Portal de Periódicos da CAPES

Alteplase for Acute Ischemic Stroke

2015; Lippincott Williams & Wilkins; Volume: 46; Issue: 3 Linguagem: Inglês

10.1161/strokeaha.114.006573

1524-4628

Richard I. Lindley, Joanna M. Wardlaw, William Whiteley, Geoff Cohen, Lisa Blackwell, Gordon Murray, Peter Sandercock, Colin Baigent, David Chadwick, Pippa Tyrrell, Gordon Lowe, Martin Dennis, Karen Innes, Heather Goodare, Andrew Farrall, Rüdiger von Kummer, Lesley Cala, Anders von Heijne, Zoë Morris, Alessandro Adami, André Peeters, Gillian Potter, Nick Brady, Rory Collins, Philip M. Bath, J. van Gijn, Richard Gray, Robert G. Hart, Salim Yusuf, Keith W. Muir, Graeme J. Hankey, Karl Matz, Michael Brainin, André Peters, Gord Gubitz, Stephen Phillips, Stefano Ricci, Antonio Araúz, Eivind Berge, Karsten Bruins Slot, Anna Członkowska, Adam Kobayashi, Manuel Correia, Phillippe Lyrer, Stefan T. Engelter, Veronica Murray, Bo Norrving, Andreas Terént, Per Wester, G.S. Venables, Karen Innes, Alison L. Clark, David Perry, Vera Soosay, Alastair M. Buchan, Sheila A. Grant, Eleni Sakka, Jonathan Drever, Pauli Walker, Indee Herath, Ann Leigh Brown, P. Chmielnik, Chris Armit, Andrea Walton, Mischa Hautvast, Steff Lewis, Graeme Heron, Sylvia Odusanya, Pam Linksted, Ingrid Kane, Robin Sellar, Phil White, Peter Keston, Andrew Farrell, Zoë Morris, Héctor Miranda, Maria Grazia Celani, Enrico Righetti, Silvia Cenciarelli, Tatiana Mazzoli, Teresa Anna Cantisani, Jan Bembenek, Eva Isaakson,

S100 Proteins and Annexins

Our aim was to identify whether particular subgroups of patients had an unacceptably high risk of symptomatic intracranial hemorrhage or low chance of benefit when treated with alteplase (recombinant tissue-type plasminogen activator).Third International Stroke Trial was an international randomized trial of the intravenous (IV) recombinant plasminogen activator alteplase (0.9 mg/kg) versus control in 3035 (1515 versus 1520) patients. We analyzed the effect of recombinant tissue-type plasminogen activator on 6-month functional outcome, early death, and symptomatic intracranial hemorrhage (both ≤7 days). We tested for any differences in treatment effect between subgroups by a test of interaction. Our 13 protocol prespecified subgroups were time to randomization, age, sex, stroke subtype, atrial fibrillation, early ischemic change (clinician and expert panel), prior antiplatelet use, stroke severity, diastolic and systolic blood pressure at randomization, center's thrombolysis experience, and trial phase. Analyses were adjusted for key baseline prognostic factors.There were no significant interactions in the subgroups analyzed that were consistent across all 3 outcomes. Treatment with recombinant tissue-type plasminogen activator increased the odds of symptomatic intracranial hemorrhage by a greater amount in patients taking prior antiplatelets than those who were not (P=0.019 for test of interaction), but had no clear detrimental effect on functional outcome at 6 months in this group (P=0.781 for test of interaction).Among the types of patient in the Third International Stroke Trial, this secondary analysis did not identify any subgroups for whom treatment should be avoided. Given the limitations of the analysis, we found no clear evidence to avoid treatment in patients with prior ischemic stroke, diabetes mellitus, or hypertension.http://www.controlled-trials.com. Unique identifier: ISRCTN25765518. http://www.controlled-trials.com/ISRCTN25765518.