Welcome to the WSC 2022 Interactive Program
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*Please note that all sessions in halls Summit 1, Summit 2 & Hall 406 will be live streamed in addition to the onsite presentation
ASK THE SPEAKER
Sessions in Halls 406, Summit 1 and Summit 2 have a Q&A component, through the congress App called “Ask the Speaker”
ECONOMIC EVALUATION OF AN INDIVIDUALISED MANAGEMENT PROGRAM AFTER STROKE
Abstract
Background and Aims
The Australian government provides reimbursement incentives to general practitioners to use individualised care plans for managing chronic diseases. However, the cost-effectiveness of these primary care policies remains unknown for patients with stroke or transient ischaemic attack (TIA). We assessed the cost-effectiveness of using an individualised management program (IMP) for people with stroke/TIA.
Methods
This was a cost-utility analysis from a societal perspective over a 2-year follow-up within a randomised controlled trial (Melbourne, Australia). Adults with stroke/TIA (N=563) were randomised by general practice to receive usual care (UC; n=280) or an 18-month intervention (n=283), comprising an individualised management plan, stroke specialist review and nurse-led education. Costs were estimated in 2015 Australian dollars (AU$) using patient-reported data on resource-use and productivity loss. Quality-adjusted life years (QALYs) were combined with costs to generate incremental cost-effectiveness ratios (ICERs). We undertook probabilistic uncertainty analyses by bootstrapping costs and QALYs with 10,000 iterations.
Results
Overall, 61 people dropped out or had no utility data, leaving 502 participants (65% male, median age 69 years), with half in the intervention group. There was no significant difference in 2-year costs (AU$-4,250; 95%CI AU$-12,119; AU$3,619) or QALYs (0.03, 95% CI -0.07; 0.13) between intervention and UC groups, but some UC participants received IMPs separate to this study. The ICER was AU$135,744/QALY. The IMP was cost-effective in 35.2% of 10,000 bootstrap replications at a willingness-to-pay of AU$50,000/QALY.
Conclusions
Use of an IMP for people with stroke/TIA was not more cost-effective than usual care at a threshold of AU$50,000/QALY.
EFFICACY AND SAFETY OF TENECTEPLASE IN MODERATE AND SEVERE ISCHEMIC STROKE: A POOLED ANALYSIS OF RANDOMIZED CLINICAL TRIALS - NOR-TEST 1 & 2
Abstract
Background and Aims
Tenecteplase as a promising thrombolytic agent for ischemic stroke has been studied intensively. We present a pooled analysis of the clinical trials NOR-TEST 1 & 2 showing the efficacy and safety of Tenecteplase compared to Alteplase in patients with moderate and severe stroke.
Methods
NOR-TEST 1 & 2 were multi-center PROBE trials conducted at Norwegian hospitals. In both studies, patients were randomized either to 0.4mg/kg single bolus Tenecteplase or standard 0.9 mg/kg (10% bolus + 90% infusion/60 minutes) Alteplase. The pooled analysis contains all patients included in NOR-TEST 2 and all patients with NIHSS≥6 included in NOR-TEST 1. The patients with NIHSS≤5 in NOR-TEST 1 were excluded. The primary endpoint was good outcome at three months with mRS 0-1 or return to baseline if prestroke mRS was 2. Secondary endpoints included major neurological improvement and safety data.
Results
There were 597 patients included in the intention to treat analysis of which 287 were assigned to Tenecteplase and 310 to Alteplase. The demographics were mostly similar. There was no difference between the groups regarding good functional outcome at 3 months or major neurological improvement. Safety analyses showed a trend of more sICH and significantly increased mortality at 3 months in the Tenecteplase group.
Conclusions
For ischemic stroke with NIHSS≥6, we found no difference in efficacy of the two thrombolytic agents, but mortality rates were higher in the tenecteplase group. A lower dose should be considered in future studies.
ATTICUS RANDOMIZED CONTROLLED TRIAL - RESULTS OF PRE-SPECIFIED SECONDARY ANALYSES
Abstract
Background and Aims
ATTICUS is the third prospective RCT that compared a NOAC vs. acetylsalicylic acid (ASA) for secondary prevention after embolic stroke of undetermined source (ESUS). Aim of ATTICUS was to determine whether apixaban, initiated within 28 days after ESUS, is superior to ASA in preventing new ischemic lesions on 12-month follow- up MRI (primary endpoint) in subjects with continuous atrial fibrillation (AF) monitoring.
Methods
Multicenter prospective randomized (1:1) open-label blinded endpoint. ESUS patients with at least one risk factor for AF/cardiac thromboembolism (i.e., left atrium (LA) size >45mm, spontaneous echo contrast in LA appendage, LA appendage flow velocity ≤0.2m/s, atrial high-rate episodes, CHA2DS2-VASc ≥4, patent foramen ovale) were enrolled. Study drug was initiated 3-28 days after minor/moderate stroke and 15-28 days after major stroke. ClinicalTrials.gov: NCT02427126. Funding by Bristol Meyers Squibb-Pfizer Alliance (Euro 2.2 Mio.) and Medtronic.
Results
Final analysis includes 352 patients. New ischemic lesion(s) were found in 13.6% vs. 16.0% of patients in the apixaban- and the ASA-arm (p=0.57), intention-to-treat. AF was detected in 25.6 % of patients. No difference between study arms was found for other thromboembolism, death, SAE, major and clinically relevant bleeds.
Conclusions
ATTICUS was the first trial testing the concept of DOAC vs. ASA in an enriched ESUS population. Mandatory cardiac monitoring, vessel imaging, and MRI in all ATTICUS patients allows the pre-specified secondary analyses that will be presented (incl. on-treatment analysis, prevention of embolic/disabling lesions/strokes, association of stroke pattern with AF occurrence/macroangiopathic changes).