MedWorm: Thrombolytic Therapy

Door-to-Needle Times in Acute Myocardial Infarction [ORIGINAL ARTICLE]

Asian Cardiovascular and Thoracic Annals — Fri, 19 Mar 2010 09:53:54 +0100

We examined the effects of implementing a better organized team approach to reduce door-to-needle times in patients with acute myocardial infarction. Fully trained emergency department personnel with special equipment facilitated direct communication between offsite cardiologists and pre-hospital emergency personnel, allowing for patient triage directly to the coronary care unit. Demographic, laboratory, and time interval data were prospectively collected and compared with data from previous years. From April to December 2007, 60 patients with acute ST-elevation myocardial infarction were triaged to the coronary care unit and enrolled in this study. Improvements were seen in mean door-to-needle time (reduced from 80 to 30 min during regular hours, and 85 to 33 min outside regular hours) co...

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Management of Pulmonary Embolism: 2010 State-of-the-Art Update

Current Treatment Options in Cardiovascular Medicine — Tue, 16 Mar 2010 14:52:59 +0100

Opinion statement The morbidity and mortality of venous thromboembolism remain underrecognized and underappreciated. Suspected pulmonary embolism should be risk stratified using a validated clinical risk prediction tool; intermediate to high clinical suspicion requires objective diagnostic testing to confirm or refute the diagnosis. Therapy with unfractionated heparin, low molecular weight heparin, or fondaparinux should be initiated while diagnostic testing is pursued. Conversion to vitamin K antagonists requires a minimum of 5 days’ overlap between the parenteral agent and the vitamin K antagonist. Anticoagulation should be continued for a minimum of 3 to 6 months. Longer or even indefinite therapy may be required with a persistent hypercoagulable state. In p...

Acceptable reperfusion delay to prefer primary angioplasty over fibrin-specific thrombolytic therapy is affected (mainly) by the patient's mortality risk: 1 h does not fit all

European Heart Journal — Mon, 15 Mar 2010 16:45:22 +0100

Conclusion Baseline mortality risk of ST elevation myocardial infarction patients is a major determinant of the acceptable time delay to choose the most appropriate therapy. Although a longer delay lowers the survival advantage of PPCI, a longer PPCI-related delay could be acceptable in high-risk STEMI patients. (Source: European Heart Journal)

Systemic thrombolysis with recombinant tissue plasminogen activator in acute ischemic stroke: first Croatian experiences

Neurological Sciences — Sun, 14 Mar 2010 11:29:21 +0100

We present a 2-year experience of thrombolytic therapy (2006–2008) in the stroke unit of the University Hospital in Zagreb, Croatian largest hospital, serving nearly one-fifth of the citizens of Croatia. Obtained data (vitals at admission and before administration of rt-PA; NIHSS and MRS scores at admission, 2 h and 7th day after rt-PA treatment, “time to door” and “door to needle” intervals, duration of hospital treatment as well as outcomes and complications of our 66 thrombolysed patients) are presented and discussed. We also present our results regarding benefits of this therapy as well as possible reasons for complications noticed. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s10072-010-0237-1Authors Vesna Matijević, University Hospital ...

Outcomes of Thrombolytic Therapy for Acute Ischemic Stroke in Chinese Patients. The Taiwan Thrombolytic Therapy for Acute Ischemic Stroke (TTT-AIS) Study.

Stroke — Thu, 11 Mar 2010 00:00:00 +0100

CONCLUSIONS: This study suggests that the standard dose of 0.9 mg/kg alteplase may not be optimal for treating aged Chinese patients. However, the dose of recombinant tissue plasminogen activator for ischemic stroke in Chinese patients should be based on more broad and convincing evidences and randomized trials of lower versus higher doses are needed. PMID: 20224056 [PubMed - as supplied by publisher] (Source: Stroke)

Deep vein and intracardiac thrombosis during the post-partum period in Behçet's disease.

International Journal of Hematology — Wed, 10 Mar 2010 00:00:00 +0100

Deep vein and intracardiac thrombosis during the post-partum period in Behçet's disease. Int J Hematol. 2010 Mar 10; Authors: Hiwarkar P, Stasi R, Sutherland G, Shannon M A 22-year-old woman presented on the 10th post-partum day with deep vein thrombosis involving the right ilio-femoral and popliteal veins. This thrombosis was refractory to conventional anticoagulation and subsequently over a period of 6 weeks progressed to involve inferior vena cava and right ventricle. A diagnosis of Behçet's disease was made on the clinical grounds of fever, night sweats, and recurrent oral ulcers. In view of refractory thrombosis, anticoagulation with lepirudin was commenced followed by thrombolysis with streptokinase. After thrombolysis, anticoagulation was switched to fondaparin...

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Different therapy options protecting microvasculature after experimental cerebral ischaemia and reperfusion.

Thrombosis and Haemostasis — Tue, 09 Mar 2010 00:00:00 +0100

Authors: Burggraf D, Vosko MR, Schubert M, Stassen JM, Hamann GF Recombinant tissue plasminogen activator (rt-PA) is successfully used in human stroke, but often shows serious drawbacks. To find an alternative, we hypothesised that the novel thrombolytic microplasmin would have fewer adverse effects on haemoglobin extravasation and microvascular damage compared with the effects of rt-PA and tenecteplase (TNK). A constant period of ischaemia (3 hours) was induced in a rat suture model followed by reperfusion (24 hours). Mikroplasmin (10 mg/kg), TNK (5 mg/kg), rt-PA (9 mg/kg) and saline (control), were administered. The volume of the ischaemic lesion was calculated, the loss of collagen type IV and the extravasation of haemoglobin were quantified by Western blotting. The matrix-metallopr...

21. MR perfusion imaging in diagnostics of brain pathologies

Clinical Neurophysiology — Mon, 08 Mar 2010 18:13:03 +0100

The knowledge of parameters which describe oxygen and nutrients supply to tissues is essential from standpoint of diagnostics and follow-up of pathologies of brain. Due to their low spatial resolution MR angiographic techniques cannot visualize blood flow inside bulk tissue. In order to obtain the hemodynamic parameters which describe perfusion, MR perfusion imaging use drop in tissue signal during the first pass of contrast agent. Decrease in MR signal is proportional to intravascular concentration of contrast agent, which provides basis for calculation of regional cerebral volume (rCBV), regional cerebral flow (rCBF) and mean transition time (MTT) and corresponding maps of these parameters. Such maps can pinpoint to changes in perfusion of brain tissue which can be consequence or cause o...

4. MR perfusion imaging in diagnostics of brain pathologies

Clinical Neurophysiology — Mon, 08 Mar 2010 18:13:02 +0100

The knowledge of parameters which describe oxygen and nutrients supply to tissues is essential from standpoint of diagnostics and follow-up of pathologies of brain. Due to their low spatial resolution MR angiographic techniques cannot visualize blood flow inside bulk tissue. MR perfusion imaging is technique which use drop in tissue signal during the first pass of contrast agent in order to obtain the haemodynamic parameters which describe perfusion. Calculation of those values requires determination of time course of change of agent concentration in both tissue and feeding artery. Decrease in MR signal is proportional to intravascular concentration of contrast agent, which provides basis for calculation of regional cerebral volume (rCBV), regional cerebral flow (rCBF) and mean transition ...

Sonothrombolysis Effective in Clot Evacuation in Intracerebral Hemorrhage

Medscape Today Headlines — Thu, 04 Mar 2010 20:48:16 +0100

Adding ultrasonography to thrombolytic therapy to dissolve blood clots in patients with intracerebral hemorrhage appears to be effective and safe. Medscape Medical News (Source: Medscape Today Headlines)

Combination of Endovascular Hypothermia, Thrombolytic Therapy Feasible, Safe, in Acute Stroke

Medscape Today Headlines — Wed, 03 Mar 2010 18:26:16 +0100

Endovascular hypothermia in patients with moderate to severe acute ischemic stroke appears to be safe and feasible, although a higher than average rate of pneumonia needs further investigation. Medscape Medical News (Source: Medscape Today Headlines)

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Gender-based differences in stroke outcome

NeLM - News — Wed, 03 Mar 2010 00:00:00 +0100

Source: Neurology Area: News A retrospective cohort study, examining the relationship between sex and outcome after thrombolysis has suggested that female stroke patients fared worse than their male counterparts if left untreated. However, women who were treated had comparable outcomes to men who were treated. Researchers used data on 2113 stroke patients from the Registry of Canadian Stroke Network phase 1 (June 2001-February 2002) and phase 2 (June 2002-December 2002), of which women accounted for 43.5% of the cohort . Variables including demographics, history, clinical data, process measures, and outcome were analyzed. The primary outcomes were the Stroke Impact Scale-16 score (SIS-16) and mortality at 6 months and these were comp...

Determinants of functional recovery after myocardial infarction of patients treated with bone marrow-derived stem cells after thrombolytic therapy

Heart — Tue, 02 Mar 2010 14:19:58 +0100

Conclusions The global LVEF recovers most significantly after intracoronary infusion of BMC in patients with the most severe impairment of LVEF on admission. The baseline levels of natriuretic peptides seem also to be associated with LVEF recovery after BMC treatment. Trial registration ClinicalTrials.gov number, NCT00363324. (Source: Heart)

Pancreatic cholangiocarcinoma as an ST-elevation myocardial infarction with thrombolytic therapy

The American Journal of Emergency Medicine — Mon, 01 Mar 2010 00:00:00 +0100

We report the case of a 46-year-old patient who presented a chest pain with ST-segment elevation in precordial leads V1 (2 mm), V2 (4 mm), and V3 (3 mm). Thrombolytic therapy was initiated with the combination tenecteplase tissue plasminogene activator, aspirin, and heparin. Further electrocardiogram and cardiac enzymes measured every 2 hours during the first 24 hours remained normal, and after a computed tomography of the abdomen, the patient was taken to surgery for an exploratory abdominal operation that revealed pancreatic cholangiocarcinoma. No adverse effects were attributed to the initial thrombolytic therapy. Finally, myocardial ischemia was excluded because the electrocardiogram, cardiac enzymes, and a 1-month later cardiac stress test remained normal and because no coronary event...

Endovascular Techniques in Acute Arterial Mesenteric Ischemia

Seminars in Vascular Surgery — Mon, 01 Mar 2010 00:00:00 +0100

Rapid developments in preoperative noninvasive imaging as well as advanced endovascular techniques have made endovascular treatment of acute arterial mesenteric ischemia a feasible treatment option in many patients. Multidecector computed tomographic angiography will provide the diagnosis and guide treatment in most cases. The use of mechanical and aspiration embolectomy, sometimes in combination with thrombolytic therapy, is often successful in offering these very sick patients a good treatment option to open surgical revascularization. Underlying occlusive lesions can be treated in the same setting. Hybrid techniques using open abdominal exploration in combination with endovascular tools have the possibility of offering minimally invasive treatment to even more patients. Access to a hybr...

[Radiological interventional procedures for the acute abdomen.]

Der Radiologe — Fri, 26 Feb 2010 00:00:00 +0100

Authors: Trumm C, Hoffmann RT, Reiser MF In patients with acute thrombo-embolic occlusion of the superior mesenteric artery, catheter-assisted thrombolytic therapy represents a procedure of increasing importance in addition to surgery and intensive care treatment. The thrombolytic drugs utilized for this purpose are urokinase, streptokinase and recombinant tissue plasminogen activator (rtPA).Therapeutic embolization is predominantly used in the treatment of arterial bleeding from the gastro-intestinal tract, the liver, the intestines (due to an aneurysm or vascular malformation) and in bleeding from intestinal anastomoses. Polyvinyl alcohol particles, embospheres, gelfoam and microcoils can be utilized as embolic agents. Percutaneous transhepatic cholangiodrainage and stent implantatio...

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Reperfusion Therapies for Acute Ischemic Stroke

Current Treatment Options in Neurology — Tue, 23 Feb 2010 08:08:29 +0100

Opinion statement Ischemic stroke is most often caused by an acute extracranial or intracranial thromboembolic lesion obstructing an artery. It has been demonstrated that recanalization is the most important modifiable predictor of a good clinical outcome. Reperfusion strategies focus on early reopening of the vessel to reestablish antegrade flow within the penumbra. Current standard therapy within 4.5 h is intravenous thrombolysis (IVT) with tissue plasminogen activator (tPA, 0.9 mg/kg body weight, maximum dose 90 mg). Thrombolytic therapy appears to be safe and effective across various types of hospitals, if the treatment is conducted by a physician with stroke expertise. New imaging methods (MR diffusion/perfusion, CT perfusion) are being invest...

