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T-pa hemorrhage

Antonio J Salazar, Nicolás Useche, Manuel F Granja, Aníbal J Morillo, Sonia Bermúdez, Didier Sossa, Claudia J Ortiz, Oscar J Torres, Brenda Ropero
Aim: This study compares the reliability of brain CT interpretations performed using a diagnostic workstation and a mobile tablet computer in a telestroke context. Methods: A factorial design with 1,452 interpretations was used. Reliability was evaluated using the Fleiss' kappa coefficient on the agreements of the interpretation results on the lesion classification, presence of imaging contraindications to the intravenous recombinant tissue-type plasminogen activator (t-PA) administration, and on the Alberta Stroke Program Early CT Score (ASPECTS)...
December 30, 2018: Colombia Médica: CM
Nirav Bhatt, Erika T Marulanda-Londoño, Kunakorn Atchaneeyasakul, Amer M Malik, Negar Asdaghi, Nida Akram, Daniel D'Amour, Kathy Hesse, Tony Zhang, Ralph L Sacco, Jose G Romano
The therapeutic window for acute ischemic stroke with intravenous recombinant tissue plasminogen activator (IV rt-PA) is brief and crucial. The American Heart Association/American Stroke Association Target: Stroke Best Practice Strategies (TSBPS) aim to improve intravenous thrombolysis door-to-needle (DTN) time. We assessed the efficacy of implementation of selected TSBPS to reduce DTN time in a large tertiary care hospital. A multidisciplinary DTN committee assessed causes of delayed DTN time and implemented focused TSBPS in our urban academic medical center...
January 2019: Neurohospitalist
Bhavya Rehani, Yi Zhang, Simon Ammanuel, Wade Smith, Ramon G Gonzalez, Daniel L Cooke, Steven W Hetts, S Andrew Josephson, Anthony Kim, J Claude Hemphill, William Dillon
Stroke is one of the leading causes of death and disability worldwide. Standard treatment for stroke is intravenous (IV) injection of tissue plasminogen activator (t-PA) rapidly after symptom onset. However, there are limitations of IV t-PA treatment, such as a short time window for administration and risk for hemorrhage. Recent trials have demonstrated the benefit of endovascular treatment when added to standard treatment to improve outcomes for patients. Advanced imaging was utilized in some trials to identify patients with proximal intracranial occlusion to target for endovascular reperfusion therapy, and to exclude patients with large infarct cores or poor collateral circulation who would not be expected to benefit from intervention...
December 14, 2018: Emergency Radiology
Eriko Suzuki, Naoko Nishimura, Tetsuya Yoshikawa, Yudai Kunikiyo, Keiko Hasegawa, Keiji Hasumi
SMTP-7 ( Stachybotrys microspora triprenyl phenol-7) is a small molecule that promotes thrombolysis and suppresses inflammation possibly through plasminogen modulation and soluble epoxide hydrolase (sEH) inhibition, respectively. Here, we demonstrate an efficacy of SMTP-7 in a severe embolic stroke model in monkeys. The middle cerebral artery was embolized by an autologous blood clot. Saline, SMTP-7, or tissue-type plasminogen activator (t-PA) (n = 5 in each group) was given after 3 hours, and neurologic deficit scoring and infarct characterization were performed after 24 hours...
December 2018: Pharmacology Research & Perspectives
Junichiro Suzuki, Noriyoshi Nakai, Naohide Kondo, Hirotake Tsuji, Ryosuke Inagaki, Soma Furukawa, Mai Iwata, Suguru Nishida, Yasuhiro Ito
BACKGROUND: Emergency medical services are an important part of acute stroke management. We devised a prehospital stroke scale, the TOYOTA prehospital stroke scale for tissue plasminogen activator (t-PA) intravenous therapy (TOPSPIN) for triaging patients with ischemic stroke and especial indications for intravenous t-PA therapy in December 2006; this scale comprises 5 items including consciousness, atrial fibrillation, language disorder, disturbance of the upper extremities, and disturbance of the lower extremities...
2018: Cerebrovascular Diseases
Ali M Al Khathaami, Haya Aloraini, S Almudlej, Haifa Al Issa, Nourhan Elshammaa, Sami Alsolamy
Background and Objectives: Tissue plasminogen activator (t-PA) within 4.5 hours from onset improves outcome in patients with ischemic stroke and has been recommended by several international guidelines. Since its approval in 1996, the debate among emergency physicians continues particularly around the result interpretation of the first positive randomized controlled trial, the National Institute of Neurological Disorders and Stroke (NINDS) clinical trial. This lack of consensus might negatively affect the delivery of effective stroke care...
