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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article discusses the results of a retrospective study that used data from the rt-PA arm of the National Institute of Neurological Disorders (NINDS) trial [Kwiatkowski TG et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 1999] to evaluate dramatic early improvement after treatment with IV-rt-PA as a risk factor for the development of posttreatment ICH. A secondary objective was to characterize the subgroup of patients with dramatic early improvement.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EIschemia Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003ENIHSS baseline score and time to treatment \u0026lt;90 minutes are independent predictors of dramatic early response to rt-PA therapy. The occurrence of intracerebral hemorrhage (ICH) is similar between dramatic and nondramatic responders.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EClinical experience demonstrates that a certain percentage of patients with acute ischemic stroke improve rapidly after the administration of IV-rtPA [Felberg RA et al. \u003Cem\u003EStroke\u003C\/em\u003E 2002]. Although research in a small number of patients has pointed to the development of subtypes of mild hemorrhage as a marker for early recanalization and good clinical outcomes at 90 days (OR, 10.9) [Molina CA et al. \u003Cem\u003EStroke\u003C\/em\u003E 2002], anecdotal clinical experience has suggested a potential relationship between dramatic early improvement and posttreatment symptomatic ICH.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EJordan Bonomo, MD, University of Cincinnati, Cincinnati, OH, reported on the results of a retrospective study that used data from the rt-PA arm of the National Institute of Neurological Disorders (NINDS) trial [Kwiatkowski TG et al. \u003Cem\u003ENew Engl J Med\u003C\/em\u003E 1999] to evaluate dramatic early improvement after treatment with IV-rt-PA as a risk factor for the development of posttreatment ICH. A secondary objective was to characterize the subgroup of patients with dramatic early improvement.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EDemographics, baseline clinical characteristics, rates of ICH, and outcomes were compared between subjects with and without dramatic improvement. Dramatic improvement was defined as either NIHSS \u22642 at 2 hours or a 10-point improvement from baseline at 2 hours after initiation of therapy [Alexandrov et al. \u003Cem\u003EStroke\u003C\/em\u003E 2000]. Logistic regression was used to predict posttreatment ICH, as well as good clinical outcome at 90 days (mRS 0\u20131).\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EOf the 312 patients who were treated with IV-rt-PA, 65 (20.8%) had dramatic early improvement and 246 (78.8%) did not. Early dramatic improvement was strongly associated with good clinical outcome at 90 days (78% dramatic responders vs 33% of nondramatic responders; p\u0026lt;0.0001). NIHSS baseline score and time to rt-PA therapy \u0026lt;90 minutes were the only independent predictors of early dramatic improvement. The occurrence of ICH by 36 hours (both symptomatic and asymptomatic) was not significantly different (p=0.27) between the dramatic (4\/65; 6.2%) and nondramatic improvement (29\/246; 11.8%) groups. After adjustment for dramatic improvement, age, and CT edema, only CT mass effect and baseline NIHSS were predictive of symptomatic ICH in dramatic improvers. Age, baseline NIHSS, and dramatic improvement were independent predictors of good outcome at 90 days (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/11406\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/11406\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11406\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EPredictors of Rapid Response, sICH in Rapid Responders, and Outcome.\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2009 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/9\/1\/17.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmlce\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzmlce\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}