• Filter By:
• Specialty
• Source
• Condition
• Cancer
• Infectious Disease
• Drug
• Training
• Management
• Procedure
• Therapy
• Vaccine
• Nutrition
• Country

Seminar Stroke
In the past decade, the definition of stroke has been revised and major advances have been made for its treatment and prevention. For acute ischaemic stroke, the addition of endovascular thrombectomy of proximal large artery occlusion to intravenous alteplase increases functional independence for a further fifth of patients. The benefits of aspirin in preventing early recurrent ischaemic stroke are greater than previously recognised. Other strategies to prevent recurrent stroke now include direct oral anticoagulants as an alternative to warfarin for atrial fibrillation, and carotid stenting as an alternative to endarterect...
Source: LANCET - September 12, 2016 Category: Journals (General) Authors: Graeme J Hankey Tags: Seminar Source Type: research

Correspondence Thrombolysis in acute stroke
In a meta-analysis of data from nine randomised trials, Jonathan Emberson and colleagues1 concluded that, irrespective of age or stroke severity, alteplase delivered within 4·5 h of stroke onset significantly improved the overall odds of a good stroke outcome. Shorter time to treatment was associated with even greater proportional benefits.
Source: LANCET - April 10, 2015 Category: Journals (General) Authors: Valeria Caso, Patrik Michel Tags: Correspondence Source Type: research

Correspondence Thrombolysis in acute stroke – Authors' reply
We thank the correspondents for their interest in our meta-analysis of individual patient data from trials of alteplase for patients with acute ischaemic stroke.1
Source: LANCET - April 10, 2015 Category: Journals (General) Authors: Jonathan Emberson, Kennedy R Lees, Patrick Lyden, Colin Baigent, Peter Sandercock, Werner Hacke, on behalf of the Stroke Treatment Trialists' Collaboration Tags: Correspondence Source Type: research

Correspondence Thrombolysis in acute stroke
In their meta-analysis of intravenous thrombolysis with alteplase for acute ischaemic stroke, Jonathan Emberson and colleagues (Nov 29, p 1929)1 concluded that the increased risk of early death from intracranial haemorrhage in patients taking alteplase was offset by an increase in disability-free survival. This interpretation gives the impression that the high level of mortality in the acute phase tends to diminish with time, but that is not the case. In the latest Cochrane analysis of thrombolysis for acute ischaemic stroke,2 thrombolysis gave no survival advantage between 7 days after thrombolysis and the end of follow-up.
Source: LANCET - April 10, 2015 Category: Journals (General) Authors: Peter Appelros, Andreas Terént Tags: Correspondence Source Type: research

Editorial Thrombolysis for stroke: clinical judgment at its apogee
In the Correspondence section of today's Lancet, we publish a selection of letters challenging the report by Jonathan Emberson and colleagues on the effect of treatment delay, age, and stroke severity on the effects of thrombolysis with alteplase for acute ischaemic stroke. Emberson and colleagues concluded from their meta-analysis of 6756 patients that despite early increases in fatal intracranial haemorrhage, alteplase improves the overall likelihood of a good stroke outcome at 3–6 months when delivered within 4·5 h of the initial stroke symptoms, with earlier treatment increasing proportional benefit, irrespective of...
Source: LANCET - April 10, 2015 Category: Journals (General) Authors: The Lancet Tags: Editorial Source Type: research

Articles Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials
Irrespective of age or stroke severity, and despite an increased risk of fatal intracranial haemorrhage during the first few days after treatment, alteplase significantly improves the overall odds of a good stroke outcome when delivered within 4·5 h of stroke onset, with earlier treatment associated with bigger proportional benefits.
Source: LANCET - November 28, 2014 Category: Journals (General) Authors: Jonathan Emberson, Kennedy R Lees, Patrick Lyden, Lisa Blackwell, Gregory Albers, Erich Bluhmki, Thomas Brott, Geoff Cohen, Stephen Davis, Geoffrey Donnan, James Grotta, George Howard, Markku Kaste, Masatoshi Koga, Ruediger von Kummer, Maarten Lansberg, R Tags: Articles Source Type: research

Comment Alteplase in acute ischaemic stroke: the need for speed
Doctors treating patients who have had an acute ischaemic stroke must feel the need for speed more feverishly than a racing driver. Stroke does not hurt. There is none of the pain that might be registered on the face of a patient with acute myocardial infarction or the visceral sight of blood in the case of trauma to evoke a sense of immediacy. Yet stroke is exactly like acute myocardial infarction and acute trauma in the need for very fast treatment.
Source: LANCET - November 28, 2014 Category: Journals (General) Authors: Michael D Hill, Shelagh B Coutts Tags: Comment Source Type: research

Correspondence Alteplase for ischaemic stroke
Roger Shinton's Correspondence (Aug 23, p 659) called into question the evidence supporting the safe use of alteplase in patients with acute ischaemic stroke. Ian Hudson, of the Medicines and Healthcare Products Regulatory Agency (MHRA), responded to this Correspondence by convening an expert working group to review the benefits and risks of this drug. A review of reports of spontaneous adverse drug reactions (ADR) should inform this query, but a substantial level of under-reporting might restrict its use.
Source: LANCET - October 25, 2014 Category: Journals (General) Authors: Daniel Burrage Tags: Correspondence Source Type: research

Correspondence Questions about authorisation of alteplase for ischaemic stroke
Stroke thrombolysis can cause potentially fatal intracerebral haemorrhage, but advocates claim the potential reduction in disability justifies this risk. Alteplase was authorised following the National Institute of Neurological Disorders and Stroke (NINDS) trial. A 2004 review raised concerns over the trial data. Outcomes across the centres differed considerably. Bias could explain the observation that the plot of outcome (modified Rankin score 0–1) against number of patients recruited does not resemble the expected symmetrical funnel ().
Source: LANCET - August 23, 2014 Category: Journals (General) Authors: Roger Shinton Tags: Correspondence Source Type: research

Correspondence Alteplase for ischaemic stroke—responses
Roger Shinton's Correspondence contains numerous factual inaccuracies and statements that are not consistent with the text of the cited references, and do not in our opinion merit a reconsideration of the authorisation of alteplase in acute ischaemic stroke.
Source: LANCET - August 23, 2014 Category: Journals (General) Authors: Peter Sandercock, Richard Lindley, Joanna M Wardlaw, Gordon Murray, Will Whiteley, Geoff Cohen Tags: Correspondence Source Type: research