scholarly journals Successful intravenous thrombolysis in acute ischemic stroke after reversal of dabigatran etexilate with idarucizumab at the end of therapeutic time window

2020 ◽  
Vol 20 (2) ◽  
pp. 90
Author(s):  
Sabina Deveđija* ◽  
Gorana Vukorepa ◽  
Miljenko Crnjaković ◽  
Mirna Karakaš ◽  
Zeljka Cuk
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Time Window ◽  
Dabigatran Etexilate ◽  
Intravenous Thrombolysis ◽  
Therapeutic Time Window

Abstract T P10: Therapeutic Time Window for Endovascular Therapy of Acute Ischemic Stroke Depends on THRIVE Score: A Retrospective Single-center Study

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Kenichi Todo ◽  
Nobuyuki Sakai ◽  
Tomoyuki Kono ◽  
Taku Hoshi ◽  
Hirotoshi Imamura ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Time Window ◽  
Medical Center ◽  
Multivariate Logistic Regression Analysis ◽  
Symptom Duration ◽  
Vascular Events ◽  
Good Outcome ◽  
Therapeutic Time Window

Background and purpose: The outcome after endovascular therapy in acute ischemic stroke is associated with onset-to-reperfusion time (ORT). The Totaled Health Risks in Vascular Events (THRIVE) score is also an important pre-thrapeutic predictor of outcome. We hypothesized that the therapeutic time window is narrower in patients with the higher THRIVE score. Methods: We retrospectively studied consecutive 109 ischemic stroke patients with successful reperfusion after endovascular therapy between October 2005 and March 2014 at a single institute (Kobe City Medical Center General Hospital). Inclusion criteria was as follows: National Institutes of Health Stroke Scale (NIHSS) score ≥8, stroke symptom duration ≤8 h, premorbid modified Rankin Scale (mRS) score ≤2, and thrombolysis myocardial infarction score 2-3. We analyzed the relationships of ORT, THRIVE score, and THRIVE+ORT score with good outcome (mRS ≤2 at 3 months). The THRIVE+ORT score was defined as the sum of the THRIVE score and ORT (h). Results: Median ORT was 5.5 h (IQR; 4.4-7.1 h), median THRIVE score was 5 (IQR; 4-6), and median THRIVE+ORT score was 10.8 (IQR; 9.2-12.5). Good outcome rates for patients with ORT ≤4 h, >4 and ≤6 h, >6 and ≤8 h, and >8h were 50.0%, 45.8%, 37.0%, and 21.4%, respectively (p=0.3), those with THRIVE score ≤3, >3 and ≤5, >5 and ≤7, and >7 were 57.1%, 51.4%, 28.3%, and 20.0%, respectively (p9 and ≤11, >11 and ≤13, and >13 were 64.0%, 44.1%, 34.4%, and 16.7%, respectively (p<0.05). Multivariate logistic regression analysis revealed that THRIVE+ORT score was an independent predictor of good outcome after adjusted for THRIVE score (odds ratio [OR], 1.367; 95% confidence interval [CI], 1.082-1.728) or after adjusted for ORT (OR, 1.517: 95% CI, 1.160-1.983). Conclusion: Our study showed that THRIVE+ORT score was associated with outcome that was independent from THRIVE score or ORT. This is the first report to suggest that patients with the higher THRIVE score require the shorter ORT for good outcome.

scholarly journals Using thrombin time to evaluate the efficacy of anticoagulant therapy for acute cerebral infarction

2020 ◽  
Author(s):  
Qianqian Li ◽  
Tingjiao Liu ◽  
Shanshan Yang
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Time Window ◽  
Intravenous Thrombolysis ◽  
Clinical Effectiveness ◽  
Complete Recovery ◽  
Initial Therapy ◽  
Thrombin Time ◽  
Risk Of Hemorrhage ◽  
The Relationship

