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Dual Antiplatelet Therapy vs Alteplase for Patients With Minor Nondisabling Acute Ischemic Stroke
This randomized trial examines whether dual antiplatelet therapy is noninferior to intravenous thrombolysis among patients with minor nondisabling acute ischemic stroke.
Source: JAMA - June 27, 2023 Category: General Medicine Source Type: research

Cost-effectiveness of endovascular thrombectomy with alteplase versus endovascular thrombectomy alone for acute ischemic stroke secondary to large vessel occlusion
CMAJ Open. 2023 May 16;11(3):E443-E450. doi: 10.9778/cmajo.20220096. Print 2023 May-Jun.ABSTRACTBACKGROUND: Recent randomized trials have suggested that endovascular thrombectomy (EVT) alone may provide similar functional outcomes as the current standard of care, EVT combined with intravenous alteplase treatment, for acute ischemic stroke secondary to large vessel occlusion. We conducted an economic evaluation of these 2 therapeutic options.METHODS: We constructed a decision analytic model with a hypothetical cohort of 1000 patients to assess the cost-effectiveness of EVT with intravenous alteplase treatment versus EVT alo...
Source: cmaj - May 16, 2023 Category: General Medicine Authors: Zhikang Ye Ting Zhou Mengmeng Zhang Junwen Zhou Feng Xie Michael D Hill Eric E Smith Jason W Busse Yi Zhang Ying Liu Xin Wang Zhuo Ma Zhuoling An Source Type: research

Effect of Argatroban Plus Alteplase vs Alteplase on Neurologic Function After Acute Ischemic Stroke
This randomized clinical trial examines the efficacy of argatroban plus altepase for acute ischemic stroke within 4.5 hours from onset.
Source: JAMA - Journal of the American Medical Association - February 9, 2023 Category: General Medicine Source Type: research

Using body cameras to quantify the duration of a Code Stroke and identify workflow issues: a continuous observation workflow time study
Conclusions Codes are time intensive. Time spent on decision-making was a relatively small component of the overall Code duration. Data from body cameras can provide granular data on all aspects of Code workflow to inform potential areas for improvement at individual centres.
Source: BMJ Open - January 25, 2023 Category: General Medicine Authors: Wong, J. Z. W., Park, P. S. W., Frost, T., Stephens, K., Newk-Fon Hey Tow, F. K., Garcia, P. G., Senanayake, C., Choi, P. M. C. Tags: Open access, Neurology Source Type: research

Economic evaluation of endovascular treatment for acute ischaemic stroke in Thailand
Conclusions EVT represents good value for money in the Thai context, both when provided to patients eligible for intravenous alteplase, and when provided alone to those who are ineligible for intravenous alteplase.
Source: BMJ Open - September 27, 2022 Category: General Medicine Authors: Rattanavipapong, W., Worakijthamrongchai, T., Soboon, B., Luankongsomchit, V., Kongmuangpuk, M., Isaranuwatchai, W., Teerawattananon, Y., Nilanont, Y. Tags: Open access, Health economics Source Type: research

Systemic thrombolysis for acute central retinal artery occlusion in sickle cell disease: Case report
We describe a 42-year-old African- American man with SCD (HbSS) who presented with an acute central retinal artery occlusion (CRAO) within an hour of onset and subsequently received IV thrombolysis with alteplase. His labs were significant for HbS 91%. He had no central vascular access to undergo emergent red blood cell (RBC) exchange so interventional radiology was consulted to minimize his bleeding risk after receiving tissue plasminogen activator (tPA). A right internal jugular catheter was placed with fluoro-guidance, resulting in minimal blood loss. After two sessions of RBC exchange, his HbS decreased to 26%. He repo...
Source: Journal of the National Medical Association - September 26, 2022 Category: General Medicine Authors: Estevana Isaac Ali A Saherwal Shaista Alam Source Type: research

Intra-arterial Alteplase vs Placebo After Successful Thrombectomy and Functional Outcomes in Patients With Large Vessel Occlusion Acute Ischemic Stroke
To the Editor We have some concerns about the recent CHOICE study that compared intra-arterial alteplase with placebo among patients with large vessel occlusion acute ischemic stroke after successful thrombectomy.
Source: JAMA - June 28, 2022 Category: General Medicine Source Type: research

Intra-arterial Alteplase vs Placebo After Successful Thrombectomy and Functional Outcomes in Patients With Large Vessel Occlusion Acute Ischemic Stroke —Reply
In Reply In response to the comments by Dr Mai and colleagues about the change in the primary outcome of the CHOICE trial, we would like to provide several clarifications. First, the definition of the primary outcome in the original protocol was submitted for publication on July 15, 2019. Second, the registered protocol (NCT03876119) was first posted on March 15, 2019, but the primary outcome definition was changed and posted on March 19, 2021. Third, the summary of the history of these protocol changes was included in Supplement 2 of the article. As required by Spanish law, these changes were also communicated to the Span...
Source: JAMA - June 28, 2022 Category: General Medicine Source Type: research

Use of Oral Anticoagulants and Intracranial Hemorrhage Among Patients With Acute Ischemic Stroke
To the Editor A recent article suggested that the use of non –vitamin K antagonist oral anticoagulants (NOACs) within 7 days of intravenous alteplase was not associated with an increased risk of intracranial hemorrhage. However, we are concerned that some readers may interpret these results as an endorsement of the use of alteplase in patients with acute st roke who were taking NOACs, irrespective of the time frame of last use. Based on dose-finding studies, the drug half-life is 12 hours for apixaban, 11 to 13 hours for rivaroxaban, 10 to 14 hours for edoxaban, and 12 to 17 hours for dabigatran in patients with normal k...
Source: JAMA - June 21, 2022 Category: General Medicine Source Type: research

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