Murray, Gordon

Thompson, Douglas

Whiteley, William

Trials

PubMed

Edinburgh Research Explorer

     Edinburgh Research Explorer                                      The risks and benefits of RTPA in acute ischemic stroke forpatients at high risk of intracranial haemorrhage and poorfunctional outcome: a secondary analysis of the IST-3 trial andsystematic review of prediction modelsCitation for published version:Thompson, D, Murray, G & Whiteley, W 2013, 'The risks and benefits of RTPA in acute ischemic stroke forpatients at high risk of intracranial haemorrhage and poor functional outcome: a secondary analysis of theIST-3 trial and systematic review of prediction models' Trials, vol. 14, no. Suppl 1, O9. DOI: 10.1186/1745-6215-14-S1-O9Digital Object Identifier (DOI):10.1186/1745-6215-14-S1-O9Link:Link to publication record in Edinburgh Research ExplorerDocument Version:Publisher's PDF, also known as Version of recordPublished In:TrialsPublisher Rights Statement:© 2013 Thompson et al; licensee BioMed Central Ltd.This is an Open Access article distributed under the terms of the Creative Commons Attribution License(http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction inany medium, provided the original work is properly cited.General rightsCopyright for the publications made accessible via the Edinburgh Research Explorer is retained by the author(s)and / or other copyright owners and it is a condition of accessing these publications that users recognise andabide by the legal requirements associated with these rights.Take down policyThe University of Edinburgh has made every reasonable effort to ensure that Edinburgh Research Explorercontent complies with UK legislation. If you believe that the public display of this file breaches copyright pleasecontact openaccess@ed.ac.uk providing details, and we will remove access to the work immediately andinvestigate your claim.Download date: 05. Apr. 2019ORAL PRESENTATION Open AccessThe risks and benefits of RTPA in acute ischemicstroke for patients at high risk of intracranialhaemorrhage and poor functional outcome:a secondary analysis of the IST-3 trial andsystematic review of prediction modelsDouglas Thompson1*, Gordon Murray1, William Whiteley1,2From 2nd Clinical Trials Methodology Conference: Methodology MattersEdinburgh, UK. 18-19 November 2013BackgroundTreating acute ischaemic stroke patients with iv-rtPA isof overall benefit. An associated increase in the risk ofsymptomatic intracranial haemorrhage (SICH) maycause considerable harm. We investigated (i) whethernovel or existing prediction models could predict SICHor poor functional outcome in rtPA treated patients and(ii) whether ischemic stroke patients at either a highpredicted risk of SICH or poor functional outcomeexperienced less benefit from rtPA.MethodsWe used the IST-3 trial data, an international, multicen-tre, open treatment randomised trial of rtPA versus con-trol in 3035 acute ischemic stroke patients. Wedeveloped and internally evaluated a multivariate logisticregression model for SICH following rtPA includingvariables identified as important in a systematic review.We compared the discrimination (area under the recei-ver operating characteristic curve (AUROCC)) of ourmodel with those existing in the medical literature. Wecalculated the absolute risk reduction of death or depen-dency with rtPA in patients at a low, medium or highpredicted risk of SICH or poor functional outcome witheach model.ResultsOur model had similar discrimination for SICH(AUROCC 0.68 95% CI: 0.63-0.74) to nine previouslydeveloped models (HAT, SEDAN, SITS, GRASPS,SPAN-100, Stroke-TPI, DRAGON, THRIVE and amodel with NIHSS and age). There was no evidencethat patients at high predicted risk of SICH or poorfunctional outcome after stroke derived less benefitfrom rtPA.ConclusionsWe found no evidence to support a stratified approachin administering rtPA to acute ischaemic stroke patientsat a high predicted risk of intracranial haemorrhage orpoor functional outcome.Authors’ details1Edinburgh MRC Hub for Trials Methodology Research, University ofEdinburgh, Edinburgh, UK. 2Division of Clinical Neurosciences, University ofEdinburgh, Western General Hospital, Edinburgh, UK.Published: 29 November 2013doi:10.1186/1745-6215-14-S1-O9Cite this article as: Thompson et al.: The risks and benefits of RTPA inacute ischemic stroke for patients at high risk of intracranialhaemorrhage and poor functional outcome: a secondary analysis of theIST-3 trial and systematic review of prediction models. Trials 2013 14(Suppl 1):O9.1Edinburgh MRC Hub for Trials Methodology Research, University ofEdinburgh, Edinburgh, UKFull list of author information is available at the end of the articleThompson et al. Trials 2013, 14(Suppl 1):O9http://www.trialsjournal.com/content/14/S1/O9 TRIALS© 2013 Thompson et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the CreativeCommons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, andreproduction in any medium, provided the original work is properly cited.

The risks and benefits of RTPA in acute ischemic stroke for patients at high risk of intracranial haemorrhage and poor functional outcome: a secondary analysis of the IST-3 trial and systematic review of prediction models

Douglas Thompson

Gordon Murray

William Whiteley

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http://dx.doi.org/10.1186/1745-6215-14-S1-O9

The risks and benefits of RTPA in acute ischemic stroke for patients at high risk of intracranial haemorrhage and poor functional outcome: a secondary analysis of the IST-3 trial and systematic review of prediction models

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