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Intraclot Recombinant Tissue-type Plasminogen Activator Reduces Perihematomal Edema and Mortality in Patients with Spontaneous Intracerebral Hemorrhage 被引量:9
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作者 连立飞 许峰 +8 位作者 唐洲平 薛峥 梁奇明 胡琦 朱文浩 康慧聪 刘晓艳 王芙蓉 朱遂强 《Journal of Huazhong University of Science and Technology(Medical Sciences)》 SCIE CAS 2014年第2期165-171,共7页
The study aimed to investigate the impact of intraclot recombinant tissue-type plasminogen activator (rt-PA) on perihematomal edema (PHE) development in patients with intracerebral hemorrhage (ICH) treated with ... The study aimed to investigate the impact of intraclot recombinant tissue-type plasminogen activator (rt-PA) on perihematomal edema (PHE) development in patients with intracerebral hemorrhage (ICH) treated with minimally invasive surgery (MIS) and the effects of intraclot rt-PA on the 30-day survival. We reviewed the medical records of ICH patients undergoing MIS between October 2011 and July 2013. A volumetric analysis was done to assess the change in PHE and ICH volumes at pre-MIS (T1), post-MIS (T2) and day 10-16 (T3) following diagnostic computed tomographic scans (To). Forty-three patients aged 52.8±11.1 years with (n=30) or without rt-PA (n=13) were enrolled from our institutional ICH database. The median rt-PA dose was 1.5 (1) mg, with a maximum dose of 4.0 mg. The ratio of clot evacuation was significantly increased by intraclot rt-PA as compared with controls (77.9%±20.4% vs. 64%±15%; P=0.046). From TI to T2, reduction in PHE volume was strongly associ- ated with the percentage of clot evacuation (p=0.34; P=-0.027). In addition, PHE volume was positively correlated with residual ICH volume at the same day (p ranging from 0.39-0.56, P〈0.01). There was no correlation between the cumulative dose of rt-PA and early (T2) PHE volume (p=0.24; P=0.12) or de- layed (T3) PHE volume (p=0.19; P=0.16). The 30-day mortality was zero in this cohort. In the selected cohort of ICH patients treated with MIS, intraclot rt-PA accelerated clot removal and had no effects on PHE formation. MIS aspiration and low dose of rt-PA seemed to be feasible to reduce the 30-day mor- tality in patients with severe ICH. A large, randomized study addressing dose titration and long-term outcome is needed. 展开更多
关键词 intracerebral hemorrhage minimally invasive surgery clot aspiration perihematomaledema recombinant tissue-type plasminogen activator
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Recombinant Tissue Plasminogen Activator-conjugated Nanoparticles Effectively Targets Thrombolysis in a Rat Model of Middle Cerebral Artery Occlusion 被引量:3
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作者 Jun DENG Heng MEI +6 位作者 Wei SHI Zhi-qing PANG Bo ZHANG Yao GUO Hua-fang WANG Xin-guo JIANG Yu HU 《Current Medical Science》 SCIE CAS 2018年第3期427-435,共9页
The efficacy and safety of recombinant tissue plasminogen activator (rtPA) need to be improved due to its low bioavailability and requirement of large dose administration. The purpose of this study was to develop a ... The efficacy and safety of recombinant tissue plasminogen activator (rtPA) need to be improved due to its low bioavailability and requirement of large dose administration. The purpose of this study was to develop a fibrin-targeted nanoparticle (NP) drug delivery system for thrombosis combination therapy. We conjugated rtPA to poly(ethylene glycol)- poly(ε-caprolactone) (PEG-PCL) nanoparticles (rtPA-NP) and investigated its physicochemical characteristics such as particle size, zeta potential, enzyme activity of conjugated rtPA and its storage stability at 4℃. The thrombolytic activity of rtPA-NP was evaluated in vitro and in vivo as well as the half-life of rtPA-NP, the properties to fibrin targeting and its influences on systemic hemostasis in vivo. The results showed that rtPA-NP equivalent to 10% of a typical dose of rtPA could dissolve fibrin clots and were demonstrated to have a neuroprotective effect after focal cerebral ischemia as evidenced by decreased infarct volume and improved neurological deficit (P〈0.001). RtPA-NP did not influence the in vivo hemostasis or coagulation system. The half-life of conjugated rtPA was shown to be approximately 18 times longer than that of free rtPA. These experiments suggested that rtPA-conjugated PEG-PCL nanoparticles might be a promising fibrin-targeted delivery system for a combination treatment of thrombosis. 展开更多
