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Thrombolytic Therapy - Top 30 Publications

A case report on 2 unique presentations of upper extremity deep vein thrombosis.

Thoracic outlet syndrome (TOS) is a rare cause of upper extremity deep vein thrombosis (UEDVT). The treatment usually involves catheter directed thrombolysis followed by systemic anticoagulation. Surgical decompression is frequently recommended after anticoagulation for definitive therapy.

Self-Management of an Inferior ST-Segment Elevation Myocardial Infarction.

Variation in Patient Backgrounds, Practice Patterns, and Outcomes of High-Risk Pulmonary Embolism in Japan.

High-risk pulmonary embolism (PE) with hypotension, circulatory failure, or cardiac arrest is a rare, but life-threating condition. Many guidelines recommend that thrombolytic therapy is the first-line therapy for this condition and surgical embolectomy is an alternative treatment. However, nationwide data have been lacking on patient characteristics and practice patterns for high-risk PE in a real-world clinical setting.We defined high-risk PE patients as those who received noradrenaline and underwent surgical embolectomy or thrombolysis within one day after admission. Using a Japanese national inpatient database, we identified high-risk PE patients from July 2010 to March 2014, and divided them into patients with and without embolectomy and those with and without cardiopulmonary arrest (CPA) at admission. We examined variation in patient backgrounds, procedures, and outcomes in this population.We identified 361 patients were eligible. Among those, including 266 received thrombolysis and 95 received embolectomy. The 30-day mortality was 41.4% in 266 patients with thrombolysis, and 14 patients died in 95 patients with embolectomy. Among the thrombolysis group, 30-day mortality was 35% in 187 patients without CPA thrombolysis and was 56% in 79 patients with CPA. Among the embolectomy group, 30-day mortality was 14% in 81 patients without CPA, and 21% patients died in 14 patients with CPA.The present nationwide study showed that surgical embolectomy had a relatively low mortality. Further studies are needed to verify the comparative effectiveness of embolectomy.

Pulmonary Embolism: Current Role of Catheter Treatment Options and Operative Thrombectomy.

Pulmonary embolism remains a leading cause of death in the United States, with an estimated 180,000 deaths per year. Guideline-based treatment in most cases recommends oral anticoagulation for 3 months. However, in a small subset of patients, the "submassive, high-risk" by current nomenclature, with hemodynamic instability, more advanced therapeutic options are available. Treatment modalities to extract the thromboembolism and reduce pressure overload in the cardiopulmonary system include use of intravenous or catheter-directed thrombolytic agents, catheter-directed mechanical thrombectomy, and surgical embolectomy. This article discusses current minimally invasive and surgical methods for reducing embolic burden in patients with submassive, high-risk pulmonary embolism.

Catheter-Directed Therapy Options for Iliofemoral Venous Thrombosis.

Proximal deep venous thrombosis (DVT) is linked to a 50% risk of pulmonary embolism and a 50% risk of postthrombotic syndrome. This article reviews catheter-directed thrombolysis options for iliofemoral DVT and discusses the risks, benefits, and techniques commonly used in performing endovascular procedures for iliofemoral DVT.


The stroke mortality rate in Poland is one of the highest in Europe with particularly large percentage of deaths in early phase of stroke. The aim of the study was to analyze the causes and risk factors for treatment failure and early death in patient with ischemic stoke treated with thrombolysis in the Department of Neurology, Military Institute of Medicine. The study included 295 patients treated with thrombolysis over the period 2005-2015. The study protocol defined for each patient include demographic data, time of recombinant tissue plasminogen activator (rt-PA) administration from the onset of symptoms, the presence of stroke risk factors. The incidence of in-hospital deaths was 8.1% within the first week and 15.6% in the first month. In the final model, relevant death predictors were: baseline National Institutes of Health Stroke Score (NIHSS), hemorrhagic transformation type 2, hyperglycemia at admission and increased blood pressure above 180/110 mmHg during or in the first day after thrombolysis. The most common cause of death was a massive stroke with increased intracranial pressure, (36.4%), intracerebral hemorrhage (15.3%), concomitant edema and hemorrhage (27%), pneumonia (15.3%), cardiac disorders (13.4%). The important risk factors of death directly associated with thrombolytic therapy were hemorrhagic transformation and hemisphere stroke with malignant edema increasing the risk of bleeding.

Predictors of Thrombolysis Administration in Mild Stroke: Florida-Puerto Rico Collaboration to Reduce Stroke Disparities.

Mild stroke is the most common cause for thrombolysis exclusion in patients acutely presenting to the hospital. Thrombolysis administration in this subgroup is highly variable among different clinicians and institutions. We aim to study the predictors of thrombolysis in patients with mild ischemic stroke in the FL-PR CReSD registry (Florida-Puerto Rico Collaboration to Reduce Stroke Disparities).

