TICH-2 trial – Tranexamic acid for IntraCerebral Haemorrhage 2

investigator meeting italy , Mantova 19 Nov 2014 hosting Alfonso Ciccone

  • The trial is funded by the NIHR HTA
  • The trial opened in March 2013 and will run until February 2017
  • The University of Nottingham is acting as trial sponsor
  • The trial is live and recruitment is ongoing, with 682 participants so far
  • Start up phase — March 2013
  • Main phase — April 2014
  • New sites welcome in the UK and internationally

For further information please contact us.

Trial Manager: Hayley Foster <hayley.foster@nottingham.ac.uk>
Chief Investigator: Dr Nikola Sprigg <nikola.sprigg@nottingham.ac.uk>
Nottingham Stroke Trials Office:

IST-3 Bibliography: published full papers in peer-reviewed journals

  1.  Innes K. Thrombolysis for acute ischaemic stroke: core nursing requirements. British Journal of Nursing 2003;12(7):416-24
  2. Kane I, Lindley R, Lewis S, Sandercock P. Impact of stroke syndrome and stroke severity on the process of consent in the Third International Stroke Trial. Cerebrovascular Diseases 2006;21:348-52

http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowPDF&ArtikelNr=91541&Ausgabe=231712&ProduktNr=224153&filename=91541.pdf

  1. Whiteley W, Lindley R, Wardlaw J, Sandercock P. Third International Stroke Trial. Int J Stroke. 2006;1:172-6.

http://onlinelibrary.wiley.com/doi/10.1111/j.1747-4949.2006.00043.x/full

  1. Sandercock P, Lindley R, Wardlaw J, Protocol 06PRT/1269: Third International Stroke Trial (IST-3). Lancet

     http://www.thelancet.com/journals/lancet/misc/protocol/06PRT-1269.

  1. Wardlaw JM, Bath P, Sandercock P, Perry D, Palmer J, Watson G, Lloyd S, Geddes J, Farrall A. The NeuroGrid stroke exemplar clinical trial protocol. Int J Stroke. 2007;2:63-9 http://onlinelibrary.wiley.com/doi/10.1111/j.1747-4949.2007.00092.x/full
  2. The third international stroke trial (IST-3) of thrombolysis for acute ischaemic stroke. Sandercock P, Lindley R, Wardlaw J, Dennis M, Lewis S, Venables G, Kobayashi A, Czlonkowska A, Berge E, Bruins Slot K, Murray V, Peeters A, Hankey G, Matz K, Brainin M, Ricci S, Celani MG, Righetti E, Cantisani T, Gubitz G, Phillips S, Arauz A, Prasad K, Correia M, Lyrer P; the IST-3 collaborative group. Trials 2008;9(1):37. http://www.trialsjournal.com/content/9/1/37
  3. SCOPE (Stroke Complications and Outcomes Prediction Engine) Collaborations and IST. Predicting outcome in hyper-acute stroke: validation of a prognostic model in the Third International Stroke Trial (IST3). JNNP 2008;79:397-400

http://jnnp.bmj.com/content/79/4/397.full.pdf+html

  1. EPITHET-where next? Sandercock P, Wardlaw J, Dennis M, Lindley R, Hankey G, Matz K, Peeters A, Phillips S, Gubitz G, Prasad K, Ricci S, Celani MG, Righetti E, Cantisani T, Arauz A, Berge E, Slot KB, Kobayashi A, Czlonkowska A, Correia M, Murray V, Lyrer P, Venables G; IST-3 Collaborative Group. Lancet Neurology 2008;7(7):570-1.

http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(08)70123-6/fulltext

  1. Oxfordshire community stroke project clinical stroke syndrome and appearances of tissue and vascular lesions on pre-treatment CT in hyper-acute ischemic stroke among the first 510 patients in the Third International Stroke Trial (IST-3). Kobayashi A, Wardlaw J, Lindley R, Lewis S, Sandercock P, Czlonkowska A; IST-3 Collaborative Group.Stroke 2009;40(3):743-8.

http://stroke.ahajournals.org/content/40/3/743.full

  1. Should more patients with acute ischaemic stroke receive thrombolytic treatment? Wardlaw J, Murray V, Sandercock P,BMJ 2009; 339.      http://www.bmj.com/content/339/bmj.b4584
  2. The Third International Stroke Trial: Thrombolysis (IST-3) in Poland: are we recruiting the right patients? Czlonkowska A, Kobayashi A, Lewis S, Sandercock P, Lindley R, Baranska-Gieruszczak M on behalf of the IST-3 collaborative group. Polish Journal of Neurology and Neurosurgery. 2009; 43, 3:228-235.

