2022
Association of Recent Use of Non–Vitamin K Antagonist Oral Anticoagulants With Intracranial Hemorrhage Among Patients With Acute Ischemic Stroke Treated With Alteplase
Kam W, Holmes D, Hernandez A, Saver J, Fonarow G, Smith E, Bhatt D, Schwamm L, Reeves M, Matsouaka R, Khan Y, Unverdorben M, Birmingham M, Lyden P, Asimos A, Altschul D, Schoonover T, Jumaa M, Nomura J, Suri M, Moore S, Lafranchise E, Olson D, Peterson E, Xian Y. Association of Recent Use of Non–Vitamin K Antagonist Oral Anticoagulants With Intracranial Hemorrhage Among Patients With Acute Ischemic Stroke Treated With Alteplase. JAMA 2022, 327: 760-771. PMID: 35143601, PMCID: PMC8832308, DOI: 10.1001/jama.2022.0948.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeSymptomatic intracranial hemorrhageSecondary functional outcomesSecondary safety outcomesProportion of patientsIntravenous alteplaseIntracranial hemorrhageIschemic strokeFunctional outcomeOral anticoagulantsInpatient mortalitySafety outcomesNon-Vitamin K Antagonist Oral AnticoagulantsK Antagonist Oral AnticoagulantsBaseline clinical factorsGuidelines-Stroke programIntravenous alteplase administrationLong-term anticoagulantsUse of NOACsRetrospective cohort studyUse of anticoagulantsSignificant differencesAlteplase administrationCardiovascular comorbiditiesNOAC group
2020
Acute ischemic stroke: improving access to intravenous tissue plasminogen activator
Turner A, Schwamm L, Etherton M. Acute ischemic stroke: improving access to intravenous tissue plasminogen activator. Expert Review Of Cardiovascular Therapy 2020, 18: 277-287. PMID: 32323590, DOI: 10.1080/14779072.2020.1759422.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeIschemic stroke patientsIschemic strokeStroke patientsTreatment windowAcute ischemic stroke patientsIntravenous tissue plasminogen activatorTreatment ratesUnknown symptom onsetAcute stroke careTissue plasminogen activatorQuality improvement initiativesHealth care resourcesUnited States FoodStroke outcomeSymptom onsetStroke careStroke specialistsStroke systemsTelestroke networkDrug AdministrationAlteplasePatientsPlasminogen activatorStates Food
2019
Intravenous Tissue Plasminogen Activator in Stroke Mimics
Ali-Ahmed F, Federspiel J, Liang L, Xu H, Sevilis T, Hernandez A, Kosinski A, Prvu Bettger J, Smith E, Bhatt D, Schwamm L, Fonarow G, Peterson E, Xian Y. Intravenous Tissue Plasminogen Activator in Stroke Mimics. Circulation Cardiovascular Quality And Outcomes 2019, 12: e005609. PMID: 31412730, PMCID: PMC6699639, DOI: 10.1161/circoutcomes.119.005609.Peer-Reviewed Original ResearchMeSH KeywordsAdministration, IntravenousAdultAgedAged, 80 and overBrain IschemiaDiagnosis, DifferentialFemaleFibrinolytic AgentsHumansIntracranial HemorrhagesMaleMiddle AgedPredictive Value of TestsRegistriesRisk AssessmentRisk FactorsStrokeThrombolytic TherapyTissue Plasminogen ActivatorTreatment OutcomeUnited StatesUnnecessary ProceduresConceptsTransient ischemic attackStroke mimicsIschemic strokeIschemic attackPrior stroke/transient ischemic attackStroke/transient ischemic attackIntravenous