Use Of Tissue Plasminogen Activator Research Articles

Use of a novel configuration of ports for patients needing intermittent long-term apheresis.

In patients with a need for frequent but intermittent apheresis, vascular access can prove challenging. We describe the migration of the use of a Vortex LP dual lumen port (Angiodynamics, Latham, NY) to one Powerflow and one ClearVUE power injectable port (Becton Dickinson, Franklin Lakes, NJ) in a series of patients undergoing intermittent apheresis. All patients had a need for long-term intermittent apheresis. Eight had double lumen Vortex port (pre) and were exchanged for one Powerflow port and one conventional subcutaneous venous port with 90° needle entry (post) while 12 did not have any port in place and received the same configuration. IRB approval was granted. We recorded the treatment time, flow rate, and tissue plasminogen activator (tPA) use for five treatment sessions after placement. When available, we compared five treatments with the Vortex port and the new configuration. The mean treatment time is reduced with the new configuration (P = 0.0033). The predicted mean treatment time, adjusting for gender, race, BMI and age and accounting for correlations within a patient is 91.18 min pre and 77.96 min post. The flow rate is higher with the new configuration (P < 0.0001). The predicted mean flow rate in mL/min is 61.59 for the Vortex port and 71.89 for the new configuration. tPA use was eliminated in the population converted from Vortex ports and had a 48% reduction when compared to all other configurations in the study. The introduction of a novel device configuration of venous access ports for intermittent apheresis resulted in higher flow rates and less total time for treatment. Use of tPA was greatly reduced. These results suggest that the new configuration could result in less expense for the hospital and better throughput in a busy pheresis practice. Clinical trial registration with ClinicalTrials.gov: NCT04846374.

Bacterial Aggregation in Cerebral Spinal Fluid: The Extent it Occurs and the Clinical Ramifications.

Bacteria can form aggregates in synovial fluid that are resistant to antibiotics, but the ability to form aggregates in cerebral spinal fluid (CSF) is poorly defined. Consequently, the aims of this study were to assess the propensity of four bacterial species to form aggregates in CSF under various conditions. To achieve these aims, bacteria were added to CSF in microwell plates and small flasks at static and different dynamic conditions with the aid of an incubating shaker. The aggregates that formed were assessed for antibiotic resistance and the ability of tissue plasminogen activator (TPA) to disrupt these aggregates and reduce the number of bacteria present when used with antibiotics. The results of this study show that under dynamic conditions all four bacteria species formed aggregates that were resistant to high concentrations of antibiotics. Yet with static conditions, no bacteria formed aggregates and when the CSF volume was increased, only Staphylococcus aureus formed aggregates. Interestingly, the aggregates that formed were easily dispersed by TPA and significant (p < 0.005) decreases in colony-forming units were seen when a combination of TPA and antibiotics were compared to antibiotics alone. These findings have clinical significance in that they show bacterial aggregation does not habitually occur in central nervous system infections, but rather occurs under specific conditions. Furthermore, the use of TPA combined with antibiotics may be advantageous in recalcitrant central nervous system infections and this provides a pathophysiological explanation for an unusual finding in the CLEAR III clinical trial.

Use of recombinant tissue plasminogen activator (rTPA) for treatment of fibrin in the anterior chamber of the horse.

Recombinant intracameral tissue plasminogen activator (rTPA) administration can aid clearance of fibrin from the anterior chamber. In this retrospective multicentre case series, the effect of intracameral rTPA administration to treat fibrin in the anterior chamber resulting from trauma or inflammatory ocular disease was evaluated. Clinical data from 30 treatments in 29 horses were obtained from medical records from 2003 to 2022. Association between time from onset of clinical signs and time for rTPA treatment to effect was studied with regression analysis. Twenty-seven horses (93.1%) had no previous history of ophthalmic disease; one had an iridic cyst, and another had equine recurrent uveitis. The majority of cases were related to trauma (79.3%). Median time from the onset of clinical signs to treatment was 12h (IQR=4-48h). rTPA (72% 20µg; 24% 25µg; 3.3% 40µg) was administered once in all but one eye, which was treated twice. Resolution of fibrin was seen in 96.9% (29/30) of treatments. Fibrin accumulation recurred in one case but resolved 14 days after the second treatment. Complications were seen in four treatments (13.3%): moderate pain for 24h, intracameral debris and mild intracameral haemorrhage in a horse that received 40µg of tissue plasminogen activator. Recurrence of fibrin accumulation was absent in 96.7% of cases. Median time to effect was 20min (IQR=10-45min). Time for rTPA treatment to effect was not associated with time from fibrin formation (R2=0.09; p=0.11). Intracameral rTPA treatment can be considered at 20-25µg in 0.1mL solution to aid resolution of fibrin accumulation.