http://www.termedia.pl/Original-paper-The-Third-International-Stroke-Trial-Thrombolysis-IST-3-in-Poland-are-we-recruiting-the-right-patients-,15,12742,0,1.html

  1. Update on the third international stroke trial (IST-3) of thrombolysis for acute ischaemic stroke and baseline features of the 3035 patients recruited. Sandercock P, Lindley R, Wardlaw J, Dennis M, Lewis S, Venables G, Kobayashi A, Czlonkowska A, Berge E, Bruins Slot K, Murray V, Peeters A, Hankey G, Matz K, Brainin M, Ricci S, Celani MG, Righetti E, Cantisani T, Gubitz G, Phillips S, Arauz A, Prasad K, Correia M, Lyrer P; the IST-3 collaborative group. Trials2011, 12:252

http://www.trialsjournal.com/content/12/1/252

  1. How many patients might receive thrombolytic therapy in the light of the ECASS-3 and IST-3 data? Jan Bembenek, Adam Kobayashi, Peter Sandercock, Anna Czlonkowska. Int J Stroke 2010; 5:428–431.

http://onlinelibrary.wiley.com/doi/10.1111/j.1747-4949.2010.00479.x/full

  1. ‘Where are we now with intravenous thrombolysis for acute ischaemic stroke’? Peter Sandercock, Joanna Wardlaw, and Richard Lindley. Int J Stroke 2010; 5: 381–382: http://onlinelibrary.wiley.com/doi/10.1111/j.1747-4949.2010.00465.x/abstract
  2. Statistical analysis plan for the third International Stroke Trial (IST-3); part of a ‘thread’ of reports of the trial. Int J Stroke 2012; 7: 186–18. http://onlinelibrary.wiley.com/doi/10.1111/j.1747-4949.2012.00782.x/full
  3. The IST-3 Collaborative Group. The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial. Lancet 2012; 379(9834):2352-2363.

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60768-5/fulltext

  1. Wardlaw J M, Murray V, Berge E, del Z G, Sandercock P, Lindley R L et al. Recombinant tissue plasminogen activator for acute ischaemic stroke: an updated systematic review and meta-analysis. Lancet 2012; 379(9834):2364-2372. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60738-7/fulltext
  2. IST-3 Collaborative Group. Effect of thrombolysis with alteplase within 6h of acute ischaemic stroke on long-term outcomes (the third international stroke trial [IST-3]): 18-month follow-up of a randomised controlled trial. Lancet Neurology 2013;12:768-76. doi:10.1016/S1474-4422(13)70130-3.

http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(13)70130-3/fulltext

  1. Whiteley WN, Thompson D, Murray G, Cohen G, Lindley RI, Wardlaw J, Sandercock P. Targeting recombinant tissue-type plasminogen activator in acute ischemic stroke based on risk of intracranial hemorrhage or poor functional outcome. An analysis of the Third International Stroke trial. Stroke 2014;45:1000-6: http://dx.doi.org/1161/STROKEAHA.113.004362
  2. Whiteley WN, Thompson D, Murray G, Cohen G, Lindley RI, Wardlaw J et al. Effect of Alteplase Within 6 Hours of Acute Ischemic Stroke on All-Cause Mortality (Third International Stroke Trial). Stroke Published online before print November 4, 2014, http://dx.doi.org/1161/STROKEAHA.114.006890
  3. Mair G, von Kummer R, Adami A, White PM, Adams ME, Yan B et al. Observer reliability of CT angiography in the assessment of acute ischaemic stroke: data from the Third International Stroke Trial. Neuroradiology 2014 October 7. http://dx.doi.org/10.1007/s00234-014-1441-0
  4. Impact of treatment delay, age and stroke severity of the effects of intravenous thrombolysis with alteplase in acute ischaemic stroke: an individual participant data meta-analysis of randomised trials Emberson J and the Stroke Thrombolysis Trialists Collaboration Lancet. 2014 Aug 5. pii: S0140-6736(14)60584-5. http://dx.doi.org/10.1016/S0140-6736(14)60584-5 .
  5. Mair G, Boyd EV, Chappell FM, von Kummer R, Lindley RI, Sandercock P, Wardlaw JM IST-3 Collaborative Group. Sensitivity and specificity of the Hyperdense Artery Sign for arterial obstruction in acute ischemic stroke Stroke (in press)
  6. Lindley RI, Wardlaw JM, Whiteley W, Cohen G, Blackwell B, Murray G, Sandercock P & the IST-3 Collaborative Group. Alteplase for acute ischemic stroke: outcomes by clinically important subgroups in the Third International Stroke Trial Stroke (submitted for publication)

