The Experts below are selected from a list of 57 Experts worldwide ranked by ideXlab platform
Kennedy R Lees - One of the best experts on this subject based on the ideXlab platform.
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elevated pulse pressure during the acute period of ischemic stroke is associated with poor stroke outcome
Stroke, 2004Co-Authors: Stella Aslanyan, Christopher J Weir, Kennedy R LeesAbstract:Background— It is controversial which component of blood pressure (BP) during acute period of stroke best predicts outcome. We hypothesized that elevated pulse pressure (PP), the difference between systolic BP (SBP) and diastolic BP (DBP), is independently associated with poor stroke outcome at 3 months. Methods— We analyzed both treatment groups from the Glycine Antagonist (Gavestinel) in Neuroprotection (GAIN) International trial (1455 ischemic stroke cases of mostly moderate severity). Cox proportional hazards and logistic regression modeling corrected for demography, medical history, heart rate, stroke severity, and clinical subtype. Results— Elevated weighted average PP during the first 60 hours was associated with poor outcome by mortality, Barthel index, National Institutes of Health Stroke Score (NIHSS) and Rankin scores. Elevated baseline PP was associated with Barthel index and Rankin score. Conclusion— Elevated PP is associated with poor stroke outcome at 3 months.
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pneumonia and urinary tract infection after acute ischaemic stroke a tertiary analysis of the gain international trial
European Journal of Neurology, 2004Co-Authors: Stella Aslanyan, Markku Kaste, Christopher J Weir, H C Diener, Kennedy R LeesAbstract:The third most common stroke complication is infection. We studied the rates of aspiration pneumonia and urinary tract infection (UTI), their risk factors and their effect on outcome in the 1455 Glycine Antagonist (Gavestinel) in Neuroprotection (GAIN) International patients with ischaemic stroke. Forward stepwise logistic regression and Cox proportional hazards modelling identified baseline factors that predicted events and the independent effect of events up to day 7 on poor stroke outcome at 3 months in patients alive at day 7, after correcting for prognostic factors. Higher baseline National Institute of Health Stroke Scale (NIHSS) and age, male gender, history of diabetes and stroke subtype predicted pneumonia, which occurred in 13.6% of patients. Female gender and higher baseline NIHSS and age predicted UTI, which occurred in 17.2% of patients. Pneumonia was associated with poor outcome by mortality (hazard ratio, 2.2; 95% confidence interval, 1.5–3.3), Barthel index (<60) (odds ratio, 3.8; 2.2–6.7), NIHSS (4.9; 1.7–14) and Rankin scale (≥2) (3.4; 1.4–8.3). UTI was associated with Barthel index (1.9; 1.2–2.9), NIHSS (2.2; 1.2–4.0) and Rankin scale (3.1; 1.6–4.9). Pneumonia and UTI are independently associated with stroke poor outcome. Patients with identified risk factors must be closely monitored for infection.
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glycine antagonist Gavestinel in neuroprotection gain international in patients with acute stroke a randomised controlled trial
The Lancet, 2000Co-Authors: Kennedy R Lees, Kjell Asplund, Antonio Carolei, Stephe M Davis, Hanschristoph Diene, Markku Kaste, Jeanmarc Orgogozo, Joh WhiteheadAbstract:Summary Background Early treatment may improve acute ischaemic stroke outcome. Gavestinel is a selective antagonist at the glycine site of the N-methyl-D-aspartate (NMDA) receptor, and is neuroprotective in animal models of ischaemic stroke. Methods We did a randomised, double-blind, placebo-controlled trial to test whether Gavestinel could improve functional outcome after acute stroke in human beings. Conscious patients with stroke involving limb weakness received either Gavestinel at an intravenous loading dose of 800 mg followed by 200 mg every 12 h for five doses, or matching placebo, within 6 h of stroke onset. Stratification variables were age and stroke severity. A computed tomography brain scan within 18 h of stroke onset identified the primary efficacy population with ischaemic stroke. Outcome was assessed by an independent observer with the Barthel index at 3 months. Three outcome categories were applied: good (Barthel index 95–100), moderate (60–90), and poor (0–55 or dead). Analysis was by intention to treat. Findings Of 1804 patients randomised, 16 received no treatment, and 333 had primary intracranial haemorrhage. 891 patients received Gavestinel and 897 received placebo. Outcome in 721 patients who received Gavestinel and were analysed for the primary endpoint at 3 months was good in 246 (34·1%), moderate in 136 (18·8%), and poor in 339 (47·0%), compared with 256 (34·9%), 133 (18·1%), and 345 (47·0%), respectively, of 734 patients who received placebo (p=0·8). Mortality at 3 months was 147 (20·4%) in the Gavestinel group and 138 (18·8%) in the placebo group. Outcomes within preplanned subgroup and secondary analyses were also neutral. There were no significant differences in serious side-effects between the groups. Interpretation Treatment with Gavestinel within 6 h of acute ischaemic stroke did not improve outcome.
