20,923 results match your criteria treatment alteplase


Puerperium Stroke and Subsequent Tissue-Type Plasminogen Activator-Induced Hemorrhage: A Case Report.

A A Pract 2021 May 6;15(5):e01459. Epub 2021 May 6.

From the Anesthesiology Institute.

We report a case of ischemic stroke in an apparently healthy 35-year-old gravida 2 para 1 who was treated with tissue-type plasminogen activator (tPA) 9 hours after vaginal delivery that resulted in severe hemorrhage. Limited data suggest use of thrombolytics in pregnancy is safe, but there is a paucity of evidence assessing their use immediately postpartum. We describe successful combination of tPA with endovascular mechanical thrombectomy (EMT) for treatment of postpartum stroke, which was followed by extensive uterine bleeding. Read More

View Article and Full-Text PDF

Remote Ischemic Conditioning and Stroke Recovery.

Neurorehabil Neural Repair 2021 May 6:15459683211011224. Epub 2021 May 6.

University of Ottawa, ON, Canada.

Remote ischemic conditioning (RIC) is a noninvasive procedure whereby several periods of ischemia are induced in a limb. Although there is growing interest in using RIC to improve stroke recovery, preclinical RIC research has focused exclusively on neuroprotection, using male animals and the intraluminal suture stroke model, and delivered RIC at times not relevant to either brain repair or behavioral recovery. In alignment with the Stroke Recovery and Rehabilitation Roundtable, we address these shortcomings. Read More

View Article and Full-Text PDF

Factors influencing thrombectomy decision making for primary medium vessel occlusion stroke.

J Neurointerv Surg 2021 May 4. Epub 2021 May 4.

Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada

Background: We aimed to explore the preference of stroke physicians to treat patients with primary medium vessel occlusion (MeVO) stroke with immediate endovascular treatment (EVT) in an international cross-sectional survey, as there is no clear guideline recommendation for EVT in these patients.

Methods: In the survey MeVO-Finding Rationales and Objectifying New Targets for IntervEntional Revascularization in Stroke (MeVO-FRONTIERS), participants were shown four cases of primary MeVOs (six scenarios per case) and asked whether they would treat those patients with EVT. Multivariable logistic regression with clustering by respondent was performed to assess factors influencing the decision to treat. Read More

View Article and Full-Text PDF

Changes of fibrinolytic system in thrombolytic resuscitation of pulmonary thromboembolism-induced cardiac arrest model.

Int Wound J 2021 May 4. Epub 2021 May 4.

Department of Emergency, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.

The objective of this study is to explore the changes in the coagulation and fibrinolysis system in an animal model with pulmonary embolism after cardiopulmonary bypass and to provide a theoretical basis for clinical practice. An animal model of cardiac arrest due to pulmonary embolism was established for venous thrombus (10-15 mL) in the left external jugular vein of 21 pigs. Computed tomography (CT) pulmonary arteriography was performed after the recovery of the underlying state, cardiac arrest state and spontaneous circulation, and then thrombolysis and cardiopulmonary resuscitation (recombinant tissue plasminogen activator [t-PA] 50 mg) were performed immediately. Read More

View Article and Full-Text PDF

2,5TT genotype of the MMP-9-1562C/T polymorphism may be a risk factor for thrombolytic therapy-induced hemorrhagic complications after acute ischemic stroke.

Pharmacotherapy 2021 May 4. Epub 2021 May 4.

St. Sava Hospital, Belgrade, Serbia.

Introduction: Levels of matrix metalloproteinases (MMPs) and their tissue inhibitors (TIMPs) influence recombinant tissue plasminogen activator (rtPA) therapy response in patients with acute ischemic stroke (AIS). Serum levels of MMPs and TIMPs along with the expression of genes coding these proteins are related to the recovery and appearance of adverse effects (AE) after AIS. Consequently, it is important to explore whether polymorphisms in regulatory sequences of MMPs and TIMPs are associated with rtPA response in AIS patients. Read More

View Article and Full-Text PDF

Thrombolysis of Pulmonary Emboli via Endobronchial Ultrasound-Guided Transbronchial Needle Injection.

Ann Thorac Surg 2020 Oct 24. Epub 2020 Oct 24.