Underuse of Thrombolytic Therapy in Acute Myocardial Infarction and Left Bundle Branch Block

Clinical Cardiology — Fri, 12 Feb 2010 00:00:00 +0100

Thrombolytic therapy reduces mortality in patients with acute myocardial infarction (AMI) and left bundle branch block (LBBB). The difficulty in accurately diagnosing AMI in patients with LBBB, however, might result in their undertreatment. Among 3,890 patients hospitalized with chest pain, 241 (6.2%) had LBBB at presentation. The only variable independently associated with AMI among patients with LBBB was in-hospital left ventricular failure (odds ratio [OR]: 4.32, 95% confidence interval [CI]: 1.95-9.57, p < 0.0005). Only 16 (29%) of the LBBB patients with AMI received thrombolytic therapy compared with 583 (78%) of the 747 patients with ST-elevation AMI (p < 0.0005). A further 19 (10%) LBBB patients without AMI also received thrombolysis. Difficulty in making an accurate early diagnosis...

Stability of large diffusion/perfusion mismatch in anterior circulation strokes for 4 or more hours

BioMed Central — Wed, 10 Feb 2010 00:00:00 +0100

Background: The stability of hypoperfused brain tissue in stroke patients with major artery occlusions is unknown. The purpose of this study was to determine the persistence of a diffusion/perfusion mismatch in patients with ICA or proximal MCA occlusions. Methods: Fourteen patients with ICA and/or proximal MCA occlusion and a diffusion/perfusion mismatch at presentation were studied. All were enrolled in a pilot randomized study of normobaric oxygen therapy. None received thrombolytic therapy; 8 received normobaric oxygen and 6 room air. Diffusion/perfusion MRI was performed at baseline, 4 hours, 24 hours, and 1 week. Abnormal DWI, ADC, and MTT volumes were determined using standard image analysis methods. Results: The mean time from symptom onset to baseline MRI was 7.5+/-1 hours. Across...

Effect of daytime, weekday and year of admission on outcome in acute ischaemic stroke patients treated with thrombolytic therapy

European Journal of Neurology — Wed, 10 Feb 2010 00:00:00 +0100

Conclusions: Stroke treatment in potential candidates for thrombolytic therapy revealed no impairment on weekend or at night already in 2003. During 4 years, it was possible to increase rate of rTPA treatment from 8.9% to 21.8% without increment of complications or death, confirming that rTPA is safe and can be implemented with full daily and weekly coverage. (Source: European Journal of Neurology)

Study on effect of shenmai injection protecting myocardium against ischemia-reperfusion injury in thrombolytic therapy with urokinase for acute myocardial infarction patient evaluated byp99mTc-MIBI myocardial imaging

Chinese Journal of Integrative Medicine — Tue, 09 Feb 2010 17:28:29 +0100

Content Type Journal ArticleDOI 10.1007/BF02935033Authors Guo Song-peng, Weifang People’s Hospital, Shandong 261041Zhang Yan-zhen, Weifang People’s Hospital, Shandong 261041 Journal Chinese Journal of Integrative MedicineOnline ISSN 1993-0402Print ISSN 1672-0415 Journal Volume Volume 7 Journal Issue Volume 7, Number 2 / June, 2001 (Source: Chinese Journal of Integrative Medicine)

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Foreword

Current Problems in Cardiology — Tue, 09 Feb 2010 13:53:54 +0100

Coronary artery thrombus has been known to cause acute myocardial infarction for almost a century. There was a short period in the 1970s when it was considered due to an embolus on the basis of one pathologic study. The emboli theory was never seriously accepted and was completely discarded based on: (1) a study of coronary arteriographic findings and (2) the success of thrombolytic therapy. (Source: Current Problems in Cardiology)

Successful percutaneous mechanical thrombectomy in a haemodynamically unstable patient with massive pulmonary embolism

Respirology — Mon, 08 Feb 2010 00:00:00 +0100

Massive pulmonary embolism with haemodynamic instability has a high mortality. Traditionally these patients are treated with i.v. thrombolytic therapy. When this therapeutic approach is contraindicated, surgical embolectomy and most recently, percutaneous mechanical interventions are alternative treatment options. This case report presents a 73-year-old female with a residual hemiparesis secondary to a mengingioma resection 45 days previously, who presented with progressive shortness of breath, accompanied by oppressive chest pain, hypotension, tachycardia and severe hypoxaemia. CT pulmonary angiogram confirmed a massive pulmonary embolism extending into the lobar branches bilaterally. The patient was treated with percutaneous mechanical thrombectomy with excellent haemodynamic and clinica...

Years of Disability-Adjusted Life Gained as a Result of Thrombolytic Therapy for Acute Ischemic Stroke.

Stroke — Thu, 04 Feb 2010 00:00:00 +0100

CONCLUSIONS: For patients who benefit from treatment, <3-hour thrombolytic therapy adds the equivalent of 4.4 years of healthy life, free of disability. The DALY metric provides a continuous scale that increases statistical power, is intuitively understandable, and is applicable to a wide range of conditions and treatments. PMID: 20133917 [PubMed - as supplied by publisher] (Source: Stroke)

Incidence and Profile of Inpatient Stroke-Induced Aphasia in Ontario, Canada

Archives of Physical Medicine and Rehabilitation — Mon, 01 Feb 2010 00:00:00 +0100

Conclusions: A significant number of people with stroke experience aphasia, with advancing age associated with a higher risk. The profile and patterns for stroke patients with aphasia differed significantly from those who did not experience aphasia as a residual disability after stroke, particularly in relation to service usage. Given the personal and system cost associated with aphasia, best practices in the area of stroke should include recommendations on how to best serve this population throughout the clinical pathway. (Source: Archives of Physical Medicine and Rehabilitation)

Massive pulmonary embolism in spite of temporary vena caval filter.

VASA. Zeitschrift fur Gefasskrankheiten. Journal for Vascular Diseases — Mon, 01 Feb 2010 00:00:00 +0100

Authors: Brodmann M, Gary T, Pilger E Anticoagulation still remains the primary therapy for venous thromboembolism (VTE) in order to prevent the most life-threatening form of VTE, pulmonary embolism (PE). Nevertheless in some patients anticoagulation is impossible. Then vena caval filters serve as a valuable second line therapy against the most feared complication of VTE, fatal PE. We want to present a patient with preceding PE and DVT in whom for the perioperative period a temporary vena caval filter was placed and who showed the complication of a nearly fatal PE. A seventy-two year-old white male was admitted for thrombolytic therapy for massive pulmonary embolism, which was performed successfully. Some hours later the patient developed gastrointestinal bleeding. An adenocarcinoma of...

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Signaling, delivery and age as emerging issues in the benefit/risk ratio outcome of tPA For treatment of CNS ischemic disorders

Journal of Neurochemistry — Fri, 22 Jan 2010 00:00:00 +0100

J. Neurochem. (2010) 10.1111/j.1471-4159.2010.06613.x Stroke is a leading cause of morbidity and mortality. While tissue-type plasminogen activator (tPA) remains the only FDA-approved treatment for ischemic stroke, clinical use of tPA has been constrained to roughly 3% of eligible patients because of the danger of intracranial hemorrhage and a narrow 3 h time window for safe administration. Basic science studies indicate that tPA enhances excitotoxic neuronal cell death. In this review, the beneficial and deleterious effects of tPA in ischemic brain are discussed along with emphasis on development of new approaches toward treatment of patients with acute ischemic stroke. In particular, roles of tPA-induced signaling and a novel delivery system for tPA administration based on tPA coupling t...

Do Iodinated Contrast Agents Impair Fibrinolysis in Acute Stroke? A Systematic Review [INTERVENTIONAL]

American Journal of Neuroradiology — Thu, 14 Jan 2010 16:02:10 +0100

CONCLUSIONS: Recanalization rates were not significantly different in patients who received iodinated contrast agents in clinical studies. A randomized trial to test whether ICM affect recanalization would require a prohibitively large number of subjects. (Source: American Journal of Neuroradiology)

Annexin A2 combined with low-dose tPA improves thrombolytic therapy in a rat model of focal embolic stroke

Journal of Cerebral Blood Flow — Wed, 13 Jan 2010 00:00:00 +0100

Authors: Haihao Zhu, Xiang Fan, Zhanyang Yu, Jianxiang Liu, Yoshihiro Murata, Jie Lu, Song Zhao, Katherine A Hajjar, Eng H Lo & Xiaoying Wang (Source: Journal of Cerebral Blood Flow)

Spontaneous splenic rupture in a patient receiving thrombolytic therapy

Jornal Vascular Brasileiro — Tue, 12 Jan 2010 16:51:41 +0100

We describe the case of a 67-year-old female patient with a history of femoral-distal bypass graft with sudden onset of unremitting leg pain, who had recently received tissue plasminogen activator (t-PA). The patient reported non-compliance with her warfarin regimen. Angiography revealed occlusion of the bypass graft. Infusion of t-PA was performed via a right femoral artery approach. On hospital day two, the patient developed nausea and abdominal pain with associated hypotension. A CT scan showed a massive intra-abdominal and pelvic free fluid consistent with blood. The spleen was enlarged and fluid noted around the liver. At laparotomy, a grade III splenic laceration at the hilum was identified and a splenectomy performed. The patient recovered completely. Although rare, spontaneous sple...

“Remote Ischemic Postconditioning” for No-Reflow in Patients Undergoing Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction?

The American Journal of Cardiology — Tue, 05 Jan 2010 13:52:39 +0100

A recent “state of the art” report on the no-reflow phenomenon (NRP) in patients with ST-segment elevation myocardial infarctions (STEMIs) who undergo primary percutaneous coronary intervention (PCI) brings up thoughts regarding efforts to protect the ischemic myocardium (an old therapeutic paradigm) in addition to the current scenario of providing immediate reperfusion for victims of heart attacks. Among the many factors contributing to the deleterious role of reperfusion, the investigators cited the “sarcolemmal Na+/Ca++ exchanger which produces calcium overload that triggers uncontrolled hypercontraction and stimulates opening of the mitochondrial permeability transition pore (m-PTP), which further enhances calcium overload.” They also referred to a report by Jaffe et al in whic...

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Time of Day, Outcome, and Response to Thrombolytic Therapy: The National Institute of Neurological Disorders and Stroke Recombinant Tissue Plasminogen Activator Stroke Trial Experience

Journal of Stroke and Cerebrovascular Diseases — Fri, 01 Jan 2010 00:00:00 +0100

Conclusions: We did not find a circadian pattern to time of day of stroke onset in the patients included in the NINDS rt-PA Stroke Trial. The effect of rt-PA treatment on favorable outcome was independent of time of day of stroke onset. Patients who received rt-PA between 4 and 8 am were less likely to develop symptomatic ICH. (Source: Journal of Stroke and Cerebrovascular Diseases)

Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Third Edition)

Regional Anesthesia and Pain Medicine — Fri, 01 Jan 2010 00:00:00 +0100

The actual incidence of neurologic dysfunction resulting from hemorrhagic complications associated with neuraxial blockade is unknown. Although the incidence cited in the literature is estimated to be less than 1 in 150,000 epidural and less than 1 in 220,000 spinal anesthetics, recent epidemiologic surveys suggest that the frequency is increasing and may be as high as 1 in 3000 in some patient populations. Overall, the risk of clinically significant bleeding increase with age, associated abnormalities of the spinal cord or vertebral column, the presence of an underlying coagulopathy, difficulty during needle placement, and an indwelling neuraxial catheter during sustained anticoagulation (particularly with standard heparin or low-molecular weight heparin). The need for prompt diagnosis an...

Executive Summary: Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy: American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Third Edition)

Regional Anesthesia and Pain Medicine — Fri, 01 Jan 2010 00:00:00 +0100

Executive Summary (Source: Regional Anesthesia and Pain Medicine)

Thrombolytic therapy in pulmonary embolism.

