Intravenous Thrombolysis At 3 45 Hours After Acute Ischemic Stroke A Retrospective Multi Center Observational Study In Taiwan

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Intravenous Thrombolysis at 3-4.5 Hours After Acute Ischemic Stroke: A Retrospective Multi-center Observational Study in Taiwan

Author : Jeng Jiann-Shing
Publisher :
ISBN 13 :
Total Pages : pages
Book Rating : 4.:/5 (116 download)

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Book Synopsis Intravenous Thrombolysis at 3-4.5 Hours After Acute Ischemic Stroke: A Retrospective Multi-center Observational Study in Taiwan by : Jeng Jiann-Shing

Download or read book Intravenous Thrombolysis at 3-4.5 Hours After Acute Ischemic Stroke: A Retrospective Multi-center Observational Study in Taiwan written by Jeng Jiann-Shing and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Background: Intravenous thrombolysis with alteplase 3 to 4.5 hours after ischemic stroke onset has been proved by a randomized trial and recommended by several guidelines. However, it is still an off-label treatment in many countries, including Taiwan. The present study aimed to investigate the effectiveness and safety of alteplase administered between 3 and 4.5 hours after stroke onset by a retrospective observational study.Methods: Multi-center stroke registry has been well undertaken in Taiwan since 2006. Based on Taiwan Stroke Registry, we included ischemic stroke patients who received intravenous thrombolysis with alteplase 3 to 4.5 hours after onset of a stroke into analysis. Patients who received superimposed endovascular treatment, or enrolled in acute stroke treatment trials were excluded. Age-and-sex matched controls were also selected as the following criteria: onset to hospital arrival 2-4.5 hours, no absolute contraindication for thrombolytic therapy, and no use of any thrombolytic agents or endovascular treatment. The effectiveness was evaluated by a favorable outcome at 3 months, modified Rankin scale 0 or 1, and safety was determined by symptomatic intracranial hemorrhage (ICH) and mortality at 3 months.Results: A total of 748 patients were recruited from 16 hospitals, including 374 (67% men, mean age, 67.8+12.5 years) in the alteplase group and 374 (67% men, mean age, 66.1+13.2 years) in the control group. Patients in the alteplase group had more favorable outcome than in the control group (34.0% vs. 22.7%; odds ratio [OR], 1.75; 95% confidence interval [CI], 1.27-2.42; P=0.001). There was no significant difference of symptomatic ICH (alteplase, 5.6% vs. control 2.9%, OR, 1.96; 95% CI, 0.93-4.13; P=0.076), and mortality (alteplase, 7.8% vs. control 7.5%; OR, 1.04; 95% CI, 0.61-1.78; P=0.89) between two groups. Compared to patients received standard dose of alteplase (n=182), those with reduced dose of alteplase (n=192) did not have lower hemorrhagic transformation and better functional outcome.Conclusion: The effectiveness and safety of intravenous alteplase administration 3 to 4.5 hours after stroke onset was confirmed in this retrospective analysis in Taiwan.

SINGLE-CENTRE, RETROSPECTIVE, CASE-CONTROL STUDY OF LOW-DOSE VS. STANDARD-DOSE THROMBOLYSIS IN ACUTE ISCHEMIC STROKE

Author : Ghil Schwarz
Publisher :
ISBN 13 :
Total Pages : pages
Book Rating : 4.:/5 (116 download)

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Book Synopsis SINGLE-CENTRE, RETROSPECTIVE, CASE-CONTROL STUDY OF LOW-DOSE VS. STANDARD-DOSE THROMBOLYSIS IN ACUTE ISCHEMIC STROKE by : Ghil Schwarz

