Management of Acute Saddle Pulmonary Embolism in Pregnancy Following Fetal Surgery.

A 33-year-old gravidity three parity three (G3P3) woman at 34 weeks of pregnancy underwent fetal surgery to repair an open lumbosacral myelomeningocele at 22 weeks gestation and experienced preterm premature rupture of membranes as a result. She developed a saddle pulmonary embolus with signs of right heart strain while on prolonged bed rest. She was treated emergently with aspiration thrombectomy and suprarenal inferior vena cava (IVC) filter placement, followed by an uncomplicated cesarean delivery thereafter.

Readiness of the Stroke Treatment in India: Still an Uphill Task!

How to cite this article: Singhal V, Prabhakar H. Readiness of the Stroke Treatment in India: Still an Uphill Task! Indian J Crit Care Med 2023;27(9):607-608.

Stumbling Blocks to Stroke Thrombolysis: An Indian Perspective.

Background and purpose: Stroke is a leading cause of morbidity and mortality worldwide. Developing countries, however, still lag behind in providing timely thrombolytic therapy (TLT) to many eligible patients owing to various reasons. This study aims to identify such factors. Materials and methods: This was a descriptive observational study undertaken over a period of 18 months at a tertiary care teaching hospital and included 252 acute ischemic stroke patients of which 200 were not thrombolyzed. The reasons for nonthrombolysis were recorded and analyzed. Results: The study included 252 acute ischemic stroke patients of which only 20% were thrombolyzed. Of the 200 nonthrombolyzed patients, 55% arrived out of the window period while patient-related factors were the second biggest factor preventing thrombolysis. Hospital factors at 14% and financial constraints at 4.5% contributed significantly. Delayed consent emerged as an important factor making 6% of the delays. Conclusion: Stroke thrombolysis still faces various pre- and intrahospital barriers in India. There is an urgent need to improve infrastructure and organizational streamlining to enable eligible patients to receive prompt treatment. How to cite this article: Shah A, Diwan A. Stumbling Blocks to Stroke Thrombolysis: An Indian Perspective. Indian J Crit Care Med 2023;27(9):616-619.

Intravenous Thrombolysis for Central Retinal Artery Occlusion: A Look at the Literature for the Emergency Medicine Physician.

Central retinal artery occlusion (CRAO) is a subtype of ischemic stroke and true ocular emergency presenting with acute, painless, monocular vision loss. Typical findings include poor visual acuity (VA), impaired color vision, relative afferent pupillary defect, and on fundoscopic evaluation, retinal edema, cherry red spot, and occasionally visualization of retinal artery emboli. While there are no proven treatments for CRAO, options include orbital massage, hyperbaric oxygen therapy, and intra-arterial or intravenous thrombolysis (IVT). This study reviews the current literature on the efficacy of IVT for patients affected by acute, symptomatic CRAO and provides an up-to-date, evidence-based background for emergency physicians (EPs) who evaluate and manage these patients.

Blood glucose level affects prognosis of patients who received intravenous thrombolysis after acute ischemic stroke? A meta-analysis.

Background and objectives: Intravenous recombinant tissue plasminogen activator (rtPA) thrombolysis is an effective treatment for acute ischemic stroke. Hyperglycemia is a major risk factor for the occurrence, development, and prognosis of ischemic stroke. This meta-analysis purposefully estimates the association between hyperglycemia and poor prognosis in acute ischemic stroke patients receiving intravenous rtPA thrombolytic therapy. Materials and methods: According to the predefined inclusion criteria, we searched PubMed, Web of Science, and Cochrane Library databases. The association of high blood glucose(>140mg/dl) with symptomatic intracranial hemorrhage (sICH), poor clinical outcome and mortality at 90 days post-rtPA thrombolysis was studied using both a common effects model and a random effects model. Odds ratios (ORs) were plotted on forest plots. Results: Of a total cohort of 2565 patients who received intravenous thrombolytic therapy, 721 had higher blood glucose. High glucose level significantly increased the odds of sICH (OR 1.80; 95% confidence interval(95%CI): 1.30- 2.50) and poor clinical outcome at 90 days (OR 1.82; 95%CI: 1.52-2.19), and all-cause mortality at 90 days (OR 2.51; 95%CI:1.65-3.82). Conclusions: In our meta-analysis, high blood glucose was significantly associated with sICH, poor clinical outcome and higher mortality at 90 days.