tissue plasminogen activatorGuidelines-Stroke registrySymptomatic intracranial hemorrhageCardiovascular risk factorsHealth Stroke ScaleHospital mortality rateAcute ischemic strokeStroke-like symptomsTissue plasminogen activatorUse of tPANonstroke diagnosisThrombolysis safetyIntravenous tPAStroke ScaleComplication rateIntracranial hemorrhagePresumed strokeRisk factorsFunctional disordersIntravenous Tissue-Type Plasminogen Activator in Acute Ischemic Stroke Patients With History of Stroke Plus Diabetes Mellitus
Ehrlich M, Liang L, Xu H, Kosinski A, Hernandez A, Schwamm L, Smith E, Fonarow G, Bhatt D, Peterson E, Xian Y. Intravenous Tissue-Type Plasminogen Activator in Acute Ischemic Stroke Patients With History of Stroke Plus Diabetes Mellitus. Stroke 2019, 50: 1497-1503. PMID: 31035901, PMCID: PMC6538420, DOI: 10.1161/strokeaha.118.024172.Peer-Reviewed Original ResearchConceptsIntravenous tissue-type plasminogen activatorSymptomatic intracerebral hemorrhageAcute ischemic strokeHistory of strokeTissue-type plasminogen activatorIschemic stroke patientsDiabetes mellitusIschemic strokeIntracerebral hemorrhagePlasminogen activatorStroke patientsUnadjusted ratesAcute ischemic stroke patientsBaseline clinical factorsConcomitant diabetes mellitusECASS III trialGuidelines-Stroke registryPrior ischemic strokeCardiovascular risk factorsHospital mortalityPrior strokeSevere strokeIII trialsClinical factorsRisk factors
2018
Intravenous tPA (Tissue-Type Plasminogen Activator) in Patients With Acute Ischemic Stroke Taking Non–Vitamin K Antagonist Oral Anticoagulants Preceding Stroke
Jin C, Huang R, Peterson E, Laskowitz D, Hernandez A, Federspiel J, Schwamm L, Bhatt D, Smith E, Fonarow G, Xian Y. Intravenous tPA (Tissue-Type Plasminogen Activator) in Patients With Acute Ischemic Stroke Taking Non–Vitamin K Antagonist Oral Anticoagulants Preceding Stroke. Stroke 2018, 49: 2237-2240. PMID: 30354981, PMCID: PMC6706353, DOI: 10.1161/strokeaha.118.022128.Peer-Reviewed Original ResearchMeSH KeywordsAdministration, IntravenousAdministration, OralAntibodies, Monoclonal, HumanizedAnticoagulantsAntidotesAntithrombinsBrain IschemiaDabigatranFactor Xa InhibitorsFibrinolytic AgentsHumansIntracranial HemorrhagesOdds RatioPractice Guidelines as TopicPyrazolesPyridonesRivaroxabanStrokeTissue Plasminogen ActivatorConceptsSymptomatic intracranial hemorrhageAcute ischemic strokeIntravenous tPAIntracranial hemorrhageFavorable outcomeIschemic strokeThrombin timeAnti-Xa assaySensitive laboratory testsNOAC patientsOral anticoagulantsTPA administrationProhibitive riskSymptom onsetPatient characteristicsMedian timeMedication intakeCurrent guidelinesAnticoagulant effectLarge cohortClinical carePatientsOverall observed rateNOACsHemorrhage
2017
Treatment and Outcome of Hemorrhagic Transformation After Intravenous Alteplase in Acute Ischemic Stroke