Association between repeat imaging and readmission in patients with acute ischaemic stroke: a 16-year nationwide population-based study.

This study aims to evaluate such usage patterns and identify factors that may contribute to the need for repeat imaging in acute ischaemic stroke patients and determine the association between repeat imaging and readmission in Taiwan. We searched and analysed data from the Taiwan National Health Insurance Research Database for patients admitted for acute ischaemic stroke between 2002 and 2017. Cases where repeat brain imaging during the initial hospital admission occurred and where patients were readmitted within 30 days following discharge were documented. Of a total of 195 016 patients with new onset ischaemic stroke, 51 798 (26.6%) underwent repeat imaging during their initial admission. Factors associated with repeat brain imaging included younger age, longer hospital stay, use of recombinant tissue plasminogen activator (rt-PA) therapy (odds ratio = 2.10 [95% CI, 1.98-2.22]), more recent year of diagnosis, higher National Institutes of Health Stroke Scale (NIHSS) score, and admission to a hospital offering a higher level of care. Repeat imaging was also associated with an increased risk of ischaemic stroke and all types of stroke readmission. Repeat brain imaging of patients with stroke has increased in recent years, and it is associated with certain factors including age, length of stay, use of rt-PA, hospital level of care, and NIHSS score. It is also associated with increased readmission. Knowledge of the associations of repeat imaging may help clinicians use repeat imaging more carefully and efficaciously.

Postprocedural delirium following mechanical thrombectomy for acute ischemic stroke: a retrospective study

IntroductionNational representative estimates on in-hospital delirium after acute ischemic stroke are not well established and there is limited data on the impact of delirium on clinical outcomes following mechanical thrombectomy. We evaluated risk factors for delirium and the impact on outcomes following mechanical thrombectomy for acute ischemic stroke.MethodsThis is a retrospective study of patients who underwent mechanical thrombectomy for acute ischemic stroke at a single tertiary comprehensive stroke center between April 2011 and December 2019. Delirium was assessed using the Confusion Assessment Method for the Intensive Care Unit. Patient characteristics, comorbidities, laboratory data, elapsed times, tissue plasminogen activator use, duration of the procedure, type of anesthesia, National Institute of Health stroke scores (NIHSS), sedation scores, reperfusion grades, complications, length of hospital stay, discharge disposition, and 90-day mortality were evaluated.ResultsFive hundred and two patients were evaluated, and post-procedural delirium was identified in 24/467 (5.1%) patients. Thirty-five patients could not be assessed for delirium due to excessive sedation. The incidence of delirium in white vs. non-white patients &amp;lt;65 years was 5/137 (3.6%) compared to 0/91 (0%), and 7/176 (4.0%) compared to 12/63 (19%) in patients ≥65 years, P = 0.006. Bias reduction multi-variable analysis identified low postprocedural hemoglobin level odds ratio of 0.76 (95% CI 0.61–0.92, P = 0.006), greater age (odds ratio 1.04, 95% CI 1.01–1.009, P = 0.024), and non-white race odds ratio of 2.52 (95% CI 1.06–6.38, P = 0.030) as factors associated with delirium [Brier score = 0.045, C-index = 0.800, and Akaike Information Criterion (AIC) = 174]. General anesthesia was not associated with an increased delirium risk. NIHSS at 24 and 48 h and discharge, length of stay, and 90-day mortality were not different between delirium and no-delirium groups. Delirium patients had a reduced odds ratio of 0.13 (05% CI 0.01–1.00, P = 0.02) for home discharge.DiscussionDelirium following mechanical thrombectomy for acute ischemic stroke primarily affected older patients and was associated with reduced odds of home discharge following hospitalization. Changes in NIHSS during hospitalization and 90-day mortality were not adversely affected by the presence of delirium. General anesthesia was not associated with an increased delirium risk following mechanical thrombectomy.

