Publications by authors named "Donnan G"
Introduction: The effects of imaging-based intravenous thrombolysis on outcomes based on patient sex remain unclear. We aimed to investigate whether outcomes among patients with stroke with an unknown onset time and treated with imaging-based intravenous thrombolysis are influenced by their sex.
Patients And Methods: This study was a pooled analysis of individual patient-level data acquired from the Evaluation of unknown Onset Stroke thrombolysis trials.
Introduction: Little is known of the long-term prognosis of patients with acute ischaemic stroke in the absence of standard modifiable stroke risk factors (SMoRFs). In acute coronary syndromes, patients without modifiable risk factors have a higher mortality rate. We analysed data from the Swedish Stroke Register to determine survival of patients without SMoRFs following an ischaemic stroke.
View Article and Find Full Text PDFRationale: The benefit of tenecteplase in the treatment of large vessel occlusion (LVO) patients presenting within 24 hours of symptom onset remains unclear.
Aim: To assess the effectiveness and safety of tenecteplase, compared to standard of care, in patients presenting within the first 24 hours of symptom onset with a LVO and target mismatch on perfusion CT.
Methods And Design: The "Extending the time window for Tenecteplase by Effective Reperfusion of peNumbrAL tissue in patients with Large Vessel Occlusion" (ETERNAL-LVO) trial is a prospective, randomized, open-label, blinded endpoint, phase 3, parallel-group, superiority trial with covariate-adjusted 1:1 randomization, and adaptive sample size re-estimation.
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.
Article Synopsis
- - The study analyzed 3847 patients who suffered from a transient ischemic attack or minor ischemic stroke, focusing on those without traditional risk factors (like hypertension and diabetes) to compare their outcomes with those who did have risk factors.
- - After one year, the risk of major cardiovascular events (MACE) was similar between the two groups, but after five years, those without traditional risk factors had a significantly lower risk of MACE (7.9% vs 13.9%).
- - In patients without traditional risk factors, arterial stenosis was identified as a critical predictor for MACE, indicating that while their long-term risk was lower, they were not entirely without risk.
Background: Cerebrovascular accident (CVA) is an outdated term for describing stroke as it implies stroke is an accident. We conducted an integrative review to examine the use of CVA in terms of (1) frequency in major medical journals over time; (2) associated publication characteristics (e.g.
View Article and Find Full Text PDFBackground: Mobile stroke units have been shown to deliver faster patient care and improve clinical outcomes. However, costs associated with staffing limit their use to densely populated cities. Using the Melbourne mobile stroke unit, we aim to evaluate the safety, timeliness, and resource efficiency of a telemedicine model, where the neurologist assesses a patient remotely, via telemedicine, compared with an onboard neurologist model.
View Article and Find Full Text PDFBackground: Mild stroke affects more than half the stroke population, yet there is limited evidence characterizing cognition over time in this population, especially with predictive approaches applicable at the individual-level. We aimed to identify patterns of recovery and the best combination of demographic, clinical, and lifestyle factors predicting individual-level cognitive state at 3- and 12-months after mild stroke.
Methods: In this prospective cohort study, the Montreal Cognitive Assessment (MoCA) was administered at 3-7 days, 3- and 12-months post-stroke.
Objectives: The objectives are to assess smoking abstinence and its effects on vascular risk and to report tobacco-cessation counselling and pharmacotherapy use in patients who had a recent minor stroke or transient ischaemic attack (TIA).
Design And Setting: The TIA registry.org project is a prospective, observational registry of patients with TIA and minor stroke that occurred in the previous 7 days with a 5-year follow-up, involving 61 sites with stroke specialists in 21 countries (Europe, Asia, Latin America and Middle East).
Background: Patients with a large vessel occlusion require a transfer from a primary stroke centre to access thrombectomy, often over significant distances in regional areas. We sought to optimise stroke care access in the regional South Australian Tele-Strokeservice (SATS) to improve patient access to thrombectomy.
Methods: We undertook a 24-month interventional historically controlled cohort study comparing acute stroke care metrics in the SATS.
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 investigates the effects of stroke on cognitive function over time in older adults, focusing on how different cognitive domains are impacted before and after a stroke event.
- A longitudinal cohort of 19,114 older individuals was monitored for up to 11 years, revealing that those who suffered a stroke experienced a significant and immediate decline in various cognitive tests compared to those who did not have a stroke.