Division of Thoracic Surgery, Toronto General Hospital, University Health Network, Ontario, Canada. Electronic address:

Background: Endobronchial ultrasound-guided transbronchial needle injection (EBUS-TBNI) is a novel technique for treating peribronchial targets. The aim of this study was to evaluate preliminary feasibility of thrombolysis of pulmonary emboli via EBUS-TBNI.

Methods: Yorkshire pigs (30-48 kg) were anesthetized and mechanically ventilated. Read More

View Article and Full-Text PDF
October 2020

Safety and efficacy of intravenous thrombolytic treatment in wake-up stroke: Experiences from a single center.

Authors:
Adam Wiśniewski

Brain Behav 2021 May 3:e02152. Epub 2021 May 3.

Department of Neurology, Faculty of Medicine, Collegium Medium in Bydgoszcz, Nicolaus Copernicus University in Toruń, Bydgoszcz, Poland.

Objectives: Wake-up stroke is an important clinical problem that may account for a quarter of all ischemic strokes. This study aimed to establish the safety and efficacy of intravenous thrombolytic treatment of wake-up strokes by comparing it to the standard thrombolysis treatment in strokes with clear onsets and wake-up strokes that did not receive reperfusion therapy.

Methods: This retrospective study enrolled 95 patients with ischemic strokes who underwent thrombolytic treatment with alteplase, including nine patients with wake-up strokes. Read More

View Article and Full-Text PDF

Compartment syndrome following use of tissue plasminogen activator for frostbite in the setting of concomitant diaphyseal tibia fracture.

OTA Int 2020 Jun 22;3(2):e079. Epub 2020 May 22.

Department of Orthpaedic Surgery, MetroHealth Medical Center, Cleveland, OH.

Background: Tissue plasminogen activator (tPA) is a thrombolytic agent increasingly being employed for the treatment of acute frostbite. Although tPA has been shown with success to increase digit salvage rates, data on potential complications, including risk of hemorrhage, is limited. As a result, acute trauma is considered a contraindication to use in many institution-based protocols. Read More

View Article and Full-Text PDF

A Serpin With a Finger in Many PAIs: PAI-1's Central Function in Thromboinflammation and Cardiovascular Disease.

Front Cardiovasc Med 2021 16;8:653655. Epub 2021 Apr 16.

Aberdeen Cardiovascular and Diabetes Centre, Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, United Kingdom.

Plasminogen activator inhibitor 1 (PAI-1) is a member of the serine protease inhibitor (serpin) superfamily. PAI-1 is the principal inhibitor of the plasminogen activators, tissue plasminogen activator (tPA), and urokinase-type plasminogen activator (uPA). Turbulence in the levels of PAI-1 tilts the balance of the hemostatic system resulting in bleeding or thrombotic complications. Read More

View Article and Full-Text PDF

Angioedema after rt-PA infusion led to airway emergency: a case report of rescue treatment with fresh frozen plasma.

Braz J Anesthesiol 2021 Apr 28. Epub 2021 Apr 28.

Ospedale Maggiore, Intensive Care and Prehospital Emergency Service, Department of Anesthesia, Bologna, Italy.

The authors report the case of a 71-year-old woman presented to the Emergency Department with AIS. She was treated with rt-PA and interventional endovascular revascularization and developed rapidly progressing angioedema that led to emergency intubation. The standard treatment was not very effective and the swelling improved after infusion of fresh frozen plasma. Read More

View Article and Full-Text PDF

Adjunctive Intraarterial Thrombolysis in Endovascular Thrombectomy: A Systematic Review and Meta-analysis.

Neurology 2021 Apr 30. Epub 2021 Apr 30.

Department of Medicine, University of Auckland, Auckland, New Zealand;

Objective: To evaluate the safety and efficacy of intra-arterial thrombolysis (IAT) as an adjunct to endovascular thrombectomy (EVT) in ischemic stroke, we performed a systematic review and meta-analysis of the literature.

Methods: Searches were performed using Medline, Embase, and Cochrane databases for studies that compared EVT to EVT with adjunctive IAT (EVT+IAT). Safety outcomes included symptomatic intracerebral hemorrhage (sICH) and mortality at three months. Read More

View Article and Full-Text PDF

Mechanical Thrombectomy in Stroke. Experience from Switching from Stent Retriever Only to Stent Retriever Combined with Aspiration Catheter.

J Clin Med 2021 Apr 21;10(9). Epub 2021 Apr 21.

