Response to Letter Regarding Article, “Targeting Recombinant Tissue-Type Plasminogen Activator in Acute Ischemic Stroke Based on Risk of Intracranial Hemorrhage or Poor Functional Outcome: An Analysis of the Third International Stroke Trial”
2014; Lippincott Williams & Wilkins; Volume: 45; Issue: 7 Linguagem: Inglês
10.1161/strokeaha.114.005871
ISSN1524-4628
AutoresWilliam Whiteley, Douglas Thompson, Peter Sandercock,
Tópico(s)Protease and Inhibitor Mechanisms
ResumoHomeStrokeVol. 45, No. 7Response to Letter Regarding Article, "Targeting Recombinant Tissue-Type Plasminogen Activator in Acute Ischemic Stroke Based on Risk of Intracranial Hemorrhage or Poor Functional Outcome: An Analysis of the Third International Stroke Trial" Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBResponse to Letter Regarding Article, "Targeting Recombinant Tissue-Type Plasminogen Activator in Acute Ischemic Stroke Based on Risk of Intracranial Hemorrhage or Poor Functional Outcome: An Analysis of the Third International Stroke Trial" William N. Whiteley, PhD Douglas Thompson, BSc Peter Sandercock, MDOn behalf of all authors William N. WhiteleyWilliam N. Whiteley Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom Douglas ThompsonDouglas Thompson Edinburgh MRC Hub for Trials Methodology Research, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom Peter SandercockPeter Sandercock Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom and On behalf of all authors Originally published10 Jun 2014https://doi.org/10.1161/STROKEAHA.114.005871Stroke. 2014;45:e133Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: January 1, 2014: Previous Version 1 We agree with Dai et al1 that the existing clinical prognostic models for the prediction of symptomatic intracranial hemorrhage (SICH) or poor outcome after thrombolysis perform only modestly and are unable to identify a group of patients at a high risk of SICH.In the Third International Stroke Trial (IST-3), we found that groups of patients who were predicted to be at a high risk of SICH with recombinant tissue plasminogen activator treatment by clinical prognostic models tended to have a better functional outcome when they were treated with recombinant tissue plasminogen activator than when they were treated with control.2 We agree this is surprising, but is not because of defects in the statistical methods in our study; instead it is because the existing models do not reliably identify a group of patients with a high risk of SICH.If existing clinical prognostic models cannot reliably identify patients with a high risk of SICH, what is the way forward? First, there may be predictors of SICH (eg, novel imaging or blood markers) that might better identify those at highest risk. Second, the risk of SICH might be reduced with different thrombolysis regimes, for example, lower doses, with treatment to lower blood pressure or with different agents, as are currently being tested in the Enhanced Control of Hypertension and Thrombolysis in Stroke Disease (ENCHANTED; NCT01422616), Tenecteplase Versus Alteplase for Stroke Thrombolysis Evaluation (TASTE; ACTRN12613000243718), and Alteplase-Tenecteplase Trial Evaluation for Stroke Thrombolysis (ATTEST; NCT01472926) trials.William N. Whiteley, PhDCentre for Clinical Brain Sciences, University of EdinburghEdinburgh, United KingdomDouglas Thompson, BScEdinburgh MRC Hub for Trials Methodology Research, Centre for Population Health Sciences, University of EdinburghEdinburgh, United KingdomPeter Sandercock, MDCentre for Clinical Brain Sciences, University of EdinburghEdinburgh, United KingdomOn behalf of all authorsSources of FundingThe Third International Stroke Trial (IST-3) was supported by Stroke Association, The Health Foundation UK, UK Medical Research Council (G0400069, G0902303, G0800803, EME 09-800-15), Research Council of Norway, AFA Insurances, the Swedish Heart Lung Fund, Foundation of Marianne and Marcus Wallenberg, Stockholm County Council and Karolinska Institute, the Government of Poland (2PO5B10928), Australian Heart Foundation (G 04S 1638), Australian NHMRC (457343), Swiss National Research Foundation, the Swiss Heart Foundation Foundation for health and cardio/neurovascular research, Assessorato alla Sanita, Regione dell'Umbria, Danube University, Chest Heart and Stroke Scotland, DesAcc, University of Edinburgh, Danderyd Hospital R&D Department, Karolinska Institutet, Oslo University Hospital, and the Dalhousie University Internal Medicine Research Fund. Drug and placebo for the 300 patients in the double-blinded component of the start-up phase were supplied by Boehringer Ingelheim. Dr Whiteley is supported by an MRC Clinician Scientist Fellowship (G0902303), and D. Thompson is supported by an MRC HTMR grant (G0800803).DisclosuresNone.FootnotesStroke welcomes Letters to the Editor and will publish them, if suitable, as space permits. Letters must reference a Stroke published-ahead-of-print article or an article printed within the past 3 weeks. The maximum length is 750 words including no more than 5 references and 3 authors. Please submit letters typed double-spaced. Letters may be shortened or edited. References 1. Dai Q, Sun W, Liu X. Letter by Dai et al regarding article, "Targeting recombinant tissue-type plasminogen activator in acute ischemic stroke based on risk of intracranial hemorrhage or poor functional outcome: an analysis of the Third International Stroke Trial."Stroke. 2014; 45:e132.LinkGoogle Scholar2. Whiteley WN, Thompson D, Murray G, Cohen G, Lindley RI, Wardlaw J, et al; IST-3 Collaborative Group. Targeting recombinant tissue-type plasminogen activator in acute ischemic stroke based on risk of intracranial hemorrhage or poor functional outcome: an analysis of the third international stroke trial.Stroke. 2014; 45:1000–1006.LinkGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Yang W, Zhang L, Chen S, Yao Q, Chen H, Zhou J, Chen W, He L and Zhang Y (2020) Longshengzhi Capsules Improve Ischemic Stroke Outcomes and Reperfusion Injury via the Promotion of Anti-Inflammatory and Neuroprotective Effects in MCAO/R Rats, Evidence-Based Complementary and Alternative Medicine, 10.1155/2020/9654175, 2020, (1-14), Online publication date: 9-Mar-2020. Li Y, Zhu Z, Lu B, Huang T, Zhang Y, Zhou N, Xuan W, Chen Z, Wen D, Yu W and Li P (2019) Rosiglitazone ameliorates tissue plasminogen activator‐induced brain hemorrhage after stroke, CNS Neuroscience & Therapeutics, 10.1111/cns.13260, 25:12, (1343-1352), Online publication date: 1-Dec-2019. Li M, Zhou J, Jin W, Li X and Zhang Y (2018) Danhong Injection Combined With t-PA Improves Thrombolytic Therapy in Focal Embolic Stroke, Frontiers in Pharmacology, 10.3389/fphar.2018.00308, 9 July 2014Vol 45, Issue 7 Advertisement Article InformationMetrics © 2014 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.114.005871PMID: 24916910 Originally publishedJune 10, 2014 PDF download Advertisement SubjectsTreatment
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