- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
ACUTE ISCHEMIC STROKE AND CONCOMITANT STEMI: AN UNUSUAL PRESENTATION OF MILD HYPERHOMOCYSTEINEMIA (Hall B4-5) - Jan 26, 2024 - Abstract #ACC2024ACC_856;
Initial CT head ruled out intracranial hemorrhage.Decision?making: After a multidisciplinary discussion, we proceeded with thrombolysis with alteplase for acute stroke, followed by coronary angiogram which showed nonobstructive coronary artery disease, suggestive of lysed coronary emboli or stress cardiomyopathy... Hyperhomocysteinemia is a known prothrombotic condition with no definitive treatment and can present with massive cardioembolic stroke and STEMI secondary to coronary emboli.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
LOST IN TRANSIT: ACCIDENTAL LV PLACEMENT OF A MICRA THROUGH A PFO (Hall B4-5) - Jan 26, 2024 - Abstract #ACC2024ACC_291;
Imaging revealed a left middle cerebral artery stroke and he subsequently received intravenous alteplase and underwent thrombectomy...Apixaban was restarted for lifelong anticoagulation given his preference for a conservative approach and he elected against removal of the Micra.Decision?making: Left ventricular placement could occur via iatrogenic septal perforation or across a congenital septal defect. This case highlights the importance of evaluating pre-procedural cardiac anatomy to ensure successful implantation keeping in mind the high prevalence of PFOs in the general population.
- |||||||||| argatroban / Generic mfg.
Clinical, Retrospective data, Review, Journal: Argatroban as an Add-On to rtPA in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis. (Pubmed Central) - Jan 23, 2024
Analysis of risk ratio and relative risk shows that the add-on therapy with argatroban seems to be effective and favors a good clinical outcome (mRS 0-2) at 90 days, similar to that of alteplase...Argatroban as an add-on treatment to IVT seems not to be associated with excessive bleeding risk; however, its efficacy remains unproven. According to this synopsis of the currently available evidence, it is premature to use argatroban as an add-on to IVT treatment outside the current clinical trial setting.
- |||||||||| TNKASE (tenecteplase) / Roche, Boehringer Ingelheim
Journal, Real-world evidence, Real-world: Tenecteplase for Acute Ischemic Stroke Thrombolysis: Practical Considerations and Real-World Implementation. (Pubmed Central) - Jan 15, 2024
This commentary provides a practical synthesis of the current evidence and discusses our institutional experience with tenecteplase including treatment considerations, off-label use, patient consent, stroke center accreditation, and cost savings. Necessary "Code Stroke" workflow changes to ensure a safe transition from alteplase to tenecteplase are detailed.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Journal: Effects of Butylphthalide on Cerebral Vascular Circulation, Coagulation Function, and Neurological Function in Patients with Acute Severe Ischemic Stroke Following Intravenous Thrombolysis: A Preliminary Study. (Pubmed Central) - Jan 10, 2024
Compared to Alteplase alone, the addition of Butylphthalide further improves cerebral vascular circulation and coagulation function, promoting the recovery and reconstruction of neurological function in patients. Importantly, the addition of Butylphthalide does not increase the risk of adverse reactions, making it a safe and ideal option for clinical application.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Clinical guideline, Review, Journal: A Review of an Interfacility Transport Program Pediatric Stroke Clinical Practice Guideline. (Pubmed Central) - Jan 9, 2024
To our knowledge, the CMCCT CPG is the first pediatric transport protocol aimed at recognition and management of pediatric stroke described in the literature. Retrospective calculation of LVO scores show that they may be helpful in application to pediatric patients.
- |||||||||| TNKASE (tenecteplase) / Roche, Boehringer Ingelheim, Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Retrospective data, Review, Journal: Tenecteplase versus alteplase for patients with acute ischemic stroke: a meta-analysis of randomized controlled trials. (Pubmed Central) - Jan 8, 2024
Compared with alteplase, TNK was effective at doses of 0.1 mg/kg and 0.25 mg/kg without increased risk of symptomatic intracerebral hemorrhage (sICH), but patients treated with TNK 0.4 mg/kg showed increased odds of sICH. In conclusion, compared with alteplase, intravenous thrombolysis with TNK at dose of 0.25 mg/kg has a better efficacy and similar safety profile and is a reasonable option for patients with AIS.
