Abstract:
:Few patients presenting with acute ischemic stroke (AIS) are eligible for alteplase, especially those receiving ongoing anticoagulation. We describe the first reported case of a patient receiving full-dose intravenous (IV) alteplase for AIS after heparin reversal with protamine. A 73-year-old man presented with AIS. He was treated with IV heparin, tirofiban, loading-dose prasugrel, and aspirin before percutaneous coronary intervention (PCI) for placement of a right coronary artery stent. One hour following PCI, he abruptly developed left hemiparesis and dysphagia. The National Institutes of Health Stroke Scale was 12, and activated partial thromboplastin time (aPTT) was longer than 150 seconds. Head computed tomography (CT) showed no acute pathology, and CT angiogram showed no large-vessel occlusion amenable to mechanical thrombectomy. Repeat aPTT, obtained 45 minutes later, was 110 seconds, at which time protamine 40 mg IV was administered. At 144 minutes from last known well time, full-dose IV alteplase (0.9 mg/kg) was administered. Follow-up head imaging at 25 hours showed right pontine and cerebellar AIS with no evidence of hemorrhage. The patient was discharged to inpatient rehabilitation 2 days later. Modified Rankin Scale at 3 months was 3, improved from 5 at discharge. Given the lack of adverse events associated with IV alteplase in our patient, we advocate cautious evaluation for potential reversal of acutely administered anticoagulation to facilitate alteplase administration in severely disabled patients who are not eligible for mechanical intervention and would have been excluded from definitive AIS treatment.
journal_name
Pharmacotherapyjournal_title
Pharmacotherapyauthors
Fontaine GV,Smith SMdoi
10.1002/phar.1997subject
Has Abstractpub_date
2017-10-01 00:00:00pages
e103-e106issue
10eissn
0277-0008issn
1875-9114journal_volume
37pub_type
相关文献
PHARMACOTHERAPY文献大全abstract:STUDY OBJECTIVES:To determine the frequency and type of complementary and alternative medicine (CAM) use among healthy volunteers participating in research, and to investigate the potential for interactions between commonly used CAM modalities and various drugs. DESIGN:Prospective evaluation. SETTING:University gener...
journal_title:Pharmacotherapy
pub_type: 杂志文章
doi:10.1592/phco.26.12.1794
更新日期:2006-12-01 00:00:00
abstract::Two patients with chronic kidney disease experienced a major bleeding event, retroperitoneal hematoma, requiring a blood transfusion after the administration of enoxaparin. The first patient was a 61-year-old Caucasian woman with multiple comorbidities, including chronic kidney disease stage 4. She received subcutaneo...
journal_title:Pharmacotherapy
pub_type: 杂志文章
doi:10.1592/phco.25.5.769.63596
更新日期:2005-05-01 00:00:00
abstract:OBJECTIVE:To review the literature on clonidine, venlafaxine, selective serotonin reuptake inhibitors, and gabapentin for the treatment of hot flashes. DATA SOURCES:A MEDLINE search (January 1966-July 2003) was conducted to identify English-language literature available on the treatment of hot flashes that focused on ...
journal_title:Pharmacotherapy
pub_type: 杂志文章,评审
doi:10.1592/phco.24.1.79.34812
更新日期:2004-01-01 00:00:00
abstract::A 58-year-old man went to his physician with complaints of midepigastric pain, flatulence, belching, and shortness of breath. During a physical examination, the patient was in no acute distress. The patient underwent an ultrasound examination, which revealed cholelithiasis, a laparoscopic cholecystectomy, which reveal...
journal_title:Pharmacotherapy
pub_type: 杂志文章
doi:10.1592/phco.27.2.299
更新日期:2007-02-01 00:00:00
abstract:STUDY OBJECTIVE:To compare the effectiveness of darbepoetin alfa with epoetin alfa (recombinant human erythropoietin [rHuEPO]) for achieving transfusion independence and increasing hemoglobin concentrations in critically ill patients. DESIGN:Retrospective, descriptive study. SETTING:Level I trauma center intensive ca...