Stella Aslanyan - One of the best experts on this subject based on the ideXlab platform.
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Poststroke neurological improvement within 7 days is associated with subsequent deterioration. Stroke
2016Co-Authors: Stella Aslanyan, Md Christopher, J. Weir, Phd Claiborne S. JohnstonAbstract:has been associated with subsequent neurological deterioration. We hypothesized that a similar association would be apparent for events occurring after 7 days, when acute changes from edema and herniation are less common. We evaluated the degree of NIHSS improvement at 7 days (recovery) as a predictor of subsequent neurological deterioration from day 7 to day 90. Methods—We studied all patients of the Glycine Antagonist (Gavestinel) In Neuroprotection (GAIN) International Trial with ischemic stroke alive at day 7, excluding patients with hemorrhagic events and deaths from nonstroke-related causes. The GAIN International Trial was a randomized, double-blind, placebo-controlled, and parallel-group trial; because the study drug had no effect on stroke outcome, treatment groups were combined for this analysis. Neurological deterioration was assessed by the combined measure, including: (1) stroke-related events recorded as “serious adverse events, ” (2) recurrent stroke recorded on a separate case report form, and (3) any NIHSS worsening. Results—Among 1187 patients included, 25 % had 65 % recovery. Deterioration was more prevalent in the group with 65 % early recovery (15.5 % versus 10.3%; P0.01). Logistic regression modeling indicated that recovery was associated with subsequent neurological deterioration (odds ratio, 1.2; 95 % CI, 1.1 to 1.3, per 10 % recovery) after adjusting for age, NIHSS at 7 days, and stroke subtype. Conclusions—Substantial neurological recovery at 7 days is associated with subsequent neurological deterioration
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elevated pulse pressure during the acute period of ischemic stroke is associated with poor stroke outcome
Stroke, 2004Co-Authors: Stella Aslanyan, Christopher J Weir, Kennedy R LeesAbstract:Background— It is controversial which component of blood pressure (BP) during acute period of stroke best predicts outcome. We hypothesized that elevated pulse pressure (PP), the difference between systolic BP (SBP) and diastolic BP (DBP), is independently associated with poor stroke outcome at 3 months. Methods— We analyzed both treatment groups from the Glycine Antagonist (Gavestinel) in Neuroprotection (GAIN) International trial (1455 ischemic stroke cases of mostly moderate severity). Cox proportional hazards and logistic regression modeling corrected for demography, medical history, heart rate, stroke severity, and clinical subtype. Results— Elevated weighted average PP during the first 60 hours was associated with poor outcome by mortality, Barthel index, National Institutes of Health Stroke Score (NIHSS) and Rankin scores. Elevated baseline PP was associated with Barthel index and Rankin score. Conclusion— Elevated PP is associated with poor stroke outcome at 3 months.
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pneumonia and urinary tract infection after acute ischaemic stroke a tertiary analysis of the gain international trial
European Journal of Neurology, 2004Co-Authors: Stella Aslanyan, Markku Kaste, Christopher J Weir, H C Diener, Kennedy R LeesAbstract:The third most common stroke complication is infection. We studied the rates of aspiration pneumonia and urinary tract infection (UTI), their risk factors and their effect on outcome in the 1455 Glycine Antagonist (Gavestinel) in Neuroprotection (GAIN) International patients with ischaemic stroke. Forward stepwise logistic regression and Cox proportional hazards modelling identified baseline factors that predicted events and the independent effect of events up to day 7 on poor stroke outcome at 3 months in patients alive at day 7, after correcting for prognostic factors. Higher baseline National Institute of Health Stroke Scale (NIHSS) and age, male gender, history of diabetes and stroke subtype predicted pneumonia, which occurred in 13.6% of patients. Female gender and higher baseline NIHSS and age predicted UTI, which occurred in 17.2% of patients. Pneumonia was associated with poor outcome by mortality (hazard ratio, 2.2; 95% confidence interval, 1.5–3.3), Barthel index (<60) (odds ratio, 3.8; 2.2–6.7), NIHSS (4.9; 1.7–14) and Rankin scale (≥2) (3.4; 1.4–8.3). UTI was associated with Barthel index (1.9; 1.2–2.9), NIHSS (2.2; 1.2–4.0) and Rankin scale (3.1; 1.6–4.9). Pneumonia and UTI are independently associated with stroke poor outcome. Patients with identified risk factors must be closely monitored for infection.
