ISC 2014

SAN DIEGO – Dr. Aneesh B. Singhal, Director of Neurology Quality and Safety at Massachusetts General Hospital Institute for Heart, Vascular and Stroke Care, discusses highlights of this year’s Annual Stroke Conference in this video interview. For more coverage, please check out our Stroke Conference page.

Watch more here:

SAN DIEGO – Dr. Aneesh B. Singhal, Director of Neurology Quality and Safety at Massachusetts General Hospital Institute for Heart, Vascular and Stroke Care, discusses highlights of this year’s Annual Stroke Conference in this video interview. For more coverage, please check out our Stroke Conference page.

Watch more here:

SAN DIEGO – Dr. Aneesh B. Singhal, Director of Neurology Quality and Safety at Massachusetts General Hospital Institute for Heart, Vascular and Stroke Care, discusses highlights of this year’s Annual Stroke Conference in this video interview. For more coverage, please check out our Stroke Conference page.

Watch more here:

SAN DIEGO – Moderate exercise reduced the risk of stroke by 12%-22% and appeared to offset some of the increased stroke risk from postmenopausal hormone therapy. We spoke to Sophia S. Wang, Ph.D., about her study and to Dr. Bruce Ovbiagele for his perspective on the findings.

SAN DIEGO – Moderate exercise reduced the risk of stroke by 12%-22% and appeared to offset some of the increased stroke risk from postmenopausal hormone therapy. We spoke to Sophia S. Wang, Ph.D., about her study and to Dr. Bruce Ovbiagele for his perspective on the findings.

SAN DIEGO – Moderate exercise reduced the risk of stroke by 12%-22% and appeared to offset some of the increased stroke risk from postmenopausal hormone therapy. We spoke to Sophia S. Wang, Ph.D., about her study and to Dr. Bruce Ovbiagele for his perspective on the findings.

SAN DIEGO – Moderate exercise significantly reduced the risk of stroke in women and seemed to offset much but not all of the increased stroke risk in postmenopausal women on hormone therapy, a large retrospective study found.

A self-reported history of moderate-to-strenuous physical activity in the prior 3 years was associated with a roughly 20%-30% lower risk for stroke in an analysis of data on 133,479 women in the California Teachers Study who had been followed every 4-5 years since 1995 by questionnaire, Sophia S. Wang, Ph.D., and her associates reported.

They linked the data set with hospitalization data during 1996-2010 to identify 2,416 ischemic strokes and 710 hemorrhagic strokes in the cohort that were validated by a review of medical records.

The strongest reduction in stroke risk was seen in women who reported moderate physical activity such as brisk walking, recreational tennis, golf, volleyball, or cycling on level streets. Women who reported in 1995-1996 questionnaires that they had engaged in moderate activity in the prior 3 years were 12%-22% less likely to develop a stroke, depending on the amount of activity each week, compared with inactive women who reported less than a half-hour per week of moderate activity.

"You don’t have to climb a mountain" to gain the stroke-reducing benefits of exercise, Dr. Wang said in an interview at the International Stroke Conference. And the fact that people tend to overreport how much they exercise when surveyed makes the findings "particularly robust," she said.

Indeed, reports of strenuous activity were not significantly associated with lower stroke risk. Strenuous activity included swimming laps, aerobics, running, calisthenics, jogging, basketball, racquetball, or cycling on hills. Risk levels ranged from an increase of 3% to a reduction of 18% with strenuous activity, compared with inactive women.

Because most women who exercised strenuously also reported moderate activity, the investigators combined those two activity categories and again found approximately a 20% reduction in stroke risk that clearly was being driven by the benefits of moderate activity, said Dr. Wang of Beckman Research Institute at the City of Hope, Duarte, Calif. Stroke risk reductions ranged from 15%-23% in the combined activity analysis for the 1995-1996 surveys.

Surveyed again in 2005-2006, women who reported moderate or strenuous activity in the prior 3 years were 12%-20% less likely to develop a stroke, compared with inactive women, she said at the meeting, sponsored by the American Heart Association.

More than 5 hours of activity wasn’t more beneficial than fewer hours, she added. Stroke reduction benefits seemed greatest with 3.5-5 hours of activity per week, which was associated with a 23% risk reduction in the earlier survey and a 29% reduction in the later survey. With more than 5 hours, the risk reduction was 17% and 27%, respectively.

In inactive postmenopausal women, current hormone use was associated with a 59% higher risk for stroke and former hormone use was associated with a 16% increased risk, compared with postmenopausal women who didn’t use hormones, Dr. Wang said. However, the elevated stroke risk with hormone use fell in women who exercised, compared with those who didn’t.

