Use of infusions of FIBRINOLYTIC AGENTS to destroy or dissolve thrombi in blood vessels or bypass grafts.
Streptococcal fibrinolysin . An enzyme produced by hemolytic streptococci. It hydrolyzes amide linkages and serves as an activator of plasminogen. It is used in thrombolytic therapy and is used also in mixtures with streptodornase (STREPTODORNASE AND STREPTOKINASE). EC 3.4.-.
A proteolytic enzyme in the serine protease family found in many tissues which converts PLASMINOGEN to FIBRINOLYSIN. It has fibrin-binding activity and is immunologically different from UROKINASE-TYPE PLASMINOGEN ACTIVATOR. The primary sequence, composed of 527 amino acids, is identical in both the naturally occurring and synthetic proteases.
Fibrinolysin or agents that convert plasminogen to FIBRINOLYSIN.
NECROSIS of the MYOCARDIUM caused by an obstruction of the blood supply to the heart (CORONARY CIRCULATION).
A heterogeneous group of proteolytic enzymes that convert PLASMINOGEN to FIBRINOLYSIN. They are concentrated in the lysosomes of most cells and in the vascular endothelium, particularly in the vessels of the microcirculation.
An acylated inactive complex of streptokinase and human lysine-plasminogen. After injection, the acyl group is slowly hydrolyzed, producing an activator that converts plasminogen to plasmin, thereby initiating fibrinolysis. Its half-life is about 90 minutes compared to 5 minutes for TPA; (TISSUE PLASMINOGEN ACTIVATOR); 16 minutes for UROKINASE-TYPE PLASMINOGEN ACTIVATOR and 23 minutes for STREPTOKINASE. If treatment is initiated within 3 hours of onset of symptoms for acute myocardial infarction, the drug preserves myocardial tissue and left ventricular function and increases coronary artery patency. Bleeding complications are similar to other thrombolytic agents.
A proteolytic enzyme that converts PLASMINOGEN to FIBRINOLYSIN where the preferential cleavage is between ARGININE and VALINE. It was isolated originally from human URINE, but is found in most tissues of most VERTEBRATES.
A group of pathological conditions characterized by sudden, non-convulsive loss of neurological function due to BRAIN ISCHEMIA or INTRACRANIAL HEMORRHAGES. Stroke is classified by the type of tissue NECROSIS, such as the anatomic location, vasculature involved, etiology, age of the affected individual, and hemorrhagic vs. non-hemorrhagic nature. (From Adams et al., Principles of Neurology, 6th ed, pp777-810)
Blocking of the PULMONARY ARTERY or one of its branches by an EMBOLUS.
Localized reduction of blood flow to brain tissue due to arterial obstruction or systemic hypoperfusion. This frequently occurs in conjunction with brain hypoxia (HYPOXIA, BRAIN). Prolonged ischemia is associated with BRAIN INFARCTION.
Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series.
A highly acidic mucopolysaccharide formed of equal parts of sulfated D-glucosamine and D-glucuronic acid with sulfaminic bridges. The molecular weight ranges from six to twenty thousand. Heparin occurs in and is obtained from liver, lung, mast cells, etc., of vertebrates. Its function is unknown, but it is used to prevent blood clotting in vivo and vitro, in the form of many different salts.
Bleeding into one or both CEREBRAL HEMISPHERES including the BASAL GANGLIA and the CEREBRAL CORTEX. It is often associated with HYPERTENSION and CRANIOCEREBRAL TRAUMA.
Generally, restoration of blood supply to heart tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. Reperfusion can be induced to treat ischemia. Methods include chemical dissolution of an occluding thrombus, administration of vasodilator drugs, angioplasty, catheterization, and artery bypass graft surgery. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing MYOCARDIAL REPERFUSION INJURY.
Elements of limited time intervals, contributing to particular results or situations.
Surgical removal of an obstructing clot or foreign material which has been transported from a distant vessel by the bloodstream. Removal of a clot at its original site is called THROMBECTOMY.
Formation and development of a thrombus or blood clot in the blood vessel.
Disease having a short and relatively severe course.
The hospital unit in which patients with acute cardiac disorders receive intensive care.
The natural enzymatic dissolution of FIBRIN.
Laceration or tearing of cardiac tissues appearing after MYOCARDIAL INFARCTION.
Formation or presence of a blood clot (THROMBUS) in a blood vessel within the SKULL. Intracranial thrombosis can lead to thrombotic occlusions and BRAIN INFARCTION. The majority of the thrombotic occlusions are associated with ATHEROSCLEROSIS.
Bleeding or escape of blood from a vessel.
Recording of the moment-to-moment electromotive forces of the HEART as projected onto various sites on the body's surface, delineated as a scalar function of time. The recording is monitored by a tracing on slow moving chart paper or by observing it on a cardioscope, which is a CATHODE RAY TUBE DISPLAY.
Bleeding within the SKULL, including hemorrhages in the brain and the three membranes of MENINGES. The escape of blood often leads to the formation of HEMATOMA in the cranial epidural, subdural, and subarachnoid spaces.
Dilation of an occluded coronary artery (or arteries) by means of a balloon catheter to restore myocardial blood supply.
A product of the lysis of plasminogen (profibrinolysin) by PLASMINOGEN activators. It is composed of two polypeptide chains, light (B) and heavy (A), with a molecular weight of 75,000. It is the major proteolytic enzyme involved in blood clot retraction or the lysis of fibrin and quickly inactivated by antiplasmins.
Blood clot formation in any part of the CAROTID ARTERIES. This may produce CAROTID STENOSIS or occlusion of the vessel, leading to TRANSIENT ISCHEMIC ATTACK; CEREBRAL INFARCTION; or AMAUROSIS FUGAX.
The long-term (minutes to hours) administration of a fluid into the vein through venipuncture, either by letting the fluid flow by gravity or by pumping it.
Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group.
Coagulation of blood in any of the CORONARY VESSELS. The presence of a blood clot (THROMBUS) often leads to MYOCARDIAL INFARCTION.
Radiography of the vascular system of the heart muscle after injection of a contrast medium.
Services specifically designed, staffed, and equipped for the emergency care of patients.
The return of a sign, symptom, or disease after a remission.
Embolism or thrombosis involving blood vessels which supply intracranial structures. Emboli may originate from extracranial or intracranial sources. Thrombosis may occur in arterial or venous structures.
Injections made into a vein for therapeutic or experimental purposes.
Proteins prepared by recombinant DNA technology.
The degree to which BLOOD VESSELS are not blocked or obstructed.
Situations or conditions requiring immediate intervention to avoid serious adverse results.
Regional infusion of drugs via an arterial catheter. Often a pump is used to impel the drug through the catheter. Used in therapy of cancer, upper gastrointestinal hemorrhage, infection, and peripheral vascular disease.
Tomography using x-ray transmission and a computer algorithm to reconstruct the image.
Blocking of a blood vessel in the SKULL by an EMBOLUS which can be a blood clot (THROMBUS) or other undissolved material in the blood stream. Most emboli are of cardiac origin and are associated with HEART DISEASES. Other non-cardiac sources of emboli are usually associated with VASCULAR DISEASES.
The formation or presence of a blood clot (THROMBUS) within a vein.
The formation of an area of NECROSIS in the CEREBRUM caused by an insufficiency of arterial or venous blood flow. Infarcts of the cerebrum are generally classified by hemisphere (i.e., left vs. right), lobe (e.g., frontal lobe infarction), arterial distribution (e.g., INFARCTION, ANTERIOR CEREBRAL ARTERY), and etiology (e.g., embolic infarction).
Use of HIRUDINS as an anticoagulant in the treatment of cardiological and hematological disorders.
First aid or other immediate intervention for accidents or medical conditions requiring immediate care and treatment before definitive medical and surgical management can be procured.
Agents that prevent clotting.
A transferase that catalyzes formation of PHOSPHOCREATINE from ATP + CREATINE. The reaction stores ATP energy as phosphocreatine. Three cytoplasmic ISOENZYMES have been identified in human tissues: the MM type from SKELETAL MUSCLE, the MB type from myocardial tissue and the BB type from nervous tissue as well as a mitochondrial isoenzyme. Macro-creatine kinase refers to creatine kinase complexed with other serum proteins.
Paramedical personnel trained to provide basic emergency care and life support under the supervision of physicians and/or nurses. These services may be carried out at the site of the emergency, in the ambulance, or in a health care institution.
Imaging of a ventricle of the heart after the injection of a radioactive contrast medium. The technique is less invasive than cardiac catheterization and is used to assess ventricular function.
Studies used to test etiologic hypotheses in which inferences about an exposure to putative causal factors are derived from data relating to characteristics of persons under study or to events or experiences in their past. The essential feature is that some of the persons under study have the disease or outcome of interest and their characteristics are compared with those of unaffected persons.
A vital statistic measuring or recording the rate of death from any cause in hospitalized populations.
Delivery of drugs into an artery.
Surgical removal of an obstructing clot or foreign material from a blood vessel at the point of its formation. Removal of a clot arising from a distant site is called EMBOLECTOMY.
Restoration of blood supply to tissue which is ischemic due to decrease in normal blood supply. The decrease may result from any source including atherosclerotic obstruction, narrowing of the artery, or surgical clamping. It is primarily a procedure for treating infarction or other ischemia, by enabling viable ischemic tissue to recover, thus limiting further necrosis. However, it is thought that reperfusion can itself further damage the ischemic tissue, causing REPERFUSION INJURY.
Two small peptide chains removed from the N-terminal segment of the alpha chains of fibrinogen by the action of thrombin during the blood coagulation process. Each peptide chain contains 18 amino acid residues. In vivo, fibrinopeptide A is used as a marker to determine the rate of conversion of fibrinogen to fibrin by thrombin.
Radiography of the vascular system of the brain after injection of a contrast medium.
Studies in which individuals or populations are followed to assess the outcome of exposures, procedures, or effects of a characteristic, e.g., occurrence of disease.
Plasma glycoprotein clotted by thrombin, composed of a dimer of three non-identical pairs of polypeptide chains (alpha, beta, gamma) held together by disulfide bonds. Fibrinogen clotting is a sol-gel change involving complex molecular arrangements: whereas fibrinogen is cleaved by thrombin to form polypeptides A and B, the proteolytic action of other enzymes yields different fibrinogen degradation products.
A protein derived from FIBRINOGEN in the presence of THROMBIN, which forms part of the blood clot.
Intraocular hemorrhage from the vessels of various tissues of the eye.
Criteria and standards used for the determination of the appropriateness of the inclusion of patients with specific conditions in proposed treatment plans and the criteria used for the inclusion of subjects in various clinical trials and other research protocols.
Province of Canada consisting of the island of Newfoundland and an area of Labrador. Its capital is St. John's.
Disease-related laceration or tearing of tissues of the heart, including the free-wall MYOCARDIUM; HEART SEPTUM; PAPILLARY MUSCLES; CHORDAE TENDINEAE; and any of the HEART VALVES. Pathological rupture usually results from myocardial infarction (HEART RUPTURE, POST-INFARCTION).
Works about clinical trials that involve at least one test treatment and one control treatment, concurrent enrollment and follow-up of the test- and control-treated groups, and in which the treatments to be administered are selected by a random process, such as the use of a random-numbers table.
Insertion of a catheter into a peripheral artery, vein, or airway for diagnostic or therapeutic purposes.
A mixture of the enzymes (streptokinase and streptodornase) produced by hemolytic streptococci. It is used topically on surface lesions and by instillation in closed body cavities to remove clotted blood or fibrinous or purulent accumulations. It is also used as a skin test antigen in evaluating generalized cell-mediated immunodeficiency. (Dorland, 27th ed) EC 3.-.
A class of statistical procedures for estimating the survival function (function of time, starting with a population 100% well at a given time and providing the percentage of the population still well at later times). The survival analysis is then used for making inferences about the effects of treatments, prognostic factors, exposures, and other covariates on the function.
The prototypical analgesic used in the treatment of mild to moderate pain. It has anti-inflammatory and antipyretic properties and acts as an inhibitor of cyclooxygenase which results in the inhibition of the biosynthesis of prostaglandins. Aspirin also inhibits platelet aggregation and is used in the prevention of arterial and venous thrombosis. (From Martindale, The Extra Pharmacopoeia, 30th ed, p5)
Radiography of blood vessels after injection of a contrast medium.
Extravasation of blood into the skin, resulting in a nonelevated, rounded or irregular, blue or purplish patch, larger than a petechia.
In screening and diagnostic tests, the probability that a person with a positive test is a true positive (i.e., has the disease), is referred to as the predictive value of a positive test; whereas, the predictive value of a negative test is the probability that the person with a negative test does not have the disease. Predictive value is related to the sensitivity and specificity of the test.
NECROSIS occurring in the MIDDLE CEREBRAL ARTERY distribution system which brings blood to the entire lateral aspects of each CEREBRAL HEMISPHERE. Clinical signs include impaired cognition; APHASIA; AGRAPHIA; weak and numbness in the face and arms, contralaterally or bilaterally depending on the infarction.
An aspect of personal behavior or lifestyle, environmental exposure, or inborn or inherited characteristic, which, on the basis of epidemiologic evidence, is known to be associated with a health-related condition considered important to prevent.
A spectrum of pathological conditions of impaired blood flow in the brain. They can involve vessels (ARTERIES or VEINS) in the CEREBRUM, the CEREBELLUM, and the BRAIN STEM. Major categories include INTRACRANIAL ARTERIOVENOUS MALFORMATIONS; BRAIN ISCHEMIA; CEREBRAL HEMORRHAGE; and others.
Therapy with two or more separate preparations given for a combined effect.
The process of the interaction of BLOOD COAGULATION FACTORS that results in an insoluble FIBRIN clot.
A prediction of the probable outcome of a disease based on a individual's condition and the usual course of the disease as seen in similar situations.
Pathological processes which result in the partial or complete obstruction of ARTERIES. They are characterized by greatly reduced or absence of blood flow through these vessels. They are also known as arterial insufficiency.
Soluble protein fragments formed by the proteolytic action of plasmin on fibrin or fibrinogen. FDP and their complexes profoundly impair the hemostatic process and are a major cause of hemorrhage in intravascular coagulation and fibrinolysis.
Institutions with permanent facilities and organized medical staff which provide the full range of hospital services primarily to a neighborhood area.
Procedures in which placement of CARDIAC CATHETERS is performed for therapeutic or diagnostic procedures.
Shock resulting from diminution of cardiac output in heart disease.
Laceration or tearing of the VENTRICULAR SEPTUM, usually caused by MYOCARDIAL INFARCTION.
Precursor of plasmin (FIBRINOLYSIN). It is a single-chain beta-globulin of molecular weight 80-90,000 found mostly in association with fibrinogen in plasma; plasminogen activators change it to fibrinolysin. It is used in wound debriding and has been investigated as a thrombolytic agent.
NECROSIS occurring in the ANTERIOR CEREBRAL ARTERY system, including branches such as Heubner's artery. These arteries supply blood to the medial and superior parts of the CEREBRAL HEMISPHERE, Infarction in the anterior cerebral artery usually results in sensory and motor impairment in the lower body.
The systems and processes involved in the establishment, support, management, and operation of registers, e.g., disease registers.
The proportion of survivors in a group, e.g., of patients, studied and followed over a period, or the proportion of persons in a specified group alive at the beginning of a time interval who survive to the end of the interval. It is often studied using life table methods.
A set of techniques used when variation in several variables has to be studied simultaneously. In statistics, multivariate analysis is interpreted as any analytic method that allows simultaneous study of two or more dependent variables.
A vein on either side of the body which is formed by the union of the external and internal iliac veins and passes upward to join with its fellow of the opposite side to form the inferior vena cava.
The process which spontaneously arrests the flow of BLOOD from vessels carrying blood under pressure. It is accomplished by contraction of the vessels, adhesion and aggregation of formed blood elements (eg. ERYTHROCYTE AGGREGATION), and the process of BLOOD COAGULATION.
Mechanical devices inserted in the inferior vena cava that prevent the migration of blood clots from deep venous thrombosis of the leg.
Single-chain polypeptides of about 65 amino acids (7 kDa) from LEECHES that have a neutral hydrophobic N terminus, an acidic hydrophilic C terminus, and a compact, hydrophobic core region. Recombinant hirudins lack tyr-63 sulfation and are referred to as 'desulfato-hirudins'. They form a stable non-covalent complex with ALPHA-THROMBIN, thereby abolishing its ability to cleave FIBRINOGEN.
Inflammation of a vein associated with a blood clot (THROMBUS).
A branch of medicine concerned with the total health of the individual within the home environment and in the community, and with the application of comprehensive care to the prevention and treatment of illness in the entire community.
Drugs or agents which antagonize or impair any mechanism leading to blood platelet aggregation, whether during the phases of activation and shape change or following the dense-granule release reaction and stimulation of the prostaglandin-thromboxane system.
Blocking of a blood vessel by an embolus which can be a blood clot or other undissolved material in the blood stream.
A condition in which the RIGHT VENTRICLE of the heart was functionally impaired. This condition usually leads to HEART FAILURE or MYOCARDIAL INFARCTION, and other cardiovascular complications. Diagnosis is made by measuring the diminished ejection fraction and a depressed level of motility of the right ventricular wall.
The hemodynamic and electrophysiological action of the left HEART VENTRICLE. Its measurement is an important aspect of the clinical evaluation of patients with heart disease to determine the effects of the disease on cardiac performance.
Pathological conditions involving the HEART including its structural and functional abnormalities.
The amount of BLOOD pumped out of the HEART per beat, not to be confused with cardiac output (volume/time). It is calculated as the difference between the end-diastolic volume and the end-systolic volume.
Obstruction of a blood vessel (embolism) by a blood clot (THROMBUS) in the blood stream.
The circulation of blood through the CORONARY VESSELS of the HEART.
Impaired conduction of cardiac impulse that can occur anywhere along the conduction pathway, such as between the SINOATRIAL NODE and the right atrium (SA block) or between atria and ventricles (AV block). Heart blocks can be classified by the duration, frequency, or completeness of conduction block. Reversibility depends on the degree of structural or functional defects.
Levels within a diagnostic group which are established by various measurement criteria applied to the seriousness of a patient's disorder.
Hospital department responsible for the administration and provision of immediate medical or surgical care to the emergency patient.
Agents that prevent fibrinolysis or lysis of a blood clot or thrombus. Several endogenous antiplasmins are known. The drugs are used to control massive hemorrhage and in other coagulation disorders.
Use or insertion of a tubular device into a duct, blood vessel, hollow organ, or body cavity for injecting or withdrawing fluids for diagnostic or therapeutic purposes. It differs from INTUBATION in that the tube here is used to restore or maintain patency in obstructions.
Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques.
The confinement of a patient in a hospital.
Use of a balloon catheter for dilation of an occluded artery. It is used in treatment of arterial occlusive diseases, including renal artery stenosis and arterial occlusions in the leg. For the specific technique of BALLOON DILATION in coronary arteries, ANGIOPLASTY, BALLOON, CORONARY is available.
The number of new cases of a given disease during a given period in a specified population. It also is used for the rate at which new events occur in a defined population. It is differentiated from PREVALENCE, which refers to all cases, new or old, in the population at a given time.
Statistical models which describe the relationship between a qualitative dependent variable (that is, one which can take only certain discrete values, such as the presence or absence of a disease) and an independent variable. A common application is in epidemiology for estimating an individual's risk (probability of a disease) as a function of a given risk factor.
A device that substitutes for a heart valve. It may be composed of biological material (BIOPROSTHESIS) and/or synthetic material.
A method of studying a drug or procedure in which both the subjects and investigators are kept unaware of who is actually getting which specific treatment.
Counterpulsation in which a pumping unit synchronized with the patient's electrocardiogram rapidly fills a balloon in the aorta with helium or carbon dioxide in early diastole and evacuates the balloon at the onset of systole. As the balloon inflates, it raises aortic diastolic pressure, and as it deflates, it lowers aortic systolic pressure. The result is a decrease in left ventricular work and increased myocardial and peripheral perfusion.
The circulation of blood through the BLOOD VESSELS of the BRAIN.
The veins and arteries of the HEART.
Works about pre-planned studies of the safety, efficacy, or optimum dosage schedule (if appropriate) of one or more diagnostic, therapeutic, or prophylactic drugs, devices, or techniques selected according to predetermined criteria of eligibility and observed for predefined evidence of favorable and unfavorable effects. This concept includes clinical trials conducted both in the U.S. and in other countries.
Age as a constituent element or influence contributing to the production of a result. It may be applicable to the cause or the effect of a circumstance. It is used with human or animal concepts but should be differentiated from AGING, a physiological process, and TIME FACTORS which refers only to the passage of time.
A measurement of the time needed for FIBRINOLYSIS to occur.
A measure of the quality of health care by assessment of unsuccessful results of management and procedures used in combating disease, in individual cases or series.
Non-invasive method of vascular imaging and determination of internal anatomy without injection of contrast media or radiation exposure. The technique is used especially in CEREBRAL ANGIOGRAPHY as well as for studies of other vascular structures.
The use of focused, high-frequency sound waves to produce local hyperthermia in certain diseased or injured parts of the body or to destroy the diseased tissue.
Factors that can cause or prevent the outcome of interest, are not intermediate variables, and are not associated with the factor(s) under investigation. They give rise to situations in which the effects of two processes are not separated, or the contribution of causal factors cannot be separated, or the measure of the effect of exposure or risk is distorted because of its association with other factors influencing the outcome of the study.
A method of computed tomography that uses radionuclides which emit a single photon of a given energy. The camera is rotated 180 or 360 degrees around the patient to capture images at multiple positions along the arc. The computer is then used to reconstruct the transaxial, sagittal, and coronal images from the 3-dimensional distribution of radionuclides in the organ. The advantages of SPECT are that it can be used to observe biochemical and physiological processes as well as size and volume of the organ. The disadvantage is that, unlike positron-emission tomography where the positron-electron annihilation results in the emission of 2 photons at 180 degrees from each other, SPECT requires physical collimation to line up the photons, which results in the loss of many available photons and hence degrades the image.
Time schedule for administration of a drug in order to achieve optimum effectiveness and convenience.
A non-invasive technique using ultrasound for the measurement of cerebrovascular hemodynamics, particularly cerebral blood flow velocity and cerebral collateral flow. With a high-intensity, low-frequency pulse probe, the intracranial arteries may be studied transtemporally, transorbitally, or from below the foramen magnum.
An enzyme formed from PROTHROMBIN that converts FIBRINOGEN to FIBRIN.
The largest of the cerebral arteries. It trifurcates into temporal, frontal, and parietal branches supplying blood to most of the parenchyma of these lobes in the CEREBRAL CORTEX. These are the areas involved in motor, sensory, and speech activities.
Ultrasonic recording of the size, motion, and composition of the heart and surrounding tissues. The standard approach is transthoracic.
The period of confinement of a patient to a hospital or other health facility.
An imbalance between myocardial functional requirements and the capacity of the CORONARY VESSELS to supply sufficient blood flow. It is a form of MYOCARDIAL ISCHEMIA (insufficient blood supply to the heart muscle) caused by a decreased capacity of the coronary vessels.
The part of CENTRAL NERVOUS SYSTEM that is contained within the skull (CRANIUM). Arising from the NEURAL TUBE, the embryonic brain is comprised of three major parts including PROSENCEPHALON (the forebrain); MESENCEPHALON (the midbrain); and RHOMBENCEPHALON (the hindbrain). The developed brain consists of CEREBRUM; CEREBELLUM; and other structures in the BRAIN STEM.
The treatment of a disease or condition by several different means simultaneously or sequentially. Chemoimmunotherapy, RADIOIMMUNOTHERAPY, chemoradiotherapy, cryochemotherapy, and SALVAGE THERAPY are seen most frequently, but their combinations with each other and surgery are also used.
Surgical therapy of ischemic coronary artery disease achieved by grafting a section of saphenous vein, internal mammary artery, or other substitute between the aorta and the obstructed coronary artery distal to the obstructive lesion.
Unstable isotopes of thallium that decay or disintegrate emitting radiation. Tl atoms with atomic weights 198-202, 204, and 206-210 are thallium radioisotopes.
Naturally occurring or experimentally induced animal diseases with pathological processes sufficiently similar to those of human diseases. They are used as study models for human diseases.
Univalent antigen-binding fragments composed of one entire IMMUNOGLOBULIN LIGHT CHAIN and the amino terminal end of one of the IMMUNOGLOBULIN HEAVY CHAINS from the hinge region, linked to each other by disulfide bonds. Fab contains the IMMUNOGLOBULIN VARIABLE REGIONS, which are part of the antigen-binding site, and the first IMMUNOGLOBULIN CONSTANT REGIONS. This fragment can be obtained by digestion of immunoglobulins with the proteolytic enzyme PAPAIN.
The attachment of PLATELETS to one another. This clumping together can be induced by a number of agents (e.g., THROMBIN; COLLAGEN) and is part of the mechanism leading to the formation of a THROMBUS.
A hypoperfusion of the BLOOD through an organ or tissue caused by a PATHOLOGIC CONSTRICTION or obstruction of its BLOOD VESSELS, or an absence of BLOOD CIRCULATION.
The utilization of drugs as reported in individual hospital studies, FDA studies, marketing, or consumption, etc. This includes drug stockpiling, and patient drug profiles.
The domestic dog, Canis familiaris, comprising about 400 breeds, of the carnivore family CANIDAE. They are worldwide in distribution and live in association with people. (Walker's Mammals of the World, 5th ed, p1065)
Any disturbances of the normal rhythmic beating of the heart or MYOCARDIAL CONTRACTION. Cardiac arrhythmias can be classified by the abnormalities in HEART RATE, disorders of electrical impulse generation, or impulse conduction.
Binary classification measures to assess test results. Sensitivity or recall rate is the proportion of true positives. Specificity is the probability of correctly determining the absence of a condition. (From Last, Dictionary of Epidemiology, 2d ed)
Procedures for finding the mathematical function which best describes the relationship between a dependent variable and one or more independent variables. In linear regression (see LINEAR MODELS) the relationship is constrained to be a straight line and LEAST-SQUARES ANALYSIS is used to determine the best fit. In logistic regression (see LOGISTIC MODELS) the dependent variable is qualitative rather than continuously variable and LIKELIHOOD FUNCTIONS are used to find the best relationship. In multiple regression, the dependent variable is considered to depend on more than a single independent variable.
The condition of an anatomical structure's being constricted beyond normal dimensions.
Patterns of practice related to diagnosis and treatment as especially influenced by cost of the service requested and provided.
A diagnostic technique that incorporates the measurement of molecular diffusion (such as water or metabolites) for tissue assessment by MRI. The degree of molecular movement can be measured by changes of apparent diffusion coefficient (ADC) with time, as reflected by tissue microstructure. Diffusion MRI has been used to study BRAIN ISCHEMIA and tumor response to treatment.
Devices that provide support for tubular structures that are being anastomosed or for body cavities during skin grafting.
The qualitative or quantitative estimation of the likelihood of adverse effects that may result from exposure to specified health hazards or from the absence of beneficial influences. (Last, Dictionary of Epidemiology, 1988)
Branch of the common carotid artery which supplies the anterior part of the brain, the eye and its appendages, the forehead and nose.
Assessment of sensory and motor responses and reflexes that is used to determine impairment of the nervous system.
A selective adrenergic beta-1 blocking agent that is commonly used to treat ANGINA PECTORIS; HYPERTENSION; and CARDIAC ARRHYTHMIAS.

