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1

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Intravenous nicardipine for Japanese patients with acute intracerebral hemorrhage: an individual participant data analysis

Toyoda, Kazunori ; Yoshimura, Sohei ; Fukuda-Doi, Mayumi ; [et al.]

Springer Science and Business Media LLC ; 2023

In: Hypertension Research Vol. 46, No. 1 ( 2023-01), p. 75-83

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In: Hypertension Research, Springer Science and Business Media LLC, Vol. 46, No. 1 ( 2023-01), p. 75-83

Abstract: The effects of acute systolic blood pressure levels achieved with continuous intravenous administration of nicardipine for Japanese patients with acute intracerebral hemorrhage on clinical outcomes were determined. A systematic review and individual participant data analysis of articles were performed based on prospective studies involving adults developing hyperacute intracerebral hemorrhage who were treated with intravenous nicardipine. Outcomes included death or disability at 90 days, defined as the modified Rankin Scale score of 4–6, and hematoma expansion, defined as an increase 6 mL or more from baseline to 24 h computed tomography. Of the total 499 Japanese patients (age 64.9 ± 11.8 years, 183 women, initial BP 203.5 ± 18.3/109.1 ± 17.2 mmHg) studied, death or disability occurred in 35.6%, and hematoma expansion occurred in 15.6%. Mean hourly systolic blood pressure during the initial 24 h was positively associated with death or disability (adjusted odds ratio 1.25, 95% confidence interval 1.03–1.52 per 10 mmHg) and hematoma expansion (1.49, 1.18–1.87). These odds ratios were relatively high as compared to the reported ones for overall global patients of this individual participant data analysis [1.12 (95% confidence interval 1.00–1.26) and 1.16 (1.02–1.32), respectively]. In conclusion, lower levels of systolic blood pressure by continuous intravenous nicardipine were associated with lower risks of hematoma expansion and 90-day death or disability in Japanese patients with hyperacute intracerebral hemorrhage. The impact of systolic blood pressure lowering on better outcome seemed to be stronger in Japanese patients than the global ones.

Type of Medium: Online Resource

ISSN: 0916-9636 , 1348-4214

URL: Article

DOI: 10.1038/s41440-022-01046-4

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2023

detail.hit.zdb_id: 2110941-2

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2

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Intravenous alteplase for stroke with unknown time of onset guided by advanced imaging: systematic review and meta-analysis of individual patient data

Thomalla, Götz ; Boutitie, Florent ; Ma, Henry ; [et al.]

Elsevier BV ; 2020

In: The Lancet Vol. 396, No. 10262 ( 2020-11), p. 1574-1584

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In: The Lancet, Elsevier BV, Vol. 396, No. 10262 ( 2020-11), p. 1574-1584

Type of Medium: Online Resource

ISSN: 0140-6736

URL: Article

DOI: 10.1016/S0140-6736(20)32163-2

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XA 10000

Language: English

Publisher: Elsevier BV

Publication Date: 2020

detail.hit.zdb_id: 2067452-1

detail.hit.zdb_id: 3306-6

detail.hit.zdb_id: 1476593-7

SSG: 5,21

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3

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Magnetic Resonance Imaging–Guided Thrombolysis (0.6 mg/kg) Was Beneficial for Unknown Onset Stroke Above a Certain Core Size : THAWS RCT Substudy

Toyoda, Kazunori ; Inoue, Manabu ; Yoshimura, Sohei ; [et al.]

Ovid Technologies (Wolters Kluwer Health) ; 2021

In: Stroke Vol. 52, No. 1 ( 2021-01), p. 12-19

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In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 52, No. 1 ( 2021-01), p. 12-19

