- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Outcomes in the Elderly Post-Endovascular Therapy in a Community Setting (Hall H) - Dec 21, 2019 - Abstract #ISC2020ISC_1943;
For those who underwent EST in a large community setting with a standardized approach to acute stroke treatment, being elderly was associated with a higher risk of 90-day mortality. Further data analyses are being carried out with additional co-morbidities, inpatient complications, and 90-day functional outcome to better understand outcomes in older patients undergoing EST.
- |||||||||| methamphetamine / Generic mfg., Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
No Need to 'Card' Here; Cocaine/Opioid Use in Middle Age and Stroke (Hall H) - Dec 21, 2019 - Abstract #ISC2020ISC_1942;
Rural America has seen an increase in methamphetamine (Meth) users...We included all stroke assessed consults for age (ranged by decade), thrombolysis (alteplase use), alcohol and smoking use, consult gender, race, initial deficit level at presentation using the national institutes of health stroke scale (NIHSS) and symptom to door time (minutes)...There was no effect of race in incidence of drug use, or deficits. Conclusion - While the incidence of drug use does persist in the rural communities, demographics suggest it is more common in the middle age group than younger patients.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
The Trend of Successful First Pass in M2 Segment Stroke Thrombectomy- Insights From the STAR Collaboration (Hall H) - Dec 21, 2019 - Abstract #ISC2020ISC_1773;
Presenting after 2014 was an independent predictor of SFP (OR 1.9, 95% CI 1.1-3.2, P=0.019) after controlling for age, sex, NIHSS on presentation, intravenous alteplase (IV-tPA), and onset to groin time. Conclusion : SFP rate of M2 segment occlusion has increased after 2014 likely secondary the improvement in stroke thrombectomy devices and neurointerventionists experience.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Current Trends in Thrombolytic Use for Acute Ischemic Stroke (Hall H) - Dec 21, 2019 - Abstract #ISC2020ISC_1767;
Since 2011, weight-based dosing has been widely adopted for treatment with and without EVT, which represents adherence to guidelines. Differences in payer mix and rurality among patients receiving alteplase + EVT may represent opportunities to improve access to care.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Tenecteplase in Wake-up Ischaemic Stroke Trial (TWIST) (Hall H) - Dec 21, 2019 - Abstract #ISC2020ISC_1735;
Tenecteplase has pharmacological advantages over alteplase, and can be given as a bolus...Conclusion TWIST will show whether patients with wake-up stroke can be treated with tenecteplase within 4.5 hours of awakening, and whether multi-modal CT can be used for identification of patients who benefit from treatment. The trial has on the 5th of November 2019 included 284 patients.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Alteplase - Tenecteplase Trial Evaluation for Stroke Thrombolysis (attest 2) (Hall H) - Dec 21, 2019 - Abstract #ISC2020ISC_1729;
P3
An agent with superior risk:benefit ratio to alteplase would potentially extend thrombolytic treatment to a greater proportion of patients and contribute to the optimisation of reperfusion strategies. NCT02814409
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Stroke Subtype Predicts Neurological Deterioration After Intravenous Alteplase for Acute Ischemic Stroke (Hall H) - Dec 21, 2019 - Abstract #ISC2020ISC_1569;
Conclusions : Non-cryptogenic/Non-cardioembolic stroke subtypes are associated with early RCVE, and RCVE is associated with long term disability. Studies are needed to confirm our findings and test interventions optimizing stroke prevention strategies in these subtypes.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Thrombolysis for AIS in the Unwitnessed or Extended Therapeutic Time Window: A Systematic Review and Meta-Analysis (Hall H) - Dec 21, 2019 - Abstract #ISC2020ISC_1553;
We performed random-effects meta-analyses on the unadjusted and adjusted for potential confounders associations of IVT (alteplase 0.9 mg/kg) with the following outcomes: 3-month favorable functional outcome [FFO, modified Rankin Scale (mRS) scores: 0-1], 3-month functional independence (FI, mRS-scores: 0-2), 3-month mortality, 3-month functional improvement (assessed with ordinal analysis on the mRS-scores), symptomatic intracranial hemorrhage (sICH) and complete recanalization (CR)... IVT in AIS patients with unknown symptom onset time or elapsed time from symptom onset more than 4.5 hours, selected with advanced neuroimaging, results in a higher likelihood of complete recanalization and functional improvement at three months despite the increased risk of sICH.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Redefining Early Neurological Improvement After Intravenous Tissue Plasminogen Activator Treatment of Stroke (Hall H) - Dec 21, 2019 - Abstract #ISC2020ISC_1550;