Department of Neurosurgery and Neurology, Faculty of Health Sciences, Nicolaus Copernicus University in Toruń, Ludwik Rydygier Collegium Medicum, Ujejskiego 75 Street, 85-168 Bydgoszcz, Poland.

Endovascular treatment is a rapidly evolving technique; therefore, there is a constant need to evaluate this method and its modifications. This paper discusses a single-center experience and the results of switching from the stent retriever only (SO) mechanical thrombectomy (MT) to the combined approach (CA), with a stent retriever and aspiration catheters.

Methods: The study involved a retrospective analysis of 70 patients undergoing MT with the use of either SO or CA. Read More

View Article and Full-Text PDF

Overview of the Therapeutic Potential of Aptamers Targeting Coagulation Factors.

Int J Mol Sci 2021 Apr 9;22(8). Epub 2021 Apr 9.

Department of Biology, Case Western Reserve University, Cleveland, OH 44106, USA.

Aptamers are single-stranded DNA or RNA sequences that bind target molecules with high specificity and affinity. Aptamers exhibit several notable advantages over protein-based therapeutics. Aptamers are non-immunogenic, easier to synthesize and modify, and can bind targets with greater affinity. Read More

View Article and Full-Text PDF

Astragalin Inhibits Cigarette Smoke-Induced Pulmonary Thrombosis and Alveolar Inflammation and Disrupts PAR Activation and Oxidative Stress-Responsive MAPK-Signaling.

Int J Mol Sci 2021 Apr 1;22(7). Epub 2021 Apr 1.

Department of Food and Nutrition and Korean Institute of Nutrition, Hallym University, Chuncheon 24252, Korea.

Epidemiological evidence shows that smoking causes a thrombophilic milieu that may play a role in the pathophysiology of chronic obstructive pulmonary disease (COPD) as well as pulmonary thromboembolism. The increased nicotine level induces a prothrombotic status and abnormal blood coagulation in smokers. Since several anticoagulants increase bleeding risk, alternative therapies need to be identified to protect against thrombosis without affecting hemostasis. Read More

View Article and Full-Text PDF

Prospects of Therapeutic Target and Directions for Ischemic Stroke.

Pharmaceuticals (Basel) 2021 Apr 1;14(4). Epub 2021 Apr 1.

Research Institute, e-biogen Inc., Seoul 07282, Korea.

Stroke is a serious, adverse neurological event and the third leading cause of death and disability worldwide. Most strokes are caused by a block in cerebral blood flow, resulting in neurological deficits through the death of brain tissue. Recombinant tissue plasminogen activator (rt-PA) is currently the only immediate treatment medication for stroke. Read More

View Article and Full-Text PDF

ASPECTS-Region-Dependent Functional Outcomes after Endovascular Therapy in Patients with Cardioembolic Stroke.

J Stroke Cerebrovasc Dis 2021 Apr 26;30(7):105814. Epub 2021 Apr 26.

Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan. Electronic address:

Objectives: Cardioembolic stroke has a poor prognosis. We evaluated the region-dependent efficacy of endovascular therapy (EVT) based on diffusion-weighted imaging-Alberta Stroke Program Early CT Score (DWI-ASPECTS).

Methods: This post-hoc analysis of the RELAXED study, which investigated the optimal timing of rivaroxaban to prevent nonvalvular atrial fibrillation (NVAF) recurrence in patients with acute ischemic stroke (AIS), included NVAF patients admitted with AIS or transient ischemic attack in the middle cerebral artery (MCA), with internal carotid artery (ICA), M1, or M2-MCA occlusion. Read More

View Article and Full-Text PDF

Intravenous thrombolysis for acute ischemic stroke in centenarians.

Eur Geriatr Med 2021 Apr 28. Epub 2021 Apr 28.

Department of Neurology, Hospital Universitario Ramón y Cajal, Ctra de Colmenar Km 9, 100, 28034, Madrid, Spain.

Purpose: The benefit of intravenous alteplase is well established for patients with disabling stroke symptoms regardless of age, although data on outcomes in centenarian patients are scarce. We present our experience in patients beyond 100 years.

Methods: Descriptive study including centenarians from our single-centre prospective registry who underwent intravenous thrombolysis with alteplase for acute ischemic stroke in our tertiary university hospital. Read More

View Article and Full-Text PDF

[Intravenous thrombolytic therapy with Revelisa of ischemic stroke in real-world clinical practice: interim results of an open-label, prospective, multicenter, non-interventional study IVT-AIS-R].