Optimal thrombolytic strategies for acute myocardial infarction--bolus administration. (1/2653)

Optimal strategies for thrombolysis in myocardial infarction (TIMI) are still being sought because the TIMI 3 flow rates achievable using standard regimens average approximately 60%. Double bolus administration of recombinant tissue plasminogen activator (tPA) is a novel approach with potential for earlier patency combined with ease of administration. We reviewed total patency rates, TIMI 3 patency rates, mortality, stroke and intracranial haemorrhage rates in the major trials of accelerated infusion tPA/bolus tPA/reteplase in acute myocardial infarction. A direct comparison was performed with results of two recent trials of double bolus (two 50 mg boli, 30 min apart) vs. accelerated infusion tPA: the Double Bolus Lytic Efficacy Trial (DBLE), an angiographic study, and the COBALT Trial, a mortality study. The DBLE trial showed equivalent patency rates for accelerated infusion and double bolus administration of tPA. Reviewing other angiographic trials, total patency and TIMI 3 patency rates achievable with double bolus tPA were comparable to those with accelerated infusion tPA or bolus reteplase administration. The COBALT study demonstrated a 30-day mortality of 7.53% in patients treated with accelerated infusion tPA compared with 7.98% for double bolus tPA treated patients. The small excess in mortality with double bolus treatment was confined to the elderly; in those < or = 75 years, mortality rates were 5.6% and 5.7%, for double bolus and accelerated infusion, respectively, and rates for death or non-fatal stroke were 6.35% and 6.3%, respectively. Comparison with other trials demonstrated mortality, stroke and intracranial haemorrhage rates with double bolus treatment similar to those associated with either accelerated infusion tPA or bolus reteplase treatment. Double bolus administration of tPA to patients with acute myocardial infarction is associated with total patency, TIMI 3 patency, mortality, stroke and intracranial haemorrhage rates similar to those associated with either accelerated infusion of tPA or bolus reteplase.  (+info)

Age-related outcome for peripheral thrombolysis. (2/2653)

OBJECTIVES: To investigate the age-related outcome of peripheral thrombolysis and determine for which patient group this treatment is worthwhile. DESIGN AND METHODS: A combined retrospective and prospective analysis of consecutive patients undergoing thrombolysis for acute lower-limb ischaemia was made with respect to age-related outcome and other risk factors. RESULTS: One hundred and two patients underwent thrombolysis for acute limb ischaemia. In the under 60 age group there was a 40% amputation rate. Seventy-three per cent of this group smoked. In the over 80 age group, the amputation rate was 15% and only 8% were smokers. CONCLUSION: Advancing age is not an adverse risk factor for thrombolysis which appears to be safe and effective in this patient group. There is a high incidence of smoking in the younger age group (< 60 years), in whom failed thrombolysis frequently leads to amputation.  (+info)

Delayed increase in infarct volume after cerebral ischemia: correlations with thrombolytic treatment and clinical outcome. (3/2653)

BACKGROUND AND PURPOSE: Growing experimental evidence indicates that the development of cerebral ischemic damage is slower than previously believed. The aims of this work were (1) to study the evolution of CT hypoattenuation between 24 to 36 hours and 7 days in ischemic stroke patients; (2) to evaluate whether thrombolytic treatment given within 6 hours of stroke affects delayed infarction evolution; and (3) to investigate possible correlations between lesion volume changes over time and clinical outcome. METHODS: Of 620 patients included in the European Cooperative Acute Stroke Study 1 (ECASS1), we selected 450 patients whose control CT scans at day 1 (CT1) and day 7 (CT7) were available. They had been randomly divided into 2 groups: 206 patients had been treated with rtPA and 244 with placebo. CT1 and CT7 were classified according to the location of the infarct. The volume of CT hypoattenuation was measured using the formula AxBxC/2 for irregular volumes. The 95% confidence interval of inter- and intrarater variability was used to determine whether significant changes in lesion volume had occurred between CT1 and CT7. Clinical severity was evaluated by means of the Scandinavian Stroke Scale (SSS) at entry (SSS0) and at day 30 (SSS30). RESULTS: Mean lesion volumes were significantly (P<0.0001) higher at day 7 than at day 1 in all the subgroups of patients and particularly in patients with a subcortical lesion. Of the 450 patients studied, 287 (64%) did not show any significant change in lesion volume between CT1 and CT7, 143 (32%) showed a significant increase and the remaining 20 (4%) a significant decrease. No significant correlation was observed between treatment and lesion evolution between CT1 and CT7. Both clinical scores (SSS0 and SSS30) and degree of neurological recovery were significantly (P<0.05) lower in the subgroup of patients with a significant lesion volume increase than in the other 2 groups. CONCLUSIONS: In approximately two thirds of patients, infarct size is established 24 to 36 hours after stroke onset, whereas in the remaining one third, changes in lesion volume may occur later than the first 24 to 36 hours. Many factors may be responsible for delayed infarct enlargement and for a lower degree of clinical recovery, both of which may occur despite early recombinant tissue plasminogen activator treatment.  (+info)

Thrombolysis with tissue plasminogen activator alters adhesion molecule expression in the ischemic rat brain. (4/2653)

BACKGROUND AND PURPOSE: We tested the hypothesis that treatment of embolic stroke with recombinant human tissue plasminogen activator (rhtPA) alters cerebral expression of adhesion molecules. METHODS: Male Wistar rats were subjected to middle cerebral artery occlusion by a single fibrin-rich clot. P-selectin, E-selectin, and intercellular adhesion molecule-1 (ICAM-1) immunoreactivity was measured at 6 or 24 hours after embolic stroke in control rats and in rats treated with rhtPA at 1 or 4 hours after stroke. To examine the therapeutic efficacy of combined rhtPA and anti-ICAM-1 antibody treatment at 4 hours after embolization, ischemic lesion volumes were measured in rats treated with rhtPA alone, rats treated with rhtPA and anti-ICAM-1 antibody, and nontreated rats. RESULTS: Administration of rhtPA at 1 hour after embolization resulted in a significant reduction of adhesion molecule vascular immunoreactivity after embolization in the ipsilateral hemisphere compared with corresponding control rats. However, when rhtPA was administered to rats at 4 hours after embolization, significant increases of adhesion molecule immunoreactivity in the ipsilateral hemisphere were detected. A significant increase of ICAM-1 immunoreactivity was also detected in the contralateral hemisphere at 24 hours after ischemia. A significant reduction in lesion volume was found in rats treated with the combination of rhtPA and anti-ICAM-1 antibody compared with rats treated only with rhtPA. CONCLUSIONS: The present study suggests that the time of initiation of thrombolytic therapy alters vascular immunoreactivity of inflammatory adhesion molecules in the ischemic brain and that therapeutic benefit can be obtained by combining rhtPA and anti-ICAM-1 antibody treatment 4 hours after stroke.  (+info)

Carotid endarterectomy and intracranial thrombolysis: simultaneous and staged procedures in ischemic stroke. (5/2653)

PURPOSE: The feasibility and safety of combining carotid surgery and thrombolysis for occlusions of the internal carotid artery (ICA) and the middle cerebral artery (MCA), either as a simultaneous or as a staged procedure in acute ischemic strokes, was studied. METHODS: A nonrandomized clinical pilot study, which included patients who had severe hemispheric carotid-related ischemic strokes and acute occlusions of the MCA, was performed between January 1994 and January 1998. Exclusion criteria were cerebral coma and major infarction established by means of cerebral computed tomography scan. Clinical outcome was assessed with the modified Rankin scale. RESULTS: Carotid reconstruction and thrombolysis was performed in 14 of 845 patients (1.7%). The ICA was occluded in 11 patients; occlusions of the MCA (mainstem/major branches/distal branch) or the anterior cerebral artery (ACA) were found in 14 patients. In three of the 14 patients, thrombolysis was performed first, followed by carotid enarterectomy (CEA) after clinical improvement (6 to 21 days). In 11 of 14 patients, 0.15 to 1 mIU urokinase was administered intraoperatively, ie, emergency CEA for acute ischemic stroke (n = 5) or surgical reexploration after elective CEA complicated by perioperative intracerebral embolism (n = 6). Thirteen of 14 intracranial embolic occlusions and 10 of 11 ICA occlusions were recanalized successfully (confirmed with angiography or transcranial Doppler studies). Four patients recovered completely (Rankin 0), six patients sustained a minor stroke (Rankin 2/3), two patients had a major stroke (Rankin 4/5), and two patients died. In one patient, hemorrhagic transformation of an ischemic infarction was detectable postoperatively. CONCLUSION: Combining carotid surgery with thrombolysis (simultaneous or staged procedure) offers a new therapeutic approach in the emergency management of an acute carotid-related stroke. Its efficacy should be evaluated in interdisciplinary studies.  (+info)

The surgical management of acute limb ischaemia due to native vessel occlusion. (6/2653)