Effects of Prehospital Thrombolysis in Stroke Patients With Prestroke Dependency.

Data on effects of intravenous thrombolysis on outcome of patients with ischemic stroke who are dependent on assistance in activities of daily living prestroke are scarce. Recent registry based analyses in activities of daily -independent patients suggest that earlier start of intravenous thrombolysis in the prehospital setting leads to better outcomes when compared with the treatment start in hospital. We evaluated whether these observations can be corroborated in patients with prestroke dependency.

National Practice Patterns of Obtaining Informed Consent for Stroke Thrombolysis.

No standard approach to obtaining informed consent for stroke thrombolysis with tPA (tissue-type plasminogen activator) currently exists. We aimed to assess current nationwide practice patterns of obtaining informed consent for tPA.

Long-Term Survival After Intravenous Thrombolysis for Ischemic Stroke: A Propensity Score-Matched Cohort With up to 10-Year Follow-Up.

Intravenous thrombolysis with alteplase is one of the few approved treatments for acute ischemic stroke; nevertheless, little is known about its long-term effects on survival and recovery because clinical trials follow-up times are limited.

Thrombus Neutrophil Extracellular Traps Content Impair tPA-Induced Thrombolysis in Acute Ischemic Stroke.

Neutrophil Extracellular Traps (NETs) are DNA extracellular networks decorated with histones and granular proteins produced by activated neutrophils. NETs have been identified as major triggers and structural factors of thrombosis. A recent study designated extracellular DNA threads from NETs as a potential therapeutic target for improving tissue-type plasminogen activator (tPA)-induced thrombolysis in acute coronary syndrome. The aim of this study was to assess the presence of NETs in thrombi retrieved during endovascular therapy in patients with acute ischemic stroke (AIS) and their impact on tPA-induced thrombolysis.

A case report of parenchymal hematoma after intravenous thrombolysis in a rivaroxaban-treated patient: Is it a true rivaroxaban hemorrhagic complication?

To date, the only treatment approved for acute ischemic strokes is thrombolysis. Whether intravenous thrombolysis may be safe in patients taking direct oral anticoagulants (DOACs) is currently a matter of debate.

Comorbid Psychiatric Disease Is Associated With Lower Rates of Thrombolysis in Ischemic Stroke.

Intravenous thrombolysis (IVT) improves outcomes after acute ischemic stroke but is underused in certain patient populations. Mental illness is pervasive in the United States, and patients with comorbid psychiatric disease experience inequities in treatment for a range of conditions. We aimed to determine whether comorbid psychiatric disease is associated with differences in IVT use in acute ischemic stroke.

Erythrocyte Fraction Within Retrieved Thrombi Contributes to Thrombolytic Response in Acute Ischemic Stroke.

Recent advent of endovascular thrombectomy (EVT) enables us to provide a new perspective on the use of tPA (tissue-type plasminogen activator) through histological analysis of retrieved thrombus. We investigated the responsiveness of intravenous thrombolysis (IVT) according to the thrombus composition in EVT-attempted patients with acute ischemic stroke.

Late Window Paradox.

Surgical Management of Moyamoya Disease.

Thrombolysis in stroke patients: Comparability of point-of-care versus central laboratory international normalized ratio.

In acute stroke patients, thrombolysis is one gold standard therapy option within the first four hours after the ischemic event. A contraindication for thrombolysis is an International Normalized Ratio (INR) value >1.7. Since time is brain, rapid and reliable INR results are fundamental. Aim was to compare INR values determined by central laboratory (CL) analyzer and Point-of-Care Testing(POCT)-device and to evaluate the quality of POCT performance in cases of potential therapeutic thrombolysis at a certified stroke unit.

Agitation thrombolysis and catheter-directed thrombolysis for normotensive patients with acute pulmonary thromboembolism.

To assess the feasibility, efficacy, and safety of agitation thrombolysis and catheter-directed thrombolysis (AT-CDT) in the treatment of normotensive patients with acute pulmonary thromboembolism (PTE).

Venous acute disturbance of mesenteric circulation: diagnosis and treatment.

Response by Voelkel and Hubert to Letter Regarding Article, "Thrombolysis in Postoperative Stroke".

Letter by Liu et al Regarding Article, "Thrombolysis in Postoperative Stroke".

Intravenous Thrombolysis for Stroke and Presumed Stroke in Human Immunodeficiency Virus-Infected Adults: A Retrospective, Multicenter US Study.

