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DC Field | Value | Language |
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dc.contributor.author | Yogendrakumar, V. | - |
dc.contributor.author | Churilov, L. | - |
dc.contributor.author | Mitchell, P. J. | - |
dc.contributor.author | Kleinig, T. J. | - |
dc.contributor.author | Yassi, N. | - |
dc.contributor.author | Thijs, V. | - |
dc.contributor.author | Wu, T. | - |
dc.contributor.author | Shah, D. | - |
dc.contributor.author | Bailey, P. | - |
dc.contributor.author | Dewey, H. M. | - |
dc.contributor.author | Choi, P. M. C. | - |
dc.contributor.author | Ma, A. | - |
dc.contributor.author | Wijeratne, T. | - |
dc.contributor.author | Garcia-Esperon, C. | - |
dc.contributor.author | Cloud, G. | - |
dc.contributor.author | Chandra, R. V. | - |
dc.contributor.author | Cordato, D. J. | - |
dc.contributor.author | Yan, B. | - |
dc.contributor.author | Sharma, G. | - |
dc.contributor.author | Desmond, P. M. | - |
dc.contributor.author | Parsons, M. W. | - |
dc.contributor.author | Donnan, G. A. | - |
dc.contributor.author | Davis, S. M. | - |
dc.contributor.author | Campbell, B. C. V. | - |
dc.contributor.author | Dowling, R. | - |
dc.contributor.author | Bush, S. | - |
dc.contributor.author | Scroop, R. | - |
dc.contributor.author | Simpson, M. | - |
dc.contributor.author | Brooks, M. | - |
dc.contributor.author | Asadi, H. | - |
dc.contributor.author | Ang, T. | - |
dc.contributor.author | Miteff, F. | - |
dc.contributor.author | Levi, C. | - |
dc.contributor.author | Rodrigues, E. | - |
dc.contributor.author | Zhao, H. | - |
dc.contributor.author | Ng, F. | - |
dc.contributor.author | Alemseged, F. | - |
dc.contributor.author | Salvaris, P. | - |
dc.contributor.author | Rice, H. | - |
dc.contributor.author | De Villiers, L. | - |
dc.contributor.author | Brown, H. | - |
dc.contributor.author | Redmond, K. | - |
dc.contributor.author | Leggett, D. | - |
dc.contributor.author | Fink, J. | - |
dc.contributor.author | Collecutt, W. | - |
dc.contributor.author | Kraemer, T. | - |
dc.contributor.author | Muller, C. | - |
dc.contributor.author | Coulthard, A. | - |
dc.contributor.author | Mitchell, K. | - |
dc.contributor.author | Clouston, J. | - |
dc.contributor.author | Mahady, K. | - |
dc.contributor.author | Field, D. | - |
dc.contributor.author | O'Brien, B. | - |
dc.contributor.author | Clissold, B. | - |
dc.contributor.author | Clissold, A. | - |
dc.contributor.author | Bolitho, L. | - |
dc.contributor.author | Bonavia, L. | - |
dc.contributor.author | Bhattacharya, A. | - |
dc.contributor.author | Wright, A. | - |
dc.contributor.author | Mamun, A. | - |
dc.contributor.author | O'Rourke, F. | - |
dc.contributor.author | Worthington, J. | - |
dc.contributor.author | Wong, A. | - |
dc.contributor.author | Ma, H. | - |
dc.contributor.author | Phan, T. | - |
dc.contributor.author | Chong, W. | - |
dc.contributor.author | Slater, L. A. | - |
dc.contributor.author | Krause, M. | - |
dc.contributor.author | Harrington, T. | - |
dc.contributor.author | Faulder, K. | - |
dc.contributor.author | Steinfort, B. | - |
dc.contributor.author | Bladin, C. | - |
dc.date.accessioned | 2023-08-18T05:08:22Z | - |
dc.date.available | 2023-08-18T05:08:22Z | - |
dc.date.issued | 2023 | - |
dc.identifier.issn | 00283878 (ISSN) | - |
dc.identifier.uri | https://swslhd.intersearch.com.au/swslhdjspui/handle/1/9592 | - |
dc.description.abstract | Background and ObjectivesThe safety and efficacy of tenecteplase (TNK) in patients with tandem lesion (TL) stroke is unknown. We performed a comparative analysis of TNK and alteplase in patients with TLs.MethodsWe first compared the treatment effect of TNK and alteplase in patients with TLs using individual patient data from the EXTEND-IA TNK trials. We evaluated intracranial reperfusion at initial angiographic assessment and 90-day modified Rankin scale (mRS) with ordinal logistic and Firth regression models. Because 2 key outcomes, mortality and symptomatic intracranial hemorrhage (sICH), were few in number among those who received alteplase in the EXTEND-IA TNK trials, we generated pooled estimates for these outcomes by supplementing trial data with estimates of incidence obtained through a