DWI-ASPECTS ≥7 was an independent predictor of short-term neurological recovery after an M1-MCAO. Limited DWI changes before IV-tPA have been reported as a predictor of neurological recovery.4 Presence of a clinical-DWI mismatch defined as DWI-ASPECTS ≥7 and an NIHSS score ≥8 has also been reported to be predictors of neurological recovery after IV-tPA.5 An advantage of our study is that the utility of DWI-ASPECTS was evaluated after adjusting for several established imaging and laboratory parameters.. Although early recanalization was associated with DR in patients with DWI-ASPECTS ≥7 and ,7, its role regarding clinical and radiological outcomes depended on the initial DWI-ASPECTS. In patients with DWI-ASPECTS ≥7, the favorable outcome rate and follow-up infarct volume were not statistically different between patients with and without early recanalization. To the contrary, in patients with DWI-ASPECTS ,7, favorable outcomes were only seen in patients with early recanalization. Early ...
TY - JOUR. T1 - Role of recombinant tissue plasminogen activator in free flap salvage. AU - Rinker, Brian D.. AU - Stewart, Daniel H.. AU - Pu, Lee Li-Qun. AU - Vasconez, Henry C.. PY - 2007/2. Y1 - 2007/2. N2 - The use of recombinant tissue plasminogen activator (rTPA) in microvascular surgery has been previously reported, but no consensus exists regarding its indications, dose, efficacy, or safety. The records of all patients undergoing free tissue transfer at one institution between 2000 and 2005 were reviewed. Patients requiring reexploration for pedicle thrombosis were identified. Chi-square and the two-sided Fishers exact tests were used to compare differences between the two groups. Two hundred seventy-five free flaps were performed in 259 patients. In 27 cases (10 percent), reexploration for impending failure was performed, and pedicle thrombosis was observed in 22 cases. In 15 cases, rTPA was administered. Ten of these flaps (67 percent) were successfully salvaged, compared to 2/7 (29 ...
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 ...
TY - JOUR. T1 - Endothelium-derived hyperpolarizing factor mediates bradykinin-stimulated tissue plasminogen activator release in humans. AU - Rahman, Ayaz M.. AU - Murrow, Jonathan R.. AU - Ozkor, Muhiddin A.. AU - Kavtaradze, Nino. AU - Lin, Ji. AU - De Staercke, Christine. AU - Hooper, W. Craig. AU - Manatunga, Amita. AU - Hayek, Salim. AU - Quyyumi, Arshed A.. PY - 2014/1/1. Y1 - 2014/1/1. N2 - Bradykinin (BK) stimulates tissue plasminogen activator (t-PA) release from human endothelium. Although BK stimulates both nitric oxide and endothelium-derived hyperpolarizing factor (EDHF) release, the role of EDHF in t-PA release remains unexplored. This study sought to determine the mechanisms of BK-stimulated t-PA release in the forearm vasculature of healthy human subjects. Methods: In 33 healthy subjects (age 40.3 ± 1.9 years), forearm blood flow (FBF) and t-PA release were measured at rest and after intra-arterial infusions of BK (400 ng/min) and sodium nitroprusside (3.2 mg/min). Measurements ...
