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Treatments in Ischemic Stroke: Current and Future
Background and Aim: Despite progress made over the last 30 years, stroke is still a leading cause of disability and mortality; likewise, its burden is expected to increase over the next decades, due to population growth and aging. The development of drugs with better safety-efficacy profiles as well as strategies able to improve ischemic stroke management from the pre-hospital setting is needed.Summary: The pathophysiology of ischemic stroke involves multiple pathways resulting in cerebral artery obstruction and brain tissue ischemia. To date, the only approved drug for acute ischemic stroke is intravenous thrombolytic alt...
Source: European Neurology - August 2, 2022 Category: Neurology Source Type: research

STudy of Alteplase for Respiratory failure in SARS-Cov2 COVID-19 (STARS): A Vanguard Multicenter, Rapidly Adaptive, Pragmatic, Randomized, Controlled Trial
Chest. 2021 Sep 27:S0012-3692(21)04063-0. doi: 10.1016/j.chest.2021.09.024. Online ahead of print.ABSTRACTBACKGROUND: Pulmonary vascular microthrombi are a proposed mechanism of COVID19 respiratory failure. We hypothesized that early administration of tissue-plasminogen activator(tPA) followed by therapeutic heparin would improve pulmonary function in these patients.RESEARCH QUESTION: Does tPA improve pulmonary function in severe COVID-19 respiratory failure, and is it safe?STUDY DESIGN AND METHODS: Adults with COVID-19-induced respiratory failure were randomized May14,2020-March 3,2021 in two phases: Phase-1(n=36): contro...
Source: Chest - September 30, 2021 Category: Respiratory Medicine Authors: Christopher D Barrett Hunter B Moore Ernest E Moore D Janice Wang Negin Hajizadeh Walter L Biffl Lawrence Lottenberg Purvesh R Patel Michael S Truitt Robert McIntyre Todd M Bull Lee Anne Ammons Arsen Ghasabyan James Chandler Ivor Douglas Eric Schmidt Pete Source Type: research

Advances in stroke medicine.
Authors: Campbell BC Abstract In recent years, reperfusion therapies such as intravenous thrombolysis and endovascular thrombectomy for ischaemic stroke have dramatically reduced disability and revolutionised stroke management. Thrombolysis with alteplase is effective when administered to patients with potentially disabling stroke, who are not at high risk of bleeding, within 4.5 hours of the time the patient was last known to be well. Emerging evidence suggests that other thrombolytics such as tenecteplase may be even more effective. Treatment may be possible beyond 4.5 hours in patients selected using brain imagi...
Source: Medical Journal of Australia - May 6, 2019 Category: General Medicine Tags: Med J Aust Source Type: research

Efficacy and safety of minimally invasive surgery with thrombolysis in intracerebral haemorrhage evacuation (MISTIE III): a randomised, controlled, open-label, blinded endpoint phase 3 trial
This study is registered with ClinicalTrials.gov, number NCT01827046.FindingsBetween Dec 30, 2013, and Aug 15, 2017, 506 patients were randomly allocated: 255 (50%) to the MISTIE group and 251 (50%) to standard medical care. 499 patients (n=250 in the MISTIE group; n=249 in the standard medical care group) received treatment and were included in the mITT analysis set. The mITT primary adjusted efficacy analysis estimated that 45% of patients in the MISTIE group and 41% patients in the standard medical care group had achieved an mRS score of 0–3 at 365 days (adjusted risk difference 4% [95% CI −4 to 12]; p=0·33). Sensi...
Source: The Lancet - February 8, 2019 Category: General Medicine Source Type: research

Incidence of orolingual angioedema after intravenous thrombolysis for stroke
DiscussionThe incidence of orolingual angioedema was very low in our series. Although OA is usually mild, anaphylactoid reactions may rarely occur, because of the variable degree of activation of the complement system and kinin cascade caused by alteplase. In such instances, admission to neurointensive care may be required. Specific bradykinin antagonists or drugs that target the kallikrein-kinin system are beginning to be used in the more severe cases. Thus, doctors and nurses caring for acute stroke patients need to be able to recognize and treat this complication.
Source: Neurological Sciences - August 6, 2018 Category: Neurology Source Type: research

Complications associated with recombinant tissue plasminogen activator therapy for acute ischaemic stroke.
Abstract Intravenous recombinant human tissue plasminogen activato (rtPA, formulated as alteplase) is the primary therapy for acute ischaemic stroke by breaking down a clot of an occluded vessel. There are several randomised controlled trials and observational studies that support the use of rtPA to improve functional outcome following acute ischaemic stroke. However, thrombolytic therapy with rtPA can be associated with a number of complications. Many of the rtPA-related complications result from its thrombolytic action including bleeding (intracerebral and systemic haemorrhage), reperfusion injury with oedema, a...
Source: CNS and Neurological Disorders Drug Targets - February 4, 2013 Category: Drugs & Pharmacology Authors: Balami JS, Sutherland BA, Buchan AM Tags: CNS Neurol Disord Drug Targets Source Type: research