Deans' stroke musings: WAKE-UP: Alteplase effective in acute stroke with suspected recent onset

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.

Sunday, May 27, 2018

WAKE-UP: Alteplase effective in acute stroke with suspected recent onset

Their definition of 'favorable' is setting the bar so low as to be meaningless. Better than doing nothing, true, but survivors want 100% recovery. What are you doing after that to get them there?
Damn it all, don't crow about minor victories, the war hasn't come close to being won. Rankin scale 1 still means some symptoms exist, YOU NEED TO FIX THOSE.
https://www.healio.com/cardiology/stroke/news/online/%7Ba6e9c317-c9c5-40ae-b719-65b6e59397d6%7D/wake-up-alteplase-effective-in-acute-stroke-with-suspected-recent-onset

Among patients with acute stroke of unknown time of onset but MRI findings indicating onset was recent, IV thrombolysis with alteplase resulted in a better functional outcome than treatment with placebo, according to the results of the WAKE-UP trial.

The findings were presented at the European Stroke Organization Conference and published in The New England Journal of Medicine.

“Intravenous thrombolysis with alteplase, a recombinant tissue plasminogen activator, is the standard medical treatment for acute ischemic stroke within 4.5 hours after the onset of symptoms. In 14% to 27% of strokes, the time of symptom onset is not known, frequently because stroke symptoms are recognized when the patient awakes from sleeping,” Götz Thomalla, MD, from the department of neurology at the University Medical Center Hamburg-Eppendorf, Germany, and colleagues wrote. “Such patients are generally excluded from treatment with intravenous alteplase, and only some of them are candidates for mechanical thrombectomy.”

To determine whether treatment with alteplase (Activase, Genentech) would improve functional outcomes in patients with an unknown time of stroke onset and a mismatch between diffusion-weighted imaging and fluid-attenuated inversion recovery (FLAIR) findings on MRI, the researchers conducted an investigator-initiated, multicenter, randomized, double-blind, placebo-controlled clinical trial.

According to the study, all the patients enrolled had an ischemic lesion that was visible on MRI diffusion-weighted imaging but no parenchymal hyperintensity on FLAIR, which indicated that the stroke had occurred approximately within the previous 4.5 hours.

Patients who had planned thrombectomies were excluded.

The primary endpoint of the study was favorable outcome, as defined by a score of 0 or 1 on the modified Rankin scale of neurologic disability at 90 days.

The secondary outcome was the likelihood that alteplase would lead to lower ordinal scores on the modified Rankin scale compared with placebo.

The trial was stopped early due to the cessation of funding and 503 patients of a planned 800 were enrolled.

Of the cohort, 254 were randomly assigned alteplase (mean age, 65 years; 65% men) and 249 to placebo (mean age, 65 years; 64% men).

At 90 days, a favorable outcome was observed in 53.3% of patients in the alteplase group and in 41.8% of patients in the placebo group (adjusted OR = 1.61; 95% CI, 1.09-2.36).

At 90 days, there was a median score on the modified Rankin scale of 1 in the alteplase group and 2 in the placebo group (adjusted common OR = 1.62; 95% CI, 1.17-2.23).