Yaghi S, Willey JZ, Cucchiara B, Goldstein JN, Gonzales NR, Khatri P, Kim LJ, Mayer SA, Sheth KN, Schwamm LH. Treatment and Outcome of Hemorrhagic Transformation After Intravenous Alteplase in Acute Ischemic Stroke. Stroke 2017, 48: e343-e361. PMID: 29097489, DOI: 10.1161/str.0000000000000152.Peer-Reviewed Original ResearchConceptsSymptomatic intracranial hemorrhageAcute ischemic strokeIschemic strokeSystemic thrombolysisCase seriesIntravenous thrombolytic therapyMainstay of treatmentSmall case seriesTreatment of patientsBlood-brain barrierWriting group membersHemorrhagic transformationIntravenous alteplaseFeared complicationSevere complicationsPrompt diagnosisRandomized trialsThrombolytic therapyIntracranial hemorrhageRetrospective studyRisk factorsEarly correctionAlteplaseStrokeLiterature reviewUse of Intravenous Recombinant Tissue Plasminogen Activator in Patients With Acute Ischemic Stroke Who Take Non–Vitamin K Antagonist Oral Anticoagulants Before Stroke
Xian Y, Federspiel J, Hernandez A, Laskowitz D, Schwamm L, Bhatt D, Smith E, Fonarow G, Peterson E. Use of Intravenous Recombinant Tissue Plasminogen Activator in Patients With Acute Ischemic Stroke Who Take Non–Vitamin K Antagonist Oral Anticoagulants Before Stroke. Circulation 2017, 135: 1024-1035. PMID: 28119380, DOI: 10.1161/circulationaha.116.023940.Peer-Reviewed Original ResearchMeSH KeywordsAdministration, IntravenousAgedAged, 80 and overAnticoagulantsDabigatranFemaleFibrinolytic AgentsHemorrhageHospital MortalityHumansInternational Normalized RatioMalePyrazolesPyridonesRecombinant ProteinsRegistriesRetrospective StudiesRisk FactorsRivaroxabanStrokeTime FactorsTissue Plasminogen ActivatorTreatment OutcomeWarfarinConceptsIntravenous rt-PASymptomatic intracranial hemorrhageIschemic strokeRt-PAIntracranial hemorrhageOdds ratioNon-Vitamin K Antagonist Oral AnticoagulantsIntravenous recombinant tissue plasminogen activatorK Antagonist Oral AnticoagulantsRecombinant tissue plasminogen activatorGuidelines-Stroke registrySerious systemic hemorrhageAcute ischemic strokeAdjusted odds ratioAmerican Heart AssociationTissue plasminogen activatorOutcomes of useHospital mortalityRegistry hospitalsOral anticoagulantsSevere strokeAdverse eventsProhibitive riskRankin ScaleThrombolytic therapy
2016
Baseline Predictors of Poor Outcome in Patients Too Good to Treat With Intravenous Thrombolysis
Ali S, Siddiqui K, Ay H, Silverman S, Singhal A, Viswanathan A, Rost N, Lev M, Schwamm L. Baseline Predictors of Poor Outcome in Patients Too Good to Treat With Intravenous Thrombolysis. Stroke 2016, 47: 2986-2992. PMID: 27834750, DOI: 10.1161/strokeaha.116.014871.Peer-Reviewed Original ResearchConceptsIntravenous tissue-type plasminogen activatorHealth Stroke ScaleTissue-type plasminogen activatorPoor outcomeIntravenous thrombolysisStroke ScaleMultivariable analysisPlasminogen activatorHigher median National InstitutesConsecutive stroke admissionsCurrent safety profileGuidelines-Stroke databaseInitial National InstitutesMedian National InstitutesThird of patientsVascular risk factorsNational InstituteSkilled nursing facilitiesMultifocal infarctionPoor collateralsStroke admissionsImaging predictorsInpatient rehabilitationSafety profileImaging featuresWhy are acute ischemic stroke patients not receiving IV tPA?
