Abstract WP84: Thrombolysis is Safe in the Nonagenarians With Acute Ischemic Stroke

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Tapan Abrol ◽  
Zeeshan Hussain ◽  
Varun Chaubal ◽  
Gaurav Dighe ◽  
Muhammad F Bilal ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Multiple Logistic Regression Analysis ◽  
Discharge Disposition ◽  
Intravenous Tissue Plasminogen Activator ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Tissue Plasminogen ◽  
History Of ◽  
Symptomatic Intracranial Hemorrhage ◽  
Iv Tpa

Introduction: People aged 90 years or older are the fastest growing group in North America. This group was excluded from traditional clinical trials of intravenous tissue plasminogen activator (iv tPA) thrombolysis. IV tPA is the most beneficial emergent therapy in acute ischemic stroke (AIS). We have compassionately treated AIS patients in this age group with iv tPA in recent years. Hypothesis: Our aim is to evaluate the safety and outcome of iv tPA use in nonagenarian patients with AIS Methods: Consecutively iv tPA-treated AIS patients who were older than 90 years and were admitted at our institution from January 2004-June 2015 were included. The administration of iv tPA was within 3 hours after the stroke onset. We reviewed the clinical features of the patients at presentation, complications, and outcomes. Outcome measures at discharge included improvement of NIHSS, mRS, symptomatic intracranial hemorrhage (sICH), and discharge disposition. We also assessed the rate of complications of iv tPA. Multiple logistic regression analysis was used to evaluate association between the outcome versus the severity of stroke, or versus pre-stroke dependence. Results: A total of 35 AIS patients who were 90 years or older (female 80%; and median age 93 years old) were treated with iv tPA. At baseline twenty-two patients (62.9%) had a history of atrial fibrillation without anticoagulation, and more than half (20/35) patients needed assistance for gait instability, but they were otherwise functional. Median NIHSS on admission was 16 (IQR 9-22). Two patients (5.7%) had symptomatic intracerebral hemorrhage. At discharge the median NIHSS was 10 (IQR 1-19). Ten patients (28.6%) had favorable outcome (mRS ≤ 2) while sixteen patients (45.7%) had good outcome (mRS ≤ 3). Four patients were discharged home and 16 patients went to rehabilitation facility. Fifteen patients (42.9%) succumbed to cardio-pulmonary failure or were discharged to hospice. Mild AIS patients (NIHSS <7) had better outcomes (p < 0.05). The pre-existing dependence (mRS ≥3) did not predict poor outcome. Conclusion: It is safe to administer iv tPA to AIS patients who are 90 years or older although the benefits are less robust compared to younger patients. Patients with milder deficits had more favorable outcomes.

A Pregnant Woman with Aphasia and Right-Sided Weakness

2017 ◽  
Author(s):  
M. Angela O’Neal
Keyword(s):  
Ischemic Stroke ◽  
Pregnant Woman ◽  
Acute Ischemic Stroke ◽  
Case Series ◽  
Intravenous Tissue Plasminogen Activator ◽  
Common Causes ◽  
Tissue Plasminogen ◽  
Multiple Trials ◽  
Iv Tpa ◽  
In Pregnancy

This chapter discusses the evaluation and management of acute ischemic stroke in pregnancy. Stroke in pregnancy is rare, but is a significant cause of morbidity. The etiologies of stroke in pregnancy are diverse. The most common causes in hospital-based studies are cardioembolic or related to eclampsia. The use of intravenous tissue plasminogen activator (IV tPA) as well as intra-arterial clot retrieval in stroke have been validated by multiple trials. Small case series support the safety of both therapies in pregnancy. Therefore, the management of stroke in pregnancy should be based on the mechanism and severity of the stroke, not on obstetrical issues.

Treatment of Acute Right-Sided Weakness

2016 ◽  
Author(s):  
Ji Y. Chong ◽  
Michael P. Lerario
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Symptom Onset ◽  
Randomized Trials ◽  
Stroke Therapy ◽  
Eligibility Criteria ◽  
Off Label ◽  
Intravenous Tissue Plasminogen Activator ◽  
Tissue Plasminogen ◽  
Iv Tpa

Intravenous tissue plasminogen activator (IV tPA) is the mainstay of stroke therapy and is US Food and Drug Administration-approved for the treatment of acute ischemic stroke. Its benefit on functional outcome has been established in multiple randomized trials when administered within 3 hours. Select patients may be treated off-label up to 4.5 hours from symptom onset. Eligibility criteria need to be reviewed carefully to optimize benefit and to minimize complications, namely reperfusion hemorrhage.

