ebook img

Thrombolytic Therapy for Acute Stroke PDF

388 Pages·2005·7.37 MB·English
Save to my drive
Quick download
Download
Most books are stored in the elastic cloud where traffic is expensive. For this reason, we have a limit on daily download.

Preview Thrombolytic Therapy for Acute Stroke

T HROMBOLYTIC T HER APY FOR A S CUTE TROKE SECOND EDITION E DITED BY P D. L , ATRICK YDEN MD Thrombolytic Therapy for Acute Stroke C C N U R R E N T L I N I C A L E U RO LO G Y Daniel Tarsy, , S E MD ERIES DITOR Thrombolytic Therapy for Acute Stroke, Second Edition, edited by Patrick D. Lyden, 2005 Psychiatry for Neurologists, edited by Dilip V. Jeste and Joseph H. Friedman, 2005 Status Epilepticus: A Clinical Perspective, edited by Frank W. Drislane, 2005 Parkinson’s Disease and Nonmotor Dysfunction, edited by Ronald F. Pfeiffer and Ivan Bodis-Wollner, 2005 Movement Disorder Emergencies: Diagnosis and Treatment, edited by Steven J. Frucht and Stanley Fahn, 2005 Inflammatory Disorders of the Nervous System: Pathogenesis, Immunology, and Clinical Management, edited by Alireza Minagar and J. Steven Alexander, 2005 Neurological and Psychiatric Disorders: From Bench to Bedside, edited byFrank I. Tarazi and John A. Schetz, 2005 Multiple Sclerosis: Etiology, Diagnosis, and New Treatment Strategies, edited by Michael J. Olek, 2005 Seizures in Critical Care: A Guide to Diagnosis and Therapeutics, edited by Panayiotis N. Varelas, 2005 Vascular Dementia: Cerebrovascular Mechanisms and Clinical Management, edited by Robert H. Paul, Ronald Cohen, Brian R. Ott, Stephen Salloway, 2005 Atypical Parkinsonian Disorders: Clinical and Research Aspects, edited by Irene Litvan, 2005 Handbook of Neurocritical Care, edited by Anish Bhardwaj, Marek A. Mirski, and John A. Ulatowski, 2004 Handbook of Stroke Prevention in Clinical Practice, edited by Karen L. Furie and Peter J. Kelly, 2004 Clinical Handbook of Insomnia, edited by Hrayr P. Attarian, 2004 Critical Care Neurology and Neurosurgery, edited by Jose I. Suarez, 2004 Alzheimer’s Disease: A Physician’s Guide to Practical Management, edited by Ralph W. Richter and Brigitte Zoeller Richter, 2004 The Visual Field: A Perimetric Atlas, edited by Jason J. S. Barton and Michael Benatar, 2003 Surgical Treatment of Parkinson’s Disease and Other Movement Disorders, edited by Daniel Tarsy, Jerrold L. Vitek, and Andres M. Lozano, 2003 Myasthenia Gravis and Related Disorders, edited by Henry J. Kaminski, 2003 Seizures: Medical Causes and Management, edited by Norman Delanty, 2002 Clinical Evaluation and Management of Spasticity, edited by David A. Gelber and Douglas R. Jeffery, 2002 Early Diagnosis of Alzheimer's Disease, edited by Leonard F. M. Scinto and Kirk R. Daffner, 2000 Sexual and Reproductive Neurorehabilitation, edited by Mindy Aisen, 1997 Thrombolytic Therapy for Acute Stroke Second Edition Edited by Patrick D. Lyden, MD USCD Stroke Center, University of California, San Diego and Veteran’s Affairs Medical Center San Diego, CA © 2005 Humana Press Inc. 999 Riverview Drive, Suite 208 Totowa, New Jersey 07512 humanapress.com All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise without written permission from the Publisher. All papers, comments, opinions, conclusions, or recommendations are those of the author(s), and do not necessarily reflect the views of the publisher. Due diligence has been taken by the publishers, editors, and authors of this book to assure the accuracy of the information published and to describe generally accepted practices. The contributors herein have carefully checked to ensure that the drug selections and dosages set forth in this text are accurate and in accord with the standards accepted at the time of publication. Notwithstanding, as new research, changes in government regulations, and knowledge from clinical experience relating to drug therapy and drug reactions constantly occurs, the reader is advised to check the product information provided by the manu- facturer of each drug for any change in dosages or for additional warnings and contraindications. This is of utmost importance when the recommended drug herein is a new or infrequently used drug. It is the responsibility of the treating physician to determine dosages and treatment strategies for individual pa- tients. Further it is the responsibility of the health care provider to ascertain the Food and Drug Administration status of each drug or device used in their clinical practice. The publisher, editors, and