34,768 results match your criteria Thrombolytic Therapy


Statistical analysis plan for the randomized controlled trial Tenecteplase in Wake-up Ischaemic Stroke Trial (TWIST).

Trials 2022 May 19;23(1):421. Epub 2022 May 19.

Department of Neurology, University Hospital of North Norway, Tromsø, Norway.

Background: Patients with wake-up ischemic stroke are frequently excluded from thrombolytic treatment due to unknown symptom onset time and limited availability of advanced imaging modalities. The Tenecteplase in Wake-up Ischaemic Stroke Trial (TWIST) is a randomized controlled trial of intravenous tenecteplase 0.25 mg/kg and standard care versus standard care alone (no thrombolysis) in patients who wake up with acute ischemic stroke and can be treated within 4. Read More

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Effect of Alteplase Thrombolysis on Coagulation Function and Nerve Function of Patients with Ischemic Stroke.

Evid Based Complement Alternat Med 2022 9;2022:9440271. Epub 2022 May 9.

Department of Geriatrics, Cangzhou Central Hospital, Cangzhou 061000, Hebei, China.

Objective: To investigate the effects of alteplase thrombolysis on coagulation function and nerve function of patients with ischemic stroke.

Methods: 76 cases with ischemic stroke receiving thrombolytic therapy in Cangzhou Central Hospital from November 2018 to November 2019 were recruited. They were assigned via the random number table method at a ratio of 1 : 1 to receive alteplase thrombolysis either within 3h after the onset (observation group) or within 3-4. Read More

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Tenecteplase in Ischemic Stroke: Challenge and Opportunity.

Neuropsychiatr Dis Treat 2022 11;18:1013-1026. Epub 2022 May 11.

Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.

Purpose Of Review: Intravenous thrombolysis is the first-line therapy for ischemic stroke, and alteplase has been used as an intravenous thrombolysis drug for over 20 years. However, considering its low rate of recanalization and risk of intracerebral hemorrhage, alteplase may not be the optimal thrombolytic drug of choice for ischemic stroke. Tenecteplase (TNK) is a genetically engineered, mutant, tissue plasminogen activator that is a potential substitute to alteplase in ischemic stroke. Read More

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Elevated troponin I levels on admission predict long-term mortality in patients with acute cerebral infarction following thrombolysis.

Neurol Sci 2022 May 17. Epub 2022 May 17.

Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Zhejiang, 310014, Hangzhou, China.

Background/objective: Cardiac diseases are frequently accompanied by elevated levels of biomarkers, among which, troponin is commonly investigated. The levels of plasma cardiac troponin I (cTnI), which has been shown to predict short-term mortality, are elevated in patients with acute cerebral infarction (ACI). However, few studies have assessed the association between cTnI concentration and long-term mortality in patients with ACI following thrombolysis. Read More

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Socioeconomic Inequalities in Reperfusion Therapy for Acute Ischemic Stroke.

Stroke 2022 May 17:101161STROKEAHA121037687. Epub 2022 May 17.

Department of Neurology, Aarhus University Hospital, Denmark (S.M.Ø.B., M.L.S., G.A., C.Z.S.).

Background: Reperfusion therapies (thrombolysis and thrombectomy) are of paramount importance for the recovery after ischemic stroke. We aimed to investigate if socioeconomic status (SES) was associated with the chance of receiving reperfusion therapy for ischemic stroke in a country with tax-funded health care.

Methods: This nationwide register-based cohort study included patients with ischemic stroke registered in the Danish Stroke Registry between 2015 and 2018. Read More

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Emergency Cervical Carotid Artery Stenting After Intravenous Thrombolysis in Patients With Hyperacute Ischemic Stroke.

J Korean Med Sci 2022 May 16;37(19):e156. Epub 2022 May 16.

Department of Neurology, Keimyung University School of Medicine, Daegu, Korea.

Background: Intravenous recombinant tissue plasminogen activator (IV rtPA) is the mainstay of treatment for acute ischemic stroke to recanalize thrombosed intracranial vessels within 4.5 hours. Emergency carotid artery stenting for the treatment of acute stroke due to steno-occlusion of the proximal internal carotid artery (ICA) can improve symptoms, prevent neurological deterioration, and reduce recurrent stroke risk. Read More

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Utilization of Telestroke Prior to and Following the COVID-19 Pandemic.

