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In-hospital outcomes of thrombolysis for acute ischemic stroke in patients with primary brain tumors
Publication date: March 2015 Source:Journal of Clinical Neuroscience, Volume 22, Issue 3 Author(s): Santosh B. Murthy , Yogesh Moradiya , Shreyansh Shah , Aditi Shastri , Eric M. Bershad , Jose I. Suarez Data on thrombolysis outcomes in patients with primary brain tumors are limited. Our aim was to study stroke outcomes following thrombolysis in these patients in a population-based study. Patients with acute ischemic stroke who received thrombolysis were identified from the 2002–2011 USA Nationwide Inpatient Sample. We compared demographics, comorbidities, and outcomes between primary brain tumor-associated strokes (BT...
Source: Journal of Clinical Neuroscience - February 16, 2015 Category: Neuroscience Source Type: research

Efficacy of telemedicine for thrombolytic therapy in acute ischemic stroke: a meta-analysis
The aim of this study was to assess the benefits of telemedicine in the delivery of thrombolytic therapy for patients with acute ischemic stroke. We performed a meta-analysis using combinations of the following terms: telestroke, telemedicine, tissue plasminogen activator/t-PA, and acute ischemic stroke. The primary outcome was favorable outcome based on the modified Rankin score. Secondary outcomes were incidence of symptomatic intracranial hemorrhage and overall mortality. We found no significant difference in favorable outcome between the telemedicine and control groups, and no significant difference was found between t...
Source: Journal of Telemedicine and Telecare - March 31, 2015 Category: Information Technology Authors: Zhai, Y.-k., Zhu, W.-j., Hou, H.-l., Sun, D.-x., Zhao, J. Tags: RESEARCH/Original articles Source Type: research

The safety and efficacy of tPA intravenous thrombolysis for treating acute ischemic stroke patients with a history of cerebral hemorrhage.
Abstract Alteplase (tPA) intravenous thrombolysis is an effective treatment for acute ischemic stroke (AIS) when administered within 4.5 h of initial stroke symptoms. Here, its safety and efficacy were evaluated among AIS patients with a previous history of cerebral hemorrhage. Patients who arrived at the hospital within 4.5 h of initial stroke symptoms and who were treated with tPA intravenous thrombolysis or conventional therapies were analyzed. The 90-day modified Rankin scale (90-d mRS) was used alongside mortality and incidence of symptomatic intracerebral hemorrhage (SICH) rates to evaluate the curative effe...
Source: Braz J Med Biol Res - January 24, 2019 Category: Research Authors: Zhao GJ, Wang ZR, Lin FZ, Cui YS, Xu SL Tags: Braz J Med Biol Res Source Type: research

Treatment With Intravenous Alteplase for Acute Ischemic Stroke After Reversal of Dabigatran With Idarucizumab: A Case Study
Treatment options for anticoagulated patients presenting with ischemic stroke are limited. Off-label use of idarucizumab to rapidly reverse the anticoagulant effect of dabigatran may ensure eligibility for thrombolytic therapy with alteplase. This case describes a 77-year-old white male who presented to the hospital 89 minutes after sudden onset of right-sided hemiparesis, dysarthria, and facial palsy. Significant history included atrial fibrillation and previous right-sided cortical stroke. Medication reconciliation revealed he was taking dabigatran 150 mg twice a day, with the last dose being 179 minutes before presentat...
Source: Journal of Neuroscience Nursing - January 8, 2019 Category: Neuroscience Tags: Case Study Source Type: research

Multimode Computed-Tomography-Guided Thrombolysis under a Prolonged Time Window in Acute Ischemic Stroke Patients with Atrial Fibrillation.
Authors: Yang Y, Sun W, Li D, Li XY, Wang XT, Li SC, Zhao HJ, Zhang JB Abstract Atrial fibrillation (AF) is an independent risk factor for intracranial hemorrhage in patients receiving recombinant-tissue-type plasminogen activator (rt-PA) thrombolytic therapy. Research showed that patients with acute ischemic stroke (AIS) could benefit from multimode computed-tomography- (CT-) guided intravenous thrombolysis over 4.5 hours. The medical data of patients with AIS in our center were retrospectively reviewed, and the data of the multimode CT-guided thrombolytic therapy or nonthrombolytic therapy within different time w...
Source: International Heart Journal - July 2, 2019 Category: Cardiology Tags: Int Heart J Source Type: research

Frequency, Risk Factors, and Clinical Significance of Incorrect Dose of Alteplase Due to Weight Estimation in Acute Ischemic Stroke Patients: A Single-Center Retrospective Study
Stroke is a clinical emergency requiring urgent recombinant tissue-type plasminogen activator treatment in eligible patients. The dosage of thrombolytic agent (alteplase) is weight dependent. However, many patients receive thrombolytic therapy based on weight estimation. Here, we assess the frequency of incorrect thrombolytic therapy dose as a result of weight estimation and evaluate the short-term safety and efficacy of alteplase misdose. Of 237 patients, weight was estimated in 147 (62%), of which 33 patients (22.4%) were treated with an erroneous dose of alteplase. An incorrect dose was associated with neither poor outc...
Source: Journal of Neuroscience Nursing - September 9, 2019 Category: Neuroscience Tags: Article Source Type: research

