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thrombolysis in elderly patients

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Journal of Geriatric Cardiology 2007年第4期4卷 250-253页

作者： Santiago Herrero Jose Antonio Lapuerta-Irigoyen Pacemaker and Coronary Unit Intensive Care ServiceCabuees HospitalGijon Spain Pacemaker and Coronary Unit Intensive Care ServiceCabuees HospitalGijonSpain

The elderly population consists of those over age 75 years and appears to represent the fastest-growing segment of the population. Intravenous thrombolytic therapy (TT) is the most common strategy for the treatment of acute myocardial infarction (AMI) in many parts of the world. However, TT carries a higher risk of intra-cranial hemorrhage (ICH) in the elderly patients. Primary percutaneous transluminal coronary angioplasty and stenting (PCI) represents an important alternative in these elderly individuals with contraindications to TT. In developing countries, or in areas without availability of primary PCI, TT remains the only therapeutic modality. Dedicated randomized trials are needed to provide a comprehensive understanding of AMI management in the elderly group.(J Geriatr Cardiol 2007;4:250-253.)

关键词： acute myocardial infarction thrombolysis elderly

Haemorrhage after thrombectomy with adjuvant thrombolysis in unknown onset stroke depends on high early lesion water uptake

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Stroke & Vascular Neurology 2024年第4期9卷 390-398页

作者： Gabriel Broocks Lukas Meyer Uta Hanning Tobias Djamsched Faizy Matthias Bechstein Helge Kniep Noel Van Horn Gerhard Schön Ewgenia Barow Götz Thomalla Jens Fiehler Andre Kemmling Department of Diagnostic and Interventional Neuroradiology University Medical Center Hamburg-EppendorfHamburgGermany Department of Medical Biometry and Epidemiology University Medical Center Hamburg EppendorfHamburgGermany Department of Neurology University Medical Center Hamburg-EppendorfHamburgGermany Department of Neuroradiology University MarburgMarburgGermany

Background and purpose In wake-up stroke,CT-based quantitative net water uptake(NWU)might serve as an alternative tool to MRI to guide intravenous thrombolysis with alteplase(IVT).An important complication after IVT is symptomatic intracerebral haemorrhage(sICH).As NWU directly implies ischaemic lesion progression,reflecting blood-brain barrier injury,we hypothesised that NWU predicts sICH in patients who had a ischaemic stroke undergoing thrombectomy with unknown *** Consecutive analysis of all patients who had unknown onset anterior circulation ischaemic stroke who underwent CT at baseline and endovascular treatment between December 2016 and October *** NWU was assessed on baseline *** primary endpoint was *** association of NWU and other baseline parameters to sICH was investigated using inverse-probability weighting(IPW)*** A total of 88 patients were included,of which 46 patients(52.3%)received *** median NWU was 10.7%(IQR:5.1–17.7).The proportion of patients with any haemorrhage and sICH were 35.2%and 13.6%.NWU at baseline was significantly higher in patients with sICH(19.1%vs 9.6%,p<0.0001)and the median Alberta Stroke Program Early CT Score(ASPECTS)was lower(5 vs 8,p<0.0001).Following IPW,there was no association between IVT and sICH in unadjusted ***,after adjusting for ASPECTS and NWU,there was a significant association between IVT administration and sICH(14.6%,95%CI:3.3%to 25.6%,p<0.01).Conclusion In patients with ischaemic stroke with unknown onset,the combination of high NWU with IVT is directly linked to higher rates of *** ASPECTS for evaluating the extent of the early infarct lesion,quantitative NWU could be used as an imaging biomarker to assess the degree of blood-brain barrier damage in order to predict the risk of sICH in patients with wake up stroke.

关键词： throm thrombolysis high

Outcomes of catheter-directed thrombolysis versus systemic thrombolysis in the treatment of pulmonary embolism: a metaanalysis

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Journal of Geriatric Cardiology 2023年第6期20卷 459-468页

作者： Huang-Tai MIAO Ying LIANG Xiao-Ying LI Xiao WANG Hui-Juan ZUO Zhe-Chun ZENG Shao-Ping NIE Center for Coronary Artery Disease Beijing Anzhen HospitalCapital Medical UniversistyBeijingChina Emergency&Critical Care Center Beijing Anzhen HospitalCapital Medical UniversityBeijingChina Department of Health Care for Cadres Beijing Jishuitan HospitalBeijingChina Department of Clinical&Community Cardiovascular Disease Prevention Beijing Institute of Heart Lung and Blood Vessel DiseaseBeijing Anzhen HospitalCapital Medical UniversityBeijingChina

