Breaking news: EXTEND expands thrombolysis window to up to 9 hours after stroke

Health Care Comments Off

(Medscape excerpts)

Using perfusion imaging to identify patients with salvageable brain tissue following ischemic stroke is the key to extending the window for thrombolysis out to 9 hours.

The results of the EXTEND trial show that more patients presenting between 4.5 and 9 hours treated with tPA (alteplase) under these conditions achieved a score of 0 or 1 on the modified Rankin scale (indicating no deficits or minimal deficits, respectively) than those give placebo.

The EXTEND trial is published in the May 9 issue of The New England Journal of Medicine. The results were first presented at the International Stroke Conference (ISC) in Hawaii earlier this year.

These results open up the possibility of treating many more stroke patients with thrombolysis.

The study is positive and provides level 1 evidence for tPA out to 9 hours (including wake-up strokes) in patients with suitable imaging showing that brain tissue is salvageable.

There have been two previous studies looking at late tPA with a similar design — ECASS-4 and EPITHET, and a meta-analysis of all three trials is about to be presented at this months European Stroke Organisation Conference (ESOC) meeting in Milan, Italy.

225 patients with ischemic stroke who had hypoperfused but salvageable regions of brain detected on automated perfusion imaging were randomly assigned to receive intravenous alteplase or placebo between 4.5 and 9 hours after the onset of stroke or on awakening with stroke (if within 9 hours from the midpoint of sleep).

The primary outcome (a score of 0 or 1 on the modified Rankin scale at 90 days) occurred in 40 patients (35.4%) in the alteplase group and in 33 patients (29.5%) in the placebo group.

Symptomatic intracerebral hemorrhage occurred in 7 patients (6.2%) in the alteplase group and in 1 patient (0.9%) in the placebo group.

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

Weather variations can affect and alter body functions: HCFI

Health Care, Heart Care Foundation of India, Medicine Comments Off

Drinking adequate water and consumption of food according to the weather are imperative

New Delhi, 16th May 2019: Recent statistics indicate that between 2030 and 2050, weather extremes are expected to cause around 250,000 additional annual deaths from malnutrition, malaria, diarrhea and heat stress. Extreme heat can make a person feel hot and sweaty and further cause dehydration and heat stroke particularly in people at risk. This includes young children, people over 65 years of age, and those with pre-existing medical conditions like diabetes and heart disease.

The need of the hour is to raise awareness on importance of drinking adequate water and staying out of the heat as much as possible. This can help in preventing dehydration and other heat-related problems.

Speaking about this, Padma Shri Awardee, Dr KK Aggarwal, President, HCFI, said, “The early summer season or grishma ritu is hot and dry, while the later part of summer, when rains are on the horizon, is hot and moist. Rains are not usual in early summer in North India. However, this year, early summer has been marked by an unusually increased frequency of dust and thunderstorms, and rains. In Vedas, this is termed vikruti (vitiation) of ritu (season), when the weather forgets its dharma and behaves abnormally. When this happens, all body circadian rhythms also behave abnormally, and body functions are exaggerated. In such weather conditions, wind-sensitive individuals with no evidence of target organ damage can have accelerated hypertension. They are also sensitive to changes in atmospheric pressure.”

Adding further, Dr Aggarwal, who is also the Group Editor-in-Chief of IJCP, said, “Vitiation of vata (movement) leads to high blood pressure, arrhythmia; pitta (metabolism) increases metabolism and more acidity, while vitiated kapha (structure) may disrupt sugar profile. Any change in environment affects the functions of the body, something that is well-known in Vedic sciences. For instance, the current weather profile in Delhi can lead to the development of accelerated hypertension.”

The significance of a ‘medical vrata’ needs to be underlined for everyone during summer. The simpler version of ‘vrata’ can be: not eating carbohydrates at all once in a week and replacing them with fruits and vegetables.

Some summer tips from HCFI

  • Avoid prolonged exposure to sun when the temperature is high. Use an umbrella if you need to go out. Wear light cotton clothes to avoid heat absorption.
  • Make sure that you are properly hydrated before you step out in the heat. The water requirement in summer is 500 ml more than that in winter. Summer drinks should be refreshing and cool such as panna, khas khas, rose and lemon water, bel sharbat and sattu sharbat.
  • Any drink with more than 10% sugar becomes a soft drink and should be avoided. Ideally, the percentage of sugar, jaggery or khand should be 3%, also present in oral rehydration drinks.
  • A sign of adequate hydration is passing urine at least once in 8 hours. If you develop heat cramps, drink plenty of lemon water with sugar and salt.