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Novel Telestroke Program Improves Thrombolysis for Acute Stroke Across 21 Hospitals of an Integrated Healthcare System Clinical Sciences
This study included 310 patients treated with alteplase in the pre–EXpediting the PRrocess of Evaluating and Stopping Stroke period and 557 patients treated with alteplase in the EXpediting the PRrocess of Evaluating and Stopping Stroke period. After implementation, alteplase administrations increased to 62/mo from 34/mo at baseline (P
Source: Stroke - December 22, 2017 Category: Neurology Authors: Mai N. Nguyen-Huynh, Jeffrey G. Klingman, Andrew L. Avins, Vivek A. Rao, Abigail Eaton, Sunil Bhopale, Anne C. Kim, John W. Morehouse, Alexander C. Flint Tags: Treatment, Cerebrovascular Disease/Stroke, Ischemic Stroke Original Contributions Source Type: research

Thrombolysis with Low-Dose Tissue Plasminogen Activator 3–4.5 h After Acute Ischemic Stroke in Five Hospital Groups in Japan
We present data from 2005 to 2012 using a therapeutic window <3 h showing comparable results. tPA following endovascular therapy with recanalization might be superior to tPA only with recanalization (81.0 vs. 59.1 %). Compared with administration within 3 h of ischemic stroke onset, tPA administration within 3–4.5 h of ischemic stroke onset in real-world stroke emergency settings at multiple sites in Japan is as safe and has the same outcomes.
Source: Translational Stroke Research - January 27, 2016 Category: Neurology Source Type: research

Recurrent stroke in a patient with vitamin B12 deficiency and MTHFR mutation
We report an unusual case of recurrent stroke in a patient with vitamin B12 deficiency who was also homozygous for the methylene tetrahydrofolate reductase (MTHFR) gene mutation. The patient was a 35-year-old male vegetarian with no known medical history who initially presented with global aphasia, slurred speech, right facial weakness, and right-sided hemiplegia and was found to have a stroke (NIH Stroke Scale score of 25). At that time a CT scan of the head ruled out intracranial hemorrhage and a CT angiogram of the head and neck was done. The patient was found to have occlusion of the M1 segment of the left middle cereb...
Source: Neurology Clinical Practice - February 12, 2017 Category: Neurology Authors: Zacharia, G., Shani, D., Ortiz, R. A. Tags: Stroke in young adults, Stroke prevention, Hematologic, All Cerebrovascular disease/Stroke Case Source Type: research

Functional outcomes of pre-hospital thrombolysis in a mobile stroke treatment unit compared with conventional care: an observational registry study
This study is registered with ClinicalTrials.gov, number NCT02358772. Findings Between Feb 5, 2011, and March 5, 2015, 427 patients were treated within the STEMO vehicle and their data were entered into a pre-hospital registry. 505 patients received conventional care and their data were entered into an in-hospital thrombolysis registry. Of these, 305 patients in the STEMO group and 353 in the conventional care group met inclusion criteria and were included in the analysis. 161 (53%) patients in the STEMO group versus 166 (47%) in the conventional care group had an mRS score of 1 or lower (p=0·14). Compared with conventio...
Source: The Lancet Neurology - July 15, 2016 Category: Neurology Source Type: research

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

Predictors of functional outcome and hemorrhagic complications in acute ischemic stroke patients treated with intravenous thrombolysis - A retrospective analysis 
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Predictors of functional outcome and hemorrhagic complications in acute ischemic stroke patients treated with intravenous thrombolysis - A retrospective analysis
. Int J Clin Pharmacol Ther. 2017 Oct 26;: Authors: Zhao Q, Shan W, Liu L, Fu X, Liu P, Hu Y Abstract Intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (rt-PA) within 4.5 hours is an effective and routine therapy for acute ischemic stroke (AIS). The purpose of the study was to identify predictors of functional outcome at 3 months and hemorrhagic complications after IVT. A total of 123 AIS patients treated with in...
Source: International Journal of Clinical Pharmacology and Therapeutics - November 4, 2017 Category: Drugs & Pharmacology Tags: Int J Clin Pharmacol Ther 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

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

Recent Use of NOACs and Intracranial Hemorrhage in Patients With Stroke Treated With Alteplase
This retrospective cohort study uses data from hospitals participating in the Get With The Guidelines –Stroke registry on patients with acute ischemic stroke and compares the safety and functional outcomes of intravenous alteplase among patients who were taking non–vitamin K antagonist oral anticoagulants (NOACs) prior to stroke vs patients who were not taking long-term anticoagulants.
Source: JAMA - February 22, 2022 Category: General Medicine Source Type: research

And why not thrombolysis in the ambulance (at least for some)?
The fear that alteplase may aggravate primary intracerebral hemorrhages has led to the mandatory prerequisite for prealteplase imaging in all acute stroke patients in order to exclude such hemorrhages. Consequently, in a situation in which "time is brain," administration of alteplase is delayed until the patients are transferred to a hospital where such imaging is available, at the cost of additional ischemic damage to the brain parenchyma. Yet, theoretical considerations and empirical data suggest that alteplase's effects on primary intracerebral hemorrhages may not be that detrimental. Moreover, at least some of the pati...
Source: Neurology - July 10, 2016 Category: Neurology Authors: Rosenberg, G., Steiner, I. Tags: CT, All Clinical trials, All Cerebrovascular disease/Stroke, Intracerebral hemorrhage VIEWS & amp;amp; REVIEWS 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

Prognosis comparisons in acute ischemic stroke patients with thrombolysis and nonthrombolysis therapy: a retrospective study with larger sample size
We compared the short-term, middle-term and long-term primary outcomes between thrombolysis and nonthrombolysis therapy in acute ischemic stroke (AIS) patients. Medical records were collected from patients suffered from AIS between 2010 and 2013 and allocated into either the intravenous recombinant tissue plasminogen activator (as rt-PA group) treatment, or non-rt-PA treatment group (as control group). The primary outcomes included a proportion of patients with favorable outcome [as defined with a modified Rankin Scale (mRS) of 0–1], functional independence (mRS of 0–2) or with bad outcome (mRS of 5–6) at 3, 6 and 12...
Source: Blood Coagulation and Fibrinolysis - February 9, 2018 Category: Hematology Tags: Original Articles 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

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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