Semin Neurol 2022 Feb 16;42(1):3-11. Epub 2022 May 16.

Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.

For over two decades, telestroke has been utilized as a means for improving acute access to a stroke specialist when this expertise is otherwise unavailable. During this time, telestroke use has increased and improvements in care metrics have been widely reported. Several telestroke model variations are utilized; each has different workflow implications. Read More

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February 2022

Thrombolytic tPA-Induced Hemorrhagic Transformation of Ischemic Stroke is Mediated by PKCβ phosphorylation of Occludin.

Blood 2022 May 16. Epub 2022 May 16.

University of Michigan, United States.

The current standard of care for moderate to severe ischemic stroke is thrombolytic therapy with tissue plasminogen activator (tPA). Treatment with tPA can significantly improve neurological outcomes; however, thrombolytic therapy is associated with an increased risk of intracerebral hemorrhage (ICH). The risk of hemorrhage significantly limits the use of thrombolytic therapy and identifying pathways induced by tPA that increase this risk could provide new therapeutic options to extend thrombolytic therapy to a wider patient population. Read More

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Ultrashort Door-to-Needle Time for Intravenous Thrombolysis Is Safer and Improves Outcome in the Czech Republic: Nationwide Study 2004 to 2019.

J Am Heart Assoc 2022 May 16;11(10):e023524. Epub 2022 May 16.

Department of Neurology and AGEL Research and Training Institute Ostrava Vítkovice Hospital Ostrava Czech Republic.

Background The benefit of intravenous thrombolysis is time dependent. It remains unclear, however, whether dramatic shortening of door-to-needle time (DNT) among different types of hospitals nationwide does not compromise safety and still improves outcome. Methods and Results Multifaceted intervention to shorten DNT was introduced at a national level, and prospectively collected data from a registry between 2004 and 2019 were analyzed. Read More

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Impact of Medical Community Model on Intravenous Alteplase Door-to-Needle Times and Prognosis of Patients With Acute Ischemic Stroke.

Front Surg 2022 27;9:888015. Epub 2022 Apr 27.

Department of Neurology, Dongyang People's Hospital, Affiliated to Wenzhou Medical University, Dongyang, China.

Objective: In this study, we retrospectively analyzed 795 AIS patients who received intravenous alteplase for thrombolytic therapy in one third-class hospital or three second-class hospitals in Dongyang City and sought to evaluate the effects of the medical community model on intravenous alteplase door-to-needle time (DNT) and prognosis of patients with acute ischemic stroke.

Methods: According to whether the medical community model is established or not, 303 AIS patients (204 cases from the third-class hospital and 99 cases from three second-class hospitals) were assigned to control group unavailable to the medical community model and 492 AIS patients (297 cases from the third-class hospital, and 195 cases from three second-class hospitals) into observational group available to the medical community model.

Results: A higher thrombolysis rate, a shorter DNT, more patients with DNT ≤ 60 min and DNT ≤ 45 min, a shorter ONT, lower National Institutes of Health Stroke Scale (NIHSS) scores at 24 h, 7 d, 14 d, and modified Rankin scale (mRS) scores at 3 months after thrombolytic therapy, a shorter length of hospital stay, and less hospitalization expense were found in the observational group than the control group. Read More

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Safety and Efficacy of Tirofiban During Intravenous Thrombolysis Bridging to Mechanical Thrombectomy for Acute Ischemic Stroke Patients: A Meta-Analysis.

Front Neurol 2022 29;13:851910. Epub 2022 Apr 29.

Cerebrovascular Disease Center of Gansu Provincial People's Hospital, Lanzhou, China.

Introduction: The safety and efficacy of tirofiban in intravenous thrombolysis (IVT) bridging to mechanical thrombectomy in patients with acute ischemic stroke (AIS) is unknown. The purpose of this meta-analysis was to evaluate the safety and efficacy of tirofiban in IVT bridging to mechanical thrombectomy in acute ischemic stroke.

