Acute Ischemic Stroke In China Research Articles

Relationship between Blood Pressure and Outcomes in Acute Ischemic Stroke Patients Administered Lytic Medication in the TIMS-China Study.

ObjectiveIncreased blood pressure (BP) management following acute ischemic stroke (AIS) remains controversial. This study aimed to identify the association between BP and clinical outcomes in AIS patients administered lytic medication in the TIMS-China (thrombolysis implementation and monitor of acute ischemic stroke in China) database.MethodsThe sample comprised 1128 patients hospitalized within 4.5 hours (h) of AIS for intravenous recombinant tissue plasminogen activator (i.v. rt-PA) thrombolysis. Systolic BP (SBP) and diastolic BP (DBP) at baseline, 2 h and 24 h after treatment, and changes from baseline were analyzed. The study outcomes comprised a favorable outcome (modified Rankin Scale 0–1 at 90 days) and symptomatic intracerebral hemorrhage (SICH), analyzed using logistic regression, with low BP as the reference group.ResultsLower BP (baseline, 2 h, and 24 h) was beneficial in AIS patients and significantly related to a favorable outcome (P<0.05). A substantial BP decrease at 24 h after rt-PA thrombolysis was significantly associated with a favorable outcome compared with a moderate BP decrease (P = 0.0298). A SBP >160 mmHg 2 h after rt-PA thrombolysis was significantly associated with SICH compared with a SBP <140 mmHg (P = 0.0238). An increase or no change (>25 mmHg) in SBP was significantly associated with SICH (P = 0.002) compared with a small SBP decrease (1–9 mmHg).ConclusionsThis study provides novel evidence that lower BP within the first 24 h is associated with a more favorable outcome and less frequent SICH in AIS patients administered lytic medication. Routine BP-lowering treatment should be considered in AIS patients following lytic medication.

Determinants of Emergency Medical Services Utilization Among Acute Ischemic Stroke Patients in Hubei Province in China.

Emergency medical services (EMS) can effectively shorten the prehospital delay for patients with acute ischemic stroke. This study aimed to investigate EMS utilization and its associated factors in patients with acute ischemic stroke in China. A cross-sectional study was conducted from October 1, 2014, to January 31, 2015, which included 2096 patients admitted for acute ischemic stroke from 66 hospitals in Hubei province in China. A multivariable stepwise logistic regression model was undertaken to identify the factors associated with EMS utilization. Of the 2096 participants, only 323 cases (15.4%) used EMS. Those acute ischemic stroke patients who previously used EMS (odds ratio [OR] =9.8), whose National Institutes of Health Stroke Scale score was ≥10 (OR=3.7), who lived in urban communities (OR=2.5), who had sudden onset of symptoms (OR=2.4), who experienced their first stroke (OR=1.8), and who recognized initial symptom as stroke (OR=1.4) were more likely to use EMS. Additionally, when acute ischemic stroke patients' stroke symptom were noticed first by others (OR=2.1), rather than by the patients, EMS was more likely to be used. A very low proportion of patients with acute ischemic stroke used the EMS in Hubei province in China. Considerable education programs are required regarding knowledge of potential symptoms and the importance of EMS for stroke.

Thrombolytic-Related Asymptomatic Hemorrhagic Transformation Does Not Deteriorate Clinical Outcome: Data from TIMS in China.

ObjectiveIt has been unclear whether thrombolytic-related asymptomatic hemorrhagic transformation (AHT) affects the clinical outcome. To answer this question, we examined whether thrombolytic-related AHT affect short-term and long-term clinical outcome.MethodsAll data were collected from the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS-China) registry. The patients were diagnosed as having AHT group and non- hemorrhagic transformation (HT) group based on clinical and imaging data. The patients with symptomatic hemorrhagic transformation were excluded from this study. Thrombolytic-related AHT was defined according to European-Australasian Acute Stroke Study (ECASS) II criteria. 90-day functional outcome, 7-day National Institutes of Health Stroke Scale (NIHSS) score, 7-day and 90-day mortalities were compared between two groups. Logistic regression analysis was used to evaluate the effects of AHT on a short-term and long-term clinical outcome.Results904 of all 1440 patients in TIMS-China registry were enrolled. 89 (9.6%) patients presented with AHT after thrombolysis within 24-36h. These patients with AHT were more likely to be elder age, cardioembolic subtype, and to have higher National Institutes of Health Stroke Scale score before thrombolysis than patients without AHT. No significant difference was found on the odds of 7-day (95% CI:0.692 (0.218–2.195), (P = 0.532) or 90-day mortalities (95% CI:0.548 (0.237–1.268), P = 0.160) and modified Rankin Score(0–1) at 90-day (95% CI:0.798 (0.460–1.386), P = 0.423) or modified Rankin Score(0–2) at 90-day (95% CI:0.732 (0.429–1.253), P = 0.116) or modified Rankin Score(5–6) at 90-day (95% CI:0.375 (0.169–1.830), P = 0.116) between two groups.ConclusionsThrombolytic-related AHT does not deteriorate short-term and long-term clinical outcome.

