Guidelines for Intravenous Thrombolysis (Recombinant Tissue-type Plasminogen Activator), the Third Edition, March 2019: A Guideline from the Japan Stroke Society

Toyoda, Kazunori; Koga, Masatoshi; Iguchi, Yasuyuki; Itabashi, Ryo; Inoue, Matsuhisa; Okada, Yasushi; Ogasawara, Kuniaki; Tsujino, Akira; Hasegawa, Yasuhiro; Hatano, Taketo; Yamagami, Hiroshi; Iwama, Toru; Shiokawa, Yoshiaki; Terayama, Yasuo; Minematsu, Kazuo

doi:10.2176/nmc.st.2019-0177

Cited by 86 publications

(63 citation statements)

References 168 publications

(189 reference statements)

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“…The benefits of endovascular therapy were uncertain, considering a DWI ASPECTS of 5. 12,13 Nevertheless, endovascular therapy was planned for case 1 because angiography revealed M1 occlusion, which was within 6 h of symptom onset. The conditions of case 2 indicated that endovascular therapy was suitable.…”

Section: Discussionmentioning

confidence: 99%

“…As for case 3, because the patient had occlusion of the superior trunk of the left MCA (M2), the benefits of endovascular therapy were also uncertain. 12,13 We performed endovascular therapy because recanalization was not achieved after rt-PA therapy and we could puncture at only 88 min after symptom onset. These three patients were diagnosed with AF after hemodialysis initiation.…”

Section: Discussionmentioning

confidence: 99%

“…The patient described in case 2 was sent to another hospital where hemodialysis could not be administered; however, endovascular therapy was performed. Although his lowest NIHSS at onset and the fact that endovascular therapy was suitable for his condition according to the guideline 12,13 might have affected his outcome, his ORT was the shortest and his mRS score at discharge was the best among the three patients. The ORT determines favorable outcomes and mortality; shorter ORT leads to decreased mortality rates and increased patient independence.…”

Section: Discussionmentioning

confidence: 99%

“…3,5,11 Patients undergo hemodialysis with anticoagulants, typically heparin, which elevates their APTT. According to the guidelines, rt-PA therapy should not be administered if APTT is prolonged 11,13 or if patients received a treatment dose of low-molecular-weight heparin within the previous 24 h. 12 If cerebral infraction occurs during or after hemodialysis, then rt-PA therapy is likely to be contraindicated; however, endovascular therapy may be a suitable option. Usually, patients undergo regular blood pressure and pulse checks during hemodialysis.…”

Section: Discussionmentioning

confidence: 99%

“…Current guidelines recommend that recombinant tissue plasminogen activator (rt-PA) therapy should be started within 4.5 h after the onset of ischemic stroke. 12,13 Endovascular therapy is recommended for patients in whom rt-PA therapy is contraindicated and for those who have received rt-PA therapy but did not achieve blood flow restoration. 12,13 However, rt-PA therapy is more likely to be contraindicated in hemodialysis patients with AF because anticoagulants are usually administered during hemodialysis and oral anticoagulants are sometimes administered to patients with AF.…”

Section: Introductionmentioning

confidence: 99%

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Endovascular therapy for hemodialysis patients with atrial fibrillation and cerebral thromboembolism: A case series

et al. 2019

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Introduction: Hemodialysis patients with atrial fibrillation are at high risk for stroke. Intravenous recombinant tissue plasminogen activator is considered for acute ischemic stroke. However, recombinant tissue plasminogen activator therapy is contraindicated for some hemodialysis patients with atrial fibrillation. These patients and those who have received recombinant tissue plasminogen activator therapy without blood flow recovery are candidates for endovascular therapy. Methods and results: Three hemodialysis patients with atrial fibrillation received endovascular therapy for acute cerebral infarction. Cerebrovascular incident occurred during or after hemodialysis in two of these patients. All three patients achieved successful recanalization after endovascular therapy. Conclusion: In this series, endovascular therapy showed good results without complications. More cases should be investigated to obtain more evidence of successful endovascular therapy for hemodialysis patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Endovascular therapy for hemodialysis patients with atrial fibrillation and cerebral thromboembolism: A case series

et al. 2019

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Effect of Mechanical Thrombectomy Without vs With Intravenous Thrombolysis on Functional Outcome Among Patients With Acute Ischemic Stroke

Suzuki

Matsumaru

Takeuchi

et al. 2021

JAMA

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399

435

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IMPORTANCEWhether intravenous thrombolysis is needed in combination with mechanical thrombectomy in patients with acute large vessel occlusion stroke is unclear.OBJECTIVE To examine whether mechanical thrombectomy alone is noninferior to combined intravenous thrombolysis plus mechanical thrombectomy for favorable poststroke outcome. Investigator-initiated, multicenter, randomized, open-label, noninferiority clinical trial in 204 patients with acute ischemic stroke due to large vessel occlusion enrolled at 23 hospital networks in DESIGN, SETTING, AND PARTICIPANTS

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Acute Stroke Treatment in an Anticoagulated Patient: When Is Thrombolysis an Option?

Siller

Chandratheva

Bücke

et al. 2021

Curr Treat Options Neurol

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Purpose of Review Direct oral anticoagulants (DOACs: the factor Xa inhibitors rivaroxaban, apixaban, and edoxaban and the direct thrombin inhibitor dabigatran) are the mainstay of stroke prevention in patients with non-valvular atrial fibrillation (AF). Nevertheless, there is a residual stroke risk of 1–2% per year despite DOAC therapy. Intravenous thrombolysis (IVT) reduces morbidity in patients with ischemic stroke and improves functional outcome. Prior DOAC therapy is a (relative) contraindication for IVT but emerging evidence supports its use in selected patients. Recent Findings Recent observational studies highlighted that IVT in patients on prior DOAC therapy seems feasible and did not yield major safety issues. Different selection criteria and approaches have been studied including selection by DOAC plasma levels, non-specific coagulation assays, time since last intake, and prior reversal agent use. The optimal selection process is however not clear and most studies comprised few patients. Summary IVT in patients taking DOAC is a clinically challenging scenario. Several approaches have been proposed without major safety issues but current evidence is weak. A patient-oriented approach balancing potential benefits of IVT (i.e., amount of salvageable penumbra) against expected bleeding risk including appropriate monitoring of anticoagulant activity seem justified.

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Guidelines for Intravenous Thrombolysis (Recombinant Tissue-type Plasminogen Activator), the Third Edition, March 2019: A Guideline from the Japan Stroke Society

Cited by 86 publications

References 168 publications

Endovascular therapy for hemodialysis patients with atrial fibrillation and cerebral thromboembolism: A case series

Endovascular therapy for hemodialysis patients with atrial fibrillation and cerebral thromboembolism: A case series

Effect of Mechanical Thrombectomy Without vs With Intravenous Thrombolysis on Functional Outcome Among Patients With Acute Ischemic Stroke

Acute Stroke Treatment in an Anticoagulated Patient: When Is Thrombolysis an Option?

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