Zh Nevrol Psikhiatr Im S S Korsakova 2021 ;121(3. Vyp. 2):33-37

Institute of Cerebrovascular Pathology and Stroke, Federal Center for Brain and Neurotechnology of the Federal Medical and Biological Agency, Moscow, Russia.

Objective: To assess the safety and efficacy of Revelisa in patients with ischemic stroke in real-world clinical practice.

Material And Methods: The interim analysis of an open-label, prospective, multicenter, non-interventional study IVT-AIS-R included 223 patients (50.2% women and 49. Read More

View Article and Full-Text PDF

Related factors with orolingual angioedema after intravenous alteplase in acute ischemic stroke: results from a single-center cohort and meta-analysis.

Neurol Sci 2021 Apr 27. Epub 2021 Apr 27.

Stroke Centre - Department of Vascular Neurology, Hospital General Universitario Gregorio Marañón, Calle del Doctor Esquerdo, 46, 2800, Madrid, Spain.

Introduction: Orolingual angioedema (OA) after intravenous thrombolysis (IVT) with alteplase in acute stroke can be a life-threatening complication. Our aim was to describe its incidence, clinical features, and related factors.

Patients And Methods: We analyzed a single-center cohort of stroke patients treated with IVT in an 8-year period. Read More

View Article and Full-Text PDF

[Screening of intravenous thrombolysis for eligible patients with ischemic stroke].

Authors:
H Q Qin Y J Wang

Zhonghua Nei Ke Za Zhi 2021 May;60(5):476-482

Department of Neurology, Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases, Beijing 100070, China.

View Article and Full-Text PDF

Effectiveness of intravenous r-tPA versus UK for acute ischaemic stroke: a nationwide prospective Chinese registry study.

Stroke Vasc Neurol 2021 Apr 26. Epub 2021 Apr 26.

Neurology, General Hospital of Northern Theatre Command, Shenyang, Liaoning, China

Background: Intravenous recombinant tissue plasminogen activator (r-tPA) and urokinase (UK) are both recommended for the treatment of acute ischaemic stroke (AIS) in China, but with few comparative outcome data being available. We aimed to compare the outcomes of these two thrombolytic agents for the treatment of patients within 4.5 hours of onset of AIS in routine clinical practice in China. Read More

View Article and Full-Text PDF

Preexisting Mild Cognitive Impairment, Dementia, and Receipt of Treatments for Acute Ischemic Stroke.

Stroke 2021 Apr 27:STROKEAHA120032258. Epub 2021 Apr 27.

Department of Neurology and Stroke Program, University of Michigan, Ann Arbor. (D.A.L., L.B.M., D.B.Z., L.D.L.).

Background And Purpose: Differences in acute ischemic stroke (AIS) treatment by cognitive status are unclear, but some studies have found patients with preexisting dementia get less treatment. We compared AIS care by preexisting cognitive status.

Methods: Cross-sectional analysis of prospectively obtained data on 836 adults ≥45 with AIS from the population-based Brain Attack Surveillance in Corpus Christi project from 2008 to 2013. Read More

View Article and Full-Text PDF

A real-world single-centre analysis of alemtuzumab and cladribine for multiple sclerosis.

Mult Scler Relat Disord 2021 Apr 11;52:102945. Epub 2021 Apr 11.

University of Ottawa and The Ottawa Hospital Research Institute, Department of Medicine, The Ottawa Hospital General Campus, Multiple Sclerosis Clinic, 501 Smyth Road, Box 601, Ottawa ON K1H 8L6, Canada. Electronic address:

Background: Highly active MS may warrant higher efficacy treatments for disease control. However, these often confer more risk and have not been compared in head-to-head clinical trials, making relative efficacy and safety difficult to interpret. Alemtuzumab and cladribine are two high-efficacy treatments given as discrete courses separated by one year, followed by a durable response that potentially does not require ongoing treatment. Read More

View Article and Full-Text PDF

Low-Dose vs. Standard-Dose Intravenous Alteplase in Bridging Therapy Among Patients With Acute Ischemic Stroke: Experience From a Stroke Center in Vietnam.

Front Neurol 2021 9;12:653820. Epub 2021 Apr 9.

Stroke Center, Bach Mai Hospital, Ha Noi, Vietnam.

