Thrombolytic Therapy In Patients Research Articles

Barthel Index, SPAN-100, and NIHSS Studies on the Predictive Value of Prognosis in Patients With Thrombolysis.

We mainly explore the predictive value of Barthel Index (BI), SPAN-100, and National Institute of Health stroke scale (NIHSS) scores on clinical prognosis and functional outcomes in thrombolytic patients and compare the differences in the predictive values of the above 3 scales so as to provide an effective basis to evaluate the prognosis of thrombolytic patients. Data were collected from 212 patients with the first-onset AIS (acute ischemic stroke). The enrolled patients were treated with recombinant tissue plasminogen activator thrombolytic therapy and were divided into 2 groups according to the modified Rankin Scale (mRS) score at discharge: the prognosis group (mRS≤2 points) and the poor prognosis group (mRS≥3 points). Logistic multivariate analysis was used to analyze the predictors of poor prognosis in patients with thrombolysis. MedCalc software was used to plot receiver operating characteristic (ROC) curves, calculate the area under the ROC curve (AUC), and compare the prediction performance of the 3 scales by the Delong and colleagues' method, and the difference of P <0.05 was statistically significant. Logistic binary regression multivariate analysis suggested that BI was a predictor of poor prognosis for thrombolytic therapy in patients with AIS. The lower the BI score, the poorer the prognosis. The AUC for BI score was 0.862, 95% CI (0.808-0.906), NIHSS score AUC was 0.665, 95% CI (0.597-0.728), and SPAN-100 score AUC was 0.640, 95% CI (0.572-0.705). AUC comparison of 3 scoring ROC curves suggested statistically significant differences between BI and NIHSS ( PC =0.0000), BI and SPAN-100 ( PC =0.0000); no significant difference was observed between SPAN-100 and NIHSS ( PC =1.7997). Simple BI scores have a high prognostic value for thrombolytic therapy in AIS.

Efficacy of cerebroxin capsules combined with aspirin in prevention of post-ischemic stroke in patients treated with thrombolysis

Purpose: To analyze the efficacy of Cerebro-Cardiac capsules combined with aspirin for secondary prevention in post-ischemic stroke patients treated with thrombolysis, and also to explore its clinical application value. &#x0D; Methods: 224 ischemic stroke patients in the outpatient clinic of Changsha First Hospital, China from June 2022 to December 2022 were randomly divided into treatment and control groups, with 112 patients per group. Both groups were given oral aspirin (100 mg/daily) but treatment group received cerebroxin capsules (four capsules, three times daily) in addition. The types of recurrent strokes, clinical efficacy, NIHSS score scale, modified Barthel index, levels of fibrinogen and plasma viscosity, total cholesterol and triacylglycerol were assessed and compared between the groups. &#x0D; Results: During the 6-month follow-up, 10 patients in treatment group and 12 patients in control group experienced dislodgment, and 202 cases completed treatment, but the difference was not statistically significant (p &gt; 0.05). Treatment group showed a higher effective rate (92 %) compared to control group (75 %), with a statistically significant difference in clinical symptom efficacy (p &lt; 0.05). Hemodynamic parameters were significantly better in treatment group than in control group (p &lt; 0.05). Both groups exhibited improved total cholesterol levels, triacylglycerol levels and modified Barthel index post-treatment. Treatment group had better NIHSS scores and Barthel index than control group (p &lt; 0.05), while their triacylglycerol levels were lower (p &lt; 0.05). &#x0D; Conclusions: Cerebroxin capsules combined with aspirin improve the symptomatic effect of thrombolytic therapy in patients after ischemic stroke with high safety profile. Analysis of the effect of this combination in an increased sample size and a longer follow-up period will be required in the future.

