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.

Friday, July 20, 2018

Effect of alteplase vs aspirin on functional outcome for patients with acute ischemic stroke and minor nondisabling neurologic deficits: The PRISMS randomized clinical trial

Regardless, both of these are failures. 100% recovery is the goal, not just a nebulous favorable outcome.
https://www.mdlinx.com/journal-summaries/alteplase-aspirin-acute-ischemic-stroke-minor/2018/07/18/7527902/ZZ3559DFF1FDFD43F3965FF05AF76C7B18?
JAMA — Khatri P, et al. | July 18, 2018
In patients with National Institutes of Health Stroke Scale (NIHSS) scores of 0 to 5 whose deficits are not clearly disabling, the efficacy and safety of alteplase were evaluated. Findings suggested that treatment with alteplase vs aspirin did not increase the odds of favorable functional outcome at 90 days in patients with minor nondisabling acute ischemic stroke. However, the very early study termination precludes any definitive conclusions.

Methods

  • The PRISMS trial was designed as a 948-patient, phase 3b, double-blind, double-placebo, multicenter randomized clinical trial comparing alteplase with aspirin for emergent stroke at 75 stroke hospital networks in the US.
  • Subjects with acute ischemic stroke whose deficits were scored as 0 to 5 on the NIHSS and judged not clearly disabling and in whom study treatment could be started within 3 hours of onset were qualified and enlisted from May 30, 2014 to December 20, 2016, with final follow-up on March 22, 2017.
  • After that, patients were randomly allocated to receive intravenous alteplase at the standard dose (0.9 mg/kg) with oral placebo (n=156) or oral aspirin, 325 mg, with intravenous placebo (n=157).
  • The primary outcome was the difference in favorable functional outcome, characterized as a modified Rankin Scale score of 0 or 1 at 90 days through Cochran-Mantel-Haenszel test stratified by pretreatment NIHSS score, age, and time from onset to treatment.
  • Due to early termination of the trial, before unblinding or interim analyses, the revised plan was to investigate the risk difference of the primary outcome by a linear model adjusted for the same factors.
  • Symptomatic intracranial hemorrhage (sICH) within 36 hours of intravenous study treatment was the primary safety end point.

Results

  • The study results showed that among 313 patients enlisted at 53 stroke networks (mean age, 62 [SD, 13] years; 144 [46%] women; median NIHSS score, 2 [interquartile range {IQR}, 1-3]; median time to treatment, 2.7 hours [IQR, 2.1-2.9]), 281 (89.8%) finished the trial.
  • It was observed that 122 patients (78.2%) in the alteplase group vs 128 (81.5%) in the aspirin group achieved a favorable outcome (adjusted risk difference, -1.1%; 95% CI, -9.4% to 7.3%) at 90 days.
  • Findings revealed that 5 alteplase-treated patients (3.2%) vs 0 aspirin-treated patients had sICH (risk difference, 3.3%; 95% CI, 0.8%-7.4%).
 Read the full article on JAMA
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