Thrombolysis-Related Hemorrhage

Intravenous tissue plasminogen activator (tPA) improves outcomes when administered within 4.5 hours of symptom onset of ischemic stroke. Symptomatic intracranial hemorrhage (sICH) is the most feared complication after administration of intravenous tPA. The percentage of patients with a good functional outcome after sICH (as defined by the Safe Implementation of Thrombolysis in Stroke-Monitoring Study) following administration of tPA has been shown to be less than 7%, and mortality rates can be greater than 50%. Almost 2 decades after approval of intravenous tPA by the US Food and Drug Administration, our ability to prevent thrombolysis-related sICH has not advanced much beyond adhering to inclusion and exclusion criteria and controlling blood pressure after thrombolysis. Moreover, there is no clear consensus on how to manage thrombolysis-related sICH. Although the occurrence of sICH is uncommon, the known risk of this complication may weigh heavily on the decision to administer thrombolysis. The high morbidity and mortality associated with sICH represent an area where even a small improvement in prevention or treatment could have a dramatic effect.
Source: JAMA Neurology - Category: Neurology Source Type: research

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ConclusionsStroke or stroke-like syndrome of infectious origin can be observed in an important proportion of case presenting with sensory-motor deficit of unknown origin; their accurate diagnosis has a considerable impact in terms of treatment choices and outcome.
Source: Infection - Category: Infectious Diseases Source Type: research
ConclusionThis propensity score analysis demonstrated that the EVT patients with acute ICAD-related MCA M1 occlusion had similar angiographic and clinical outcomes compared to those with M1 embolism on a  similar baseline condition.
Source: Klinische Neuroradiologie - Category: Radiology Source Type: research
CONCLUSIONS: Given the trend toward expedited treatment of acute ischemic stroke with subsequent transfer to regional referral centers, vascular specialists will be confronted with an increasing number of patients who may require urgent CEA after antecedent IVT. Further study is warranted to clearly delineate the appropriate interval from IVT to CEA and, specifically, to establish the safety of CEA with 72 hours of tPA administration. PMID: 32225134 [PubMed - in process]
Source: The Journal of Cardiovascular Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: J Cardiovasc Surg (Torino) Source Type: research
This study aimed to investigate pump position, derived from chest X-rays of HM3 patients, in correlation to any neurological dysfunction (ND) and specifically to ischemic stroke (IS) and intracranial hemorrhage (ICH).
Source: The Journal of Heart and Lung Transplantation - Category: Transplant Surgery Authors: Tags: (216) Source Type: research
Abstract INTRODUCTION: Stroke is a leading cause of death and disability, with the administration of reverse transcriptase-plasminogen activator (rtPA) improving outcomes in a time-dependent manner. Only 52.3% of our eligible stroke patients received rtPA within 60 minutes of arrival. We aimed to better the percentage of acute stroke patients receiving rtPA within 60 minutes of arrival at the emergency department (ED). METHODS: Results from the first year of a clinical practice improvement project, where quality improvement interventions were implemented, are presented. Primary outcome measure was percentage ...
Source: Singapore Medical Journal - Category: General Medicine Authors: Tags: Singapore Med J Source Type: research
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Source: Journal of Stroke and Cerebrovascular Diseases - Category: Neurology Authors: Tags: Case Report Source Type: research
In conclusion, available evidence from aggregate data supported a modest advantage of ticagrelor-involving regimens for the primary stroke prevention in CAD compared with other antiplatelet regimens after the trade-off between reducing IS and inducing ICH, where more benefits might be expected from long-term and low-dose use of tica grelor among patients with chronic coronary syndrome. Further collaborative meta-analysis of individual participant data from well-designed and statistically-powered trials would be needed to generate high quality evidence on this issue.
Source: Journal of Thrombosis and Thrombolysis - Category: Hematology Source Type: research
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Source: Diabetes Therapy - Category: Endocrinology Source Type: research
Intracerebral hemorrhage (ICH) occurs in about 10%-20% of all stroke patients, and the overall incidence is approximately 25 of 100 000 per year1 and is expected to increase, given the increasing age of the population globally. Compared with ischemic stroke, ICH is correlated with a worse outcome, a mortality rate of around 40% and a dearth of effective treatments.1,2 It has been proven that serum lipid plays a vital role in the progression of cardiovascular disease and ischemic stroke.3 Nevertheless, the relationship between serum lipid concentrations and ICH remains unclear.
Source: Journal of Stroke and Cerebrovascular Diseases - Category: Neurology Authors: Source Type: research
There is a lack of information on the natural history of asymptomatic carotid artery stenosis (AsymCS) associated with cardiovascular diseases that require surgery. The aim of this study was to investigate risk factors for postoperative ipsilateral ischemic stroke and all-cause mortality after cardiovascular surgery in patients with AsymCS.
Source: Journal of the Neurological Sciences - Category: Neurology Authors: Source Type: research
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