scholarly journals Safety and Efficacy of Intrapleural Tissue Plasminogen Activator and DNase during Extended Use in Complicated Pleural Space Infections

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Jason R. McClune ◽  
Candice L. Wilshire ◽  
Jed A. Gorden ◽  
Brian E. Louie ◽  
Alexander S. Farviar ◽  
...  
Keyword(s):  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Surgical Intervention ◽  
Pleural Space ◽  
Increased Risk ◽  
Tissue Plasminogen ◽  
Future Prospective Study ◽  
The Mean ◽  
Outcome Differences ◽  
Potential Area

The use of intrapleural therapy with tissue plasminogen activator and DNase improves outcomes in patients with complicated pleural space infections. However, little data exists for the use of combination intrapleural therapy after the initial dosing period of six doses. We sought to describe the safety profile and outcomes of intrapleural therapy beyond this standard dosing. A retrospective review of patients receiving intrapleural therapy with tissue plasminogen activator and DNase was performed at two institutions. We identified 101 patients from January 2013 to August 2015 receiving intrapleural therapy for complicated pleural space infection. The extended use of intrapleural tissue plasminogen activator and DNase therapy beyond six doses was utilized in 20% (20/101) of patients. The mean number of doses in those undergoing extended dosing was 9.8 (range of 7–16). Within the population studied there appears to be no statistically significant increased risk of complications, need for surgical referral, or outcome differences when comparing those receiving standard or extended dosing intrapleural therapy. Future prospective study of intrapleural therapy as an alternative option for patients who fail initial pleural drainage and are unable to tolerate/accept a surgical intervention appears a potential area of study.

scholarly journals A clinical study investigation the three months prognosis of patients with ischemic stroke treated with recombinant tissue plasminogen activator (rtPA) and its effective factors

2019 ◽  
Vol 5 (2) ◽  
pp. 47-50
Author(s):  
Vahid Abbasi ◽  
Abolfazl Atalu ◽  
Afshan Sharghi ◽  
Fatemeh Taghvatalab
Keyword(s):  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Recombinant Tissue Plasminogen Activator ◽  
Close Monitoring ◽  
Cross Sectional ◽  
Admission Time ◽  
Tissue Plasminogen ◽  
The Mean

Objective: Currently, treating ischemic stroke by intravenous thrombolytic therapy has acceptable results in patients with stroke. This study aimed to evaluate the three months prognosis of patients treated with recombinant tissue plasminogen activator (rt-PA). Methods: This cross-sectional prospective study was conducted on 30 patients with cerebral ischemic stroke with the National Institutes of Health Stroke Scale (NIHSS) >5. Data such as demographic information, signs and symptoms, medical history, risk factors, focused neurological examination, and the NIHSS were collected for all patients. Then, all patients received 0.9 mg/kg of rt-PA as intravenous bolus doses and intravenous infusion under close monitoring in the emergency department. All patients were checked for necessary outcomes and also disability at the admission time, 7 days later and after three months all patients were checked again. All collected data were analyzed by appropriate tests using SPSS version 22. Results: Of all patients, 63.3% were males and 36.7% were females. The mean age of the patients was 62.37 ± 12.62 years with a range of 40-91 years. The mean of NIHSS was 12.46 ± 4.28 at admission time, in day seven it was 8.06 ± 3.72 and in month three after treatment it was 3.62 ± 2.31. There was a significant relationship between age, place of residence and NIHSS. Thirty percent of patients had NIHSS more than 15 at admission time and after 7 days this rate reached to 10% and three months later it declined to 6.7%. These differences were statistically significant. Conclusion: Intravenous thrombolytic therapy is associated with proper short term results in most patients with ischemic stroke.

scholarly journals Medicolegal Considerations with Intravenous Tissue Plasminogen Activator in Stroke: A Systematic Review

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Archit Bhatt ◽  
Adnan Safdar ◽  
Dhara Chaudhari ◽  
Diane Clark ◽  
Amber Pollak ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Malpractice Litigation ◽  
Extensive Search ◽  
Intravenous Tissue Plasminogen Activator ◽  
Increased Risk ◽  
Tissue Plasminogen ◽  
Iv Tpa

