Fixed Dose IV rt-PA and Clinical Outcome in Ischemic Stroke Patients With Body Weight >100 kg: Pooled Data From 3 Randomized Clinical Trials

2018 ◽  
Vol 27 (10) ◽  
pp. 2843-2848
Author(s):  
Shahram Majidi ◽  
Christopher R. Leon Guerrero ◽  
Kathleen M. Burger ◽  
Dimitri Sigounas ◽  
Wayne J. Olan ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Body Weight ◽  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Randomized Clinical Trials ◽  
Fixed Dose ◽  
Stroke Patients ◽  
Pooled Data

Abstract TMP18: An Analysis of Fixed Dose IV Recombinant Tissue Plasminogen Activator (rtPA) and Clinical Outcome in Acute Ischemic Stroke Patients with Body Weight >100 kg: Pooled Data From Three Randomized Clinical Trials

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Shahram Majidi ◽  
Christopher Leon Guerrero ◽  
Kathleen Burger ◽  
Adnan Qureshi
Keyword(s):  
Body Weight ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Plasminogen Activator ◽  
Recombinant Tissue Plasminogen Activator ◽  
Fixed Dose ◽  
Stroke Patients ◽  
Ordinal Analysis ◽  
Pooled Data ◽  
Tissue Plasminogen

Background: The ASA/AHA guidelines recommend a fixed dose of 90 mg of intravenous recombinant tissue plasminogen activator(rt-PA) for acute stroke patients weighing more than 100 kilograms(kg). Previous analyses in small studies have suggested that the magnitude of benefit with IV rt-PA is lower in patients with body weight >100 kg. We determined if body weight >100 kg(and receiving <0.9 mg/kg dose) independently influence patient clinical outcomes following IV rt-PA treatment. Methods: We pooled data from IV rt-PA treatment arms from 3 randomized controlled trials; NINDS IV rt-PA study, IMS-III and Albumin Treatment of Acute Ischemic Stroke(ALIAS part 1 and 2). Patients demographic, stroke severity, comorbidities, hospital outcome and 90-day modified Rankin Scale(mRS) were compared between patients >100 kg and those ≤100 kg body weight(defined by estimated weight). Multivariate logistic regression model was used to identify independent effect of >100 kg body weight on 90-day favorable outcome(defined as mRS 0-2). An ordinal analysis of the mRS was also performed. Results: Among 977 patients treated with IV rt-PA, total of 111 subjects had body weight >100 kg(11% of all patients). The mean age(±SD) for the patients with weight >100 Kg was significantly lower(60±11 versus 68±13, p<0.0001). The median admission NIHSS score was not different between the two groups(12 versus 13, p=0.08). Patients with weight >100 kg had higher rates of history of hypertension, diabetes mellitus, and hyperlipidemia. Patients with body weight >100 kg had longer period(days±SD) of hospitalization(11±14 versus 8±7, p=0.04). Compared with patients with ≤100 kg body weight, the rate of favorable outcome at 90 days was not significantly different among patients with >100 kg body weight[OR; (95% CI): 0.99 (0.91-1.04)p=0.91], after adjusting for potential confounders. The ordinal analysis did not showed any significant shift in the distribution of scores on the mRS in patients with >100 kg body weight(OR, 0.93; 95% CI, 0.64 to 1.37; P = 0.74). Conclusion: Body weight >100 kg(and receiving <0.9 mg/kg dose) did not reduce the benefit of IV rt-PA treatment in acute ischemic stroke patients. Our results support the current recommendations in the ASA/AHA guidelines.

scholarly journals Efficacy and Safety of Intravenous rtPA in Ischemic Strokes Due to Small-Vessel Occlusion: Systematic Review and Meta-Analysis

2021 ◽  
Author(s):  
Bartosz Karaszewski ◽  
Adam Wyszomirski ◽  
Bartosz Jabłoński ◽  
David J. Werring ◽  
Dominika Tomaka
Keyword(s):  
Clinical Trials ◽  
Ischemic Stroke ◽  
Randomized Clinical Trials ◽  
Small Vessel Disease ◽  
Small Vessel ◽  
Efficacy And Safety ◽  
Eligibility Criteria ◽  
Vessel Occlusion ◽  
Excellent Outcome ◽  
Symptomatic Intracerebral Hemorrhage

