Effect Of Thrombolytic Therapy Research Articles

Роль биохимических маркеров в прогнозировании исходов ишемического инсульта

Despite significant advances in the treatment of ischemic stroke, which were achieved due to the implementation of the program to combat stroke, the mortality and disability rates in this pathology continue to remain high. The identification of biochemical markers of the unfavorable clinical course of cerebral infarction is quite urgent, since it can be a useful addition to the optimization of predicting the outcomes of acute cerebrovascular catastrophe and the effectiveness of thrombolytic therapy.

Simulation Trainings in the Optimization of Medical Care for Patients with Acute Coronary Syndrome

The study analyzes the effectiveness of simulation training aimed at introducing protocols for resuscitation and thrombolytic therapy for emergency medical workers and vascular centers in teamwork by analyzing the clinical outcomes of resuscitation measures, the number and effectiveness of thrombolytic therapy at the prehospital stage and in vascular centers. It has been shown that team simulation trainings contribute to improving the quality of medical care for patients with acute coronary syndrome, improving patient survival and their quality of life.

Identification of characteristics, risk factors, and predictors of recurrent LVAD thrombosis: conditions in HeartWare devices

BackgroundRedictors of repetitive left-ventricular assist device (LVAD)-thrombosis have not been studied yet.MethodsWe identified predictors of recurrent LVAD thrombosis in HeartWare (HVAD) patients in a long-term study from 2010 until 2020. We included all patients with two or more thrombolysis treatments for repetitive HVAD thrombosis and effectiveness of thrombolytic therapy was defined as freedom from stroke, death, another HVAD thrombosis, or surgical device exchange within 30 days after the event. Study endpoints also include all-cause mortality and heart transplantation.ResultsA total of 534 HVAD implantations have been screened, and 73 patients (13.7%) developed first HVAD thrombosis after a median of 10 months (IQR; 6–21 months). 46 of these patients had effective thrombolysis in 71.7% (n = 33/46). After a median of 14 months (IQR 4–32 months) follow-up, 17 patients (51.5%) had developed a second HVAD thrombosis and all were treated with t-PA therapy again, resulting in effectiveness in 76.5% (n = 13/17). The four patients with ineffective t-PA therapy underwent subsequent surgical HVAD exchange. Multiple Cox regression model analysis revealed time interval between HVAD implantation and first thrombosis as an independent risk factor of recurrent thrombosis (HR, 0.93, 95% CI 0.87–0.99, p = 0.031). Kaplan–Meier analysis at 3 year follow-up showed no significant difference in overall survival for recurrent vs non-recurrent thrombosis groups (log-rank test, p = 0.959).ConclusionRecurrent HVAD thrombosis mostly appears within 12 months after first thrombosis. Systemic t-PA therapy for recurrent pump thrombosis seems safe, achieving comparable effectiveness rates to initial t-PA therapy. Survival does not differ between patients with or without recurrent HVAD thrombosis.

The effects of thrombolytic therapy on prognostic clinical markers in patients with intermediate-high risk pulmonary embolism

The effects of thrombolytic therapy on prognostic clinical markers in patients with intermediate-high risk pulmonary embolism

Effects of Thrombolytic Therapy in Low-Risk Patients With Pulmonary Embolism

We performed this investigation to determine the effects on mortality of thrombolytic therapy in low-risk patients with pulmonary embolism (PE). This was a retrospective cohort study based on administrative data from the Nationwide Inpatient Sample, 2016 and 2017. Patients with a primary (first-listed) diagnosis of acute PE who were not in shock and not on a ventilator who did not have acute cor pulmonale were defined as low-risk. Patients were identified by International Classification of Diseases-10-Clinical Modification Codes. Mortality was assessed according to treatment with catheter-directed thrombolysis, intravenous thrombolytic therapy, or anticoagulants alone. Mortality with inferior vena cava (IVC) filters was also assessed. Mortality was lowest in low-risk patients treated with anticoagulants alone, 6,765 of 331,430 (2.0%). Mortality was somewhat higher with catheter-directed thrombolysis, 195 of 6915 (2.8%; p <0.0001), and highest with intravenous thrombolysis 510 of 5,200 (9.8%; p <0.0001). Matched patients showed similar results. IVC filters did not reduce mortality in patients treated with anticoagulants alone. Mortality was only 0.5% higher in patients treated with anticoagulants who had saddle PE than in patients with nonsaddle PE, 450 of 17,935 (2.5%) versus 6,315 of 313,495 (2.0%; p <0.0001). However, a larger proportion of low-risk patients with saddle PE received catheter-directed thrombolysis than patients who had nonsaddle PE, 2,330 of 21,760 (11%) versus 4,585 of 321,785 (1.4%; p <0.0001). Similarly, a larger proportion of patients with saddle PE received intravenous thrombolytic therapy than patients with nonsaddle PE, 1,495 of 21,760 (6.9%) versus 3,705 of 321,785 (1.2%; p <0.0001). In conclusion, low-risk patients with PE did not have lower mortality with catheter-directed thrombolysis or intravenous thrombolytic therapy than with anticoagulants alone, and IVC filters did not reduce mortality with anticoagulants alone.