Abstract Background Although intravenous thrombolysis therapy has been considered as a significant progress in the treatment of acute ischemic stroke, there are limited effective treatments for patients with onset ischemic symptom that beyond six hours during acute ischemic stroke. In this study, we investigated the effectiveness of the intravenous argatroban therapy in acute ischemic stroke patients who cannot be treated with intravenous thrombolysis due to the limited time window. Methods One hundred and eighty patients with acute ischemic stroke that had beyond six hours ischemic symptom were admitted to our hospital and were analyzed retrospectively. Levels of activated partial thromboplastin time (aPTT), prothrombin time (PT) and thrombin time (TT) in peripheral blood of these patients were measured by ELISA at 24 hours post initial therapy. Results We found that plasma TT was significantly prolonged after 24 hours of argatroban treatment. aPTT showed slightly increased prolongation after 24 hours of argatroban treatment. PT also showed slightly prolonged after treatment, however, there was no difference from the basal line. We further investigated the relationship between the level of TT and the clinical effectiveness and safety of intravenous argatroban therapy. We found that when TT was between 40 and 80 seconds, intravenous argatroban effectively promoted the complete recovery rates without increasing the risk of hemorrhage. Conclusion Our study implies that TT assay might be useful for guiding regular dose of agratroban for therapy.

Neuroimaging Prediction of Hemorrhagic Transformation for Acute Ischemic Stroke

2022 ◽  
pp. 1-11
Author(s):  
Lan Hong ◽  
Tzu-Ming Hsu ◽  
Yiran Zhang ◽  
Xin Cheng
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Time Window ◽  
Treatment Strategies ◽  
Onset Time ◽  
Intravenous Thrombolysis ◽  
Reperfusion Therapy ◽  
Hemorrhagic Transformation ◽  
Advanced Technology ◽  
Future Research

<b><i>Background:</i></b> Hemorrhagic transformation (HT) is a common complication of acute ischemic stroke, often resulting from reperfusion therapy. Early prediction of HT can enable stroke neurologists to undertake measures to avoid clinical deterioration and make optimal treatment strategies. Moreover, the trend of extending the time window for reperfusion therapy (both for intravenous thrombolysis and endovascular treatment) further requires more precise detection of HT tendency. <b><i>Summary:</i></b> In this review, we summarized and discussed the neuroimaging markers of HT prediction of acute ischemic stroke patients, mainly focusing on neuroimaging markers of ischemic degree and neuroimaging markers of blood-brain barrier permeability. This review is aimed to provide a concise introduction of HT prediction and to elicit possibilities of future research combining advanced technology to improve the accessibility and accuracy of HT prediction under emergent clinical settings. <b><i>Key Messages:</i></b> Substantial studies have utilized neuroimaging, blood biomarkers, and clinical variables to predict HT occurrence. Although huge progress has been made, more individualized and precise HT prediction using simple and robust imaging predictors combining stroke onset time should be the future goal of development.

Intravenous Thrombolysis in Acute Ischemic Stroke

2018 ◽  
pp. 128-152
Author(s):  
Waldo R. Guerrero ◽  
Edgar A. Samaniego ◽  
Santiago Ortega
Keyword(s):  
Ischemic Stroke ◽  
Clinical Practice ◽  
Acute Ischemic Stroke ◽  
Symptom Onset ◽  
American Heart Association ◽  
American Heart ◽  
Time Window ◽  
Intravenous Thrombolysis ◽  
Heart Association ◽  
Standard Of Care

The only proven therapy for patients with acute ischemic stroke is early recanalization. The use of intravenous thrombolytic alteplase is the standard of care for patients presenting with ischemic stroke within the first 4.5 hours from symptom onset. This chapter reviews the indications and contraindications to alteplase including the 2015 American Heart Association guidelines and their relevance to clinical practice. Furthermore, emerging research and ongoing trials on expanding the time window for intravenous thrombolysis are discussed.