Download or read book SINGLE-CENTRE, RETROSPECTIVE, CASE-CONTROL STUDY OF LOW-DOSE VS. STANDARD-DOSE THROMBOLYSIS IN ACUTE ISCHEMIC STROKE written by Ghil Schwarz and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Background and Aims. Low-dose intravenous thrombolysis is a possible option in older patients with borderline criteria fulfilment (Chao AC, 2019). Low dose rtPA is currently used in Japanese subjects (Yamaguchi, 2006), however, limited data and no clear evidence of benefit is available for Caucasian-descent patients (Cheng JW, 2018). Our aim was to evaluate safety and efficacy of low- dose thrombolysis in Italian tertiary care stroke patientsu2019 cohort. Methods. Retrospective study of 40 consecutive acute ischemic stroke patients treated in a tertiary care centre between 2013 and 2018 with low-dose (0.60u00b10.15 mg/kg) alteplase, propensity score-matched with 80 stroke patients treated with standard-dose (0.9 mg/kg) alteplase. Three-months modified Rankin scale (mRS) score was primary outcome; haemorrhagic transformation rate was safety outcome. Results. We assessed 120 patients with median age 76, baseline NIHSS score 12; 24/120 (20.0%) subjects received additional endovascular treatment. Clinical-demographic variables were comparable between case and control group; trend for significance was observed only for median premorbid mRS score, namely 0 (IQR 2) in low-dose vs. 0 (IQR 0) in control group (p=0.11), and prior dual antiplatelet therapy 3/40 (7.5%) in low-dose vs. 1/80 (1.3%) in control group (p=0.16). Low-dose group received median 0.66 (IQR 0.14) mg/kg alteplase, while standard-dose group 0.90 (0.01) mg/kg, at a median of 170 (53) minutes from symptom onset. Good outcome (3-month mRSu22642) was observed in 21/40 (52.5%) low-dose patients and 42/80 (52.5%) standard-dose patients (p=1.00); median 3-month mRS was 2 (IQR 3) for both groups, with mean utility-weighted mRS of 0.62 (SD 0.34) in low- dose vs. 0.66 (SD 0.30) in standard-dose group (p=0.35). No difference in haemorrhagic transformation rate was observed (p=1.00): 15% for both groups; of which 2.5% symptomatic (NIHSS change u22654 points). Conclusions. Efficacy and safety of low-dose rtPA were comparable to standard-dose rtPA. Due to the small number of patients, the results of this exploratory study cannot be generalized and need to be confirmed in a larger stroke population. However, it appears feasible to consider using low- dose rtPA in frail stroke subjects population with higher risk of haemorragic transofrmation. References 1 Chao AC et al. Low-dose versus standard-dose intravenous alteplase for octogenerian acute ischemic stroke patients: A multicenter prospective cohort study. J Neurol Sci. 2019 Apr 15;399:76-81u20282. Yamaguchi T, Mori E, Minematsu K, et al. Alteplase at 0.6 mg/kg for acute ischemic stroke within 3 hours of onset: Japan Alteplase Clinical Trial (J-ACT). Stroke 2006;37:1810-5 u20283. Cheng JW et al. Low-dose tissue plasminogen activator in acute ischemic stroke: a systematic review and meta-analysis. J Stroke Cerebrovasc.Dis 2018 Feb;27(2):381-390.

GENDER DIFFERENCES IN EFFECT ON PATIENTS WITH ACUTE ISCHEMIC STROKE FOLLOWING THROMBOLYSIS: A 11-YEAR COHORT STUDY IN NORTHERN TAIWAN

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Author : YA-JU LIN
Publisher :
ISBN 13 :
Total Pages : pages
Book Rating : 4.:/5 (116 download)

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Book Synopsis GENDER DIFFERENCES IN EFFECT ON PATIENTS WITH ACUTE ISCHEMIC STROKE FOLLOWING THROMBOLYSIS: A 11-YEAR COHORT STUDY IN NORTHERN TAIWAN by : YA-JU LIN

Download or read book GENDER DIFFERENCES IN EFFECT ON PATIENTS WITH ACUTE ISCHEMIC STROKE FOLLOWING THROMBOLYSIS: A 11-YEAR COHORT STUDY IN NORTHERN TAIWAN written by YA-JU LIN and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Background and Aims Intravenous (IV) recombinant tissue plasminogen activator (rt-PA) has become the standard care in selected patients with acute ischemic stroke (AIS). Stroke women without treatment of thrombolysis have a worse clinical outcome than men, but given thrombolysis, their outcome is similar or better compared with men. The main objective is to determine whether there is a gender difference in clinical outcomes among Asian AIS patients following thrombolysis.Method We conducted a retrospective cohort analysis of 345 AIS patients treated with IV rt-PA within 3 hours from stroke onset in a medical center in Northern Taiwan. The baseline characteristics, clinical features, baseline National Institute of Health Stroke Scale score , radiological and laboratory data, onset to needle time, stroke mechanism and outcomes were compared between the sexes.Results From July 2005 to December 2016, 63 men (31.0%) and 36 women (25.3%) had an excellent functional outcome, defined as modified Rankin Scale score of 0-1 at 90-days after thrombolysis. There are no gender differences in both crude (p=0.252) and adjusted odds ratio (p=0.965) of the excellent functional outcome after adjusting for age, glucose, hypertension, atrial fibrillation, stroke subtypes, dyslipidemia, baseline NIHSS score, and time from symptom onset to thrombolysis. Noticeably, women waited significantly longer than men from hospital arrival to thrombolysis (p=0.01).Conclusion The usual u201cpooreru201d outcome of untreated stroke women is nullified after thrombolysis resulting in the similar outcome between treated men and women. This finding may suggest that the greater benefit for stroke women from thrombolysis than men.

