Publications by authors named "Atte Meretoja"
Article Synopsis
- Tranexamic acid, an antifibrinolytic agent, was tested in a study on patients with intracerebral hemorrhage who had ongoing bleeding (spot signs) to assess its effect on hematoma growth when administered within 4.5 hours of onset.
- A systematic review and meta-analysis were conducted, evaluating randomized trials comparing tranexamic acid to a placebo, specifically including 162 participants with follow-up imaging.
- Results showed that tranexamic acid treatment did not significantly reduce hematoma growth compared to placebo, with a slightly lower growth rate in the treatment group, but overall outcomes suggested continued monitoring and assessment of safety was needed.
Tenecteplase versus alteplase for thrombolysis in patients selected by use of perfusion imaging within 4·5 h of onset of ischaemic stroke (TASTE): a multicentre, randomised, controlled, phase 3 non-inferiority trial.
Lancet Neurol
August 2024
Article Synopsis
- The study compared the effectiveness of intravenous tenecteplase and alteplase in treating ischaemic stroke patients identified as having salvageable brain tissue using perfusion imaging, focusing on whether tenecteplase is at least as effective (non-inferior) to alteplase in terms of patient outcomes after 3 months.
- Conducted across 35 hospitals in eight countries, the trial enrolled 680 patients aged 18 and older, who were randomly assigned to receive either tenecteplase or alteplase, with the primary outcome being the rate of patients without disability measured through the modified Rankin Scale.
- The trial was halted early due to positive results
Article Synopsis
- The study investigated whether intravenous tranexamic acid can reduce haematoma growth in patients experiencing an acute intracerebral hemorrhage when administered within 2 hours of onset, compared to a placebo.
- Conducted as a double-blind, randomized phase 2 trial across multiple countries, the research included 201 eligible participants who were assigned to receive either tranexamic acid or saline as a placebo.
- The primary outcome measured was haematoma growth assessed through CT scans at 24 hours, alongside safety endpoints including mortality and thromboembolic events at specified intervals.
Background: The relationship between baseline perihematomal edema (PHE) and inflammation, and their impact on survival after intracerebral hemorrhage (ICH) are not well understood.
Objective: Assess the association between baseline PHE, baseline C-reactive protein (CRP), and early death after ICH.
Methods: Analysis of pooled data from multicenter ICH registries.
Article Synopsis
- Hyperglycemia in acute ischemic stroke negatively impacts treatment effectiveness and outcomes, leading researchers to explore exenatide, a GLP-1 receptor agonist, as a potential alternative.
- The TEXAIS trial involved 350 patients, comparing the effects of exenatide versus standard care on stroke recovery over a 5-day period, focusing on improvements in the National Institutes of Health Stroke Scale (NIHSS) scores.
- Results showed slightly better recovery outcomes in the exenatide group, with no instances of hypoglycemia noted, though the differences were not statistically significant, and recruitment was halted early due to COVID-19 challenges.
Objectives: Investigate temporal and age-specific trends in the incidence of ischaemic stroke and case-fatality risk in Victoria, Australia.
Materials And Methods: Patients hospitalised with first ischaemic stroke between 2012 and 2018 were included. Trends in age-standardised incidence rates of ischaemic stroke were assessed using linear regression models.
Rationale: Alteplase is the only approved thrombolytic agent for acute stroke. An alternative plasminogen activator, tenecteplase, has been previously shown to increase early biological effectiveness (reperfusion) resulting in early clinical recovery in acute stroke patients with target mismatch on perfusion imaging; however, phase III data are lacking.
Aim And Hypothesis: In this study, we assess the efficacy and safety of tenecteplase compared to alteplase in acute stroke patients with target mismatch on perfusion imaging.
Article Synopsis
- Injury is a significant public health concern in Europe, with notable differences in injury death rates and disability-adjusted life years (DALYs) across sub-regions and countries, particularly between Eastern, Central, and Western Europe.