Ir Med J — Fri, 01 Jan 2010 00:00:00 +0100

We report a case of deep vein thrombosis leading to progressive massive pulmonary embolism despite appropriate anticoagulation, where thrombolysis with IVC filter placement resulted in a successful outcome. PMID: 20222389 [PubMed - in process] (Source: Ir Med J)

Alcohol and Hypothermia

The Poison Review — Thu, 31 Dec 2009 19:03:46 +0100

º4 out of 5 stars CASE 41-2009: A 16-YEAR-OLD BOY WITH HYPOTHERMIA AND FROSTBITE Sheridan RL et al. N Eng J Med 31 Dec 2009;361:2654-62. Extract This week’s “Case Records” discussion in the New England Journal of Medicinepresents a teenager who was found unconscious and partially unclothed in a snowbank approximately 7 hours after leaving a New Year’s Eve party at which he consumed alcohol. When brought to the emergency department his rectal temperature was 31.3°C (88.3ºF) and he was not shivering. On exam, his right food was encased in ice and both hands were hard and cold. Ethanol level was 117 mg/dL. After systemic rewarming with warm IV fluids and a forced-hot-air blanket, and thawing of distal extremities with a water bath at 40ºC (104ºF), the distal ...

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Use of intrathecal urokinase in repeated shunt and external ventricular drain blockage from high CSF protein due to an optic pathway glioma

Child's Nervous System — Wed, 16 Dec 2009 07:01:15 +0100

Conclusion Intrathecal urokinase was effective in unblocking the EVD and lysing the protein clots within the ventricle. We found no previously published cases of intrathecal urokinase for this problem. This novel intervention seemed promising as a safe and effective means of maintaining EVD patency in cases complicated by excessive protein loads in CSF and hydrocephalus. Content Type Journal ArticleCategory Brief CommunicationDOI 10.1007/s00381-009-1064-7Authors David Shooman, Southampton General Hospital Department of Neurosurgery, Wessex Neurological Centre Tremona Road Southampton Hampshire SO16 6YD UKGirish V. Vajramani, Southampton General Hospital Department of Neurosurgery, Wessex Neurological Centre Tremona Road Southampton Hampshire SO16 6YD UKJennifer Davids...

Prescription at discharge of recommended treatments for secondary prevention in patients with ST-segment elevation myocardial infarction according to reperfusion strategies. Results from the IN-ACS outcome study.

Acute Cardiac Care — Fri, 11 Dec 2009 04:20:03 +0100

CONCLUSIONS: According to our results NR patients with STEMI, despite their higher risk profile, were less likely to receive the recommended drugs at discharge compared to patients treated with pPCI. PMID: 19995261 [PubMed - in process] (Source: Acute Cardiac Care)

Acute perimyocarditis mimicking transmural myocardial infarction

International Archives of Medicine — Wed, 09 Dec 2009 00:00:00 +0100

This report aims to sensitize readers to this debate and create awareness among cardiologists and intensivists with both presentations and how to reach an accurate diagnosis. (Source: International Archives of Medicine)

Patient’s baseline risk dictates acceptable delay in primary PCI treatment

MedWire News - Cardiology — Tue, 08 Dec 2009 00:00:00 +0100

The baseline mortality risk of ST-segment elevation myocardial infarction patients is a major determinant of the primary angioplasty-related delay time at which the invasive strategy holds a survival advantage over thrombolytic therapy, says an Italian team. (Source: MedWire News - Cardiology)

Unsuspected coagulopathy rarely prevents IV thrombolysis in acute ischemic stroke

Neurology — Mon, 07 Dec 2009 21:01:57 +0100

Conclusions: Based on the experience of a large thrombolysis referral center, stroke patients without suspected clotting abnormality can safely begin thrombolytic therapy before clotting results are available. These data support the current practice guidelines, and may reassure clinicians that the benefits of early administration greatly outweigh the risks due to an unsuspected bleeding diathesis. (Source: Neurology)

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Emerging Inflammatory Biomarkers with Acute Stroke

Critical Care Nursing Clinics of North America — Tue, 01 Dec 2009 00:00:00 +0100

Despite newer neuroimaging techniques, timely and accurate diagnosis of acute stroke remains a significant challenge. The ability to identify stroke patients rapidly using a biologic biomarker would be highly beneficial. Inflammation following stroke is one physiologic mechanism that has been studied extensively in biomarker research. Several emerging inflammatory biomarkers have been identified and may be useful to diagnosis stroke, to predict the evolution of stroke, and to predict hemorrhagic transformation, particularly with the administration of thrombolytic therapy. Many challenges must be overcome before application to clinical practice can be recommended. Nevertheless, emerging inflammatory biomarkers demonstrate considerable promise, particularly as part of a multiple biomarker st...

Preoperative Thrombolysis and Venoplasty Affords no Benefit in Patency Following First Rib Resection and Scalenectomy for Subclavian Vein Thrombosis

Journal of Vascular Surgery — Tue, 01 Dec 2009 00:00:00 +0100

This study reviewed our extensive experience and compared the effectiveness of preoperative thrombolysis and venoplasty with anticoagulation alone in those undergoing FRRS to preserve subclavian vein patency. (Source: Journal of Vascular Surgery)

Acceptable reperfusion delay to prefer PCI over fibrin-specific thrombolytic therapy

NeLM - Surgery — Mon, 30 Nov 2009 00:00:00 +0100

In this study they sought to explore the relationship between patient risk and PCI delay, in order to identify the time delay leading to equivalent 30-day mortality between PCI and fibrin-specific thrombolytic therapy (TT). They identified 16 RCTs comparing PCI with fibrin-specific TT for the treatment of STEMI that enrolled at least 50 patients, and pooled these for analyses (total n=6,281). According to the slope of the regression line, the patients with a mortality risk <4.5% unlikely obtain a survival benefit by PCI compared with TT. The baseline mortality risk, ... (Source: NeLM - Surgery)

Acute Massive Pulmonary Embolism With Hemodynamic Compromise Treated Successfully With Thrombolytic Therapy Selcuk

Clinical and Applied Thrombosis/Hemostasis — Thu, 19 Nov 2009 05:33:27 +0100

A 78 year-old woman presented with a history of 15 days of dyspnea and tachypnea at rest. A distended right ventricle with free-wall hypokinesis and displacement of the interventricular septum toward the left ventricle were shown on echocardiography. The patient suddenly arrested. She underwent cardiac catheterization and selective pulmonary angiography for suspected pulmonary embolism while undergoing cardiopulmonary resuscitation. With the diagnosis of pulmonary embolism confirmed, recombinant tissue plasminogen activator was given immediately in the catheterization room. This case shows how pulmonary embolism can be diagnosed with pulmonary angiography during cardiopulmonary resuscitation and the life-saving result from rapid thrombolysis with recombinant tissue plasminogen activator. (...

Mismatch-Based Delayed Thrombolysis. A Meta-Analysis.

Stroke — Thu, 19 Nov 2009 00:00:00 +0100

CONCLUSIONS: Delayed thrombolysis amongst patients selected according to mismatch imaging is associated with increased reperfusion/recanalization. Recanalization/reperfusion is associated with improved outcomes. However, delayed thrombolysis in mismatch patients was not confirmed to improve clinical outcome, although a useful clinical benefit remains possible. Thrombolysis carries a significant risk of symptomatic intracerebral hemorrhage and possibly increased mortality. Criteria to diagnose mismatch are still evolving. Validation of the mismatch selection paradigm is required with a phase III trial. Pending these results, delayed treatment, even according to mismatch selection, cannot be recommended as part of routine care. PMID: 19926836 [PubMed - as supplied by publisher] (Source: ...

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What you should know about the 2008 American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th) on Antithrombotic and Thrombolytic Therapy

Journal of Thrombosis and Thrombolysis — Wed, 18 Nov 2009 05:13:57 +0100

The objective of this article is to help answer ten common clinical questions frequently faced by anticoagulation management services. Content Type Journal ArticleDOI 10.1007/s11239-009-0415-2Authors Scott Kaatz, Henry Ford Hospital Department of Medicine Detroit MI 48202 USA Journal Journal of Thrombosis and ThrombolysisOnline ISSN 1573-742XPrint ISSN 0929-5305 (Source: Journal of Thrombosis and Thrombolysis)

Recombinant Tissue Plasminogen Activator Increases Blood-Brain Barrier Disruption in Acute Ischemic Stroke: An MR Imaging Permeability Study [BRAIN]

American Journal of Neuroradiology — Fri, 13 Nov 2009 18:02:23 +0100

CONCLUSIONS: The results of this study indicate that KPS is able to identify patients at higher risk of HT and may allow use of physiologic imaging rather than time from onset of symptoms to guide treatment decision. (Source: American Journal of Neuroradiology)

Influence of antiplatelet pre-treatment on the risk of intracranial haemorrhage in acute ischaemic stroke after intravenous thrombolysis

European Journal of Neurology — Thu, 12 Nov 2009 00:00:00 +0100

Conclusions: Pre-treatment with AP is associated with an increased risk of PH after intravenous thrombolysis in patients with acute ischaemic stroke. (Source: European Journal of Neurology)

Impact on patient care: patient case through the continuum of care

Journal of Thrombosis and Thrombolysis — Mon, 09 Nov 2009 18:26:05 +0100

Abstract Hospitalized patients are at increased risk of venous thromboembolism and the Joint Commission has initiated practice measures to improve the rates of preventable events. The Joint Commission also initiated the National Patient Safety Goals for medication prescribing and administration, of which, goal 03.05.01 is specifically aimed at anticoagulation therapy. These measures and goals are consistent with the American College of Chest Physicians’ Consensus Guidelines on Antithrombotic and Thrombolytic Therapy. This narrative review uses a case-based approach that brings up practical clinical questions regarding these measures, goals and guidelines as they apply to a patient going through the continuum of care from the hospital to their home. Content Type Journal...

[Reflection and Reaction] Extending the time window for thrombolytic therapy—primum non tardare

Lancet Neurology — Mon, 09 Nov 2009 00:00:00 +0100

More than 15 years ago, thrombolytic therapy for acute was shown to be safe and effective in a pivotal trial by the National Institute of Neurological Disorders and Stroke (NINDS). Subsequent analyses of the dataset confirmed benefit in all subgroups; that therapy was cost-effective; that haemorrhage was more likely in treated patients but benefit remained; and that benefits were sustained after 1 year. Initial misunderstanding of the data analysis method and criticism from naysayers delayed implementation of thrombolytic therapy for acute stroke. Despite these initial delays, the treatment is now approved globally and is widely accepted. (Source: Lancet Neurology)

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Prehospital Triage "Immediately Successful" in Boosting Rates of Thrombolytic Therapy for Stroke

Medscape Pulmonary Medicine Headlines — Fri, 06 Nov 2009 14:56:01 +0100

Toronto researchers report that a citywide prehospital protocol raised their rates of thrombolytic treatment to among the highest in North America, underlining, they say, the critical importance of organized stroke care. Medscape Medical News (Source: Medscape Pulmonary Medicine Headlines)

An embolus in the right atrium caught in the Chiari network and resistant to thrombolysis

Journal of Thrombosis and Thrombolysis — Fri, 06 Nov 2009 06:55:24 +0100

Abstract Case report is presented, which describes a patient with thromboemboli trapped in the Chiari network within the right heart and resistant to thrombolysis. The right atrial masses were completely removed under cardiopulmonary bypass. Histological evaluation confirmed a mixed thromboemboli, with thrombus structures showing signs of organization and surrounded by a fibrous capsule. A heterozygous methylenetetrahydrofolate reductase gene polymorphism was found, and the plasma level of the plasminogen activator inhibitor type-1 (PAI-1) was 50% higher than the normal upper limit. In this presented case, the Chiari network displayed a protective function, but the expansion and organization of the thromboembolus caught there made it resistant to lytic therapy. Another imp...

Paul Coverdell National Acute Stroke Registry Surveillance - four states, 2005-2007.

