- |||||||||| Eylea (aflibercept intravitreal) / Bayer, Regeneron, Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
New P3 trial, Head-to-Head: Vitrectomy, Subretinal Tissue Plasminogen Activator (TPA) and Intravitreal Gas for Submacular Haemorrhage Secondary to Exudative (Wet) Age-related Macular Degeneration (TIGER). (clinicaltrials.gov) - Dec 11, 2020
P3, N=210, Not yet recruiting,
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Trial completion date, Trial primary completion date: A Study in Healthy Men to Compare 2 Different Formulations of Alteplase (clinicaltrials.gov) - Dec 8, 2020
P1, N=60, Suspended,
Trial completion date: Nov 2020 --> Aug 2021 | Trial primary completion date: Nov 2020 --> Aug 2021
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Clinical, Retrospective data, Review, Journal: Intravenous Thrombolysis With Tenecteplase in Patients With Large Vessel Occlusions: Systematic Review and Meta-Analysis. (Pubmed Central) - Dec 5, 2020
Trial completion date: Nov 2020 --> Aug 2021 | Trial primary completion date: Nov 2020 --> Aug 2021 Acute ischemic stroke patients with LVO receiving intravenous thrombolysis with tenecteplase have significantly better recanalization and clinical outcomes compared with patients receiving intravenous alteplase.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Journal: Intravenous Thrombolysis Guided by Perfusion CT with Alteplase in >4.5 Hours from Stroke Onset. (Pubmed Central) - Dec 1, 2020
Acute ischemic stroke patients with LVO receiving intravenous thrombolysis with tenecteplase have significantly better recanalization and clinical outcomes compared with patients receiving intravenous alteplase. IVT in patients with WUS, SUKO, or stroke beyond >4.5 h from LSN, with salvageable brain tissue on CTP, seems to be safe and has similar functional outcomes at 90 days to the standard therapeutic window, even when combined with MT.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Clinical, Journal, HEOR: Brain Imaging Signs and Health-Related Quality of Life after Acute Ischemic Stroke: Analysis of ENCHANTED Alteplase Dose Arm. (Pubmed Central) - Dec 1, 2020
IVT in patients with WUS, SUKO, or stroke beyond >4.5 h from LSN, with salvageable brain tissue on CTP, seems to be safe and has similar functional outcomes at 90 days to the standard therapeutic window, even when combined with MT. In thrombolysed AIS patients, right-sided and deep ischemia within the MCA territory predict poor overall HRQoL, whilst features of old cerebral ischemia are associated with reduced physical HRQoL.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Journal: Time is brain: timing of revascularization of brain arteries in stroke. (Pubmed Central) - Nov 28, 2020
They consist of intravenous thrombolysis (IVT) with alteplase, recommended by the guidelines within 4.5 h of the onset of symptoms, and endovascular treatment, recommended within 6 h of the onset of symptoms...Advanced neuroimaging methods with perfusion studies are a fundamental tool in patient selection. Their spread in the territory, together with a greater availability of neurovascular treatment units are desirable to ensure a fair delivery of treatment to all patients with ischaemic stroke.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Journal: Comparative Significance of Invasive Measures of Microvascular Injury in Acute Myocardial Infarction. (Pubmed Central) - Nov 26, 2020
P2
In acute ST-segment-elevationl infarction, IMR and RRR, but not CFR, were associated with MVO, myocardial hemorrhage, infarct size, and clinical outcomes. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02257294.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Clinical, Journal: Futile complete recanalization: patients characteristics and its time course. (Pubmed Central) - Nov 25, 2020
There was no heterogeneity in the effect of mTICI-3 with respect to age, neurological deficit, alteplase use, occluded vessels, or infarct size...A significant heterogeneity was found in the effect of mTICI-3 reperfusion across the puncture-to-reperfusion time subgroups (P for interaction = 0.025). Until when operators should continue the procedure after mTICI-2b has been achieved, needs to be studied.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Trial completion date, Trial primary completion date: SITS_ELDERLY: SITS-IVT in Patients >80 Years Study (clinicaltrials.gov) - Nov 20, 2020
P=N/A, N=2000, Active, not recruiting,
Recruiting --> Completed Trial completion date: Jun 2021 --> Aug 2022 | Trial primary completion date: Jun 2021 --> Aug 2022
