MSC 2021 Virtual E-Abstract

1. Challenges Of Post-Acute Stroke Rehabilitation In Obese Patients : A Case Series.2. Overview Of Ischemic Stroke Among End Stage Renal Failure Patients On Hemodialysis.3. Driving Advice Documentation On Discharge Letters For Cardiac And Other Patients.4. Preparedness In Stroke Caregiving Among Family Caregivers.5. Acute Stroke Unit of Seberang Jaya Hospital – One Year Experience.6. UKM Medical Center Stroke Unit: Team Recruitment of Patients To The AVERT DOSE Trial During The COVID-19 Pandemic.7. Successful Thrombolysis Beyond Guidelines: A Case Series.

A Cross-Sectional Study of Comparative Coronary Angiographic Profile of Successful and Failed Thrombolysis with Tenecteplase Conducted at Osmania General Hospital, Hyderabad

BACKGROUND Acute Myocardial Infarction (AMI) can lead to death, and thrombolytic therapy (TLT) is a common treatment protocol. However, thrombolysis is not always successful, and there are numerous contributing factors. We wanted to compare and contrast the coronary angiographic profile of patients with successful and failed thrombolysis with tenecteplase. METHODS Cases of AMI receiving tenecteplase were categorized as successful and failed thrombolysis groups. Fifty patients in each group were compared for various characteristics such as age, sex, risk factors, time to thrombolysis, LV function, number of coronary vessels involved, angiographic lesion characteristics, thrombolysis in myocardial infarction (TIMI) flow, and to look for features that may predispose to thrombolysis failure. To determine the association between variables, chi-square test and logistic regression were used. RESULTS The mean age in the successful & failed thrombolysis group was 50.72 years and 53.48 years. Gender, diabetes, hypertension, smoking, alcohol, type of MI were not statistically significant for failed thrombolysis. All patients with window period < 3 hrs had successful thrombolysis and most patients with window period > 6 hrs had failed thrombolysis (87.2 %). (P < 0.001). Most patients (75.9 %) with Type A lesions had successful thrombolysis and patients with Type B & C lesions (88.1 %) had failed thrombolysis. (P < 0.001). CONCLUSIONS In patients with longer window periods, failed thrombolysis was more common and was associated with complex coronary lesion morphology. This study reemphasizes the value of early thrombolysis for effective reperfusion and clinical outcome improvement. KEYWORDS Failed Thrombolysis, Tenecteplase, Angiographic Profile

Successful thrombolysis in essential thrombocythemia-related acute ischaemic stroke

Essential thrombocythemia (ET)-related acute ischaemic stroke (AIS) may account for approximately 0.25%–0.5% of all ischaemic strokes. If left undiagnosed and untreated, patients with ET carry an increased risk of recurrent thrombosis involving major organs including the brain. We report an interesting case of a 67-year-old man, who was successfully thrombolysed for AIS resulting from ET. He presented with sudden onset of left-sided hemiparesis with a left-ventricular clot. His subsequent investigations including positive JAK2 V617F mutation confirmed the diagnosis of ET. He made a significant recovery with thrombolysis, anticoagulation, antiplatelet and hydroxyurea. A fear of post-thrombolytic haemorrhagic complications appears the major reason for the lack of reports of thrombolysis in ET-related AIS. Although the diagnosis of ET was confirmed on subsequent investigations, successful thrombolysis in our case provides preliminary evidence that ET-related AIS cases can undergo successful thrombolysis using tenecteplase. To date, ours is only the second case of ET-related AIS being thrombolysed.

Successful thrombolysis of normotensive pulmonary embolism with life-threatening hypoxia in a young man with Klinefelter syndrome

Klinefelter syndrome (KS) affects males born with an additional X chromosome giving the genotype 47XXY classically. This syndrome has primary features of infertility and hypogonadism along with other features including a genetically hypercoagulable state. When associated with other risk factors, KS further increases the risk of venous thromboembolism and could result in life-threatening pulmonary embolism (PE). There should be a lower threshold in suspecting PE as a cause of acute respiratory failure in this patient group and thrombolysis should be considered early in normotensive PE with severe hypoxia for best patient outcomes. Furthermore, clinicians should be cautious in managing testosterone therapy in patients with KS and additional thromboembolic risk factors.

The Outcome of thrombolysis with streptokinase in patients with prosthetic valve thrombosis

Objective: To evaluate the outcome of thrombolysis in patients of prosthetic valve thrombosis. Methods: This retrospective analysis was conducted on data of 84 patients of prosthetic valve thrombosis who presented to emergency room of Faisalabad Institute of Cardiology between July 2017 to December 2019. The diagnosis of prosthetic valve thrombosis was based on clinical suspicion and bed side transthoracic echocardiography done by a consultant cardiologist. Fluoroscopy was done to confirm the diagnosis by observing immobile valve leaflet. The confirmed patients were then treated in emergency with streptokinase after taking an informed consent. Quantitative variables like age were summarized by mean and standard deviation. Qualitative variables like gender, successful thrombolysis, stroke, major bleeding, mortality or re-do surgery were summarized by frequency and percentage. Results: Mean age was 29 ± 6.36, years and there were more female patients (n=43, 51.25%) as compared to males (n=41, 48.8%). Among the 66 surviving patients thrombolysis was successful without any complications in 56 patients (66.7%). Thrombolysis was successful with minor complications in six patients (7.1%) and it failed to produce desired results in four patients (4.8%). In this study 18 (21.4%) patients died. The common complications included minor bleeding in four patients (4.8%) and major bleeding in 10 patients (12.0 %). Conclusion: Thrombolysis produces reasonable success rate in cases of prosthetic valve thrombosis who are in functional class I or II. However, it has very high mortality rate in patients presenting with functional class III and IV. doi: https://doi.org/10.12669/pjms.37.2.3226 How to cite this:Abbas S, Hameed N, Khilji SA, Jalal A. Outcome of thrombolysis with streptokinase in patients with prosthetic valve thrombosis. Pak J Med Sci. 2021;37(2):---------. doi: https://doi.org/10.12669/pjms.37.2.3226 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.