Safety and Efficacy of Ethanol for Catheter Salvage and Central Line-Associated Bloodstream Infection Prophylaxis in Polyurethane Catheters in the PICU.

Ethanol lock therapy (ELT) is a potential method of central catheter salvage following central line-associated bloodstream infection (CLABSI) although there is potential risk of catheter damage in polyurethane catheters. Further, there is limited efficacy data across the spectrum of common pediatric catheters, and published ELT protocols describe dwell times that are not feasible for critically ill children. We sought to evaluate the safety and efficacy of ELT in polyurethane catheters using brief (30 min to 2 hr) dwell times in our PICU. Investigational pilot study using historical control data. PICU in quaternary care, free-standing children's hospital. ELT in polyurethane central venous catheters for catheter salvage. ELT with brief dwell times was used in 25 patients, 22 of whom were bacteremic. Ultimately 11 patients, comprising 14 catheters, were diagnosed with a primary CLABSI. The catheter salvage rate in primary CLABSI patients receiving ELT was 92% (13/14) and significantly higher than the salvage rate in patients receiving antibiotics alone (non-ELT) (62%, 39/64; mean difference 0.32, 95% CI [0.14-0.50], p = 0.03). The rate of catheter fracture in all patients receiving ELT was 8% (2/25) while the rate of fracture in the non-ELT group was 13% (8/64; mean difference -0.05, 95% CI [-0.18 to 0.09], p = 0.72). The rate of tissue plasminogen activator (tPA) use in the ELT group was 8% (2/25), whereas the rate of tPA use in the non-ELT group was significantly higher at 42% (26/64; mean difference -0.34, 95% CI [-0.49 to -0.17], p = 0.002). The use of ELT for catheter salvage and prophylaxis in the PICU is safe in a variety of polyurethane catheters. Dwell times ranging from 30 minutes to 2 hours were effective in sterilizing the catheters while allowing other therapies to continue. This approach may decrease the need for frequent line changes in a medically fragile pediatric population.

Early surgical displacement of submacular hemorrhage without tissue plasminogen activator use: one-year outcomes

ObjectiveThis study evaluated changes in best-corrected visual acuity and submacular hemorrhage (SMH) resolution in eyes after a single rapid subretinal displacement surgery using subretinal balanced saline solution and sterile air without tissue plasminogen activator (tPA). DesignA retrospective comparative interventional analysis. ParticipantsTwenty-six eyes with thick SMH who underwent pars plana vitrectomy and subretinal fluid displacement without tPA from 2015 and 2021 and at least 1-year of follow-up. MethodsSurgical intervention included a standard small-gauge pars plana vitrectomy with subretinal displacement using balanced saline solution with subretinal sterile air and partial gas–air fluid exchange. Main outcome measures included degree of subfoveal SMH displacement, best and final postoperative visual acuities, and adverse events. Snellen acuity was converted to logMARs for statistical analysis. ResultsThe most common etiology associated with thick SMH (92.3%) was neovascular age-related macular degeneration. Within 1 month postoperatively, 21 patients (80.8%) saw complete subfoveal blood displacement. Most of the SMH surgical displacements were done within 1 week of presenting symptoms. Average preoperative duration of SMH was 3.60 ± 2.78 days (range, 1–12 days). Mean logMAR best-corrected visual acuity improved from 1.63 ± 0.58 (Snellen 20/800 baseline) to 0.90 ± 0.42 letters (Snellen 20/160) at last follow-up (p = 0.001). This study's visual acuity improvement is comparable with that of prior studies using tPA. Early postoperative complications included 1 retinal detachment, 1 vitreous hemorrhage, and 1 macular hole. ConclusionRapid surgery with subretinal balanced saline solution–sterile air injection without tPA was found to be effective for displacement of thick SMH with retinal function, visual acuity, and corneal refractive therapy improvement.

