Evidence map›Paper›PMID 25370587›Full record

Trial reportStroke2014

Effect of alteplase within 6 hours of acute ischemic stroke on all-cause mortality (third International Stroke Trial).

William N Whiteley, Douglas Thompson, Gordon Murray, Geoff Cohen, Richard I Lindley, Joanna Wardlaw, Peter Sandercock, IST-3 Collaborative Group

Open access · bronzeAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Stroke, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed, 1 pooled it
1.9field-weighted citation impact, top 15% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed, 1 synthesis or guideline pooled it, 18 citations in OpenAlex.

  1. Pooled it
  2. Trial
  3. Article
  4. Article
  5. Stroke-induced blood-brain barrier breakdown along the vascular tree - No preferential affection of arteries in different animal models and in humans.Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism · 2017
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 2 institutions in 1 country.

William N WhiteleyFrom the Centre for Clinical Brain Sciences (W.N.W., G.C., J.W., P.S.) and Centre for Population Health Sciences (D.T., G.M.), University of Edinburgh, United Kingdom; Neurological & Mental Health Division, George Institute for Global Health, University of Sydney, Australia (R.I.L.); and Neuroimaging Sciences, Edinburgh, United Kingdom (J.W.). william.whiteley@ed.ac.uk.
Douglas ThompsonFrom the Centre for Clinical Brain Sciences (W.N.W., G.C., J.W., P.S.) and Centre for Population Health Sciences (D.T., G.M.), University of Edinburgh, United Kingdom; Neurological & Mental Health Division, George Institute for Global Health, University of Sydney, Australia (R.I.L.); and Neuroimaging Sciences, Edinburgh, United Kingdom (J.W.).
Gordon MurrayFrom the Centre for Clinical Brain Sciences (W.N.W., G.C., J.W., P.S.) and Centre for Population Health Sciences (D.T., G.M.), University of Edinburgh, United Kingdom; Neurological & Mental Health Division, George Institute for Global Health, University of Sydney, Australia (R.I.L.); and Neuroimaging Sciences, Edinburgh, United Kingdom (J.W.).
Geoff CohenFrom the Centre for Clinical Brain Sciences (W.N.W., G.C., J.W., P.S.) and Centre for Population Health Sciences (D.T., G.M.), University of Edinburgh, United Kingdom; Neurological & Mental Health Division, George Institute for Global Health, University of Sydney, Australia (R.I.L.); and Neuroimaging Sciences, Edinburgh, United Kingdom (J.W.).
Richard I LindleyFrom the Centre for Clinical Brain Sciences (W.N.W., G.C., J.W., P.S.) and Centre for Population Health Sciences (D.T., G.M.), University of Edinburgh, United Kingdom; Neurological & Mental Health Division, George Institute for Global Health, University of Sydney, Australia (R.I.L.); and Neuroimaging Sciences, Edinburgh, United Kingdom (J.W.).
Joanna WardlawFrom the Centre for Clinical Brain Sciences (W.N.W., G.C., J.W., P.S.) and Centre for Population Health Sciences (D.T., G.M.), University of Edinburgh, United Kingdom; Neurological & Mental Health Division, George Institute for Global Health, University of Sydney, Australia (R.I.L.); and Neuroimaging Sciences, Edinburgh, United Kingdom (J.W.).
Peter SandercockFrom the Centre for Clinical Brain Sciences (W.N.W., G.C., J.W., P.S.) and Centre for Population Health Sciences (D.T., G.M.), University of Edinburgh, United Kingdom; Neurological & Mental Health Division, George Institute for Global Health, University of Sydney, Australia (R.I.L.); and Neuroimaging Sciences, Edinburgh, United Kingdom (J.W.).
IST-3 Collaborative Group
The George Institute for Global Health · AUUniversity of Sydney · AU

Funding

Medical Research Council G0400069Medical Research Council G0800803Medical Research Council G0902303
6 · The paper itself

Abstract

background and purposePrompt thrombolytic therapy with intravenous alteplase reduces disability after acute ischemic stroke. In an exploratory analysis, we examined whether long-term survival varied by baseline characteristics after alteplase.

methodsIn this open-treatment, international, randomized, controlled trial, ischemic stroke patients were randomly allocated <6 hours of onset to intravenous alteplase (0.9 mg/kg) plus standard care (n=1515) or standard care alone (n=1520). We followed patients to death, censoring when last known to be alive. We grouped patients by delay to randomization, and good or poor predicted prognosis (calculated from baseline National Institutes of Health Stroke Scale [NIHSS] score and age). We present absolute mortality differences between treated and control groups at 7 days, 6 months, and 18 months poststroke.

resultsAlteplase was not associated with a significant increase in mortality within 18 months (0.6% [95% confidence interval (CI), -2.9% to +4.2] P=0.72] in all patients with complete vital status (99.9%, 3034/3035). In patients randomized <3 hours of stroke, 18-month mortality was lower in the alteplase-treated group than the control group (40.6% [95% CI, 42.6-52.7] versus 47.8% [95% CI, 35.5-45.3]; P=0.0434]. The difference in 18-month mortality between alteplase-treated and control patients was greater in patients who were randomized early (<3 hours) compared with late (3-6 hours; +9% [95% CI, 1-17]; P=0.0317). Alteplase led to a greater improvement in 18-month survival in patients with a poor prognosis than in patients with a good prognosis (+8% [95% CI, 2-14]; P=0.0091).

conclusionsThese exploratory analyses of the third International Stroke Trial (IST-3) trial support improving acute stroke patients' access to earlier alteplase treatment, treatment of patients with poor prognosis, and further randomized controlled trials in minor stroke to replicate these findings. CLINICAL TRIAL REGISTRATION URL: http://www.controlled-trials.com. Unique identifier: ISRCTN25765518.

Indexed as

AdultAgedFemaleFibrinolytic AgentsHumansKaplan-Meier EstimateMaleMiddle AgedStrokeTime FactorsTissue Plasminogen ActivatorTreatment OutcomeFibrinolytic AgentsTissue Plasminogen Activatormortalityrandomized controlled trialthrombolytic therapy

Identifiers

PMID25370587
PMCPMC4282176
OpenAlexW2004526572

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.