adult hemodialysis patients with internal jugular tunnelled intravascular catheters using TCH were compared with 34 patients using TC and 34 patients using heparin 5000 U/ml respectively. Outcomes were time to first use of thrombolysis and b...

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Observational Study of Need for Thrombolytic Therapy and Incidence of Bacteremia using Taurolidine-Citrate-Heparin, Taurolidine-Citrate and Heparin Catheter Locks in Patients Treated with Hemodialysis.

Seminars in Dialysis — Thu, 15 Sep 2011 04:00:00 +0100

Authors: Solomon LR, Cheesbrough JS, Bhargava R, Mitsides N, Heap M, Green G, Diggle P Abstract Catheter-related blood stream infections may be reduced by interdialytic locking with Taurolidine, a nontoxic antimicrobial agent. A formulation of 1.35% Taurolidine in 4% citrate (TC) is associated with a greater need for thrombolysis to maintain catheter patency than 5000 U/ml heparin. Our aim was to determine whether addition of 500 Units/ml of heparin to TC reduces the need for thrombolysis. TCH (1.35% taurolidine, 4% citrate and 500 U/ml heparin) was compared to TC and Heparin 5000 U/ml using retrospective data. Hundred and six adult hemodialysis patients with internal jugular tunnelled intravascular catheters using TCH were compared with 34 patients using TC and 34 patients...

Low-dose rtPA may help IVH patients

MedWire News - Stroke — Mon, 12 Sep 2011 00:00:00 +0100

Thrombolytic therapy to remove blood clots is feasible in patients with intracerebral hemorrhage (ICH) and intraventricular bleeding, shows a preliminary study. (Source: MedWire News - Stroke)

The clot burden score, the Boston Acute Stroke Imaging Scale, the cerebral blood volume ASPECTS, and two novel imaging parameters in the prediction of clinical outcome of ischemic stroke patients receiving intravenous thrombolytic therapy

Neuroradiology — Fri, 09 Sep 2011 05:49:12 +0100

Conclusion CBS, BASIS, and CBV ASPECTS are statistically robust and sensitive but unspecific predictors of good clinical outcome. Two new derived imaging parameters, CBSV and M1-BASIS, share these properties and may have increased prognostic value. Content Type Journal ArticleCategory Diagnostic NeuroradiologyPages 1-10DOI 10.1007/s00234-011-0954-zAuthors Niko Sillanpaa, Medical Imaging Center, Tampere University Hospital, PL 2000, 33521 Tampere, FinlandJukka T. Saarinen, Department of Neurology, Tampere University Hospital, Tampere, FinlandHarri Rusanen, Department of Neurology, Oulu University Hospital, Oulu, FinlandJari Hakomaki, Medical Imaging Center, Tampere University Hospital, PL 2000, 33521 Tampere, FinlandArto Lahteela, Medical Imaging Center, Tampere Unive...

Thrombolysis to Treat Thrombi of the Aortic Arch

Clinical and Applied Thrombosis/Hemostasis — Thu, 08 Sep 2011 04:00:00 +0100

We report 3 cases of symptomatic TAMT treated with systemic alteplase (tissue plasminogen activator [t-PA]) thrombolysis. The first patient was symptomatic with repetitive thromboembolism to the left brachial artery. She was treated with repetitive thrombolysis after surgical embolectomy of the brachial artery. The second patient was symptomatic with splenic infarction and mesenteric ischemia. She was treated with a single cycle of systemic thrombolysis followed by ileocoecal resection. The third patient presented with a TAMT obstructing the left common carotid artery, causing ischemic stroke. After systemic thrombolysis, a reduction in thrombus size was documented; however, the patient died later, of acute heart failure, during the clinical course. On follow-up 6 months after the incidenc...

Intravenous Thrombolytic Therapy for Acute Ischemic Stroke

New England Journal of Medicine — Wed, 07 Sep 2011 21:00:07 +0100

New England Journal of Medicine, Volume 365, Issue 10, Page 964-967, September 2011. (Source: New England Journal of Medicine)

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Diagnosis and Management of Life-Threatening Pulmonary Embolism

Journal of Intensive Care Medicine — Wed, 07 Sep 2011 04:00:00 +0100

Pulmonary embolus (PE) is estimated to cause 200 000 to 300 000 deaths annually. Many deaths occur in hemodynamically unstable patients and the estimated mortality for inpatients with hemodynamic instability is between 15% and 25%. The diagnosis of PE in the critically ill is often challenging because the presentation is nonspecific. Computed tomographic pulmonary angiography appears to be the most useful study for diagnosis of PE in the critically ill. For patients with renal insufficiency and contrast allergy, the ventilation perfusion scan provides an alternative. For patients too unstable to travel, echocardiography (especially transesophageal echocardiography) is another option. A positive result on lower extremity Doppler ultrasound can also aid in the decision to treat. The choice o...

MRI‐based intravenous thrombolysis in stroke patients with unknown time of symptom onset

European Journal of Neurology — Mon, 05 Sep 2011 23:00:00 +0100

Conclusions: Thrombolysis after MRI seems safe and effective in UTOS. This observation may encourage those who plan prospective placebo‐controlled trials of thrombolytics in this subgroup of stroke patients. (Source: European Journal of Neurology)

Thrombolysis for acute occlusion of the superior mesenteric artery

Journal of Vascular Surgery — Mon, 05 Sep 2011 04:00:00 +0100

Conclusion: Local thrombolysis for acute SMA occlusion is a minimally invasive and effective treatment alternative in a select group of patients without peritonitis. The few technique-related complications were mild. (Source: Journal of Vascular Surgery)

Statin use ‘no barrier to thrombolysis in acute stroke’

MedWire News - Stroke — Sat, 03 Sep 2011 17:48:00 +0100

Statin use does not independently predict functional outcomes or bleeding risk in patients receiving thrombolytic therapy for ischemic stroke, research suggests. (Source: MedWire News - Stroke)

Angioedema after Administration of tPA for Ischemic Stroke: Case Report

Air Medical Journal — Thu, 01 Sep 2011 04:00:00 +0100

We describe an uncommon life-threatening adverse reaction to thrombolytic therapy during air transport for acute stroke. (Source: Air Medical Journal)

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Improvement of clinical outcome and cerebral perfusion in a patient of atherosclerotic cerebral infarction after repetitive hyperbaric oxygen treatment--a case report and literature review.

Undersea and Hyperbaric Medicine — Thu, 01 Sep 2011 04:00:00 +0100

Authors: Chen SY, Huang E, Wang V, Fan YM, Ho CF, Yip PK Abstract This is a case report of hyperbaric oxygen therapy (HBO2T) for ischemic stroke. HBO2T should be the potential or additional treatment (with thrombolytic therapy) for ischemic stroke according to the preclinical and clinical studies. Hereby, we present a 56-year-old Chinese man with vascular risk factors. He had an acute ischemic stroke on the left corona radiata, with right hemiparesis and dysarthria resulting from atherosclerosis. The patient could not get thrombolytic treatment because the time to ER was in excess of five hours. He experienced great improvement after the general course of HBO2T; this was evaluated with standard rating scales for stroke research and cerebral perfusion images, including brain-compute...

Rapamycin protects against middle cerebral artery occlusion induced focal cerebral ischemia in rats.

