• 主题
高级搜索  >
历史搜索 清空历史
首页> 外文期刊>Lancet Neurology >Effects of alteplase beyond 3 h after stroke in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET): a placebo-controlled randomised trial.
【24h】

Effects of alteplase beyond 3 h after stroke in the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET): a placebo-controlled randomised trial.

机译：脑卒中后3小时后阿替普酶的影响在Echoplanar成像溶栓评估试验（EPITHET）中进行：安慰剂对照的随机试验。

获取原文
获取原文并翻译 | 示例
           
页面导航
  • 摘要
  • 著录项
  • 相似文献
  • 相关主题

摘要

BACKGROUND: Whether intravenous tissue plasminogen activator (alteplase) is effective beyond 3 h after onset of acute ischaemic stroke is unclear. We aimed to test whether alteplase given 3-6 h after stroke onset promotes reperfusion and attenuates infarct growth in patients who have a mismatch in perfusion-weighted MRI (PWI) and diffusion-weighted MRI (DWI). METHODS: We prospectively and randomly assigned 101 patients to receive alteplase or placebo 3-6 h after onset of ischaemic stroke. PWI and DWI were done before and 3-5 days after therapy, with T2-weighted MRI at around day 90. The primary endpoint was infarct growth between baseline DWI and the day 90 T2 lesion in mismatch patients. Major secondary endpoints were reperfusion, good neurological outcome, and good functional outcome. Patients, caregivers, and investigators were unaware of treatment allocations. Primary analysis was per protocol. This study is registered with ClinicalTrials.gov, number NCT00238537. FINDINGS: We randomly assigned 52 patients to alteplase and 49 patients to placebo. Mean age was 71.6 years, and median score on the National Institutes of Health stroke scale was 13. 85 of 99 (86%) patients had mismatch of PWI and DWI. The geometric mean infarct growth (exponential of the mean log of relative growth) was 1.24 with alteplase and 1.78 with placebo (ratio 0.69, 95% CI 0.38-1.28; Student's t test p=0.239); the median relative infarct growth was 1.18 with alteplase and 1.79 with placebo (ratio 0.66, 0.36-0.92; Wilcoxon's test p=0.054). Reperfusion was more common with alteplase than with placebo and was associated with less infarct growth (p=0.001), better neurological outcome (p<0.0001), and better functional outcome (p=0.010) than was no reperfusion. INTERPRETATION: Alteplase was non-significantly associated with lower infarct growth and significantly associated with increased reperfusion in patients who had mismatch. Because reperfusion was associated with improved clinical outcomes, phase III trials beyond 3 h after treatmentare warranted. FUNDING: National Health and Medical Research Council, Australia; National Stroke Foundation, Australia; Heart Foundation of Australia.
机译：背景：急性缺血性中风发作后3小时后，静脉内纤溶酶原激活剂（阿替普酶）是否有效尚不清楚。我们的目的是测试在灌注加权MRI（PWI）和弥散加权MRI（DWI）不匹配的患者中风发作3-6小时后给予的阿替普酶是否能促进再灌注并减轻梗死灶的生长。方法：我们前瞻性并随机分配101例缺血性中风发作后3-6小时接受阿替普酶或安慰剂的患者。 PWI和DWI在治疗前和治疗后3-5天进行，T2加权MRI在第90天左右进行。主要终点是不匹配患者在基线DWI和90天T2病变之间的梗塞生长。主要的次要终点是再灌注，良好的神经系统预后和良好的功能预后。患者，护理人员和研究者并未意识到治疗的分配。主要分析是根据方案进行的。该研究已在ClinicalTrials.gov上注册，编号为NCT00238537。结果：我们随机分配52例患者接受阿替普酶治疗，49例患者接受安慰剂治疗。平均年龄为71.6岁，美国国立卫生研究院卒中量表的中位数为13。99名患者中的85名（86％）患有PWI和DWI不匹配。阿替普酶的几何平均梗塞增长（相对增长的平均对数的指数）和安慰剂分别为1.24和1.78（比率0.69，95％CI 0.38-1.28; Student's t检验p = 0.239）;阿替普酶的中位相对梗塞生长中位数为1.18，而安慰剂的中位相对梗塞生长中位数为1.79（比率0.66，0.36-0.92; Wilcoxon检验，p = 0.054）。阿替普酶的再灌注比安慰剂更为普遍，并且与无再灌注相比，梗死灶的生长较轻（p = 0.001），神经系统预后更好（p <0.0001），功能预后更好（p = 0.010）。解释：阿替普酶与失配患者的梗死生长无显着相关，而与再灌注增加显着相关。因为再灌注与改善临床结果相关，所以治疗后3小时应进行III期试验。资金：澳大利亚国家卫生和医学研究理事会;澳大利亚国家中风基金会;澳大利亚心脏基金会。

著录项

相似文献

  • 外文文献
  • 中文文献
  • 专利
获取原文

客服邮箱：kefu@zhangqiaokeyan.com

京公网安备：11010802029741号 ICP备案号：京ICP备15016152号-6 六维联合信息科技 (北京) 有限公司©版权所有

  • 客服微信

  • 服务号