SAT464 Hyperthyroidism Does Not Negatively Impact Outcomes of Adult Hospitalizations for Pulmonary Embolism: A Nationwide Analysis

Abstract Disclosure: A.G. Olafimihan: None. V. Deenadayalan: None. P.E. Ojemolon: None. R. Litvin: None. U.A. Ogar: None. E. Krishnaraju: None. F. Sami: None. E.H. Olojakpoke: None. Introduction: Acute pulmonary embolism (PE) is a medical emergency associated with high mortality rates. Hyperthyroidism has been associated with an increased risk of venous thromboembolism and PE. However, there are limited studies on its impact on the outcomes of patients with PE. We aimed to assess hyperthyroidism’s effect on in-hospital PE outcomes using the National Inpatient Sample (NIS). Methods: Data were extracted from the US Nationwide Inpatient Sample (NIS) from 2016 to 2019. The NIS contains hospital discharge information estimating yearly US hospitalizations. We included hospitalizations with a principal discharge diagnostic code for PE using the ICD-10-CM code (E22.2). Hospitalizations of patients less than 18 years of age were excluded from the study. This cohort was divided based on the secondary diagnosis of hyperthyroidism.The primary outcome was inpatient mortality, and secondary outcomes were hospital length of stay (LOS), total hospital charge, odds of acute respiratory failure (ARF), acute renal failure (AKI), undergoing embolectomy, tissue plasminogen activator (tPA) use and Inferior vena cave (IVC) filter placement. Multivariate linear regression analysis was used to adjust for confounders. Statistical significance was set at a p-value &amp;lt; 0.05. Results: There were 745,360 hospitalizations involving PE as the reason for admission, and 20.1% had comorbidity with hyperthyroidism. Admissions for PE with comorbid hyperthyroidism had similar in-hospital mortality (adjusted OR:1.17, P=0.41), mean LOS (4.9 vs 4.3 days, P=0.11) and mean THC ($53,127 vs $48,236, P=0.43) compared to those without hyperthyroidism. The odds of developing ARF (aOR: 0.93, P=0.466) or AKI (aOR: 0.95, P=0.71) were similar. Odds of undergoing embolectomy (aOR: 1.07, p=0.83), receiving tPA (aOR=1.03, P=0.87) and placing IVC filter (aOR=0.80, P=0.19) were similar between both groups. Conclusion: Hospitalizations for pulmonary embolism with hyperthyroidism had similar inpatient mortality compared to those without hyperthyroidism. Also, mean LOS, total hospital charge, ARF and AKI complications, and odds of embolectomy, tPA administration and IVC filter placement were alike for both categories. Presentation Date: Saturday, June 17, 2023

Safety and functional outcomes of early antiplatelet therapy within 24 hours following mechanical thrombectomy for secondary prevention in emergent large-vessel occlusion strokes: a registry study.

The aim of this study was to demonstrate the safety and functional outcomes of antiplatelet use within 24 hours following mechanical thrombectomy (MT). A retrospective review of prospectively collected data for consecutive patients who underwent MT for acute ischemic stroke (AIS) between 2016 and 2020 was performed. Patient demographics, comorbidities, Alberta Stroke Program Early CT Score (ASPECTS), antiplatelet use, neurological status, and tissue plasminogen activator use were collected. Patients were stratified into two groups, early (< 24 hours) or late (> 24 hours), based on when antiplatelet therapy was initiated post-MT. The primary outcome was safety, determined based on the rate of symptomatic intracranial hemorrhage (sICH) and inpatient mortality. The secondary outcome was functional independence (defined as modified Rankin Scale [mRS] score ≤ 2) at discharge and 30 days and 90 days postoperatively. The two cohorts were compared using univariate analysis. Multiple imputations were used to create complete data sets for missing data. Multivariable analysis was used to identify predictors for sICH and functional outcomes. A total of 190 patients met inclusion criteria (95 per group). Significant differences between the early and late groups included sex, preoperative intravenous thrombolysis, angioplasty, stent placement, and thrombectomy site. ICH (symptomatic and asymptomatic) and inpatient mortality were not significantly different between the groups. The mRS score was significantly lower at discharge (p < 0.001), 30 days (p = 0.011), and 90 days (p = 0.024) following MT in the early group. Functional independence was significantly higher in the early antiplatelet group at discharge (p = 0.015) and at 30 days (p = 0.006). Early antiplatelet use was independently associated with significantly increased odds of achieving functional independence at discharge (OR 3.07, p = 0.007) and 30 days (OR 5.78, p = 0.004). Early antiplatelet therapy was not independently associated with increased odds of sICH. Early antiplatelet initiation after MT in patients with AIS was independently associated with significantly increased odds of improved postoperative functional outcomes without increased odds of developing sICH.