AIMS: To determine whether circulating tissue plasminogen activator (t-PA) antigen concentrations are prospectively related to risk of coronary heart disease (CHD) in the general population. METHODS AND RESULTS: We measured baseline concentrations of t-PA antigen in the stored serum samples of 606 CHD cases and 1227 controls nested in a prospective cohort of 5661 men monitored for 16 years, and conducted a meta-analysis of previous relevant studies to place our findings in context. Tissue plasminogen activator antigen values were strongly correlated with several vascular risk factors, including serum lipids, body mass index, alcohol consumption, and markers of systemic inflammation. In a comparison of men in the top third compared with those in the bottom third of baseline t-PA antigen values, the odds ratio for CHD was 2.20 (95% confidence interval (CI) 1.70-2.85) after adjustment for age and town only, but this fell to 1.48 (1.09-2.01) after further adjustment. Analysis of t-PA as a continuous
TY - JOUR. T1 - Recombinant tissue plasminogen activator in acute thrombotic and embolic stroke. AU - Del Zoppo, Gregory J.. AU - Poeck, Klaus. AU - Pessin, Michael S.. AU - Wolpert, Samuel M.. AU - Furlan, Anthony J.. AU - Ferbert, Andreas. AU - Alberts, Mark J.. AU - Zivin, Justin A.. AU - Wechsler, Lawrence. AU - Busse, Otto. AU - Greenlee, Ralph. AU - Brass, Lawrence. AU - Mohr, J. P.. AU - Feldmann, Edward. AU - Hacke, Werner. AU - Kase, Carlos S.. AU - Biller, Jose. AU - Gress, Daryl. AU - Otis, Shirley M.. PY - 1992/7. Y1 - 1992/7. N2 - An open angiography-based, dose rate escalation study on the effect of intravenous infusion of recombinant tissue plastninogen activator (rt-PA) on cerebral arterial recanalization in patients with acute focal cerebral ischemia was performed at 16 centers. Arterial occlusions consistent with acute ischemia in the carotid or vertebrobasilar territory in the absence of detectable intracerebral hemorrhage were prerequisites for treatment. After the 60-minute ...
RESULTS: Thirty three hemithoraces were treated in 25 horses, with 55 separate treatments. Recombinant tissue plasminogen activator (375-20,000 μg/hemithorax) was administered 1-4 times. Sonographically visible reduction in fibrin mat thickness, loculations, fluid depth, or some combination of these was seen in 32/49 (65%) treatments. Response to at least 1 treatment was seen in 17/20 (85%) horses with sonographic follow-up evaluation after every treatment. Earlier onset of rTPA treatment associated with increased survival odds. No association was found between cumulative rTPA dose or number of rTPA doses and survival, development of complications, duration of hospitalization or total charges. Clinical evidence of hypocoagulability or bleeding was not observed. Eighteen horses (72%) survived to discharge ...
Alteplase is the only drug licensed for acute ischemic stroke, and in this formulation, the thrombolytic agent recombinant tissue plasminogen activator (rtPA) is stabilized in a solution of L-arginine. Improved functional outcomes after alteplase administration have been shown in clinical trials, along with improved histological and behavioral measures in experimental models of embolic stroke. However, in animal models of mechanically induced ischemia, alteplase can exacerbate ischemic damage. We have systematically reviewe d the literature of both rtPA and L-arginine administration in mechanical focal ischemia. The rtPA worsens ischemic damage under certain conditions, whereas L-arginine can have both beneficial and deleterious effects dependent on the time of administration. The interaction between rtPA and L-arginine may be leading to the production of nitric oxide, which can cause direct neurotoxicity, altered cerebral blood flow, and disruption of the neurovascular unit. We suggest that alternative
UJIAN TAKE HOME FARMAKOTERAPI DAN TERMINOLOGI MEDIK Pengampu : dr. Luciana Kuswibawati, M.Kes. Disusun Oleh : Ema Nillafita Puri Kusuma (068115097) PROGRAM PROFESI APOTEKER FAKULTAS FARMASI UNIVERSITAS SANATA DHARMA YOGYAKARTA 2007 Penggunaan Alteplase (Recombinant Tissue Plasminogen Activator (rt-PA)) pada terapi Acute Ischemic Stroke Stroke merupakan penyebab kematian terbesar di seluruh dunia, setelah penyakit kardiovaskuler dan…
To describe our outcomes using thrombolysis during the cardiopulmonary resuscitation (CPR) of patients in cardiorespiratory arrest (CA) caused by fulminant pulmonary embolism (FPE). A case series. Intensive care units of a district hospital and a referral centre. Six patients that suffered CA secondary to an FPE. Administration of recombinant tissue plasminogen activator during usual CPR manoeuvres when there was a strong suspicion of FPE. Permission for the thrombolytic therapy was sought from family members in all cases. Four out of the six patients survived and remain symptom-free. The thrombolysis was not associated with any fatal complications. Early thrombolysis during CPR manoeuvres for CA apparently caused by an FPE may reduce the mortality rate among these patients. ...
