DLBS1033 treatment for ischemic stroke patients and clinical outcomes: systematic review of randomized controlled trial study

DLBS1033 is a lumbrokinase earned from extraction of earthworms, Lumbricus rubellus. Lumbrokinase has 2 main activities: fibrinolytic and fibrinogenolytic – these activities reduce blood viscosity and platelet aggregation. With all of those properties, DLBS1033 will be a promising agent in patients with ischemic stroke. The objective of this research is to identify the advantage of DLBS1033 in ischemic stroke patients' clinical outcome. We used Pub Med, Cochrane, and Clinical Key as our major database for this systematic review. "DLBS1033", "lumbrokinase", and "stroke" keywords selected to particularize the search. The 2 authors calculated each of the studies using Jadad score. Only certain studies with scores above 3 will be included for further review using PRISMA checklist. There were 27 studies relating to DLBS1033 or lumbrokinase and stroke. Further examination by 2 authors resulted in 23 articles being removed leaving 2 studies. Subjects in all of the said studies are ischemic stroke patients; predominantly male patients. All of the said studies compare DLBS1033 with standard therapy; either utilizing DLBS1033 as an additional therapy or as a separate therapy. Clinical outcomes were measured using NIHSS and BI. Compared to standard therapy, DLBS1033 proved successful in improving clinical outcomes among patients with ischemic stroke. It's also found to be safe with none serious adverse events and significantly has lower bleeding events.

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Impacts of treatments on recurrence and 28-year survival of ischemic stroke patients

Scientific Reports ◽

10.1038/s41598-021-94757-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ting-Ann Wang ◽

Tzy-Haw Wu ◽

Shin-Liang Pan ◽

Hsiu-Hsi Chen ◽

Sherry Yueh-Hsia Chiu

Keyword(s):

Ischemic Stroke ◽

Cerebrovascular Disease ◽

Cox Regression ◽

Controlled Trial ◽

Stroke Recurrence ◽

Long Term Effects ◽

Stroke Patients ◽

Double Blind ◽

Term Survival

AbstractAspirin and nicametate are well-established therapies for preventing recurrence and mortality from stroke in patients diagnosed as ischemic stroke. However, their respective effects on the recurrence, making allowance for the duration of recurrence and death without the occurrence of recurrence, and long-term survival have not been well elucidated. We aimed to evaluate long-term effect of two kinds of treatment on cerebrovascular death among ischemic stroke patients with or without the recurrence of stroke. Data used in this study were derived from the cohort based on a multicenter randomized double-blind controlled trial during 1992 to 1995 with the enrollment of a total of 466 patients with first-time non-cardioembolic ischemic stroke who were randomly allocated to receive aspirin (n = 222) or nicametate (n = 244). The trial cohort was followed up over time to ascertain the date of recurrence within trial period and death until Sep of 2019. The time-dependent Cox regression model was used to estimate the long-term effects of two treatments on death from cerebrovascular disease with and without recurrence. A total of 49 patients experienced stroke recurrence and 89 cerebrovascular deaths was confirmed. Patients treated with nicametate were more likely, but non statistically significantly, to have recurrence (aHR: 1.73, 95% CI 0.96–3.13) as compared with those treated by aspirin. Nicametate reduced the risk of cerebrovascular death about 37% (aHR: 0.63, 95% CI 0.41–0.97) compared with aspirin. The aspirin group had a lower recurrence rate than the nicametate group even with recurrence after 1–2 years of follow-up of first stroke but the latter had significantly reduced death from cerebrovascular disease for nicametate group, which requires more research to verify.

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Serotonin Versus Levodopa in Ischemic Stroke Patients (SELEIS): A Randomised, Double- Blind, Placebo-Controlled Trial

SSRN Electronic Journal ◽

10.2139/ssrn.3809815 ◽

2021 ◽

Author(s):

Dolores D. Cocho ◽

Jordi J. Espinosa ◽

Miguel M. Cuadrado ◽

Carlos C. Segui ◽

Raquel R. Cuevas ◽

...