Risk factors of outcomes in elderly patients with acute ischemic stroke in China.

Stroke results in poor outcomes among elderly patients. However, the factors associated with outcome over different follow-up periods in this population are unknown. To evaluate the outcomes and risk factors of outcomes in elderly patients after stroke. Outcomes, including mortality, dependency (defined as a mRS >2), and recurrence rates, and associated risk factors were assessed at 3 and 12months after stroke in patients aged ≥80years. There were 419 acute ischemic stroke patients aged ≥80years at 3months, and 309 patients at 12months; outcomes and relevant risk factors were assessed in these patients. Hypertension was more prevalent in women than in men. At 3months, the mortality, dependency, and recurrence rates were 13.8, 54.2, and 18.1%, respectively; the corresponding rates at 12months were 26.9, 58.0, and 32.6%, respectively. In the multivariate analysis, after adjusting by confounding factors, TOAST classification and stroke severity were associated with mortality and recurrence, while stroke severity was associated with dependency at 3months. The mortality and dependency rates at 12months were significantly associated with moderate and severe stroke, but severe stroke was an independent factor associated with recurrence. Stroke subtype and severity were associated with stroke outcomes among elderly patients in northern China. These findings suggest that it is crucial to highlight the affected factors of stroke outcome among elderly patients for reduce the burden of stroke in China.

Validation of the DRAGON Score in a Chinese Population to Predict Functional Outcome of Intravenous Thrombolysis–Treated Stroke Patients

The DRAGON score predicts functional outcome of ischemic stroke patients treated with intravenous thrombolysis. Our aim was to evaluate its utility in a Chinese stroke population. Patients with acute ischemic stroke treated with intravenous thrombolysis were prospectively registered in the Thrombolysis Implementation and Monitor of acute ischemic Stroke in China. We excluded patients with basilar artery occlusion and missing data, leaving 970 eligible patients. We calculated the DRAGON score, and the clinical outcome was measured by the modified Rankin Scale at 3 months. Model discrimination was quantified by calculating the C statistic. Calibration was assessed using Pearson correlation coefficient. The C statistic was .73 (.70-.76) for good outcome and .75 (.70-.79) for miserable outcome. Proportions of patients with good outcome were 94%, 83%, 70%, and 0% for 0 to 1, 2, 3, and 8 to 10 score points, respectively. Proportions of patients with miserable outcome were 0%, 3%, 9%, and 50% for 0 to 1, 2, 3, and 8 to 10 points, respectively. There was high correlation between predicted and observed probability of 3-month favorable and miserable outcome in the external validation cohort (Pearson correlation coefficient, .98 and .98, respectively, both P < .0001). The DRAGON score showed good performance to predict functional outcome after tissue-type plasminogen activator treatment in the Chinese population. This study demonstrated the accuracy and usability of the DRAGON score in the Chinese population in daily practice.

Factors impact the adherence rate of prophylaxis for deep venous thrombosis in acute ischaemic stroke patients: an analysis of the China National Stroke Registry