Hypothermia is Associated with Improved Neurological Outcomes After Mechanical Thrombectomy

Acute ischemic stroke (AIS) is the second leading cause of death globally. Mechanical thrombectomy (MT) has improved patient prognosis but expedient treatment is still necessary to minimize anoxic injury. Lower intraoperative body temperature decreases cerebral oxygen demand, but the role of hypothermia in treatment of AIS with MT is unclear. We retrospectively reviewed patients undergoing MT for AIS from 2014 to 2020 at our institution. Patient demographics, comorbidities, intraoperative parameters, and outcomes were collected. Maximum body temperature was extracted from minute-by-minute anesthesia readings, and patients with maximal temperature below 36°C were considered hypothermic. Risk factors were assessed by χ2 and multivariate ordinal regression. Of 68 patients, 27 (40%) were hypothermic. There was no significant association of hypothermia with patient age, comorbidities, time since last known well, number of passes intraoperatively, favorable revascularization, tissue plasminogen activator use, and immediate postoperative complications. Hypothermic patients exhibited better neurologic outcome at 3-month follow-up (P= 0.02). On multivariate ordinal regression, lower maximum intraoperative body temperature was associated with improved 3-month outcomes (P < 0.001), when adjusting for other factors influencing neurological outcomes. Other significant protective factors included younger age (P= 0.03), better revascularization (P= 0.03), and conscious sedation (P= 0.02). Lower intraoperative body temperature during MT was independently associated with improved neurological outcome in this single center retrospective series. These results may help guide clinicians in employing therapeutic hypothermia during MT to improve long-term neurologic outcomes from AIS, although larger studies are needed.

Use of recombinant tissue plasminogen activator (rTPA) for treatment of fibrin and blood in the anterior chamber of the horse

Use of recombinant tissue plasminogen activator (rTPA) for treatment of fibrin and blood in the anterior chamber of the horse

Intracardiac thrombosis and pulmonary thromboembolism during liver transplantation: A systematic review and meta-analysis

Intracardiac thrombosis and/or pulmonary thromboembolism (ICT/PE) is a rare but devastating complication during liver transplantation. Its pathophysiology remains poorly understood, and successful treatment remains a challenge. This systematic review summarizes the available published clinical data regarding ICT/PE during liver transplantation. Databases were searched for all publications reporting on ICT/PE during liver transplantation. Data collected included its incidence, patient characteristics, the timing of diagnosis, treatment strategies, and patient outcomes. This review included 59 full-text citations. The point prevalence of ICT/PE was 1.42%. Thrombi were most often diagnosed during the neohepatic phase, particularly at allograft reperfusion. Intravenous heparin was effective in preventing early-stage thrombus from progressing further and restoring hemodynamics in 76.32% of patients it was utilized for; however, the addition of tissue plasminogen activator or sole use of tissue plasminogen activator offered diminishing returns. Despite all resuscitation efforts, the in-hospital mortality rate of an intraoperative ICT/PE was 40.42%, with nearly half of these patients dying intraoperatively. The results of our systematic review are an initial step for providing clinicians with data that can help identify higher-risk patients. The clinical implications of our results warrant the development of identification and management strategies for the timely and effective treatment of these tragic occurrences during liver transplantation.

Use of Intracameral Tissue Plasminogen Activator During Uveitic Cataract Surgery

ABSTRACT Purpose To report the outcomes of intracameral tissue plasminogen activator (tPA) use during uveitic cataract surgery. Design Retrospective case series from a single United States tertiary center of 36 eyes from 31 consecutive patients with established uveitis who received intraoperative intracameral tPA during cataract surgery between 2016 and 2020. Results Mean visual acuity (VA) improved from logMAR 1.0 ± 0.7 preoperatively to logMAR 0.7 ± 0.8 by POM12. VA improved from baseline postoperatively (POM1 p = 0.0002, POM6 p = 0.006 and POM12 p = 0.007). Minimal to no anterior chamber inflammation was achieved in 47.2% of the eyes by POW1 and 80.0% of the eyes by POM1. Mean clock-hours of posterior synechiae improved from 8.2 ± 3.8 preoperatively to 0.1 ± 0.6 by POM12. Six eyes developed hyphema and/or vitreous hemorrhage, four of which resolved spontaneously. Conclusions Adjunctive intracameral tPA during uveitic cataract surgery improves VA and intraocular inflammation, but risks postoperative hemorrhage. Intraoperative tPA as adjunctive anti-inflammatory therapy warrants randomized prospective studies.