Methods: We systematically searched PubMed, EMBASE, Web of Science, and The Cochrane Library, CNKI, and Wan Fang databases for randomized controlled trials and observational studies (case-control studies and cohort studies) comparing the tirofiban and non-tirofiban groups in AIS intravenous thrombolysis bridging to mechanical thrombectomy (Published by November 20, 2021). Read More

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Pulmonary embolism bleeding score index (PEBSI): A new tool for the detection of patients with low risk for major bleeding on thrombolytic therapy.

Thromb Res 2022 May 8;214:138-143. Epub 2022 May 8.

Department of Cardiology, Clinical Hospital Centre Zemun, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia.

Background: Estimation of bleeding risk is an unmet need for individualized therapy in acute pulmonary embolism (PE) patients with increased mortality risk.

Methods: We analyzed the association between various patients' characteristics and occurrence of major bleeding (MB) according to the modified International Society of Thrombosis and Hemostasis (ISTH) criteria ("overt" bleeding is the only modification from the original criteria) at 7 days from admission to the hospital and thrombolytic therapy with a tissue-plasminogen activator (tPA). Pulmonary embolism bleeding score index (PEBSI) was created using multivariate regression analyses, and finely, dichotomous index was used for the discrimination of patients with low risk for MB from those with high risk. Read More

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Magnet-Guided Bionic System with LIFU Responsiveness and Natural Thrombus Tropism for Enhanced Thrombus-Targeting Ability.

Int J Nanomedicine 2022 4;17:2019-2039. Epub 2022 May 4.

Department of Radiology, Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, People's Republic of China.

Background: Arterial thrombosis is a serious threat to human health. Recently, many thrombus-targeted nanoparticles (NPs) have been constructed for detecting thrombi or monitoring thrombolysis, but their thrombus-targeting performance is limited. Considering this drawback, we designed a specific bionic system with enhanced thrombus-targeting ability. Read More

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Dramatical Response to "Low Dose Ultra-Slow Infusion" of Alteplase for Massive Mitral Mechanical Valve Thrombosis.

Anatol J Cardiol 2022 May;26(5):E6-E7

Department of Cardiology, School of Medicine, Ondokuz Mayıs University, Samsun, Turkey.

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An Optimal Animal Model of Ischemic Stroke Established by Digital Subtraction Angiography-Guided Autologous Thrombi in Cynomolgus Monkeys.

Front Neurol 2022 25;13:864954. Epub 2022 Apr 25.

Department of Radiology, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Suzhou, China.

Objective: Ischemic stroke seriously threatens human health, characterized by the high rates of incidence, disability, and death. Developing a reliable animal model that mimics most of the features of stroke is critical for pathological studies and clinical research. In this study, we aimed to establish and examine a model of middle cerebral artery occlusion (MCAO) guided by digital subtraction angiography (DSA) in cynomolgus monkeys. Read More

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Fragility Index Meta-Analysis of Randomized Controlled Trials Shows Highly Robust Evidential Strength for Benefit of <3 Hour Intravenous Alteplase.

Stroke 2022 May 11:101161STROKEAHA121038153. Epub 2022 May 11.

Department of Neurology, David Geffen School of Medicine, University of California Los Angeles (K.T.M., D.S.L., J.L.S.).

Background: Cumulative fragility index (FI) analysis enables quantification of the evidential strength of intravenous alteplase's core indication-treatment of disabling acute ischemic stroke within 3 hours of onset.

Methods: Meta-analyses were performed (study level) or identified (individual participant level) for freedom-from-disability (modified Rankin Scale [mRS] score 0-1, primary efficacy), functional independence (mRS score 0-2, secondary efficacy), and mortality outcomes. Individual trial and cumulative FI analyses were serially conducted after each successive randomized controlled trial (RCT). Read More

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A Novel Thrombolytic Regimen for Mechanical Prosthetic Valve Thrombosis in a Patient With Antiphospholipid Syndrome.

Cureus 2022 Apr 9;14(4):e23979. Epub 2022 Apr 9.