Objectives:Little is known about the clinical practice of deep venous thrombosis (DVT) prophylaxis in patients with acute ischaemic stroke in China. We examined the factors that impact the adherence rate of DVT prophylaxis in stroke patients from the China National Stroke Registry (CNSR).Methods:Records of 12 173 acute ischaemic stroke patients with follow-up admitted to 132 hospitals in CNSR from September 1, 2007 to August 30, 2008 were reviewed. Data from 4643 patients eligible for DVT prophylaxis were analysed. Generalised estimating equations were used to identify the patient's and hospital's factors that impact the practice of DVT prophylaxis.Results:Among 4643 acute ischaemic stroke patients eligible for DVT prophylaxis, the overall adherence rate of DVT prophylaxis was 59·6%. The median hospital prophylaxis rate was 57·8% (inter quartile range: 33·3(70·2%). Venous thromboembolism was found in 1·6% of patients. Factors associated with increased likelihood of practicing DVT prophylaxis in the multivariable model included history of atrial fibrillation (AF) (P = 0·04), receiving rehabilitation evaluation (P < 0·001), receiving care in the East (P < 0.001) or Central (P = 0.001) regions compared to west regions of China. Increasing age (P = 0.014), NIHSS score on admission (P < 0.001), annual stroke discharges (P = 0.001), and the hospital size (P = 0.003) were associated with lower likelihood of DVT prophylaxis.Discussion:The adherence rate of DVT prophylaxis among non-ambulance patients with acute ischaemic stroke was suboptimal in China. It varied among patients by age, stroke severity, and history of AF, and among hospitals by different locations, number of beds and annual stroke discharges.

Totaled health risks in vascular events score predicts clinical outcome and symptomatic intracranial hemorrhage in chinese patients after thrombolysis.

The performance of the Totaled Health Risks in Vascular Events (THRIVE) score in predicting clinical outcomes in Chinese patients with acute ischemic stroke post intravenous thrombolysis is unknown. Data from the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS-China) study was used to compare the THRIVE score with other scores used to predict clinical outcomes and symptomatic intracranial hemorrhage after intravenous thrombolysis. Among the 1128 patients with acute ischemic stroke who were included in this study, areas under the curve of the THRIVE score for symptomatic intracranial hemorrhage, 3-month poor functional outcomes, and death rate were 0.69, 0.71, and 0.78, respectively. The increased THRIVE score was related to the higher risk of developing symptomatic intracranial hemorrhage, poor functional outcomes, or death in patients with acute ischemic stroke at 3 months after thrombolysis. The THRIVE score predicted reliably the risks of developing symptomatic intracranial hemorrhage, poor functional outcome, or death after intravenous thrombolysis therapy in Chinese patients with acute ischemic stroke.

Abstract W P159: Impact of Body Mass Index on 1-year Outcome After Acute Ischemic Stroke

Introduction: Debates exist in the impact of overweight and obesity on the outcome after stroke. Our study is aimed to investigate the relation between body mass index(BMI) and stroke outcome in a broad range of hospitalized patients with acute ischemic stroke in China. Methods: Data are from the ChinaQUEST (QUality Evaluation of Stroke Care and Treatment) study, a multi-centre, prospective, 62-hospital registry in China during 2006-07. Patients were categorized as underweight(BMI&lt;18.5), normal(BMI 18.5 to &lt;25), overweight(BMI 25 to &lt;30) and obesity(BMI≥30). The primary endpoint was all-cause mortality at 12 months. The secondary endpoint was the proportion of death or dependency (modified Rankin Scale score 3-5) at 12 months. Results: There were 4782 patients with acute ischemic stroke enrolled in ChinaQUEST registry study. According to BMI, 282(5.9%) patients were of underweight, 2889(60.4%) were of normal weight, 1408(29.4%) were of overweight, and 203(4.2%) were obese. Outcome measures at 12 months were available in 4645 patients. The mortality was 21.3%(58/272) for underweight group, 10.6%(299/2810) for normal weight group, 8.5%(116/1365) for overweight group and 9.1%(18/198) for obesity group. The corresponding proportion of death or dependency was 45.6%(124/272), 30.9%(867/2810), 28.1%(384/1365) and 29.3%(58/198), respectively. After adjustment for all confounders, compared with patients of normal weight, odds ratio(95% confidence interval) of death at 12 months was 1.985(1.373-2.868) for underweight group, 0.952(0.738-1.229) for overweight group and 0.844(0.468-1.522) for obesity group. The corresponding odds ratio(95% confidence interval) of death or dependency at 12 months was 1.541(1.155-2.054), 1.004(0.853-1.181) and 0.837(0.578-1.211), respectively. Conclusion: In ischemic stroke patients, a J-shaped relationship between BMI and stroke outcome was observed. Underweight was associated with the highest risk for unfavorable outcome. No benefit of overweight and obesity on the survival or functional outcome over normal weight was found.

Mailuoning for acute ischaemic stroke.

