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CVA Thrombolysis

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1. CVA Thrombolysis

CVA Thrombolysis CVA Thrombolysis Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 CVA Thrombolysis CVA Thrombolysis Aka: CVA (...) Thrombolysis , Stroke Thrombolysis , Thrombolysis in Cerebrovascular Accident , CVA Fibrinolytic Checklist , CVA Thrombolytic Contraindications From Related Chapters II. Indications (Inclusion Criteria) Age over 18 years Clinical Diagnosis of acute with persistent deficits (typically with 5 or higher) compatible with diagnosis Known time of onset under 3 hours before s Expedite evaluation and discuss with stroke team Do not use intravenous tPA beyond 3 hours of symptom onset unless indicated below

2018 FP Notebook

2. CVA Management

CVA Management CVA Management Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 CVA Management CVA Management Aka: CVA Management , CVA (...) Evaluation , Cerebrovascular Accident Management , Stroke Management From Related Chapters II. Protocol: Step 1 Prehospital Assessment Activate EMS system in all potential CVA patients Prehospital evaluation of patient ( ) Transport to hospital with Stroke Team if possible (otherwise nearest facility) Fingerstick III. Protocol: Step 2 Immediate General Assessment (<10 minutes) Obtain full s including Deliver Oxygen by (if <90%) Do not delay (see Step 4 below) Consider having paramedics wheel patient

2018 FP Notebook

3. CVA Thrombolysis

CVA Thrombolysis CVA Thrombolysis Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 CVA Thrombolysis CVA Thrombolysis Aka: CVA (...) Thrombolysis , Stroke Thrombolysis , Thrombolysis in Cerebrovascular Accident , CVA Fibrinolytic Checklist , CVA Thrombolytic Contraindications From Related Chapters II. Indications (Inclusion Criteria) Age over 18 years Clinical Diagnosis of acute with persistent deficits (typically with 5 or higher) compatible with diagnosis Known time of onset under 3 hours before s Expedite evaluation and discuss with stroke team Do not use intravenous tPA beyond 3 hours of symptom onset unless indicated below

2015 FP Notebook

4. MI Thrombolysis

MI Thrombolysis MI Thrombolysis Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 MI Thrombolysis MI Thrombolysis Aka: MI Thrombolysis (...) , Fibrinolysis for ST Elevation MI , Myocardial Infarction Thrombolysis , Thrombolysis in STEMI , Thrombolysis in ST Elevation Myocardial Infarction , MI Fibrinolytic Checklist , Acute Coronary Syndrome Thrombolytic Contraindications , Thrombolysis of Coronary Artery by Intravenous Infusion From Related Chapters II. Indications (Inclusion Criteria - all must be present) >15 minutes and less than 12 hours EKG demonstrates or new III. Contraindications: Absolute (Exclusion Criteria - all must be absent

2018 FP Notebook

5. Use of thrombolysis in acute ischaemic stroke

Use of thrombolysis in acute ischaemic stroke BestBets: Use of thrombolysis in acute ischaemic stroke Use of thrombolysis in acute ischaemic stroke Report By: Craig Ferguson - SPR Emergency Medicine Search checked by Craig Ferguson - SPR Emergency Medicine Institution: Salford Royal Foundation Trust Date Submitted: 14th March 2007 Date Completed: 14th April 2010 Last Modified: 14th April 2010 Status: Green (complete) Three Part Question In [patients diagnosed with acute ischaemic stroke] does (...) [thrombolysis] improve [mortality and functional outcome]? Clinical Scenario A 49 y/o women is brought to the emergency department by ambulance. She was having lunch with friends when she suddenly collapsed at the table. On arrival, she is aphasic and has a marked weakness of her right side. Her partner attends and informs you of her medical history which consists of treated hypertension and nil else of note. You arrange for an urgent CT scan and contact the on-call stroke physician. The patient has

2010 BestBETS

6. CVA Management

CVA Management CVA Management Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 CVA Management CVA Management Aka: CVA Management , CVA (...) Evaluation , Cerebrovascular Accident Management , Stroke Management From Related Chapters II. Protocol: Step 1 Prehospital Assessment Activate EMS system in all potential CVA patients Prehospital evaluation of patient ( ) Transport to hospital with Stroke Team if possible (otherwise nearest facility) Fingerstick III. Protocol: Step 2 Immediate General Assessment (<10 minutes) Obtain full s including Deliver Oxygen by (if <90%) Do not delay (see Step 4 below) Consider having paramedics wheel patient