MMWR Surveill Summ — Fri, 06 Nov 2009 00:00:00 +0100

This report summarizes PCNASR data collected during 2005-2007 from Georgia, Illinois, Massachusetts, and North Carolina, the first states to have PCNASRs implemented in and led by state health departments. DESCRIPTION OF SYSTEM: PCNASR was established by CDC in 2001 to track and improve the quality of hospital-based acute stroke care. The prototype phase (2001-2004) registries were led by CDC-funded clinical investigators in academic and medical institutions, whereas the full implementation of the 2005-2007 statewide registries was led by CDC-funded state health departments. Health departments in each state recruit hospitals to collect data. To be included in PCNASR, patients must be aged >or=18 years and have a clinical diagnosis of acute ischemic stroke, intracerebral hemorrhage, suba...

Prehospital triage "immediately successful" in boosting rates of thrombolytic therapy for stroke

theHeart.org — Thu, 05 Nov 2009 16:00:44 +0100

Prehospital triage "immediately successful" in boosting rates of thrombolytic therapy for stroke

theHeart.org — Thu, 05 Nov 2009 16:00:44 +0100

Toronto researchers report that a citywide prehospital protocol raised their rates of thrombolytic treatment to among the highest in North America, underlining, they say, the critical importance of... For complete story visit theheart.org. (Source: theHeart.org)

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[Thrombolytic therapy in cerebral infarction.]

Tidsskrift for den Norske Laegeforening — Thu, 05 Nov 2009 00:00:00 +0100

Authors: Varga V, Waje-Andreassen U, Næss H, Lundstadsveen MT, Thomassen L Background. Intravenous thrombolysis has gained widespread acceptance during the last 10 years, and is the only specific treatment approved for cerebral infarction. Haukeland University hospital introduced thrombolysis in 1998. The aim of this paper is to summarize our experience with the first 100 patients who had stroke caused by middle cerebral artery (MCA) occlusion and were treated with thrombolysis. Materials and methods. Patients receiving intravenous thrombolytic treatment between 1998 and 2005 were prospectively included into our database. We registered demographic data, risk factors, time aspects, short and long-term clinical results and complications. Results. Two hours after treatment, a definit...

Gender differences in patients with acute ST-elevation myocardial infarction complicated by cardiogenic shock

Clinical Research in Cardiology — Sat, 24 Oct 2009 16:52:30 +0100

Conclusion In women, STEMI was more often complicated by cardiogenic shock when compared to men. However, the use of early reperfusion therapy did not differ between the sexes. Primary PCI was associated with the best outcome in female patients with STEMI complicated by cardiogenic shock and is therefore the therapy of choice. Content Type Journal ArticleCategory Original PaperDOI 10.1007/s00392-009-0080-7Authors Oliver Koeth, Herzzentrum Ludwigshafen Department of Cardiology Ludwigshafen GermanyRalf Zahn, Herzzentrum Ludwigshafen Department of Cardiology Ludwigshafen GermanyTobias Heer, Herzzentrum Ludwigshafen Department of Cardiology Ludwigshafen GermanyTimm Bauer, Herzzentrum Ludwigshafen Department of Cardiology Ludwigshafen GermanyClaus Juenger, Institut für He...

The decrease in procarboxypeptidase U (TAFI) concentration in acute ischemic stroke correlates with stroke severity, evolution and outcome

Journal of Thrombosis and Haemostasis — Fri, 23 Oct 2009 00:00:00 +0100

Conclusions: The decrease in proCPU concentration in the first 72 h after stroke onset correlates with more severe stroke, unfavourable stroke evolution, and poor long-term stroke outcome. (Source: Journal of Thrombosis and Haemostasis)

Thrombolysis for Acute Ischemic Stroke.

Current Topics in Medicinal Chemistry — Thu, 22 Oct 2009 00:00:00 +0100

Authors: Uyttenboogaart M, De Keyser J, Luijckx GJ In the last decennium, thrombolytic therapy has changed the management of acute ischemic stroke. Randomized clinical studies have demonstrated that intravenous thrombolysis with tissue plasminogen activator improves functional outcomes. Recently the time window for intravenous thrombolysis has been extended from 3 to 4.5 hours after stroke onset, which will allow more stroke patients to benefit from this treatment. Currently several studies are investigating how to improve recanalization rates of thrombolytic therapy. In this review several aspects of intravenous and intra-arterial thrombolysis are discussed. PMID: 19849662 [PubMed - as supplied by publisher] (Source: Current Topics in Medicinal Chemistry)

Intervention May Benefit Trial-Ineligible Heart Patients

Modern Medicine — Wed, 14 Oct 2009 23:00:00 +0100

In patients with ST-elevation myocardial infarction who are usually excluded from randomized controlled trials, primary percutaneous coronary intervention is associated with a lower rate of in-hospital death than thrombolytic therapy, according to a study in the Oct. 15 issue of the American Journal of Cardiology. (Source: Modern Medicine)

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Primary Stroke Centers Use More Thrombolytic Therapy Than Other Hospitals, but Overall Numbers Still Low

Medscape Medical News Headlines — Wed, 14 Oct 2009 17:13:33 +0100

A new study using data from the National Inpatient Sample shows about 3% of ischemic stroke patients received tPA at primary stroke centers between 2004 and 2006. Medscape Medical News (Source: Medscape Medical News Headlines)

Thrombolytic therapy in acute myocardial infarction: Third Irish Working Party Consensus

Irish Journal of Medical Science — Wed, 14 Oct 2009 17:05:14 +0100

Content Type Journal ArticleCategory GuidelinesDOI 10.1007/BF03166907Authors A Brown on behalf of the Irish Thrombolysis Concenus GroupJ. Horgan, Beaumont Hospital Dublin 9M. Conway, St Luke’s Hospital KilkennyW. Fennell, Cork University Hospital IrelandH. McCann, Mater Hospital DublinB. Meaney, Limerick Regional Hospital IrelandM. O’Reilly, Waterford Regional Hospital IrelandP. Sullivan, Mallow General Hospital Ireland Journal Irish Journal of Medical ScienceOnline ISSN 1863-4362Print ISSN 0021-1265 Journal Volume Volume 169 Journal Issue Volume 169, Number 2 / April, 2000 (Source: Irish Journal of Medical Science)

Management of acute ischaemic stroke.

British Journal of Hospital Medicine — Wed, 14 Oct 2009 00:00:00 +0100

This article summarizes the clinical management of ischaemic strokes including recent advances. PMID: 19966702 [PubMed - as supplied by publisher] (Source: British Journal of Hospital Medicine)

Utilization and outcome of thrombolytic therapy for acute stroke in Pakistan

Neurological Sciences — Fri, 09 Oct 2009 06:16:54 +0100

In conclusion, the utilization of thrombolytic therapy is low and complication rate is high. Interventions for training physicians are needed. Content Type Journal ArticleCategory Brief CommunicationDOI 10.1007/s10072-009-0159-yAuthors Mohammad Wasay, Aga Khan University Department of Neurology and Medicine Stadium Road Karachi 74800 PakistanHazim Barohi, Aga Khan University Department of Neurology and Medicine Stadium Road Karachi 74800 PakistanAbdul Malik, Liaquat National Hospital Department of Neurology Karachi PakistanAdnan Yousuf, Aga Khan University Department of Neurology and Medicine Stadium Road Karachi 74800 PakistanSafia Awan, Aga Khan University Department of Neurology and Medicine Stadium Road Karachi 74800 PakistanAyeesha K. Kamal, Aga Khan University Department of Neu...

Can RAP save your brain?

Blood — Thu, 08 Oct 2009 16:03:04 +0100

In this issue of Blood, Suzuki and colleagues report that the bleeding complications associated with thrombolytic therapy after ischemic stroke might be counteracted by RAP, the receptor-associated protein that inhibits ischemia-induced LRP, a signaling receptor for t-PA. (Source: Blood)

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SIGN issues draft guidelines on management of VTE and indications for antithrombotics for consultation

NeLM - Cardiovascular Medicine — Tue, 06 Oct 2009 23:00:00 +0100

Source: SIGN Area: News The Scottish Intercollegiate Guidelines Network (SIGN) has issued draft guidelines on the prevention, investigation and management of venous thromboembolism, and, indications and management of antithrombotics for consultation. The venous thromboembolism guideline identifies patient groups at risk of VTE, and describes the available methods of prophylaxis. Additionally, recommendations are made on treatment options for thrombosis in various anatomical regions, including choice of anticoagulant and duration of use. The antithrombotics guideline aims to provide recommendations on the management of adults on such treatments. It includes antiplatelet therapy (including aspirin, dipyridamole and clopidogrel), parenteral and oral anticoagulant therap...

Role of Endogenous Granulocyte-Macrophage Colony Stimulating Factor Following Stroke and Relationship to Neurological Outcome.

Current Neurovascular Research — Tue, 06 Oct 2009 23:00:00 +0100

Authors: Navarro M, Rosell A, Penalba A, Ribó M, Alvarez-Sabín J, Fernández-Cadenas I, Montaner J Granulocyte-Macrophage Colony Stimulating Factor (GM-CSF) is a proinflammatory cytokine with neuroprotective and angiogenic properties demonstrated in animal models of cerebral ischemia but their role in human ischemic stroke is still unknown. Thus, our aim is to determine human GM-CSF plasma level in control subjects and stroke patients and its relationship to clinical outcome. Forty-three patients with middle cerebral artery occlusion who received thrombolytic therapy within the first three hours of stroke onset and nineteen healthy controls were included. Blood samples were drawn before tissue plasminogen activator (t-PA). In a group of thirteen strokes blood samples were...

Excellent response to thrombolysis following prolonged basilar artery occlusion with extensive ischemic changes on MRI

Clinical Neurology and Neurosurgery — Mon, 05 Oct 2009 18:50:48 +0100

Mortality rates following acute basilar artery (BA) occlusion range between 50 and 95% . Recanalization of the BA with intra-arterial (IA) thrombolytic therapy has been shown to improve outcomes, particularly in selected patients treated within 24h of symptom onset . A number of features have been associated with poor outcome, including coma, tetraplegia and neuroimaging evidence of brainstem ischemia . We recently treated a patient who made an excellent recovery, despite the presence of all these prognostic features. (Source: Clinical Neurology and Neurosurgery)

Do women benefit more from systemic thrombolysis in acute ischemic stroke? A Serbian experience with thrombolysis in ischemic stroke (SETIS) study

Clinical Neurology and Neurosurgery — Mon, 05 Oct 2009 18:50:47 +0100

Conclusion: There were no sex differences in functional outcome at 90 days after the stroke among patients treated with IV rtPA. This finding might confirm that thrombolytic therapy nullifies usual sex differences in stroke outcome and suggests that women with stroke may benefit more from rtPA treatment. (Source: Clinical Neurology and Neurosurgery)

More Patients Arriving Within 2 Hours of Ischemic Stroke Are Receiving TPA

Medscape Today Headlines — Fri, 02 Oct 2009 03:13:47 +0100

Although no more stroke patients arrived within 2 hours of symptom onset between 2001 and 2004, more of those who did arrive received thrombolytic therapy, suggesting system improvements. Medscape Medical News (Source: Medscape Today Headlines)

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Should thrombolysis have a greater role in the management of pulmonary embolism?

Clinical Medicine — Thu, 01 Oct 2009 00:00:00 +0100

Authors: Jenkins PO, Sultanzadeh J, Bhagwat M, Jenkins PF Pulmonary embolism (PE) continues to be associated with significant mortality despite advances in the diagnostic techniques available for its detection. Anticoagulation remains standard treatment in PE although there is a consensus view that 'step-up' to thrombolytic therapy in addition to anticoagulation is indicated in those patients who are systemically shocked at presentation--a group defined as having suffered 'massive pulmonary embolism'. Considerable research has been directed at attempting to identify further groups of patients with PE who are at high risk of morbidity and mortality--notably those who are labelled as having suffered 'sub-massive pulmonary embolism' where this is defined as the presence of right-heart str...

Hunting for the “Sweet Spot” in P2Y12 Receptor Blockade⁎

Journal of the American College of Cardiology — Wed, 30 Sep 2009 16:18:49 +0100

The addition of the P2Y12 antagonist clopidogrel to aspirin reduces ischemic events in unstable angina/non–ST-segment elevation myocardial infarction treated with medical therapy, percutaneous coronary intervention (PCI), or coronary artery bypass grafting (), in ST-segment elevation myocardial infarction (STEMI) treated with thrombolytic therapy (), and in elective PCI (). Dual antiplatelet therapy also reduces major adverse cardiovascular events and stent thrombosis after PCI compared with aspirin alone or the combination of aspirin and warfarin (). However, there are significant limitations of clopidogrel therapy. Clopidogrel is a pro-drug with a slow onset of action, requiring conversion to an active thiol metabolite by the hepatic cytochrome P450 (CYP450) system (). The degree of pl...