Background.Intravenous tPA (tissue plasminogen activator) therapy remains underutilized in patients with Acute Ischemic Stroke (AIS). Anecdotal data indicates that physicians are increasingly liable for administering and for failure to administer tPA.Methods.An extensive search of Medline, Embase, Westlaw, LexisNexis Legal, and Google Scholar databases was performed. Case studies that involved malpractice litigation in ischemic stroke and thrombolytic therapy were analyzed systematically.Results.We identified 789 ischemic stroke litigation cases, of which 46 cases were related to intravenous tPA and stroke litigation. Case descriptions of 40 cases were available. Data for verdicts were available for 38 patients. The most frequent plaintiff claim was related to failure to administer intravenous tPA (38, 95%). Only 2 (5.0%) claim involved complications of treatment with tPA. Hospitals were defendants in majority of the 36 cases. Physicians were involved in 33 cases. While ED physicians were involved in 25 (60.52%) cases, neurologists were involved in 8 (20.0%) cases. There were 26 (65%) defendant-favored and 12 (30%) plaintiff-favored verdicts.Conclusion.Physicians and hospitals are at an increased risk of litigation in patients with AIS when in IV-tPA is being considered for treatment. While majority of the cases litigated were cases where tPA was not administered, only about 1 in 20 cases was litigated when complications occurred.

Tissue Plasminogen Activator Levels and Risk of Breast Cancer in a Case–Cohort Study on Italian Women: Results from the Moli-sani Study

2020 ◽  
Author(s):  
Simona Costanzo ◽  
Roberta Parisi ◽  
Amalia De Curtis ◽  
Sara Gamba ◽  
Laura Russo ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cohort Study ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Cox Regression ◽  
Enzyme Linked Immunosorbent Assay ◽  
Potential Biomarker ◽  
Increased Risk ◽  
Tissue Plasminogen ◽  
Incident Cases

Abstract Background Elevated levels of key enzymes of the fibrinolytic system, such as tissue plasminogen activator (tPA), are reported as predictors of poor outcome in cancer patients. Limited information is available about their potential predictive value for breast cancer (BC) risk in the general population. Aim We examined the association of tPA levels with BC risk in a case–cohort study including women from the prospective Moli-sani cohort. Methods A sample of 710 women (mean age: 54.6 ± 12.1 years) was selected as a subcohort and compared with 84 BC cases, in a median follow-up of 4.2 years. Incident cases of BC were validated through medical records. tPA plasma levels were measured using an enzyme-linked immunosorbent assay kit. Hazard ratio (HR) and 95% confidence interval (CI), adjusted for relevant covariates, were estimated by a Cox regression model using the Prentice method. Results Compared with the lowest quartile (<4.9 ng/mL), women in the highest quartile of tPA (>11.2 ng/mL) had increased risk of BC (HRIVvsI: 2.20, 95% CI: 1.13–4.28) after adjusted for age, smoking, education, menopause, and residence. Further adjustment for biochemical markers did not modify this association. The risk of BC increased by 34% for each increase in 1 standard deviation of log-transformed tPA levels (p = 0.046). Elevated levels of tPA were associated mainly with estrogen-receptor-positive BC (2.08, 95% CI: 1.18–3.66). Conclusion Higher levels of tPA, reported to predict cardiovascular risk, are a potential biomarker for BC risk, supporting the hypothesis of a “common soil” linking the pathogenic mechanisms of hormone-dependent tumors and cardiovascular disease.

Recombinant Tissue Plasminogen Activator in the Treatment of Intraventricular Hemorrhage Secondary to Periventricular Arteriovenous Malformation before Surgery: Case Report

Neurosurgery ◽  
2003 ◽  
Vol 52 (4) ◽  
pp. 964-969 ◽  
Author(s):  
Krishna Kumar ◽  
Denny D. Demeria ◽  
Ashok Verma
Keyword(s):  
Magnetic Resonance ◽  
Arteriovenous Malformation ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Intraventricular Hemorrhage ◽  
Surgical Intervention ◽  
Obstructive Hydrocephalus ◽  
External Ventricular Drain ◽  
Recombinant Tissue Plasminogen Activator ◽  
Tissue Plasminogen