Behavioural Brain Research — Wed, 31 Aug 2011 04:00:00 +0100

Hand-held minimised extracorporeal membrane oxygenation: a new bridge to recovery in patients with out-of-centre cardiogenic shock [Original articles]

European Journal of Cardio-Thoracic Surgery — Sun, 28 Aug 2011 23:00:00 +0100

Conclusions: The use of hand-held Mini-ECMO systems enables for the first time the rapid onset of extracorporeal life support independent from the patient's current location. However, success is extremely time- and team dependent. Highly skilled interdisciplinary patient management is essential to let minimised-ECMO become a new and highly effective bridge to recovery in out-of-centre cardiogenic shock patients. (Source: European Journal of Cardio-Thoracic Surgery)

Perfusion computer tomography helps to differentiate seizure and stroke in acute setting

Clinical Neurology and Neurosurgery — Fri, 26 Aug 2011 04:00:00 +0100

We report the case of a patient with an acute onset of aphasia and right-sided hemiparesis, in which a P-CT scan revealed regional hyperperfusion and further diagnostic supported an epileptic origin. (Source: Clinical Neurology and Neurosurgery)

Neonatal renal vein thrombosis

Seminars in Fetal and Neonatal Medicine — Thu, 25 Aug 2011 04:00:00 +0100

Summary: Neonatal renal vein thrombosis (RVT) continues to pose significant challenges for pediatric hematologists and nephrologists. The precise mechanism for the onset and propagation of renal thrombosis within the neonatal population is unclear, but there is suggestion that acquired and/or inherited thrombophilia traits may increase the risk for renal thromboembolic disease during the newborn period. This review summarizes the most recent studies of neonatal RVT, examining its most common features, the prevalence of acquired and inherited prothrombotic risk factors among these patients, and evaluates their short and long term renal and thrombotic outcomes as they may relate to these risk factors. Although there is some consensus regarding the management of neonatal RVT, the most recent ...

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Management of Hyperglycemia in Acute Ischemic Stroke

Current Treatment Options in Neurology — Mon, 22 Aug 2011 16:00:11 +0100

Opinion statement There is considerable clinical evidence that hyperglycemia at the onset of acute ischemic stroke may negatively impact not only acute morbidity but also brain recovery. Establishing hyperglycemia treatment protocols is challenging, given the variation among patients and acute stroke care settings. Relatively few randomized trials have examined glycemic control protocols in this population, and there is not yet any clear evidence that “correcting” hyperglycemia in patients with acute stroke leads to better functional outcomes. Intensification of glucose regimens, using lower glucose targets, leads to more hypoglycemic events, but the immediate and long-term impact of these events on the acutely ischemic brain is unknown. It is reasonable to treat patie...

Thrombosis of Tunneled‐Cuffed Hemodialysis Catheters: Treatment With High‐Dose Urokinase Lock Therapy

Artificial Organs — Mon, 15 Aug 2011 23:00:00 +0100

In conclusion, group B patients obtained (i) a significantly better TCC patency than group A patients; (ii) a low UK administration in the following HD sessions; and (iii) no bleeding complications. (Source: Artificial Organs)

The effect of streptokinase therapy in STEMI and conventional therapy in NSTEMI patients on TIMI risk index, B-type natriuretic peptide and high-sensitive C-reactive protein.

Anadolu Kardiyol Der... — Sun, 07 Aug 2011 23:00:00 +0100

CONCLUSION: Thrombolytic therapy with streptokinase failed to decrease BNP, hs-CRP and TRI values in STEMI patients. Conventional therapy in NSTEMI patients also resulted in higher TRI values than baseline values. We reached TIMI 3 flow in only 10.5% of the study patients, which may be responsible for our findings. PMID: 21821500 [PubMed - as supplied by publisher] (Source: Anadolu Kardiyol Der...)

Emergency Department Focused Bedside Echocardiography in Massive Pulmonary Embolism

The Journal of Emergency Medicine — Fri, 05 Aug 2011 04:00:00 +0100

Conclusion: In the hands of an experienced emergency physician ultrasonographer, ED focused bedside echocardiography provides a safe, rapid, and non-invasive diagnostic adjunct for evaluation of the patient suspected of having massive PE. (Source: The Journal of Emergency Medicine)

Emergency Department Focused Bedside Echocardiography in Massive Pulmonary Embolism.

Pain Physician — Tue, 02 Aug 2011 23:00:00 +0100

CONCLUSION: In the hands of an experienced emergency physician ultrasonographer, ED focused bedside echocardiography provides a safe, rapid, and non-invasive diagnostic adjunct for evaluation of the patient suspected of having massive PE. PMID: 21820258 [PubMed - as supplied by publisher] (Source: Pain Physician)

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[Spinal and epidural anesthesia in patients with hemorrhagic diathesis : Decisions on the brink of minimum evidence?]

Der Anaesthesist — Sat, 30 Jul 2011 23:00:00 +0100

Authors: Englbrecht JS, Pogatzki-Zahn EM, Zahn P Neuraxial anesthesia is an established and safe procedure in perioperative pain therapy which can help to minimize complications and to improve perioperative outcome. In patients with acquired bleeding disorders by comorbidities or concomitant antithrombotic medication an individual decision should be made based on risks and benefits. A large number of literature references and guidelines help making a decision, for example the recently updated evidence-based guidelines of the American Society of Regional Anesthesia and Pain Medicine for patients receiving antithrombotic or thrombolytic therapy. However, no explicit recommendations or guidelines exist for patients with hemorrhagic diatheses, such as von Willebrand disease (vWD), hemophil...

Brain Bleed Post Lysis Informs Outcome (CME/CE)

MedPage Today Geriatrics — Tue, 26 Jul 2011 18:43:03 +0100

(MedPage Today) -- Among patients treated with thrombolytic therapy following an ischemic stroke, development of a symptomatic intracerebral hemorrhage adds value as a predictor of worse outcomes, researchers found. (Source: MedPage Today Geriatrics)

The prognostic value of ST-segment elevation in the lead aVR in patients with acute pulmonary embolism.

Kardiologia Polska — Tue, 26 Jul 2011 14:15:03 +0100

Conclusions: The presence of STE in lead aVR in patients with APE is associated with poor prognosis. The presence of STE in lead aVR could be an easily obtainable and noninvasive ECG parameter, helpful in risk stratification of patients with APE. Kardiol Pol 2011; 69, 7: 649-654. PMID: 21769779 [PubMed - in process] (Source: Kardiologia Polska)

[Massive pulmonary thromboembolism after abdominoplasty and liposuction.]

Turk Kardiyoloji Dernegi arsivi — Tue, 26 Jul 2011 00:30:03 +0100

Authors: Conkbayır C, Kenan S, Emiroğlu O Pulmonary embolism is a rare complication of abdominoplasty and liposuction that may result in a fatal consequence. A 65-year-old obese woman presented with complaints of shortness of breath, palpitation, and hypotension (90/60 mmHg) seven weeks after abdominoplasty and liposuction. The electrocardiogram showed sinus tachycardia, right axis deviation, and right bundle branch block. The chest X-ray showed atelectatic and focally infiltrated areas, and minimal bilateral pleural effusion. Laboratory findings were normal except for D-dimer level (3500 ng/ml). Echocardiography revealed dilated right heart chambers and a thrombus in the left ventricle. Ejection fraction was normal and pulmonary artery pressure was 50 mmHg. Doppler ultrasound showed...