TY - JOUR. T1 - Early MRI Findings in Patients Receiving Tissue Plasminogen Activator Predict Outcome. T2 - Insights into the Pathophysiology of Acute Stroke in the Thrombolysis Era. AU - Chalela, Julio A.. AU - Kang, Dong Wha. AU - Luby, Marie. AU - Ezzeddine, Mustapha. AU - Latour, Lawrence L.. AU - Todd, Jason W.. AU - Dunn, Billy. AU - Warach, Steven. PY - 2004/1/1. Y1 - 2004/1/1. N2 - We measured ischemic brain changes with diffusion and perfusion MRI in 42 ischemic stroke patients before and 2 hours (range approximately 1.5 to 4.5 hours) after standard intravenous tissue plasminogen activator (tPA) therapy. The median time from stroke onset to tPA was 131 minutes. Clinical and MRI variables (change in perfusion and/or diffusion weighted lesion volume) were compared between those with excellent outcome defined as 3-month modified Rankin score (mRS) of 0 to I and those with incomplete recovery (mRS , 1). In multivariate logististic regression analysis, the most powerful independent predictor ...
See related article, p 2458.. Thrombolysis with intravenous recombinant tissue-type plasminogen activator (r-tPA)-still the only licensed therapy in hyperacute treatment ischemic stroke-has a clear population benefit on functional outcome, but there are likely to be individuals for whom the risk of severe harm outweighs benefit. The most dreaded complication is early symptomatic intracranial hemorrhage (sICH), which occurs in 6.8% of r-tPA-treated patients within 7 days when compared with 1.3% in controls, and is associated with higher disability.1. Unfortunately, it is not yet possible to predict any subgroup of patients more likely to be harmed than helped by intravenous thrombolysis, despite efforts to develop predictive sICH scores incorporating clinical and simple computed tomography-based imaging variables: such scores have c- statistics in the range of 0.62 to 0.70, making them unhelpful for individual treatment decisions.2 Limited predictive power reflects limited understanding of the ...
Abcams Tissue type Plasminogen Activator ELISA Kit suitable for Cell culture supernatant, Saliva, Milk, Urine, Serum, Plasma, Tissue in human. Reliably…
References for Abcams Tissue type Plasminogen Activator Human Chromogenic Activity Assay Kit (ab108905). Please let us know if you have used this product in…
Among 7193 patients treated with intravenous tissue plasminogen activator, 516 (7·2%) died during hospitalization. Factors associated with in-hospital death were older age, male gender, National Institutes of Health Stroke Scale score, history of myocardial infarction or coronary artery disease, and history of nonvalvular atrial fibrillation. Increasing age, higher National Institutes of Health Stroke Scale score, and history of dyslipidemia were associated with symptomatic intracerebral hemorrhage. There was no difference in the rates of in-hospital death or symptomatic intracerebral hemorrhage among patients treated with intravenous tissue plasminogen activator within three-hours of time last known to be well and those treated between three and 4·5 hours after this time ...
Purpose: : Recent studies on the treatment of acute subretinal macular hemorrhage have shown that the volume of the clot and the time to evacuation have strong prognostic factors on visual outcome. The purpose of this study was to evaluate a novel technique for surgical evacuation of these lesions involving direct injection of tissue plasminogen activator into the hematoma using pars plana vitrectomy. Methods: : Seventeen consecutive patients with subretinal macular hemorrhages due to age-related macular degeneration were enrolled. Patient demographics, acuities, and fluorescein angiograms were obtained for all evaluations. All patients underwent complete 3-port pars plana vitrectomy to enable direct cannulation of the subretinal space and injection of 48 ug of tissue plasminogen activator, partial fluid-air exchange, one hour face-up supine positioning postoperatively, followed by upright positioning overnight. Results: : Eighty-eight percent of patients with in the study had stabilization or ...
