- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
[VIRTUAL] Safety outcomes of tenecteplase versus alteplase for acute ischemic stroke () - Dec 26, 2020 - Abstract #ASHP2020ASHP_5040;
The secondary functional objectives are change in modified Rankin scale, pre-thrombectomy and post-thrombectomy reperfusion of the ischemic territory based on TICI (thrombolysis in cerebral infarction) score, and mortality. The following data will be collected: patient demographics, inpatient mortality, length of stay, reason for admission, NIHSS and MEND scores, etiology of stroke, radiographic site of vessel occlusion, discharge disposition, adverse events related to thrombolytic, and bleeding events.
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[VIRTUAL] Impact of bedside preparation of alteplase by a pharmacist on time to compound and deliver alteplase for patients with acute ischemic stroke () - Dec 26, 2020 - Abstract #ASHP2020ASHP_4792;
The primary endpoint will be comparing the elapsed time from physician order for alteplase to the delivery of the alteplase by pharmacy to the patient’s nurse between the before and after groups. Secondary endpoints include door-to-needle time, the percent of patients with a door-to-needle time less than 45 minutes, the percent of patients with a door-to-needle time of less than 30 minutes, length of hospital stay, discharge disposition, and total cost of wasted alteplase.
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[VIRTUAL] Comparison of dosing errors for tenecteplase vs alteplase for management of acute ischemic stroke. () - Dec 26, 2020 - Abstract #ASHP2020ASHP_4449;
Secondary outcomes will be analyzed using student’s t-test for parametric data or Wilcoxin rank sum test for non-parametric data. Given an estimate of about 22% dosing errors with alteplase administration enrollment of 264 patients will yield 80 percent power to detect a 15 % difference between groups.
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[VIRTUAL] Thirty-day post intervention outcomes following mechanical thrombectomy with or without alteplase () - Dec 26, 2020 - Abstract #ASHP2020ASHP_4292;
The primary investigator will review patient charts for inclusion criteria and baseline characteristics including: demographics (sex, age, BMI, blood glucose on arrival, ethnicity, disposition prior to admission), medical history (atrial fibrillation, diabetes mellitus, hypertension, hyperlipidemia, chronic kidney disease (CKD Stage 3-5), liver disease (Child-Pugh Class B or C), prior CVA/TIA, uses anticoagulants, uses antithrombotics), social history (smokes/vapes, drinks alcohol, illicit drug use), and thrombectomy admission (length of stay, stroke location, HAS-BLED score, treatment within six hours of stroke symptom onset, Modified Treatment in Cerebral Ischemia (mTICI) scale score, NIHSS score on admission, and NIHSS score at discharge). All study outcomes will be evaluated from post procedure day #1 up to post procedure day #30.
- |||||||||| modafinil / Generic mfg.
[VIRTUAL] Modafinil for wakefulness in ischemic stroke () - Dec 26, 2020 - Abstract #ASHP2020ASHP_4136;
The following baseline characteristics will be included: age, sex, body mass index, stroke location, hypertension, admission national institutes of health stroke scale (NIHSS) score, national institutes of health stroke scale (NIHSS) at modafinil initiation, national institutes of health stroke scale (NIHSS) at discharge, alteplase use, thrombectomy, and length of hospital stay/length of intensive care unit (ICU) stay The following data will be collected to assess outcomes: discharge disposition, time from stroke to modafinil initiation, duration of modafinil use, starting dose of modafinil, continuation status at discharge, reason for change/discontinuation, documentation of any side effects, discharge modified rankin, Glascow coma scale (GCS) on admission, and Glascow coma scale (GCS) at discharge. not applicable
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
[VIRTUAL] Impact of expanded pharmacist coverage on institutional guideline adherence and cost avoidance in the emergency department () - Dec 26, 2020 - Abstract #ASHP2020ASHP_4048;
Secondary endpoints related to administering critical, time-sensitive medications include the proportion of patients who received institutional guideline-recommended antimicrobial dosing, number of empiric broad-spectrum antimicrobial de-escalations, door-to-needle times, adherence to institutional guidelines for prescribing alteplase and anticoagulant reversal agents, and estimated cost avoidance associated with EMP interventions during this period...A pre-determined subgroup analysis will include additional patients who receive critical time-sensitive medications during this period comparing the aforementioned secondary outcomes. Cost avoidance will be estimated for EMP interventions during this period.
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[VIRTUAL] Evaluation of Tenecteplase Usage for Acute Ischemic Stroke () - Dec 26, 2020 - Abstract #ASHP2020ASHP_3967;
6 patients received 0.25 mg/kg instead of 0.4 mg/kg for treatment of mild stroke, though the retrospective nature of this study makes it challenging to assess original indication. Rates of intracranial hemorrhage were higher than previously seen in the EXTEND-IA TNK trial.
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[VIRTUAL] Evaluation of post-tPA events to determine appropriate ICU monitoring duration for ischemic stroke patients () - Dec 26, 2020 - Abstract #ASHP2020ASHP_3946;
Purpose: Alteplase, a tissue plasminogen activator (tPA), is the only FDA-approved medication for treating acute ischemic stroke (AIS)...Significant factors associated with early clinical deterioration will be identified with univariate analysis and analyzed using multivariable logistic regression. This study has been submitted to the local Institutional Review Board and is pending approval.
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[VIRTUAL] Evaluating the use of alteplase at a single center in 2019 () - Dec 26, 2020 - Abstract #ASHP2020ASHP_3212;
There is a substantial loss of revenue with over 30 percent of alteplase infusions being wasted. Further discussion at our institution is warranted to combat this apparent cost ineffectiveness.
