Most recents (3)

Jay Mohan, D.O., FACC, FSCAI, FASE, RPVI

@DrJayMohan

1/ Atypical CLOT- a tweetorial

I recently saw a controversial tweet arguing against tx of chronic clot and restricting tx SOLEY to the CFV/iliac. While I agree (for the most part)- data is limited. At the end of the day we care about the pt, and not every pt is the same! Case➡️

2/ Pathophysiology of chronic #clot formation.

It’s important to recognize the lesions that can form after a clot:

Spurs/Webs
Rokitansky/NIVL/fibrosis

Your pts CEAP >5 always consider for non thrombotic obstructions! Consider #IVUS if things don’t fit!

3/ Clot is in a constant state of evolution. #Fibrin—> #Collagen.

Unfortunately many patients present in the subacute or late phase of #clot development which hinders many of our treatment approaches.

7️⃣days- 20% collagen

1️⃣5️⃣ days- 50% collagen

2️⃣1️⃣days- 80% (!!) collagen

Read 19 tweets

WorldStrokeAcademy

@WorldStrokeEd

#WeekendLecture
#Tenecteplase #TNK
Part 1
✅3rd generation rtPA
🧬Targeted genetic upgrade
3 specific alterations to #alteplase molecule:
👉⬆️Half life
👉⬆️Binding affinity for #fibrin
👉⬆️Resistance to inactivation by #PAI-1
bit.ly/3pqbEb1

#WeekendLecture
#TNK

👉⬆️T1/2 allows single bolus dosing and⬆️clot exposure to TNK
👉Higher affinity to fibrin-rich clots & + potent/faster clot #lysis vs alteplase
👉 < consumption of fibrinogen/plasminogen/ a2- antiplasmin👉⬇️systemic fibrinolytic effect👉⏬risk for bleeding

#WeekendLecture
#TNK
First analysis in stroke patients was a #dose-scalation safety study
There was no #symptomatic ICHs in dosis of 0.1-0.2-0.4mg/kg, and 15% (2 of 13) in 0.5mg/kg
No differences in clinical outcomes
bit.ly/3DNHamV

Read 11 tweets

Jay Mohan, D.O., FACC, FSCAI, FASE, RPVI

@DrJayMohan