1.Low- versus Standard-Dose Intravenous Alteplase in the Context of Bridging Therapy for Acute Ischemic Stroke: A Korean ENCHANTED Study
Jong S KIM ; Yeon Jung KIM ; Kyung Bok LEE ; Jae Kwan CHA ; Jong Moo PARK ; Yangha HWANG ; Eung Gyu KIM ; Joung Ho RHA ; Jaseong KOO ; Jei KIM ; Yong Jae KIM ; Woo Keun SEO ; Dong Eog KIM ; Thompson G ROBINSON ; Richard I LINDLEY ; Xia WANG ; John CHALMERS ; Craig S ANDERSON
Journal of Stroke 2018;20(1):131-139
BACKGROUND AND PURPOSE: Following the positive results from recent trials on endovascular therapy (EVT), bridging therapy (intravenous alteplase plus EVT) is increasingly being used for the treatment of acute ischemic stroke. However, the optimal dose of intravenous alteplase remains unknown in centers where bridging therapy is actively performed. The optimal dose for eventual recanalization and positive clinical outcomes in patients receiving bridging therapy also remains unknown. METHODS: In this prospective Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED) sub-study, we explored the outcomes following treatment with two different doses (low- [0.6 mg/kg] or standard-dose [0.9 mg/kg]) of intravenous alteplase across 12 Korean centers where EVT is actively performed. The primary endpoint was a favorable outcome at 90 days (modified Rankin Scale scores 0 to 1). Secondary endpoints included symptomatic intracerebral hemorrhage (ICH) in all patients, and the recanalization rate and favorable outcome in patients who underwent cerebral angiography for EVT (ClinicalTrials.gov, number NCT01422616). RESULTS: Of 351 patients, the primary outcome occurred in 46% of patients in both the standard-(80/173) and low-dose (81/178) groups (odds ratio [OR], 1.14; 95% confidence interval [CI], 0.72 to 1.81; P=0.582), although ICHs tended to occur more frequently in the standard-dose group (8% vs. 3%, P=0.056). Of the 67 patients who underwent cerebral angiography, there was no significant difference in favorable functional outcome between the standard- and low-dose groups (39% vs. 21%; OR, 2.39; 95% CI, 0.73 to 7.78; P=0.149). CONCLUSIONS: There was no difference in functional outcome between the patients receiving different doses of alteplase in centers actively performing bridging therapy.
Cerebral Angiography
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Cerebral Hemorrhage
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Cerebral Infarction
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Humans
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Hypertension
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Intracranial Hemorrhages
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Prospective Studies
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Stroke
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Thrombectomy
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Tissue Plasminogen Activator
2.Effect of the Coronavirus Disease 2019 Pandemic on the Quality of Stroke Care in Stroke Units and Alternative Wards: A National Comparative Analysis
Dominique A. CADILHAC ; Joosup KIM ; Geoffrey CLOUD ; Craig S. ANDERSON ; Emma K. TOD ; Sibilah J. BREEN ; Steven FAUX ; Timothy KLEINIG ; Helen CASTLEY ; Richard I. LINDLEY ; Sandy MIDDLETON ; Bernard YAN ; Kelvin HILL ; Brett JONES ; Darshan SHAH ; Katherine JAQUES ; Benjamin CLISSOLD ; Bruce CAMPBELL ; Natasha A. LANNIN ;
Journal of Stroke 2022;24(1):79-87
Background:
and Purpose Changes to hospital systems were implemented from March 2020 in Australia in response to the coronavirus disease 2019 pandemic, including decreased resources allocated to stroke units. We investigate changes in the quality of acute care for patients with stroke or transient ischemic attack during the pandemic according to patients’ treatment setting (stroke unit or alternate ward).
Methods:
We conducted a retrospective cohort study of patients admitted with stroke or transient ischemic attack between January 2019 and June 2020 in the Australian Stroke Clinical Registry (AuSCR). The AuSCR monitors patients’ treatment setting, provision of allied health and nursing interventions, prescription of secondary prevention medications, and discharge destination. Weekly trends in the quality of care before and during the pandemic period were assessed using interrupted time series analyses.
Results:
In total, 18,662 patients in 2019 and 8,850 patients in 2020 were included. Overall, 75% were treated in stroke units. Before the pandemic, treatment in a stroke unit was superior to alternate wards for the provision of all evidence-based therapies assessed. During the pandemic period, the proportion of patients receiving a swallow screen or assessment, being discharged to rehabilitation, and being prescribed secondary prevention medications decreased by 0.58% to 1.08% per week in patients treated in other ward settings relative to patients treated in stroke units. This change represented a 9% to 17% increase in the care gap between these treatment settings during the period of the pandemic that was evaluated (16 weeks).
Conclusions
During the first 6 months of the pandemic, widening care disparities between stroke units and alternate wards have occurred.
3.Temporal trends in diagnosis, treatment, and outcome for non-ST-segment elevation acute coronary syndrome in three regions of China, 2008-2015.
Rong LIU ; Yu-Qing SUN ; Xiao-Xia HOU ; Yang ZHENG ; Mark D HUFFMAN ; Craig S ANDERSON ; Liu HE ; Shi-Jun XIA ; Chao JIANG ; Xin DU ; Jian-Zeng DONG ; Chang-Sheng MA
Chinese Medical Journal 2021;134(16):1997-1999