To date, the role of bridging intravenous thrombolysis before mechanical thrombectomy (MTE) is controversial but still recommended in eligible patients. Different doses of intravenous alteplase have been used for treating patients with acute ischemic stroke from large-vessel occlusion (LVO-AIS) in Asia, largely due to variations in the risks for intracerebral hemorrhage (ICH) and treatment affordability. Uncertainty exists over the potential benefits of treating low-dose alteplase, as opposed to standard-dose alteplase, prior to MTE among patients with LVO-AIS. Read More

View Article and Full-Text PDF

5-Fluorouracil associated neurovascular toxicities.

Curr Probl Cancer 2021 Apr 18:100746. Epub 2021 Apr 18.

Department of Hematology and Oncology, Boston University School of Medicine, Boston, Massachusetts.

Fluorouracil (5-FU) is a commonly used chemotherapeutic agent in many cancers. The widely reported adverse effects are infusion reactions, rash, fever, nausea, vomiting, peripheral neuropathy, and hepatic injury. However, there are limited data about its neurological side effects. Read More

View Article and Full-Text PDF

Factors that Influence Door-to-Needle Administration for Acute Stroke Patients in the Emergency Department.

J Neurosci Nurs 2021 Jun;53(3):134-139

Abstract: BACKGROUND: There is growing importance on discovering factors that delay time to intervention for acute ischemic stroke (AIS) patients, as rapid intervention is essential for better patient outcomes. The management of these patients involves a multidisciplinary effort and quality improvement initiatives to safely increase treatment with intravenous (IV) thrombolytic. The objective of this pilot study is to evaluate factors of acute stroke care in the emergency department (ED) and their impact on IV alteplase administration. Read More

View Article and Full-Text PDF

A novel and potent thrombolytic fusion protein consisting of anti-insoluble fibrin antibody and mutated urokinase.

Thromb Haemost 2021 Apr 21. Epub 2021 Apr 21.

National Cancer Center Research Institute, Immune Medicine, Tokyo, Japan.

Tissue plasminogen activator (tPA) is used clinically because it has higher binding specificity for insoluble fibrin (IF) than urokinase (UK), but even pro-tPA has catalytic activity in places other than IF. UK has the advantage that it is specifically activated on IF, but it binds IF weakly. Previously, we established a monoclonal antibody (mAb) that recognizes a pit structure formed only in IF. Read More

View Article and Full-Text PDF

Neutrophil extracellular traps promote tPA-induced brain hemorrhage via cGAS in mice with stroke.

Blood 2021 Feb 24. Epub 2021 Feb 24.

Fudan University, Shanghai, China.

Intracerebral hemorrhage associated with thrombolytic therapy with tissue plasminogen activator (tPA) in acute ischemic stroke continues to present a major clinical problem. Here, we report that infusion of tPA resulted in a significant increase in markers of neutrophil extracellular traps (NETs) in the ischemic cortex and plasma of mice subjected to photothrombotic middle cerebral artery occlusion. Peptidylarginine deiminase 4 (PAD4), a critical enzyme for NET formation, is also significantly upregulated in the ischemic brains in tPA-treated mice. Read More

View Article and Full-Text PDF
February 2021

Electroacupuncture Ameliorates Depressive-Like Behaviors in Poststroke Rats via Activating the tPA/BDNF/TrkB Pathway.

Neuropsychiatr Dis Treat 2021 13;17:1057-1067. Epub 2021 Apr 13.

Beijing Bo'ai Hospital, China Rehabilitation Research Center, China Rehabilitation Science Institute, Beijing, People's Republic of China.

Background: Electroacupuncture (EA) is a form of physical therapy that has been widely used in clinical practice in China. Post-stroke depression (PSD) is the most common neuropsychiatric complication after stroke. EA has been shown to have beneficial effects on PSD patients. Read More

View Article and Full-Text PDF

Case of right ventricular and aortic thrombi in a patient with severe COVID-19.

BMJ Case Rep 2021 Apr 19;14(4). Epub 2021 Apr 19.

Department of Hematology, Massachusetts General Hospital, Boston, Massachusetts, USA.

Emerging evidence suggests that novel COVID-19 is associated with increased prothrombotic state and risk of thromboembolic complications, particularly in severe disease. COVID-19 is known to predispose to both venous and arterial thrombotic disease. We describe a case of a 61-year-old woman with history of type II diabetes, hypertension and hyperlipidaemia who presented with dry cough and acute abdominal pain. Read More

View Article and Full-Text PDF