Pericytes, important elements of the blood-brain barrier (BBB), play critical roles in maintaining BBB integrity and modulating hemostasis, angiogenesis, inflammation and phagocytic function. We investigated whether pericytes are involved in the recombinant tissue plasminogen activator (rt-PA)-induced inflammatory response, which disrupts the BBB, and investigated the potential mechanisms. Middle cerebral artery occlusion (MCAO) and oxygen-glucose deprivation (OGD) were employed to mimic hypoxic-ischemic conditions. Rt-PA was intravenously injected into mice 1 h after 1 h MCAO, and Rt-PA was added to the culture medium after 4 h OGD. Rt-PA treatment aggravated the disruption of the BBB compared with hypoxia treatment, and etanercept (TNF-α inhibitor) combined with rt-PA alleviated the rt-PA-induced BBB disruption in vivo and in vitro. Rt-PA treatment increased the TNF-α and MCP-1 levels and decreased the TGF-β, p-Smad2/3 and PDGFR-β levels compared with hypoxia
AlphaLISA no-wash assay kit for detection and quantitation of Human Tissue Plasminogen Activator (tPA) in serum, buffered solution or cell culture medium.
Summary. Background: Tissue plasminogen activator (tPA) is unusual in the coagulation and fibrinolysis cascades in that it is produced as an active single-chain enzyme (sctPA) rather than a zymogen. Two chain tPA (tctPA) is produced by plasmin but there are conflicting reports in the literature on the behaviour of sc- and tctPA and little work on inhibition by the specific inhibitor plasminogen activator inhibitor-1 (PAI-1) under physiological conditions.. Objectives: To perform a systematic study on the kinetics of sctPA and tctPA as plasminogen activators and targets for PAI-1.. Methods: Detailed kinetic studies were performed in solution and in the presence of template stimulators, fibrinogen and fibrin, including native fibrin and partially digested fibrin. Numerical simulation techniques were utilized to cope with the challenges of investigating kinetics of activation and inhibition in the presence of fibrin(ogen).. Results: Enzyme efficiency (kcat/Km) was higher for tctPA than sctPA in ...
Tissue plasminogen activator (tPA) is expressed by many types of neurons in the developing and adult rodent brain. We have now mapped tPA transcripts and protein in the human central nervous system using tissue arrays and find widespread expression, in particular in neocortical mantle, thalamus, amygdala, and hippocampal pyramidal neurons. The abundant presence of tPA protein in cellular vesicles implies that its acute release, e.g. upon ischaemic stroke or trauma, could play a role in neuronal damage. We also found in patients with multiple sclerosis (MS), and to a lesser extent patients with leukaemia and encephalitis, prominently elevated tPA activity in the cerebrospinal fluid and in MS in neurons in the proximity of areas of demyelination elevated tPA mRNA and antigen levels. In addition, we observed up-regulation of tPA expression in a mouse model of MS, experimental autoimmune encephalomyelitis. Accumulating evidence implies roles for tPA in normal neural function, as well as in ...
Combined accelerated tissue-plasminogen activator and platelet glycoprotein iib/iiia integrin receptor blockade with integrin in acute myocardial infarction - results of a randomized, placebo-controlled, dose-ranging trial ...
Data on children treated with intravenous tPA for neuroimaging-confirmed arterial ischemic stroke were collected retrospectively from 16 former TIPS sites to establish preliminary safety data. Participating sites were required to report all children who were treated with intravenous tPA to minimize reporting bias. Symptomatic intracranial hemorrhage (SICH) was defined as ECASS (European Cooperative Acute Stroke Study) II parenchymal hematoma type 2 or any intracranial hemorrhage associated with neurological deterioration within 36 after following tPA administration. A Bayesian ...