Mailuoning is widely used in the treatment of acute ischaemic stroke in China. Animal experimental studies and clinical pharmacological research indicate that mailuoning might improve blood circulation, prevent ischaemic injury, and protect heart and brain tissue. This review was last published in 2009. As new data have become available, it is necessary to reassess the evidence from randomised controlled trials. To determine the effects and safety of mailuoning agents (injection or oral liquid) in the treatment of people with acute ischaemic stroke. We searched the Cochrane Stroke Group Trials Register (May 2014), the Cochrane Central Register of Controlled Trials (CENTRAL;2014, Issue 4), MEDLINE (1966 to May 2014), Embase (1980 to May 2014), AMED (1985 to May 2014), the Chinese Stroke Trials Register (June 2014), the China Biological Medicine Database (CBM-disc; 1979 to June 2014), China Science and Technology Journal database (CSTJ; 1979 to June 2014), Wanfang Data Chinese databases (1979 to June 2014), and the China National Knowledge Infrastructure (1979 to June 2014). We searched clinical trials and research registers, handsearched 10 Chinese journals including relevant conference proceedings, scanned reference lists, and contacted the pharmaceutical company that manufactures mailuoning. We also attempted to contact trial authors to obtain further data. Randomised controlled trials comparing mailuoning with placebo or mailuoning plus other treatment compared with that other treatment in people with acute ischaemic stroke. Two review authors independently selected trials for inclusion, assessed trial quality, and extracted data. We included 21 trials, involving 1746 participants, in this update; six trials were new. The included trials did not report the numbers of dead and dependent participants at the end of at least three months' follow-up. Of the 12 trials that reported adverse events, five events occurred in two trials. There was no significant difference between the treatment group and the control group. We assessed 20 trials to be of a poor quality: When analysing these trials together, mailuoning was associated with a significant increase in the number of participants with an improved neurological deficit (risk ratio (RR) 0.31, 95% confidence interval (CI) 0.23 to 0.42) and showed a significant improvement of neurological deficit with the European Stroke Scale (ESS) (mean difference (MD) (fixed) 8.29, 95% CI 3.44 to 13.15). One placebo-controlled trial, assessed to be of a better methodological quality, failed to show a significant improvement of neurological deficit at the end of three months' follow-up (MD (fixed) 2.49, 95% CI -1.45 to 6.43) or in quality of life. One trial, which reported cognitive function using the Montreal Cognitive Assessment as a continuous scale, showed a significant improvement of cognitive function (MD (fixed) 2.68, 95% CI 1.82 to 3.54). Two trials assessed activities of daily life: One trial showed a significant improvement, but the other did not. This review did not provide sufficient evidence to support the routine use of mailuoning for the treatment of people with acute ischaemic stroke. High-quality large-scale randomised controlled trials are needed to confirm the efficacy of mailuoning.

Postthrombolytic Antiplatelet Use for Patients with Intercerebral Hemorrhage without Extensive Parenchymal Involvement Does Not Worsen Outcome.

Background and PurposeIt is unclear whether postthrombolytic antiplatelet (AP) therapy after thrombolytic-related hemorrhage without extensive parenchymal involvement (THEPI) affects the clinical outcome. This study explored whether AP administration in patients with THEPI affects short- and long-term outcomes.MethodsAll of the data for this study were collected from the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS-China) registry. Patients with THEPI were assigned to either the AP (AP therapy should be commenced 24 h after intravenous thrombolysis) or AP-naïve groups. THEPI was defined according to European-Australasian Acute Stroke Study II criteria. The 90-day functional outcome, 7-day National Institutes of Health Stroke Scale (NIHSS) score, and 7-day and 90-day mortalities were compared between the AP and AP-naïve groups. Logistic regression analysis was used to evaluate the effects of AP therapy on the short- and long-term clinical outcomes.ResultsOf the 928 patients enrolled from those in the TIMS-China registry (n=1,440), 89 (9.6%) had nonsymptomatic intracerebral hemorrhage (ICH) within 24-36 h after thrombolysis; 33 (37%) of these patients were given AP therapy (AP group) and 56 (63%) were not (AP-naïve group). No significant differences were found for the risk of 7-day aggravated ICH (p=0.998), 7-day NIHSS score (p=0.5491), 7-day mortality [odds ratio (OR)=3.427; 95% confidence interval (95% CI)=0.344-34.160; p=0.294], 90-day mortality (OR=0.788, 95% CI=0.154-4.040, p=0.775), or modified Rankin score 5 or 6 at 90-days (OR=1.108, 95% CI=0.249-4.928, p=0.893) between the AP and AP-naïve groups after THEPI.ConclusionsEarly administration of postthrombolytic AP therapy after THEPI does not worsen either the short- or long-term outcome. AP therapy may be a reasonable treatment option for patients with THEPI to reduce the risk of ischemic stroke recurrence.

