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【Stroke】阿昔单抗不能改善觉醒型卒中的预后
Treating Patients With ‘Wake-Up’ Stroke. The Experience of the AbESTT-II Trial
Harold P. Adams Jr MD*; Enrique C. Leira MD; James C. Torner PhD; Elliot Barnathan MD; Lakshmi Padgett PhD; Mark B. Effron MD; Werner Hacke MD; for the AbESTT-II Investigators
From the Department of Neurology (H.P.A., E.C.L.), Carver College of Medicine and the Department of Epidemiology (J.C.T.), College of Public Health, University of Iowa, Iowa City, Iowa; Centocor Research (E.B., L.P.), Malvern, Pa; Eli Lilly and Company (M.B.E.), Indianapolis, Ind; and the Department of Neurology (W.H.), University of Heidelberg, Heidelberg, Germany.
* To whom correspondence should be addressed. E-mail: harold-adams@uiowa.edu.
Background and Purpose—Approximately 10% to 20% of patients with a new stroke have symptoms present on awakening (wake-up stroke), but these persons are not treated with interventions to restore perfusion because the time of onset is not known. We elected to test the safety and possible efficacy of abciximab in treatment of enrolled subjects with wake-up stroke.
Methods—Abciximab in Emergency Stroke Treatment Trial-II (AbESTT-II) tested the usefulness of abciximab in improving outcomes after acute ischemic stroke and it prospectively tested an intervention in subjects that awakened with their stroke. We compared the outcomes among the subjects in the wake-up group with the other subjects in the trial.
Results—Of the 801 subjects randomized in the trial, 43 (22 abciximab and 21 placebo) had wake-up strokes. Those with wake-up strokes had similar baseline characteristics as the other subjects except for a higher rate of a new stroke found on CT. Recruitment of patients into the wake-up group was halted early because of the rate of bleeding with abciximab exceeded the prespecified safety margins (3 of 22 [13.6%]) within 5 days or at discharge versus 15 of 375 (4.0%) for the nonwake-up group (P=0.07). Favorable outcomes at 3 months, as defined by scores on the modified Rankin Scale, among the wake-up group (4 of 43 [9.3%]) were worse than the nonwake-up group (221 of 758 [29.2%]; P=0.005).
Conclusions—Although the baseline characteristics of the wake-up group of subjects were similar to those of persons enrolled in the nonwake-up group, their outcomes were much poorer. Patients with wake-up stroke may not tolerate reperfusion therapies even when started within a short time of awakening.
注：由于觉醒型卒中（‘Wake-Up’ Stroke）通常难以判断卒中发生的时间，所以无法确定患者是否符合溶栓治疗时间窗，因此多数不采用介入治疗。本对照研究发现，阿昔单抗（新型抗血小板聚集药）并未改善觉醒型卒中的预后。 请战友纠错哈～
http://stroke.ahajournals.org/cgi/content/abstract/STROKEAHA.107.508853v1
Treating Patients With ‘Wake-Up’ Stroke. The Experience of the AbESTT-II Trial
阿昔单抗不能改善觉醒型卒中的预后
Harold P. Adams Jr MD*; Enrique C. Leira MD; James C. Torner PhD; Elliot Barnathan MD; Lakshmi Padgett PhD; Mark B. Effron MD; Werner Hacke MD; for the AbESTT-II Investigators
From the Department of Neurology (H.P.A., E.C.L.), Carver College of Medicine and the Department of Epidemiology (J.C.T.), College of Public Health, University of Iowa, Iowa City, Iowa; Centocor Research (E.B., L.P.), Malvern, Pa; Eli Lilly and Company (M.B.E.), Indianapolis, Ind; and the Department of Neurology (W.H.), University of Heidelberg, Heidelberg, Germany.
* To whom correspondence should be addressed. E-mail: harold-adams@uiowa.edu.
Background and Purpose—Approximately 10% to 20% of patients with a new stroke have symptoms present on awakening (wake-up stroke), but these persons are not treated with interventions to restore perfusion because the time of onset is not known. We elected to test the safety and possible efficacy of abciximab in treatment of enrolled subjects with wake-up stroke.
背景及目的－大约10%-20%新卒中患者在觉醒过程中出现症状（觉醒型卒中），但由于不知卒中发作时间所以无法采用介入治疗恢复灌注。我们评价了阿昔单抗治疗觉醒型卒中的安全性和有效性。
Methods—Abciximab in Emergency Stroke Treatment Trial-II 编译:
http://stroke.ahajournals.org/cgi/content/abstract/STROKEAHA.107.508853v1
大约10%-20%新卒中患者在觉醒过程中出现症状（觉醒型卒中），但由于不知卒中发作时间所以无法采用介入治疗恢复灌注。美国衣阿华州立大学、德国海德堡大学及礼来公司的研究人员评价了阿昔单抗治疗觉醒型卒中的安全性和有效性。
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作者:admin@医学,生命科学 2010-10-24 05:11
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