In current hormone users, stroke risk was 37% higher in women who reported 0.51-3.5 hours of moderate or strenuous activity per week and 29% higher in women who reported more than 3.5 hours of activity per week, compared with non-hormone users. In former hormone users, stroke risk was 15% higher in those who reported 0.51-3.5 hours of activity per week and 5% higher in those who exercised more than 3.5 hours per week, compared with non-hormone users.

Because of smaller numbers of women in the subset analyses of postmenopausal hormone use, these differences between groups did not reach statistical significance, Dr. Wang said.

She and her associates plan further studies related to these findings, including whether or not activity levels may help prevent stroke in women who’ve already had a stroke, she said.

Dr. Wang and her colleagues reported having no financial disclosures. The National Institute of Neurological Disorders and Stroke funded the study.

sboschert@frontlinemedcom.com

On Twitter @sherryboschert

SAN DIEGO – Moderate exercise significantly reduced the risk of stroke in women and seemed to offset much but not all of the increased stroke risk in postmenopausal women on hormone therapy, a large retrospective study found.

A self-reported history of moderate-to-strenuous physical activity in the prior 3 years was associated with a roughly 20%-30% lower risk for stroke in an analysis of data on 133,479 women in the California Teachers Study who had been followed every 4-5 years since 1995 by questionnaire, Sophia S. Wang, Ph.D., and her associates reported.

They linked the data set with hospitalization data during 1996-2010 to identify 2,416 ischemic strokes and 710 hemorrhagic strokes in the cohort that were validated by a review of medical records.

The strongest reduction in stroke risk was seen in women who reported moderate physical activity such as brisk walking, recreational tennis, golf, volleyball, or cycling on level streets. Women who reported in 1995-1996 questionnaires that they had engaged in moderate activity in the prior 3 years were 12%-22% less likely to develop a stroke, depending on the amount of activity each week, compared with inactive women who reported less than a half-hour per week of moderate activity.

"You don’t have to climb a mountain" to gain the stroke-reducing benefits of exercise, Dr. Wang said in an interview at the International Stroke Conference. And the fact that people tend to overreport how much they exercise when surveyed makes the findings "particularly robust," she said.

Indeed, reports of strenuous activity were not significantly associated with lower stroke risk. Strenuous activity included swimming laps, aerobics, running, calisthenics, jogging, basketball, racquetball, or cycling on hills. Risk levels ranged from an increase of 3% to a reduction of 18% with strenuous activity, compared with inactive women.

Because most women who exercised strenuously also reported moderate activity, the investigators combined those two activity categories and again found approximately a 20% reduction in stroke risk that clearly was being driven by the benefits of moderate activity, said Dr. Wang of Beckman Research Institute at the City of Hope, Duarte, Calif. Stroke risk reductions ranged from 15%-23% in the combined activity analysis for the 1995-1996 surveys.

Surveyed again in 2005-2006, women who reported moderate or strenuous activity in the prior 3 years were 12%-20% less likely to develop a stroke, compared with inactive women, she said at the meeting, sponsored by the American Heart Association.

More than 5 hours of activity wasn’t more beneficial than fewer hours, she added. Stroke reduction benefits seemed greatest with 3.5-5 hours of activity per week, which was associated with a 23% risk reduction in the earlier survey and a 29% reduction in the later survey. With more than 5 hours, the risk reduction was 17% and 27%, respectively.

In inactive postmenopausal women, current hormone use was associated with a 59% higher risk for stroke and former hormone use was associated with a 16% increased risk, compared with postmenopausal women who didn’t use hormones, Dr. Wang said. However, the elevated stroke risk with hormone use fell in women who exercised, compared with those who didn’t.

In current hormone users, stroke risk was 37% higher in women who reported 0.51-3.5 hours of moderate or strenuous activity per week and 29% higher in women who reported more than 3.5 hours of activity per week, compared with non-hormone users. In former hormone users, stroke risk was 15% higher in those who reported 0.51-3.5 hours of activity per week and 5% higher in those who exercised more than 3.5 hours per week, compared with non-hormone users.

Because of smaller numbers of women in the subset analyses of postmenopausal hormone use, these differences between groups did not reach statistical significance, Dr. Wang said.

She and her associates plan further studies related to these findings, including whether or not activity levels may help prevent stroke in women who’ve already had a stroke, she said.

Dr. Wang and her colleagues reported having no financial disclosures. The National Institute of Neurological Disorders and Stroke funded the study.

sboschert@frontlinemedcom.com

On Twitter @sherryboschert

SAN DIEGO – Moderate exercise significantly reduced the risk of stroke in women and seemed to offset much but not all of the increased stroke risk in postmenopausal women on hormone therapy, a large retrospective study found.