Extending the time window for intravenous thrombolysis in acute ischemic stroke using magnetic resonance imaging-based patient selection

2019 ◽  
Vol 14 (5) ◽  
pp. 483-490 ◽  
Author(s):  
Peter Ringleb ◽  
Martin Bendszus ◽  
Erich Bluhmki ◽  
Geoffrey Donnan ◽  
Christoph Eschenfelder ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Acute Ischemic Stroke ◽  
Time Window ◽  
Intravenous Thrombolysis ◽  
Modified Rankin Scale ◽  
Resonance Imaging ◽  
Stroke Patients ◽  
Symptomatic Intracranial Hemorrhage

Background Intravenous thrombolysis with alteplase within a time window up to 4.5 h is the only approved pharmacological treatment for acute ischemic stroke. We studied whether acute ischemic stroke patients with penumbral tissue identified on magnetic resonance imaging 4.5–9 h after symptom onset benefit from intravenous thrombolysis compared to placebo. Methods Acute ischemic stroke patients with salvageable brain tissue identified on a magnetic resonance imaging were randomly assigned to receive standard dose alteplase or placebo. The primary end point was disability at 90 days assessed by the modified Rankin scale, which has a range of 0–6 (with 0 indicating no symptoms at all and 6 indicating death). Safety end points included death, symptomatic intracranial hemorrhage, and other serious adverse events. Results The trial was stopped early for slow recruitment after the enrollment of 119 (61 alteplase, 58 placebo) of 264 patients planned. Median time to intravenous thrombolysis was 7 h 42 min. The primary endpoint showed no significant difference in the modified Rankin scale distribution at day 90 (odds ratio alteplase versus placebo, 1.20; 95% CI, 0.63–2.27, P = 0.58). One symptomatic intracranial hemorrhage occurred in the alteplase group. Mortality at 90 days did not differ significantly between the two groups (11.5 and 6.8%, respectively; P = 0.53). Conclusions Intravenous alteplase administered between 4.5 and 9 h after the onset of symptoms in patients with salvageable tissue did not result in a significant benefit over placebo. (Supported by Boehringer Ingelheim, Germany; ISRCTN 71616222).

Recombinant Tissue-Type Plasminogen Activator Study of Wake-Up Ischemic Strokes Guided by Rapid MRI

2019 ◽  
Vol 48 (1-2) ◽  
pp. 85-90 ◽  
Author(s):  
CuiPing Guo ◽  
QingKe Bai ◽  
ZhenGuo Zhao ◽  
JianYing Zhang
Keyword(s):  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Acute Ischemic Stroke ◽  
Scale Score ◽  
Time Window ◽  
Onset Time ◽  
Intravenous Thrombolysis ◽  
Baseline Data ◽  
Tissue Type ◽  
Rapid Mri

Background: rt-PA intravenous thrombolytic therapy and its efficacy have been widely recognized and proved for strokes. However, for patients with wake-up ischemic stroke (WUIS), they lose the opportunity to receive rt-PA intravenous thrombolytic therapy because of the difficulty of determining the onset time window. Aim: This study is aimed at investigating the intravenous thrombolytic therapy of WUIS guided by rapid MRI. Methods: Data were collected from patients with acute ischemic stroke within 4.5 h and from WUIS patients with uncertain onset time window, who received the treatment of rt-PA intravenous thrombolytic therapy in our hospital from November 2006 to April 2018. The improved Rankin scale was used to evaluate neurological function recovery. According to the Rankin scale score, patients were divided into two groups: those with good prognosis (modified Rankin scale [mRS] score 0–1) and those with poor prognosis (mRS score 2–6). Results: A total of 253 patients received rt-PA intravenous thrombolysis after head MRI evaluation; this included 177 cases of acute ischemic stroke and 76 cases of WUIS (which contains 2 death cases, 0.8% mortality; 3 cases of symptomatic bleeding, 1.2% bleeding rate; and 5 cases of aggravation, 2.0% aggravation rate). There was no statistical difference between the baseline data from the acute ischemic stroke patients with 4.5 h onset time window and the baseline data from the WUIS patients with undetermined onset time window, when the treatment was guided by rapid MRI. There were also no significant statistical differences in National Institutes of Health Stroke Scale score, Rankin scale score, symptomatic bleeding, death and aggravation of the disease between the 2 groups at 24 h, 3 days, and 7 days after admission (p < 0.05). Conclusion: According to the characteristic of undetermined onset time window of WUIS, more WUIS patients would be benefited from the rt-PA intravenous thrombolytic treatment when it is conducted under the guidance of rapid MRI.

