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Outcomes and risk factors of perforating and non-perforating middle cerebral artery infarctions after intravenous thrombolysis
AbstractThe clinical symptoms of perforating arteries differ, and responses to intravenous thrombolytic therapy are heterogeneous. Here, we investigated the effect of intravenous thrombolytic therapy and the related factors influencing acute perforating and non-perforating middle cerebral artery infarctions. We analyzed 320 patients with acute middle cerebral artery infarction who received alteplase thrombolysis within 4.5  h of onset at two stroke centers from January 2016 to December 2019. Outcome measures included rates of a favorable functional outcome (modified Rankin Scale scores of 0–2), distribution of modified ...
Source: Journal of Thrombosis and Thrombolysis - January 14, 2022 Category: Hematology Source Type: research

Metal ion chelation enhances tissue plasminogen activator (tPA)-induced thrombolysis: an in vitro and in vivo study
AbstractStroke is the third leading cause of death in the United States and the leading cause of adult disability. Despite enormous research efforts including many clinical trials, tissue plasminogen activator (tPA) remains the only FDA-approved treatment for acute ischemic stroke. Unfortunately, only 1 –3% of stroke patients in the US receive this therapy because of the narrow time window and severe side effects for using tPA. The most deadly and damaging side effect is the risk of intracranial bleeding or hemorrhage. For that reason, the dose of tPA and its overall administration are under tigh t control, which may com...
Source: Journal of Thrombosis and Thrombolysis - November 10, 2021 Category: Hematology Source Type: research

Evaluating the safety and efficacy of intravenous thrombolysis for acute ischemic stroke patients with a history of intracerebral hemorrhage: a systematic review and meta-analysis
This study aims to investigate the safety and efficacy of IV-tPA in AIS patients with previous ICH. We performed a systematic review and meta-analysis of studies reporting on IV-tPA use in AIS patients with and without previous ICH. We searched Embase, PubMed and Cochrane Library from inception to 20 April 2021. Outcomes measured included symptomatic ICH (sICH), 3-month modified Rankin Scale (mRS) score, and 3-month mortality. We included seven retrospective cohort studies comprising 5760 AIS patients who had received IV-tPA, of which 134 had previous ICH. There was no significant difference in the odds of sICH (OR 1.57, 9...
Source: Journal of Thrombosis and Thrombolysis - July 24, 2021 Category: Hematology Source Type: research

Adverse consequences of immediate thrombolysis-related complications: a multi-centre registry-based cohort study of acute stroke
In conclusion, the risk of nosocomial infections, worsening of stroke severity, longer HASU stay, disability and death is increased following immediate TRC. The management of patients following immediate TRC is more complex than previously thought and such complexity needs to be considere d when planning an increased thrombolysis service.
Source: Journal of Thrombosis and Thrombolysis - July 13, 2021 Category: Hematology Source Type: research

Comparing the efficacy and safety of direct oral anticoagulants with vitamin K antagonist in cerebral venous thrombosis
AbstractCerebral venous thrombosis (CVT) causes significant disability and mortality. Current guidelines for CVT management support the initial use of unfractionated heparin or low molecular weight heparin followed by longer-term oral vitamin K antagonist (VKA). There has been increasing, albeit limited, evidence for the use of direct oral anticoagulants (DOAC) as an alternative to VKA. We performed a systematic review and meta-analysis of studies that compared the safety and efficacy of DOACs to VKA in treating CVT. A comprehensive literature search was carried out in Medline, Embase and Cochrane Stroke Group Trials Regis...
Source: Journal of Thrombosis and Thrombolysis - April 10, 2020 Category: Hematology Source Type: research

Management of oral anticoagulation in very old patients with non valvular atrial fibrillation related acute ischemic stroke
AbstractThe optimal management of oral anticoagulation (OAC) in the acute phase of non valvular atrial fibrillation (NVAF)-related acute ischemic stroke (AIS) remains controversial, especially in very old patients. Therefore, the aim of our study was to evaluate the practical management of OAC in this context. We conducted an observational retrospective study on patients 85-years old and older admitted to two Italian hospitals for NVAF-related AIS. For each patient, clinical and brain computed tomography data were recorded. Type of OAC (vitamin K antagonists, VKAs or Direct Oral Anticoagulants, DOACs), dosage and starting ...
Source: Journal of Thrombosis and Thrombolysis - October 16, 2019 Category: Hematology Source Type: research

Venous thromboembolism: thrombosis, inflammation, and immunothrombosis for clinicians
AbstractVenous thromboembolism (VTE) is a worldwide disease related with mortality, cardiovascular disability, impaired quality of life and, cause major long-term complications. Clinicians related to the acute and long-term patients care must be involved in the molecular mechanisms of thrombosis. The vessel wall and its inner lining of the endothelium are critical to the maintenance of a patent vasculature. After endothelial disruption, collagen (first line of endothelial defense) and intravascular tissue factor (second line of endothelial defense) are exposed to blood flow, starting the formation of a thrombus. Anticoagul...
Source: Journal of Thrombosis and Thrombolysis - July 20, 2017 Category: Hematology Source Type: research

Clinical recovery and health-related quality of life in ischaemic stroke survivors receiving thrombolytic treatment: a 1-year follow-up study
AbstractThe aims of this study were to examine prospectively the course of neurological and functional recovery and health related quality of life (HRQoL) in ischaemic stroke patients after intravenous thrombolysis, to assess the 1-year outcome and to determine the early predictors. A group of 53 consecutive patients were assessed at admission to the acute stroke unit (T0), before their discharge (T1), and at 3 (T2) and 12 (T3) months after hospital discharge. The National Institutes of Health Stroke Scale (NIHSS), the Barthel Index (BI) and the Stroke Specific Quality of Life Scale (SSQoL) were used to evaluate stroke sev...
Source: Journal of Thrombosis and Thrombolysis - December 31, 2016 Category: Hematology Source Type: research

Reasons for exclusion from intravenous thrombolysis in stroke patients admitted to the Stroke Unit
AbstractIntravenous (IV) thrombolysis is the treatment in ischemic stroke, but only the minority of patients receive this medication. The primary objective of this study was to explore the reasons associated with the decision not to offer IV thrombolysis to stroke patients admitted to the Stroke Unit (SU). We conducted a retrospective analysis based on data collected from 876 consecutive stroke patients admitted to the SU  <12  h of symptoms onset, treated or not with IV thrombolysis at the discretion of the treating neurologist. Of the 876 patients, 449 were thrombolysed and 427 non-thrombolysed. Stroke onset >4....
Source: Journal of Thrombosis and Thrombolysis - August 5, 2016 Category: Hematology Source Type: research