Tpa Clot Buster
2021年10月21日Register here: http://gg.gg/wac3o
*Tpa Clot Buster Drug
*Tpa Clot Buster Risks
*Tpa Clot Buster Pulmonary Embolism
*Names Of Clot Busting Drugs
*Tpa Clot Buster Dangers
Since tPA works best on smaller blood clots, some ischemic stroke patients with larger blockages may be candidates for a mechanical thrombectomy. With this procedure, a device is threaded through an artery and into the brain, where it is used to mechanically grab and remove the blood clot. TPA is a protein produced by the body and has several functions. One is to activate the enzyme plasmin, which breaks down clots. But Yepes’ team has discovered that the protein has additional functions. Ever since its introduction in the 1990s, the ’clot-busting’ drug tPA has been considered a ’double-edged sword’ for people experiencing a stroke. Known by the generic name alteplase and marketed as Activase® (Genentech), tPA is given to patients through an IV in the arm, and it works by dissolving blood clots that block blood flow to the brain. TPA is a thrombolytic or a “Clot Buster” drug. This clot buster is used to break-up the clot that is causing a blockage or disruption in the flow of blood to the brain and helps restore the blood flow to the area of the brain. It is given by intravenous (IV), not by mouth. What tests are required? (Redirected from Clot buster)ThrombolysisAngiograph before and after thrombolytic therapy in a case of acute limb ischemia.Other namesFibrinolytic therapyMedlinePlus007089eMedicine811234
Thrombolysis, also called fibrinolytic therapy, is the breakdown (lysis) of blood clots formed in blood vessels, using medication. It is used in ST elevation myocardial infarction, stroke, and in cases of severe venous thromboembolism (massive pulmonary embolism or extensive deep vein thrombosis).
The main complication is bleeding (which can be dangerous), and in some situations thrombolysis may therefore be unsuitable. Thrombolysis can also play an important part in reperfusion therapy that deals specifically with blocked arteries.Medical uses[edit]
Diseases where thrombolysis is used:
*ST elevation myocardial infarction: Large trials have shown that mortality can be reduced using thrombolysis (particularly fibrinolysis) in treating heart attacks.[1] It works by stimulating secondary fibrinolysis by plasmin through infusion of analogs of tissue plasminogen activator (tPA), the protein that normally activates plasmin.
*Stroke: Thrombolysis reduces major disability or death when given within 3 hours (or perhaps even 6 hours) of ischaemic stroke onset when there are no contraindications to treatment.[2][3][4]
*Massive pulmonary embolism. For the treatment of a massive pulmonary embolism, catheter-directed therapy is a safer and more effective alternative to systemic thrombolysis. This involves the injecting of drugs directly into the clot.[5]
*Severe deep vein thrombosis (DVT), such as phlegmasia cerulea dolens, which threatens limb loss, or iliofemoral DVT, where clots involve at a minimum the common iliac vein[6]Tpa Clot Buster Drug
Apart from streptokinase, all thrombolytic drugs are administered together with heparin (unfractionated or low molecular weight heparin), usually for 24 to 48 hours.[citation needed]
Thrombolysis is usually intravenous. It may also be used directly into the affected blood vessel during an angiogram (intra-arterial thrombolysis), e.g. when patients present with stroke beyond three hours or in severe deep vein thrombosis (catheter-directed thrombolysis).[7]
Thrombolysis is performed by many types of medical specialists, including interventional radiologists, vascular surgeons, cardiologists, interventional neuroradiologists, and neurosurgeons. In some countries such as the United States of America, emergency medical technicians may administer thrombolytics for heart attacks in prehospital settings, by on-line medical direction. In countries with more extensive and independent qualifications, prehospital thrombolysis (fibrinolysis) may be initiated by the emergency care practitioner (ECP). Other countries which employ ECP’s include, South Africa, the United Kingdom, and New Zealand. Prehospital thrombolysis is always the result of a risk-benefit calculation of the heart attack, thrombolysis risks, and primary percutaneous coronary intervention (pPCI) availability.Contraindications[edit]
Thrombolysis is not without risks. Therefore, clinicians must select patients who are to be best suited for the procedure, and those who have the least risk of having a fatal complication. An absolute contraindication is in itself enough to avoid thrombolysis, while a relative contraindication needs to be considered in relation to the overall clinical situation.Myocardial infarction[edit]
Absolute contraindications:[8]
*Any previous history of hemorrhagic stroke, ischemic stroke within 3 months.