Link to video of public lecture on stroke and thrombolysis by Peter Sandercock

http://www.ed.ac.uk/schools-departments/clinical-brain-sciences/news/latest-news/public-lectures-epilepsy-stroke

Editorials and commentaries on IST-3 since 2012

 

  1. Lyden PD. In anticipation of International Stroke Trial-3 (IST-3). Stroke 2012;43:1691-4
  2. Leys L, Cordonnier C. rt-PA for ischaemic stroke: what will the next question be?. Lancet 2012;379:2320-1
  3. Donnan GA, Davis SM. IST-3: a major contribution to thrombolysis research. International Journal of Stroke 2012;7:566-7
  4. Furlan AJ. IST-3: no pragmatic answers. International Journal of Stroke 2012;7:568-9
  5. Hoffman JR, Cooper RJ. How is more negative evidence being used to support claims of benefit: the curious case of the international stroke trial (IST-3). Emergency Medicine Australasia 2012;24:473-6
  6. Fatovich DM. Believing is seeing: stroke thrombolysis remains unproven after the third international stroke trial (IST-3). Emergency Medicine Australasia 2012;24:477-9
  7. Kleinig TJ, Churilov L, Parsch CS, Dewey HM, Barber PA. Stroke thrombolysis and the third international stroke trial: examining “the totality of the evidence”. Emergency Medicine Australasia 2012;25:107-9
  8. Hughes S. IST-3: tPA benefits sustained out to 18 months. Medscape. 2013. Article ID 806690. [http://www.medscape.com]
  9. Anderson C. Thrombolysis with alteplase after stroke: extending outcomes. Lancet Neurology 2013;12:731-2
  10. Evidence and doubt in the translation of research into care. Lancet 2014;384:638

Correspondence since 2012

 

  1. Fatovich DM, MacDonald SP, Brown SG, Smith B, Newman DH, Shreves AE, Barer D, Durtis D, Sandercock P, Wardlaw J, Dennis M, Murray G, Lindley R. Thrombolysis in acute ischaemic stroke. Lancet 2012;380:1053-5
  2. Shinton R, Sandercock P, Wardlaw JM, Hudson I. Questions about authorisation of alteplase for ischaemic stroke. Lancet 2014;384:659-63
  3. Dai Q, Sun W, Liu X,Whiteley WN, Thompson D, Sandercock P. Letter by Dai et al regarding article “Targeting recombinant tissue-type plasminogen activator in acute ischemic stroke based on risk of intracranial hemorrhage or poor functional outcome: an analysis of the Third International Stroke Trial”. Stroke 2014;45:e132-3

 