journal_title:Pharmacotherapy
pub_type: 临床试验,杂志文章
doi:10.1592/phco.27.4.535
更新日期:2007-04-01 00:00:00
abstract::Ongoing improvements in immunosuppression and posttransplantation care have dramatically improved patient and graft outcomes after transplantation. The frequency of graft loss due to acute rejection has declined considerably as a result of the availability of a variety of more potent immunosuppressive agents and proba...
journal_title:Pharmacotherapy
pub_type: 杂志文章,评审
doi:10.1592/phco.22.5.316.33198
更新日期:2002-03-01 00:00:00
abstract:STUDY OBJECTIVES:To examine glycosylated hemoglobin (A1C) values longitudinally in patients who newly started metformin, sulfonylurea, or thiazolidinedione monotherapy; in a subset of patients whose A1C values were 7% or greater before starting therapy (baseline) and who achieved A1C goal (A1C < 7%) during therapy, rat...
journal_title:Pharmacotherapy
pub_type: 杂志文章
doi:10.1592/phco.27.8.1102
更新日期:2007-08-01 00:00:00
abstract::Bar code technology has been used for 5 years to improve the efficiency of identifying and documenting clinical pharmacy services at our institution. Data for an entire year (1993) were analyzed to quantify the nature and magnitude of pharmacy services provided for critically ill patients in intensive care units (ICU)...
journal_title:Pharmacotherapy
pub_type: 杂志文章
doi:
更新日期:1996-03-01 00:00:00
abstract:STUDY OBJECTIVE:To evaluate the ability of seven widely known herbal references and electronic databases to answer questions about herbal products asked at drug information centers. DESIGN:Cross-sectional study. SETTING:Five academic and institutional drug information centers. METHODS:Fifty-seven herbal-related ques...
journal_title:Pharmacotherapy
pub_type: 杂志文章
doi:10.1592/phco.22.17.1611.34126
更新日期:2002-12-01 00:00:00
abstract::Our objective was to describe the implementation and clinical outcomes of an employer-sponsored, pharmacist-provided medication therapy management (MTM) program for health plan beneficiaries with diabetes mellitus and/or hypertension. We conducted a single-center retrospective medical record review. The setting was a ...
journal_title:Pharmacotherapy
pub_type: 杂志文章
doi:10.1002/phar.1650
更新日期:2015-11-01 00:00:00
abstract:STUDY OBJECTIVE:To evaluate the effectiveness and safety of enoxaparin therapy in a neonatal intensive care unit (NICU). DESIGN:Retrospective chart review. SETTING:Level III NICU in a Canadian academic center. PATIENTS:All neonates treated with enoxaparin while in the NICU between January 1, 1998, and June 1, 2006. ...
journal_title:Pharmacotherapy
pub_type: 杂志文章
doi:10.1592/phco.27.9.1263
更新日期:2007-09-01 00:00:00
abstract::Two analyses were conducted to compare the cost-effectiveness of different intravenous immunoglobulin (IGIV) formulations: IGIV purified by caprylate precipitation and chromatography (IGIV-C) and IGIV manufactured by an older solvent-detergent method (IGIV-S/D). The results indicated that IGIV-C is associated with cos...
journal_title:Pharmacotherapy
pub_type: 杂志文章
doi:10.1592/phco.2005.25.11part2.94S
更新日期:2005-11-01 00:00:00
abstract::Patients with ST-segment elevation acute myocardial infarction require immediate reperfusion therapy. Reperfusion therapy can be provided by either pharmacologic or mechanical means. Pharmacologic reperfusion therapy consists of administering fibrinolytics, whereas mechanical reperfusion consists of performing percuta...