Messé S, Khatri P, Reeves M, Smith E, Saver J, Bhatt D, Grau-Sepulveda M, Cox M, Peterson E, Fonarow G, Schwamm L. Why are acute ischemic stroke patients not receiving IV tPA? Neurology 2016, 87: 1565-1574. PMID: 27629092, PMCID: PMC5067546, DOI: 10.1212/wnl.0000000000003198.Peer-Reviewed Original ResearchMeSH KeywordsAdministration, IntravenousAgedAged, 80 and overBrain IschemiaDatasets as TopicFemaleFibrinolytic AgentsHealthcare DisparitiesHumansLogistic ModelsMaleMultivariate AnalysisRegistriesRetrospective StudiesSeverity of Illness IndexStrokeThrombolytic TherapyTissue Plasminogen ActivatorUnited StatesConceptsAcute ischemic strokeTissue plasminogen activatorHours of onsetEligible patientsAcute ischemic stroke patientsNIH Stroke Scale scoreStroke center certificationRetrospective cohort studyStroke Scale scoreIschemic stroke patientsEarlier calendar yearsEquation logistic regressionProsthetic heart valvesEmergency medical servicesGuidelines-StrokePrior strokeCohort studyIschemic strokeOlder patientsStroke onsetStroke severityDiabetes mellitusCenter HospitalStroke patientsAtrial fibrillationUse and Outcomes of Intravenous Thrombolysis for Acute Ischemic Stroke in Patients ≥90 Years of Age
Arora R, Salamon E, Katz J, Cox M, Saver J, Bhatt D, Fonarow G, Peterson E, Smith E, Schwamm L, Xian Y, Libman R. Use and Outcomes of Intravenous Thrombolysis for Acute Ischemic Stroke in Patients ≥90 Years of Age. Stroke 2016, 47: 2347-2354. PMID: 27491734, DOI: 10.1161/strokeaha.116.012241.Peer-Reviewed Original ResearchMeSH KeywordsAdministration, IntravenousAdolescentAdultAge FactorsAgedAged, 80 and overBrain IschemiaFemaleFibrinolytic AgentsHospital MortalityHumansIntracranial HemorrhagesMaleMiddle AgedPractice Patterns, Physicians'PrognosisRegistriesRetrospective StudiesStrokeThrombolytic TherapyTissue Plasminogen ActivatorTreatment OutcomeYoung AdultConceptsIntravenous tissue-type plasminogen activatorTissue-type plasminogen activatorAcute ischemic strokeSymptomatic hemorrhageTPA useIschemic strokeYounger patientsFunctional outcomeQuality improvement registryGood functional outcomeYears of ageYounger age groupsIntravenous thrombolysisHospital mortalityFibrinolytic therapyAcute rehabilitationIndependent ambulationDischarge outcomesMultivariable analysisHospice dischargePatientsAge groupsHemorrhagePlasminogen activatorMortalityTelestroke—the promise and the challenge. Part two—expansion and horizons
Akbik F, Hirsch J, Chandra R, Frei D, Patel A, Rabinov J, Rost N, Schwamm L, Leslie-Mazwi T. Telestroke—the promise and the challenge. Part two—expansion and horizons. Journal Of NeuroInterventional Surgery 2016, 9: 361. PMID: 26984867, DOI: 10.1136/neurintsurg-2016-012340.Peer-Reviewed Original ResearchMeSH KeywordsAdministration, IntravenousEndovascular ProceduresFibrinolysisHumansStrokeTelemedicineThrombectomyThrombolytic TherapyConceptsSpecialist careMajor public health concernAcute ischemic strokeTime-sensitive therapiesExamination of patientsUse of telemedicinePublic health concernNovel therapeutic platformIntravenous thrombolysisStroke preventionEndovascular thrombectomyIschemic strokeStroke presentationStroke expertiseTreatment benefitVideo consultationsTreatment ratesHealth concernTelestrokeCarePotential roleStrokeSensitive therapyTherapeutic platformThrombectomyRisks and Benefits Associated With Prestroke Antiplatelet Therapy Among Patients With Acute Ischemic Stroke Treated With Intravenous Tissue Plasminogen Activator