- Results suggest a need for thorough neuropsychological evaluations post-stroke, as affected individuals demonstrated greater long-term cognitive decline in most domains, emphasizing the importance of early intervention and monitoring.
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 topography of arterial territories has been defined using digital maps of supratentorial infarcts. Regions with a high probability of infarction (Pi) exist in the deep compartment due to a paucity of collaterals. However, less attention has been given to regions with a low Pi.
View Article and Find Full Text PDFBackground And Objectives: Early treatment with intravenous alteplase increases the probability of lytic-induced reperfusion in large vessel occlusion (LVO) patients. The relationship of tenecteplase-induced reperfusion and the timing of thrombolytic administration has not been explored. In this study, we performed a comparative analysis of tenecteplase and alteplase reperfusion rates and assessed their relationship to the time of thrombolytic administration.
View Article and Find Full Text PDFArticle Synopsis
- The study examines the differences in the effectiveness and safety of intravenous thrombolysis (IVT) for treating strokes of unknown onset, dividing patients into two categories: wake-up stroke (WUS) and non-wake-up unwitnessed stroke (non-WUS).
- Using data from two trials, researchers analyzed 634 patients to see how IVT compared to control treatments, looking at outcomes like functional independence and adverse events like bleeding and mortality.
- Results showed that for WUS, IVT led to better outcomes than control, while for non-WUS, the differences were not significant; overall, the mode of stroke onset did not significantly impact the treatment effect.
Can We Miniaturize CT Technology for a Successful Mobile Stroke Unit Roll-Out?
Annu Int Conf IEEE Eng Med Biol Soc
July 2023
Mortality from stroke remains high in Australia, especially for patients located outside the metropolitan cities. This is because they have limited access to specialized stroke facilities for optimal stroke treatment. Mobile stroke units have the capability to take CT scanners out to the patient however current CT commercial scanner designs are large and heavy.
View Article and Find Full Text PDFImplementation of evidence-informed rehabilitation of the upper limb is variable, and outcomes for stroke survivors are often suboptimal. We established a national partnership of clinicians, survivors of stroke, researchers, healthcare organizations, and policy makers to facilitate change. The objectives of this study are to increase access to best-evidence rehabilitation of the upper limb and improve outcomes for stroke survivors.
View Article and Find Full Text PDFArticle 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.
Background: Disparities in the availability of reperfusion services for acute ischemic stroke are considerable globally and require urgent attention. Contemporary data on the availability of reperfusion services in different countries are used to provide the necessary evidence to prioritize where access to acute stroke treatment is needed.
Aims: To provide a snapshot of published literature on the provision of reperfusion services globally, including when facilitated by telemedicine or mobile stroke unit services.
Importance: The coexistence of underlying causes in patients with transient ischemic attack (TIA) or minor ischemic stroke as well as their associated 5-year risks are not well known.
Objective: To apply the ASCOD (atherosclerosis, small vessel disease, cardiac pathology, other cause, or dissection) grading system to assess coexistence of underlying causes of TIA and minor ischemic stroke and the 5-year risk for major vascular events.
Design, Setting, And Participants: This international registry cohort (TIAregistry.
Background: Internationally, Mobile Stroke Unit (MSU) ambulances have changed pre-hospital acute stroke care delivery. MSU clinical and cost-effectiveness studies are emerging, but little is known about important factors for achieving sustainability of this innovative model of care.
Methods: Mixed-methods study from the Melbourne MSU (operational since November 2017) process evaluation.
Importance: Low-dose aspirin has been widely used for primary and secondary prevention of stroke. The balance between potential reduction of ischemic stroke events and increased intracranial bleeding has not been established in older individuals.
Objective: To establish the risks of ischemic stroke and intracranial bleeding among healthy older people receiving daily low-dose aspirin.
Background: Tenecteplase administered to patients with ischaemic stroke in a mobile stroke unit (MSU) has been shown to reduce the perfusion lesion volumes and result in ultra-early recovery. We now seek to assess the cost-effectiveness of tenecteplase in the MSU.
Methods: A within-trial (TASTE-A) economic analysis and a model-based long-term cost-effectiveness analysis were performed.
Background: Despite cardiovascular diseases and thrombosis being major causes of death in patients with chronic kidney disease (CKD), there remains no effective biomarker to predict thrombotic risk in this population.
Objective: To evaluate global coagulation assays in patients with CKD and correlate the biomarkers to clinical outcomes.
Material And Methods: Patients with eGFR<30 mL/min/1.