Oral health and functional outcomes following mechanical thrombectomy for ischemic stroke

BackgroundAn association between poor dentition and the risk of ischemic stroke has previously been reported in the literature. In this study we assessed oral hygiene (OH), including tooth loss and...

Effect of Perioperative Antithrombotics on Head and Neck Microvascular Free Flap Survival After Anastomotic Revision.

To determine if antithrombotic therapy improves head and neck microvascular free flap survival following anastomotic revision. A retrospective review of all patients with microvascular free tissue transfer to the head and neck between August 2013 and July 2021. Otolaryngology-Head and Neck Surgery Departments at University of Alabama at Birmingham, University of Colorado, and University of California Irvine. Perioperative use of anticoagulation, antiplatelets, intraoperative heparin bolus, tissue plasminogen activator (tPA) and vasopressor use, and leech therapy were collected plus microvascular free flap outcomes. The primary endpoint was free flap failure. Analyses of free flaps that underwent anastomotic revision with or without thrombectomy were performed. A total of 843 microvascular free flaps were included. The overall rate of flap failure was 4.0% (n = 34). The overall rate of pedicle anastomosis revision (artery, vein, or both) was 5.0% (n = 42) with a failure rate of 47.6% (n = 20) after revision. Anastomotic revision significantly increased the risk of flap failure (odds ratio [OR] 52.68, 95% confidence interval [CI] [23.90, 121.1], p < .0001) especially when both the artery and vein were revised (OR 9.425, 95% CI [2.117, 52.33], p = .005). Free flap failure after the anastomotic revision was not affected by postoperative antiplatelet therapy, postoperative prophylactic anticoagulation, intraoperative heparin bolus, tPA, and therapeutic anticoagulation regardless of which vessels were revised and if a thrombus was identified. In cases of microvascular free tissue transfer pedicle anastomotic revision, the use of antithrombotic therapy does not appear to significantly change free flap survival outcomes.

Transvitreal fibrinoid reaction

Transvitreal fibrin web is an uncommon consequence of pars plana vitrectomy, seen predominantly in diabetic patients. It is an early postoperative response and is treated with topical corticosteroids, although some cases may warrant the use of tissue plasminogen activator intravitreally, or re-surgery as in our case. Fibrin web should be differentiated from endophthalmitis so as to avoid panic and improper management.

Tools of the cornea specialist

To report a case of a successful Descemet's membrane endothelial keratoplasty (DMEK) facilitated by the use of intracameral tissue plasminogen activator (tPA) in a 4-year old with posterior polymorphous corneal dystrophy (PPCD).A 4-year old male was referred for bilateral corneal haze and blurry vision. Patient's exam and genetic testing were consistent with a diagnosis of PPCD. Patient was successfully treated with DMEK augmented by the use of intracameral tPA intraoperatively to combat the anterior chamber fibrin formation that can occur in DMEK.To our knowledge, this case represents the youngest reported successful DMEK procedure and the first case describing the use of intracameral tPA intraoperatively to attenuate the anterior chamber fibrin formation that can occur in DMEK.

Low-Dose Alteplase versus Conventional Anticoagulation to treat Submassive Pulmonary Embolism in Hispanic Patients.

