http://dgnews.docguide.com/tissue-plasminogen-activator-provides-no-benefit-mild-strokes?
January 30, 2018
By Alex Morrisson
LOS ANGELES -- January 30, 2018 -- Treatment of mild strokes with tissue plasminogen activator (tPA) may cause more harm than good, according to a study presented here at the 2018 International Stroke Conference (ISC).
In the PRISM trial, 78.2% of patients who experienced a stroke but did not have clearly disabling deficits and were treated with alteplase were discharged with modified Rankin Scores of 0-1. However, if these patients were treated with aspirin, 81.5% were discharged with modified Rankin Scores of 0-1.
Symptomatic intracranial haemorrhage in the trial was experienced by 5 of the 154 (3.2%) patients on alteplase compared with zero symptomatic intracranial haemorrhages in the 153 patients who were assigned to aspirin.
“Among patients with low National Institutes of Health Stroke Scale scores and not clearly-disabling deficits, alteplase may not provide benefit and increases the risk of intracranial haemorrhage,” said Pooja Khatri, MD, University of Cincinnati, Cincinnati, Ohio.
Patients in the study were randomised to receive alteplase 0.9 mg/kg plus aspirin 325 mg or aspirin alone. The intravenous drug had to be administered within 3 hours of the last time the person was known well. Patients were ineligible for the study if they had a modified Rankin Score of 2-5 prior to having the stroke. The primary endpoint was functional outcome (Rankin score of 0-1 at 90 days).
The PRISM trial was truncated due to slow enrolment. The researchers enrolled 313 patients, shy of the 948 patients that were considered necessary to determine the role of alteplase in the the treatment algorithm for stroke. The researchers analysed in an intent-to-treat method the 156 patients in the alteplase group and 157 in the aspirin only group.
“The benefits of alteplase are not likely to extend to those without clearly-disabling deficits at presentation,” said Dr. Khatri. “These findings should not be extrapolated to patients with NIHSS 0-5 scores and clearly-disabling strokes.”
[Presentation title: Alteplase for the Treatment of Acute Ischemic Stroke in Patients With Low NIHSS and Not Clearly-Disabling Deficits: Primary Results of the PRISMS Trial. Abstract LB9]
LOS ANGELES -- January 30, 2018 -- Treatment of mild strokes with tissue plasminogen activator (tPA) may cause more harm than good, according to a study presented here at the 2018 International Stroke Conference (ISC).
In the PRISM trial, 78.2% of patients who experienced a stroke but did not have clearly disabling deficits and were treated with alteplase were discharged with modified Rankin Scores of 0-1. However, if these patients were treated with aspirin, 81.5% were discharged with modified Rankin Scores of 0-1.
Symptomatic intracranial haemorrhage in the trial was experienced by 5 of the 154 (3.2%) patients on alteplase compared with zero symptomatic intracranial haemorrhages in the 153 patients who were assigned to aspirin.
“Among patients with low National Institutes of Health Stroke Scale scores and not clearly-disabling deficits, alteplase may not provide benefit and increases the risk of intracranial haemorrhage,” said Pooja Khatri, MD, University of Cincinnati, Cincinnati, Ohio.
Patients in the study were randomised to receive alteplase 0.9 mg/kg plus aspirin 325 mg or aspirin alone. The intravenous drug had to be administered within 3 hours of the last time the person was known well. Patients were ineligible for the study if they had a modified Rankin Score of 2-5 prior to having the stroke. The primary endpoint was functional outcome (Rankin score of 0-1 at 90 days).
The PRISM trial was truncated due to slow enrolment. The researchers enrolled 313 patients, shy of the 948 patients that were considered necessary to determine the role of alteplase in the the treatment algorithm for stroke. The researchers analysed in an intent-to-treat method the 156 patients in the alteplase group and 157 in the aspirin only group.
“The benefits of alteplase are not likely to extend to those without clearly-disabling deficits at presentation,” said Dr. Khatri. “These findings should not be extrapolated to patients with NIHSS 0-5 scores and clearly-disabling strokes.”
[Presentation title: Alteplase for the Treatment of Acute Ischemic Stroke in Patients With Low NIHSS and Not Clearly-Disabling Deficits: Primary Results of the PRISMS Trial. Abstract LB9]
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