Hours Of Thrombolytic Therapy Research Articles

Multimode Computed-Tomography-Guided Thrombolysis under a Prolonged Time Window in Acute Ischemic Stroke Patients with Atrial Fibrillation.

Atrial fibrillation (AF) is an independent risk factor for intracranial hemorrhage in patients receiving recombinant-tissue-type plasminogen activator (rt-PA) thrombolytic therapy. Research showed that patients with acute ischemic stroke (AIS) could benefit from multimode computed-tomography- (CT-) guided intravenous thrombolysis over 4.5 hours. The medical data of patients with AIS in our center were retrospectively reviewed, and the data of the multimode CT-guided thrombolytic therapy or nonthrombolytic therapy within different time windows (3-9 hours) were evaluated. 134 AIS cases were selected successfully and divided into three groups: patients with AF treated by rt-PA (AF rt-PA), patients with AF not treated by rt-PA (AF non-rt-PA), and patients without AF treated by rt-PA (non-AF rt-PA). After correcting for the baseline NIH Stroke Scale (NIHSS), sex, age, and hypertension data, the comparison results showed that the NIHSS improved significantly at hospital discharge for rt-PA-treated patients (n = 47) compared to non-rt-PA-treated patients with AIS (n = 31) with AF (P = 0.0156). The NIHSS evaluation at 90 days of follow-up also improved in rt-PA-treated patients (P = 0.0157). The NIHSS at hospital discharge was higher in AF rt-PA-treated patients compared to non-AF rt-PA-treated patients (P = 0.0167) after correction; the difference was not statistically significant at 90 days of follow-up (P = 0.091). Our research showed that the neural function improved after 3-9 hours of thrombolytic therapy with rt-PA in patients with AIS and AF. If there is no thrombolytic taboo, the patients could benefit from the thrombolytic therapy, although the onset time window has been extended to 9 hours.

Analysis of Risk Factors Increased Hemorrhagic Transformation after Acute Ischemic Stroke

BackgroundThe purpose of this study was to analyze the risk factors of hemorrhagic transformation (HT) after intravenous thrombolysis using a recombinant tissue plasminogen activator (r-tPA) in acute ischemic stroke (AIS). MethodsWe included 199 consecutive patients in the First Affiliated Hospital of Wenzhou Medical University from January 2016 to October 2017 with a diagnosis of AIS. The patients were divided into 2 groups: HT and non-HT. The related risk factors were recruited before and after receiving r-tPA thrombolysis. ResultsUsing univariate analysis, we found that there was a significant difference between the HT and non-HT group (P < .05) in the level of age, atrial fibrillation, baseline National Institute of Health Stroke Scale (NIHSS) score and NIHSS score after 2 hours of thrombolytic therapy, hyperlipidemia. Multivariate logistic regression analysis indicated that NIHSS score after 2 hours of thrombolytic therapy (odds ratio [OR] = 1.091, 95% confidence interval [CI] = 1.015-1.173 P = .018) and atrial fibrillation (OR = 2.188, 95%CI = 1.024-4.672 P = .043) are the risk factors of HT. ConclusionsNIHSS score after 2 hours of thrombolytic therapy and atrial fibrillation were risk factors for HT after thrombolysis. Age (OR = 1.022, 95%CI = .988-1.056 P = .205), Hyperlipidemia (OR = .591, 95%CI = .29-1.206 P = .148), and Baseline NIHSS score (OR = .998, 95%CI = .914-1.089 P = .043) were not significant independent predictors but showed an association with HT. These 5 factors should be carefully taken into account.

Early vs Late Coronary Angiography and Intervention Following Thrombolytic Therapy; a Cohort Study.