OBJECTIVE To evaluate the safety and efficacy of catheter-directed thrombolysis(CDT)versus systemic thrombolysis(ST)in the treatment of pulmonary embolism(PE).METHODS The Cochrane Library,PubMed,and Embase databases were searched to collect the literature on the comparison of the results of CDT and ST in the treatment of PE from the beginning of their records to May 2020,and meta-analysis was performed by STATA software(version 15.1).Using standardized data-collection forms,the authors screened the studies and independently extracted data,and assessed the quality of the studies using the Newcastle-Ottawa Scale for cohort *** studies that examined the following results were included in the current study:in-hospital mortality,all-cause bleeding rate,gastrointestinal bleeding rate,intracranial hemorrhage rate,the incidence of shock,and hospital length of *** A total of eight articles,with 13,242 participants,involving 3962 participants in the CDT group and 9280 participants in the ST group were *** compared with ST in the treatment of PE can significantly affect in-hospital mortality rate[odds ratio(OR)=0.41,95%CI:0.30–0.56,P<0.05],all-cause bleeding rate(OR=1.20,95%CI:1.04–1.39,P=0.012),gastrointestinal bleeding rate(OR=1.43,95%CI:1.13–1.81,P=0.003),the incidence of shock(OR=0.46,95%CI:0.37–0.57,P<0.05),and hospital length of stay[standard mean difference(SMD)=0.16,95%CI:0.07–0.25,P<0.05].However,there was no significant effect on intracranial hemorrhage rate in patients with PE(OR=0.70,95%CI:0.47–1.03,P=0.070).CONCLUSIONS CDT is a viable alternative to ST in the treatment of PE,as it can significantly reduce in-hospital mortality rate,all-cause bleeding rate,gastrointestinal bleeding rate,and incidence of ***,CDT may prolong hospital length of stay to a certain *** research is needed to evaluate the safety and efficacy of CDT and ST in the treatment of acute PE and other clinical outcomes.

关键词： thrombolysis mortality treatment

Tenecteplase thrombolysis for stroke up to 24 hours after onset with perfusion imaging selection:the umbrella phase IIa CHABLIS-T randomised clinical trial

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Stroke & Vascular Neurology 2024年第5期9卷 551-559页

作者： Xin Cheng Lan Hong Leonid Churilov Longting Lin Yifeng Ling Jin Zhang Jianhong Yang Yu Geng Danhong Wu Xueyuan Liu Xiaoyu Zhou Yuwu Zhao Qijin Zhai Liandong Zhao Yangmei Chen Ying Guo Xiaofei Yu Fan Gong Yi Sui Gang Li Lumeng Yang Hong-Qiu Gu Yilong Wang Mark Parsons Qiang Dong the CHABLIS-T collaborators Department of Neurology National Center for Neurological DisordersNational Clinical Research Centre for Aging and MedicineHuashan HospitalFudan UniversityShanghaiChina Melbourne Medical School The Royal Melbourne HospitalUniversity of MelbourneParkvilleVictoriaAustralia University of New South Wales South Western Sydney Clinical School Ingham Institute for Applied Medical ResearchDepartment of NeurologyLiverpool HospitalSydneyNew South WalesAustralia Department of Neurology the First Hospital of Shanxi Medical UniversityTaiyuanChina Department of Neurology Ningbo First HospitalNingboChina Center for Rehabilitation Medicine Department of NeurologyZhejiang Provincial People’s Hospital(Affiliated People’s HospitalHangzhou Medical College)HangzhouChina Department of Neurology Shanghai Fifth People's HospitalFudan UniversityShanghaiChina Department of Neurology Shanghai Tenth People's HospitalTongji University School of MedicineShanghaiChina Department of Neurology Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina Department of Neurology Xuzhou Medical University Affiliated Hospital of HuaianHuaianChina Department of Neurology The Second Affiliated Hospital of Chongqing Medical UniversityChongqingChina Department of Neurology Pu'er People's HospitalPu'erChina Department of Neurology Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese MedicineShanghaiChina Department of Neurology Shenyang First People's HospitalShenyang Medical College Affiliated Brain HospitalShenyangChina Department of Neurology Shanghai East HospitalTongji UniversityShanghaiChina China National Clinical Research Center for Neurological Diseases Beijing Tiantan HospitalBeijingChina Department of Neurology Beijing Tiantan HospitalCapital Medical UniversityBeijingChina 不详

