Intravenous Alteplase for acute ischemic stroke in patients with current malignant neoplasm

Cappellari, Manuel; Carletti, Monica; Micheletti, Nicola; Tomelleri, Giampaolo; Ajena, Domenico; Moretto, Giuseppe; Bovi, Paolo

doi:10.1016/j.jns.2012.12.008

Cited by 18 publications

(22 citation statements)

References 9 publications

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“…Results from small observational studies indicate that a general history of cancer should not preclude stroke patients from receiving treatment with intravenous alteplase, assuming other criteria are met. 172,173 In a single-center, retrospective study of 44 thrombolyzed stroke patients with cancer, 5 patients with a hematologic malignancy were included. Diseases such as chronic myelogenous leukemia, chronic lymphocytic leukemia, non-Hodgkin lymphoma, and essential thrombocythemia were included, but the complication rate and outcomes of this subset were not reported.…”

Section: Hematologic Disordersmentioning

confidence: 99%

“…Only small case series of intravenous alteplase for stroke in patients with current malignancy in clinical practice have been published. [172][173][174]288 These 4 studies included a combined 38 patients with active malignancy (without brain metastases) and suggest no increased risk of intracranial systemic hemorrhage after intravenous alteplase administration. Thrombolysis in patients with intracranial neoplasm and intracardiac tumors is discussed in other sections of this statement.…”

Section: Malignancymentioning

confidence: 99%

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Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke

Demaerschalk¹,

Kleindorfer²,

Adeoye³

et al. 2016

Stroke

585

237

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Purpose-To critically review and evaluate the science behind individual eligibility criteria (indication/inclusion and contraindications/exclusion criteria) for intravenous recombinant tissue-type plasminogen activator (alteplase) treatment in acute ischemic stroke. This will allow us to better inform stroke providers of quantitative and qualitative risks associated with alteplase administration under selected commonly and uncommonly encountered clinical circumstances and to identify future research priorities concerning these eligibility criteria, which could potentially expand the safe and judicious use of alteplase and improve outcomes after stroke. Methods-Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association Stroke Council's Scientific Statement Oversight Committee and the American Heart Association's Manuscript Oversight Committee. The writers used systematic literature reviews, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge and, when appropriate, formulated recommendations using standard American Heart Association criteria. All members of the writing group had the opportunity to comment on and approved the final version of this document. The document underwent extensive American Heart Association internal peer review, Stroke The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on September 24, 2015, and the American Heart Association Executive Committee on October 5, 2015. A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By Topic" link or the "By Publication Date" link. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@ wolterskluwer.com.The online-only Data Supplement, which contains literature search strategies and Figures A, B, and C, is available with this article at http://circ. ahajournals.org/lookup/suppl/doi:10.1161/STR.0000000000000086/-/DC1.The American Heart Association requests that this document be cited as follows: Demaerschalk BM, Kleindorfer DO, Adeoye OM, Demchuk AM, Fugate JE, Grotta JC, Khalessi AA, Levy EI, Palesch YY, Prabhakaran S, Saposnik G, Saver JL, Smith EE; on behalf of the American Heart Association Stroke Council and Council on Epidemiology and Prevention. Scientific rational...

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Section: Hematologic Disordersmentioning

confidence: 99%

Section: Malignancymentioning

confidence: 99%

Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke

Demaerschalk¹,

Kleindorfer²,

Adeoye³

et al. 2016

Stroke

585

237

View full text Add to dashboard Cite

show abstract

“…However, little is known about the hemorrhagic complications of thrombolytic therapy in patients with cancer, because they have usually been excluded from clinical trials of such therapy to rule out the possibility that morbidity due to cancer might influence stroke outcomes. Recent studies have found that thrombolytic therapy does not seem to increase symptomatic bleeding complications in patients with cancer, [8][9][10][11] but the numbers of patients in these reports were limited.…”

Section: Discussionmentioning

confidence: 99%

“…Although a large-scale analysis with a sufficient sample size is needed to determine the value of thrombolytic therapy for acute ischemic stroke associated with NBTE, this case might be a warning for the idea that thrombolytic therapy is not so dangerous for ischemic stroke patients with cancer. [8][9][10][11] Careful consideration should be needed before deciding to administer thrombolytic therapy for cancer patients who suddenly develop neurologic symptoms and other embolic manifestations, because thrombolytic therapy in patients with NBTE-associated stroke might be associated with very poor outcomes. …”

Section: Discussionmentioning

confidence: 99%

Fatal Intracranial Hemorrhage after Intravenous Thrombolytic Therapy for Acute Ischemic Stroke Associated with Cancer-related Nonbacterial Thrombotic Endocarditis

Yagi

Takahashi

Tanikawa

et al. 2014

Journal of Stroke and Cerebrovascular Diseases

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“…In many case-control series involving active or recurrent cancer without brain metastasis, IV tPA for acute stroke has not been associated with an increase in intracranial and systemic hemorrhagic complications, which suggests that it is safe (71,72,73,74).…”

Section: Question: Does Intracardiac Mass Impede the Administration Omentioning

confidence: 99%

Intravenous Thrombolytic Therapy in Acute Stroke: Frequent Systemic Problems and Solutions

Topçuoğlu¹,

Arsava²,

Özdemi̇r³

et al. 2018

tnd

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Ad dress for Cor res pon den ce/Ya z›fl maOne of the most important reasons why the use of the intravenous (IV) tissue plasminogen activator (tPA), which is one of the key elements of acute ischemic stroke treatment, is not sufficiently widespread is the fact that many common questions have not been adequately answered. In this review, questions about systemic nonneurologic conditions, problems related with IV tPA treatment and complications of treatment, which were collected from our colleagues practicing in Turkey and which are more important in clinical practice, were answered on the basis of the current literature and clear recommendations are made. Keywords: Stroke, thrombectomy, contraindication, avoidance, cerebral hemorrhage Akut iskemik inme tedavisinin ana elementlerinin başında gelen intravenöz (IV) doku plazminojen aktivatörü (tPA) kullanımının yeterince yaygınlaşamamasının en önemli nedenlerinden biri sık karşılaşılan birçok soruya yeterince yanıt veril(e)memiş olmasıdır. Bu derlemede akut inmede IV tPA tedavisi ile ilgili olarak meslektaşlarımızdan toplanan, daha çok uygulamada önemi olan sistemik soru ve sorunlar ile tedavinin komplikasyonlarına dair, sorulara güncel literatür temelinde yanıt verilmiş ve net tavsiyelerde bulunulmuştur. Anahtar Kelimeler: Strok, trombektomi, kontrendikasyon, kaçınma, serebral kanama Abstract Öz

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Intravenous Alteplase for acute ischemic stroke in patients with current malignant neoplasm

Cited by 18 publications

References 9 publications

Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke

Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke

Fatal Intracranial Hemorrhage after Intravenous Thrombolytic Therapy for Acute Ischemic Stroke Associated with Cancer-related Nonbacterial Thrombotic Endocarditis

Intravenous Thrombolytic Therapy in Acute Stroke: Frequent Systemic Problems and Solutions

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