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Wen SY, Chen FF, Chen XT, Zhang Q, Zhou CQ. Repeated intravenous thrombolysis in recurrent ischemic stroke within 3 months: a systematic review. BMC Neurol 2023; 23:422. [PMID: 38012577 PMCID: PMC10680229 DOI: 10.1186/s12883-023-03472-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 11/20/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Repeated intravenous thrombolysis (RIVT) within 3 months is an off-guideline therapy, however, may be an effective and safe way to treat early recurrent ischemic stroke. This study was conducted to assess the potential influencing factors on the efficacy and safety of RIVT in recurrent ischemic stroke within 3 months and to explore the strategy of RIVT within 3 months. METHODS PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure, and Wanfang Database were searched for cases of RIVT in recurrent ischemic stroke within 3 months up to February 1, 2023. Clinical characteristics were compared and analyzed between the good-outcome and poor-outcome groups and between the symptomatic intracranial hemorrhage (sICH) and non-sICH groups respectively. RESULTS A total of 16 studies including 24 cases of RIVT within 3 months were retrospectively analyzed in the present study. The patients' ages ranged from 42 to 87 years (median 73.5 years) and the intervals between thrombolysis were from 0.25 to 90 days (median 9.5 days). Comparing the clinical characteristics between the good-outcome group and the poor-outcome group, no statistically significant differences were found (P > 0.05), but the differences in baseline National Institutes of Health stroke scale (NIHSS) score of the recurrent stroke (P = 0.056) and good outcome after the previous IVT (P = 0.054) nearly reached statistical significance. Comparing the data between the non-sICH group and the sICH group, statistically significant differences were found in terms of the proportion of cardiogenic embolism (P = 0.036), baseline NIHSS score in the recurrent stroke (P = 0.007) and the interval between thrombolysis (P = 0.041), but no significant difference was found by regression analysis. CONCLUSION In patients with recurrent ischemic stroke within 3 months, those with a good outcome after the previous IVT and a low baseline NIHSS score in the recurrent stroke may be considered for RIVT, whereas those with a high baseline NIHSS score, a short interval between thrombolysis, and cardiogenic embolism may suffer a higher risk of sICH. Due to sample size and publication bias, more studies with larger sample sizes and more rigorous designs are needed to confirm this conclusion.
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Affiliation(s)
- Si-Yuan Wen
- Department of Neurology, Bishan Hospital of Chongqing Medical University, Chongqing, China
| | - Fei-Fei Chen
- Department of Neurology, Bishan Hospital of Chongqing Medical University, Chongqing, China
| | - Xiang-Ting Chen
- Department of Neurology, Bishan Hospital of Chongqing Medical University, Chongqing, China
| | - Qian Zhang
- Department of Neurology, Bishan Hospital of Chongqing Medical University, Chongqing, China
| | - Chang-Qing Zhou
- Department of Neurology, Bishan Hospital of Chongqing Medical University, Chongqing, China.
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Malaeb D, Hallit S, Sakr F, Dabbous M, Saadeh W, Mansour S, Cherri S, Sarayeldyine SA, Salameh P, Hosseini H. The use of intravenous thrombolytics in acute ischemic stroke management: A scoping review from 2008 till 2021 in the Arab world in the Middle East and North Africa. J Stroke Cerebrovasc Dis 2023; 32:107201. [PMID: 37290154 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/09/2023] [Accepted: 05/25/2023] [Indexed: 06/10/2023] Open
Abstract
OBJECTIVE The aim of this review was to assess and analyze the research output on intravenous thrombolysis in acute ischemic stroke in the Arab world in the Middle East and North Africa. METHODS Published literature on intravenous thrombolysis for acute ischemic stroke from 2008 to 2021 were retrieved from several electronic databases. Extracted records were analyzed in terms of year of publication, country, journal, research area, authors, and organizational affiliations. RESULTS A total of 37 studies were published between 2008 and 2021 from different Arab countries. Eight studies assessed the safety and efficacy of thrombolytic agents in AIS. Three studies were KAP studies addressing the knowledge, attitude and practice towards IVT. The majority of the selected studies (n=16) discussed the utilization rate of IVT among patients in different hospital settings across these countries. Ten studies reported the outcomes associated with the use of IVT for AIS. CONCLUSION This is the first scoping review to study the research activity related to the use of IVT in stroke in the Arab nations. In the last 15 years, stroke research productivity was very low in the Arab world compared to other regions of the world due to several impeding factors. Given the high burden of in-adherence to acute stroke treatment in the Arab nations, there is a serious need for an increased high-quality research activity to highlight the roadblocks associated with the limited use of IVT.
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Affiliation(s)
- Diana Malaeb
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates; School of Pharmacy, Lebanese International University, Beirut, Lebanon.
