التفاصيل البيبلوغرافية
| العنوان: |
Association of Reperfusion After Thrombolysis With Clinical Outcome Across the 4.5-to 9-Hours and Wake-Up Stroke Time Window A Meta-Analysis of the EXTEND and EPITHET Randomized Clinical Trials |
| المؤلفون: |
Campbell, Bruce C. V., Ma, Henry, Desmond, Patricia M., Wijeratne, Tissa, Curtze, Sami, Barber, P. Alan, De Silva, Deidre A., Thijs, Vincent, Levi, Christopher R., Bladin, Christopher F., Sharma, Gagan, Bivard, Andrew, Parsons, Mark W., Donnan, Geoffrey A., Davis, Stephen M., Churilov, Leonid, Yassi, Nawaf, Kleinig, Timothy J., Hsu, Chung Y., Dewey, Helen M., Butcher, Kenneth S., Yan, Bernard |
| المساهمون: |
The University of Newcastle. Faculty of Health & Medicine, School of Medicine and Public Health |
| بيانات النشر: |
American Medical Association |
| سنة النشر: |
2020 |
| المجموعة: |
NOVA: The University of Newcastle Research Online (Australia) |
| مصطلحات موضوعية: |
neurology, cerebrovascular disease, cerebrovascular infarction, clinical pharmacy and pharmacology, stroke, bleeding and transfusion, SDG 3, Sustainable Development Goals |
| الوصف: |
Importance Intravenous alteplase reduces disability after ischemic stroke in patients 4.5 to 9 hours after onset and with wake-up onset stroke selected using perfusion imaging mismatch. However, whether the benefit is consistent across the 4.5- to 6-hours, 6- to 9-hours, and wake-up stroke epochs is uncertain. Objective To examine the association of reperfusion with reduced disability, including by onset-to-randomization time strata in the Extending the Time for Thrombolysis in Emergency Neurological Deficits (EXTEND) and Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET) randomized clinical trials. Design, Setting, and Participants Individual patient meta-analysis of randomized clinical trials performed from August 2001 to June 2018 with 3-month follow-up. Patients had acute ischemic stroke with 4.5-to 9-hours poststroke onset or with wake-up stroke were randomized to alteplase or placebo after perfusion mismatch imaging. Analysis began July 2019 and ended May 2020. Exposures Reperfusion was defined as more than 90% reduction in time to maximum of more than 6 seconds’ lesion volume at 24- to 72-hour follow-up. Main Outcomes and Measures Ordinal logistic regression adjusted for baseline age and National Institutes of Health Stroke Scale score was used to analyze functional improvement in day 90 modified Rankin Scale score overall, including a reperfusion × time-to-randomization multiplicative interaction term, and in the 4.5- to 6-hours, 6- to 9-hours, and wake-up time strata. Symptomatic hemorrhage was defined as large parenchymal hematoma with a National Institutes of Health Stroke Scale score increase of 4 points or more. Results Reperfusion was assessable in 270 of 295 patients (92%), 68 of 133 (51%) in the alteplase group, and 38 of 137 (28%) in the placebo reperfused group (P < .001). The median (interquartile range) age was 76 (66-81) years in the reperfusion group vs 74 (64.5-81.0) years in the group with no reperfusion. The median (interquartile range) baseline National Institutes of Health ... |
| نوع الوثيقة: |
article in journal/newspaper |
| اللغة: |
English |
| تدمد: |
2168-6149 |
| العلاقة: |
NHMRC.APP1079696 http://purl.org/au-research/grants/nhmrc/1079696Test, APP1132621 http://purl.org/au-research/grants/nhmrc/1132621Test; JAMA Neurology Vol. 78, Issue 2, p. 236-240; http://hdl.handle.net/1959.13/1440141Test; uon:41084 |
| الإتاحة: |
http://hdl.handle.net/1959.13/1440141Test |
| رقم الانضمام: |
edsbas.30205116 |
| قاعدة البيانات: |
BASE |