Treatment of massive pulmonary embolism utilizing a multidisciplinary approach: a case study.

Perfusion — Tue, 29 Sep 2009 23:00:00 +0100

Authors: Griffith KE, Haft J, Jenkins E Massive pulmonary embolism (PE) is associated, historically, with a high mortality rate. Treatment options include systemic anticoagulation, catheter-directed thrombolytic therapy, surgical embolectomy, fragmentation techniques, and catheter embolectomy. Extracorporeal membrane oxygenation (ECMO) repeatedly has demonstrated effectiveness in providing cardiopulmonary support for the patient with a massive PE too unstable to undergo thrombolysis or embolectomy. The present case study describes a morbidly obese patient, status post gastric bypass surgery, who presented with PE, and acute respiratory and cardiac failure. A description of the patient's management plan, which includes a simple, rapidly deployed ECMO system (Levitronix(R) CentriMag(R) a...

Magnetic Resonance Imaging for Monitoring the Efficacy of Thrombolytic Therapy in Subacute Pulmonary Artery Embolism

Journal of the American College of Cardiology — Wed, 23 Sep 2009 16:16:01 +0100

A 67-year-old woman complained of recurrent episodes of dyspnea for 9 months with increasing intensity over the previous 10 days, culminating in resting dyspnea. Cardiovascular magnetic resonance (CMR) imaging revealed right ventricular enlargement with dyskinesia of the mid right ventricular free wall (McConnell sign, white arrows in D). CMR pulmonary angiography identified multiple pulmonary emboli with 2 thrombi lodging in the upper and lower lobe pulmonary branches (A and D). (Source: Journal of the American College of Cardiology)

Management of Acute Superior Mesenteric Artery Occlusion by Thrombolytic Therapy

Karger Publishers — Mon, 21 Sep 2009 23:00:00 +0100

Case Rep Gastroenterol 2009;3:300-305 (DOI:10.1159/000239293) (Source: Karger Publishers)

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Multiorgan paradoxical embolism consequent to acute pulmonary thromboembolism with patent foramen ovale: a case report

Cases Journal — Wed, 16 Sep 2009 23:00:00 +0100

We report a case of a 79 years old woman admitted to hospital because of dyspnea and lower left limb pain. CT scan revealed multiple thrombi to kidney, lower limb and superior mesenteric artery during acute pulmonary embolism. Echocardiogram documented a patent foramen ovale with a right-to-left shunt. The patient was treated with thrombolytic therapy and heparin with progressive improvement of symptoms and resolution of pulmonary embolism and peripheral thrombosis. Patent foramen ovale closure was not performed because a life-long anticoagulation therapy was necessary, a tunnel-type patent foramen ovale may increases difficulty in realizing device implantation and there are no clear evidence-based guidelines to date addressing treatment in presence of a patent foramen ovale. (Source: Case...

The Alberta Stroke Program Early CT Score in clinical practice: what have we learned?

International Journal of Stroke — Tue, 15 Sep 2009 23:00:00 +0100

The introduction of brain imaging with computed tomography revolutionised the treatment of patients with acute ischaemic stroke. With the visual differentiation of haemorrhagic stroke from ischaemic stroke, thrombolytic therapy became feasible. The Alberta Stroke Program Early CT Score was devised to quantify the extent of early ischaemic changes in the middle cerebral artery territory on noncontrast computed tomography. With its systematic approach, the score is simple and reliable. However, the assessment of early ischaemic changes and Alberta Stroke Program Early CT scoring require training. The Alberta Stroke Program Early CT Score is a strong predictor of functional outcome. Furthermore, the effectiveness of intraarterial thrombolysis in patients with middle cerebral artery occlusion ...

Thrombolytic therapy for stroke

Future Medicine: Therapy — Mon, 14 Sep 2009 14:53:34 +0100

Therapy , September 2009, Vol. 6, No. 5, Pages 733-745. (Source: Future Medicine: Therapy)

Identification of Unexpected Nonatherosclerotic Cardiovascular Disease With Coronary CT Angiography

Journal of the American College of Cardiology: Cardiovascular Imaging — Sun, 13 Sep 2009 23:00:00 +0100

Conclusions Approximately 1% of patients undergoing MDCT angiography for suspicion of CAD proved to have otherwise unsuspected, but clinically relevant, cardiovascular abnormalities unrelated to coronary atherosclerosis. Almost one-third of these patients had cardiovascular diseases with major clinical implications for subsequent therapy. These findings underscore the value of MDCT angiography and the importance of careful assessment of scans for the recognition of a variety of cardiovascular abnormalities. (Source: Journal of the American College of Cardiology: Cardiovascular Imaging)

Intravenous Tissue Plasminogen Activator in Patients With Cocaine-Associated Acute Ischemic Stroke.

Stroke — Wed, 09 Sep 2009 23:00:00 +0100

CONCLUSIONS: Thrombolytic therapy for CIS appears to be safe in this small study. Further research is needed to more definitively assess safety and efficacy of tissue plasminogen activator for CIS. PMID: 19745181 [PubMed - as supplied by publisher] (Source: Stroke)

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Sub-analysis: Baseline antiplatelet therapy increases haemorrhage risk after thrombolytic therapy for ischaemic stroke

NeLM - News — Mon, 07 Sep 2009 23:00:00 +0100

Source: Reuters Health News Area: News According to sub-analysis of the Stroke-Acute Ischemic NXY Treatment [SAINT] I and II Trials cohort studies, baseline antiplatelet therapy is associated with an increased risk of intracerebral haemorrhage after thrombolytic therapy for ischaemic stroke. The investigators examined patients (n=965; mean age, 68 years, 57% male; 92% Caucasian) with acute ischaemic stroke who were treated with intravenous tissue plasminogen activator within 3 hours of symptom onset and were enrolled in the placebo arms of the SAINT studies. Early CT changes were graded using the Alberta Stroke Program Early CT Score (ASPECTS). Post-tissue plasminogen activator symptomatic intracerebral haemorrhage was defined as a worsening in National Institutes of...

Baseline Antiplatelet Therapy Increases Hemorrhage Risk After Stroke Treatment

Medscape Medical News Headlines — Fri, 04 Sep 2009 15:57:20 +0100

Baseline antiplatelet therapy is associated with an increased risk of intracerebral hemorrhage after thrombolytic therapy for ischemic stroke, according to a report in the September Stroke. Reuters Health Information (Source: Medscape Medical News Headlines)

Massive Pulmonary Embolism: Percutaneous Emergency Treatment Using an Aspirex Thrombectomy Catheter

CardioVascular and Interventional Radiology — Thu, 03 Sep 2009 06:33:08 +0100

Abstract Massive pulmonary embolism (PE) is a life-threatening condition with a high early mortality rate caused by acute right ventricular failure and cardiogenic shock. A 51-year-old woman with a massive PE and contraindication for thrombolytic therapy was treated with percutaneous mechanical thrombectomy using an Aspirex 11F catheter (Straub Medical AG, Wangs, Switzerland). The procedure was successfully performed and showed a good immediate angiographic result. The patient made a full recovery from the acute episode and was discharged on heparin treatment. Our case report indicates that in patients with contraindications to systemic thrombolysis, catheter thrombectomy may constitute a life-saving intervention for massive PE. Content Type Journal ArticleCategory Case ...

Primary Angioplasty Bests Thrombolysis in Very Elderly AMI Patients: TRIANA

Medscape Today Headlines — Tue, 01 Sep 2009 15:52:37 +0100

Very elderly patients with acute MI fare better when treated with primary angioplasty than with thrombolytic therapy, Spanish researchers say. Heartwire (Source: Medscape Today Headlines)

Safe and Effective Intravenous Thrombolysis for Acute Ischemic Stroke Caused by Left Atrial Myxoma

Journal of Stroke and Cerebrovascular Diseases — Mon, 31 Aug 2009 23:00:00 +0100

We describe a young man who presented with syncope and a dense stroke developing as a complication of atrial myxoma, followed by a remarkable recovery after treatment with intravenous recombinant tissue plasminogen activator and urgent cardiac surgery. Contrary to some expert opinion, systemic thrombolytic therapy may be safely and effectively used to treat acute ischemic strokes from atrial myxoma. (Source: Journal of Stroke and Cerebrovascular Diseases)

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The MERCI retrieval system for the management of acute ischaemic stroke--the NNI Singapore experience.

Annals of the Academy of Medicine, Singapore — Mon, 31 Aug 2009 23:00:00 +0100

CONCLUSION: Re-canalisation rates using the Merci Retrieval System was comparable to the multi-Merci trial. Haemorrhagic complications and safety were also found to be satisfactory. Importantly, treatment success with eventual good clinical outcome hinges strongly on the ability of the device to achieve complete re-canalisation. PMID: 19816632 [PubMed - in process] (Source: Annals of the Academy of Medicine, Singapore)

Primary angioplasty bests thrombolysis in very elderly AMI patients: TRIANA

theHeart.org — Mon, 31 Aug 2009 21:15:17 +0100

Very elderly patients with acute MI fare better when treated with primary angioplasty than with thrombolytic therapy, Spanish researchers say. (Source: theHeart.org)

MRI predicts hemorrhage risk in acute stroke

MedWire News - Stroke — Fri, 14 Aug 2009 10:38:23 +0100

Using magnetic resonance imaging to measure blood–brain barrier disruption may predict the risk for hemorrhagic transformation after thrombolytic therapy, a Canadian team has shown. (Source: MedWire News - Stroke)

Geography, Structure, and Evolution of Diffusion and Perfusion Lesions in Diffusion and Perfusion Imaging Evaluation For Understanding Stroke Evolution (DEFUSE).

Stroke — Wed, 12 Aug 2009 23:00:00 +0100

CONCLUSIONS: Before thrombolytic therapy in the 3- to 6-hour time window, Type 2 geography is predominant and is associated with DWI reversal. After thrombolysis, both Type 2 geography and multiple lesion structure are associated with reperfusion. PMID: 19679845 [PubMed - as supplied by publisher] (Source: Stroke)

Acute lower limb ischemia in a patient with aortic thrombus and essential thrombocytosis.

International Journal of Hematology — Mon, 10 Aug 2009 23:00:00 +0100

Authors: Morata Barrado PC, Blanco Cañibano E, García Fresnillo B, Guerra Requena M Aortic thrombus is rare in patients with essential thrombocytosis (ET), so the optimal treatment remains undefined. A 45-year-old man with history of ET, under chronic treatment with aspirin, presented to the emergency department complaining of acute onset in both the legs and abdominal pain. Physical examination revealed that both dorsalis pedis pulses were not palpable with cold and pale feet. His abdomen was soft and nondistended. The platelet count was 436 x 10(9)/L. The thoraco-abdominal computerized tomographic scanning revealed normal aortic diameter with supraceliac and infrarenal nonoccluding thrombus and infarction areas in spleen and left kidney. At the emergency department he prese...

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Invited Article: Searching for oracles?: Blood biomarkers in acute stroke

Neurology — Sun, 02 Aug 2009 23:00:00 +0100

Emerging data suggest that a wide array of measurable biomarkers in blood may provide a novel window into the pathophysiology of stroke. In this review, we survey the state of progress in the field. Three specific questions are assessed. Can biomarkers augment the clinical examination and powerful brain imaging tools to enhance the accuracy of the diagnostic process? Can biomarkers be used to help triage patients for thrombolytic therapy? Can biomarkers help predict patients who are most susceptible to malignant infarction? Many encouraging molecular candidates have been found that appear to match the known cascades of neurovascular injury after stroke. However, whether these putative biomarkers may indeed have direct clinical utility remains to be quantitatively validated. Larger clinical...

Right ventricular function in ST elevation myocardial infarction: effect of reperfusion.