关键词 recombinant tissue plasminogen activator THROMBOLYSIS NANOPARTICLES drug delivery system
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Therapeutic effect of recombinant tissue plasminogen activator on acute cerebral infarction at different times 被引量:20
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作者 Ming Liu Hai-rong Wang +4 位作者 Jia-fu Liu Hao-jun Li Shen-xing Chen Sha Shen Shu-ming Pan 《World Journal of Emergency Medicine》 CAS 2013年第3期205-209,共5页
BACKGROUND:The study aimed to compare the therapeutic effect of recombinant tissue plasminogen activator(rt-PA) on the onset of acute cerebral infarction(ACI) at different time points of the first 6 hours.METHODS:A re... BACKGROUND:The study aimed to compare the therapeutic effect of recombinant tissue plasminogen activator(rt-PA) on the onset of acute cerebral infarction(ACI) at different time points of the first 6 hours.METHODS:A retrospective analysis was conducted in 74 patients who received rt-PA thrombolysis treatment within 4.5 hours after ACI and another 15 patients who received rt-PA thrombolysis treatment between 4.5-6 hours after ACI.RESULTS:National Institute of Health Stroke Scale(NIHSS) scores were statistically decreased in both groups(P>0.05) at 24 hours and 7 days after ACI.There was no significant difference in modified ranking scores and mortality at 90 days after the treatment between the two groups(P>0.05).CONCLUSIONS:The therapeutic effect and mortality of rt-PA treatment in patients with ACI between 4.5-6 hours after the onset of the disease were similar to those in patients who received rtPA within 4.5 hours after the onset of this disease.Therefore,intravenous thrombolytic therapy for ACI within 4.5-6 hours after ACI was effective and safe. 展开更多
关键词 Acute cerebral infarction THROMBOLYSIS recombinant tissue type plasminogen activator
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Platelet-to-neutrophil ratio predicts hemorrhagic transformation and unfavorable outcomes in acute ischemic stroke with intravenous thrombolysis
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作者 Ausanee Chaiwisitkun Sombat Muengtaweepongsa 《World Journal of Experimental Medicine》 2024年第3期80-89,共10页
BACKGROUND Acute ischemic stroke(AIS)retains a notable stance in global disease burden,with thrombolysis via recombinant tissue plasminogen activator(rtPA)serving as a viable management approach,albeit with variable o... BACKGROUND Acute ischemic stroke(AIS)retains a notable stance in global disease burden,with thrombolysis via recombinant tissue plasminogen activator(rtPA)serving as a viable management approach,albeit with variable outcomes and the potential for complications like hemorrhagic transformation(HT).The platelet-to-neutrophil ratio(P/NR)has been considered for its potential prognostic value in AIS,yet its capacity to predict outcomes following rtPA administration demands further exploration.AIM To elucidate the prognostic utility of P/NR in predicting HT and clinical outcomes following intravenous rtPA administration in AIS patients.METHODS Data from 418 AIS patients treated with intravenous rtPA at Thammasat University Hospital from January 2018 to June 2021 were retrospectively analyzed.The relationship between P/NR and clinical outcomes[early neurological deterioration(E-ND),HT,delayed ND(D-ND),and 3-mo outcomes]was scrutinized.RESULTS Notable variables,such as age,diabetes,and stroke history,exhibited statistical disparities when comparing patients with and without