{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T22:30:20Z","timestamp":1791153020740,"version":"4.1.0"},"reference-count":0,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Stroke"],"published-print":{"date-parts":[[1992,5]]},"abstract":"<jats:p>There is little reported of the safety and efficacy of high-dose intravenous recombinant tissue plasminogen activator (alteplase) in combination with heparin anticoagulation in patients presenting with acute ischemic stroke.<\/jats:p>\n          <jats:p>Thirty-two patients with severe hemispheric stroke syndrome caused by angiographically proven middle cerebral artery and\/or intracranial internal carotid artery occlusion were treated with 100 mg alteplase by intravenous infusion over 90 minutes within a mean +\/- SD of 226 +\/- 68 minutes after symptom onset. Recanalization was assessed by digital subtraction angiography in all patients immediately after treatment and by transcranial Doppler monitoring (n = 30) and\/or a third angiogram (n = 5) 12-24 hours later.<\/jats:p>\n          <jats:p>Complete or partial reperfusion was observed in 11 patients (34%) 90 minutes after the initiation of alteplase infusion and in 17 patients (53%) within 12-24 hours. Hemorrhagic infarction without clinical deterioration was detected by follow-up computed tomography in nine patients (28%). Fatal parenchymal hemorrhage occurred in three patients (9%) with huge middle cerebral artery infarcts. Serious hemorrhage from the puncture site occurred in two patients (6%). Good clinical outcome correlated with reperfusion (p less than 0.05) and the presence of grade 2 collateral blood flow (p less than 0.01).<\/jats:p>\n          <jats:p>When 100 mg of recombinant tissue plasminogen activator was given within the first 6 hours of acute stroke together with heparin the incidence of deleterious hemorrhage was less than 10%. Reperfusion and effective collateral blood flow seem to be two important factors associated with a small infarct volume and good clinical outcome.<\/jats:p>","DOI":"10.1161\/01.str.23.5.646","type":"journal-article","created":{"date-parts":[[2011,6,17]],"date-time":"2011-06-17T20:08:03Z","timestamp":1308341283000},"page":"646-652","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":175,"title":["Safety and efficacy of intravenous tissue plasminogen activator and heparin in acute middle cerebral artery stroke."],"prefix":"10.1161","volume":"23","author":[{"given":"R","family":"von Kummer","sequence":"first","affiliation":[{"name":"Department of Neuroradiology, University of Heidelberg, FRG."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W","family":"Hacke","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, University of Heidelberg, FRG."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","container-title":["Stroke"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/pdf\/10.1161\/01.STR.23.5.646","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,12]],"date-time":"2024-05-12T22:26:58Z","timestamp":1715552818000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/01.STR.23.5.646"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1992,5]]},"references-count":0,"journal-issue":{"issue":"5","published-print":{"date-parts":[[1992,5]]}},"alternative-id":["10.1161\/01.STR.23.5.646"],"URL":"https:\/\/doi.org\/10.1161\/01.str.23.5.646","relation":{},"ISSN":["0039-2499","1524-4628"],"issn-type":[{"value":"0039-2499","type":"print"},{"value":"1524-4628","type":"electronic"}],"subject":[],"published":{"date-parts":[[1992,5]]},"assertion":[{"value":"1992-05-01","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}