The establishment of a telestroke service using multimodal CT imaging decision assistance: “Turning on the fog lights”
Publication date: March 2017 Source:Journal of Clinical Neuroscience, Volume 37 Author(s): Jelle Demeestere, Claire Sewell, Jennifer Rudd, Timothy Ang, Louise Jordan, James Wills, Carlos Garcia-Esperon, Ferdinand Miteff, Venkatesh Krishnamurthy, Neil Spratt, Longting Lin, Andrew Bivard, Mark Parsons, Christopher Levi Telestroke services have been shown to increase stroke therapy access in rural areas. The implementation of advanced CT imaging for patient assessment may improve patient selection and detection of stroke mimics in conjunction with telestroke. We implemented a telestroke service supported by multimodal CT ima...
Source: Journal of Clinical Neuroscience - January 31, 2017 Category: Neuroscience Source Type: research

International benchmarking for acute thrombolytic therapy implementation in Australia and Japan
Publication date: July 2016 Source:Journal of Clinical Neuroscience, Volume 29 Author(s): Hiroyuki Kawano, Christopher Levi, Yuichiro Inatomi, Heather Pagram, Erin Kerr, Andrew Bivard, Neil Spratt, Ferdinand Miteff, Toshiro Yonehara, Yukio Ando, Mark Parsons Although a wide range of strategies have been established to improve intravenous tissue plasminogen activator (IV-tPA) treatment rates, international benchmarking has not been regularly used as a systems improvement tool. We compared acute stroke codes (ASC) between two hospitals in Australia and Japan to study the activation process and potentially improv...
Source: Journal of Clinical Neuroscience - May 29, 2016 Category: Neuroscience Source Type: research

The Case Files: Traumatic Carotid Dissection
By Hsiao, Jonie MD   A 30-year-old man who was right-hand dominant presented 10 days after sustaining left-sided face and head trauma from a fall from a skateboard at an unknown speed. He lost consciousness for several seconds, and initially developed a headache with nausea and vomiting. A non-contrast head CT performed at another hospital done two days after the incident was reportedly negative.   He now presents primarily with concerns about the appearance of his left eye. He has notable anisocoria and a droopy eyelid. His left pupil is notably smaller, 2 mm, compared with the right eye, 5 mm. Both are reactive. The re...
Source: The Case Files - June 4, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: research

Life-saving systemic thrombolysis in a patient with massive pulmonary embolism and a recent hemorrhagic cerebrovascular accident.
We present the case of a 60-year-old woman in whom massive pulmonary embolism led to cardiac arrest with pulseless electrical activity. Eight weeks earlier, she had sustained a hemorrhagic cerebrovascular accident-a classic absolute contraindication to thrombolytic therapy. Despite this practice guideline, we administered tissue plasminogen activator systemically in order to save the patient's life. This therapy did not evoke intracranial bleeding, and the patient was eventually discharged from the hospital. Until guidelines specific to venous thromboembolic disease are developed, we think that the current contraindication...
Source: Texas Heart Institute Journal - April 1, 2014 Category: Cardiology Authors: Bottinor W, Turlington J, Raza S, Roberts CS, Malhotra R, Jovin IS, Abbate A Tags: Tex Heart Inst J Source Type: research

Thrombosis: Novel nanomedical concepts of diagnosis and treatment.
Abstract Intravascular thrombosis, a critical pathophysiological feature of many cardiovascular disorders, leads to the formation of life-threatening obstructive blood clots within the vessels. Rapid recanalization of occluded vessels is essential for the patients' outcome, but the currently available systemic fibrinolytic therapy is associated with low efficacy and tremendous side effects. Additionally, many patients are ineligible for systemic thrombolytic therapy, either due to delayed admission to the hospital after symptom onset, or because of recent surgery, or bleeding. In order to improve the treatment eff...
Source: World Journal of Cardiology - August 26, 2015 Category: Cardiology Authors: Cicha I Tags: World J Cardiol Source Type: research

Evaluating safety of thrombolysis in chronic kidney disease patients presenting with pulmonary embolism using propensity score matching
AbstractTo assess the safety of thrombolytic therapy in chronic kidney disease (CKD) patients who present with pulmonary embolism (PE). We used the Nationwide Inpatient Sample Database to identify patients who underwent thrombolysis for PE between 2010 and 2014. The patients were divided into two groups: (1) No CKD and (2) CKD. Patients with and without CKD were matched using 1:1 propensity score matching and a caliper width of 0.01. The primary outcomes were in-hospital mortality and hemorrhagic events. The secondary outcomes were blood transfusions, length of stay and total hospitalization charge. Two separate, multivari...
Source: Journal of Thrombosis and Thrombolysis - September 1, 2017 Category: Hematology Source Type: research

Symptomatic Intracerebral Hemorrhage after Intravenous Thrombolysis: Predictive Factors and Validation of Prediction Models
Objective: Thrombolytic therapy with intravenous alteplase (IV-rtPA) has a known risk of symptomatic intracerebral hemorrhage (sICH). We aim to identify factors with a significant association with the development of sICH post-IV-rtPA. We also aim to perform an external validation of sICH predicting scores in our patient population. Material and Methods: We performed a retrospective chart review of patients who received IV-rtPA at our tertiary care hospital. We excluded patients who underwent mechanical thrombectomy.
Source: Journal of Stroke and Cerebrovascular Diseases - September 5, 2019 Category: Neurology Authors: Taha Nisar, Rajanigandhi Hanumanthu, Priyank Khandelwal Source Type: research

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