E-ND,HT,D-ND,and 3-mo outcomes.P/NR prognostication revealed an optimal cutoff of 43.4 with a 60.3%sensitivity and a 52.5%specificity for 90-d outcomes.P/NR prognostic accuracy was statistically significant for 90-d outcomes[area under the curve(AUC)=0.562],D-ND(AUC=0.584),and HT(AUC=0.607).CONCLUSION P/NR demonstrated an association with adverse 3-mo clinical outcomes,HT,and D-ND in AIS patients post-rtPA administration,indicating its potential as a predictive tool for complications and prognoses.This infers that a diminished P/NR may serve as a novel prognostic indicator,assisting clinicians in identifying AIS patients at elevated risk for unfavorable outcomes following rtPA therapy. 展开更多
关键词 Acute ischemic stroke Platelet-to-neutrophil ratio PROGNOSIS Hemorrhagic transformation recombinant tissue plasminogen activator THROMBOLYSIS Clinical outcomes
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Factors influencing clinical outcomes of acute ischemic stroke treated with intravenous recombinant tissue plasminogen activator 被引量:19
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作者 HUANG Yin-hui ZHUO Shi-tu +5 位作者 CHEN Ya-fang LI Ming-mei LIN You-yu YANG Mei-li CHEN Zhen-jie CAI Ruo-wei 《Chinese Medical Journal》 SCIE CAS CSCD 2013年第24期4685-4690,共6页
Background Thrombolysis with recombinant tissue plasminogen activator (rt-PA) has gained international recognition, clinical outcomes following this thrombolytic therapy varied from patient to patient. Factors affec... Background Thrombolysis with recombinant tissue plasminogen activator (rt-PA) has gained international recognition, clinical outcomes following this thrombolytic therapy varied from patient to patient. Factors affecting clinical outcomes have not been well understood yet, so this retrospective case-control study aimed to investigate factors that may influence clinical outcomes of acute ischemic stroke treated with intravenous rt-PA. Methods One hundred and one patients with acute ischemic stroke who received intravenous rt-PA thrombolysis within 4.5 hours from disease onset were included. Patients were divided into good or poor outcome group according to modified Rankin Scale (mRS) score, good outcome group: mRS score of 0-1; poor outcome group: mRS of 2-6. Stroke characteristics were compared between the two groups. Factors for stroke outcomes were analyzed via univariate analysis and Logistic regression. Results Of the 101 patients studied, patients in good outcome group (n=55) were significantly younger than patients in poor outcome group (n=46, (62.82±14.25) vs. (68.81±9.85) years, P=0.029). Good outcome group had fewer patients with diabetic history (9.09% vs. 28.26%, P=0.012), fewer patients with leukoaraiosis (7.27% vs. 28.26%, P=-0.005) and presented with lower blood glucose level ((5.72±1.76) vs. (6.72±1.32) mmol/L, P=0.012), lower systolic blood pressure level ((135.45±19.36) vs. (148.78±19.39) mmHg, P=0.003), lower baseline NIHSS score (12.02±5.26 vs. 15.78±4.98, P=0.002) and shorter onset-to-treatment time (OTT) ((2.38±1.21) vs. (2.57±1.03) hours, P=0.044) than poor outcome group. Logistic regression analysis showed that absence of diabetic history (odds ratio (OR) 0.968 (95% CI 0.941-0.996)), absence of leukoaraiosis (OR 0.835 (95% C/0.712-0.980)), lower baseline NIHSS score (OR 0.885 (95% Cl 0.793- 0.989)), lower pre-thrombolysis systolic blood pressure (OR 0.962 (95% CI 0.929-0.997)), and lower blood glucose level (OR 0.699 (95% Cl 0.491-0.994)) before thrombolysis were significantly associated with better outcome. Conclusion Patients with no history of diabetes, no leukoaraiosis, low blood glucose level, low systolic blood pressure level and low baseline NIHSS score before thrombolvsis have a better outcome. 展开更多
关键词 recombinant tissue plasminogen activator introvenous thrombolysis acute ischemic stroke outcome
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Analysis of the Efficacy and Safety of Recombinant Tissue Plasminogen Activator for Chinese Patients over 80 Years of Age with Acute Ischemic Stroke: A Pilot Study 被引量:7