authors are not responsible for errors or omissions or for any consequences from the application of the information presented in this book and make no warranty, express or implied, with respect to the contents in this publication. This publication is printed on acid-free paper. ∞ ANSI Z39.48-1984 (American Standards Institute) Permanence of Paper for Printed Library Materials. Cover design by Patricia F. Cleary Production Editor: Robin B. Weisberg For additional copies, pricing for bulk purchases, and/or information about other Humana titles, contact Humana at the above address or at any of the following numbers: Tel.: 973-256-1699; Fax: 973-256-8314; E- mail: [email protected], or visit our Website: http://humanapress.com Photocopy Authorization Policy: Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by Humana Press Inc., provided that the base fee of US $30.00 per copy is paid directly to the Copyright Clearance Center at 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license from the CCC, a separate system of payment has been arranged and is acceptable to Humana Press Inc. The fee code for users of the Transactional Reporting Service is: [0-58829- 398-X/05 $30.00]. Printed in the United States of America. 10 9 8 7 6 5 4 3 2 1 eISBN: 1-59259-933-8 Library of Congress Cataloging-in-Publication Data Thrombolytic therapy for acute stroke / edited by Patrick D. Lyden.-- 2nd ed. p. cm. -- (Current clinical neurology) Includes bibliographical references and index. ISBN 1-58829-398-X (alk. paper) 1. Cerebrovascular disease--Chemotherapy. 2. Thrombolytic therapy. I. Lyden, Patrick D. II. Series. RC388.5.T476 2005 616.8'10651--dc22 2005000628 Dedication This book is again dedicated to our families, who daily cope with the vagaries, inconveniences, and turmoil surrounding our involvement in a Stroke Team. It is also dedicated to the patients who volunteered to participate in the placebo-con- trolled trials of thrombolytic stroke therapy: a more courageous and selfless group activity, on such a scale, may not be seen again in medical research. v Series Editor’s Introduction It often takes time for a new therapeutic modality to mature into an accepted treatment option. After initial approval, new drugs, devices, and procedures all go through this process until they become “vetted” by the scientific community as well as the medical community at large. Thrombolysis for treatment of stroke is no exception. Thrombolytic Therapy for Acute Stroke, Second Edition comes four years after the first edition and provides a very comprehensive, updated perspective on the use of intravenous rt-TPA in acute stroke. The authors provide longer term follow-up on the pivotal clinical trials that led to Food and Drug Administration approval, data concerning phase 4 trials in larger numbers of patients, and, most importantly, the community experience that has accumulated since its release. They add to this the latest promising information concerning intra-arterial thrombolysis, which is still under investigation and more speculative sections concerning possible new avenues of clinical research such as combining intravenous throm- bolysis with neuroprotective therapies or intra-arterial thrombolysis. A wealth of factual information is supplemented by chapters containing sage opinion from Drs. Lyden and Caplan concerning the logistical, economic, and procedural issues that have been generated since the advent of this technology. Importantly, diagnosis does not take a back seat to therapeutics as illustrated by sections devoted to evalu- ation of the stroke patient, very useful illustrative cases and clinical comments, and chapters on the latest in imaging as applied to this field. Practical chapters concerning how to run a stroke code and hospital acute stroke protocols are espe- cially helpful and are must reading for anyone contemplating this therapy for their institution. As pointed out by Dr. Lyden, the implementation of thrombolytic therapy has been an uphill battle from the start. It is sobering to read about the disappointing results of early clinical trials, many of which startlingly were carried out without modern imaging. The pivotal NINDS trial for intravenous rt-TPA in stroke required unusual dedication and effort to succeed. Even after thrombolysis was demonstrated to be effective, concerns for its safety and skepticism regarding the logistics of speedy patient evaluation created some inertia and reluctance among clinicians. For