*History of stroke, dementia, or central nervous system damage within 1 year
*Head trauma within 3 weeks or brain surgery within 6 months
*Known intracranial neoplasm
*Suspected aortic dissection
*Internal bleeding within 6 weeks
*Active bleeding or known bleeding disorder
*Traumatic cardiopulmonary resuscitation within 3 weeks
Relative contraindications:[8]
*Oral anticoagulant therapy
*Acute pancreatitis
*Pregnancy or within 1 week postpartum
*Active peptic ulceration
*Transient ischemic attack within 6 months
*Dementia
*Infective endocarditis
*Active cavitating pulmonary tuberculosis
*Advanced liver disease
*Intracardiac thrombi
*Uncontrolled hypertension (systolic blood pressure >180 mm Hg, diastolic blood pressure >110 mm Hg)
*Puncture of noncompressible blood vessel within 2 weeks
*Previous streptokinase therapy
*Major surgery, trauma, or bleeding within 2 weeksStroke[edit]
Absolute contraindications:[9]
*Uncertainty about time of stroke onset (e.g. patients awakening from sleep).
*Coma or severe obtundation with fixed eye deviation and complete hemiplegia.
*Hypertension: systolic blood pressure ≥ 185mmHg; or diastolic blood pressure >110mmHg on repeated measures prior to study. (if reversed, patient can be treated)
*Clinical presentation suggestive of subarachnoid haemorrhage even if the CT scan is normal.
*Presumed septic embolus.
*Patient having received a heparin medication within the last 48 hours and has an elevated Activated Prothrombin Time (APTT) or has a known hereditary or acquired haemorrhagic diathesis
*INR >1.7
*Known advanced liver disease, advanced right heart failure, or anticoagulation, and INR > 1.5 (no need to wait for INR result in the absence of the former three conditions).
*Known platelet count <100,000 uL.
*Serum glucose is < 2.8 mmol/l or >22.0 mmol/l.
Relative contraindications:[10]
*Severe neurological impairment with NIHSS score >22.
*Age >80 years.
*CT evidence of extensive middle cerebral artery (MCA) territory infarction (sulcal effacement or blurring of grey-white junction in greater than 1/3 of MCA territory).
*Stroke or serious head trauma within the past three months where the risks of bleeding are considered to outweigh the benefits of therapy.
*Major surgery within the last 14 days (consider intra-arterial thrombolysis).
*Patient has a known history of intracranial haemorrhage, subarachnoid haemorrhage, known intracranial arteriovenous malformation or previously known intracranial neoplasm
*Suspected recent (within 30 days) myocardial infarction.
*Recent (within 30 days) biopsy of a parenchymal organ or surgery that, in the opinion of the responsible clinician, would increase the risk of unmanageable (e.g. uncontrolled by local pressure) bleeding.
*Recent (within 30 days) trauma with internal injuries or ulcerative wounds.
*Gastrointestinal or urinary tract haemorrhage within the last 30 days or any active or recent haemorrhage that, in the opinion of the responsible clinician, would increase the risk of unmanageable (e.g. by local pressure) bleeding.
*Arterial puncture at non-compressible site within the last 7 days.
*Concomitant serious, advanced or terminal illness or any other condition that, in the opinion of the responsible clinician would pose an unacceptable risk.
*Minor or Rapidly improving deficit.
*Seizure: If the presenting neurological deficit is deemed due to a seizure.
*Pregnancy is not an absolute contraindication. Consider intra-arterial thrombolysis.Side-effects[edit]
Hemorrhagic stroke is a rare but serious complication of thrombolytic therapy. If a patient has had thrombolysis before, an allergy against the thrombolytic drug may have developed (especially after streptokinase). If the symptoms are mild, the infusion is stopped and the patient is commenced on an antihistamine before infusion is recommenced. Anaphylaxis generally requires immediate cessation of thrombolysis.Agents[edit]
Thrombolysis therapy uses thrombolytic drugs that dissolve blood clots. Most of these drugs target fibrin (one of the main constituent of blood clots) and are therefore called fibrinolytics. All currently approved thrombolytic drugs are biologics, either derived from Streptococcus species, or, more recently, using recombinantbiotechnology whereby tPA is manufactured using cell culture, resulting in a recombinant tissue plasminogen activator or rtPA.
