Guidelines for the Intravenous Application of Recombinant Tissue-type Plasminogen Activator (Alteplase), the Second Edition, October 2012: A Guideline From the Japan Stroke Society

Minematsu, Kazuo; Toyoda, Kazunori; Hirano, Teruyuki; Kimura, Kazumi; Kondo, Rei; Mori, Etsuro; Nakagawara, Jyoji; Sakai, Nobuyuki; Shiokawa, Yoshiaki; Tanahashi, Norio; Yasaka, Masahiro; Katayama, Yasuo; Miyamoto, Susumu; Ogawa, Akira; Sasaki, Makoto; Suga, S.; Yamaguchi, Takenori

doi:10.1016/j.jstrokecerebrovasdis.2013.04.001

Cited by 128 publications

(107 citation statements)

References 155 publications

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“…Okada et al reported that 65 (41%) of 160 patients with a recent stroke demonstrated hemorrhagic transformation within 1 month of onset, and none of them occurred beyond 1 month [23]. Therefore, the revised Japanese guideline approved the t-PA therapy for patients with a prior stroke beyond 1 month after onset, and classified them as falling within the relative exclusion criteria [10]. Furthermore, although patients with a prior stroke have been historically considered to be at high risk of ICH after t-PA therapy, multicenter registries, including the Safe Implementation of Thrombolysis in Stroke-Monitoring Study registry, showed that prior stroke was not related to sICH [24,25].…”

Section: Discussionmentioning

confidence: 99%

“…Third, introduction of MRI at 3-T may provide different results because it is superior to MRI at 1.5-T for the detection of MBs [39]. Finally, a 0.6-mg/kg dose of t-PA was used, based on the Japanese guideline [10]. …”

Section: Discussionmentioning

confidence: 99%

“…Patients who had implants containing metallic materials, such as pacemakers and metal clips, were excluded because MRI was contraindicated. In Japan, intravenous t-PA therapy was generally administered based on the Japan Alteplase Clinical Trial (J-ACT) [2,10]. In addition, in our hospital, acute ischemic stroke patients with unknown onset time were also treated with t-PA therapy based on diffusion-weighted imaging (DWI)/fluid-attenuated inversion recovery (FLAIR) mismatch [11].…”

Section: Methodsmentioning

confidence: 99%

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Risk of Intracerebral Hemorrhage After Thrombolysis in Patients with Asymptomatic Hemorrhage on T2*

Aoki¹,

Shibazaki²,

Saji³

et al. 2014

Cerebrovasc Dis

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Background: Intravenous thrombolysis using the tissue-type plasminogen activator (t-PA) is contraindicated for patients with a history of intracerebral hemorrhage (ICH). T2*-weighted magnetic resonance imaging (MRI) is able to detect asymptomatic ICH. If there is an association between asymptomatic ICH on T2* before t-PA therapy and ICH after t-PA therapy, we may be able to take preventive measures before starting t-PA therapy in patients with MRI-proven hemorrhage. The aim of the present study was to investigate whether asymptomatic ICH seen on T2* increases the risk of new ICH after t-PA therapy. Methods: Patients who had consecutive stroke treated with t-PA between October 2005 and November 2013 were enrolled. A hypointense T2* signal with a diameter >5 mm was defined as asymptomatic ICH before t-PA therapy. The presence of new ICH at 24 h after t-PA therapy was assessed using T2*. Symptomatic ICH (sICH) was defined as new ICH combined with an increase in the National Institutes of Health Stroke Scale score ≥4. At 3 months after onset, good and poor outcomes were defined as modified Rankin Scale (mRS) scores of 0-1 and 4-6, respectively. Results: Of 300 patients (age 77 [68-83] years; 173 [58%] males), 25 (8%) had an asymptomatic ICH on T2* before t-PA therapy. Eleven (45%) patients showed an isolated asymptomatic ICH. Three (12%) patients had a round hypointense lesion similar to microbleeds. Nine (36%) patients had a hemorrhagic transformation within a prior infarcted area. Multiple asymptomatic ICHs were seen in 2 (8%) patients. The rates of good and poor outcomes at 3 months were 24 and 59% of patients with asymptomatic ICH and 38 and 41% of patients without asymptomatic ICH (p = 0.300 and 0.202, respectively). At 24 h after t-PA therapy, 11 (44%) of the 25 patients with asymptomatic ICH before t-PA therapy and 87 (32%) of 275 without asymptomatic ICH had new ICH (p = 0.265). Only 1 (4%) of 25 patients with asymptomatic ICH before t-PA therapy and 6 (2%) of 275 without asymptomatic ICH had sICH within 24 h (p = 0.460). On multivariate logistic regression analysis, neither new ICH (odds, 1.19; 95% CI, 0.40-3.54, p = 0.753) nor sICH (odds, 0.95; 95% CI, 0.08-11.90, p = 0.970) was related to asymptomatic ICH on T2* before t-PA therapy. Conclusion: The presence of T2* hypointensity as a marker of asymptomatic ICH may not be associated with new ICH and sICH after t-PA therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Risk of Intracerebral Hemorrhage After Thrombolysis in Patients with Asymptomatic Hemorrhage on T2*