Analysis of effectiveness of thrombolytic therapy and introduction of new innovative projects for improving the quality of health care for patients with acute coronary syndrome in the Pavlodar regional ambulance station of the Republic of Kazakhstan

The article provides statistics on the volume of care for patients with acute coronary syndrome (ACS) at the prehospital stage in the Pavlodar region of the Republic of Kazakhstan. A comparative analysis of the use of thrombolytic therapy (TLT) at the Pavlodar regional ambulance station and other countries was carried out. This article shows what the positive effect from TLT is. The article indicates all the new innovative technologies that have been introduced in the Pavlodar station over the past 5 years and how this has contributed to improving the quality of emergency care.

Effect of thrombolytic therapy on intravenous thrombolytic therapy of DNT in acute ischemic stroke and its effect analysis

Objective Analyze the effect of emergency thrombolytic therapy on door to needle time (DNT) in patients with acute ischemic stroke (AIS) and effect. Method Selected 182 cases of AIS patients underwent intravenous thrombolysis at the First Hospital of Qinhuangdao from May 2015 to June 2017 . Thrombolytic therapy group (83 cases), for the May 2015-May 2016 after neurological consultation intravenous thrombolysis patients; Emergency thrombolytic group(99 cases), for the June 2016-June 2017 emergency thrombolysis group Emergency Department of intravenous thrombolysis patients. Compare the two groups of DNT, thrombolytic therapy 24 h symptomatic hemorrhage conversion rate, Thrombolysis 24 h, 7 dNIHSS score, 7 dthrombolysis and 3 months thrombolysis and thrombolysis 3 months improved Rankin score (mRs). Results There was no significant difference in baseline characteristics between the two groups (P>0.05).Compared with the consultation group, the DNT[(69.77±11.66)min vs (80.12±15.49) min, t=5.745, P 0.05). Conclusions The emergency thrombolytic model can shorten the DNT of rt-PA intravenous thrombolysis in patients with AIS. The safety and efficacy of DNT are not different from the neurological consultation mode, and can improve the good prognosis rate. Key words: Acute Ischemic Stroke; Thrombolytic therapy; Emergency thrombolytic therapy; Door to Needle time; Hemorrhagic transformation; Safety; Treatment effect; Prognosis

Outcome of Thrombolysis in Acute Myocardial Infarction in a Tertiary Care Hospital

Introduction: The main purpose of thrombolysis in acute myocardial infarction is early and complete reperfusion. Incomplete or delayed thrombolysis is associated with an increased risk of death and left ventricular dysfunction. The time to reperfusion and complete reperfusion remain the key determinants for appropriate outcome of cardiovascular events.&#x0D; Objective: To find out the effect of thrombolytic therapy and its outcome in relation with timing of thrombolysis and associated risk factors in ST elevated myocardial infarction (STEMI) patients.&#x0D; Materials and Methods: This cross-sectional interventional study was carried out in combined military hospital, Dhaka from July 2017 to May 2018. Total 85 patients of acute STEMI having specified criteria were selected and treated with Streptokinase at a dose of 1.5 million units diluted in 100 mL normal saline. Twelve-lead ECG was recorded immediately before the start of thrombolytic therapy and 180 min afterwards.&#x0D; Results: Among 85 STEMI patients 65 were male and the age range was 40-80 years. Sixty nine patients (81.2%) underwent thrombolysis within 12 hours of onset of chest pain among them complete resolution of ST segment occurs in 45(65.2%) patients while 16 patients (18.8%) received thrombolysis after 12 hours among them complete resolution occurs only in 7(43.8%) patients. Fully reperfused patients have no complications. Patients having diabetes mellitus, presented with atypical chest pain and received thrombolytic therapy after 12 hours had various types of complication.&#x0D; Conclusion: STEMI patients received thrombolysis therapy within 12 hours of onset of chest pain responded well to thrombolytic therapy.&#x0D; Journal of Armed Forces Medical College Bangladesh Vol.13(2) 2017: 42-44

