scholarly journals Methodology for the Canadian Activase for Stroke Effectiveness Study (CASES)

2001 ◽  
Vol 28 (3) ◽  
pp. 232-238 ◽  
Author(s):  
Michael D. Hill ◽  
Alastair M. Buchan ◽  
The CASES Investigators
Keyword(s):  
Ischemic Stroke ◽  
Recombinant Tissue Plasminogen Activator ◽  
Effectiveness Study ◽  
Multiple Stakeholders ◽  
Stakeholder Collaboration ◽  
Stroke Treatment ◽  
Early Results ◽  
Canadian Context ◽  
Tissue Plasminogen ◽  
Multi Stakeholder

Background:Intravenous recombinant tissue plasminogen activator (tPA, alteplase) was conditionally licensed for the treatment of acute ischemic stroke (AIS) in Canada on February 17, 1999. As a condition of licensure, the Canadian Activase for Stroke Effectiveness Study (CASES) was established to monitor the use of alteplase for AIS in Canada. The study involves multiple stakeholders.Methods:CASES is a prospective registry of patients treated with alteplase for AIS. The purposes of this registry are to ensure the safety of the drug in the Canadian context, to assess effectiveness of alteplase for AIS and to gather further information to try to establish which patients are most likely to benefit from treatment.Results:Both community (n=25) and tertiary centres (n=35) have enrolled a total of 944 patients to date. Early results suggest that thrombolytic stroke treatment is both safe and effective among these centres.Conclusion:This paper outlines the development of and methods for the CASES study. The study is an example of a multi-stakeholder collaboration to advance the care of patients with acute stroke.

scholarly journals Investigation of Recombinant Tissue Plasminogen Activator Complications in Treatment of patients with ischemic stroke visiting Vali-e-Asr hospital in Birjand, 2016-2017

2019 ◽  
Author(s):  
Hamid Reza Riasi ◽  
Elham Zarei ◽  
Forod Salehi ◽  
Fatemeh Sayehmiri
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Treatment Options ◽  
Recombinant Tissue Plasminogen Activator ◽  
Current Treatment ◽  
Fisher Exact Test ◽  
Stroke Treatment ◽  
Tissue Plasminogen

Abstract Background: Current treatment options for the sake of treating acute ischemic stroke include recombinant tissue plasminogen activator or dual anti platelet therapies. This study aims to evaluate the complications of recombinant tissue plasminogen activator in treatment of patients with ischemic stroke who were admitted in Vali-e-Asr hospital in Birjand, 2016-2017. Method: This descriptive analytic study was performed on patients with acute ischemic stroke who were admitted in neurology ward of Vali-e-Asr hospital in Birjand from 2016 to 2017. A total of 127 patients participated in this study. The data about complications of treatment were collected by questionnaires and entered into SPSS 21. Then, data were analyzed by Chi-square or Fisher exact test at a significant level of p≤ 0.5. Results: A total of 127 subjects received treatment for ischemic stroke. Thirty-one (24.4%) patients have been treated with recombinant tissue plasminogen activator and ninety-six (75.6%) have been treated conventionally with dual antiplatelet. These two groups were matched in terms of age and sex. The history of hypertension in the recombinant tissue plasminogen activator group and the conventional treatments were 32.3% and 67.7%, respectively (p=0.03). 99% of patients in the antiplatelet treatment group (N=96) and 96.8% of patients in the recombinant tissue plasminogen activator group (N=31) have been discharged and one death was occurred in each group (p=0.4). Regarding the incidence of recombinant tissue plasminogen activator complications, IVH was reported in two patients (6.5%, p = 0.06) Conclusion: The incidence of mortality was the same in two groups. Also, complications were only reported in two patients in the recombinant tissue plasminogen activator group (both intraventricular hemorrhage) and the difference was not statistically significant. Researchers recommend that more clinical trials must be conducted. If it is approved, the findings of the current studies will be widely taken into consideration for acute stroke treatment.

Association of admission leukocyte count with clinical outcomes in acute ischemic stroke patients undergoing intravenous thrombolysis with recombinant tissue plasminogen activator

2020 ◽  
Vol 17 ◽  
Author(s):  
Jie Chen ◽  
Fu-Liang Zhang ◽  
Shan Lv ◽  
Hang Jin ◽  
Yun Luo ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Leukocyte Count ◽  
Intravenous Thrombolysis ◽  
Recombinant Tissue Plasminogen Activator ◽  
Functional Independence ◽  
Tissue Plasminogen ◽  
Poor Outcomes

