Canadian Association of Emergency Physicians Position Statement on Acute Ischemic Stroke

Harris, Devin; Hall, Christopher; Lobay, K.; McRae, Andrew; Monroe, Tanya; Perry, Jeffrey J.; Shearing, Anthony D; Wollam, Gabe; Goddard, Tom; Lang, Eddy

doi:10.1017/cem.2015.26

Cited by 12 publications

(10 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This time window is considered essential for recovery, but no suitable candidates are now available because of increased risks of intracranial hemorrhages associated with early administration of conventional drugs, including COX1 inhibitor aspirin and antagonists of the platelet ADP-receptor P2Y 12 . 43 …”

Section: Discussionmentioning

confidence: 99%

Design, development and characterization of ACT017, a humanized Fab that blocks platelet's glycoprotein VI function without causing bleeding risks

Lebozec

Jandrot‐Perrus

Avenard

et al. 2017

mAbs

View full text Add to dashboard Cite

Glycoprotein VI is a platelet-specific collagen receptor critical for in vivo formation of arterial thrombosis. It is also considered as an attractive target for the development of anti-thrombotic drugs because blocking glycoprotein (GP)VI inhibits platelet aggregation without inducing detrimental effects on physiologic hemostasis.Here, we present data on the identification, in vitro and ex vivo pharmacology of a humanized Fab fragment designated as ACT017. ACT017 was selected out of 15 humanized variants based upon structural and functional properties. It was produced under GMP-like conditions followed by detailed physico-chemical analysis and functional characterization indicating high antigen-binding specificity and affinity. In addition, we demonstrate, in a dose-escalation study, that ACT017 has a high capacity to specifically inhibit collagen-induced platelet aggregation ex vivo after injection to the macaque without inducing thrombocytopenia, GPVI depletion or bleeding side effects as is the case for conventional anti-platelets. Therefore, ACT017 is a promising therapeutic candidate for the development of a new generation of safe and efficient anti-thrombotic drugs.

show abstract

Section: Discussionmentioning

confidence: 99%

Design, development and characterization of ACT017, a humanized Fab that blocks platelet's glycoprotein VI function without causing bleeding risks

Lebozec

Jandrot‐Perrus

Avenard

et al. 2017

mAbs

View full text Add to dashboard Cite

show abstract

“…For example, the Canadian Association of Emergency Physicians Position Statement on Acute Ischemic Stroke recommends against the use of t-PA outside of the research setting in 2001 [21]. After 14 years of debate, the same association recommended the use of t-PA within the first 3 h of onset (strong recommendation, high level of evidence) but recommended against its use beyond 3 h, except in specialized stroke centers with advanced imaging capabilities or as part of a research protocol, despite increasing evidence supporting its effectiveness [22]. In the United States, it took the American College of Emergency Physicians a while to settle this dispute [12].…”

Section: Discussionmentioning

confidence: 99%

Knowledge and Attitudes of Saudi Emergency Physicians toward t-PA Use in Stroke

Khathaami

Aloraini

Almudlej

et al. 2018

Neurology Research International

View full text Add to dashboard Cite

Background and Objectives Tissue plasminogen activator (t-PA) within 4.5 hours from onset improves outcome in patients with ischemic stroke and has been recommended by several international guidelines. Since its approval in 1996, the debate among emergency physicians continues particularly around the result interpretation of the first positive randomized controlled trial, the National Institute of Neurological Disorders and Stroke (NINDS) clinical trial. This lack of consensus might negatively affect the delivery of effective stroke care. Here we aimed to assess the knowledge and attitude of Saudi emergency physicians toward t-PA use within 4.5 hours of onset in acute ischemic stroke. Methods A web-based, self-administered, locally designed questionnaire was sent to all emergency physicians practicing in the city of Riyadh from January to September 2017. Results Out of 450 emergency physicians, 122 from ten hospitals in Riyadh participated in the survey, with a 27% response rate. The majority of participants were men (78%), and their mean age was 40 ± 8 years. Half of the participants were board certified, and 36% were consultants. Half of the participants consider the evidence for t-PA use in stroke within 4.5 hours of stroke onset to be controversial, and 41% recommend against its use due to lack of proven efficacy (37%), the risk of hemorrhagic complications (35%), lack of stroke expertise (21%), and medicolegal liability (9%). Nearly half were willing to administer IV t-PA for ischemic stroke in collaboration with remote stroke neurology consultation if telestroke is implemented. Conclusion Our study detected inadequate knowledge and a negative attitude among Saudi emergency physicians toward t-PA use in acute stroke. This might negatively impact patient outcome. Therefore, we recommend developing urgent strategies to improve emergency physicians' knowledge, attitudes, and beliefs in the management of acute stroke.

show abstract

“…In 2015, these were revised to reflect new literature in thrombolysis, but also included recommendations on stroke systems, EMS, telestroke, and post-stroke (specifically, stroke unit) care. 4 Only 3 years later, the guideline summary enclosed herein reflects major advances in stroke treatment and prevention.…”

Section: Introductionmentioning

confidence: 99%

A new era in stroke care

Harris

2018

CJEM

View full text Add to dashboard Cite

Canadian Association of Emergency Physicians Position Statement on Acute Ischemic Stroke

Cited by 12 publications

References 31 publications

Design, development and characterization of ACT017, a humanized Fab that blocks platelet's glycoprotein VI function without causing bleeding risks

Design, development and characterization of ACT017, a humanized Fab that blocks platelet's glycoprotein VI function without causing bleeding risks

Knowledge and Attitudes of Saudi Emergency Physicians toward t-PA Use in Stroke

A new era in stroke care

Contact Info

Product

Resources

About