The rationale supporting the use of thrombolytic therapy is based on the knowledge that most ischemic strokes are the result of thrombotic or thromboembolic occlusion of the brain arteries. Thrombolytic therapy is of proven benefit for selected patients with ischemic stroke. Thrombolytic agents convert plasminogen to plasmin which breaks fibrin strands in intravascular thrombi resulting in clot lysis and restoration of blood flow to the affected areas of the brain. Interest in thrombolytic therapy for acute ischemic stroke was triggered by the success of thrombolytic therapy in the management of acute myocardial infarcts.
The administration of recombinant tissue plasminogen activator (tPA) has revolutionized the acute management of stroke. Currently, tissue plasminogen activator (tPA) is the only approved therapy for acute ischemic stroke. It requires that a stroke be promptly diagnosed and treated as a time-critical emergency. The report from the National Institute of Neurological Disorders and Stroke (NINDS report) demonstrated substantial benefit from the intravenous administration of tissue plasminogen activator (tPA) to a selected group of patients with acute ischemic strokes of less than 3 hours duration from its onset.
Intra-arterial thrombolytic therapy can be administered either by regional or local infusion directly into the thrombus using specialized catheters. Advantages of this method include the improved diagnostic accuracy, increased safety due to the administration of smaller amounts of drugs and the increased rate of recanalization.
Patients who are not eligible for tissue plasminogen activator (tPA) therapy should be evaluated for antithrombotic therapy. Heparin, low-molecular-weight heparins and heparinoids as well as aspirin have been used for this purpose. Use of antithrombotic therapy is aimed at reducing the risk of stroke progression or recurrent cerebral thromboembolism and for the prevention of venous thromboembolic complications such as deep vein thrombosis (DVT) or pulmonary embolism (PE).
If you are suffering from complications due to a delayed diagnosis of a stroke or the mismanagement of a stroke, let Dr. Borten and the Boston area medical malpractice attorneys at Gorovitz & Borten review the specifics of your case. review the specifics of your case. At Gorovitz & Borten we have the necessary experience, understanding and resources available to properly evaluate the complications of a stroke, and give you a timely assessment of its merits.
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