ALTEPLASE IN ACUTE ISCHEMIC STROKE WITHIN 3-4.5 HOURS AFTER STROKE ONSET: RESULTS FROM A MULTICENTER, SINGLE-ARM TRIAL IN CHINA

Author : Yongjun Wang
Publisher :
ISBN 13 :
Total Pages : pages
Book Rating : 4.:/5 (116 download)

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Book Synopsis ALTEPLASE IN ACUTE ISCHEMIC STROKE WITHIN 3-4.5 HOURS AFTER STROKE ONSET: RESULTS FROM A MULTICENTER, SINGLE-ARM TRIAL IN CHINA by : Yongjun Wang

Download or read book ALTEPLASE IN ACUTE ISCHEMIC STROKE WITHIN 3-4.5 HOURS AFTER STROKE ONSET: RESULTS FROM A MULTICENTER, SINGLE-ARM TRIAL IN CHINA written by Yongjun Wang and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: ALTEPLASE IN ACUTE ISCHEMIC STROKE WITHIN 3-4.5 HOURS AFTER STROKE ONSET: RESULTS FROM A MULTICENTER, SINGLE-ARM TRIAL IN CHINAHuaguang Zheng1, Yi Yang2, Huisheng Chen3, Chuanling Li4, Yongjun Wang1, on behalf of the Study Group for Alteplase in Chinese Acute Ischemic Stroke Patients 1Department of Neurology, Tiantan Hospital affiliated to Capital Medical University, Beijing, China; 2Department of Neurology, the First Hospital of Jilin University, Jilin, China; 3Department of Neurology, the General Hospital of Northern Theater Command, Shenyang, China; 4Department of Neurology, Xuzhou Central Hospital, Xuzhou, ChinaBackground and aims: To evaluate the efficacy and safety for alteplase in Chinese patients with acute ischemic stroke (AIS) within 3-4.5 hr after onset in a multicenter, single-arm trial.Method: AIS patients within 3-4.5 hr after symptoms onset otherwise fulfilling current Chinese alteplase label selection criteria received 0.9 mg/Kg i.v. of alteplase. The primary efficacy endpoint was defined as favourable outcome (modified Rankin Scale [mRS] 0-1) at 3 months. The primary safety endpoint was symptomatic intracranial haemorrhage (sICH) according to the European Cooperative Acute Stroke Study III (ECASS III) criteria.Results: Between Dec 2016 and Dec 2017, 120 patients (96 males) were enrolled and treated from 11 sites in China. The mean age was 61.1 (u00b110.9) years, most of the patients had mild-to-moderate stroke with a median baseline NIHSS score of 6. Median time from onset to needle was 3 hr 54 min. The primary efficacy endpoint was achieved in 63.3% of patients (95% CI: 54.4-71.4%) and was statistically significantly higher than the predefined threshold of 40% (p

Outcomes of Thrombolysis and Intra-arterial Thrombectomy in Acute Ischemic Stroke from a Single Medical Center in Taiwan

Author :
Publisher :
ISBN 13 :
Total Pages : pages
Book Rating : 4.:/5 (116 download)

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Book Synopsis Outcomes of Thrombolysis and Intra-arterial Thrombectomy in Acute Ischemic Stroke from a Single Medical Center in Taiwan by :

Download or read book Outcomes of Thrombolysis and Intra-arterial Thrombectomy in Acute Ischemic Stroke from a Single Medical Center in Taiwan written by and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Background:Endovascular therapy (EVT) is a novel treatment for acute ischemic stroke (AIS) from large vessel occlusion. This study described the application and the outcomes of EVT in southern Taiwan, exploring the incidences and factors related to favorable outcomes.Methods:This was a retrospective study of AIS treated by EVT at Chang Gung Memorial Hospital, Kaohsiung, Taiwan. Outcome parameters included National Institute of Health Stroke Scale (NIHSS), modified Rankin scale (mRS), and modified treatment in cerebral ischemic scale (mTICI) scores. Intracranial hemorrhage (ICH) and mortality at 90 days were analyzed.Results:Sixty-three patients received EVT from February 2016 to May 2018. The median time from onset to ER, to groin needle and recanalization was 172, 310 and 330 minutes respectively. The median NIHSS was 19, and 34.9% treated by IV rt-PA before EVT. Forty-three patients (68.3%) achieved mTICI uf0b3 2b and 12 (19.0%) had mRS 0-2 at 90 days. Thirty-three patients (52.4%) were transferred from surrounding hospitals with a prolonged time from onset to groin puncture. Overall, 41.3% of the patients had hemorrhagic transformation and 15.9% had symptomatic ICH without impact to favorable outcomes. Eleven patients died. Dyslipidemia, IV rt-PA pretreatment and time from onset to groin puncture were associated with recanalization.Conclusion:The incidence EVT was relative low. The efficacy of inter-hospital transfer could be important for the better outcomes by minimizing the time from onset to groin needle. IV rt-PA pretreatment before EVT was crucial for better recanalization. EVT is feasible to be applied in the study hospital.