Short-Term Clinical Follow-Up After Thrombolytic Therapy in Patients With Prosthetic Valve Thrombosis: A Single-Center Experience

BackgroundThrombolytic therapy has evolved as an alternative to surgery for prosthetic valve thrombosis (PVT). Therefore, this retrospective, single-center study aimed to evaluate the clinical profile of PVT and the role of thrombolytic therapy in patients with PVT.MethodsData from a total of 16 consecutive patients with PVT enrolled between January 2017 and January 2018 at a tertiary care center in India were retrospectively evaluated. PVT was diagnosed based on clinical presentation, transthoracic echocardiography, and fluoroscopy. All patients received 0.25 MU intravenous (IV) bolus streptokinase over 30 min, followed by a 0.1 MU/h IV infusion for a maximum of 72 h. Transthoracic echocardiography and fluoroscopy were repeated after completion of thrombolysis session. The clinical endpoints were death and hemodynamic success within 24 h of thrombolytic therapy or during the hospital stay, and major complications, including stroke or major bleeding (intracranial bleed or bleeding requiring transfusion or surgical treatment) during the hospital stay and within 3 months of thrombolytic therapy.ResultsThe median age of the patients was 40 ± 11.60 years and about 62.5% (n = 10) were females. The median time between the valve placement and presentation for PVT was 3 years (range: 1 - 4 years). The peak gradient across the thrombotic mitral and aortic valve was 43.79 ± 18.47 and 93.5 ± 33.11 mmHg, respectively. At 3 days post-thrombolysis, peak gradient across both mitral valve (15.91 ± 7.56; mean gradient: 8.45 ± 4.01) and aortic valve (23.50 ± 6.45; mean gradient: 13.60 ± 3.83) decreased significantly (P ≤ 0.05). The thrombolytic therapy was successful in 13 (81.25%) patients. While, two (12.50%) patients died, none developed stroke or myocardial infarction during the study period.ConclusionsThe present study with short-term follow-up demonstrated the acceptable clinical efficacy of thrombolytic therapy. However, larger trials with a greater number of patients and longer follow-up are warranted to establish the safety and effectiveness of thrombolytic therapy in patients with PVT.

Анализ эффективности тромболитической терапии в Рязанской ОКБ за 2013-2017 гг.

Анализ эффективности тромболитической терапии в Рязанской ОКБ за 2013-2017 гг.

Lipoproteinuria as an independent predictor of unfavorable outcome after intravenous thrombolysis in ischaemic stroke

Patients with proteinuria and declined glomerular filtration rate (GFR) are at high risk of developing stroke. Purpose of this study was to review and analyze available literature to identify role of proteinuria along with decreased GFR as one the of predictors of unfavorable outcome of ischaemic stroke in patients receiving intravenous thrombolysis therapy in routine clinical practice. Proteinuria is an independent predictor of negative outcome after intravenous thrombolysis treatment in ischaemic stroke, which demonstrates significant impact of chronic kidney disorders in effectiveness of thrombolytic therapy.

Clinical course of pulmonary embolism and efficacy of thrombolytic therapy in patients with thrombophilia

The article presents a comparative analysis of the clinical course of pulmonary embolism and the effectiveness of thrombolytic therapy in patients with thrombophilia and in those without identified thrombolytic disorders. The impact of thrombophilia on the incidence of pulmonary embolism and phlebothrombosis was analyzed. The results obtained indicate the presence of thrombophilia in 25.7% of patients with pulmonary embolism. It was found out that thrombosis and embolism in the vena cava filter occurred more frequently in patients with thrombophilia rather than in those with pulmonary embolism of unknown etiology.

