scholarly journals Predicting the Risk of Symptomatic Intracerebral Hemorrhage in Ischemic Stroke Treated With Intravenous Alteplase

Stroke ◽  
2012 ◽  
Vol 43 (6) ◽  
pp. 1524-1531 ◽  
Author(s):  
Michael Mazya ◽  
José A. Egido ◽  
Gary A. Ford ◽  
Kennedy R. Lees ◽  
Robert Mikulik ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Intravenous Alteplase

scholarly journals Low-dose versus standard-dose alteplase in acute ischemic stroke in Asian stroke registries: an individual patient data pooling study

2019 ◽  
Vol 14 (7) ◽  
pp. 670-677
Author(s):  
Xia Wang ◽  
Jingwei Li ◽  
Tom J Moullaali ◽  
Keon-Joo Lee ◽  
Beom Joon Kim ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Acute Stroke ◽  
Acute Ischemic Stroke ◽  
Real World ◽  
Low Dose ◽  
Standard Dose ◽  
Stroke Registry ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Intravenous Alteplase

Objective To investigate the comparative efficacy and safety of the low-dose versus standard-dose alteplase using real-world acute stroke registry data from Asian countries. Methods Individual participant data were obtained from nine acute stroke registries from China, Japan, Philippines, Singapore, South Korea, and Taiwan between 2005 and 2018. Inverse probability of treatment weight was used to remove baseline imbalances between those receiving low-dose versus standard-dose alteplase. The primary outcome was death or disability defined by modified Rankin Scale scores of 2 to 6 at 90 days. Secondary outcomes were symptomatic intracerebral hemorrhage and death. Generalized linear mixed models with the individual registry as a random intercept were performed to determine associations of treatment with low-dose alteplase and outcomes. Results Of the 6250 patients (mean age 66 years, 36% women) included in these analyses, 1610 (24%) were treated with low-dose intravenous alteplase. Clinical outcomes for low-dose alteplase were not significantly different to those for standard-dose alteplase, adjusted odds ratios for death or disability: 1.00 (0.85–1.19) and symptomatic intracerebral hemorrhage 0.87 (0.63–1.19), except for lower death with borderline significance, 0.77 (0.59–1.01). Conclusions 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.

Abstract TP404: D-Dimer Elevation Following Intravenous Alteplase Can Predict Early Recurrence of Ischemic Stroke and Symptomatic Intracerebral Hemorrhage

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Masaya Kumamoto ◽  
Masatoshi Koga ◽  
Takeshi Yashimoto ◽  
Hiroshi Yamagami ◽  
Masafumi Ihara ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Early Recurrence ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Intravenous Alteplase ◽  
D Dimer

scholarly journals Mechanical Thrombectomy in Ischemic Stroke Patients With Alberta Stroke Program Early Computed Tomography Score 0–5

Stroke ◽  
2019 ◽  
Vol 50 (4) ◽  
pp. 880-888 ◽  
Author(s):  
Johannes Kaesmacher ◽  
Panagiotis Chaloulos-Iakovidis ◽  
Leonidas Panos ◽  
Pasquale Mordasini ◽  
Patrik Michel ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Mechanical Thrombectomy ◽  
Functional Independence ◽  
Favorable Outcome ◽  
Large Vessel Occlusion ◽  
Stroke Patients ◽  
Anterior Circulation ◽  
Vessel Occlusion ◽  
Symptomatic Intracerebral Hemorrhage

Background and Purpose— If anterior circulation large vessel occlusion acute ischemic stroke patients presenting with ASPECTS 0–5 (Alberta Stroke Program Early CT Score) should be treated with mechanical thrombectomy remains unclear. Purpose of this study was to report on the outcome of patients with ASPECTS 0–5 treated with mechanical thrombectomy and to provide data regarding the effect of successful reperfusion on clinical outcomes and safety measures in these patients. Methods— Multicenter, pooled analysis of 7 institutional prospective registries: Bernese-European Registry for Ischemic Stroke Patients Treated Outside Current Guidelines With Neurothrombectomy Devices Using the SOLITAIRE FR With the Intention for Thrombectomy (Clinical Trial Registration—URL: https://www.clinicaltrials.gov . Unique identifier: NCT03496064). Primary outcome was defined as modified Rankin Scale 0–3 at day 90 (favorable outcome). Secondary outcomes included rates of day 90 modified Rankin Scale 0–2 (functional independence), day 90 mortality and occurrence of symptomatic intracerebral hemorrhage. Multivariable logistic regression analyses were performed to assess the association of successful reperfusion with clinical outcomes. Outputs are displayed as adjusted Odds Ratios (aOR) and 95% CI. Results— Two hundred thirty-seven of 2046 patients included in this registry presented with anterior circulation large vessel occlusion and ASPECTS 0–5. In this subgroup, the overall rates of favorable outcome and mortality at day 90 were 40.1% and 40.9%. Achieving successful reperfusion was independently associated with favorable outcome (aOR, 5.534; 95% CI, 2.363–12.961), functional independence (aOR, 5.583; 95% CI, 1.964–15.873), reduced mortality (aOR, 0.180; 95% CI, 0.083–0.390), and lower rates of symptomatic intracerebral hemorrhage (aOR, 0.235; 95% CI, 0.062–0.887). The mortality-reducing effect remained in patients with ASPECTS 0–4 (aOR, 0.167; 95% CI, 0.056–0.499). Sensitivity analyses did not change the primary results. Conclusions— In patients presenting with ASPECTS 0–5, who were treated with mechanical thrombectomy, successful reperfusion was beneficial without increasing the risk of symptomatic intracerebral hemorrhage. Although the results do not allow for general treatment recommendations, formal testing of mechanical thrombectomy versus best medical treatment in these patients in a randomized controlled trial is warranted.