The precise time of using percutaneous coronary intervention (PCI) after fibrinolytic therapy for maximum efficiency and minimum side effects is still undetermined. Therefore, the present study was designed to compare the outcome of myocardial infarction (MI) patients who underwent surgical intervention (angiography and PCI) within 48 hours of thrombolytic therapy or after that. The present study is a prospective cohort study aiming to compare the occurrence of no-reflow phenomenon, unstable angina, bleeding during intervention, and one month major adverse cardiac outcomes (recurrent MI, need for repeating surgical intervention, and mortality) between MI patents undergoing surgical intervention within the first 48 hours of or after 48 hours of thrombolytic therapy. 90 patients with the mean age of 54.97 ± 10.54 were studied (86.67% male). 50 (56%) patients underwent surgical intervention within 48 hours and 40 (44%) after that. The 2 groups were not significantly different regarding baseline characteristics. No-reflow phenomenon in the < 48 hours group was about twice the > 48 hours group (OR = 0.35; 95% confidence interval: 0.14 - 0.92; p = 0.03), other outcomes were not significantly different. No case of mortality was seen in the 1 month follow up. Based on the results of the present study, it seems that no-reflow phenomenon rate is significantly lower in patients undergoing surgical intervention after 48 hours of fibrinolytic therapy. The difference between the two groups regarding prevalence of major adverse cardiac outcomes was not statistically significant.

Safety and Benefit of Early Elective Percutaneous Coronary Intervention After Successful Thrombolytic Therapy for Acute Myocardial Infarction

The aim of this study was to assess the safety and benefits of early elective percutaneous coronary intervention (PCI) after successful thrombolytic therapy for acute myocardial infarction. Early elective PCI after successful thrombolysis is controversial, and the optimal time for PCI is elusive. Using data from the Korea Acute Myocardial Infarction Registry from November 2005 to June 2007, a total of 383 patients with acute myocardial infarction who underwent elective PCI within 2 weeks of successful thrombolytic therapy were grouped based on time between thrombolysis and PCI as group 1, <24 hours (n = 81, age 59.5 +/- 10.5 years, 10.9 +/- 7.2 hours); group 2, > or =24 and <48 hours (n = 79, 59.5 +/- 11.6 years, 36.4 +/- 6.8 hours); group 3, > or =48 hours and <72 hours (n = 79, 61.0 +/- 10.9 years, 59.8 +/- 6.8 hours); and group 4, >72 hours (n = 144, 61.7 +/- 12.9 years, 117.8 +/- 48.5 hours). Primary study outcomes included major bleeding, in-hospital death, and major adverse cardiac events (MACEs; cardiac death, myocardial infarction, repeated PCI, and coronary artery bypass surgery) at 1, 6, and 12 months. There were no differences among the 4 groups in baseline clinical characteristics and angiographic findings. There were no differences in the incidences of major bleeding, in-hospital mortality, and 1-month outcomes among groups. Rates of composite MACEs and repeated PCI at 6 and 12 months were significantly lower in patients who underwent PCI within 48 hours of thrombolytic therapy compared with those who underwent PCI later (6-month MACEs: 1.0% vs 9.5%, p = 0.014; 6-month repeated PCI: 0% vs 6.8%, p = 0.028; 12-month MACEs: 4.1% vs 14.9%, p = 0.026; 12-month repeated PCI: 1.4% vs 9.6%, p = 0.034). In conclusion, early elective PCI within 48 hours of successful thrombolytic therapy for AMI appeared safe and more beneficial compared with PCI performed later.

Clinical comparison of intra-arterial v.s. Intravenous thrombolytic therapy with urokinase(UK) for acute cerebral infarction

目的 比较尿激酶动、静脉溶栓治疗急性脑梗死的疗效和安全性.方法50例急性脑梗死(发病≤8 h)患者分为动脉溶栓、静脉溶栓治疗组和对照组.采用美国国立卫生院神经功能缺失评分表(NIHSS)于治疗前,治疗后24 h、1周、2周记录神经功能缺损程度.对临床症状恶化者复查头颅CT,明确症状性颅内出血的发生率.结果尿激酶溶栓治疗后24 h治疗组NIHSS低于对照组(P＜0.05),1周后差异更加显著(P＜0.01),但溶栓治疗组之间(经动脉或静脉溶栓)NIHSS差异无显著意义(P＞0.05).三组症状性颅内出血的发生率分别为6.67%、9.52%和14.29%,无统计学差异(P＞0.05).结论尿激酶溶栓治疗急性脑梗死疗效确切、安全,动脉溶栓的疗效并不优于静脉溶栓。