Recanalization of an occluded vessel with recombinant tissue plasminogen activator is an effective strategy for treating acute ischemic stroke. Recombinant tissue plasminogen activator is administered as alteplase, a formulation containing many excipients including L-arginine, the substrate for nitric oxide production. Most studies fail to compare the effects of alteplase on brain injury to its L-arginine carrier solution. This study aimed to verify the previously reported detrimental effects of alteplase after cerebral ischemia and delineate the contribution of L-arginine. Male Wistar rats, subjected to 90 minutes of intraluminal middle cerebral artery occlusion (MCAO), were administered alteplase, the carrier solution or saline upon reperfusion. Neither alteplase nor the carrier affected cerebral blood flow (CBF) restoration throughout the first 60 minutes of reperfusion. Alteplase treatment was associated with increased mortality after MCAO. Twenty-four hours after MCAO, neurologic function and
Recanalization of an occluded vessel with recombinant tissue plasminogen activator is an effective strategy for treating acute ischemic stroke. Recombinant tissue plasminogen activator is administered as alteplase, a formulation containing many excipients including L-arginine, the substrate for nitric oxide production. Most studies fail to compare the effects of alteplase on brain injury to its L-arginine carrier solution. This study aimed to verify the previously reported detrimental effects of alteplase after cerebral ischemia and delineate the contribution of L-arginine. Male Wistar rats, subjected to 90 minutes of intraluminal middle cerebral artery occlusion (MCAO), were administered alteplase, the carrier solution or saline upon reperfusion. Neither alteplase nor the carrier affected cerebral blood flow (CBF) restoration throughout the first 60 minutes of reperfusion. Alteplase treatment was associated with increased mortality after MCAO. Twenty-four hours after MCAO, neurologic function and
Human tissue plasminogen activator, purified, glycosylated, 355 residues purified from CHO cells. Retavase is considered a third-generation thrombolytic agent, genetically engineered to retain and delete certain portions of human tPA. Retavase is a deletion mutein of human tPA formed by deleting various amino acids present in endogenous human tPA. Retavase contains 355 of the 527 amino acids of native human tPA (amino acids 1-3 and 176-527), and retains the activity-related kringle-2 and serine protease domains of human tPA. Three domains are deleted from retavase - kringle-1, finger, and epidermal growth factor (EGF).
Next, the timing of symptomatic infarct swelling after recombinant tissue plasminogen activator treatment is evaluated. To carry out this evaluation, 14,868 patients with acute ischemic stroke were retrospectively analyzed from a stroke registry data-bank.. An additional study assesses whether serum lipid levels are associated with the risk of symptomatic intracerebral hemorrhage and functional outcomes in patients with acute ischemic stroke after receiving intravenous thrombolysis.. The coronary characteristics of patients with ischemic stroke are also studied by way of coronary computed tomographic angiographies carried out in 349 patients with stroke and 349 age- and sex-matched patients without stroke. The coronary calcium scores and the prevalence of significant stenosis and high-risk plaque between the groups are compared.. This compilation also studies subclinical coronary artery disease in low to intermediate risk patients through coronary computed tomographic angiographies carried out ...
Tissue Plasminogen Activator: 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.
Thrombolysis is of net benefit in patients with acute ischaemic stroke, who are younger than 80 years of age and are treated within 4·5 h of onset. The third International Stroke Trial (IST-3) sought to determine whether a wider range of patients mi
This pilot trial will be the first step toward direct comparison of delivery of endovascular reperfusion therapy to intravenous recombinant tissue plasminogen activator (rt-PA) in a time-to-treatment framework shown as most effective by the NINDS rt-PA Stroke Trial. A randomized trial is justified for the following reasons: 1) The high rate of death and disability associated with ischemic stroke despite treatment with intravenous rt-PA mandates critical analysis of alternate therapies with therapeutic potential, 2) endovascular treatment for acute ischemic stroke is expanding in North America without compelling evidence of safety and efficacy from well-designed clinical trials, 3) critical cost-effectiveness analysis cannot be done without acquiring pertinent outcomes data from controlled studies. Trial Stopped: Poor recruitment ...
