- |||||||||| [VIRTUAL] Right Heart Thrombus in Transit (ATS 2020 Virtual) - Jul 6, 2020 - Abstract #ATSI2020ATS-I_7214;
Case A 74-year-old African American woman with subdural hematoma 1 month ago, treated with burr hole and drainage with previous history of pulmonary embolism a few years ago was treated with 3 months of rivaroxaban presented with lightheadedness, dyspnea, found to be hypotensive with systolic of 78mmHg, and clot in transit seen on bedside ultrasound...The patient received 4mg alteplase bolus via the infusion catheter & was continued on alteplase infusion via the infusion catheter at 1mg/hr for 10 hours...Patient did well and was discharged home on apixaban...Patients treated with thrombolysis or surgical thrombectomy have shown lower mortality rates compared to anticoagulation alone 2 . Our patient was managed by neurosurgery, interventional cardiology and intensivist team together.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
[VIRTUAL] Post Pneumonectomy Pulmonary Embolism: A Perplexing Problem (ATS 2020 Virtual) - Jul 6, 2020 - Abstract #ATSI2020ATS-I_7168;
Alteplase was infused via a 5-French Cragg-McNamara infusion catheter that was placed in the right mid PA segment with concurrent heparin infusion...In recent years, due to the increasing use of CDT in acute PE, there have been some studies exhibiting major outcomes and superior safety of CDT to systemic thrombolysis in mortality, hemorrhagic complications, and readmission rates [2,5]. This case highlights the paucity and thus the need for further investigations for specific uses of CDT in lieu of systemic thrombolysis for overall improved outcomes.
- |||||||||| piperacillin sodium/tazobactam sodium / Generic mfg., vancomycin / Generic mfg., Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
[VIRTUAL] Bubbly Consolidation Post Pulmonary Embolism Complicated with Empyema (ATS 2020 Virtual) - Jul 6, 2020 - Abstract #ATSI2020ATS-I_7154;
She was treated with chest tube thoracotomy, heparin drip, vancomycin and piperacillin- tazobactam...Due to failed re-expansion of left lung with pigtail chest tube and alteplase/DNAse thrombolysis patient underwent VATS...Areas of lung infarction were seeded with multiple organisms. The superimposed infection led to the development of a hydropneumothorax with empyema.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
[VIRTUAL] Sleep or Stroke? (ATS 2020 Virtual) - Jul 6, 2020 - Abstract #ATSI2020ATS-I_6874;
Although his ptosis may have been misconstrued as somnolence, sleep/wake cycle disturbances have been previously described in patients with AOP infarction. Early recognition with CT angiogram of the head and possibly MRI of the brain could improve outcomes in these patients, especially if presenting within time window for alteplase administration.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
[VIRTUAL] ‘Tis the Season to Be Wary; a Case of Fatal EEE in Western Massachusetts (ATS 2020 Virtual) - Jul 6, 2020 - Abstract #ATSI2020ATS-I_6803;
He developed acute left-sided weakness and was treated with Alteplase for an acute stroke and transferred to higher level of care...EEEV should be part of the differential diagnosis of cases of aseptic meningitis and encephalitis during the peak season on the east and Gulf coasts of the United States. Reporting infection to regional health departments facilitates diagnosis and mitigates the risk of further transmission, especially in the absence of a developed human vaccine.
- |||||||||| piperacillin sodium/tazobactam sodium / Generic mfg., vancomycin / Generic mfg., Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
[VIRTUAL] Intrapleural Lytic Therapy to Treat a Rare Cause of Pleural Effusion (ATS 2020 Virtual) - Jul 6, 2020 - Abstract #ATSI2020ATS-I_5229;
Given the degree of septations, we administered half-dose intrapleural lytics to aid in adequate drainage of the effusion as a means of avoiding the need for surgical decortication if unsuccessful. In this case, intrapleural lytics resulted in improvement of the effusion and may be considered therapeutic for loculated bilothorax moving forward.