Thrombolytic Therapy for Acute Stroke

Author : Patrick D. Lyden
Publisher : Springer Science & Business Media
ISBN 13 : 1592599338
Total Pages : 372 pages
Book Rating : 4.5/5 (925 download)

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Book Synopsis Thrombolytic Therapy for Acute Stroke by : Patrick D. Lyden

Download or read book Thrombolytic Therapy for Acute Stroke written by Patrick D. Lyden and published by Springer Science & Business Media. This book was released on 2007-11-08 with total page 372 pages. Available in PDF, EPUB and Kindle. Book excerpt: It often takes time for a new therapeutic modality to mature into an accepted treatment option. After initial approval, new drugs, devices, and procedures all go through this process until they become “vetted” by the scientific community as well as the medical community at large. Thrombolysis for treatment of stroke is no exception. Thrombolytic Therapy for Acute Stroke, Second Edition comes four years after the first edition and provides a very comprehensive, updated perspective on the use of intravenous rt-TPA in acute stroke. The authors provide longer term follow-up on the pivotal clinical trials that led to Food and Drug Administration approval, data concerning phase 4 trials in larger numbers of patients, and, most importantly, the community experience that has accumulated since its release. They add to this the latest promising information concerning intra-arterial thrombolysis, which is still under investigation and more speculative sections concerning possible new avenues of clinical research such as combining intravenous thr- bolysis with neuroprotective therapies or intra-arterial thrombolysis. A wealth of factual information is supplemented by chapters containing sage opinion from Drs. Lyden and Caplan concerning the logistical, economic, and procedural issues that have been generated since the advent of this technology. Importantly, diagnosis does not take a back seat to therapeutics as illustrated by sections devoted to eva- ation of the stroke patient, very useful illustrative cases and clinical comments, and chapters on the latest in imaging as applied to this field.

Thrombolytic Therapy in Acute Ischemic Stroke III

Author : Takenori Yamaguchi
Publisher : Springer Science & Business Media
ISBN 13 : 443168459X
Total Pages : 358 pages
Book Rating : 4.4/5 (316 download)

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Book Synopsis Thrombolytic Therapy in Acute Ischemic Stroke III by : Takenori Yamaguchi

Download or read book Thrombolytic Therapy in Acute Ischemic Stroke III written by Takenori Yamaguchi and published by Springer Science & Business Media. This book was released on 2012-12-06 with total page 358 pages. Available in PDF, EPUB and Kindle. Book excerpt: On the threshold of an exciting new era for acute stroke diagnosis and treatment, the Third International Symposium on Thrombolytic Therapy in Acute Ischemic Stroke was held in Nara, Japan, in April 1994. The symposium brought together some 200 basic and clinical scientists for presentations and discussions of issues vital to the understanding of thrombolytic therapy. This volume compiles the major presentations of the symposium, with attention to applications of new diagnostic measures such as diffusion and perfusion MRI, contrast-enhanced transcranial Doppler and angioscopy. Other presentations examine the mechanisms of ischemia/reperfusion injury, hemorrhagic transformation, and reocclusion, with reviews of recent developments in thrombolytic agents. The proceedings of the symposium will be of special interest to researchers, physicians, and students in the fields of neurology, neurosurgery, and nuclear medicine, as well as those in pharmacology, critical care medicine, and related fields.

Thrombolytic Therapy in Acute Ischemic Stroke II

Author : Gregory J. DelZoppo
Publisher : Springer Science & Business Media
ISBN 13 : 364278061X
Total Pages : 485 pages
Book Rating : 4.6/5 (427 download)

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Book Synopsis Thrombolytic Therapy in Acute Ischemic Stroke II by : Gregory J. DelZoppo

Download or read book Thrombolytic Therapy in Acute Ischemic Stroke II written by Gregory J. DelZoppo and published by Springer Science & Business Media. This book was released on 2012-12-06 with total page 485 pages. Available in PDF, EPUB and Kindle. Book excerpt: Over the last decade, interest in treatment of ischemic stroke has increased significantly. Perhaps the single most important feature of attempts to improve the outcome of stroke patients has been that the interventions be applied within the very early hours of stroke symptoms. This has spawned efforts to understand the vascular and neuronal responses to cerebral artery reperfusion experimentally. Important prospective clinical studies of thrombolysis in acute ischemic stroke have been completed, and large placebo-controlled, symptom-based studies are now underway worldwide. Here, we consider the central features of those studies, their experimental basis, and the future importance of adjunctive therapies to recanalization in focal brain ischemia acutely. Risks and benefits are discussed. This collection benefits from the opinions of experts and workers in this rapidly evolving and exciting field.

