scholarly journals Angioedema Secondary to tPA Use in Acute Ischemic Stroke Patient with Hypertension: A Case Report

2021 ◽  
Vol 2 (5) ◽  
pp. 159-162
Author(s):  
Chris Kim ◽  
Andrea Hladik
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Case Report ◽  
Acute Ischemic Stroke ◽  
Ace Inhibitor ◽  
Sudden Onset ◽  
Acute Ischemic Stroke Patient ◽  
Factors Associated ◽  
Tissue Plasminogen ◽  
Life Threatening

Introduction: A well-documented complication of administering tissue plasminogen activator (tPA) in stroke patients is acute intracranial bleeding. A lesser known but still significant complication is angioedema secondary to tPA administration, which can develop in certain individuals with risk factors such as angiotensin converting enzyme (ACE) inhibitor use and location of the stroke. Knowing the potential for this life-threatening complication and being prepared for its proper management is vital for emergency physicians. Case Report: We report a 53-year-old Black female who presented to the emergency department with sudden onset of slurred speech and a facial droop. She was found to have an acute ischemic stroke and tPA was administered. She subsequently developed angioedema. Retrospectively, the patient was found to have risk factors that are thought to predispose patients to tPA-induced angioedema. Conclusion: Risk factors associated with angioedema secondary to tPA administration have been documented in patients taking ACE inhibitors, as well as patients who develop strokes in the frontal lobe. While many cases may be mild, some patients may develop life-threatening angioedema. Although this complication does not necessarily contraindicate tPA use, it is prudent for the emergency physician to be vigilant for its development, prepared for its treatment, and to be diligent in assessing the need for control of the patient’s airway.

scholarly journals Prevalence and factors associated with memory disturbance and dementia after acute ischemic stroke

2018 ◽  
Vol 10 (3) ◽  
Author(s):  
Jesada Surawan ◽  
Teabpaluck Sirithanawutichai ◽  
Suchat Areemit ◽  
Somsak Tiamkao ◽  
Suprawita Saensak
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Stroke Severity ◽  
Factors Associated ◽  
Laboratory Test Results ◽  
Khon Kaen ◽  
Memory Disturbance ◽  
State Examination ◽  
With Memory

Prevalence and risk factors associated with memory disturbance and dementia were determined in acute ischemic stroke (AIS) patients in hospitals before discharge, three and six months after stroke. A prospective cohort study was conducted during January-December 2017 with 401 AIS patients admitted to Srinagarind Hospital, Khon Kaen Hospital and Chum Phae Hospital, Khon Kaen, Thailand. The demographics and clinical characteristics, previous illness and past medical history, and laboratory test results of the patients were collected from the medical records, while depression screening, NIH stroke scale (NIHSS) scoring and mini mental state examination (MMSE) were performed using particular medical record forms. The prevalence of memory disturbance and dementia was 56.6, 41.6 and 38.2% before discharge, three and six months after stroke, respectively. Based on logistic regression analysis, age, education and stroke severity were the risk factors associated with the studied disorders before discharge and three months after stroke. Meanwhile, age and education were the risk factors for six months after stroke. Our findings suggested that the prevalence of memory disturbance and dementia remained high at all study periods.

Risk factors and outcomes of intravenous tissue plasminogen activator and endovascular thrombectomy utilization amongst pediatrics acute ischemic stroke

2020 ◽  
pp. 174749302090491
Author(s):  
Preeti Malik ◽  
Urvish K Patel ◽  
Surabhi Kaul ◽  
Ramit Singla ◽  
Tapan Kavi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Recombinant Tissue Plasminogen Activator ◽  
Pediatric Stroke ◽  
Endovascular Thrombectomy ◽  
Intravenous Tissue Plasminogen Activator ◽  
Tissue Plasminogen