A self-reported history of moderate-to-strenuous physical activity in the prior 3 years was associated with a roughly 20%-30% lower risk for stroke in an analysis of data on 133,479 women in the California Teachers Study who had been followed every 4-5 years since 1995 by questionnaire, Sophia S. Wang, Ph.D., and her associates reported.

They linked the data set with hospitalization data during 1996-2010 to identify 2,416 ischemic strokes and 710 hemorrhagic strokes in the cohort that were validated by a review of medical records.

The strongest reduction in stroke risk was seen in women who reported moderate physical activity such as brisk walking, recreational tennis, golf, volleyball, or cycling on level streets. Women who reported in 1995-1996 questionnaires that they had engaged in moderate activity in the prior 3 years were 12%-22% less likely to develop a stroke, depending on the amount of activity each week, compared with inactive women who reported less than a half-hour per week of moderate activity.

"You don’t have to climb a mountain" to gain the stroke-reducing benefits of exercise, Dr. Wang said in an interview at the International Stroke Conference. And the fact that people tend to overreport how much they exercise when surveyed makes the findings "particularly robust," she said.

Indeed, reports of strenuous activity were not significantly associated with lower stroke risk. Strenuous activity included swimming laps, aerobics, running, calisthenics, jogging, basketball, racquetball, or cycling on hills. Risk levels ranged from an increase of 3% to a reduction of 18% with strenuous activity, compared with inactive women.

Because most women who exercised strenuously also reported moderate activity, the investigators combined those two activity categories and again found approximately a 20% reduction in stroke risk that clearly was being driven by the benefits of moderate activity, said Dr. Wang of Beckman Research Institute at the City of Hope, Duarte, Calif. Stroke risk reductions ranged from 15%-23% in the combined activity analysis for the 1995-1996 surveys.

Surveyed again in 2005-2006, women who reported moderate or strenuous activity in the prior 3 years were 12%-20% less likely to develop a stroke, compared with inactive women, she said at the meeting, sponsored by the American Heart Association.

More than 5 hours of activity wasn’t more beneficial than fewer hours, she added. Stroke reduction benefits seemed greatest with 3.5-5 hours of activity per week, which was associated with a 23% risk reduction in the earlier survey and a 29% reduction in the later survey. With more than 5 hours, the risk reduction was 17% and 27%, respectively.

In inactive postmenopausal women, current hormone use was associated with a 59% higher risk for stroke and former hormone use was associated with a 16% increased risk, compared with postmenopausal women who didn’t use hormones, Dr. Wang said. However, the elevated stroke risk with hormone use fell in women who exercised, compared with those who didn’t.

In current hormone users, stroke risk was 37% higher in women who reported 0.51-3.5 hours of moderate or strenuous activity per week and 29% higher in women who reported more than 3.5 hours of activity per week, compared with non-hormone users. In former hormone users, stroke risk was 15% higher in those who reported 0.51-3.5 hours of activity per week and 5% higher in those who exercised more than 3.5 hours per week, compared with non-hormone users.

Because of smaller numbers of women in the subset analyses of postmenopausal hormone use, these differences between groups did not reach statistical significance, Dr. Wang said.

She and her associates plan further studies related to these findings, including whether or not activity levels may help prevent stroke in women who’ve already had a stroke, she said.

Dr. Wang and her colleagues reported having no financial disclosures. The National Institute of Neurological Disorders and Stroke funded the study.

sboschert@frontlinemedcom.com

On Twitter @sherryboschert

Findings from a large study of women following their first pregnancy extend the postpartum period of heightened risk for thromboembolic events from the previously known 6 weeks to 12 weeks, leaving physicians with new questions that need to be answered in further studies about the need for longer periods of anticoagulation therapy in some women. In a video interview, Dr. Bruce Ovbiagele of the Medical University of South Carolina, Charleston, comments on the findings at the International Stroke Conference. The study also was published Feb. 13 in the New England Journal of Medicine in conjunction with the report at the conference (2014 Feb. 13 [doi:10.1056/NEJMoa1311485).

Findings from a large study of women following their first pregnancy extend the postpartum period of heightened risk for thromboembolic events from the previously known 6 weeks to 12 weeks, leaving physicians with new questions that need to be answered in further studies about the need for longer periods of anticoagulation therapy in some women. In a video interview, Dr. Bruce Ovbiagele of the Medical University of South Carolina, Charleston, comments on the findings at the International Stroke Conference. The study also was published Feb. 13 in the New England Journal of Medicine in conjunction with the report at the conference (2014 Feb. 13 [doi:10.1056/NEJMoa1311485).