Background The performance of intravenous tenecteplase in patients who had an acute ischaemic stroke with large/medium vessel occlusion or severe stenosis in an extended time window remains unknown. We investigated the promise of efficacy and safety of different doses of tenecteplase manufactured in China, in patients who had an acute ischaemic stroke with large/ medium vessel occlusion beyond 4.5- hour time window. Methods The CHinese Acute tissue- Based imaging selection for Lysis In Stroke- Tenecteplase was an investigator- initiated, umbrella phase IIa, open- label, blinded- endpoint, Simon’s two- stage randomised clinical trial in 13 centres across China's Mainland. Participants who had salvageable brain tissue on automated perfusion imaging and presented within 4.5-24 hours from time of last seen well were randomised to receive 0.25 mg/ kg tenecteplase or 0.32 mg/kg tenecteplase, both with a bolus infusion over 5-10 s. The primary outcome was proportion of patients with promise of efficacy and safety defined as reaching major reperfusion without symptomatic intracranial haemorrhage at 24-48 hours after thrombolysis. Assessors were blinded to treatment allocation. All participants who received tenecteplase were included in the analysis. Results A total of 86 patients who had an acute ischaemic stroke identified with anterior large/medium vessel occlusion or severe stenosis were included in this study from November 2019 to December 2021. All of the 86 patients enrolled either received 0.25 mg/kg (n=43) or 0.32 mg/kg (n=43) tenecteplase, and were available for primary outcome analysis. Fourteen out of 43 patients in the 0.25 mg/kg tenecteplase group and 10 out of 43 patients in the 0.32 mg/kg tenecteplase group reached the primary outcome, providing promise of efficacy and safety for both doses based on Simon’s two- stage design. Discussion Among patients with anterior large/medium vessel occlusion and significant penumbral mismatch presented within 4.5-24 hours

关键词： doses thrombolysis random

Acute extensive portal and mesenteric venous thrombosis after splenectomy:Treated by interventional thrombolysis with transjugular approach

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World Journal of Gastroenterology 2009年第24期15卷 3038-3045页

作者： Mao-Qiang Wang Han-Ying Lin Li-Ping Guo Feng-Yong Liu Feng Duan Zhi-Jun Wang Department of Interventional Radiology Chinese PLA General Hospital Beijing 100853 China

AIM:To present a series of cases with symptomatic acute extensive portal vein(PV)and superior mesenteric vein(SMV)thrombosis after splenectomy treated by transjugular intrahepatic approach catheter-directed thrombolysis. METHODS:A total of 6 patients with acute extensive PV-SMV thrombosis after splenectomy were treated by transjugular approach catheter-directed thrombolysis. The mean age of the patients was 41.2 *** access to the portal system via the transjugular approach,pigtail catheter fragmentation of clots, local urokinase injection,and manual aspiration thrombectomy were used for the initial treatment of PV-SMV thrombosis,followed by continuous thrombolytic therapy via an indwelling infusion catheter in the SMV,which was performed for three to six days. Adequate anticoagulation was given during treatment, throughout hospitalization,and after discharge. RESULTS:Technical success was achieved in all 6 *** improvement was seen in these patients within 12-24 h of the *** complications were *** 6 patients were discharged 6-14 d(8±2.5 d)after *** mean duration of follow-up after hospital discharge was 40±16.5 *** and contrast-enhanced computed tomography confirmed patency of the PV and SMV,and no recurrent episodes of PV-SMV thrombosis developed during the follow-up period. CONCLUSION:Catheter-directed thrombolysis via transjugular intrahepatic access is a safe and effective therapy for the management of patients with symptomatic acute extensive PV-SMV thrombosis.