Clinical and Investigative Medicine — Sat, 01 Aug 2009 05:30:03 +0100

CONCLUSIONS: RV function deteriorated in STEMI compared with healthy controls. Contrary to the expectation, RV dysfunction was observed in anterior STEMI, but not in non anterior MI. There was no difference in RV function between the two treatment modalities. PMID: 19640332 [PubMed - in process] (Source: Clinical and Investigative Medicine)

Primary Stent in Occluded Femoropopliteal Bypass Graft in a Patient with Contraindications for Thrombolytic Therapy: Case Report

CardioVascular and Interventional Radiology — Fri, 31 Jul 2009 08:48:31 +0100

Content Type Journal ArticleCategory Letter to the EditorDOI 10.1007/s00270-009-9656-xAuthors M. Rabellino, Hospital Hospiten Rambla Department of Endovascular Therapy General Franco 115 Santa Cruz de Tenerife 38001 SpainL. García-Nielsen, Hospital Hospiten Rambla Department of Interventional Cardiology General Franco 115 Santa Cruz de Tenerife 38001 SpainG. Gonzalez, Hospital Hospiten Rambla Department of Endovascular Therapy General Franco 115 Santa Cruz de Tenerife 38001 SpainS. Baldi, Hospital Hospiten Rambla Department of Endovascular Therapy General Franco 115 Santa Cruz de Tenerife 38001 SpainT. Zander, Hospital Hospiten Rambla Department of Endovascular Therapy General Franco 115 Santa Cruz de Tenerife 38001 SpainI. Zerolo, Hospital Hospiten Rambla Department of Vascular Surge...

Serum myeloperoxidase level predicts reperfusion in patients with myocardial infarction receiving thrombolytic therapy

Heart and Vessels — Fri, 24 Jul 2009 23:49:58 +0100

Abstract Polymorphonuclear leukocytes play a central role in all stages of the atherothrombotic inflammatory process. The atherothrombotic activity of polymorphonuclear leukocytes is exerted by mediators such as myeloperoxidase (MPO). Although the role of MPO has been studied with respect to the development of adverse cardiac events in acute coronary syndromes (ACS), the association of this molecule with effectiveness of reperfusion in patients receiving thrombolysis is not yet known. The study population consisted of a total of 158 patients with acute coronary syndromes. Final diagnosis was ST-segment elevation myocardial infarction in 86 patients, 80 of whom received thrombolysis. Blood samples were drawn at presentation of the patients and serum myeloperoxidase levels w...

Original article Acute pulmonary embolism registry in the Małopolska region – clinical course

Articles of Polish Heart Journal - TERMEDIA publishing house — Fri, 17 Jul 2009 11:15:12 +0100

Conclusions: 1. In our registry mortality rate in patients with APE was 11%. 2. In about 30% of patients APE was under mask of acute coronary syndrome or syncope, 34% of patients had elevated troponin level, and 30% of patients had complication during hospitalisation. 3. In patients treated with thrombolytics mortality rate was 45%. 4. Reperfusion strategy (trombolysis or embolectomy) in the high risk group was used in only 41% of patients. 5. Elevated troponin level in normotensive patient was associated with 4-fold times higher risk of death. 6. New risk stratification according to the ESC guidelines 2008 correctly predicts prognosis in everyday clinical practise. (Source: Articles of Polish Heart Journal - TERMEDIA publishing house)

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Neuropsychological functioning in right hemisphere infarct patients—Does thrombolytic treatment matter?

Journal of the Neurological Sciences — Fri, 17 Jul 2009 11:09:41 +0100

Background and aims: The effect of thrombolytic therapy on neuropsychological deficits following acute stroke has received only limited research attention. This preliminary study examines the influence of thrombolytic therapy on neuropsychological performance in right hemisphere infarct patients. Since visual abilities are known to be defective after right hemisphere damage, the present study concentrates on visuoconstructive abilities, visual search and reasoning, and visual neglect. (Source: Journal of the Neurological Sciences)

Starting point as an indicator of neglect in right hemisphere infarct patients

Journal of the Neurological Sciences — Fri, 17 Jul 2009 11:09:36 +0100

Background and aims: Visual neglect (VN) is a common defect after right hemisphere (RH) infarct, and RH patients have a tendency to begin visual scanning from the right side of a given stimulus. Our aim was to find out whether neglect, non-neglect and thrombolytic therapy patients with first-ever RH infarct differ in terms of their starting points in cancellation tasks. (Source: Journal of the Neurological Sciences)

Factors Associated With Intracerebral Hemorrhage After Thrombolytic Therapy for Ischemic Stroke. Pooled Analysis of Placebo Data From the Stroke-Acute Ischemic NXY Treatment (SAINT) I and SAINT II Trials.

Stroke — Wed, 15 Jul 2009 23:00:00 +0100

CONCLUSIONS: Along with higher National Institutes of Health Stroke Scale and extensive early CT changes, baseline antiplatelet use (particularly double antiplatelet therapy) was associated with an increased risk of post-tissue plasminogen activator symptomatic intracerebral hemorrhage. Of these factors, only National Institutes of Health Stroke Scale was associated with clinical outcome. PMID: 19608993 [PubMed - as supplied by publisher] (Source: Stroke)

Clinical application of multidetector CT angiography and perfusion imaging in acute stroke

Australasian Radiology — Mon, 13 Jul 2009 23:00:00 +0100

This article illustrates clinical application of 64 Detector CT Angiography and Perfusion of the Brain in the triage of acute stroke in patients with a view to thrombolytic therapy. CTA and perfusion of the Brain is less expensive and relatively widely available compared to Magnetic Resonance Imaging. This technique is likely to be widely used in the triage of the acute stroke patient in the near future. (Source: Australasian Radiology)

Prognostic Value of a Comprehensive Cardiac Magnetic Resonance Assessment Soon After a First ST-Segment Elevation Myocardial Infarction

Journal of the American College of Cardiology: Cardiovascular Imaging — Sun, 12 Jul 2009 23:00:00 +0100

Conclusions A comprehensive CMR assessment is useful for stratifying risk soon after STEMI, but only the extent of systolic dysfunction and of transmural necrosis provide independent prognostic information. (Source: Journal of the American College of Cardiology: Cardiovascular Imaging)

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Drug-Eluting Stent May Be Better When PCI Follows Thrombolysis

Medscape Today Headlines — Tue, 07 Jul 2009 15:34:26 +0100

In patients with acute ST-segment elevation myocardial infarction (STEMI) treated with thrombolytic therapy and then percutaneous coronary intervention (PCI), the risk of major cardiac events is higher when bare-metal stents are used than when drug-eluting stents are used, according to a report in the June 15 issue of the American Journal of Cardiology. Reuters Health Information (Source: Medscape Today Headlines)

Treatment of venous thromboembolism: guidelines translated for the clinician

Journal of Thrombosis and Thrombolysis — Mon, 06 Jul 2009 20:01:50 +0100

Abstract Venous thromboembolism is a major cause of morbidity and mortality affecting over 2 million people in the United States each year. The American College of Chest Physicians (ACCP) published their first consensus statement on antithrombotic therapy in 1986, and the most recent guidelines from the ACCP on this topic were released in 2008. We aim to summarize the most recent ACCP guidelines on therapy for venous thromboembolism with practical application and interpretation for the practicing physician. We will briefly review the rating system used in the guidelines for the level of evidence and the strength of the recommendation. We will then discuss the recommendations for initial anticoagulant therapies including low molecular weight heparin, unfractionated heparin,...

Evaluation of Initial Diffusion-weighted Image Findings in Acute Stroke Patients using a Semiquantitative Score.

Magnetic Resonance in Medical Sciences : MRMS — Sun, 05 Jul 2009 23:26:02 +0100

Conclusions: The semiquantitative DWI score easily evaluated extent of acute ischemic lesion on DWI and might be used to predict patient outcome after thrombolytic therapy more accurately than ASPECTS or DWI volume. PMID: 19571496 [PubMed - in process] (Source: Magnetic Resonance in Medical Sciences : MRMS)

The Only Better Alternative to Rescue Percutaneous Coronary Intervention Is Primary Percutaneous Coronary Intervention⁎

Journal of the American College of Cardiology — Wed, 01 Jul 2009 15:09:13 +0100

The superiority of primary percutaneous coronary intervention (PCI) over thrombolysis as a reperfusion strategy in patients with ST-segment elevation myocardial infarction (STEMI) has been sufficiently documented (). However, thrombolysis still remains a frequently used therapeutic option for patients with STEMI, for the most part due to constraints in offering PCI in a timely manner (). Even with the use of advanced fibrin-specific thrombolytic agents, thrombolysis restores normal epicardial blood flow—Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 —in only slightly more than one-half of patients with STEMI (). The efficacy of thrombolysis is highly time-dependent, with drastic attenuation in benefit if the interval from onset of symptoms exceeds 6 h (). Available evidence ...

Facilitated angioplasty with combo therapy among patients with ST-segment elevation myocardial infarction: a meta-analysis of randomized trials

The American Journal of Emergency Medicine — Tue, 30 Jun 2009 23:00:00 +0100

Conclusions: This meta-analysis shows that among patients with STEMI undergoing primary angioplasty, pharmacologic facilitation with combined reduced-dose thrombolytic therapy and Gp IIbIIIa inhibitors is not superior to Gp IIb-IIIa inhibitors alone and, thus, may not be routinely recommended. However, future randomized trials should investigate whether this strategy may further improve outcome when applied within the first hours from symptoms onset, especially in patients undergoing transferring for primary angioplasty. (Source: The American Journal of Emergency Medicine)

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Acute pulmonary embolism registry in the Małopolska region - clinical course.

Kardiologia Polska — Tue, 30 Jun 2009 23:00:00 +0100

Conclusions: 1. In our registry mortality rate in patients with APE was 11%. 2. In about 30% of patients APE was under mask of acute coronary syndrome or syncope, 34% of patients had elevated troponin level, and 30% of patients had complication during hospitalisation. 3. In patients treated with thrombolytics mortality rate was 45%. 4. Reperfusion strategy (trombolysis or embolectomy) in the high risk group was used in only 41% of patients. 5. Elevated troponin level in normotensive patient was associated with 4-fold times higher risk of death. 6. New risk stratification according to the ESC guidelines 2008 correctly predicts prognosis in everyday clinical practise. PMID: 19649995 [PubMed - as supplied by publisher] (Source: Kardiologia Polska)

Varied opinions on thrombolysis for venous thromboembolism in infants and children: Findings from a survey of pediatric hematology-oncology specialists

Pediatric Blood and Cancer — Wed, 17 Jun 2009 23:00:00 +0100

Recent guidelines discourage routine use of thrombolytic agents for treatment of venous thromboembolism (VTE) in pediatric patients, but actual practice patterns are unknown.An electronic survey was emailed to all active and trainee members of the American Society of Pediatric Hematology/Oncology in April 2008. Respondents were asked a series of multiple-choice questions based on hypothetical case scenarios describing pediatric VTE, pertinent to the implementation of thrombolytic therapy and other professional demographic information.Two hundred eighty-five evaluable responses were obtained (22% response rate) which varied greatly with respect to all spheres of questioning. Tissue plasminogen activator (tPA) was the thrombolytic agent chosen by most respondents, but no clear consensus emer...

ORIGINAL ARTICLE: Portomesenteric Venous Thrombosis After Laparoscopic Surgery: A Systematic Literature Review

Archives of Surgery — Sun, 14 Jun 2009 23:00:00 +0100

Conclusions Portomesenteric venous thrombosis following laparoscopic surgery usually manifests as nonspecific abdominal pain. Computed tomography can readily provide the diagnosis and demonstrate the extent of the disease. Treatment should be individualized based on the extent of thrombosis and the presence of bowel ischemia but should include anticoagulation therapy. Venous stasis from increased intra-abdominal pressure, intraoperative manipulation of splanchnic vasculature, and systemic thrombophilic states likely converges to produce this potentially lethal condition. (Source: Archives of Surgery)

Successful thrombolytic therapy for acute kidney injury secondary to thrombosis of suprarenal inferior vena cava filter

Journal of Thrombosis and Thrombolysis — Fri, 12 Jun 2009 11:30:45 +0100

We report a case of acute kidney injury (AKI) due to acute thrombosis of a suprarenal IVCF, which was successfully treated with systemic thrombolytic therapy. We also provide a review of the literature in regard to the indications, complications, and outcomes of suprarenal IVCF. Suprarenal IVCF placement should be performed rarely, and then only after careful evaluation of the underlying renal function, and likely should be avoided in patients with malignancy and known hypercoagulable state. Systemic thrombolytic therapy is a feasible treatment option for acute thrombotic episodes of IVCF, assuming it is diagnosed early and there are no known contraindications. Content Type Journal ArticleDOI 10.1007/s11239-009-0359-6Authors Azra Bihorac, University of Florida College of Medicine...

