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 ...
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
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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
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 ...
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 ...
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
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.
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 ...