Intracranial Bleeding after Reperfusion Therapy in Acute Ischemic Stroke

Author : Nishant K. Mishra
Publisher : Frontiers Media SA
ISBN 13 : 2889715086
Total Pages : 210 pages
Book Rating : 4.8/5 (897 download)

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Book Synopsis Intracranial Bleeding after Reperfusion Therapy in Acute Ischemic Stroke by : Nishant K. Mishra

Download or read book Intracranial Bleeding after Reperfusion Therapy in Acute Ischemic Stroke written by Nishant K. Mishra and published by Frontiers Media SA. This book was released on 2021-10-20 with total page 210 pages. Available in PDF, EPUB and Kindle. Book excerpt:

GREATER EFFICACY OF INTRAVENOUS THROMBOLYSIS WITH ALTEPLASE IN CARDIOEMBOLIC STROKE COMPARED TO THROMBOEMBOLIC STROKE IN SARDINIAN PATIENTS: A THREE YEARS RETROSPECTIVE STUDY

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Author : Federico Cabigiosu
Publisher :
ISBN 13 :
Total Pages : pages
Book Rating : 4.:/5 (116 download)

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Book Synopsis GREATER EFFICACY OF INTRAVENOUS THROMBOLYSIS WITH ALTEPLASE IN CARDIOEMBOLIC STROKE COMPARED TO THROMBOEMBOLIC STROKE IN SARDINIAN PATIENTS: A THREE YEARS RETROSPECTIVE STUDY by : Federico Cabigiosu

Download or read book GREATER EFFICACY OF INTRAVENOUS THROMBOLYSIS WITH ALTEPLASE IN CARDIOEMBOLIC STROKE COMPARED TO THROMBOEMBOLIC STROKE IN SARDINIAN PATIENTS: A THREE YEARS RETROSPECTIVE STUDY written by Federico Cabigiosu and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Background and Aims:Among patients with ischemic stroke, a significant proportion is represented by those with cardioembolic stroke; among whom the prevalent share is represented by patients with atrial fibrillation. The relationship between acute ischemic cardioembolic stroke associated with atrial fibrillation and intravenous thrombolysis appear still unclear. Our study aims to evaluate the relationship between the post-thrombolysis clinical course and the factors that may influence this course, with particular attention to the difference between stroke patients with a cardioembolic and non-cardioembolic etiology.Methods:The present work is a monocentric retrospective study that evaluates a population of 311 consecutive patients afferent to the Stroke Unit of Sassari from January 2014 to December 2017 with acute ischemic stroke undergoing intravenous thrombolysis. Patients were classified with respect to the etiology of ischemic stroke in atherosclerosis of large vessels, cardioembolism, lacunar and other causes. All patients received an NIHSS evaluation at the time of fibrinolysis and after 2 hours, 24 hours, 7 days after fibrinolysis, and at discharge.Results:We found that the basal NIHSS is higher in the group of patients with cardioembolic stroke, following the group of atherothrombotic strokes and finally of the lacunars; despite of this finding, patients with cardioembolic stroke show a better response to intravenous thrombolytic treatment with a greater reduction of NSAHSS at 7 days and discharge compared to the other two groups. Conclusions:The data from our study seem to show a greater reduction of NIHSS in patients with cardioembolic stroke undergoing thrombolysis, although a higher baseline NIHSS than the other groups.

Thrombolytic Therapy for Stroke

Author : Patrick D. Lyden
Publisher : Springer Science & Business Media
ISBN 13 : 1592591310
Total Pages : 398 pages
Book Rating : 4.5/5 (925 download)

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Book Synopsis Thrombolytic Therapy for Stroke by : Patrick D. Lyden

Download or read book Thrombolytic Therapy for Stroke written by Patrick D. Lyden and published by Springer Science & Business Media. This book was released on 2001-02-23 with total page 398 pages. Available in PDF, EPUB and Kindle. Book excerpt: Thrombolytic Therapy for Stroke is intended for physicians who will be treating patients in the first few hours after stroke: neurologists, neurosurgeons, emergency medicine physicians, internists, and radiologists. In some areas, fam ily medicine general practice physicians may provide the majority of acute stroke care. We will provide the reader with all the data necessary to understand the utility and limitations of thrombolytic therapy. By reading the protocols, and working through the case tutorials, the reader will become sufficiently familiar with the indications and contraindications of thrombolytic therapy to begin evalu ating potential patients. Although nothing can replace direct instruction by more experienced physicians, we hope that by imparting our accumulated knowledge we may guide those physicians who cannot attend a "hands-on" workshop, or who, having heard the appropriate lectures, feel the need for further guidance. We will review the scientific rationale for thrombolysis: first, most ischemic stroke is caused by thrombo-emboli; second, a portion of brain, the penumbra, remains salvageable for a few hours after vascular occlusion; and third, promptly delivered thrombolysis can remove the offending occlusion and restore cerebral blood flow to the penumbra in time to salvage brain and neurologic function. Then we will review the preclinical development of thrombolytics for stroke pa tients and the early pilot trials. Next, we will present the pivotal clinical trials that demonstrated the efficacy and safety of thrombolysis.