2015 FP Notebook

7. MI Thrombolysis

MI Thrombolysis MI Thrombolysis Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 MI Thrombolysis MI Thrombolysis Aka: MI Thrombolysis (...) , Fibrinolysis for ST Elevation MI , Myocardial Infarction Thrombolysis , Thrombolysis in STEMI , Thrombolysis in ST Elevation Myocardial Infarction , MI Fibrinolytic Checklist , Acute Coronary Syndrome Thrombolytic Contraindications , Thrombolysis of Coronary Artery by Intravenous Infusion From Related Chapters II. Indications (Inclusion Criteria - all must be present) >15 minutes and less than 12 hours EKG demonstrates or new III. Contraindications: Absolute (Exclusion Criteria - all must be absent

2015 FP Notebook

9. ESC/EACTS Guidelines on Myocardial Revascularization

Coronary artery bypass grafting 111 6.3.3 Percutaneous coronary intervention vs. coronary artery bypass grafting 111 6.4 Gaps in the evidence 112 7 Revascularization in ST-segment elevation myocardial infarction 112 7.1 Time delays 112 7.2 Selection of reperfusion strategy 112 7.3 Primary percutaneous coronary intervention 113 7.4 Percutaneous coronary intervention after thrombolysis and in patients with late diagnosis 114 7.5 Gaps in the evidence 114 8 Myocardial revascularization in patients (...) cardiovascular events in Addition to Standard therapy in subjects with Acute Coronary Syndrome–Thrombolysis In Myocardial Infarction 51 ATOLL Acute STEMI Treated with primary PCI and intravenous enoxaparin Or UFH to Lower ischaemic and bleeding events at short- and Long-term follow-up AWESOME Angina With Extremely Serious Operative Mortality Evaluation BARC Bleeding Academic Research Consortium BARI-2D Bypass Angioplasty Revascularization Investigation 2 Diabetes BES Biolimus-eluting stent BEST Randomised

Full Text available with Trip Pro

2018 European Society of Cardiology

10. ClearWay RX for drug delivery to coronary artery thrombotic lesions

administration. These included the extent of stenosis, thrombolysis in myocardial infarction frame count, procedure-related myocardial infarctions and major adverse coronary events at 1 year. The list price of a single ClearWay RX unit is £600 excluding VAT. Note that administering drugs such as abciximab using ClearWay RX may be outside their UK marketing authorisation. © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 1 (...) ), or intravenous delivery (Crystal AMI). In the COCTAIL trial (n=50), there was no statistically significant difference in the primary outcome (thrombus score) with ClearWay RX compared with guide catheter delivery of abciximab. There was a statistically significant improvement in the extent of stenosis of the target artery, coronary blood flow as measured by the thrombolysis in myocardial infarction frame count (TIMI), procedure-related myocardial infarctions and major adverse cardiac events at 1 year

2016 National Institute for Health and Clinical Excellence - Advice

12. Patient self-testing and self-management of oral anti-coagulants with vitamin K antagonists

in a training programme by the patient (or for dependant patients, both the patient and their carer) is important. Failure of patients to successfully complete a training programme and demonstrate competency has been reported to be related to age, history of cerebrovascular accident (CVA), poor cognition, low literacy or poor manual dexterity (Fitzmaurice et al , ; Matchar et al , ). UK studies have demonstrated that training programmes can be successfully completed by 75% of patients (Fitzmaurice et al (...) of Thrombosis and Thrombolysis , 30 , 263 – 275 . Fitzmaurice, D.A. , Murray, E.T. , Gee, K.M. , Allan, T.F. & Hobbs, F.D. ( 2002 ) A randomised controlled trial of patient self management of oral anticoagulation treatment compared with primary care management . Journal of Clinical Pathology , 55 , 845 – 849 . Fitzmaurice, D.A. , Gardiner, C. , Kitchen, S. , Mackie, I. , Murray, E.T. , Machin, S.J. & British Society of Haematology Taskforce for Haemostasis and Thrombosis ( 2005a ) An evidence‐based review

