Safety of IV thrombolysis in acute ischemic stroke related to Chagas disease

Cougo-Pinto, Pedro Telles; Santos, Bruno Lopes dos; Dias, F.T.; Camilo, Millene Rodrigues; Aléssio-Alves, Frederico Fernandes; Barreira, Clara M; Santos-Pontelli, Taiza E. G.; Abud, Daniel Giansante; Leite, João Pereira; Pontes-Neto, Octávio Marques

doi:10.1212/01.wnl.0000435566.30728.be

Cited by 8 publications

(3 citation statements)

References 10 publications

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“…In the acute phase of stroke, there is no evidence to suggest that management should differ between patients with Chagas disease and other patients with ischemic stroke. Thrombolysis is safe in patients with Chagas disease without an increased risk of bleeding compared with other patients undergoing thrombolysis 36,37 .…”

Section: Stroke Treatmentmentioning

confidence: 99%

Stroke in Chagas disease: from pathophysiology to clinical practice

Lage

Tupinambás

Pádua

et al. 2022

Rev. Soc. Bras. Med. Trop.

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Despite substantial progress toward its control, Chagas disease continues to be a major public health problem in Latin America and has become a global health concern. The disease affects approximately 6 million people, of whom 20-40% will develop cardiomyopathy over the years after the initial Trypanosoma cruzi infection. Chagas cardiomyopathy is the most serious and frequent manifestation of Chagas disease. Clinical manifestations vary widely according to the severity of myocardial dysfunction, ranging from asymptomatic to severe forms, including dilated cardiomyopathy with heart failure, arrhythmias, thromboembolism events, and sudden death. Chagas disease is a risk factor for stroke regardless of the severity of cardiomyopathy, which is a leading cause of chronic disability. Classically, stroke etiology in patients with Chagas disease is thought to be cardioembolic and related to apical aneurysm, mural thrombus, and atrial arrhythmias. Although most strokes are thromboembolic, other etiologies have been observed. Small vessel disease, atherosclerosis, and cryptogenic diseases have been reported in patients with Chagas disease and stroke. The potential mechanisms involved in non-embolic strokes include the presence of associated risk factors, pro-inflammatory and prothrombotic disease states, and endothelial dysfunction. However, the contribution of each mechanism to stroke in Chagas disease remains unclear. The review aims to provide an overview of stroke in Chagas disease, highlighting the main pathophysiological mechanisms, clinical presentation, approaches for prevention, and unanswered questions regarding treatment strategies.

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Section: Stroke Treatmentmentioning

confidence: 99%

Stroke in Chagas disease: from pathophysiology to clinical practice

Lage

Tupinambás

Pádua

et al. 2022

Rev. Soc. Bras. Med. Trop.

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“…Given that most stroke cases in CHD patients are related to LV thrombi, most neurologists recommend an earlier start of anticoagulation therapy in such cases. In cases of acute stroke in CHD, the experience with thrombolysis is limited, but short-term treatment with thrombolytics seems to have similar success compared to non-Chagas stroke[ 90 , 91 ].…”

Section: Strokementioning

confidence: 99%

Chagas heart disease: An overview of diagnosis, manifestations, treatment, and care

Saraiva¹,

Mediano²,

Mendes³

et al. 2021

WJC

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Chagas heart disease (CHD) affects approximately 30% of patients chronically infected with the protozoa Trypanosoma cruzi . CHD is classified into four stages of increasing severity according to electrocardiographic, echocardiographic, and clinical criteria. CHD presents with a myriad of clinical manifestations, but its main complications are sudden cardiac death, heart failure, and stroke. Importantly, CHD has a higher incidence of sudden cardiac death and stroke than most other cardiopathies, and patients with CHD complicated by heart failure have a higher mortality than patients with heart failure caused by other etiologies. Among patients with CHD, approximately 90% of deaths can be attributed to complications of Chagas disease. Sudden cardiac death is the most common cause of death (55%–60%), followed by heart failure (25%–30%) and stroke (10%–15%). The high morbimortality and the unique characteristics of CHD demand an individualized approach according to the stage of the disease and associated complications the patient presents with. Therefore, the management of CHD is challenging, and in this review, we present the most updated available data to help clinicians and cardiologists in the care of these patients. We describe the clinical manifestations, diagnosis and classification criteria, risk stratification, and approach to the different clinical aspects of CHD using diagnostic tools and pharmacological and non-pharmacological treatments.

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“…The middle cerebral arterial territory is most commonly affected (87% of cases of Chagas-associated stroke) [16]. Intravenous tissue plasminogen activator (IV-tPA) appears to be safe for treatment of acute stroke in Chagas disease [17]. The development of cognitive impairment following Chagas disease has been described in case-control and large, population-based cohort studies [18], but a causal relationship has not been confirmed [8,19].…”

Section: Chagas Disease (Trypanosoma Cruzi)mentioning

confidence: 99%