Thrombolysis and Mechanical Thrombectomy for Acute Ischemic Stroke in Octogenarian Patients

Author : Manon Michelard
Publisher :
ISBN 13 :
Total Pages : 0 pages
Book Rating : 4.:/5 (12 download)

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Book Synopsis Thrombolysis and Mechanical Thrombectomy for Acute Ischemic Stroke in Octogenarian Patients by : Manon Michelard

Download or read book Thrombolysis and Mechanical Thrombectomy for Acute Ischemic Stroke in Octogenarian Patients written by Manon Michelard and published by . This book was released on 2020 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Introduction: Elderly patients represent a growing stroke population characterized by a higher frailty, underrepresented in randomized trials. We investigated safety, effectiveness and prognostic factors of intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) in this age group. Methods: Retrospective analysis of a regional stroke-unit registry of consecutive acute ischemic stroke (AIS) patients between 2014 and 2019. We compared clinical characteristics, mortality, and functional outcome between 80 years (

Protocol Adherence During Inter-facility Transfer of Acute Ischemic Stroke Patients Treated with IV RtPA

Author : Robin Reed Jones
Publisher :
ISBN 13 :
Total Pages : 104 pages
Book Rating : 4.:/5 (861 download)

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Book Synopsis Protocol Adherence During Inter-facility Transfer of Acute Ischemic Stroke Patients Treated with IV RtPA by : Robin Reed Jones

Download or read book Protocol Adherence During Inter-facility Transfer of Acute Ischemic Stroke Patients Treated with IV RtPA written by Robin Reed Jones and published by . This book was released on 2011 with total page 104 pages. Available in PDF, EPUB and Kindle. Book excerpt: Stroke is a common and serious health disorder, affecting approximately 795,000 people in the United States every year. Intravenous recombinant tissue plasminogen activator (IV rtPA) is the only FDA approved thrombolytic for treating acute ischemic stroke within 3 hours of symptom onset. Patients treated at rural health centers are often transported within hours to the closest primary stroke center. The purpose of this study was to evaluate the structure, process and outcomes related to the inter-facility transport of ischemic stroke patients treated with intravenous rtPA. The Quality-Caring Model© was the guiding framework. A quantitative, retrospective, non-experimental analysis of inter-facility transport documentation was conducted. The study population included ischemic stroke patients treated with intravenous rtPA at a North Carolina hospital and were subsequently transferred to the primary stroke center. The study correlated structural and process components (type of transport, time of transport, and adherence to protocol) in relation to patient outcomes (presence of post rtPA intracerebral hemorrhage and discharge disposition). The study sample size was considered too small to support statistical significance. However, the sample demonstrated the variation in terms of age, community and transport type. Factors associated with protocol adherence include: air medical transport, shorter transport times, and transporting with the intravenous rtPA infusing en route. Factors associated with protocol non-adherence include: night shift transport and transport times greater than or equal to 60 minutes. The research confirms the need for a state-wide guideline for inter-facility transport of ischemic stroke patients treated with intravenous rtPA.

The Relationship Between Recombinant Tissue Plasminogen Activator (rtPA) Beyond the 3 Hour Therapeutic Window and the Incidence of Intracerebral Hemorrhage in Acute Ischemic Stroke Patients

Download The Relationship Between Recombinant Tissue Plasminogen Activator (rtPA) Beyond the 3 Hour Therapeutic Window and the Incidence of Intracerebral Hemorrhage in Acute Ischemic Stroke Patients PDF Online Free

Author : Aklil M. Rostai
Publisher :
ISBN 13 :
Total Pages : 31 pages
Book Rating : 4.:/5 (85 download)

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Book Synopsis The Relationship Between Recombinant Tissue Plasminogen Activator (rtPA) Beyond the 3 Hour Therapeutic Window and the Incidence of Intracerebral Hemorrhage in Acute Ischemic Stroke Patients by : Aklil M. Rostai