Findings from a large study of women following their first pregnancy extend the postpartum period of heightened risk for thromboembolic events from the previously known 6 weeks to 12 weeks, leaving physicians with new questions that need to be answered in further studies about the need for longer periods of anticoagulation therapy in some women. In a video interview, Dr. Bruce Ovbiagele of the Medical University of South Carolina, Charleston, comments on the findings at the International Stroke Conference. The study also was published Feb. 13 in the New England Journal of Medicine in conjunction with the report at the conference (2014 Feb. 13 [doi:10.1056/NEJMoa1311485).

SAN DIEGO – The risk of thrombosis after giving birth remains significantly elevated for 12 weeks after delivery, twice as long as previously thought, an analysis of data on 1.7 million women found.

Dr. Hooman Kamel and his associates analyzed data on 1,687,930 million women admitted to nonfederal acute-care hospitals or emergency departments in California for first-time labor and delivery during 2005-2010, 1,015 of whom had a thrombotic event within 24 weeks after delivery (0.06%). These included strokes (248), MIs (47), and venous thromboemboli (720 cases).

The chance of a clotting event was 11-fold higher than normal in the first 6 weeks after delivery and was doubled when compared with normal in postpartum weeks 7-12, he reported in a press briefing at the International Stroke Conference.

An extra 22 cases/100,000 deliveries occurred in the first 6 weeks postpartum and an extra 3 cases per 100,000 deliveries occurred in weeks 7-12 postpartum.

By 13-18 weeks after delivery, a 40% higher odds of blood clot was not significantly different than with a year later, said Dr. Kamel, a neurologist at Cornell University, N.Y.

The blood clot risk returned to normal levels seen in women who’ve never delivered a baby by 19-24 weeks after delivery.

The New England Journal of Medicine published the findings online (2014 Feb. 13 [doi: 10.1056/NEJMoa1311485]).

The study confirms that thrombosis after delivery is rare and suggests that clinicians may want to take seriously any possible symptoms of stroke beyond the period that’s generally thought of as postpartum: 6 weeks after delivery. Especially in women who have other risk factors for thrombosis, awareness of continued elevated risk in weeks 7-12 could lead to quicker treatment if a blood clot forms, he said in an interview at the meeting, sponsored by the American Heart Association.

Current guidelines call for postpartum blood-thinning therapy in high-risk women who had an elevated stroke risk prior to pregnancy or other risk factors, and it’s unclear whether this should be extended beyond 6 weeks postpartum, Dr. Kamel said. The new findings may prompt research in this direction.

Meanwhile, physicians and women should take seriously any symptoms of possible thrombosis out to 12 weeks after delivery, such as chest pain or pressure, he said.

The study was supported by a grant from the National Institute of Neurological Disorders and Stroke. Dr. Kamel and his colleagues reported having no financial disclosures.

sboschert@frontlinemedcom.com

On Twitter @sherryboschert

Correction, 3/4/2014: An earlier version of this article misstated the amount of time passed between delivery and blood clot formation.

SAN DIEGO – The risk of thrombosis after giving birth remains significantly elevated for 12 weeks after delivery, twice as long as previously thought, an analysis of data on 1.7 million women found.

Dr. Hooman Kamel and his associates analyzed data on 1,687,930 million women admitted to nonfederal acute-care hospitals or emergency departments in California for first-time labor and delivery during 2005-2010, 1,015 of whom had a thrombotic event within 24 weeks after delivery (0.06%). These included strokes (248), MIs (47), and venous thromboemboli (720 cases).

The chance of a clotting event was 11-fold higher than normal in the first 6 weeks after delivery and was doubled when compared with normal in postpartum weeks 7-12, he reported in a press briefing at the International Stroke Conference.

An extra 22 cases/100,000 deliveries occurred in the first 6 weeks postpartum and an extra 3 cases per 100,000 deliveries occurred in weeks 7-12 postpartum.

By 13-18 weeks after delivery, a 40% higher odds of blood clot was not significantly different than with a year later, said Dr. Kamel, a neurologist at Cornell University, N.Y.

The blood clot risk returned to normal levels seen in women who’ve never delivered a baby by 19-24 weeks after delivery.

The New England Journal of Medicine published the findings online (2014 Feb. 13 [doi: 10.1056/NEJMoa1311485]).

The study confirms that thrombosis after delivery is rare and suggests that clinicians may want to take seriously any possible symptoms of stroke beyond the period that’s generally thought of as postpartum: 6 weeks after delivery. Especially in women who have other risk factors for thrombosis, awareness of continued elevated risk in weeks 7-12 could lead to quicker treatment if a blood clot forms, he said in an interview at the meeting, sponsored by the American Heart Association.