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2014 British Committee for Standards in Haematology

13. Effectiveness and Safety of Thrombolytics for the Treatment of Ischemic Stroke

within 60 minutes of presentation to the emergency department. (2) Overall, only 8% of patients with ischemic stroke receive rt-PA. (2) However, among those who do receive it, 49% receive rt-PA within the first 2 hours of onset of symptoms. (2) Other reperfusion strategies include intra-arterial administration of thrombolytics, mechanical thrombolysis through ultrasound or embolectomy, and combination therapies that involve the combination of mechanical and intravenous/intra-arterial thrombolytics (...) , systematic reviews, and health technology assessments ? inhospital setting ? intravenous thrombolytics therapies for ischemic stroke Exclusion Criteria ? studies where outcomes of interest cannot be abstracted ? intra-arterial or other nonintravenous routes of administration ? nondrug thrombolysis techniques (e.g., sonothrombolytics) or combination therapies (e.g., ultrasound enhanced thrombolysis) Outcomes of Interest ? mortality ? dependency (as a measure of degree of neurological impairment

2013 Health Quality Ontario

14. Optimized Timing of Thrombolytic Therapy for the Treatment of Stroke

for the administration of thrombolytic therapy for stroke to maximize patient independence and minimize the risk of symptomatic intracranial hemorrhage (SICH). Clinical Need and Intervention Acute Ischemic Stroke Ischemic strokes account for 80% of strokes, and result from the blockage of oxygen and blood flow to the brain. (1) Pending confirmation of the absence of intracranial hemorrhage with diagnostic imaging, thrombolysis via mechanical or pharmaceutical means may be undertaken to obliterate the obstructing (...) thrombolysis in hospital Exclusion Criteria ? randomized controlled trials, observational studies, case reports, editorials, letters to the editor ? mechanical and/or combination thrombolytic interventions ? patient populations other than ischemic stroke (e.g., myocardial infarction) Outcomes of Interest ? independence (a functional outcome characterized by a lack or low level of dependency) ? symptomatic intracranial hemorrhage (SICH) Expert Panel In August 2012, an Expert Advisory Panel on Episodes

2013 Health Quality Ontario

15. Venous Thromboembolism (VTE)

, May 2014 Table 1. Glossary of Abbreviations aPTT Activated Partial Thromboplastin Time APS Antiphospholipid antibody syndrome ABGs Arterial Blood Gases BNP B-type natriuretic peptide CVA Cerebrovascular accident CTEPH Chronic thromboembolic pulmonary hypertension CTA Computed tomography angiography CTV Computed tomographic venography COCs Estrogen-containing combined oral contraceptives DVT Deep venous thrombosis GSV Great saphenous vein HIT Heparin-induced thrombocytopenia HRT Hormone replacement (...) ; a negative result with either study confers approximately a 1% VTE rate within 6 months. However, because angiography is invasive, it carries a greater risk of complications and mortality. The mortality from angiography has been estimated at 0.5% while 1% may experience major complications including arrhythmias, hypotension, bleeding, and nephrotoxicity. We do not recommend pulmonary angiography, except in circumstances such as inadequate V/Q imaging or when catheter-directed thrombolysis is recommended

2014 University of Michigan Health System

16. Royal Flying Doctor Service Western Operations Clinical manual part 1.Clinical guidelines

Computerised tomography pulmonary angiogram AFB Acid fast bacilli CVA Cerebrovascular accident ALS Advanced life support CVC Central venous catheter APH Antipartum haemorrhage CVP Central venous pressure APO Acute pulmonary oedema CXR Chest x-ray ARCBS Australian Red Cross Blood Service DBP Diastolic blood pressure ARDS Adult respiratory distress syndrome DC Direct current ATLS Advanced trauma life support DIC Disseminated intravascular coagulopathy BBB Bundle branch block DKA Diabetic keto-acidosis BP (...) . Alternatively metoprolol 5mg-15mg IV OR 25-100mg orally. Titrate to HR of 55- 60bpm. ? Correct electrolyte abnormalities that may predispose to arrhythmia (K+ and Mg2+ ) ? Maintain glycaemic control. ? Consider a statin and an angiotensin converting enzyme inhibitor (ACEI). ? Glycoprotein IIb / IIIa inhibitors (tirofiban) should be avoided after thrombolysis and should only be given with cardiologist advice (not widely available). 3. Reperfusion therapy. ? STEMIs should be diagnosed early and reperfusion