2018: Neurology Research International
Teng-Hsiang Chang, Ping-Fang Chiu, Chun-Chieh Tsai, Chin-Hua Chang, Chia-Lin Wu, Chew-Teng Kor, Jhao-Rong Li, Cheng-Ling Kuo, Ching-Shan Huang, Cheng-Chung Chu, Chih-Ming Lin, Chia-Chu Chang
BACKGROUND AND PURPOSE: Recombinant tissue plasminogen activator (rt-PA) administration is the most prevalent treatment for acute ischemic within golden time. However, the effects of rt-PA on the kidney function in such patients remain unknown. This study determined long-term renal outcomes in patients with acute ischemic stroke receiving systemic rt-PA. METHODS: We enrolled patients who were hospitalized for acute ischemic stroke from January 2001 to January 2017...
October 17, 2018: Nephrology
Karla P Mercado-Shekhar, Robert T Kleven, Hermes Aponte Rivera, Ryden Lewis, Kunal B Karani, Hendrik J Vos, Todd A Abruzzo, Kevin J Haworth, Christy K Holland
The lytic recombinant tissue plasminogen activator (rt-PA) is the only drug approved by the Food and Drug Administration for treating ischemic stroke. Less than 40% of patients with large vessel occlusions who are treated with rt-PA have improved blood flow. However, up to 6% of all patients receiving rt-PA develop intracerebral hemorrhage. Predicting the efficacy of rt-PA treatment a priori could help guide therapeutic decision making, such that rt-PA is administered only to those individuals who would benefit from this treatment...
December 2018: Ultrasound in Medicine & Biology
Verena R Juncal, Mostafa Hanout, Filiberto Altomare, David R Chow, Louis R Giavedoni, Rajeev H Muni, David T Wong, Alan R Berger
OBJECTIVE: To report the anatomical and visual outcomes of patients with thick submacular hemorrhage (SMH) treated with pars plana vitrectomy (PPV), subretinal tissue plasminogen activator (t-PA), and pneumatic displacement. DESIGN: Single-centre, retrospective case series. PARTICIPANTS: A total of 99 eyes of 99 consecutive patients with thick SMH secondary to any underlying etiology treated with PPV with subretinal t-PA and pneumatic displacement by 6 vitreoretinal surgeons at St...
August 2018: Canadian Journal of Ophthalmology. Journal Canadien D'ophtalmologie
Omar Hussein, Khalid Sawalha, Mohammad Hamed, Ahmed Abd ElAzim, Lai Wei, Michel T Torbey, Archana Hinduja
BACKGROUND: The presence of the spot sign on computed tomography angiogram (CTA) is considered a sign of active bleeding, and studies have shown it can predict hematoma expansion in intraparenchymal hemorrhage (IPH). The spot sign in intraventricular hemorrhage (IVH) has not been explored yet. The purpose of this study is to estimate the prevalence of the intraventricular-spot sign, and its prediction of hematoma expansion and clinical outcomes. METHODS: We retrieved data of hemorrhagic stroke patients seen at our medical center from January 2013 to January 2018...
October 2018: Journal of Neurology
Ali Alawieh, Meredith Andersen, DeAnna L Adkins, Stephen Tomlinson
Because complement activation in the subacute or chronic phase after stroke was recently shown to stimulate neural plasticity, we investigated how complement activation and complement inhibition in the acute phase after murine stroke interacts with subsequent rehabilitation therapy to modulate neuroinflammation and neural remodeling. We additionally investigated how complement and complement inhibition interacts with tissue plasminogen activator (tPA), the other standard of care therapy for stroke, and a U...
July 18, 2018: Journal of Neuroscience: the Official Journal of the Society for Neuroscience
Futoshi Nagashima, Satoshi Inoue, Hiroyuki Koami, Toru Miike, Yuichiro Sakamoto, Keita Kai
BACKGROUND: Trauma-associated coagulopathy (TAC) is an early and primary complication in severe trauma patients. Factor XIII (FXIII) is reported to stabilize a clot in the late phase of the coagulation cascade. The goal of this study was to investigate whether the administration of FXIII improves the condition of TAC both in vitro and in vivo. METHODS: We evaluated the effects of different doses, including a very high dose of FXIII (3.6-32.4 IU/mL) on tissue-plasminogen activator-induced hyperfibrinolysis and the combined condition of dilutional coagulopathy and tissue-plasminogen activator-induced hyperfibrinolysis in vitro...
September 2018: Journal of Trauma and Acute Care Surgery
YinZhong Ma, Li Li, LingLei Kong, ZhiMei Zhu, Wen Zhang, JunKe Song, Junlei Chang, GuanHua Du
Tissue-type plasminogen activator (t-PA) remains the only approved therapy for acute ischemic stroke but has a restrictive treatment time window of 4.5 hr. Prolonged ischemia causes blood-brain barrier (BBB) damage and increases the incidence of hemorrhagic transformation (HT) secondary to reperfusion. In this study, we sought to determine the effect of pinocembrin (PCB; a pleiotropic neuroprotective agent) on t-PA administration-induced BBB damage in a novel rat thromboembolic stroke model. By assessing the leakage of Evans blue into the ischemic hemisphere, we demonstrated that PCB pretreatment 5 min before t-PA administration significantly reduced BBB damage following 2 hr, 4 hr, 6 hr, and even 8 hr ischemia...