Abstract: We determined to identify patients with unknown onset stroke who could have favorable 90-day outcomes after low-dose thrombolysis from the THAWS (Thrombolysis for Acute Wake-Up and Unclear-Onset Strokes With Alteplase at 0.6 mg/kg) database. Methods: This was a subanalysis of an investigator-initiated, multicenter, randomized, open-label, blinded–end point trial. Patients with stroke with a time last-known-well 〉 4.5 hours who showed a mismatch between diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery were randomly assigned (1:1) to receive alteplase at 0.6 mg/kg intravenously or standard medical treatment. The patients were dichotomized by ischemic core size or National Institutes of Health Stroke Scale score, and the effects of assigned treatments were compared in each group. The efficacy outcome was favorable outcome at 90 days, defined as a modified Rankin Scale score of 0 to 1. Results: The median DWI-Alberta Stroke Program Early CT Score (ASPECTS) was 9, and the median ischemic core volume was 2.5 mL. Both favorable outcome (47.1% versus 48.3%) and any intracranial hemorrhage (26% versus 14%) at 22 to 36 hours were comparable between the 68 thrombolyzed patients and the 58 control patients. There was a significant treatment-by-cohort interaction for favorable outcome between dichotomized patients by ASPECTS on DWI ( P =0.026) and core volume ( P =0.035). Favorable outcome was more common in the alteplase group than in the control group in patients with DWI-ASPECTS 5 to 8 (RR, 4.75 [95% CI, 1.33–30.2]), although not in patients with DWI-ASPECTS 9 to 10. Favorable outcome tended to be more common in the alteplase group than in the control group in patients with core volume 〉 6.4 mL (RR, 6.15 [95% CI, 0.87–43.64]), although not in patients with volume ≤6.4 mL. The frequency of any intracranial hemorrhage did not differ significantly between the 2 treatment groups in any dichotomized patients. Conclusions: Patients developing unknown onset stroke with DWI-ASPECTS 5 to 8 showed favorable outcomes more commonly after low-dose thrombolysis than after standard treatment. Registration: URL: https://www.clinicaltrials.gov ; Unique Identifier: NCT02002325. URL: https://www.umin.ac.jp/ctr ; Unique Identifier: UMIN000011630.

Type of Medium: Online Resource

ISSN: 0039-2499 , 1524-4628

URL: Article

DOI: 10.1161/STROKEAHA.120.030848

RVK:

XA 10000

Language: English

Publisher: Ovid Technologies (Wolters Kluwer Health)

Publication Date: 2021

detail.hit.zdb_id: 1467823-8

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Nationwide Trends in Reperfusion Therapy and Outcomes of Acute Ischemic Stroke According to Severity: The Japan Stroke Data Bank

Koge, Junpei ; Yoshimura, Sohei ; Koga, Masatoshi ; [et al.]

Ovid Technologies (Wolters Kluwer Health) ; 2023

In: Stroke: Vascular and Interventional Neurology

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In: Stroke: Vascular and Interventional Neurology, Ovid Technologies (Wolters Kluwer Health)

Abstract: It is unclear whether all patient subgroups with acute ischemic stroke have benefited from advances in reperfusion therapy. We investigated long‐term trends of reperfusion therapy and outcomes according to the stroke severity. METHODS Patients with acute ischemic stroke registered in the prospective nationwide hospital‐based registry between 2000 and 2020 were examined. Baseline National Institutes of Health Stroke Scale (NIHSS) score ≥10 and ≤5 was considered to indicate possible large vessel occlusions and minor deficits, respectively. Secular changes were assessed per 5‐year cohorts (2000–2005, 2006–2010, 2011–2015, 2016–2020). Outcomes included favorable outcome (modified Rankin scale score 0–2 at discharge). RESULTS Of 127 741 patients, NIHSS score was ≥10 in 31 747 patients (24.9%), 6–9 in 17 083 patients (13.4%), and ≤5 in 78 911 patients (61.8%). In patients with NIHSS score ≥10, intravenous thrombolysis frequency increased from 1.6% to 26.5% between the 2000 to 2005 and 2016 to 2020 cohorts; endovascular therapy frequency increased from 2.0% to 29.8%. Favorable outcomes increased over time (adjusted odds ratio per 1‐cohort, 1.254 [95% CI, 1.204–1.306] ). In patients with NIHSS score 6–9, intravenous thrombolysis frequency increased from 0.5% to 16.4%, and endovascular therapy frequency increased from 1.1% to 9.0%. Favorable outcomes did not change over time (1.005 [0.966–1.046]). In patients with NIHSS score ≤5, intravenous thrombolysis frequency increased from 0.2% to 5.1%, and endovascular therapy frequency increased from 0.7% to 2.8%. Favorable outcomes decreased over time (0.954 [0.931–0.978] ). CONCLUSIONS Use of reperfusion therapy has increased, particularly in patients with NIHSS score ≥10. Favorable outcomes significantly increased over time in patients with NIHSS score ≥10 but decreased in those with NIHSS score ≤5.