- The study analyzed GBD 2019 data from 44 European countries over 20 years, focusing on injury mortality and DALY rates by cause and sex while assessing inequalities based on country comparisons.
- Findings reveal that Eastern Europe has the highest injury death rates (80 deaths per 100,000), while Italy has the lowest injury DALY rate, indicating that males experience greater disparities in injury impact than females.
Background: Male sex predicts case-fatality in SARS-CoV-2 (COVID-19) - a phenomenon linked to systemic inflammation. We compared sex-related associations of inflammation parameters and outcome in a population-based setting with low case-fatality prior to wide use of immunosuppressives.
Methods: A population-based quality registry with laboratory-confirmed COVID-19 cases of specialized hospitals of the Capital Province of Finland were analysed to compare inflammatory parameters by sex during the first COVID-19 wave February-June 2020.
Background: Trials of tranexamic acid (TXA) in acute intracerebral hemorrhage (ICH) have focused on the imaging outcomes of intraparenchymal hematoma growth. However, intraventricular hemorrhage (IVH) growth is also strongly associated with outcome after ICH. Revised definitions of hematoma expansion incorporating IVH growth have been proposed.
View Article and Find Full Text PDFObjectives: Motivated by reports of increased risk of coronavirus disease 2019 (COVID-19) in ethnic minorities of high-income countries, we explored whether patients with a foreign first language are at an increased risk of COVID-19 infections, more serious presentations, or worse outcomes.
Methods: In a retrospective observational population-based quality registry study covering a population of 1.7 million, we studied the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), admissions to specialist healthcare and the intensive care unit (ICU), and all-cause case fatality in different language groups between 27th February and 3rd August 2020 in Southern Finland.
Rationale: Haematoma growth is common early after intracerebral haemorrhage (ICH), and is a key determinant of outcome. Tranexamic acid, a widely available antifibrinolytic agent with an excellent safety profile, may reduce haematoma growth.
Methods And Design: Stopping intracerebral haemorrhage with tranexamic acid for hyperacute onset presentation including mobile stroke units (STOP-MSU) is a phase II double-blind, randomised, placebo-controlled, multicentre, international investigator-led clinical trial, conducted within the estimand statistical framework.
Aims: We reprocessed the Extending the time for Thrombolysis in Emergency Neurological Deficits (EXTEND) perfusion imaging with a different automated software with the aim of comparing mismatch eligibility and outcomes.
Methods: EXTEND baseline perfusion imaging data were reprocessed using autoMIStar software to identify patients who were eligible based on the same target mismatch criteria as per the original trial.
Results: From the 225 patients fulfilling RAPID-based mismatch criteria randomized in the EXTEND study, 196 (87%) patients met the revised mismatch criteria.
Background: Men reportedly suffer from a more severe disease and higher mortality during the global SARS-CoV-2 (Covid-19) pandemic. We analysed sex differences in a low epidemic area with low overall mortality in Covid-19 in a population based setting with patients treated in specialized healthcare.
Methods: We entered all hospitalized laboratory-confirmed Covid-19 cases of all specialized healthcare hospitals of the Capital Province of Finland, into a population-based quality registry and described demographics, severity and case-fatality by sex of the first Covid-19 wave February-June 2020.
Background: Despite intracerebral haemorrhage causing 5% of deaths worldwide, few evidence-based therapeutic strategies other than stroke unit care exist. Tranexamic acid decreases haemorrhage in conditions such as acute trauma and menorrhoea. We aimed to assess whether tranexamic acid reduces intracerebral haemorrhage growth in patients with acute intracerebral haemorrhage.
View Article and Find Full Text PDFBackground: While there is a long history of measuring death and disability from injuries, modern research methods must account for the wide spectrum of disability that can occur in an injury, and must provide estimates with sufficient demographic, geographical and temporal detail to be useful for policy makers. The Global Burden of Disease (GBD) 2017 study used methods to provide highly detailed estimates of global injury burden that meet these criteria.