Cardiology, Hennepin Healthcare, Minneapolis, USA.

Management of mechanical prosthetic valve thrombosis (PVT) includes medical and surgical options. Standard medical treatment involves thrombolytic therapy with repeated slow infusions of low-dose IV tissue plasminogen activator (t-PA). The evidence for managing mechanical PVT that does not respond to the standard t-PA dosing is limited in the setting of an exacerbating hypercoagulable condition. Read More

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Ex Vivo Machine Thrombolysis Reduces Rethrombosis Rates in Salvaged Thrombosed Myocutaneous Flaps in Swine.

Plast Reconstr Surg 2022 May 10. Epub 2022 May 10.

From the Departments of Plastic and Reconstructive Surgery, Pathology, Laboratory Medicine, and Cardiothoracic Surgery, Radboud University Medical Centre.

Background: There is a risk for thrombotic complications (2 to 5 percent) associated with microsurgical reconstruction. Current thrombolytic therapy has a salvage rate between 60 and 70 percent, but it is afflicted by bleeding complications (2 to 6 percent). The use of machine perfusion for delivering thrombolytic agents is a new method that could potentially reduce these complications. Read More

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Comparison of Craniotomy and Stereotactic Aspiration Plus Thrombolysis in Isolated Capsulo-Ganglionic Hematoma: A Retrospective Analyses.

Neurol India 2022 Mar-Apr;70(2):535-542

Department of Critical Care, Ramkrishna Care Hospital, Raipur, Chhattisgarh, India.

Background: Published trials and meta-analyses have suggested the role of surgery in select patients of hypertensive intracerebral hematoma.

Objective: This study compares two methods of hematoma aspiration, craniotomy, and stereotactic aspiration.

Methods And Material: We conducted retrospective analyses of patients who underwent surgery for capsule-ganglionic hematoma during Jan-2015-Dec-2019. Read More

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Comparison of tenecteplase with alteplase for the early treatment of ischaemic stroke in the Melbourne Mobile Stroke Unit (TASTE-A): a phase 2, randomised, open-label trial.

Lancet Neurol 2022 Jun 4;21(6):520-527. Epub 2022 May 4.

Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia.

Background: Mobile stroke units (MSUs) equipped with a CT scanner reduce time to thrombolytic treatment and improve patient outcomes. We tested the hypothesis that tenecteplase administered in an MSU would result in superior reperfusion at hospital arrival, when compared with alteplase.

Methods: The TASTE-A trial is a phase 2, randomised, open-label trial at the Melbourne MSU and five tertiary hospitals in Melbourne, VIC, Australia. Read More

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Tenecteplase versus alteplase for the management of acute ischaemic stroke in Norway (NOR-TEST 2, part A): a phase 3, randomised, open-label, blinded endpoint, non-inferiority trial.

Lancet Neurol 2022 Jun 4;21(6):511-519. Epub 2022 May 4.

Department of Neurology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.

Background: Tenecteplase is a modified tissue plasminogen activator with pharmacological and practical advantages over alteplase-which is currently the only approved thrombolytic drug for ischaemic stroke. The NOR-TEST trial showed that 0·4 mg/kg tenecteplase had an efficacy and safety profile similar to that of a standard dose (0·9 mg/kg) of alteplase, albeit in a patient population with a high prevalence of minor stroke. The aim of NOR-TEST 2 was to establish the non-inferiority of tenecteplase 0·4 mg/kg to alteplase 0·9 mg/kg for patients with moderate or severe ischaemic stroke. Read More

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Tenecteplase for acute stroke: the thrombolysis puzzle.

Lancet Neurol 2022 Jun 4;21(6):496-497. Epub 2022 May 4.

Department of Medicine (Neurology), University of Toronto, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.

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MRI-guided thrombolysis for lenticulostriate artery stroke within 12 h of symptom onset.

Sci Rep 2022 May 6;12(1):7445. Epub 2022 May 6.

Department of Neurology, Huashan Hospital, Fudan University, No. 12 Wulumuqi Zhong Rd, Shanghai, 200040, People's Republic of China.