Human immunodeficiency virus (HIV) infection has been shown to increase both ischemic and hemorrhagic stroke risks, but there are limited data on the safety and outcomes of intravenous thrombolysis with tPA (tissue-type plasminogen activator) for acute ischemic stroke in HIV-infected patients.

A Case of Massive Pulmonary Embolism Following Varicose Vein Surgery That Was Successfully Treated with Thrombolytic Therapy.

High-risk Pulmonary Embolism: Should We Be Less Patient with Thrombolytic Therapy?

Novel Telestroke Program Improves Thrombolysis for Acute Stroke Across 21 Hospitals of an Integrated Healthcare System.

Faster treatment with intravenous alteplase in acute ischemic stroke is associated with better outcomes. Starting in 2015, Kaiser Permanente Northern California redesigned its acute stroke workflow across all 21 Kaiser Permanente Northern California stroke centers to (1) follow a single standardized version of a modified Helsinki model and (2) have all emergency stroke cases managed by a dedicated telestroke neurologist. We examined the effect of Kaiser Permanente Northern California's Stroke EXpediting the PRrocess of Evaluating and Stopping Stroke program on door-to-needle (DTN) time, alteplase use, and symptomatic intracranial hemorrhage rates.

Use of local thrombolysis in patients with massive pulmonary thromboembolism and moderate-to-severe pulmonary hypertension.

Presented herein are the results of treating a total of 110 patients with acute massive pulmonary thromboembolism. The patients included in the study were divided into 2 groups depending on the degree of severity of pulmonary hypertension. All patients underwent interventional treatment, i.e., endovascular mechanical fragmentation with local thrombolysis. Both short- and long-term outcomes were then analysed. Performing local thrombolysis made it possible to achieve regression of clinical manifestations of acute respiratory insufficiency in more than 98% of patients. Stabilization of the clinical condition in the early postoperative period was accompanied by improvement of haemodynamics of the right heart in the remote terms of follow up after the intervention. There were 2 (1.8%) lethal outcomes resulting from progression of acute cardiovascular insufficiency. Clinically significant haemorrhage was observed in 1 (0.8%) case and was successfully arrested by conservative therapy. It was shown that local thrombolysis contributed not only to improving perfusion of the lesser circulation, a reduction of pressure in pulmonary arteries and the right heart, but also to a decrease or normalization of the linear dimensions of the right auricle and right ventricle, as well as prevented the formation of chronic postembolic pulmonary hypertension in more than 90% of patients. It was also demonstrated that while performing this type of treatment, the initial level of pulmonary hypertension did not influence either the prognosis or the outcome of the disease.

Thrombolysis for acute upper extremity deep vein thrombosis.

About 5% to 10% of all deep vein thromboses occur in the upper extremities. Serious complications of upper extremity deep vein thrombosis, such as post-thrombotic syndrome and pulmonary embolism, may in theory be avoided using thrombolysis. No systematic review has assessed the effects of thrombolysis for the treatment of individuals with acute upper extremity deep vein thrombosis.

Managing Venous Thromboembolic Disease On-Call.

Managing venous thromboembolic disease on-call requires the interventional radiologist consider not only potential risk and benefit to the patient but also available resources in the IR suite as well as throughout the hospital, such as intensive care monitoring during treatment. We demonstrate how our practice manages these on-call cases ranging from deep venous thrombosis to acute pulmonary embolism and decide which patients need emergent treatment and which can undergo delayed intervention during working hours. In all cases, an adequate preprocedural clinical assessment is crucial.

Acute Limb Ischemia.

Acute limb ischemia is technically defined as ischemia of the lower extremities lasting 14 days or less. The condition affects between 15 and 26 persons per 100,000 each year in the United States. The associated morbidity and mortality is extremely high, with 1-year mortality rates reported at over 40%. Acute limb ischemia is 20 times more common in the lower extremities than the upper extremities. Both interventional radiologists and vascular surgeons bring unique skills to the table in caring for these patients, and therefore should approach the care of these patients in a multidisciplinary manner to ensure the best outcomes for each patient. Patients should be classified according to the Rutherford classification scale for acute limb ischemia. Catheter-directed thrombolysis can be a viable treatment alternative for these patients, offering a minimally invasive option to patients with outcomes similar to surgery. It is important to know the presentation, physical examination, risks and benefits, as well as the techniques and equipment required to treat patients with acute lower limb ischemia.

Contemporary risk model for inhospital major bleeding for patients with acute myocardial infarction: The acute coronary treatment and intervention outcomes network (ACTION) registry®-Get With The Guidelines (GWTG)®.

Major bleeding is a frequent complication for patients with acute myocardial infarction (AMI) and is associated with significant morbidity and mortality.