Efficacy Of Intravenous Thrombolytic Therapy Research Articles

Intravenous thrombolysis in ischemic stroke patients based on non-contrast CT in the extended time-window

Purpose of reviewRecent trials provided evidence for safety and efficacy of intravenous thrombolytic therapy (IVT) in ischemic stroke patients beyond the 4.5 h time-window if ischemic penumbra is present in multimodal imaging. However, advanced imaging by either Magnet Resonance Imaging (MRI) or Computed Tomography Perfusion (CTP) is not available 24/7 at most stroke-centers. Therefore, the current review addresses the use of non-contrast CT (NCCT) to identify ischemic stroke patients suitable for IVT in the unknown or extended time-window in terms of efficacy and safety.Recent findingsThe current data on NCCT based IVT strategies in ischemic stroke patients presenting in the unknown or late time-window are relatively scarce and mainly provided by small retrospective samples. One larger registry (TRUST-CT) underlines the safety and efficacy of IVT without advanced imaging with more IVT-patients reaching an excellent outcome compared to the non-IVT treated control group. Current meta-analysis provides evidence that the rate of symptomatic intracerebral hemorrhage (sICH) is similar in the wake-up and unknown onset time-window compared to the 4.5 h time-window if patients are selected by NCCT. Results of the upcoming TWIST-trial investigating Tenecteplase (TNK) for NCCT-based IVT revealed no signals regarding an increased rate of sICH, however there was no benefit regarding functional outcomes.SummarySo far, it is not well-established whether advanced imaging is indispensable and NCCT could be sufficient to identify stroke patients in the extended window who would benefit from IVT-treatment. However, current data suggests the safety of NCCT-based IVT in the extended time-window. Therefore, unavailable advanced neuroimaging should not cause delay, or even exclusion of patients from IVT and other recanalizing therapies per se.

The effect of intravenous thrombolytic therapy on post stroke depression and cognitive dysfunction: A 3-months follow up study

Several studies have demonstrated the efficacy of intravenous thrombolytic therapy with recombinant plasminogen activator (rt-PA) on functional recovery at 3–18 months following the treatment. The objectives of this study were to investigate differences between thrombolytic or no thrombolytic treatment and if could be a relationship between patients who have underwent the thrombolytic treatment in terms of depressive symptoms and cognitive impairment. In this retrospective study, we evaluated 92 patients affected by ischemic stroke recruited from our rehabilitation center, coming from a Stroke Unit. All the eligible subjects were assessed at admission (T0) and two months later, at discharge, upon concluded the rehabilitation program (T1). The patients were divided into two groups: Thrombolysis Group (n.40 subjects) and no Thrombolysis Group (n.52 subjects). Cognitive functions were evaluated with the Montreal Overall Cognitive Assessment. Functional status were evaluated with the Barthel Index and the Functional Independent Misure. We administered Beck Depression Inventory-II to verify the presence of a depressive state. We found that at three months after stroke, the prevalence of depressive symptoms and cognitive improvement, among patient who had undergone thrombolytic treatment, and who had not, was not different. Conversely, we found an improvement of depressive symptoms in each group.

Advances in safety and efficacy of intravenous thrombolytic therapy for post-stroke stroke patients based on multi-modal MRI

Wake up ischemic stroke (WUIS), also known as awakening stroke, refers to patients with no new stroke symptoms during sleep, but after waking up, the patients or witness who found the acute cerebral infarction with stroke performance.The key to the treatment of acute ischemic stroke is to effectively restore reperfusion within the time window.The original intravenous recombinant tissue-type plasminogen activator (rt-PA) thrombolytic therapy, is widely recognized as an effective treatment method of choice for 4.5h onset of acute ischemic stroke reperfusion.Because the exact onset time of WUIS is unclear and limited by current scientific and technical levels, intravenous thrombolysis may lead to an increased risk of intracranial hemorrhage.Therefore, the American Heart Association and the American Stroke Association (AHA/ASA) were included in the Thrombolysis . Intravenous thrombolysis is not recommended in the Standard Scientific Statement.Patients who may be suitable for thrombolytic therapy are not able to obtain thrombolytic therapy, resulting in poor clinical prognosis.In recent years, with the further development of relevant clinical research and the rapid development of imaging technology, the latest research found that multi-mode imaging examination is safe and effective for intravenous thrombolytic therapy in patients with post-stroke stroke.Multi-mode imaging studies help screening patients with acute reperfusion therapy, so that part of WUIS patients will benefit from the acute reperfusion therapy.This article reviews and summarizes the literature findings of WUIS in recent years.The pathophysiological changes, clinical features and imaging changes of patients with WUIS and non-WUIS are almost unanimously.Early CT and MRI examinations can help to extend acute stroke treatment to patients with WUIS.At present, for this type of patients, there are great research progress in the formulation and implementation of clinical treatment strategies.This article will briefly summarize the research progress and treatment status of WUIS. Key words: Stroke; Thrombolytic therapy; Magnetic resonance imaging; Review

Safety and Efficacy of Intravenous Thrombolytic Therapy in Patients With Acute Posterior Circulation Stroke: A Single-Center Study

