Systemic lupus erythematosus (SLE) is a multi-organ autoimmune disorder that can cause significant morbidity and mortality. A large body of evidence has shown that African-Americans experience the disease more severely than other racial-ethnic groups. Relevant literature for the years 2000 to August 2015 were obtained from systematic searches of PubMed, Scopus, and the EBSCOHost platform that includes MEDLINE, CINAHL, etc. to evaluate research focused on SLE in African-Americans. Thirty-six of the 1502 articles were classified according to their level of evidence. The systematic review of the literature reported a wide range of adverse outcomes in African-American SLE patients and risk factors observed in other mono and multi-ethnic investigations. Studies limited to African-Americans with SLE identified novel methods for more precise ascertainment of risk and observed novel findings that hadn't been previously reported in African-Americans with SLE. Both environmental and genetic studies included in this review have highlighted unique African-American populations in an attempt to isolate risk attributable to African ancestry and observed increased genetic influence on overall disease in this cohort. The review also revealed emerging research in areas of quality of life, race-tailored interventions, and self-management. This review reemphasizes the importance of additional studies to better elucidate the natural history of SLE in African-Americans and optimize therapeutic strategies for those who are identified as being at high risk.
Background:
Most of the original exclusion criteria for recombinant tissue plasminogen activator (rt-PA) from NINDS trial, European, and FDA contribute to the low rt-PA use because of their stringent criteria. The new AHA/ASA guideline suggests that by relaxing the already existing criteria the use of rt-PA could be increased from its current use. The impact of the new AHA/ASA guideline in expanding the use, outcomes and benefits of rt-PA is not clear. We determined these issues in the current study.
Methods:
We characterized absolute and relative contraindications to rt-PA using a large sample size collected between 2010 and 2013 in a stroke registry. We analyzed both imaging and rt-PA data to determine whether there would have been significant increase in use, outcomes and benefit of rt-PA if the AHA/ASA guideline was used instead of the old FDA package insert of Alterplase (Activase).
Results:
A total of 663 ischemic stroke patients were eligible to receive rt-PA. Out of the 663, 241 received rt-PA and 422 did not. We identified specific differences in outcomes and contributing factors to contraindications at the level of individual patients and stroke population. We observed clinical conditions of similar exclusion criteria but with differential stroke deficits in both AHA/ASA guideline and the old FDA package insert of Alterplase (Activase).
Conclusion:
Although the new AHA guideline may serve the purpose of helping to expand the safe and judicious use of alteplase after stroke, there are specific clinical factors that are necessary to achieve the goal of the new AHA/ASA guideline.
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