Abstracts published since trial results made public in 2012

  1. Sandercock P, Wardlaw JM, Lindley RI, Dennis MS, Cohen G. The third international stroke trial (IST-3) main results part I: primary and secondary outcomes among 3035 patients randomised. Cerebrovascular Diseases 2012;33 Suppl 2:16
  2. Lindley RI, Sandercock P, Wardlaw JW, Dennis MS, Cohen G. The third international stroke trial (IST-3) of thrombolysis main results III. Effect of iv thrombolysis with iv t-PA on death or dependency in the 3035 patients randomized: subgroup analysis. Cerebrovascular Diseases 2012;33(suppl 2):79 (Abst.1) [Ref 19448]
  3. Roots A, Birns J, Bhalla A, Rudd A. Nurse-led telemedicine-directed hyper-acute stroke trial randomisation and management of post-thrombolysis anaphylaxis. Cerebrovascular Diseases 2012;33(suppl 2):477-8 (Abst.2022) [Ref 19403]
  4. Farrall A, Wardlaw J, Sandercock P, Lindley R, Cohen G, von Kummer R, et al. The third international stroke trial (IST-3) of intravenous thrombolysis with rt-PA: baseline imaging features among 3035 patients randomised. International Journal of Stroke 2012;7 Suppl 2:61-2 (Abst.142)
  5. Sandercock P; IST-3 Collaborative Group. The Third International Stroke Trial (IST-3) of thrombolysis. Main results & implications for clinical practice. Cerebrovascular Diseases 2012;34 Suppl 1:6-7 (Abst.S5-1)
  6. Sandercock PAG, Wardlaw JM, Lindley RI, Cohen G; IST3 collaborative group. The third international stroke trial (IST-3) of intravenous rt-PA: effect of age and time on treatment effect among 3035 patients randomised. International Journal of Stroke 2012;7 Suppl 2:6
  7. Lindley RI, Sandercock PA, Wardlaw JM, Dennis MS, Cohen G, IST-3 Collaborative Group. Third international stroke trial (IST-3): subgroup effects of iv rt-PA < 6 hrs in acute ischemic stroke on symptomatic intracranial haemorrhage and outcome at 6 months. Stroke 2013;44 (Abst.TMP23)
  8. Sandercock PA, Wardlaw JM, Lindley RI, Dennis MS, IST-3 Collaborative Group. Third international stroke trial (IST-3): effect of iv rt-pa < 6 hours in acute ischaemic stroke on living circumstances and health related quality of life at six months. Stroke 2013;44 (Abst.WMP22)]
  9. Wardlaw J, Carpenter T, von Kummer R, Cohen G, Lindley R, Sandercock P. Perfusion imaging in patients randomised to rt-PA or control in the third international stroke trial (IST-3): baseline characteristics and association with outcome. Stroke 2013;44 (Abst.A10)
  10. Wardlaw J, von Kummer R, Farrall A, Cala L, von Heijne A, Peeters A, etal. The impact of ischemic and structural brain tissue changes on response to rt-PA: an analysis of imaging from 3035 patients in the third international stroke trial. Stroke 2013;44 (Abst.A104)
  11. Sandercock P, Wardlaw J, Dennis M, Cohen G, Whiteley W, Lindley, et al. Impact of thrombolysis on important aspects of daily life at 18 months in the third International Stroke Trial (IST-3). International Journal of Stroke 2013;8 Suppl 3:4
  12. Whiteley WN, Cohen G, Wardlaw J, Lindley R, Sandercock PAG. IST-3 trial: impact of rt-PA on survival to 18 months post ischaemic stroke. Cerebrovascular Diseases 2013;35(Suppl 3):19 (Abst.6)
  13. Sandercock PAG, Lindley RI, Wardlaw JM, Dennis MS, Cohen G. The third international stroke trial (IST-3): benefits of iv thrombolysis on functional outcome and health-related quality of life (HRQoL) persist to 18 months after treatment. Cerebrovascular Diseases 2013;35(Suppl 3):34 (Abst.4)
  14. Wardlaw JM, Carpenter T, Cohen G, von Kimmer R, Lindley R, Sandercock P. Does perfusion imaging lesion size or mismatch influence six month outcomes after rt-PA given up to six hours after acute ischaemic stroke? The third International Stroke Trial (IST-3). Cerebrovascular Diseases 2013;35(Suppl 3):111 (Abst.12)
  15. Whiteley WN, Thompson D, Cohen G, Lindley R, Wardlaw JM, Sandercock PAG. Predictions of intracranial haemorrhage and the risks and benefits of rtPA in acute ischaemic stroke: an analysis of the IST-3 trial. Cerebrovascular Diseases 2013;35(Suppl 3):169 (Abst.4)
  16. Mair G, Wardlaw JM, Sandercock P, Lindley R, von Kummer R. Combining CT angiography with non-contrast CT to predict infarct on follow up CT in acute ischaemic stroke. Substudy analysis of imaging from the third International Stroke Trial (IST-3). Cerebrovascular Diseases 2013;35(Suppl 3):237 (Abst.15)
  17. Mair G, Wardlaw JM, Sandercock P, Lindley R, von Kummer R, Farrall AJ. Association of non-contrast CT and CT angiography with baseline clinical deficit and functional outcome. Substudy analysis of imaging from the third International Stroke Trial (IST-3). Cerebrovascular Diseases 2013;35(Suppl 3):405 (Abst.226)
  18. Sakka E, Perry D, Buchanan D, Innes K, Sandercock P, Lindley RI, Wardlaw JM. Medical image management for multicentre trials. Experience from the Third International Stroke Trial (IST-3) with 6576 scans. Cerebrovascular Diseases 2013;35(Suppl 3):562 (Abst.24)
  19. Mair G, Wardlaw JM, von Kummer R, Sandercock PA. Response to thrombolysis treatment in ischemic stroke patients with and without arterial occlusion on computed tomographic angiography: the Third International Stroke Trial. Stroke 2014;45(Suppl 1) (Abst.A6)
  20. Khatri P, Tayama D, Cohen G, Lindley RI, Wardlaw JM, Yeatts SD, et al. Effect of IV rtPA in mild strokes in the third international stroke trial (IST3): a post hoc analysis. Stroke 2014;45(Suppl 1) (Abst.ATMP21)

 

 

 

For the World Stroke Day this year, the World Stroke Organization has decided to dedicate it to the woman, Often she is the victim of this disease and needs thereby special attention. ARS Umbria has produced this short spot to help the public to know- understand and better prevent stroke in women. Directed by Marzia Raspa

The WHO atlas addresses the global epidemic of heart disease and stroke in a clear and accessible format.