Keyword(s):

Ischemic Stroke ◽

Controlled Trial ◽

Stroke Patients ◽

Double Blind ◽

Double Blind Placebo

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Abstract P132: Clinical Outcomes In Ischemic Stroke Patients With Uncontrolled Hypertension

Hypertension ◽

10.1161/hyp.78.suppl_1.p132 ◽

2021 ◽

Vol 78 (Suppl_1) ◽

Author(s):

Zahra Abuzaid ◽

Sara Almuslem ◽

Farah Aleisa

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Clinical Outcomes ◽

Recurrent Stroke ◽

Uncontrolled Hypertension ◽

Stroke Recurrence ◽

Stroke Patients ◽

Stroke Event ◽

Uncontrolled Blood Pressure

Background: Hypertension is considered major risk factor for incidence of ischemic stroke, controlling blood pressure reduces this risk, the relationship of uncontrolled blood pressure and stroke outcomes is complex, post stroke uncontrolled blood pressure remains one of the major contributing factors for stroke recurrence and mortality, in our study we studied the long term effects of uncontrolled hypertension in modern health care setting. Methodology: Patients in the study were admitted to the neurology department at KFSH-D between March 2015- August 2019, we included 102 acute ischemic stroke patients whom had hypertension, all patients had follow up appointments at stroke clinic a minimum of 2 visits over 4 years. We retrospectively compared blood pressure data from stroke patients with recurrent ischemic stroke events vs. patients with initial stroke event, and recurrent stroke, also we studied blood pressure readings for different stroke severity groups, patients who had severe stroke with mRS>4, compared to milder stroke group of mRS<4. Results: We found 48 patients identified with recurrent stroke event, those with uncontrolled hypertension had significantly higher stroke recurrence events (P=0.002), despite acute stroke treatment, patients who had history of uncontrolled hypertension were found to have more severe stroke deficits than those who had controlled blood pressure (P=0.029). We found significant difference in the long term stroke clinical outcomes between patients who had uncontrolled blood pressure and patients who had controlled blood pressure recordings within the same hospital setting (P=0.064). Conclusion: Based on our findings, uncontrolled hypertension was associated with higher risk of stroke recurrence, it also increased susceptibility to worse stroke clinical outcomes up to 1 year after initial stroke event, which deserved further close attention and better blood pressure control.

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CLINICAL OUTCOMES OF ACUTE ISCHEMIC STROKE PATIENTS STRATIFIED BY CARDIAC TROPONIN-I: A RETROSPECTIVE ANALYSIS

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(17)33529-5 ◽

2017 ◽

Vol 69 (11) ◽

pp. 140

Author(s):

Dylan Stanger ◽

Siu Him Chan ◽

Samuel Yip ◽

Belinda Rodis ◽

Andrew Starovoytov ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Retrospective Analysis ◽

Clinical Outcomes ◽

Cardiac Troponin ◽

Troponin I ◽

Cardiac Troponin I ◽

Stroke Patients

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Abstract TP24: Trends in Iv r-tpa and Thrombectomy Treatment Rates Before and After the LVO RCT’s in a Regional Tele-stroke Network

Stroke ◽

10.1161/str.48.suppl_1.tp24 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Naregnia Pierre Louis ◽

Suman Nalluri ◽

Benny Kim ◽

Aashish Anand ◽

Tanzila Shams ◽

...

Keyword(s):