Nurses' knowledge and practice of thrombolytic therapy in the emergency department of King Salman Hospital: A comparative analysis

This study aimed to assess the knowledge and practice of nurses regarding thrombolytic therapy for patients with acute myocardial infarction (AMI) in the emergency department of King Salman Specialist Hospital, Hail, Saudi Arabia. Using a descriptive, correlational, cross-sectional design, data were collected from staff nurses in the emergency department through a questionnaire that included their demographic details and assessed their knowledge and practice concerning thrombolytic therapy. Analysis methods such as frequency and percentage, ANOVA, t-test, and bivariate analysis were utilized. Findings showed that nurses had an acceptable level of knowledge and practice with scores of 1.18 (SD=.361) and 1.29 (SD=.391), respectively. There was no significant difference in knowledge based on gender, age, or years of experience. However, years of experience significantly affected practice levels. The study highlights that while demographic factors do not majorly influence knowledge of thrombolytic therapy, experience plays a crucial role in the practical application of this knowledge in the emergency care of AMI patients. In conclusion, nurses at King Salman Specialist Hospital demonstrated competent knowledge and practice in administering thrombolytic therapy to AMI patients, underscoring the importance of experience in enhancing practical skills. This suggests a need for continuous education and training to maintain high standards of care in emergency departments.

Optional therapeutic management of intermediate-risk pulmonary embolism patients

Background: Few studies have evaluated the thrombolytic treatment in patients with intermediate-high risk pulmonary embolism, making this study more valuable. Material and methods: It was a prospective, non-randomized, open-label, single-center study. Eligible patients at the age of 18 or older with an acute pulmonary embolism (PE) confirmed by CT pulmonary angiography with onset until 14 day and signs of right ventricular (RV) overload on echocardiography took part in the study. Pulmonary Arterial CT Obstruction Index Rate (PACTOIR) was used to define the localization and the expansion zone of thromboembolism. This study included 18 patients with intermediate risk and acute submassive pulmonary thromboembolism. In thrombolysis (TT) group (n=9) were used 50 mg of tissue-plasminogen activator (t-PA) administered in infusion as 0.4 mg/h for 2 hours. In the standard anticoagulation group, unfractioned heparin (UFH) was administered as a bolus of 70 units/kg or a maximum of 5000 units, followed by continuous infusion at an initial rate of 16 units/kg or a maximum of 1000 units/h. Results: The mean age for TT group was 69 vs 63 for the UFH group. PACTOIR was 100% in 3 patients in the half-dose rt-PA group and in 2 patients in the UFH group. RV/LV diameter ratio decreased from baseline to 48 h post-procedure (1.55 vs. 1.13; mean difference, -0.42; p &lt; 0.0001). Mean pulmonary artery systolic pressure was 55 mm Hg in both groups (p &lt; 0.05), with 53 [43–60] in TT group vs. 41.5 [37–45] mmHg in UFH group, P&lt;0.05. Also, RV/ LV ratio and systolic PAP decreased significantly in both groups. Severe bleeding with a need in red blood cell transfusion was seen in 0.11% (1 patient) in the TT group vs 0 in UFH group. The hospitalization length of stay was significantly shorter in the TT group (3.8±1.8, p &lt; 0.05). The rate of secondary endpoints was significantly higher in the UFH group with a high rate of pulmonary hypertension (0 vs. 19%, p=0.003). Conclusions: Half-dose thrombolytic therapy in patients diagnosed with submassive pulmonary embolism significantly reduced death and hemodynamic decompensation in the first 7 days compared to anticoagulant therapy only. With all that being said, it can be concluded that patients with high-intermediate risk PE could benefit from reduced-dose TT.

Abstract 12155: Trends in the Clinical Outcomes and Resource Utilization of Catheter-Based Thrombolytic Therapy vs. Systemic Thrombolytic Therapy in Patients With Acute Pulmonary Embolism

