Spontaneous Splenic Rupture Following Intravenous Thrombolysis with Alteplase Applied as Stroke Therapy - Case Report and Review of Literature

Aleksić-Shihabi, Anka; Jadrijević, Eni; Milekic, Nina; Buličić, Ana Repić; Titlić, Marina; Suljić, Enra

doi:10.5455/medarh.2016.70.69-71

Cited by 5 publications

(3 citation statements)

References 22 publications

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“…It can selectively activate fibrinolytic enzyme in thrombus site and convert it to plasmin, which is featured by fast thrombolysis and good efficacy. 18 , 19 The results showed that the total effective rate of the observation group treated with alteplase was significantly higher than that of the control group treated with urokinase, and the improvement of the NIHSS score and MMSE score in the observation group after treatment was significantly superior to that in the control group (P<0.05). The above results showed that the efficacy of intravenous thrombolysis with alteplase was better than that of urokinase.…”

Section: Discussionmentioning

confidence: 96%

Intravenous thrombolysis with alteplase in the treatment of acute cerebral infarction

Gao

Zhang²,

Wo³

et al. 2022

Pak J Med Sci

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Objectives: To compare the efficacy and safety of intravenous thrombolysis with alteplase and intravenous thrombolysis with urokinase for patients with acute cerebral infarction. Methods: This prospective study included 140 patients with acute cerebral infarction who were admitted to our hospital between June 2018 and June 2019. They were randomly divided into two groups. The control group (70 cases) was treated with urokinase intravenous thrombolysis, and the observation group (70 cases) was given alteplase intravenous thrombolytic therapy. The treatment efficacy and safety of the two groups were compared. Results: The total effective rate of the observation group was 95.7%, and that of the control group was 78.6%, i.e., the total effective rate of the observation group was significantly superior to the that of the control group (P < 0.05). After treatment, the observation group had significantly lower National Institutes of Health Stroke Scale (NIHSS) score and significantly higher mini-mental state examination (MMSE) score than the control group; the difference was statistically significant (P<0.05). After treatment, the levels of inflammatory factors of both groups significantly decreased compared to before treatment, and the decrease in the observation group was larger than that in the control group (P<0.05). The levels of serum homocysteine (Hcy) and monocyte chemoattractant protein-1 (MCP-1) in the observation group were significantly lower than those in the control group after treatment, and the differences were statistically significant (P<0.05). The incidence of hemorrhagic adverse reaction in the observation group was lower than that in the control group (P<0.05). Conclusion: In the treatment of acute cerebral infarction, ccompared with urokinase, alteplase can further relieve cognitive impairment and promote the recovery of nerve function through inhibiting levels of inflammatory factors and levels of serum Hcy and MCP-1. doi: https://doi.org/10.12669/pjms.38.3.4521 How to cite this:Gao L, Zhang S, Wo X, Shen X, Tian Q, Wang G. Intravenous thrombolysis with alteplase in the treatment of acute cerebral infarction. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.4521 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Section: Discussionmentioning

confidence: 96%

Intravenous thrombolysis with alteplase in the treatment of acute cerebral infarction

Gao

Zhang²,

Wo³

et al. 2022

Pak J Med Sci

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“…Therefore, management should be aggressive, with early surgical intervention and hemoderivative support 6,7 . Unlike patients with traumatic splenic rupture, who may prefer conservative treatment to preserve splenic function or splenorraphy as a repair technique, patients with spontaneous rupture will always require splenectomy for resolution 7,[10][11][12] . When the spleen exceeds 1000-2000 g, as in the case presented here, laparoscopic splenectomy becomes technically complicated, so an open procedure would be indicated 13 .…”

Section: Discussionmentioning

confidence: 99%

Splenic rupture after anticoagulant therapy in a patient with a history of COVID-19: a case report

López-Almanza,

Andrade-Martínez-Garza,

González-Hermosillo-Cornejo

et al. 2024

CIRUE

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We present the case of a 75-year-old man with a history of COVID-19 and splenic infarct treated with enoxaparin, who presented with intense abdominal pain and tomographic findings of free peri-splenic fluid and a hyperdense image in the spleen. An emergency laparotomy was performed, with findings of a splenic rupture at the vascular hilum. Spontaneous splenic rupture is a rare and fatal entity that should be suspected in a patient with history of COVID-19 who presents with acute abdominal pain after the administration of heparin.

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“…Because splenic infarction is less symptomatic than other infarct types, and thus often found incidentally, the actual incidence is unclear in acute ischemic stroke patients. However, given that there have been several reports of splenic rupture following thrombolysis in stroke patients, 21,22 splenic infarction may lead to subsequent hemorrhagic events.…”

Section: Discussionmentioning

confidence: 99%

Yield of Whole Body Computed Tomography in Hyper-Acute Stroke Patients With Large Vessel Occlusion

Sakuta,

Yaguchi,

Nakada

et al. 2023

Vasc Endovascular Surg

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Purpose In the majority of cases, large vessel occlusion (LVO) in ischemic stroke patients has an embolic origin. Systemic embolism can occur simultaneously with brain thrombosis. This retrospective study evaluated the frequency and locations of systemic embolism in LVO stroke patients receiving revascularization therapy. Materials and Methods In our facility, we use contrast-enhanced computed tomography (CE-CT) to assess suspected stroke patients and routinely perform CE-CT from the chest to the abdomen after brain CT angiography to rule out contraindications like aortic dissection and trauma for thrombolysis. Systemic embolism is also assessed using these images, while myocardial infarction is evaluated based on electrocardiograms and laboratory findings. Other relevant clinical features of each patient are also analyzed. Results In total, 612 consecutively admitted stroke patients and 32 LVO patients who underwent revascularization therapy were included in the present study. Systemic embolism was identified in four patients (13%). The spleen was the most commonly affected organ, followed by the heart, kidneys, limbs, and lungs. All four patients with systemic embolism exhibited LVO resulting from embolism as the underlying mechanism. Conclusion Systemic embolism was observed in 13% of our LVO patients, all of whom had LVO of embolic origin.

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Spontaneous Splenic Rupture Following Intravenous Thrombolysis with Alteplase Applied as Stroke Therapy - Case Report and Review of Literature

Cited by 5 publications

References 22 publications

Intravenous thrombolysis with alteplase in the treatment of acute cerebral infarction

Intravenous thrombolysis with alteplase in the treatment of acute cerebral infarction

Splenic rupture after anticoagulant therapy in a patient with a history of COVID-19: a case report

Yield of Whole Body Computed Tomography in Hyper-Acute Stroke Patients With Large Vessel Occlusion

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