Current guidelines call for postpartum blood-thinning therapy in high-risk women who had an elevated stroke risk prior to pregnancy or other risk factors, and it’s unclear whether this should be extended beyond 6 weeks postpartum, Dr. Kamel said. The new findings may prompt research in this direction.

Meanwhile, physicians and women should take seriously any symptoms of possible thrombosis out to 12 weeks after delivery, such as chest pain or pressure, he said.

The study was supported by a grant from the National Institute of Neurological Disorders and Stroke. Dr. Kamel and his colleagues reported having no financial disclosures.

sboschert@frontlinemedcom.com

On Twitter @sherryboschert

Correction, 3/4/2014: An earlier version of this article misstated the amount of time passed between delivery and blood clot formation.

SAN DIEGO – The risk of thrombosis after giving birth remains significantly elevated for 12 weeks after delivery, twice as long as previously thought, an analysis of data on 1.7 million women found.

Dr. Hooman Kamel and his associates analyzed data on 1,687,930 million women admitted to nonfederal acute-care hospitals or emergency departments in California for first-time labor and delivery during 2005-2010, 1,015 of whom had a thrombotic event within 24 weeks after delivery (0.06%). These included strokes (248), MIs (47), and venous thromboemboli (720 cases).

The chance of a clotting event was 11-fold higher than normal in the first 6 weeks after delivery and was doubled when compared with normal in postpartum weeks 7-12, he reported in a press briefing at the International Stroke Conference.

An extra 22 cases/100,000 deliveries occurred in the first 6 weeks postpartum and an extra 3 cases per 100,000 deliveries occurred in weeks 7-12 postpartum.

By 13-18 weeks after delivery, a 40% higher odds of blood clot was not significantly different than with a year later, said Dr. Kamel, a neurologist at Cornell University, N.Y.

The blood clot risk returned to normal levels seen in women who’ve never delivered a baby by 19-24 weeks after delivery.

The New England Journal of Medicine published the findings online (2014 Feb. 13 [doi: 10.1056/NEJMoa1311485]).

The study confirms that thrombosis after delivery is rare and suggests that clinicians may want to take seriously any possible symptoms of stroke beyond the period that’s generally thought of as postpartum: 6 weeks after delivery. Especially in women who have other risk factors for thrombosis, awareness of continued elevated risk in weeks 7-12 could lead to quicker treatment if a blood clot forms, he said in an interview at the meeting, sponsored by the American Heart Association.

Current guidelines call for postpartum blood-thinning therapy in high-risk women who had an elevated stroke risk prior to pregnancy or other risk factors, and it’s unclear whether this should be extended beyond 6 weeks postpartum, Dr. Kamel said. The new findings may prompt research in this direction.

Meanwhile, physicians and women should take seriously any symptoms of possible thrombosis out to 12 weeks after delivery, such as chest pain or pressure, he said.

The study was supported by a grant from the National Institute of Neurological Disorders and Stroke. Dr. Kamel and his colleagues reported having no financial disclosures.

sboschert@frontlinemedcom.com

On Twitter @sherryboschert

Correction, 3/4/2014: An earlier version of this article misstated the amount of time passed between delivery and blood clot formation.

The risk of thrombosis in women giving birth for the first time was 10- to 11-fold higher in the first 6 weeks postpartum, but in a report presented at the International Stroke Conference, Dr. Hooman Kamel of Cornell University, N.Y., and his colleagues found that the risk of thrombosis (stroke, MI, and venous thromboembolism) is still doubled during 7-12 weeks postpartum. The study was published Feb. 13 in the New England Journal of Medicine in conjunction with the report at the conference (2014 Feb. 13 [doi:10.1056/NEJMoa1311485]).

The risk of thrombosis in women giving birth for the first time was 10- to 11-fold higher in the first 6 weeks postpartum, but in a report presented at the International Stroke Conference, Dr. Hooman Kamel of Cornell University, N.Y., and his colleagues found that the risk of thrombosis (stroke, MI, and venous thromboembolism) is still doubled during 7-12 weeks postpartum. The study was published Feb. 13 in the New England Journal of Medicine in conjunction with the report at the conference (2014 Feb. 13 [doi:10.1056/NEJMoa1311485]).

The risk of thrombosis in women giving birth for the first time was 10- to 11-fold higher in the first 6 weeks postpartum, but in a report presented at the International Stroke Conference, Dr. Hooman Kamel of Cornell University, N.Y., and his colleagues found that the risk of thrombosis (stroke, MI, and venous thromboembolism) is still doubled during 7-12 weeks postpartum. The study was published Feb. 13 in the New England Journal of Medicine in conjunction with the report at the conference (2014 Feb. 13 [doi:10.1056/NEJMoa1311485]).