Comparison of thrombolytic therapy for prosthetic valve thrombosis at the mitral and aortic position

Indian Journal of Thoracic and Cardiovascular Surgery — Thu, 14 Jul 2011 05:59:26 +0100

Conclusion Thrombolytic therapy may be considered as first line of therapy in low risk patients . Those patients in NYHA III/IV, thrombolysis may still be used with almost 50% complete response to thrombolytic therapy and surgery can be avoided in them. Those patients who do not respond to thrombolytic therapy early should be considered for surgery especially in cases of PVT at aortic position. Content Type Journal ArticlePages 1-5DOI 10.1007/s12055-011-0110-8Authors Aditya Kumar Singh, Department of Cardiothoracic & Vascular Surgery, G. B. Pant Hospital, New Delhi, IndiaSaket Agarwal, Department of Cardiothoracic & Vascular Surgery, G. B. Pant Hospital, New Delhi, IndiaSubodh Satyarthi, Department of Cardiothoracic & Vascular Surgery, G. B. Pant Hospital, New Delhi...

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Low Body Temperature Does Not Compromise the Treatment Effect of Alteplase.

Stroke — Wed, 13 Jul 2011 23:00:00 +0100

CONCLUSIONS: There is no evidence of influence of body temperature on alteplase treatment response. These results are reassuring that low temperatures across a physiological range do not compromise therapeutic effect of alteplase. PMID: 21757664 [PubMed - as supplied by publisher] (Source: Stroke)

Incidence and Management of Ischemic Stroke and Intracerebral Hemorrhage in Patients on Dabigatran Etexilate Treatment

Neurocritical Care — Tue, 12 Jul 2011 06:10:49 +0100

Abstract Dabigatran etexilate is an oral, reversible direct thrombin inhibitor and has been recently approved for the prevention of stroke in patients with non-valvular atrial fibrillation. This review describes the incidence and management of stroke and related complications in patients on dabigatran etexilate. Dabigatran is a rapidly acting, and highly selective and reversible inhibitor of thrombin. It also has a potent inhibitory effect on thrombin-induced platelet aggregation, making it effective in preventing both venous and arterial thrombosis. The activated partial thromboplastin time, ecarin clotting time and thrombin time are sensitive tests to evaluate the anticoagulant effects of dabigatran. The rate of ischemic stroke is significantly lower in patients on 150&n...

3-Dimensional optical frequency domain imaging for the evaluation of primary percutaneous coronary intervention in ST-segment elevation myocardial infarction

International Journal of Cardiology — Thu, 07 Jul 2011 23:00:00 +0100

Primary percutaneous coronary intervention (PCI) in the setting of ST-segment elevation myocardial infarction (STEMI) has shown better clinical outcomes, improved residual left ventricular function, better restoration of flow and less re-occlusion compared to thrombolytic therapy . (Source: International Journal of Cardiology)

Matrix Metalloproteinase-9 in an Exploratory Trial of Intravenous Minocycline for Acute Ischemic Stroke.

Stroke — Wed, 06 Jul 2011 23:00:00 +0100

CONCLUSIONS: Lower plasma matrix metalloproteinase-9 was seen among tPA-treated subjects in the MINOS trial. Combining minocycline with tPA may prevent the adverse consequences of thrombolytic therapy through suppression of matrix metalloproteinase-9 activity. PMID: 21737808 [PubMed - as supplied by publisher] (Source: Stroke)

Thrombolysis for lower extremity bypass graft occlusion

Journal of Vascular Surgery — Mon, 04 Jul 2011 04:00:00 +0100

Conclusions: Our findings support the use of thrombolysis in the treatment of acute bypass graft occlusion in the lower limb given its acceptable short- and long-term amputation-free survival rates. Technical failure and higher age were factors associated with major amputation. Synthetic grafts appeared to have a somewhat increased likelihood of technically successful thrombolysis compared with vein grafts, but on the other hand, they exhibited an increased risk of amputation during follow-up. (Source: Journal of Vascular Surgery)

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Response to the recent best evidence topic on the use of thrombolysis in stroke

Emergency Medicine Journal — Wed, 22 Jun 2011 23:00:00 +0100

I would like to comment on the negative findings of the recently published best evidence topic report on the use of thrombolysis in acute ischaemic stroke (AIS).1The meta-analysis by Wardlaw et al for the Cochrane Collaboration was updated in 2009 and now includes data on 26 trials including 7152 patients.2 Its conclusions are unchanged from the 2003 version but the same concerns remain. The dataset includes a heterogeneous group of clinical trials with only approximately 55% of the data from trials testing recombinant tissue plasminogen activator (rtPA). Despite this the meta-analysis demonstrated that thrombolytic therapy administered less than 6 h after the onset of AIS significantly reduced the proportion of patients who were dead or dependent (modified Rankin score 3–6) at ...

Drainage Efficiency with Dual Versus Single Catheters in Severe Intraventricular Hemorrhage

Neurocritical Care — Fri, 17 Jun 2011 10:55:32 +0100

Conclusion The decision to place dual EVDs is generally reserved for large IVH (>40 ml) with casting and mass effect. The use of dual simultaneous catheters may increase clot resolution with or without adjunctive thrombolytic therapy. Content Type Journal ArticlePages 1-7DOI 10.1007/s12028-011-9569-9Authors Holly E. Hinson, Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Meyer 8-140, 600 N. Wolfe St., Baltimore, MD, USAEric Melnychuk, Division of Brain Injury Outcomes, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USAJohn Muschelli, Division of Brain Injury Outcomes, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USADaniel F. Hanley, Division of ...

Successful pulmonary artery embolectomy in a patient with a saddle Wilms tumor embolus

Pediatric Blood and Cancer — Wed, 15 Jun 2011 23:00:00 +0100

We report a 5‐year‐old male with Denys–Drash syndrome who rapidly developed Wilms tumor with vascular invasion, subsequent saddle tumor embolus, and required emergent embolectomy. This case illustrates the rapid emergence of Wilms tumor in a patient with Denys–Drash syndrome and the importance of considering embolectomy over thrombolytic therapy for PE in this population, given a high likelihood of tumor embolus. Pediatr Blood Cancer © 2011 Wiley‐Liss, Inc. (Source: Pediatric Blood and Cancer)

“Reperfusion ST-elevation peak”: an interesting phenomenon that needs to be studied and implemented further

Journal of Electrocardiology — Fri, 10 Jun 2011 04:00:00 +0100

The report by Demidova et al and the accompanying editorial by Terkelsen, in the January/February issue of the Journal of Electrocardiology, focuses on the “reperfusion peak” (RP), that is, the transient additional ST-elevation (STE) detected in both the porcine model after restoration of coronary flow, and patients with an STE myocardial infarction, undergoing primary percutaneous coronary intervention. The realization of the phenomenon of paradoxical increase in STE after reperfusion is not new. It has been described in several articles as occurring during intravenous thrombolytic therapy. At first, it was thought to represent a good sign of reperfusion. Later, the concept has been changed suggesting that the RP represents some form of “reperfusion injury.” Although it is far fro...

Low-Dose, Once-Daily, Intraclot Injections of Alteplase for Treatment of Acute Deep Venous Thrombosis

Journal of Vascular and Interventional Radiology : JVIR — Thu, 09 Jun 2011 23:00:00 +0100

Conclusions: Intraclot injection of low doses of alteplase is effective for acute venous thrombosis, and pharmacokinetic data suggest potentially greater safety. (Source: Journal of Vascular and Interventional Radiology : JVIR)

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Is Door‐to‐Balloon Time the Best Metric to Assess Successful Treatment of STEMI?

