We conducted a study using diffusion-weighted (DWI) and perfusion-weighted (PWI) magnetic resonance imaging (MRI) to evaluate the efficacy of thrombolysis in an embolic stroke model with recombinant tissue plasminogen activator (rt-PA) and hirulog, a novel direct-acting antithrombin. DWI can identify areas of ischemia minutes from stroke onset, while PWI identifies regions of impaired blood flow. Right internal carotid arteries of 36 rabbits were embolized using aged heterologous thrombi. Baseline DWI and PWI scans were obtained to confirm successful embolization. Four animals with no observable DWI lesion on the initial scan were excluded; therefore, a total of 32 animals were randomized to one of three treatment groups: rt-PA (n = 11), rt-PA plus hirulog (n = 11), or placebo (n = 10). Treatment was begun 1 h after stroke induction. Intravenous doses were as follows: rt-PA, 5 mg/kg over 0.5 h with 20% of the total dose given as a bolus; hirulog, 1 mg/kg bolus followed by 5 mg/kg over 1 h. MRI was performed at 2, 3, and 5 h following embolization. Six hours after embolization, brains were harvested, examined for hemorrhage, then prepared for histologic analysis. The rt-PA decreased fibrinogen levels by 73%, and hirulog prolonged the aPTT to four times the control value. Posttreatment areas of diffusion abnormality and perfusion delay were expressed as a ratio of baseline values. Significantly improved perfusion was seen in the rt-PA plus hirulog group compared with placebo (normalized ratios of the perfusion delay areas were as follows: placebo, 1.58, 0.47-3.59; rt-PA, 1.12, 0.04-3.95; rt-PA and hirulog, 0.40, 0.02-1.08; p < 0.05). Comparison of diffusion abnormality ratios measured at 5 h showed trends favoring reduced lesion size in both groups given rt-PA (normalized ratios of diffusion abnormality areas were as follows: placebo, 3.69, 0.39-15.71; rt-PA, 2.57, 0.74-5.00; rt-PA and hirulog, 1.95, 0.33-6.80; p = 0.32). Significant cerebral hemorrhage was observed in one placebo, two rt-PA, and three rt-PA plus hirulog treated animals. One fatal systemic hemorrhage was observed in each of the rt-PA groups. We conclude that rt-PA plus hirulog improves cerebral perfusion but does not necessarily reduce cerebral injury. DWI and PWI are useful methods for monitoring thrombolysis.
The clinical nurse specialist plays a valuable role in program development, implementation, and evaluation to achieve quality healthcare through interdisciplinary collaboration. Adhering to nutrition guidelines for the hospitalized adult patient improves nutrition care plan guidance and meal intake.
Modernizing service delivery by changing traditional roles can offer quality solutions ensuring that aspirin delivery is expedited by early swallow screen and CT scan. These initiatives could be used more widely to improve patient care and implement the top three process indicators for stroke.
: Venous thromboembolism (VTE) is a leading cause of death and disability worldwide. Each year, more than 10 million cases of VTE are diagnosed; studies suggest there are as many as 900,000 cases per year in the United States. The condition is estimated to cost the U.S. health care system between $7 billion and $10 billion annually. In February 2016, the American College of Chest Physicians released the 10th edition of the Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. After providing an overview of VTE pathophysiology, risk factors, signs, symptoms, and key clinical assessments, this article details recommendations from the new guideline, which incorporates the most up-to-date treatment options for patients with VTE. The authors highlight key changes from the 2012 guideline, particularly those related to nursing practice, patient education, care coordination, patient adherence, medication costs, follow-up appointments, and diagnostic testing.
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