Correction: The impact of general anesthesia, baseline ASPECTS, time to treatment, and IV tPA on intracranial hemorrhage after neurothrombectomy: pooled analysis of the SWIFT PRIME, SWIFT, and STAR trials

2021 ◽  
pp. neurintsurg-2019-014898corr1
Keyword(s):  
General Anesthesia ◽  
Intracranial Hemorrhage ◽  
Pooled Analysis ◽  
Time To Treatment ◽  
The Impact ◽  
Iv Tpa

scholarly journals The impact of general anesthesia, baseline ASPECTS, time to treatment, and IV tPA on intracranial hemorrhage after neurothrombectomy: pooled analysis of the SWIFT PRIME, SWIFT, and STAR trials

2019 ◽  
Vol 12 (1) ◽  
pp. 2-6 ◽  
Author(s):  
Radoslav Raychev ◽  
Jeffrey L Saver ◽  
Reza Jahan ◽  
Raul G Nogueira ◽  
Mayank Goyal ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Intracranial Hemorrhage ◽  
Functional Independence ◽  
Lower Probability ◽  
Stepwise Logistic Regression ◽  
Time To Treatment ◽  
Link Type ◽  
Intravenous Tissue Plasminogen Activator ◽  
The Impact ◽  
Iv Tpa

BackgroundDespite the proven benefit of neurothrombectomy, intracranial hemorrhage (ICH) remains the most serious procedural complication. The aim of this analysis was to identify predictors of different hemorrhage subtypes and evaluate their individual impact on clinical outcome.MethodsPooled individual patient-level data from three large prospective multicenter studies were analyzed for the incidence of different ICH subtypes, including any ICH, hemorrhagic transformation (HT), parenchymal hematoma (PH), subarachnoid hemorrhage (SAH), and symptomatic intracranial hemorrhage (sICH). All patients (n=389) treated with the Solitaire device were included in the analysis. A multivariate stepwise logistic regression model was used to identify predictors of each hemorrhage subtype.ResultsGeneral anesthesia and higher baseline Alberta Stroke Program Early CT score (ASPECTS) were associated with a lower probability of any ICH (OR 0.36, p=0.003), (OR 0.80, p=0.032) and HT (OR 0.54, p=0.023), (OR 0.78, p=0.001), respectively. Longer time from onset to treatment was associated with a higher likelihood of HT (OR 1.08, p=0.001) and PH (OR 1.11, p=0.015). Intravenous tissue plasminogen activator (IV-tPA) was also a strong predictor of PH (OR 7.63, p=0.013). Functional independence at 90 days (modified Rankin Scale (mRS) 0–2) was observed significantly less frequently in all hemorrhage subtypes except SAH. None of the patients who achieved functional independence at 90 days had sICH.ConclusionsGeneral anesthesia and smaller baseline ischemic core are associated with a lower probability of HT whereas IV-tPA and prolonged time to treatment increase the risk of PH after neurothrombectomy.Trial registration numbersSWIFT-NCT01054560; post results, SWIFT PRIME-NCT01657461; post results, STAR-NCT01327989; post results.

Abstract TMP77: Baseline Nihss-adjusted Time Window For Iv Tpa In Acute Stroke

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Marian Muchada ◽  
Marta Rubiera ◽  
Jorge Pagola ◽  
David Rodriguez- Luna ◽  
Alan A. Flores ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Time Window ◽  
Favorable Outcome ◽  
Minor Stroke ◽  
Stroke Severity ◽  
Ischemic Lesion ◽  
Severe Stroke ◽  
Time To Treatment ◽  
The Impact ◽  
Iv Tpa