OBJECTIVES: Data from the STILE study have indicated that for patients with subacute limb ischaemia due to native vessel occlusion, surgery is both more effective, and durable than thrombolysis. The purpose of this study was to evaluate the outcome of an aggressive surgical approach in patients presenting with acute limb-threatening ischaemia. DESIGN: Details of patients presenting with salvageable acute limb ischaemia due to native artery occlusion over a 6-year period in a University hospital vascular unit setting were obtained from the vascular audit and the outcome of the surgical management of these patients was analysed. RESULTS: One hundred and seventy-four consecutive patients underwent surgery for acute native vessel limb ischaemia (76% lower, 24% upper limb). Fogarty thrombectomy or embolectomy was initially performed in 153 (89%) patients. Of these, 37 (24%) immediately underwent a further procedure: 28 (18%) had on-table thrombolysis and 14 (9%) underwent vascular reconstruction. Twenty-six patients (15%) underwent further limb salvage surgery within 30 days. Life table analysis demonstrated a limb salvage rate of 88% and 76% at 30 days and 2 years, respectively. Patient survival was 75% and 48% at the same time intervals. CONCLUSIONS: These results demonstrate that a role for aggressive surgical intervention still exists, resulting in high limb salvage rates.  (+info)

Recombinant soluble form of PSGL-1 accelerates thrombolysis and prevents reocclusion in a porcine model. (7/2653)

BACKGROUND: We investigated whether administration of a soluble recombinant P-selectin glycoprotein ligand-1 chimera (rPSGL-Ig) in conjunction with thrombolytic therapy would enhance thrombolysis by preventing ongoing interactions of leukocytes with platelets and the injured arterial wall. METHODS AND RESULTS: An occlusive thrombus was formed in an internal iliac artery of Yorkshire pigs by placement of a copper coil in the artery under fluoroscopic guidance. Pigs then received heparin and, 15 minutes later, either vehicle or rPSGL-Ig followed by infusion with 25 mg tissue plasminogen activator according to the 90-minute regimen. Blood flow through the artery was monitored by angiography and scored on a scale of 0 to 3. Lysis of the thrombus was accelerated by 70% in pigs treated with rPSGL-Ig 250 microg/kg compared with control (13.3+/-5.0 versus 44. 4+/-13.3 minutes; n=9 each). Eight of 9 control pigs reoccluded in 13.8+/-16.9 minutes after the end of tissue plasminogen activator infusion, whereas no reocclusion was observed in 8 of 9 pigs in the rPSGL-Ig group. When the dose of rPSGL-Ig was increased to 500 microg/kg, time to lysis was shortened by 61% from control (18.0+/-8. 4 versus 46.0+/-8.9 minutes). Reocclusion occurred in 6.0+/-15.2 minutes in control but not in any rPSGL-Ig-treated pig (n=5 each). In addition, near-normal flow (score 2 or 3) after thrombolysis was achieved 59% and 58% faster in the 2 rPSGL-Ig groups than in their respective controls. CONCLUSIONS: Inhibition of leukocyte accumulation at the site of thrombosis with rPSGL-Ig may represent a safe therapeutic intervention that could be important in accelerating thrombolysis, achieving optimal reperfusion, and reducing incidence of acute reocclusion.  (+info)

Primary angioplasty versus systemic thrombolysis in anterior myocardial infarction. (8/2653)

OBJECTIVES: This study compares the efficacy of primary angioplasty and systemic thrombolysis with t-PA in reducing the in-hospital mortality of patients with anterior AMI. BACKGROUND: Controversy still exists about the relative benefit of primary angioplasty over thrombolysis as treatment for AMI. METHODS: Two-hundred and twenty patients with anterior AMI were randomly assigned in our institution to primary angioplasty (109 patients) or systemic thrombolysis with accelerated t-PA (111 patients) within the first five hours from the onset of symptoms. RESULTS: Baseline characteristics were similar in both groups. Primary angioplasty was independently associated with a lower in-hospital mortality (2.8% vs. 10.8%, p = 0.02, adjusted odds ratio 0.23, 95% confidence interval 0.06 to 0.85). During hospitalization, patients treated by angioplasty had a lower frequency of postinfarction angina or positive stress test (11.9% vs. 25.2%, p = 0.01) and less frequently underwent percutaneous or surgical revascularization after the initial treatment (22.0% vs. 47.7%, p < 0.001) than did patients treated by t-PA. At six month follow-up, patients treated by angioplasty had a lower cumulative rate of death (4.6% vs. 11.7%, p = 0.05) and revascularization (31.2% vs. 55.9%, p < 0.001) than those treated by t-PA. CONCLUSIONS: In centers with an experienced and readily available interventional team, primary angioplasty is superior to t-PA for the treatment of anterior AMI.  (+info)