Effect of thrombolytic therapy with ateplase on inflammatory cytokines and Hcy levels in patients with acute cerebral ischemic stroke

Objective To study the clinical curative effect of thrombolytic therapy with ateplase on acute cerebral ischemic stroke(ACIS) and its effect on serum interleukin-6(IL-6), tumor necrosis factor-α(TNF-α) and homocysteine(Hcy) levels. Methods 84 patients with ACIS were selected as observation subjects, and they were divided into observation group and control group according to the random table method, 42 cases in each group.The control group was given conventional treatment of ACIS, and the observation group was given thrombolytic therapy with ateplase on the basis of conventional treatment.The clinical efficacy of the two groups was compared, the National Institutes of Health Stroke Scale(NIHSS) scores, Barthel index changes before treatment and 24h, 14d after treatment, the IL-6, TNF-α and Hcy levels before treatment and 14d after treatment of the two groups were observed and compared. Results The total effective rate of the observation group was 95.24%, which was significantly higher than 78.57% of the control group(χ2=5.126, P<0.05). The NIHSS scores of the observation group 24h and 14d after treatment were (7.41±1.52)points and (5.48±0.93)points, respectively, which were significantly lower than (9.69±2.08)points and (8.07±1.35)points of the control group(t=5.736, 10.239, all P<0.05). The Barthel index scores of observation group 24h and 14d after treatment were (79.48±5.83)points and (86.21±4.33)points, respectively, which were significantly higher than (54.87±5.51)points and (67.22±4.27)points of the control group(t=19.882, 20.237, all P<0.05).14d after treatment, the levels of IL-6, TNF-α and Hcy in the observation group were (7.61±1.39)ng/L, (5.05±0.66)ng/L, (11.19±2.81)μmol/L, respectively, which were significantly lower than (9.29±1.57)ng/L, (8.79±0.93)ng/L, (15.67±2.32)μmol/L in the control group(t=5.192, 21.254, 7.968, all P<0.05). Conclusion The effect of thrombolytic therapy with ateplase for ACIS patients is significant, which can effectively improve the NIHSS and Barthel index scores, and reduce the serum levels of IL-6, TNF-α and Hcy.It is worthy of clinical promotion. Key words: Alteplase; Stroke; Thrombolytic therapy; Chemokines; Homocysteine

Efficacy of Thrombolytic Therapy in Treatment of Patients with Ischemic Stroke

The purpose: to evaluate the effectiveness of thrombolytic therapy in patients with ischemic stroke according to radiological methods.Materials and methods. The study included 60 people who were divided into two groups. The main group included 34 (56.7%) patients with ischemic stroke (20 men and 14 women) aged 22 to 78 years (mean age 62 ± 8.6 years) who were treated in Republican research center of emergency medical care. The control group consisted of 26 (43.3%) patients to estimate the parameters of normeperidine in the middle cerebral artery (MCA): the maximum blood flow velocity, linear blood flow velocity, index Gosling (PI) and coefficient overshoot (KO). Evaluation of patients included: assessment of nevrostatus according NIHSS scale, computered tomograhy of brain to exclude hemorrhagic stroke, transcranial and extracranial arteries Duplex scanning, digital subtraction angiography. Thrombolysis was performed to all patients of main group with ischemic stroke: systemic thrombolysis with streptokinase – in 17 (50%) cases, selective thrombolysis of Actilyse – 17 (50%). Thrombolysis was performed in a period from 90 minutes to 4 hours after the manifestation of symptoms. Results. Significant positive changes were observed in 22 (64.7%) patients. Asymptomatic hemorrhagic transformation of ischemic lesion was observed in 4 (11.7%). In acute occlusion of the internal carotid artery recanalization was registered only in 11.7% of cases, while the M1 MCA occlusion segment – at 52.9%. Transcranial Doppler is manifested by registration of hyperperfusion flow after thrombolysis in the presence of residual flow to thrombolysis. Re-occlusion was observed in 2 (5.8%) patients. In these cases, before and after thrombolysis TCD fixed flow hypoperfusion. Mortality was 14.7%.Conclusions. Thrombolytic therapy is effective treatment for ischemic stroke, especially in the delivery of the patient to a hospital for the first 2 hours after the manifestation of clinical symptoms. The marker of effectiveness thrombolysis is registration on the CMA normoperfusion or hyperperfusion pattern. Good functional outcome marked when a patient achieved result ≤2 points on the mRS. Asymptomatic hemorrhagic transformation can also be considered as a marker of effective thrombolysis. The combination of a CT scan of the brain with transcranial Doppler allows to assess not only the size of the lesion of the brain, but also to investigate the nature of cerebral hemodynamics. Further development of a set of measures designed to raise awareness among the population and general practitioners about the symptoms of stroke and its effective treatment in the case of delivery of the patient to a specialized hospital in which is possible to conduct thrombolysis.

