Article

Additional outcomes and subgroup analyses of NXY-059 for acute ischemic stroke in the SAINT I trial

DOI:Lees, KR et al. (2006) Additional outcomes and subgroup analyses of NXY-059 for acute ischemic stroke in the SAINT I trial. Stroke, 37 . pp. 2970-2978.
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    Article: Issues pertaining to the critiques of the SAINT-I Trial.
    Marc Fisher, David C Hess, Kennedy Lees
    Stroke 12/2007; 38(11):e126-7; author reply e128. · 5.73 Impact Factor
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    Article: Multimodal neuroprotective therapy with induced hypothermia after ischemic stroke.
    Thomas M Hemmen, Patrick D Lyden
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    ABSTRACT: Neuroprotective therapies have so far failed to provide improved neurological function and outcome after stroke. A recent focus on multimodal therapies, including the combination of neuroprotective medications with hypothermia, opens a promising new treatment strategy. Advances in hypothermia administration make it one of the most promising neuroprotective therapies available and an ideal candidate for combination with other neuroprotective approaches.
    Stroke 01/2009; 40(3 Suppl):S126-8. · 5.73 Impact Factor
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    Article: Comparison of outcomes following thrombolytic therapy among patients with prior stroke and diabetes in the Virtual International Stroke Trials Archive (VISTA).
    Nishant Kumar Mishra, Stephen M Davis, Markku Kaste, Kennedy R Lees
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    ABSTRACT: The use of alteplase in patients who have had a prior stroke and concomitant diabetes is not approved in Europe. To examine the influence of diabetes and prior stroke on outcomes, we compared data on thrombolysed patients with nonthrombolysed comparators. We selected patients with ischemic stroke on whom we had data on age, pretreatment baseline National Institutes of Health Stroke Scale (b-NIHSS), and 90-day outcome measures (functional modified Rankin score [mRS]) and neurological measures [NIHSS]) in the Virtual International Stroke Trials Archive. We compared outcomes between thrombolysed patients and nonthrombolysed comparators in those with and without diabetes, those who have had a prior stroke, or both and report findings using the Cochran-Mantel-Haenszel (CMH) test and proportional odds logistic regression analyses. We report an age-adjusted and b-NIHSS-adjusted CMH P value and odds ratio (OR). Rankin data were available for 5,817 patients: 1,585 thrombolysed patients and 4,232 nonthrombolysed comparators. A total 1,334 (24.1%) patients had diabetes, 1,898 (33.7%) patients have had a prior stroke, and 491 (8%) patients had both. Diabetes and nondiabetes had equal b-NIHSS (median 13; P = 0.3), but patients who have had a prior stroke had higher b-NIHSS than patients who have not had a prior stroke (median 13 vs. 12; P < 0.0001). Functional outcomes were better for thrombolysed patients versus nonthrombolysed comparators among both nondiabetic (P < 0.0001; OR 1.4 [95% CI 1.3-1.6]) and diabetic (P = 0.1; 1.3 [1.05-1.6 ]) subjects. Similarly, outcomes were better for thrombolysed patients versus nonthrombolysed comparators among who have not had a prior stroke (P < 0.0001; 1.4 [1.2-1.6 ]) and those who have (P = 0.02; 1.3 [1.04-1.6 ]). There was no interaction of diabetes and prior stroke with treatment (P = 0.8). Neurological outcomes were consistent with the mRS. Outcomes from thrombolysis are better among patients with diabetes and/or those who have had a prior stroke than in control subjects. Withholding thrombolytic treatment from otherwise-eligible patients may not be justified.
    Diabetes care 12/2010; 33(12):2531-7. · 8.09 Impact Factor
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