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Management of portal vein thrombosis after liver transplantation with a combined open and endovascular approach.
Kensinger CD, Sexton KW, Baron CM, Lipnik AJ, Meranze SG, Gorden DL
(2015) Liver Transpl 21: 132-4
MeSH Terms: Aged, Fibrinolytic Agents, Humans, Infusions, Intravenous, Laparotomy, Liver Diseases, Alcoholic, Liver Transplantation, Male, Phlebography, Portal Vein, Thrombolytic Therapy, Tissue Plasminogen Activator, Tomography, X-Ray Computed, Treatment Outcome, Vascular Patency, Venous Thrombosis
Added February 12, 2015
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1 Members
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16 MeSH Terms
In-center thrombolysis for clotted AV access: a cohort review.
Umanath K, Morrison RS, Christopher Wilbeck J, Schulman G, Bream P, Dwyer JP
(2013) Semin Dial 26: 124-9
MeSH Terms: Arteriovenous Shunt, Surgical, Fibrinolytic Agents, Graft Occlusion, Vascular, Humans, Renal Dialysis, Thrombolytic Therapy
Show Abstract · Added February 26, 2014
Thrombosis is the leading cause of arteriovenous (AV) access failure for hemodialysis patients requiring frequent interventions. We describe a novel approach to the lyse-and-wait technique in thrombosed AV access using nurse-administered thrombolytics in a hospital-based hemodialysis unit. All patients at a single-center, large, urban, tertiary care hospital, who underwent in-center thrombolysis via alteplase instilled directly into a thrombosed AV access by inpatient hemodialysis unit staff between January 1, 2003 and December 31, 2007, were eligible. Included subjects were at least 18 years old and did not have known or suspected infection or trauma to the AV access site. Primary outcome measure was successful thrombolysis defined as hemodialysis performed immediately or after the interventional radiology (IR) procedure. Adverse events related to the procedure were collected. A total of 321 procedures, performed on 145 subjects (77 (53%) male, 68 (47%) female) remained for analysis. Successful instillation occurred in 317 of 321 procedures (98.8%). Successful thrombolysis occurred in 237 of 321 procedures (73.8%). Adverse events (8 major and 10 minor) occurred in 18 procedures, yielding a complication rate of 5.6%. In-center thrombolysis with alteplase administration by hemodialysis unit nursing staff under physician supervision is safe and effective with an adverse outcome rate similar to the literature. Thus, this modified lyse-and-wait protocol can be adopted with appropriate IR and surgical backup in place.
© 2012 Wiley Periodicals, Inc.
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2 Members
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6 MeSH Terms
New trials and therapies for acute myocardial infarction.
Gumina RJ
(2007) Med Clin North Am 91: 729-49; xii
MeSH Terms: Angioplasty, Balloon, Coronary, Anticoagulants, Cardiovascular Agents, Clinical Trials as Topic, Humans, Hypothermia, Induced, Myocardial Infarction, Oxygen, Platelet Aggregation Inhibitors, Platelet Glycoprotein GPIIb-IIIa Complex, Shock, Cardiogenic, Stents, Thrombectomy, Thrombolytic Therapy
Show Abstract · Added February 21, 2015
Acute coronary syndromes (ACSs), which include the clinical entities of unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI), account for more than 1.5 million hospital admissions annually in the United States alone. Approximately 1 million of these admissions are classified as UA/NSTEMI and approximately 500,000 are STEMI. Because of the overwhelming number of studies on ACSs over the past several years, this article focuses on new trials and therapies for treating patients diagnosed with STEMI.
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14 MeSH Terms
Quality improvement guidelines for percutaneous management of acute limb ischemia.
Rajan DK, Patel NH, Valji K, Cardella JF, Bakal C, Brown D, Brountzos E, Clark TW, Grassi C, Meranze S, Miller D, Neithamer C, Rholl K, Roberts A, Schwartzberg M, Swan T, Thorpe P, Towbin R, Sacks D, CIRSE and SIR Standards of Practice Committees
(2005) J Vasc Interv Radiol 16: 585-95
MeSH Terms: Acute Disease, Arm, Combined Modality Therapy, Humans, Ischemia, Leg, Patient Selection, Peripheral Vascular Diseases, Radiography, Interventional, Thrombectomy, Thrombolytic Therapy
Added March 5, 2014
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1 Members
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11 MeSH Terms
Strong predictive value of TIMI risk score analysis for in-hospital and long-term survival of patients with right ventricular infarction.