Aoki¹,

Shibazaki²,

Saji³

et al. 2014

Cerebrovasc Dis

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“…19 Now, >12 000 patients are estimated to undergo this therapy each year, roughly corresponding to 5% to 6% of the overall patients with ischemic stroke. The official dosage of alteplase is 0.6 mg/kg based on the results of a dose comparison study using duteplase 20 and the multicenter single-dose Japan Alteplase Clinical Trial.…”

Section: Current Status and Prospects Of Intravenousmentioning

confidence: 99%

Acute Reperfusion Therapy and Stroke Care in Asia After Successful Endovascular Trials

Toyoda

Koga

Hayakawa

et al. 2015

Stroke

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Abstract-The current status of and prospects for acute stroke care in Asia in the situation where both intravenous thrombolysis and endovascular therapies have been recognized as established strategies for acute stroke are reviewed. Of 15 million people annually having stroke worldwide, ≈9 million are Asians. The burdens of both ischemic and hemorrhagic strokes are severe in Asia. The unique features of stroke in Asia include susceptibility to intracranial atherosclerosis, high prevalence of intracerebral hemorrhage, effects of dietary and lifestyle habits, and several disorders with genetic causes. These features affect acute stroke care, such as the dosage of alteplase for thrombolysis and consideration of bleeding complications during antithrombotic therapy. Acute endovascular thrombectomy, as well as intravenous thrombolysis, is relatively prevalent in East Asia, but most of the other Asian countries need to develop their human resources and fundamental medical infrastructure for stroke care. A limitation of endovascular therapy in East Asia is the high prevalence of intracranial atherosclerosis that can cause recanalization failure and require additional angioplasty or permanent stent insertion although intracranial stenting is not an established strategy. Multinational collaboration on stroke research among Asian countries is infrequent. Asians should collaborate to perform their own thrombolytic and endovascular trials and seek the optimal strategy for stroke care specific

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“…14) Thrombectomy was indicated for patients with an National Institute of Health Stroke Scale (NIHSS) score of 4 or higher at the initial examination confirmed to have large vessel occlusion such as the internal carotid artery and the M1-M2 segment of the middle cerebral artery.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of the CT High-density Area after Endovascular Treatment for Acute Ischemic Stroke

Takei

Irie

Tanaka

et al. 2017

JNET

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Objective: To evaluate the relationship between the incidence of the CT high-density area that appears immediately after endovascular treatment for acute ischemic stroke with postprocedural hemorrhagic transformation and its significance in the clinical outcome.Methods: Ten patients with ischemic stroke of the anterior circulation encountered between May 2014 and December 2015 in whom recanalization could be achieved within 8 hours after the onset were retrospectively analyzed. In addition, 695 patients presented in 13 reports were divided into thrombolysis and mechanical thrombectomy groups, and the postprocedural incidence of CT high-density areas was compared between the two groups.Results: Postprocedural CT high-density areas were observed in six (60%) of our patients. Hemorrhagic transformation occurred in three of them, but no exacerbation of neurological symptoms was noted. The incidence of postprocedural CT high-density areas was 43.1% (191/443) in the thrombolysis group and 71.8% (188/262) in the mechanical thrombectomy group including our patients, being significantly higher in the latter group (p <0.01). Conclusion:Although CT high-density areas appear more frequently after mechanical thrombectomy than after thrombolysis, they are considered to be infrequently developed into hemorrhagic transformation and exert relatively few negative effects on the neurological outcome.

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Guidelines for the Intravenous Application of Recombinant Tissue-type Plasminogen Activator (Alteplase), the Second Edition, October 2012: A Guideline From the Japan Stroke Society

Cited by 128 publications

References 155 publications

Risk of Intracerebral Hemorrhage After Thrombolysis in Patients with Asymptomatic Hemorrhage on T2*

Risk of Intracerebral Hemorrhage After Thrombolysis in Patients with Asymptomatic Hemorrhage on T2*

Acute Reperfusion Therapy and Stroke Care in Asia After Successful Endovascular Trials

Evaluation of the CT High-density Area after Endovascular Treatment for Acute Ischemic Stroke

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