scholarly journals Endovascular Therapy Demonstrates Benefit over Intravenous Recombinant Tissue Plasminogen Activator Based on Repeatedly Measured National Institutes of Health Stroke Scale

2016 ◽  
Vol 6 (1-2) ◽  
pp. 25-30
Author(s):  
Liqiong Fan ◽  
Sharon D. Yeatts ◽  
Lydia D. Foster ◽  
Pooja Khatri ◽  
Thomas Tomsick ◽  
...  
Keyword(s):  
Plasminogen Activator ◽  
Endovascular Therapy ◽  
Treatment Effect ◽  
Covariance Structure ◽  
Recombinant Tissue Plasminogen Activator ◽  
National Institutes Of Health ◽  
Structure Model ◽  
Tissue Plasminogen ◽  
Covariance Structure Model ◽  
Over Time

Background and Purpose: The Interventional Management of Stroke (IMS) III trial was a randomized controlled trial designed to compare the effect of endovascular therapy after intravenous recombinant tissue plasminogen activator (i.v. rt-PA) as compared to i.v. rt-PA alone. The primary outcome was modified Rankin Scale at 90 days. Secondary outcomes included National Institutes of Health Stroke Scale (NIHSS), which was assessed repeatedly through 90 days. The objective of this analysis is to evaluate the treatment effect of endovascular therapy over time on NIHSS. Methods: 656 subjects were enrolled in the IMS III trial, including 434 subjects randomized to endovascular therapy and 222 to i.v. rt-PA only. NIHSS scores evaluated at 40 min, 24 h, Day 5, and Day 90 were included in the analysis. A covariance structure model was used to investigate the treatment effect on NIHSS over time, adjusting for relevant covariates including baseline stroke severity. Model assumptions were valid. Results: Based on the covariance structure model, after adjusting for relevant baseline covariates, a significant time-by-treatment interaction effect (p = 0.0137) was observed. Only NIHSS at Day 90 showed a significant treatment effect (p = 0.0473), with subjects in the endovascular arm having a lower NIHSS (less neurologic deficit) compared to the i.v. rt-PA arm. Conclusions: The IMS III trial demonstrated an endovascular treatment effect based on the secondary outcome of NIHSS. However, the magnitude of this treatment effect varied by the time of assessment. It was only at Day 90 that the endovascular arm had a significantly lower NIHSS compared to that in the i.v. rt-PA arm.

scholarly journals Serial markers of coagulation and inflammation and the occurrence of clinical pulmonary thromboembolism in mechanically ventilated patients with SARS-CoV-2 infection; the prospective Maastricht intensive care COVID cohort

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Mark M. G. Mulder ◽  
LIoyd Brandts ◽  
Renée A. G. Brüggemann ◽  
Marcel Koelmann ◽  
Alexander S. Streng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Pulmonary Thromboembolism ◽  
Recombinant Tissue Plasminogen Activator ◽  
Apache Ii Score ◽  
Tissue Plasminogen ◽  
D Dimer ◽  
Over Time

Abstract Background The incidence of pulmonary thromboembolism is high in SARS-CoV-2 patients admitted to the Intensive Care. Elevated biomarkers of coagulation (fibrinogen and D-dimer) and inflammation (c-reactive protein (CRP) and ferritin) are associated with poor outcome in SARS-CoV-2. Whether the time-course of fibrinogen, D-dimer, CRP and ferritin is associated with the occurrence of pulmonary thromboembolism in SARS-CoV-2 patients is unknown. We hypothesise that patients on mechanical ventilation with SARS-CoV-2 infection and clinical pulmonary thromboembolism have lower concentrations of fibrinogen and higher D-dimer, CRP, and ferritin concentrations over time compared to patients without a clinical pulmonary thromboembolism. Methods In a prospective study, fibrinogen, D-dimer, CRP and ferritin were measured daily. Clinical suspected pulmonary thromboembolism was either confirmed or excluded based on computed tomography pulmonary angiography (CTPA) or by transthoracic ultrasound (TTU) (i.e., right-sided cardiac thrombus). In addition, patients who received therapy with recombinant tissue plasminogen activator were included when clinical instability in suspected pulmonary thromboembolism did not allow CTPA. Serial data were analysed using a mixed-effects linear regression model, and models were adjusted for known risk factors (age, sex, APACHE-II score, body mass index), biomarkers of coagulation and inflammation, and anticoagulants. Results Thirty-one patients were considered to suffer from pulmonary thromboembolism ((positive CTPA (n = 27), TTU positive (n = 1), therapy with recombinant tissue plasminogen activator (n = 3)), and eight patients with negative CTPA were included. After adjustment for known risk factors and anticoagulants, patients with, compared to those without, clinical pulmonary thromboembolism had lower average fibrinogen concentration of − 0.9 g/L (95% CI: − 1.6 – − 0.1) and lower average ferritin concentration of − 1045 μg/L (95% CI: − 1983 – − 106) over time. D-dimer and CRP average concentration did not significantly differ, 561 μg/L (− 6212–7334) and 27 mg/L (− 32–86) respectively. Ferritin lost statistical significance, both in sensitivity analysis and after adjustment for fibrinogen and D-dimer. Conclusion Lower average concentrations of fibrinogen over time were associated with the presence of clinical pulmonary thromboembolism in patients at the Intensive Care, whereas D-dimer, CRP and ferritin were not. Lower concentrations over time may indicate the consumption of fibrinogen related to thrombus formation in the pulmonary vessels.