Deep Vein Thrombosis of Lower Extremity: Direct Intraclot Injection of Alteplase Once Daily with Systemic Anticoagulation—Results of Pilot Study

Journal of Vascular Surgery — Mon, 01 Jun 2009 04:00:00 +0100

Conclusion: Daily intraclot injection of a venous thrombus with alteplase can be an alternative to continuous infusion thrombolytic therapy for treatment of deep venous thrombosis (DVT). (Source: Journal of Vascular Surgery)

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Outcome of non-transplant surgical strategy for end-stage dilated cardiomyopathy in young children.

Circulation Journal — Sun, 31 May 2009 23:00:00 +0100

Conclusions: PLV and MVR are feasible and effective and should be considered when heart failure resists conventional therapy. (Circ J 2009; 73: 1045-1048). PMID: 19359814 [PubMed - in process] (Source: Circulation Journal)

Assessing capacity and obtaining consent for thrombolysis for acute stroke.

Clinical Medicine — Sun, 31 May 2009 23:00:00 +0100

This article presents patients' and doctors' perspectives on assessing capacity to consent to thrombolytic therapy for stroke. PMID: 19634386 [PubMed - in process] (Source: Clinical Medicine)

Locally Applied Recombinant Plasmin Results in Effective Thrombolysis in a Porcine Model of Arteriovenous Graft Thrombosis

Journal of Vascular and Interventional Radiology : JVIR — Wed, 27 May 2009 23:00:00 +0100

Conclusions: The thrombolytic efficacy of recombinant plasmin was shown to be superior to that of TPA in this study. (Source: Journal of Vascular and Interventional Radiology : JVIR)

Combined anti-platelet therapy with aspirin and clopidogrel: Risk factor for thrombolysis-related intracerebral hemorrhage in acute ischemic stroke?

Journal of the Neurological Sciences — Tue, 26 May 2009 23:00:00 +0100

Conclusion: In our retrospective study, only pre-treatment with aspirin and clopidogrel was associated with thrombolysis-related intracerebral hemorrhage. This finding should be further validated in large prospective databases like the SITS-MOST registry. (Source: Journal of the Neurological Sciences)

Reply

American Journal of Ophthalmology — Sat, 23 May 2009 07:40:37 +0100

Drs Falavarjani and Modarres pointed out that classification of central retinal artery occlusion (CRAO) is crucial for correctly interpreting results after thrombolytic treatment. We entirely agree, but did not address the issue of classification in our article because we investigated a highly selected group of patients with classic nonarteritic CRAO with retinal ischemia and a cherry red spot and no evidence of temporal arteritis. As outlined in our article, arteritic CRAO was an exclusion criterion for thrombolytic therapy. Furthermore, we included only patients with nonarteritic CRAO without cilioretinal artery sparing. Because the study by Hayreh and Zimmerman involved CRAO patients with an interval between the onset of symptoms and the first visit ranging from less than 1 day to more ...

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Treatment of Bilateral Hand Frostbite Using Transcatheter Arterial Thrombolysis After Papaverine Infusion

CardioVascular and Interventional Radiology — Sat, 16 May 2009 05:56:26 +0100

We report the case of severe frostbite of the hands successfully treated with transcatheter intra-arterial tPA after papaverine infusion in a 37-year-old man. Upper extremity and hand angiography within 16 h of the insult showed thrombotic occlusive disease and vasospasm. Intra-arterial catheters were placed in the brachial arteries and a papaverine infusion was initiated, followed by intra-arterial tPA thrombolysis. Follow-up examination at 4 months revealed full hand function and complete resolution of symptoms. Content Type Journal ArticleCategory Case ReportDOI 10.1007/s00270-009-9584-9Authors Arash M. Saemi, University of Vermont College of Medicine and Fletcher Allen Health Care Section of Interventional Radiology, Department of Radiology Burlington VT 05401 USAJas...

Hyperdense middle cerebral artery sign in multidetector computed tomography: Definition, occurrence, and reliability analysis

Neurology India — Fri, 15 May 2009 15:14:12 +0100

Conclusion:</b> Performing CT examinations on MDCT and assessment of the images in PACS might have contributed to improvement of the reliability of evaluating HMCAS on CT by enabling an objective evaluation of this sign with measurements of attenuation value in the course of MCA using oval or pixel sized ROIs as well as estimation of MCA<sub> ratio</sub> . (Source: Neurology India)

Liver laceration associated with the use of a chest compression device

Resuscitation — Thu, 14 May 2009 04:00:00 +0100

A 71-year-old man was found by the resuscitation team in cardiac arrest in the bathroom of a urology ward after a radical prostatectomy. The patient's trachea was intubated and chest compressions were started using the Autopulse™ device. There were no manual chest compressions before the Autopulse™ was started. A spontaneous circulation returned after 20min of chest compression with the Autopulse™ and administration of high dosages of adrenaline (epinephrine). Electrocardiographic changes and transthoracic cardiac echocardiography suggested a pulmonary embolism was the cause of cardiac arrest. Intravenous thrombolytic therapy was started with recombinant tissue plasminogen activator (Alteplase, 10mg bolus over 2min followed by 90mg over 2h). Two hours later, a computed tomography (CT...

Spinal epidural hematoma after intravenous thrombolysis for acute ischemic stroke

Journal of the Neurological Sciences — Sun, 03 May 2009 23:00:00 +0100

We report, probably the first case of spinal epidural hemorrhage after systemic thrombolysis for acute ischemic stroke. Spinal hemorrhage should be considered as a differential diagnosis for neurological worsening after intravenous thrombolysis for acute ischemic stroke, especially when the brain imaging studies do not reveal an appropriate intracranial pathology. (Source: Journal of the Neurological Sciences)

Perception and Attitude towards Stroke by Professionals of Emergency Medical Service in an Urban City in Southeastern Brazil

Journal of Stroke and Cerebrovascular Diseases — Fri, 01 May 2009 04:00:00 +0100

Discussion: It appears that professionals allied to medicine can diagnosis stroke of anterior circulation; however, they do not have thrombolytic therapy in mind, and this should be considered the default treatment for all patients with stroke within the “therapeutic window.” (Source: Journal of Stroke and Cerebrovascular Diseases)

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Acute Myocardial Infarction in a Patient with Behçet's Disease.

Archives of Iranian Medicine — Thu, 30 Apr 2009 23:00:00 +0100

Acute Myocardial Infarction in a Patient with Behçet's Disease. Arch Iran Med. 2009 May;12(3):313-6 Authors: Beyranvand MR, Namazi MH, Mohsenzadeh Y, Assadpour Piranfar M A 37-year-old man, a known case of Behcet's disease with its vascular complications such as abdominal and thoracic artery aneurysms, was admitted with the diagnosis of acute anterior myocardial infarction and received thrombolytic therapy. Coronary angiography and percutaneous coronary intervention via transradial approach were performed for the patient on the eighth day of admission. The patient did not suffer from any symptoms, myocardial infarction, or readmission in the nine-month follow-up. About 25 cases of myocardial infarction associated with Behcet's disease have been reported previously. Althoug...

Clinical, Biochemical and Neuroimaging Parameters after Thrombolytic Therapy Predict Long-Term Stroke Outcome

European Neurology — Thu, 30 Apr 2009 08:37:34 +0100

Eur Neurol 2009;62:9-15 (DOI:10.1159/000215876) (Source: European Neurology)

Open vs. endovascular repair of isolated iliac artery aneurysms: A 12-year experience

Journal of Vascular Surgery — Wed, 29 Apr 2009 05:07:21 +0100

Conclusion: These data demonstrate that in appropriately selected patients, endovascular repair of isolated iliac artery aneurysms is a safe, effective alternative to open repair with mid-term follow-up. Endovascular repair is associated with a significantly reduced hospital length of stay and may be associated with decreased need for transfusion and mortality when compared with open repair. (Source: Journal of Vascular Surgery)

Young Investigator Database Research Seed Grant -- Council on Clinical Cardiology

ScanGrants feed — Sun, 26 Apr 2009 04:00:00 +0100

General InformationThe Council on Clinical Cardiology places a great value on the development of young clinical investigators. To further this effort, the council has a limited number of seed grants for young investigators for meritorious research projects based on the data gathered from Get With The GuidelinesSM (GWTG). A description of GWTG and the database content follows. The Executive Database Steering Committee and the Get With The Guidelines Steering and Science Sub Committee oversee the large database. Members of these committees will be available as mentors to the applicants. Young investigators may be current fellows in training or within five years of completing their cardiology, or neurology fellowship or other doctoral prepared professionals who are early in their career devel...

Major Adverse Cardiac Events at Follow-Up After Bare-Metal Stenting Versus Drug-Eluting Stenting in ST-Elevated Myocardial Infarction

The American Journal of Cardiology — Sun, 19 Apr 2009 23:00:00 +0100

In conclusion, patients with bare-metal stents had a 1.8 times greater risk of developing major adverse cardiac events than did those using drug-eluting stents after controlling the confounding effects of previous coronary artery bypass surgery and stent width. (Source: The American Journal of Cardiology)

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The actuarial survival analysis of the surgical and non-surgical therapy regimen for chronic thromboembolic pulmonary hypertension

Journal of Thrombosis and Thrombolysis — Sat, 11 Apr 2009 06:52:38 +0100

Conclusion The PTE procedure has statistically superiority over thrombolytic therapy for the proximal type of CTEPH in terms of actuarial survival; however, for the distal type of CTEPH, the PTE procedure provides no benefits with regard to actuarial survival. Content Type Journal ArticleDOI 10.1007/s11239-009-0319-1Authors Hui-Li Gan, Capital Medical University (BAZH–CMU), Beijing Institute of Heart, Lung and Vessel Disease Department of Cardiac Surgery, Beijing Anzhen Hospital Beijing 100029 ChinaJian-Qun Zhang, Capital Medical University (BAZH–CMU), Beijing Institute of Heart, Lung and Vessel Disease Department of Cardiac Surgery, Beijing Anzhen Hospital Beijing 100029 ChinaPing Bo, Capital Medical University (BAZH–CMU), Beijing Institute of Heart, Lung and Vessel Disease De...

Central retinal artery occlusion: timing and mode of presentation

European Journal of Neurology — Fri, 03 Apr 2009 04:00:00 +0100

Conclusions: Just under half (48%) of our cohort of CRAO patients were reviewed by an in-hospital ophthalmologist within the 20-h therapeutic time window for thrombolytic therapy and thus could qualify for inclusion in a randomized controlled trial according to EAGLE inclusion criteria. If thrombolysis is proven to be a feasible and safe treatment in CRAO then public awareness should be raised of the symptoms and an efficient direct referral pathway to an in-hospital ophthalmologist established to aid treatment delivery. (Source: European Journal of Neurology)

Stroke: percent of acute ischemic stroke patients for whom IV thrombolytic therapy was initiated at the hospital within 3 hours (less than or equal to 180 minutes) of time last known well.

National Quality Measures Clearinghouse (NQMC) — Wed, 01 Apr 2009 05:00:00 +0100

This measure* is used to assess the percentage of acute ischemic stroke patients who arrive at the hospital within 120 minutes (2 hours) of time last known well and for whom intravenous recombinant tissue plasminogen activator (IV r-TPA or t-PA) was initiated at this hospital within 180 minutes (3 hours) of time last known well. *This is a Joint Commission only measure. (Source: National Quality Measures Clearinghouse (NQMC))

Treatment options in massive pulmonary embolism during pregnancy; A case-report and review of literature.