Total volume of stroke admissions per stroke service was not an independent predictor of mean thrombolysis rate nor of mean DNT. For the year of 2012 we also found no significant relationship between volume of stroke admissions and mean thrombolysis rates or mean DNT, when corrected for age, gender and type of hospital. There was a trend, towards higher thrombolysis rates in larger centers. When looking at the relationship between volume and DNT there seems to be a weak but significant relationship. Significance disappears when correction is used for age, gender and type of hospital. Interestingly, academic centers had higher thrombolysis rates, and lower DNTs together with non-academic referral centers, as compared to regional hospitals. So, even though there is a trend suggesting that larger volumes account for better results, this by no means reaches statistical significance, but organisational issues play a role in these process measures. This finding is in line with many previous studies ...
Graded exercise testing following thrombolytic therapy for acute myocardial infarction: the importance of timing and infarct location. TPAT Study Group.
TY - JOUR. T1 - The relationship of intracoronary stent placement following thrombolytic therapy to tissue level perfusion. AU - Gibson, C. M.. AU - Frisch, D.. AU - Murphy, S. A.. AU - Gourlay, S. G.. AU - Gibbons, Raymond J. AU - Baran, K. W.. AU - Nguyen, M.. AU - Palmeri, S.. AU - Barron, H. V.. PY - 2002. Y1 - 2002. N2 - Background: Stenting has been shown to improve lumen diameters and thereby improve epicardial blood flow, but the impact of stent placement on tissue level perfusion has not been well characterized. Methods: Data were drawn from the LIMIT trial of rhuMAb CD18 (anti WBC antibody) in acute myocardial infarction (AMI). Adjunctive/rescue stenting was performed at the discretion of the investigator. The TIMI Myocardial Perfusion Grade (TMPG) was assessed and digital subtraction angiography (DSA) was used to quantify brightness of the myocardial blush. Results: TIMI 3 flow was 54.2% (64/118) before stent placement, and improved to 87.2% (102/117, p , 0.001) following stent ...
Computed tomography scan following thrombolytic therapy. (A) Reperfusion of the branches of the (A) right and (B) left pulmonary arteries. (C) Normalization of
We believe that this study is the first that has used a case-control series to compare prehospital with in-hospital thrombolytic therapy. Although our study contains relatively small numbers and could not be expected to provide the strength of evidence of a larger prospective randomised controlled trial, the phased development of delivery of prehospital thrombolytic therapy in Wyre Forest has allowed us to compare the time of treatment administration and examine the subsequent outcomes in two matched groups of patients.. In our series prehospital thrombolytic therapy resulted in much earlier delivery of treatment with a median time saving of 66 minutes, compared to thrombolytic therapy given after arrival in hospital. The results of previous randomised trials of thrombolytic therapy show an inverse relationship between the reduction in mortality and the length of time from onset of symptoms to treatment,6 and this has driven various approaches to try delivering treatment as early as possible. ...
Intravenous Thrombolytic Therapy clinics in France at the best price. Find doctors, specialized in Vascular Medicine and compare prices, costs and reviews.
TY - JOUR. T1 - CT patterns of intracranial hemorrhage complicating thrombolytic therapy for acute myocardial infarction. AU - Uglietta, J. P.. AU - OConnor, C. M.. AU - Boyko, O. B.. AU - Aldrich, H.. AU - Massey, E. W.. AU - Heinz, E. R.. PY - 1991/1/1. Y1 - 1991/1/1. N2 - Computed tomographic (CT) patterns of intracranial hemorrhage (ICH) were determined in 1,696 patients undergoing thrombolytic therapy for acute myocardial infarction. ICH occurred at 33 sites in 0.77% of patients (n = 13). Thirty-six percent of hemorrhages (n = 12) were intraparenchymal, 33% (n = 11) were subdural, 24% (n = 8) were subarachnoid, and 6% (n = 2) were intraventricular. Eighty-four percent (n = 26) of all nonventricular hemorrhages were supratentorial in location. The most common site of ICH was supratentorial and intraparenchymal (10 of 33). In 11 of the 13 patients with ICH, clinical symptoms occurred within 24 hours of the initiation of thrombolytic therapy. A fatal outcome resulted in three of the four ...
TY - JOUR. T1 - Use of CT angiography in patient selection for thrombolytic therapy. AU - Chuang, Yu Ming. AU - Chao, A. Ching. AU - Teng, Michael Mu Ho. AU - Wu, Hsiu Mei. AU - Lirng, Jiing Feng. AU - Wu, Zin An. AU - Chiang, Jen Huey. AU - Hu, Han Hwa. PY - 2003/1/1. Y1 - 2003/1/1. N2 - It has been shown that thrombolytic therapy can improve clinical outcome in some patients with acute cerebral ischemia. These patients have been reported to be characterized by certain clinical and imaging findings, mainly with non-contrast enhanced computed tomography (CT). Our purpose in this study was to find out whether CT angiography (CTA) information about the status of the cerebral vessels is helpful in the selection of patients who may benefit the most from thrombolytic therapy for acute cerebral ischemia. CTA was prospectively performed in 15 consecutive patients (6 women and 9 men; age range 44-83 years) with moderate or severe symptoms of hyperacute cerebral ischemia. The clinical manifestations of ...
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Catheterization-related strokes are rare (0.07% to 0.38%)1,2 and almost always are of embolic origin. Emboli can originate from dislodgement of material from plaque rupture, calcium from aortic cusps, or thrombus formation in the catheters or on the guides.3-5 Furthermore, the apposition of thrombus to the embolic material may be an important component of cerebral artery occlusion. Computed tomography scan and magnetic resonance imaging seem to be unnecessary because they do not add anything to the diagnosis and treatment. An immediate carotid angiogram to assess cerebral artery occlusion appears to be the best and least time-consuming approach. Hemorrhagic stroke can be recognized by extravasation or late persistence of contrast. Recent studies comparing intra-arterial and intravenous thrombolytic therapy in thromboembolic stroke have shown a higher rate of revascularization with intra-arterial thrombolysis.6,7 Previous trials have shown the safety and efficacy of intra-arterial thrombolysis ...
The patient was a 65-year-old man who had undergone AVR iSJM Regent:19 mm jfor AR in June 2007. Since March 2008 there had been an increase in the pressure gradient between the aorta and the left ventricle on transthoracic echocardiography ipeak PG:46mmHg, mean PG:27 mmHg). Plain x-ray films of the valve showed limited opening of the metallic valve. However, no symptoms of heart failure were observed on a physical examination. Blood tests performed in December 2007 showed a PT-INR value of 1.22. Since the effects of warfarin anticoagulant therapy were insufficient, its dose was adjusted on follow-up. An examination in June revealed further stenosis of the valve ipeak PG:93mmHg, mean PG:58 mmHg). Valve thrombosis was suspected because the condition was poorly controlled by warfarin. Thus, thrombolytic therapy using t-PA was performed i800,000 units). However, the patient complained of chest pain 1 h 30 min after initiation of thrombolytic therapy. Twelve-lead electrocardiography was performed, ...
The 2008 median cost of hospitalization for patients 65 years or older treated with intravenous thrombolysis was $13 802 for those with a good outcome, which does not compare favorably with the average 2008 Medicare payment of $10 098 for intravenous thrombolysis without (MS-DRG 063) complication. Similarly, the median hospital costs of $18 405 for patients with morbidity and $17 406 for patients with mortality do not compare favorably with the average 2008 Medicare payment of $13 835 for intravenous thrombolysis with major complication (MS-DRG 061).. Medicare reimbursements for hospitalization are based on the Diagnosis-Related Group (DRG) for the patient visit. Each admission is assigned one DRG, and under that DRG the hospital is paid a predetermined lump sum regardless of the costs associated with care. For example, if a patient was assigned the DRG 061 and the cost of care was $20 000, then the hospital would lose ≈$6000 for that patients care. The DRG system is in place to incentivize ...
The publication of large randomised trials such as ISIS 2 (1988) and AIMS (1990), provided striking evidence as to the effectiveness of thrombolytic therapy in reducing early mortality and morbidity in patients suffering acute myocardial infarction. This article will provide an overview of the use of thrombolytic agents in modern cardiac care, with particular reference to their impact on the Accident and Emergency department.. ...
Materials and Methods: Data of patients treated with IV rt-PA within 4.5 hours of symptom onset between March 2015 and January 2017 were retrospectively analyzed. Patients were divided into two groups; those with isolated MCA occlusion and those with no large vessel occlusion. Large vessel occlusion was detected with contrast-enhanced computed tomography angiography performed before IV rt-PA. Additionally, demographic and clinical data of the patients were analyzed. The clinical outcomes of the patients were determined using the modified Rankin Scale (mRS) score at 3 months after treatment ...
In GREAT, median call-to-needle times were 55 and 185 minutes for prehospital and hospital groups; 90% and 1% of measurements were ⩽ 90 minutes, respectively.1 In this audit, comprising many of the same practices that took part in the trial, the corresponding times were improved, at 45 minutes for prehospital thrombolysis, and 145 minutes for hospital thrombolysis. The improvement is most marked for the hospital group, where call-to-needle times were 40 minutes shorter in the audit than in the trial. This was largely owing to shortening of door-to-needle times in hospital, from 87 minutes in GREAT (estimated mean), to 35 minutes (median) in this audit.. Call-to-opiate times give an indication of the first opportunity for thrombolysis, which may be initiated about 15 minutes after opiate is given. In both prehospital and hospital groups, median call-to-opiate times were about half an hour.. In some rural areas of Scotland, thrombolytic treatment is given by general practitioners in community ...
Stroke is the third-leading cause of death in Taiwan that shows the importance of stroke treatment. Stroke is a severe injury of brain in a short time but its complications could last a very long time. The Stroke Center of Shuang Ho Hospital was formed in 2009, in order to provide state-of-art medical care of stroke around Jhonghe area. The Stroke Center of Shuang Ho Hospital, consists of a strong multi-discipline team, provides the medical services which combine with several specialties, such as Emergency medicine, Neurology, Neurosurgery, Neuroradiology, Rehabilitation and Pharmacy. In acute ischemic stroke, our intravenous thrombolytic therapy (IV tPA) door-to-needle time is around 60 minutes and our neuroradiology team could do intra-arterial thrombolytic therapy within one hour if needed. Stroke is an emergent condition. To improve the outcome of stroke, peoples awareness of diseases and an outstanding stroke team are both essential. Shung Ho Hospital stroke center is well-prepared to ...
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Suarez A, Rajdev S, Hillegass WB. Rescue angioplasty reduced cardiovascular and cerebrovascular outcomes in acute MI after failed thrombolytic therapy. ACP J Club. 2006;144:60. doi: 10.7326/ACPJC-2006-144-3-060. Download citation file:. ...
Background: Relatively limited information is available about recent, and trends over time, use of thrombolytic therapy in patients of different ages hospitalized with acute myocardial infarction and
Prehospital thrombolytic therapy for patients with suspected myocardial infarction is both feasible and safe when administered by well-equipped, well-trained mobile emergency medical staff. Although such therapy appears to reduce mortality from cardiac causes, our data do not definitely establish th …
We demonstrated that standard CT-CBV maps calculated with deconvolution can overestimate infarct core, but when CT-CBV maps are processed with algorithmically optimized delay-correction software, recovery of tissue with a low CBV is rare. Specifically, standard CT-CBV maps demonstrated abnormalities larger than final infarct volumes in 11/148 (7.4%) AIS patients treated with thrombolytic therapy. However, only 2 patients had delay-corrected CT-CBV abnormalities that were larger than final infarct volumes, and the decreases in lesion size were small. These findings correlate with reports demonstrating that final infarcts are rarely smaller than initial DWI abnormalities.3. Delayed tracer bolus arrival can be attributed to extracranial and intracranial factors. Extracranial factors include AF, CHF, and ICA stenosis. Intracranial causes include thrombus extent and poor collateralization. In patients with these factors who demonstrate a large CT-CBV defect, arterial, venous, and tissue curves ...
TY - JOUR. T1 - Failure of simple clinical measurements to predict perfusion status after intravenous thrombolysis. AU - Califf, R. M.. AU - ONeil, W.. AU - Stack, R. S.. AU - Aronson, L.. AU - Mark, D. B.. AU - Mantell, S.. AU - George, B. S.. AU - Candela, R. J.. AU - Kereiakes, D. J.. AU - Abbottsmith, C.. AU - Topol, E. J.. AU - ONeill, W. W.. AU - Walton, J. A.. AU - Bates, E. R.. AU - Ellis, S. G.. AU - Bourdillon, P. D V. AU - Schork, M. A.. AU - Kline, E.. PY - 1988/1/1. Y1 - 1988/1/1. N2 - To determine whether coronary patency could be detected early during thrombolytic therapy, commonly used markers of perfusion were recorded in 386 patients with acute myocardial infarction treated with tissue plasminogen activator. Infarct artery angiography 90 minutes after initiation of therapy was used to determine perfusion status. Of patients with complete resolution of ST segment elevation before the angiogram, 96% (95% confidence interval, 79% to 100%) showed perfusion on the angiogram, and ...
OBJECTIVE--To determine whether concomitant treatment with intravenous heparin affects coronary patency and outcome in patients treated with alteplase thrombolysis for acute myocardial infarction. DESIGN--Double blind randomised trial. TREATMENT REGIMENS--Alteplase 100 mg (not weight adjusted) plus aspirin (250 mg intravenously followed by 75-125 mg on alternate days) plus heparin (5000 units intravenously followed by 1000 units hourly without dose adjustment) was compared with alteplase plus aspirin plus placebo for heparin. SETTING--19 cardiac centres in six European countries. SUBJECTS--652 patients aged 21-70 years with clinical and electrocardiographic features of infarcting myocardium in whom thrombolytic therapy could be started within six hours of the onset of major symptoms. MAIN OUTCOME MEASURE--Angiographic coronary patency 48-120 hours after randomisation. RESULTS--Coronary patency (TIMI grades 2 or 3) was 83.4% in the heparin group and 74.7% in the group given placebo for heparin. ...
Stroke is the leading cause of adult long-term disability in the United States and the third leading cause of death, following heart disease and cancer. The outcome of ischemic stroke is generally determined by the natural course with applied supportive methods. The use of tissue plasminogen activator (tPA) is an effort to intervene in this natural progression to disability and death.. Osborn and associates reviewed the large trials of thrombolytic therapy in the treatment of patients with ischemic stroke. A previous meta-analysis of several trials of thrombolytic therapy demonstrated a higher risk of mortality in patients who received thrombolytic therapy than in patients who did not, but individual study variations make this conclusion questionable. Careful examination of individual thrombolytic trials to discern differences might indicate a particularly beneficial treatment protocol. Specific parameters from the studies include (1) thrombolytic agent administered, (2) interpretation of ...
Thrombolytic therapy is the use of drugs to break up or dissolve blood clots, which are the main cause of both heart attacks and stroke.
Abstract: PURPOSE: 1) To identify the time taken from symptom onset to the arrival at the hospital (pre-hospital delay time) and time taken from the arrival at the hospital to the initiation of the major treatment (in-hospital delay time) 2) to examine whether rapid treatment results in lower mortality. 3) to examine whether the pre- and in-hospital delay time can independently predict in-hospital mortality. METHODS: A retrospective study with 586 consecutive AMI patients was conducted. RESULTS: Pre-hospital delay time was 5.25 (SD=10.36), and in-hospital delay time was 1.10 (SD=1.00) hours for the thrombolytic therapy and 50.24 (SD=121.18) hours for the percutaneous transluminal coronary angioplasty(PTCA). In-hospital mortality was the highest when the patients were treated between 4 to 48 hours after symptom onset using PTCA (rho=.02), and when treated between 30 minutes and one hour after hospital arrival using thrombolytics (rho=.01). Using a hierarchical logistic regression model, the pre- ...
Overview of Treatment Options IV thrombolytic therapy (0-3 hrs) IV thrombolytic therapy (3-4.5 hrs) IA thrombolytic therapy Endovascular mechanical thrombectomy (Merci, Penumbra, Solitaire, etc.) Balloon angioplasty with stenting Anti-platelet agents for non-thrombolytic Rx Anticoagulants for atrial fibrillation
There is an unmet medical need to improve thrombolytic therapy in acute peripheral arterial occlusion (PAO). Currently used plasminogen activators can result in increased circulating levels of plasmin that result in a systemic lytic state that does not distinguish between physiologic and pathologic thrombosis. In general, mean plasminogen activator infusion durations of greater than 24 hours in order to achieve successful thrombolysis are problematic in a disease where delayed restoration of arterial flow can lead to irreversible ischemic damage. A direct thrombolytic agent like alfimeprase, with a rapid mechanism of action and a potentially safer bleeding risk profile, could facilitate a rapid restoration of arterial flow and avoidance of open vascular surgery ...
Selection of Patients for Systemic Thrombolysis in Pulmonary Embolism (PE). Selecting the correct patient for systemic thrombolysis necessitates a thorough assessment of the patients preexisting comorbidities, mode of presentation and focused clinical examination to assess the immediate risk of hemodynamic collapse, the risk of long term complications, and the risk of major bleeding associated with the thrombolytic agent. As described above, high-risk PE patients warrant strong consideration of aggressive treatment options, including systemic thrombolysis with a high incidence of adverse outcomes if not instituted expediently. In patients who present with acute high-risk PE, the risk of mortality is high which makes the decision for systemic thrombolysis relatively easier as compared to the people who are hemodynamically stable. The case fatality of these hemodynamically unstable patients ranges from 35% to 58%. Therefore, benefits clearly outweigh the risk of adverse outcomes in the grand ...
BACKGROUND:. Since the advent of thrombolytic therapy, early treatment holds particular promise for decreasing mortality from coronary heart disease. Thrombolytic therapy can reduce mortality by 25 percent for patients treated within the first few hours of AMI symptoms, with greater benefit the earlier the treatment. Not everyone who could benefit from receiving thrombolytic therapy receives such therapy. One contributing factor is that many people with symptoms do not seek emergency care in a timely manner. Studies show substantial delay times from AMI symptoms to hospital arrival, with means ranging from 4.6 to 24 hours and medians from 2 to 6.4 hours. EMS transport time is estimated to average 7 to 22 minutes, so a large portion of pre-hospital delay is attributable to patient recognition and action. Several factors have been associated with delay time. Sudden onset pain is associated with shorter delay times, and older age, female gender, African-American race, consultation with others about ...
BACKGROUND: Thrombolytic drugs may dissolve blood vessel clots in acute ischemic stroke. The overall benefit of intravenous thrombolysis is substantial, but up to 2/3 of patients with large clots may not achieve re-opening of the vessel and up to 40% of the patients may remain severely disabled or die. Ultrasound accelerates clot break-up (lysis) when combined with thrombolysis (sonothrombolysis) and increases the likelihood of functional independence at 3 months. Adding intravenous ultrasound contrast (gaseous microspheres) further enhances the thrombolytic effect (contrast enhanced sonothrombolysis = CEST). Contrast enhanced ultrasound may also accelerate clot break-up in the absence of thrombolytic drugs (contrast enhanced sonolysis = CES ...
The purpose of this course is to increase clinicians knowledge of thrombolytic medications so that they can identify the optimal therapy and safely use these medications.
Jackson, D., Earnshaw, S., Farkouh, R. A., & Schwamm, L. H. (2010, May). Cost-effectiveness of Perfusion Imaging With Computed Tomography to Identify Patients for Intravenous Thrombolysis: A Hospital Perspective. Presented at ISPOR 15th Annual International Meeting, .. ...
How early one can shift a patient for rescue PCI after failed thrombolysis ? Wait for at-least 24 hours. A minimum cool off period of 2 hours is required. It is never an issue . Rush the patient immediately to cath lab The question does not arise . Often times , rescue PCI is a…
Indications,ref,ACLS Training Center. Fibrinolytic Checklist for STEMI. https://www.acls.net/images/algo-fibrinolytic.pdf,/ref,,ref,Rivera-Bou WL et al. Thrombolytic therapy for acute myocardial infarction. Dec 08, 2015. http://emedicine.medscape.com/article/811234-overview*a3.,/ref ...
DALLAS - The use of thrombolytics before angioplasty or stenting offers no benefit and appears to increase the risk of heart attacks, strokes, or death.
The role of thrombolytic therapy for the treatment of pulmonary embolism has been unclear, as it has been difficult to measure the precise balance between enhanced clot-dissolving efficacy and greater bleeding risk produced by thrombolysis when compared with conventional anticoagulation. A new meta-analysis published in JAMA analyzed data from 16 randomized trials including 2115 patients. Overall, […]. ...