Abstract 2281: Full Dose IV-tPA Followed By IA Therapy For Acute Ischemic Stroke Does Not Increase Morbidity Or Mortality

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Jeffrey M Katz ◽  
Calvin Natanzon ◽  
Avi Setton ◽  
Richard Libman
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Control Group ◽  
Bridging Therapy ◽  
Full Dose ◽  
Tissue Plasminogen ◽  
Symptomatic Intracranial Hemorrhage ◽  
The Mean ◽  
Iv Tpa

Background and Purpose: “Bridging Therapy” is well described in the literature. However the dose of bridging tissue plasminogen activator (tPA) is a matter of debate given the well-established guideline of 0.9 mg/kg as the standard intravenous dose. Previous and ongoing bridging trials use lower doses of IV-tPA (0.6 mg/kg) with a goal of maximizing safety. Our aim was to explore whether full bridging dose IV-tPA at 0.9 mg/kg can be given safely in combination with intra-arterial (IA)-tPA. Methods: Data were collected prospectively on 47 consecutive patients with acute ischemic stroke who were treated with endovascular stroke therapy (EST, that is IA-tPA +/- mechanical embolectomy (ME)). Patients who were candidates for IV-tPA, who did not clinically improve after receiving full dose IV-tPA (0.9mg/Kg), underwent EST (bridging group, n=23, 15/23 IA-tPA + ME). These patients were compared to patients treated with EST alone because they were not candidates for IV-tPA (control group, n=24, 14/24 IA-tPA + ME). Symptomatic intracranial hemorrhage (ICH) rates were recorded, as defined in the NINDS IV-tPA trial. Death rates were recorded at one month and modified Rankin score was used to measure functional outcome (6 month mean follow-up). Results: Mean age was 62 years in the bridging group and 63 years in the control group. Baseline mean National Institute of Health Stroke Scale was 20 in the bridging group and 21 in the control group (p = 0.188). The mean IA-tPA dose was 14.4 mg in the bridging group and 18.3 mg in the control group (p = 0.371). There was an 8% risk of symptomatic ICH in the control group and no symptomatic ICH in the bridging group (p = 0.155). At 30 days, mortality was 17% in the bridging group and 29% in the control group (p = 0.313). The mean follow-up modified Rankin score was 3 in the bridging group and 4 in the control group (p = 0.20). Conclusion: This non-randomized retrospective cohort study suggests that full dose IV-tPA combined with IA-tPA administered during EST is safe in patients with acute ischemic stroke. Given the possibility that full bridging dose tPA may be more effective than lower dose IV-tPA, a prospective, randomized bridging trial using full dose IV-tPA may be warranted.

scholarly journals Imaging Evidence for Cerebral Hyperperfusion Syndrome after Intravenous Tissue Plasminogen Activator for Acute Ischemic Stroke

2016 ◽  
Vol 2016 ◽  
pp. 1-5
Author(s):  
Yi Zhang ◽  
Abhay Kumar ◽  
John B. Tezel ◽  
Yihua Zhou
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Cerebral Hyperperfusion Syndrome ◽  
Hyperperfusion Syndrome ◽  
Cerebral Hyperperfusion ◽  
Intravenous Tissue Plasminogen Activator ◽  
Tissue Plasminogen ◽  
Iv Tpa

Background. Cerebral hyperperfusion syndrome (CHS), a rare complication after cerebral revascularization, is a well-described phenomenon after carotid endarterectomy or carotid artery stenting. However, the imaging evidence of CHS after intravenous tissue plasminogen activator (iv tPA) for acute ischemic stroke (AIS) has not been reported.Case Report. Four patients were determined to have manifestations of CHS with clinical deterioration after treatment with iv tPA, including one patient who developed seizure, one patient who had a deviation of the eyes toward lesion with worsened mental status, and two patients who developed worsened hemiparesis. In all four patients, postthrombolysis head CT examinations were negative for hemorrhage; CT angiogram showed patent cervical and intracranial arterial vasculature; CT perfusion imaging revealed hyperperfusion with increased relative cerebral blood flow and relative cerebral blood volume and decreased mean transit time along with decreased time to peak in the clinically related artery territory. Vascular dilation was also noted in three of these four cases.Conclusions. CHS should be considered in patients with clinical deterioration after iv tPA and imaging negative for hemorrhage. Cerebral angiogram and perfusion studies can be useful in diagnosing CHS thereby helping with further management.

scholarly journals Not only the Sugar, Early infarct sign, hyperDense middle cerebral artery, Age, Neurologic deficit score but also atrial fibrillation is predictive for symptomatic intracranial hemorrhage after intravenous recombinant tissue plasminogen activator