Type of Medium: Online Resource

ISSN: 2694-5746

URL: Article

DOI: 10.1161/SVIN.123.000950

Language: English

Publisher: Ovid Technologies (Wolters Kluwer Health)

Publication Date: 2023

detail.hit.zdb_id: 3144224-9

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5

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Intravenous Alteplase at 0.6 mg/kg for Unknown Onset Stroke with Prior Antithrombotic Medication: THAWS Randomized Clinical Trial

Koga, Masatoshi ; Inoue, Manabu ; Miwa, Kaori ; [et al.]

Japan Atherosclerosis Society ; 2023

In: Journal of Atherosclerosis and Thrombosis Vol. 30, No. 1 ( 2023-1-1), p. 15-22

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In: Journal of Atherosclerosis and Thrombosis, Japan Atherosclerosis Society, Vol. 30, No. 1 ( 2023-1-1), p. 15-22

Type of Medium: Online Resource

ISSN: 1340-3478 , 1880-3873

URL: Article

DOI: 10.5551/jat.63337

Language: English

Publisher: Japan Atherosclerosis Society

Publication Date: 2023

detail.hit.zdb_id: 2185870-6

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6

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Abstract P7: Prior Antithrombotic Medication May Affect Outcomes Following Alteplase at 0.6mg for Unknown Onset Stroke: THAWS Randomized Clinical Trial

Koga, Masatoshi ; Inoue, Manabu ; Miwa, Kaori ; [et al.]

Ovid Technologies (Wolters Kluwer Health) ; 2021

In: Stroke Vol. 52, No. Suppl_1 ( 2021-03)

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In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 52, No. Suppl_1 ( 2021-03)

Abstract: Background and purpose: To assess the potential effect of prior antithrombotic medication for thrombolysis using alteplase at 0.6mg/kg in unknown onset stroke. Methods: This was a prespecified sub-analysis of a THAWS trial (an investigator-initiated, multicenter, randomized, open, blinded-endpoint trial). Stroke patients with a time last-known-well 〉 4.5 h who had a mismatch between diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery were randomly assigned (1:1) to receive alteplase at 0.6mg/kg or standard medical treatment (SMT). Patients were dichotomized by taking prior antithrombotic medication. The favorable outcome defined as a modified Rankin Scale score of 0-1 at 90 days and any intracranial hemorrhage within 22-36 h were compared in each group. Results: Of 126 patients (intention-to-treat population), 68 received alteplase and 58 had SMT. Seventeen in the alteplase group and 23 in the SMT group took antithrombotic medication (10 with antiplatelet alone, 5 with anticoagulant alone and 2 with both in the IVT group, and 14, 8 and 1, respectively, in the SMT group) before stroke onset. Antithrombotic therapy was more frequently initiated within 24 hours after randomization in the SMT group than in the alteplase group (86% vs. 12%, p 〈 0.0001). Both any intracranial hemorrhage (26% in the alteplase group vs. 14% in the SMT group) and favorable outcome (47% vs. 48%) were comparable between the two treatment groups. There was a significant treatment-by-cohort interaction for favorable outcome between patients with prior antithrombotic medication and those without (p=0.006). Favorable outcome was more common in the alteplase group than in the SMT group in patients with prior antithrombotic medication (59% vs. 26%; RR 2.25, 95% CI 1.02 to 4.99), but it tended to be less common in the alteplase group than in the SMT group in those without prior antithrombotic medication (43% vs. 63%; RR 0.69, 95% CI 0.46 to 1.03). The frequency of any intracranial hemorrhage did not differ significantly between the two treatment groups in any dichotomized patients. Conclusions: Alteplase at 0.6mg/kg appears more beneficial in patients with prior antithrombotic medication.

Type of Medium: Online Resource

ISSN: 0039-2499 , 1524-4628

URL: Article

DOI: 10.1161/str.52.suppl_1.P7

RVK:

XA 10000

Language: English

Publisher: Ovid Technologies (Wolters Kluwer Health)

Publication Date: 2021

detail.hit.zdb_id: 1467823-8

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7

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Abstract TMP53: Nationwide Secular Changes In Severity And Outcome Of Ischemic And Hemorrhagic Strokes: A 20-Year Analysis From Japan Stroke Data Bank Involving 183,082 Patients

Toyoda, Kazunori ; Yoshimura, Sohei ; nakai, michikazu ; [et al.]

