ABSTRACT
RATIONALE: In-stent reocclusion after endovascular therapy has a negative impact on outcomes in acute ischemic stroke (AIS) due to tandem lesions (TL). Optimal antiplatelet therapy approach in these patients to avoid in-stent reocclusion is yet to be elucidated. AIMS: To assess efficacy and safety of intravenous tirofiban versus intravenous aspirin in patients undergoing MT plus carotid stenting in the setting of AIS due to TL. SAMPLE SIZE ESTIMATES: Two hundred forty patients will be enrolled, 120 in every treatment arm. METHODS AND DESIGN: A multicenter, prospective, randomized, controlled (aspirin group), assessor-blinded clinical trial will be conducted. Patients fulfilling the inclusion criteria will be randomized at MT onset to the experimental or control group (1:1). Intravenous aspirin will be administered at a 500-mg single dose and tirofiban at a 500-mcg bolus followed by a 200-mcg/h infusion during the first 24 h. All patients will be followed for up to 3 months. STUDY OUTCOMES: Primary efficacy outcome will be the proportion of patients with carotid in-stent thrombosis within the first 24 h after MT. Primary safety outcome will be the rate of symptomatic intracranial hemorrhage. DISCUSSION: This will be the first clinical trial to assess the best antiplatelet therapy to avoid in-stent thrombosis after MT in patients with TL. TRIAL REGISTRATION: The trial is registered as NCT05225961. February, 7th, 2022.
Subject(s)
Aspirin , Ischemic Stroke , Thrombosis , Tirofiban , Humans , Aspirin/adverse effects , Aspirin/therapeutic use , Platelet Aggregation Inhibitors/adverse effects , Platelet Aggregation Inhibitors/therapeutic use , Prospective Studies , Tirofiban/adverse effects , Tirofiban/therapeutic use , Randomized Controlled Trials as Topic , Multicenter Studies as TopicABSTRACT
Background: In-stent thrombosis after mechanical thrombectomy (MT) worsen outcomes in acute ischemic stroke (AIS) due to tandem lesions (TL). Although an optimal antiplatelet therapy is needed, the best approach to avoid in-stent thrombosis is yet to be elucidated. Hypothesis: Low-dose intravenous tirofiban is superior to intravenous aspirin in avoiding in-stent thrombosis in patients undergoing MT plus carotid stenting in the setting of AIS due to TL. Methods: The ATILA-trial is a multicenter, prospective, phase IV, randomized, controlled (aspirin group as control), assessor-blinded clinical trial. Patients fulfilling inclusion criteria (AIS due to TL, ASPECTS ⩾ 6, pre-stroke modified Rankin Scale ⩽2 and onset <24 h) will be randomized (1:1) at MT onset to experimental (intravenous tirofiban) or control group (intravenous aspirin). Intravenous aspirin will be administered at a 500 mg single dose and tirofiban at a 500 µg bolus followed by a 200 µg/h infusion during first 22 h. All patients will be followed up to 3 months. Sample size estimated is 240 patients. Outcomes: The primary efficacy outcome is the proportion of patients with carotid in-stent thrombosis within the first 24 h after MT. The primary safety outcome is the rate of symptomatic intracranial hemorrhage. Secondary outcomes include functional independence defined as modified Rankin Scale 0-2, proportion of patients undergoing rescue therapy due to in-stent aggregation during MT and carotid reocclusion at 30 days. Discussion: ATILA-trial will be the first clinical trial regarding the best antiplatelet therapy to avoid in-stent thrombosis after MT in patients with TL. Trial registration: NCT0522596.
Subject(s)
Brain Ischemia , Ischemic Stroke , Thrombosis , Humans , Tirofiban/therapeutic use , Ischemic Stroke/drug therapy , Platelet Aggregation Inhibitors/adverse effects , Prospective Studies , Brain Ischemia/chemically induced , Treatment Outcome , Aspirin/adverse effects , Thrombectomy/adverse effects , Thrombosis/drug therapy , Randomized Controlled Trials as Topic , Multicenter Studies as Topic , Clinical Trials, Phase IV as TopicABSTRACT
BACKGROUND: The aim of this study was to know the impact of the coronavirus disease 2019 (COVID-19) pandemic on Spanish patients with Parkinson's disease (PD). METHODS: This is a descriptive, observational, cross-sectional study. An anonymous online survey with 95 questions was distributed among patients. Responses were collected from 11 May 2020 to 20 July 2020. RESULTS: Of a total of 570 questionnaires received, 568 (99.6%) were considered valid for the analysis (mean age, 63.5 ± 12.5 years; 53% females). A total of 553 patients (97.4%) were aware of the COVID-19 pandemic and 68.8% were concerned about it; 95.6% took preventive measures. A total of 484 patients (85.2%) had no contact with cases of COVID-19, and only 15 (2.6%) had confirmed COVID-19. Although up to 72.7% remained active during confinement, 65.7% perceived a worsening of their symptoms. CONCLUSIONS: Spanish patients with PD perceived the COVID-19 pandemic with concern and responsibility. More than half experienced worsening of their symptoms during confinement. © 2020 International Parkinson and Movement Disorder Society.
Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections , Disease Progression , Pandemics , Parkinson Disease/drug therapy , Pneumonia, Viral , Aged , COVID-19 , Coronavirus Infections/complications , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Pneumonia, Viral/complications , SARS-CoV-2 , Spain , Surveys and QuestionnairesABSTRACT
Tras una breve introducción sobre qué es una Unidad de Ictus, se describe el proyecto de la Unidad de Ictus del Hospital Universitario Dr. Josep Trueta de Gerona. Posteriormente se analizan su desarrollo y los resultados obtenidos en el tiempo. Se concluye un considerable aumento de beneficios para los pacientes, al tratarlos con nuevas pautas terapéuticas en una unidad especializada y la posibilidad de desarrollar nuevas líneas de investigación, tanto para los médicos como para enfermería (AU)
Subject(s)
Aged , Female , Male , Humans , Stroke/nursing , Intensive Care Units/organization & administration , Skilled Nursing Facilities/organization & administration , Nursing Care/methodsABSTRACT
After a brief introduction about what an lctus Word is, the authors describe the project for an lctus Ward at the Dr. Josep Trueta University Hospital in Girona. Afterwards, the authors analyze its development and its results during its existence. The authors conclude that there has been a significant increase in benefits for patients since they have received new therapeutic treatments in a specialized ward, furthermore, both doctors and nurses have had the opportunity to develop new research projects.
