Results Of Thrombolytic Therapy Research Articles

The Efficacy of Thrombolytic Therapy in Inferior Myocardial Infarction with Damage to the Right Ventricular

Aim. To study the results of thrombolytic therapy and accuracy of electrocardiographic assessment of thrombolysis efficiency in inferior myocardial infarction with and without right ventricular lesion.Material and methods. The118 patients with inferior myocardial infarction were included in this study. They received TLT in the first 12 hours of the disease. The dynamics of ST-segment in 90 minutes from the TLT start and coronary angiography data were analyzed.Results. Right ventricular myocardial infarction (RVMI) was diagnosed in 49 (41.5%) of 118 patients by echocardiography. Patients with and without RVMI did not differ in age, gender and comorbidities, but patients with RVMI were more likely to have arterial hypotension, atrioventricular block, and atrial fibrillation. All patients with RVMI had occlusion of the right coronary artery (RCA) in the proximal (34.7%) or medial segment (65.3%). Occlusion of the circumflex coronary artery was found in 20 (29.0%) patients without RVMI, and RCA occlusion - in other patients. The infarction-associated artery blood flow equal TIMI 2-3 was found in 17 (34.7%) patients with RVMI and in 46 (66.7%) patients without RVMI (p<0.005). ST-segment decrease by 50% or more in 90 minutes from the TLT was found in 35 (71.4%) patients with RVMI and in 49 (71.0%) patients without RVMI (p>0.05). The false-positive assessment of thrombolysis efficiency was noted in patients with and without RVMI in 21 (42.9%) and 11 (15.9%) cases (p <0.005), respectively. There were no false-positive assessments in patients with RVMI when using ST-segment decrease to the isoline.Conclusion. TLT should be considered effective in patients with inferior myocardial infarction with the right ventricle lesion, if ST-segment decreases to isoline in 90 minutes from the TLT start.

Reperfusion therapy in ischemic stroke

Aim. To assess the main results of thrombolytic therapy (TLT) in patients with ischemic stroke (IS) in the Regional Vascular Center at the premises of Emergency Hospital in Ufa. Material and methods . A retrospective study of the TLT use was carried out in patients with acute cerebrovascular accident (CVA) who were admitted to the hospital from January 1, 2014 to December 26, 2017 The inclusion criteria were all IS cases in which patients received alteplase (actilyse) in accordance with the thrombolysis protocol. Results. There was a decrease in the number of patients with acute CVA hospitalized in the department for CVA patients. The proportion of ischemic stroke increased from 76,3% in 2014 to 79,1% in 2017 Annually, there was an increase in the number of patients with onset-to-door time <4,5 hours and reduction in door-to-needle time for thrombolysis from 1,5 hours in 2014 to 52,5 minutes in 2017 The share of TLT procedures increased from 2,4% in 2014 to 7,3% in 2017 In total, 180 (4,8%) procedures was performed. In 96% of patients there was a significant regression of neurologic deficit according to the NIH Stroke Scale after reperfusion therapy for the entire period. A complication of TLT was hemorrhagic transformation (HT), which was symptomatic in 8 (4,4%) patients. The highest 30-day mortality rate after TLT was in 2014 — 7,7%, the lowest in 2015 — 2,3%. For the entire study period, this parameter was 3,8% . Conclusion. During the study period of TLT in IS patients, there was a positive trend in the number of patients with onset-to-door time <4,5 hours and a reduction in door-to-needle time for thrombolysis. We also observed increase of total thrombolysis procedure amount, and most patients had significant neurological deficit improvement. The incidence of significant complications and mortality after TLT was lower than in the Russian Federation. The safety of TLT is based on adherence to uniform patient selection criteria and thrombolysis protocol. A personalized approach in selecting patients for TLT is a predictor of the hemorrhagic complications. The adherence to the thrombolysis algorithm and guidelines of patient management after thrombolysis contributes to the successful use of this treatment method in IS patients.