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), P.O Box: 446, Jounieh lebanon; Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon; Applied Science Research Center, Applied Science Private University, Amman, Jordan
| | - Fouad Sakr
- School of Pharmacy, Lebanese International University, Beirut, Lebanon; INSPECT-LB (Institut National de Sant e Publique, d'Épid emiologie Clinique et de Toxicologie-Liban); UMR U955 INSERM, Institut Mondor de Recherche Biomédicale, Université Paris-Est Créteil, 94010 Créteil, France; École Doctorale Sciences de la Vie et de la Santé, Université Paris-Est Créteil, 94010 Créteil, France
| | - Mariam Dabbous
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Wadih Saadeh
- Faculty of Pharmacy, Lebanese University, Beirut, Lebanon; Faculty of Public health, Lebanese University, Fanar, Lebanon
| | - Sara Mansour
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Sarah Cherri
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | | | - Pascale Salameh
- INSPECT-LB (Institut National de Sant e Publique, d'Épid emiologie Clinique et de Toxicologie-Liban); Faculty of Pharmacy, Lebanese University, Beirut, Lebanon; Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus; School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Hassan Hosseini
- INSERM U955-E01, IMRB, Henri Mondor Hospital, Créteil, France; Department of Neurology, Henri Mondor Hospital, AP-HP, Créteil, France
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Meta-Analysis of Predictive Role of Early Neurological Deterioration after Intravenous Thrombolysis. Emerg Med Int 2022; 2022:2894426. [PMID: 35912390 PMCID: PMC9337960 DOI: 10.1155/2022/2894426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/25/2022] [Accepted: 06/02/2022] [Indexed: 11/17/2022] Open
Abstract
With the popularization of intravenous thrombolysis, more and more people use intravenous thrombolysis to treat related diseases, but problems also arise. There are still a considerable number of patients with early disease after thrombolytic therapy not only not significantly improving, but also progressing, that is, early neurological deterioration (END). In view of this problem, the prediction of END after intravenous thrombolysis becomes very important. With the development of medical technology, research on the prediction of END after intravenous thrombolysis has gradually been carried out. Effective prediction is of great significance for the prevention and treatment of END after intravenous thrombolysis. This article aimed to carry out a meta-analysis of the predictive role of END after intravenous thrombolysis. Through an informed analysis of all studies of this type in this field, this article determines a method for predicting END after intravenous thrombolysis. The actual effect of its role is revealed in this paper, and its purpose is to promote the development of this field. This article addresses the same type of study on the predictive role of neurological deterioration after intravenous thrombolysis. The article performs test and meta-analysis of its role by conditionally searching for literature studies. It is explained using the relevant theoretical formulas. The analysis results show that the prediction of END after intravenous thrombolysis in this paper can effectively help make a preliminary judgment on the possible later neurological deterioration. Although there is an error between the predicted curve and the actual curve, the difference between the two is between 1% and 5%. It can basically effectively predict the occurrence of END. Therefore, the prediction of END after intravenous thrombolysis has a very large preventive effect on the END after intravenous thrombolysis.
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Černík D, Ospalík D, Šaňák D, Cihlář F. Repeated Intravenous Thrombolysis in Patients with Recurrent Ischemic Stroke in the Vertebrobasilar Territory. Case Rep Neurol 2021; 13:510-514. [PMID: 34720955 PMCID: PMC8460951 DOI: 10.1159/000518193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/29/2021] [Indexed: 11/23/2022] Open
Abstract
Acute ischemic vertebrobasilar stroke (AIVBS) is usually associated with poor outcome and prognosis and in case of basilar artery occlusion (BAO) with high mortality. Intravenous thrombolysis (IVT), as a standard recanalization therapy of acute ischemic stroke (IS) within first 4.5 h, can be administrated beyond this therapeutic time window in case of symptomatic BAO. Repeated IVT is generally contraindicated in case of early recurrent IS, despite a risk of poor outcome or death after recurrent IS. The aim was to present 2 cases of repeated IVT for recurrent AIVBS and discuss specific situations where repeated IVT may be considered. Up to now, repeated IVT has been reported only in recurrent stroke in anterior circulation.
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Affiliation(s)
- David Černík
- Department of Neurology, Comprehensive Stroke Center, Masaryk Hospital Ústí nad Labem, KZ a.s., Ústí nad Labem, Czechia
| | - Dušan Ospalík
- Department of Neurology, Comprehensive Stroke Center, Masaryk Hospital Ústí nad Labem, KZ a.s., Ústí nad Labem, Czechia
| | - Daniel Šaňák
- Department of Neurology, Comprehensive Stroke Center, Palacký University Medical, School and Hospital, Olomouc, Czechia
| | - Filip Cihlář
- Department of Radiology, Masaryk Hospital, Faculty of Health Studies, J.E. Purkinje University, KZ a.s., Ústí nad Labem, Czechia
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