Sacco R.l. - One of the best experts on this subject based on the ideXlab platform.
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Gavestinel does not improve outcome after acute intracerebral hemorrhage: an analysis from the GAIN International and GAIN Americas studies
American Heart Association, 2005Co-Authors: Haley E.c., Thompson J.l.p., Levin B., Davis S., Lees K.r., Pittman J.g., Derosa J.t., Ordronneau P., Brown D.l., Sacco R.l.Abstract:Background and Purpose: Glycine Antagonist in Neuroprotection (GAIN) International and GAIN Americas trials were prospectively designed, randomized, placebo-controlled trials of Gavestinel, a glycine-site antagonist and putative neuroprotectant drug administered within 6 hours of suspected ischemic or hemorrhagic stroke. Both trials reported that Gavestinel was ineffective in ischemic stroke. This analysis reports the results in those with primary intracerebral hemorrhage. Methods: The primary hypothesis was that Gavestinel treatment did not alter outcome, measured at 3 months by the Barthel Index (BI), from acute intracerebral hemorrhage, based on pooled results from both trials. The BI scores were divided into 3 groups: 95 to 100 (independent), 60 to 90 (assisted independence), and 0 to 55 (dependent) or dead. Results: In total, 3450 patients were randomized in GAIN International (N=1804) and GAIN Americas (N=1646). Of these, 571 were ultimately identified to have spontaneous intracerebral hematoma on baseline head computerized tomography scan. The difference in distribution of trichotomized BI scores at 3 months between Gavestinel and placebo was not statistically significant (P=0.09). Serious adverse events were reported at similar rates in the 2 treatment groups. Conclusions: These observations from the combined GAIN International and GAIN Americas trials suggest that Gavestinel is not of substantial benefit or harm to patients with primary intracerebral hemorrhage. These findings are similar to results previously reported in patients with ischemic stroke.
Lees K.r. - One of the best experts on this subject based on the ideXlab platform.
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Gavestinel does not improve outcome after acute intracerebral hemorrhage: an analysis from the GAIN International and GAIN Americas studies
American Heart Association, 2005Co-Authors: Haley E.c., Thompson J.l.p., Levin B., Davis S., Lees K.r., Pittman J.g., Derosa J.t., Ordronneau P., Brown D.l., Sacco R.l.Abstract:Background and Purpose: Glycine Antagonist in Neuroprotection (GAIN) International and GAIN Americas trials were prospectively designed, randomized, placebo-controlled trials of Gavestinel, a glycine-site antagonist and putative neuroprotectant drug administered within 6 hours of suspected ischemic or hemorrhagic stroke. Both trials reported that Gavestinel was ineffective in ischemic stroke. This analysis reports the results in those with primary intracerebral hemorrhage. Methods: The primary hypothesis was that Gavestinel treatment did not alter outcome, measured at 3 months by the Barthel Index (BI), from acute intracerebral hemorrhage, based on pooled results from both trials. The BI scores were divided into 3 groups: 95 to 100 (independent), 60 to 90 (assisted independence), and 0 to 55 (dependent) or dead. Results: In total, 3450 patients were randomized in GAIN International (N=1804) and GAIN Americas (N=1646). Of these, 571 were ultimately identified to have spontaneous intracerebral hematoma on baseline head computerized tomography scan. The difference in distribution of trichotomized BI scores at 3 months between Gavestinel and placebo was not statistically significant (P=0.09). Serious adverse events were reported at similar rates in the 2 treatment groups. Conclusions: These observations from the combined GAIN International and GAIN Americas trials suggest that Gavestinel is not of substantial benefit or harm to patients with primary intracerebral hemorrhage. These findings are similar to results previously reported in patients with ischemic stroke.