The effects of the coronavirus disease pandemic on intravenous thrombolytic therapy among patients with acute ischemic stroke in Dalian, China.

BACKGROUND: We investigated the influence of the coronavirus disease 2019 (COVID-19) pandemic on the number of patients with acute ischemic stroke who received intravenous thrombolytic therapy (ITT) in Dalian, China, in 2020. METHODS: This retrospective descriptive study, conducted from February 1, 2020, to August 31, 2020, examined 13 hospitals in Dalian that participated in the "stroke emergency map". To use this "stroke emergency map" of China, patients followed the official "Stroke Map" WeChat account and dialed 120 for emergency medical services. We analyzed the number of patients with acute ischemic stroke who underwent ITT. In particular, we examined the onset-to-door time (ODT), door-to-needle time (DNT), onset-to-needle time (ONT), mode of transportation to the hospital, and National Institutes of Health Stroke Scale (NIHSS) scores before and after ITT. Data were collected for the aforementioned period and compared with the 2021 baseline data from the same time of year. The Mann‒Whitney U test was performed for data analysis. RESULTS: Compared with the data from 2020, the number of patients with acute ischemic stroke who underwent ITT increased (from 735 to 1719 cases) in 2021, but the DNT decreased (from 59 to 45 min; P = 0.002). Moreover, 83.9% of patients in 2020 presented to the hospital without ambulance transport, compared to 81.1% of patients in the 2021 non-COVID-19 pandemic period. Patients with NIHSS scores of 6-14 were more likely to call an ambulance for transport to the hospital than to transport themselves to the emergency department. CONCLUSIONS: During the 2020 COVID-19 pandemic, the DNT was prolonged as a result of strengthened fever surveillance. In 2021, the number of patients with acute ischemic stroke who underwent ITT increased compared to the previous year. Notably, the growth in the number of patients with acute ischemic stroke who underwent ITT benefited from both the "stroke emergency map" of China and the "green channel," a novel treatment approach that focuses on the rational design of the rescue process. TRIAL REGISTRATION: Our study was a retrospective descriptive study, not a clinical trial, thus we did not have to register for clinical trials.

Intravenous thrombolysis in ischemic stroke patients with a prior intracranial hemorrhage: a meta-analysis.

BACKGROUND: The history of intracranial hemorrhage (ICrH) is considered a contraindication for intravenous thrombolysis (IVT) among patients with acute ischemic stroke (AIS). Objective: This study aimed at comparing the safety of IVT among patients with and without a history of ICrH. METHODS: We performed a systematic review of the literature. Data regarding all AIS patients with prior ICrH who received IVT were retrieved. Meta-analysis was performed to compare the rate of symptomatic hemorrhagic transformation (sHT), death within 90 days, and favorable and unfavorable 90-day functional outcomes based on modified Rankin Scale (mRS) among stroke patients with and without prior ICrH. RESULTS: Out of 13,032 reviewed records, 7 studies were included in the systematic review and meta-analysis. Quantitative synthesis of data regarding the rate of sHT (5068 patients) revealed no significant difference between the two groups [odds ratio, OR: 1.55 (0.77, 3.12); p = 0.22]. However, a significantly higher risk of death within 90 days [OR: 3.91 (2.16, 7.08); p < 0.00001] and a significantly higher 90-day poor functional outcomes (mRS, 4-6) [OR: 1.57 (1.07, 2.30); p = 0.02] were observed among patients with prior ICrH. Likewise, the percentage of 90-day good functional outcomes (mRS, 0-1) was lower in the prior ICrH group [OR: 0.54 (0.35, 0.84); p = 0.06]. Subgroup analyses in patients with a history of ICrH (based on both patients' medical history and imaging confirmation) revealed no significant between-group differences in rates of sHT. Also, sensitivity analysis consisting of only studies using standard-dose IVT showed no difference in sHT rates and 90-day outcomes between the two groups. There was no evidence of heterogeneity (I 2 >50%) among included studies. CONCLUSION: The results of this study indicated that prior history of ICrH does not increase the risk of sHT post-IVT, but it is associated with a higher risk of death and poor functional outcomes in 90 days.

Branch atheromatous disease and treatment.

Branch atheromatous disease (BAD) is a subtype of ischemic stroke caused by perforating arteries occlusion due to proximal atherosclerosis of the arteries. Early neurological deterioration and recurrent stereotyped transient ischemic attacks are typical clinical manifestations of BAD. The optimal treatment for BAD has not been determined. This article explores a possible mechanism of BAD and effective treatment measures to prevent early progression and attack of transient ischemic events. This article explains the current status of intravenous thrombolysis, tirofiban, and argatroban for BAD and subsequent prognosis.