Cardiovascular disease now ranks as the world s top causeof death, causing one third of all deaths globally. Heartdisease can no longer be seen as the problem ofoverworked, overweight middle-aged men in developed countries. In todays world, women and children too are atrisk. Already, 75% of all CVD deaths occur in the poorer regions of the world, and this is likely to increase in the future. Following on from the success of WHO s Tobacco Atlas , the Atlas of Heart Disease and Stroke  addresses this most
urgent health issue in a ground-breaking, clear and accessible format, designed to inform UN agencies,
government officials, politicians, and other decision makers, the media, researchers, and the general public, as well as provide an essential tool for the health professional.
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Topics include:

* Risk factors: high blood pressure, tobacco use,
inactivity, obesity, lipids, diabetes
* Women, childhood and youth
* The global burden of CVD, including the economic
burden
* Research
* Prevention
* Policies and legislation
* Treatment
* Predictions

IMG_1409

data from the ministery of health for central italy

So far it was a secret given to word of mouth among health professionals. The new Guide to Health Focus, now in its third edition with the most current data, it also recognizes the right of patients to know which are the most reliable centers to turn to be taken care of in the best way.Of course, hard to choose when you have a heart attack or a stroke: it relies on the ETS and it is hoped that in their region and in their local health healthcare is efficient.

“>1. Shall be established a biennial award for the best original scientific research conducted in the field “>youth
“>The honorary president of the award is Prof. Domenico Inzitari. “>author’s statement that the date of submission of the same work is not yet “acce “>2.
“>Italy, the Sin (Italian Society of Neurology), Sno (Neurological Hospital), the Region “>and the Order of Physicians of the Province of Vibo Valentia
“>3. Prizes will be awarded three jobs, with prizes “>euro, respectively, to be allocated
“>This year, the two scientific societies “>Neurological most representative (SIN and SNO) “>distributed “>the burden of premiums
“>4. The competition is open to researchers in experimental and clinical sciences in the field of stroke  “> in a clinical or research established in Italy. “>experimental design and conduct of research that has produced results “>such preferred securities.
brain. Must be research with scientific results and their originals. “>action
be paramount. “>articles, meta-analyzes or other items without
“>6. Entries must be sent in full (in Italian or English),
“>September 201 “>President of ‘Hipponion STROKE NATIONAL PRIZE, Dr. Domenico Consoli, Avenue of the
“>domco@tiscali.it
“>neurologiavv@live.it
“>sent by post, the date of dispatch of postmark) backed by sections
“>surfaces: table of contents, introduction, materials and methods, results, discussion,
words. “>, Under their own responsibility, the role he / she played in the research work. “>host / presenter, with regard to design, conduct of the study, analysis of results, year elements of privilege for the award. “>prepared an attached card that contains the data, the tax code, the professional role, the “>h and under its responsibility to “>7., The Commission will assess the scientific work sent anonymously each of three independent reviewers. “>tion will be:
“>Originality of the scientific question (innovative contribution compared to the previous knowledge of the
“>-
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“>with the previous literature, score from 1 to 10.
“>Conclusions congruous with the results (degree of inference
“>generalizability of the results) pts “>to 10.
“>Overall assessment, taking into account the age of the investigator and the role he played in
“>In case of conflict between the two referees, the evaluation with
“>jointly by all the members of the advisory board.
“>directly by the candidate / in the premium, for the val
“>a report of 15 minutes (10 for presentation, 5 for discussion) to be held
“>No
“>and
“>9. Scientific work of the Committee will
“>10. The awards av
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“>’Stroke’
. “>P. Binelli,
“>Carolei,
C. Fieschi, G.F. “>L. Provincial
“>Quattrone, V. Toso

IMG_1409

The European Stroke Organisation (ESO) announced on May 9th, 2014, that the first ESO Stroke Conference will be held in Glasgow on April 17-19, 2015. Here topics it will be nice to be there with all my colleagues. In the pipeline we have a couple of nice contributions

European Stroke Conference  #ESOC14 #eurostroke14 in Nice

#ESOC14 en còte d’azur

https://www.youtube.com/watch?v=YaQjM-SSohg

stroke guidelines

stroke guidelines

foto(14)

foto(15)

GUIDELINES for Stroke Management

The ESO Guidelines 2008 represent an update of the ESO 2008 and 2003 EUSI Guidelines. Again, they cover the whole spectrum of ischaemic stroke, from teaching and awareness, to stroke unit and stroke management strategies, primary and secondary prevention, acute treatment and rehabilitation.

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