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Review, Journal: Thrombolytic Salvage of Threatened Frostbitten Extremities and Digits: A Systematic Review. (Pubmed Central) - Nov 19, 2020
Thrombolytics are a safe and effective treatment of severe frostbite. They represent the first significant advancement in frostbite treatment by preventing otherwise inevitable amputations warranting both greater utilization and further research to clarify the ideal thrombolytic protocol.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Journal: Management of Acute Ischemic Stroke-Specific Focus on Anesthetic Management for Mechanical Thrombectomy. (Pubmed Central) - Nov 14, 2020
Current American Heart Association/American Stroke Association (AHA/ASA) guidelines recommend thrombolytic therapy with intravenous (IV) alteplase within the first 3-4.5 hours of initial stroke symptoms and endovascular mechanical thrombectomy within the first 16-24 hours depending on specific inclusion criteria...At different phases of stroke care, different blood pressure targets are recommended. This narrative review will focus on the anesthesia and critical care providers' roles in the management of both perioperative stroke and acute ischemic stroke with a focus on anesthetic management for mechanical thrombectomy.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Clinical, P3 data, Journal: Thrombolysis with alteplase 3-4.5 hours after acute ischaemic stroke: the first multicentre, phase III trial in China. (Pubmed Central) - Nov 12, 2020
P3
This narrative review will focus on the anesthesia and critical care providers' roles in the management of both perioperative stroke and acute ischemic stroke with a focus on anesthetic management for mechanical thrombectomy. Intravenous alteplase with a standard dose administered between 3 and 4.5 hours after onset of symptoms is effective and safe for Chinese AIS patients.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Clinical, Journal: MRI and intravenous thrombolysis for unclear-onset stroke during the COVID-19 pandemic: a case report (Pubmed Central) - Nov 12, 2020
Accordingly, intravenous thrombolysis with alteplase (0.6 mg/kg, the dose approved in Japan) was administered at 1,660 minutes after the last known well and 116 minutes after the symptom recognition...Although the use of MRI is recommended to be minimized in the emergency stroke management during the COVID-19 pandemic, MRI is occasionally mandatory for patient selection, such as cases with unclear onset to perform intravenous thrombolysis. The individualized protected code stroke is essential and must be well considered by each institute for diagnosing patients by selecting appropriate modalities.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Journal: Acute limb ischemia due to paradoxical embolism treated with systemic thrombolysis. (Pubmed Central) - Nov 12, 2020
Vascular surgeon decided against embolectomy, interventional radiologist against pharmacomechanical thrombolysis due to the extent of the occlusions. Systemic thrombolysis (alteplase) was administered successfully with resolution of the emboli in the left subclavian artery, left common femoral artery and superior mesenteric artery.
- |||||||||| enoxaparin sodium / Generic mfg.
[VIRTUAL] COVID-19 Thrombosis: Understanding the Negative Predictive Value in a Pandemic () - Nov 5, 2020 - Abstract #ASH2020ASH_4891;
The patient was treated for a possible ischemic stroke with alteplase thrombolysis at a local hospital...She recovered fully after anticoagulation with enoxaparin and subsequent dabigatran...Prophylactic and therapeutic regimens for hospitalized patients are in evolution, and have been associated with improved clinical outcomes.[5] We are aware that the role of anticoagulation in outpatient cases is not well studied, but we believe it deserves proper investigation. References:
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Clinical, Journal: Percutaneous rescue therapy in a child with blocked cavo-pulmonary shunt. (Pubmed Central) - Nov 4, 2020
Acute thrombosis of the left-sided Glenn was noted with significant anastomotic narrowing. Successful rescue thrombolysis was done using recombinant tissue plasminogen activator (Alteplase) along with balloon dilatation of the attenuated segments.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Journal: Systemic Thrombolytic Therapy for Massive and Submassive Pulmonary Embolism. (Pubmed Central) - Oct 25, 2020
