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Titolo:
CLINICAL-FEATURES AND PATHOGENESIS OF INTRACEREBRAL HEMORRHAGE AFTER RT-PA AND HEPARIN-THERAPY FOR ACUTE MYOCARDIAL-INFARCTION - THE THROMBOLYSIS IN MYOCARDIAL-INFARCTION (TIMI)-II PILOT AND RANDOMIZED CLINICAL-TRIAL COMBINED EXPERIENCE
Autore:
SLOAN MA; PRICE TR; PETITO CK; RANDALL AMY; SOLOMON RE; TERRIN ML; GORE J; COLLEN D; KLEIMAN N; FEIT F; BABB J; HERMAN M; ROBERTS WC; SOPKO G; BOVILL E; FORMAN S; KNATTERUD GL;
Indirizzi:
UNIV MARYLAND HOSP,DEPT NEUROL,22 S GREENE ST BALTIMORE MD 21201 MARYLAND MED RES INST BALTIMORE MD 00000 UNIV MARYLAND,SCH MED,DEPT NEUROL BALTIMORE MD 21201 UNIV MIAMI,SCH MED,DEPT PATHOL MIAMI FL 33152 NHLBI,OFF PROGRAM PLANNING & EVALUAT BETHESDA MD 20892 UNIV MASSACHUSETTS,SCH MED,DEPT MED WORCESTER MA 01605 UNIV VERMONT,COLL MED,DEPT BIOCHEM BURLINGTON VT 05405 BAYLOR COLL MED,DEPT MED HOUSTON TX 77030 NYU,SCH MED,DEPT MED NEW YORK NY 10016 BRIDGEPORT HOSP,CARDIOL SECT BRIDGEPORT CT 00000 NEW YORK MED COLL,DEPT MED VALHALLA NY 10595 BAYLOR UNIV,MED CTR,BAYLOR CARDIOVASC INST DALLAS TX 75246 NHLBI,DIV HEART & VASC DIS BETHESDA MD 20892 UNIV VERMONT,SCH MED,DEPT PATHOL BURLINGTON VT 05405
Titolo Testata:
Neurology
fascicolo: 4, volume: 45, anno: 1995,
pagine: 649 - 658
SICI:
0028-3878(1995)45:4<649:CAPOIH>2.0.ZU;2-I
Fonte:
ISI
Lingua:
ENG
Soggetto:
TISSUE PLASMINOGEN-ACTIVATOR; CEREBRAL AMYLOID ANGIOPATHY; INTRACRANIAL HEMORRHAGE; CORONARY THROMBOLYSIS; INTRAVENOUS STREPTOKINASE; ALZHEIMERS-DISEASE; PHASE-II; RISK; COMPLICATIONS; STROKE;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
78
Recensione:
Indirizzi per estratti:
Citazione:
M.A. Sloan et al., "CLINICAL-FEATURES AND PATHOGENESIS OF INTRACEREBRAL HEMORRHAGE AFTER RT-PA AND HEPARIN-THERAPY FOR ACUTE MYOCARDIAL-INFARCTION - THE THROMBOLYSIS IN MYOCARDIAL-INFARCTION (TIMI)-II PILOT AND RANDOMIZED CLINICAL-TRIAL COMBINED EXPERIENCE", Neurology, 45(4), 1995, pp. 649-658

Abstract

Parenchymatous intracerebral hemorrhage (ICH) is a serious, infrequent complication of thrombolytic therapy for acute myocardial, infarction. We studied the clinical and radiologic features, manner of presentation, associated factors, and temporal course in 23 patients with ICH associated with 150 mg or 100 mg recombinant tissue-type plasminogen activator (rt-PA) and heparin therapy for acute myocardial infarction in the Thrombolysis in Myocardial Infarction (TIMI) II Pilot and Randomized Clinical Trial. In TIMI II, 13 of the 23 ICH patients developed or maintained systolic blood pressure greater than or equal to 160 mm Hg or diastolic blood pressure greater than or equal to 90 mm Hg duringthe rt-PA infusion and before the onset of neurologic symptoms. Six patients (26%) had life-threatening ventricular arrhythmias, five before onset of neurologic symptoms. A decreased level of consciousness wasthe earliest neurologic abnormality in 15 (65%) and the most common initial physical finding (in 19, or 82%). Onset was usually gradual (70%), but time to maximal deficit was frequently (61%) within 6 hours ofonset. The locations of the primary ICH sites were lobar in 16 (70%),thalamic in four (17%), and brainstem-cerebellum in three (13%), but the putamen was never the primary site. Multiple lobar hemorrhages occurred in six cases (26%). The timing and size of ICH was similar amongpatients treated with 150 mg rt-PA and 100 mg rt-PA. Brain CT demonstrated an arteriovenous malformation in one case. Four patients had hypofibrinogenemia, which was profound in three patients. Pathologic findings were available for five patients. Of these, three patients had cerebral amyloid angiopathy, and one had hemorrhagic transformation of an ischemic cerebral infarction found at autopsy. We conclude that ICH following rt-PA and heparin therapy for acute myocardial infarction presents as a distinctive clinical syndrome. Intracerebral bleeding after combined thrombolytic and antithrombotic therapy may be associated with cerebral amyloid angiopathy and other vascular lesions. Acute or persistent hypertension before or during rt-PA infusion, life-threatening ventricular arrhythmias, and hypofibrinogenemia, either alone or incombination, may play roles in some cases. Care should be exercised when considering thrombolytic therapy for patients with risk factors for ICH.

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Documento generato il 02/12/20 alle ore 14:05:59