2017 ◽  
Vol 08 (01) ◽  
pp. 049-054 ◽  
Author(s):  
Sombat Muengtaweepongsa ◽  
Pornpoj Prapa-Anantachai ◽  
Pornpat A. Dharmasaroja
Keyword(s):  
Heart Disease ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Intracranial Hemorrhage ◽  
Cerebral Artery ◽  
Recombinant Tissue Plasminogen Activator ◽  
Tissue Plasminogen ◽  
History Of ◽  
Symptomatic Intracranial Hemorrhage ◽  
Hyperdense Middle Cerebral Artery

ABSTRACTBackground: Symptomatic intracranial hemorrhage (sICH) is the most unwanted adverse event in patients with acute ischemic stroke who received intravenous recombinant tissue plasminogen activator (i.v. rt-PA). Many tool scores are available to predict the probability of sICH. Among those scores, the Sugar, Early infarct sign, hyperDense middle cerebral artery, Age, Neurologic deficit (SEDAN) gives the highest area under the curve-receiver operating characteristic value. Objective: We aimed to examine any factors other than the SEDAN score to predict the probability of sICH. Methods: Patients with acute ischemic stroke treated with i.v. rt-PA within 4.5 h time window from January 2010 to July 2012 were evaluated. Compiling demographic data, risk factors, and comorbidity (hypertension, diabetes mellitus, dyslipidemia, atrial fibrillation (AF), ischemic heart disease, valvular heart disease, previous stroke, gout, smoking cigarette, drinking alcoholic beverage, family history of stroke, and family history of ischemic heart disease), computed tomography scan of patients prior to treatment with rt-PA, and assessing the National Institutes of Health Stroke Scale (NIHSS) score for the purpose of calculating SEDAN score were analyzed. Results: Of 314 patients treated with i.v. rt-PA, there were 46 ICH cases (14.6%) with 14 sICH (4.4%) and 32 asymptomatic intracranial hemorrhage cases (10.2%). The rate of sICH occurrence was increased in accordance with the increase in the SEDAN score and AF. Age over 75 years, early infarction, hyperdense cerebral artery, baseline blood sugar more than 12 mmol/l, NIHSS as 10 or more, and AF were the risk factors to develop sICH after treated with rt-PA at 1.535, 2.501, 1.093, 1.276, 1.253, and 2.492 times, respectively. Conclusions: Rather than the SEDAN score, AF should be a predictor of sICH in patients with acute ischemic stroke after i.v. rt-PA treatment in Thai population.

Systemic Inflammation Indices in Patients With Acute Ischemic Stroke Treated With Intravenous Tissue Plasminogen Activator: Clinical Yield and Utility

Angiology ◽  
2020 ◽  
pp. 000331972096999
Author(s):  
Mehmet Akif Topcuoglu ◽  
Mehmet Yasir Pektezel ◽  
Ezgi Yilmaz ◽  
Ethem Murat Arsava
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Clinical Utility ◽  
Lymphocyte Ratio ◽  
Intravenous Tissue Plasminogen Activator ◽  
Tissue Plasminogen ◽  
Immune Inflammation ◽  
Iv Tpa

Inflammation indices derived from complete blood counts (CBCs) have been proposed to estimate benefit and risk of intravenous (IV) tissue plasminogen activator (tPA) in acute ischemic stroke. In 165 acute ischemic patients, the neutrophil-to-lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio, and systemic immune-inflammation index (SII) were calculated before and 24 hours after IV tPA. The area under receiver operating characteristic (AUC-ROC) curves, and positive and negative likelihood ratios (+LR,−LR) were produced to measure their diagnostic accuracy and clinical utility for tPA effectiveness, hemorrhage risk and third-month prognosis. None of the indices obtained “before” IV-tPA was found to be useful in determining acute and long-term functional efficacy and bleeding risk. Lymphocyte decrease, neutrophil increase, and parallel NLR and SII increase at the 24th-hour were associated with poor functional outcome. However, their clinical utility was not sufficient due to absence of effective thresholds. NLR threshold >5.65 provided ROC-AUC 0.86, sensitivity 71.3%, specificity 65.7%, −LR 0, +LR 3.76, and SII threshold >1781 had ROC-AUC 0.802, sensitivity 58.7%, specificity 72.7%, −LR 0.11, +LR 4.52, corresponding to an acceptable clinical yield. Systemic immune-inflammation index and NLR, but not other CBC-derived inflammatory parameters, have moderate utility as marker of tPA-related symptomatic hemorrhage occurrence.

Sign in / Sign up

Export Citation Format

Share Document