Systematic Review ◽

Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Statistical Test ◽

Stroke Therapy ◽

Stroke Patients ◽

Chi Square ◽

The Third ◽

Before And After ◽

Acute Stroke Therapy

The presentation of endovascular stroke trials at international stroke conference was a land mark event in acute stroke therapy. This study aims to analyze the rates of utilization of IV r-tPA, with or without mechanical thrombectomy before and after the 2015 International Stroke Conference (ISC) in a large regional tele-stroke network. Methods: A systematic review of prospective telestroke and procedure database was performed for 18 months prior and 18 months post conference. There were three groups included in the analysis. The first group consisted ischemic stroke patients presented within 12 hours of onset including inpatient events, transfers from primary centers and rural clinics. The second group consisted of patients who received IV r-tPA, and the third group consisted of patients who received IV r-tPA and/or underwent mechanical thrombectomy for a demonstrated LVO. Results: A total of 2628 consecutive ischemic stroke events presented within 12 hours of onset were evaluated. In the pre-ISC conference group, there were 1135 ischemic stroke patients. IV r-tPA was given 535 times(47.1%) and mechanical thrombectomy was utilized in addition to IV r-tPA or alone 42 times(3.7%). In the post-ISC conference group, there were 1493 ischemic stroke patients. IV r-tPA was given 642 times(43%) and mechanical thrombectomy was utilized in addition to IV r-tPA or alone 132 times(8.84%). The Chi Square statistical test was performed comparing these groups. When comparing the rate of IV r-tPA usage, there was a significant decrease from the pre-ISC conference group to the post-ISC conference group (P= 0.04). When comparing the rate of mechanical thrombectomy performed, there was a significant increase of greater than double the percentage of thrombectomy procedures performed in the post conference group compared to the preconference group (p< 0.001). Conclusion: There was a significant decrease in IV r-tPA usage but a greater than double the increase in the thrombectomy rate . This may be secondary to increased awareness of benefit of thrombectomy at referral centers. Slightly lower rates of IV r-tPA usage may be secondary to an increase in transfers of patients outside of the 0-4.5 hr window but were deemed candidates for thrombectomy.

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Abstract TP13: Procedural Time (Groin Puncture to Recanalization) Significantly Predicts Outcomes in Endovascular Treatment: A Pooled Analysis of SWIFT, STAR and SWIFT PRIME Trials

Stroke ◽

10.1161/str.48.suppl_1.tp13 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Ameer E Hassan ◽

Jeffrey L Saver ◽

Mayank Goyal ◽

David S Liebeskind ◽

Reza Jahan ◽

...

Keyword(s):

Ischemic Stroke ◽

Endovascular Treatment ◽

Acute Ischemic Stroke ◽

Clinical Outcomes ◽

Pooled Analysis ◽

Favorable Outcome ◽

Stroke Patients ◽

Nihss Score ◽

Post Procedure ◽

Procedural Time

Background: Recent single center studies have suggested that “procedural time” independent of “time to procedure” can affect outcomes of acute ischemic stroke patients undergoing endovascular treatment (ET). We performed a pooled analysis from three ET trials to determine the effect of procedural time on angiographic and clinical outcomes. Objective: To determine the relationship between procedural time and clinical outcomes among acute ischemic stroke patients undergoing successful recanalization with ET. Methods: We analyzed data from SWIFT, STAR and SWIFT PRIME trials. Baseline demographic and clinical characteristics, NIHSS score on admission, intracranial hemorrhage rates and mRS at 3 months post procedure were analyzed. TICI scale was used to grade post procedure angiographic recanalization. Procedural time was defined by the time interval between groin puncture and recanalization. We estimated the procedural time after which favorable clinical outcome was unlikely even after recanalization (futile) after age and NIHSS score adjustment. Results: We analyzed 301 patients who underwent ET and had near complete or complete recanalization (TICI 2b or 3). The procedural time (±SD) was significantly shorter in patients who achieved a favorable outcome (mRS 0-2) compared with those who did not achieve favorable outcome (44±25 vs 51±33 minutes, p=0.04). Table 1. In the multivariate analysis (including all baseline characteristics with a p value <0.05 as independent variables), shorter procedural time was a significant predictor of lower odds of unfavorable outcome (OR 0.49, 95% CI 0.28, 0.85, p=0.012). The rates of favorable outcomes were significantly higher when the procedural time was <60 minutes compared with ≥60 minutes (62% vs 45%, p=0.020). Conclusion: Procedural time in patients undergoing mechanical thrombectomy for acute ischemic stroke is an important determinant of favorable outcomes in those with near complete or complete recanalization.

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Effectiveness of enteral ivabradine for heart rate control in septic shock: A randomised controlled trial

Anaesthesia and Intensive Care ◽

10.1177/0310057x211009913 ◽

2021 ◽

pp. 0310057X2110099

Author(s):

Priyankar K Datta ◽

Vimi Rewari ◽

Rashmi Ramachandran ◽

Preet M Singh ◽

Bikash R Ray ◽

...

