17 research outputs found
It is safe to use transdermal glyceryl trinitrate to lower blood pressure in patients with acute ischaemic stroke with carotid stenosis
Background There is concern that blood pressure (BP) lowering in acute stroke may compromise cerebral perfusion and worsen outcome in the presence of carotid stenosis. We assessed the effect of glyceryl trinitrate (GTN) in patients with carotid stenosis using data from the Efficacy of Nitric Oxide in Stroke (ENOS) Trial.Methods ENOS randomised 4011 patients with acute stroke and raised systolic BP (140â220âmm Hg) to transdermal GTN or no GTN within 48âhours of onset. Those on prestroke antihypertensives were also randomised to stop or continue their medication for 7 days. The primary outcome was the modified Rankin Scale (mRS) at day 90. Ipsilateral carotid stenosis was split
Relationship between hyperacute blood pressure and outcome after ischemic stroke: data from the VISTA Collaboration
Background and PurposeâHigh blood pressure (BP) is associated independently with poor outcome after acute ischemic stroke, although in most analyses âbaselineâ BP was measured 24 hours or more postictus, and not during the hyperacute period.
MethodsâAnalyses included 1722 patients in hyperacute trials (recruitment 8 hours) from the Virtual Stroke
International Stroke Trial Archive (VISTA) Collaboration. Data on BP at enrolment and after 1, 2, 16, 24, 48, and 72
hours, neurological impairment at 7 days (NIHSS), and functional outcome at 90 days (modified Rankin scale) were
assessed using logistic regression models, adjusted for confounding variables; results are for 10-mm Hg change in BP. ResultsâMean time to enrolment was 3.7 hours (range 1.0 to 7.9). High systolic BP (SBP) was significantly associated
with increased neurological impairment (odds ratio, OR 1.06, 95% confidence interval, 95% CI 1.01 to 1.12), and poor functional outcome; odds ratios for both increased with later BP measurements made at up to 24 hours poststroke. Smaller (versus larger) declines in SBP over the first 24 hours were significantly associated with poor NIHSS scores (OR 1.16, 95% CI 1.05 to 1.27) and functional outcome (OR 1.23, 95% CI 1.13 to 1.34). A large variability in SBP was also associated with poor functional outcome.
ConclusionsâHigh SBP and large variability in SBP in the hyperacute stages of ischemic stroke are associated with
increased neurological impairment and poor functional outcome, as are small falls in SBP over the first 24 hours
A randomised controlled trial of triple antiplatelet therapy (Aspirin, Clopidogrel and Dipyridamole) in the secondary prevention of stroke: safety, tolerability and feasibility
Background: Aspirin, dipyridamole and clopidogrel are effective in secondary vascular prevention. Combination therapy with three antiplatelet agents might maximise the benefit of antiplatelet treatment in the secondary prevention of ischaemic stroke.
Methodology/Principal Findings: A randomised, parallel group, observer-blinded phase II trial compared the combination of aspirin, clopidogrel and dipyridamole with aspirin alone. Adult patients with ischaemic stroke or transient ischaemic attack (TIA) within 5 years were included. The primary outcome was tolerability to treatment assessed as the number of patients completing randomised treatment. Recruitment was halted prematurely after publication of the ESPRIT trial (which confirmed that combined aspirin and dipyridamole is more effective than aspirin alone). 17 patients were enrolled: male 12
(71%), mean age 62 (SD 13) years, lacunar stroke syndrome 12 (71%), median stroke/TIA onset to randomisation 8 months.
Treatment was discontinued in 4 of 9 (44%) patients receiving triple therapy vs. none of 8 taking aspirin (p = 0.08). One recurrent stroke occurred in a patient in the triple group who was noncompliant of all antiplatelet medications. The number of patients with adverse events and bleeding complications, and their severity, were significantly greater in the triple therapy group (p,0.01).
Conclusions/Significance: Long term triple antiplatelet therapy was asociated with a significant increase in adverse events and bleeding rates, and their severity, and a trend to increased discontinuations. However, the patients had a low risk of recurrence and future trials should focus on short term therapy in high risk patients characterised by a very recent event or failure of dual antiplatelet therapy
The relationship between baseline blood pressure and computed tomography findings in acute stroke: data from the Tinzaparin in Acute Ischaemic Stroke Trial (TAIST)
Background and PurposeâHigh blood pressure (BP) is present in 80% of patients with acute ischemic stroke and is
independently associated with poor outcome. There are few data examining the relationship between admission BP and
acute CT findings.
MethodsâTAIST was a randomized controlled trial assessing 10 days of treatment with tinzaparin versus aspirin in 1489
patients with acute ischemic stroke (48 hr) with admission BP of 220/120 mm Hg. CT brain scans were performed before randomization and after 10 days. The relationships between baseline BP and adjudicated CT findings were assessed. Odds ratios per 10 mm Hg change in BP were calculated.
ResultsâHigher systolic BP (SBP) was associated with abnormal CT scans because of independent associations with
chronic changes of leukoariosis (OR, 1.12; 95% CI, 1.05â1.17) and old infarction (OR, 1.12; 95% CI, 1.06 â1.17) at
baseline, and signs of visible infarction at day 10 (OR, 1.06; 95% CI, 1.00 â1.13). A lower SBP was associated with
signs of acute infarction (OR, 0.94; 95% CI, 0.89â0.99). Hemorrhagic transformation, dense middle cerebral artery
sign, mass effect, and cerebral edema at day 10 were not independently associated with baseline BP.
ConclusionâAlthough high baseline BP is independently associated with a poor outcome after stroke, this was not shown to be through an association with increased hemorrhagic transformation, cerebral edema, or mass effect; trial design may be suboptimal to detect this. Higher SBP is associated with visible infarction on day 10 scans. The influence of changing BP in acute stroke on CT findings is still to be ascertained