Factors associated with early improvement after intravenous thrombolytic treatment in acute ischemic stroke.

OBJECTIVE: : The aim of this study was to determine the factors associated with early neurological improvement (ENI) in patients who experienced acute ischemic stroke and were treated with intravenous recombinant tissue plasminogen activator (IV rt-PA), and determine the relationship with the outcome at the first control. METHOD: : This study included 377 patients who were treated with IV rt-PA in Izmir Dokuz Eylül University Hospital between January 2010 and October 2018. ENI was defined as a 4 or more improvement in the National Institutes of Health Stroke Scale (NIHSS) score in the first hour, the twenty-fourth hour and the seventh day when compared to the pretreatment phase. The modified Rankin Scale (mRS) 0-1 score was defined as 'very good outcome'. RESULTS: : The basal NIHSS (p=0.003, p=0.003, p=0.022) was high in the first hour, twenty-fourth hour, and seventh day ENI groups. Blood urea nitrogen (BUN) level was low in the first- and twenty-fourth-hour ENI groups (p=0.007, p=0.020). Furthermore, admission glucose was low at the twenty-fourth hour and on the seventh day ENI groups (p=0.005, p=0.048). A high infarct volume was observed on magnetic resonance imaging (MRI) at the twenty-fourth hour and on the seventh day non-ENI groups (p= <0.001, p= <0.001). CONCLUSION: : Management of factors associated with ENI and determination of treatment strategies accordingly are important for obtaining a better clinical outcome. It can help quickly select patients, who, even though they will not respond to rt-PA, may be appropriate candidates for bridging therapy.

Serum calcium, albumin, globulin and matrix metalloproteinase-9 levels in acute cerebral infarction patients.

BACKGROUND: Hemorrhagic transformation (HT) is a common complication in patients with cerebral infarction. However, its pathogenesis is poorly understood. The knowledge of factors that may increase risk for HT may help in improving the safety of thrombolytic therapy. AIM: To investigate the predictive value of serum calcium, albumin, globulin and matrix metalloproteinase-9 (MMP-9) levels for HT after intravenous thrombolysis (IVT) in patients with acute cerebral infarction. METHODS: Five hundred patients with acute cerebral infarction who received IVT with alteplase within 4.5 h after the onset of disease between January 2018 and January 2021 at our hospital were selected as the study subjects. They were divided into groups based on computed tomography scan results of the brain made within 36 h after thrombolysis. Forty patients with HT were enrolled in an observation group and 460 patients without HT were enrolled in a control group. Serum calcium, albumin, globulin and MMP-9 levels were compared between the two groups. Regression analysis was used to discuss the relationship between these indices and HT. RESULTS: The previous history of hypertension, diabetes, atrial fibrillation, cerebrovascular diseases, smoking and alcohol intake were not associated with HT after IVT in patients with acute cerebral infarction (all P > 0.05). The National Institutes of Health stroke scale (NHISS) score was associated with HT after IVT in patients with acute cerebral infarction (P < 0.05). The serum calcium and albumin levels were lower in the observation group than in the control group (all P < 0.05). The levels of globulin and MMP-9 were significantly higher in the observation group than in the control group (all P < 0.05). Logistic regression analysis showed that NHISS score, serum calcium, albumin, globulins and MMP-9 were independent factors influencing the occurrence of HT following IVT in patients with cerebral infarction (P < 0.05). CONCLUSION: Serum calcium, albumin, globulin and MMP-9 levels are risk factors for HT after IVT in patients with acute cerebral infarction. Moreover, NHISS score can be used as a predictor of post-thrombolytic HT.