Keyword(s):

Heart Rate ◽

Septic Shock ◽

Adverse Events ◽

Standard Therapy ◽

Controlled Trial ◽

Cardiac Pacemaker ◽

Stroke Volume Index ◽

Volume Index ◽

Serious Adverse Events ◽

Group I

Persistent tachycardia in patients with septic shock predicts poor outcome. This study sought to investigate the effect of the cardiac pacemaker current inhibitor ivabradine on heart rate and cardio-circulatory function in patients with septic shock. After informed consent, 60 patients with septic shock and persistent tachycardia (heart rate >95 /minute) were prospectively randomly assigned to receive either standard therapy for septic shock (group S) or standard therapy along with enteral ivabradine (group I) for the initial 96 hours after enrolment. Primary outcome was the difference in heart rate between the two groups during the first 96 hours. Secondary outcomes included the effect of ivabradine on haemodynamic, oxygenation, myocardial function and organ function parameters, incidence of adverse events and 30-day overall survival. Heart rate was lower in group I compared to group S (median difference in area under the curve –25.6 (95% confidence intervals –31.4 to –15.9) /minute; P <0.001). Vasopressor requirements, blood lactate levels, Sequential Organ Failure Assessment scores and E/e′ ratio were lower in group I compared to group S. Stroke volume index and ejection fraction were higher in group I while cardiac index and oxygen delivery parameters were maintained similar to group S. There was no difference in 30-day mortality or in the incidence of serious adverse events. Enteral ivabradine is effective in reducing heart rate, and improving haemodynamic parameters and cardiac function in patients with septic shock and persistent tachycardia, without increasing the incidence of adverse events.

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Abstract WP372: Hydration Status and Clinical Outcomes in Acute Ischemic Stroke Patients Undergoing Mechanical Thrombectomy

Stroke ◽

10.1161/str.51.suppl_1.wp372 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Mona N Bahouth ◽

Rebecca Gottesman

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Clinical Outcomes ◽

Blood Urea Nitrogen ◽

Mechanical Thrombectomy ◽

Large Vessel ◽

Hydration Status ◽

Creatinine Ratio ◽

Stroke Patients ◽

Anterior Circulation

Introduction: Impaired hydration measured by elevated blood urea nitrogen (BUN) to creatinine ratio has been associated with worsened outcome after acute ischemic stroke. Whether hydration status is relevant for patients with acute ischemic stroke treated with mechanical thrombectomy remains unknown. Materials and Methods: We conducted a retrospective review of consecutive acute ischemic stroke patients who underwent endovascular procedures for anterior circulation large artery occlusion at Johns Hopkins Comprehensive Stroke Centers between 2012 and 2017. A volume contracted state (VCS), was determined based on surrogate lab markers and defined as blood urea nitrogen (BUN) to creatinine ratio greater than 15. Endpoints were achievement of successful revascularization (TICI 2b or 3), early re-occlusion, and short term clinical outcomes including development of early neurological worsening and functional outcome at 3 months. Results: Of the 158 patients who underwent an endovascular procedure, 102 patients had a final diagnosis of anterior circulation large vessel occlusion and met the inclusion criteria for analysis. Volume contracted state was present in 62/102 (61%) of patients. Successful revascularization was achieved in 75/102 (74%) of the cohort. There was no relationship between VCS and successful revascularization, but there was a 1.13 increased adjusted odds (95% CI 1.01, 1.27) of re-occlusion within 24 hours for every point higher BUN/creatinine ratio in the subset of patients who underwent radiological testing for pre-procedure planning (n=57). There was no relationship between VCS and clinical outcomes including early neurological worsening and 3 month outcome. Conclusions: Patients with VCS and large vessel anterior circulation stroke may have a higher odds of early re-occlusion after mechanical thrombectomy than their non-VCS counterparts, but no differences in successful revascularization nor clinical outcomes were present in this cohort. These results may suggest an opportunity for the exploration of pre-procedure hydration to improve outcomes.

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