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作者 Jiandao Yang Huazheng Liang +2 位作者 Yanyan Song Lingda Shen Shaoshi Wang 《Neuroscience Bulletin》 SCIE CAS CSCD 2016年第2期202-203,共2页
Dear Editor,Recombinant tissue plasminogen activator(rt-PA)remains the only proven therapy for acute ischemic stroke patients who meet the selection criteria for treatment[1–3].A small number of studies have invest... Dear Editor,Recombinant tissue plasminogen activator(rt-PA)remains the only proven therapy for acute ischemic stroke patients who meet the selection criteria for treatment[1–3].A small number of studies have investigated the efficacy of rt-PA for elderly stroke patients in Japanese and Caucasian populations[4,5].According to the American Heart Association/American Stroke Association Guidelines, 展开更多
关键词 recombinant activator Pilot populations Japanese proven elderly plasminogen mortality continued
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Minimally invasive puncture and drainage or patients with hypertensive spontaneous basal ganglia intracerebral hemorrhage: A prospective non-randomized comparative study of 198 cases 被引量:2
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作者 Guo-Qiang Wang Shi-Qiang Li +11 位作者 Wei-Wei Zhang Yong-Hua Huang Wen-Wei Ruan Jia-Zhen Qin Ying Li Wei-Min Yin Yun-Jun Li Zheng-Jun Ran Ji-Qiang Zhu Yun-Yan Ding Jun-Qi Peng Pei-Jian Li 《Journal of Medical Colleges of PLA(China)》 CAS 2014年第1期19-31,共13页
Background: The treatment of hypertensive spontaneous intracranial hemorrhage(ICH) is still controversial. The purpose of the present study was to investigate whether minimally invasive puncture and drainage(MIPD) cou... Background: The treatment of hypertensive spontaneous intracranial hemorrhage(ICH) is still controversial. The purpose of the present study was to investigate whether minimally invasive puncture and drainage(MIPD) could provide improved patient outcome compared with decompressive craniectomy(DC).Methods: Eligible, consecutive patients with ICH(≥30 ml, in basal ganglia, within 24 hours of ictus) were nonrandomly assigned to receive MIPD(group A) or to undergo DC(group B) hematoma evacuation. The primary outcome was death at 30 days after onset. Functional independence was assessed at 1 year using the Glasgow Outcome Scale(GOS, scores range from 1 to 5, score 1 indicating death, ≥4 indicating functional independence, with lower scores indicating greater disability). Results: A total of 198 patients met the per protocol analysis(84 cases in group A and 114 cases in group B), including 9 cases lost during follow-up(2 cases in group A and 7 cases in group B). For these 9 patients, their last observed data were used as their final results for intention-to-treat analysis. The mean age of all patients was 57.1 years(range of 31-95 years), and 114 patients were male. The initial Glasgow Coma Scale(GCS) score was 8.1±3.4, and the National Institutes of Health Stroke Scale(NIHSS) score was 20.8±5.3. The mean hematoma volume(HV) was 56.7±23.0 ml(range of 30-144 ml), and there was extended intraventricular hemorrhage(IVH) in 134 patients(67.7%). There were no significant intergroup differences in the above baseline data, except group A had a higher mean age(59.4±14.5years) than the mean age of group B(55.3±11.1 years, P=0.025). The total cumulative mortalities at 30 days and 1 year were 32.3% and 43.4%, respectively, and there were no significant differences between groups A and B(30 days: 27.4% vs. 36.0%, P=0.203; 1 year: 36.1% vs. 48.2%, P=0.112, respectively). However, the mortality for patients ≤60 years, NIHSS【15 or HV≤60 ml was significantly lower in group A than that in group B(all P【0.05). The total cumulative functional independence at 1 year was 26.8%, and the difference between group A(33/43, 39.3%) and group B(20/144, 17.5%) was significant(absolute difference 21.7%, odds ratio [OR] 0.329, 95% confidence