How does this one compare to
these 31 hyperacute possibilities I'm going to insist my doctor give me the first week.
Exactly when is your doctor going to start clinical trials to prove efficacy of therapies in the first week? Or is your doctor a lazy bastard because it is
somebody elses' problem?
Prehospital use of magnesium sulfate as neuroprotection in acute stroke.
Saver JL1,
Starkman S,
Eckstein M,
Stratton SJ,
Pratt FD,
Hamilton S,
Conwit R,
Liebeskind DS,
Sung G,
Kramer I,
Moreau G,
Goldweber R,
Sanossian N;
FAST-MAG Investigators and Coordinators.
Abstract
BACKGROUND:
Magnesium
sulfate is neuroprotective in preclinical models of stroke and has
shown signals of potential efficacy with an acceptable safety profile
when delivered early after stroke onset in humans. Delayed initiation of
neuroprotective agents has hindered earlier phase 3 trials of
neuroprotective agents.
METHODS:
We
randomly assigned patients with suspected stroke to receive either
intravenous magnesium sulfate or placebo, beginning within 2 hours after
symptom onset. A loading dose was initiated by paramedics before the
patient arrived at the hospital, and a 24-hour maintenance infusion was
started on the patient's arrival at the hospital. The primary outcome
was the degree of disability at 90 days, as measured by scores on the
modified Rankin scale (range, 0 to 6, with higher scores indicating
greater disability).
RESULTS:
Among
the 1700 enrolled patients (857 in the magnesium group and 843 in the
placebo group), the mean (±SD) age was 69±13 years, 42.6% were women,
and the mean pretreatment score on the Los Angeles Motor Scale of stroke
severity (range, 0 to 10, with higher scores indicating greater motor
deficits) was 3.7±1.3. The final diagnosis of the qualifying event was
cerebral ischemia in 73.3% of patients, intracranial hemorrhage in
22.8%, and a stroke-mimicking condition in 3.9%. The median interval
between the time the patient was last known to be free of stroke
symptoms and the start of the study-drug infusion was 45 minutes
(interquartile range, 35 to 62), and 74.3% of patients received the
study-drug infusion within the first hour after symptom onset. There was
no significant shift in the distribution of 90-day disability outcomes
on the global modified Rankin scale between patients in the magnesium
group and those in the placebo group (P=0.28 by the
Cochran-Mantel-Haenszel test); mean scores at 90 days did not differ
between the magnesium group and the placebo group (2.7 in each group,
P=1.00). No significant between-group differences were noted with
respect to mortality (15.4% in the magnesium group and 15.5% in the
placebo group, P=0.95) or all serious adverse events.
CONCLUSIONS:
Prehospital
initiation of magnesium sulfate therapy was safe and allowed the start
of therapy within 2 hours after the onset of stroke symptoms,
but it did
not improve disability outcomes at 90 days. (Funded by the National
Institute of Neurological Disorders and Stroke; FAST-MAG
ClinicalTrials.gov number,
NCT00059332.).
No comments:
Post a Comment