QA3 - Cost-Effectiveness of Thrombolysis Within 4.5 Hours of Acute Ischemic Stroke in China

QA3 - Cost-Effectiveness of Thrombolysis Within 4.5 Hours of Acute Ischemic Stroke in China

Cost-effectiveness of thrombolysis within 4.5 hours of acute ischemic stroke in China.

BackgroundPrevious economic studies conducted in developed countries showed intravenous tissue-type plasminogen activator (tPA) is cost-effective for acute ischemic stroke. The present study aimed to determine the cost-effectiveness of tPA treatment in China, the largest developing country.MethodsA combination of decision tree and Markov model was developed to determine the cost-effectiveness of tPA treatment versus non-tPA treatment within 4.5 hours after stroke onset. Outcomes and costs data were derived from the database of Thrombolysis Implementation and Monitor of acute ischemic Stroke in China (TIMS-China) study. Efficacy data were derived from a pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Costs and quality-adjusted life-years (QALYs) were compared in both short term (2 years) and long term (30 years). One-way and probabilistic sensitivity analyses were performed to test the robustness of the results.ResultsComparing to non-tPA treatment, tPA treatment within 4.5 hours led to a short-term gain of 0.101 QALYs at an additional cost of CNY 9,520 (US$ 1,460), yielding an incremental cost-effectiveness ratio (ICER) of CNY 94,300 (US$ 14,500) per QALY gained in 2 years; and to a long-term gain of 0.422 QALYs at an additional cost of CNY 6,530 (US$ 1,000), yielding an ICER of CNY 15,500 (US$ 2,380) per QALY gained in 30 years. Probabilistic sensitivity analysis showed that tPA treatment is cost-effective in 98.7% of the simulations at a willingness-to-pay threshold of CNY 105,000 (US$ 16,200) per QALY.ConclusionsIntravenous tPA treatment within 4.5 hours is highly cost-effective for acute ischemic strokes in China.

Standard-Dose Intravenous Tissue-Type Plasminogen Activator for Stroke Is Better Than Low Doses

It remains uncertain whether lower dose intravenous tissue-type plasminogen activator (tPA) for stroke is as effective and safe as the standard dose. We analyzed data from the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS-China). Patients who were treated within 4.5 hours after symptom onset were included. These patients were divided into 5 groups according to tPA doses given: <0.5, 0.5 to 0.7, 0.7 to 0.85, 0.85 to 0.95, and ≥0.95 mg/kg. Symptomatic intracranial hemorrhage, mortality, and 90-day outcome assessed by modified Rankin scale were analyzed. A total of 919 patients were enrolled. Among them, 9 had <0.5 mg/kg, 75 had 0.5 to 0.7 mg/kg, 131 had 0.7 to 0.85 mg/kg, 678 had 0.85 to 0.95 mg/kg, and 26 had ≥0.95 mg/kg. Because of sample sizes, only 0.5 to 0.7, 0.7 to 0.85, and 0.85 to 0.95 mg/kg groups were compared. Median tPA doses were 0.64, 0.79, and 0.90 mg, respectively. After adjustment for the baseline variables, there were no significant differences in mortality(5.41% versus 8.66% versus 7.36%; P=0.695) and symptomatic intracranial hemorrhage (0% versus 3.82% versus 1.46%; P=0.106). The 0.5 to 0.7 mg/kg group had less excellent recovery outcome (modified Rankin scale, 0-1) than 0.85 to 0.95 mg/kg group (41.89% versus 53.83%; odds ratio=0.58; P=0.031) at 90 days. The 0.70 to 0.85 mg/kg group had less functional independence outcome (modified Rankin scale, 0-2) than 0.85 to 0.95 mg/kg group (54.33% versus 64.51%; odds ratio=0.66; P=0.036) at 90 days. Our study suggests that standard-dose intravenous tPA for stroke had more favorable outcome without increasing the risk of symptomatic intracranial hemorrhage than low-dose tPA. For Asian people, 0.9 mg/kg should be the optimal dose of tPA to treat acute ischemic stroke.