Early reperfusion strategy selection and prognosis analysis in patients with acute ST segment elevation myocardial infarction: based on the data of 49 hospitals in Hebei Province / 中华危重病急救医学

Objective:To explore the selection of strategies for early reperfusion therapy and its impact on prognosis in patients with acute ST segment elevation myocardial infarction (STEMI).Methods:The treatment data and 3-year follow-up results of acute myocardial infarction (AMI) patients in 49 hospitals in Hebei Province from January to December 2016 were collected. Patients with STEMI who received either intravenous thrombolytic therapy (ITT) or primary percutaneous coronary intervention (PPCI) within 12 hours of onset were enrolled. Baseline data, the time from the first diagnosis to the start of reperfusion (FMC2N for ITT patients and FMC2B for PPCI patients), vascular recanalization rate, in-hospital mortality, 1-year mortality, and 3-year mortality were compared between ITT and PPCI groups. The efficacy and prognosis of ITT and PPCI at different starting time of reperfusion (FMC2N≤30 minutes, FMC2N > 30 minutes, FMC2B≤120 minutes, FMC2B > 120 minutes) were analyzed.Results:A total of 1 371 STEMI patients treated with ITT or PPCI were selected, including 300 patients in the ITT group and 1 071 patients in the PPCI group. 1 055 patients were actually followed up (205 patients in the ITT group and 850 patients in the PPCI group), with a rate of 79.4%. There were no significant differences in age, gender, and previous history between the two groups. The time from the first diagnosis to the start of reperfusion in the ITT group was shorter than that in the PPCI group [minutes: 63 (38, 95) vs. 95 (60, 150), U = -9.286, P = 0.000], but was significantly longer than the guideline standard. Compared with the ITT group, the vascular recanalization rate in the PPCI group was higher [95.5% (1 023/1 071) vs. 88.3% (265/300), P < 0.01], and in-hospital mortality was lower [2.1% (22/1 071) vs. 6.7% (20/300), P < 0.01], but there were no significant differences in the 1-year mortality and 3-year mortality [5.3% (45/850) vs. 4.4% (9/205), 9.5% (81/850) vs. 9.3% (19/205), both P > 0.05]. Between ITT group and PPCI group with different reperfusion starting time, the FMC2N > 30 minutes group had the lowest vascular recanalization rate and the highest in-hospital mortality. Pairwise comparison showed that the vascular recanalization rate of the FMC2B ≤ 120 minutes group and the FMC2B > 120 minutes group were significantly higher than those of the FMC2N > 30 minutes group [95.5% (654/685), 95.6% (369/386) vs. 88.0% (220/250), both P < 0.008], the in-hospital mortality was significantly lower than that of the FMC2N > 30 minutes group [2.0% (14/685), 2.1% (8/386) vs. 7.6% (19/250), both P < 0.008]. There was no significant difference in 1-year mortality (χ 2 = 2.507, P = 0.443) and 3-year mortality (χ 2 = 2.204, P = 0.522) among the four groups. Conclusions:For STEMI patients within 12 hours of onset, reperfusion therapy should be performed as soon as possible. PPCI showed higher infarct related artery opening rate and lower in-hospital mortality compared with ITT, and had no effect on 1-year and 3-year mortality.

Intravenous Thrombolysis Is Not Associated with Increased Time to Endovascular Treatment.

BACKGROUND: Endovascular treatment (EVT) with or without intravenous thrombolysis (IVT) is effective and safe in is-chemic stroke caused by large vessel occlusion, but IVT might delay time to EVT or increase risk of intracranial hemorrhage (ICH). We assessed the influence of prior IVT on time to treatment and risk of ICH in patients treated with EVT. METHODS: We analyzed data from the MR CLEAN Registry and included patients with an anterior circulation occlusion treated with EVT who presented directly to an intervention center, between 2014 and 2017. Primary endpoint was the door to groin time. Secondary outcomes were workflow time intervals and safety outcomes. We compared patients who received EVT only with patients who received IVT prior to EVT. RESULTS: We included 1,427 patients directly referred to an intervention center of whom 1,023 (72%) received IVT + EVT. Adjusted door to CT imaging and door to groin time were shorter in IVT + EVT patients (difference 5.7 min [95% CI: 4.6-6.8] and 7.0 min [95% CI: 2.4-12], respectively) while CT imaging to groin time was similar between the groups. Early recanalization on digital subtraction angiography before EVT was seen more often after prior IVT (11 vs. 5.2%, aOR 2.4 [95% CI: 1.4-4.2]). Rates of symptomatic ICH were similar. CONCLUSION: Prior IVT did not delay door to groin times and was associated with higher rates of early recanalization, without increasing the risk of ICH. Our results do not warrant withholding IVT prior to EVT.