关键词： Mechanical thrombectomy Portal vein Splenectomy Superior mesenteric vein thrombolysis Thrombosis

Intracoronary arterial retrograde thrombolysis with percutaneous coronary intervention: a novel use of thrombolytic to treat acute ST-segment elevation myocardial infarction

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Journal of Geriatric Cardiology 2019年第6期16卷 458-467页

作者： Jin-Wen TIAN Mei ZHU Feng-Qi WANG Ke LI Chao-Fei ZHOU Bo LI Min WANG Jue-Lin DENG Bo JIANG Jing BAI Yi GUO Rong-Jie JIN Zhao ZHANG Ying LIN Ji-Hang WANG Shi-Hao ZHAO Ming-Zhi SHEN Department of Cardiology Hainan Hospital of PLA General Hospital Hainan China Department of Cardiology Chinese PLA General Hospital Beijing China

Background Clearance of coronary arterial thrombosis is necessary in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing urgent percutaneous coronary intervention (PCI). There is currently no highly-recommended method of thrombus removal during interventional procedures. We describe a new method for opening culprit vessels to treat STEMI: intracoronary arterial retrograde thrombolysis (ICART) with PCI. Methods & Results Eight patients underwent ICART. The guidewire was advanced to the distal coronary artery through the occlusion lesion. Then, we inserted a microcatheter into the distal end of the occluded coronary artery over the guidewire. Urokinase (5–10 wu) mixed with contrast agents was slowly injected into the occluded section of the coronary artery through the microcatheter. The intracoronary thrombus gradually dissolved in 3–17 min, and the effect of thrombolysis was visible in real time. Stents were then implanted according to the characteristics of the recanalized culprit lesion to achieve full revascularization. One patient experienced premature ventricular contraction during vascular revascularization, and no malignant arrhythmias were seen in any patient. No reflow or slow flow was not observed post PCI. thrombolysis in myocardial infarction flow grade and myocardial blush grade post-primary PCI was 3 in all eight patients. No patients experienced bleeding or stroke. Conclusions ICART was accurate and effective for treating intracoronary thrombi in patients with STEMI in this preliminary study. ICART was an effective, feasible, and simple approach to the management of STEMI, and no intraprocedural complications occurred in any of the patients. ICART may be a breakthrough in the treatment of acute STEMI.

关键词： ST elevation myocardial infarction Therapeutic thrombolysis Thrombus Urokinase

Association between fluid-attenuated inversion recovery vascular hyperintensity and outcome varies with different lesion patterns in patients with intravenous thrombolysis

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Stroke & Vascular Neurology 2021年第3期6卷 449-457,I0076页

作者： Erling Wang Chuanjie Wu Dandan Yang Xihai Zhao Jie Zhao Hong Chang Qi Yang Department of Radiology Beijing Chaoyang HospitalCapital Medical UniversityBeijingChina Department of Neurology Xuanwu HospitalCapital Medical UniversityBeijingChina Beijing Institute of Brain Disorders Laboratory of Brain DisordersMinistry of Science and TechnologyCollaborative Innovation Center for Brain DisordersCapital Medical UniversityBeijingChina Center for Biomedical Imaging Research Department of Biomedical EngineeringTsinghua UniversityBeijingChina Key Laboratory of Medical Engineering for Cardiovascular Disease Ministry of EducationBeijingChina

Background and purpose To evaluate relationship between fluid-attenuated inversion recovery vascular hyperintensity(FVH)after intravenous thrombolysis and outcomes in different lesion patterns on diffusion-weighted imaging(DWI).Methods Patients with severe internal carotid or intracranial artery stenosis who received intravenous thrombolysis from March 2012 to April 2019 were *** were divided into four groups by DWI lesion patterns:border-zone infarct(BZ group),multiple lesions infarct(ML group),large territory infarct(LT group),and single cortical or subcortical lesion infarct(SL group).Logistic regression was performed to identify risk factors for outcome(unfavourable outcome,modified Rankin Scale(mRS)≥2;poor outcome,mRS≥3).Results Finally,203 participants(63.3±10.2 years old;BZ group,n=72;ML group,n=64;LT group,n=37;SL group,n=30)from 1190 patient cohorts were *** adjusting for confounding factors,FVH(+)was associated with unfavourable outcome in total group(OR 3.02;95%CI 1.49 to 6.13;p=0.002),BZ group(OR 4.22;95%CI 1.25 to 14.25;p=0.021)and ML group(OR 5.44;95%CI 1.41 to 20.92;p=0.014)***(+)was associated with poor outcome in total group(OR 2.25;95%CI 1.01 to 4.97;p=0.046),BZ group(OR 5.52;95%CI 0.98 to 31.07;p=0.053)and ML group(OR 4.09;95%CI 1.04 to 16.16;p=0.045)patients,which was marginal ***(+)was not associated with unfavourable or poor outcome in LT and SL *** This study suggests that association between FVH and outcome varies with different lesion patterns on *** presence of FVH after intravenous thrombolysis may help to identify patients who require close observations in the hospitalisation in patients with border-zone and multiple lesion infarcts.