AbstractIntravenous recombinant tissue plasminogen activator (iv-rtPA) has been routinely used to treat ischemic stroke for 25 years, following large clinical trials. However, there are few prospective studies on the efficacy and safety of this therapy in strokes attributed to cerebral small vessel disease (SVD). We evaluated functional outcome (modified Rankin scale, mRS) and symptomatic intracerebral hemorrhage (sICH) using all available data on the effects of iv-rtPA in SVD-related ischemic stroke (defined either using neuroimaging, clinical features, or both). Using fixed-effect and random-effects models, we calculated the pooled effect estimates with regard to excellent and favorable outcomes (mRS=0–1 and 0–2 respectively, at 3 months), and the rate of sICH. Twenty-three studies fulfilled the eligibility criteria, 11 of which were comparative, and there were only 3 randomized clinical trials. In adjusted analyses, there was an increased odds of excellent outcome (adjusted OR=1.53, 95% CI: 1.29–1.82, I2: 0%) or favorable outcome (adjusted OR=1.68, 95% CI: 1.31–2.15,I2: 0%) in patients who received iv-rtPA compared with placebo. Across the six studies which reported it, the incidence of sICH was higher in the treatment group (M-H RR = 8.83, 95% CI: 2.76–28.27). The pooled rate of sICH in patients with SVD administered iv-rtPA was only 0.72% (95% CI: 0.12%–1.64%). We conclude that when ischemic stroke attributed to SVD is considered separately, available data on the effects of iv-rtPA therapy are insufficient for the highest level of recommendation, but it seems to be safe. Although further therapeutic trials in SVD-related ischemic stroke appear to be justified, our findings should not prevent its continued use for this group of patients in clinical practice.

Abstract 74: Early Arterial Recanalization After Intra-venous Tissue-Plasminogen-Activator Treatment in the Interventional Management of Stroke-3 Study

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Ruediger Von Kummer ◽  
Andrew M Demchuk ◽  
Lydia D Foster ◽  
Bernard Yan ◽  
Wouter J Schonewille ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
Internal Carotid ◽  
Arterial Occlusion ◽  
Posterior Circulation ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Tissue Plasminogen ◽  
Arterial Recanalization

Background: Data on arterial recanalization after IV t-PA treatment are rare. IMS-3 allows the study of variables affecting arterial recanalization after IV t-PA in acute ischemic stroke patients with CTA-proved major artery occlusions. Methods: Of 656 acute ischemic stroke patients in IMS-3, 306 were examined with baseline CTA and randomized either to IV t-PA (N=95) or to IV t-PA followed by digital subtraction angiography (DSA) and endovascular therapy (EVT) (N=211). Comparison of baseline CTA to DSA within 5 hours of stroke onset assessed early arterial recanalization after IV t-PA. A central core lab categorized DSA vessel occlusion as “no, partial, or complete”. We studied the association between arterial occlusion sites on baseline CTA with early recanalization for the endovascular group and analyzed its impact on clinical outcome at 90 days. Results: In the EVT group, 22 patients (10.4%) had no CTA intracranial occlusions, but 1 extracranial occlusion; 42 patients (19.9%) had occlusions of intracranial internal carotid artery (ic-ICA); 10 patients (4.7%) had tandem occlusions of the cervical ICA and middle cerebral artery (MCA); 95 patients (45.0%) had MCA-trunk (M1) occlusions, 33 patients (15.6%) had M2 occlusions, 3 patients (1.4%) had M3/4 occlusions, and 6 patients (2.8%) occlusions within posterior circulation. Partial or complete recanalization occurred in 28.6% of patients before DSA and was marginally associated with occlusion site (p=0.0525) (8 patients (19.0%) with ic-ICA occlusion, 0 patients with tandem ICA/MCA occlusions, 34 patients (35.8%) with M1 occlusions, 11 patients (33.3%) with M2 occlusions, 0 patients with M3/4 occlusions, and 1 patient (16.7%) with occlusion within posterior circulation). Three CTA negative patients had intracranial occlusions on DSA. Thirty-two patients (59.3%) with early recanalization achieved mRS of 0-2 at 90 days compared to 51 patients (38.4%) without early recanalization (p=0.0099). There was no relationship between early recanalization and time to IV t-PA or mean t-PA dose. Conclusion: Before EVT, IV rt-PA may facilitate arterial recanalization and better clinical outcome in about one third of patients.