Background: Updated metaanalysis have shown that beneficial effect of iv tPA on functional outcome decreases progressively overtime until 4.5 h. However, given the differential pattern of arterial occlusion, stroke severity and speed of ischemic lesion growth among candidates for reperfusion, the time window should be adjusted accordingly. We aim to identify time windows for different categories of stroke severity and occlusion location. Methods: Were included patients treated according to the criteria of the European Summary of Product Characteristics for alteplase treatment < 4.5h in a Universitary Hospital from 2001- 2011. Patients were grouped according to NIHSS severity in minor NIHSS ≤ 8, moderate stroke NIHSS 9-15, severe stroke NIHSS ≥ 16. We sequentially analyzed time-to-treatment to achieve favorable outcome as mRS ≤ 2 at 3 months. Results: 640 patients were included, of whom 123 patients (19.22%) with minor stroke, 205 (32.5%) with moderate stroke and 312 (48.75%) with severe stroke. The rate of favorable outcome was 79.8%, 62.5%, 24.2% respectively. In patients with minor stroke time-to-treatment did not predict outcome (OR 1.005, 95% CI: 0.997- 1.012; p = 0.264). After adjusting for age and occlusion location only age was a independent variable (OR 1.198; 95% CI: 1.054-1.336; p= 0.001). In patients with moderate stroke time-to-treatment ≤ 240 minutes predict favorable outcome (OR 0.041, 95% CI 0.160- 0.962; p= 0.041), although only age and occlusion location, were independent predictors: (OR 1.061, 95% CI 1.024- 1.098; p= 0.001) and (OR 2.968, 95% CI 1.293- 6.614; p= 0.010), respectively. In patients with severe stroke time-to-treatment ≤ 90 minutes predict favorable outcome (OR 0.428, 95% CI 0.186-0.985; p= 0.046). Adjusting for proximal occlusion, age and time-to-treatment before 90 minutes were independent variables: age (OR 1.045, 95% CI 1.014-1.077, p= 0.004) and time-to-treatment (OR 0.267, 95% CI 0.088- 0.809, p= 0.020) Conclusions: The impact of time-to-treatment on favorable outcome varies widely depending on baseline stroke severity. The window for favorable outcome was <90min for severe strokes and extends to <240min in moderate stokes. However, time-to-treatment appeared unrelated to functional outcome in minor stroke.

Abstract TP76: Symptomatic Intracranial Hemorrhage After IV tPA for Acute Ischemic Stroke in Patients with Relative Contraindications

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Kyle C Smith ◽  
Mohammed Alkuwaiti ◽  
Caitlin Bell ◽  
Donna Lindsay ◽  
Angela Heyer ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Intracranial Hemorrhage ◽  
Hemorrhagic Transformation ◽  
Exclusion Criteria ◽  
Exact Test ◽  
Medical Chart Review ◽  
Significant Difference ◽  
The Impact ◽  
Iv Tpa

Introduction: Contraindications to IV tPA in acute ischemic stroke (AIS) limits access to a proven medical therapy. A 2015 AHA review assigned Class 3 recommendations (harm) to IV tPA for AIS patients with prior intracranial hemorrhage (pICH), stroke within the last 3 months (SW3), or low platelets (LP) defined as platelets < 100,000. These recommendations, however, were based on sparse literature, notably only 4 AIS patients with pICH and 31 with LP, were reviewed. Our study further investigates the safety of IV tPA in these patient populations. Methods: We retrospectively reviewed all AIS cases treated with IV tPA at 2 academic centers from 1998-2015 and 2013-2015. Clinical data, including patient demographics, NIHSS, and relative exclusion criteria, was abstracted from each institution’s prospectively maintained stroke database. Neuroimaging and medical chart review was performed by two stroke neurologists. Results: 324 consecutive AIS patients treated with IV tPA were reviewed. We identified 12 patients who met current Class 3 exclusion criteria (eight pICH, two SW3, two LP). Two patients developed symptomatic hemorrhagic transformation and both had pICH (Table). For comparison, the symptomatic ICH rate in AIS patients receiving IV tPA without relative exclusion criteria was 2.37%, a statistically significant difference (p<0.02, using Fisher’s exact test). Conclusions: 12 AIS patients with Class 3 exclusion criteria were treated with IV tPA. Our eight reported cases of IV tPA in pICH patients adds substantially to the existing literature. In this study, 25% of patients with pICH developed symptomatic ICH after IV tPA. Although the low number of eligible patients limits interpretation of our findings, continued caution when considering IV tPA for AIS patients with pICH may be warranted. More data is needed to clarify the impact these relative contraindications have on the treatment of AIS.

Prognostic value of absolute monocyte count in chronic lymphocytic leukaemia

2015 ◽  
Vol 156 (15) ◽  
pp. 592-597
Author(s):  
László Szerafin ◽  
János Jakó ◽  
Ferenc Riskó
Keyword(s):  
Chronic Lymphocytic Leukaemia ◽  
Prognostic Value ◽  
Lymphocytic Leukaemia ◽  
Treatment Time ◽  
Monocyte Count ◽  
Time To Treatment ◽  
Causes Of Mortality ◽  
The Absolute ◽  
The Impact ◽  
Overal Survival

