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Used to treat people who are having a heart attack. Also used to break up blood clots in the blood vessels of lungs, leg veins, and around the heart.

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Results: 1 to 20 of 46

Intraventricular streptokinase after intraventricular hemorrhage in newborn infants

There is no evidence of benefit from giving streptokinase to newborn babies after brain haemorrhage.Bleeding (hemorrhage) into the ventricles of the brain is a serious complication of premature birth and large hemorrhages often lead to hydrocephalus, the process by which fluid accumulates under pressure inside the brain, expanding the head excessively and damaging the brain tissue. The insertion of a valve and drainage system (ventriculoperitoneal shunt) is fraught with problems in this patient group and alternatives to this therapy are needed. A possible approach is to try to dissolve the blood clots initially blocking the reabsorption of fluid in the brain. Streptokinase is a "clot‐busting" agent that has been successfully used to unblock coronary arteries. The review found no good evidence that intraventricular injection of streptokinase to infants with large intraventricular hemorrhage or post‐hemorrhagic ventricular enlargement reduces the need for ventriculoperitoneal shunt or improves outcome.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2008

Drugs to break down blood clots for people with sudden onset peripheral arterial occlusion

Acute reduction in blood flow to a limb can be caused by a blood clot blocking an artery or a vascular graft. If not treated promptly this condition, known as peripheral arterial occlusion, can result in amputation or be life threatening. Infusion of clot‐busting drugs can restore blood flow by dissolving the clot (thrombolysis). This review found some evidence from five randomized controlled trials, involving a total of 687 patients that suggested local infusion of a drug into the affected artery is more effective than infusion into a vein, and is also associated with a lower risk of unwanted bleeding. No particular drug was more effective in preventing limb loss or death than another. The drugs investigated were streptokinase, urokinase, recombinant tissue plasminogen activator and pro‐urokinase. More research is needed to confirm these findings. All of the findings of this review came from small studies that involved people with peripheral arterial ischaemia of differing severity.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Intra‐pleural fibrinolytic therapy versus conservative management in the treatment of adult parapneumonic effusions and empyema

Infected purulent pleural effusions (empyema) with isolated collections (loculations) of fluid or pus (complicated parapneumonic effusions) may develop with pneumonia. Drainage of this infected fluid via an intercostal catheter is important in healing. Evidence from seven randomised controlled trials (RCTs) with 761 participants indicates that flushing the pleural space with a fibrinolytic agent such as streptokinase or urokinase may help to break down the fibrinous bands or loculations that prevent total drainage of infected pleural fluid and therefore may significantly increase the amount of pus drained. Meta‐analysis of these RCTs indicates that intrapleural fibrinolytic therapy confers a benefit in reducing the requirement for surgical intervention for patients in some studies but not in others . The safety profile of intrapleural fibrinolytics remains uncertain.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Debridement for surgical wounds

Following surgery most surgical wounds heal naturally with no complications. However, complications such as infection and wound dehiscence (opening) can occur which may result in delayed healing or wound breakdown. Infected surgical wounds may contain dead (devitalised) tissue. Removal of this dead tissue (debridement) from surgical wounds is believed to enable wound healing. Many methods are available to clinicians to debride surgical wounds. This review showed that there is insufficient valid research evidence to recommend any one particular method.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2013

Early thrombolysis for the treatment of acute myocardial infarction: a systematic review and economic evaluation

Bibliographic details: Boland A, Dundar Y, Bagust A, Haycox A, Hill R, Mota R M, Walley T, Dickson R.  Early thrombolysis for the treatment of acute myocardial infarction: a systematic review and economic evaluation. Health Technology Assessment 2003; 7(15): 1-13612773258

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2003

Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomized trials

This review assessed primary percutaneous transluminal coronary angioplasty (PTCA) versus intravenous thrombolytic therapy for acute myocardial infarction (AMI). The review found that primary PTCA is more effective than thrombolytic therapy for the treatment of AMI. Limited details on the review process makes it difficult to assess the quality of included studies and verify the reliability of the review conclusion.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2003

Venous Thromboembolic Diseases: The Management of Venous Thromboembolic Diseases and the Role of Thrombophilia Testing [Internet]