scholarly journals HUBUNGAN PERDARAHAN GASTROINTESTINAL DENGAN LUARAN PASIEN STROKE ISKEMIK AKUT

2020 ◽  
Vol 36 (2) ◽  
Author(s):  
Rico Defryantho ◽  
Lisda Amalia ◽  
Ahmad Rizal ◽  
Suryani Gunadharma ◽  
Siti Aminah ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Length Of Stay ◽  
Clinical Outcome ◽  
Gastrointestinal Bleeding ◽  
Acute Ischemic Stroke ◽  
Stroke Patients ◽  
Exclusion Criteria ◽  
Risk Of Death ◽  
History Of ◽  
Gcs Score

     ASSOCIATION BETWEEN GASTROINTESTINAL BLEEDING WITH CLINICAL OUTCOME ACUTE ISCHEMIC STROKE PATIENTABSTRACTIntroduction: Gastrointestinal bleeding associated by the delay in the administration of antiplatelet and anticoagulant, thus affected the clinical outcome and patient treatment.Aims: To find the association between gastrointestinal bleeding and clinical outcome in acute ischemic stroke patient.Methods: This study was a prospective observational, conducted at Hasan Sadikin Hospital Bandung in November 2017 to February 2018. Acute ischemic stroke patients that fulfill the inclusion and exclusion criteria were observed while being treated in the ward and the survival rate and length of stay were studied. This study used univariate, bivariate, multivariate, and stratification analysis.Results: In the study period, 100 acute ischemic stroke patients were found and 24 patients had gastrointestinal bleeding. A history of previous peptic ulcer/gastrointestinal bleeding was found in patient with gastrointestinal bleeding (20.8%). Median NIHSS score was higher (16 vs 7) and GCS score was lower (12 vs 15) in patients with bleeding. Multivariate analysis showed that gastrointestinal bleeding were significantly associated with survival and length of stay. The analysis of stratification showed subjects with infections who later experienced gastrointestinal bleeding had a lower risk of death and length of stay than subjects without infection who experienced gastrointestinal bleeding (1.7  vs  22.5 times and 1.5 vs 2 times).Discussion: Ischemic stroke with gastrointestinal bleeding had higher mortality and length of stay than without gastrointestinal bleeding in acute ischemic stroke patient.Keyword: Acute ischemic stroke, gastrointestinal bleeding, length of stay, mortalityABSTRAKPendahuluan: Perdarahan gastrointestinal berhubungan dengan penundaan terapi antiplatelet atau antikoagulan, sehingga berpengaruh terhadap luaran dan tata laksana pasien.Tujuan: Mengetahui hubungan perdarahan gastrointestinal dengan luaran pasien stroke iskemik akut.Metode: Penelitian prospektif observasional terhadap pasien stroke iskemik akut di RSUP Dr. Hasan Sadikin, Bandung pada bulan November 2017 hingga Februari 2018. Pasien stroke iskemik akut yang memenuhi kriteria inklusi dan eksklusi diobservasi selama perawatan untuk mengetahui survival dan lama perawatan di rumah sakit. Analisis statistik yang digunakan adalah univariat, bivariat, multivariat, dan stratifikasi.Hasil: Selama periode penelitian didapatkan 100 subjek stroke iskemik akut dengan 24 subjek mengalami perdarahan gastrointestinal. Riwayat ulkus peptikum/perdarahan gastrointestinal sebelumnya sebanyak 20,8% pada perdarahan gastrointestinal. Median skor NIHSS lebih tinggi (16 vs 7) dan skor GCS lebih rendah (12 vs 15) pada perdarahan. Analisis multivariat didapatkan perdarahan gastrointestinal memiliki hubungan signifikan dengan survival dan lama perawatan. Berdasarkan analisis stratifikasi subjek dengan infeksi yang kemudian mengalami perdarahan gastrointestinal memiliki risiko mortalitas dan lama perawatan lebih rendah dibandingkan subjek tanpa infeksi kemudian mengalami perdarahan gastrointestinal (1,7 vs 22,5 kali dan 1,5 vs 2 kali).Diskusi: Stroke iskemik akut yang mengalami perdarahan gastrointestinal memiliki risiko mortalitas dan lama perawatan lebih tinggi dibandingkan tanpa perdarahan gastrointestinal.Kata kunci: Lama perawatan, mortalitas, perdarahan gastrointestinal, stroke iskemik akut

scholarly journals Correlation of neutrophil-to-lymphocyte ratio and clinical outcome of acute thrombotic stroke in patients with COVID-19