Gumina RJ, Wright RS, Kopecky SL, Miller WL, Williams BA, Reeder GS, Murphy JG
(2002) Eur Heart J 23: 1678-83
MeSH Terms: Aged, Female, Hospital Mortality, Hospitalization, Humans, Male, Myocardial Infarction, Prognosis, Retrospective Studies, Risk Assessment, Risk Factors, Survival Analysis, Thrombolytic Therapy
Show Abstract · Added February 21, 2015
BACKGROUND - While right ventricular myocardial infarction is associated with increased in-hospital morbidity and mortality, prognostic risk factors for in-hospital and long-term mortality are poorly defined.
OBJECTIVES - To evaluate the prognostic value of TIMI (Thrombolysis in Myocardial Infarction) risk score analysis in patients with right ventricular myocardial infarction (RVI).
DESIGN - Retrospective analysis of a community population.
SETTING - Mayo Clinic Coronary Care Unit.
PATIENTS - One hundred and two patients with RVI from 580 consecutive patients from Rochester, Minnesota admitted to the Coronary Care Unit with acute inferior or lateral wall myocardial infarction from January 1988 through March 1998.
MEASUREMENT - Combined TIMI risk score analysis with in-hospital and long-term mortality.
RESULTS - In-hospital morbidity (RVI: 54.9% vs non-RVI: 22.2%; P<0.001) and mortality (RVI: 21.6% vs non-RVI: 6.9%;P <0.001) were increased in patients with RVI. The TIMI risk score predicted risk (per one point increase in TIMI score) for in-hospital mortality (OR 1.23, 95% CI 1.02-1.51, P=0.037) and long-term mortality (OR 1.57, 95% CI 1.25-1.96, P<0.001). Patients with RVI whose TIMI risk score was >or=4 had significantly worse long-term survival compared to those patients with RVI and TIMI score <4 (P=0.006).
CONCLUSIONS - In-hospital morbidity and mortality, and long-term mortality are increased by right ventricular infarction and can be accurately predicted by the initial TIMI risk score.
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13 MeSH Terms
Cessation of platelet-mediated cyclic canine coronary occlusion after thrombolysis by combining nitric oxide inhalation with phosphodiesterase-5 inhibition.
Schmidt U, Han RO, DiSalvo TG, Guerrero JL, Gold HK, Zapol WM, Bloch KD, Semigran MJ
(2001) J Am Coll Cardiol 37: 1981-8
MeSH Terms: Administration, Inhalation, Animals, Blood Platelets, Coronary Thrombosis, Dipyridamole, Dogs, Drug Therapy, Combination, Nitric Oxide, Phosphodiesterase Inhibitors, Purinones, Thrombolytic Therapy
Show Abstract · Added May 27, 2014
OBJECTIVES - We sought to evaluate the ability of type 5 phosphodiesterase (PDE5) inhibitors to augment the antithrombotic effects of inhaled nitric oxide (NO) in a canine model of platelet-mediated coronary thrombosis after thrombolysis.
BACKGROUND - Type 5 phosphodiesterase inhibitors potentiate the ability of NO to inhibit platelet aggregation in vitro by preventing platelet cyclic guanosine monophosphate catabolism. We previously reported that breathing low concentrations of NO gas attenuated, but did not prevent, cyclic flow reductions (CFRs) in a canine model of coronary thrombosis after thrombolysis.
METHODS - Cyclic flow reductions were induced after creation of a left anterior descending coronary artery stenosis, endothelial injury, thrombus formation and thrombolysis. Dogs were either untreated or treated with inhaled NO (20 ppm by volume), intravenous zaprinast, intravenous dipyridamole or the combination of inhaled NO with either PDE5 inhibitor (n = 4 per group).