Abstract 8: Association Between Hospital "Get With The Guidelines-Stroke" Performance Measures And Outcomes Among Patients With Acute Ischemic Stroke In China

Background: To assess contemporary care practices consistent with the evidence-based performance measures adopted by GWTG-Stroke and whether the composite measure rate was associated with in-hospital outcomes, the Second China National Stroke Registry (CNSRII), a national hospital-based, prospective registry, was initiated by the Ministry of Health of China. Methods: Between January 2012 and February 2013, CNSRII recruited 31,048 patients with stroke or transient ischemic attack from 221 hospitals throughout China. Among 24,597 patients with acute ischemic stroke, adherence to seven GWTG-Stroke performance measures (Intravenous tissue plasminogen activator within 3 hours of symptom onset, Deep Venous Thrombosis prophylaxis, Early and Discharge antithrombotics, Anticoagulation for atrial fibrillation, Lipid-lowering for LDL ≥100 mg/dl, and Smoking cessation), all-or-none measure and composite measure (defined as the total number of performance measure interventions performed among eligible patients divided by the total number of possible performance measure interventions among eligible patients) were assessed. The association between the composite measure adherence quartile and unadjusted in-hospital outcome (death, pneumonia and venous thromboembolism) was evaluated using the Pearson correlation coefficients. The multivariate logistic regression was employed to examine the association between composite measure with in-hospital outcomes and adjusted by age, gender, admission NIHSS, health insurance, history of prior stroke/TIA, diabetes, hypertension, atrial fibrillation or flutter, coronary artery diseases/MI, peripheral vascular disease, dyslipidemia, carotid stenosis, and smoker. Results: Among 24,597 patients with acute ischemic stroke, conformity with 7 performance measures ranged from 13.7% (259 of 1,897) for tPA use to 96.5% (23,247 of 24,079) for early antithrombotics. The all-or-none measure and composite measure were 55.5% and 82.1% separately. The composite measure rate was significantly associated with in-hospital death and pneumonia, with observed mortality rates decreasing from 4.8% (32 of 667) for the lowest adherence quartile to 0.4% (56 of 14212) for the highest adherence quartile (P&lt;.001), and observed pneumonia rates decreasing from 20.3% (133 of 667) for the lowest adherence quartile to 4.8% (670 of 14212) for the highest adherence quartile (P&lt;.001). After risks adjustment, multivariate models showed that composite measure adherence was associated with in-hospital outcomes of death (adjusted OR: 0.075 with 95% CI: 0.048-0.118, P&lt;.001) and pneumonia (adjusted OR: 0.256 with 95% CI: 0.212-0.310, P&lt;.001). Conclusions: A significant association between hospital care process and outcomes was found, supporting the use of GWTG-Stroke performance metrics as a means of assessing and helping improve stroke care quality in China.

Preexisting dual antiplatelet treatment increases the risk of post-thrombolysis intracranial hemorrhage in Chinese stroke patients

Objective:Previous studies have shown conflicting results on the use of antiplatelet (AP) agent and its risk of symptomatic intracerebral hemorrhage (sICH) following thrombolysis for acute ischemic stroke. Our study was to explore the safety of intravenous (IV) thrombolysis in Chinese stroke patients who were on AP prior to stroke.Methods:Data were collected from the thrombolysis implementation and monitor of acute ischemic stroke in China (TIMS-China) registry. Symptomatic ICH defined per SITS-MOST (safe implementation of treatments in stroke-monitoring study), ECASS II (second European-Australasian acute stroke study), and NINDS (National Institute of Neurological Disorders and Stroke) criteria, 90-day functional outcome, and 7-day and 90-day mortalities were compared between the stroke patients who were on mono and dual AP therapy.Results:A total of 157 (14·2%) patients received at least one AP drug within 24 hours before thrombolysis. Patients with preexisting dual AP treatment had higher rate of sICH (14·3% (2/14) per SITS-MOST, 21·4% (3/14) per ECASS II definitions) than those on no AP treatment. No significant difference was found in the rate of sICH or 7-day or 90-day mortalities between the groups on aspirin (ASA) alone and on no AP treatment.Discussion:The risk of developing sICH is low when thrombolysis is given to patients who are on ASA alone. However, there is potential increased risk of sICH if a patient is on dual AP treatment.

