03865nas a2200565   4500000000100000008004100001653001100042653001100053653000900064653000900073653001500082653002200097653001600119653001400135653001100149653001600160653001900176653002400195653002200219653004200241653003200283653002000315653003100335653002400366653002500390653003300415653003300448100001800481700001900499700001300518700001600531700001800547700002500565700002000590700001900610700002200629700001800651700001300669700002400682700001800706700001700724700002800741700001500769700002000784245018700804300001400991490000701005520227301012022001403285       2017                            d10aFemale10aHumans10aAged10aMale10aOdds Ratio10aTreatment Outcome10aMiddle Aged10aPrognosis10aStroke10aComorbidity10aBrain Ischemia10aCerebral Hemorrhage10aAged, 80 and over10aRandomized Controlled Trials as Topic10aAdministration, Intravenous10aLogistic Models10aGlomerular Filtration Rate10aFibrinolytic Agents10aThrombolytic Therapy10aTissue Plasminogen Activator10aRenal Insufficiency, Chronic1 aWoodward Mark1 aAnderson Craig1 aWang Xia1 aChalmers J.1 aLavados Pablo1 aOlavarría Verónica1 aLindley Richard1 aSato Shoichiro1 aRobinson Thompson1 aLee Tsong-Hai1 aKim Jong1 aPontes-Neto Octavio1 aRicci Stefano1 aSharma Vijay1 aENCHANTED Investigators1 aCarr Susan1 aRodriguez Jorge00aInfluence of Renal Impairment on Outcome for Thrombolysis-Treated Acute Ischemic Stroke: ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study) Post Hoc Analysis.  a2605-26090 v483 a<p>
<b>BACKGROUND AND PURPOSE: </b>Renal dysfunction (RD) is associated with poor prognosis after stroke. We assessed the effects of RD on outcomes and interaction with low- versus standard-dose alteplase in a post hoc subgroup analysis of the ENCHANTED (Enhanced Control of Hypertension and Thrombolysis Stroke Study).
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<b>METHODS: </b>A total of 3220 thrombolysis-eligible patients with acute ischemic stroke (mean age, 66.5 years; 37.8% women) were randomly assigned to low-dose (0.6 mg/kg) or standard-dose (0.9 mg/kg) intravenous alteplase within 4.5 hours of symptom onset. Six hundred and fifty-nine (19.8%) patients had moderate-to-severe RD (estimated glomerular filtration rate, &lt;60 mL/min per 1.73 m(2)) at baseline. The impact of RD on death or disability (modified Rankin Scale scores, 2-6) at 90 days, and symptomatic intracerebral hemorrhage, was assessed in logistic regression models.
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<b>RESULTS: </b>Compared with patients with normal renal function (&gt;90 mL/min per 1.73 m(2)), those with severe RD (&lt;30 mL/min per 1.73 m(2)) had increased mortality (adjusted odds ratio, 2.07; 95% confidence interval, 0.89-4.82; P=0.04 for trend); every 10 mL/min per 1.73 m(2) lower estimated glomerular filtration rate was associated with an adjusted 9% increased odds of death from thrombolysis-treated acute ischemic stroke. There was no significant association with modified Rankin Scale scores 2 to 6 (adjusted odds ratio, 1.03; 95% confidence interval, 0.62-1.70; P=0.81 for trend), modified Rankin Scale 3 to 6 (adjusted odds ratio, 1.20; 95% confidence interval, 0.72-2.01; P=0.44 for trend), or symptomatic intracerebral hemorrhage, or any heterogeneity in comparative treatment effects between low-dose and standard-dose alteplase by RD grades.
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<b>CONCLUSIONS: </b>RD is associated with increased mortality but not disability or symptomatic intracerebral hemorrhage in thrombolysis-eligible and treated acute ischemic stroke patients. Uncertainty persists as to whether low-dose alteplase confers benefits over standard-dose alteplase in acute ischemic stroke patients with RD.
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<b>CLINICAL TRIAL REGISTRATION: </b>URL: http://www.clinicaltrials.gov. Unique identifier: NCT01422616.
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  a1524-4628