- |||||||||| amoxicillin / Generic mfg.
[VIRTUAL] Eikenella Corrodens as Primary Cause in Pulmonary Infection (ATS 2020 Virtual) - Jul 6, 2020 - Abstract #ATSI2020ATS-I_4783;
Patient was then discharged home to complete a four week antibiotic course with Amoxicillin...Our patient had none of these risk factors. It is important to consider Eikenella as an infectious agent in patients presenting with empyema, even if patients do not have typical risk factors.
- |||||||||| piperacillin sodium/tazobactam sodium / Generic mfg., vancomycin / Generic mfg., Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
[VIRTUAL] Complicated Parapneumonic Effusion Growing Chryseobacterium in a Newly Diagnosed Diabetic (ATS 2020 Virtual) - Jul 6, 2020 - Abstract #ATSI2020ATS-I_4776;
He was started on piperacillin/tazobactam and vancomycin...This first required right sided thoracentesis and eventually bilateral chest tube placement with alteplase/dornase administration...Nevertheless, given the growing epidemic of diabetes, and more specifically, uncontrolled diabetes, this is a pathogen that should be considered in patients who are not improving on broad-spectrum antibiotic coverage. Currently, there are no guidelines for treatment of Chryseobacterium , but empiric coverage with TMP-SMX appears to be a good starting point based on recent susceptibility research data 6 .
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
[VIRTUAL] Experience with Mechanical Thrombectomy in Ischemic Stroke (ATS 2020 Virtual) - Jul 6, 2020 - Abstract #ATSI2020ATS-I_4434;
Of these, 19.7% underwent thrombolysis with intravenous alteplase...CONCLUSIONS Our study showed results of efficacy and safety of mechanical thrombectomy in acute stroke. In addition, we found no direct relationship between Cerebral Hemorrhage and time from onset of symptoms to onset of procedure.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
[VIRTUAL] Inravenous Alteplase for Massive Pulmonary Embolus in a Patient with Sub Arachnoid Hemorrhage: A Case Report (ATS 2020 Virtual) - Jul 6, 2020 - Abstract #ATSI2020ATS-I_4333;
CASE Intravenous Alteplase is contraindicated with a history of intracranial hemorrhage. To the best of our knowledge, this represents the first case ever reported where a patient received full dose (100 mg) of intravenous Alteplase twice within a 24 hour period for massive pulmonary embolism in the setting of an active subarachnoid hemorrhage with no neurologic complications and a stable neurologic exam at discharge.
- |||||||||| meropenem / Generic mfg., Daewon Pharmaceutical
[VIRTUAL] Acute Pulmonary Embolism Unmasking Chronic Thromboembolic Pulmonary Hypertension, Leading to Infraction, Lung Abscess and Empyema (ATS 2020 Virtual) - Jul 6, 2020 - Abstract #ATSI2020ATS-I_4288;
Low molecular weight heparin, meropenem and linezolid were also administered...The diagnosis of chronic thromboembolic pulmonary hypertension (CTEPH) was confirmed, and the patient was treated with riociguat...Conclusion Acute pulmonary embolism might result in infraction formation and subsequent lung abscess and empyema in predisposed subjects. An unrecognised diagnosis of CTEPH might complicate the clinical course of these patients.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Clinical, Journal: Efficacy of different doses of alteplase thrombolysis on acute ischemic stroke in patients. (Pubmed Central) - Jul 3, 2020
The results showed that different doses of alteplase could improve neurological function and living ability of patients. Future studies need to broaden the sample size to study the safety of low and standard doses of alteplase in patients with acute cerebral infarction.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Journal: Ethnicity and Other Determinants of Quality of Functional Outcome in Acute Ischemic Stroke: The ENCHANTED Trial. (Pubmed Central) - Jul 2, 2020