This pilot trial will be the first step toward direct comparison of delivery of endovascular reperfusion therapy to intravenous recombinant tissue plasminogen activator (rt-PA) in a time-to-treatment framework shown as most effective by the NINDS rt-PA Stroke Trial. A randomized trial is justified for the following reasons: 1) The high rate of death and disability associated with ischemic stroke despite treatment with intravenous rt-PA mandates critical analysis of alternate therapies with therapeutic potential, 2) endovascular treatment for acute ischemic stroke is expanding in North America without compelling evidence of safety and efficacy from well-designed clinical trials, 3) critical cost-effectiveness analysis cannot be done without acquiring pertinent outcomes data from controlled studies ...
The findings of the present study show that endothelium-dependent vasodilation was preserved in young untreated subjects with BH, in whom their BP elevation had persisted over a period of 4 to 5 years. However, BH subjects had a nonspecific attenuation of the vasodilatory response to the NO donor SNP. The observation that the relative vascular response to MCh over SNP was even greater in BH subjects supports the interpretation that the reduced FBF response was not due to a dysfunction of the endothelium per se. Rather, it appears that the functional impairment of the vasorelaxant response may be related to some as-yet-undefined ineffective action of NO on the vascular smooth muscle cells or to structural changes in the vasculature. To test this hypothesis, we also investigated the postischemic vasodilatory capacity, which may reflect structural vascular changes and/or reduced production or action of endogenous vasodilator release during tissue ischemia. However, BH subjects had no evidence of ...
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 ...
TY - JOUR. T1 - An activated protein C analog with reduced anticoagulant activity extends the therapeutic window of tissue plasminogen activator for ischemic stroke in rodents. AU - Wang, Yaoming. AU - Zhang, Zhenggang. AU - Chow, Nienwen. AU - Davis, Thomas P. AU - Griffin, John H.. AU - Chopp, Michael. AU - Zlokovic, Berislav V.. PY - 2012/9. Y1 - 2012/9. N2 - BACKGROUND AND PURPOSE-: Tissue plasminogen activator (tPA) is the only approved therapy for acute ischemic stroke. However, tPA has a brief therapeutic window. Its side effects include intracerebral bleeding and neurotoxicity. Therefore, a combination therapy with tPA and agents that can extend the therapeutic window of tPA and/or counteract its side effects are warranted. Here, we studied whether 3K3A-APC, a neuroprotective analog of activated protein C with reduced anticoagulant activity, can enhance the therapeutic effects of tPA in models of ischemic stroke in rodents. METHODS-: Human recombinant tPA (10 mg/kg), alone or in ...
In the European Cooperative Acute Stroke Study 3 (ECASS3), the efficacy of intravenous thrombolysis between 3 and 4.5 hours following onset of ischaemic stroke was investigated. Compared to the placebo group, patients treated with intravenous alteplase had a better functional outcome after 3 months (odds ratio 1.34, 95% confidence interval 1.02-1.76). The risk of symptomatic intracerebral haemorrhage was higher in the alteplase group (2.4% versus 0.3%). The time window for intravenous alteplase can be safely extended to 4.5 hours, but efforts should be made to start treatment as soon as possible, since the effectiveness ofalteplase decreases over time.
TY - JOUR. T1 - Revascularization grading in endovascular acute ischemic stroke therapy. AU - Zaidat, O. O.. AU - Lazzaro, M. A.. AU - Liebeskind, D. S.. AU - Janjua, N.. AU - Wechsler, L.. AU - Nogueira, R. G.. AU - Edgell, R. C.. AU - Kalia, J. S.. AU - Badruddin, A.. AU - English, J.. AU - Yavagal, Dileep R. AU - Kirmani, J. F.. AU - Alexandrov, A. V.. AU - Khatri, P.. PY - 2012/9/25. Y1 - 2012/9/25. N2 - Background: Recanalization and angiographic reperfusion are key elements to successful endovascular and interventional acute ischemic stroke (AIS) therapy. Intravenous recombinant tissue plasminogen activator (rt-PA), the only established revascularization therapy approved by the US Food & Drug Administration for AIS, may be less effective for large artery occlusion. Thus, there is enthusiasm for endovascular revascularization therapies, which likely provide higher recanalization rates, and trials are ongoing to determine clinical efficacy and compare various methods. It is anticipated that ...