Some fibrinolytics are:
*Streptokinase (Kabikinase)[11]
*Anistreplase (Eminase)[11]
*Recombinant tissue plasminogen activators (rtPA)
*Alteplase (Activase or Actilyse)[11]
*Reteplase (Retavase)[12]
*Tenecteplase[12]
*Urokinase[13]Research[edit]
In people who receive thrombolytic therapy delivered through a catheter, there is a risk of hemorrhage as a side effect. Scientists have studied whether measuring fibrinogen in blood can be used as a biomarker to predict hemorrhage. As of 2017 it was not known if this works or not.[14]See also[edit]
*TIMI – thrombolysis in myocardial infarctionReferences[edit]
*^’Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Fibrinolytic Therapy Trialists’ (FTT) Collaborative Group’. Lancet. 343 (8893): 311–22. 5 February 1994. doi:10.1016/s0140-6736(94)91161-4. PMID7905143.
*^Wardlaw JM, Murray V, Berge E, Del Zoppo GJ (2014). ’Thrombolysis for acute ischaemic stroke’. Cochrane Database Syst Rev (7): CD000213. doi:10.1002/14651858.CD000213.pub3. PMC4153726. PMID25072528.
*^Wechsler LR (2011). ’Intravenous thrombolytic therapy for acute ischemic stroke’. N Engl J Med. 364 (22): 2138–46. doi:10.1056/NEJMct1007370. PMID21631326.
*^Mistry EA (2017). ’Mechanical Thrombectomy Outcomes With and Without Intravenous Thrombolysis in Stroke Patients: A Meta-Analysis’. Stroke. 48 (9): 2450–2456. doi:10.1161/STROKEAHA.117.017320. PMID28747462.
*^Kuo WT, Gould MK, Louie JD, Rosenberg JK, Sze DY, Hofmann LV (November 2009). ’Catheter-directed therapy for the treatment of massive pulmonary embolism: systematic review and meta-analysis of modern techniques’. J Vasc Interv Radiol. 20 (11): 1431–40. doi:10.1016/j.jvir.2009.08.002. PMID19875060.CS1 maint: multiple names: authors list (link)
*^Tran HA, Gibbs H, Merriman E, Curnow JL, Young L, Bennett A, Tan C, Chunilal SD, Ward CM, Baker R, Nandurkar H (March 2019). ’New guidelines from the Thrombosis and Haemostasis Society of Australia and New Zealand for the diagnosis and management of venous thromboembolism’. The Medical Journal of Australia. 210 (5): 227–235. doi:10.5694/mja2.50004. PMID30739331.
*^Catanese L, Tarsia J, Fisher M (3 February 2017). ’Acute Ischemic Stroke Therapy Overview’. Circ Res. 120 (3): 541–558. doi:10.1161/CIRCRESAHA.116.309278. PMID28154103.CS1 maint: uses authors parameter (link)
*^ abHarvey D. White; Frans J. J. Van de Werf (1998). ’Clinical Cardiology: New Frontiers Thrombolysis for Acute Myocardial Infarction’. Circulation. 97 (16): 1632–1646. doi:10.1161/01.CIR.97.16.1632. PMID9593569.CS1 maint: multiple names: authors list (link)
*^Department of Health, Western Australia. ’Protocol for Administering Alteplase in Acute Ischaemic Stroke Guidelines’(PDF). Perth: Health Networks Branch, Department of Health, Western Australia. Retrieved 12 June 2013.
*^Jason Thurman; Edward C. Jauch (2002). ’Acute ischemic stroke: emergent evaluation and management’. Emergency Medicine Clinics of North America. 20 (3): 609–630. doi:10.1016/s0733-8627(02)00014-7. PMID12379964.
*^ abc’Therapeutic Biologic Applications (BLA) > Difficulties in Obtaining Sufficient Amounts of Urokinase (Abbokinase)’. US Food and Drug Administration. 10/07/2016. Retrieved 2016-12-28.Check date values in: |date= (help)
*^ ab’Therapeutic Biologics Applications (BLA)’. US Food and Drug Administration. 07-10- 2016. Retrieved 2016-12-28.Check date values in: |date= (help)
*^’Urokinase’. www.drugbank.ca. Retrieved 17 March 2019.
*^Poorthuis, Michiel H. F.; Brand, Eelco C.; Hazenberg, Constantijn E. V. B.; Schutgens, Roger E. G.; Westerink, Jan; Moll, Frans L.; de Borst, Gert J. (5 March 2017). ’Plasma fibrinogen level as a potential predictor of hemorrhagic complications after catheter-directed thrombolysis for peripheral arterial occlusions’. Journal of Vascular Surgery. 65 (5): 1519–1527.e26. doi:10.1016/j.jvs.2016.11.025. ISSN1097-6809. PMID28274749.Retrieved from ’https://en.wikipedia.org/w/index.php?title=Thrombolysis&oldid=995136347’To use the sharing features on this page, please enable JavaScript.
Thrombolytic therapy is the use of drugs to break up or dissolve blood clots, which are the main cause of both heart attacks and stroke.