scholarly journals Simultaneous Combined Intravenous Recombinant Tissue Plasminogen Activator and Endovascular Therapy for Hyperacute Middle Cerebral Artery M1 Occlusion

2011 ◽  
Vol 17 (1) ◽  
pp. 115-122 ◽  
Author(s):  
S. Toyota ◽  
S. Sugiura ◽  
K. Iwaisako
Keyword(s):  
Middle Cerebral Artery ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Cerebral Artery ◽  
Endovascular Therapy ◽  
Recombinant Tissue Plasminogen Activator ◽  
Simultaneous Treatment ◽  
Tissue Plasminogen ◽  
Group A ◽  
Group B

We investigated the efficacy and safety of combined intravenous (IV) recombinant tissue plasminogen activator (rtPA) and simultaneous endovascular therapy (ET) for hyperacute middle cerebral artery (MCA) M1 occlusion. Between October 2005 and April 2007, in the combined group, 22 patients eligible for IV rtPA, who were diagnosed as having MCA M1 occlusion, were treated with IV rtPA and simultaneous ET was initiated as soon as possible. The other patients were treated with IV rtPA alone (IV group A: n = 11). Between May 2007 and November 2008, all patients eligible for IV rtPA, who were diagnosed as having MCA M1 occlusion, underwent thrombolysis by IV rtPA alone (IV group B: n = 24). The improvement of the National Institutes of Health Stroke Scale score at 24 hours was highest in the combined group (10 ± 4.1). In contrast, it was 5.1 ± 4.7 in the IV group A (P = 0.017) and 5.6 ± 5.6 in IV group B (P = 0.006). In the combined group, successful recanalization was observed in 18 of 22 patients with one symptomatic intracranial hemorrhage. The rate of mRS0–2 at three months was highest in the combined group, 36% in the IV group A and 33% in the IV group B (P = 0.008). Simultaneous treatment with IV rtPA and ET improved the clinical outcome of MCA M1 occlusion without a significant increase of adverse effects in our study.

scholarly journals HUBUNGAN THRIVE SCORE TERHADAP BARTHEL INDEX PASIEN STROKE ISKEMIK AKUT DI UNIT STROKE RUMAH SAKIT UMUM PUSAT (RSUP) DR. SARDJITO

2018 ◽  
Vol 1 (2) ◽  
Author(s):  
John Kenedi ◽  
Paryono Paryono ◽  
Ismail Setyopranoto
Keyword(s):  
Diabetes Mellitus ◽  
Computed Tomography ◽  
Health Risk ◽  
Plasminogen Activator ◽  
Barthel Index ◽  
Recombinant Tissue Plasminogen Activator ◽  
National Institutes Of Health ◽  
Vascular Events ◽  
Chi Square ◽  
Tissue Plasminogen