RESULTS - Cyclic flow reductions ceased, and complete coronary patency was achieved in all dogs after they breathed NO combined with zaprinast (by 12.0+/-4.7 min [mean +/- SEM]) or dipyridamole (by 9.8+/-4.7 min). The frequency of CFRs was unaffected by NO, dipyridamole or zaprinast alone. Systemic arterial blood pressure and bleeding time were unchanged with any treatment. Ex vivo thrombin-induced platelet aggregation in dogs breathing NO and receiving dipyridamole was reduced by 75+/-7% (p < 0.05).
CONCLUSIONS - The PDE5 inhibitors potentiated the antithrombotic properties of inhaled NO in a canine model of platelet-mediated coronary artery thrombosis after thrombolysis, without prolonging the bleeding time or causing systemic hypotension.
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11 MeSH Terms
Using full probability models to compute probabilities of actual interest to decision makers.
Harrell FE, Shih YC
(2001) Int J Technol Assess Health Care 17: 17-26
MeSH Terms: Arterial Occlusive Diseases, Bayes Theorem, Clinical Trials as Topic, Coronary Disease, Decision Making, Evidence-Based Medicine, Health Services Research, Humans, Models, Statistical, Nifedipine, Risk Assessment, Thrombolytic Therapy, Treatment Outcome, Vasodilator Agents
Show Abstract · Added February 28, 2014
The objective of this paper is to illustrate the advantages of the Bayesian approach in quantifying, presenting, and reporting scientific evidence and in assisting decision making. Three basic components in the Bayesian framework are the prior distribution, likelihood function, and posterior distribution. The prior distribution describes analysts' belief a priori, the likelihood function captures how data modify the prior knowledge; and the posterior distribution synthesizes both prior and likelihood information. The Bayesian approach treats the parameters of interest as random variables, uses the entire posterior distribution to quantify the evidence, and reports evidence in a "probabilistic" manner. Two clinical examples are used to demonstrate the value of the Bayesian approach to decision makers. Using either an uninformative or a skeptical prior distribution, these examples show that the Bayesian methods allow calculations of probabilities that are usually of more interest to decision makers, e.g., the probability that treatment A is similar to treatment B, the probability that treatment A is at least 5% better than treatment B, and the probability that treatment A is not within the "similarity region" of treatment B, etc. In addition, the Bayesian approach can deal with multiple endpoints more easily than the classic approach. For example, if decision makers wish to examine mortality and cost jointly, the Bayesian method can report the probability that a treatment achieves at least 2% mortality reduction and less than $20,000 increase in costs. In conclusion, probabilities computed from the Bayesian approach provide more relevant information to decision makers and are easier to interpret.
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14 MeSH Terms
Effectiveness of early coronary angioplasty and abciximab for failed thrombolysis (reteplase or alteplase) during acute myocardial infarction (results from the GUSTO-III trial). Global Use of Strategies To Open occluded coronary arteries.
Miller JM, Smalling R, Ohman EM, Bode C, Betriu A, Kleiman NS, Schildcrout JS, Bastos E, Topol EJ, Califf RM
(1999) Am J Cardiol 84: 779-84
MeSH Terms: Abciximab, Analysis of Variance, Angioplasty, Balloon, Coronary, Antibodies, Monoclonal, Anticoagulants, Chi-Square Distribution, Coronary Angiography, Female, Fibrinolytic Agents, Humans, Immunoglobulin Fab Fragments, Male, Middle Aged, Myocardial Infarction, Patient Selection, Prospective Studies, Recombinant Proteins, Thrombolytic Therapy, Time Factors, Tissue Plasminogen Activator, Treatment Failure, Treatment Outcome
Show Abstract · Added May 27, 2014
We evaluated the effects of abciximab treatment during early angioplasty after clinically failed thrombolysis for acute myocardial infarction. In the Global Use of Strategies To Open occluded coronary arteries (GUSTO-III) trial of reteplase versus alteplase for acute infarction (n = 15,059), 392 patients underwent angioplasty a median of 3.5 hours after thrombolysis and had complete procedural data. We compared 30-day mortality and in-hospital outcomes between patients who received abciximab (n = 83) and those who did not (n = 309), and (among patients given abciximab) between those randomized to alteplase versus reteplase. Patients given abciximab had anterior infarction less often, but were more often in Killip classes III or IV. The 30-day mortality rate tended to be lower with abciximab (3.6% vs 9.7%, p = 0.076), more so after adjustment for baseline differences (p = 0.042). The composite of death, stroke, or reinfarction did not differ significantly with abciximab treatment (12% vs 14%, p = 0.7), but it occurred less often among abciximab-treated patients who had been randomized to reteplase (n = 55) versus alteplase (n = 28) (7% vs 21%, p = 0.08). Severe bleeding was increased among abciximab-treated patients (3.6% vs 1.0%, p = 0.08), despite less heparin use. No intracranial hemorrhages occurred with abciximab. The use of abciximab for early angioplasty after clinically failed thrombolysis resulted in trends toward lower 30-day mortality and increased bleeding.