- |||||||||| TNKASE (tenecteplase) / Roche, Boehringer Ingelheim, Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Observational data, Journal: Moving From Alteplase to Tenecteplase for Acute Ischemic Stroke-Mayo Clinic Experience. (Pubmed Central) - Jan 8, 2024
In conclusion, compared with alteplase, intravenous thrombolysis with TNK at dose of 0.25 mg/kg has a better efficacy and similar safety profile and is a reasonable option for patients with AIS. Tenecteplase use as the thrombolytic agent in acute ischemic stroke was associated with lower rates of symptomatic intracranial hemorrhage, higher rates of spontaneous recanalization, but similar door-to-needle time and 90-day modified Rankin Scale as compared with tissue plasminogen activator.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Journal: Piceatannol improved cerebral blood flow and attenuated JNK3 and mitochondrial apoptotic pathway in a global ischemic model to produce neuroprotection. (Pubmed Central) - Jan 8, 2024
The only FDA-approved treatment is recanalization with systemic tissue plasminogen activators like alteplase, although reperfusion caused by recanalization can result in neuroinflammation, which can cause brain cell apoptosis...According to our current research, JNK3 downstream signaling and the mitochondrial apoptosis pathway are both inhibited by PCT, which results in neuroprotection under conditions of global brain ischemia. Piceatannol attenuated JNK3 phosphorylation during the ischemic condition and prevented neuronal apoptosis.
- |||||||||| nerinetide (NA 1) / NoNO, Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Clinical, Journal: Mediation of Age and Thrombectomy Outcome by Neuroimaging Markers of Frailty in Patients With Stroke. (Pubmed Central) - Jan 6, 2024
In this cohort study, a secondary analysis of the ESCAPE-NA1 trial, most of the association between age and 90-day outcome was mediated by neuroimaging frailty, underscoring the importance of features like brain atrophy and small vessel disease, as opposed to chronological age alone, in predicting poststroke outcomes. Future trials could include such frailty features to stratify randomization or improve adjustment in outcome analyses.
- |||||||||| nerinetide (NA 1) / NoNO
Journal: Infarct Evolution on MR-DWI After Thrombectomy in Acute Stroke Patients Randomized to Nerinetide or Placebo. (Pubmed Central) - Jan 6, 2024
P3
Patients with acute large vessel occlusive stroke exhibited appreciable early infarct growth both in the gray matter and the white matter after undergoing EVT. Acknowledging relatively small overall infarct volumes in this study, treatment with nerinetide was associated with slightly reduced percentage infarct growth in the white matter and basal ganglia compared with placebo in patients not receiving intravenous alteplase and had no effect on the total early secondary infarct growth.
- |||||||||| Aggrastat (tirofiban) / Correvio, Medicure, Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Enrollment open, Trial initiation date: ADJUVANT: Intravenous Tirofiban Versus Alteplase Before Mechanical Thrombectomy in Stroke (clinicaltrials.gov) - Jan 3, 2024
P2/3, N=800, Recruiting,
In this cohort study with meta-analysis, compared to no treatment with anticoagulants, treatment with NOACs prior to stroke was not associated with a higher risk of intracranial hemorrhage, major bleeding, or mortality in patients receiving intravenous alteplase for acute ischemic stroke. Not yet recruiting --> Recruiting | Initiation date: Mar 2023 --> Nov 2023
- |||||||||| TNKASE (tenecteplase) / Roche, Boehringer Ingelheim, Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Journal: Comparative safety of tenecteplase vs alteplase for acute ischemic stroke. (Pubmed Central) - Jan 2, 2024
In the context of a stroke telemedicine program, the rates of hemorrhage observed with either agent were lower than expected based on prior trials and registry data. The more easily prepared tenecteplase was associated with a lower door-to-needle time.
- |||||||||| TNKASE (tenecteplase) / Roche, Boehringer Ingelheim, Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Tying It ALTogether: Real-World Application (Congress Digital) - Dec 24, 2023 - Abstract #SCCM2024SCCM_664;
Phase classification: P2 --> P3 When presented with cases regarding patients presenting with stroke, discuss who would be a good candidate for tenecteplase and considerations when using tenecteplase vs alteplase.
- |||||||||| TNKASE (tenecteplase) / Roche, Boehringer Ingelheim, Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Logistics Logistics (Congress Digital) - Dec 24, 2023 - Abstract #SCCM2024SCCM_635;
This change requires numerous considerations including getting buy in from providers, making the formulary change, and educating nurses and providers on administration and dosing. This session will focus on the logistical issues to consider when making the transition from Alteplase to Tenecteplase.