关键词： patients thrombolysis intravenous

Effect of sex differences on prognosis of intravenous thrombolysis: data from the thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS- China)

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Stroke & Vascular Neurology 2021年第1期6卷 10-15页

作者： Hongyu Zhou Weiqi Chen Yuesong Pan Yue Suo Xia Meng Hao Li Yongjun Wang Department of Neurology Beijing Tiantan HospitalCapital Medical UniversityBeijingChina China National Clinical Research Center for Neurological Diseases Beijing Tiantan HospitalCapital Medical UniversityBeijingChina

Background and purpose Previous studies have reported conflicting results as to whether women have poorer functional outcome than men after thrombolytic *** study aims to investigate the relationship between sex differences and the prognosis of intravenous thrombolysis in Chinese patients with acute ischaemic *** The patients enrolled in this study were from the Chinese Acute Ischemic Stroke thrombolysis Monitoring and Registration *** primary outcome was poor functional outcome,defined as a 3-month modified Rankin score of *** safe outcome was symptomatic intracranial haemorrhage(SICH)and mortality within 7 days and 90 *** Cox regression model was used to correct the potential covariates to evaluate the association between sex disparities and ***,the interaction of preonset Rankin scores,baseline National Institute of Health Stroke Scale(NIHSS)scores and Trial of Org 10172 in Acute Stroke Treatment(TOAST)types was statistically *** A total of 1440 patients were recruited,including 541 women and 899 *** baseline information indicated that women were older at the time of onset(66.2±11.2 years vs 61.0±11.3 years,pthrombolysis is not si

关键词： thrombolysis Acute prognosis

Implementation of regional Acute Stroke Care Map increases thrombolysis rates for acute ischaemic stroke in Chinese urban area in only 3 months

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Stroke & Vascular Neurology 2021年第1期6卷 87-94页

作者： Yi Sui Jianfeng Luo Chunyao Dong Liqiang Zheng Weijin Zhao Yao Zhang Ying Xian Huaguang Zheng Bernard Yan Mark Parsons Li Ren Ying Xiao Haoyue Zhu Lijie Ren Qi Fang Yi Yang Weidong Liu Bing Xu Department of Neurology Shenyang Brain HospitalShenyang Medical CollegeShenyangChina Department of Biostatistics Fudan University School of Public HealthShanghaiChina Department of Clinical Epidemiology Shengjing Hospital of China Medical UniversityShenyangChina Department of Neurology Duke Clinical Research InstituteDurhamNorth CarolinaUSA Department of Neurology Beijing Tiantan HospitalBeijingChina Department of Neurology at Melbourne Brain Center The University of Melbourne Medicine at Royal Melbourne HospitalParkvilleVictoriaAustralia Department of Neurology Shenzhen University 1st Affiliated HospitalShenzhen Second People’s HospitalShenzhenChina Department of Neurology The First Affiliated Hospital of Soochow UniversitySuzhouChina Department of Neurology The First Affiliated Hospital of Jilin UniversityChangchunChina Department of Neurosurgery Liaocheng People’s HospitalLiaochengChina

Background The rate of intravenous thrombolysis for acute ischaemic stroke remains low in *** investigated whether the implementation of a citywide Acute Stroke Care Map(ASCaM)is associated with an improvement of acute stroke care quality in a Chinese urban *** The ASCaM comprises 10 improvement strategies and has been implemented through a network consisting of 20 tertiary *** identified 7827 patients with ischaemic stroke admitted from April to October 2017,and 506 patients underwent thrombolysis were finally included for *** Compared with‘pre-ASCaM period’,we observed an increased rate of administration of tissue plasminogen activator within 4.5 hours(65.4% vs 54.5%;adjusted OR,1.724;95% CI 1.21 to 2.45;p=0.003)during‘ASCaM period’.In multivariate analysis models,‘ASCaM period’was associated with a significant reduction in onset-to door time(114.1±55.7 vs 135.7±58.4 min,p=0.0002)and onset-to needle time(ONT)(169.2±58.1 vs 195.6±59.3 min,pthrombolysis and shorter *** ASCaM may,in proof-of principle,serve as a model to reduce treatment delay and increase thrombolysis rates in Chinese urban areas and possibly other highly populated Asian regions.

关键词： thrombolysis needle admitted