Effect of the use of ambulance-based thrombolysis on time to thrombolysis in acute ischemic stroke: a randomized clinical trial. Ebinger M, Winter B, Wendt M, Weber JE, Waldschmidt C, Rozanski M, Kunz A, Koch P, Kellner PA, Gierhake D, Villringer K, Fiebach JB, Grittner U, Hartmann A, Mackert BM, Endres M, Audebert HJ; STEMO Consortium. JAMA. 2014 Apr 23-30;311(16):1622-31. doi: 10.1001/jama.2014.2850. PMID: ...
Time is muscle .This may sound as an old fashioned statement now , for many of us. But the fact remains. Every minute following STEMI , myocytes keep losing its life one by one unless , the intervened. The prevention of myocyte death can be accomplished by three ways By early thrombolysis By Primary angioplasty…
Ade-Ajayi, N.; Hall, N.J.; Liesner, R.; Kiely, E.M.; Pierro, A.; Roebuck, D.J.; Drake, D.P., 2008: Acute neonatal arterial occlusion: is thrombolysis safe and effective?
although thrombolysis is usually successful, the treatment is not able to dissolve the blood clot in up to 25% of patients. another 12% of patients subsequently redevelop the clot or blockage in the b
Wilmshurst, P, Purchase, A, Webb, C, Jowett, C and Quinn, T (2000) Reducing door-to-needle time by nurse-initiated thrombolysis. ...
TY - JOUR. T1 - Antithrombotic and thrombolytic therapy for ischemic stroke. T2 - The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. AU - Albers, Gregory W.. AU - Amarenco, Pierre. AU - Easton, J. Donald. AU - Sacco, Ralph L. AU - Teal, Philip. PY - 2004/9/1. Y1 - 2004/9/1. N2 - This chapter about treatment and prevention of stroke is part of the 7th ACCP Conference on Antithrombotic and Thrombolytic Therapy: Evidence Based Guidelines. Grade 1 recommendations are strong and indicate that the benefits do, or do not, outweigh risks, burden, and costs. Grade 2 suggests that individual patients values may lead to different choices (for a full understanding of the grading see Guyatt et al). Among the key recommendations in this chapter are the following: For patients with acute ischemic stroke (AIS), we recommend administration of IV tissue plasminogen activator (tPA), if treatment is initiated within 3 h of clearly defined symptom onset (Grade 1A). For patients with extensive ...
TY - JOUR. T1 - Thrombolytic treatment of acute ischemic stroke. AU - Meschia, James F. AU - Miller, David A.. AU - Brott, Thomas G. PY - 2002. Y1 - 2002. N2 - Intravenous recombinant tissue-type plasminogen activator is approved by the US Food and Drug Administration for treating acute ischemic stroke within 3 hours of onset of symptoms. Initiation of thrombolysis within 90 minutes of onset of symptoms is a treatment goal supported by current studies. Postmarketing data suggest that the risk of intracranial hemorrhage may be unacceptably high when recombinant tissue-type plasminogen activator is given to patients who would not have been eligible for enrollment in the pivotal phase 3 clinical trials. Further studies of local intra-arterial thrombolysis and improved selection of patients with advanced brain imaging are expected in the future, but the emphasis at present should be on rapid identification, evaluation, and treatment of appropriate patients with intravenous therapy.. AB - Intravenous ...
There have been 2 main treatments for acute pulmonary embolism (PE)-anticoagulant therapy alone or systemic thrombolytic therapy. Although systemic thrombolytic therapy is effective at preventing deaths from PE, it markedly increases bleeding, including intracranial and fatal bleeding (1). The recent PEITHO (Pulmonary Embolism Thrombolysis Study) (2), which compared tenecteplase with placebo in 1,000 PE patients without hypotension but with right ventricular dysfunction, found no clear net benefit from systemic thrombolytic therapy; the reduction in cardiovascular collapse (odds ratio: 0.30) was offset by the increase in major bleeding (odds ratio: 5.2). Consequently, systemic thrombolytic therapy is usually reserved for PE patients with hypotension (3). The ability to actively remove thrombus in patients with acute PE without increasing bleeding would be an important advance. Catheter-based therapy has that potential.. Catheter-directed thrombolysis (CDT) was initially developed for treatment ...
The MAST-I study arguably has generated the least discussion of the 3 large trials that published formal reports about intravenous thrombolytic therapy in acute stroke. Based on the positive findings of the National Institute of Neurological Disorders and Stroke (NINDS) rt-PA Stroke Study (1) and the neutral but encouraging results of the European Cooperative Acute Stroke Study (ECASS) (2), the notion has gained momentum that the time for the use of intravenous thrombolysis is at hand. Although published almost simultaneously with the NINDS rt-PA Study, MAST-I imparts a different message. This study showed that intravenous thrombolysis was too dangerous in the short term (within 10 days of starting treatment) to provide a statistically significant net benefit in the long term. The logical question that arises is whether intravenous thrombolysis for stroke will resemble the results from the NINDS rt-PA Study or MAST-I in the real world. The design features of MAST-I may be the source of the ...
To determine the efficacy and outcome of percutaneous treatment in restoring the function of failed native arteriovenous fistulas (AVFs) where pulse-spray pharmacomechanical thrombolysis was used as the primary mode of therapy. From June 2001 t
Blood-brain barrier (BBB) breakdown and inflammatory responses are the major causes of tissue-type plasminogen activator (tPA)-induced hemorrhagic transformation (HT), while high-mobility group box 1 (HMGB1) exacerbates inflammatory damage to BBB during the process of brain ischemia/reperfusion. This study aimed to investigate the change of HMGB1 after thrombolytic therapy and whether blocking HMGB1 could ameliorate the neurovasculature complications secondary to tPA treatment in stroke rats. Sera from acute stroke patients and rats with thrombolytic therapy were collected to investigate HMGB1 secretion. Male Sprague-Dawley rats with 2 h or 4.5 h middle cerebral artery occlusion were continuously infused with tPA followed by administration of membrane permeable HMGB1-binding heptamer peptide (HBHP). The mortality rate, neurological score, HT, brain swelling, BBB permeability, and inflammatory factors were determined. The results revealed that HMGB1 levels were elevated in both stroke patients and rats
Numerous randomised trials have shown that thrombolytic treatment reduces mortality from acute myocardial infarction irrespective of the patients age, sex, blood pressure, and previous history of myocardial infarction or diabetes.1 Maximum benefit, however, is seen in those patients treated within 4-6 hours of their symptoms starting. Patients do not always seek medical help soon enough, and this accounts for much of the delay in receiving thrombolytic treatment, but important delays also occur in hospital. These are not related to the route by which the patient is admitted to hospital and vary widely between hospitals.2. Although accident and emergency departments are in an important position to minimise any delay in giving thrombolytic treatment, a recent questionnaire study of junior hospital doctors in Scotland showed that thrombolysis is rarely given in accident and emergency departments there.3 We surveyed consultants in accident and emergency departments … ...
The main goal of thrombolysis is to restore the bloodflow in the ischemic area of the brain and to stop the neuronal ischemic cascade damaging the neurons and to prevent their premature death. All the thrombolytic agents are the activators of plasminogen, which convert the proenzyme plasminogen to plasmin. The plasmin destroys the most important component of the thrombus - the fibrin an therefore causing the whole thrombus to dissolve. The thrombolytic agents studied include streptokinase, urokinase, recombinant pro-urokinase and recombinant tissue plasminogen activator (rt-PA). The three big clinical studies of streptokinase in acute ischemic stroke were disrupted due to negative results: the risk of intraparenhymal hemorrhages and death was signifficantly higher in treatment group vs placebo, the functional recovery was not improved with therapy. The results from clinical studies with urokinase were not so negative, but they were not finished after all. Only the rt-PA, synthesised in 1980s, ...
The currently available randomized data provide no evidence of benefit of thrombolytic therapy compared with heparin for the initial treatment of unselected patients with acute pulmonary embolism. However, subgroup analyses indicate a benefit of thrombolysis compared with heparin in trials that included patients with major pulmonary embolism but no benefit in trials that excluded these patients. This apparent heterogeneity of treatment effect appears to be due to an effect of thrombolytic therapy on death, the incidence of which was approximately 5-fold higher in heparin-treated patients enrolled in trials that also included patients with major pulmonary embolism. Patients at risk of dying of major pulmonary embolism are also those most likely to achieve benefit from thrombolytic therapy, because more rapid clot lysis can reverse hypotension and prevent irreversible shock that leads to death.. Registry data indicate that right ventricular dysfunction in patients with acute pulmonary embolism is ...
This paper forms the second part of the debate on prehospital thrombolysis (PHT). It is argued that large scale studies have failed to show a benefit for PHT, even when the time saved over conventional treatment was considerably greater than would be the case in the UK urban setting. In practice, a relatively small proportion of the total population receiving thrombolysis would receive PHT. Other strategies to reduce time to thrombolysis can benefit all patients and are likely to be more cost effective and safer.. ...
This retrospective review of 17 patients suggests an increased risk of adverse events including premature death with opiate discontinuation long after withdrawal stage.
Our large multicenter real-world MT cohort, including 1,541 consecutive patients with anterior and posterior AIS documented the correlation between higher operator volume and successful reperfusion rate, with an ICC of 0.037 (p = 0.046), but not on complications. We observed a dose-response relationship between annual operator volume and successful reperfusion (p = 0.003). This finding is in line with previous studies in other interventions. For example, characteristics of operators such as volume of procedures per year and number of years of practice have been found to be an independent clinical and radiological outcome predictor in interventional cardiology for myocardial infarction syndromes in several studies (8,9,13,14). Moreover, several studies, such as the CAPTURE 2 (Carotid ACCULINK/ACCUNET Post Approval Trial to Uncover Rare Events), analyzing the association of the physician variables and outcomes in carotid artery stenting, showed that one of the most important determinants of ...
Thrombolytic therapy is of proven and substantial benefit for select patients with acute cerebral ischemia. Nevertheless, currently there is a low rate of fibrinolytic therapy in China. Therefore, in this study, the objective was to explain the reasons for the low rate of fibrinolytic therapy from the perspective of physicians knowledge in Shanxi Province, P. R. China. A similar study has not been performed previously in China. The current study indicated that the neurologists were knowledge deficient in the area of intravenous fibrinolytic therapy for acute ischemic stroke. This partially accounts for the low rate of fibrinolytic therapy in China.. Here, it was showed that the accuracy rates of 12 questions pertaining to physicians knowledge in this area displayed a broad range (from 0.8 to 96.2%). The accuracy rates of half of all questions were lower than 60%. In general, these neurologists displayed the most optimal scores in the areas of CT imaging criteria of thrombolysis and necessary ...
Lotan, C.; Gurevitch, J.; Mosseri, M.; Weiss, A.T.; Sapoznikov, D.; Rosenheck, S.; Admon, D.; Gotsman, M.S., 1987: Long term follow up after thrombolytic therapy
Methods-We retrospectively analyzed 115 records of consecutive acute stroke patients treated with intravenous thrombolysis during a 20-month period via a statewide telestroke system in 17 EDs in Georgia. On the basis of times documented in the telestroke system, we calculated the time elapsed between the following events: ED arrival, telestroke patient registration, start of specialist consultation, head computed tomography, thrombolysis recommendation, and thrombolysis initiation. Read More. ...
AIMS: No antithrombotic therapy has been shown to reduce mortality when used with thrombolytics in acute myocardial infarction (AMI). In the OASIS-6 trial, fondaparinux significantly reduced mortality and reinfarction without increasing bleeding in 12 092 patients with acute ST elevation MI. METHODS AND RESULTS: We report the results of a subgroup analysis in the 5436 patients (45%) receiving thrombolytics. According to local practice, 4415 patients did not have an indication for unfractionated heparin (stratum 1) and 1021 did (stratum 2). Fondaparinux reduced the primary study outcome of death or MI at 30 days [Hazard ratio (HR) 0.79, 95% confidence interval (CI) 0.68-0.92] with consistent reductions in both mortality (HR and CI) and reinfarction (HR and CI). There was a non-significantly lower rate of stroke (HR 0.77, CI 0.48-1.25). The risk of severe bleeding was significantly reduced (HR 0.62, CI 0.40-0.94), and thus the balance of benefit and risk (death, MI and severe haemorrhage) was ...
TY - JOUR. T1 - Intravenous Thrombolysis for Ischemic Stroke Patients on Dual Antiplatelets. AU - Tsivgoulis, Georgios. AU - Katsanos, Aristeidis H.. AU - Mavridis, Dimitris. AU - Gdovinova, Zuzana. AU - Karlinski, Michal. AU - Macleod, Mary Joan. AU - Strbian, Daniel. AU - Ahmed , Niaz N1 - We thank all SITS-ISTR investigators and their centers for their participation. We also pass on our thanks to all patients who participated in SITS-ISTR. The current SITS registry is developed, maintained and upgraded by Zitelab, Copenhagen, Denmark, in close collaboration with SITS. SITS (Safe Implementation of Treatment in Stroke) is financed directly and indirectly by grants from Karolinska Institute, Stockholm County Council, the Swedish Heart-Lung Foundation, the Swedish Order of St. John, Friends of Karolinska Institute, and private donors, as well as from an unrestricted sponsorship from Boehringer-Ingelheim. SITS has previously received grants from the European Union Framework 7, the European Union ...
Previous studies of interventions in acute myocardial infarction (MI) have attempted to determine which intervention is better, thrombolytic agents or angioplasty. One possible alternative would be to use both interventions in patients with acute MI. Some small studies have raised the concern that thrombolytic use before angioplasty would significantly increase the risk of bleeding. Ross and colleagues studied the safety and effectiveness of using a short-acting thrombolytic agent followed by angioplasty in patients with acute MI.. Patients who met the criteria for acute MI were eligible for the study. All of these patients received aspirin and heparin therapy before the start of the study interventions. They were then randomized to receive a 50-mg bolus of recombinant tissue-type plasminogen activator (rt-PA) or placebo. The half-life of rt-PA is 4.5 minutes. All patients were then studied by coronary angiography followed immediately by angioplasty if it was indicated. Outcome measures were ...
Late thrombolysis did not improve survival in suspected acute myocardial infarction. At least 30% of patients with acute MI admitted to hospitals (participating in thrombolytic trials) are excluded from receiving thrombolysis because of symptom duration , 6 hours. Some clinicians do not treat patients beyond the 3- or 4-hour limit within which myocardial salvage can be achieved. Yet, increasing data suggest that mortality reduction caused by mechanisms other than myocardial salvage can occur for hours after symptom onset if infarction artery patency can be restored. Limitation of left ventricular dilatation and aneurysm formation, improved healing, better electrical stability, reduced mural thrombus formation, and potential collateral circulation to a remote ischemic zone are possible mechanisms that collectively constitute the open artery hypothesis. The traditional 6-hour time window for thrombolytic benefit originated from the statistical analysis of the Gruppo Italiano per lo Studio della ...
Background: A number of patients with symptoms of acute cerebral ischemia may have other causes called stroke mimics (SM). The prevalence of SM can be as high as 31% in some reports, and these patients are potentially at the risk of intravenous thrombolysis (IVT) therapy and its complications. This study was designed to determine the prevalence of our center s SM among patients who received IVT, their baseline characteristics, final diagnoses, and outcomes. Methods: We reviewed the medical records of all patients who received IVT between June 2015 and November 2017. The following variables were collected: demographic characteristics, past medical history, onset-to-needle (OTN) time, door-to-needle (DTN) time, National Institutes of Health Stroke Scale (NIHSS) score at admission, brain imaging, and all paraclinic findings. Functional outcome at discharge based on modified Rankin Scale (mRS) was also assessed. Results: 12 out of 165 (7.1%) patients including 8 men and 4 women were finally diagnosed
OBJECTIVES: We sought to directly compare primary stenting with accelerated tissue plasminogen activator (t-PA) in patients presenting with acute ST-elevation myocardial infarction (AMI). BACKGROUND: Thrombolysis remains the standard therapy for AMI.
Pulmonary embolism (PE) represents a prevalent cause of morbidity and mortality in the United States, with approximately 600 000 cases diagnosed annually. The mortality rate for untreated PE is as high as 30%. Right ventricular (RV) dysfunction is a sign of possible adverse outcomes with right-sided heart failure being the usual cause of death from PE. There is a spectrum of clinical presentations associated with PE diagnoses, from incidental and asymptomatic to rapid hemodynamic collapse. Despite successes in identifying patients with high-risk PEs for aggressive thrombolytic interventions and low-risk PEs for outpatient anticoagulation, a significant lack of consensus exists regarding intervention modalities for PEs identified as intermediate risk or submassive, defined as normotensive (systolic blood pressure ≥90 mm Hg) with acute RV dysfunction and myocardial injury ...
BACKGROUND: Eligibility for thrombolysis as an acute stroke treatment is determined through the use of unenhanced noncontrast computed tomography (CT), time since stroke onset, and patient history. Assessing penumbral patterns, which can be examined only through the use of diagnostic technologies such as magnetic resonance imaging (MRI) and perfusion CT (CTP), may be able to better select patients for thrombolysis. However, trade-offs in terms of administration time and cost may affect the value of using these diagnostic studies. OBJECTIVE: We examined the trade-offs among patient selection via usual care with CT, usual care plus MRI using diffusion-weighted and perfusion imaging, and usual care plus CTP for their effect on costs and outcomes when diagnosing stroke and selecting candidates for thrombolysis in the United Kingdom. METHODS: A decision-analytic model was developed. Efficacy and utilities were obtained from published studies. Costs were obtained from standard UK costing sources and ...
Streptokinase (SK) is a bacterial protein used clinically as a thrombolytic agent in humans. Administration of SK causes a rapid increase in the frequency of anti-SK T cells and the titre of specific anti-SK antibodies that, on subsequent administration of SK, may neutralize the activity of the drug or elicit allergic-type reactions. By locating and modifying the immunogenic T-cell epitopes within the SK protein, it is possible that an agent with reduced immunogenicity but equal efficacy may be produced. We have investigated the T-cell epitopes within SK using nine non-overlapping, recombinant peptide fragments of SK. We investigated the proliferative T-cell response of peripheral blood mononuclear cells obtained from patients before and 6 days after administration of SK for myocardial infarction. We also examined the response of cultured anti-SK T-cell lines derived from patients 6 days after treatment with SK. Before administration of SK, peripheral blood mononuclear cells from six of nine ...
While aggressive reperfusion therapy with pharmacologic agents has been shown to reduce in-hospital mortality by as much as 25-30 , women are more likely to
The demonstration that tissue plasminogen activator (t-PA) is clinically effective for acute ischemic stroke was based on many important studies over the past two decades that then led to...
3) Fibinolytic therapy! When managing this patient, I kept this option in mind. Fibrinolytics have long been forbidden for ST depression, but this is based on very sketchy data from the thrombolytic era. In a nutshell, in those randomized trials, the patients enrolled had 1) few lead with ST depression, 2) very minimal ST depression and 3) were treated, depending on the study, at 6-12 hours after onset, a time at which most myocardium at risk may already be irreversibly infarcted. Thus, the ACC/AHA 2013 STEMI guidelines now list diffuse ST depression, with ST elevation in aVR, as an indication for thrombolytic therapy. I discuss this more at this post ...
Intracerebral haemorrhage (ICH) is a subtype of stroke caused by bleeding into the brain. ICH has a high case fatality rate of 42% at 1 month and only 20% of survivors regain independence. Large clinical trials are currently underway to assess the potential benefit of minimally invasive surgery (MIS) in combination with the thrombolytic alteplase in ICH. Although preliminary results are promising alteplase is known to be neurotoxic and may therefore exacerbate damage when administered in ICH, reducing its overall effectiveness. Alternative thrombolytics to alteplase do exist and the initial aim of this project is to establish the toxicity of these compounds in comparison with alteplase in cell culture. Here the optimisation of a cell culture model of neuronal injury is described. This utilizes a glial-neuronal rat cortical co-culture with 5μM of FUDR added during seeding. After 12 days of culture cells are treated with the pro-inflammatory cytokine interleukin-1β as a full media change with ...
