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Dual Antiplatelet Therapy vs Alteplase for Patients With Minor Nondisabling Acute Ischemic Stroke
This randomized trial examines whether dual antiplatelet therapy is noninferior to intravenous thrombolysis among patients with minor nondisabling acute ischemic stroke.
Source: JAMA - June 27, 2023 Category: General Medicine Source Type: research

Intra-arterial Alteplase vs Placebo After Successful Thrombectomy and Functional Outcomes in Patients With Large Vessel Occlusion Acute Ischemic Stroke
To the Editor We have some concerns about the recent CHOICE study that compared intra-arterial alteplase with placebo among patients with large vessel occlusion acute ischemic stroke after successful thrombectomy.
Source: JAMA - June 28, 2022 Category: General Medicine Source Type: research

Intra-arterial Alteplase vs Placebo After Successful Thrombectomy and Functional Outcomes in Patients With Large Vessel Occlusion Acute Ischemic Stroke —Reply
In Reply In response to the comments by Dr Mai and colleagues about the change in the primary outcome of the CHOICE trial, we would like to provide several clarifications. First, the definition of the primary outcome in the original protocol was submitted for publication on July 15, 2019. Second, the registered protocol (NCT03876119) was first posted on March 15, 2019, but the primary outcome definition was changed and posted on March 19, 2021. Third, the summary of the history of these protocol changes was included in Supplement 2 of the article. As required by Spanish law, these changes were also communicated to the Span...
Source: JAMA - June 28, 2022 Category: General Medicine Source Type: research

Use of Oral Anticoagulants and Intracranial Hemorrhage Among Patients With Acute Ischemic Stroke
To the Editor A recent article suggested that the use of non –vitamin K antagonist oral anticoagulants (NOACs) within 7 days of intravenous alteplase was not associated with an increased risk of intracranial hemorrhage. However, we are concerned that some readers may interpret these results as an endorsement of the use of alteplase in patients with acute st roke who were taking NOACs, irrespective of the time frame of last use. Based on dose-finding studies, the drug half-life is 12 hours for apixaban, 11 to 13 hours for rivaroxaban, 10 to 14 hours for edoxaban, and 12 to 17 hours for dabigatran in patients with normal k...
Source: JAMA - June 21, 2022 Category: General Medicine Source Type: research

Highlights From the International Stroke Conference 2022 —Thrombectomy and Alteplase, Access to Stroke Centers, and Warfarin vs Direct Oral Anticoagulants
Timely topics discussed at the AHA/ASA ’s International Stroke Conference included giving stroke patients intra-arterial alteplase following successful thrombectomy.
Source: JAMA - March 15, 2022 Category: General Medicine Source Type: research

Intra-arterial Alteplase After Successful Thrombectomy and Functional Outcomes in Large Vessel Occlusion Stroke
This randomized clinical trial assesses the effect of intra-arterial alteplase infusion vs placebo on functional outcomes (modified Rankin Scale scores) among patients with large vessel occlusion acute ischemic stroke and successful reperfusion following thrombectomy.
Source: JAMA - March 1, 2022 Category: General Medicine Source Type: research

Intravenous Thrombolytic Therapy for Treatment of Acute Ischemic Stroke in Patients Taking NOACs
Intravenous thrombolytic therapy with recombinant tissue plasminogen activator (alteplase) is the cornerstone of acute ischemic stroke reperfusion therapy and is associated with significant improvements in outcomes. Historically, a number of exclusion criteria for use of alteplase had been in place, but over the past 20 years, some of these have been eliminated (eg, age>80 years, seizures at stroke onset) or have become less stringent (eg, exclusion criteria may not strictly apply to recent vitamin K antagonist treatment if the patient has an international normalized ratio<1.7, and treatment may be administered in an...
Source: JAMA - February 22, 2022 Category: General Medicine Source Type: research

Recent Use of NOACs and Intracranial Hemorrhage in Patients With Stroke Treated With Alteplase
This retrospective cohort study uses data from hospitals participating in the Get With The Guidelines –Stroke registry on patients with acute ischemic stroke and compares the safety and functional outcomes of intravenous alteplase among patients who were taking non–vitamin K antagonist oral anticoagulants (NOACs) prior to stroke vs patients who were not taking long-term anticoagulants.
Source: JAMA - February 22, 2022 Category: General Medicine Source Type: research

Effect of Endovascular Treatment With vs Without IV Alteplase on Functional Independence After Acute Ischemic Stroke
This noninferiority trial compares the effects of endovascular treatment with vs without intravenous alteplase on 90-day functional independence among patients with acute ischemic stroke.
Source: JAMA - January 19, 2021 Category: General Medicine Source Type: research

Effect of Mechanical Thrombectomy Without vs With Intravenous Thrombolysis in Acute Ischemic Stroke
This noninferiority trial compares the effects of mechanical thrombectomy with vs without intravenous thrombolysis (0.6-mg/kg alteplase) on 90-day disability among patients with acute large vessel occlusive ischemic stroke.
Source: JAMA - January 19, 2021 Category: General Medicine Source Type: research

Alteplase Inhibits Nerinetide, a Novel Stroke Drug
The investigational neuroprotectant nerinetide did not reduce disability in all patients with ischemic stroke who were treated with endovascular thrombectomy, a trial in The Lancet reported. However, patients who were not concurrently treated with alteplase had a large benefit from nerinetide.
Source: JAMA - April 28, 2020 Category: General Medicine Source Type: research

Clinical and Imaging Characteristics Associated With Thrombus Recanalization in Ischemic Stroke
This cohort study examines baseline clinical and biochemical variables, intracranial thrombus characteristics, and stroke workflow interval times associated with clot recanalization among patients with ischemic stroke treated with intravenous alteplase.
Source: JAMA - September 11, 2018 Category: General Medicine Source Type: research

Intravenous Alteplase for Mild Nondisabling Acute Ischemic Stroke
Treatment of patients with stroke has changed substantially during the past 25 years. In 1995, the NINDS rt-PA trial showed among selected patients with acute ischemic stroke who were treated with intravenous alteplase within 3 hours of known stroke onset or last known well time had reduced disability at 3 months. In 2008, the ECASS III trial demonstrated benefit of intravenous alteplase among selected patients treated up to 4.5 hours after known stroke onset or last known well time. Benefit from alteplase treatment occurred despite higher rates of symptomatic intracranial hemorrhage compared with placebo (6.4% vs 0.6% in ...
Source: JAMA - July 10, 2018 Category: General Medicine Source Type: research

Alteplase vs Aspirin and Functional Outcome in Ischemic Stroke With Minor Nondisabling Neurologic Deficits
This randomized trial compares the effects of intravenous alteplase vs oral aspirin treatment on functional outcomes in patients with minor nondisabling acute ischemic stroke.
Source: JAMA - July 10, 2018 Category: General Medicine Source Type: research