You mentioned your quote for explaining the risk of sICH with tPA that you say to your patients being from UC San Diego. Can you explain this quote further? Is this from a certain study? I would like to consider using this example but I'd like to know where it derives from. Thanks!
32-35 out of 100 will have show benefit at 3 months with tPA? I thought NINDs showed just 12% benefit with 6% bleed. Is there another newer study confirming NINDs results or showing better numbers? It wouldn't be the last time I was behind on newer studies.
Mark W Yes the ninds trial shows ARR of 12% so NNT = 8 but it is not that simple. The sooner you treat after symptoms onset the better they do so if they show up within 30 minutes of symptom onset the ARR would be higher so the NNT would be lower.
I need some clarification. Mild strokes - this seems to be based on your score rather than on the underlying pathology. Are you meaning these patients who present within the 3 hour window get lytics based on clinical findings or do they all get imaging? I would have thought they all would have been imaged and mild would be irrelevant if there was a major vessel occlusion. The trial that was discontinued seems a shame as I would have thought getting the answer to who benefits would be ideal. The earlier lytic trials seemed to indicate poor outcomes with lytics.
Geoffrey M PRISMS described mild strokes as ones with an NIHSS of less than 6. Also they had to be strokes that the doc thought would be too mild to warrant tpa treatment. If the doc said they were not treating with tpa then we could approach them for enrollment. They may or may not have had a CTA of the head. I expect we may see results from the trial in late January of 2018.... you can google prisms to get to clinical trials.gov to see the inclusion exclusion criteria. thanks jon
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Michael P. - October 13, 2017 9:59 AM
You mentioned your quote for explaining the risk of sICH with tPA that you say to your patients being from UC San Diego. Can you explain this quote further? Is this from a certain study? I would like to consider using this example but I'd like to know where it derives from. Thanks!
Jon S., MD - October 13, 2017 10:17 AM
Micheal P.
Here is a link to the figure I am referring to....
https://www.google.com/search?biw=1920&bih=974&tbm=isch&sa=1&q=stroke+consent+image&oq=stroke+consent+image&gs_l=psy-ab.3...17373.17373.0.17531.1.1.0.0.0.0.92.92.1.1.0....0...1.1.64.psy-ab..0.0.0....0.LLq_vNgzH4E#imgrc=s_6p8FkUFGNWeM:
If you cannot find it please email me at jschrock@metrohealth.org
thanks
jon
Mark W., D.O. - October 30, 2017 12:54 PM
32-35 out of 100 will have show benefit at 3 months with tPA? I thought NINDs showed just 12% benefit with 6% bleed. Is there another newer study confirming NINDs results or showing better numbers? It wouldn't be the last time I was behind on newer studies.
Thanks, Mark
Jon S., MD - November 5, 2017 4:41 PM
Mark W
Yes the ninds trial shows ARR of 12% so NNT = 8 but it is not that simple. The sooner you treat after symptoms onset the better they do so if they show up within 30 minutes of symptom onset the ARR would be higher so the NNT would be lower.
thanks
jon
Geoffrey M. - November 5, 2017 2:51 PM
I need some clarification. Mild strokes - this seems to be based on your score rather than on the underlying pathology. Are you meaning these patients who present within the 3 hour window get lytics based on clinical findings or do they all get imaging? I would have thought they all would have been imaged and mild would be irrelevant if there was a major vessel occlusion. The trial that was discontinued seems a shame as I would have thought getting the answer to who benefits would be ideal. The earlier lytic trials seemed to indicate poor outcomes with lytics.
Jon S., MD - November 5, 2017 4:46 PM
Geoffrey M
PRISMS described mild strokes as ones with an NIHSS of less than 6. Also they had to be strokes that the doc thought would be too mild to warrant tpa treatment. If the doc said they were not treating with tpa then we could approach them for enrollment. They may or may not have had a CTA of the head. I expect we may see results from the trial in late January of 2018.... you can google prisms to get to clinical trials.gov to see the inclusion exclusion criteria.
thanks
jon