- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Journal: Evaluation of Rescue Thrombolysis in Cardiac Arrest Secondary to Suspected or Confirmed Pulmonary Embolism. (Pubmed Central) - Apr 16, 2020
This retrospective review included adults who received alteplase or tenecteplase during cardiac arrest for suspected or confirmed PE...Conclusion and Relevance: Medical advances in PE management continue to evolve; yet the role of thrombolytic therapy in PE-related cardiac arrest remains unclear, with low overall rates of survival. These findings add to the relatively small body of evidence and highlight that optimal dosing remains unknown in this setting.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Journal: Innovations in Care Delivery of Stroke from Emergency Medical Services to the Neurointerventional Operating Room. (Pubmed Central) - Apr 15, 2020
The Neuro ED acts as our hub for EMS communication, imaging, administration of intravenous alteplase, and transition to the Neurointerventional OR. Our structure with its enabling of shortened IV alteplase delivery times and faster door-to-needle (DTN) times may serve as an international model for stroke centers.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Journal: Quantitative Signal Intensity in Fluid-Attenuated Inversion Recovery and Treatment Effect in the WAKE-UP Trial. (Pubmed Central) - Apr 15, 2020
In the randomized controlled WAKE-UP trial (Efficacy and Safety of MRI-Based Thrombolysis in Wake-Up Stroke Trial), intravenous alteplase was effective in patients with unknown onset stroke selected by visual assessment of diffusion weighted imaging fluid-attenuated inversion recovery mismatch, that is, in those with no marked fluid-attenuated inversion recovery hyperintensity in the region of the acute diffusion weighted imaging lesion...Conclusions- In patients in whom no marked parenchymal fluid-attenuated inversion recovery hyperintensity was detected by visual judgement in the WAKE-UP trial, higher FLAIR-rSI of diffusion weighted imaging lesions was associated with decreased treatment effects of intravenous thrombolysis. This parallels the known association of treatment effect and elapsing time of stroke onset.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Journal: HaNDL is transient headache, neurological deficits and lymphocytic pleocytosis in the cerebrospinal fluid (Pubmed Central) - Apr 10, 2020
This is a case report of a 31-year-old woman, who experienced acute neurological deficits and was treated with IV alteplase on suspicion of acute ischaemic stroke...Every clinician working in acute neurology should have knowledge of this syndrome. Increased knowledge will help to diagnose and to differentiate from other potentially more harmful neurological states.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
[VIRTUAL] Predictors of malignant middle cerebral artery infarction after mechanical thrombectomy. (HoC Room) - Apr 9, 2020 - Abstract #EAN2020EAN_2221;
We selected patients from a prospective local database which reference all patients eligible for treatment with Alteplase thrombolysis and/or mechanical endovas- cular thrombectomy in acute stroke... Our study proposes a practical decision tree including DWI lesion volume and delay before recanalization to early and accurately predict MMI in a subgroup of patients with MCA infarction undergoing MET regardless to the status of reperfusion.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
[VIRTUAL] Don’t stop until you understand it - case series of Artery of Percheron infarction (Room: Screen B2) - Apr 9, 2020 - Abstract #EAN2020EAN_1128;
Neither was treated with intravenous alteplase... Strokes in the AOP territory should be considered in patients with nonlaterilizing neurological symptoms especially if MRI brain scan is not available and if the clincial features are not fully explained by the initial CT scan or the laboratory work-up.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
[VIRTUAL] Changes in the quality of care in Polish stroke units - the role of RES-Q registry (Room: Screen B1) - Apr 9, 2020 - Abstract #EAN2020EAN_1117;
Polish stroke units reporting cases to RES-Q in years 2017-2019 significantly improved their perfor- mance, including door-to-needle time and early dysphagia screening. It confirms that regular involvement in this quality oriented project may drive improvement, even in centres with high baseline standards of care.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
[VIRTUAL] Extending intravenous thrombolysis time window guided by CT Perfusion (Room Berlin) - Apr 9, 2020 - Abstract #EAN2020EAN_812;
Time onset of symptoms to the beginning of alteplase was 319min (range 280-510)... In our experience, selecting patients for IVT beyond 4.5 hours guided by CT perfusion is safe and effective, and is asociated with a good neurological prognosis at 3 months.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Clinical, Journal: Thrombus Migration Paradox in Patients With Acute Ischemic Stroke. (Pubmed Central) - Apr 1, 2020
Administration of intravenous alteplase increases the chance of thrombus migration and resolution. Thrombus migration is associated with better functional outcome but reduces the rate of complete reperfusion.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Review, Journal: Thrombolytic Therapy in Cocaine Users with Ischemic Stroke: A Review of Current Practice. (Pubmed Central) - Mar 31, 2020
