02728nas a2200349   4500000000100000008004100001653001100042653001100053653000900064653000900073653002200082653002200104653003200126653004900158653005800207653002100265653004900286100001800335700001300353700001500366700001500381700001700396700001400413700001400427700001400441245016200455250001500617300001100632490000700643520167700650020005102327       2015                            d10aFemale10aHumans10aAged10aMale10aTreatment Outcome10aAged, 80 and over10aAdministration, Intravenous10aFibrinolytic Agents/ administration & dosage10aTissue Plasminogen Activator/ administration & dosage10aInternationality10aStroke/ diagnosis/ drug therapy/epidemiology1 aSandercock P.1 aCohen G.1 aLindley R.1 aWardlaw J.1 aBroderick J.1 aYeatts S.1 aKhatri P.1 aTayama D.00aEffect of Intravenous Recombinant Tissue-Type Plasminogen Activator in Patients With Mild Stroke in the Third International Stroke Trial-3: Post Hoc Analysis  a2015/06/25  a2325-70 v463 a<p>
BACKGROUND AND PURPOSE: Randomized trial evidence on the risk/benefit ratio of thrombolysis for mild stroke is limited. We sought to determine the efficacy of intravenous recombinant tissue-type plasminogen activator (IV r-tPA) in a subset of patients with mild deficit in the third International Stroke Trial (IST-3). METHODS: IST-3 compared IV r-tPA with control within 6 hours of onset in patients for whom IV r-tPA was considered promising but unproven. Analysis was restricted to subjects randomized within 3 hours of onset with a baseline National Institutes of Health Stroke Scale <!--=5, pretreatment blood pressure <185/110, and no other r-tPA exclusion criteria. We compared r-tPA and control arms for primary (Oxfordshire Handicap Score [OHS] 0-2) and secondary (ordinal OHS and OHS 0-1) outcomes at 6 months. RESULTS: Among 3035 IST-3 subjects, 612 (20.2%) had an National Institutes of Health Stroke Scale </=5; of these 106 (17.6%) met the restricted criteria. Allocation to r-tPA was associated with an increase in OHS 0 to 2 (84% r-tPA versus 65% control; adjusted odds ratio, 3.31; 95% confidence interval, 1.24-8.79) and a favorable shift in OHS distribution (adjusted odds ratio, 2.38; 95% confidence interval, 1.17-4.85). There was no significant effect of r-tPA on OHS 0 to 1 (60% versus 51%; adjusted odds ratio, 1.92; 95% confidence interval, 0.83-4.43). CONCLUSIONS: This post hoc analysis in a highly selected sample of IST-3 supports the rationale of A Study of the Efficacy and Safety of Activase (Alteplase) in Patients With Mild Stroke (PRISMS) trial-a randomized, phase IIIb study to evaluate IV r-tPA in mild ischemic stroke.-->
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