Selection of P2Y12 antagonist in patients with myocardial infarction who received thrombolytic therapy. Results of annual follow-up of TREAT study patients

Dual antiplatelet therapy serves to improve the clinical results of thrombolytic therapy after STEMI, until recently consisted of acetylsalicylic acid and clopidogrel. In this category of patients, ticagrelor, widely used by acute coronary syndrome as more effective than clopidogrel, had no serious evidence of efficacy and safety. The TREAT study discussed in this article has been implemented to supply a gap in the evidence base of ticagrelor. The results of observation within 12 months after randomization to taking ticagrelor or clopidogrel of patients who received thrombolytic showed that the hemorrhagic safety regarding the major bleeding of ticagrelor is comparable with clopidogrel. The results of the TREAT study with the previously obtained results of the PLATO study make it possible to broaden indications for the use of ticagrelor (or switching from clopidogrel) in the first 24 hours from the onset of a myocardial infarction in patients who received thrombolytic therapy as an initial reperfusion.

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

PREINFARCTION ANGINA AS A CLINICAL FORM OF THE ISCHEMIC PRECONDITIONING PHENOMENON

Brief episodes of myocardial ischemia initiate a cascade of endogenous mechanisms which protect the heart during further ischemic attack. This phenomenon is called an ischemic preconditioning. Preinfarction angina is a clinical model of this phenomenon. Clinical studies have demonstrated that preinfarction angina is associated with: lower incidence of cardiogenic shock, pulmonary edema, ventricular tachycardia and ventricular fibrillation, reduced infarct size, less severe left ventricular dysfunction, better results of thrombolytic therapy, less severe myocardial reperfusion injury, better hospital and long-term prognosis. There is evidence that elderly age, presence of diabetes mellitus, left ventricular hypertrophy and hypercholesterolemia do reduce the cardioprotective effect of preinfarction angina. Preinfarction angina may be an additional criterion of risk stratification in myocardial infarction patients. This review summarizes data from the literature on the most important aspects of preinfarction angina.

Patients with and without Left Ventricular Dysfunction Suffering from Acute Ischemic Stroke Benefit Similarly from Thrombolytic Therapy

Heart failure is an important risk factor for thromboembolic events and it is associated with a greater incidence of ischemic stroke and worse outcomes. However, little is known regarding results of thrombolytic therapy in patients with left ventricle systolic dysfunction suffering from ischemic stroke. In this scenario, where cerebral perfusion may be impaired by lower cardiac output, thrombolysis may not be as effective as expected.

CLINICAL RESULTS OF THROMBOLYTIC THERAPY WITH ALTEPLASE AND TENECTEPLASE IN PATIENTS WITH MYOCARDIAL INFARCTION

Aim. To evaluate the clinical results of thrombolytic therapy with thrombolytics (alteplase, tenecteplase) in patients with ST segment elevation myocardial infarction (STEMI). Material and methods. Patients with STEMI (n=181) included in the study were split into two groups depending on the thrombolytic agent: patients treated with alteplase - group 1 (n=78); patients treated with tenecteplase — group 2 (n=52). Patients with STEMI who had no thrombolysis due to late treatment-seeking or the presence of contraindications were included into the group 3 (n=51). Thrombolysis took place both in pre-hospital and in-hospital period. Time before the thrombolysis, STEMI clinical course, mortality , and complications were analyzed. Results. The average time pain-thrombolysis was 2.7±0.22 hours. High efficacy of both thrombolytic drugs was proved in the most of patients. Mortality in patients received thrombolysis was 6.4–7.7%; this in patients without thrombolytic therapy — 24%. Thrombolysis performed in the first 3 hours after STEMI onset reduced mortality to 3.4%. No one intracranial hemorrhage or allergic reaction was registered. Conclusion. Thrombolytic therapy with alteplase and tenecteplase in patients with STEMI in the real clinical practice was high efficient, reduced hospital mortality and induced a few adverse reactions.

Comparison of thrombolytic therapy for prosthetic valve thrombosis at the mitral and aortic position

Introduction Prosthetic Valve Thrombosis (PVT) is a devastating complication of mechanical valve implantation. Treatment of PVT is usually by thrombolysis or by surgery. While the results of thrombolysis of thrombosed mitral valve is well established, results at the aortic position are not well reported. We sought to compare the results of thrombolytic therapy for thrombosed prosthetic bileaflet mechanical valve at the mitral and the aortic position.