Download or read book The Relationship Between Recombinant Tissue Plasminogen Activator (rtPA) Beyond the 3 Hour Therapeutic Window and the Incidence of Intracerebral Hemorrhage in Acute Ischemic Stroke Patients written by Aklil M. Rostai and published by . This book was released on 2009 with total page 31 pages. Available in PDF, EPUB and Kindle. Book excerpt: Introduction: Thrombolytic treatment with recombinant tissue plasminogen activator (rtPA) is approved by the FDA and national institute of neurological disorders for use within 3 hours as standard therapeutic care after the onset of thrombolytic stroke. Therefore all patients who present later than 3 hours and those with an unknown time window are currently excluded from this treatment option. Thus only a small percentage of patients can benefit. It is essential to assess the safety and efficacy of tissue plasminogen activator, alteplase, when administered after the 3 hour onset for acute ischemic stroke patients to determine the increase in the incidence of intracerebral hemorrhage. Methods: The focus of this study is to review the current literature for the last 10 years on all studies pertaining to the safety and efficacy of tissue plasminogen activator 0́Alteplase0́+ for thrombolytic stroke patients given beyond the 3 hour standard therapeutic care window. An extensive online article search via Ovid, Pubmed, and Up-to-date was performed as well as a review of articles from the years 1999-2009. Five articles were assessed along with several complimentary articles for use of thrombolysis treatment within and beyond the 3 hour time window after stroke onset. Results: A total of 5 articles; two controlled randomized trials, one prospective cohort studies, one parallel group trial, and one open label nonrandomized trial, qualified for this systematic review. Two studies indicate that Alteplase remains safe and improves clinical outcomes in patient with acute ischemic stroke. Another study concluded patient selection was more important than time of treatment for good outcome, a further study indicated that alteplase was non-significantly associated with lower infract growth and significantly associated with increased reperfusion in patients who had mismatch of diffusion weighted MRI vs. Perfusion weighted MRI, and the last study concluded that patients with large baseline of diffusion weighted MRI lesion volume who received early reperfusion appear to be at greater risk of symptomatic intracerebral hemorrhage after tPA therapy. Conclusion: Based on this literature review, the use of intravenous thrombolysis alteplase improves functional outcomes at three months if given within three hours of the standard therapeutic window, however, alteplase can be given at 3 to 4.5 hours after ischemic stroke onset which will lead to moderate improvement, but it will increase the incidence of symptomatic intracerebral hemorrhage. In the last ten years several randomized trials have been published and studied on the use of thrombolysis for acute ischemic stroke beyond the three hour window, but there not enough studies to answer several questions like: which type of patients are most likely to be harmed, how accurate and precise is the benefit in these patients, what is the maximum dosage that can used in ischemic stroke patients after the three hour window without any harm to the patient? Additional randomized trials on this treatment are needed to improve the safety and efficacy of intravenous thrombolysis alteplase.

Intravenous Thrombolysis For Suspected Ischemic Stroke With Seizure At Onset

Author : Stefan Engelter
Publisher :
ISBN 13 :
Total Pages : pages
Book Rating : 4.:/5 (125 download)

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Book Synopsis Intravenous Thrombolysis For Suspected Ischemic Stroke With Seizure At Onset by : Stefan Engelter

Download or read book Intravenous Thrombolysis For Suspected Ischemic Stroke With Seizure At Onset written by Stefan Engelter and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: ObjectiveSeizure at onset (SaO) has been considered a relative contraindication for intravenous thrombolysis (IVT) in patients with acute ischemic stroke, although this appraisal is not evidence-based. Here, we investigated the prognostic significance of SaO in patients treated with IVT for suspected ischemic stroke. MethodsIn this multicenter, IVT-registry-based study we assessed the association between SaO and symptomatic intracranial hemorrhage (sICH, ECASS-II definition), 3-month mortality and 3-month functional outcome on the modified Rankin Scale (mRS) using unadjusted and adjusted logistic regression, coarsened exact matching and inverse probability weighted analyses. ResultsAmong 10,074 IVT-treated patients, 146 (1.5%) had SaO. SaO patients had significantly higher NIHSS and glucose on admission and more often female sex, prior stroke and prior functional dependence than non-SaO patients. In unadjusted analysis, they had generally less favorable outcomes. After controlling for confounders in adjusted, matched and weighted analyses, all associations between SaO and any of the outcomes disappeared, including sICH (odds ratio [OR]unadjusted 1.53 [95% confidence interval: 0.74,3.14], ORadjusted 0.52[0.13,2.16], ORmatched 0.68[0.15,3.03], ORweighted 0.95[0.39,2.32]), mortality (ORunadjusted 1.49[1.00,2.24], ORadjusted 0.98[0.5,1.92], ORmatched 1.13[0.55,2.33], ORweighted 1.17[0.73,1.88]) and functional outcome (mRSu22653 / ordinal mRS: ORunadjusted 1.33[0.96,1.84] / 1.35[1.01,1.81], ORadjusted 0.78[0.45,1.32] / 0.78[0.52,1.16], ORmatched 0.75[0.43,1.32] / 0.45[0.10,2.06], ORweighted 0.87[0.57,1.34] / 1.00[0.66,1.52]). These results were consistent regardless of whether patients had an eventual diagnosis of ischemic stroke (89/146) or stroke mimic (57/146 SaO patients). InterpretationSaO was not an independent predictor of poor prognosis. Withholding IVT from patients with assumed ischemic stroke presenting with SaO seems unjustified.