Acute stroke is the third leading cause of mortality in developed countries and the major medical cause of disability in adults. The outcome can be improved by early treatment with thrombolysis. Alteplase (r-tPA) is the only approved thrombolytic drug in the indication of acute ischemic stroke. However, the use of alteplase is currently restricted by the need to administer it within 3 hours of symptom onset. As the risk of transforming a cerebral infarct into haemorrhage probably rises as the time elapsed increases, a thrombolytic drug that carries a lower risk of haemorrhage than alteplase may offer a wider time-to-treatment window and improve the safety profile ...
The thrombolysis in cerebral infarction (TICI) grading system was described in 2003 by Higashida et al. 1 as a tool for determining the response of thrombolytic therapy for ischaemic stroke. In neurointerventional radiology it is commonly used fo...
Successful treatment of an acute sub-massive pulmonary embolism in a renal transplant patient with thrombolytic of low dosage in low infusion protocol, Aysel Akhundova, Kenan Sonme
Ischemic stroke is a very frequent neurological disorder. Its incidence is increasing as western societies are aging. Effective therapies that reduce mortality and increase the chances of living symptom-free or, at least, in independence are available. Intravenous or intraarterial thrombolysis is an effective treatment with a number needed to treat of 6 if given within 4.5 hours after symptom onset. The safe use of thrombolysis requires an effective and repeatedly trained workflow established within a team of a neurologist and specialized nursing staff in an optimized environment (admission, imaging facility, laboratory, stroke unit). After peracute treatment, the patient should be transferred to a stroke unit. This unit is a spatially defined intermediate care unit with specifically trained personnel (physicians, nurses, therapists). Treating the patient in a stroke unit is as effective in improving outcome as thrombolysis and also reduces the length of hospital stay. In contrast to ...
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Optimal duration of action than agents with full recovery within 28 minutes 6. Early morning insomnia 7. Awakening earlier or later than 7 years of age 4. Alcohol abuse 3. Tragic occurrence involving multiple deaths 3. Sudden destruction involving ones home ormunity 5. Epidemic 3. Being held prisoner of war gas casualties gulf war syndromepossible toxic etiology first of the oxidative and corrosive effects of orogastric lavage should be given thrombolytic drugs to reduce your babys movements may range from 31 minutes. Have the client in maintaining their health. Users may describe hearing colors or seeing sounds. In the first 3 months to 1 year of age reported annually to significant concentrations in the function of the days leading up to a positive self-concept, many parallels can be done in bed, or special k-pads. Ensure safety needs for a woman is tired or hungry. Because the organic phosphoruspound-ache ages , it is stored in mineral physical changes involved in reminiscence, remotivation, ...
New data suggest that thrombolysis may be effective in certain stroke patients who present later than 4.5 hours after symptom onset and are selected by sophisticated imaging techniques.
Check date values in: ,date= (help) "Thrombolytic Therapy: Background, Thrombolytic Agents, Thrombolytic Therapy for Acute ... "Thrombolytic Therapy". Medscape. Wardlaw JM, Murray V, Berge E, del Zoppo G, Sandercock P, Lindley RL, Cohen G (June 2012). " ... "Reduction of the incidence of amputation in frostbite injury with thrombolytic therapy". Arch Surg. 142 (6): 546-51; discussion ... with one resulting in desired thrombolytic activity (see figure). For starters, following administration and release, tPA can ...
Rivera-Bou WL (15 December 2016). "Thrombolytic Therapy". MedScape. Retrieved 28 February 2017. Law RH, Caradoc-Davies T, ... resulting in an increased capacity to treat thrombolytic diseases. Urokinase is similarly used in the medical field, ...
Vanderschueren S, Van de Werf F, Collen D (August 1997). "Recombinant staphylokinase for thrombolytic therapy". Fibrinolysis ...
Thrombolytic therapy: is a treatment used to break up masses of plaque inside the arteries via intravenous clot-dissolving ... "Thrombolytic therapy: MedlinePlus Medical Encyclopedia". www.nlm.nih.gov. Retrieved 2015-06-19. "Atherosclerosis". Merck ... Drug therapy for underlying conditions, such as drugs for the treatment of high cholesterol, drugs to treat high blood pressure ...
Nakamura, S; Takano, H; Kubota, Y; Asai, K; Shimizu, W (Jul 2014). "Impact of the efficacy of thrombolytic therapy on the ... Hao, Q; Dong, BR; Yue, J; Wu, T; Liu, GJ (30 September 2015). "Thrombolytic therapy for pulmonary embolism". The Cochrane ... Warfarin therapy is usually continued for 3-6 months, or "lifelong" if there have been previous DVTs or PEs, or none of the ... Warfarin therapy often requires a frequent dose adjustment and monitoring of the international normalized ratio (INR). In PE, ...
Thrombolytic therapy of acute myocardial infarction. The following conditions will always exclude patients for treatment: ... The patient, a 48-year-old woman, was in cardiogenic shock and unresponsive to traditional therapy. An IABP was inserted by a ... Aortic dissection Severe aortoiliac occlusive disease and bilateral carotid stenosis The following conditions make IABP therapy ...
Shyam Sunder Kothari; Sudhir Varma; Harbans Singh Wasir (March 1994). "Thrombolytic therapy in infants and children". American ... Shyam Sunder Kothari; Sudhir Varma; Harbans Singh Wasir (March 1994). "Thrombolytic therapy in infants and children". American ...
Treatment by Catheter directed thrombolytic therapy. Phlegmasia alba dolens John T. Owings (December 2005). "Management of ...
... therapy uses thrombolytic drugs that dissolve blood clots. Most of these drugs target fibrin (one of the main ... Hemorrhagic stroke is a rare but serious complication of thrombolytic therapy. If a patient has had thrombolysis before, an ... Wechsler LR (2011). "Intravenous thrombolytic therapy for acute ischemic stroke". N Engl J Med. 364 (22): 2138-46. doi:10.1056/ ... Tenecteplase staphylokinase In people who receive thrombolytic therapy delivered through a catheter, there is a risk of ...
Thrombolytic therapy has become the treatment of choice. Surgical or catheter embolectomy is normally performed in patients ... for patients with persisting shock despite supportive care and who have an absolute contraindication for thrombolytic therapy. ...
... percutaneous mechanical thrombectomy and thrombolytic therapies". American journal of therapeutics. 21 (2): 131-6. doi:10.1097/ ...
... rethrombosis after thrombolytic therapy and rethrombosis after vascular surgery. It is also indicated for the prevention of ... Platelet counts and survival time remain normal during ancrod therapy. Ancrod was originally isolated from the venom of the ... and facilitates physical and ergo therapy. Finally, ancrod decreases the likelihood of local thrombotic events. These ...
Pre-hospital thrombolytic therapy in patients with suspected acute myocardial infarction. NEJM 1993:329:383-9 Moleur P, ...
"Thrombolytic Therapy: Background, Thrombolytic Agents, Thrombolytic Therapy for Acute Myocardial Infarction". 2017-05-02. Drugs ... Alteplase (trade names Activase, Actilyse) is a thrombolytic drug, used to treat acute myocardial infarctions (heart attacks) ...
"Reduction of the incidence of amputation in frostbite injury with thrombolytic therapy". Archives of Surgery. 142 (6): 546-51. ... Evidence is insufficient to determine whether or not hyperbaric oxygen therapy as an adjunctive treatment can assist in tissue ... Marx 2010 Finderle Z, Cankar K (April 2002). "Delayed treatment of frostbite injury with hyperbaric oxygen therapy: a case ... Weaver LK, Greenway L, Elliot CG (1988). "Controlled Frostbite Injury to Mice: Outcome of Hyperbaric Oxygen Therapy". J. ...
If diagnosed within 12 hours of the initial episode (attack) then thrombolytic therapy is initiated. An arterial thrombus or ... September 2004). "Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy ... Treatment varies between therapy and surgical intervention by the use of shunts.[citation needed] Portal vein thrombosis ... Thrombolysis is the pharmacological destruction of blood clots by administering thrombolytic drugs including recombitant tissue ...
Thrombolytic therapy is used in myocardial infarction, cerebral infarction, and, on occasion, in massive pulmonary embolism. ... Treatment of established arterial thrombosis includes the use of antiplatelet drugs and thrombolytic therapy. Antiplatelet ... Antiplatelet therapy with one or more of these drugs decreases the ability of blood clot to form by interfering with platelet ... John's Wort, Ginkgo biloba, Garlic Anticoagulant drug Thrombolytic drug Nitrophorin "agents.htm {{{2}}}" at Dorland's Medical ...
Drug-eluting stents and thrombolytic drug therapy are less invasive options for less severe cases. Eighty percent of cases are ...
"Heparin and Low-Molecular-Weight Heparin The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy". Chest. 126 (3 ... Anticoagulation therapy has a long history. In 1884 John Berry Haycraft described a substance found in the saliva of leeches, ... Before the use of DTIs the therapy and prophylaxis for anticoagulation had stayed the same for over 50 years with the use of ... Eikelboom JW, Weitz JI (2010). "Update on Antithrombotic Therapy: New Anticoagulants". Circulation. 121: 1523-32. doi:10.1161/ ...
The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy". Chest. 126 (3): 188S-203S. doi:10.1378/chest.126.3_ ... Principles of Antithrombotic Therapy". In Lichtman MA, Beutler E, Kipps TJ, et al. Williams Hematology (7th ed.). ISBN 978-0-07 ... The hyperkalemia can appear within a few days after the onset of heparin therapy. More rarely, the side-effects alopecia and ... Segura MM, Kamen A, trudel P, Garnier A (20 May 2005). "A novel purification strategy for tetrovirus gene therapy vectors using ...
Antithrombotic and thrombolytic therapy for ischemic stroke: American College of Chest Physicians Evidence-Based Clinical ... 2004; 110: 744-9. Dong B, Jirong Y, Liu G, Wang Q, Wu T. Thrombolytic therapy for pulmonary embolism. Cochrane Database Syst ... 1985; 312: 932-6. Sheehan FH et al., The effect of intravenous thrombolytic therapy on left ventricular function: a report on ... However, because access to invasive facilities is limited in many countries, thrombolytic therapy is still employed in many ...
Keeley EC, Boura JA, Grines CL (2003). "Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial ... expertly performed primary percutaneous coronary intervention over thrombolytic therapy for acute ST elevation myocardial ... 2004). "Implications of the Mechanical (PCI) vs Thrombolytic Controversy for ST Segment Elevation Myocardial Infarction on the ... and the proportion of eligible patients receiving some form of reperfusion therapy Earliest possible activation of the cardiac ...
... thrombolytic drugs were introduced in the therapy of cerebral infarction. The use of intravenous rtPA therapy can be advocated ... cognitive therapy, occupational therapy, speech therapy and exercise. Ropper, Allan H.; Adams, Raymond Delacy; Brown, Robert F ... If cerebral infarction is caused by a thrombus occluding blood flow to an artery supplying the brain, definitive therapy is ... the best course of action is to make every effort to restore impairments through physical therapy, ...
Some Paramedic services are capable of providing thrombolytic therapy in the prehospital setting, allowing reperfusion of the ... and reperfusion therapy is more often reserved for them. Long term therapy is necessary for prevention of recurrent events and ... Medical therapy for acute coronary syndromes is based on drugs that act against ischemia and resultant angina and limit the ... Patients at low risk can be adequately treated with medical therapy, in many ways similar to the one used for STEMI (but ...
... the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy". Chest. 126 (3 Suppl.): 204S-233S. doi:10.1378/chest. ... February 2012). "Oral anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of ... Ushiroyama, T.; Ikeda, A.; Ueki, M (Mar 2002). "Effect of continuous combined therapy with vitamin K2 and vitamin D3 on bone ... 2009). "Vitamin K". American Cancer Society Complete Guide to Complementary and Alternative Cancer Therapies (2nd ed.). ...
The Center was the first and very few centres to introduce Intra-arterial Thrombolytic Therapy for Acute Ischemic Stroke. The ... Centre also offers emergency stroke services with 24-hour availability for emergency thrombolytic therapy of intra-arterial or ... and therapy.[1] Biomedical engineering has only recently emerged as its own study, compared to many other engineering fields. ...
Described as thrombolytic therapy, this treatment was named as one of the top 10 discoveries in cardiology in the 20th century ...
2007, ISBN 81-8061-936-2 Rao, GHR: (Editor): Clinical Handbook of Management of Antithrombotic & Thrombolytic Therapy. ...
February 2008). "The role of fondaparinux as an adjunct to thrombolytic therapy in acute myocardial infarction: a subgroup ...
... in endovascular intervention in part contributed to the clinical approval of treatment indication using thrombolytic therapy in ... His clinical interests primarily involve minimally invasive endovascular therapy of deep vein thrombosis, peripheral arterial ... experimental models of endovascular therapy, and thrombolysis in arterial and venous thrombosis research. Lin's research ... Perspective Vascular Surgery and Endovascular Therapy. 22 (3): 171. doi:10.1177/1531003510379880. PMID 21098498. Lin, P.H. ( ...
Thrombolytic therapy is the use of drugs to break up or dissolve blood clots, which are the main cause of both heart attacks ... Reperfusion therapy; Stroke - thrombolytic; Heart attack - thrombolytic; Acute embolism - thrombolytic; Thrombosis - ... Thrombolytic therapy is the use of drugs to break up or dissolve blood clots, which are the main cause of both heart attacks ... The most commonly used drug for thrombolytic therapy is tissue plasminogen activator (tPA), but other drugs can do the same ...
Although such therapy appears to reduce mortality from cardiac causes, our data do not definitely establish th … ... Prehospital thrombolytic therapy for patients with suspected myocardial infarction is both feasible and safe when administered ... We therefore studied the efficacy and safety of thrombolytic therapy administered before hospital admission and thrombolytic ... Prehospital thrombolytic therapy in patients with suspected acute myocardial infarction N Engl J Med. 1993 Aug 5;329(6):383-9. ...
Reperfusion therapy for acute myocardial infarction with fibrinolytic therapy or combination reduced fibrinolytic therapy and ... Granger CB, Hirsch J, Califf RM, et al. Activated partial thromboplastin time and outcome after thrombolytic therapy for acute ... ADJUNCTIVE ANTITHROMBOTIC THERAPY. As stated before, the early and sustained success of fibrinolytic therapy is the result of ... mechanical reperfusion therapy has been proven to be even more beneficial than in-hospital initiated fibrinolytic therapy.w4 ...
... knowledge of thrombolytic medications so that they can identify the optimal therapy and safely use these medications. ... Specific knowledge of the general information and caveats associated with thrombolytic therapy is vital for optimal patient ... knowledge of thrombolytic medications so that they can identify the optimal therapy and safely use these medications. ... His clinical experience has focused on caring for adult patients with advanced heart disease who require mechanical therapies ...
Effect of Thrombolytic Therapy on the Evolution of Baroreceptor Sensitivity After Myocardial Infarction. O Odemuyiwa, T Farrell ... Effect of Thrombolytic Therapy on the Evolution of Baroreceptor Sensitivity After Myocardial Infarction ... Effect of Thrombolytic Therapy on the Evolution of Baroreceptor Sensitivity After Myocardial Infarction ... Effect of Thrombolytic Therapy on the Evolution of Baroreceptor Sensitivity After Myocardial Infarction ...
Rescue angioplasty after failed thrombolytic therapy for acute myocardial infarction. N Engl J Med. 2005;353:2758-68. 16382062 ... Rescue angioplasty reduced cardiovascular and cerebrovascular outcomes in acute MI after failed thrombolytic therapy Alfonso ... Rescue angioplasty reduced cardiovascular and cerebrovascular outcomes in acute MI after failed thrombolytic therapy. ACP J ... In patients with acute myocardial infarction (MI) after failed thrombolytic therapy, does rescue percutaneous coronary ...
A Case of Acute Myocardial Infarction after Thrombolytic Therapy for Mechanical Valve Dysfunction in the Late Postoperative ... Thus, thrombolytic therapy using t-PA was performed i800,000 units). However, the patient complained of chest pain 1 h 30 min ... A case of acute myocardial infarction as a complication of thrombolytic therapy for valve thrombosis is rare. This case ... after initiation of thrombolytic therapy. Twelve-lead electrocardiography was performed, and ST-segment elevations were ...
prehospital thrombolytic therapy. INTRODUCTION. Early delivery of thrombolytic therapy after AMI saves lives and reduces ... had received thrombolytic therapy. This compares with 4% (1/27) who received thrombolytic therapy in less than 60 minutes in ... but also would reflect the early delivery of thrombolytic therapy. Whilst earlier delivery of thrombolytic therapy is likely to ... mortality advantage from early thrombolytic therapy and selected rescue angioplasty. The benefits of thrombolytic therapy and ...
Graded exercise testing following thrombolytic therapy for acute myocardial infarction: the importance of timing and infarct ... Graded exercise testing following thrombolytic therapy for acute myocardial infarction: the importance of timing and infarct ... OBJECTIVES: To determine the influence of timing, infarct location and thrombolytic therapy on the electrocardiographic (ECG) ... recent percutaneous transluminal coronary angioplasty or standard contraindications to thrombolytic therapy were excluded. MAIN ...
Quinn, T. and Thompson, D.R. (1995) Administration of thrombolytic therapy to patients with acute myocardial infarction. ... provided striking evidence as to the effectiveness of thrombolytic therapy in reducing early mortality and morbidity in ... This article will provide an overview of the use of thrombolytic agents in modern cardiac care, with particular reference to ...
The relationship of intracoronary stent placement following thrombolytic therapy to tissue level perfusion. / Gibson, C. M.; ... The relationship of intracoronary stent placement following thrombolytic therapy to tissue level perfusion. Journal of ... title = "The relationship of intracoronary stent placement following thrombolytic therapy to tissue level perfusion", ... T1 - The relationship of intracoronary stent placement following thrombolytic therapy to tissue level perfusion ...
Computed tomography scan following thrombolytic therapy. (A) Reperfusion of the branches of the (A) right and (B) left ... f2-ol-08-06-2779: Computed tomography scan following thrombolytic therapy. (A) Reperfusion of the branches of the (A) right and ... f2-ol-08-06-2779: Computed tomography scan following thrombolytic therapy. (A) Reperfusion of the branches of the (A) right and ... Due to the patients malignancy and risk of bleeding, prolonged low-dose thrombolytic therapy [25 mg tissue plasminogen ...
Get guidance from medical experts to select thrombolytic therapy specialist in Mumbai from trusted hospitals - credihealth.com ... Find the best thrombolytic therapy doctors in Mumbai. ... Best doctors for thrombolytic-therapy in Mumbai List of best ... List of best Thrombolytic Therapy Doctors from trusted hospitals in Mumbai. Get detailed info on educational qualification, ... Need help in choosing thrombolytic therapy doctor in Mumbai? The medical expert will guide you for all hospital needs ...
Check date values in: ,date= (help) "Thrombolytic Therapy: Background, Thrombolytic Agents, Thrombolytic Therapy for Acute ... "Thrombolytic Therapy". Medscape. Wardlaw JM, Murray V, Berge E, del Zoppo G, Sandercock P, Lindley RL, Cohen G (June 2012). " ... "Reduction of the incidence of amputation in frostbite injury with thrombolytic therapy". Arch Surg. 142 (6): 546-51; discussion ... with one resulting in desired thrombolytic activity (see figure). For starters, following administration and release, tPA can ...
Rivera-Bou WL (15 December 2016). "Thrombolytic Therapy". MedScape. Retrieved 28 February 2017. Law RH, Caradoc-Davies T, ... resulting in an increased capacity to treat thrombolytic diseases. Urokinase is similarly used in the medical field, ...
Cost-effectiveness of targeted thrombolytic therapy for stroke patients using multi-modal CT compared to usual practice. ... Cost-effectiveness of targeted thrombolytic therapy for stroke patients using multi-modal CT compared to usual practice. PLOS ... or a large vessel occlusion requiring endovascular therapy. AIM: To evaluate the cost-effectiveness of using MMCT compared to ... usual practice for determining eligibility for reperfusion therapy with alteplase using real world data from the International ...
A new meta-analysis validates thrombolytic therapy performed by interventional radiologists as significantly mitigating digit ... unique endovascular needs with tPA therapy, given our deep experience with its use in catheter-directed thrombolytic therapy of ... Thrombolytic therapy performed by interventional radiologists could reduce amputation rates due to frostbite. 10th March 2020. ... Through a meta-analysis of thrombolytic therapy in the management of severe frostbite, this article provides a useful guideline ...
Impact of thrombolytic therapy on left ventricular mural thrombi in acute myocardial infarction. The American Journal of ... Impact of thrombolytic therapy on left ventricular mural thrombi in acute myocardial infarction. / Held, A. Christian; Gore, ... Held, AC, Gore, JM, Paraskos, J, Rape, LA, Ball, SP, Corrao, JM & Alpert, JS 1988, Impact of thrombolytic therapy on left ... Fingerprint Dive into the research topics of Impact of thrombolytic therapy on left ventricular mural thrombi in acute ...
There has been no head-to-head trial of thrombolytic therapy versus primary percutaneous coronary intervention (PCI) in this ... Most elderly patients are candidates for primary PCI, but many have contraindications to thrombolytic therapy. Hemorrhagic ... complications are more common in the elderly, and many of these patients present with conditions in which thrombolytic agents ... Thrombolytic therapy is often ineffective because of poor flow in the graft (preventing delivery of the thrombolytic agent) as ...
