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Conference/Presentation Title: | Prehospital recruitment of ultra-early ICH patients in the STOP-MSU trial: implications for patient selection in ICH trials. | Authors: | Zhao H.;Yassi N.;Wu T.;Churilov L.;Yogendrakumar V.;Ma H. ;Anderson D.;Campbell B.;Donnan G.;Davis S. | Monash Health Department(s): | Neurology | Institution: | (Zhao, Yassi, Churilov, Yogendrakumar, Campbell, Donnan, Davis) Royal Melbourne Hospital, Parkville, VIC, Australia (Zhao, Yassi, Yogendrakumar, Campbell, Donnan, Davis) Department of Medicine, University of Melbourne, Melbourne, VIC, Australia (Yassi) Walter and Elizabeth Hall Insitute of Medical Research, Melbourne, Australia (Wu) Department of Neurology, Christchurch Hospital, Christchurch, New Zealand (Churilov) Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia (Ma) Department of Neurology, Monash Medical Centre, Melbourne, VIC, Australia (Anderson) Ambulance Victoria, Manningham, VIC, Australia |
Presentation/Conference Date: | 13-Nov-2024 | Copyright year: | 2024 | Publication information: | Cerebrovascular Diseases. Conference: Asia Pacific Stroke Conference 2024 Combined Australian and New Zealand Stroke Organisation Transcending Borders. Adelaide, SA Australia. 53(Supplement 1) (pp 39), 2024. Date of Publication: 2024. | Journal: | Cerebrovascular Diseases | Abstract: | Background/Aims: The STOP-MSU RCT of tranexamic acid (TXA) in ICH <2h onset was the first haemostatic trial to include recruitment on a Mobile Stroke Unit (MSU). Although the trial did not demonstrate benefit of TXA, we investigated haematoma growth and outcomes in participants receiving prehospital treatment on the MSU compared to hospital-recruited patients. Method(s): We conducted a post-hoc analysis of the STOP-MSU trial assuming neutral treatment effect. We compared MSU-recruited to hospital-recruited patients for treatment time and haematoma growth (dichotomised 33%/6ml or absolute growth) and 90-day mRS (adjusted for age, sex, NIHSS and baseline ICH volume). Result(s): Of n=201 trial patients, 44(21.9%) were recruited on MSU. There were no significant differences in baseline demographics including age, location, baseline volume, BP or glucose. MSU-recruited patients received faster treatment from onset (76min [IQR 67.5-100] vs 107min [IQR 97-118], p<0.001) and were treated more frequently <=60min (OR 15.0[95%CI 3.0-75.1]). MSU patients had higher rates of growth on both dichotomised (52.3% vs 36.3%, aOR 2.0[95%CI 1.0-4.2], p=0.062) and absolute criteria (median 3.3ml [IQR 0.5-17.8] vs 0.8ml [IQR -0.8-6.5], mean 16.0ml [SD28.5] vs 7.0 [SD15.4]). MSU patients trended towards poorer outcomes for mRS 0-3/return-to-baseline (40.9% vs 52.2%, aOR 0.75 [95%CI 0.33-1.71]) and mortality (25.0% vs 14.7%, aOR 1.3 [95%CI 0.4-3.8] with no modification from TXA (pinteraction= 0.07). Conclusion(s): MSU-recruited patients received significantly faster treatment and showed a two-fold increased odds of haematoma growth compared to hospital-recruited patients. Growth parameters were comparable or even surpassed previous TXA trials that required CTA spot-sign for eligibility. As such MSU-facilitated ultra-early recruitment may be key for optimal patient selection in acute ICH trials. | Conference Name: | Asia Pacific Stroke Conference 2024 Combined Australian and New Zealand Stroke Organisation Transcending Borders | Conference Start Date: | 2024-09-25 | Conference End Date: | 2024-09-28 | Conference Location: | Adelaide, SA, Australia | DOI: | http://monash.idm.oclc.org/login?url=https://dx.doi.org/10.1159/000541320 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/52784 | Type: | Conference Abstract | Subjects: | cerebrovascular accident hematoma stroke unit |
Type of Clinical Study or Trial: | Clinical trial |
Appears in Collections: | Conferences |
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