Introduction: Contemporary trends in clinical outcomes and resource utilization in patients with acute pulmonary embolism (PE) undergoing thrombolytic therapy are not well-known. Research Question: We wanted to analyze the trends in outcomes of catheter-based thrombolytic therapy (CDT) vs. systemic thrombolytic therapy (ST) in patients with PE. Aim: We aimed to compare the trends in in-hospital mortality, length of stay (LOS), and hospital costs in patients with PE who underwent CDT vs. ST. Methods: Using the National Inpatient Sample, all adult patients hospitalized with PE from 2012 to 2018 were identified using the International Classification of Disease diagnostic codes. Multivariate linear and logistic regression were used to obtain trends and effect sizes. Results: We identified 1.27 million patients with PE, of which 45,950 underwent thrombolytic therapy (CDT=30.1% and ST=69.9%). The mean age of patients receiving CDT vs. ST wasn't different (59.7 vs. 59.3, P=0.14). The proportion of CDT among all patients with PE increased from 0.4% in 2012 to 1.9% in 2018. Baseline characteristics of patients who underwent CDT vs. ST are shown in panel A. Risk-adjusted mortality was significantly lower in patients receiving CDT vs. ST (AOR=0.38, P=&lt;.01). Risk-adjusted LOS was 0.19 days non-significantly higher in patients with CDT vs. ST (P-value=0.12). The hospital cost was significantly higher in patients who underwent CDT vs. ST (β=2917 USD, P&lt;.01). Temporal trends of these outcomes are shown in panels B-D. Conclusions: It is encouraging to see an increasing trend in the utilization of CDT. In-hospital mortality decreased in patients with CDT and ST, but CDT continues to be superior. The LOS was not significantly different among these groups but significantly decreased in both groups over time. Finally, hospital cost was higher in patients with CDT vs ST, but these cost differences between CDT and ST narrowed due to decreasing cost of CDT and increasing cost of ST over time.

Thrombolytic Therapy in Strokes: A Retrospective Clinical Data Analysis of 40 Patients in a 7-Year Period: The Experience of a Greek Internal Medicine Department

Stroke is one of the main causes of mortality and disability in developed countries. In acute ischemic stroke, the standard treatment is recombinant tissue plasminogen activator (rt-PA). The benefits of the treatment depend on the time of administration, the earlier it is administered, the greater its benefit. There are limited studies on the retrospective outcome of thrombolytic therapy in patients with acute ischemic stroke outside of clinical trials. The present retrospective study aimed to analyze the clinical data of 40 patients over 7 years who were hospitalized with acute ischemic stroke at the AHEPA University Hospital in Greece. From January 2013 to December 2020, 40 patients with acute ischemic stroke were admitted and treated. Computed tomography (CT) was performed at 24 h after thrombolytic treatment or earlier in case of neurological worsening. The hospital had 3 months follow-up at the stroke clinic and data consisting of the National Institute of Health Stroke Scale (NIHSS), functional outcome assessed by modified Rankin Scale (mRS) and mortality were reviewed in the medical records from the stroke clinic. The clinical outcome of functional independence defined by the modified Rankin Scale (mRS) ≤ 2 at 3 months was evaluated. Safety outcomes were in-hospital mortality, mortality at 3 months, and symptomatic intracerebral hemorrhage (sICH) defined by the Safe Implementation of Thrombolysis in Stroke-Monitoring Study (SITS-MOST) criteria. The main finding of the present study, that there was an overall reduction in the NIHSS scale after thrombolysis, proves that the patients showed improvement after performing thrombolysis. Consequently, from the total of 40 thrombolysis performed at the clinic, it can be concluded that most patients had a good outcome.

Abstract 216: Endovascular Thrombectomy +/‐ Thrombolytics In Patients With Cocaine‐Related Acute Ischemic Stroke

Introduction The safety of thrombolytic therapy in patients with cocaine‐related acute ischemic strokes (AIS) has been investigated, but the safety of endovascular thrombectomy in cocaine‐related AIS remains unknown (1‐2). Here, we report preliminary descriptive data on endovascular thrombectomy with or without thrombolytics performed in cocaine‐related ischemic strokes at our institution. Methods A retrospective chart review was performed at our comprehensive stroke center from June 2020 to May 2022 to identify AIS patients with cocaine‐positive urine toxicology screens on admission. Baseline demographics, urine toxicology, National Institute of Health Stroke Scale (NIHSS) scores, neuroimaging, Trial of ORG 10127 in Acute Stroke Treatment (TOAST) criteria, location of stroke, home medications, comorbidities, medical management, and outcomes including modified Rankin Score (mRS) were reported. Results A total of 74 AIS patients were identified to be cocaine‐positive. Of these patients, 14 underwent endovascular thrombectomy (EVT). Only 3 of these 14 patients received intravenous thrombolytics. Including the EVT group, 8 out of 74 AIS patients received thrombolytics. The mean age was found to be 61 years with 86% being male. The most common locations of large vessel occlusion were the M2 branch of the right middle cerebral artery (MCA) (40%), the M2 branch of the left MCA (33%), the M1 branch of the right MCA (13%), left internal carotid artery (7%), and A1 branch of the anterior cerebral artery (7%). Based on TOAST criteria, 64% of strokes were large artery atherosclerosis, 29% cardioembolic, and 7% cryptogenic stroke. The mean initial NIHSS was 14. Average mRS on admission was found to be &lt; 1 and follow‐up mRS at 3 months was found to be 3. Conclusion Our data suggest that cocaine patients who underwent EVT on average had unfavorable functional outcomes defined as mRS &gt; 2, on follow‐up mRS at 3 months. This study highlights the importance of future larger studies to investigate endovascular thrombectomy +/‐ thrombolytics in cocaine‐related AIS.