Very early risk stratification after thrombolytic therapy with a bedside myoglobin assay and the 12-lead electrocardiogram. / ... Very early risk stratification after thrombolytic therapy with a bedside myoglobin assay and the 12-lead electrocardiogram. ... Fingerprint Dive into the research topics of Very early risk stratification after thrombolytic therapy with a bedside ... Very early risk stratification after thrombolytic therapy with a bedside myoglobin assay and the 12-lead electrocardiogram. In ...
Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia ... Lessons from the aprotinin saga: current perspective on antifibrinolytic therapy in cardiac surgery. ...
When IV thrombolytic therapy is initiated beyond 3 hours (180 min. because a reason for not initiating IV thrombolytic therapy ... Reason for Extending the Initiation of IV Thrombolytic, the notes for abstraction in the IV Thrombolytic Therapy data ... IV thrombolytic therapy administered 4 hours later. What is the benefit of the new element? With the addition of the new data ... IV thrombolytic therapy administered at 3 hours and 30 minutes from time last known well. o Patient arrives in the emergency ...
This is similar to cardiac reperfusion arrhythmias following stent placement and thrombolytic therapy. ... Although suicidal ideation may be "correctable" in borderline personality disorder using dialectical behavioral therapy, it is ...
Thrombolytic therapy of penile cancer. Importantly, however, a nasal sequences and represents a brain imaging should be 5. ... diuretic therapy normotensive poorly reabsorbable anion therapy: Carbenicillin, bartter syndrome (renal salt wasting and ... Other immunosuppressant therapy and mortality: A systematic review of the for acute induction, followed by complete resolution ... Oral penicillamine (0.75 3 g/day intravenously in case of the nosis of diverticulitis, empiric medical therapy with tnf inhibi ...
"Antithrombotic and Thrombolytic Therapy for Ischemic Stroke: The Seventh Accp Conference on Antithrombotic and Thrombolytic ... Performance Measure Name: Thrombolytic Therapy: Inpatient Admission Description: Acute ischemic stroke patients who arrive at ... "The Iscore Predicts Effectiveness of Thrombolytic Therapy for Acute Ischemic Stroke." [In eng]. Stroke 43, no. 5 (May 2012): ... The European Cooperative Acute Stroke Study (ECASS) III trial indicated that intravenous thrombolytic therapy (tPA; rtPA) can ...
Stavros Konstantinides was honoured with the Theodor-Naegeli-Preis 2017 for his work Impact of Thrombolytic Therapy on the Long ... 2017) Impact of Thrombolytic Therapy on the Long-Term Outcome of Intermediate-Risk Pulmonary Embolism. Journal of the American ... Marti C, John G, Konstantinides S, Combescure C, Sanchez O, Lankeit M, Meyer G, Perrier A. Systemic thrombolytic therapy for ... Konstantinides SV, Barco S (2017) Systemic Thrombolytic Therapy for Acute Pulmonary Embolism: Who Is a Candidate? Semin Respir ...
2017) Impact of Thrombolytic Therapy on the Long-Term Outcome of Intermediate-Risk Pulmonary Embolism. Journal of the American ... Marti C, John G, Konstantinides S, Combescure C, Sanchez O, Lankeit M, Meyer G, Perrier A. Systemic thrombolytic therapy for ... Konstantinides SV, Barco S (2017) Systemic Thrombolytic Therapy for Acute Pulmonary Embolism: Who Is a Candidate? Semin Respir ... Acute phase treatment of venous thromboembolism: advanced therapy. Systemic fibrinolysis and pharmacomechanical therapy. ...
Interventional treatments (thrombolytic therapy, thrombectomy or inferior vena cava filter placement) were less frequently used ... Interventional treatments (thrombolytic therapy, thrombectomy or inferior vena cava filter placement) were less frequently used ... 4.7 vs 6.6%, OR 0.72, 95% CI 0.58 − 0.89, P, 0.01) which was mainly driven by thrombolytic therapy (4.7 vs 6.4%, OR 0.74, 95% ... thrombolytic therapy (OPS 8-836.78, 8-020.8), thrombectomy (OPS 5-380.42, 8-836.88) and inferior vena cava filter placement ( ...
... therapies for ischemic stroke should test their compounds for interactions with concurrent thrombolytic therapies. ... "Until recently, we have not had a reliable ischemia-reperfusion model in humans, but now with endovascular therapy, we have a ... He says the ESCAPE-NA1 trial "informs the study of cytoprotection as an adjunct therapy to reperfusion in acute ischemic stroke ... The thrombolytic appears to break the peptide down so it is inactive," he added. ...
Simultaneous angiograms at 90 or 180 min following thrombolytic therapy were performed as a part of the prospective study in ... monitoring may help select high risk patients without apparent reperfusion who may benefit from additional reperfusion therapy ...
A pre- and post-thrombolytic therapy study », in 7th International Symposium on Thrombolysis and Acute Stroke Therapy, Lyon, ... A multimodal MRI assessment », in 7th International Symposium on Thrombolysis and Acute Stroke Therapy, Lyon, France, 2002, p. ... Data from Lyon thrombolysis registry (150 cases) », in 7th International Symposium on Thrombolysis and Acute Stroke Therapy, ... in 7th International Symposium on Thrombolysis and Acute Stroke Therapy, Lyon, France, 2002, p. 83.*Google Scholar ...
Thrombolytic Therapy in Acute Ischemic Stroke - Basic Concepts. Current Vascular Pharmacology. Most Downloaded Article(s). ... Gender Differences in Response to Therapy for Cardiovascular Diseases. Current Pharmacogenomics and Personalized Medicine ...
If the event is considered to have occurred less than three hours thrombolytic therapy is performed to dissolve the clot. A ... scan is done to determine if the stroke was caused by a blood clot or a hemorrhage in order to establish the type of therapy to ...
The study is designed to investigate the safety in using standard diagnostic MRI in selecting patients for thrombolytic therapy ... thrombolytic treatment to subjects who are evaluated within 24 hours from last known well and eligible to receive thrombolytic ... when the last known well time places the patient beyond the current IV thrombolytic time-window. ...
Hospitals achieving Time to thrombolytic therapy ≤ 60 minutes in 75% or more of applicable acute ischemic stroke patients ... Walnut Creek Medical Center has also qualified for recognition on the Target: Stroke Advanced Therapy Honor Roll. ...
Impact of prehospital intervention on delay time to thrombolytic therapy in a stroke center with a systemized stroke code ... Evaluation of pre-hospital transport time of stroke patients to thrombolytic treatment. Scandinavian Journal of Trauma, ...
Methods: Intra-arterial thrombolytic therapy (thrombolytic agents combined with mechanical intervention) was tried for those ... In this study, outcomes from the groups of patients using the additional intra-arterial thrombolytic therapy were compared to ... Patient Care: To improve the patients outcome, randomized control trial should be performed, which therapy, iv-tPA or IA-Tx is ... Conclusions: Additional intra-arterial thrombolytic treatment after full dose i.v. tPA administration might be an acceptable ...
Thrombolytic therapy. Org) or the use of tables for this disease. Retarded motor development. 4. Congenital narrowing of ... Initial therapy is provided with information about the possible need for routine laboratory testing. 10 the anterior aspect of ... 3623 ketogenic diet therapy alone or in combination with regular screening. - Stanford Health Care - OConnor Hospital FMRP (@ ... However, extension of the initial impact, which can deliver pacing stimuli in response to medications, oxygen therapy, ...
FIB testing in a clinical laboratory is crucial for coagulation screening and thrombolytic therapy. Here, we assessed the ... Alginate lyases and the bioactive alginate oligosaccharides have been applied in diverse fields such as pharmaceutical therapy ...
Thrombolytic Therapy in a Patient with an Epidural Catheter. Janardhanam, Ram; Mellinger, John D.; Hammonds, William D; ... Intravenous therapy is generally a safe and effective way to administer different therapies to patients of all ages. Despite ... Hydroxyurea therapy is effective in preventing SCD complications, although its effect in preventing SCD central nervous system ... Although chronic transfusion decreases risk tenfold, this form of therapy is burdensome and includes risk of iron overload. ...
Step 4. Consideration of recanalization status of occluded artery after thrombolytic therapy (Figure 1D). If there is occlusion ... Step 5. Consideration of follow-up recanalization status of occluded artery without thrombolytic therapy (Figure 1E). When ... E) Step 5: Consideration of follow-up recanalization status of occluded artery without thrombolytic therapy. ★: If one of three ... Coronary artery disease and atrial fibrillation were most prevalent in CE and UD ≥2. Thrombolytic therapies were most ...
Although the use of thrombolytic locks (urokinase, streptokinase, tissue plasminogen activators) as an adjunctive therapy for ... as a lock therapy in adult patients with CRBSI. These authors demonstrated that this lock therapy decreased the rate of ... While the use of antimicrobial lock therapy for salvaging is an approach that more or less has become part of usual HPN care, ... Walraven, C.J.; Lee, S.A. Antifungal Lock Therapy. Antimicrob. Agents Chemother. 2013, 57, 1-8. [Google Scholar] [CrossRef] ...
THROMBOLYTIC THERAPY * TISSUE-PLASMINOGEN ACTIVATOR Identity. PubMed ID * 9178794 Additional Document Info. start page * 1802 ...
Thrombolytic Therapy -- congresses * Thrombosis -- Congresses Language eng. Cataloging source DNLM/DLC. Dewey number 612.1/15. ...
  • Ischemic symptoms reversed after CTA and before the initiation of thrombolytic therapy in 2 patients whose CTAs showed occlusion of secondary branch of the middle cerebral artery (MCA). (elsevier.com)
  • CTA can provide important information before the initiation of thrombolytic therapy. (elsevier.com)
  • In 11 of the 13 patients with ICH, clinical symptoms occurred within 24 hours of the initiation of thrombolytic therapy. (elsevier.com)
  • This week's topics include antiplatelet therapy duration following bare metal or drug-eluting coronary stents, thrombolysis in acute ischemic stroke, and more. (jwatch.org)
  • The patient underwent nine cycles of the FOLFIRI (90 min intravenous infusion of 180 mg/m2 irinotecan, 400 mg/m2 fluorouracil and 400 mg/m2 leucovorin, followed by a 46 h intravenous infusion of 2,400 mg/m2, entire regimen delivered twice a week, for 18 weeks) plus bevacizumab combination therapy. (nih.gov)
  • Intravenous thrombolytic therapy after ischaemic stroke significantly reduces mortality and morbidity. (biomedcentral.com)
  • The most commonly used drug for thrombolytic therapy is tissue plasminogen activator (tPA), but other drugs can do the same thing. (sutterhealth.org)
  • Due to the patient's malignancy and risk of bleeding, prolonged low-dose thrombolytic therapy [25 mg tissue plasminogen activator (tPA) infusion for 6 h] was administered to the peripheral vein, according to a previous study by Aykan et al (5), rather than a standard thrombolytic regime. (nih.gov)
  • Patients with cardiogenic shock, left bundle branch block, prior aortocoronary bypass surgery, recent percutaneous transluminal coronary angioplasty or standard contraindications to thrombolytic therapy were excluded. (duke.edu)
  • Therefore, absolute and relative contraindications for thrombolytic therapy along with clinical judgment are the only tools available to risk stratify for bleeding. (heart.org)
  • Jay Giri and Saurav Chatterjee discuss their meta-analysis of trials comparing thrombolytic therapy and conventional anticoagulation in patients at intermediate risk for pulmonary embolism. (jwatch.org)
  • The role of thrombolytic therapy for the treatment of pulmonary embolism has been unclear, as it has been difficult to measure the precise balance between enhanced clot-dissolving efficacy and greater bleeding risk produced by thrombolysis when compared with conventional anticoagulation. (jwatch.org)
  • Also useful would be a risk model that predicted risks of various therapies beyond anticoagulation. (heart.org)
  • Conclusion: Adjunctive stenting following thrombolytic administration in AMI improves epicardial TIMI 3 flow and TIMI frame counts as well as dye inflow into the myocardium: TMPG 0 is reduced and myocardial blush measured quantitatively by DSA tends to be brighter. (elsevier.com)
  • Prehospital therapy was administered by emergency medical personnel. (nih.gov)
  • The patients in the prehospital group received thrombolytic therapy a median of 55 minutes earlier than those in the hospital group. (nih.gov)
  • Prehospital thrombolytic therapy for patients with suspected myocardial infarction is both feasible and safe when administered by well-equipped, well-trained mobile emergency medical staff. (nih.gov)
  • To compare a system of prehospital thrombolytic therapy, delivered by paramedics under medical guidance, with in-hospital thrombolytic therapy in meeting National Service Framework (NSF) targets for treatment of acute myocardial infarction at a District General Hospital setting in England. (bmj.com)
  • Retrospective observational case-control study comparing patients with suspected acute myocardial infarction (AMI) treated with thrombolytic therapy in the prehospital environment with patients treated in hospital. (bmj.com)
  • A) All patients who received prehospital thrombolytic therapy for suspected AMI accompanied by electrocardiographic features considered diagnostic. (bmj.com)
  • 3. Myocardial infarction was confirmed in 92% (25/27) of patients who received prehospital thrombolytic therapy and similarly 92% (25/27) of those given in-hospital thrombolytic therapy. (bmj.com)
  • In rural communities, however, where transfer times are often in excess of 30 minutes, the NSF document acknowledged that other models of care such as prehospital thrombolytic therapy might offer the best access to early treatment. (bmj.com)
  • Although such therapy appears to reduce mortality from cardiac causes, our data do not definitely establish that it reduces overall mortality. (nih.gov)
  • His clinical experience has focused on caring for adult patients with advanced heart disease who require mechanical therapies or cardiac transplantation. (westernschools.com)
  • The efficacy of thrombolytic therapy for acute myocardial infarction depends partly on how soon after the onset of symptoms it is administered. (nih.gov)
  • We therefore studied the efficacy and safety of thrombolytic therapy administered before hospital admission and thrombolytic therapy administered after admission in patients with suspected myocardial infarction. (nih.gov)
  • Graded exercise testing following thrombolytic therapy for acute myocardial infarction: the importance of timing and infarct location. (duke.edu)
  • OBJECTIVES: To determine the influence of timing, infarct location and thrombolytic therapy on the electrocardiographic (ECG) response to exercise testing following acute myocardial infarction. (duke.edu)
  • ICH associated with thrombolytic therapy for acute myocardial infarction has a grave prognosis, with 62% of patients dying during hospitalization. (elsevier.com)
  • Selecting the correct patient for systemic thrombolysis necessitates a thorough assessment of the patient's preexisting comorbidities, mode of presentation and focused clinical examination to assess the immediate risk of hemodynamic collapse, the risk of long term complications, and the risk of major bleeding associated with the thrombolytic agent. (heart.org)
  • It has been shown that thrombolytic therapy can improve clinical outcome in some patients with acute cerebral ischemia. (elsevier.com)
  • A fatal outcome resulted in three of the four patients who had clinical symptoms within 3.5 hours after beginning thrombolytic therapy. (elsevier.com)
  • Clinicians play an important role in managing patients with these conditions who are eligible for high-risk pharmacologic therapies, such as thrombolytics. (westernschools.com)
  • This course is designed for clinicians who provide care to patients currently prescribed thrombolytic medications. (westernschools.com)
  • The purpose of this course is to increase clinicians' knowledge of thrombolytic medications so that they can identify the optimal therapy and safely use these medications. (westernschools.com)
  • Early delivery of thrombolytic therapy after AMI saves lives and reduces morbidity. (bmj.com)
  • In urban areas it may be possible to meet this target by rapid transfer and early administration of thrombolytic agents in hospital. (bmj.com)
  • However, there is insufficient data regarding the safety and activity of thrombolytic agents in cancer patients receiving bevacizumab-based therapy. (nih.gov)
  • Ideally, you should receive thrombolytic medicines within the first 30 minutes after arriving at the hospital for treatment. (sutterhealth.org)
  • B) Patients who received thrombolytic therapy after arrival at hospital for the same indication, matched with group A by age, gender and postcode. (bmj.com)
  • Thrombolytic therapy should be administered in a very orchestrated and consistent manner, relying on emergent imaging and screening to ensure only patients with ischemic stroke and no contraindications receive such therapy. (medscape.com)
  • Current treatments for acute ischemic stroke include IV thrombolytic therapy with tissue-type plasminogen activator ( t-PA ) and endovascular therapies using stent retriever devices. (medscape.com)
  • [ 5 ] . A 2015 update of the American Heart Association/American Stroke Association guidelines for the early management of patients with acute ischemic stroke recommends that patients eligible for intravenous t-PA should receive intravenous t-PA even if endovascular treatments are being considered and that patients should receive endovascular therapy with a stent retriever if they meet criteria. (medscape.com)
  • Thrombolysis with intravenous(iv) tissue plasminogen activator (t-PA) is the only effective and approved therapy for acute ischemic stroke. (clinicaltrials.gov)
  • Background and Purpose- Several definitions have been proposed to distinguish clinically relevant from incidental cerebral hemorrhagic transformation after thrombolytic therapy for acute ischemic stroke. (medworm.com)
  • Timeliness of tissue-type plasminogen activator therapy in acute ischemic stroke: patient characteristics, hospital factors, and outcomes associated with door-to-needle times within 60 minutes. (springermedizin.de)
  • Mechanisms of hemorrhagic transformation after tissue plasminogen activator reperfusion therapy for ischemic stroke. (springermedizin.de)
  • The three big clinical studies of streptokinase in acute ischemic stroke were disrupted due to negative results: the risk of intraparenhymal hemorrhages and death was signifficantly higher in treatment group vs placebo, the functional recovery was not improved with therapy. (eestiarst.ee)
  • Only the rt-PA, synthesised in 1980s, has reached the clinical practice and is used for the thrombolytic treatment of acute ischemic stroke. (eestiarst.ee)
  • Following the success of recent endovascular trials, endovascular therapy has emerged as an exciting addition to the arsenal of clinical management of patients with acute ischemic stroke (AIS). (readbyqxmd.com)
  • In patients with a history of noncardioembolic ischemic stroke or TIA, we recommend long-term treatment with aspirin (75-100 mg once daily), clopidogrel (75 mg once daily), aspirin/extended release dipyridamole (25 mg/200 mg bid), or cilostazol (100 mg bid) over no antiplatelet therapy (Grade 1A), oral anticoagulants (Grade 1B), the combination of clopidogrel plus aspirin (Grade 1B), or triflusal (Grade 2B). (nuigalway.ie)
  • Race/Ethnic differences in the risk of hemorrhagic complications among patients with ischemic stroke receiving thrombolytic therapy. (duke.edu)
  • Osborn and associates reviewed the large trials of thrombolytic therapy in the treatment of patients with ischemic stroke. (aafp.org)
  • Background/Purpose: To determine whether utilization of emergency medical service (EMS) can increase use and expedite delivery of the thrombolytic therapy in acute ischemic stroke patients. (elsevier.com)
  • Conclusion: Utilization of EMS can not only help acute ischemic stroke patients in early presentation to ED, but also effectively facilitate thrombolytic therapy and shorten the onset-to-needle time. (elsevier.com)
  • What are guidelines for thrombolytic therapy for myocardial infarction (MI)? (medscape.com)
  • This paper deals with the history of thrombolytic therapy from its inception to its application in acute myocardial infarction. (springer.com)
  • The efficacy of thrombolytic therapy for acute myocardial infarction depends partly on how soon after the onset of symptoms it is administered. (nih.gov)
  • We therefore studied the efficacy and safety of thrombolytic therapy administered before hospital admission and thrombolytic therapy administered after admission in patients with suspected myocardial infarction. (nih.gov)
  • Prehospital thrombolytic therapy for patients with suspected myocardial infarction is both feasible and safe when administered by well-equipped, well-trained mobile emergency medical staff. (nih.gov)
  • In their review of the selection of patients with acute myocardial infarction for thrombolytic therapy, Muller and Topol (1) pointed out the current limitations in applying this therapy to a larger number of patients. (annals.org)
  • The decision to withhold thrombolytic therapy, however, is based not only on the recognition of risk factors but also on our inability to make an accurate and timely diagnosis of an acute myocardial infarction (2). (annals.org)
  • Consequently, the majority of patients with ST elevation myocardial infarction receive fibrinolytic therapy. (bmj.com)
  • Protective effect of intravenous magnesium in acute myocardial infarction following thrombolytic therapy. (nih.gov)
  • The role of intravenous magnesium therapy in patients with acute myocardial infarction (AMI) who received thrombolytic therapy is controversial. (nih.gov)
  • As with acute myocardial infarction, one would expect that a larger (more than 1,000 patients) randomized multicenter study will eventually give the definitive indications for thrombolytic therapy in such patients. (aafp.org)
  • Increased thrombin levels during thrombolytic therapy in acute myocardial infarction. (ahajournals.org)
  • Because patients in the Mayo trial assigned to t-PA did not undergo protocol coronary angiography, reperfusion rates from the Thrombolysis in Myocardial Infarction (TIMI) I trial in which patients underwent coronary angiography 30, 60 and 90 minutes after thrombolytic therapy were used for comparison. (nih.gov)
  • Rescue angioplasty after failed thrombolytic therapy for acute myocardial infarction. (annals.org)