Short-term outcome of acute inferior wall myocardial infarction with emphasis on conduction blocks: a prospective observational study in Indian population.

Objective:The primary aim of the present study was to evaluate the complications, particularly conduction blocks, subsequent morbidity and mortality, and effect of thrombolytic therapy in Indian patients with inferior wall myocardial infarction (IWMI).Methods:This was a prospective, observational, single-center study conducted at LPS Institute of Cardiology, Kanpur, from December 2011 to May 2014. Patients who presented with typical chest pain and were subsequently diagnosed by standardized diagnostic criteria as having IWMI were enrolled. Patients were grouped on basis of conduction abnormalities, right ventricular (RV) infarction and thrombolytic treatment. Each group was analyzed for comparison of complication profile and mortality.Results:Of 573 patients with IWMI enrolled in the study (mean age: 58.90±12.3 years), 81.2% were male, 225 (39.3%) had conduction blocks, and 189 (32.9%) had RV infarction. In patients with conduction blocks, mortality occurred in 27 patients (12.0%) in contrast to 3.4% of patients without conduction block (p<0.03). Also, there were 27 cases of in-hospital mortality in patients with RV infarction compared with 9 cases in patients without RV infarction (p<0.01). Thrombolytic therapy significantly reduced mortality in patients with IWMI (p<0.001). A significant reduction was observed in cardiogenic shock (p=0.002), severe mitral regurgitation (p=0.007), and left ventricular failure (p<0.001) in patients undergoing thrombolytic therapy.Conclusion:In Indian patients with IWMI, incidence of conduction blocks was higher than previously reported studies. Major complications such as atrioventricular block and RV infarction are associated with increased mortality and poor clinical outcomes. Thrombolytic therapy has a beneficial role in reduction of mortality rate and other complications.

Effect of thrombolytic therapy and percutaneous coronary intervention (PCI) on inflammatory mediators

Effect of thrombolytic therapy and percutaneous coronary intervention (PCI) on inflammatory mediators

Cognitive Outcomes following Thrombolysis in Acute Ischemic Stroke: A Systematic Review

Patients treated with thrombolytic therapy within 4.5 hours after stroke onset appear to have improved survival and functional outcomes. Poststroke cognitive impairment is associated with reduced quality of life and survival and needs to be reviewed in consideration of the administration of thrombolysis. This review aims to systematically evaluate literature exploring the effect of thrombolysis for ischemic stroke on cognition. An electronic search was conducted to identify articles and gray literature applying broad Medical Subject Heading terms. Literature was reviewed with a 2-step process against predetermined inclusion criteria. All relevant studies were included if they investigated global or individual cognitive domains. Three studies satisfied the inclusion criteria but were diverse in outcome measures and duration, their heterogeneity limiting any possible pooled analysis. One study examined long-term treatment effects on global cognition and did not find a positive effect at 6 months. A positive treatment effect was reported in the acute phase in 1 study examining domains of visuoconstructive and perceptive abilities. One study retrospectively analyzed treatment effects on language and found improvement in the acute phase but not in the long term. The limited existing evidence on the effects of thrombolytic therapy on long- and short-term cognition is varied in both outcome measures and diagnostic classifications, making it difficult to extrapolate results to a global stroke population. This review should be used to inform future research in stroke treatment outcomes and highlights the immediate need for larger, more robust studies in this area.

