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9 results

  • Chapter 11 - Ischemic Stroke and Transient Ischemic Attack

  • from Section 3 - Specific Neurological Disorders in Emergency Medicine
  • Edited by Thomas P. Campbell, Allegheny Health Network, Pittsburgh, Kevin M. Kelly, Allegheny Health Network, Pittsburgh
  • Book:
    Handbook of Emergency Neurology
    Published online:
    10 January 2024
    Print publication:
    17 August 2023, pp 137-172

  • Summary

    In the United States, one stroke occurs every 40 seconds on average. Ischemic stroke is a leading cause of serious long-term disability and the fifth leading cause of death. Every year, 795,000 people experience a new or recurrent stroke. In 2018, stroke accounted for 1 of every 19 deaths. Stroke typically occurs suddenly, with symptoms of motor weakness, impaired speech, vision loss, or numbness, and can lead to significant disability. The financial burden of stroke, including direct medical costs and potential wages lost, is greater than $30 billion per year. Time-based acute stroke treatments improve functional outcome and reduce mortality, which makes rapid recognition of stroke of utmost importance.

  • Effectiveness of alteplase infusion for the management of prosthetic mitral valve thrombosis in paediatric age group and proposed algorithm

  • Mohamed H Mashali, Zaheer Ahmad, Mohammed Omar Galal, Amjad Al-Kouatli
  • Journal:
    Cardiology in the Young / Volume 33 / Issue 5 / May 2023
    Published online by Cambridge University Press:
    03 June 2022, pp. 747-753
    • Article
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  • Introduction:

    The incidence of prosthetic valve implantation is increasing in the paediatric population. Prosthetic valve thrombosis leading to obstruction could potentially be a life-threatening complication. There is a debate regarding optimal management of this complication, and there is limited use of thrombolytic therapy in childhood in the setting of valve thrombosis.

    Objective:

    We aim to share our experience of successfully using fibrinolytic therapy in terms of alteplase for paediatric prosthetic mitral valve thrombosis and to propose a management algorithm.

    Methods:

    This retrospective analysis of the database was conducted at our hospital including patients who underwent thrombolysis (alteplase) for prosthetic mitral valve thrombosis from June, 2011 to June, 2021. A total of 10 patients with 20 attempts of alteplase infusion were found in our record.

    Results:

    Alteplase was successful in 19 attempts to relieve valve thrombosis. The safe and effective dose of alteplase was between 0.1 and 0.3 mg/kg/hour. There were no associated major bleeding complications and alteplase was administered either by central or peripheral line.

    Conclusion:

    Thrombolysis by alteplase infusion was found to be successful in relief of prosthetic mitral valve thrombosis in paediatric population without major bleeding complications.

  • Chapter 6 - Reperfusion of Ischaemic Brain by Intravenous Thrombolysis

  • from Part III - Acute Treatment of Ischaemic Stroke and Transient Ischaemic Attack
  • Edited by Jeffrey L. Saver, Graeme J. Hankey, University of Western Australia, Perth
  • Book:
    Stroke Prevention and Treatment
    Published online:
    15 December 2020
    Print publication:
    10 December 2020, pp 98-126

  • Summary

    Intravenous thrombolytic therapy (IV) with recombinant tissue-plasminogen activator (alteplase; 0.9 mg/kg over 1h) is beneficial for acute ischaemic stroke patients with potentially disabling neurological deficits, and without contraindications, when started =4.5h of onset. Benefit is time-dependent: among 1000 patients, IVT =3h lessen long-term disability in 178 patients, between 3-4.5h in 66. IVT under 4.5h is associated with an increase in symptomatic haemorrhage, but not an increase in death or severe disability. Based on trial evidence, IVT =3h is strongly endorsed, and between 3-4.5 hours moderately endorsed, by guidelines on 5 continents. Benefit is evident in patients under and over age 80, and in patients with up to moderate, but not extensive (more than 100 cc), early ischaemic changes on initial CT or MRI. IVT is also beneficial for patients =4.5h after onset with substantial salvageable tissue on penumbral CT or MR imaging. Systems of care should be optimized to start IVT =60m, and optimally =30m, after ED arrival. Large-scale trials are needed to further enhance IVT, testing: faster treatment start in mobile stroke units (mobile CT ambulances): fibrinolytic agent and concomitant lytic-enhancing combinations; bridging neuroprotection and collateral enhancement; and the optimal way to combine intravenous thrombolytic therapy and endovascular mechanical thrombectomy.

  • The use of alteplase in a newborn with an aortic arch thrombus during extracorporeal membrane oxygenation

  • Lijun Yang, Lifen Ye, Ru Lin
  • Journal:
    Cardiology in the Young / Volume 29 / Issue 10 / October 2019
    Published online by Cambridge University Press:
    02 September 2019, pp. 1307-1309

  • We report a neonatal case of the use of alteplase for the lysis of a large aortic arch thrombus formed during extracorporeal membrane oxygenation support. Alteplase (0.1–0.15 mg/kg/hour) was infused for thrombolysis, and meanwhile, unfractionated heparin was administrated at 5–10 U/kg/hour for the anticoagulation purpose. Alteplase was successfully administered to this neonate after the repair of congenital diaphragmatic hernia on extracorporeal membrane oxygenation, and the patient survived without apparent catastrophic long-term complications. It is reasonable to consider alteplase therapy during extracorporeal membrane oxygenation support in this setting.

  • Efficacy and safety of recombinant tissue plasminogen activator for venous thrombosis after paediatric heart surgery

  • Lindsey B. Justice, David P. Nelson, Joseph Palumbo, Jaclyn Sawyer, Manish N. Patel, Jonathan W. Byrnes
  • Journal:
    Cardiology in the Young / Volume 28 / Issue 2 / February 2018
    Published online by Cambridge University Press:
    11 September 2017, pp. 214-221
  • Objective

    Reports in the literature of treatment with recombinant tissue plasminogen activator following cardiac surgery are limited. We reviewed our experience to provide a case series of the therapeutic use of tissue plasminogen activator for the treatment of venous thrombosis in children after cardiac surgery. The data describe the morbidity, mortality, and clinical outcomes of tissue plasminogen activator administration for treatment of venous thrombosis in children following cardiac surgery.

    Design

    The study was designed as a retrospective case series.

    Setting

    The study was carried out in a 25-bed cardiac intensive care unit in an academic, free-standing paediatric hospital.

    Patients

    All children who received tissue plasminogen activator for venous thrombosis within 60 days of cardiac surgery, a total of 13 patients, were included.

    Interventions

    Data was collected, collated, and analysed as a part of the interventions of this study.

    Measurements and main results

    Patients treated with tissue plasminogen activator were principally young infants (median 0.2, IQR 0.07–0.58 years) who had recently (22, IQR 12.5–27.3 days) undergone cardiac surgery. Hospital mortality was high in this patient group (38%), but there was no mortality attributable to tissue plasminogen activator administration, occurring within <72 hours. There was one major haemorrhagic complication that may be attributable to tissue plasminogen activator. Complete or partial resolution of venous thrombosis was confirmed using imaging in 10 of 13 patients (77%), and tissue plasminogen activator administration was associated with resolution of chylous drainage, with no drainage through chest tubes, at 10 days after tissue plasminogen activator treatment in seven of nine patients who had upper-compartment venous thrombosis-associated chylothorax.

    Conclusions

    On the basis of our experience with administration of tissue plasminogen activator in children after cardiac surgery, tissue plasminogen activator is both safe and effective for resolution of venous thrombosis in this high-risk population.