Ovid Technologies (Wolters Kluwer Health) ; 2022

In: Stroke Vol. 53, No. Suppl_1 ( 2022-02)

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In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 53, No. Suppl_1 ( 2022-02)

Abstract: Introduction: The Japan Stroke Data Bank (JSDB) is a 20-year long ongoing hospital-based multicenter prospective registry of hospitalized patients with acute stroke/TIA based on a web database from 130 stroke centers distributed evenly over Japan. Hypothesis: Secular changes in the severity and functional outcome of stroke patients would be clarified by long-lasting hospital-based registries. Methods: Patients registered in JSDB within 7 days after stroke onset from Jan 2000 through Dec 2019 were studied. The initial severity was assessed by the NIHSS for ischemic stroke (IS) and intracerebral hemorrhage (ICH) and by the WFNS grading for subarachnoid hemorrhage (SAH). Outcomes at hospital discharge was assessed by the mRS. Results: Of a total 183,082 stroke patients, 135,268 (women in 39.8%) developed IS, 36,014 (women in 42.7%) developed ICH, and 11,800 (women in 67.2%) developed SAH. Median ages at onset increased and the NIHSS and WFNS scores decreased after multivariable-adjustment in all three stroke types. Patients with favorable outcome, corresponding to the mRS 0-2, significantly increased after age-adjustment in all three IS subtypes, remained increasing after further adjustment by NIHSS and stroke history only in cardioembolic stroke (OR 1.014, 95% CI 1.008-1.020, per year), and no longer increased after further adjustment by reperfusion therapy in any subtypes. Both the frequencies of unfavorable outcome, corresponding to the mRS 5-6, and in-hospital death, significantly decreased in cardioembolic stroke (OR 0.974, 95% CI 0.968-0.980) and large-artery atherosclerosis (OR 0.975, 95% CI 0.967-0.982, both for unfavorable outcome) after multivariable-adjustment. In ICH and SAH, favorable outcome significantly decreased after multivariable-adjustment, except for SAH in men. Both the frequencies of unfavorable outcome and death after SAH significantly decreased, but those after ICH were not. These findings were generally common to both sexes when separately analyzed. Conclusions: Short-term functional outcome improved in IS patients during the past 20 years presumably partly due to development of acute reperfusion therapy. The outcome of hemorrhagic stroke patients did not clearly show the improvement during the same duration.

Type of Medium: Online Resource

ISSN: 0039-2499 , 1524-4628

URL: Article

DOI: 10.1161/str.53.suppl_1.TMP53

RVK:

XA 10000

Language: English

Publisher: Ovid Technologies (Wolters Kluwer Health)

Publication Date: 2022

detail.hit.zdb_id: 1467823-8

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8

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Thrombolysis with Alteplase at 0·6 mg/kg for Acute FLAIR-Negative Stroke with Unknown Time of Onset: THAWS Randomized Controlled Trial

Koga, Masatoshi ; Yamamoto, Haruko ; Inoue, Manabu ; [et al.]

Elsevier BV ; 2019

In: SSRN Electronic Journal

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In: SSRN Electronic Journal, Elsevier BV

Type of Medium: Online Resource

ISSN: 1556-5068

URL: Article

DOI: 10.2139/ssrn.3420407

Language: English

Publisher: Elsevier BV

Publication Date: 2019

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9

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Twenty-Year Change in Severity and Outcome of Ischemic and Hemorrhagic Strokes

Toyoda, Kazunori ; Yoshimura, Sohei ; Nakai, Michikazu ; [et al.]

American Medical Association (AMA) ; 2022

In: JAMA Neurology Vol. 79, No. 1 ( 2022-01-01), p. 61-

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In: JAMA Neurology, American Medical Association (AMA), Vol. 79, No. 1 ( 2022-01-01), p. 61-

Type of Medium: Online Resource

ISSN: 2168-6149

URL: Article

DOI: 10.1001/jamaneurol.2021.4346

Language: English

Publisher: American Medical Association (AMA)

Publication Date: 2022

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10

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Characteristics and outcomes of unknown onset stroke: The Japan Stroke Data Bank

Wada, Shinichi ; Yoshimura, Sohei ; Toyoda, Kazunori ; [et al.]

Elsevier BV ; 2023

In: Journal of the Neurological Sciences Vol. 453 ( 2023-10), p. 120798-

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In: Journal of the Neurological Sciences, Elsevier BV, Vol. 453 ( 2023-10), p. 120798-

Type of Medium: Online Resource

ISSN: 0022-510X

URL: Article

DOI: 10.1016/j.jns.2023.120798

Language: English

Publisher: Elsevier BV

Publication Date: 2023

detail.hit.zdb_id: 1500645-1

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