Uric Acid Boosts 'Clot-Busting' Therapy for Stroke

How hard will it be for this research from Spain to be implemented in the US? I'm guessing 50 years so US survivors will be fucked over for that long because no one is implementing research into clinical applications.
http://www.medpagetoday.com/Cardiology/Strokes/52559?xid=nl_mpt_DHE_2015-07-13&eun=g424561d0r
Giving uric acid (UA) with intravenous thrombolytic therapy to patients with acute ischemic stroke could help improve 90-day outcomes, particularly in women, Spanish researchers have found.
Reanalyzing results of the Efficacy Study of Combined Treatment With Uric Acid and rtPA in Acute Ischemic Stroke (URICO-ICTUS) trial -- - a 10-center study in which 411 stroke patients were treated with alteplase and either 1,000 mg of UA or placebo within 4.5 hours of symptom onset -- - researchers found that 47 of 111 (42%) women treated with UA, and 28 of 95 (29%) women treated with placebo, achieved an excellent outcome at 90 days.

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Excellent outcome was defined as a modified Rankin Scale (mRS) of 0 to 1, in patients with a premorbid mRS score <2, or an mRS of 2, in patients with a premorbid mRS score equal to 2. By comparison, 36 of 100 (36%) men treated with UA and 38 of 105 (34%) men treated with placebo achieved excellent outcome.
"UA therapy doubled the effect of placebo to attain an excellent outcome in women (OR 2.088; 95% C.I. 1.050-4.150; P=0.036) but not in men (OR 0.999; 95% C.I. 0.516-1.934; P=0.997)," wrote Laura Llull, MD, of the University of Barcelona, Spain, and colleagues in the journal Stroke. In addition, interactions between treatment and serum UA levels (P<0.001) or allantoin/UA ratio (P<0.001) on infarct growth were found to be significant only in women, they said.
During the URICO-ICTUS study, patients had a non-contrast CT at baseline and at 36 hours were admitted to stroke-dedicated hospital units. Vital signs and blood pressure were monitored for at least 24 hours; neurological status was assessed using the NIH Stroke Scale (NIHSS) every four to eight hours during hospitalizations; functional outcome was assessed with the mRS at 90 days by certified stroke neurologists.
Multimodal brain imaging was performed in 46 participants, of whom blood samples were collected in 43. Infarct growth was defined as the difference between 72-hour diffusion-weighted imaging infarct volume and baseline nonviable tissue volume on CT perfusion. Serum UA and allantoin were measured in blood samples collected before treatment onset, at 6 to 12 hours, at 48 hours, and at 90 days. The AL/UA ratio and the percent change of serum UA from baseline values also were calculated.
During the reanalysis, researchers divided patient records by gender, and compared baseline demographic features, risk factors, baseline biological findings, stroke subtypes, neurological course and radiological findings between the two groups.

The 206 women and 205 men had significant differences in demographics, risk factors, stroke subtypes and clinical severity at baseline, the authors found. The interaction between treatment (UA or placebo) and gender had a significant effect on the rate of excellent outcome (P=0.045), indicating that the effect of therapy on outcome differed by gender. Statistical analyses found that UA therapy was more effective than placebo in women but not men, and that the NIHSS score at study onset was the only additional independent factor associated with excellent outcome at 90 days in both women (OR 0.844; 95% C.I. 0.790-0.902; P<0.001) and men (OR 0.821; [95% CI 0.762 - 0.866] P <0.001).
UA and allantoin were highly correlated in baseline serum, at 6 to 12 hours, at 48 hours and at 90 days, they found. Treatment and gender had a significant interaction with UA levels at 6 to 12 hours, with serum allantoin at 6 to 12 hours and at 48 hours, and with the AL/UA ratio at 6 to 12 hours and at 48 hours. In untreated patients, serum UA declined at 6 to 12 hours, 48 hours and 90 days after stroke onset, and the serum UA levels were lower in women than in men. After UA therapy, both genders had increased serum UA levels at 6 to 12 hours. Serum allantoin did not change over time in the placebo group; women had lower levels than men at 6 to 12 hours and 48 hours, but not at 90 days. Both genders showed a significant rise in allantoin levels at 6 to 12 hours, 48 hours and at 90 days of UA therapy.
The interaction between treatment and gender with regard to infarct growth was not significant (P=0.973) but UA therapy was found to be better than placebo in reducing infarct growth in women but not men, and there was a significant interaction between treatment and UA levels on infarct growth in women but not in men. Infarct growth decreased in women with higher AL/UA ratio at 6 to 12 hours after UA treatment; this correlation was not significant in men.
Study limitations were the smaller cohort of patients who had multimodal brain imaging, or serum samples collected for evaluation, the authors said.
"This exploratory reanalysis of the URICO-ICTUS trial highlighted the clinical value of the administration of UA in women with acute ischemic stroke who received thrombolysis within 4.5 hours of clinical onset," the authors wrote. "Given the major practical implications that could be derived in the field of acute ischemic stroke, larger confirmatory studies will be urgently required to confirm these encouraging results."