The most common serious adverse reaction related to alteplase is the development of spontaneous intracerebral hemorrhage and the presence of cerebral small vessel disease may increase this risk, particularly in cocaine users, even if only few data have been published on this topic. Here we reviewed in cocaine users with acute ischemic stroke the efficacy and safety of thrombolytic therapy.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Journal: Observer Agreement on Computed Tomography Perfusion Imaging in Acute Ischemic Stroke. (Pubmed Central) - Mar 31, 2020
Methods- We selected 24 cases from the IST-3 (Third International Stroke Trial), ATTEST (Alteplase Versus Tenecteplase for Thrombolysis After Ischaemic Stroke), and POSH (Post Stroke Hyperglycaemia) studies to illustrate various perfusion abnormalities...Intraobserver agreement was fair to substantial in the majority of readers (Krippendorff-α ranged from 0.29 to 0.80). Conclusions- There are high levels of interobserver and intraobserver agreement for the interpretation of CTP in acute stroke, particularly of mean transit time, delay time, and penumbra maps.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Enrollment change, Trial withdrawal: FAMTAIS: Combinating Fingolimod With Alteplase Bridging With Mechanical Thrombectomy in Acute Ischemic Stroke (clinicaltrials.gov) - Mar 31, 2020
P2, N=0, Withdrawn,
Conclusions- There are high levels of interobserver and intraobserver agreement for the interpretation of CTP in acute stroke, particularly of mean transit time, delay time, and penumbra maps. N=96 --> 0 | Not yet recruiting --> Withdrawn
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Clinical, Journal: Intrapleural Alteplase and Dornase in a Pregnant Woman with Complicated Parapneumonic Effusion. (Pubmed Central) - Mar 29, 2020
The use of intrapleural alteplase (t-PA) and dornase in pregnant patients remains an uncertain practice since bleeding complications in these cases could be devastating. We present a case in which we successfully used a modified protocol safely.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Journal: Intra-reservoir administration of alteplase to treat a distal ventriculo-atrial shunt obstruction. (Pubmed Central) - Mar 29, 2020
Intrareservoir administration of alteplase can be a useful nonoperative treatment strategy for ventriculoatrial shunt malfunction. This strategy may be particularly useful in cases with higher perioperative risk, such as patients with advanced metastatic cancer.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Clinical, Journal: Low-dose versus standard-dose alteplase in acute ischemic stroke in Asian stroke registries: an individual patient data pooling study. (Pubmed Central) - Mar 24, 2020
Despite the high level of participation, equipoise over the dose of alteplase among UK clinician investigators favored the inclusion of older, frailer, milder AIS patients in the ENCHANTED trial. The present analyses of real-world Asian acute stroke registry data suggest that low-dose intravenous alteplase has overall comparable efficacy for functional recovery and greater potential safety in terms of reduced mortality, to standard-dose alteplase for the treatment of acute ischemic stroke.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Kirin, Mitsubishi Tanabe
Trial suspension: PLATyPuS: Inhaled Tissue Plasminogen Activator for Acute Plastic Bronchitis (clinicaltrials.gov) - Mar 23, 2020
P2, N=24, Suspended,
The present analyses of real-world Asian acute stroke registry data suggest that low-dose intravenous alteplase has overall comparable efficacy for functional recovery and greater potential safety in terms of reduced mortality, to standard-dose alteplase for the treatment of acute ischemic stroke. Recruiting --> Suspended
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Journal: Early Fibrinogen Depletion and Symptomatic Intracranial Hemorrhage After Reperfusion Therapy. (Pubmed Central) - Mar 22, 2020
P=N/A
Methods- This study included 1135 stroke patients with baseline and follow-up fibrinogen levels at 2 hours after the beginning of alteplase infusion for those with IVT only or immediately after the end of EVT for those with combined IVT and EVT...Clinical Trial Registration- URL: https://www.clinicaltrials.gov. Unique identifier: NCT03367286.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Journal: Educating Paramedics on the Finger-to-Nose Test Improves Recognition of Posterior Stroke. (Pubmed Central) - Mar 22, 2020
We compared the change in posterior stroke recognition, door-to-CT times, and alteplase delivery between the FTN (intervention) and control agencies...Conclusions- Paramedics trained in the FTN test were more likely to identify posterior stroke. If future studies confirm these findings, such training may expedite the care of posterior stroke patients transported by EMS.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Journal: Clot Burden Score and Early Ischemia Predict Intracranial Hemorrhage following Endovascular Therapy. (Pubmed Central) - Mar 18, 2020
However, in our experience, this beneficial effect is strongly influenced by FD at admission. Radiologic factors, early ischemia on CT, and increased CTA clot burden are associated with an increased risk of intracranial hemorrhage in patients undergoing endovascular therapy.
