Prourokinase vs Standard Care for Patients With Mild Ischemic Stroke

 Safety concerns could easily be eliminated by this. No definition of mild stroke so bad research.

You wouldn't have to worry about hemorrhages if you vastly reduced the bolus by delivering it via magnetic nanoparticles. Or are you FUCKING INCOMPETENT in not knowing about that?

We should have been using magnetic nanoparticles to deliver tPA for years. Then you wouldn't have to waste money on research like this.

Maybe this solution from March, 2015

Magnetic nanoparticles could stop blood clot-caused strokes

Or this from May, 2012

Future of med devices: Nanorobots in your blood stream 

Send me hate mail on this: oc1dean@gmail.com. I'll print your complete statement with your name and my response in my blog. Or are you afraid to engage with my stroke-addled mind? No excuses are allowed! You're medically trained; it should be simple to precisely refute all my points with NO EXCUSES!! And what is your definition of competence in stroke? Swearing at me is allowed, I'll return the favor. Don't even attempt to use that brain research is hard.

The latest here:

Prourokinase vs Standard Care for Patients With Mild Ischemic Stroke

The PUMICE Randomized Clinical Trial

Yunyun Xiong, MD, PhD^1,2; Xia Meng, MD, PhD^1,2; Aoming Jin, MD, PhD²; et al Bruce C. V. Campbell, MBBS, PhD³; Anding Xu, MD, PhD⁴; Qiang Dong, MD, PhD⁵; Yun Xu, MD, PhD⁶; Yuesong Pan, PhD²; Yong Jiang, PhD²; Siying Niu, MD²; Zhiliang Li, MD⁷; Xianbo Zhuang, MD⁸; Na Guo, MD⁹; Zhimei Yuan, MD¹⁰; Zhenyu Kong, MD¹¹; Lixia Zong, MD, PhD¹; Chunmiao Duan, MD, PhD²; Zhixin Cao, MD¹; Liyuan Wang, MD¹; Manjun Hao, MD¹; Shuangzhe Wu, MD¹; Xueyan Feng, MD, PhD¹; Hao Li, PhD²; Na Wu, MD¹; Zixiao Li, MD, PhD^1,2; Xingquan Zhao, MD, PhD¹; Yongjun Wang, MD^1,2,12,13; for the PUMICE Investigators

Author Affiliations

JAMA Neurol. Published online January 21, 2025. doi:10.1001/jamaneurol.2024.4688

Abstract

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Key Points

Question  Does intravenous prourokinase benefit patients with ischemic stroke presenting with minor neurologic deficits?

Findings  In this randomized clinical trial that included 1446 patients with acute ischemic stroke, there was no significant difference in excellent functional outcome at 90 days between those treated with prourokinase vs standard care.

Meaning  Results demonstrate that prourokinase was not superior to standard care for the treatment of patients with mild ischemic stroke within 4.5 hours after symptom onset.

Abstract

Importance  Trials have not demonstrated superiority of alteplase or tenecteplase vs standard care in patients with mild stroke and have raised safety concerns. Prourokinase is an alternative fibrinolytic that may have a favorable safety profile, and the benefit-risk profile of prourokinase in mild stroke is unknown.

Objective  To investigate the efficacy and safety of prourokinase in mild ischemic stroke within 4.5 hours of symptom onset.

Design, Setting, and Participants  This was a multicenter, prospective, open-label, blinded–end point randomized clinical trial conducted from November 2022 through December 2023 with 3 months of follow-up. The trial was conducted at 89 hospitals in China. Patients with a baseline National Institutes of Health Stroke Scale score of 5 or less (scores range from 0-42, with higher scores indicating more severe neurological deficit) within 4.5 hours from the time the patient was last known to be well. Patients with intention to proceed to endovascular treatment were excluded.

Interventions  Eligible patients were randomly assigned in a 1:1 ratio to receive prourokinase, 35 mg (15-mg bolus + 20-mg infusion over 30 minutes) or standard care, including antiplatelet or anticoagulant therapy, at the discretion of local investigators.

Main Outcomes and Measures  The primary outcome was modified Rankin Scale score of 0 or 1 (range, 0-6, with higher scores indicating greater disability) at day 90. Safety outcomes were symptomatic intracranial hemorrhage and death.

Results  Of 3836 patients who underwent screening, 1446 (37.7%) were enrolled in the trial. Median (IQR) age was 65.9 (57.7-72.7) years, and 948 were male (65.5%). A total of 723 patients were assigned to prourokinase and 723 to standard care. The primary outcome occurred in 639 patients (88.5%) in the prourokinase group and 658 (91.0%) in the standard care group (relative risk, 0.97; 95% CI, 0.94-1.01; 2-sided P = .12). Symptomatic intracranial hemorrhage was 0.7% (5 of 723 patients) with prourokinase and 0% with standard care, and mortality at 90 days was 2.3% and 1.4%, respectively.

Conclusions and Relevance  Results of this randomized clinical trial demonstrate that prourokinase was not superior to standard care to improve the functional outcomes for patients with mild ischemic stroke within 4.5 hours after symptom onset but had a similar safety profile.

Trial Registration  ClinicalTrials.gov Identifier: NCT05507645

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