Clinical analysis of 11 stroke warning syndrome patients treated with alteplase intravenous thrombolysis / 第二军医大学学报

Objective To investigate the clinical characteristics of stroke warning syndrome (SWS) and to explore the effectiveness of intravenous thrombolysis with alteplase. Methods Eleven patients with SWS, who received intravenous thrombolysis with alteplase in Stroke Center of our hospital between Sep. 2013 and Jan. 2018, were selected. The clinical features, imaging findings and therapeutic effects were analyzed. Results There were risk factors of cerebrovascular diseases in the 11 patients with SWS, in which 7 had hypertension, 4 had diabetes mellitus, 2 had hyperlipoidemia, and 1 had gout. In the classification of symptoms, 7 patients were pure motor type and 4 were motor-sense type. Magnetic resonance diffusion weighted imaging showed that 10 patients developed ischemic stroke. The infarction located in the posterior limb of internal capsule, putamen, globus pallidus, corona and pons. Head and neck computed tomography angiography examination found no large vascular stenosis in the patients. The modified Rankin scale scored 0-1 in 9 patients, 2 in 1 patient, and 3 in 1 patient. Conclusion Perforating artery disease is the main pathogenesis of SWS. Intravenous thrombolysis does not prevent SWS to ischemic stroke, but it improves the prognosis of the patients.

Related factors and clinical feature analysis of unexplained early neurological deterioration after intravenous thrombolysis / 第二军医大学学报

Objective To investigate the related factors and clinical features of unexplained early neurological deterioration (END) of acute ischemic stroke (AIS) patients after intravenous thrombolysis. Methods A total of 258 AIS patients, who underwent intravenous thrombolysis treatment within 4.5 h of onset and were registered continuously in Stroke Center of our hospital between Jan. 2016 and Feb. 2018, were included in this study. The unexplained END was defined as the National Institutes of Health stroke scale (NIHSS) score increasing by more than 4 within 24 h of onset compared with that before thrombolysis, with no definite mechanism by imaging examination. The baseline and clinical data were compared between the unexplained END and non-END patients. The clinical features of the AIS patients with unexplained END were analyzed. Results Among the 258 patients enrolled in this study, 243 (94.2%) had no END and 15 (5.8%) had unexplained END. Compared with the patients without END, the proportion of diabetes mellitus in the patients with unexplained END was significantly higher and the door-to-needle time (DNT) was significantly longer (χ2＝6.093, P＝0.048; Z＝2.055, P＝0.040). The NIHSS score of 15 patients with unexplained END before thrombolysis was low (5 [4, 9]). The most common type of trial of Org 10172 in Acute Stroke Treatment (TOAST) classification was small artery occlusion (11 cases, 73.3%). The most common infarction sites were posterior limb of internal capsule (6 cases, 40.0%) and ventromedial pons (6 cases, 40.0%). Conclusion Diabetes mellitus and long DNT may be the risk factors of unexplained END in the patients with AIS after intravenous thrombolysis. Unexplained END usually occurs in the AIS patinets with small artery occlusion and has lower NIHSS score; the common sites of infarction are posterior limb of the internal capsule and ventromedial pons.

Prognostic factors of acute cardiogenic ischemic stroke patients treated with alteplase intravenous thrombolysis / 第二军医大学学报

Objective To explore the prognostic influencing factors of acute cardiogenic ischemic stroke patients treated with alteplase intravenous thrombolysis. Methods Ninety-one patients with acute cardiogenic ischemic stroke, who received intravenous thrombolysis with alteplase in Stroke Center of Changhai Hospital of Navy Medical University (Second Military Medical University) between Sep. 2013 and Sep. 2017, were included in this study. The modified Rankin scale (mRS) score at 3 months after thrombolysis was used as an prognostic indicator, and the patients with mRS score≤2 were good prognosis group (n＝54) and those with mRS score 3-6 were poor prognosis group (n＝37). The age, gender, medical history, baseline National Institutes of Health stroke scale (NIHSS) score, baseline Glasgow coma scale (GCS) score and Alberta stroke program early computed tomograghy score (ASPECTS) before thrombolysis were analyzed in each group. Multivariate logistic regression analysis was used to analyze the prognostic influencing factors. Results The good prognosis rate was 59.3% (54/91) at 3 months after thrombolysis. There were significant differences in age ([66.57±13.46] years vs [75.95±6.06] years), incidence of patent foramen ovale (11.1% [6/54] vs 0.0% [0/37]), baseline NIHSS score (7.5 [3.5, 13.0] vs 18.0 [13.0, 22.0]), baseline GCS score (14.5 [12.0, 15.0] vs 10.0 [8.0, 14.0]), ASPECTS before thrombolysis (10.0 [9.0, 10.0] vs 9.0 [8.0, 10.0]) and incidence of symptomatic intracranial hemorrhage (SICH, 1.9% [1/54] vs 32.4% [12/37]) between the good and poor prognosis groups (t＝3.964, χ2＝4.401, Z＝5.235, Z＝4.079, Z＝2.519, χ2＝16.768; all P0.05). Multivariate logistic regression analysis showed that age (odds ratio [OR]＝3.236, 95% confidence interval [CI] 1.077-9.709, P＝0.036), baseline NIHSS score (OR＝2.874, 95% CI 1.074-6.329, P＝0.034) and SICH (OR＝9.346, 95% CI 1.017-83.333, P＝0.048) were influencing factors for poor prognosis of acute cardiogenic ischemic stroke patients treated with intravenous thrombolysis. Conclusion The age, baseline NIHSS score and SICH are independent factors for poor prognosis of patients with acute cardiogenic ischemic stroke. The patients with elder age, more serious stroke or SICH may have a worse prognosis.

