Ischemic stroke patients who received IV thrombolysis on the way to the hospital in a specialized ambulance kitted out with a CT scanner did not have a better chance of returning home without functional disability at 3 months than did those who got the same treatment at the hospital after usual transport.
So found a study from Berlin, where the system has been rolled out. But the researchers noted secondary findings suggestive "that pre-hospital start of intravenous thrombolysis might lead to improved functional outcome in patients."
"This evidence requires substantiation in future large-scale trials," they wrote in Lancet Neurology.
Isolated DVT Tx
For first-time, new-onset deep vein thrombosis (DVT) in the calf, anticoagulation was associated with a 66% reduced risk of proximal DVT or pulmonary embolism at 6 months but more than a four-fold increased risk of bleeding, including one death, a single-center observational study of 384 consecutive patients showed.
Both findings, reported online in JAMA Surgery, remained statistically significant after adjustment for confounding factors and in sensitivity analyses.
An accompanying editorial called the data "further evidence that anticoagulation should strongly be considered in patients with provoked muscular branch DVT, because some calf DVT clearly can propagate and lead to pulmonary embolism. This recommendation must be tempered by the sobering fact that anticoagulation can lead to life-threatening bleeding.
"We agree with the authors that a multi-institutional, prospective, randomized study is needed to better answer this question."
Cancer Tx for Angina?
For patients with intractable angina, a less invasive means of stem cell therapy boosted by a drug used in multiple myeloma and lymphoma appeared to help, Indonesian researchers reported in a 15-patient single-arm study.
Granulocyte colony-stimulating factor injections were given to stimulate bone marrow stem cells to enter the circulation, then blood was drawn and separated to concentrate the stem cells before intravenous re-injection. This treatment reduced angina frequency and increased exercise tolerance significantly from baseline to week 4.
"Most patients reported mild myalgia which were easily managed with acetaminophen," the researchers reported at the American Heart Association's Basic Cardiovascular Sciences meeting in Phoenix.
Less-Invasive Mitral Surgery
A novel system for surgical mitral valve repair using preformed polytetrafluoroethylene cords had 100% procedural success and only mild mean residual mitral regurgitation at 1 month in an 11-patient initial clinical experience reported online in Circulation.
End-diastolic and left atrial volumes also improved significantly by 1 month in the study, although further follow-up will be needed to assess long-term efficacy, the researchers acknowledged.
The Harpoon TSD-5 system, used in a beating-heart, image-guided procedure via a small left thoracotomy, "has the potential to significantly reduce surgical morbidity," they concluded.