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[VIRTUAL] Assessing the association of pre-alteplase blood pressure medication administration with door-to needle times () - Dec 26, 2020 - Abstract #ASHP2020ASHP_3072;
A significant difference was not observed in DTN times between patients treated with BP medications prior to alteplase administration versus patients without BP treatment. Small sample size likely contributed to the observed results.However, a medium time of 28 minutes from arrival to BP medication administration presents an opportunity for process improvement to achieve the AHA/ASA goal of DTN time within30 minutes in AIS patients with elevated BP otherwise eligible for alteplase.In the follow-up study, we aim to optimize the time to BP medication administration and perform further evaluation.
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[VIRTUAL] Tenecteplase versus alteplase for acute ischemic stroke in the time of COVID-19 () - Dec 26, 2020 - Abstract #ASHP2020ASHP_2383;
Patients will follow-up at three months post fibrinolytic administration to determine the modified Rankin score. Modified Rankin scores will be compared to pre-morbid scores and inpatient post-stroke scores as a means to evaluate patient improvement back to baseline.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
[VIRTUAL] Medication use evaluation of alteplase for catheter directed thrombolysis within a five hospital health system () - Dec 26, 2020 - Abstract #ASHP2020ASHP_2262;
Once the collection of data is complete, analysis of data for potential cost savings will include a comparison of initial dose and infusion rate for standardization based on available literature and standard practice. Data comparing waste generated from 50mg vial versus 2 mg vials will be evaluated to determine the optimal standardization to be used across the five-hospital health system.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
[VIRTUAL] Evaluation of blood pressure following alteplase administration for acute ischemic stroke () - Dec 26, 2020 - Abstract #ASHP2020ASHP_2014;
Implementation of BP goal ranges on continuous infusions of BP management medications following alteplase administration has improved the initiation rate of BP management infusions based off high diastolic BP. Implementation of the order set has not reduced the incidence of antihypertensive continuation despite SBP < 165 or DBP < 90.
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[VIRTUAL] Characterization and Analysis of Delays in Alteplase Administration for Acute Ischemic Stroke () - Dec 26, 2020 - Abstract #ASHP2020ASHP_1821;
The primary outcome is the average overall door to alteplase administration time. Secondary outcomes include time from door to imaging, time from hemorrhagic stroke rule out to alteplase administration, time from alteplase order entry to alteplase administration, and other documented delays, such as elevated blood pressure, laboratory information delays, consent delays, or confirmation of time last seen normal.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Clinical, Journal: Hospital Factors Associated With Interhospital Transfer Destination for Stroke in the Northeast United States. (Pubmed Central) - Dec 23, 2020
Conclusions Among northeast US hospitals, we found that differences in hospital quality, specifically higher levels of alteplase administration, may be associated with increased likelihood of being a transfer destination. Further research is needed to better understand acute ischemic stroke transfer patterns to optimize stroke transfer systems.
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Journal: Use of Tissue Plasminogen Activator Alteplase for Suspected Impella® Thrombosis. (Pubmed Central) - Dec 20, 2020
Trial completion date: Jun 2022 --> Sep 2022 Based on our experience, tPA administration appears to be a viable and safe salvage option to delay or prevent device exchange in the setting of suspected Impella® thrombosis.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Clinical, Journal: Safety and efficacy of intravenous thrombolysis in stroke patients on prior antiplatelet therapy in the WAKE-UP trial. (Pubmed Central) - Dec 17, 2020
Treatment benefit of intravenous alteplase and rates of post-treatment hemorrhagic transformation were not modified by prior antiplatelet intake among MRI-selected patients with unknown onset stroke. Worse functional outcome in patients on antiplatelets may result from a higher load of cardiovascular co-morbidities in these patients.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Journal: Treatment of Mobile Right Heart Thrombi. (Pubmed Central) - Dec 17, 2020
We briefly review the literature and discuss the therapeutic options, focusing on the advantages of thrombolysis. Mobile right heart thrombi require rapid therapeutic choices between surgical thrombectomy and thrombolysis.Half-dose alteplase may be effective, even in the presence of an extensive thrombus burden.
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Review, Journal: Thrombolysis beyond 4.5 h in Acute Ischemic Stroke. (Pubmed Central) - Dec 16, 2020
Additionally, an automated perfusion-based approach, assessing for a disproportionate amount of salvageable tissue, is effective in identifying patients likely to benefit from late window alteplase treatment. In patients with stroke of unknown symptom onset, an individualized approach using neuroimaging to determine time of stroke onset or presence of salvageable brain tissue is feasible in the acute setting and associated with improved long-term outcomes.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Journal, Adverse events: Gastrointestinal Angioedema as a Side Effect of Alteplase for Acute Stroke. (Pubmed Central) - Dec 16, 2020
In patients with stroke of unknown symptom onset, an individualized approach using neuroimaging to determine time of stroke onset or presence of salvageable brain tissue is feasible in the acute setting and associated with improved long-term outcomes. No abstract available
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Journal: Impact of Emergency Department Crowding on Delays in Acute Stroke Care. (Pubmed Central) - Dec 16, 2020
In our single institution analysis, we found no significant delays in stroke care delivery associated with increased ED crowding. This finding suggests that robust processes of care may enable continued high-quality acute care delivery, even during times with an increased capacity burden.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Review, Journal: Novel Treatments for Transient Ischemic Attack and Acute Ischemic Stroke. (Pubmed Central) - Dec 15, 2020
Although the phrase "time is brain" is relevant today, emerging treatment strategies use more specific markers for consideration of reperfusion than time alone. Innovations in early stroke detection and individualized patient selection for reperfusion therapies have equipped the emergency medicine clinician with more opportunities to help stroke patients and minimize the impact of this disease.
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