جستجوی مقالات مرتبط با کلیدواژه « alteplase » در نشریات گروه « پزشکی »

Intravenous thrombolysis with recombinant tissue plasminogen activator (rtPA) has been considered as primary therapy in ischemic stroke patients. Alteplase is prescripted as the thrombolytic therapy for more than two decades. Tenecteplase is a new type of tPA that is reported to have beneficial effects in recent years. The present research focused on the effectiveness and the side effects of tenecteplase in the ischemic stroke.

Here we administrated 0.25 mg/kg tenecteplase in 36 individuals with acute ischemic stroke in the first 4.5 hours of stroke occurrence. The NIHSS in baseline, 24 hours, 7 days after and the modified Rankin scale (mRS) at 90 days were assessed. The primary efficacy outcome was reduction of at least 4 points in the NIHSS during 7 days and the secondary efficacy outcome was defined as mRS 0 and 1 at 90 days. The safety outcome was evaluated based on the symptomatic intracranial hemorrhage (ICH) and death occurance during 90 days.

The mean NIHSS at baseline was 12.7±4.6, and the mean NIHSS corresponding to 24 hours after admission was 9.6±4.8. The mean 7-day NIHSS was 7.6±4.4. The primary and secondary efficacy outcomes were met in 18 (50%) and 22 (61.1 %) of the patients respectively. Symptomatic ICH was observed in one patient with lung cancer who died of respiratory failure.

This study confirmed the efficacy and safety of tenecteplase in thrombolysis for acute ischemic stroke treatment. Tenecteplase appears to be an appropriate therapy as thrombolytic agent against ischemic stroke.

Strokes rank among the leading causes of death and disability worldwide, with acute ischemic stroke (AIS) on the rise in Iran. Thrombolytic drugs constitute a primary treatment for ischemic stroke. However, due to limited studies in Iran, there exists hesitation among physicians regarding their administration. This study aims to assess the efficacy of these drugs on AIS patients.

In a clinical trial, 80 patients with ischemic stroke were divided into treatment and control groups. Both groups were assessed upon admission and 72 hours later using the National Institutes of Health Stroke Scale (NIHSS) and the Modified Rankin Scale (mRS) scores at discharge. The treatment group received Alteplase (0.9mg/kg), while the control group received standard care. Statistical analysis was performed using SPSS 20.

The mean NIHSS ± SD scores at admission and 72 hours later in the treatment group were 10.0±3.51 and 4.55±8.75, respectively, compared to 8.53±3.52 and 7.88±9.21 in the control group, showing a significant difference in favor of the treatment group (P < 0.001). Similarly, the mean mRS± SD score in the treatment group was 1.68±1.79, significantly lower than the control group's 3.15±1.61 (P < 0.001).

 Intravenous Alteplase administration proved effective in treating patients with ischemic stroke, significantly reducing neurological complications and disabilities compared to standard medical care.

Primary percutaneous coronary intervention (PPCI) is the gold standard approach to restore blood flow in ST-segment elevation myocardial infarction (STEMI); however, the no-reflow phenomenon as a potential complication of PPCI can worsen the outcomes. It has been hypothesized that adjunctive prophylactic intracoronary infusion of low-dose fibrinolytic might improve the PPCI outcomes; however, this theory is a matter of debate. The current study aims to investigate the value of adjunctive prophylactic intracoronary low-dose alteplase to prevent the no-reflow phenomenon in patients with STEMI. This case-control study was conducted on 80 STEMI patients who underwent PPCI. The patients were assigned into the case group who were intervened by 10 mg adjunctive intracoronary alteplase immediately at the end of the balloon angioplasty (n=40) and controls (n=40) who underwent conventional PPCI only. The angioplasty-associated outcomes including final TIMI score, need for no-reflow treatment, ST-segment resolution, post-PPCI complications, and death were compared between the groups. Alteplase use was accompanied by significantly improved final TIMI flow scores (P-value<0.001) and fewer requirements for no-reflow treatments (P-value<0.001); however, it did not improve the ST-segment resolution (P-value=0.491). The mortality rate and post-angioplasty complications did not differ between the groups (P-value>0.05). Based on the findings of this study, adjunctive infusion of low-dose intracoronary alteplase during PPCI could not efficiently prevent the no-reflow phenomenon. Although the final TIMI flow and need for post-stenting no-reflow treatment improved, ST-segment resolution did not occur dramatically. Given that, this approach requires further investigations and should be considered cautiously.