meta-analysis of studies identified in a systematic review. We then calculated unadjusted risk differences to compare the pooled estimates for those receiving alteplase with the incidence observed in the trial among those receiving TNK.ResultsSeventy-one of 483 patients (15%) in the EXTEND-IA TNK trials possessed a TL. In patients with TLs, intracranial reperfusion was observed in 11/56 (20%) of TNK-treated patients vs 1/15 (7%) alteplase-treated patients (adjusted odds ratio 2.19; 95% CI 0.28-17.29). No significant difference in 90-day mRS was observed (adjusted common odds ratio 1.48; 95% CI 0.44-5.00). A pooled study-level proportion of alteplase-associated mortality and sICH was 0.14 (95% CI 0.08-0.21) and 0.09 (95% CI 0.04-0.16), respectively. Compared with a mortality rate of 0.09 (95% CI 0.03-0.20) and an sICH rate of 0.07 (95% CI 0.02-0.17) in TNK-treated patients, no significant difference was observed.DiscussionFunctional outcomes, mortality, and sICH did not significantly differ between patients with TLs treated with TNK and those treated with alteplase.Classification of EvidenceThis study provides Class III evidence that TNK is associated with similar rates of intracranial reperfusion, functional outcome, mortality, and sICH compared with alteplase in patients with acute stroke due to TLs. However, the CIs do not rule out clinically important differences. ? American Academy of Neurology. | - |
dc.publisher | Lippincott Williams and Wilkins | - |
dc.subject | Brain Ischemia Fibrinolytic Agents Humans Intracranial Hemorrhages Stroke Tenecteplase Tissue Plasminogen Activator Treatment Outcome abciximab acetylsalicylic acid alteplase anticoagulant agent antithrombocytic agent clopidogrel eptifibatide heparin prasugrel ticagrelor tirofiban fibrinolytic agent adult aged Article basilar artery occlusion brain hemorrhage brain perfusion carotid angioplasty carotid endarterectomy cerebrovascular accident computed tomographic angiography controlled study digital subtraction angiography drug efficacy drug safety female fibrinolytic therapy human internal carotid artery internal carotid artery occlusion major clinical study male meta analysis middle cerebral artery occlusion mortality mortality rate multicenter study (topic) nuclear magnetic resonance imaging odds ratio outcome assessment patient coding post hoc analysis randomized controlled trial (topic) Rankin scale regression model risk assessment systematic review tandem lesion stroke | - |
dc.title | Safety and Efficacy of Tenecteplase and Alteplase in Patients With Tandem Lesion Stroke: A Post Hoc Analysis of the EXTEND-IA TNK Trials | - |
dc.type | Journal Article | - |
dc.description.affiliates | The Department of Medicine and Neurology, Melbourne Brain Centre, The Royal Melbourne Hospital, Parkville, Australia Melbourne Medical School, University of Melbourne, Heidelberg, Australia Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia Department of Neurology, Royal Adelaide Hospital, Australia Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia Department of Neurology, Christchurch Hospital, New Zealand Department of Neurology, Princess Alexandra Hospital, Brisbane, Australia Department of Neurology, Southport, Australia Gold Coast University Hospital, Southport, Australia Department of Neurosciences, Monash University, Clayton, Australia Eastern Health and Eastern Health Clinical School, Monash University, Clayton, Australia Royal North Shore Hospital, NSW, Australia Department of Medicine and Neurology, Melbourne Medical School, The University of Melbourne and Western Health, Sunshine Hospital, St Albans, Australia Department of Neurology, John Hunter Hospital, Newcastle, NSW, Australia Department of Neurology, Alfred Hospital, Melbourne, Australia Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia NeuroInterventional Radiology Unit, Monash Health, Monash University, Australia Department of Neurology, Liverpool Hospital, University of New South Wales, Sydney, Australia | - |
dc.identifier.doi | 10.1212/WNL.0000000000207138 | - |
dc.type.studyortrial | Article | - |
dc.identifier.journaltitle | Neurology | - |
Appears in Collections: | Liverpool Hospital |
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