Thrombolytic medicines are approved for the emergency treatment of stroke and heart attack. The most commonly used drug for thrombolytic therapy is tissue plasminogen activator (tPA), but other drugs can do the same thing.
Ideally, you should receive thrombolytic medicines within the first 30 minutes after arriving at the hospital for treatment.
HEART ATTACKS
A blood clot can block the arteries to the heart. This can cause a heart attack, when part of the heart muscle dies due to a lack of oxygen being delivered by the blood.
Thrombolytics work by dissolving a major clot quickly. This helps restart blood flow to the heart and helps prevent damage to the heart muscle. Thrombolytics can stop a heart attack that would otherwise be larger or potentially deadly. Outcomes are better if you receive a thrombolytic drug within 12 hours after the heart attack starts. But the sooner treatment begins, the better the results.
The drug restores some blood flow to the heart in most people. However, the blood flow may not be completely normal and there may still be a small amount of muscle damaged. Further therapy, such as cardiac catheterization with angioplasty and stenting, may be needed.
Your health care provider will base the decisions about whether to give you a thrombolytic medicine for a heart attack on many factors. These factors include your history of chest pain and the results of an ECG test.
Other factors used to determine if you are a good candidate for thrombolytics include:
*Age (older people are at increased risk of complications)
*Sex
*Medical history (including your history of a previous heart attack, diabetes, low blood pressure, or increased heart rate)
Generally, thrombolytics may not be given if you have:
*A recent head injury
*Bleeding problems
*Bleeding ulcers
*Pregnancy
*Recent surgery
*Taken blood thinning medicines such as Coumadin
*Trauma
*Uncontrolled (severe) high blood pressure
STROKES
Most strokes are caused when blood clots move to a blood vessel in the brain and block blood flow to that area. For such strokes (ischemic strokes), thrombolytics can be used to help dissolve the clot quickly. Giving thrombolytics within 3 hours of the first stroke symptoms can help limit stroke damage and disability.
Results Way Corporate Center, Cupertino, CA 95014 - Office Space. Results Way Corporate Center is located at 5 Results Way in the Cupertino neighborhood, CA, Cupertino, 95014. The Class B Office building was completed in 1979 and features a total of 146,000 Sqft. There are 41 office spaces for lease in the Cupertino neighborhood, totaling 393,454 Sqft of available office. 5 Results Way, Cupertino, CA 95014. Claim this business. Hotels in Cupertino, CA.
The decision to give the drug is based upon:
*A brain CT scan to make sure there has not been any bleeding
*A physical exam that shows a significant stroke
*Your medical history
As in heart attacks, a clot-dissolving drug isn’t usually given if you have one of the other medical problems listed above.
Thrombolytics are not given to someone who is having a stroke that involves bleeding in the brain. They could worsen the stroke by causing increased bleeding.Tpa Clot Buster Risks
RISKS
Bleeding is the most common risk. It can be life threatening.
Minor bleeding from the gums or nose can occur in approximately 25% of people who receive the drug. Bleeding into the brain occurs approximately 1% of the time. This risk is the same for both stroke and heart attack patients.
If thrombolytics are felt to be too dangerous, other possible treatments for clots causing a stroke or heart attack include:
*Removal of the clot (thrombectomy)
*A procedure to open narrowed or blocked blood vessels that supply blood to the heart or the brain
CONTACT A HEALTH CARE PROVIDER OR CALL 911
Heart attacks and strokes are medical emergencies. The sooner treatment with thrombolytics begins, the better the chance for a good outcome.
Tissue plasminogen activator; TPA; Alteplase; Reteplase; Tenecteplase; Activase thrombolytic agent; Clot-dissolving agents; Reperfusion therapy; Stroke - thrombolytic; Heart attack - thrombolytic; Acute embolism - thrombolytic; Thrombosis - thrombolytic; Lanoteplase; Staphylokinase; Streptokinase (SK); Urokinase; Stroke - thrombolytic therapy; Heart attack - thrombolytic therapy; Stroke - thrombolysis; Heart attack - thrombolysis; Myocardial infarction - thrombolysis
Bohula EA, Morrow DA. ST-elevation myocardial infarction: management. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 59.