Intrapleural instillation of fibrinolytic agents is novel in treating empyema. Although the efficacy of this method for treating empyema remains a topic of debate among experts, several studies have shown that the results of this technique are almost equivalent to surgical operations in the lower stages of the disease. However, in more advanced stages of empyema, surgery may be required. Despite the worldwide use of fibrinolytic agents instead of surgical procedures, the benefits of using these agents postoperatively still need to be defined.

In this prospective study, we aimed to compare the effects of streptokinase and alteplase in managing empyema in patients who underwent any surgical operations.

We prospectively compared the outcomes of using alteplase and streptokinase in children who underwent surgical operations for empyema between 2015 and 2022. Following the surgery, fibrinolytic agents were instilled through thoracostomy tubes according to a specific protocol. The length of stay, frequency of complications, need for another surgery, and mortality were measured in each group.

Among 53 patients who met the inclusion criteria, 31 (58.5%) patients received streptokinase postoperatively, while the others were treated using alteplase. The length of stay after the surgery, wound infection, and mortality rate did not differ significantly between the groups (P-value = 0.394, 0.080, 0.767, respectively). However, the need for another surgery due to unexpanded lungs was significantly lower in the alteplase group (0% vs. 19.4%, P = 0.028).

Alteplase as an intrapleural fibrinolytic is more effective than streptokinase in patients who underwent surgical operations due to empyema. The need for another surgery following the instillation of alteplase through chest tubes postoperatively may be decreased.

Despite the tendency to important infectious and mechanical complications, central venous catheters have become a common means of vascular access worldwide for patients requiring hemodialysis. In some studies, the use of fibrinolytic drugs is effective in the treatment of catheter function problems. In this study, the effects of Alteplase (a fibrinolytic drug) on catheter function was investigated.

This study was performed on 100 dialysis patients in the dialysis ward of Imam Reza Hospital in Kermanshah (Iran) who had a catheter dysfunction. After confirmation by the nephrologist, in case of catheter dysfunction and failure to resolve it with the usual methods, one milligram of Alteplase with normal saline was added to each lumen of the catheter and left in place for one hour. After aspirating the lacquered solution, the rate of blood outflow was assessed by aspiration, and catheter function was evaluated.

The mean age was 60.31 +- 11.67 years. 52 patients were male and 48 patients were female. In terms of catheter implantation time, 20 patients were less than 3 months, 12 patients were between 3 to 6 months and 68 patients were more than 6 months. The duration of proper catheter function after injection was less than 3 months in 11 patients, between 3 to 6 months in 31 patients, and more than 6 months in 58 patients. Only 6 out of 100 cases received 2 mg and others received 1 mg of the drug. 25 patients had the insufficient effect of the drug on catheter function in terms of blood flow velocity, and in 75 patients this effect was good. Only 8 patients had inoperable lock catheters. Out of 100 patients studied, 7 had temporary catheters and 93 had permanent catheters.

Alteplase is safe and effective on catheter function in hemodialysis patients.

Alteplase is a thrombolytic drug that is produced by recombinant DNA technology. Tissue plasminogen activator enzymewhich converts plasminogen to the active form of plasmin is also produced by the same technology; it causes fibrinolysis and clot dissolution. This study aimed to compare the efficacy and complications of Alteplase injection in patients with acute ischemicstroke (AIS(during the first 3hours and 3-4.5hours after the onset of symptoms.

In this study, patients with AIS who were referred to Golestan Hospital of Ahvaz city during 2018-2019 were selected. Information was collected by a checklist.

The results showed that the mean Modified Rankin Scale(mRS)for 3 months and 6 months (p-value: 0.91 for 3months and p-value: 0.80 for 6months) and National Institutes of Health Stroke Scale(NIHSS)(p-value: 0.21) were not significantly different between both groups; statistically, no significant relationship was observed between them. The incidence of complications after treatment was almost similar, in both groups.

Finally, it was concluded that complications and efficacy of rt-PA (Alteplase) injection were not statistically different, between the two groups under study.