Venous thromboembolism (VTE) is a condition in which a blood clot (a thrombus) forms in a vein and then dislodges to travel in the blood (an embolus). A venous thrombus most commonly occurs in the deep veins of the legs or pelvis; this is then called a deep vein thrombosis (DVT). Blood flow through the affected vein can be limited by the clot, and it can cause swelling and pain in the leg. If it dislodges and travels to the lungs, to the pulmonary arteries, it is called a pulmonary embolism (PE), which in some cases may be fatal. VTE as a term includes both DVT and PE. Major risk factors for VTE include a prior history of DVT, age over 60 years, surgery, obesity, prolonged travel, acute medical illness, cancer, immobility, thrombophilia (an abnormal tendency for the blood to clot) and pregnancy.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: June 2012
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Early thrombolysis for the treatment of acute myocardial infarction: a systematic review and economic evaluation

Coronary heart disease (CHD) is a major cause of morbidity and mortality in the UK accounting for around 125,000 deaths a year. Acute myo-cardial infarction (AMI) affects an estimated 274,000 people each year. Of these, approximately 50% (137,000) die within 30 days of AMI and over half these deaths occur prior to reaching hospital or other medical assistance.

NIHR Health Technology Assessment programme: Executive Summaries - NIHR Journals Library.

Version: 2003

Thrombolytic agents for arterial and venous thromboses in neonates

Major blood clots are infrequent, but serious complications that can occur in neonatal intensive care. Most often, blood clots are related to catheters (thin tubes inserted into the body), especially those inserted into the torso, for instance umbilical catheters. These are used in treating or monitoring sick newborn babies. Sometimes blood clots do not cause symptoms, but symptomatic blood clots can impair circulation and result in damage in the arms, legs, lungs, kidneys, heart, brain or intestines. The most common treatments are observation (no treatment), anti‐clotting drugs (heparin), or clot‐dissolving drugs (streptokinase, urokinase, and TPA). Surgery is also sometimes done. Administration of clot‐dissolving drugs (thrombolytics) has a risk of causing severe bleeding. It is important to understand which treatment of blood clots produces the best short‐term and long‐term results. However, a search of the medical literature found no randomized clinical trials that compared clot‐dissolving drugs with other blood clot treatments in newborns. Thus, no conclusions could be drawn.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Myocardial Infarction with ST-Segment Elevation: The Acute Management of Myocardial Infarction with ST-Segment Elevation [Internet]

When myocardial blood flow is acutely impaired (ischaemia), and often not provoked by exertion, a person will commonly suffer more prolonged pain; this is referred to as acute coronary syndrome (ACS). The underlying common pathophysiology of ACS involves the erosion or sudden rupture of an atherosclerotic plaque within the wall of a coronary artery. Exposure of the circulating blood to the cholesterol-rich material within the plaque stimulates blood clotting (thrombosis), which obstructs blood flow within the affected coronary artery. This coronary obstruction may be of short duration, and may not result in myocardial cell damage (necrosis), in which case the clinical syndrome is termed unstable angina. Unstable angina may result in reversible changes on the electrocardiogram (ECG) but does not cause a rise in troponin, a protein released by infarcting myocardial cells. Ischaemia which causes myocardial necrosis (infarction) will result in elevated troponin. When the ischaemia-causing infarction is either short-lived or affects only a small territory of myocardium the ECG will often show either no abnormality or subtle changes. This syndrome is termed non-ST-segment elevation myocardial infarction (NSTEMI). The diagnosis and immediate management of STEMI and the management of unstable angina and NSTEMI is addressed in other NICE Clinical Guidelines (CG95 and CG94).

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: July 2013
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Drugs to dissolve a blood clot lodged in the lungs (pulmonary embolism)

A blood clot that lodges in the main artery of the lungs (pulmonary embolism) strains the right side of the heart, affects blood circulation and can be fatal. Patients are also at risk of new blood clots forming (recurrence). With large blood clots (massive pulmonary embolism), restoring blood flow is urgently required. Heparin thins the blood but newer drugs that actively break up the clots (thrombolytics) may act more quickly and be more effective. These newer drugs include streptokinase, urokinase and recombinant tissue‐type plasminogen activator. The major complication of treatment is bleeding. The review authors searched the literature and were able to combine data from eight randomized controlled clinical trials. The trials involved 679 adult patients who were in a stable condition and randomly assigned to a thrombolytic agent or heparin. Thrombolytics did not show any benefit over heparin in terms of deaths and recurrence of blood clots. Limited information from only three of the trials showed that they were better at improving blood flow through the lungs. Major bleeding events were similar with both therapies.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Thrombolysis for treatment of acute deep vein thrombosis