Crocco TJ, Meurer WJ. Stroke. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 91.Tpa Clot Buster Pulmonary Embolism
Jaffer IH, Weitz JI. Antithrombotic drugs. In: Hoffman R, Benz EJ, Silberstein LE, et al, eds. Hematology: Basic Principles and Practice. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 149.Names Of Clot Busting Drugs
O’Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127
https://diarynote.indered.space
*Tpa Clot Buster Drug
*Tpa Clot Buster Risks
*Tpa Clot Buster Pulmonary Embolism
*Names Of Clot Busting Drugs
*Tpa Clot Buster Dangers
Since tPA works best on smaller blood clots, some ischemic stroke patients with larger blockages may be candidates for a mechanical thrombectomy. With this procedure, a device is threaded through an artery and into the brain, where it is used to mechanically grab and remove the blood clot. TPA is a protein produced by the body and has several functions. One is to activate the enzyme plasmin, which breaks down clots. But Yepes’ team has discovered that the protein has additional functions. Ever since its introduction in the 1990s, the ’clot-busting’ drug tPA has been considered a ’double-edged sword’ for people experiencing a stroke. Known by the generic name alteplase and marketed as Activase® (Genentech), tPA is given to patients through an IV in the arm, and it works by dissolving blood clots that block blood flow to the brain. TPA is a thrombolytic or a “Clot Buster” drug. This clot buster is used to break-up the clot that is causing a blockage or disruption in the flow of blood to the brain and helps restore the blood flow to the area of the brain. It is given by intravenous (IV), not by mouth. What tests are required? (Redirected from Clot buster)ThrombolysisAngiograph before and after thrombolytic therapy in a case of acute limb ischemia.Other namesFibrinolytic therapyMedlinePlus007089eMedicine811234
Thrombolysis, also called fibrinolytic therapy, is the breakdown (lysis) of blood clots formed in blood vessels, using medication. It is used in ST elevation myocardial infarction, stroke, and in cases of severe venous thromboembolism (massive pulmonary embolism or extensive deep vein thrombosis).
The main complication is bleeding (which can be dangerous), and in some situations thrombolysis may therefore be unsuitable. Thrombolysis can also play an important part in reperfusion therapy that deals specifically with blocked arteries.Medical uses[edit]
Diseases where thrombolysis is used:
*ST elevation myocardial infarction: Large trials have shown that mortality can be reduced using thrombolysis (particularly fibrinolysis) in treating heart attacks.[1] It works by stimulating secondary fibrinolysis by plasmin through infusion of analogs of tissue plasminogen activator (tPA), the protein that normally activates plasmin.
*Stroke: Thrombolysis reduces major disability or death when given within 3 hours (or perhaps even 6 hours) of ischaemic stroke onset when there are no contraindications to treatment.[2][3][4]
*Massive pulmonary embolism. For the treatment of a massive pulmonary embolism, catheter-directed therapy is a safer and more effective alternative to systemic thrombolysis. This involves the injecting of drugs directly into the clot.[5]
*Severe deep vein thrombosis (DVT), such as phlegmasia cerulea dolens, which threatens limb loss, or iliofemoral DVT, where clots involve at a minimum the common iliac vein[6]Tpa Clot Buster Drug
Apart from streptokinase, all thrombolytic drugs are administered together with heparin (unfractionated or low molecular weight heparin), usually for 24 to 48 hours.[citation needed]
Thrombolysis is usually intravenous. It may also be used directly into the affected blood vessel during an angiogram (intra-arterial thrombolysis), e.g. when patients present with stroke beyond three hours or in severe deep vein thrombosis (catheter-directed thrombolysis).[7]
Thrombolysis is performed by many types of medical specialists, including interventional radiologists, vascular surgeons, cardiologists, interventional neuroradiologists, and neurosurgeons. In some countries such as the United States of America, emergency medical technicians may administer thrombolytics for heart attacks in prehospital settings, by on-line medical direction. In countries with more extensive and independent qualifications, prehospital thrombolysis (fibrinolysis) may be initiated by the emergency care practitioner (ECP). Other countries which employ ECP’s include, South Africa, the United Kingdom, and New Zealand. Prehospital thrombolysis is always the result of a risk-benefit calculation of the heart attack, thrombolysis risks, and primary percutaneous coronary intervention (pPCI) availability.Contraindications[edit]
Thrombolysis is not without risks. Therefore, clinicians must select patients who are to be best suited for the procedure, and those who have the least risk of having a fatal complication. An absolute contraindication is in itself enough to avoid thrombolysis, while a relative contraindication needs to be considered in relation to the overall clinical situation.Myocardial infarction[edit]
Absolute contraindications:[8]
*Any previous history of hemorrhagic stroke, ischemic stroke within 3 months.