P3
Methods- ENCHANTED was an international quasi-factorial clinical trial of different doses of intravenous alteplase and intensities of blood pressure control in acute ischemic stroke patients, with outcomes on the 5-Dimensional European Quality of Life Scale and mRS assessed at 90 days post-randomization...Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT01422616.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Biomarker, Journal: End-of-Treatment Intracerebral and Ventricular Hemorrhage Volume Predicts Outcome: A Secondary Analysis of MISTIE III. (Pubmed Central) - Jul 2, 2020
Methods- In this secondary analysis of the MISTIE III trial (Minimally Invasive Surgery Plus Alteplase for Intracerebral Hemorrhage Evacuation III), we included patients randomized to the surgical arm...Conclusion s-After surgical clot evacuation, both ICH and intraventricular hemorrhage volumes have a strong association with good neurological outcome. The EoT ICH volume score needs independent verification, but such an approach could be used for prognostication and therapeutic planning.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Retrospective data, Journal: Thrombolysis in acute pulmonary embolism. (Pubmed Central) - Jul 1, 2020
Thrombolysis in patients with high-risk APE or intermediate-high risk had a severe bleeding rate of 17.6%. However, the high mortality of this population (47%) due to right ventricular failure justifies the use of this therapeutic modality.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Journal: Thrombectomy for Stroke in the Public Health Care System of Brazil. (Pubmed Central) - Jun 28, 2020
P3
In this randomized trial conducted in the public health care system of Brazil, endovascular treatment within 8 hours after the onset of stroke symptoms in conjunction with standard care resulted in better functional outcomes at 90 days than standard care alone. (Funded by the Brazilian Ministry of Health; RESILIENT ClinicalTrials.gov number, NCT02216643.).
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Journal: Association of Serum Troponin Obtained During Stroke Codes with Cardioembolic Strokes. (Pubmed Central) - Jun 25, 2020
This finding may have implications for clinical workup, and patients with admission troponin levels of greater than or equal to .05 ng/mL may need further clinical investigations to look for a cardioembolic source. A troponin level of greater than or equal to .05 ng/ml may prompt a more thorough search for a cardioembolic source in cases in which such a source is not identified on initial evaluation.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Clinical, Journal: Risk factors for peripherally inserted central catheter line-related deep venous thrombosis in critically ill intensive care unit patients. (Pubmed Central) - Jun 23, 2020
In this retrospective study, we did not identify any association of peripherally inserted central catheter-related deep venous thrombosis with a prior history of deep venous thrombosis, use of alteplase, antiplatelet therapy, prophylactic or therapeutic anticoagulation, international normalized ratio, platelet count and the use of peripherally inserted central catheters for total parenteral nutrition...The study findings should be confirmed in a larger study designed to identify risk factors of peripherally inserted central catheter-related deep venous thrombosis. In the meantime, the peripherally inserted central catheter lines should be used judiciously in critically ill patients.