2018: BioMed Research International
Min Li, Jing Zhou, Weifeng Jin, Xiaohong Li, Yuyan Zhang
Background: Hemorrhagic transformation, neurotoxicity, short treatment time windows, and other defects are considered as the major limitations for the thrombolytic therapy. This study is devoted to figure out whether Danhong injection (DHI) combined with tissue-plasminogen activator (t-PA) could extend the treatment time windows and ameliorate brain injury, hemorrhagic complication and BBB disruption after focal embolic stroke. Methods: In vitro , the combined concentrations of DHI and t-PA were added to wells reacted with plasminogen and D-Val-Leu-Lys-AMC...
2018: Frontiers in Pharmacology
Tie Bo Wu, Sheng Wu, Matthew Buoni, Thomas Orfeo, Kathleen Brummel-Ziedins, Mitchell Cohen, Linda Petzold
The onset of acute traumatic coagulopathy in trauma patients exacerbates hemorrhaging and dramatically increases mortality. The disease is characterized by increased localized bleeding, and the mechanism for its onset is not yet known. We propose that the fibrinolytic response, specifically the release of tissue-plasminogen activator (t-PA), within vessels of different sizes leads to a variable susceptibility to local coagulopathy through hyperfibrinolysis which can explain many of the clinical observations in the early stages from severely injured coagulopathic patients...
August 2018: Annals of Biomedical Engineering
Hebun Erdur, Alexandros Polymeris, Ulrike Grittner, Jan F Scheitz, Serdar Tütüncü, David J Seiffge, Heinrich J Audebert, Christian H Nolte, Stefan T Engelter, Andrea Rocco
Background: Symptomatic intracranial hemorrhage (sICH) after intravenous thrombolysis with recombinant tissue-plasminogen activator (rt-PA) for acute ischemic stroke is associated with a poor functional outcome. We aimed to develop a score assessing risk of sICH including novel putative predictors-namely, pretreatment with statins and severe renal impairment. Methods: We analyzed our local cohort (Berlin) of patients receiving rt-PA for acute ischemic stroke between 2006 and 2016...
2018: Frontiers in Neurology
Christopher Jan Schwarzbach, Anne Ebert, Michael G Hennerici, Eva Neumaier-Probst, Michael Platten, Marc Fatar
Background: The safety of systemic thrombolysis in patients with intracranial tumor and cavernoma are unknown. So far evidence is limited to a number of case reports and few case series or unspecified data based on population-based analysis. Our aim was to comprehend the risk of systemic thrombolysis in these patients. Methods: Patients with additional evidence of intracranial tumor or cavernoma who received IV tissue plasminogen activator (t-PA) treatment at our comprehensive stroke center over a period of 7 years were identified in our stroke database and compared to the same number of matched control subjects without any evidence of intracranial tumor and cavernoma...
2018: Therapeutic Advances in Neurological Disorders
Hansen Chen, Binghe Guan, Xi Chen, Xingmiao Chen, Caiming Li, Jinhua Qiu, Dan Yang, Ke Jian Liu, Suhua Qi, Jiangang Shen
Tissue plasminogen activator (t-PA) has a restrictive therapeutic window within 4.5 h after ischemic stroke with the risk of hemorrhagic transformation (HT) and neurotoxicity when it is used beyond the time window. In the present study, we tested the hypothesis that baicalin, an active compound of medicinal plant, could attenuate HT in cerebral ischemia stroke with delayed t-PA treatment. Male Sprague-Dawley rats were subjected to middle cerebral artery occlusion (MCAO) for 4.5 h and then continuously received t-PA infusion (10 mg/kg) for 0...
October 2018: Translational Stroke Research
Keita Shibata, Terumasa Hashimoto, Keiji Hasumi, Kazuo Honda, Koji Nobe
We reported previously that Stachybotrys microspora triprenyl phenol-7 (SMTP-7) showed potential thrombolytic, anti-inflammatory and anti-oxidant effects that account for its excellent pharmacological activity such as having a wider therapeutic time window than tissue plasminogen activator (t-PA) and a significant protection against hemorrhage. The aim of the present study was to evaluate and compare the effect of a new series of SMTPs in the acetic acid-induced embolic cerebral infarct mouse model. Thrombotic occlusion was produced in mice by inducing the transfer of acetic acid-induced thrombi from the right common carotid artery into the brain...
January 5, 2018: European Journal of Pharmacology
Shan Liu, Xiaozhou Feng, Rong Jin, Guohong Li
Thrombolysis with intravenous tissue plasminogen activator (tPA) is the only FDA approved treatment for patients with acute ischemic stroke, but its use is limited by narrow therapeutic window, selective efficacy, and hemorrhagic complication. In the past two decades, extensive efforts have been undertaken to extend its therapeutic time window and explore alternative thrombolytic agents, but both show little progress. Nanotechnology has emerged as a promising strategy to improve the efficacy and safety of tPA...
February 2018: Expert Opinion on Drug Delivery
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