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22 MeSH Terms
Selection of thrombolytic therapy for individual patients: development of a clinical model. GUSTO-I Investigators.
Califf RM, Woodlief LH, Harrell FE, Lee KL, White HD, Guerci A, Barbash GI, Simes RJ, Weaver WD, Simoons ML, Topol EJ
(1997) Am Heart J 133: 630-9
MeSH Terms: Age Factors, Aged, Anticoagulants, Blood Pressure, Fibrinolytic Agents, Forecasting, Heart Rate, Heparin, Humans, Injections, Intravenous, Injections, Subcutaneous, Logistic Models, Middle Aged, Models, Statistical, Myocardial Infarction, Plasminogen Activators, Prognosis, Risk Factors, Streptokinase, Survival Rate, Thrombolytic Therapy, Tissue Plasminogen Activator, Treatment Outcome
Show Abstract · Added February 28, 2014
We developed a logistic regression model with data from the GUSTO-I trial to predict mortality rate differences in individual patients who received accelerated tissue plasminogen activator (TPA) versus streptokinase treatment for acute myocardial infarction. A nomogram was developed from a reduced version of this model that approximated the underlying risk of patients treated with streptokinase, and thus the benefit of TPA. The 30-day mortality rate with accelerated TPA was 0.063 versus 0.073 with streptokinase and subcutaneously administered heparin and 0.074 with streptokinase and intravenously administered heparin. No baseline patient characteristics were significantly associated with a different relative effect of TPA. Older patients and those with anterior infarction, higher Killip classification (except Killip class IV), lower blood pressure, and increased heart rate had the greatest absolute benefit with accelerated TPA. Patients with acute myocardial infarction who had more high-risk characteristics derived a greater absolute benefit from treatment with accelerated TPA versus streptokinase.
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23 MeSH Terms
Plasminogen activator inhibitor-1 secretion of endothelial cells increases fibrinolytic resistance of an in vitro fibrin clot: evidence for a key role of endothelial cells in thrombolytic resistance.
Handt S, Jerome WG, Tietze L, Hantgan RR
(1996) Blood 87: 4204-13
MeSH Terms: Cells, Cultured, Coronary Thrombosis, Drug Administration Schedule, Drug Resistance, Endothelium, Vascular, Fibrinolysis, Fibrinolytic Agents, Humans, Plasminogen Activator Inhibitor 1, Thrombolytic Therapy, Time Factors, Umbilical Veins
Show Abstract · Added December 10, 2013
Time-dependent thrombolytic resistance is a critical problem in thrombolytic therapy for acute myocardial infarction. Platelets have been regarded as the main source of plasminogen activator inhibitor-1 (PAI-1) found in occlusive platelet-rich clots. However, endothelial cells are also known to influence the fibrinolytic capacity of blood vessels, but their ability to actively mediate time-dependent thrombolytic resistance has not been fully established. We will show that, in vitro, tumor necrosis factor-alpha-stimulated endothelial cells secrete large amounts of PAI-1 over a period of hours, which then binds to fibrin and protects the clot from tissue plasminogen activator-induced fibrinolysis. In vivo, endothelial cells covering atherosclerotic plaques are influenced by cytokines synthesized by plaque cells. Therefore, we propose that continuous activation of endothelial cells in atherosclerotic blood vessels, followed by elevated PAI-1 secretion and storage of active PAI-1 in the fibrin matrix, leads to clot stabilization. This scenario makes endothelial cells a major factor in time-dependent thrombolytic resistance.
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12 MeSH Terms