scholarly journals Dose-Related Effects of Statins on Symptomatic Intracerebral Hemorrhage and Outcome After Thrombolysis for Ischemic Stroke

Stroke ◽  
2014 ◽  
Vol 45 (2) ◽  
pp. 509-514 ◽  
Author(s):  
Jan F. Scheitz ◽  
David J. Seiffge ◽  
Serdar Tütüncü ◽  
Henrik Gensicke ◽  
Heinrich J. Audebert ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Symptomatic Intracerebral Hemorrhage

Intra-arterial Reteplase and Intravenous Abciximab in Patients with Acute Ischemic Stroke: An Open-label, Dose-ranging, Phase I Study

Neurosurgery ◽  
2006 ◽  
Vol 59 (4) ◽  
pp. 789-797 ◽  
Author(s):  
Adnan I. Qureshi ◽  
Pansy Harris-Lane ◽  
Jawad F. Kirmani ◽  
Nazli Janjua ◽  
Afshin A. Divani ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Acute Ischemic Stroke ◽  
Symptom Onset ◽  
Favorable Outcome ◽  
Platelet Glycoprotein ◽  
Open Label ◽  
Neurological Improvement ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Label Dose

Abstract OBJECTIVE: New approaches are focusing on using a combination of medication that lyse fibrin and prevent aggregation of platelets to achieve higher rates of recanalization and improved clinical outcomes. METHODS: A prospective, nonrandomized, open-label trial evaluated the safety of an escalating dose of reteplase in conjunction with intravenous abciximab (platelet glycoprotein IIb/IIIa inhibitor) in patients with acute ischemic stroke (3–6 h after symptom onset). The primary endpoint was symptomatic intracerebral hemorrhage at 24 to 72 hours, and secondary endpoints were partial or complete recanalization (≥ one grade improvement), early neurological improvement (decrease in National Institutes of Health Stroke Scale ≥ 4 at 24 h), and favorable outcome at 1 month (defined by modified Rankin scale ≤ 2). RESULTS: A total of 20 patients (mean age, 65 yr; 13 men) were recruited. Five patients were recruited in each of the escalating tiers of intra-arterial reteplase (0.5, 1, 1.5, and 2 units). Intravenous abciximab (0.25 mg/kg bolus followed by 0.125 μg/kg/min) was successfully administered in 18 out of 20 patients. The safety stopping rule was not activated in any of the tiers. One symptomatic intracerebral hemorrhage was observed in one of the 20 patients (in the 1-unit tier). Partial or complete recanalization was observed in 13 of the 20 patients. Thirteen patients demonstrated early neurological improvement, and favorable outcome at 1 month was observed in six patients. CONCLUSION: In this study, a combination of intra-arterial reteplase and intravenous abciximab was safely administered to patients with ischemic stroke presenting between 3 and 6 hours after symptom onset.

scholarly journals PREDIKTOR SYMPTOMATIC INTRACEREBRAL HEMORRHAGE PASCATROMBOLISIS INTRAVENA PADA STROKE ISKEMIK AKUT

2018 ◽  
Vol 35 (3) ◽  
Author(s):  
Al Rasyid ◽  
Salim Harris ◽  
Mohammad Kurniawan ◽  
Rakhmad Hidayat ◽  
Taufik Mesiano
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Intracerebral Hemorrhage ◽  
Intravenous Thrombolysis ◽  
Definitive Treatment ◽  
Stroke Patients ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Stroke Thrombolysis ◽  
Withholding Therapy ◽  
Diabetes Melitus

PREDICTORS OF SYMPTOMATIC INTRACEREBRAL HEMORRHAGE FOLLOWING INTRAVENOUS THROMBOLYSIS IN ACUTE ISCHEMIC STROKEABSTRACTDespite its effectiveness, the percentage of ischemic stroke patients who received definitive treatment, thrombolysis, never went above 10%, due to one of the reason is the occurrence of severe, post-therapeutic complications, such as symptomatic intracerebral hemorrhage (sICH). Several factors contribute to sICH occurrence are age, severity of stroke, early changes of ischemic sign, hyperglycemia, blood pressure, antiplatelet use and its interval. Patients with highest risk of sICH has been shown to have the greatest benefits from thrombolysis among other subgroup patients, therefore withholding therapy is not a choice. Compliance to the stroke’s guidelines could reduce the risk of complications as well as boost effectiveness of treatment.Keywords: Safety predictors, acute ischemic stroke, thrombolysis, sICH ABSTRAK Walau terbukti efektif, persentase pasien yang dapat dilakukan tindakan definitif stroke iskemik akut berupa trombolisis  tidak  pernah  mencapai  angka  10%,  salah  satunya  disebabkan  pertimbangan  terhadap  komplikasi  berat, seperti symptomatic intracerebral hemorrhage (sICH). Beberapa faktor yang berpengaruh terhadap kejadian sICH antara lain usia, derajat stroke, perubahan tanda iskemik dini, hiperglikemia dan diabetes melitus, tekanan darah, penggunaan antiplatelet, serta waktu pemberian. Pasien dengan risiko sICH tertinggi memiliki keuntungan terbesar dari trombolisis sehingga menunda tindakan bukanlah suatu opsi. Kepatuhan terhadap panduan tindakan dapat mengurangi angka kejadian komplikasi berat.Kata kunci: Prediktor keamanan, stroke iskemik akut, trombolisis, sICH

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