Management of Postthrombolysis Hemorrhagic and Orolingual Angioedema Complications

O’Carroll, Cumara B; Aguilar, Maria I.

doi:10.1177/1941874415587680

Cited by 39 publications

(24 citation statements)

References 72 publications

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“…Sources: Foster-Goldman and McCarthy, 158 Gorski and Schmidt, 159 Lewis, 160 Lin et al, 161 Correia et al, 162 O'Carroll and Aguilar, 163 Myslimi et al, 164 and Pahs et al Cryoprecipitate (includes factor VIII): 10 U infused over 10-30 min (onset in 1 h, peaks in 12 h); administer additional dose for fibrinogen level of <200 mg/dL Tranexamic acid 1000 mg IV infused over 10 min OR ε-aminocaproic acid 4-5 g over 1 h, followed by 1 g IV until bleeding is controlled (peak onset in 3 h) Hematology and neurosurgery consultations Supportive therapy, including BP management, ICP, CPP, MAP, temperature, and glucose control AIS indicates acute ischemic stroke; aPTT, activated partial thromboplastin time; BP, blood pressure; CBC, complete blood count; CPP, cerebral perfusion pressure; CT, computed tomography; ICP, intracranial pressure; INR, international normalized ratio; IV, intravenous; LOE, Level of Evidence; MAP, mean arterial pressure; and PT, prothrombin time.…”

Section: † (Class Iia; Loe B-nr)mentioning

confidence: 99%

2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

Powers¹,

Rabinstein²,

Ackerson³

et al. 2018

Stroke

4,392

2,535

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Background and Purpose-The purpose of these guidelines is to provide an up-to-date comprehensive set of recommendations for clinicians caring for adult patients with acute arterial ischemic stroke in a single document. The intended audiences are prehospital care providers, physicians, allied health professionals, and hospital administrators. These guidelines supersede the 2013 guidelines and subsequent updates. Methods-Members of the writing group were appointed by the American Heart Association Stroke Council's Scientific Statements Oversight Committee, representing various areas of medical expertise. Strict adherence to the American Heart Association conflict of interest policy was maintained. Members were not allowed to participate in discussions or to vote on topics relevant to their relations with industry. The members of the writing group unanimously approved all recommendations except when relations with industry precluded members voting. Prerelease review of the draft guideline was performed by 4 expert peer reviewers and by the members of the Stroke Council's Scientific Statements Oversight 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. Guidelines for the Early Management of PatientsThis guideline was approved by the American Heart Association Science Advisory and Coordinating Committee on November 29, 2017, and the American Heart Association Executive Committee on December 11, 2017. A copy of the document is available at http://professional.heart.org/statements by using either "Search for Guidelines & Statements" or the "Browse by Topic" area. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@ wolterskluwer.com. Tables) is available The American Heart Association requests that this document be cited as follows: Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, Biller J, Brown M, Demaerschalk BM, Hoh B, Jauch EC, Kidwell CS, Leslie-Mazwi TM, Ovbiagele B, Scott PA, Sheth KN, Southerland AM, Summers DV, Tirschwell DL; on behalf of the American Heart Association Stroke Council. 2018 Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2018;49:eXXXeXXX. doi: 10.1161/STR.0000000000000158. Data Supplement 1 (EvidenceThe expert peer review of AHA-commissioned documents (eg, scientific statements, clinical practice guidelines, systematic reviews) is conducted by the AHA Office of Science Operations. For more on AHA statements and guidelines development, visit http://professional.heart.org/statements. Select the "Guidelines & Statem...

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Section: † (Class Iia; Loe B-nr)mentioning

confidence: 99%

2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

Powers¹,

Rabinstein²,

Ackerson³

et al. 2018

Stroke

4,392

2,535

View full text Add to dashboard Cite

show abstract

“…In 2012, the stroke academic industry roundtable suggested beneficial assessment of (1) neuroprotective agents, (2) IV-tPA, and (3) emerging treatments to decrease reperfusion damage. [12345678910111213141516171819202122232425262728293031] Henninger and Fisher reported that <10% of all patients with AIS receive intravenous thrombolysis and it has been expected that only around 7%–15% of AIS patients are qualified for acute endovascular intervention. [29]…”

Section: Discussionmentioning

confidence: 99%

“…Although publication in 2012 stated that IV-rtPA given within 6 h of stroke onset, another publication in 2013 recommended valuable early administration within 0–3 h, destructive later prescription of 3–4.5 h, and again beneficial of administration of 4.5–6 h.[131415] Recent approaches mentioned that IV-rtPA therapy could be administered to cautiously nominated patients who can be treated within 4.5 h of AIS onset. Related to the populations that neurologic signs are revealed on awakening (wake-up stroke), they usually are not given IV-rtPA because of the doubt about the time of stroke onset.…”