*History of stroke, dementia, or central nervous system damage within 1 year
*Head trauma within 3 weeks or brain surgery within 6 months
*Known intracranial neoplasm
*Suspected aortic dissection
*Internal bleeding within 6 weeks
*Active bleeding or known bleeding disorder
*Traumatic cardiopulmonary resuscitation within 3 weeks
Relative contraindications:[8]
*Oral anticoagulant therapy
*Acute pancreatitis
*Pregnancy or within 1 week postpartum
*Active peptic ulceration
*Transient ischemic attack within 6 months
*Dementia
*Infective endocarditis
*Active cavitating pulmonary tuberculosis
*Advanced liver disease
*Intracardiac thrombi
*Uncontrolled hypertension (systolic blood pressure >180 mm Hg, diastolic blood pressure >110 mm Hg)
*Puncture of noncompressible blood vessel within 2 weeks
*Previous streptokinase therapy
*Major surgery, trauma, or bleeding within 2 weeksStroke[edit]
Absolute contraindications:[9]
*Uncertainty about time of stroke onset (e.g. patients awakening from sleep).
*Coma or severe obtundation with fixed eye deviation and complete hemiplegia.
*Hypertension: systolic blood pressure ≥ 185mmHg; or diastolic blood pressure >110mmHg on repeated measures prior to study. (if reversed, patient can be treated)
*Clinical presentation suggestive of subarachnoid haemorrhage even if the CT scan is normal.
*Presumed septic embolus.
*Patient having received a heparin medication within the last 48 hours and has an elevated Activated Prothrombin Time (APTT) or has a known hereditary or acquired haemorrhagic diathesis
*INR >1.7
*Known advanced liver disease, advanced right heart failure, or anticoagulation, and INR > 1.5 (no need to wait for INR result in the absence of the former three conditions).
*Known platelet count <100,000 uL.
*Serum glucose is < 2.8 mmol/l or >22.0 mmol/l.
Relative contraindications:[10]
*Severe neurological impairment with NIHSS score >22.
*Age >80 years.
*CT evidence of extensive middle cerebral artery (MCA) territory infarction (sulcal effacement or blurring of grey-white junction in greater than 1/3 of MCA territory).
*Stroke or serious head trauma within the past three months where the risks of bleeding are considered to outweigh the benefits of therapy.
*Major surgery within the last 14 days (consider intra-arterial thrombolysis).
*Patient has a known history of intracranial haemorrhage, subarachnoid haemorrhage, known intracranial arteriovenous malformation or previously known intracranial neoplasm
*Suspected recent (within 30 days) myocardial infarction.
*Recent (within 30 days) biopsy of a parenchymal organ or surgery that, in the opinion of the responsible clinician, would increase the risk of unmanageable (e.g. uncontrolled by local pressure) bleeding.
*Recent (within 30 days) trauma with internal injuries or ulcerative wounds.
*Gastrointestinal or urinary tract haemorrhage within the last 30 days or any active or recent haemorrhage that, in the opinion of the responsible clinician, would increase the risk of unmanageable (e.g. by local pressure) bleeding.
*Arterial puncture at non-compressible site within the last 7 days.
*Concomitant serious, advanced or terminal illness or any other condition that, in the opinion of the responsible clinician would pose an unacceptable risk.
*Minor or Rapidly improving deficit.
*Seizure: If the presenting neurological deficit is deemed due to a seizure.
*Pregnancy is not an absolute contraindication. Consider intra-arterial thrombolysis.Side-effects[edit]
Hemorrhagic stroke is a rare but serious complication of thrombolytic therapy. If a patient has had thrombolysis before, an allergy against the thrombolytic drug may have developed (especially after streptokinase). If the symptoms are mild, the infusion is stopped and the patient is commenced on an antihistamine before infusion is recommenced. Anaphylaxis generally requires immediate cessation of thrombolysis.Agents[edit]
Thrombolysis therapy uses thrombolytic drugs that dissolve blood clots. Most of these drugs target fibrin (one of the main constituent of blood clots) and are therefore called fibrinolytics. All currently approved thrombolytic drugs are biologics, either derived from Streptococcus species, or, more recently, using recombinantbiotechnology whereby tPA is manufactured using cell culture, resulting in a recombinant tissue plasminogen activator or rtPA.
Some fibrinolytics are:
*Streptokinase (Kabikinase)[11]
*Anistreplase (Eminase)[11]
*Recombinant tissue plasminogen activators (rtPA)
*Alteplase (Activase or Actilyse)[11]
*Reteplase (Retavase)[12]
*Tenecteplase[12]
*Urokinase[13]Research[edit]
In people who receive thrombolytic therapy delivered through a catheter, there is a risk of hemorrhage as a side effect. Scientists have studied whether measuring fibrinogen in blood can be used as a biomarker to predict hemorrhage. As of 2017 it was not known if this works or not.[14]See also[edit]
*TIMI – thrombolysis in myocardial infarctionReferences[edit]
*^’Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Fibrinolytic Therapy Trialists’ (FTT) Collaborative Group’. Lancet. 343 (8893): 311–22. 5 February 1994. doi:10.1016/s0140-6736(94)91161-4. PMID7905143.