Clinical Cardiology — Wed, 08 Jun 2011 23:00:00 +0100

Abstract In 2011, all cardiologists believe that rapid opening of the infarct‐related artery is critical to enhanced survival. The preferred way to open an occluded vessel is percutaneous intervention (PCI), but thrombolytic therapy remains a viable option in hospitals when PCI capability is not immediately available. © 2011 Wiley Periodicals, Inc.The author has no funding, financial relationships, or conflicts of interest to disclose. (Source: Clinical Cardiology)

Modified Thrombolytic Therapy for Massive Pulmonary Emboli

The American Journal of Medicine — Tue, 07 Jun 2011 23:00:00 +0100

In this report, we present a case of a patient with a thrombus in transit through the right ventricle detected on transthoracic echocardiogram, subsequently causing a massive pulmonary embolism and cardiac arrest. The tPA stroke protocol along with 10,000 units of heparin was successfully implemented with full recovery. (Source: The American Journal of Medicine)

Do we need echocardiography before commencing thrombolytic therapy also for pulmonary embolism?

The American Journal of Emergency Medicine — Sun, 05 Jun 2011 23:00:00 +0100

We read with great interest the letter by Dr Hasanin and Kinsara in the February 2011 issue of the American Journal of Emergency Medicine, in which they described a case of fatal multiple infarcts 1 hour after initiation of thrombolytic therapy for acute ST-elevation myocardial infarction . In their case report, echocardiography study disclosed a dilated left ventricle with severe global hypokinesis suggestive of preexisting cardiomyopathy and a disintegrated left ventricular apical thrombus pointing out to the source of the embolic complications. The authors raise the question whether echocardiography before initiating thrombolytic therapy would affect the decision of commencing thrombolytic therapy and help avoiding complications. (Source: The American Journal of Emergency Medicine)

More stroke patients getting thrombolytic therapy

theHeart.org — Fri, 03 Jun 2011 15:15:17 +0100

Rates of thrombolysis roughly doubled over five years, but the proportion "remains small," and continued educational efforts are needed to further boost rates, experts say. For complete story visit theheart.org. (Source: theHeart.org)

More Stroke Patients Getting Thrombolytic Therapy

Medscape Today Headlines — Fri, 03 Jun 2011 14:18:21 +0100

Rates of thrombolysis roughly doubled over 5 years, but the proportion "remains small" and continued educational efforts are needed to further boost rates, experts say. Medscape Medical News (Source: Medscape Today Headlines)

More Stroke Patients Getting Thrombolytic Therapy More Stroke Patients Getting Thrombolytic Therapy

Medscape Emergency Medicine Headlines — Fri, 03 Jun 2011 14:18:21 +0100

Gender-based differences in the management and prognosis of acute coronary syndrome in Korea.

Yonsei Medical Journal — Fri, 03 Jun 2011 13:02:57 +0100

Conclusion: Female ACS patients were older than male subjects and had more atypical presentation. They arrived at the hospital later than men and had longer hospital stays, but less often required revascularization therapy. However, no gender-based differences were noted in ACS-related mortality and morbidity. PMID: 21623596 [PubMed - in process] (Source: Yonsei Medical Journal)

Intravenous Thrombolytic Therapy for Acute Ischemic Stroke

New England Journal of Medicine — Wed, 01 Jun 2011 21:00:10 +0100

New England Journal of Medicine, Volume 364, Issue 22, Page 2138-2146, June 2011. (Source: New England Journal of Medicine)

Thrombin activatable fibrinolysis inhibitor.

Hamostaseologie — Tue, 31 May 2011 23:00:00 +0100

Authors: Declerck PJ Thrombin activatable fibrinolysis inhibitor (TAFI) was discovered two decades ago as a consequence of the identification of an unstable carboxypeptidase (CPU), which was formed upon thrombin activation of the respective pro-enzyme (proCPU). The antifibrinolytic function of the activated form (TAFIa, CPU) is directly linked to its capacity to remove C-terminal lysines from the surface of the fibrin clot. No endogenous inhibitors have been identified, but TAFIa activity is regulated by its intrinsic temperature-dependent instability with a half-life of 8 to 15 min at 37 °C. A variety of studies have demonstrated a role for TAFI/TAFIa in venous and arterial diseases. In addition, a role in inflammation and cell migration has been shown. Since an elevated level of TAF...

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Vascular complications and microvascular free flap salvage: The role of thrombolytic agents

Microsurgery — Mon, 30 May 2011 23:00:00 +0100

Conclusions: The decreased incidence of fat necrosis may be attributable to dissolution of thrombi in the microvasculature with the administration of thrombolytics. Although the use of adjuvant thrombolytic therapy does not appear to impact the rate of flap salvage, their use may have secondary benefits on overall flap outcomes. © 2011 Wiley‐Liss, Inc. Microsurgery 2011. (Source: Microsurgery)

Predictors of infarct-related artery patency following combined lytic therapy in patients with ST-segment elevation myocardial infarction treated with immediate percutaneous coronary intervention.

Kardiologia Polska — Sun, 29 May 2011 05:00:04 +0100

Conclusions: Angiographic (anatomical) IRA parameter as distance from CLMLD point to nearest proximal side branch may influence the efficacy of combined fibrinolytic therapy before PCI despite the similar clinical characteristics and time delay to angiography. Smoking has a paradoxical beneficial effect on combined thrombolytic therapy effectiveness. Kardiol Pol 2011; 69, 5: 452-457. PMID: 21594830 [PubMed - in process] (Source: Kardiologia Polska)

Thrombolysis No Better Than Anticoagulation for PE

Medscape Today Headlines — Wed, 25 May 2011 20:56:15 +0100

Thrombolytic therapy was no better than anticoagulation for pulmonary embolism (PE), and carried a slightly higher risk for death in normotensive patients. Medscape Medical News (Source: Medscape Today Headlines)

Thrombolysis in Acute Ischaemic Stroke: An Update

Medscape Today Headlines — Tue, 24 May 2011 11:04:47 +0100

This article summarizes recent advances in thrombolytic therapy and looks at the key issues faced by clinicians. Therapeutic Advances in Chronic Disease (Source: Medscape Today Headlines)

Scintigraphic parameters with emphasis on perfusion appraisal in rest 99mTc-sestamibi SPECT in the recovery of myocardial function after thrombolytic therapy in patients with ST elevation myocardial infarction (STEMI).