- |||||||||| TNKASE (tenecteplase) / Roche, Boehringer Ingelheim, Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Challenging the Status Quo: Scientific Rationale for Tenecteplase Versus Alteplase Therapy (Congress Digital) - Dec 24, 2023 - Abstract #SCCM2024SCCM_602;
Tenecteplase has emerged as an alternative to alteplase for thrombolytic therapy in patients with acute ischemic stroke with evidence suggesting potential improved outcomes in select patient populations. Scientific evidence, operational logistics, and cost considerations can guide institutional conversations when determining preferred formulary thrombolytic therapy.
- |||||||||| TNKASE (tenecteplase) / Roche, Boehringer Ingelheim, Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
ALT With the Old and TEN With the New: Converting from Alteplase to Tenecteplase (Congress Digital) - Dec 24, 2023 - Abstract #SCCM2024SCCM_569;
Speakers will engage audience members to solicit thoughts and allow for questions. Learning Objectives: Review the literature surrounding the use of tenecteplase versus alteplase and considerations before switching agents at an institution Identify key multiprofessional members essential to facilitating and assisting with a transition from alteplase to tenecteplase Discuss considerations and strategies to ensure a smooth transition in prescribing, ordering, administration, and monitoring of the medication
- |||||||||| Pro-UK (recombinant human pro-urokinase for injection) / Tasly, Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
P2a data, Journal: Thrombolysis with Recombinant Human Prourokinase 4.5-6 h After Acute Ischemic Stroke: A Phase IIa, Randomized, and Open-Label Multicenter Clinical Trial. (Pubmed Central) - Nov 30, 2023
Thus, intravenous rhPro-UK was effective and safe for patients with AIS within 4.5-6 h after stroke onset. While no significant differences were identified between different dosages of rhPro-UK regarding clinical outcomes, it is a logical step to further test the safety and efficacy of the low dose of rhPro-UK in a well-powered phase III study.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Journal, HEOR: The budget impact of alteplase in the treatment of acute ischemic stroke in Egypt. (Pubmed Central) - Nov 29, 2023
The total cumulative cost savings for alteplase in AIS patients were estimated at EGP -228,146,871 ($ -7,359,576) over 5 years. The budget impact model estimates suggest that from a societal perspective, alteplase is likely to be a cost-saving option for the treatment of AIS in Egypt due to the treatment benefits, resulting in savings in acute hospitalization and annual post-hospitalization costs.
- |||||||||| TNKASE (tenecteplase) / Roche, Boehringer Ingelheim, Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Journal: Tenecteplase: More Evidence It Should Replace Alteplase for Ischemic Stroke Treatment. (Pubmed Central) - Nov 27, 2023
The budget impact model estimates suggest that from a societal perspective, alteplase is likely to be a cost-saving option for the treatment of AIS in Egypt due to the treatment benefits, resulting in savings in acute hospitalization and annual post-hospitalization costs. No abstract available
- |||||||||| TNKASE (tenecteplase) / Roche, Boehringer Ingelheim
Journal, Real-world evidence, Real-world: Tenecteplase real-world data: A three phase sequential comparison. (Pubmed Central) - Nov 27, 2023
There was no inter-group difference when comparing the two alteplase phases. Our results suggest that previously reported benefits from tenecteplase in a real-world setting were not likely attributable to a temporal confounding.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Review, Journal: Therapeutic management of ischemic stroke. (Pubmed Central) - Nov 15, 2023
Alteplase is the only therapy the American Food and Drug Administration has approved for ischemic stroke under the thrombolysis category...The rapid intervention has been linked to more favorable clinical results. This study focuses on the pathogenesis of stroke, as well as its recent advancements, future prospects, and potential therapeutic targets in stroke therapy.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Journal: A case series analysis of bicarbonate-based purge solution administration via Impella ventricular assist device. (Pubmed Central) - Nov 12, 2023
This case series adds to the literature describing clinical outcomes for patients on Impella support with BBPS. While BBPS offers a viable option for the management of patients on Impella devices who are unable to tolerate heparin-based purge solutions, further data is needed to determine the longevity of the Impella device with BBPS to minimize risk of Impella complications.
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