03328nas a2200397   4500000000100000008004100001100001900042700001900061700001800080700001300098700002000111700001800131700002500149700002100174700001900195700002200214700001800236700001800254700002000272700001600292700001300308700001800321700001700339700001800356700002800374700001700402700001900419700002000438700001900458700002500477245020400502300001200706490000700718520219100725022001402916       2018                            d1 aAnderson Craig1 aArima Hisatomi1 aWoodward Mark1 aWang Xia1 aDonnan Geoffrey1 aLavados Pablo1 aOlavarría Verónica1 aBroderick Joseph1 aSato Shoichiro1 aRobinson Thompson1 aChalmers John1 aLee Tsong-Hai1 aPandian Jeyaraj1 aBath Philip1 aKim Jong1 aRicci Stefano1 aSharma Vijay1 aWang Ji-Guang1 aENCHANTED Investigators1 aThang Nguyen1 aBillot Laurent1 aMinhas Jatinder1 aMartins Sheila1 aPontes-Neto Octávio00aLipid-Lowering Pretreatment and Outcome Following Intravenous Thrombolysis for Acute Ischaemic Stroke: A Post Hoc Analysis of the Enhanced Control of Hypertension and Thrombolysis Stroke Study Trial.  a213-2200 v453 a<p><b>BACKGROUND: </b>Debate exists as to whether statin pretreatment confers an increased risk of 90-day mortality and symptomatic intracranial haemorrhage (sICH) in acute ischaemic stroke (AIS) patients treated with intravenous thrombolysis. We assessed the effects of undifferentiated lipid-lowering pretreatment on outcomes and interaction with low-dose versus standard-dose alteplase in a post hoc subgroup -analysis of the Enhanced Control of Hypertension and Thrombolysis Stroke Study.</p><p><b>METHODS: </b>In all, 3,284 thrombolysis-eligible AIS patients (mean age 66.6 years; 38% women), with information on lipid-lowering pretreatment, were randomly assigned to low-dose (0.6 mg/kg) or standard-dose (0.9 mg/kg) intravenous alteplase within 4.5 h of symptom onset. Of the total number of patients, 615 (19%) received statin or other lipid-lowering pretreatment. The primary clinical outcome was combined endpoint of death or disability (modified Rankin Scale scores 2-6) at 90 days.</p><p><b>RESULTS: </b>Compared with patients with no lipid-lowering pretreatment, those with lipid-lowering pretreatment were significantly older, more likely to be non-Asian and more likely to have a medical history including vascular co-morbidity. After propensity analysis assessment and adjustment for important baseline variables at the time of randomisation, as well as imbalances in management during the first 7 days of hospital admission, there were no significant differences in mortality (OR 0.85; 95% CI 0.58-1.25, p = 0.42), or in overall -90-day death and disability (OR 0.85, 95% CI 0.67-1.09, p = 0.19), despite a significant decrease in sICH among those with -lipid-lowering pretreatment according to the European Co-operative Acute Stroke Study 2 definition (OR 0.49, 95% CI 0.28-0.83, p = 0.009). No differences in key efficacy or safety outcomes were seen in patients with and without lipid-lowering pretreatment between low- and standard-dose alteplase arms.</p><p><b>CONCLUSIONS: </b>Lipid-lowering pretreatment is not associated with adverse outcome in AIS patients treated with intravenous alteplase, whether assessed by 90-day death and disability or death alone.</p>  a1421-9786