Deep vein thrombosis (DVT) occurs when a blood clot forms in a leg vein. The clot can break up and move to the lungs, leading to a potentially serious blockage in blood flow (pulmonary embolism or PE). Because of the damage to the leg vein, post‐thrombotic syndrome (PTS) may develop any time over the next couple of years. Symptoms include leg pain, swelling, skin pigmentation and leg ulcers, leading to loss of mobility. Anticoagulants are the standard treatment for DVT or a clot in a calf vein. These thin the blood to reduce further clots forming and prevent PE; yet PTS can still develop. Thrombolysis breaks down the blood clot. For DVT, drugs such as streptokinase, urokinase and tissue plasminogen activator are infused into a vein in the arm or foot or, in some cases, directly at the site of the clot using a catheter and X‐ray control. Bleeding complications, stroke or intracerebral haemorrhage are potential harmful events for both treatments.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Clot‐dissolving drugs for treating ischaemic stroke in the early stages

We wanted to compare the safety and efficacy of clot‐dissolving (thrombolytic) drugs versus placebo or no treatment in the early stages of ischaemic stroke to see if clot‐dissolving drugs improve outcome after stroke.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Surgical Site Infection: Prevention and Treatment of Surgical Site Infection

Infections that occur in the wound created by an invasive surgical procedure are generally referred to as surgical site infections (SSIs). SSIs are one of the most important causes of healthcare-associated infections (HCAIs). A prevalence survey undertaken in 2006 suggested that approximately 8% of patients in hospital in the UK have an HCAI. SSIs accounted for 14% of these infections and nearly 5% of patients who had undergone a surgical procedure were found to have developed an SSI. However, prevalence studies tend to underestimate SSI because many of these infections occur after the patient has been discharged from hospital.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: October 2008
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Criteria for Distinguishing Effectiveness From Efficacy Trials in Systematic Reviews

To propose and test a simple instrument based on seven criteria of study design to distinguish effectiveness (pragmatic) from efficacy (explanatory) trials while conducting systematic reviews.

Technical Reviews - Agency for Healthcare Research and Quality (US).

Version: April 2006
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Developing a Protocol for Observational Comparative Effectiveness Research: A User's Guide

The Observational CER User's Guide serves as a resource for investigators and stakeholders when designing observational comparative effectiveness research (CER) studies, particularly those with findings that are intended to translate into decisions or actions. The User's Guide provides principles for designing research that will inform health care decisions of patients and other stakeholders. Furthermore, it serves as a reference for increasing the transparency of the methods used in a study and standardizing the review of protocols through checklists provided in every chapter.

Agency for Healthcare Research and Quality (US).

Version: January 2013
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Detection of Associations Between Trial Quality and Effect Sizes [Internet]

To examine associations between a set of trial quality criteria and effect sizes and to explore factors influencing the detection of associations in meta-epidemiological datasets.

Methods Research Reports - Agency for Healthcare Research and Quality (US).

Version: January 2012
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Treatment Strategies for Women With Coronary Artery Disease [Internet]

Although coronary artery disease (CAD) is the leading cause of death for women in the United States, treatment studies to date have primarily enrolled men and may not reflect the benefits and risks that women experience. Our systematic review of the medical literature assessed the comparative effectiveness of major treatment options for CAD specifically in women. The comparisons were (1) percutaneous coronary intervention (PCI) versus fibrinolysis/supportive pharmacologic therapy in ST elevation myocardial infarction (STEMI), (2) early invasive versus initial conservative management in non-ST elevation myocardial infarction (NSTEMI) or unstable angina, and (3) PCI versus coronary artery bypass surgery (CABG) versus optimal medical therapy in stable or unstable angina. The endpoints assessed were clinical outcomes, modifiers of effectiveness by demographic and clinical factors, and safety outcomes.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: August 2012
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Cardiopulmonary Syndromes (PDQ®): Health Professional Version

Expert-reviewed information summary about common conditions that produce chest symptoms. The cardiopulmonary syndromes addressed in this summary are cancer-related dyspnea, malignant pleural effusion, pericardial effusion, and superior vena cava syndrome.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: October 21, 2014

Testing of CYP2C19 Variants and Platelet Reactivity for Guiding Antiplatelet Treatment [Internet]

This comparative effectiveness review evaluated the analytic validity, prognostic value, and comparative effectiveness of two types of medical tests (genetic testing for CYP2C19 variants and phenotypic testing to measure platelet reactivity) to identify patients who are most likely to benefit from clopidogrel-based antiplatelet therapy and to guide antiplatelet therapy in patient populations who are eligible to receive or are already receiving clopidogrel treatment.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: September 2013
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