Stroke

TRACE-2 RCT – Tenecteplase vs Alteplase for Stroke

Neurology, Pharmacy/Pharmacology, Stroke

Spoon Feed
Tenecteplase was non-inferior to alteplase in patients with acute ischemic stroke who were eligible for intravenous thrombolytic therapy but ineligible or refused endovascular thrombectomy.

Source
Tenecteplase versus alteplase in acute ischaemic cerebrovascular events (TRACE-2): a phase 3, multicentre, open-label, randomised controlled, non-inferiority trial. Lancet. 2023 Feb 8;S0140-6736(22)02600-9. doi: 10.1016/S0140-6736(22)02600-9. Online ahead of print.

Concise Review of Lytics and Endovascular Therapy for ‘Wake Up’ Stroke

Stroke

Happy Thanksgiving!

From all of us here at JournalFeed, we wish you the very best. Thank you for reading!

Spoon Feed
In patients presenting with ‘wake-up’ strokes, endovascular therapy improves functional outcomes, while intravenous alteplase may also provide a small beneficial impact.

Source
What is the Efficacy and Safety of Intravenous Thrombolysis and Thrombectomy Among Patients With a Wake-Up Stroke?. Ann Emerg Med. 2022;80(2):165-167. doi:10.1016/j.annemergmed.2022.02.013

ATTENTION RCT – Thrombectomy Benefits Basilar Artery Occlusion Stroke?

Neurology, Stroke

Spoon Feed
Endovascular thrombectomy was associated with improved functional neurologic outcomes compared to best medical care for patients with basilar-artery occlusion who presented within 12 hours of stroke onset. However, thrombectomy was also associated with significant procedural complications and an increased risk of intracranial hemorrhage.

Source
Trial of Endovascular Treatment of Acute Basilar-Artery Occlusion. N Engl J Med. 2022 Oct 13;387(15):1361-1372. doi: 10.1056/NEJMoa2206317.

NOR-TEST 2 – What’s the Right Dose of Tenecteplase for Stroke?

Neurology, Pharmacy/Pharmacology, Stroke

Spoon Feed
Tenecteplase, at a dose of 0.4 mg/kg, is not safe for patients with moderate to severe ischemic stroke.

Source
Tenecteplase versus alteplase for the management of acute ischaemic stroke in Norway (NOR-TEST 2, part A): a phase 3, randomised, open-label, blinded endpoint, non-inferiority trial. Lancet Neurol. 2022 Jun;21(6):511-519. doi: 10.1016/S1474-4422(22)00124-7. Epub 2022 May 4.

Does NOAC Use Preclude tPA for Acute Stroke?

Neurology, Pharmacy/Pharmacology, Stroke

Spoon Feed
There was no significant difference in intracranial hemorrhage, serious systemic hemorrhage, or inpatient mortality for patients who used non-vitamin K oral anticoagulants in the seven days prior to receiving alteplase for acute ischemic stroke.

Source
Association of Recent Use of Non-Vitamin K Antagonist Oral Anticoagulants With Intracranial Hemorrhage Among Patients With Acute Ischemic Stroke Treated With Alteplase. JAMA. 2022 Feb 22;327(8):760-771. doi: 10.1001/jama.2022.0948.

CHOICE RCT – Post-Thrombectomy tPA for Stroke

Pharmacy/Pharmacology, Stroke

Spoon Feed
Among patients with acute ischemic stroke with large vessel occlusion that have been successfully reperfused with thrombectomy, the use of post-thrombectomy adjunctive intra-arterial alteplase results in greater likelihood of excellent neurologic outcome at 90 days – modified-Rankin score 0 or 1 – when compared with placebo.

Source
Effect of Intra-arterial Alteplase vs Placebo Following Successful Thrombectomy on Functional Outcomes in Patients With Large Vessel Occlusion Acute Ischemic Stroke: The CHOICE Randomized Clinical Trial. JAMA. 2022 Feb 10;e221645. doi: 10.1001/jama.2022.1645. Online ahead of print.

Early Endovascular Therapy for Basilar Artery Occlusion

Neurology, Stroke

Spoon Feed
Time from symptom onset of a basilar artery occlusion (BAO) to endovascular therapy (EVT) of less than 6 hours compared to greater than 6 hours (up to 24 hours) was associated with lower odds of in-hospital mortality, disability, symptomatic intracranial hemorrhage, and higher odds of ambulation at discharge, discharge home and reperfusion.

Source
Association Between Endovascular Therapy Time to Treatment and Outcomes in Patients with Basilar Artery Occlusion. Circulation. 2022 Jan 20. doi: 10.1161/CIRCULATIONAHA.121.056554. Online ahead of print.

Scroll to Top