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A matched comparison of eptifibatide plus rt-PA versus rt-PA alone in acute ischemic stroke.
Adeoye, Opeolu; Knight, William A; Khoury, Jane; Schmit, Pamela A; Sucharew, Heidi; Broderick, Joseph P; Pancioli, Arthur M.
Afiliación
  • Adeoye O; University of Cincinnati Neuroscience Institute, Cincinnati, Ohio; Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio; Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio. Electronic address: opeolu.adeoye@uc.edu.
  • Knight WA; University of Cincinnati Neuroscience Institute, Cincinnati, Ohio; Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio; Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio.
  • Khoury J; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
  • Schmit PA; University of Cincinnati Neuroscience Institute, Cincinnati, Ohio; Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio.
  • Sucharew H; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
  • Broderick JP; University of Cincinnati Neuroscience Institute, Cincinnati, Ohio; Department of Neurology, University of Cincinnati, Cincinnati, Ohio.
  • Pancioli AM; University of Cincinnati Neuroscience Institute, Cincinnati, Ohio; Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio.
J Stroke Cerebrovasc Dis ; 23(5): e313-5, 2014.
Article en En | MEDLINE | ID: mdl-24534128
BACKGROUND: The Combined Approach to Lysis Utilizing Eptifibatide and Recombinant Tissue Plasminogen Activator (rt-PA) in Acute Ischemic Stroke-Enhanced Regimen (CLEAR-ER) trial found that intravenous rt-PA plus eptifibatide (combination arm) in acute ischemic stroke (AIS) was safe and had a direction of effect that would justify a phase III trial. CLEAR-ER had unanticipated imbalances between treatment groups. We compared the rates of symptomatic intracranial hemorrhage (sICH) and good outcomes for combination therapy patients in the CLEAR-ER trial to a matched cohort of rt-PA patients from the National Institute of Neurological Disorders and Stroke (NINDS) trial. METHODS: CLEAR-ER was a multicenter, double-blind, randomized study; rt-PA-eligible AIS patients were randomized to .6 mg/kg rt-PA plus eptifibatide (135 mcg/kg bolus and .75mcg/kg/min two-hour infusion) versus standard rt-PA (.9 mg/kg). For this analysis, we matched 1:1 CLEAR-ER combination therapy patients with rt-PA arm NINDS trial patients. Patients were matched by age, gender, race, baseline modified Rankin Scale score, baseline National Institutes of Health Stroke Scale (NIHSS) score, and stroke onset to rt-PA time. RESULTS: Fifty-four matches were made. One (1.8%) sICH occurred in each group (odds ratio [OR] 1.00, 95% confidence interval [CI] .01-78.50). At 90 days, 51.8% of the CLEAR-ER group had good outcomes versus 46.3% in the NINDS rt-PA group (OR 1.30, 95% CI .57-2.96). For subjects with baseline NIHSS score > 12 (CLEAR-ER median NIHSS score), 38.5% of the CLEAR-ER group had good outcomes versus 23.1% in the NINDS group (OR 2.33, 95% CI .60-9.02). CONCLUSIONS: The safety and direction of effect of eptifibatide plus rt-PA were confirmed. A phase III trial is needed to determine the efficacy of eptifibatide plus rt-PA for improving long-term outcomes after AIS.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Péptidos / Inhibidores de Agregación Plaquetaria / Terapia Trombolítica / Isquemia Encefálica / Activador de Tejido Plasminógeno / Accidente Cerebrovascular / Fibrinolíticos Tipo de estudio: Clinical_trials / Diagnostic_studies / Etiology_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: J Stroke Cerebrovasc Dis Asunto de la revista: ANGIOLOGIA / CEREBRO Año: 2014 Tipo del documento: Article Pais de publicación: Estados Unidos
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Péptidos / Inhibidores de Agregación Plaquetaria / Terapia Trombolítica / Isquemia Encefálica / Activador de Tejido Plasminógeno / Accidente Cerebrovascular / Fibrinolíticos Tipo de estudio: Clinical_trials / Diagnostic_studies / Etiology_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged País/Región como asunto: America do norte Idioma: En Revista: J Stroke Cerebrovasc Dis Asunto de la revista: ANGIOLOGIA / CEREBRO Año: 2014 Tipo del documento: Article Pais de publicación: Estados Unidos