Dependence of the effectiveness of thrombolytic therapy at ischemic stroke from clinical and paraclinical predictors

The aim of the work. The aim of the work is an assessment of informativeness of several clinical and paraclinical predictors in prognostics of the results of effectiveness of thrombolytic therapy at the most acute period of ishemic stroke with the further definition of the most significant ones for achieving the least neurologic deficiency. Methods of research: There were retrospectively considered 61 patients 60,5±7,8 years old with ishemic stroket who sucsessfully underwent thrombolytic therapy as an intravenous administration of Actilyse. These patients demonstrated the next factors of gemostasis: prothrombin time, prothrombin index, fibrinogen. For the research there were also used the scales of neurological deficiency activisation (Rankin and NIHSS); ultrasound of the magistral arteries and extracranial CT of brain; methods of mathematical statistics (the definition of chances and confidence intervals ratio, Pirson and Student criteria, verification of hypothesis about the law of distribution and equality of the mean values in the both samplings. Results. There were defined the most informative factors in prognostication of the good result after thrombolytic therapy. There was formed the list of output factors that the results of actilyse thrombolytic therapy effectiveness in Lviv region are depending on. There was grounded the necessity of laboratory data monitoring in patients with stroke for receiving the best results of thrombolytic therapy. There was established that thrombolytic therapy of ishemic stroke must begin as early as possible (in computed tomography department if possible) for receiving the maximal effectiveness. There was detected that ultrasound of magistral vessels that supply brain with blood is necessary for all patients who are candidates for thrombolytic therapy because the stenosis of the vessel lumen more than 60 % significantly worsens an effectiveness of treatment

The incidence and risk factors of portal vein system thrombosis after splenectomy and pericardial devascularization.

This study aimed to investigate the incidence and risk factors of portal vein system thrombosis (PVST) in patients with liver cirrhosis after splenectomy and pericardial devascularization. We retrospectively analyzed 71 patients who underwent splenectomy with pericardial devascularization for portal hypertension due to cirrhosis. Patients were categorized into Group A (n=23): early prophylactic anticoagulants therapy; Group B (n=29): late prophylactic anticoagulants therapy; and Group C (n=19): no anticoagulation therapy. Univariate and multivariate analyses of the risk factors of PVST were performed. The incidence of PVST and the effect of thrombolytic therapy were evaluated. Multivariate analysis revealed a wider preoperative splenic vein diameter (≥8 mm), and lower preoperative platelet counts (<50×109/L) were significantly correlated with PVST development. The incidence of PVST in Groups A, B, and C was 26.1% (6/23), 44.8% (13/29), and 52.6% (10/19), respectively (all p>0.05). The complete resolution rate of portal, superior mesenteric, and splenic vein thrombosis was 75%, 62.5%, and 23.8%, respectively. A wider preoperative splenic vein diameter and lower preoperative platelet counts are independent risk factors of PVST. Early anticoagulation therapy had a tendency towards a reduced incidence of PVST, but it was not statistically significant. The complete resolution rate of splenic vein thrombosis was lower than that of portal and superior mesenteric vein thrombosis.

Effects of thrombolytic therapy in patients with cardiac arrest from suspected pulmonary thromboembolism

To explore the effects of thrombolytic therapy with recombinant tissue-type plasminogen activator (rt-PA) in patients with cardiac arrest from suspected pulmonary thromboembolism (PTE). A total of 12 hospitalized patients with cardiac arrest from suspected pulmonary embolism at Beijing Chaoyang Hospital from January 2010 to June 2014 were retrospectively studied. Thrombolysis was given only as a single dose of 50 mg of rt-PA during cardiopulmonary resuscitation. And their clinical features, effocacies and outcomes of thrombolysis were analyzed. There were 6 males and 6 females with a mean age of (54.8±18.6) (16-81) years. Seven patients were hospitalized in surgery ward while another 6 perioperatively. The mean time of resuscitation before thrombolysis was (47.8±26.0) (17-90) min. Nine patients regained spontaneous circulation. The mean time of restored spontaneous circulation was (15.8±5.4) (5-20). The 24-hour survival rate was 8/12. Four patients had bleeding complications, but only 2 life-threatening major cases. Four patients obtained a long-term survival. For suspected PTE patients with sudden cardiac arrest, thrombolysis therapy with 50 mg of rt-PA may restore spontaneous circulation and boost 24-hour survival rate.