THROMBOLYSIS OVER 80 YEARS IN THE LATER TIME WINDOW. A HOSPITAL-BASED STUDY

Author : Péter Pál Böjti
Publisher :
ISBN 13 :
Total Pages : 0 pages
Book Rating : 4.:/5 (125 download)

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Book Synopsis THROMBOLYSIS OVER 80 YEARS IN THE LATER TIME WINDOW. A HOSPITAL-BASED STUDY by : Péter Pál Böjti

Download or read book THROMBOLYSIS OVER 80 YEARS IN THE LATER TIME WINDOW. A HOSPITAL-BASED STUDY written by Péter Pál Böjti and published by . This book was released on 2017 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: THROMBOLYSIS OVER 80 YEARS IN THE LATER TIME WINDOW. HOSPITAL-BASED STUDYBackground and Aims:About 30% of admitted ischemic stroke patients are over 80 years old. Large portion of these elderly patients are possible candidates for intravenous thrombolysis (IVT). However regulations and reccomendations regarding to this population are divergent. Aim of our retrospective study to determine the rate of intracerebral hemorrhage (ICH), symptomatic ICH (SICH), mortality and functional outcome of IVT in patients with acute ischemic stroke (AIS) over 80 years within 3 hours compared to 3-4,5 hours.Method:We analyzed all the AIS patients over 80 years who went through IVT at our hospital between 01/01/2015 and 31/10/2017. NIH Stroke Scale (NIHSS), rate of ICH and SICH, mortality, modified Rankin Scale (mRS) at 3 moths and radiographic description of ICH according to Heidelberg classification were compared between the groups treated within 3 hours and 3-4,5 hours.Results:Majority of ICH were classified as class 1a (33,3%) and class 2 (33,3%) in the early time window and as class 2 (57,1%) in the later time window.Conclusion:AIS patients over 80 years treated with IVT at 3-4,5 hours compared within 3 hours do not differ significantly in the rate of ICH, SICH, mortality and functional independence at 3 months. Elderly patients should not be denied IVT in the later time window solely beause of age.

INTRAVENOUS THROMBOLYSIS IN PATIENTS WITH RECENT MYOCARDIAL INFARCTION PRESENTING WITH ACUTE ISCHEMIC STROKE: CASE SERIES AND SYSTEMATIC LITERATURE REVIEW

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Author : Jou00e3o Pedro Marto
Publisher :
ISBN 13 :
Total Pages : pages
Book Rating : 4.:/5 (116 download)

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Book Synopsis INTRAVENOUS THROMBOLYSIS IN PATIENTS WITH RECENT MYOCARDIAL INFARCTION PRESENTING WITH ACUTE ISCHEMIC STROKE: CASE SERIES AND SYSTEMATIC LITERATURE REVIEW by : Jou00e3o Pedro Marto

Download or read book INTRAVENOUS THROMBOLYSIS IN PATIENTS WITH RECENT MYOCARDIAL INFARCTION PRESENTING WITH ACUTE ISCHEMIC STROKE: CASE SERIES AND SYSTEMATIC LITERATURE REVIEW written by Jou00e3o Pedro Marto and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Introduction The safety of intravenous thrombolysis (iv-rtPA) for acute ischemic stroke (AIS) after recent myocardial infarction (MI) is still a matter of debate. We aimed to study the safety of delivering iv-rtPA to AIS patients with a MI within the preceding 3 months.MethodsRetrospective review of consecutive AIS admitted to two university hospitalsu2019 stroke units and systematic literature review (PubMed and EMBASE) for AIS patients treated with iv-rtPA and MI in the previous 3 months. Cardiac complications (cardiac rupture/tamponade, intracardiac thrombus embolization or life-threatening arrhythmias) were assessed by type of MI (non-[NSTEMI] or ST-elevation [STEMI]), MI location and time-elapsed between events.ResultsForty-five patients were included, 29 hospital cases and 16 from the literature review. Twenty-three (51%) patients had concurrent AIS and MI. In the remaining, MI occurred 1 to 63 days before AIS. Twenty-three patients had a STEMI, 10 (43.5%) left anterior and 13 (56.5%) inferior. Two patients died due to cardiac rupture, both with left anterior STEMI, 1 to 3 days before stroke. Both cases of tamponade after pericarditis and death due to presumed cardiac rupture occurred in patients with an inferior STEMI in the week preceding stroke. Thrombus embolization occurred in one patient with inferior STEMI, 2 days before stroke, who also experienced a life-threatening arrhythmia. The other two major arrhythmia cases occurred in patients with inferior STEMI, one concurrent with AIS and one in the preceding week. No NSTEMI patients had cardiac complications.ConclusionIn patients with acute ischemic stroke and recent or concurrent myocardial infarction, myocardial infarction type and location, and the time elapsed between the two events should be taken into consideration when deciding to deliver intravenous thrombolysis. While recent NSTEMI or concurrent events seem safe, STEMI in the week preceding stroke, should prompt caution.