Perfusion — Tue, 17 May 2011 23:00:00 +0100

CONCLUSION: These data showed that redistributionand reverse redistribution of 99mTc-sestamibi post thrombolytic therapy can be used as a marker of viability to predictthe recovery of segmental wall motion abnormality (stunning), as well as the improvement of segmental perfusion uptake.This study also demonstrates that the resting 99mTc-sestamibi SPECT can be used for an approximate assessment of LVfunction status and can predict the recovery of jeopardized myocardium function after thrombolytic therapy. PMID: 21593086 [PubMed - as supplied by publisher] (Source: Perfusion)

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Multimodal Imaging Does Not Delay Intravenous Thrombolytic Therapy in Acute Stroke [BRAIN]

American Journal of Neuroradiology — Thu, 12 May 2011 23:00:00 +0100

CONCLUSIONS: In our single-center experience, the use of multimodal imaging in patients with acute stroke did not delay IV tPA beyond 60 minutes. Further study is needed to assess the feasibility of the routine use of multimodal imaging in the acute stroke setting. (Source: American Journal of Neuroradiology)

Ultrasound-assisted thrombolysis of thrombus and pulmonary embolus

Journal of Vascular Nursing — Thu, 12 May 2011 22:42:49 +0100

Discussions of current methods and potential future use for emerging methods are presented. The science of ultrasound is used as an example of how such advances are highly effective in reducing time in treatment. Finally a case study of a life-threatening pulmonary embolism and its management is presented, highlighting the efficacy of new treatment methods, and the potential for improved patient outcomes is described. (Source: Journal of Vascular Nursing)

Provider perceptions of barriers to the emergency use of tPA for Acute Ischemic Stroke: A qualitative study

BMC Emergency Medicine — Thu, 05 May 2011 23:00:00 +0100

Conclusions: Healthcare providers perceive environmental and patient-related factors as the primary barriers to adherence with acute stroke treatment guidelines. Interventions focused on increasing physician familiarity with and motivation to follow guidelines may be of highest yield in improving adherence. Improving self-efficacy in performing guideline concordant care may also be useful.Trial Registration: ClinicalTrials.gov identifier: NCT00349479 (Source: BMC Emergency Medicine)

Causal relationship between hyperfibrinogenemia, thrombosis, and resistance to thrombolysis in mice

Blood — Wed, 04 May 2011 23:00:00 +0100

Epidemiologic studies have correlated elevated plasma fibrinogen (hyperfibrinogenemia) with risk of cardiovascular disease and arterial and venous thrombosis. However, it is unknown whether hyperfibrinogenemia is merely a biomarker of the proinflammatory disease state or is a causative mechanism in the etiology. We raised plasma fibrinogen levels in mice via intravenous infusion and induced thrombosis by ferric chloride application to the carotid artery (high shear) or saphenous vein (lower shear); hyperfibrinogenemia significantly shortened the time to occlusion in both models. Using immunohistochemistry, turbidity, confocal microscopy, and elastometry of clots produced in cell and tissue factor-initiated models of thrombosis, we show that hyperfibrinogenemia increased thrombus fibrin con...

Unusual cause of acute right ventricular dysfunction: rapid progression of superior vena cava aneurysm complicated by thrombosis and pulmonary thromboembolism.

J Korean Med Sci — Sat, 30 Apr 2011 23:00:00 +0100

We report an extremely rare case of rapidly progressing superior vena cava (SVC) aneurysm complicated by thrombosis and acute pulmonary thromboembolism (PTE) with right ventricular dysfunction. Thrombolytic therapy for hemodynamically significant acute PTE was harmful to the patient in the present case, because it induced further thrombosis and mobilization of the thrombi within the aneurysm, subsequently causing de novo PTE. Surgical aneurysmectomy combined with pulmonary artery embolectomy would be a treatment of choice in patients with SVC aneurysm complicated by acute PTE. PMID: 21532864 [PubMed - in process] (Source: J Korean Med Sci)

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Imaging Stroke Patients with Unclear Onset Times

Neuroimaging Clinics — Sat, 30 Apr 2011 23:00:00 +0100

This article reviews and compares some of these imaging-based approaches to thrombolysis eligibility, which can potentially expand the use of thrombolytic therapy to a broader population of acute stroke patients. (Source: Neuroimaging Clinics)

Very low bleeding rates with local thrombolytic therapy given during percutaneous endovenous intervention for the treatment of deep venous thrombosis

Cardiovascular Revascularization Medicine — Sat, 30 Apr 2011 23:00:00 +0100

We report our experience with the delivery of regional thrombolytic therapy as an adjunctive modality in percutaneous endovenous intervention (PEVI) for the treatment of DVT and explore its safety and efficacy. (Source: Cardiovascular Revascularization Medicine)

Safety of bivalirudin in primary percutaneous coronary intervention following thrombolytic therapy

Cardiovascular Revascularization Medicine — Sat, 30 Apr 2011 23:00:00 +0100

This study aimed to compare the safety of BIV vs. unfractionated heparin (UFH) in patients undergoing primary PCI following initial management with thrombolytic therapy. (Source: Cardiovascular Revascularization Medicine)

The International Stroke Trial database

Trials — Wed, 20 Apr 2011 23:00:00 +0100

Conclusions: The IST dataset provides a source of primary data which could be used for planning further trials, for sample size calculations and for novel secondary analyses. Given the age distribution and nature of the background treatment given, the data may be of value in planning trials in older patients and in resource-poor settings. (Source: Trials)

Using Recombinant Tissue Plasminogen Activator to Treat Acute Ischemic Stroke in China: Analysis of the Results From the Chinese National Stroke Registry (CNSR).

Stroke — Wed, 20 Apr 2011 23:00:00 +0100

CONCLUSIONS: Approximately 1 in 5 patients with stroke presenting within 3 hours received thrombolytic therapy. The onset-to-needle time, door-to-needle time, and especially imaging-to-needle time were significantly longer than those in developed countries. Reducing prehospital and in-emergency department response time would help increase intravenous rtPA use in China. PMID: 21512182 [PubMed - as supplied by publisher] (Source: Stroke)

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Association of Early National Institutes of Health Stroke Scale Improvement With Vessel Recanalization and Functional Outcome After Intravenous Thrombolysis in Ischemic Stroke.

Stroke — Wed, 20 Apr 2011 23:00:00 +0100

CONCLUSIONS: Early 20% neurological improvement at 2 hours was the best predictor of 3-month functional outcome and recanalization after thrombolysis, although fairly accurate, and may serve as a surrogate marker of recanalization if only imaging evaluation of vessel status is not available. If recanalization status is required after intravenous thrombolysis, vascular imaging is recommended despite ENI. PMID: 21512176 [PubMed - as supplied by publisher] (Source: Stroke)

Case Series of Post-Thrombolysis Patients Undergoing Hemicraniectomy for Malignant Anterior Circulation Ischaemic Stroke

International Journal of Photoenergy — Mon, 18 Apr 2011 14:01:36 +0100

While ischaemic stroke remains a leading cause of death and disability, there have been recent advancements in treatment modalities including thrombolysis and decompressive hemicraniectomy. A retrospective review of patients treated in our NHS teaching hospital, in Plymouth (UK), over a 2 year period identified 17 thrombolysed patients, of whom two had undergone subsequent decompressive hemicraniectomy. These were non-dominant hemisphere strokes in young patients, aged 51 and 57. Initial NIHSS scores were 16 and 17, and they received thrombolysis at 2 hrs 42 min and 5 hrs 10 min post onset of symptoms respectively. CT imaging demonstrated cerebral swelling with significant midline shift in both cases, and decompressive hemicraniectomy was undertaken at 29 ...