interval [CI] 0.171 to 0.631, P=0.001). For patient with severe IVH, the 30 days and 1 year mortality rates were significant lower in group B than those in group A(P=0.025, P=0.036). However, the number of favorable outcomes had no significant difference between groups at 1 year post ictus. Multivariate logistic regression analysis showed that a favorable outcome after 1 year was associated with the difference in therapies(OR 0.280, 95% CI 0.104–0.752, P=0.012), age(OR 0.215, 95% CI 0.069–0.671, P=0.008), GCS(OR 1.187, 95% CI 1.010–1.395, P=0.037), HV(OR 0.943, 95% CI 0.906–0.982, P=0.005), IVH(OR 0.655, 95% CI 0.506–0.849, P=0.001) and PI(OR 0.211, 95% CI 0.071–0.624, P=0.001). Conclusions: Our results suggest that for patients with hypertensive spontaneous ICH(HV≥30 ml in basal ganglia), MIPD may be a more effective treatment than DC, as assessed by a higher rate of functional independence at 1 year after onset as well as reduced mortality in patients ≤60 years of age, NIHSS【15 or HV≤60 ml. For patients with HV 】60 ml, deep coma and severe IVH, the outcomes of the two therapies were similar. 展开更多
关键词 intracerebral hemorrhage intraventricular hemorrhage minimal invasive puncture decompressive craniectomy recombinant tissue plasminogen activator UROKINASE
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Submacular hemorrhage:treatment update and remaining challenges
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作者 Chee Wai Wong Jan Carlo Yu Alegre +1 位作者 Yew San Ian Yeo Chui Ming Gemmy Cheung 《Annals of Eye Science》 2017年第1期7-11,共5页
Submacular haemorrhage(SMH)is a sight threatening complication that can occur in exudative age related macular degeneration(AMD),but has been described to occur more frequently in eyes with polypoidal choroidal vascul... Submacular haemorrhage(SMH)is a sight threatening complication that can occur in exudative age related macular degeneration(AMD),but has been described to occur more frequently in eyes with polypoidal choroidal vasculopathy(PCV).Left untreated,SMH carries a grave visual prognosis.Thus,expedient diagnosis and effective management of this complication is of paramount importance.The treatment strategies for SMH include(I)displacement of blood from the fovea,usually by injection of an expansile gas;(II)pharmacologic clot lysis such as with recombinant tissue plasminogen activator(rtPA);and(III)treatment of the underlying choroidal neovascularization(CNV)or PCV,such as with anti-vascular endothelial growth factor(anti-VEGF)agents.These three strategies have been employed in isolation or in combination,some concurrently and others in stages.rtPA has demonstrable effect on the liquefaction of submacular clots but there are remaining uncertainties with regards to the dose,safety and the timing of initial and repeat treatments.Potential side effects of rtPA include retinal pigment epithelial toxicity,increased risk of breakthrough vitreous haemorrhage and systemic toxicity.In cases presenting early,pneumatic displacement alone with anti-VEGF may be sufficient.Anti-VEGF monotherapy is a viable treatment option particularly in patients with thinner SMH and those who are unable to posture post pneumatic displacement. 展开更多
关键词 Submacular hemorrhage(SMH) recombinant tissue plasminogen activator(rtPA) polypoidal choroidal vasculopathy(PCV)
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Factors Associated with Thrombolysis Outcome in Ischemic Stroke Patients with Atrial Fibrillation 被引量:14
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作者 Qiuyun Zhao Xiaobo Li +16 位作者 Wanli Dong Min Ye Yongjun Cao Meijuan Zhang Qiantao Cheng Junshan Zhou Guofang Chen Ming Yu Shanshan Hong Xiue Wei Bei Wang Guiyun Cui Peng Zhang Hong Ding Rongzhen Xu Yan Chen Yun Xu 《Neuroscience Bulletin》 SCIE CAS CSCD 2016年第2期145-152,共8页