“Mirror-lake” serial relationship of electrocardiographic and biochemical indices for the detection of reperfusion and the prediction of salvage in patients with acute myocardial infarction

Background Serial observations of biochemical markers in the blood and bioelectric markers on the electrocardiogram (ECG) have been used to evaluate the effectiveness of reperfusion therapy in acute myocardial infarction (AMI). This study presents a combined method for clinical use, based on the “mirror-lake” tendency of the serial changes in these markers. Methods Consecutive thrombolytic-treated patients with AMI (n = 43) had ST-segment monitoring (Mortara Eli 100) and frequent serum sampling of myoglobin (MG) concentration. Their acutely predicted and finally estimated AMI sizes and myocardial salvage extents were calculated from the 12-lead standard ECG. Patients having 2 positive reperfusion indices (ST resolution at least 50%, and an increase in MG at least 2.4 fold) at 2 hours after initiation of thrombolytic therapy were considered the “complete reperfusion” group, and patients with discordant or 2 negative reperfusion indices after 2 hours of thrombolytic therapy were considered the “limited reperfusion” group. Results Patients with complete reperfusion (n = 22) versus patients with limited reperfusion (n = 21) had +12% versus −1% myocardial salvage ( P < .0001). The serial changes in the ST segment mirrored the serial changes in the MG concentration, and the rates of increase in MG correlated with the rates of resolution of the ST-segment elevation. Conclusion Myocardial salvage (measured by ECG indices) is greatest when an early increase in serum MG is “mirrored” by early resolution of ST-segment elevation.

Overview of Cochrane thrombolysis meta-analysis.

The Cochrane Database of Systematic Reviews summarizes all the existing randomized evidence of all treatments for all diseases, so that doctors can quickly access the most up-to-date information. The trials for the Cochrane systematic review of thrombolytic therapy in acute ischemic stroke were identified from extensive searching of the literature and contact with trial investigators. Data on several prespecified outcomes (death and symptomatic intracranial hemorrhages within the first 7 to 10 days after treatment, and death and poor functional outcome at long-term follow-up) were sought in each identified randomized, controlled trial. There have thus far been 17 completed randomized, controlled trials of thrombolytic therapy versus control in 5,216 patients (including the provisional data from the Alteplase Thrombolysis for Acute Noninterventional Therapy in Ischemic Stroke [ATLANTIS] A and B and Recombinant Prourokinase in Acute Cerebral Thromboembolism [PROACT] II trials). Of these, eight trials tested recombinant tissue plasminogen activator (rt-PA) in 2,889 patients (56% of all data). Overall, there was an increase in the odds of death within the first 10 days (odds ratio [OR] 1.85, 95% confidence interval [CI] 1.48 to 2.32) and symptomatic intracranial hemorrhage (OR 3.53, 95% CI 2.79 to 4.45) with thrombolysis (slightly less with rt-PA). The odds of death at the end of follow-up were also slightly increased with thrombolysis (OR 1.31, 95% CI 1.13 to 1.52), although this increase was not significant in patients receiving rt-PA. Despite this, overall there was a significant reduction in the number of patients with a poor functional outcome (combined death or dependency) at the end of follow-up (OR 0.83, 95% CI 0.73 to 0.94), which was slightly better in patients receiving rt-PA. Most of the data came from trials testing thrombolysis up to 6 hours after stroke, but the subgroup of patients treated within 3 hours showed a greater reduction in poor functional outcome with thrombolysis (OR 0.58, 95% CI 0.46 to 0.74) with a less adverse effect on death. The available data do not allow much further subgroup analysis, although there is reasonable evidence to indicate that aspirin or heparin given within 24 hours of thrombolytic therapy causes a significant increase in intracranial hemorrhage and death. It is hoped that a meta-analysis using individual patient data may be able to address the effect of thrombolysis in further specific subgroups and examine the interaction between the severity of stroke and the effect of thrombolysis.