Case of “Slow” Stroke from Carotid Artery Occlusion Treated by Delayed but Cautious Endovascular Intervention

Anesthesiology Research and Practice — Wed, 13 Apr 2011 14:27:59 +0100

We present such a case in which we used multimodal imaging techniques, including MR-perfusion, to facilitate endovascular revascularization. Our approach of delayed but cautious intra-arterial thrombolytic therapy, guided by brain imaging, and followed by stent placement across the residual stenosis, enabled revascularization of the occluded artery without overt in-hospital complications. (Source: Anesthesiology Research and Practice)

Barriers of Thrombolysis Therapy in Developing Countries

Anesthesiology Research and Practice — Fri, 08 Apr 2011 14:18:14 +0100

The developing world carries the highest burden of stroke mortality and stroke-related disability. The number of stroke patients receiving r-tPA in the developing world is extremely low. Prehospital delay, financial constraints, and lack of infrastructure are main barriers of thrombolysis therapy in developing countries. Until a cheaper thrombolytic agent and the proper infrastructure for utilization of thrombolytic therapy is available, developing countries should focus on primary and secondary stroke prevention strategies. However, governments and health systems of developing countries should efforts exerb for promotion of their infrastructure of stroke care. (Source: Anesthesiology Research and Practice)

Ultrasound Accelerated Catheter Directed Thrombolysis for Pulmonary Embolus and Right Heart Thrombus Secondary to Transvenous Pacing Wires

Vascular and Endovascular Surgery — Thu, 07 Apr 2011 23:00:00 +0100

Acute pulmonary embolism is associated with a significant number of deaths each year, which are commonly attributed to deep venous thrombosis of the lower extremity. Pulmonary embolism due to right-sided cardiac thrombus associated with transvenous wires is a rare occurrence. Treatment considerations have been systemic anticoagulation with heparin or systemic thrombolytic therapy. A unique case of a patient with symptomatic PE and extensive atrial and ventricle thrombus formation associated with transvenous pacing wires treated with ultrasound accelerated catheter directed thrombolysis is presented. (Source: Vascular and Endovascular Surgery)

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Translational Stroke Research of the Combination of Thrombolysis and Antioxidant Therapy.

Stroke — Wed, 06 Apr 2011 23:00:00 +0100

This article contends that further translational research should explore newer antioxidant drugs in combination with thrombolytic agents, but only if the combination yields additive or synergistic effects in preclinical thromboembolic models or in biomarker-assisted Phase II studies. Edaravone and novel nitrones endowed with a better pharmacokinetic profile or multitarget and thrombolytic activity are discussed as well as the latest research data on uric acid, a strong endogenous antioxidant in blood that is early consumed after acute stroke. The coadministration of uric acid and recombinant tissue plasminogen activator has shown to provide synergistic neuroprotection in experimental thromboembolic models and to lessen several biomarkers of oxidative stress in patients with acute stroke. T...

Attacking Pulmonary Embolism -- A Practice-Changing Procedure

Medscape Today Headlines — Fri, 01 Apr 2011 14:10:47 +0100

Watch this breakthrough and simple approach for delivering thrombolytic therapy in patients with PE. Tod Englehardt, who describes this procedure, believes this will change the standard of care. Medscape Cardiology (Source: Medscape Today Headlines)

The Annexin A2 System and Vascular Homeostasis.

Vascular Pharmacology — Wed, 23 Mar 2011 00:00:00 +0100

Authors: Flood EC, Hajjar KA Optimal fibrin balance requires precisely controlled plasmin generation on the surface of endothelial cells, which line the blood vessel wall. As a co-receptor for plasminogen and tissue plasminogen activator (tPA), which are key factors in plasmin generation, the annexin A2 (A2) complex promotes vascular fibrinolysis. The intracellular A2 complex is a heterotetramer of two A2 monomers and two copies of the associated protein, p11. In response to endothelial cell activation, A2 is phosphorylated by src-kinase, and translocated to the cell surface in a highly regulated manner. Over- expression of A2 is seen in acute promyelocytic leukemia during the early hemorrhagic phase, while high titer antibodies to A2, as in antiphospholipid syndrome or cerebral venous...

Nonsurgical Hepatic Decompression In Budd-Chiari

Health News from Medical News Today — Wed, 16 Mar 2011 11:00:00 +0100

Budd-Chiari syndrome (BCS) results from hepatic venous outflow obstruction at any level from hepatic venules to the right atrium. Few patients respond to medical treatment (anticoagulation with or without thrombolytic therapy, diuretics). However, most patients need intervention to restore the hepatic blood flow. Restoring outflow in one of the major hepatic veins by balloon dilatation with or without stenting is the management of choice. When not possible or failed, transjugular intrahepatic portosystemic shunt (TIPS) is used... (Source: Health News from Medical News Today)

Thrombolysis for Acute Stroke in Hemodialysis: International Survey of Expert Opinion.

Clinical Journal of the American Society of Nephrology : CJASN — Thu, 10 Mar 2011 00:00:00 +0100

Conclusions Despite the acknowledged absence of data and prevalent concerns about bleeding risk, most surveyed experts favored its use. One-third reported treating hemodialysis patients with this therapy. Although these results do not substitute for data, they usefully define the range of current practice of stroke experts. PMID: 21393487 [PubMed - as supplied by publisher] (Source: Clinical Journal of the American Society of Nephrology : CJASN)

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The role of thrombolysis in the clinical management of deep vein thrombosis.

Arteriosclerosis, Thrombosis and Vascular Biology — Tue, 01 Mar 2011 00:00:00 +0100

Authors: Popuri RK, Vedantham S The cornerstones of current management of deep vein thrombosis (DVT) are the routine use of anticoagulant therapy, graduated elastic compression stockings, and early ambulation. Thrombolytic therapy was previously reserved only for patients with life-, limb-, or organ-threatening complications. However, the postthrombotic syndrome has been increasingly recognized as a frequent and serious long-term complication of DVT. In parallel, endovascular thrombolytic methods have evolved considerably in recent years, prompting discussion and controversy as to whether they should be more liberally used. In some centers, pharmacomechanical catheter-directed thrombolysis is now routinely used in the treatment of acute iliofemoral DVT. Randomized trials are currently ...

Intravenous thrombolytic therapy in patients with stroke mimics: baseline characteristics and safety profile

European Journal of Neurology — Tue, 01 Mar 2011 00:00:00 +0100

Conclusion: Patients with stroke mimics have a good safety profile when treated with rt‐PA. In case of doubt, physicians should not postpone thrombolysis, because its potential benefit in confirmed ischaemic stroke might be higher than the risk of complications in stroke mimics. A combined analysis of such small series of cases would be useful to have a better delineation of the clinical profile of these patients. (Source: European Journal of Neurology)

High-frequency electrocardiogram during reperfusion therapy of acute inferior myocardial infarction

Journal of Electrocardiology — Tue, 01 Mar 2011 00:00:00 +0100

Resolution of ST-segment elevation in electrocardiogram (ECG) is used as a reperfusion sign during thrombolytic therapy in acute myocardial infarction (MI). Previous studies have shown that acute myocardial ischemia is accompanied by reduced amplitude of high-frequency QRS components (HF-QRS) in the frequency range of 150 to 250 Hz. Studies during thrombolytic therapy, using few electrocardiographic leads, in patients with acute MI suggest that analysis of the HF-QRS also may have the ability to detect reperfusion. In these studies, reperfusion was accompanied by an increase in HF-QRS. The present study compares changes in HF-QRS to ST-segment changes in the standard ECG during thrombolytic therapy. (Source: Journal of Electrocardiology)

Home Time Is Extended in Patients With Ischemic Stroke Who Receive Thrombolytic Therapy: A Validation Study of Home Time as an Outcome Measure.

