Deans' stroke musings: Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Tuesday, August 19, 2014

Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials

This makes it sound like tPA is 32.9% effective as compared to 12% from an earlier report. Your doctor should be able to compare their hospital statistics to see if they are least match this better result. If your hospital doesn't even know how well tPA works then the head stroke doctor should be fired.
http://www.mdlinx.com/internal-medicine/newsl-article.cfm/5461158/ZZF307965849E94474BB34FC062CEC0F93/?
Alteplase is effective for treatment of acute ischaemic stroke but debate continues about its use after longer times since stroke onset, in older patients, and among patients who have had the least or most severe strokes. Authors assessed the role of these factors in affecting good stroke outcome in patients given alteplase. Irrespective of age or stroke severity, and despite an increased risk of fatal intracranial haemorrhage during the first few days after treatment, alteplase significantly improves the overall odds of a good stroke outcome when delivered within 4•5 h of stroke onset, with earlier treatment associated with bigger proportional benefits.
Methods

Authors did a pre–specified meta–analysis of individual patient data from 6756 patients in nine randomised trials comparing alteplase with placebo or open control.
They included all completed randomised phase 3 trials of intravenous alteplase for treatment of acute ischaemic stroke for which data were available.
Retrospective checks confirmed that no eligible trials had been omitted.
They defined a good stroke outcome as no significant disability at 3—6 months, defined by a modified Rankin Score of 0 or 1. (mine was obviously a failure)
Additional outcomes included symptomatic intracranial haemorrhage (defined by type 2 parenchymal haemorrhage within 7 days and, separately, by the SITS–MOST definition of parenchymal type 2 haemorrhage within 36 h), fatal intracranial haemorrhage within 7 days, and 90–day mortality.

Results

Alteplase increased the odds of a good stroke outcome, with earlier treatment associated with bigger proportional benefit.
Treatment within 3•0 h resulted in a good outcome for 259 (32•9%) of 787 patients who received alteplase versus 176 (23•1%) of 762 who received control (OR 1•75, 95% CI 1•35—2•27); delay of greater than 3•0 h, up to 4•5 h, resulted in good outcome for 485 (35•3%) of 1375 versus 432 (30•1%) of 1437 (OR 1•26, 95% CI 1•05—1•51); and delay of more than 4•5 h resulted in good outcome for 401 (32•6%) of 1229 versus 357 (30•6%) of 1166 (OR 1•15, 95% CI 0•95—1•40).
Proportional treatment benefits were similar irrespective of age or stroke severity.
Alteplase significantly increased the odds of symptomatic intracranial haemorrhage (type 2 parenchymal haemorrhage definition 231 [6•8%] of 3391 vs 44 [1•3%] of 3365, OR 5•55, 95% CI 4•01—7•70, p<0•0001; SITS–MOST definition 124 [3•7%] vs 19 [0•6%], OR 6•67, 95% CI 4•11—10•84, p<0•0001) and of fatal intracranial haemorrhage within 7 days (91 [2•7%] vs 13 [0•4%]; OR 7•14, 95% CI 3•98—12•79, p<0•0001).
The relative increase in fatal intracranial haemorrhage from alteplase was similar irrespective of treatment delay, age, or stroke severity, but the absolute excess risk attributable to alteplase was bigger among patients who had more severe strokes.
There was no excess in other early causes of death and no significant effect on later causes of death.
Consequently, mortality at 90 days was 608 (17•9%) in the alteplase group versus 556 (16•5%) in the control group (hazard ratio 1•11, 95% CI 0•99—1•25, p=0•07).
Taken together, therefore, despite an average absolute increased risk of early death from intracranial haemorrhage of about 2%, by 3—6 months this risk was offset by an average absolute increase in disability–free survival of about 10% for patients treated within 3•0 h and about 5% for patients treated after 3•0 h, up to 4•5 h.