Prognostic Markers in Thrombolytic Therapy: Looking Beyond Mortality

In the era of multiple new therapies (e.g., aspirin, β blockers, thrombolysis, angiotensin-converting enzyme inhibitors, etc.) with the potential to improve outcome, the utility of traditional methods for predicting risk for adverse outcome after acute myocardial infarction (MI) is being reevaluated. Recent data suggest that heart failure, male gender, older age, and ischemia on ambulatory electrocardiogram (ECG) monitoring are the best predictors for increased risk of death or nonfatal MI. Exercise stress testing and ejection fraction determination provide little, if any, additional prognostic information. A new, highly promising strategy is to assess the degree of resolution in ST-segment elevation on repeated ECG monitoring following thrombolytic therapy. Studies have shown that failure to achieve prespecified degrees of ST-segment resolution within the first few hours of thrombolytic therapy is a reliable indicator of risk for post-MI mortality. Emerging data are also raising the possibility that cardiac troponin-T levels can be utilized as an important prognostic marker for adverse outcome in patients who present with acute ischemic syndromes. © 1996 by Excerpta Medica, Inc. Am J Cardiol 1996;78(suppl 12A):24–27

Obstruction of the St. Jude Medical Valve - Diagnostic and Therapeutic Values of Cineradiography

Between 1984, and 1992, we observed 8 patients with an obstructed St. Jude Medical (SJM) valve. Of these, 1 had an obstructed SJM valve in the aortic position, 3 in the mitral position, and 4 in the tricuspid position. Diagnosis of obstruction of the SJM valve was made by cineradiography combined with echocardiography in all 8 patients. Restriction or absence of movement of the leaflet of the SJM valve was observed by cineradiography in all of the 8 patients. Normal range of leaflet mobility of the SJM valve was measured by conventional cineradiography in 70 patients with a normal SJM valve, and the results were compared with the leaflet mobility obtained from the 8 patients with an obstructed SJM valve. In this study, leaflet function in the obstructed SJM valve was strikingly abnormal, with both opening and closing angles, and leaflet motion clearly outside the normal range. Of the 8 patients, 4 underwent urgent prosthetic valve replacements after cineradiography and echocardiography were carried out. Thrombolysis using urokinase was performed in 4 patients, and this treatment was successful in 1 patient. Efficacy of thrombolytic therapy was evaluated by repeat cineradiography. Three of the 4 patients who received thrombolysis showed no significant improvement of leaflet mobility after at least 72 hours of thrombolytic therapy, and finally required surgical correction for the obstructed SJM valve. We believe that cineradiography combined with echocardiography is the optimal method for the diagnosis of obstruction of the SJM valve, and to follow the effect of thrombolytic therapy on prosthetic valve function.(ABSTRACT TRUNCATED AT 250 WORDS)

Ultrasound-assisted thrombolysis.

Current use of thrombolytic agents to lyse thrombus, though safe, is complicated by stroke, bleeding, and clot embolization. Therapy may be protracted, resulting in further ischemia and possible tissue loss. Peripheral arterial and graft occlusions often require several hours of thrombolytic therapy, which may occasionally exceed 48 hours and may also require expensive intensive care monitoring. It is desirable to accelerate clot lysis and to thereby reduce the risks and costs associated with the procedure and minimize morbidity. In this article, the authors propose the use of intravascular ultrasound in conjunction with thrombolytic agents to increase the rate of thrombolysis. In-vitro thrombolysis of fresh human blood clots was studied with and without urokinase by using continuous wave, 20-KHz ultrasound at the power levels 1-2 watts. Loss in weight of each clot was used to measure the extent of thrombolysis. Clot lysis was observed when ultrasound and thrombolytic agents were used alone. At modest power levels of 1.0 to 1.5 watts of ultrasonic energy a significant increase in lysis was observed in conjunction with 5,000 units of urokinase. In the short treatment duration of this in-vitro study, 5,000 units of urokinase combined with 20-KHz ultrasound energy at 1.0 and 1.5 watts was associated with a greater percentage thrombolysis by weight than either urokinase or ultrasound alone.