Stroke thrombolysis treatment is generally administered within 4.5 h, but a greater time window may be permitted depending upon the ischemic penumbra on neuroimaging. This observational cohort study investigated the outcomes of thrombolysis given within 12 h after symptom onset of lenticulostriate artery stroke. Read More

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Right heart thrombi (RHT) and clot in transit with concomitant PE management: Approach and considerations.

Pulm Circ 2022 Apr 25;12(2):e12080. Epub 2022 Apr 25.

Department of Radiology and Biomedical Imaging, Section of Vascular and Interventional Radiology Yale University School of Medicine New Haven Connecticut USA.

Right heart thrombi (RHT) continues to pose a clinical dilemma for multiple specialties and is especially concerning when present with concomitant pulmonary embolism (PE). Patients with PE and RHT are at an increased risk of poor outcomes compared to PE without RHT. Although the exact incidence of RHT is unknown, the increasing use of point-of-care ultrasound may lead to an increased detection and frequency of RHT. Read More

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Cervical carotid occlusion in acute ischemic stroke: Should we give tPA?

Surg Neurol Int 2022 29;13:177. Epub 2022 Apr 29.

Department of Neuroscience, Ascension St Mary's Hospital, Saginaw, Michigan, United States.

Background: Acute ischemic stroke (AIS) due to cervical internal carotid artery (cICA) occlusion is challenging to treat, with the lower revascularization rates, higher risk for complications, and poor response to thrombolytic therapy compared to isolated intracranial occlusions. While emergent revascularization through mechanical thrombectomy (MT) improves outcomes, the impact of tissue plasminogen activator (tPA) on outcomes in this subgroup of patients remains unclear. The objective of this study is to report our preliminary experience in treating AIS with cICA occlusions secondary to severe atherosclerotic stenosis and to establish the need for further clinical studies to determine the optimal intervention strategy for these lesions. Read More

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The End of Tissue-Type Plasminogen Activator's Reign?

Authors:
Imad Derraz

Stroke 2022 May 4:101161STROKEAHA122039287. Epub 2022 May 4.

Department of Neuroradiology, Hôpital Guide Chauliac, Montpellier University Medical Center, France.

Mechanical thrombectomy is a highly effective treatment for acute ischemic stroke caused by large-vessel occlusion in the anterior cerebral circulation, significantly increasing the likelihood of recovery to functional independence. Until recently, whether intravenous thrombolysis before mechanical thrombectomy provided additional benefits to patients with acute ischemic stroke-large-vessel occlusion remained unclear. Given that reperfusion is a key factor for clinical outcome in patients with acute ischemic stroke-large-vessel occlusion and the efficacy of both intravenous thrombolysis and mechanical thrombectomy is time-dependent, achieving complete reperfusion with a single pass should be the primary angiographic goal. Read More

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Efficacy and Safety of Recombinant Human Prourokinase in Acute Ischemic Stroke: A Phase IIa Randomized Clinical Trial.

Transl Stroke Res 2022 May 3. Epub 2022 May 3.

Department of Neurology, Xuanwu Hospital, Capital Medicine University, 45 Chang Chun St, Beijing, 100053, China.

Recombinant human prourokinase (rhPro-UK) is a novel thrombolytic that has been approved to treat patients with acute myocardial infarction. However, the safety and efficacy of intravenous rhPro-UK in patients with acute ischemic stroke (AIS) has not been well established. We aimed to investigate the safety and preliminary efficacy of rhPro-UK in patients with AIS in a multi-center phase IIa trial setting. Read More

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[Intermediate-high risk pulmonary embolism: identification and treatment].

Ned Tijdschr Geneeskd 2022 03 17;166. Epub 2022 Mar 17.

Medisch Spectrum Twente, Intensive Care, Enschede.

Patients with intermediate-high risk pulmonary embolism have a different mix of clinical symptoms. Optimal treatment of patients with intermediate high-risk pulmonary embolism is necessary to prevent short-term mortality. According to the current guidelines, the use of standard coagulation is the treatment of choice in hemodynamic stable patients with intermediate-high risk pulmonary embolism. Read More

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