- |||||||||| Pro-UK (recombinant human pro-urokinase for injection) / Tasly
Trial completion, Trial completion date, Trial primary completion date: Study of rhPro-UK in Patients With Acute Ischaemic Stroke in 4.5 Hours After Stroke Onset(PROST) (clinicaltrials.gov) - Jun 22, 2020
P3, N=674, Completed,
In the meantime, the peripherally inserted central catheter lines should be used judiciously in critically ill patients. Recruiting --> Completed | Trial completion date: Aug 2022 --> May 2020 | Trial primary completion date: Mar 2022 --> Apr 2020
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Enrollment closed: SITS_ELDERLY: SITS-IVT in Patients >80 Years Study (clinicaltrials.gov) - Jun 19, 2020
P=N/A, N=2000, Active, not recruiting,
Standard-dose and low-dose alteplase were comparable in reducing major disability, but low-dose alteplase for mild stroke showed much reduced mortality on day 90 for octogenarians. Not yet recruiting --> Active, not recruiting
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Review, Journal: Bacterial staphylokinase as a promising third-generation drug in the treatment for vascular occlusion. (Pubmed Central) - Jun 14, 2020
Despite the potent clot lysis achievable using approved thrombolytic drugs such as alteplase, reteplase, streptokinase, tenecteplase, and some other fibrinolytic agents, there are some drawbacks, such as high production cost, systemic bleeding, intracranial hemorrhage, vessel re-occlusion by platelet-rich and retracted secondary clots, and non-fibrin specificity...A fibrin-bound plasmin-staphylokinase complex shows high resistance to a-antiplasmin-related inhibition. Staphylokinase has the potential to be considered as a promising thrombolytic agent with properties of cost-effective production and the least side effects.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Clinical, Journal: Not All Patients with Hemiplegia Need Alteplase: A Case of Hemiplegic Migraine. (Pubmed Central) - Jun 13, 2020
This case demonstrates the importance of a thorough history, intercommunication between health systems and integrated Electronic Medical Records (EMR) for early diagnosis and management of HM. Hemiplegic migraine (HM) is difficult to diagnose and can mimic stroke, resulting in administration of dangerous medications such as thrombolytics/alteplase.A thorough history, intercommunication between health systems and integrated EMR are essential for early diagnosis and management of HM.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Clinical, Journal: Successful Intravenous Alteplase for a Centenarian Woman with Acute Ischaemic Stroke. (Pubmed Central) - Jun 12, 2020
There are no data on what is the best method to use to manage centenarians. Our successful thrombolysis case indicates that biologically young centenarians may profit from thrombolysis, despite the very high age.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Retrospective data, Journal: Identifying stroke therapeutics from preclinical models: A protocol for a novel application of network meta-analysis. (Pubmed Central) - Jun 12, 2020
This protocol details planned methods to conduct a systematic review to identify and appraise eligible studies and to use a network meta-analysis to synthesize available evidence to answer the following questions: in preclinical in vivo models of focal ischemic stroke, what are the relative benefits of competing therapies tested in combination with the gold standard treatment alteplase in (i) reducing cerebral infarction size, and (ii) improving neurobehavioural outcomes?...Combining all evidence to simultaneously compare mutliple therapuetics tested preclinically may provide a rationale for the clinical translation of therapeutics for patients with ischemic stroke. Dissemination: Review findings will be submitted to a peer-reviewed journal and presented at relevant scientific meetings to promote knowledge transfer. Registration: PROSPERO number to be submitted following peer review.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Clinical, P3 data, Journal: Safety and efficacy of sonothrombolysis for acute ischaemic stroke: a multicentre, double-blind, phase 3, randomised controlled trial. (Pubmed Central) - Jun 8, 2020
P3
Sonothrombolysis delivered by an operator-independent device to patients treated with alteplase after acute ischaemic stroke was feasible and most likely safe, but no clinical benefit was seen at 90 days. Sonothrombolysis could be further investigated either in randomised trials undertaken in stroke centres that are dependent on patient transfer for endovascular reperfusion therapies or in countries where these treatments cannot yet be offered as the standard of care.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Journal: Endovascular Thrombectomy with or without Intravenous Alteplase in Acute Stroke. (Pubmed Central) - Jun 8, 2020
P=N/A
In Chinese patients with acute ischemic stroke from large-vessel occlusion, endovascular thrombectomy alone was noninferior with regard to functional outcome, within a 20% margin of confidence, to endovascular thrombectomy preceded by intravenous alteplase administered within 4.5 hours after symptom onset. (Funded by the Stroke Prevention Project of the National Health Commission of the People's Republic of China and the Wu Jieping Medical Foundation; DIRECT-MT ClinicalTrials.gov number, NCT03469206.).