Tenecteplase vs. Alteplase for Intravenous Thrombolytic Therapy of Acute Ischemic Stroke: A Systematic Review and Meta-Analysis.

In recent years, as one of the drugs for the treatment of acute ischemic stroke (AIS), the clinical application of tenecteplase is still controversial. Therefore, we aimed to evaluate the safety and efficacy of tenecteplase versus alteplase to guide clinical practice. A search of PubMed, MEDLINE, EMBASE, Cochrane Library, and Web of Science databases until February15, 2023 was conducted to identify eligible articles. The quality of the included studies was assessed using the Cochrane Risk of Bias tool. RevMan5.3 and Stata17 were used to perform the meta-analysis and detect publication bias, and risk ratios (RRs) with 95% confidence intervals (95%CIs) were reported for each outcome measure. A total of 1326 records were retrieved in this meta-analysis. As a result of the limited reports on tenecteplase in patients with AIS and the lack of high-quality randomized controlled trials (RCTs), and considering the impact of publication bias, we did not include any of these studies published before 2015. Ultimately we included 16 RCTs with a total of 7508 patients, including 3940 patients treated with alteplase and 3568 patients treated with tenecteplase. Tenecteplase was associated with better early neurological improvement (RR 0.10; 95%CI 0.00-0.19; P = 0.04), recanalization of blood vessels (RR 0.24; 95%CI 0.07-0.40; P = 0.01), and 90-day excellent neurological recovery (RR 0.12; 95%CI 0.01-0.24; P = 0.04). In addition, there were no significant differences in other efficacy and safety outcomes between the two groups. The funnel plot and Begg's as well as Egger's tests showed no significant publication bias. This meta-analysis showed that tenecteplase was not inferior to alteplase in early thrombolytic therapy in patients with AIS, and was even better than alteplase on some efficacy outcomes with no significant differences in safety. However, as a result of some inherent limitations of this study, more high-quality prospective clinical studies are needed to confirm these results.

Tenecteplase: A Review of Its Pharmacology and Uses.

Tenecteplase: A Review of Its Pharmacology and Uses.

The potential role of micro-RNA 125b-5p level in predicting outcome from thrombolytic therapy in patients with acute ischemic stroke

Several studies highlighted a significant role of specific miRNA as diagnostic and prognostic biomarkers for acute ischemic stroke. The aim of this work was to study micro-RNA 125b-5p level in patients with acute ischemic stroke in relation to stroke etiology, risk factors, severity and outcome. This case–control study was conducted on 40 patients with acute ischemic stroke eligible for receiving rt-PA and 40 age and sex matched healthy controls, Patients were submitted to neurological and radiological assessment. Functional outcome after 3 months was assessed using the modified Rankin Scale (mRS). Plasma micro-RNA 125b-5p levels were measured for both patients and control groups by quantitative real time PCR. MiRNA-125b-5p was extracted from the plasma samples then Real-time quantitative reversed transcription PCR (RT-qPCR) analysis was done. To analyze miRNA-125b-5p expression in plasma, the ∆Cq value of miRNA-125b-5p was calculated by subtracting Cq of miRNA-125b-5p from the average Cq of MiRNA RNU6B. Stroke patients had significantly higher circulating micro-RNA 125b-5p levels in comparison to healthy controls (P value = 0.01). The circulating levels of micro-RNA 125b-5p were positively correlated with stroke severity assessed by National Institutes of Health Stroke Scale (NIHSS) and infarction size. Stroke patients with poor outcome had significantly higher circulating levels of micro-RNA 125b-5p in comparison to those with good outcome (P value ≤ 0.001). The circulating levels of micro-RNA 125b-5p were significantly higher in patients who developed complications after receiving rt-PA (P value ≤ 0.001). Logistic regression model revealed that each unit increase in micro-RNA125b-5p decreased the odds of good outcome by 0.095 (95% CI 0.016–0.58, P value = 0.011). Plasma micro-RNA 125b-5p is significantly elevated is ischemic stroke patients. It is positively correlated with stroke severity and strongly associated with poor outcome and complications after thrombolytic therapy.