*^Wardlaw JM, Murray V, Berge E, Del Zoppo GJ (2014). ’Thrombolysis for acute ischaemic stroke’. Cochrane Database Syst Rev (7): CD000213. doi:10.1002/14651858.CD000213.pub3. PMC4153726. PMID25072528.
*^Wechsler LR (2011). ’Intravenous thrombolytic therapy for acute ischemic stroke’. N Engl J Med. 364 (22): 2138–46. doi:10.1056/NEJMct1007370. PMID21631326.
*^Mistry EA (2017). ’Mechanical Thrombectomy Outcomes With and Without Intravenous Thrombolysis in Stroke Patients: A Meta-Analysis’. Stroke. 48 (9): 2450–2456. doi:10.1161/STROKEAHA.117.017320. PMID28747462.
*^Kuo WT, Gould MK, Louie JD, Rosenberg JK, Sze DY, Hofmann LV (November 2009). ’Catheter-directed therapy for the treatment of massive pulmonary embolism: systematic review and meta-analysis of modern techniques’. J Vasc Interv Radiol. 20 (11): 1431–40. doi:10.1016/j.jvir.2009.08.002. PMID19875060.CS1 maint: multiple names: authors list (link)
*^Tran HA, Gibbs H, Merriman E, Curnow JL, Young L, Bennett A, Tan C, Chunilal SD, Ward CM, Baker R, Nandurkar H (March 2019). ’New guidelines from the Thrombosis and Haemostasis Society of Australia and New Zealand for the diagnosis and management of venous thromboembolism’. The Medical Journal of Australia. 210 (5): 227–235. doi:10.5694/mja2.50004. PMID30739331.
*^Catanese L, Tarsia J, Fisher M (3 February 2017). ’Acute Ischemic Stroke Therapy Overview’. Circ Res. 120 (3): 541–558. doi:10.1161/CIRCRESAHA.116.309278. PMID28154103.CS1 maint: uses authors parameter (link)
*^ abHarvey D. White; Frans J. J. Van de Werf (1998). ’Clinical Cardiology: New Frontiers Thrombolysis for Acute Myocardial Infarction’. Circulation. 97 (16): 1632–1646. doi:10.1161/01.CIR.97.16.1632. PMID9593569.CS1 maint: multiple names: authors list (link)
*^Department of Health, Western Australia. ’Protocol for Administering Alteplase in Acute Ischaemic Stroke Guidelines’(PDF). Perth: Health Networks Branch, Department of Health, Western Australia. Retrieved 12 June 2013.
*^Jason Thurman; Edward C. Jauch (2002). ’Acute ischemic stroke: emergent evaluation and management’. Emergency Medicine Clinics of North America. 20 (3): 609–630. doi:10.1016/s0733-8627(02)00014-7. PMID12379964.
*^ abc’Therapeutic Biologic Applications (BLA) > Difficulties in Obtaining Sufficient Amounts of Urokinase (Abbokinase)’. US Food and Drug Administration. 10/07/2016. Retrieved 2016-12-28.Check date values in: |date= (help)
*^ ab’Therapeutic Biologics Applications (BLA)’. US Food and Drug Administration. 07-10- 2016. Retrieved 2016-12-28.Check date values in: |date= (help)
*^’Urokinase’. www.drugbank.ca. Retrieved 17 March 2019.
*^Poorthuis, Michiel H. F.; Brand, Eelco C.; Hazenberg, Constantijn E. V. B.; Schutgens, Roger E. G.; Westerink, Jan; Moll, Frans L.; de Borst, Gert J. (5 March 2017). ’Plasma fibrinogen level as a potential predictor of hemorrhagic complications after catheter-directed thrombolysis for peripheral arterial occlusions’. Journal of Vascular Surgery. 65 (5): 1519–1527.e26. doi:10.1016/j.jvs.2016.11.025. ISSN1097-6809. PMID28274749.Retrieved from ’https://en.wikipedia.org/w/index.php?title=Thrombolysis&oldid=995136347’To use the sharing features on this page, please enable JavaScript.
Thrombolytic therapy is the use of drugs to break up or dissolve blood clots, which are the main cause of both heart attacks and stroke.