The outcomes in a double-blind, randomized, placebo-controlled trial in which uric acid was added to thrombolytic therapy for acute ischemic stroke were not statistically significant, but the positive trend seen in the outcomes indicates that a larger trial may show significant benefits, Dr. Angel Chamorro of the Hospital Clinic of the University of Barcelona (Spain) said at the International Stroke Conference.

The outcomes in a double-blind, randomized, placebo-controlled trial in which uric acid was added to thrombolytic therapy for acute ischemic stroke were not statistically significant, but the positive trend seen in the outcomes indicates that a larger trial may show significant benefits, Dr. Angel Chamorro of the Hospital Clinic of the University of Barcelona (Spain) said at the International Stroke Conference.

The outcomes in a double-blind, randomized, placebo-controlled trial in which uric acid was added to thrombolytic therapy for acute ischemic stroke were not statistically significant, but the positive trend seen in the outcomes indicates that a larger trial may show significant benefits, Dr. Angel Chamorro of the Hospital Clinic of the University of Barcelona (Spain) said at the International Stroke Conference.

Although the results of a double-blind, randomized, placebo-controlled clinical trial of adding uric acid to thrombolytic therapy hinted at potentially beneficial effects on acute ischemic stroke outcomes, Dr. Steven M. Greenberg of Harvard Medical School, Boston, advised waiting for the results of larger trials that confirm the potential benefits given the poor history behind seemingly promising preclinical therapies for acute stroke.

Although the results of a double-blind, randomized, placebo-controlled clinical trial of adding uric acid to thrombolytic therapy hinted at potentially beneficial effects on acute ischemic stroke outcomes, Dr. Steven M. Greenberg of Harvard Medical School, Boston, advised waiting for the results of larger trials that confirm the potential benefits given the poor history behind seemingly promising preclinical therapies for acute stroke.

Although the results of a double-blind, randomized, placebo-controlled clinical trial of adding uric acid to thrombolytic therapy hinted at potentially beneficial effects on acute ischemic stroke outcomes, Dr. Steven M. Greenberg of Harvard Medical School, Boston, advised waiting for the results of larger trials that confirm the potential benefits given the poor history behind seemingly promising preclinical therapies for acute stroke.

SAN DIEGO – Adding uric acid to thrombolytic therapy for acute stroke looked promising enough in a double-blind placebo-controlled trial of 420 adult patients that investigators will seek funding for a larger trial.

Thirty-nine percent of 211 patients randomized to the uric acid group achieved an "excellent" outcome on measures of symptoms and function 90 days later, but the 200 patients in the placebo group also had a robust response with 33% achieving excellent outcomes, Dr. Angel Chamorro reported at the International Stroke Conference. Nine patients were excluded from the analysis because they didn’t take the medication or were determined not to have a stroke.

The difference between groups did not reach statistical significance, and the study was not powered to assess less than a 14% difference between groups. Safety outcomes were similar between groups, however, and statistical trends toward better outcomes with uric acid in this proof-of-concept trial are enough to justify a study of 1,500 patients to determine whether this is a useful treatment, said Dr. Chamorro, director of the comprehensive stroke center at Hospital Clinic of the University of Barcelona (Spain).

If the results are validated in subsequent trials, it could mean that for every 14 patients given uric acid for acute stroke, 1 patient would become completely free of stroke symptoms, he said in an interview. Uric acid, a potent antioxidant, is thought to help in stroke by inhibiting free radicals that are created during loss of blood flow and that damage brain cells. Uric acid is being explored by other investigators as a treatment for Parkinson’s disease, he added.

All patients in the Urico-ictus Study were treated with recombinant tissue plasminogen activator (rtPA) within 4.5 hours of acute ischemic stroke symptom onset and randomized to receive a single IV infusion of 1 g uric acid dissolved in vehicle or to a control group whose IV infusion contained the vehicle alone (500 mL containing 0.1% lithium carbonate and 5% mannitol). All patients had a baseline National Institutes of Health Stroke Scale (NIHSS) score greater than 6 but less than 25, a modified Rankin Scale (mRS) score no greater than 2 prior to the stroke, and a cranial CT showing the absence of blood in the CNS.

The primary results showed modified Rankin Scale scores of 0-1 (or 2 if premorbid was 2) at 90 days in 39% on uric acid and 33% on placebo (P = .099).

Among secondary outcomes, the median mRS was 2 in the uric acid group and 3 on placebo (P = .045), suggesting a trend toward greater effectiveness with uric acid. A 1-point absolute reduction in median mRS is similar to the effects seen in the first trials of thrombolytic therapy, Dr. Chamorro pointed out.