Background and Purpose: The safety and efficacy of intravenous thrombolytic therapy (IVT) for posterior circulation stroke (PCS) in the real world are rarely studied. This study was designed to evaluate the prestroke and baseline characteristics, stroke sub-types, complications, and outcomes of PCS patients and compare them with anterior circulation stroke (ACS) after intravenous thrombolysis. Methods: Data of consecutive patients with PCS and ACS treated with alteplase in a standard dose of 0.9 mg/kg in our stroke center were collected and analyzed retrospectively. Presenting characteristics, hemorrhage transformation, mortality, and favorable outcomes (modified Rankin scale 0 or 1) at 90 days were compared between PCS and ACS patients. Results: A total of 462 patients were included in this study, including 350 (75.8%) in ACS group and 112 (24.2%) in PCS group. A history of coronary artery disease was significantly more common in ACS patients than that in PCS patients (15.1% versus 6.3%, P = .015). There was no significant difference in fast glucose and baseline NIHSS scores between PCS and ACS groups. In PCS group, 7 patients (6.3%) had hemorrhage transformation after IVT and 5 patients (4.5%) were symptomatic versus 32 (9.1%) and 22 (6.3%) in ACS group (P > .05). 75.5% PCS patients versus 72.2% ACS patients had excellent recovery outcomes (mRS 0-1) at 90 days (P = .507). For PCS patients, logistic regression analysis after adjusting the covariates identified age (P = .047, OR .920, 95% CI = .847-.999) and atrial fibrillation (P = .007, OR 12.149, 95% CI = 1.966-75.093) as independent significant predictors of hemorrhage transformation. In addition, atrial fibrillation was also an independent predictor of symptomatic intracranial hemorrhage (P = .008, OR 21.176, 95% CI = 2.228-201.273). Multivariate logistic analysis identified hemorrhage transformation (P = .012; OR .131, 95% CI = .027-.644) and onset to drug time (P = .026, OR 1.006, 95% CI = 1.001-1.011) as independent predictors of functional independence (mRS 0-2). Symptomatic intracranial hemorrhage (P = .007, OR 15.094, 95% CI = 2.097-108.661) and baseline NIHSS score (P = .050; OR 1.070, 95% CI = 1.000-1.145) were independent predictors of mortality. Conclusion: Our results suggest that IVT in PCS patients is safe and effective as that in ACS patients. In PCS patients, long onset to needle time and hemorrhage transformation were identified as independent predictors of unfavorable outcomes.

Safety and Efficacy of Thrombolysis with Intravenous Alteplase in Older Stroke Patients

Stroke is a common cause of death and persisting disability worldwide, and thrombolysis with intravenous alteplase is the only approved treatment for acute ischaemic stroke. Older age is the most important non-modifiable risk factor for stroke, and demographic changes are also resulting in an increasingly ageing population. However, clinical trial evidence for the use of intravenous alteplase is limited for the older age group where stroke incidence is highest. In this article, the current evidence regarding the safety and efficacy of intravenous thrombolytic therapy in stroke patients aged ≥80 years is critically analysed and the gap in current knowledge highlighted. In summary, intravenous thrombolysis in stroke patients aged ≥80 years seems to be associated with less favourable clinical outcomes and higher mortality than in younger patients, which is consistent with the natural course in untreated patients. The risk of symptomatic intracranial haemorrhage does not appear to be significantly higher in the elderly group, suggesting that intracranial bleeding complications are unlikely to outweigh the potential benefit in this age group. Overall, withholding thrombolytic treatment in ischaemic stroke on the basis of advanced age alone is no longer justifiable.

Comparison of thrombolytic therapy for acute myocardial infarction in rural and urban settings

In this study, a tertiary care hospital served as a registry and information source to rural hospitals in northwestern Ohio where thrombolytic therapy had not previously been used. The study was designed to compare the safety and efficacy of intravenous thrombolytic therapy for acute myocardial infarction in the two settings. Fifty-five patients in eight rural hospitals and 36 patients in the urban tertiary care center received intravenous streptokinase. Of the 87 patients whose symptoms first occurred out of the hospital, 63 percent were treated within three hours. There were no significant differences in rates of clinically determined coronary artery recanalization (63 percent versus 69 percent for rural and tertiary hospitals, respectively), in-hospital mortality (5.4 percent versus 11 percent), bleeding complications (3.6 percent versus 5.5 percent), or time from the onset of pain to infusion of streptokinase (3.4 hours versus 2.9 hours). There were also no differences in the completeness of collection of serial coagulation data and cardiac enzyme values, or in the documentation of chest pain onset and cessation. Major differences between rural centers and the tertiary care center involved the use of serial electrocardiography (58 percent versus 89 percent, respectively), subsequent cardiac catheterization (49 percent versus 86 percent), and the timing of catheterization, when performed (30.4 days versus 4.6 days) (p <0.005 for all values). Thrombolytic therapy for acute myocardial infarction can be administered quickly, safely, and effectively in rural hospital settings even by physicians previously unfamiliar with this form of treatment.