Please use this identifier to cite or link to this item: http://hdl.handle.net/11054/1599
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dc.contributorCampbell, B. C. V.en_US
dc.contributorMitchell, P. J.en_US
dc.contributorChurilov, L.en_US
dc.contributorYassi, N.en_US
dc.contributorKleinig, T. J.en_US
dc.contributorDowling, R. J.en_US
dc.contributorYan, B.en_US
dc.contributorBush, S. J.en_US
dc.contributorThijs, V.en_US
dc.contributorScroop, R.en_US
dc.contributorSimpson, M.en_US
dc.contributorBrooks, M.en_US
dc.contributorAsadi, H.en_US
dc.contributorWu, T. Y.en_US
dc.contributorShah, D. G.en_US
dc.contributorWijeratne, T.en_US
dc.contributorZhao, H.en_US
dc.contributorAlemseged, F.en_US
dc.contributorNg. F.en_US
dc.contributorBailey, P.en_US
dc.contributorRice, H.en_US
dc.contributorde Villiers, L.en_US
dc.contributorDewey, H. M.en_US
dc.contributorChoi, P. M.en_US
dc.contributorBrown, H.en_US
dc.contributorRedmond, K.en_US
dc.contributorLeggett, D.en_US
dc.contributorFink, J. N.en_US
dc.contributorCollecutt, W.en_US
dc.contributorKraemer, Thomasen_US
dc.contributorKrause, M.en_US
dc.contributorCordato, D.en_US
dc.contributorField, D.en_US
dc.contributorMa, H.en_US
dc.contributorO'Brien, B.en_US
dc.contributorClissold, B.en_US
dc.contributorMiteff, F.en_US
dc.contributorClissold, A.en_US
dc.contributorCloud, G. C.en_US
dc.contributorBolitho, L.en_US
dc.contributorBonavia, Lukeen_US
dc.contributorBhattacharya, A.en_US
dc.contributorWright, A.en_US
dc.contributorMamun, A.en_US
dc.contributorO'Rourke, F.en_US
dc.contributorWorthington, J.en_US
dc.contributorWong, A.en_US
dc.contributorLevi, C.en_US
dc.contributorBladin, C.en_US
dc.contributorSharma, G.en_US
dc.contributorDesmond, P.en_US
dc.contributorParsons, M.en_US
dc.contributorDonnan, G.en_US
dc.contributorDavis, S.en_US
dc.date.accessioned2020-08-18T08:52:17Z-
dc.date.available2020-08-18T08:52:17Z-
dc.date.issued2020-
dc.identifier.govdoc01528en_US
dc.identifier.urihttp://hdl.handle.net/11054/1599-
dc.description.abstractImportance Intravenous thrombolysis with tenecteplase improves reperfusion prior to endovascular thrombectomy for ischemic stroke compared with alteplase. Objective To determine whether 0.40 mg/kg of tenecteplase safely improves reperfusion before endovascular thrombectomy vs 0.25 mg/kg of tenecteplase in patients with large vessel occlusion ischemic stroke. Design, Setting, and Participants Randomized clinical trial at 27 hospitals in Australia and 1 in New Zealand using open-label treatment and blinded assessment of radiological and clinical outcomes. Patients were enrolled from December 2017 to July 2019 with follow-up until October 2019. Adult patients (N = 300) with ischemic stroke due to occlusion of the intracranial internal carotid, \basilar, or middle cerebral artery were included less than 4.5 hours after symptom onset using standard intravenous thrombolysis eligibility criteria. Interventions Open-label tenecteplase at 0.40 mg/kg (maximum, 40 mg; n = 150) or 0.25 mg/kg (maximum, 25 mg; n = 150) given as a bolus before endovascular thrombectomy. Main Outcomes and Measures The primary outcome was reperfusion of greater than 50% of the involved ischemic territory prior to thrombectomy, assessed by consensus of 2 blinded neuroradiologists. Prespecified secondary outcomes were level of disability at day 90 (modified Rankin Scale [mRS] score; range, 0-6); mRS score of 0 to 1 (freedom from disability) or no change from baseline at 90 days; mRS score of 0 to 2 (functional independence) or no change from baseline at 90 days; substantial neurological improvement at 3 days; symptomatic intracranial hemorrhage within 36 hours; and all-cause death. Results All 300 patients who were randomized (mean age, 72.7 years; 141 [47%] women) completed the trial. The number of participants with greater than 50% reperfusion of the previously occluded vascular territory was 29 of 150 (19.3%) in the 0.40 mg/kg group vs 29 of 150 (19.3%) in the 0.25 mg/kg group (unadjusted risk difference, 0.0% [95% CI, −8.9% to −8.9%]; adjusted risk ratio, 1.03 [95% CI, 0.66-1.61]; P = .89). Among the 6 secondary outcomes, there were no significant differences in any of the 4 functional outcomes between the 0.40 mg/kg and 0.25 mg/kg groups nor in all-cause deaths (26 [17%] vs 22 [15%]; unadjusted risk difference, 2.7% [95% CI, −5.6% to 11.0%]) or symptomatic intracranial hemorrhage (7 [4.7%] vs 2 [1.3%]; unadjusted risk difference, 3.3% [95% CI, −0.5% to 7.2%]). Conclusions and Relevance Among patients with large vessel occlusion ischemic stroke, a dose of 0.40 mg/kg, compared with 0.25 mg/kg, of tenecteplase did not significantly improve cerebral reperfusion prior to endovascular thrombectomy. The findings suggest that the 0.40-mg/kg dose of tenecteplase does not confer an advantage over the 0.25-mg/kg dose in patients with large vessel occlusion ischemic stroke in whom endovascular thrombectomy is planned. Trial Registration ClinicalTrials.gov Identifier: NCT03340493en_US
dc.description.provenanceSubmitted by Gemma Siemensma (gemmas@bhs.org.au) on 2020-08-05T01:29:21Z No. of bitstreams: 0en
dc.description.provenanceApproved for entry into archive by Gemma Siemensma (gemmas@bhs.org.au) on 2020-08-18T08:52:17Z (GMT) No. of bitstreams: 0en
dc.description.provenanceMade available in DSpace on 2020-08-18T08:52:17Z (GMT). No. of bitstreams: 0 Previous issue date: 2020en
dc.titleEffect of intravenous tenecteplase dose on cerebral reperfusion before thrombectomy in patients with large vessel occlusion ischemic stroke. The EXTEND-IA TNK part 2 randomized clinical trial.en_US
dc.typeJournal Articleen_US
dc.type.specifiedArticleen_US
dc.contributor.corpauthorEXTEND-IA TNK Part 2 Investigatorsen_US
dc.bibliographicCitation.titleJAMAen_US
dc.bibliographicCitation.volume323en_US
dc.bibliographicCitation.issue13en_US
dc.bibliographicCitation.stpage1257en_US
dc.bibliographicCitation.endpage1265en_US
dc.subject.healththesaurusINTRAVENOUS THROMBOLYSIS-
dc.subject.healththesaurusTENECTEPLASE-
dc.subject.healththesaurusSTROKE-
dc.identifier.doihttps://doi.org/doi:10.1001/jama.2020.1511en_US
Appears in Collections:Research Output

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