Introduction: The low peripheral absolute lymphocyte and high monocyte count have been reported to correlate with poor clinical outcome in various lymphomas and other cancers. However, a few data known about the prognostic value of absolute monocyte count in chronic lymphocytic leukaemia. Aim: The aim of the authors was to investigate the impact of absolute monocyte count measured at the time of diagnosis in patients with chronic lymphocytic leukaemia on the time to treatment and overal survival. Method: Between January 1, 2005 and December 31, 2012, 223 patients with newly-diagnosed chronic lymphocytic leukaemia were included. The rate of patients needing treatment, time to treatment, overal survival and causes of mortality based on Rai stages, CD38, ZAP-70 positivity and absolute monocyte count were analyzed. Results: Therapy was necessary in 21.1%, 57.4%, 88.9%, 88.9% and 100% of patients in Rai stage 0, I, II, III an IV, respectively; in 61.9% and 60.8% of patients exhibiting CD38 and ZAP-70 positivity, respectively; and in 76.9%, 21.2% and 66.2% of patients if the absolute monocyte count was <0.25 G/l, between 0.25–0.75 G/l and >0.75 G/l, respectively. The median time to treatment and the median overal survival were 19.5, 65, and 35.5 months; and 41.5, 65, and 49.5 months according to the three groups of monocyte counts. The relative risk of beginning the therapy was 1.62 (p<0.01) in patients with absolute monocyte count <0.25 G/l or >0.75 G/l, as compared to those with 0.25–0.75 G/l, and the risk of overal survival was 2.41 (p<0.01) in patients with absolute monocyte count lower than 0.25 G/l as compared to those with higher than 0.25 G/l. The relative risks remained significant in Rai 0 patients, too. The leading causes of mortality were infections (41.7%) and the chronic lymphocytic leukaemia (58.3%) in patients with low monocyte count, while tumours (25.9–35.3%) and other events (48.1 and11.8%) occurred in patients with medium or high monocyte counts. Conclusions: Patients with low and high monocyte counts had a shorter time to treatment compared to patients who belonged to the intermediate monocyte count group. The low absolute monocyte count was associated with increased mortality caused by infectious complications and chronic lymphocytic leukaemia. The absolute monocyte count may give additional prognostic information in Rai stage 0, too. Orv. Hetil., 2015, 156(15), 592–597.

scholarly journals Meta-analysis and metaregression of risk factors associated with mortality in hip fracture patients during the COVID-19 pandemic

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Firas J. Raheman ◽  
Djamila M. Rojoa ◽  
Jvalant Nayan Parekh ◽  
Reshid Berber ◽  
Robert Ashford
Keyword(s):  
Hip Fracture ◽  
Hip Fractures ◽  
Case Fatality Rate ◽  
Excess Mortality ◽  
Meta Analysis ◽  
Case Fatality ◽  
Pooled Analysis ◽  
Fatality Rate ◽  
Increased Risk ◽  
The Impact

AbstractIncidence of hip fractures has remained unchanged during the pandemic with overlapping vulnerabilities observed in patients with hip fractures and those infected with COVID-19. We aimed to investigate the independent impact of COVID-19 infection on the mortality of these patients. Healthcare databases were systematically searched over 2-weeks from 1st–14th November 2020 to identify eligible studies assessing the impact of COVID-19 on hip fracture patients. Meta-analysis of proportion was performed to obtain pooled values of prevalence, incidence and case fatality rate of hip fracture patients with COVID-19 infection. 30-day mortality, excess mortality and all-cause mortality were analysed using a mixed-effects model. 22 studies reporting 4015 patients were identified out of which 2651 (66%) were assessed during the pandemic. An excess mortality of 10% was seen for hip fractures treated during the pandemic (OR 2.00, p = 0.007), in comparison to the pre-pandemic controls (5%). Estimated mortality of COVID-19 positive hip fracture patients was four-fold (RR 4.59, p < 0.0001) and 30-day mortality was 38.0% (HR 4.73, p < 0.0001). The case fatality rate for COVID-19 positive patients was 34.74%. Between-study heterogeneity for the pooled analysis was minimal (I2 = 0.00) whereas, random effects metaregression identified subgroup heterogeneity for male gender (p < 0.001), diabetes (p = 0.002), dementia (p = 0.001) and extracapsular fractures (p = 0.01) increased risk of mortality in COVID-19 positive patients.

