-
The international stroke trial (IST): a randomized trial of aspirin, subcutaneous heparin, both, or neither among 19 435 patients with acute ischaemic strokeInternational Stroke Trial Collaborative GroupBackground. Only a few small trials have compared antithrombotic therapy (antiplatelet or anticoagulant agents) versus control in acute ischaemic stroke, and none has been large enough to provide ... reliable evidence on safety or efficacy. Methods. The International Stroke Trial (IST) was a large, randomised, open trial of up to 14 days of antithrombotic therapy started as soon as possible after stroke onset. The aim was to provide reliable evidence on the safety and efficacy of aspirin and of subcutaneous heparin. Half the patients were allocated unfractionated heparin (5000 or 12,500 IU bd [twice daily]), and half were allocated "avoid heparin"; and, in a factorial design, half were allocated aspirin 300 mg daily and half "avoid aspirin". The primary outcomes were death within 14 days and death or dependency at 6 months. 19,435 patients with suspected acute ischaemic stroke entering 467 hospitals in 36 countries were randomised within 48 hours of symptom onset. Results. Among heparin-allocated patients, there were non-significantly fewer deaths within 14 days (876 [9.0 %] heparin vs 905 [9.3 %] no heparin), corresponding to 3 (SD 4) fewer deaths per 1000 patients. At 6 months the percentage dead or dependent was identical in both groups (62.9 %). Patients allocated to heparin had significantly fewer recurrent ischaemic strokes within 14 days (2.9 % vs 3.8 %) but this was offset by a similar-sized increase in haemorrhagic strokes (1.2 % vs 0.4 %), so the difference in death or non-fatal recurrent stroke (11.7 % vs 12.0 %) was not significant. Heparin was associated with a significant excess of 9 (SD 1) transfused or fatal extracranial bleeds per 1000. Compared with 5000 IU bd heparin, 12,500 IU bd heparin was associated with significantly more transfused or fatal extracranial bleeds, more haemorrhagic strokes, and more deaths or non-fatal strokes within 14 days (12.6 % vs 10.8 %). Among aspirin-allocated patients there were non-significantly fewer deaths within 14 days (872 [9.0 %] vs 909 [9.4 %]), corresponding to 4 (SD 4) fewer deaths per 1000 patients. At 6 months there was a non-significant trend towards a smaller percentage of the aspirin group being dead or dependent (62.2 % vs 63.5 %, 2p = 0.07), a difference of 13 (SD 7) per 1000; after adjustment for baseline prognosis the benefit from aspirin was significant (14 [SD 6] per 1000, 2p = 0.03). Aspirin-allocated patients had significantly fewer recurrent ischaemic strokes within 14 days (2.8 % vs 3.9 %) with no significant excess of haemorrhagic strokes (0.9 % vs 0.8 %), so the reduction in death or non-fatal recurrent stroke with aspirin (11.3 % vs 12.4 %) was significant. Aspirin was associated with a significant excess of 5 (SD 1) transfused or fatal extracranial bleeds per 1000; in the absence of heparin the excess was 2 (SD 1) and was not significant. There was no interaction between aspirin and heparin in the main outcomes. Interpretation. Neither heparin regimen offered any clinical advantage at 6 months. The results suggest that if heparin is given in routine clinical practice, the dose should not exceed 5000 IU subcutaneously twice daily. For aspirin, the IST suggests a small but worthwhile improvement at 6 months. Taking the IST together with the comparably large Chinese Acute Stroke Trial, aspirin produces a small but real reduction of about 10 deaths or recurrent strokes per 1000 during the first few weeks. Both trials suggest that aspirin should be started as soon as possible after the onset of ischaemic stroke; previous trials have already shown that continuation of low-dose aspirin gives protection in the longer term.Vir: The Lancet. - ISSN 0140-6736 (Vol. 349, no. 9065, May 1997, str. 1569-1581)Vrsta gradiva - članek, sestavni del ; neleposlovje za odrasleLeto - 1997Jezik - angleškiCOBISS.SI-ID - 2843455
Avtor
International Stroke Trial Collaborative Group
Drugi avtorji
Grad, Anton, 1954- |
Meglič, Bernard |
Švigelj, Viktor |
Hojs-Fabjan, Tanja
Teme
Aspirin |
administration and dosage |
therapeutic use |
Aspirin |
Dajanje in doziranje |
Terapevtska raba |
Heparin |
administration and dosage |
therapeutic use |
Heparin |
Dajanje in doziranje |
Terapevtska raba |
Platelet Aggregation Inhibitors |
administration and dosage |
therapeutic use |
Trombociti, zlepljenje, inhibitorji |
Dajanje in doziranje |
Terapevtska raba |
Cerebrovascular Disorders |
drug therapy |
mortality |
Cerebrovaskularne motnje |
Zdravljenje z zdravili |
Umrljivost |
Drug Therapy, Combination |
Zdravilo, terapija sestavljena |
Treatment Outcome |
Izid zdravljenja |
Follow-Up Studies |
Sledilne študije
Vnos na polico
Trajna povezava
- URL:
Faktor vpliva
Dostop do baze podatkov JCR je dovoljen samo uporabnikom iz Slovenije. Vaš trenutni IP-naslov ni na seznamu dovoljenih za dostop, zato je potrebna avtentikacija z ustreznim računom AAI.
Leto | Faktor vpliva | Izdaja | Kategorija | Razvrstitev | ||||
---|---|---|---|---|---|---|---|---|
JCR | SNIP | JCR | SNIP | JCR | SNIP | JCR | SNIP |
Baze podatkov, v katerih je revija indeksirana
Ime baze podatkov | Področje | Leto |
---|
Povezave do osebnih bibliografij avtorjev | Povezave do podatkov o raziskovalcih v sistemu SICRIS |
---|---|
Grad, Anton, 1954- | 01974 |
Meglič, Bernard | 10679 |
Švigelj, Viktor | 10592 |
Hojs-Fabjan, Tanja | 18036 |
Izberite prevzemno mesto:
Prevzem gradiva po pošti
Obvestilo
Gesla v Splošnem geslovniku COBISS
Izbira mesta prevzema
Mesto prevzema | Status gradiva | Rezervacija |
---|
Prosimo, počakajte trenutek.