Effect of blood pressure bundle management on prognosis of patients with acute ischemic stroke after intravenous thrombolysis / 第二军医大学学报

Objective The explore the effect of blood pressure bundle management on prognosis of patients with acute ischemic stroke after intravenous thrombolysis. Methods A total of 286 acute ischemic stroke patients, who received intravenous thrombolytic therapy in Stroke Center of our hospital between Oct. 1, 2015 and Mar. 31, 2018, were included in this study. The patients who received blood pressure bundle management after intravenous thrombolysis were assigned to bundle group, and the patients without blood pressure bundle management were in control group. The baseline data, National Institutes of Health stroke scale (NIHSS) score on admission, blood pressure before thrombolysis, the incidence of symptomatic intracranial hemorrhage and the in-hospital mortality after thrombolysis, and the 90-d modified Rankin scale (mRS) score were compared between the two groups. Multivariate logistic regression analysis was used to explore the effect of blood pressure bundle management, NIHSS score, onset-to-needle time, and blood pressure on prognosis of patients. Results Of 286 patients with acute ischemic stroke, 161 patients were in bundle group, and 125 patients were in control group. There were no significant differences in age, gender, hypertension, diabetes mellitus, atrial fibrillation, NIHSS score on admission or blood pressure before thrombolysis between the two groups (all P0.05). The incidence of symptomatic intracranial hemorrhage was significantly lower in the bundle group than that in the control group (2.48% [4/161] vs 8.00% [10/125], χ2＝4.598, P＝0.032). There was no significant difference in the in-hospital mortality between the two groups (3.73% [6/161] vs 3.20% [4/125], χ2＝0.058, P＝0.810). The 90-d good prognosis (mRS score 0-2) rate was significantly higher in the bundle group than that in the control group (62.11% [100/161] vs 49.60% [62/125], χ2＝4.485, P＝0.034). Successive variation of systolic blood pressure and successive variation of diastolic blood pressure were significantly lower in the bundle group than those in the control group ([13.37±4.92] mmHg [1 mmHg＝0.133 kPa] vs [18.42±3.87] mmHg, t＝2.437, P＝0.025; [11.23±4.02] mmHg vs [15.48±5.16] mmHg, t＝1.842, P＝0.046). Multivariate logistic regression analysis showed that blood pressure bundle management (odds ratio [OR]＝0.798, P＝0.002) and successive variation of diastolic blood pressure≤15 mmHg (OR＝0.816, P＝0.018) were independent predictors for good prognosis of acute ischemic stroke patients with intravenous thrombolysis. Conclusion Blood pressure bundle management can improve blood pressure variation of the patients with acute ischemic stroke after receiving intravenous thrombolysis, reduce the incidence of symptomatic intracranial hemorrhage and improve the prognosis of the patients.

Skip intravenous thrombolysis—is direct intra-artery thrombectomy feasible for acute ischemic stroke? / 第二军医大学学报

Stroke is the first cause of death in China, and ischemic stroke is the most common stroke and accounts for 70% of all new stroke cases. The treatment efficiency of acute ischemic stroke is closely related to the health of people in China. Bridging therapy has been proven safe and effective for acute ischemic stroke with anterior circulation large vessel occlusion. The incidence of symptomatic intracerebral hemorrhage is similar in the patients with bridging therapy and intravenous thrombolysis, suggesting that the complication is not due to intra-artery thrombectomy, but rather to intravenous thrombolysis. Thus it has become a research focus whether direct intra-artery thrombectomy is feasible for acute ischemic stroke, skipping intravenous thrombolysis. This paper discusses the related issues.