Xian Y, Federspiel J, Grau-Sepulveda M, Hernandez A, Schwamm L, Bhatt D, Smith E, Reeves M, Thomas L, Webb L, Bettger J, Laskowitz D, Fonarow G, Peterson E. Risks and Benefits Associated With Prestroke Antiplatelet Therapy Among Patients With Acute Ischemic Stroke Treated With Intravenous Tissue Plasminogen Activator. JAMA Neurology 2016, 73: 1-10. PMID: 26551916, DOI: 10.1001/jamaneurol.2015.3106.Peer-Reviewed Original ResearchConceptsIntravenous tissue plasminogen activatorSymptomatic intracranial hemorrhageAcute ischemic strokePrestroke antiplatelet therapyTissue plasminogen activatorAntiplatelet therapyIschemic strokeGood functional outcomeHospital mortalityFunctional outcomeHigher oddsPlasminogen activatorDual antiplatelet treatmentGuidelines-Stroke registryRisk-adjusted likelihoodCardiovascular risk factorsRankin Scale scoreAmerican Heart AssociationAntiplatelet treatmentRegistry hospitalsRegistry patientsAmbulatory statusTPA administrationAdult patientsAntiplatelet agents
2015
Outcomes in Mild Acute Ischemic Stroke Treated With Intravenous Thrombolysis: A Retrospective Analysis of the Get With the Guidelines–Stroke Registry
Romano J, Smith E, Liang L, Gardener H, Camp S, Shuey L, Cook A, Campo-Bustillo I, Khatri P, Bhatt D, Fonarow G, Sacco R, Schwamm L. Outcomes in Mild Acute Ischemic Stroke Treated With Intravenous Thrombolysis: A Retrospective Analysis of the Get With the Guidelines–Stroke Registry. JAMA Neurology 2015, 72: 423-431. PMID: 25642650, DOI: 10.1001/jamaneurol.2014.4354.Peer-Reviewed Original ResearchConceptsRecombinant tissue plasminogen activatorHealth Stroke Scale scoreStroke Scale scoreSymptomatic intracranial hemorrhageShort-term outcomesIntravenous recombinant tissue plasminogen activatorGuidelines-Stroke registrySerious systemic hemorrhageAcute ischemic strokeLength of stayMild strokeTreatment complicationsIschemic strokeIntracranial hemorrhageScale scoreSymptom onsetSerious complicationsRetrospective analysisSystemic hemorrhageMild acute ischemic strokeNational InstituteWorse short-term outcomesBaseline National InstitutesHigher National InstitutesQuality improvement registry
2014
Determinants of Early Outcomes in Patients with Acute Ischemic Stroke and Proximal Artery Occlusion
LaBuzetta J, Yoo A, Ali S, Fitzpatrick K, Leslie-Mazwi T, Hirsch J, Schwamm L, Rost N. Determinants of Early Outcomes in Patients with Acute Ischemic Stroke and Proximal Artery Occlusion. Journal Of Stroke And Cerebrovascular Diseases 2014, 23: 2527-2532. PMID: 25238927, PMCID: PMC4256100, DOI: 10.1016/j.jstrokecerebrovasdis.2014.03.020.Peer-Reviewed Original ResearchMeSH KeywordsAdministration, IntravenousAgedAged, 80 and overArterial Occlusive DiseasesBrain IschemiaCombined Modality TherapyEndovascular ProceduresFemaleFibrinolytic AgentsHumansInjections, Intra-ArterialLogistic ModelsMaleMiddle AgedPatient DischargeProspective StudiesRegional Blood FlowStrokeStroke RehabilitationTime FactorsTissue Plasminogen ActivatorTreatment OutcomeConceptsIntra-arterial therapyProximal artery occlusionArtery occlusionIndependent predictorsAIS patientsPoststroke outcomesFavorable outcomeAcute ischemic stroke patientsIntravenous tissue plasminogen activatorInstitutional stroke databaseAcute ischemic strokeIschemic stroke patientsOnly independent predictorTissue plasminogen activatorEligible patientsHospital mortalityTPA administrationIschemic strokeStroke databaseAtrial fibrillationEarly outcomesPrespecified protocolStroke patientsPatient subgroupsUnfavorable outcomeAdherence to Third European Cooperative Acute Stroke Study 3- to 4.5-Hour Exclusions and Association With Outcome
