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Dual Thrombolytic Therapy With Mutant Prourokinase and Small Bolus Alteplase for Ischemic Stroke
This randomized clinical trial of individuals with ischemic stroke assesses the safety and efficacy of treatment with a dual plasminogen activator vs usual treatment with intravenous alteplase.
Source: JAMA Neurology - May 22, 2023 Category: Neurology Source Type: research

Association Between Calcium Level and Hematoma Size and Expansion
Intracerebral hemorrhage (ICH) is a common and deadly type of stroke, with high rates of morbidity and mortality (40%-50% in most series). There are several well-described and validated risk factors and diseases that increase the risk of ICH, including race, hypertension, use of anticoagulants, amyloid angiopathy, renal insufficiency, thrombolytic therapy, and drug abuse. However, not all ICHs are associated with one of these risk factors. This suggests that there might be some other modifying factors involved.
Source: JAMA Neurology - September 6, 2016 Category: Neurology Source Type: research

Progress in Intravenous Thrombolytic Therapy for Acute Stroke
This review traces the development of intravenous thrombolysis to date, considers the shortcomings of alteplase, and examines alternative thrombolytic approaches currently in the pipeline, including the role of neuroimaging and the possibility of combination therapies.
Source: JAMA Neurology - June 1, 2015 Category: Neurology Source Type: research

In-Hospital Stroke
There have been tremendous strides in standardization of the care for acute ischemic stroke since widespread use of thrombolytic therapy began almost 20 years ago. Efficacy is still limited by delayed presentation to the emergency department following stroke symptom onset, although this has also improved in that period with education of emergency medical services and the community at large. The real improvement lies in development of streamlined and standardized protocols for “code stroke,” so that thrombolysis rates of 20% are becoming typical and door-to-needle times are just as typically under 1 hour. These encourag...
Source: JAMA Neurology - May 4, 2015 Category: Neurology Source Type: research

Prehospital Thrombolysis for Stroke An Idea Whose Golden Hour Has Arrived
Soon after thrombolytic therapy was established as a therapy for ischemic stroke, our colleague Anthony Furlan, MD, famously circulated a cartoon of a computed tomographic (CT) scanner visible through the back doors of an ambulance, where a happy stroke physician had hung a bottle dripping tissue plasminogen activator (tPA) into the scanned patient’s arm. Because the time interval from stroke onset to initiation of thrombolysis after ischemic stroke is inversely related to the probability of disability-free recovery, prehospital initiation of thrombolytic therapy seemed a compelling and logical ambition, if one could rul...
Source: JAMA Neurology - November 17, 2014 Category: Neurology Source Type: research