Thrombolytic therapy kick-started the era of modern cardiology but in the last few decades it has been largely supplanted by primary percutaneous coronary intervention (PCI) as the go-to treatment for acute myocardial infarction. However, these agents remain important for vast populations without access to primary PCI and acute ischemic stroke. More innovative uses have recently come up for the treatment of a variety of conditions. This article summarizes the history, evidence base and current use of thrombolytics in cardiovascular disease.
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Concurrent acute myocardial infarction and acute ischemic stroke in a diabetic patient undergoing chemotherapy for non-Hodgkin lymphoma: Should I administer thrombolytic therapy? A case report.
Egypt Heart J
December 2024
Jakaya Kikwete Cardiac Institute, P.O. Box 65141, Dar es Salaam, Tanzania.
Background: Concurrent ST-elevation myocardial infarction (STEMI) and acute ischemic stroke (AIS) are extremely rare, and their management remains perplexing due to the absence of high-quality evidence and limited resources. For the first time, we report a rare, preventable, and suboptimally managed case of concurrent AIS and STEMI in a patient with non-Hodgkin lymphoma (NHL) who received cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) chemotherapy.
Case Presentation: A 59-year-old postmenopausal woman of African origin with a background history of type 2 diabetes mellitus presented to the Jakaya Kikwete Cardiac Institute with sudden onset of left-sided weakness and typical ischemic chest pain for 3 days.
Influence of vascular embolism level and drug injection rate on thrombolytic therapy of bifurcated femoral vein: Numerical simulation and validation study.
Comput Methods Programs Biomed
December 2024
College of Mechanical and Electrical Engineering, Wenzhou University, Wenzhou, 325035, China.
Background And Objective: Deep vein thrombosis (DVT) of the lower limbs is a critical global vascular disease. Accurately assessing and predicting the efficacy of DVT treatment remains a significant challenge due to a lack of understanding of the mechanisms by which the level of patient-specific embolization and the rate of drug injection affect thrombolytic therapy.
Methods: In this study, we used the computed tomographic venography (CTV) clinical method to obtain patient-specific parameters, and the flow-solid interaction (FSI) method combined with biochemical response modeling of thrombolysis to analyze patient-specific hemodynamic and biomechanical characteristics and to quantitatively assess the effects of three vessel embolism levels (VEL) versus two drug injection rates (DIR) on bifurcated femoral venous thrombolytic therapy.
Intracoronary Tissue Plasminogen Activator Therapy to Treat Thrombotic Occlusion of a Giant Coronary Aneurysm in Early Kawasaki Disease.
Catheter Cardiovasc Interv
December 2024
Department of Fetal, Neonatal and Cardiovascular Sciences, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Kawasaki Disease (KD) is a systemic vasculitis that can lead to coronary artery aneurysms (CAA) in up to 10% of treated cases, significantly increasing the risk of thrombosis and acute myocardial infarction (AMI). While thrombolytic therapy is commonly used in adult coronary syndromes, its application in pediatric KD remains poorly studied. We report a 9-month-old infant with KD and giant CAA complicated by a subocclusive thrombus in the left anterior descending artery (LAD).
View Article and Find Full Text PDFInfluence of renal function on blood pressure control and outcome in thrombolyzed patients after acute ischemic stroke: analysis of the ENCHANTED trial.
Front Endocrinol (Lausanne)
December 2024
The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
Background: The effect of renal impairment in patients who receive intravenous thrombolysis for acute ischemic stroke (AIS) is unclear. We aimed to determine the associations of renal impairment and clinical outcomes and any modification of the effect of intensive versus guideline-recommended blood pressure (BP) control in the BP arm of the International Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED).
Methods: We conducted a analysis of the ENCHANTED BP arm, which involved 2,196 thrombolyzed AIS patients.
[Quick decisionmaking for acute pulmonary embolism patients].
Ned Tijdschr Geneeskd
December 2024
Leids Universitair Medisch Centrum, Leiden. Afd. Trombose & Hemostase.
Treatment options for patients with severe pulmonary embolism (PE) have increased substantially over the past decade. Although systemic thrombolysis is still the reperfusion therapy of choice for hemodynamically unstable PE patients, several new catheter guided reperfusion therapies have emerged as possibly safer alternatives. These therapies are increasingly implemented in clinical practice even though their efficacy and safety are yet to be proven by clinical outcome studies.
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