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Review, Journal: Recent advances in spontaneous intracerebral hemorrhage. (Pubmed Central) - Jun 5, 2020
The purpose of this review is to provide an update on important research on ICH over the past three years. Topics covered include risk factors, imaging predictors of hematoma expansion, scoring schema to predict hematoma expansion, hemostatic therapies, acute blood pressure lowering, intraventricular administration of alteplase for intraventricular hemorrhage, and the current status of surgical therapies.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Journal: The Mild and Rapidly Improving Stroke Study (MaRISS): Rationale and design. (Pubmed Central) - Jun 4, 2020
Topics covered include risk factors, imaging predictors of hematoma expansion, scoring schema to predict hematoma expansion, hemostatic therapies, acute blood pressure lowering, intraventricular administration of alteplase for intraventricular hemorrhage, and the current status of surgical therapies. MaRISS will define outcomes and their predictors and clarify the effects of alteplase in patients with mild and rapidly improving stroke symptoms, providing clinicians with important information to manage this population.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Clinical, Journal: Intravenous Thrombolysis at 3.5 Hours From Onset of Pediatric Acute Ischemic Stroke. (Pubmed Central) - May 31, 2020
With parental consent, clinicians decided to infuse an adult dose of weight-adjusted intravenous alteplase at 3.5 hours from onset of symptoms, with subsequent improvement in National Institutes of Health Stroke Scale score from 11 to 3...This case highlights the importance of magnetic resonance imaging in diagnosing pediatric acute ischemic stroke and suggests consideration of thrombolysis in select confirmed pediatric stroke cases. However, a rigorous evidence base is lacking, and clinical trials have not been successful in recruiting patients.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Journal: Pump Thrombosis, Scratching the Surface. (Pubmed Central) - May 30, 2020
In our institution, HeartWare HVAD patients with PT are thrombolysed with systemic Alteplase infusion until restoration of normal power consumption or maximum infusion duration of 20 hours...Whether this is due to impeller instability or other factors is unknown. Routine inspection of explanted pumps may provide insights into thrombosis mechanisms.
- |||||||||| Zarifa (tirofiban) / Orchid, Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Journal: Hybrid Thrombolysis for Left Ventricular Assist Device Thrombosis. (Pubmed Central) - May 30, 2020
Interpretation is limited by small group size and retrospective design. These outcomes require comparison with other approaches, ultimately in a randomised trial.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Clinical, Journal: Angioedema Associated With Thrombolysis For Ischemic Stroke: Analysis Of A Case-Control Study. (Pubmed Central) - May 26, 2020
In OHCA patients with confirmed PE and admitted with recuperation of spontaneous circulation in the hospital, there was significantly higher 30-day survival in those who received thrombolysis during CPR compared with patients who did not receive thrombolysis. This case-control study points out angiotensin-converting enzyme inhibitors and female sex as risk factors of bradykinin-angioedema associated with thrombolysis for ischemic stroke.
- |||||||||| Pulmozyme (dornase alfa) / Roche, Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Journal: The first use of combination of Intrapleural Fibrinolytics (Alteplase & DNAse) for pleural infection in Malaysia. (Pubmed Central) - May 25, 2020
Its efficacy and success rate in selected cases of complicated parapneumonic effusion unresponsive to antibiotics and chest drainage are well documented. This case report demonstrates the first use of combination intrapleural fibrinolytic (Alteplase) and DNAse (Pulmozyme) in Malaysia for a case of pleural infection/parapneumonic effusion.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
[VIRTUAL] The reality of the acute treatment for ischemic stroke in a Brazilian reference hospital () - May 24, 2020 - Abstract #EAN2020EAN_3639;
Introduction: The use of endovenous alteplase in the acute treatment of ischemic stroke (IS) is well established (NINDS, 1995; ECASS, 1995-2008) regarding an endovenous treatment in the therapeutic window of 4.5 hours since the begging of the ischemic symptoms... In the most majority of the cases, the time interval between the ictus and the first neurological evaluation was too long for an adequate acute endovenous treatment of the ischemic stroke.
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