Pemetrexed Versus Pemetrexed and Carboplatin As Second-Line Chemotherapy in Advanced Non–Small-Cell Lung Cancer: Results of the GOIRC 02-2006 Randomized Phase II Study and Pooled Analysis With the NVALT7 Trial

2012 ◽  
Vol 30 (36) ◽  
pp. 4501-4507 ◽  
Author(s):  
Andrea Ardizzoni ◽  
Marcello Tiseo ◽  
Luca Boni ◽  
Andrew D. Vincent ◽  
Rodolfo Passalacqua ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Advanced Nsclc ◽  
Pooled Analysis ◽  
Small Cell ◽  
Second Line ◽  
Small Cell Lung ◽  
Platinum Based Chemotherapy ◽  
The Impact

Purpose To compare efficacy of pemetrexed versus pemetrexed plus carboplatin in pretreated patients with advanced non–small-cell lung cancer (NSCLC). Patients and Methods Patients with advanced NSCLC, in progression during or after first-line platinum-based chemotherapy, were randomly assigned to receive pemetrexed (arm A) or pemetrexed plus carboplatin (arm B). Primary end point was progression-free survival (PFS). A preplanned pooled analysis of the results of this study with those of the NVALT7 study was carried out to assess the impact of carboplatin added to pemetrexed in terms of overall survival (OS). Results From July 2007 to October 2009, 239 patients (arm A, n = 120; arm B, n = 119) were enrolled. Median PFS was 3.6 months for arm A versus 3.5 months for arm B (hazard ratio [HR], 1.05; 95% CI, 0.81 to 1.36; P = .706). No statistically significant differences in response rate, OS, or toxicity were observed. A total of 479 patients were included in the pooled analysis. OS was not improved by the addition of carboplatin to pemetrexed (HR, 90; 95% CI, 0.74 to 1.10; P = .316; P heterogeneity = .495). In the subgroup analyses, the addition of carboplatin to pemetrexed in patients with squamous tumors led to a statistically significant improvement in OS from 5.4 to 9 months (adjusted HR, 0.58; 95% CI, 0.37 to 0.91; P interaction test = .039). Conclusion Second-line treatment of advanced NSCLC with pemetrexed plus carboplatin does not improve survival outcomes as compared with single-agent pemetrexed. The benefit observed with carboplatin addition in squamous tumors may warrant further investigation.

Abstract TP73: Transition of ECASS III Results to Clinical Practice: 90 Day Outcomes in a US Cohort

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Carolyn A Cronin ◽  
Patricia Langenberg ◽  
Tara M Dutta ◽  
Steven J Kittner
Keyword(s):  
Clinical Practice ◽  
Functional Outcome ◽  
Treatment Time ◽  
Small Community ◽  
Time To Treatment ◽  
Select Group ◽  
Symptomatic Intracerebral Hemorrhage ◽  
Increased Risk ◽  
The Usa ◽  
Iv Tpa

Introduction: ECASS III showed benefit of IV tPA for acute ischemic stroke (AIS) 3-4.5 hr from onset in a select group of patients from Europe, with this extended treatment subsequently recommended by the AHA/ASA. We prospectively enrolled AIS patients treated with IV tPA as this recommendation was being applied in clinical practice, to determine safety and efficacy in a representative cohort from the USA. Methods: Consecutive AIS patients treated with IV tPA at 18 primary stroke centers throughout Maryland were approached and informed consent obtained during hospitalization. Sites ranged from small community hospitals to large academic medical centers. In-hospital and demographic data were obtained from each site’s GWTG database or directly from the medical record. Study personnel blinded to the treatment time window obtained 90 day modified Rankin Scale (mRS) by structured phone interview. Patients were grouped by time to treatment (≤ 3hr vs. 3-4.5hr) and compared for presence of additional exclusion criteria from ECASS III that are not standard practice in the USA for ≤ 3hr (age >80, history of stroke and diabetes, oral anticoagulant treatment, and NIHSS>25). Good functional outcome (mRS 0-1 and 0-2), mortality, and symptomatic intracerebral hemorrhage (sICH) were analyzed. Results: Patients treated 3-4.5hr were somewhat younger (mean age 62.6 vs. 66.6, p=0.06), and had smaller infarcts (median NIHSS 5 vs. 8, p=0.04). There was only partial adherence to the additional ECASS exclusions (Table 1). There were no significant differences by time to treatment in sICH, mortality, or 90 day functional outcome (Table 2). Conclusion: For US patients treated with IV tPA 3-4.5 hr from onset in every day practice, there is no evidence for increased risk or worse outcomes compared to standard treatment up to 3 hr.

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