journal_title:Pharmacotherapy
pub_type: 杂志文章,评审
doi:10.1592/phco.22.11.864.33632
更新日期:2002-07-01 00:00:00
abstract::Clinical pharmacists must often interpret and use data derived from observational studies when making clinical decisions and recommendations, answering drug information questions, and educating patients about drug therapy. This is the third article in a three-part series intended to enhance clinical pharmacists' under...
journal_title:Pharmacotherapy
pub_type: 杂志文章
doi:10.1592/phco.31.2.115
更新日期:2011-02-01 00:00:00
abstract::After injecting the solution extracted from a Primatene Mist inhaler, a patient experienced epinephrine overdose that resulted in an acute myocardial infarction and acute renal failure. The exact amount of epinephrine injected was unknown, but was thought to be between 82.5 and 124 mg, more than 25 times higher than t...
journal_title:Pharmacotherapy
pub_type: 杂志文章
doi:
更新日期:1998-05-01 00:00:00
abstract::Sepsis and acute lung injury (ALI) or acute respiratory distress syndrome (ARDS) are associated with high mortality rates despite recent therapeutic advances. Both disease states involve uncontrolled host defense responses that lead to inflammation, endothelial damage, enhanced coagulation, diminished fibrinolysis and...
journal_title:Pharmacotherapy
pub_type: 杂志文章,评审
doi:10.1592/phco.22.13.1140.33519
更新日期:2002-09-01 00:00:00
abstract:STUDY OBJECTIVE:To evaluate the hemodynamic and electrocardiographic effects of a single dose of commercially available bitter-orange dried-fruit extract, which is increasingly being used in dietary supplements. DESIGN:Randomized, double-blind, placebo-controlled, crossover study. SETTING:University of Connecticut, S...
journal_title:Pharmacotherapy
pub_type: 杂志文章,随机对照试验
doi:10.1592/phco.2005.25.12.1719
更新日期:2005-12-01 00:00:00
abstract:STUDY OBJECTIVES:To compare the antiemetic effectiveness and safety of oral granisetron plus dexamethasone with those of oral ondansetron plus dexamethasone administered before emetogenic chemotherapy. DESIGN:Randomized, prospective, multicenter, open-label study. SETTINGS:University-teaching hospital and veterans he...
journal_title:Pharmacotherapy
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1592/phco.20.17.1318.34894
更新日期:2000-11-01 00:00:00
abstract::Diurnal variation in plasma norepinephrine (PNE) levels is well documented in healthy individuals but not in patients with heart failure. Therefore, we attempted to determine variations in PNE levels over 24 hours, measured hourly, in six patients with an ejection fraction below 40% and a history of heart failure of l...
journal_title:Pharmacotherapy
pub_type: 杂志文章
doi:10.1592/phco.19.11.984.31571
更新日期:1999-08-01 00:00:00
abstract:STUDY OBJECTIVE:To determine the impact of having an antimicrobial allergy label in the medical record on clinical outcomes in hospitalized patients. DESIGN:Retrospective cohort study. SETTING:Urban academic teaching hospital. PATIENTS:A total of 11,872 adults admitted to nonsurgical patient care wards who received ...
journal_title:Pharmacotherapy
pub_type: 杂志文章
doi:10.1592/phco.31.8.742
更新日期:2011-08-01 00:00:00
abstract::The accuracy of 2- and 8- hour urine collections for estimating creatinine clearance was compared with that of the standard 24-hour procedure in 45 hospitalized elderly patients (age > or = 65 yrs) with indwelling urethral catheters. Urine was collected at blocked intervals from 0-2, 2-8, and 8-24 hours and then added...
journal_title:Pharmacotherapy
pub_type: 杂志文章
doi:
更新日期:1993-03-01 00:00:00
abstract::A 43-year-old man with a 19-year history of Crohn's disease experienced serum sickness with acute lobular panniculitis and vasculitis within 2 weeks of initiating 6-mercaptopurine therapy. He had no history of extraintestinal manifestations of Crohn's disease or drug allergy. Symptoms included disabling joint pain, pr...