Narra J ◽  
2021 ◽  
Vol 1 (3) ◽  
Author(s):  
Rizky Sarengat ◽  
Mohammad S. Islam ◽  
Mohammad S. Ardhi
Keyword(s):  
Ischemic Stroke ◽  
Clinical Outcome ◽  
Acute Ischemic Stroke ◽  
National Institutes Of Health ◽  
Neutrophil To Lymphocyte Ratio ◽  
Stroke Patients ◽  
Cross Sectional ◽  
Lymphocyte Ratio ◽  
Life Threatening ◽  
The Mean

The coronavirus disease 2019 (COVID-19) pandemic has caused millions of deaths worldwide. Acute ischemic stroke is a life-threatening risk factor for COVID-19 infection. Neutrophil-to-lymphocyte ratio (NLR) is one of the predictors of poor prognosis in acute ischemic stroke. The aim of this study was to assess the correlation between NLR values and the clinical outcome of acute thrombotic stroke patients with COVID-19 that was measured using the National Institutes of Health Stroke Scale (NIHSS). A cross-sectional hospital-based study was conducted in Dr. Soetomo General Hospital Surabaya, Indonesia. Patients with acute thrombotic stroke and COVID-19 admitted between 1 March 2020 and 31 May 2021 were recruited. The NLR values and the NIHSS scores were assessed during the admission and the correlation between NLR and NIHSS scores was calculated. This study included 21 patients with acute thrombotic stroke and COVID-19, consisting of 12 males and 9 females. The mean age was 57.6 years old. The mean NLR values was 8.33±6.7 and the NIHSS scores ranging from 1 to 33. Our data suggested a positive correlation between NLR values and NIHSS scores, r=0.45 with p=0.041. In conclusion, the NLR value is potentially to be used as a predictor of the clinical outcome in acute thrombotic stroke patients with COVID-19. However, further study is warranted to validate this finding.

Abstract WMP112: Cilostazol versus Aspirin for Secondary Stroke Prevention: Systematic Review and Meta-Analysis

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Michelle P Lin ◽  
Kevin M Barrett ◽  
James F Meschia ◽  
Benjamin H Eidelman ◽  
Josephine F Huang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Trials ◽  
Ischemic Stroke ◽  
Random Effects ◽  
Intracranial Hemorrhage ◽  
Stroke Prevention ◽  
Lower Risk ◽  
Randomized Clinical Trials ◽  
Meta Analysis ◽  
Secondary Stroke Prevention

Introduction: Cilostazol has promise as an alternative to aspirin for secondary stroke prevention given its vasodilatory and anti-inflammatory properties in addition to platelet aggregation inhibition. We conducted a systematic review and meta-analysis to estimate the comparative effectiveness and safety of cilostazol compared to aspirin for stroke prevention in patients with previous stroke or TIA. Hypothesis: Cilostazol is more effective than aspirin in preventing recurrent ischemic stroke with lower risk of intracranial hemorrhage and bleeding. Methods: We searched PubMed and the Cochrane Central Register of Controlled Trials from inception to 2019. Randomized clinical trials that compared cilostazol vs aspirin and reported the endpoints of ischemic stroke, intracranial hemorrhage and bleeding were included. A random-effects estimate was computed based on Mantel-Haenszel methods. The pooled estimates with 95% confidence intervals were compared between cilostazol and aspirin and displayed as forest plots (Figure). Results: The search identified 5 randomized clinical trials comparing cilostazol vs aspirin for secondary stroke prevention that enrolled 7,240 patients from primarily Asian countries (3,615 received cilostazol and 3,625 received aspirin). The pooled results from the random-effects model showed that cilostazol was associated with significantly lower risk of recurrent ischemic stroke (Hazard ratio [HR] 0.70; 95%CI, 0.54-0.89), intracranial hemorrhage (HR 0.41; 95%CI, 0.25-0.65) and bleeding (HR 0.71; 95%CI, 0.55-0.91). See forest plots. Conclusion: This meta-analysis suggests cilostazol is more effective than aspirin in the prevention of recurrent ischemic stroke with lower risk of intracranial hemorrhage and bleeding. Confirmatory randomized trials of cilostazol for secondary stroke prevention to be performed in more generalizable populations are needed.

Sign in / Sign up

Export Citation Format

Share Document