Thrombolysis for acute arterial occlusion

Acute leg ischemia is one of the most challenging and dangerous conditions in vascular surgical practice and carries a high risk of amputation and death when left untreated. This article provides an overview of the currently held opinions on the role of catheter-based thrombolytic therapy in patients with acute leg ischemia. A systematic review of literature from 1980 to 2009 was performed. The literature analyzed included randomized trials, large single-center case series, and review articles. Three large randomized trials and 14 review articles were identified. Pharmacologic aspects and the results of thrombolytic therapy, as well as indications, contraindications, and complications are described. Catheter-directed thrombolysis can be considered a complementary and not a competing technology with surgical or percutaneous revascularization, with an acceptably low complication rate.

Relation between serum lipoprotein (a) and residual lesion stenosis of coronary artery after myocardial Infarction without reperfusion therapy.

Lipoprotein (a) (Lp(a)) is an independent risk factor for myocardial infarction (MI). It may also inhibit the fibrinolysis system, and Lp (a) affects the natural course of MI and the results of thrombolytic therapy. The purpose of this study was to investigate the influence of Lp (a) on the residual lesion stenosis of the infarction-related arteries (residual stenosis) in acute MI patients in whom reperfusion therapy was not performed. We studied 129 MI patients not given reperfusion therapy who underwent coronary angiography in the chronic stage. Morning fasting blood was collected and Lp (a), blood sugar, total cholesterol (TC), triglycerides (TG), and hemoglobin A1c (HbA1c) were measured. Residual stenosis was compared between the low Lp(a) group (< 30 mg/dL) and the high Lp(a) group (> or = 30 mg/dL). It was severe in the high Lp(a) group (85.0 +/- 24.9% vs 94.5 +/- 15.5%, P = 0.0044). We also compared residual stenosis and TIMI classification between younger and older, non-DM and DM, non-HT and HT, low-TC (< 220 mg/dL) and high-TC (> or = 220 mg/dL), low-TG (< 150 mg/dL) and high-TG (> or = 150 mg/dL), and low-Lp (a) and high-Lp (a) patients. Only the serum Lp (a) level affected the residual stenosis and TIMI classification (P < 0.05). These findings suggest that elevated Lp (a) levels inhibit fibrinolysis.

Zeitbasiertes Management des akuten Schlaganfalls

Progression in medical research and economic needs require new planning and organization of treatment strategies. This does also apply for stroke treatment: New pathophysiological knowledge, positive results of thrombolytic therapy and the demostrated importance of early treatment at Stroke Units justify that stroke must be regarded as an emergency. Timing is of utmost importance. Time-based management serves as a planning model for a new stroke treatment strategy. The treatment process is divided into three phases: alarming, pre-hospital and in-hospital phase. The effectiveness of each of these phases is influenced by several variables (personnel, technical equipment, course of the disease, etc.). Knowledge of each separate phase helps to discover weaknesses, which allows an aimed improvement, e.g. public education, training of paramedics and medical personnel. Modern communication systems allow new information transfer, which can help to avoid unnecessary transport of patients.

Incidence of Space-Occupying Brain Edema following Systemic Thrombolysis of Acute Supratentorial Ischemia

Whether ‘malignant’ brain edema following ischemic stroke is due to or aggravated by reperfusion and therefore more frequent after thrombolytic therapy of stroke is still under debate. From 3/96 to 1/97, we treated 51 patients with acute supratentorial stroke within 3 h after symptom onset with rt-PA following a protocol similar to the NINDS study. The results of thrombolytic therapy were evaluated by repeated clinical examination and computed tomography (CT) during the first week after ictus. The incidence of space-occupying brain edema following intravenous thrombolytic therapy of acute ischemic stroke was lower than the edema frequency after conventional treatment, but mortality from ‘malignant’ edema was higher in the patients with thrombolysis. Thus, space-occupying edema after acute ischemic stroke may be aggravated by thrombolytic treatment. Forced reperfusion of already irreversibly damaged tissue increases edema formation and enlarges developing infarcts with a deleterious increase of intracranial pressure.