Abstract OBJECTIVE AND IMPORTANCE Intraventricular hemorrhage (IVH) is known to cause acute obstructive hydrocephalus, refractory elevated intracranial pressures (ICPs), and lowered cerebral perfusion pressures, leading to cortical ischemia. Frequent obstruction of external ventricular drains as a result of thrombus is a recurring theme. We present a case of IVH secondary to periventricular arteriovenous malformation (AVM) that was not visible at admission angiography and was treated by intraventricular infusion of recombinant tissue plasminogen activator before surgical intervention. CLINICAL PRESENTATION An 11-year-old boy presented with acute onset of headache followed by two seizures, loss of consciousness, decerebration, right temporal hematoma, IVH, and acute obstructive hydrocephalus. INTERVENTION A right external ventricular drain was placed but functioned poorly. ICP could not be controlled by conventional methods. Five milligrams of recombinant tissue plasminogen activator was injected into the ventricular system via the external ventricular drain. This was repeated daily for 4 days. This treatment resulted in progressive improvement in ICP and clinical status. Once the clot partially cleared, magnetic resonance imaging and magnetic resonance angiography suggested the presence of a right periventricular arteriovenous malformation, which was confirmed by angiography and subsequently resected. CONCLUSION Recombinant tissue plasminogen activator is effective in resolving IVH causing obstructive hydrocephalus and uncontrollable ICP posing a life-threatening situation, secondary to ruptured arteriovenous malformation, before surgical intervention.

A Collaborative Study to Establish the 3rd International Standard for Tissue Plasminogen Activator

2002 ◽  
Vol 88 (08) ◽  
pp. 294-297 ◽  
Author(s):  
Dawn Sands ◽  
Colin Whitton ◽  
R. Merton ◽  
Colin Longstaff
Keyword(s):  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Collaborative Study ◽  
Reference Method ◽  
Mean Value ◽  
International Standards ◽  
International Standard ◽  
Tissue Plasminogen ◽  
The Mean ◽  
Study Participants

SummaryAn international collaborative study was organised to replace the 2nd International Standard (IS) for tissue plasminogen activator (tPA). The 2nd IS for tPA (86/670) was used to calibrate the replacement Standard, which was selected from two candidate materials included in the collaborative study. Participants were provided with five sets of four samples (A, B, C, D) and asked to use sample A (2nd IS, 86/670, 850 IU/ml) to determine the activity of B (86/624, approximately 850 IU/ml), C and D (coded duplicates of the same material, 98/714 approximately 11000 IU/ml). A total of 14 laboratories returned results from Europe, USA, Japan and Australia, providing data from 60 independent assays. Four laboratories used a reference method based on a published monograph from the European Pharmacopoeia for Alteplase for Injection, 1998, and the remaining 10 used their own method. Fibrin was used as promoter of tPA activity by 12 out of the 14 laboratories, the remaining two used kits where fibrinogen fragments were the promoter. Data from this collaborative study and the previous study to establish the 2nd IS for tPA show that tPA from melanoma cells and recombinant tPA from CHO cells are both suitable materials as International Standards. It was agreed that sample C, D, recombinant tPA, 98/714, be established as the 3rd International Standard for tPA with a potency of 10000 IU per ampoule, calculated as the mean value from laboratories using fibrin as a promoter of tPA activity. The standard was established by WHO in November 2000.

The role of tissue plasminogen activator in the successful treatment of infected cardiac thrombus in children

2001 ◽  
Vol 11 (3) ◽  
pp. 355-356 ◽  
Author(s):  
Eli Zalzstein ◽  
Nili Zucker ◽  
Aviva Levitas
Keyword(s):  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Antifungal Agents ◽  
Surgical Intervention ◽  
Antithrombotic Agents ◽  
First Line ◽  
Treatment Persistence ◽  
Cardiac Thrombus ◽  
Tissue Plasminogen

Infected cardiac thrombus is rare in children, with antibiotic or antifungal agents used as the first line of treatment. Persistence is an indication for surgical intervention. We describe two children who were treated successfully with a combination of antibiotic and antithrombotic agents. Use of antithrombotic agents promotes degeneration of fibrin, thus reducing the mass and facilitating the diffusion of the antibiotic and/or antifungal agents.

scholarly journals PROFIL PASIEN STROKE ISKEMIK AKUT DENGAN TERAPI RECOMBINANT TISSUE PLASMINOGEN ACTIVATOR DI RSUP DR. KARIADI SEMARANG

2020 ◽  
Vol 36 (4) ◽  
Author(s):  
Retnaningsih Retnaningsih ◽  
Theodorus Kevin Hendartono
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Barthel Index ◽  
Recombinant Tissue Plasminogen Activator ◽  
Stroke Patients ◽  
Tissue Plasminogen ◽  
The Mean ◽  
Age Range