Background and Purpose Early neurologic improvement (ENI) in patients treated with alteplase has been shown to correlate with functional outcome...Conclusion Percentage change in NIHSS may be a better surrogate marker of ENI and functional outcome in AIS patients after receiving acute thrombolytic therapy. More studies are needed to confirm our findings.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Feasibility of 24/7 Neurohospitalist Presence and Impact on Alteplase DTN Times and Mortality (Hall H) - Dec 21, 2019 - Abstract #ISC2020ISC_1538;
In-hospital 24/7 model of neurohospitalist coverage is a feasible model for large community hospitals and is associated with significantly faster DTN times and reduced mortality. We will explore other aspects of the care model and other changes occurring during the study period.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
MRI-Guided Mismatch Imaging to Identify Patients for Thrombolysis in the Unknown Time Window: Insights From the WAKE-UP Trial (Hall H) - Dec 21, 2019 - Abstract #ISC2020ISC_1528;
In patients with both DWI-FLAIR and PWI-DWI mismatch, favorable outcome was present in 52% of those treated with alteplase (11/21) vs 38% (5/13) in those receiving placebo (adjusted OR 2.02; 95% CI 0.44-9.24, p=0.36)...PWI-DWI mismatch status did not modify treatment effect in patients with DWI-FLAIR mismatch, but the analysis was underpowered. Screening for the presence of either one of the mismatch profiles with MRI seems the most inclusive approach to identify patients who can still benefit from thrombolysis in the unknown time window after stroke onset.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
A Nurse Driven Acute Stroke Alert Process Improves Treatment Times and Treatment Rates (Hall H) - Dec 21, 2019 - Abstract #ISC2020ISC_1429;
The sICH rate was reduced from Period A to C, meaning that increased treatment rate did not lead to increased hemorrhagic rate. Nursing initiatives can have a substantial positive effect on increasing the number of patients treated with IV alteplase for acute ischemic stroke.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Asymptomatic Hemorrhage Predicts Delayed Symptomatic Hemorrhage After Alteplase in Acute Ischemic Stroke (Hall H) - Dec 21, 2019 - Abstract #ISC2020ISC_1411;
Delaying initiation of antithrombotic treatment in patients with asymptomatic hemorrhage on 24 hour imaging was not associated with reduced delayed sICH risk. It is possible that other factors such as reperfusion and blood brain barrier disruption are more important determinants of delayed sICH risk as opposed to timing of antithrombotic therapy initiation.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Maryland Stroke Coalition: Six Year Coordinated Cooperative Approach Improves Thrombolytic Performance (Hall H) - Dec 21, 2019 - Abstract #ISC2020ISC_1355;
The MSC’s coordinated cooperative approach to performance improvement was associated with increased IV Alteplase administration rates and decreased median door to IV Alteplase administration times. The MSC's leadership plan is to perform a statewide cultural assessment to identify barriers and facilitators to assist stroke centers increase the percentage of patients who receive alteplase < 45 minutes and to improve door in-door out times for mechanical thrombectomy patients.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Validation of the Fast-ed Scale Use by Paramedics in a Mobile Stroke Unit (Hall H) - Dec 21, 2019 - Abstract #ISC2020ISC_1337;
28 (14%) patients received intravenous alteplase... The correlation of the FAST-ED scoring between vascular neurologists and paramedics was highly positive, indicating that FAST-ED is accurately and reliably utilized by paramedics in the pre-hospital setting.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Feasibility of a Large-Scale Teleneurology Network for Thrombolysis Administration in a Heterogeneous Multihospital Population (Hall H) - Dec 21, 2019 - Abstract #ISC2020ISC_1294;
BACKGROUND Administration of alteplase is the standard of care for eligible patients presenting with symptoms of acute ischemic stroke (AIS)...CONCLUSION A large-scale teleneurology platform for the emergent treatment of patients presenting with AIS symptoms is both safe and feasible. Due to the heterogeneity of this patient and hospital population, higher level refinement of this analysis to include hyperacute metrics, transfer data, and more comprehensive clinical and functional outcomes is warranted.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
The Multiple-Encounter Multiply-Thrombolysed Telestroke Patient - A Unique Patient Population (Hall H) - Dec 21, 2019 - Abstract #ISC2020ISC_1280;
CONCLUSION The observed phenomena of recurrent teleneurology encounters for patients presenting with suspected AIS symptoms and receiving alteplase at increased rates is not well-described and is poorly understood. Given the inherent risk and resource utilization associated with thrombolysis, further analysis of the characteristics of this patient population is warranted.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Pharmacists Improve Door to Needle Times in the Emergency Department (Hall H) - Dec 21, 2019 - Abstract #ISC2020ISC_1278;
