In brief: Alteplase dosing questions answered; What’s your experience of cannabis in Parkinson’s?; Kids head injury guidelines

Medicines

10 Feb 2021

Alteplase dosing questions answered

Low-dose alteplase (0.6mg/kg) does not appear to provide any additional benefit or harm when compared to standard-dose alteplase (0.9 mg/kg) in the management of patients with lacunar acute ischaemic stroke (AIS).

A post-hoc analysis of the ENCHANTED trial has shown patients with definite or probable lacunar AIS have better 90-day functional outcomes than patients with non-lacunar strokes. They were also less likely to have ICH, and early neurologic deterioration or death after intravenous thrombolysis.

There were no significant differences on the primary efficacy outcome (mRS 2-6) (33.7% vs. 32.9%, adjusted OR 0.96, 95% CI 0.49-1.87) or major disability or death (mRS 3-6) (20.2% vs. 15.3%, adjusted OR 1.31, 95% CI 0.54-3.19) between low-dose and standard-dose alteplase groups.

The study was published in Neurology 


Share your experience of cannabis for Parkinson disease

Researchers from the National Centre for Naturopathic Medicine at Southern Cross University are exploring the current use of cannabis in patients with Parkinson disease.

Clinical research fellow Dr Janet Schloss said self-management with cannabis exposed patients to potentially dangerous black-market preparations that did not have standardised CBD:THC ratios.

“Cannabis is not currently prescribed for Australian patients with Parkinson’s disease, however it is extremely important to look at what people are currently doing, their attitudes and conduct a clinical trial so we know what does work and what doesn’t,” she said in a statement.

The pilot study comprises an anonymous online survey of patients, their carers and health practitioners which will help inform future research. The survey runs until the end of February.


More precise risk stratification possible with Canadian TIA Score

The Canadian TIA Score performs significantly better than the established ABCD2 and ABCD2i scores in stratifying risk of subsequent early stroke in patients presenting to ED with TIA or minor stroke.

A Canadian study of over 7,000 adults presenting to 13 EDs found 1.4% had a subsequent stroke. The Canadian TIA score was able to effectively stratify patients into three pre-specified risk groups – low (<1% risk of stroke), medium (1-5%), and high (>5%).

In comparison the ABCD2 and ABCD2i scores were not able to classify any patients into the low risk group. Instead all but 3-7% of patients were bundled into the medium risk group.

The researchers said incorporating this now validated core into management plans should improve early decision making on hospital admission, timing of investigations, and specialist referral.

Read more in The BMJ


Kids head injury guidelines available

The Paediatric Research in Emergency Departments International Collaborative (PREDICT) has delivered the Australian and New Zealand Guideline for Mild to Moderate Head Injuries in Children.

The 71 recommendations cover key areas including triage, referral, imaging, and discharge planning for paediatric head injury patients. The guidelines, led by Professor Franz Babl from the Murdoch Children’s Research Institute, will help standardise the care of children with head injury across the two countries.

The full guidelines, a summary document and an algorithm on imaging and observation decision-making are available online and a version published in Emergency Medicine Australasia.

 

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