Evidence map›Paper›PMID 42497969›Full record

Trial reportJournal of stroke and cerebrovascular diseases : the official journal of National Stroke Association2026

Prehospital neuroprotectant in combination with post-arrival thrombolytic therapy for acute ischemic stroke. Secondary analysis of the FAST-MAG prehospital trial.

Kristina Shkirkova, Sokena Zaidi, May A Kim-Tenser, Manuel Morales, Kristina Van De Goor, David S Liebeskind, Scott Hamilton, Jeffrey L Saver, Nerses Sanossian

Abstract readRandomized Controlled TrialClinical Trial, Phase IIIMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Trial report in Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
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

0 citing papers in PubMed.

No citing paper in PubMed yet.

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

9 authors.

Kristina ShkirkovaKeck School of Medicine, University of Southern California, Los Angeles, CA, USA; Neurovascular Center, University of Southern California, Los Angeles, CA, USA. Electronic address: shkirkov@usc.edu.
Sokena ZaidiKeck School of Medicine, University of Southern California, Los Angeles, CA, USA.
May A Kim-TenserKeck School of Medicine, University of Southern California, Los Angeles, CA, USA; Roxanna Todd Hodges Stroke Program, University of Southern California, Los Angeles, CA, USA; Neurovascular Center, University of Southern California, Los Angeles, CA, USA.
Manuel MoralesKeck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Kristina Van De GoorKeck School of Medicine, University of Southern California, Los Angeles, CA, USA; Roxanna Todd Hodges Stroke Program, University of Southern California, Los Angeles, CA, USA.
David S LiebeskindKeck School of Medicine, University of Southern California, Los Angeles, CA, USA; Roxanna Todd Hodges Stroke Program, University of Southern California, Los Angeles, CA, USA; Neurovascular Center, University of Southern California, Los Angeles, CA, USA.
Scott HamiltonStanford University, Palo Alto, CA, USA.
Jeffrey L SaverUCLA Department of Neurology and Comprehensive Stroke Center, University of California Los Angeles, Los Angeles, CA, USA.
Nerses SanossianKeck School of Medicine, University of Southern California, Los Angeles, CA, USA; Roxanna Todd Hodges Stroke Program, University of Southern California, Los Angeles, CA, USA; Neurovascular Center, University of Southern California, Los Angeles, CA, USA.

Funding

Field Administration of Stroke Therapy-Magnesium Trial (FAST-MAG)U01NS044364 · NINDS · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI SAVER, JEFFREY L · 2003 to 2013
$46.4M
NINDS NIH HHS U01 NS044364
6 · The paper itself

Abstract

objectivePrehospital neuroprotectant therapy in combination with thrombolysis is a potential treatment strategy in acute ischemic stroke allowing for earlier therapy start and bridging period until in-hospital therapies. We describe prehospital administration of magnesium sulfate (Mg) vs. placebo for neuroprotection followed by post-arrival thrombolysis (TPA).

methodsWe analyzed subjects who received TPA in the NIH Field Administration of Stroke Therapy Magnesium (FAST-MAG) clinical trial, a phase 3 randomized clinical trial of patients presenting within 2 h of last known well time (LKWT). Primary outcome was disability measured on the modified Rankin Scale (mRS) at 90 days.

resultsAmong identified 401 cases, 214 received Mg and 187 received placebo followed by TPA. Mean (±SD) age was 70±13 years, 46% women, and median Los Angeles Motor Scale (LAMS) was 4 (IQR 3-5). Median LKWT to prehospital initiation time was 46 min (IQR 35-65), and 150 min (IQR 124-171) to thrombolysis. The median prehospital study infusion exposure prior to thrombolysis start was 93 (IQR 75-117) min. In patients with NIHSS >15, the Mg group had a higher proportion achieving favorable 90-day outcomes (mRS 0-2) and lower median LAMS scores compared with placebo, although these findings were not supported by overall 90-day outcomes mRS analysis and should be considered hypothesis-generating.

conclusionsPrehospital magnesium followed by alteplase was feasible and safe but did not demonstrate a significant overall clinical benefit. The main contribution of this analysis is to quantify the substantial pre-reperfusion exposure interval achievable with prehospital neuroprotective therapy, supporting this model for future agents requiring early biological exposure before reperfusion.

Indexed as

Emergency Medical ServicesFibrinolytic AgentsIschemic StrokeMagnesium SulfateNeuroprotective AgentsThrombolytic TherapyTissue Plasminogen ActivatorAgedAged, 80 and overDisability EvaluationFemaleFunctional StatusHumansMaleMiddle AgedRecovery of FunctionFibrinolytic AgentsMagnesium SulfateNeuroprotective AgentsTissue Plasminogen ActivatorIschemic strokeMagnesiumNeuroprotectionThrombolysis

Identifiers

PMID42497969
PMCPMC13618839

What OpenQuestion holds

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Registered trials

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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.