Presence of a pharmacist in the ED enabled fast and safe delivery of alteplase by ensuring accurate dosing and preparation. Pharmacists also performed rapid medication reconciliation and expedited antihypertensive therapies.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Predictors and Outcomes of Successful First Pass in Neurothrombectomy- Insights From the STAR Collaboration (Hall H) - Dec 21, 2019 - Abstract #ISC2020ISC_1211;
The use of Solumbra technique was an independent predictor of SFP (OR 1.2, 95% CI 1.1-1.4, P=0.004) after controlling for age, sex, location of occlusion, National Institute of Health stroke scale (NIHSS) on presentation, intravenous alteplase (IV-tPA), and onset to groin (OTG) time...Conclusion : SFP lead to higher rates of functional independence in stroke patients with large vessel occlusion. These records reiterate the importance of SFP as a benchmark measure for stroke thrombectomy devices.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
The Reality of Acute Stroke Care at a Public Hospital in Northeast Brazil (Hall H) - Dec 21, 2019 - Abstract #ISC2020ISC_1191;
Conclusion : The data show that it is necessary to implement a public policy for stroke care in this region of Brazil, including training of professionals and implementation of new acute care centers. This, along with increasing awareness among the population and devoting further attention to stroke post-treatment, can ensure universality, equity and comprehensiveness of stroke treatment in this region of Brazil and elsewhere.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Time to Alteplase and Symptomatic Intracranial Hemorrhage Complication Rates (Room 515 B) - Dec 21, 2019 - Abstract #ISC2020ISC_1149;
Interestingly, a reduction in door-to-needle times was associated with a reduction in complication rates. This supports the American Heart Association’s new Target Stroke Phase III initiative which seeks to further reduce door-to-needle times.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Reperfusion Improves Clinical Outcome Across the 4.5-9h and Wake-Up Stroke Time Continuum in EXTEND and EPITHET (Room 502 A) - Dec 21, 2019 - Abstract #ISC2020ISC_1029;
These data highlight opportunities to improve inpatient systems of stroke care further. Strong benefits of reperfusion in all time strata without differential risk in symptomatic hemorrhage support the durable treatment effect of alteplase in perfusion mismatch-selected patients throughout the 4.5-9h and wake-up stroke time window.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
CT Perfusion Imaging in Telestroke Can Assist With Decision Making Without Delaying IV Alteplase (Hall H) - Dec 21, 2019 - Abstract #ISC2020ISC_771;
Final results of the NAS-Care study will be presented at the International Stroke Conference. In conclusion, automated perfusion maps and calculated ischemic penumbra size in CTP allowed telestroke physicians to make quicker transfer decisions, without delaying DTN.
- |||||||||| aspirin / Generic mfg., warfarin / Generic mfg., Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Asian versus Non-Asian, Differences in Characteristics, Management & Outcomes in the Enchanted Trial (Hall H) - Dec 21, 2019 - Abstract #ISC2020ISC_718;
Among 4562 patients (mean age 66.6 years, 37.8% female, 65.5% Asian) Asian patients were younger and less likely to have atrial fibrillation and hypercholesterolemia and taking fewer antihypertensive, warfarin, aspirin and statin therapy compared to non-Asians... Compared to non-Asians, Asian patients were at increased risk of ICH and residual disability after thrombolysis treatment for AIS, suggesting the need to access more evidence-based care in acute management.
- |||||||||| Activase (alteplase) / Roche, Boehringer Ingelheim, Kyowa Hakko Kirin, Mitsubishi Tanabe
Contemporary Use of IV Alteplase in Acute Ischemic Stroke Beyond 4.5 Hours of Stroke Onset in Clinical Practice is Rare (Hall H) - Dec 21, 2019 - Abstract #ISC2020ISC_717;
The use of IV tPA at >4.5 h from LKW as a proportion of all tPA cases treated varied substantially across sites (median (IQR) 1.7% (0-3.1%)) but fewer than ~10% of sites had more than 5% of their tPA use occurring beyond 4.5 h. Compared to 4.5 h differed in age, AF, arrival mode/time, stroke severity and hospital region (Table). Conclusions During the past decade and prior to published RCT evidence that extended window IV tPA was effective, US sites in GWTG-Stroke rarely treated patients beyond the guideline-approved window of 4.5 h. It will be important to monitor adoption of extended window thrombolysis in the US, and determine if additional RCT data are required to change practice.
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