Acute myocardial infarction (AMI) is the leading cause of death throughout the world. One of the standard approaches to treatment of AMI is fibrinolysis. The study was conducted to evaluate the clinical efficacy of tenecteplase versus reteplase through network meta-analysis for AMI. Randomized trials were comprehensively searched in PubMed, Scopus, Cochrane library, and Web of Science using appropriate strategies. Quality assessment was done for the papers. The primary and secondary end-points were mortality, TIMI grade 3 flow at 90 minutes, death or non-fatal stroke, infarction, total stroke and major bleeding. Odds ratios (OR) were computed (95% confidence intervals). After screening 27325 records, eight articles were included with total patients of 49875 to the meta-analysis. Indirect comparison of tenecteplase vs. reteplase showed no significant differences in the risk of mortality (OR= 0.98, p>0.05), TIMI grade 3 flow at 90 minutes (OR= 0.77, p>0.05), death or non-fatal stroke (OR= 1.04, p>0.05), infarction (OR= 1.11, p>0.05), total stroke (OR=2.71, p>0.05), and major bleeding (OR= 0.81, p>0.05) (all p>0.05). Indirect comparison suggests similar efficacy and safety of tenecteplase and reteplase. Hence, the use of each one of the two medicines depends on price, facility, and accessibility of the medicine.

We report a case series of two patients in the intensive care unit with massive pulmonary embolism and obstructive shock who had resolution of shock after repeated administration of alteplase.
Case Summaries: Both patients were initially dosed 10 mg of alteplase followed by infusion of 90 mg over 2 hours, but remained in obstructive shock requiring significant inotropic and vasopressor support. Both patients were deemed poor candidates for embolectomy. The first patient received repeated doses reaching an accumulative dose of 200 mg alteplase over 15 hours. The second patient received an accumulative dose of 250 mg alteplase over 36 hours. Both patients had resolution of shock within 24 hours of repeated administration of alteplase, but also experienced significant drops in hemoglobin, which were supported with transfusions. They were transferred out of the intensive care unit after resolution of obstructive shock and hemorrhage. The first patient died one week after transfer from the intensive care unit due to invasive candidiasis and septic shock. The second patient was weaned from the ventilator and discharged home. Patients with obstructive shock secondary to massive pulmonary embolism despite a one-time dose of alteplase and poor candidacy for embolectomy may benefit from repeated doses of alteplase. Due to the short half-life, repeated administration of thrombolytic may be appropriate for younger patients without absolute contraindications to thrombolysis, but future studies are needed to identify the optimal patient population.

To evaluate the efficacy and safety of intravenous and catheter directed thrombolysis by recombinant tissue plasminogen activator (Alteplase) in the patients with non-traumatic acute limb ischemia (ALI). This was a randomized clinical trial being performed between 2009 and 2011 in Mashhad University of Medical Sciences. We included those patients who were<75 years, with symptoms of less than 14 days duration, ALI of grade IIa and IIb (according to Rutherford classification) and absence of distal run off. Baseline assessment of peripheral circulation performed in all the patients. Patients were randomly assigned to undergo intravenous (n=18) or catheter directed thrombolysis (n=20) with Alteplase. The primary endpoint of the study was improvement of clinical status measured by Rutherford classification, ankle brachial index (ABI), visual analogue scale (VAS) score measured at 1, 3 and 6 months. The secondary endpoint of the study was complete or near complete recanalization of the occluded artery. A total number of 38 patients with mean age of 54.13±13.5 years were included in the study. There were 23 (60.5%) men and 15 (39.5%) women among the patients. Overall 3 (7.9%) patients had upper and 35 (92.1%) lower extremity ischemia. There was no significant difference between two study groups. None of the patients experienced major therapeutic side effects. Both ABI and VAS score improved in patients who have received first dose of t-PA within 24-hourof ALI. There was no significant difference between two study groups regarding the 6-month clinical grade (p=0.088), VAS score (p=0.316) and ABI (p=0.360). The angiographic improvement was significantly higher in CDT group (p<0.001). Intravenous and catheter directed thrombolysis with t-PA is a safe and effective method in treatment of acute arteriolar ischemia of extremities. However there both intravenous thrombolysis and CDT are comparable regarding the clinical outcome.