 PROFILE OF ACUTE ISCHEMIC STROKE PATIENTS WITH RECOMBINANT TISSUE PLASMINOGEN ACTIVATOR THERAPY IN DR. KARIADI HOSPITAL SEMARANGABSTRACTIntroduction: The use of recombinant tissue plasminogen activator (rtPA) is recommended within 4.5 hours from onset, with door to needle (DTN) time <60 minutes, so that it will decrease morbidity and mortality rates.Aims: To evaluate the evaluate the profile of acute ischemic stroke patients with rtPA therapy in Dr. Kariadi Hospital Semarang.Methods: This was a descriptive study by looking at medical records of patients with acute ischemic stroke with onset less than 4.5 hours performed rtPA therapy in Dr. Kariadi Hospital Semarang during Januari 2017 until May 2018.Results: There were 36 patients, 19 (52.8%) male, 17 (47.2%) female. Age range from 36 to 74 years with stroke onset 15-180 minutes. There were lacuner ischemia in 29 patients (80.6%) and teritorial ischemia in 7 patients (19.4%). The mean DTN time 67.22 ± 12.29 with DTN time for rtPA >60 minutes was performed in 23 (63.9%) patients and <60 minutes in 13 (36.1%) patients. The mean NIHSS on admission 8.67±3.51; The mean NIHSS within first 24 hours 6.94±3.25; The mean NIHSS on discharge 5.64±5.50. The mean Barthel Index on admission 57.97±19.27, and The mean Barthel Index on discharge 73.33±26.25.Discussion: There was an improvement of NIHSS and Barthel Index in acute ischemic stroke patients with rtPA therapy. The mean DTN time still >60 minutes, so that service system improvements are needed in order to improve clinical outcomes of acute ischemic stroke patients with rtPA therapy (DTN time <60 minutes).Keywords: Barthel Index, NIHSS, recombinant tissue plasminogen activator (rtPA), ischemic stroke, door to needle (DTN)ABSTRAKPendahuluan: Pemberian recombinant tissue plasminogen activator (rtPA) direkomendasikan dalam waktu sampai 4,5 jam dengan waktu door to needle (DTN) <60 menit agar dapat menurunkan tingkat morbiditas dan mortalitas pada stroke iskemik akut.Tujuan: Untuk mengetahui profil pasien stroke iskemik akut dengan terapi rtPA di RSUP Dr. Kariadi Semarang.Metode: Penelitian deskriptif dengan melihat rekam medis pasien-pasien stroke iskemik akut periode Januari 2017 hingga Mei 2018 dengan onset kurang dari 4,5 jam yang mendapatkan terapi rtPA di RSUP Dr. Kariadi Semarang.Hasil: Dari 36 subjek, didapatkan proporsi laki-laki lebih banyak dari pada perempuan (52,8% vs 47,2%) dan rerata usia 58±8,63 tahun. Rerata waktu awitan adalah 92,5±42,79 menit dengan tipe iskemik lakuner (80,6%) dan rerata waktu DTN 67,22±12,29 menit.  Rerata NIHSS 24 jam pertama adalah 6,94±3,25 yang menurun menjadi 5,64±5,50 saat keluar RS. Rerata Indeks Barthel subjek saat masuk RS adalah 57,91±19,27 yang meningkat saat keluar menjadi 73,33±26,25.Diskusi: Terdapat perbaikan nilai NIHSS dan Indeks Barthel pada subjek stroke iskemik akut yang mendapatkan terapi rtPA. Rerata waktu DTN adalah >60 menit, menunjukkan perlunya perbaikan sistem pelayanan untuk meningkatkan luaran klinis pasien stroke iskemik akut dengan DTN <60 menit.Kata kunci: Door to needle, Indeks Barthel, NIHSS, recombinant tissue plasminogen activator, stroke iskemik  

scholarly journals Efficacy and safety of intravenous recombinant tissue plasminogen activator in mild ischaemic stroke: a meta-analysis

2018 ◽  
Vol 3 (1) ◽  
pp. 22-27 ◽  
Author(s):  
Shoujiang You ◽  
Anubhav Saxena ◽  
Xia Wang ◽  
WeeYong Tan ◽  
Qiao Han ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Functional Outcome ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Meta Analysis ◽  
Recombinant Tissue Plasminogen Activator ◽  
Efficacy And Safety ◽  
Increased Risk ◽  
Tissue Plasminogen ◽  
Iv Tpa