Patients on uric acid were significantly less likely to show worsening at day 3 compared with the placebo group (3% vs. 9%). The uric acid group showed a "high statistical trend" toward having fully independent functioning at 90 days as assessed by a score greater than 94 on the Barthel Index of Activities of Daily Living, with 48% on uric acid and 41% on placebo reaching this mark, Dr. Chamorro reported at the meeting, sponsored by the American Heart Association.

Thirteen percent on uric acid and 16% on placebo died within 90 days. Gout occurred within 90 days in 0.5% on uric acid and 2% on placebo. The proportions of patients with an intracranial hemorrhage whose NIHSS score worsened by 4 points within the first 36 hours of treatment were 4% in the uric acid group and 3% in the placebo groups. These safety outcomes did not differ significantly between groups.

Preplanned subgroup analyses showed trends toward greater effectiveness of uric acid in women, patients with high blood glucose levels, or those with moderate strokes, compared with placebo.

Oxidative stress in patients with ischemic stroke contributes to brain damage. The antioxidant properties of uric acid proved to be neuroprotective in animal studies. Dr. Chamorro and his associates reported in a previous prognostic study of 881 patients with acute ischemic stroke that each milligram per deciliter increase in serum uric acid was associated with a 12% increase in the odds of a good clinical outcome (Stroke 2002;33:1048-52). Previous animal studies suggest uric acid may help reduce stroke sequelae.

Dr. Chamorro and his coauthors reported having no relevant financial disclosures.

sboschert@frontlinemedcom.com

On Twitter @sherryboschert

SAN DIEGO – Adding uric acid to thrombolytic therapy for acute stroke looked promising enough in a double-blind placebo-controlled trial of 420 adult patients that investigators will seek funding for a larger trial.

Thirty-nine percent of 211 patients randomized to the uric acid group achieved an "excellent" outcome on measures of symptoms and function 90 days later, but the 200 patients in the placebo group also had a robust response with 33% achieving excellent outcomes, Dr. Angel Chamorro reported at the International Stroke Conference. Nine patients were excluded from the analysis because they didn’t take the medication or were determined not to have a stroke.

The difference between groups did not reach statistical significance, and the study was not powered to assess less than a 14% difference between groups. Safety outcomes were similar between groups, however, and statistical trends toward better outcomes with uric acid in this proof-of-concept trial are enough to justify a study of 1,500 patients to determine whether this is a useful treatment, said Dr. Chamorro, director of the comprehensive stroke center at Hospital Clinic of the University of Barcelona (Spain).

If the results are validated in subsequent trials, it could mean that for every 14 patients given uric acid for acute stroke, 1 patient would become completely free of stroke symptoms, he said in an interview. Uric acid, a potent antioxidant, is thought to help in stroke by inhibiting free radicals that are created during loss of blood flow and that damage brain cells. Uric acid is being explored by other investigators as a treatment for Parkinson’s disease, he added.

All patients in the Urico-ictus Study were treated with recombinant tissue plasminogen activator (rtPA) within 4.5 hours of acute ischemic stroke symptom onset and randomized to receive a single IV infusion of 1 g uric acid dissolved in vehicle or to a control group whose IV infusion contained the vehicle alone (500 mL containing 0.1% lithium carbonate and 5% mannitol). All patients had a baseline National Institutes of Health Stroke Scale (NIHSS) score greater than 6 but less than 25, a modified Rankin Scale (mRS) score no greater than 2 prior to the stroke, and a cranial CT showing the absence of blood in the CNS.

The primary results showed modified Rankin Scale scores of 0-1 (or 2 if premorbid was 2) at 90 days in 39% on uric acid and 33% on placebo (P = .099).

Among secondary outcomes, the median mRS was 2 in the uric acid group and 3 on placebo (P = .045), suggesting a trend toward greater effectiveness with uric acid. A 1-point absolute reduction in median mRS is similar to the effects seen in the first trials of thrombolytic therapy, Dr. Chamorro pointed out.

Patients on uric acid were significantly less likely to show worsening at day 3 compared with the placebo group (3% vs. 9%). The uric acid group showed a "high statistical trend" toward having fully independent functioning at 90 days as assessed by a score greater than 94 on the Barthel Index of Activities of Daily Living, with 48% on uric acid and 41% on placebo reaching this mark, Dr. Chamorro reported at the meeting, sponsored by the American Heart Association.

Thirteen percent on uric acid and 16% on placebo died within 90 days. Gout occurred within 90 days in 0.5% on uric acid and 2% on placebo. The proportions of patients with an intracranial hemorrhage whose NIHSS score worsened by 4 points within the first 36 hours of treatment were 4% in the uric acid group and 3% in the placebo groups. These safety outcomes did not differ significantly between groups.