Thrombolytic medicines are approved for the emergency treatment of stroke and heart attack. The most commonly used drug for thrombolytic therapy is tissue plasminogen activator (tPA), but other drugs can do the same thing.
Ideally, you should receive thrombolytic medicines within the first 30 minutes after arriving at the hospital for treatment.
HEART ATTACKS
A blood clot can block the arteries to the heart. This can cause a heart attack, when part of the heart muscle dies due to a lack of oxygen being delivered by the blood.
Thrombolytics work by dissolving a major clot quickly. This helps restart blood flow to the heart and helps prevent damage to the heart muscle. Thrombolytics can stop a heart attack that would otherwise be larger or potentially deadly. Outcomes are better if you receive a thrombolytic drug within 12 hours after the heart attack starts. But the sooner treatment begins, the better the results.
The drug restores some blood flow to the heart in most people. However, the blood flow may not be completely normal and there may still be a small amount of muscle damaged. Further therapy, such as cardiac catheterization with angioplasty and stenting, may be needed.
Your health care provider will base the decisions about whether to give you a thrombolytic medicine for a heart attack on many factors. These factors include your history of chest pain and the results of an ECG test.
Other factors used to determine if you are a good candidate for thrombolytics include:
*Age (older people are at increased risk of complications)
*Sex
*Medical history (including your history of a previous heart attack, diabetes, low blood pressure, or increased heart rate)
Generally, thrombolytics may not be given if you have:
*A recent head injury
*Bleeding problems
*Bleeding ulcers
*Pregnancy
*Recent surgery
*Taken blood thinning medicines such as Coumadin
*Trauma
*Uncontrolled (severe) high blood pressure
STROKES
Most strokes are caused when blood clots move to a blood vessel in the brain and block blood flow to that area. For such strokes (ischemic strokes), thrombolytics can be used to help dissolve the clot quickly. Giving thrombolytics within 3 hours of the first stroke symptoms can help limit stroke damage and disability.
Results Way Corporate Center, Cupertino, CA 95014 - Office Space. Results Way Corporate Center is located at 5 Results Way in the Cupertino neighborhood, CA, Cupertino, 95014. The Class B Office building was completed in 1979 and features a total of 146,000 Sqft. There are 41 office spaces for lease in the Cupertino neighborhood, totaling 393,454 Sqft of available office. 5 Results Way, Cupertino, CA 95014. Claim this business. Hotels in Cupertino, CA.
The decision to give the drug is based upon:
*A brain CT scan to make sure there has not been any bleeding
*A physical exam that shows a significant stroke
*Your medical history
As in heart attacks, a clot-dissolving drug isn’t usually given if you have one of the other medical problems listed above.
Thrombolytics are not given to someone who is having a stroke that involves bleeding in the brain. They could worsen the stroke by causing increased bleeding.Tpa Clot Buster Risks
RISKS
Bleeding is the most common risk. It can be life threatening.
Minor bleeding from the gums or nose can occur in approximately 25% of people who receive the drug. Bleeding into the brain occurs approximately 1% of the time. This risk is the same for both stroke and heart attack patients.
If thrombolytics are felt to be too dangerous, other possible treatments for clots causing a stroke or heart attack include:
*Removal of the clot (thrombectomy)
*A procedure to open narrowed or blocked blood vessels that supply blood to the heart or the brain
CONTACT A HEALTH CARE PROVIDER OR CALL 911
Heart attacks and strokes are medical emergencies. The sooner treatment with thrombolytics begins, the better the chance for a good outcome.
Tissue plasminogen activator; TPA; Alteplase; Reteplase; Tenecteplase; Activase thrombolytic agent; Clot-dissolving agents; Reperfusion therapy; Stroke - thrombolytic; Heart attack - thrombolytic; Acute embolism - thrombolytic; Thrombosis - thrombolytic; Lanoteplase; Staphylokinase; Streptokinase (SK); Urokinase; Stroke - thrombolytic therapy; Heart attack - thrombolytic therapy; Stroke - thrombolysis; Heart attack - thrombolysis; Myocardial infarction - thrombolysis
Bohula EA, Morrow DA. ST-elevation myocardial infarction: management. In: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019:chap 59.
Crocco TJ, Meurer WJ. Stroke. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 91.Tpa Clot Buster Pulmonary Embolism
Jaffer IH, Weitz JI. Antithrombotic drugs. In: Hoffman R, Benz EJ, Silberstein LE, et al, eds. Hematology: Basic Principles and Practice. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 149.Names Of Clot Busting Drugs
O’Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127
https://diarynote.indered.space
コメント