2014 Clinical Practice Guidelines Portal

17. Trial to Demonstrate the Safety and Effectiveness of the MiStent II for the Revascularization of Coronary Arteries.

lengths available at the same time are eligible for enrollment. Target lesion(s) must have visually estimated stenosis ≥50% and <100% with thrombolysis in Myocardial Infarction (TIMI) flow >1 and one of the following: Stenosis ≥70% or; Abnormal fractional flow reserve (FFR) defined as <0.80 or; Abnormal stress or imaging stress test or; Elevated biomarkers prior to the procedure Coronary anatomy is likely to allow delivery of a study device to the target lesions(s) The first lesion treated must (...) blood transfusions Subject has had a history of cerebrovascular accident (CVA) or transient ischemic attack (TIA) within the past 6 months Subject has severe symptomatic heart failure (i.e., Left Ventricular Ejection Fraction (LVEF) <30%)) Subject is participating in another investigational drug or device clinical trial that has not reached its primary endpoint Subject intends to participate in another investigational drug or device clinical trial within 12 months after the index procedure Subject

2018 Clinical Trials

18. Scoreflex NC

of the following: Successful delivery, inflation, deflation, and withdrawal of the study balloon No evidence of vessel perforation, flow limiting dissection (grade C or higher) or reduction in Thrombolysis In Myocardial Infarction (TIMI) flow from baseline as related to the Scoreflex NC study balloon Final TIMI flow grade of 3 at the conclusion of the percutaneous coronary intervention (PCI) procedure Secondary Outcome Measures : Number of Participants with Angiographic Procedural Success [ Time Frame: Peri (...) procedure. A serum creatinine level > 2.0 mg/dl within 7 days prior to index procedure. Cerebrovascular accident (CVA) within the past 6 months. Active peptic ulcer or active gastrointestinal (GI) bleeding within the past 6 months. Subject has a known left ventricular ejection fraction (LVEF) <30% (LVEF may be obtained at the time of the index procedure if the value is unknown, if necessary) Target lesion located within an arterial or saphenous vein graft or graft anastomosis Angiographic Exclusion

2018 Clinical Trials

19. Clinical Studies by Using Accelerated PDX Model to Screen Drugs for Advanced Solid Tumor

) <50%; History of pulmonary interstitial lung disease or active interstitial lung disease; Coagulation dysfunction (INR >1.5 or PT>ULN+ 4sec, or PTT>1.5 ULN), with bleeding tendency or currently receiving thrombolysis therapy or anticoagulation treatment; Clinical bleeding episode or bleeding tendency within past three months, such as GI bleeding, hemorrhagic gastric ulcer, stool guaiac++ positive, or with vasculitis; Arterial or venous thrombosis within last 12 months, such as various types of CVA

2017 Clinical Trials

20. A Clinical Trial to Assess the SYNERGY 48 mm Stent System for the Treatment of Atherosclerotic Lesion(s)

test, or elevated biomarkers prior to the procedure Subject is willing to comply with all protocol-required follow-up evaluation Angiographic Inclusion Criteria (visual estimate) Target lesion must be located in a native coronary artery with a visually estimated reference vessel diameter (RVD) ≥2.5 mm and ≤4.0 mm Target lesion length must be >34 mm and ≤44 mm (by visual estimate) Target lesion must have visually estimated stenosis ≥50% and <100% with thrombolysis in Myocardial Infarction (TIMI (...) documented or suspected liver disease, including laboratory evidence of hepatitis Subject is on dialysis or has baseline serum creatinine level >2.0 mg/dL (177µmol/L) Subject has a history of bleeding diathesis or coagulopathy or will refuse blood transfusions Subject has had a history of cerebrovascular accident (CVA) or transient ischemic attack (TIA) within the past 6 months Subject has an active peptic ulcer or active gastrointestinal (GI) bleeding Subject has signs or symptoms of active heart

2017 Clinical Trials

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