Effects of predictive nursing intervention on cognitive impairment and neurological function in ischemic stroke patients.

Ischemic stroke is a clinical emergency caused by insufficient intracranial blood supply, which eventually leads to brain tissue necrosis and neurological impairment. Predictive nursing intervention has achieved impressive success in the nursing of multiple surgeries. However, the role of predictive nursing intervention in the care of patients with ischemic stroke remains unclear. This study was a randomized controlled trial. Based on the inclusion and exclusion criteria, 126 patients were randomly assigned into two groups, namely the control group and the predictive nursing intervention group. Both groups were treated with thrombolytic therapy with alteplase. The patients in the control group were given routine nursing intervention and the predictive nursing intervention group received additional predictive care. Neurologic functions and cognitive impairment were evaluated by National Institutes of Health Stroke Scale (NIHSS), Fugl-Meyer assessment (FMA), Montreal cognitive assessment (MoCA), and mini-mental state examination (MMSE) scales, respectively. Door-to-Needle Times, venous thromboembolism (VTE)-related parameters, and complications were recorded. Predictive nursing intervention significantly shortened the Door-to-Needle Times and enhanced the peak/average femoral venous blood flow and femoral venous diameter. In addition, predictive nursing intervention improved the NIHSS, FMA, MMSE, and MoCA scores and remarkably reduced the recurrence of ischemic stroke, deep vein thrombosis and gingival bleeding. Predictive nursing intervention is beneficial to improve the effects of thrombolytic therapy in patients with ischemic stroke, which improves the neurological, cognitive and motor functions of patients, and reduces the occurrence of complications, suggesting an important clinical application value.

The Importance of Frontal QRS-T Angle in Predicting the Effectiveness and Success of Thrombolytic Therapy in Patients With Acute Pulmonary Embolism.

The frontal QRS-T angle (fQRS-T) is associated with myocardial ischemia and ventricular arrhythmias. On the other hand, acute pulmonary embolism (APE) is a major risk factor for cardiac adverse events. This research aimed to determine whether the fQRS-T, a marker of ventricular heterogeneity, can be used to predict successful thrombolytic therapy in patients with APE. This was a retrospective observational study. Patients diagnosed with APE and hospitalized in the intensive care unit between 2020 and 2022 were included in the research. A total of 136 individuals with APEs were enrolled in this research. The patients were divided into two groups: thrombolytic-treated (n=64) and non-treated (moderate to severe risk, n=72). An ECG was conducted for each patient, and echocardiography was performed. The mean age of the thrombolytic group was 58.2±17.6 years, with 35 females (55.1% of the group) and 29 males (44.9%). The non-thrombolytic group had a mean age of 63.1±16.2, with 41 females (56.5%) and 31 males (43.5%). Respiratory rate, heart rate, and fQRS-T were higher in the thrombolytic group, and oxygen saturation ratio and systolic and diastolic blood pressure were higher in the non-thrombolytic group (p=0.006, p<0.001, p=0.021; p<0.001, p=0.015, p<0.001, respectively).In the thrombolytic therapy group, comparing pre- and post-treatment ECG data revealed a statistically significant change in the fQRS-T value (p=0.019). The fQRS-T may provide important clues for the successful treatment of APEs.

