Medicolegal considerations with intravenous tissue plasminogen activator in stroke: a systematic review.

Conclusion. Physicians and hospitals are at an increased risk of litigation in patients with AIS when in IV-tPA is being considered for treatment. While majority of the cases litigated were cases where tPA was not administered, only about 1 in 20 cases was litigated when complications occurred. PMID: 24083048 [PubMed]
Source: Stroke Research and Treatment - Category: Neurology Tags: Stroke Res Treat Source Type: research

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AbstractPurpose of reviewIt has become evident that strict time-based criteria are not optimal in selecting patients for acute stroke intervention, leaving the majority of patients untreated due to missing universal time-based criteria. We discuss the pathophysiologic basis for a shift of focus from time to the imaging evidence of salvageable tissue, as well as clinical and imaging tools.Recent findingsThere is strong evidence for the benefit of thrombectomy in patients with a sustained salvageable tissue presenting within 24  h. Although evidence of benefit is limited in patients presenting longer than 24 h, tho...
Source: Current Treatment Options in Neurology - Category: Neurology Source Type: research
The role of intravenous thrombolytic therapy in the management of acute ischemic stroke is well established, and faster administration of intravenous tissue plasminogen activator (tPA) has been associated with better short-term outcomes in clinical practice.
Source: JAMA - Category: General Medicine Source Type: research
This study assesses the current practices of physicians in Lebanon routinely involved in ischemic stroke (IS) management. We conducted a prospective observational study of patients hospitalized at 8 different Lebanese hospitals in the period August 1, 2015 to July 31, 2016, with a diagnosis of acute stroke. Baseline characteristics and data on diagnostic studies, as well as treatments received during hospitalization and at discharge, were collected and analyzed. Two hundred and three strokes/transient ischemic attacks (TIAs) were recorded but only 173 patients (85%) with ischemic events were included in the study. The pati...
Source: Functional Neurology - Category: Neurology Tags: Funct Neurol Source Type: research
Future Neurology, Ahead of Print.
Source: Future Neurology - Category: Neurology Authors: Source Type: research
Specific clinical risk factors may contribute to improving or worsening neurological functions in acute ischemic stroke (AIS) patients pre-treated with a combined cholesterol reducer and recombinant tissue pla...
Source: Lipids in Health and Disease - Category: Lipidology Authors: Tags: Research Source Type: research
This study aimed to assess the relationship between baseline SBP and outcome. Materials and Methods: Studies that evaluated the association between the baseline SBP and the outcome of patients undergoing thrombolytic therapy were sought. Data were extracted according to a predefined data extraction form and then analyzed by STATA 12.0 software. The primary endpoint was the occurrence of good outcomes measured by a modified Rankin Scale score at 3 months, while the secondary endpoint was the occurrence of intracranial hemorrhage and death. Results: Eleven studies involving a total of 33,263 patients were included. Poo...
Source: The Neurologist - Category: Neurology Tags: Original Articles Source Type: research
ConclusionFurther integrated processes are required to maximise patient benefit from thrombolysis. Expansion of community education to incorporate less common symptoms and provision of alert pagers for patients may provide further reduction in thrombolysis times.
Source: Journal of Neurology - Category: Neurology Source Type: research
Abstract Thrombolytic therapy with recombinant tissue plasminogen activator (rtPA) in ischaemic stroke has been associated with neurotoxicity, blood brain barrier (BBB) disruption and intra-cerebral hemorrhage. To examine rtPA cellular toxicity we investigated the effects of rtPA on cell viability in neuronal, astrocyte and brain endothelial cell (bEnd.3) cultures with and without prior exposure to oxygen-glucose deprivation (OGD). In addition, the neuroprotective peptide poly-arginine-18 (R18D; 18-mer of D-arginine) was examined for its ability to reduce rtPA toxicity. Studies demonstrated that a 4- or 24-h expos...
Source: Neurochemical Research - Category: Neuroscience Authors: Tags: Neurochem Res Source Type: research
Conclusion: Previously undescribed, we suggest that tPA should be considered for post-TAVR AIS patients who otherwise satisfy inclusion and exclusion criteria.
Source: The Neurologist - Category: Neurology Tags: Case Report/Case Series Source Type: research
Background: Intravenous thrombolysis is the only approved pharmacological treatment for acute ischemic stroke (AIS) patients, but the immediate response to thrombolysis varies by patient. Objective: To investigate the factors associated with early neurological improvement (ENI) after the administration of intravenous recombinant tissue plasminogen activator (rt-PA) treatment to AIS patients within 4.5 hours of onset. Methods: Demographics, onset to treatment time, risk factors, and clinical and laboratory data of 209 AIS patients undergoing intravenous rt-PA therapy at a Chinese hospital between January 2013 and Au...
Source: The Neurologist - Category: Neurology Tags: Original Article Source Type: research
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