IV tissue plasminogen activator (tPA) may be given to patients who present within 3 hours of developing a disabling ischemic stroke. Because of the increased risk for complicating intracerebral hemorr... more
Annexin II is thought to serve as a profibrinolytic coreceptor for both plasminogen and tissue plasminogen activator on the surface
RATIONALE Intrapleural tissue plasminogen activator (tPA)/deoxyribonuclease (DNase) therapy for pleural infection given at the time of diagnosis has been shown to significantly improve radiological outcomes. Published cases are limited to only a single randomized controlled trial and a few case reports. OBJECTIVES Multinational observation series to evaluate the pragmatic real-life application of tPA/DNase treatment for pleural infection in a large cohort of unselected patients. METHODS All patients from eight centers who received intrapleural tPA/DNase for pleural infection between January 2010 and September 2013 were included. Measured outcomes included treatment success at 30 days, volume of pleural fluid drained, improvement in radiographic pleural opacity and inflammatory markers, need for surgery, and adverse events. MEASUREMENTS AND MAIN RESULTS Of 107 patients treated, the majority (92.3%) were successfully managed without the need for surgical intervention. No patients died as a result
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Sigma-Aldrich offers abstracts and full-text articles by [George W J Harston, Brad A Sutherland, James Kennedy, Alastair M Buchan].
BACKGROUND AND PURPOSE: Recanalization is a powerful predictor of stroke outcome in patients with arterial occlusion. Intravenous recombinant tissue plasminogen activator is limited by its recanalization rate, which may be improved with mechanical en
Free Online Library: Nursing management of acute complications following rt-PA in acute ischemic stroke.(recombinant tissue plasminogen activator, Special Issue on rt-PA Stroke Treatment) by Journal of Neuroscience Nursing; Health care industry Complications Stroke (Disease) Tissue plasminogen activator Adverse and side effects
급성 허혈뇌졸중 환자에서 폐쇄된 혈관의 빠른 재개통은 환자의 예후와 밀접한 연관성이 있다[1]. 널리 알려진 대로 급성 허혈뇌졸중 환자에서 정맥내재조합조직플라스미노젠활성제(intravenous recombinant tissue plasminogen activator, iv-rTPA) 혹은 혈관내재개통치료(endovascular recanalization therapy, ERT)의 적응증에 해당한다면 가능한 빠른 시간 내에 이를 이용한 치료가 필요하다[2-4]. 특히 ERT는 급성 허혈뇌졸중 환자에서 iv-rTPA 단독 치료에 비하여 월등한 예후 개선 효과가 있기 때문에 각광받고 있는 치료 방법이다[5-9]. ERT는 iv-rTPA를 사용할 수 없는 금기에 해당하거나 증상 발생 4.5시간 이후의 환자들에게도 허혈반음영(ischemic penumbra)을 목표로 치료할 수 있고 iv-rTPA에 의하여 재개통 확률이 낮은 큰동맥 폐색 환자들에 대한 치료 방법으로 사용될 수 있다는 장점이 있다[10,11]. ...
The initial neurological examination, including the assessment of the NIHSS score, was performed in the emergency room. Non-enhanced brain CT scans were performed immediately to rule out intracerebral hemorrhage (ICH). If no ICH was evident on CT scans, intravenous recombinant tissue plasminogen activator (rtPA; Actilyse; Boehringer Ingelheim, Basel, Switzerland) was administered in accordance with the guidelines for early management (within 3 hours of symptom onset up to December 2012 and within 4.5 hours since January 2013) of adults with ischemic stroke.13 Vascular imaging (CT angiography or MR angiography) and diffusion-weighted MRI were conducted subsequently. The institutional criteria for EVT were as follows: (1) AIS corresponding to arterial occlusion on CT angiography or MR angiography; (2) infarction volume on CT or diffusion-weighted MRI less than half of the corresponding vascular territory; and (3) no evidence of well-developed parenchymal hyperintensity on FLAIR or T2-weighted ...