Objective:: Increased leukocyte count are positively associated with poor outcomes and all-cause mortality in coronary heart disease, cancer, and ischemic stroke. The role of leukocyte count in acute ischemic stroke (AIS) remains important. We aimed to investigate the association between admission leukocyte count before thrombolysis with recombinant tissue plasminogen activator (rt-PA) and 3-month outcomes in AIS patients. Methods:: This retrospective study included consecutive AIS patients who received intravenous (IV) rt-PA within 4.5 h of symptom onset between January 2016 and December 2018. We assessed outcomes including short-term hemorrhagic transformation (HT), 3-month mortality, and functional independence (modified Rankin Scale [mRS] score of 0–2 or 0–1). Results:: Among 579 patients who received IV rt-PA, 77 (13.3%) exhibited HT at 24 h, 43 (7.4%) died within 3 months, and 211 (36.4%) exhibited functional independence (mRS score: 0–2). Multivariable logistic regression revealed admission leukocyte count as an independent predictor of good and excellent outcomes at 3 months. Each 1-point increase in admission leukocyte count increased the odds of poor outcomes at 3 months by 7.6% (mRS score: 3–6, odds ratio (OR): 1.076, 95% confidence interval (CI): 1.003–1.154, p=0.041) and 7.8% (mRS score: 2–6, OR: 1.078, 95% CI: 1.006–1.154, p=0.033). Multivariable regression analysis revealed no association between HT and 3-month mortality. Admission neutrophil and lymphocyte count were not associated with 3-month functional outcomes or 3-month mortality. Conclusion:: Lower admission leukocyte count independently predicts good and excellent outcomes at 3 months in AIS patients undergoing rt-PA treatment.

Dl-3-n-Butylphthalide (NBP): A Promising Therapeutic Agent for Ischemic Stroke

2018 ◽  
Vol 17 (5) ◽  
pp. 338-347 ◽  
Author(s):  
Shan Wang ◽  
Fei Ma ◽  
Longjian Huang ◽  
Yong Zhang ◽  
Yuchen Peng ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Complex Disease ◽  
Time Window ◽  
Recombinant Tissue Plasminogen Activator ◽  
Research Progress ◽  
Apium Graveolens ◽  
Synthetic Compound ◽  
Stroke Treatment ◽  
Single Target ◽  
Anti Oxidant

Background and Objective: Stroke is a leading cause of morbidity and mortality in both developed and developing countries all over the world. The only drug for ischemic stroke approved by FDA is recombinant tissue plasminogen activator (rtPA). However, only 2-5% stroke patients receive rtPAs treatment due to its strict therapeutic time window. As ischemic stroke is a complex disease involving multiple mechanisms, medications with multi-targets may be more powerful compared with single-target drugs. Dl-3-n-Butylphthalide (NBP) is a synthetic compound based on l-3-n- Butylphthalide that is isolated from seeds of Apium graveolens. The racemic 3-n-butylphthalide (dl- NBP) was approved by Food and Drug Administration of China for the treatment of ischemic stroke in 2002. A number of clinical studies indicated that NBP not only improved the symptoms of ischemic stroke, but also contributed to the long-term recovery. The potential mechanisms of NBP for ischemic stroke treatment may target different pathophysiological processes, including anti-oxidant, antiinflammation, anti-apoptosis, anti-thrombosis, and protection of mitochondria et al. Conclusion: In this review, we have summarized the research progress of NBP for the treatment of ischemic stroke during the past two decades.

Abstract TP286: A Literature Review of Cost-effectiveness of Intravenous Recombinant Tissue Plasminogen Activator for Treating Acute Ischemic Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Guijing Wang ◽  
Heesoo Joo ◽  
Mary G George
Keyword(s):  
Ischemic Stroke ◽  
Cost Effectiveness ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Cost Effective ◽  
Recombinant Tissue Plasminogen Activator ◽  
Tissue Plasminogen ◽  
The Cost ◽  
Effectiveness Studies

Introduction: Intravenous recombinant tissue plasminogen activator (IV rtPA) is recommended treatment for acute ischemic stroke patients, but the cost-effectiveness of IV rtPA within different time windows after the onset of acute ischemic stroke is not well reviewed. Objectives: We conducted a literature review of the cost-effectiveness studies about IV rtPA. Methods: A literature search was conducted using PubMed, MEDLINE, and EconLit, with the key words stroke, cost, economic benefit, saving, cost-effectiveness, tissue plasminogen activator, and rtPA. The review is limited to original research articles published during 1995–2014 in English-language peer-reviewed journals. Results: We found 15 studies meeting our criteria for this review. Nine of them were cost-effectiveness studies of IV rtPA treatment within 0-3 hours after stroke onset, 2 studies within 3-4.5 hours, 3 studies within 0-4.5 hours, and 1 study within 0-6 hours. IV rtPA is a cost-saving or a cost-effectiveness strategy from most of the study results. Only one study showed incremental cost-effectiveness ratio of IV rtPA within one year was marginally above $50,000 per QALY threshold. IV rtPA within 0-3 hours after stroke led to cost savings for lifetime or 30 years, and IV rtPA within 3-4.5 hours after stroke increased costs but still was cost-effective. Conclusions: The literature generally showed that intravenous IV rtPA was a dominant or a cost-effective strategy compared to traditional treatment for acute ischemic stroke patients without IV rtPA. The findings from the literature lacked generalizability because of limited data and various assumptions.

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