Document Detail


The safety and efficacy of thrombolysis for strokes after cardiac catheterization.
MedLine Citation:
PMID:  18308158     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: The purpose of this study was to systematically compare clinical outcomes of patients treated with thrombolysis with those without treatment in a multi-year, multicenter cohort of strokes after cardiac catheterization.
BACKGROUND: Ischemic strokes after cardiac catheterization procedures, although uncommon, lead to the morbidity and mortality of thousands of patients each year. Despite the availability of Food and Drug Administration-approved thrombolytic therapy for acute ischemic stroke since 1996, thrombolysis remains unestablished in the setting of cardiac catheterization, owing to unique concerns regarding safety and efficacy.
METHODS: Consecutive cases of ischemic stroke after cardiac catheterization were abstracted retrospectively and reviewed by clinicians at 7 major North American academic centers with acute stroke teams. Safety and efficacy outcome measures were pre-defined.
RESULTS: A total of 66 cases of ischemic strokes after cardiac catheterization were identified over 3 to 4 years; 12 (18%) were treated with thrombolysis, consisting of 7 intravenous and 5 intra-arterial recombinant tissue plasminogen activator cases. Improvement in stroke symptoms, as measured by the primary efficacy measure of median change in National Institutes of Health Stroke Scale score from baseline to 24 h, was greater in treated versus nontreated cases (p < 0.001). Additional secondary measures of efficacy also showed better outcomes in the treated group. There were no significant differences in bleeding events, defined as symptomatic intracerebral hemorrhage, hemopericardium, or other systemic bleeding resulting in hemodynamic instability or blood transfusions. Mortality rates were also similar.
CONCLUSIONS: Thrombolysis might improve early outcomes after post-catheterization strokes and seems safe in this context. Emergent cerebral revascularization should be a routine consideration.
Authors:
Pooja Khatri; Robert A Taylor; Vanessa Palumbo; Venkatakrishna Rajajee; Jeffrey M Katz; Julio A Chalela; Ann Geers; Joseph Haymore; Daniel M Kolansky; Scott E Kasner;
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  51     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2008 Mar 
Date Detail:
Created Date:  2008-02-29     Completed Date:  2008-03-25     Revised Date:  2014-09-08    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  906-11     Citation Subset:  AIM; IM    
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Cardiac Catheterization / adverse effects*
Female
Fibrinolytic Agents / therapeutic use*
Humans
Male
Retrospective Studies
Stroke / drug therapy*,  etiology*
Thrombolytic Therapy
Tissue Plasminogen Activator / therapeutic use
Treatment Outcome
Grant Support
ID/Acronym/Agency:
K23 NS02147/NS/NINDS NIH HHS; K23 NS059843/NS/NINDS NIH HHS; K23 NS059843-02/NS/NINDS NIH HHS; P50 NS44283/NS/NINDS NIH HHS
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents; EC 3.4.21.68/Tissue Plasminogen Activator
Comments/Corrections
Comment In:
J Am Coll Cardiol. 2008 Mar 4;51(9):912   [PMID:  18308159 ]
J Am Coll Cardiol. 2008 Jul 22;52(4):317; author reply 317-8   [PMID:  18634993 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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