Current methods of improving thrombolytic therapy in patients with acute ischemic stroke

Current methods of improving thrombolytic therapy in patients with acute ischemic stroke

Experience of using a Russian alteplase product as thrombolytic therapy in patients with ischemic stroke in routine practice

To assess the efficacy and safety of thrombolytic therapy (TLT) with Revelisa in patients with ischemic stroke (IS). The retrospective study included the data of 72 patients (mean age 64.0±17.1) with IS who were admitted to the Regional Vascular Center of the V.V. Veresaev City Clinical Hospital within the first 4.5 hours after the disease onset in the period August 2022 through February 2023. All patients underwent clinical, instrumental and laboratory examinations under the reperfusion therapy protocol. The severity of neurological deficit measured with the NIH Stroke Scale (NIHSS); the degree of self-care was assessed using the Modified Rankin Score (mRS); hemorrhagic transformation (HT) was classified according to the ECASS 3 criteria. The safety of TLT was evaluated by the incidence of HT, any extracranial hemorrhage, and mortality. At admission, the mean NIHSS score was 6.0 (IQR 4.0-10.0). In 34.7% of patients, there was an improvement in the form of neurological deficit regression in the NIHSS score by ≥4 points within 24 hours after TLT. One day after TLT, the median NIHSS score was 2 points (IQR 0.00-5.00) in all patients. The changes in neurological deficit according to the NIHSS score were statistically significant (p<0.001). At day 30 after the stroke, 68.1% of patients achieved a favorable outcome (Rankin score: 0-2). Asymptomatic HT (type 1 HT according to the ECASS classification) was reported in 5.6% of patients (4 patients). None of the patients in the sample reported symptomatic HT or extracranial bleeding. The mortality rate was 1.3%. Revelisa has demonstrated high efficacy and safety when used for TLT in patients with IS in real-world clinical practice.

THROMBOLYSIS IN PULMONARY EMBOLISM TREATMENT.

The aim: To assess the effectiveness of thrombolytic therapy in treatment pulmonary embolism. Materials and methods: The work analyzed the results of the survey and conservative treatment of 284 patients with pulmonary embolism treated in cardiological department in «Uzhgorod Central City Clinical Hospital» during 2019-2022. Patients were divided into two groups: group I - 250 (88%) patients received anticoagulant therapy; group II - 34 (12%) patients received thrombolytic therapy that was then switched to new oral anticoagulants. Results: In I group, the first three days were carried out continuously intravenous infusion of heparin in a dose of 25-30 thousand units per day, on the fourth day switched to subcutaneous injection for 10-14 days with subsequent switching to rivaroxaban. 34 (12.0%) patients of the II group, was started with thrombolytic therapy. 32 (94.1%) patients were prescribed alteplase 100 mg/day, and 2 (5.9%) patients - streptokinase 1.5 million units/day. After thrombolysis, patients were prescribed rivaroxaban for prolonged period. Thrombolytic therapy made it possible to prevent fatal cases, and in monotherapy with anticoagulants - mortality was 4.8%. Minor hemorrhagic complications like hematuria, local hematomas at the injection site, bleeding gums were observed in 7.6% of patients during thrombolytic therapy. No cases of large hemorrhages were observed. Manifestations of chronic postembolic pulmonary hypertension in the distant period were found in 97.1% and 6.9% of patients of the I and II groups, respectively. Lethality in the remote period was 5.3% - all in the 1st group of patients due to PE recurrence and acute myocardial infarction. Conclusions: Implementation of thrombolytic therapy in patients with thromboembolism of the pulmonary artery allows effectively prevent recurrence with a fatal outcome, restore the lumen of the pulmonary arteries and prevent the development of chronic postembolic pulmonary hypertension in the immediate and remote period of observation compared to isolated anticoagulant therapy.

Abstract 11239: Gender Disparities in the Utilization of Catheter-Directed Thrombolytic Therapy vs. Systemic Thrombolytic Therapy in Patients With Acute Pulmonary Embolism

Introduction: Gender disparities in the utilization of catheter-directed thrombolytic (CDT) therapy vs. systemic thrombolytic (ST) therapy in patients with acute pulmonary embolism (PE) have not been studied before. Methods: Using the National Inpatient Sample database from 2012 to 2018, we identified all adult patients with acute PE who received any thrombolytic therapy. The primary outcome was the utilization of CDT vs. ST therapy in females compared to males. The secondary outcome was the mortality in females compared to males in all patients of acute PE who received any thrombolytic therapy. Results: We identified 45,950 patients who received CDT or ST therapy. The mean age was 59.7 years in females vs. 59 in males (p-value - .03). Males were more likely to have saddle PE (33% vs. 29%, p-value &lt; .01) and less likely to have vasopressor use (3% vs. 5%, p-value &lt; .01). Baseline characteristics are shown in Table 1. Females were less likely to have CDT vs. ST therapy on adjusted analysis (AOR - 0.85, p-value &lt; .01), as shown in Table 2. Females also had 27% higher in-hospital mortality than males in the entire cohort who received any thrombolytic therapy even after adjustment for age, race, comorbidities, and hospital factors (AOR - 1.27, p-value &lt; .01). CDT was associated with a 58% lower risk of in-hospital mortality than systemic thrombolytic therapy in the adjusted model (AOR - 0.42, p-value &lt; .01). Conclusion: Gender disparities exist in the utilization of CDT in patients of acute PE who receive thrombolytic therapy, with lower utilization in females than males, despite significantly reduced in-hospital mortality associated with CDT vs. ST therapy.