Latar Belakang: Prediktor awal yang akurat terhadap luaran fungsional sangat diperlukan dalam tatalaksana pasien stroke iskemik akut. THRIVE (The Total Health Risk In Vascular Events) score telah divalidasi dan digunakan sebagai prediktor luaran pasien stroke iskemik akut yang akan menjalani prosedur endovaskular maupun recombinant-tissue Plasminogen Activator (r-tPA) intravena. Tujuan: Untuk mengetahui hubungan THRIVE score terhadap skor Barthel Index pada pasien dengan stroke iskemik akut di Unit Stroke RSUP Dr. Sardjito. Metode Penelitian: Penelitian deskriptif analitik dengan metode potong lintang. Diagnosis stroke iskemik ditegakkan dengan pemeriksaan Computed Tomography (CT)-sken kepala. Data THRIVE score yang meliputi data The National Institutes of Health Stroke Scale (NIHSS), usia, riwayat menderita diabetes mellitus (DM), hipertensi, dan atrial fibrilasi (AF) diambil melalui formulir laporan kasus. Nilai skor Barthel Index diambil saat pasien keluar rumah sakit. Hasil: Subjek penelitian berjumlah 90 dengan proporsi 60 subjek laki-laki (66,6%) dan 30 subjek perempuan (33,3%). Uji Chi-Square menunjukkan adanya korelasi signifikan antara tingginya THRIVE score dengan rendahnya skor Barthel Index dengan nilai p = 0,001 (p <0,05). Simpulan: Nilai THRIVE score saat masuk yang tinggi berhubungan dengan skor Barthel Index pasien yang rendah saat keluar rumah sakit. Kata Kunci: Stroke iskemik akut, luaran klinis, THRIVE score, Barthel Index.

Endovascular therapy for hemodialysis patients with atrial fibrillation and cerebral thromboembolism: A case series

2019 ◽  
Vol 43 (3) ◽  
pp. 150-156 ◽  
Author(s):  
Masafumi Kamijo ◽  
Waka Hayashi ◽  
Emiko Otsuka ◽  
Yoko Obata ◽  
Noriyuki Sahara ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Blood Flow ◽  
Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Endovascular Therapy ◽  
Case Series ◽  
Recombinant Tissue Plasminogen Activator ◽  
Hemodialysis Patients ◽  
Tissue Plasminogen

Introduction: Hemodialysis patients with atrial fibrillation are at high risk for stroke. Intravenous recombinant tissue plasminogen activator is considered for acute ischemic stroke. However, recombinant tissue plasminogen activator therapy is contraindicated for some hemodialysis patients with atrial fibrillation. These patients and those who have received recombinant tissue plasminogen activator therapy without blood flow recovery are candidates for endovascular therapy. Methods and results: Three hemodialysis patients with atrial fibrillation received endovascular therapy for acute cerebral infarction. Cerebrovascular incident occurred during or after hemodialysis in two of these patients. All three patients achieved successful recanalization after endovascular therapy. Conclusion: In this series, endovascular therapy showed good results without complications. More cases should be investigated to obtain more evidence of successful endovascular therapy for hemodialysis patients.

Investigation by HPLC of the Catabolism of Recombinant Tissue Plasminogen Activator in the Rat

1988 ◽  
Vol 60 (01) ◽  
pp. 107-112 ◽  
Author(s):  
Roy Harris ◽  
Louis Garcia Frade ◽  
Lesley J Creighton ◽  
Paul S Gascoine ◽  
Maher M Alexandroni ◽  
...  
Keyword(s):  
Molecular Weight ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Half Life ◽  
Recombinant Tissue Plasminogen Activator ◽  
Rat Plasma ◽  
High Molecular Weight Complex ◽  
Molecular Weights ◽  
Major Activity ◽  
Tissue Plasminogen

SummaryThe catabolism of recombinant tissue plasminogen activator (rt-PA) was investigated after injection of radiolabelled material into rats. Both Iodogen and Chloramine T iodination procedures yielded similar biological activity loss in the resultant labelled rt-PA and had half lives in the rat circulation of 1 and 3 min respectively. Complex formation of rt-PA was investigated by HPLC gel exclusion (TSK G3000 SW) fractionation of rat plasma samples taken 1-2 min after 125I-rt-PA injection. A series of radiolabelled complexes of varying molecular weights were found. However, 60% of the counts were associated with a single large molecular weight complex (350–500 kDa) which was undetectable by immunologically based assays (ELISA and BIA) and showed only low activity with a functional promoter-type t-PA assay. Two major activity peaks in the HPLC fractions were associated with Tree t-PA and a complex having a molecular weight of ̴ 180 kDa. HPLC fractionation to produce these three peaks at various timed intervals after injection of 125I-rt-PA showed each to have a similar initial rate half life in the rat circulation of 4-5 min. The function of these complexes as yet is unclear but since a high proportion of rt-PA is associated with a high molecular weight complex with a short half life in the rat, we suggest that the formation of this complex may be a mechanism by which t-PA activity is initially regulated and finally cleared from the rat circulation.

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