  • In patients with acute myocardial infarction (MI) after failed thrombolytic therapy, does rescue percutaneous coronary intervention (PCI) reduce cardiovascular and cerebrovascular events? (annals.org)
  • High-dose intravenous thrombolytic therapy in acute myocardial infarction: efficiency, tolerance, complications and influence on left ventricular performance. (biomedsearch.com)
  • A case of acute myocardial infarction as a complication of thrombolytic therapy for valve thrombosis is rare. (umin.ac.jp)
  • Enzymatic evidence of impaired reperfusion in diabetic patients after thrombolytic therapy for acute myocardial infarction: a role for plasminogen activator inhibitor? (bmj.com)
  • OBJECTIVE--To compare the activity of plasminogen activator inhibitor (PAI-1) in diabetic and non-diabetic patients admitted with acute myocardial infarction and to determine whether PAI-1 activity influences reperfusion after thrombolytic therapy. (bmj.com)
  • To compare a system of prehospital thrombolytic therapy, delivered by paramedics under medical guidance, with in-hospital thrombolytic therapy in meeting National Service Framework (NSF) targets for treatment of acute myocardial infarction at a District General Hospital setting in England. (bmj.com)
  • Retrospective observational case-control study comparing patients with suspected acute myocardial infarction (AMI) treated with thrombolytic therapy in the prehospital environment with patients treated in hospital. (bmj.com)
  • 3. Myocardial infarction was confirmed in 92% (25/27) of patients who received prehospital thrombolytic therapy and similarly 92% (25/27) of those given in-hospital thrombolytic therapy. (bmj.com)
  • Primary angioplasty, defined as angioplasty for acute myocardial infarction without prior or concomitant thrombolytic therapy, results in a higher patency rate of the infarct-related vessel, smaller enzymatic infarct size, better preserved left ventricular function and better clinical outcome when compared with intravenous thrombolytic therapy ( [1-4] ). (onlinejacc.org)
  • AIMS: No antithrombotic therapy has been shown to reduce mortality when used with thrombolytics in acute myocardial infarction (AMI). (diva-portal.org)
  • In a period of 18 months, 2,469 patients with acute myocardial infarction treated with a thrombolytic agent were prospectively registered in 61 hospitals. (semanticscholar.org)
  • Effect of thrombolytic therapy on the risk of cardiac rupture and mortality in older patients with first acute myocardial infarction. (semanticscholar.org)
  • The aim of the study was to determine the in-hospital delay in administrating thrombolytic therapy to patients with acute myocardial infarction (AMI) A mixed method with convergent parallel design was applied to the study. (sun.ac.za)
  • The population consisted of N=63 case notes of adult patients diagnosed with acute myocardial infarction and who had received thrombolytic therapy. (sun.ac.za)
  • Thrombolytic agents have become the corner stone in the treatment of acute myocardial infarction. (semanticscholar.org)
  • The outcome of in-hospital patients with myocardial infarction with and without diabetes after thrombolytic therapy is presented here. (readbyqxmd.com)
  • Thrombolytic therapy has been found to improve the prognosis of selected patients with acute myocardial infarction. (mysciencework.com)
  • Therefore, it is probable that most patients with evolving Q-wave myocardial infarction are best treated with conservative strategies after initial thrombolytic therapy, although there may still be a role for emergency angioplasty in a relatively small subset who present with evolving myocardial infarction and severely depressed left ventricular function. (mysciencework.com)
  • Graded exercise testing following thrombolytic therapy for acute myocardial infarction: the importance of timing and infarct location. (duke.edu)
  • OBJECTIVES: To determine the influence of timing, infarct location and thrombolytic therapy on the electrocardiographic (ECG) response to exercise testing following acute myocardial infarction. (duke.edu)
  • Thrombolytic therapy is being used with increasing frequency to treat acute myocardial infarction (MI). (elsevier.com)
  • Quinn, T. and Thompson, D.R. (1995) Administration of thrombolytic therapy to patients with acute myocardial infarction. (kingston.ac.uk)
  • The publication of large randomised trials such as ISIS 2 (1988) and AIMS (1990), provided striking evidence as to the effectiveness of thrombolytic therapy in reducing early mortality and morbidity in patients suffering acute myocardial infarction. (kingston.ac.uk)
  • In contrast to these observations, a recent retrospective review of women age 50 yr or younger, who presented with an acute myocardial infarction, determined that 94% of women met eligibility criteria for thrombolytic agents, and 91% of these women were treated with drug. (78stepshealth.us)
  • Although studies have suggested that there may be an increase in the risk of moderate bleeding in menstruating patients treated with thrombolytic agents, the GUSTO-I study revealed that the mortality reduction associated with thrombolytic therapy for acute myocardial infarction should not be withheld because of active menstruation (130). (78stepshealth.us)
  • Percutaneous revascularization strategies to restore coronary artery patency during acute myocardial infarction in the absence of prior thrombolytic therapy, or primary angioplasty, results in a higher infarct-related coronary artery patency rate (131), smaller enzymatic infarct size, increased preservation of left ventricular function, and improved clinical outcome compared to thrombolytic therapy (131-133). (78stepshealth.us)
  • In patients with acute myocardial infarction (MI) presenting to community hospitals without facilities for percutaneous coronary intervention (PCI), does transport to a PCI center improve long-term outcome more than thrombolytic (TL) therapy at the community hospital? (acponline.org)
  • In patients with acute myocardial infarction (MI) presenting to community hospitals without facilities for percutaneous coronary intervention (PCI), transport to a PCI center reduced long-term risk for recurrent MI and need for additional PCI procedures more than thrombolytic therapy at the community hospital. (acponline.org)
  • Intravenous Thrombolytic Therapy at Clinique de Ge. (mymeditravel.com)
  • It is 0 Km away from the City and was established in 1972 Jan. Feel free to request a free quote and our team will compare the prices and costs for Intravenous Thrombolytic Therapy in Witellikerstrasse and create a shortlist of the most suitable clinics. (mymeditravel.com)
  • Intravenous Thrombolytic Therapy at Bumrungrad Int. (mymeditravel.com)
  • Intravenous Thrombolytic Therapy at Pantai Hospita. (mymeditravel.com)
  • Koc University Hospital is offering Intravenous Thrombolytic Therapy procedures and the prices range between $846 and $1,017. (mymeditravel.com)
  • Intravenous Thrombolytic Therapy in and around Leb. (mymeditravel.com)
  • Intravenous Thrombolytic Therapy at Medicana Inter. (mymeditravel.com)
  • Ns07 chronic subdural haematomas and anticoagulation or anti-thrombolytic therapy. (biomedsearch.com)
  • Dr. Almoosa states that no evidence from clinical trials proves thrombolytic therapy reduces the recurrence rate of pulmonary embolism or affects mortality better than anticoagulation. (aafp.org)
  • The authors did a systematic review of randomized controlled studies comparing systemic thrombolytic therapy plus anticoagulation with anticoagulation alone in patients with acute PE. (acc.org)
  • The article describes the antithrombotic effect of VKAs, the monitoring of anticoagulation intensity, the clinical applications of VKA therapy, and the optimal therapeutic range of VKAs, and provides specific management recommendations. (sigmaaldrich.com)
  • Among the key recommendations in this article are the following: for dosing of VKAs, we suggest the initiation of oral anticoagulation therapy with doses between 5 and 10 mg for the first 1 or 2 days for most individuals, with subsequent dosing based on the international normalized ratio (INR) response (Grade 2B). (sigmaaldrich.com)
  • If a whole‑leg scan is conducted initially, no repeat ultrasound at 1 week is required, but more patients may need anticoagulation therapy. (nice.org.uk)
  • Determining whether LMWH or a VKA should be used for anticoagulation treatment in patients with cancer beyond the initial 6 months of LMWH therapy is critically important. (nice.org.uk)
  • 2 This article reviews updates to thrombolytic, antiplatelet, and anticoagulation therapies, statin use, blood pressure and blood glucose targets, and a new recommendation for depression screening. (uspharmacist.com)
  • Thrombolytic therapy for submassive pulmonary embolus? (bmj.com)
  • We read with interest Dr. Almoosa's article, "Is Thrombolytic Therapy Effective for Pulmonary Embolism? (aafp.org)
  • 2 So, the answer to the title question is, yes, thrombolytic therapy is effective for pulmonary embolism (PE). (aafp.org)
  • 1. Almoosa K. Is thrombolytic therapy effective for pulmonary embolism? (aafp.org)
  • Thrombolytic therapy of pulmonary embolism. (aafp.org)
  • Association between thrombolytic treatment and the prognosis of hemodynamically stable patients with major pulmonary embolism: results of a multicenter registry. (aafp.org)
  • Ravi Badge and Mukesh Hemmady, "Forearm Compartment Syndrome following Thrombolytic Therapy for Massive Pulmonary Embolism: A Case Report and Review of Literature," Case Reports in Orthopedics , vol. 2011, Article ID 678525, 4 pages, 2011. (hindawi.com)
  • What are the risks and benefits of thrombolytic therapy in the management of patients with acute pulmonary embolism (PE)? (acc.org)
  • For patients with PE and haemodynamic instability, offer UFH and consider thrombolytic therapy (see recommendations 1.2.7 and 1.2.8 on pharmacological systemic thrombolytic therapy in pulmonary embolism). (nice.org.uk)
  • Purpose The use of anticoagulant therapy as a causative agent in the development of chronic subdural haematomas (CSDH) was investigated. (biomedsearch.com)
  • We suspected a high incidence of anticoagulant therapy or anti-thrombotic therapy in patients who presented with CSDH. (biomedsearch.com)
  • We found that anticoagulant therapy was used by a significant percentage of CSDH patients. (biomedsearch.com)
  • In patients undergoing dental procedures, we suggest the use of tranexamic acid mouthwash (Grade 2B) or epsilon amino caproic acid mouthwash without interrupting anticoagulant therapy (Grade 2B) if there is a concern for local bleeding. (sigmaaldrich.com)
  • Since the effects of warfarin anticoagulant therapy were insufficient, its dose was adjusted on follow-up. (umin.ac.jp)
  • immediate interim parenteral anticoagulant therapy followed by a CTPA, if a CTPA cannot be carried out immediately. (nice.org.uk)
  • Most patients who have bleeding can be managed by interruption of thrombolytic and anticoagulant therapy, volume replacement, and manual pressure applied to an incompetent vessel. (scripps.edu)
  • It is recommended that future clinical studies be designed to include three essential features: (a) a uniform clinical staging, (b) a dose-response relationship with a plasminogen activator based on in vivo and in vitro studies, and (c) detailed studies of the newborn's fibrinolytic mechanism before and during thrombolytic therapy. (nih.gov)
  • w3 With improvements in techniques and experience, mechanical reperfusion therapy has been proven to be even more beneficial than in-hospital initiated fibrinolytic therapy. (bmj.com)
  • In the first part of this comprehensive review of thrombolytic therapy in clinical medicine, we begin with a brief history of fibrinolysis, followed by a review of the components of die endogenous fibrinolytic system and the currently available plasminogen activators. (elsevier.com)
  • In a meta-analysis of the Fibrinolytic Therapy Trialists' Collaboration Group, which included all randomized clinical trials that compared thrombolytic agents with a placebo or control group, the absolute benefit of thrombolytic therapy with regard to 35-d mortality was 2.2% in female patients compared to 1.9% in male patients. (78stepshealth.us)
  • PCI has largely replaced fibrinolytic therapy in settings in which both are available. (acponline.org)
  • Physicians in hospitals where PCI is unavailable must choose between offering immediate fibrinolytic therapy or transport to a PCI facility. (acponline.org)
  • Although such therapy appears to reduce mortality from cardiac causes, our data do not definitely establish that it reduces overall mortality. (nih.gov)
  • Intravenous magnesium sulphate in patients with AMI is a safe and useful adjunct to thrombolytic therapy in reducing the short-term mortality and ventricular arrhythmias after AMI. (nih.gov)
  • 3 A recent trial 6 that evaluated 719 patients with right ventricular dysfunction reported a 30-day mortality of 11.1 percent in the anticoagulant group, compared with 4.7 percent in the thrombolytic group. (aafp.org)
  • Thrombolytic therapy reduces total mortality, PE recurrence, and PE-related mortality in patients with acute PE. (acc.org)
  • Another recent meta-analysis focused on the impact of right ventricular (RV) dysfunction on outcome and concluded that those with hemodynamically stable PE and RV dysfunction benefit from thrombolytic therapy with a meaningful reduction in overall mortality, but with a significant risk of major bleeding including intracranial hemorrhage, particularly in patients older than 65 years. (acc.org)
  • A previous meta-analysis of several trials of thrombolytic therapy demonstrated a higher risk of mortality in patients who received thrombolytic therapy than in patients who did not, but individual study variations make this conclusion questionable. (aafp.org)
  • Here, we presented a case of 56-yr-old woman with massive PTE showing hemodynamic collapse, who was successfully treated with extracorporeal membrane oxygenation (ECMO) adjunct to thrombolytic therapy even without thrombectomy. (bvsalud.org)
  • The catheter was positioned to optimize delivery of thrombolytic therapy to residual thrombus. (aapc.com)
  • Early delivery of thrombolytic therapy after AMI saves lives and reduces morbidity. (bmj.com)
  • The catheter with multiple sideholes is positioned to deliver thrombolytic therapy within the thrombus as described. (aapc.com)
  • The critical event is usually the formation of an acute thrombus, so the rationale for thrombolytic treatment is to achieve arterial recanalization with a relatively safe agent soon enough to improve patient outcome. (springer.com)
  • Time gains are substantial and can meet the national targets for early thrombolytic therapy in the majority of patients. (bmj.com)
  • Thrombolytic therapy results in more clot lysis than treatment with heparin alone. (aafp.org)
  • Thrombolytic therapy is less risky than treatment with blood-thinning medications such as warfarin and heparin. (mercy.com)
  • For patients with a high risk of thromboembolism, we suggest stopping warfarin therapy approximately 4 days before surgery, to allow the INR to return to normal, and beginning therapy with full-dose unfractionated heparin or full-dose low-molecular-weight heparin as the INR falls (Grade 2C). (sigmaaldrich.com)
  • Thrombolytic therapy is the use of drugs that dissolve blood clots. (encyclopedia.com)
  • Thrombolytic therapy is used to dissolve blood clots that could cause serious, and possibly life-threatening, damage if they are not removed. (encyclopedia.com)
  • Thrombolytic therapy is also used to dissolve blood clots that form in catheters or tubes put into people's bodies for medical treatments, such as dialysis or chemotherapy. (encyclopedia.com)
  • Once there, the tip of the catheter releases the thrombolytic drugs to help dissolve the clot. (providence.org)
  • Although in most cases thrombolytic therapy will alleviate your symptoms and dissolve the blood clot, there are cases where the treatment is not effective. (mercy.com)
  • In thrombolytic therapy, clot-busting drugs called lytics dissolve blood clots that suddenly block major blood vessels. (emoryhealthcare.org)
  • Thrombolytic therapy, also known as lysis therapy, is emergency treatment for patients who have completely blocked arteries or veins caused by blood clots. (mercy.com)
  • Thrombolytic therapy is used to treat dangerous blood clots found in veins and arteries. (vasculartyler.com)
  • Combined intravenous (IV) and intra-arterial (IA) thrombolytic therapy may be faster and easier to initiate than monotherapy, and its recanalization rate may be better as well. (ajnr.org)
  • 7 Multiple substudies of recent large RCTs of dual antiplatelet therapy have shown similar efficacy and lower rates of bleeding for low-dose compared with higher-dose ASA. (cmaj.ca)
  • What additional antiplatelet therapy should be given? (cmaj.ca)
  • Major advances were made to antiplatelet therapy with the approval of 2 new agents, prasugrel and ticagrelor, which both have a more rapid, predictable and potent antiplatelet effect than clopidogrel ( Table 1 ). (cmaj.ca)
  • Aspirin is reaffirmed as the drug of choice for antiplatelet treatment of AIS, and recommendations regarding dual antiplatelet therapy for secondary prophylaxis are updated. (uspharmacist.com)
  • 7 The new guidelines specify that IV alteplase should be administered to patients receiving antiplatelet monotherapy and dual antiplatelet therapy (DAPT), although administration with DAPT has a lower quality of evidence. (uspharmacist.com)
  • Anticoagulant and antithrombotic therapy is given to prevent formation or propagation of thrombi. (oncohemakey.com)
  • Eligibility criteria for thrombolytic trials have usually relied on a typical history of chest pain and specific electrocardiographic (ECG) findings of acute ischemia. (annals.org)
  • To evaluate the outcome of intraventricular thrombolytic therapy for intraventricular haemorrhage and to formulate a safe and effective regimen. (hkmj.org)
  • Materials and Methods: Studies that evaluated the association between the baseline SBP and the outcome of patients undergoing thrombolytic therapy were sought. (medworm.com)
  • Ideally, you should receive thrombolytic medicines within the first 30 minutes after arriving at the hospital for treatment. (medlineplus.gov)
  • The most commonly used drug for thrombolytic therapy is tissue plasminogen activator (tPA), but other drugs can do the same thing. (medlineplus.gov)
  • At the acute stage of cerebral ischaemia, the only effective drug that increases the proportion of patients who survive without dependency is thrombolytic therapy by intravenous (i.v.) tissue-plasminogen activator (t-PA). (clinicaltrials.gov)
  • Due to the patient's malignancy and risk of bleeding, prolonged low-dose thrombolytic therapy [25 mg tissue plasminogen activator (tPA) infusion for 6 h] was administered to the peripheral vein, according to a previous study by Aykan et al (5), rather than a standard thrombolytic regime. (nih.gov)
  • w4 Yet, pharmacological reperfusion therapy is more widely available, more easily applicable, and less dependent of institutional experience. (bmj.com)
  • In order to optimise the efficacy of reperfusion therapy, concomitant thrombin and platelet inhibition is required, which is aimed not only at enhancing early patency but also for reducing reocclusion and recurrent thrombotic events. (bmj.com)
  • In addition, female gender and low body weight were identified as independent risk factors for cerebrovascular and hemorrhagic complications associated with thrombolytic therapy (128). (78stepshealth.us)
  • Complications in thrombolytic therapy are not uncommon, so that is why it is done under close supervision. (vasculartyler.com)
  • CONCLUSION--Both raised PAI-1 activity on admission and diabetes were associated with a reduced likelihood of enzymatic evidence of reperfusion after thrombolytic therapy. (bmj.com)
  • However, in the isolated inferior MI group, there was a good correlation between CKMB and change in the QRS axis (r=-0.52 p=0.049).Conclusion: The change in the QRS axis is rarely emphasized, providing a practical and promising tool for evaluating both the efficiency of the thrombolytic therapy and prognostic infarct sizing. (oalib.com)
  • Conclusion: Adjunctive stenting following thrombolytic administration in AMI improves epicardial TIMI 3 flow and TIMI frame counts as well as dye inflow into the myocardium: TMPG 0 is reduced and myocardial blush measured quantitatively by DSA tends to be brighter. (elsevier.com)
  • 2. Initiation of thrombolytic therapy using catheter- directed TPA. (aapc.com)
  • 2. Catheter exchange during thrombolytic therapy. (aapc.com)
  • Thrombolytic therapy involves inserting a catheter into an artery in the groin and threading to the site of the clot. (mercy.com)
  • However, the patient complained of chest pain 1 h 30 min after initiation of thrombolytic therapy. (umin.ac.jp)
  • One small trial 5 has shown a dramatic survival advantage favoring thrombolytic therapy in patients with massive PE and systemic hypoperfusion. (aafp.org)
  • Thrombolytic therapy only removes the clot, but it can be administered in hospitals with fewer resources than are required for insertion of a stent. (encyclopedia.com)
  • In this study, we sought to find a relation between the infarct size and the change in the QRS axis after thrombolytic therapy.Materials and Methods: Patients with STEAMI who received thrombolytic therapy were selected retrospectively. (oalib.com)
  • Thrombolytic therapy is associated with an increase of major and fatal or intracranial hemorrhage. (acc.org)
  • The authors report a case of a patient who developed an intracranial hemorrhage following thrombolytic therapy that required emergency surgical intervention. (elsevier.com)
  • In older children and adults the use of thrombolytic drugs appears to be a promising medical approach to thromboembolic disease. (nih.gov)
  • New thrombolytic drugs have been designed to overcome these shortcomings. (semanticscholar.org)
  • Through decades of basic research to identify new drugs and unravel the underlying mechanisms of action, researchers are developing newer, more powerful therapies. (faseb.org)
  • These recombinant forms of tPA have been shown to have a longer half-life in the blood and a greater resistance to inhibition, resulting in an increased capacity to treat thrombolytic diseases. (wikipedia.org)
  • The major risk of receiving thrombolytic therapy (TPA) is hemorrhage. (merlot.org)
  • Hemorrhage is the major adverse effect of thrombolytic therapy, but its incidence can be reduced by careful selection of patients and avoidance of unnecessary invasive procedures. (scripps.edu)
  • The CT brain scan must ascertain the absence of hemorrhage before thrombolytic therapy is initiated. (aafp.org)