If an imminent risk of hemodynamic instability or cardiac arrest occurs, thrombolytics should be administered if no contraindications exist. Net mortality benefit and risk of bleeding must be considered when deciding to administer thrombolytic therapy in massive or submassive PE.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Journal: Recanalization after cerebral ischemia (Pubmed Central) - Oct 21, 2020
Recanalization therapies include the endovascular approach (also called mechanical thrombectomy) and intravenous (IV) alteplase (i.e. thrombolysis)...Using MRI and perfusion brain imaging, the therapeutic window may be individualized and extended up to 24 hours. Although this extended time window is an opportunity to treat more patients, the rapidity of recanalization remains critical, as it is a major predictor of clinical outcome, emphasizing the need to reduce, as much as possible, treatment delays.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Trial completion date, Trial primary completion date: STARS: Fibrinolytic Therapy to Treat ARDS in the Setting of COVID-19 Infection (clinicaltrials.gov) - Oct 19, 2020
P2a, N=60, Recruiting,
Although this extended time window is an opportunity to treat more patients, the rapidity of recanalization remains critical, as it is a major predictor of clinical outcome, emphasizing the need to reduce, as much as possible, treatment delays. Trial completion date: Nov 2020 --> Nov 2021 | Trial primary completion date: Sep 2020 --> Sep 2021
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Journal: Different mismatch concepts for MRI-guided thrombolysis in unknown onset stroke. (Pubmed Central) - Oct 16, 2020
Evaluating both the DWI-FLAIR and PWI-DWI mismatch pattern in patients with unknown time of stroke onset will result in the highest yield of thrombolysis treatment. The treatment benefit of alteplase in patients with a DWI-FLAIR mismatch seems not merely driven by the presence of a PWI-DWI mismatch, although this analysis was underpowered.
- |||||||||| enoxaparin sodium / Generic mfg.
[VIRTUAL] MASSIVE PULMONARY EMBOLISM TREATED WITH THROMBOLYSIS IN COVID-19: A CASE SERIES () - Oct 12, 2020 - Abstract #CHEST2020CHEST_2445;
They received alteplase (50 mg, except for one patient, who required 100 mg), unfractionated heparin and transitioned to enoxaparin. Patients with COVID-19 with hemodynamically instability should be evaluated with advanced imaging for PE Systemic thrombolysis appears to be safe, but further studies are needed to establish the most adequate prophylaxis and treatment of thromboembolism in this population.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
[VIRTUAL] DUPLICATE INFERIOR VENA CAVA AS A POTENTIAL PATHWAY FOR RECURRENT PULMONARY EMBOLISM () - Oct 12, 2020 - Abstract #CHEST2020CHEST_2434;
In the setting of DVT/PE a dIVC provides an alternative pathway for embolization of a DVT. In patients with DVT/PE where IVC filter placement is indicated, the potential presence of this anatomic aberrancy should be considered.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
[VIRTUAL] DON'T WANDER OFF! RIGHT ATRIAL THROMBUS IN TRANSIT IN A PATIENT WITH UNPROVOKED PULMONARY EMBOLI () - Oct 12, 2020 - Abstract #CHEST2020CHEST_2429;
Existing treatment options can include anticoagulation, thrombolytics and surgical intervention, however no guidelines exist on the optimal management approach. Thus, it is important to pursue shared decision making in formulating the treatment plan with patients including full disclosure of risks and benefits as well as the lack of evidence available therapies.
- |||||||||| Actemra IV (tocilizumab) / Roche, JW Pharma
[VIRTUAL] RECURRENT HYPOXIA: ACUTE PULMONARY EMBOLI IN PATIENTS RECOVERING FROM COVID-19 () - Oct 12, 2020 - Abstract #CHEST2020CHEST_2380;
She was started on hydroxychloroquine, azithromycin, dexamethasone, tocilizumab, and prophylactic-dose enoxaparin...She was given alteplase and started on therapeutic unfractionated heparin with transition to coumadin... While more data is needed on the thrombotic nature of COVID-19, therapeutic doses of anticoagulation may be necessary to prevent major thrombotic events in COVID-19 patients at low risk of bleeding.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
[VIRTUAL] A DIAGNOSTIC APPROACH TO A LOCULATED PLEURAL EFFUSION () - Oct 12, 2020 - Abstract #CHEST2020CHEST_2248;
Her medical history was significant for stroke with residual right weakness, rheumatoid arthritis, and paroxysmal atrial fibrillation on warfarin...A one time dose of 10 mg alteplase & 5 mg dornase were administered via the chest tube... Use of intrapleural lytics to facilitate pleuroscopic evaluation is a novel approach that has not been previously described in the literature.
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