Cronin CA, Sheth KN, Zhao X, Messé SR, Olson DM, Hernandez AF, Bhatt DL, Schwamm LH, Smith EE. Adherence to Third European Cooperative Acute Stroke Study 3- to 4.5-Hour Exclusions and Association With Outcome. Stroke 2014, 45: 2745-2749. PMID: 25104846, DOI: 10.1161/strokeaha.114.005443.Peer-Reviewed Original ResearchConceptsAdditional exclusion criteriaExclusion criteriaDiabetes mellitusAmerican Heart Association/American Stroke Association guidelinesEuropean Cooperative Acute Stroke StudyAmerican Stroke Association guidelinesSymptomatic intracranial hemorrhageWorse hospital outcomesHealth Stroke ScalePercent of patientsHistory of strokeOral anticoagulant treatmentCertain patient groupsAcute Stroke StudyTreatment time windowHour windowECASS IIIGuidelines-StrokePrior strokeAnticoagulant treatmentHospital outcomesStroke ScaleIschemic strokeSymptom onsetIncreased riskOutcomes of intravenous tissue plasminogen activator for acute ischaemic stroke in HIV‐infected adults
Sweeney E, Thakur K, Lyons J, Smith B, Willey J, Cervantes‐Arslanian A, Hickey M, Uchino K, Haussen D, Koch S, Schwamm L, Elkind M, Shinohara R, Mateen F. Outcomes of intravenous tissue plasminogen activator for acute ischaemic stroke in HIV‐infected adults. European Journal Of Neurology 2014, 21: 1394-1399. PMID: 25040336, DOI: 10.1111/ene.12506.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeNationwide Inpatient SampleIntravenous tissue plasminogen activatorIV-tPA useIV-tPATissue plasminogen activatorUninfected patientsIschemic strokeAIS patientsUS Nationwide Inpatient SampleSex-adjusted odds ratiosPlasminogen activatorShort-term outcomesRisk of deathIV-tPA administrationProportion of deathsHospital mortalityHospital deathHIV serostatusIntracerebral hemorrhageInpatient SampleOdds ratioHIVAIS casesPatients
2013
Temporal trends in patient characteristics and treatment with intravenous thrombolysis among acute ischemic stroke patients at Get With The Guidelines-Stroke hospitals.
Schwamm L, Ali S, Reeves M, Smith E, Saver J, Messe S, Bhatt D, Grau-Sepulveda M, Peterson E, Fonarow G. Temporal trends in patient characteristics and treatment with intravenous thrombolysis among acute ischemic stroke patients at Get With The Guidelines-Stroke hospitals. Circulation Cardiovascular Quality And Outcomes 2013, 6: 543-9. PMID: 24046398, DOI: 10.1161/circoutcomes.111.000303.Peer-Reviewed Original ResearchMeSH KeywordsAdministration, IntravenousAge FactorsAgedAged, 80 and overAmerican Heart AssociationBrain IschemiaChi-Square DistributionFemaleFibrinolytic AgentsHospitalsHumansMaleMiddle AgedMultivariate AnalysisOdds RatioQuality Indicators, Health CareRegistriesRisk FactorsStrokeThrombolytic TherapyTime FactorsTime-to-TreatmentTissue Plasminogen ActivatorTreatment OutcomeUnited StatesConceptsAcute ischemic stroke patientsIschemic stroke patientsTPA useAIS patientsPatient characteristicsStroke patientsHospitalized acute ischemic stroke patientsIntravenous tissue plasminogen activator useTissue plasminogen activator useNonwhite race/ethnicityAdditional calendar yearGuidelines-Stroke hospitalsAmerican Heart AssociationRace/ethnicityAIS admissionsGuidelines-StrokeEligible patientsIntravenous thrombolysisIntravenous tPAMore patientsMultivariable analysisHeart AssociationMild strokeTPA timeUnivariate analysis