journal_title:Pharmacotherapy
pub_type: 杂志文章
doi:
更新日期:1997-01-01 00:00:00
abstract::Anemia is an undertreated but common complication of cancer and is associated with debilitating symptoms that impair the patient's ability to perform daily functions of life. Treatment with darbepoetin alfa, a novel erythropoiesis-stimulating protein, is appropriate for chemotherapy-induced anemia. Guidelines on darbe...
journal_title:Pharmacotherapy
pub_type: 杂志文章
doi:10.1592/phco.23.16.110s.31970
更新日期:2003-12-01 00:00:00
abstract::Peripheral blood has replaced bone marrow as a source of hematopoietic stem cells for autologous rescue after high-dose chemotherapy. Patients who receive peripheral blood stem cell (PBSC) transplants experience rapid and sustained hematopoietic reconstitution. As a result, transplant-related mortality is now less tha...
journal_title:Pharmacotherapy
pub_type: 杂志文章
doi:
更新日期:1996-05-01 00:00:00
abstract:STUDY OBJECTIVE:To assess the relationship of the 33 single nucleotide polymorphisms (SNPs) previously associated with fasting glucose in Caucasians in genome-wide association studies (GWAS) with glucose response to antihypertensive drugs shown to increase risk for hyperglycemia and diabetes. DESIGN:Randomized, multic...
journal_title:Pharmacotherapy
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1002/phar.1355
更新日期:2014-02-01 00:00:00
abstract:STUDY OBJECTIVE:To determine the effect of a high-fat breakfast on single-dose, zidovudine (ZDV) pharmacokinetics. DESIGN:Open-label, randomized, crossover study. PATIENTS:Eighteen asymptomatic subjects (12 men, 6 women) infected with the human immunodeficiency virus (mean CD4 cell counts of 512 +/- 178/mm3). INTERV...
journal_title:Pharmacotherapy
pub_type: 临床试验,杂志文章,随机对照试验
doi:
更新日期:1994-11-01 00:00:00
abstract:STUDY OBJECTIVE:To evaluate the clinical course and long-term impact of high-dose acyclovir (HD-A, 800 mg 4 times/day) cytomegalovirus (CMV) prophylaxis failure in a CMV-seropositive abdominal solid organ transplant population. DESIGN:Retrospective cohort study. SETTING:Tertiary academic medical center. PATIENTS:A t...
journal_title:Pharmacotherapy
pub_type: 杂志文章
doi:10.1002/phar.2126
更新日期:2018-07-01 00:00:00
abstract::Torsades de pointes is a polymorphic ventricular tachycardia characterized by marked QT prolongation on the electrocardiogram. It can be induced by both antiarrhythmic and nonantiarrhythmic drugs, such as quinidine and erythromycin. No extensive literature documents an interaction between quinidine and erythromycin wh...
journal_title:Pharmacotherapy
pub_type: 杂志文章
doi:
更新日期:1997-05-01 00:00:00
abstract:STUDY OBJECTIVE:To evaluate the impact of a hospital-acquired pneumonia (HAP) protocol on appropriateness of empiric antibiotic therapy, antibiotic deescalation, antibiotic duration, patient mortality, and length of stay. DESIGN:Before- and after-study of protocol implementation. SETTING:A 450-bed, academic medical c...
journal_title:Pharmacotherapy
pub_type: 杂志文章
doi:10.1592/phco.28.7.852
更新日期:2008-07-01 00:00:00
abstract:STUDY OBJECTIVE:To determine if transitioning patients from a pharmacist- managed anticoagulation clinic after stabilization of warfarin therapy to physician-managed care alters the quality of anticoagulation care. DESIGN:Retrospective medical record review. SETTING:Pharmacist-managed, urban academic medical center-b...
journal_title:Pharmacotherapy
pub_type: 杂志文章
doi:10.1592/phco.28.1.20
更新日期:2008-01-01 00:00:00