Background Pediatric stroke is a debilitating disease. There are several risk factors predisposing children to this life-threatening disease. Although, published literature estimates a relatively high incidence of pediatric stroke, treatment guidelines on intravenous tissue plasminogen activator and endovascular thrombectomy utilization remain a dilemma. There is a lack of large population-based studies and clinical trials evaluating the efficacy and safety outcomes associated with these treatments in this unique population. Aim We sought to determine the prevalence of risk factors, concurrent utilization of intravenous tissue plasminogen activator and endovascular thrombectomy, and associated outcomes in pediatric stroke hospitalizations. Methods We performed a retrospective analysis of the Nationwide Inpatient Sample data (2003–2014) in pediatric (1–21 years of age) acute ischemic stroke hospitalizations using ICD-9-CM codes. The multivariable survey logistic regression model was weighted to account for sampling strategy, evaluate predictors of hemorrhagic conversion, and treatment outcomes (mortality, morbidity, and discharge disposition) amongst pediatric stroke hospitalizations. Results In this analysis, 9109 patients between 1 and 21 years of age were admitted during 2003–2014 for acute ischemic stroke. Of these 9109 patients, 119 (1.30%) received endovascular thrombectomy alone, 256 (2.82%) intravenous recombinant tissue plasminogen activator, and 69 (0.75%) both endovascular thrombectomy and intravenous recombinant tissue plasminogen activator. We found overall high prevalence of conditions like epilepsy (19.59%), atrial septal defect (11.76%), sickle cell disease (8.63%), and moyamoya disease (5.41%) in pediatric acute ischemic stroke patients. Unadjusted analysis showed high prevalence of all-cause in-hospital mortality in combined endovascular thrombectomy and intravenous recombinant tissue plasminogen activator utilization group, and higher prevalence of hemorrhagic conversion and morbidity in endovascular thrombectomy utilization group compared to other groups ( p < 0.0001). Multivariate adjusted analysis showed that children with endovascular thrombectomy utilization (aOR: 19.19; 95% CI: 2.50–147.29, p = 0.005), intravenous recombinant tissue plasminogen activator utilization (aOR: 8.85; 95% CI: 1.92–40.76, p = 0.005), and both (endovascular thrombectomy and intravenous recombinant tissue plasminogen activator) utilization (aOR: 7.55; 95% CI: 1.16–49.31, p = 0.035) had higher odds of hemorrhagic conversion compared to no-treatment group. Conclusion We found various risk factors associated with pediatric stroke. The early identification can be useful to formulate preventive strategies and influence the incidence of pediatric stroke. Our study results showed that use of intravenous recombinant tissue plasminogen activator and endovascular thrombectomy increase risk of mortality and hemorrhagic conversion, but we suggest to have more clinical studies to evaluate the idea candidates for utilization of intravenous recombinant tissue plasminogen activator and endovascular thrombectomy based on risk: benefit ratio.

scholarly journals Risk Factors Associated with Outcomes of Recombinant Tissue Plasminogen Activator Therapy in Patients with Acute Ischemic Stroke

2020 ◽  
Vol 17 (2) ◽  
pp. 618 ◽  
Author(s):  
Yi-Ju Tseng ◽  
Ru-Fang Hu ◽  
Shin-Tyng Lee ◽  
Yu-Li Lin ◽  
Chien-Lung Hsu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Treatment Outcomes ◽  
Plasminogen Activator ◽  
Tissue Type ◽  
Hospital Death ◽  
Factors Associated ◽  
Laboratory Test Results ◽  
Poor Outcomes

Ischemic stroke is the most common type of stroke, and early interventional treatment is associated with favorable outcomes. In the guidelines, thrombolytic therapy using recombinant tissue-type plasminogen activator (rt-PA) is recommended for eligible patients with acute ischemic stroke. However, the risk of hemorrhagic complications limits the use of rt-PA, and the risk factors for poor treatment outcomes need to be identified. To identify the risk factors associated with in-hospital poor outcomes in patients treated with rt-PA, we analyzed the electronic medical records of patients who were diagnosed with acute ischemic stroke and treated for rt-PA at Chang Gung Memorial Hospitals from 2006 to 2016. In-hospital death, intensive care unit (ICU) stay, or prolonged hospitalization were defined as unfavorable treatment outcomes. Medical history variables and laboratory test results were considered variables of interest to determine risk factors. Among 643 eligible patients, 537 (83.5%) and 106 (16.5%) patients had favorable and poor outcomes, respectively. In the multivariable analysis, risk factors associated with poor outcomes were female gender, higher stroke severity index (SSI), higher serum glucose levels, lower mean corpuscular hemoglobin concentration (MCHC), lower platelet counts, and anemia. The risk factors found in this research could help us study the treatment strategy for ischemic stroke.

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