- |||||||||| Right Heart Thrombus in Transit (PENNSYLVANIA CONVENTION CENTER, Hall D-E (200 Level), Area B) - Mar 15, 2020 - Abstract #ATS2020ATS_9968;
We present a complex case of recent subdural hematoma with diagnosed with echocardiography that was managed with catheter thrombolysis with good outcome.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.Discussion Right heart clot in transit is a medical emergency with high mortality, 25 to 40%, that requires immediate evaluation and treatment1,2...Patients treated with thrombolysis or surgical thrombectomy have shown lower mortality rates compared to anticoagulation alone2. Our patient was managed by neurosurgery, interventional cardiology and intensivist team together.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Post Pneumonectomy Pulmonary Embolism: A Perplexing Problem (PENNSYLVANIA CONVENTION CENTER, Hall D-E (200 Level), Area B) - Mar 15, 2020 - Abstract #ATS2020ATS_9917;
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.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Full Dose Alteplase Delivered as an Intravenous Bolus for Massive Pulmonary Embolism During Cardiac Arrest in an Elderly Patient (PENNSYLVANIA CONVENTION CENTER, Hall D-E (200 Level), Area B) - Mar 15, 2020 - Abstract #ATS2020ATS_9913;
Subsequently, patient was supported with norepinephrine, vasopressin, epinephrine, milrinone and intravenous epoprostenol along with continuous renal replacement therapy and mechanical ventilation for 1 week until extubated...Large randomized controlled trials may prove unfeasible given the small proportion of patients with massive PE and the ethical conundrum to treat patients with a placebo. Registries and case series could be further useful to guide medical decision-making.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
A Case of Delayed Catheter-Directed Thrombolysis in the Management of Acute Bilateral Pulmonary Embolism (PENNSYLVANIA CONVENTION CENTER, Hall D-E (200 Level), Area B) - Mar 15, 2020 - Abstract #ATS2020ATS_9911;
Alteplase infusion was commenced at 1 mg/h, and continued for 24 hours...The patient’s pain and dyspnoea ha resolved and he was weaned off oxygen. He was converted to a direct oral anticoagulant and discharged home on the 4th hospital day.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Massive Pulmonary Embolism with a Large Right Heart Thrombus Diagnosed by Point of Care Ultrasound on a Patient Presenting with Chest Pain and Circulatory Shock (PENNSYLVANIA CONVENTION CENTER, Hall D-E (200 Level), Area B) - Mar 15, 2020 - Abstract #ATS2020ATS_9909;
POCUS plays a key role in the evaluation of acute chest pain with circulatory shock. Differential diagnosis can be rapidly established, such as cardiogenic shock due to myocardial infarction (low cardiac output with focal hypokinesia) or obstructive shock due to PE (ventricular septal deviation and RV failure) or due to tension pneumothorax (absence of pulmonary B lines and absence of pleural sliding), avoiding invasive procedures and shortening the time to start therapy.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Sleep or Stroke? (PENNSYLVANIA CONVENTION CENTER, Hall D-E (200 Level), Area A) - Mar 15, 2020 - Abstract #ATS2020ATS_9605;
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
‘Tis the Season to Be Wary; a Case of Fatal EEE in Western Massachusetts (PENNSYLVANIA CONVENTION CENTER, Hall D-E (200 Level), Area A) - Mar 15, 2020 - Abstract #ATS2020ATS_9520;
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.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Endobronchial Ultrasound Assessment of Central Pulmonary Vasculature in Critically Ill Intubated Adults: A Case Series (PENNSYLVANIA CONVENTION CENTER, Hall D-E (200 Level), Area G) - Mar 15, 2020 - Abstract #ATS2020ATS_7809;
She developed cardiac arrest and was administered 100 mg intravenous alteplase...EBUS to assess the proximal pulmonary vasculature for pulmonary emboli in critically ill patients is a potentially valuable tool, although further study is needed.Figure 1. Thrombus in the distal right pulmonary artery seen on both (A) computed tomography pulmonary angiography and (B) endobronchial ultrasound
- |||||||||| Pulmozyme (dornase alfa) / Roche
Intrapleural Lytic Therapy to Treat a Rare Cause of Pleural Effusion (PENNSYLVANIA CONVENTION CENTER, Hall D-E (200 Level), Area G) - Mar 15, 2020 - Abstract #ATS2020ATS_7788;
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.
- |||||||||| Pulmozyme (dornase alfa) / Roche, amoxicillin / Generic mfg.
Eikenella Corrodens as Primary Cause in Pulmonary Infection (PENNSYLVANIA CONVENTION CENTER, Hall D-E (200 Level), Area B) - Mar 15, 2020 - Abstract #ATS2020ATS_7294;
Patient was then discharged home to complete a four week antibiotic course with Amoxicillin.In this case, Eikenella corrodens was isolated from pleural culture in an immunocompetent individual...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
Complicated Parapneumonic Effusion Growing Chryseobacterium in a Newly Diagnosed Diabetic (PENNSYLVANIA CONVENTION CENTER, Hall D-E (200 Level), Area B) - Mar 15, 2020 - Abstract #ATS2020ATS_7287;
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 data6.
|
