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Alteplase is still safe in elderly patients over the age of 80
Each year, about 30,080 over the age of stroke patients. A for general enzyme - a thrombolysis injection L1CAM drugs - but not approved for the treatment of stroke patients over the age of 80. Although the drug can be used for ischemic stroke, heart attack, pulmonary embolism, but the drug is safe and effective time window for stroke treatment is still controversial. Two published in the Lancet study reveals A benefit for the S & P enzyme to enable stroke patients over the age of 80, and the clear value of Lag3 early treatment.The first study reported that the 3rd International Stroke Trial (IST-3) results. In the trial, the University of Edinburgh, Western General Hospital, Professor Peter Sandercock, evaluated 3035 patients, involving 156 hospitals in 12 countries, aims to determine whether treatment can make patients with stroke within 6 hours benefit (for example: lifethemselves). 53% of patients in the study over 80 years. At present, recognized LAIR1 under the age of 80 stroke patients within 4-5 hours of acute ischemic stroke through thrombolysis benefit.The study is divided into A group 1515 for S & P enzyme treatment, the control group of 1520 people. In the first six months, the researchers found that the alteplase group and 554 (37%) can take care of LAIR2 themselves, while the control group, only 534 (35%). The incidence of 6 hours of treatment per 1000 patients over 14 patients can take care of themselves. The research team also found that 27% of A for the S & P enzyme group of patients may be left less disability.

Study, 80% of patients aged over 80 are accepted within 3 hours alteplase treatment, and the results show that the LAMP1 apparent benefit. In the six months, more than 80 patients per 1,000 patients daily living. A for enzyme group in the S & P 104 (7%) within 7 days, the symptoms of fatal or nonfatal bleeding, while the control group only 16 people (1%).7 days of the alteplase group mortality rate (163 [11%]) was significantly higher (107 [7%]). However, the research team found that A death toll for the S & P enzyme group in the 7 days to 6 months, 408 people (27%) while the control group of 407 people (27%), similar to the two groups.The researchers explain: "Given the type of patients recruited in the IST-3 (about 3/4 of patients in three hours after randomization and more than half are over 80 years old), the first six months, when the evidence table Minge for the S & P enzyme can improvefunctional outcomes. These data further confirmed the strategy to treat patients as soon as possible, provide a basis for the treatment extended to patients over the age of 80. these data do not support the limitation of treatment of stroke severity and necessary existence of an early brain scan ischemic changes. "In the second study, the University of Edinburgh, Western General Hospital, Professor, Joanna Wardlaw, and its sub-analysis of the IST-3 and other alteplase trials. The researchers evaluated 7012 patients within 6 hours of stroke receive intravenous alteplase treatment per 1000 patients, more than 42 patients can take care of themselves, more than 55 patients with good prognosis in the follow-up the end of a satisfactory effect. Although early symptomatic intracranial hemorrhage and early mortality is increased, but seven days to 3-6 months of follow-up to the end of the period mortality rates lower still so that patients benefit. The researchers observed a variety of reasons-induced death, and can not take care of patients the incidence is also reduced.The results show that thrombolysis within 3 hours of stroke with good prognosis was significant: the survival of patients with an increase of 87% 0, self-care patients, an increase of 90% 0. In addition, the comparison with alteplase, especially early treatment, more than 80 years of age and patients 80 years of age, in which patients treated within three hours more than 80 years of age per 1,000 people over 96 can live themselves.
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Alteplase is one of the Recombinant Tissue Plasminogen Activators (r-tPA). It goes along with reteplase and tenecteplase. It is FDA approved and is known for the treatment of acute massive pulmonary embolism, acute ischemic stroke (AIS) and myocardial infarction with ST elevation.

Reteplase is said to have faster thrombolysis than alteplase which is why it is indicated for acute myocardial infarction. Also compared to alteplase, tenecteplase appears to have lesser bleeding complications, but have similar survival rates for persons taking it a year after.

TPA is a protein responsible for breaking down blood clots. It is found in the lining of blood vessels and can also be classified as an enzyme. This is so because it helps in converting plasminogen to plasmin, which is for the purpose of clot breakdown. In the field of medicine, it is used to treat thrombotic or embolic stroke, however contraindicated in head trauma and hemorrhagic stroke due to possible bleeding complications.

For cases like having thrombi in the proximal deep veins of the leg or for peripheral arterial thrombi, an arterial catheter can be used to administer the drug. In other cases, it is usually given systemically.

As a drug, it can be known as the brand Activase, which is a sterile, purified glycoprotein of 527 amino acids. According to RXlist, it is synthesized using the complementary DNA (cDNA) for natural human tissue-type plasminogen activator obtained from a human melanoma cell line. The manufacturing process involves the secretion of the enzyme alteplase into the culture medium by an established mammalian cell line (Chinese Hamster Ovary cells) into which the cDNA for alteplase has been genetically inserted.

It is a white to off-white lyophilized powder used to mix with sterile water. Alteplase is used to dissolve blood clots that have clumped in blood vessels. Also, it is administered immediately after heart attack symptoms occur in order to improve patient survival. Moreover, it is utilized as a treatment after stroke symptoms and for pulmonary embolism. In some cases it is used to dissolve blood clots in catheters that are placed in large blood vessels during central venous access.
Lyka Candelario, RN
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Alteplase is still safe in elderly patients over the age of 8000