Intravenous thrombolysis for acute ischemic stroke: New evidence and focus / 第二军医大学学报

Acute ischemic stroke (AIS) has the characteristics of high morbidity, disability and mortality. Intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) for AIS in time window is an effective treatment recommended by domestic and overseas guidelines. However, intravenous thrombolysis has shortcomings, such as short time window, low recanalization rate and high risk of bleeding. Therefore, in recent years, studies on prolonging the time window, using low-dose rt-PA or a new generation of thrombolytic agent, and thrombolysis combined with anti-thrombotic therapy have been carried out worldwide. Based on the studies on intravenous thrombolysis, this paper discusses several issues, including extending time window, low-dose rt-PA thrombolysis, and new generation of thrombolytic agent.

Clinical analysis and nursing intervention of intravenous thrombolysis with urokinase in patients with acute myocardial infarction / 中国生化药物杂志

Objective To investigate and analyze the clinical analysis and nursing intervention of intravenous thrombolysis with urokinase in the treatment of acute myocardial infarction. Methods 40 patients with acute myocardial infarction treated in Hangzhou Hospital of Zhejiang Medical and Health Group from February 2015 to August 2016 were selected and randomly divided into the control group and the experimental group, with 20 patients in each group. The control group received routine treatment, intravenous drip of nitroglycerin and subcutaneous injection of low molecular weight heparin. On this basis, the experimental group was given urokinase intravenous thrombolysis treatment. Two groups of patients were given reasonable nursing intervention measures to improve the quality of care. The therapeutic effects of the experimental group and the control group were compared and analyzed. Results After the corresponding treatment, the effective number of patients in the experimental group was 19 cases (95.0%). In the control group, the effective number of treatment was 13 cases (65.0%). The effective rate of treatment in the experimental group was significantly higher than that in the control group, with statistical difference (P<0.05). The remission time of the chest pain in the control group was (15.32±7.21) h, and the remission time of the chest pain in the experimental group was (2.72±0.67) h. The improvement time of chest pain in the experimental group was significantly shorter than that in the control group, with statistical difference (P<0.05). In addition, the probability of complications in the experimental group was 10%, which was significantly lower than that in the control group (40.0%), and there was a statistical difference (P<0.05). Conclusion Intravenous thrombolysis with urokinase in treatment of acute myocardial infarction treatment effect is ideal, can improve clinical symptoms in a large extent, improve the efficiency of treatment, the treatment of high safety, with the further promotion of the clinical significance.

Clinical analysis and nursing intervention of intravenous thrombolysis with urokinase in patients with acute myocardial infarction / 中国生化药物杂志

Objective To investigate and analyze the clinical analysis and nursing intervention of intravenous thrombolysis with urokinase in the treatment of acute myocardial infarction. Methods 40 patients with acute myocardial infarction treated in Hangzhou Hospital of Zhejiang Medical and Health Group from February 2015 to August 2016 were selected and randomly divided into the control group and the experimental group, with 20 patients in each group. The control group received routine treatment, intravenous drip of nitroglycerin and subcutaneous injection of low molecular weight heparin. On this basis, the experimental group was given urokinase intravenous thrombolysis treatment. Two groups of patients were given reasonable nursing intervention measures to improve the quality of care. The therapeutic effects of the experimental group and the control group were compared and analyzed. Results After the corresponding treatment, the effective number of patients in the experimental group was 19 cases (95.0%). In the control group, the effective number of treatment was 13 cases (65.0%). The effective rate of treatment in the experimental group was significantly higher than that in the control group, with statistical difference (P<0.05). The remission time of the chest pain in the control group was (15.32±7.21) h, and the remission time of the chest pain in the experimental group was (2.72±0.67) h. The improvement time of chest pain in the experimental group was significantly shorter than that in the control group, with statistical difference (P<0.05). In addition, the probability of complications in the experimental group was 10%, which was significantly lower than that in the control group (40.0%), and there was a statistical difference (P<0.05). Conclusion Intravenous thrombolysis with urokinase in treatment of acute myocardial infarction treatment effect is ideal, can improve clinical symptoms in a large extent, improve the efficiency of treatment, the treatment of high safety, with the further promotion of the clinical significance.