Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 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:

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's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:http://oc1dean.blogspot.com/2010/11/my-background-story_8.html

Friday, April 27, 2018

Tenecteplase versus Alteplase before Thrombectomy for Ischemic Stroke

Do you trust this being implemented in your stroke hospital since I bet no new stroke rehab protocols have occurred in the past 20 years? You can ask your stroke hospital president for confirmation as to how incompetent they are. Have they ever translated research into stroke protocols?
Is their full recovery after using tPA better than 12%?
Is their full recovery after rehab better than 10%?

Tenecteplase versus Alteplase before Thrombectomy for Ischemic Stroke



  • Bruce C.V. Campbell, Ph.D.,
  • Peter J. Mitchell, M.Med.,
  • Nawaf Yassi, Ph.D.,
  • Timothy J. Kleinig, Ph.D.,
  • Richard J. Dowling, M.B., B.S.,
  • Bernard Yan, M.B., B.S.,
  • Steven J. Bush, M.B., B.S.,
  • Helen M. Dewey, M.D.,
  • Vincent Thijs, M.D.,
  • Rebecca Scroop, M.B., B.S.,
  • Marion Simpson, M.B., B.S.,
  • Mark Brooks, M.B., B.S.,
  • Hamed Asadi, M.B., B.S.,
  • Teddy Y. Wu, M.B., B.S.,
  • Darshan G. Shah, M.B., B.S.,
  • Tissa Wijeratne, M.D.,
  • Timothy Ang, M.B., B.S.,
  • Ferdinand Miteff, M.B., B.S.,
  • Christopher R. Levi, M.B., B.S.,
  • Edrich Rodrigues, M.B., B.S.,
  • Henry Zhao, M.B., B.S.,
  • Patrick Salvaris, M.B., B.S.,
  • Carlos Garcia-Esperon, M.D.,
  • Peter Bailey, M.D.,
  • Henry Rice, M.B., B.S.,
  • Laetitia de Villiers, M.B., B.S.,
  • Helen Brown, M.B., B.S.,
  • Kendal Redmond, M.B., B.S.,
  • David Leggett, M.B., B.S.,
  • John N. Fink, M.D.,
  • Wayne Collecutt, M.B., B.S.,
  • Andrew A. Wong, M.B., B.S.,
  • Claire Muller, M.B., B.S.,
  • Alan Coulthard, M.B., B.S.,
  • Ken Mitchell, M.B., B.S.,
  • John Clouston, M.B., B.S.,
  • Kate Mahady, M.B., B.S.,
  • Deborah Field, M.B., B.S.,
  • Henry Ma, Ph.D.,
  • Thanh G. Phan, Ph.D.,
  • Winston Chong, M.B., B.S.,
  • Ronil V. Chandra, M.B., B.S.,
  • Lee-Anne Slater, M.B., B.S.,
  • Martin Krause, M.D.,
  • Timothy J. Harrington, M.B., B.S.,
  • Kenneth C. Faulder, M.B., B.S.,
  • Brendan S. Steinfort, M.B., B.S.,
  • Christopher F. Bladin, Ph.D.,
  • Gagan Sharma, M.C.A.,
  • Patricia M. Desmond, M.D.,
  • Mark W. Parsons, Ph.D.,
  • Geoffrey A. Donnan, M.D.,
  • and Stephen M. Davis, M.D.
  • et al.,


Abstract

Background

Intravenous infusion of alteplase is used for thrombolysis before endovascular thrombectomy for ischemic stroke. Tenecteplase, which is more fibrin-specific and has longer activity than alteplase, is given as a bolus and may increase the incidence of vascular reperfusion.

Methods

We randomly assigned patients with ischemic stroke who had occlusion of the internal carotid, basilar, or middle cerebral artery and who were eligible to undergo thrombectomy to receive tenecteplase (at a dose of 0.25 mg per kilogram of body weight; maximum dose, 25 mg) or alteplase (at a dose of 0.9 mg per kilogram; maximum dose, 90 mg) within 4.5 hours after symptom onset. The primary outcome was reperfusion of greater than 50% of the involved ischemic territory or an absence of retrievable thrombus at the time of the initial angiographic assessment. Noninferiority of tenecteplase was tested, followed by superiority. Secondary outcomes included the modified Rankin scale score (on a scale from 0 [no neurologic deficit] to 6 [death]) at 90 days. Safety outcomes were death and symptomatic intracerebral hemorrhage.

Results

Of 202 patients enrolled, 101 were assigned to receive tenecteplase and 101 to receive alteplase. The primary outcome occurred in 22% of the patients treated with tenecteplase versus 10% of those treated with alteplase (incidence difference, 12 percentage points; 95% confidence interval [CI], 2 to 21; incidence ratio, 2.2; 95% CI, 1.1 to 4.4; P=0.002 for noninferiority; P=0.03 for superiority). Tenecteplase resulted in a better 90-day functional outcome than alteplase (median modified Rankin scale score, 2 vs. 3; common odds ratio, 1.7; 95% CI, 1.0 to 2.8; P=0.04). Symptomatic intracerebral hemorrhage occurred in 1% of the patients in each group.

Conclusions

Tenecteplase before thrombectomy was associated with a higher incidence of reperfusion and better functional outcome than alteplase among patients with ischemic stroke treated within 4.5 hours after symptom onset. (Funded by the National Health and Medical Research Council of Australia and others; EXTEND-IA TNK ClinicalTrials.gov number, NCT02388061.)

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