Section: Introductionmentioning

confidence: 99%

Tissue plasminogen activator; identifying major barriers related to intravenous injection in ischemic acute cerebral infraction

et al. 2017

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Background:According to previous publications, in patients with acute ischemic cerebral infarction, thrombolytic therapy using intravenous tissue plasminogen activator (IV-tPA) necessitates precise documentation of symptoms’ onset. The aim of this study was to identify major barriers related to the IV-tPA injection in such patients.Materials and Methods:Between the year 2014-2015, patients with definitive diagnosis of acute cerebral infarction (n = 180) who attended the neurology ward located at the Isfahan Alzahra Hospital were studied. To investigate barriers related to door to IV-tPA needle time, personal reasons, and criteria for inclusion or exclusion of patients, three questionnaire forms were designed based on the Food and Drug Administration-approved indications or contraindications.Results:The mean age of males versus females was 60 versus 77.5 years (ranged 23–93 vs. 29–70 years), respectively. Out of total population, only 10.7% transferred to hospital in <4.5 h after the onset of symptoms. Regarding to eligibility for IV-tPA, 68.9% of total population have had criteria for such treatment. Concerning to both items such as transferring to hospital in <4.5 h after the onset of symptoms and eligibility for IV-tPA, only 6.6% of total population met the criteria for such management. There was ignorance or inattention to symptoms in 75% of population studied. There was a mean of 195.92 ± 6.65 min (182.8–209.04 min) for door to IV-tPA needle time.Conclusion:Despite the international guidelines for IV-tPA injection within 3–4.5 h of ischemic stroke symptoms’ onset, the results of this study revealed that falling time due to ignorance of symptoms, literacy, and living alone might need further attention. As a result, to decrease death and disability, educational programs related to the symptoms’ onset by consultant neurologist in Isfahan/Iran seem to be advantageous.

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“…Intravenous rtPA was first approved for pharmacotherapy management of AIS in the United States in 1996. Thrombolytic therapy has been established to be effective in acute is-chemic stroke treatment and shown to improve long-term functional outcomes (3). Published literature suggested significant change in large vessel occlusive stroke via extensive use of thrombolysis followed by endovascular clot abolition pharmacotherapy.…”

Section: Contextmentioning

confidence: 99%

“…Table 1 shows the pharmacotherapy properties of tPA. Feared complications include symptomatic intracerebral hemorrhage and orolingual angioedema (3). Hemorrhagic complications such as subarachnoid hemorrhage have been reported (4)(5)(6)(7)(8)(9).…”

Section: Contextmentioning

confidence: 99%

Pharmacotherapy Updates of Recombinant Tissue Plasminogen Activator (r-TPA) in Acute Ischemic Stroke

Ghamari

Mazdak

2016

Jentashapir J Health Res

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Context: According to published articles, thrombosis is the main reason for death all over of the world. With stroke time missing is brain missing, therefore, the FDA-approved drug r-TPA, could be administered as initial IV bolus in less than 3 -4.5 hours from onset of Acute Ischemic Stroke (AIS). The aim of this review was to provide updated pharmacotherapy related to r-TPA in AIS. Evidence Acquisition: Searches for associated published articles were conducted in major databases until September 2015. The main terms used in the search were a combination of words and phrases such as ischemic stroke and tissue plasminogen activator. Results: Age, time of onset, systolic blood pressure, diabetes, stroke severity, co-morbidities and premorbid medical situation, stroke scale according to national institute of health and outcomes related to CT (head, angiogram and perfusion) were considered when determining successful treatment by endovascular thrombectomy. According to the 2015 guidelines, strategies related to successful pharmacotherapy management should be based on class I evidence-care on a stroke unit, IV-r-TPA within 3 -4.5 hours of stroke onset, aspirin commenced within 48 hours of stroke onset, and decompressive cranioctomy for supratentorial malignant hemispheric cerebral infarction. Hemorrhagic stroke (intraparenchymal, subarachnoid, intraventricular, intracerebral such as orolingual angioedema), hematoma (epidural and subdural) and head trauma are the absolute contraindications related to r-TPA prescription. Conclusions: Due to considerable inter-and intra-heterogeneity among studies performed by other centers such as differences in study project, background, and population features, determining a pharmacotherapy model based on Safe Implementation of Treatments in stroke or SITS seem advantageous.

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Management of Postthrombolysis Hemorrhagic and Orolingual Angioedema Complications

Cited by 39 publications

References 72 publications

2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association

Tissue plasminogen activator; identifying major barriers related to intravenous injection in ischemic acute cerebral infraction

Pharmacotherapy Updates of Recombinant Tissue Plasminogen Activator (r-TPA) in Acute Ischemic Stroke

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