Efficacy and safety of therapies for acute ischemic stroke in China: a network meta-analysis of 13289 patients from 145 randomized controlled trials.

BackgroundMany of these therapies have been compared against placebos, but have not been directly compared against each other. To evaluate the efficacy and safety of several commonly used drugs for AIS directly or indirectly.MethodsA systematic literature review was performed to identify randomized controlled trials (RCTs) published prior to April 2013 for AIS therapies. The primary outcome measures were the National Institutes of Health Stroke Scale (NIHSS) scores and the clinical effective rate. A fixed-effects meta-analysis and meta-regression are performed; lastly, performed a mixed treatment comparison was performed through the Bayesian methods.ResultsOutcome of Efficacy of therapies for acute ischemic stroke are as followed: All of the therapies mentioned above yielded results a more effective result than placebo, Sodium ozagrel (RR 3.86, 95%CI 3.18–4.61); Sodium ozagrel + edaravone (RR 9.60, 95%CI 7.04–13.06); Edaravone (RR 4.07, 95%CI 3.30–5.01); Edaravone + Kininogenase (RR 15.33, 95%CI 10.03–23.05). The significant difference in efficacy between edaravone monotherapy and Sodium ozagrel + edaravone was evident (RR 0.43, 95%CI 0.08–0.61) and was also significant between efficacy of edaravone + Kininogenase and Sodium ozagrel (RR 4.00, 95%CI 2.47–6.24). The differences between the risk and benefit were not significant when comparing Sodium ozagrel and edaravone or edaravone + Kininogenase and Sodium ozagrel + Edaravone for AIS. Outcome of the defect of neurological function: Placebo served a significant difference in treating the defects of neurological function compared with Sodium ozagrel (WMD = −3.11, 95%CI −4.43 to −1.79), Sodium ozagrel + edaravone (WMD = −6.25, 95%CI −7.96 to −4.54) and Edaravone + Kininogenase (WMD = −3.47, 95%CI −5.73 to −1.21).ConclusionsIt provides that the efficacy of edaravone monotherapy in treatment was not more effective than Sodium ozagrel + edaravone.The efficacy of edaravone + Kininogenase monotherapy in treatment was more effective than Sodium ozagrel. Edaravone + Kininogenase and Sodium ozagrel + Edaravone appeared the most effective treatments. And Sodium ozagrel, Sodium ozagrel + edaravone, Edaravone + Kininogenase can improve the nerve dysfunction.

Abstract W P63: Comparison of the Efficacy and Safety of the Acute Stroke Patients Receiving Different Dose Intravenous Tissue Plasminogen Activator

Background and Purpose: In consideration of the racial differences, distinctly reduced cost of treatment and anticipated lower rates of symptomatic intracranial hemorrhage(SICH) coupled with the comparable efficacy, many Asian centers adopted the low dose intravenous tissue plasminogen activator (tPA). We aimed to examine whether lower dose tPA is comparable to standard dose by comparing the efficacy and safety of different doses of tPA in Chinese acute stroke patients. Methods: We analyzed data from the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China(TIMS-China)- a prospective, multicentric cohort study of intravenous alteplase treatment with patient enrollment from 67 centres across China. Patients who were fully compliant with Chinese product characteristics criteria of alteplase within 4.5 h after symptom onset were included. And these patients were divided into 5 group according to dose regimens of tPA (&lt;0.5, 0.5-0.7, 0.7-0.85 , 0.85-0.95 and &gt;=0.95 mg/kg). The SICH, mortality and 90-day outcome of patients were compared. Results: A total of 919 patients were included (&lt;0.5 n=9, 0.5-0.7 n=75, 0.7-0.85 n=131, 0.85-0.95 n=678,and &gt;=0.95 n=26). In consideration of sample size, only 0.5-0.7, 0.7-0.85 and 0.85-0.95 mg/kg group were compared. Median tPA dose were 0.90, 0.79 and 0.64mg/kg.Median Stroke onset to treatment time were 2.79h,2.86h and 2.90h (p=0.941). Median NIHSS score were 11,10 and 10(p=0.252). After adjustment for the baseline variables, there were no significant differences for mortality(5.41% vs 8.66% vs 7.36%, p=0.695) and SICH(0% vs 3.82% vs 1.46%, p=0.106). For excellent recovery outcome defined as modified Ranking Scale(mRS) 0-1 at 3 month, 0.5-0.7 mg/kg group were significantly worse than 0.85-0.95 mg/kg group(OR=0.58,p=0.031). For functional independence outcome defined as mRS 0-2 at 3 month, 0.70-0.85 mg/kg group were significantly worse than 0.85-0.95 mg/kg group(OR=0.66,p=0.036) Conclusion: Our study suggests that stoke patients receiving standard dose tPA may have more favorable outcome than those receiving lower dose tPA. For Asian people, 0.9mg/kg is also the most optimal dose for intravenous alteplase treatment.

