Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: EC:3.4.21.68 (tissue plasminogen activator)
 11,311 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We evaluated the efficacy of local intra-arterial fibrinolysis (LIF) used in tissue plasminogen activator (t-PA) and its indication for acute middle cerebral artery (MCA) occlusion on angiographic degree of leptomeningeal collateral flow in a series of 26 patients (mean age: 67.2 years old). The occlusion types were classified into three types: (1) M 1 proximal occlusion (N = 8) involved the lenticulostriate arteries (LSA), (2) M 1 distal occlusion (N = 6) without involvement of the LSA to M 2 bifurcation, (3) M 2-3 occlusion (N = 12). In M 1 proximal and distal type, 100% patients had complete or partial recanalization till 5.3 and 6 hours, and 91.7% recanalized in M 2-3 type within 3.96 hours from attack on the average. Small cerebral infarction post LIF showed in 50%, but had no clinical change for the worse in all types. There was 65% in excellent or good prognosis on 2 months after attack. Within the range of 600,000-2,400,000 units of t-PA (mean = 1,107,000 units), small hemorrhagic transformation were developed in 5 cases (19.2%) without influence on its outcome. It means that below 2,400,000 units t-PA for LIF were safety amounts. In patients with poor collateral flow in angiographic findings, good prognosis could be possible in 75% within 4 hours (M = 3.96 hours) recanalization on the average. We conclude that LIF used in t-PA would be efficatious in M 1 proximal occlusion within 4 hours of onset and in patients with poor collateral flow when recanalized within 4 hours after attack.
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PMID:[Clinical study of therapeutic time window of local fibrinolysis for acute middle cerebral artery occlusion]. 1051 55

A meta-analysis by the Cochrane Stroke Group (CSG) showed that thrombolytic therapy increased deaths as well as symptomatic and fatal intracranial hemorrhage within the first seven to 10 days and at final follow-up, although these risks are offset by a reduction in disability in survivors, so that there is overall a significant net reduction in the proportion of patients dead or dependent. Trials testing intravenous (i.v.) tPA suggest that it may be associated with less hazard and more benefit. A recent trial demonstrated that intra-arterial pro-urokinase improved long-term outcome in patients with M 1 or M 2 occlusion within 6 hours of onset. Trials of the third generation of thrombolytic agents are ongoing in patients with acute ischemic stroke. The latest CSG's meta-analysis showed that immediate anticoagulant therapy in patients with acute ischemic stroke was not associated with net short or long-term benefit because there was no evidence that anticoagulant therapy reduced deaths or non-fatal stroke during treatment or patients dead or dependent at the end of follow-up. However, an i.v. low-molecular-weight heparinoid showed a trend toward improving long-term outcome in subgroup of patients with atherothrombotic stroke. The thrombin inhibitor argatroban was proven to be comparable to the thromboxane A2 synthetase inhibitor ozagrel in the effect on the outcome at one month in patients with atherothrombotic stroke within 48 hours of onset in Japan, and a trial of the agent is ongoing in patients with ischemic stroke within 12 hours of onset in the United States. Two large trials of aspirin in patients with ischemic stroke within 48 hours of onset indicated that aspirin had a modest effect on reducing patients dead or dependent at the end of follow-up. An international trial of abciximab, a monoclonal antibody directed against platelet glycoprotein IIb/IIIa, is ongoing in patients with ischemic stroke within 6 hours of onset.
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PMID:[Strategy for circulatory disturbance]. 1223 94