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How a sequential design would have affected the GAIN international study of Gavestinel in stroke
'S. Karger AG', 2004Co-Authors: Bolland K., Whitehead J, Weeks A., Lees K.r.Abstract:While planning the GAIN International Study of Gavestinel in acute stroke, a sequential triangular test was proposed but not implemented. Before the trial commenced it was agreed to evaluate the sequential design retrospectively to evaluate the differences in the resulting analyses, trial durations and sample sizes in order to assess the potential of sequential procedures for future stroke trials. This paper presents four sequential reconstructions of the GAIN study made under various scenarios. For the data as observed, the sequential design would have reduced the trial sample size by 234 patients and shortened its duration by 3 or 4 months. Had the study not achieved a recruitment rate that far exceeded expectation, the advantages of the sequential design would have been much greater. Sequential designs appear to be an attractive option for trials in stroke. Copyright 2004 S. Karger AG, Base
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Poststroke neurological improvement within 7 days is associated with subsequent deterioration
'Ovid Technologies (Wolters Kluwer Health)', 2004Co-Authors: Aslanyan S., Weir C.j., Johnston S.c., Lees K.r.Abstract:Background and Purpose: Improvement in the National Institutes of Health Stroke Scale (NIHSS) 24 hours after stroke has been associated with subsequent neurological deterioration. We hypothesized that a similar association would be apparent for events occurring after 7 days, when acute changes from edema and herniation are less common. We evaluated the degree of NIHSS improvement at 7 days (recovery) as a predictor of subsequent neurological deterioration from day 7 to day 90. Methods: We studied all patients of the Glycine Antagonist (Gavestinel) In Neuroprotection (GAIN) International Trial with ischemic stroke alive at day 7, excluding patients with hemorrhagic events and deaths from nonstroke-related causes. The GAIN International Trial was a randomized, double-blind, placebo-controlled, and parallel-group trial; because the study drug had no effect on stroke outcome, treatment groups were combined for this analysis. Neurological deterioration was assessed by the combined measure, including: (1) stroke-related events recorded as “serious adverse events,” (2) recurrent stroke recorded on a separate case report form, and (3) any NIHSS worsening. Results: Among 1187 patients included, 25% had >65% recovery. Deterioration was more prevalent in the group with >65% early recovery (15.5% versus 10.3%; P=0.01). Logistic regression modeling indicated that recovery was associated with subsequent neurological deterioration (odds ratio, 1.2; 95% CI, 1.1 to 1.3, per 10% recovery) after adjusting for age, NIHSS at 7 days, and stroke subtype. Conclusions: Substantial neurological recovery at 7 days is associated with subsequent neurological deterioration.
Christopher J Weir - One of the best experts on this subject based on the ideXlab platform.
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elevated pulse pressure during the acute period of ischemic stroke is associated with poor stroke outcome
Stroke, 2004Co-Authors: Stella Aslanyan, Christopher J Weir, Kennedy R LeesAbstract:Background— It is controversial which component of blood pressure (BP) during acute period of stroke best predicts outcome. We hypothesized that elevated pulse pressure (PP), the difference between systolic BP (SBP) and diastolic BP (DBP), is independently associated with poor stroke outcome at 3 months. Methods— We analyzed both treatment groups from the Glycine Antagonist (Gavestinel) in Neuroprotection (GAIN) International trial (1455 ischemic stroke cases of mostly moderate severity). Cox proportional hazards and logistic regression modeling corrected for demography, medical history, heart rate, stroke severity, and clinical subtype. Results— Elevated weighted average PP during the first 60 hours was associated with poor outcome by mortality, Barthel index, National Institutes of Health Stroke Score (NIHSS) and Rankin scores. Elevated baseline PP was associated with Barthel index and Rankin score. Conclusion— Elevated PP is associated with poor stroke outcome at 3 months.
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pneumonia and urinary tract infection after acute ischaemic stroke a tertiary analysis of the gain international trial
European Journal of Neurology, 2004Co-Authors: Stella Aslanyan, Markku Kaste, Christopher J Weir, H C Diener, Kennedy R LeesAbstract:The third most common stroke complication is infection. We studied the rates of aspiration pneumonia and urinary tract infection (UTI), their risk factors and their effect on outcome in the 1455 Glycine Antagonist (Gavestinel) in Neuroprotection (GAIN) International patients with ischaemic stroke. Forward stepwise logistic regression and Cox proportional hazards modelling identified baseline factors that predicted events and the independent effect of events up to day 7 on poor stroke outcome at 3 months in patients alive at day 7, after correcting for prognostic factors. Higher baseline National Institute of Health Stroke Scale (NIHSS) and age, male gender, history of diabetes and stroke subtype predicted pneumonia, which occurred in 13.6% of patients. Female gender and higher baseline NIHSS and age predicted UTI, which occurred in 17.2% of patients. Pneumonia was associated with poor outcome by mortality (hazard ratio, 2.2; 95% confidence interval, 1.5–3.3), Barthel index (<60) (odds ratio, 3.8; 2.2–6.7), NIHSS (4.9; 1.7–14) and Rankin scale (≥2) (3.4; 1.4–8.3). UTI was associated with Barthel index (1.9; 1.2–2.9), NIHSS (2.2; 1.2–4.0) and Rankin scale (3.1; 1.6–4.9). Pneumonia and UTI are independently associated with stroke poor outcome. Patients with identified risk factors must be closely monitored for infection.