Stroke — Thu, 24 Feb 2011 00:00:00 +0100

CONCLUSIONS: HT is a responsive measure for use in multinational acute stroke trials. Its inclusion as a complementary outcome is reasonable. We propose treatment effects are adjusted for age, baseline National Institutes of Health Stroke Scale, side of stroke lesion, country of enrollment, and the presence of diabetes. PMID: 21350199 [PubMed - as supplied by publisher] (Source: Stroke)

MicroRNAs in Stroke Pathogenesis.

Current Molecular Medicine — Tue, 22 Feb 2011 00:00:00 +0100

Authors: Tan JR, Koo YX, Kaur P, Liu F, Armugam A, Wong PT, Jeyaseelan K Stroke is one of the leading causes of death and disability worldwide. There are two major types of stroke: cerebral ischemia caused by obstruction of blood vessels in the brain and haemorrhagic stroke that is triggered by the disruption of blood vessels. Thrombolytic therapy involving recombinant tissue plasminogen activator (rtPA) has been shown to be beneficial only when used within 4.5 hours of onset of acute ischemic stroke. rtPA treatment beyond this time window has been found to be unsuitable and usually resulting in haemorrhagic transformation. Stroke is a multifactorial disease that forms a possible end state for majority of patients suffering from diabetes, atherosclerosis and hypertension which are know...

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Multimodal CT-Assisted Thrombolysis in Patients With Acute Stroke: A Cohort Study.

Stroke — Thu, 17 Feb 2011 00:00:00 +0100

CONCLUSIONS: Multimodal CT use in routine clinical practice may heighten the overall efficacy of thrombolytic therapy in acute ischemic stroke. The benefits seem greater in patients treated >3 hours after stroke onset, but further randomized clinical trials are needed to confirm these findings. PMID: 21330631 [PubMed - as supplied by publisher] (Source: Stroke)

Lingual Hematoma after Thrombolytic Therapy

New England Journal of Medicine — Wed, 16 Feb 2011 22:00:12 +0100

New England Journal of Medicine, Volume 364, Issue 7, February 2011. (Source: New England Journal of Medicine)

Failure of complete recanalization is associated with poor outcome after cardioembolic stroke

European Journal of Neurology — Fri, 11 Feb 2011 18:35:35 +0100

Conclusions: In cardioembolic strokes, failure of complete recanalization following thrombolytic therapy was frequent and was associated with poor outcome after thrombolysis. (Source: European Journal of Neurology)

Endovascular Stroke Treatment Today [REVIEW ARTICLES]

American Journal of Neuroradiology — Fri, 11 Feb 2011 00:00:00 +0100

SUMMARY: The purpose of this study was to review current treatment options in acute ischemic stroke, focusing on the latest advances in the field of mechanical recanalization. These devices recently made available for endovascular intracranial thrombectomy show great potential in acute stroke treatments. Compelling evidence of their recanalization efficacy comes from current mechanical embolectomy trials. In addition to allowing an extension of the therapeutic time window, mechanical recanalization devices can be used without adjuvant thrombolytic therapy, thus diminishing the intracranial bleeding risk. Therefore, these devices are particularly suitable in patients in whom thrombolytic therapy is contraindicated. IV and IA thrombolysis and bridging therapy are viable options in acute stro...

Multimodal Imaging Does Not Delay Intravenous Thrombolytic Therapy in Acute Stroke [BRAIN]

American Journal of Neuroradiology — Thu, 10 Feb 2011 00:00:00 +0100

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Intraventricular thrombolysis with rt‐PA in patients with intraventricular hemorrhage

Acta Neurologica Scandinavica — Tue, 08 Feb 2011 00:00:00 +0100

Conclusions – IVen administration of rt‐PA seems to be safe in cases of IVH. This pilot study shows that it may be associated with better outcomes. Further studies and clinical randomized trials are needed to establish indications and IVen administration protocols. (Source: Acta Neurologica Scandinavica)

A population-based study of thrombolysis for acute stroke in South Australia.

Med J Aust — Mon, 07 Feb 2011 00:00:00 +0100

Authors: Leyden JM, Chong WK, Kleinig T, Lee A, Field JB, Jannes J To report the rate of thrombolysis for treating acute stroke in South Australia from October 2007 to September 2009. We hypothesised that the rate of thrombolytic therapy would be related to distance from an acute stroke unit. PMID: 21299483 [PubMed - in process] (Source: Med J Aust)

Predictors of early arrival at the emergency department in acute ischaemic stroke

Irish Journal of Medical Science — Sun, 06 Feb 2011 06:36:46 +0100

Conclusion The only independent predictor of early arrival to the ED is direct presentation. Improved public education of the importance of recognition of stroke symptoms and rapid contact with the emergency services will improve the early attendance following acute stroke, allowing increased use of acute stroke treatments. Content Type Journal ArticlePages 1-5DOI 10.1007/s11845-011-0686-4Authors C. Curran, Department of Geriatric Medicine, Mercy University Hospital, Cork, IrelandC. Henry, Department of Geriatric Medicine, Mercy University Hospital, Cork, IrelandK. A. O’Connor, Department of Geriatric Medicine, Mercy University Hospital, Cork, IrelandP. E. Cotter, Department of Geriatric Medicine, Mercy University Hospital, Cork, Ireland Journal Irish Journ...

Protein S blocks the extrinsic apoptotic cascade in tissue plasminogen activator/N-methyl D-aspartate-treated neurons via Tyro3-Akt-FKHRL1 signaling pathway

Molecular Neurodegeneration — Thu, 03 Feb 2011 00:00:00 +0100

Conclusions: PS blocks the extrinsic apoptotic cascade through a novel mechanism mediated by Tyro3-dependent FKHRL1 phosphorylation which inhibits FasL-dependent caspase-8 activation and can control tPA-induced neurotoxicity associated with pathologic activation of NMDA receptors. The present findings should encourage future studies in animal stroke models to determine whether PS can increase the therapeutic window of tPA by reducing its post-ischemic neuronal toxicity. (Source: Molecular Neurodegeneration)

Thrombolytic therapy for acute ischaemic stroke: is the hype justified?

Hong Kong Med J — Tue, 01 Feb 2011 00:00:00 +0100

Authors: Kumana CR, Cheung BM PMID: 21282834 [PubMed - in process] (Source: Hong Kong Med J)

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Random Treatment Assignment Using Mathematical Equipoise for Comparative Effectiveness Trials

Clinical and Translational Science — Tue, 01 Feb 2011 00:00:00 +0100

AbstractIn controlled clinical trials, random assignment of treatment is appropriate only when there is equipoise, that is, no clear preference among treatment options. However, even when equipoise appears absent because prior trials show, on average, one treatment yields superior outcomes, random assignment still may be appropriate for some patients and circumstances. In such cases, enrollment into trials may be assisted by real‐time patient‐specific predictions of treatment outcomes, to determine whether there is equipoise to justify randomization. The percutaneous coronary intervention thrombolytic predictive instrument (PCI–TPI) computes probabilities of 30‐day mortality for patients having ST elevation myocardial infarction (STEMI), if treated with thrombolytic therapy (TT), a...