Preplanned subgroup analyses showed trends toward greater effectiveness of uric acid in women, patients with high blood glucose levels, or those with moderate strokes, compared with placebo.

Oxidative stress in patients with ischemic stroke contributes to brain damage. The antioxidant properties of uric acid proved to be neuroprotective in animal studies. Dr. Chamorro and his associates reported in a previous prognostic study of 881 patients with acute ischemic stroke that each milligram per deciliter increase in serum uric acid was associated with a 12% increase in the odds of a good clinical outcome (Stroke 2002;33:1048-52). Previous animal studies suggest uric acid may help reduce stroke sequelae.

Dr. Chamorro and his coauthors reported having no relevant financial disclosures.

sboschert@frontlinemedcom.com

On Twitter @sherryboschert

SAN DIEGO – Adding uric acid to thrombolytic therapy for acute stroke looked promising enough in a double-blind placebo-controlled trial of 420 adult patients that investigators will seek funding for a larger trial.

Thirty-nine percent of 211 patients randomized to the uric acid group achieved an "excellent" outcome on measures of symptoms and function 90 days later, but the 200 patients in the placebo group also had a robust response with 33% achieving excellent outcomes, Dr. Angel Chamorro reported at the International Stroke Conference. Nine patients were excluded from the analysis because they didn’t take the medication or were determined not to have a stroke.

The difference between groups did not reach statistical significance, and the study was not powered to assess less than a 14% difference between groups. Safety outcomes were similar between groups, however, and statistical trends toward better outcomes with uric acid in this proof-of-concept trial are enough to justify a study of 1,500 patients to determine whether this is a useful treatment, said Dr. Chamorro, director of the comprehensive stroke center at Hospital Clinic of the University of Barcelona (Spain).

If the results are validated in subsequent trials, it could mean that for every 14 patients given uric acid for acute stroke, 1 patient would become completely free of stroke symptoms, he said in an interview. Uric acid, a potent antioxidant, is thought to help in stroke by inhibiting free radicals that are created during loss of blood flow and that damage brain cells. Uric acid is being explored by other investigators as a treatment for Parkinson’s disease, he added.

All patients in the Urico-ictus Study were treated with recombinant tissue plasminogen activator (rtPA) within 4.5 hours of acute ischemic stroke symptom onset and randomized to receive a single IV infusion of 1 g uric acid dissolved in vehicle or to a control group whose IV infusion contained the vehicle alone (500 mL containing 0.1% lithium carbonate and 5% mannitol). All patients had a baseline National Institutes of Health Stroke Scale (NIHSS) score greater than 6 but less than 25, a modified Rankin Scale (mRS) score no greater than 2 prior to the stroke, and a cranial CT showing the absence of blood in the CNS.

The primary results showed modified Rankin Scale scores of 0-1 (or 2 if premorbid was 2) at 90 days in 39% on uric acid and 33% on placebo (P = .099).

Among secondary outcomes, the median mRS was 2 in the uric acid group and 3 on placebo (P = .045), suggesting a trend toward greater effectiveness with uric acid. A 1-point absolute reduction in median mRS is similar to the effects seen in the first trials of thrombolytic therapy, Dr. Chamorro pointed out.

Patients on uric acid were significantly less likely to show worsening at day 3 compared with the placebo group (3% vs. 9%). The uric acid group showed a "high statistical trend" toward having fully independent functioning at 90 days as assessed by a score greater than 94 on the Barthel Index of Activities of Daily Living, with 48% on uric acid and 41% on placebo reaching this mark, Dr. Chamorro reported at the meeting, sponsored by the American Heart Association.

Thirteen percent on uric acid and 16% on placebo died within 90 days. Gout occurred within 90 days in 0.5% on uric acid and 2% on placebo. The proportions of patients with an intracranial hemorrhage whose NIHSS score worsened by 4 points within the first 36 hours of treatment were 4% in the uric acid group and 3% in the placebo groups. These safety outcomes did not differ significantly between groups.

Preplanned subgroup analyses showed trends toward greater effectiveness of uric acid in women, patients with high blood glucose levels, or those with moderate strokes, compared with placebo.

Oxidative stress in patients with ischemic stroke contributes to brain damage. The antioxidant properties of uric acid proved to be neuroprotective in animal studies. Dr. Chamorro and his associates reported in a previous prognostic study of 881 patients with acute ischemic stroke that each milligram per deciliter increase in serum uric acid was associated with a 12% increase in the odds of a good clinical outcome (Stroke 2002;33:1048-52). Previous animal studies suggest uric acid may help reduce stroke sequelae.

Dr. Chamorro and his coauthors reported having no relevant financial disclosures.

sboschert@frontlinemedcom.com

On Twitter @sherryboschert