In the liver, tissue-type plasminogen activator (t-PA) is endocytosed by hepatic parenchymal (PC), endothelial (EC) and Kupffer (KC) cells. Although the endocytosis is receptor-mediated, it remains a matter of discussion which receptors are involved in this catabolic process. To evaluate the role of a protein-specific receptor, as well as the possible involvement of the galactose receptor on PC and the mannose receptor on EC, we have employed different glycosylation variants of t-PA in biochemical and immunocytochemical studies. Partial or total removal of carbohydrate side-chains by endoglycosidases did not prevent clearance and hepatic endocytosis of t-PA by either of the liver cell types. Blockade of the galactose and mannose receptors by co-application of a large excess of the glycoprotein ovalbumin remained without effect on the binding and uptake of t-PA by hepatic cells. However, the contribution of different liver cell types to the hepatic clearance of t-PA was to a certain extent ...
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, ...
In the evidence-based era, the GUSTO-I trial sets a high standard for comparison of a new treatment with standard therapy. Administration of the accelerated tPA regimen soon after acute MI results in a substantial mortality advantage within 24 hours and a more prominent effect at 30 days. This trial shows that this early benefit continues at 1 year. Previous trials that compared thrombolysis with placebo have shown that the benefit is maintained for as long as 5 years (1). We will wait to see whether the same also holds true for the GUSTO trial results. Should tPA be considered the thrombolytic agent of choice if medical reperfusion therapy is chosen for an appropriate patient? The cost differential between tPA and SK and the modest treatment advantage (number needed to treat with tPA to prevent 1 additional death = 100) makes this a difficult choice. Given the multiplicity of health care systems (hospital, third-party payers, city, region, country), there is no "right" answer to the question ...
HONOLULU -- Attacking a brain clot directly through an artery did not improve outcomes compared with standard intravenous tissue plasminogen activator therapy, a clinical trial found.
At both the 60- and 90-minute time points, reteplase demonstrated significantly higher rates of total (TIMI grade 2 or 3) and complete (TIMI grade 3) patencies than did front-loaded alteplase. Reteplase achieved 81.8% total patency (51.2% complete) as early as 60 minutes after the start of therapy, in contrast to 66.1% (37.4% complete) in the front-loaded alteplase group. The results suggest that reteplase achieves coronary patency 30 minutes sooner than alteplase. The reteplase patency rates reported here compare favorably with those achieved with front-loaded alteplase in the TIMI 4 trial.19 In contrast to the present trial, TIMI 4 included patients only up to 6 hours after the onset of pain and excluded patients ,80 years old. Therefore, somewhat higher patency rates were to be expected.. The earliest angiographic assessment in the GUSTO trial took place at 90 minutes.5 In this trial, front-loaded alteplase achieved 80.8% total patency (53.8 complete), a result similar to the 60-minute ...
The National Institute of Neurological Disorders and Stroke trial of recombinant tissue plasminogen activator has been considered a landmark study in the acute treatment of ischemic stroke. Unfortunately, only a small percentage of all ischemic stroke patients presents to the hospital in time to receive the drug. Moreover, the recannalization rate of a major artery occlusion, such as the proximal middle cerebral artery or top of the internal carotid artery occlusion, after intravenous (IV) thrombolytic therapy has been disappointingly low. Since the Food and Drug Administrations approval of IV plasminogen activator, there have been numerous randomized clinical trials investigating the safety and efficacy of different thrombolytics administered in various time frames. In addition to the IV administration, efforts have been made in order to study the radiographic as well as clinical effects of intra-arterial (IA) thrombolysis. The combination of IV and IA thrombolysis has been studied. For ...