example, neurologists on the front line were expected to provide more than “diagnose and adios” if this treatment was going to have an impact on stroke morbidity. In fact, however, this book makes it clear that the opposite has occurred. Neurologists and other health care providers, emergency room medical and nursing staffs, hospital administrators, health care officials on the local and national level and many others have been energized to create and nourish acute stroke teams vii viii Series Editor’s Introduction throughout the country that have revolutionized the treatment of stroke. Presently, however, the proportion of acute stroke patients eligible to receive throm- bolytic therapy who are actually treated remains very small. The wisdom and knowledge provided in this volume needs to be spread throughout the medical com- munity and the public so as to maximize its benefit and fulfill its promise. Daniel Tarsy, MD Department of Neurology Beth Israel Deaconess Medical Center Harvard Medical School Boston, MA Preface Thrombolytic Therapy for Acute Stroke, Second Edition remains intended for any physician seeking to learn to use thrombolytic therapy for acute stroke. As in the first edition, we present facts and data for the reader to consider; opinion is clearly segregated and labeled (see the debate chapters provided by Dr. Lou Caplan and myself.) We updated many chapters extensively, and added sections pertaining to new technology. Notably, some of the leading developers of stroke-magnetic resonance imaging contributed a key new chapter that hopefully will set the stage for improved patient selection. Yet, computed tomography will remain the most widely available imaging procedure for at least another decade, and Professor Rudiger von Kummer extensively revised this important chapter as well. Patient selection remains the trick, and all chapters describing the background, use, and nuance of thrombolytic therapy were revised extensively. Everything one needs to know, and then some, is provided: rationale, preclinical trials, early trials, and pivotal trials. Practical how-to chapters will guide the reader in treating acute stroke patients, both with and without thrombolytic therapy. To enable the reader to practice the knowledge gained, we replaced all the case scenarios with new, detailed practice cases. Unique, I think, among stroke therapy books, this case section will allow the reader to put into play all of the facts and advice contained in the remainder of the book. Practicing these scenarios will enable practitioners to be as ready as possible for their first case. The history of thrombolytic therapy for stroke makes for remarkable reading; as evidenced by the series of pilot experiments described in Chapter 6. The first uses of thrombolysis in humans were disasters, but no one knew going in that the risks were so high. Following those horrible results, nearly 20 years passed before the medical community again attempted thrombolytic therapy in stroke. That Greg del Zoppo, Justin Zivin, and especially John Marler were able to inspire the large, randomized trials of the early 1990s, based on critical animal experiments, is impressive. As predicted in the preface to the first edition, to this day there remains no medical experiment of comparable size, complexity, or courage from patients and families as the NINDS rt-PA for Acute Stroke Trial. It is said, even now almost a decade after the landmark trial, that thrombolytic therapy can be used only in specialized centers full of “commandos” willing to take call and respond to Code Stroke calls on a moment’s notice. As the case scenarios demonstrate, the com- mando model is certainly on the wane. Stroke patients now receive thrombolytic therapy in a variety of venues, and from a wide range of physicians, including emer- gency, internal, and family medicine practitioners. There is no doubt, however, that expertise and dedication to learning the protocol is required, as elegantly docu- ix

Description:
This extensively revised and expanded second edition incorporates the knowledge gained from the widespread implementation of large rt-PA for acute stroke trials and demonstrates the power of the new technologies now available. The authors have included much new material on stroke-MRI and computed om
See more

The list of books you might like

Most books are stored in the elastic cloud where traffic is expensive. For this reason, we have a limit on daily download.