Over the last two decades, management of acute myocardial infarction (MI) has shifted from a “wait and watch” strategy to an increasingly aggressive strategy of restoring and maintaining (e.g., thrombolytics, antiplatelet agents) early patency to the infarct-related vessel and to other approaches that directly protect the myocardium (e.g., beta-blockers, angiotensin-converting enzyme inhibitors...

Strategies that enhance functional reperfusion and translate into better clinical outcomes for ST-segment elevation myocardial infarction (STEMI) remain the holy grail of reperfusion therapy. In the absence of complete understanding of the vascular and cellular processes that are initiated with plaque rupture and thrombotic coronary artery occlusion, we have had to rely on therapies that shorte...

Placebo controls are commonly used in clinical trials of investigational treatments because they have important advantages. In recent years, some have criticized the use of placebo-controlled trials when effective alternative therapy exists, regardless of the expected effect of the therapy. In part 1 of this paper, ethical arguments are addressed and the interpretive problems inherent in the us...

There have been significant improvement in the care of acute ischemic stroke (AIS) resulting reducing death and improving outcomes. Numerous groundbreaking positive randomized controlled trials demonstrated that strokes with large vessel occlusion (LVO) treated endovascular mechanical thrombectomy (EVMT) standard treatment are associated much better outcomes compared to those only therapy. Addi...

Excessive bleeding is a major concern during the administration of thrombolytic therapy. Although the great majority of these events occur at sites of vascular interruption, major gastrointestinal, retroperitoneal, genitourinary, and central nervous system hemorrhage are known to occur. We present a patient who developed spontaneous pulmonary hemorrhage during thrombolytic therapy. Lack of reco...

Tissue type plasminogen activator (t-PA) is an effective thrombolytic agent in experimental animals. The duration of the thrombolytic effect of infused t-PA is unknown. We compared the duration of the thrombolytic effect of t-PA with streptokinase by measuring the lysis of 125l-fibrinlabeled thrombi in rabbit jugular veins at different times after a bolus injection of the fibrinolytic agents. T...

renal vein thrombosis (rvt) is the most frequent vascular abnormality in newborns, but rarely seen in adults. rvt is an acute problem, and diagnostic and therapeutic approaches should be done immediately. surgical thrombectomy is not a rational approach and the treatment of choice is conservative management and thrombolytic therapy. we present a 45 years old male patient with chronic renal vein...

BACKGROUND AND PURPOSE To provide a national assessment of thrombolytic administration using drip-and-ship treatment paradigm. METHODS Patients treated with the drip-and-ship paradigm among all acute ischemic stroke patients treated with thrombolytic treatment were identified within the Nationwide Inpatient Sample. Thrombolytic utilization, patterns of referral, comparative in-hospital outcom...

OBJECTIVE To determine the outcomes related to thrombolytic treatment of an acute ischemic stroke secondary to an arterial dissection in a large national cohort. DESIGN Retrospective database study. SETTING Nationwide Inpatient Sample data files from 2005 to 2008. PATIENTS We determined the frequency of underlying arterial dissection among patients with acute ischemic stroke treated with ...

OBJECTIVE To discuss the ethical challenge in thrombolytic therapy. BACKGROUND Thrombolytic therapy with recombinant tissue-type plasminogen activator (rt-Pa) has been found to be beneficial to the outcome of patients who had a stroke. However, the ethic issue that is related to intravenous rt-Pa infusion has not been discussed. PATIENTS Four patients with a middle cerebral artery (MCA) inf...