Thrombosis Research — Sat, 28 Mar 2009 04:00:00 +0100

Conclusion: The number of reports on thrombolytic therapy, surgical embolectomy and catheter embolectomy or thrombolysis for massive pulmonary embolism during pregnancy are limited. We suggest an international registry for pregnant patients undergoing thrombolysis or embolectomy to gain more information about these treatment options. Nevertheless, complication rates of thrombolytic therapy are acceptable in the light of the underlying disease, and in the meantime, current data do not justify withholding pregnant women from thrombolytic therapy in case of life-threatening PE. PMID: 19332351 [PubMed - as supplied by publisher] (Source: Thrombosis Research)

[Postoperative ischemic acute stroke and thrombolytic therapy.]

Annales Francaises d'Anesthesie et de Reanimation — Fri, 27 Mar 2009 04:00:00 +0100

Authors: Laalou FZ, Kuntzmann H, Mahoudeau G, Kremer S, Pain L Intravenous thrombolytic therapy for ischemic stroke was performed on a 75-year-old patient at recovery from cervicocephalic superficial surgery. The patient recovered totally from ischemic stroke and no neurologic sequelae was observed. Thrombolytic therapy must be performed in an intensive care unit in order to manage some bleeding events which can occur. PMID: 19329273 [PubMed - as supplied by publisher] (Source: Annales Francaises d'Anesthesie et de Reanimation)

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Combination of T2*W and FLAIR Abnormalities for the Prediction of Parenchymal Hematoma Following Thrombolytic Therapy in 100 Stroke Patients

Journal of Neuroimaging — Wed, 25 Mar 2009 04:00:00 +0100

The objective of our study was to determine whether the combination of hypointense spots ("cerebral microbleeds," CMBs) with a leukoaraiosis is associated with the risk of parenchymal hematoma (PH) after thrombolytic therapy. We analyzed magnetic resonance imaging (MRI) scans acquired within 6 hours after symptom onset from 100 ischemic stroke patients. Multiparametric MRI including a T2*-weighted (T2*w) MRI and fluid attenuated inversion recovery (FLAIR) was performed before thrombolysis in all patients. Initial T2*w imaging was rated by two independent observers for the presence of CMBs smaller than 5 mm. White matter changes were evaluated using an adapted scale of Fazekas and Schmidt. PH was defined in follow-up imaging. A PH was observed in seven per 100 patients. CMBs were detected b...

IV vs. IA TPA in Acute Ischemic Stroke with CT Angiographic Evidence of Major Vessel Occlusion: A Feasibility Study

Neurocritical Care — Wed, 11 Mar 2009 11:11:29 +0100

Conclusions We found that it is feasible to conduct a trial comparing IV vs. IA TPA in ischemic stroke patients with major vessel occlusion presenting <3 h from onset. Patients treated with IA TPA showed a trend toward higher rate of recanalization. A larger trial may be designed to test safety and effectiveness of IA TPA in this specific group of stroke patients. Content Type Journal ArticleCategory Original ArticleDOI 10.1007/s12028-009-9204-1Authors Souvik Sen, University of North Carolina UNC Stroke Center, Department of Neurology 7001 NC Neuroscience Hospital, CB#7025 Chapel Hill NC 27599-7025 USADavid Y. Huang, University of North Carolina UNC Stroke Center, Department of Neurology 7001 NC Neuroscience Hospital, CB#7025 Chapel Hill NC 27599-7025 USAOmid ...

Comparison of treatment and outcome of acute coronary syndrome in patients with versus patients without diabetes mellitus.

The American Journal of Cardiology — Wed, 11 Mar 2009 10:40:23 +0100

In conclusion, given the current treatment, patients with and without DM with ACS had similar in-hospital adjusted mortality, but patients with DM had increased 1-year mortality. Patients with DM with non-STE ACS posed a higher risk group. PMID: 19268730 [PubMed - in process] (Source: The American Journal of Cardiology)

Thrombolytic therapy for deep vein thrombosis

Current Treatment Options in Cardiovascular Medicine — Tue, 10 Mar 2009 08:11:55 +0100

Opinion statement The incorporation of endovascular interventions into mainstream clinical practice for patients with deep vein thrombosis (DVT) has been changing rapidly as a result of four major trends. First, there now is a much greater appreciation among practicing physicians of the major impact of the postthrombotic syndrome (PTS) on DVT patients’ late quality of life. Second, there have been rapid advances in the methods by which thrombus can be rapidly removed using endovascular techniques, resulting in greater efficiency and treatment safety. Third, these changes together have spurred a major change in recommended DVT treatment paradigms: there is now published expert consensus that adjunctive endovascular DVT thrombolysis should be strongly considered as a first-...

Thrombolytic therapy for venous thromboembolism: Current clinical practice

Journal of Hospital Medicine — Thu, 05 Mar 2009 05:00:00 +0100

Venous thromboembolism (VTE) is a life-threatening condition for which thrombolytic therapy may be beneficial. The appropriate setting for the use of thrombolytic therapy remains controversial. More than 10 years ago we described the case-based practice patterns for the use of thrombolytics in VTE, and now, in the context of recent studies and guidelines, we sought to reevaluate the use of thrombolytics and to determine whether beliefs have changed.Active pulmonologists in 11 southeastern states were selected to complete a web-based questionnaire that included background questions and hypothetical case scenarios involving VTE and potential treatment with thrombolytics.Eighty-one physicians completed the survey and 84% reported using thrombolytic therapy for VTE within the last 2 years. In ...

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Can intraoperative thrombolytic therapy assist with the management of acute limb ischemia?

Seminars in Vascular Surgery — Sun, 01 Mar 2009 05:00:00 +0100

This article describes the rationale for intraoperative thrombolysis, reviews the evidence supporting its use, and suggests several technical approaches to incorporating lytic therapy intraoperatively. PMID: 19298936 [PubMed - in process] (Source: Seminars in Vascular Surgery)

[Effect and safety of the therapies for acute myocardial infarction patients with failed thrombolytic therapy: a systematic review.]

Journal of Southern Medical University — Sun, 01 Mar 2009 05:00:00 +0100

CONCLUSION: Current evidence does not confirm the effect or safety of the therapies for AMI patients with failed thrombolytic therapy, norsupport the routine use of these therapies in clinical practice except for rescue PCI that reduces mortality compared with traditional treatment. Further high-quality randomized controlled trials are needed to provide reliable evidence for the treatments of AMI patients with failed thrombolytic therapy. PMID: 19304519 [PubMed - in process] (Source: Journal of Southern Medical University)

‘Golden Hour’ Arrival Ups Odds of Getting TPA

Hospitalist News — Sun, 01 Mar 2009 05:00:00 +0100

SAN DIEGO — Patients with ischemic stroke who arrive within 1 hour of symptom onset at a hospital participating in the Get With the Guidelines-Stroke program were significantly more likely to receive thrombolytic therapy, according to a study presented at the International Stroke Conference. (Source: Hospitalist News)

Comparison of the correlation of the Selvester QRS scoring system with cardiac contrast-enhanced magnetic resonance imaging–measured acute myocardial infarct size in patients with and without thrombolytic therapy

Journal of Electrocardiology — Sun, 01 Mar 2009 05:00:00 +0100

Conclusions: The associations between Selvester QRS Score and ceMRI-based MI were statistically significant and similar in both groups. (Source: Journal of Electrocardiology)

Can Intraoperative Thrombolytic Therapy Assist with the Management of Acute Limb Ischemia?

Seminars in Vascular Surgery — Sun, 01 Mar 2009 00:00:00 +0100

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Early ischemic stroke presentation in Pakistan.

The Canadian Journal of Neurological Sciences — Sun, 01 Mar 2009 00:00:00 +0100

CONCLUSIONS: The rate of early stroke presentation in a Pakistani tertiary care facility is comparable to certain developed countries. To increase the proportion of patients who can benefit from thrombolytic therapy, programs need to be instituted to increase public awareness of treatment options for stroke and expedited referral by the primary care provider. PMID: 19378711 [PubMed - indexed for MEDLINE] (Source: The Canadian Journal of Neurological Sciences)

Warfarin therapy management: Tap in to new ways to slow the clot.

Nurse Practitioner, The — Thu, 26 Feb 2009 15:26:32 +0100

The American College of Chest Physicians (ACCP) recently published updated evidence-based clinical practice guidelines for antithrombotic and thrombolytic therapy, which can be used to direct clinical practice.Page: 22DOI: 10.1097/01.NPR.0000346589.28196.ecAuthors: Weyland, Patricia APRN-BC, MS, FNP (Source: Nurse Practitioner, The)

Future Demographic Trends Decrease the Proportion of Ischemic Stroke Patients Receiving Thrombolytic Therapy. A Call to Set-Up Therapeutic Studies in the Very Old.

Stroke — Thu, 26 Feb 2009 05:00:00 +0100

CONCLUSIONS: Future demographic changes will reduce tPA treatment rates. Therapeutic studies focusing on very old stroke patients are necessary to counteract this trend. PMID: 19246706 [PubMed - as supplied by publisher] (Source: Stroke)

Acute myocardial infarction associated with disulfiram-alcohol interaction in a young man with normal coronary arteries.

Turk Kardiyoloji Dernegi arsivi — Sat, 21 Feb 2009 06:22:58 +0100

Authors: Tayyareci Y, Acarel E Acute myocardial infarction due to acetaldehyde syndrome has been rarely reported. A 22-year-old, chronic alcoholic man was admitted to our hospital with typical angina pectoris that developed after oral intake of disulfiram and alcohol together. The electrocardiogram showed hyperacute inferior myocardial infarction and he was successfully treated by thrombolytic therapy. Coronary angiogram revealed normal coronary arteries; thus, the event was probably secondary to coronary artery thrombosis and/or coronary vasospasm. Disulfiram is not a safe drug in patients unable to adhere to the strict restriction of alcohol intake, requiring a close supervision of individuals on disulfiram therapy. PMID: 19225254 [PubMed - in process] (Source: Turk Kardiyoloji D...

ASA: Careful Thrombolysis Improves Outcomes in Intraventricular Hemorrhage

MedPage Today Geriatrics — Fri, 20 Feb 2009 19:02:20 +0100

SAN DIEGO (MedPage Today) -- After an intraventricular hemorrhage stabilizes, treatment with slow, low-dose thrombolytic therapy may substantially reduce death and disability, researchers found. (Source: MedPage Today Geriatrics)

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Stroke patients arriving within "golden hour" more likely to get tPA

theHeart.org — Fri, 20 Feb 2009 15:00:38 +0100

A greater proportion of stroke patients arriving within one hour of symptom onset—the so-called "golden hour"—receive thrombolytic therapy, although door-to-needle times were actually longer, suggesting doctors may be using the extra time to deliberate the decision to treat. (International Stroke Conference 2009.) (Source: theHeart.org)

Cerebral resuscitation after cardiocirculatory arrest.

Anesthesia and Analgesia — Fri, 20 Feb 2009 14:48:40 +0100

Authors: Schneider A, Böttiger BW, Popp E Cardiopulmonary resuscitation can restore spontaneous circulation in up to 50% of patients suffering from cardiac arrest. However, most of these patients still die during the postresuscitation period. Mortality is largely due to neuronal injury after global cerebral ischemia. There is, therefore, a clear need for therapies, which restore and protect brain function after cardiac arrest. Several years ago, mild therapeutic hypothermia was introduced into clinical practice. It represents the first treatment to improve both survival and neurological outcome of patients after out-of-hospital cardiac arrest, according to randomized clinical trials. In addition to therapeutic hypothermia, various other therapeutic options are currently being inve...

ASA: Gender Disparities Persist in Acute Stroke Treatment

MedPage Today Cardiovascular — Thu, 19 Feb 2009 16:49:45 +0100

SAN DIEGO (MedPage Today) -- Women are consistently less likely to receive thrombolytic therapy for acute stroke, according to a meta-analysis. (Source: MedPage Today Cardiovascular)

ISC 2009: Stroke Patients Arriving Within "Golden Hour" More Likely to Get tPA

Medscape Medical News Headlines — Thu, 19 Feb 2009 15:23:00 +0100

A greater proportion of stroke patients arriving within 1 hour of symptom onset -- the so-called "golden hour" -- receive thrombolytic therapy, although door-to-needle times were actually longer, suggesting doctors may be using the extra time to deliberate the decision to treat. Medscape Medical News (Source: Medscape Medical News Headlines)