Cardiovascular risk stratification and management of patients with rheumatoid arthritis in clinical practice: The “EPIDAURO registry”

services are the major factors influencing pre-hospital delays in patients of acute ischemic stroke in China. Moreover, our study provides further evidence regarding the need for pre-hospital emergency care services among stroke patients. Therefore, the EMS system for stroke patients should be improved, especially in rural areas, and strong collaboration between hospital and community healthcare facilities should be encouraged.

2013 Late-Breaking Clinical Trial Abstracts

### Nitrites in Acute Myocardial Infarction Nishat Siddiqi1, Margaret Bruce1, Christopher J. Neil1, Graeme MacLennan2, Seonaidh Cotton2, Sofia A. Papadopoulou3, Baljit Jagpal1, Sue Brown3, Fatima Perez Gonzalez3, Satnam Singh1, Konstantin Schwarz1, Martin Feelisch4, Nicholas Bunce5, Pitt O Lim5, David Hildick-Smith6, John Horowitz7, Melanie Madhani8, Nicholas Boon9, Dana Dawson10, Juan-Carlos Kaski3, Michael P Frenneaux10. 1Dept of Cardiovascular Rsch, Univ of Aberdeen, Aberdeen, United Kingdom, 2Health Sciences Building (third floor), Centre for Healthcare Randomised Trials (CHaRT), Aberdeen, United Kingdom, 3Cardiovascular Sciences Rsch Centre, St George’s Univ of London, London, United Kingdom, 4Faculty of Medicine, Univ of Southampton, Southampton, 5Cardiology Dept, St George’s Healthcare NHS Trust, 6Cardiology Research Unit, Brighton and Sussex Univ Hospitals, Brighton, United Kingdom, 7Basil Hetzel Unit for Translational Health Research, The Queen Elizabeth Hospital, Adelaide, 8Centre for Cardiovascular Sciences, Univ of Birmingham, Birmingham, United Kingdom, 9Centre for Cardiovascular Sciences, Univ of Edinburgh, Edinburgh, United Kingdom, 10School of Medicine and Dentistry, Univ of Aberdeen, Aberdeen Introduction :Despite reperfusion therapy for acute myocardial infarction (AMI), heart failure remains a major sequel. Reperfusion leads to further damage, described as ischemia-reperfusion-injury (IRI). This contributes up to 50% of the final infarct size. In pre-clinical models nitrite potently protects against IRI in the heart and other organs. Hypothesis :Intravenous (iv) sodium nitrite, administered immediately before opening of the infarct-related artery, results in significant reduction of IRI in patients with acute ST elevation MI (STEMI). Methods :In this phase II, randomised, placebo-controlled, double-blind, multicentre trial, 220 patients with first acute STEMI and TIMI 0 or 1 flow were randomised …

Letter by Dong et al Regarding Article, “CYP2C19 Polymorphisms and Antiplatelet Effects of Clopidogrel in Acute Ischemic Stroke in China”

To the Editor: With interest we read the article by Jia et al1 in which they investigated the CYP2C19 polymorphisms and antiplatelet effects of clopidogrel in acute ischemic stroke in China. They revealed the correlation between CYP2C19 genotype and neurological function of stroke patients. The authors proposed that patients with none had better outcomes than patients with CYP2C19 loss-of-function alleles, as demonstrated by the National Institute of Health Stroke Scale and the modified Rankin scale scores after treatment. As was known, clopidogrel therapy can prevent stroke patients from recurrent ischemic strokes by inhibiting ADP. Recently, nonresponsiveness is widely recognized and is related to raising rates of recurrent ischemic events and all causes of death.2,3 Cayla et …