The outcome of early intravenous thrombolysis for ischemic stroke in patients with atrial fibrillation(AF)is worse than that without thrombosis. How to increase the efficacy of intravenous thrombolysis for AF-relate... The outcome of early intravenous thrombolysis for ischemic stroke in patients with atrial fibrillation(AF)is worse than that without thrombosis. How to increase the efficacy of intravenous thrombolysis for AF-related ischemic stroke remains largely unknown. In this study, we investigated factors that influence the effect of intravenous thrombolysis in these patients. Our results showed that thrombolysis was independently associated with a favorable outcome(P / 0.001) and did not influence the mortality of AF-related ischemic stroke, although it increased the risk of hemorrhage within 24 h after treatment. Risk factors for a poor outcome at admission were:heart failure(P = 0.045); high systolic pressure(P = 0.039); high blood glucose(P = 0.030); and a high National Institutes of Health Stroke Scale(NIHSS) score(P / 0.001). Moreover, high systolic pressure at admission(P = 0.007), high blood glucose(P = 0.027), and a high NIHSS score(P / 0.001) were independent risk factors for mortality at 3 months. Besides thrombolysis, a high NIHSS score(P = 0.006) and warfarin taken within 48 h before stroke onset(P = 0.032) were also independent risk factors for symptomatic hemorrhage within 24 h after treatment. Ischemic stroke patients with AF benefited from intravenous thrombolysis with recombinant tissue plasminogen activator within 4.5 h after stroke. 展开更多
关键词 Ischemic stroke Atrial fibrillation Intravenous recombinant tissue plasminogen activator Intravenous thrombolysis Favorable outcome Risk factors
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An Experimental Study on the Flexibility of Prevention against Thrombosis Following Mechanical Valve Replacement by tPA Gene Transduction
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作者 姬尚义 季军 +4 位作者 杨晓涵 杨建安 王小雷 令文萍 张玉萍 《South China Journal of Cardiology》 CAS 2008年第3期134-138,共5页
Objectives Use a gene suture immersed recombinant tissue-type plasminogen activator (r-tPA)expression plasmid to transduce myocardia to prevent the thrombosis after mechanical tricuspid valve replacement in pigs. Me... Objectives Use a gene suture immersed recombinant tissue-type plasminogen activator (r-tPA)expression plasmid to transduce myocardia to prevent the thrombosis after mechanical tricuspid valve replacement in pigs. Methods A r-tPA gene plasmid was constructed and conjugated to a novel cationic phosphonolipid and a r-tPA gene suture was made. Eighteen pigs were selected and divided into two groups at randomization. There were 9 pigs in the experimental group and 9 in the control group, all the 18 pigs' tricuspids were replaced with mechanical valves. The gene threads were sutured into the right ventricular walls near mechanical valves and an ultrasound was used on the surfaces of the right ventricular walls for the gene transfer in the experimental group. Coagulative function, D-dimer level of the blood and the thrombosis on the surfaces of the valves were observed. Results r-tPA gene plasmid was successfully constructed and r-tPA protein was expressed in the ventricular cells around the gene sutures. D-dimer reached its peak level ( 1.67 ±0. 79) μg · mL^-1 in 1 week after operation in two groups, but it decreased to preoperation level thereafter in control group and kept on the high level and reincreased to a new high level ( 1.89 ± 0.79 ) μg · mL^-1 until the end of the experiment in experimental group. The thromboses around the valves were found in all the control group (100%) but only 1 ( 11.11% ) case in experimental group. There were no changes in prothrombin time pre and post operation in two groups. Conclusions Using gene suture immersed r-tPA expression plasmid to transduce myocardia might be a best substitution for life long anti-coagulation therapy for the patients, who underwent operation. 展开更多
关键词 recombinant tissue-type plasminogen activator gene D-DIMER THROMBOSIS mechanical valve replacement
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