The benefits and safety of intravenous recombinant tissue plasminogen activator (IV-tPA) for patients with mild ischaemic stroke (MIS) are still unclear. The objective of this meta-analysis was to evaluate the efficacy and safety of IV-tPA as treatment for patients with MIS. We performed a systematic literature search across MEDLINE, Embase, Central, Global Health and Cumulative Index to Nursing and Allied Health Literature (CINAHL) , from inception to 10 November 2016, to identify all related studies. Where possible, data were pooled for meta-analysis with odds ratio (OR) and corresponding 95% confidence interval (CI) using the fixed-effects model. MIS was defined as having National Institutes of Health Stroke Scale score of ≤6. We included seven studies with a total of 1591 patients based on the prespecified inclusion and exclusion criteria. The meta-analysis indicated a high odds of excellent functional outcome based on the modified Rankin Scale or Oxfordshire Handicap Score 0–1 (OR=1.43; 95% CI 1.14 to 1.79; P=0.002, I2=35%) in patients treated with IV-tPA compared with those not treated with IV-tPA (74.8% vs 67.6%). There was a high risk of symptomatic intracranial haemorrhage (sICH) with IV-tPA treatment (OR=10.13; 95% CI 1.93 to 53.02; P=0.006, I2=0%) (1.9% vs 0.0%) but not mortality (OR=0.78; 95% CI 0.43 to 1.43; P=0.43, I2=0%) (2.4% vs 2.9%). Treatment with IV-tPA was associated with better functional outcome but not mortality among patients with MIS, although there was an increased risk of sICH. Randomised trials are warranted to confirm these findings.

Cohort Study of Intraventricular Thrombolysis with Recombinant Tissue Plasminogen Activator for Aneurysmal Intraventricular Hemorrhage

Neurosurgery ◽  
2004 ◽  
Vol 55 (3) ◽  
pp. 532-538 ◽  
Author(s):  
J. Max Findlay ◽  
Michael J. Jacka
Keyword(s):  
Intracranial Pressure ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Intraventricular Hemorrhage ◽  
Blood Clot ◽  
Recombinant Tissue Plasminogen Activator ◽  
Ventricular Catheter ◽  
Catheter Obstruction ◽  
Tissue Plasminogen ◽  
The Mean

Abstract OBJECTIVE: Thrombolytic agents have been administered through external ventricular drains to treat intraventricular hemorrhage, the goals being to accelerate clot clearance, prevent catheter obstruction, and help control intracranial pressure. We compared these variables in a group of aneurysm patients treated by one surgeon who routinely used intraventricular recombinant tissue plasminogen activator (rt-PA) for obstructive hematocephalus with those in a group of similar patients treated by other surgeons who did not. METHODS: Patients included in this analysis were those with repaired cerebral aneurysms causing hemorrhage into at least three ventricles with ventriculomegaly requiring external ventricular drainage. The ventricular system was considered “opened” when all ventricles were patent and reduced in size on computed tomographic scans. Those treated with rt-PA received 4 mg/d through a ventricular drain until ventricular opening. RESULTS: The mean number of days to ventricular opening was 3.9 (standard deviation [SD], 1.0) for the 21 patients treated with rt-PA and 7.1 (SD, 3.7) for the 9 who were not (P = 0.001), and the mean intracranial pressure (mm Hg) 24 hours after treatment with rt-PA was 10.4 (SD, 6.1) compared with 14.1 (SD, 5.9) during the same interval for the group that did not receive rt-PA (P = 0.13). Ventricular catheter replacement was required in 1 rt-PA patient (for a misplaced catheter, before rt-PA treatment) and 3 patients who did not receive rt-PA (all for catheter obstructions with blood clot) (P = 0.07), and ventriculoperitoneal shunts were placed in 4 rt-PA patients and 3 patients who did not receive rt-PA (P = 0.4). CONCLUSION: Intraventricular thrombolysis with rt-PA seems to assist in the acute management of patients with large aneurysmal intraventricular hemorrhages, speeding clearance of aneurysmal intraventricular hemorrhage, normalizing intracranial pressure, and reducing ventricular catheter obstruction. A randomized trial is needed to confirm these findings, establish treatment safety, and determine whether treatment affects outcome.

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