Methods: In this study, we report and discuss the methods used in GBD 2017 for injury morbidity and mortality burden estimation.
Introduction: Approaches to economic evaluations of stroke therapies are varied and inconsistently described. An objective of the European Stroke Organisation (ESO) Health Economics Working Group is to standardise and improve the economic evaluations of interventions for stroke.
Methods: The ESO Health Economics Working Group and additional experts were contacted to develop a protocol and a guidance document for data collection for economic evaluations of stroke therapies.
Objectives: Posterior location affects the clinical presentation and outcome of ischemic stroke, but little is known about occipital intracerebral hemorrhage (ICH). We studied non-traumatic occipital ICH phenotype, outcome, and post-ICH epilepsy.
Materials And Methods: Occipital ICH patients were retrospectively identified from the Helsinki ICH Study registry of 1013 consecutive ICH patients treated in our tertiary center in 2005-2010.
Article Synopsis
- Injuries significantly impact global health, with the number of injury deaths rising from approximately 4.26 million in 1990 to about 4.48 million in 2017, despite a decline in age-standardized mortality rates.
- The Global Burden of Disease study measured both fatal and non-fatal injuries through years of life lost (YLLs) and years lived with disability (YLDs), which were combined into disability-adjusted life years (DALYs).
- While overall injury incidence increased, age-standardized DALYs decreased, indicating a need for ongoing research focused on injury prevention, better data collection, and improving access to medical care in high-burden areas.
Objective: Stroke is a devastating and costly disease; however, there is a paucity of information on long-term costs and on how they differ according to 3-month modified Rankin scale (mRS) score, which is a primary outcome variable in acute stroke intervention trials.
Methods: We analyzed a prospective multicenter stroke registry (Clinical Research Collaboration for Stroke in Korea) database through linkage with claims data from the National Health Insurance Service with follow-up to December 2016. Healthcare expenditures were converted into daily cost individually, and annual and cumulative costs up to 5 years were estimated and compared according to the 3-month mRS score.
Burden of injury along the development spectrum: associations between the Socio-demographic Index and disability-adjusted life year estimates from the Global Burden of Disease Study 2017.
Inj Prev
October 2020
Article Synopsis
- - The study investigates how sociodemographic factors relate to injury-related health outcomes worldwide, specifically analyzing disability-adjusted life years (DALYs) from injuries across 195 countries from 1990 to 2017.
- - Findings show that while most injury causes display a trend of decreasing DALY rates with higher Socio-demographic Index (SDI), certain injuries like road injuries, interpersonal violence, and self-harm deviate from this trend, indicating complex underlying factors.
- - The research highlights the importance of understanding these injury patterns to improve health strategies and intervention efforts at both national and global levels, especially since not all injuries follow the same developmental trajectory.
Since 2000, many countries have achieved considerable success in improving child survival, but localized progress remains unclear. To inform efforts towards United Nations Sustainable Development Goal 3.2-to end preventable child deaths by 2030-we need consistently estimated data at the subnational level regarding child mortality rates and trends.
View Article and Find Full Text PDFBackground: People with Alzheimer's disease (AD) are less likely to use oral anticoagulants than people without AD.
Objective: We investigated incidence and prevalence of warfarin and direct oral anticoagulant (DOAC) use, and determined predictors of DOAC and warfarin initiation in older people with AD and the general population.
Methods: Australian Pharmaceutical Benefits Scheme data for 356,000 people aged ≥65 years dispensed warfarin or DOACs during July 2013-June 2017 were analyzed.
Introduction: Calcium has a pivotal role in haemostasis. We investigated the association of baseline calcium levels with admission intracerebral haemorrhage (ICH) volume.
Methods: This is a retrospective analysis of consecutive ICH patients in an academic hospital between January 2005 and March 2010.