Management of HeartWare left ventricular assist device thrombosis using intracavitary thrombolytics

The Journal of Thoracic and Cardiovascular Surgery — Mon, 31 Jan 2011 00:00:00 +0100

Left ventricular assist devices (LVADs) improve the survival and quality of life in patients with refractory heart failure compared with optimal medical therapy. Compared with pulsatile LVADs (p-LVADs), continuous-flow LVADs (cf-LVADs) demonstrate better survival with fewer device-related complications. However, the blood-contact surfaces of the p-LVADs promote the formation of a pseudointima that reduces thrombogenicity, whereas the impeller cf-LVADs do not generate a pseudointima and may have a higher rate of pump thrombosis. Experience with cf-LVAD thrombosis is limited. Although thrombolytic therapy has been described with axial-flow devices, there are no reports of thrombolysis with cf-LVADs. (Source: The Journal of Thoracic and Cardiovascular Surgery)

Association Between Stroke Center Hospitalization for Acute Ischemic Stroke and Mortality [Original Contribution]

JAMA — Tue, 25 Jan 2011 00:00:00 +0100

Conclusion Among patients with acute ischemic stroke, admission to a designated stroke center was associated with modestly lower mortality and more frequent use of thrombolytic therapy. (Source: JAMA)

Stroke Center Admission Likely Improves Patient Outcomes

Modern Medicine — Tue, 25 Jan 2011 00:00:00 +0100

Admission of patients with acute ischemic stroke to a designated stroke center may lower mortality and improve use of thrombolytic therapy, and the occurrence of stroke among patients undergoing coronary artery bypass graft surgery appears to be declining despite increases in patient risk profiles, according to two studies published online Jan. 25 in the Journal of the American Medical Association. (Source: Modern Medicine)

Incidental finding of cor triatriatum sinister in an adult post-myocardial infarction

Cardiovascular Pathology — Tue, 25 Jan 2011 00:00:00 +0100

We report a case of a 51-year-old man who was transferred from a community hospital to our institution in cardiogenic shock after thrombolytic therapy for myocardial infarction. At autopsy, a cor triatriatum sinister was found. This may have contributed to his poor outcome post infarction. (Source: Cardiovascular Pathology)

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Dutch randomized trial comparing standard catheter-directed thrombolysis versus Ultrasound-accElerated Thrombolysis for thromboembolic infrainguinal disease (DUET): design and rationale

Trials — Sun, 23 Jan 2011 00:00:00 +0100

DiscussionThe DUET study is a randomized controlled trial that will provide evidence of whether US-accelerated thrombolysis will significantly reduce therapy time in patients with recently thrombosed infrainguinal native arteries or bypass grafts, without an increase in complications.Trial registration: Current Controlled Trials ISRCTN72676102 (Source: Trials)

Thrombolytic Therapy in a Patient With Suspected Pulmonary Embolism and a Negative CTPA. An Unsuspected Outcome.

Respiratory Care — Fri, 21 Jan 2011 00:00:00 +0100

We report a case of a 62-year-old male who presented to our intensive care unit with hypoxemia six hours after retinal surgery. He had a negative computed tomography pulmonary angiogram (CTPA) but an echocardiogram done emergently revealed McConnell's sign. He was thrombolysed and had rapid improvement in oxygenation and hemodynamics. Thrombolysis in hemodynamically unstable pulmonary embolism (PE) is not controversial, but most algorithms require confirmation of the diagnosis. Our patient had a negative CTPA but was thrombolysed based on the clinical picture. Autopsy confirmed the diagnosis of multiple pulmonary emboli and unexpectedly discovered a patent foramen ovale (PFO) that explained paradoxical embolism to the brain. PMID: 21255493 [PubMed - as supplied by publisher] (Source: R...

Vascular Arterial Compression Syndromes

Current Treatment Options in Cardiovascular Medicine — Mon, 17 Jan 2011 20:40:34 +0100

Opinion statement Vascular arterial compression syndromes are uncommon disorders due to dynamic anatomic compression of an artery resulting in significant ischemia in the supplied territories with ensuing symptoms. The diagnosis of these disorders requires heightened awareness and a high index of suspicion by the clinician. These diagnoses should be particularly suspected in young patients with typical symptoms but without underlying cardiovascular risk factors. Physical examination may be unremarkable, although the clinical symptoms or signs may be elicited with provocative maneuvers. The diagnostic work-up may include noninvasive tests such as Doppler waveforms, duplex ultrasonography, computed tomographic angiography, and MRI/angiography, but may require conventional an...

Comparison of Impact of Mortality Risk on the Survival Benefit of Primary Percutaneous Coronary Intervention Versus Facilitated Percutaneous Coronary Intervention

The American Journal of Cardiology — Sat, 15 Jan 2011 00:00:00 +0100

In conclusion, the higher the mortality risk of patients with ST elevation myocardial infarctions, the higher the likelihood of a survival advantage of PPCI over FPCI. (Source: The American Journal of Cardiology)

How accurately can the aetiology of cardiac arrest be established in an out-of-hospital setting? Analysis by “Concordance in Diagnosis Crosscheck Tables”

Resuscitation — Fri, 14 Jan 2011 00:00:00 +0100

Conclusion: This study demonstrates the importance of analysing concordance in presumed and definitive diagnosis of individual cases, since an overall comparison in a cohort of cases may be highly misleading. It introduces the method of the crosscheck table for visualization and comparison of presumed and final diagnoses. The two alternative approaches of inclusion rule for applying the thrombolytic therapy in out-of-hospital care were discussed with regard to the recent TROICA study. (Source: Resuscitation)

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Endovascular Stroke Treatment Today [REVIEW ARTICLE]

American Journal of Neuroradiology — Thu, 13 Jan 2011 00:00:00 +0100

The Start of a New Era for Stroke Treatment: Mechanical Thrombectomy Devices.

Current Neurovascular Research — Wed, 05 Jan 2011 00:00:00 +0100

Authors: Benmira S, Banda ZK, Bhattacharya V Stroke is a major cause of mortality in the U.K. accounting for 53,000 deaths every year. There are few options for the treatment of acute ischemic stroke and recombinant tissue plasminogen activator (rt-PA) remains the only approved and currently available thrombolytic therapy given within the first 3 hours after symptom onset. Mechanical thrombectomy is a promising new treatment modality for patients who are ineligible for or failing intravenous rt-PA, or presenting beyond the narrow 3-hour therapeutic window, and emerged with the development of the Merci retrieval system. A number of devices are now available and can be divided into two major subgroups according to their mode of action. Those using a proximal approach such as aspiration d...

Repeated vertebrobasilar thromboembolism in a patient with severe upper cervical instability because of rheumatoid arthritis

The Spine Journal — Mon, 03 Jan 2011 00:00:00 +0100

Conclusions: Repeated vertebrobasilar thromboembolism in patients with RA may sometimes be caused by severe upper cervical instability that can be treated without surgery. (Source: The Spine Journal)

Thrombolytic Therapy in the Acute Management of Frostbite Injuries

Air Medical Journal — Sat, 01 Jan 2011 00:00:00 +0100

Frostbite injuries frequently result in devastating ischemic damage to the distal extremities. This ischemia and resultant necrosis have historically been managed expectantly, with amputation of devitalized tissue commonly being the end result after severe injury. Advances in nuclear medicine, interventional radiology, and thrombolytic therapy have contributed to the development of a therapy proving successful in reversing these acute ischemic effects and ameliorating the morbidity of these rare limb-threatening injuries. (Source: Air Medical Journal)