Systemic thrombolytic therapy in patients with intermediate-high-risk pulmonary embolism

Systemic thrombolytic therapy in patients with intermediate-high-risk pulmonary embolism

Role of adjunct anticoagulant or thrombolytic therapy in cardiac arrest without ST-segment-elevation or percutaneous coronary intervention: A systematic review and meta-analysis

This study sought to compare the impact of additional anticoagulation or thrombolytic therapy in patients with cardiac arrest without ST-segment-elevation on electrocardiography and not receiving percutaneous coronary intervention. Three studies (two randomized controlled studies and one observational study) were included, which demonstrated that use of anticoagulation or thrombolytic therapy was associated with higher risk of bleeding, without improvements in time to return of spontaneous circulation or in-hospital mortality.

Efficacy and safety of thrombolytic therapy for portal venous system thrombosis: A systematic review and meta-analysis.

The role of thrombolytic therapy in patients with portal venous system thrombosis (PVST) remains ambiguous. This study aimed to systematically collect available evidence and evaluate the efficacy and safety of thrombolysis for PVST. Eligible studies were searched via PubMed, EMBASE, and Cochrane Library databases. Among the cohort studies, meta-analyses were performed to assess the outcomes of PVST patients receiving thrombolysis. Pooled proportions were calculated. Among the case reports and case series, logistic regression analyses were performed to identify the risk factors for outcomes of PVST patients receiving thrombolysis. Odds ratios (ORs) were calculated. Among the 2134 papers initially identified, 29 cohort studies and 131 case reports or case series were included. Based on the cohort studies, the pooled rates of overall response to thrombolytic therapy, complete recanalization of PVST, bleeding events during thrombolysis, further bowel resection, thrombosis recurrence, and 30-day mortality were 93%, 58%, 18%, 3%, 1%, and 4%, respectively. Based on the case reports and case series, acute pancreatitis (OR = 0.084), history of liver transplantation (OR = 13.346), and interval between onset of symptoms and initiation of thrombolysis ≤14 days (OR = 3.105) were significantly associated with complete recanalization of PVST; acute pancreatitis (OR = 6.556) was significantly associated with further bowel resection; but no factors associated with the overall response to thrombolytic therapy, bleeding events during thrombolysis, thrombosis recurrence, and 30-day mortality were identified or could be calculated. Early initiation of thrombolysis should be effective for the treatment of PVST. But its benefits for PVST secondary to acute pancreatitis are weakened.

Final benefit of primary percutaneous coronary intervention for ST-elevation myocardial infarction in older patients: long-term results of arandomised trial.

Although the short-term benefit of primary percutaneous coronary intervention (PCI) in elderly patients with ST-elevation myocardial infarction (STEMI) has been demonstrated, the final long-term survival benefit is as yet unknown. To assess the final survival benefit of primary PCI as compared to thrombolytic therapy in patients over 75years of age. Patients > 75years with STEMI were randomised to either primary PCI or thrombolysis. Long-term data on survival were available for all patients. Atotal of 46patients were randomised to primary PCI, 41to thrombolysis. There were no significant differences in baseline variables. After amaximum of 20years' follow-up, all patients had passed away. The patients randomised to thrombolysis died after amean follow-up duration of 5.2years (SD 4.9) compared to 6.7years (SD 4.8) in patients randomised to primary PCI (p = 0.15). Thus, the mean final survival benefit of primary PCI was 1.5years. The final survival benefit of primary PCI as compared to thrombolysis in elderly patients with STEMI is 1.5years and their life expectancy increases by 28.8%.