But you had the wrong endpoint. Survivors care nothing about reperfusion, they want 100% recovery. WHEN THE HELL will you design research correctly to deliver that? This is why we need survivors in charge, they will not take their eyes off the only goal in stroke, 100% recovery.
Increasing Tenecteplase Dose Does Not Improve Reperfusion in Ischaemic Stroke
By Alex MorrissonLOS ANGELES -- February 24, 2020 -- Increasing the dose of tenecteplase prior to endovascular thrombectomy does not improve reperfusion or clinical outcomes in patients with stroke, according to a study presented here at the 2020 International Stroke Conference (ISC).
In the EXTEND 1A TNK Part 2 study, Bruce Campbell, PhD, Royal Melbourne Hospital, and the University of Melbourne, Melbourne, Australia, and colleagues enrolled 300 patients who were diagnosed with ischaemic large vessel strokes and randomised half to receive tenecteplase 0.25 mg/kg and the other half to tenecteplase 0.40 mg/kg.
Only 29 patients in each group achieved the primary endpoint, which of a >50% improvement in reperfusion of blocked brain blood vessels (P = .89).
“The findings suggest that the 0.40 mg/kg dose of tenecteplase does not confer an advantage over the 0.25 mg/kg dose in patients with large vessel occlusion ischaemic stroke in whom endovascular thrombectomy is planned,” said Dr. Campbell.
The EXTEND-IA TNK Part 2 trial was an investigator-initiated, multicentre, randomised, open-label blinded trial in patients with ischaemic stroke due to large vessel occlusion of the intracranial internal carotid, middle cerebral, or basilar artery who were eligible for intravenous thrombolysis and endovascular thrombectomy within 4.5 hours of stroke onset.
Secondary outcomes, including modified Rankin Scale score at 90 days and early neurological recovery, did not differ significantly between groups. The adjusted odds ratio in ordinal analysis of the modified Rankin Scale score at 90 days was 0.96. Symptomatic intracranial haemorrhage occurred in 7 patients (4.7%) in the 0.40 mg/kg group, 4 of which were associated with wire perforation during the endovascular procedure, and 2 patients (1.3%) in the 0.25 mg/kg group (P = .12). There were 26 deaths in the 0.40 mg/kg group and 22 in the 0.25 mg/kg group (P = .35).
“That the optimal tenecteplase dose for patients with ischaemic stroke appears to be 0.25 mg/kg,” said Dr. Campbell.
ISC is sponsored by the American Heart Association and the American Stroke Association.
[Presentation title: Abstract LB1: Determining the Optimal Dose of Tenecteplase Before Endovascular Thrombectomy (EXTEND-IA TNK Part 2): a Multicenter, Randomized, Controlled Trial. Abstract LB1]
No comments:
Post a Comment