Thrombolytic Therapy: Future Issues

A considerable amount of work has been devoted to thrombolytic therapy (about 3000 references from 1991 to 1995 in a Medline search). The most important and well established indication of thrombolytic treatment is acute myocardial infarction (MI). Megatrials have evidenced a significant 30 to 40% reduction in hospital mortality in the treated patients. However, lack of sufficient thrombolysis in approximately 25% of patients, reocclusion in 6 to 16% of patients and intracranial hemorrhage in about 0.5% of patients are the main concerns regarding thrombolysis. Three approaches should improve the results of thrombolytic therapy in acute MI: earlier medical treatment, use of more efficacious thrombolytic agents in combination with more active antithrombotic agents and reduction of severe bleeding with safer combination of drugs. An improved of laboratory monitoring may also reduce the incidence of severe hemorrhagic events. In acute pulmonary embolism (PE), a change of indication for treatment based on echocardiography and high probability ventilation-perfusion lung scan results (without requiring pulmonary angiography) could broaden the use of thrombolysis. However, thus far, there has not been a demonstration of a reduction in mortality in large controlled studies. Thrombolysis in acute ischemic stroke is an attractive treatment but thrombolytic treatment is still at an experimental stage. However, the successful use of rt-PA in acute MI has renewed the interest in thrombolysis for focal cerebro-vascular ischaemia. Large controlled studies with SK, rt-PA or UK locally or intravenously administered have been recently undertaken to evaluate the benefit/risk ratio of treatment which seems surprisingly variable in different subgroups of patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Early thrombolytic treatment in acute coronary thrombosis.

It is now accepted that the earliest event in acute myocardial infarction is coronary occlusion caused by fissuring of an atherosclerotic plaque, with resultant platelet deposition on the mural flaw and build up of thrombus within the lumen. The symptoms generated are caused by myocardial ischaemia, as first described by Herrick and Levine some 80 years ago. If occlusion is not relieved, irreversible damage (infarction) begins in the ischaemic region within 30 minutes, is half completed by 2.5 hours, and is virtually completed by six hours. Thrombolysis is now accepted therapy for acute evolving myocardial infarction, but in most cases such therapy is not commenced for four hours after symptom onset, when most of the irreparable damage has already been done and when the potential for benefit has fallen substantially. The average time to thrombolysis in GUSTO worldwide, however, was two hours and, in Australia, 2.8 hours. Only patients who could be submitted to thrombolysis within six hours of the onset of pain were included. The results of thrombolytic therapy in acute thrombosis are likely to be improved if delays are minimised. This requires education of the public in the symptoms of this condition, and on the actions to take if such symptoms arise. It also requires expeditious transfer to hospital (or appropriate treatment outside) and above all it requires expeditious assessment and treatment when patients arrive in hospital. Use of the diagnosis 'myocardial infarction' for such patients implies that irreversible damage has already occurred and serves as a disincentive for the speedy, aggressive management that is logical and appropriate for dissolution of the offending coronary thrombus.

Rationale and results of thrombolytic therapy for deep-vein thrombosis

Rationale and results of thrombolytic therapy for deep-vein thrombosis

Variability of thrombolytic coronary reperfusion: An angiographic study of streptokinase and anistreplase

A total of 1,615 angiographic readings in 240 patients with acute myocardial infarction were analyzed from a randomized trial of intravenous anistreplase (Eminase), also known as anisoylated plasminogen streptokinase activator complex (APSAC), versus intracoronary streptokinase. Coronary arteriography was performed at baseline and at 15, 30, 45, 60, 75, and 90 minutes after drug infusion. Coronary flow in the infarct-related artery was defined using the TIMI criteria. Some serial change in perfusion was noted in 25% of the total patient population and in 49% of all reperfusion patients. Complete loss of perfusion (grade 2 or 3 to grade 0 or 1) occurred in 35% of all reperfused patients. Half of these patients ultimately developed complete loss of perfusion at the study endpoint. All of these changes in flow were statistically more common for the circumflex coronary artery and early treatment (less than 4 h), but did not differ for anistreplase or streptokinase. We conclude that frequent alterations in coronary blood flow occur early during reperfusion therapy and that these findings may explain reports with varying results of thrombolytic therapy. Any angiographic assessment of thrombolytic drug efficacy should take these variations as well as interobserver variability into account.

Silicone rubber catheter venography using standard angiographic techniques

Single- and double-lumen silicone rubber central venous catheters were subjected to in vitro destructive testing. Using this data we devised a clinical technique for the detection of central venous thrombosis incorporating mechanical injection of the catheters, serial filming, and magnification radiography. In 20 patients studied, thrombosis was detected in 12 and extravasation in 3. Two partially occluded catheters burst during forceful injection. Our technique demonstrated the presence and extent of thrombosis at the catheter tip more clearly than did other venographic methods and has been especially useful in assessing the results of thrombolytic therapy.