The use of low-dose tissue plasminogen activator (tPA) in Hispanic patients with submassive pulmonary embolism (PE) is understudied. The purpose of this study is to explore the use of low-dose tPA in Hispanic patients with submissive PE compared with counterparts that received heparin alone. We retrospectively analyzed a single-center registry of patients with acute PE between 2016 and 2022. Out of 72 patients admitted for acute PE and cor pulmonale, we identified six patients that were treated with conventional anticoagulation (heparin alone) and six patients who received low-dose tPA (and heparin afterward). We analyzed if low-dose tPA was associated with differences in length of stay (LOS) and bleeding complications. Both groups were similar in regard to age, gender, and PE severity (based on Pulmonary Embolism Severity Index scores). Mean total LOS for the low-dose tPA group was 5.3 days, compared with 7.3 days in the heparin group ( p = 0.29). Mean intensive care unit (ICU) LOS for the low-dose tPA group was 1.3 days compared with 3 days in the heparin group ( p = 0.035). There were no clinically relevant bleeding complications documented in either the heparin or the low-dose tPA group. Low-dose tPA for submassive PE in Hispanic patients was associated with a shorter ICU LOS without a significant increase in bleeding risk. Low-dose tPA appears to be a reasonable treatment option in Hispanic patients with submassive PE who are not at high bleeding risk (<5%).

Management and diagnosis of subretinal and suprachoroidal haemorrhage

AbstractSubretinal and suprachoroidal haemorrhage, particularly when central macula is involved, represent challenging clinical entities since their natural course, if left untreated, often leads to severe, progressive and irreversible vision loss, due to photoreceptor and retinal pigment epithelium (RPE) damage. Significant variation in prognosis and treatment of different types of haemorrhage dictates the need to establish the level of haemorrhage, which is primarily based on fundus appearance, as haemorrhage in different levels tends to present with a distinct configuration. Additional modalities, such as ultra‐sonography, optical coherence tomography, fluorescein angiography and focal electroretinography, contribute to diagnosis the clinical evaluation.Despite the wide range of techniques described for managing both subretinal and suprachoroidal haemorrhage, there is still no consensus among vitreoretinal surgeons on optimal approach. Pneumatic displacement with or without the intraretinal use of tissue plasminogen activator (t‐PA), pars plana vitrectomy with subretinal t‐PA and gas tamponade, pars plana vitrectomy and retinectomy for clot extraction and co‐treatment with anti‐vascular endothelial growths factors (anti‐VEGFs) and pars plana vitrectomy with choroidal blood drainage, have all been described as effective management approaches. Over the last few years, a trend towards a more timely and less invasive approach has emerged. However, the preferred technique is often determined by the level, the extent and duration of haemorrhage as well as surgeon preference.

Abstract 9746: Atrial Fibrillation Among the Elderly With Amyloidosis Admitted for Acute Ischemic Stroke in the United States

Introduction: Amyloidosis can disrupt several tissues, including the heart, causing various cardiac arrhythmias. Factors influencing the presence of Atrial Fibrillation in the elderly with amyloidosis admitted for Acute Ischemic Stroke (AIS) have been sparsely studied. Methods: Elderly patients of ages 60 and more with a diagnosis of amyloidosis and a principal diagnosis of Acute Ischemic Stroke (I63.x) were filtered from the 2019 National Inpatient Sample (NIS). All forms of Atrial Fibrillation and multiple risk factors were also identified via their appropriate codes provided by HCUP and based on recommendations from past studies. Results: Our analysis found 1570 elderly amyloidosis patients admitted for AIS in 2019. Among them, 490 cases (31.2%) also had a diagnosis of Atrial Fibrillation. Predictors of atrial fibrillation included hypertension (aOR 1.543, p=0.024), chronic pulmonary disease (aOR 1.541, p&lt;0.01), use of intravenous tissue plasminogen activator (aOR 2.062, p&lt;0.01), old CABG (aOR 3.350, p&lt;0.01), current anticoagulation therapy (aOR 13.426, p&lt;0.01), supraventricular tachycardia (aOR 3.970, p&lt;0.01). Smoking (aOR 0.680, p&lt;0.01), diabetes (aOR 0.597, p&lt;0.01), and ventricular tachycardia (aOR 0.504, p= 0.033) showed lower risks. While a higher mortality rate was seen among patients with Atrial Fibrillation (30 deaths, 6.1% in Atrial Fibrillation vs. 4.6% in others), the result was not statistically significant (p=0.213). Patients with Atrial Fibrillation were also older (80.35 vs. 76.11 years) but had a shorter stay (6.22 vs. 6.81 days) with a lower mean hospital charge ($77,977.01 vs. $78,940.89). Conclusions: While various factors can influence the odds of Atrial Fibrillation in the elderly with amyloidosis admitted for acute ischemic stroke, it did not increase mortality risk.