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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

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

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

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

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

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 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

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

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

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

A pulmonary embolism is a potentially fatal blood clot that lodges in the main artery of the lungs, straining the right side of the heart and affecting blood circulation. Patients are also at risk of new embolisms forming (recurrence). In the case of a massive pulmonary embolism, treatment to restore 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 this treatment is bleeding.

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

Version: 2015

Prevention of pressure ulcers usually involves an assessment to identify people most at risk of pressure ulcers, such as elderly, immobile people or those with spinal cord injury. Assessments are most commonly carried out using specific pressure area risk scores (for example, the Braden or Waterlow scales for predicting pressure sore risk or the, Glamorgan scale for paediatric pressure ulcers).

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

Version: April 2014

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 from 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: 2016

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

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

Chest pain or discomfort caused by acute coronary syndromes (ACS) or angina has a potentially poor prognosis, emphasising the importance of prompt and accurate diagnosis. Treatments are available to improve symptoms and prolong life, hence the need for this guideline.

NICE Clinical Guidelines - National Clinical Guideline Centre for Acute and Chronic Conditions (UK).

Version: March 2010

This guideline covers interventions in the acute stage of a stroke (‘acute stroke’) or transient ischaemic attack (TIA). Most of the evidence considered relates to interventions in the first 48 hours after onset of symptoms, although some interventions of up to 2 weeks are covered as well. This guideline is a stand-alone document, but is designed to be read alongside the Intercollegiate Stroke Working Party guideline ‘National clinical guideline for stroke’ which considers evidence for interventions from the acute stage into rehabilitation and life after stroke. The Intercollegiate Stroke Working Party guideline is an update of the 2004 2nd edition and includes all the recommendations contained within this guideline. This acute stroke and TIA guideline is also designed to be read alongside the Department of Health’s (DH) ‘National stroke strategy’ (NSS). Where there are differences between the recommendations made within this acute stroke and TIA guideline and the NSS, the Guideline Development Group (GDG) members feel that their recommendations are derived from systematic methodology to identify all of the relevant literature.

NICE Clinical Guidelines - National Collaborating Centre for Chronic Conditions (UK).

Version: 2008

Beta blockers inhibit the chronotropic, inotropic, and vasoconstrictor responses to the catecholamines, epinephrine, and norepinephrine. Beta blockers differ in their duration of effect (3 hours to 22 hours), the types of beta receptors they block (β1-selective or β1/β2-nonselective), whether they are simultaneously capable of exerting low level heart rate increases (intrinsic sympathomimetic activity [ISA]), and in whether they provide additional blood vessel dilation effects by also blocking alpha-1 receptors. All beta blockers are approved for the treatment of hypertension. Other US Food and Drug Administration-approved uses are specific to each beta blocker and include stable and unstable angina, atrial arrhythmias, bleeding esophageal varices, coronary artery disease, asymptomatic and symptomatic heart failure, migraine, and secondary prevention of post-myocardial infarction. The objective of this review was to evaluate the comparative effectiveness and harms of beta blockers in adult patients with hypertension, angina, coronary artery bypass graft, recent myocardial infarction, heart failure, atrial arrhythmia, migraine or bleeding esophageal varices.

Drug Class Reviews - Oregon Health & Science University.

Version: July 2009

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

Myocardial infarction (MI) remains one of the most dramatic presentations of coronary artery disease (CAD). Complete occlusion of the artery often produces myocardial necrosis and the classical picture of a heart attack with severe chest pain, electrocardiographic (ECG) changes of ST-segment elevation, and an elevated concentration of myocardial specific proteins in the circulation. Such people are described as having a ST-segment elevation myocardial infarction (STEMI). Intermittent or partial occlusion produces similar, but often less severe clinical features, although no or transient and undetected ST elevation. Such cases are described as a non-ST segment elevation myocardial infarction (NSTEMI). People who have suffered from either of these conditions are amenable to treatment to reduce the risk of further MI or other manifestations of vascular disease, secondary prevention.

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

Version: November 2013

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