scholarly journals Repeated Intravenous Thrombolysis in Patients with Recurrent Ischemic Stroke in the Vertebrobasilar Territory

2021 ◽  
pp. 510-514
Author(s):  
David Černík ◽  
Dušan Ospalík ◽  
Daniel Šaňák ◽  
Filip Cihlář
Keyword(s):  
Ischemic Stroke ◽  
Time Window ◽  
Recurrent Stroke ◽  
Intravenous Thrombolysis ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Anterior Circulation ◽  
Poor Outcome ◽  
Vertebrobasilar Stroke ◽  
Therapeutic Time Window

Acute ischemic vertebrobasilar stroke (AIVBS) is usually associated with poor outcome and prognosis and in case of basilar artery occlusion (BAO) with high mortality. Intravenous thrombolysis (IVT), as a standard recanalization therapy of acute ischemic stroke (IS) within first 4.5 h, can be administrated beyond this therapeutic time window in case of symptomatic BAO. Repeated IVT is generally contraindicated in case of early recurrent IS, despite a risk of poor outcome or death after recurrent IS. The aim was to present 2 cases of repeated IVT for recurrent AIVBS and discuss specific situations where repeated IVT may be considered. Up to now, repeated IVT has been reported only in recurrent stroke in anterior circulation.

scholarly journals Acute Ischemic Stroke Endovascular Treatment of Patients With Large Vessel Occlusions / Akūta Cerebrāla Infarkta Endovaskulāra Ārstēšana Pacientiem ar Maģistrālo Artēriju Oklūzijām

2015 ◽  
Vol 69 (5) ◽  
pp. 205-209
Author(s):  
Arturs Balodis ◽  
Maija Radziņa ◽  
Evija Miglāne ◽  
Ramona Valante ◽  
Andrejs Millers ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Endovascular Treatment ◽  
Acute Ischemic Stroke ◽  
Active Treatment ◽  
Mechanical Thrombectomy ◽  
Time Window ◽  
Intravenous Thrombolysis ◽  
University Hospital ◽  
Large Artery ◽  
Early Therapy

Abstract Mechanical thrombectomy as an active treatment method has recently been chosen for patients with large artery occlusions and thrombolysis beyond a time window. The aim of our study was to evaluate the results of endovascular treatment in patients with proximal vessel occlusion, compare this group with the intravenous thrombolysis group, and to identify possible criteria of active treatment. The prospective study included 81 patients hospitalised in the Pauls Stradiņš Clinical University Hospital due to acute ischemic stroke; 48 of them received mechanical thrombectomy and 33 - intravenous thrombolysis. Thrombectomy (TE) was performed using Solitaire FR stent retrievers. The NIHSS score was used for evaluation of early therapy results and mRS (modified Rankin Scale) was used for late therapy results. ASPECTS was used to define the lesion size using imaging on admission and after treatment. Median NIHSS on admission was higher in the TE group - 16 (range 12 to 19) than in the TL group - 12 (range 8 to 15) (p < 0.05). Ninety days after treatment, mRS (0-2) was seen in 67% of patients in the TE group (n = 29), and 34% of patients in the TL group (n = 9) patients (p < 0.05). Median ASPECTS was lower in TE group - 5, in comparison to the TL group - 7 (p < 0.01) Mortality frequency was higher in the TL group (p > 0.05). Frequency of symptomatic intracerebral haemorrhages was similar in the groups. Mechanical thrombectomy can achieve better late functional outcome than thrombolysis in a selected patients group.

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