Stroke outcome evaluation

Anakinra/Kineret, an IL-1 receptor antagonist approved for use in rheumatoid arthritis, was recently evaluated in a small phase II trial. When initiated within 6 hours after stroke onset, Anakinra treatment yielded promising preliminary results it was deemed safe with demonstrable biologic activity and likely favorable clinical outcome." ... 

FIGURE 5.2 Clinical outcome of patients in the double-blind, proof-of-concept trial evaluating EPO in acute stroke, (a) Barthel Index (rhEPO vs. placebo, p < 0.05). (b) Modified Rankin Scale (rhEPO vs. placebo, p < 0.07) on day 30. Dead patients received the worst possible score. Evolution of lesion size of patients in the efficacy trial of Albumin in acute stroke, ((a-1) and DWI and (a-2) FLAIR.) (Reprinted with permission from reference 50.)... 

Lacy CR, Suh DC, Bueno M, Kostis JB. Delay in presentation and evaluation for acute stroke Stroke Time Registry for Outcomes Knowledge and Epidemiology (S.T.R.O.K.E.). Stroke 2001 32 63-69. 

In the Heart Outcomes Prevention Evaluation 2 (HOPE-2) study, 5522 patients aged 55 or older with vascular disease or diabetes were randomized to treatment with either placebo or a combination 2, 5 mg of folic acid, 50 mg vitamin B6, and I mg vitamin B 2, for an average of five years. The primary outcome was a composite of death from cardiovascular causes, myocardial infarction, and stroke. Mean plasma homocysteine levels decreased by 2.4 jimol/L in the treatment group and increased by 0.8 jimol/L in the placebo group. The primary outcome occurred in 18.8% of patients assigned to active therapy and in 19.8% of those assigned to placebo (relative risk = 0.95 95% Cl = 0.84-1.07 P = 0.41) (68). 

Lovblad KO, Baird AE, Schlaug G et al. (1997). Ischemic lesion volumes in acute stroke by diffusion-weighted magnetic resonance imaging correlate with clinical outcome. Annals of Neurology 42 164-170 Lyden PD, Hantson L (1998). Assessment scales for the evaluation of stroke patients. Journal... 

The evaluation of acute stroke patients with CTA is being performed to evaluate for the underlying vascular etiology (Smith et al., 2006). CTA can nicely demonstrate areas of stenosis or thrombosis in the arteries. The presence of a large vessel intracranial occlusion in an acute stroke patient has been found to even be an independent predictor of poor outcome (Smith et al., 2006). Also, computed tomographic venography has been found to be beneficial for evaluating patients for the presence of venous thrombosis. 

The Health Outcomes Institute has developed and validated several outcome instruments that can be used to 11 evaluate patient outcomes following interventions by pharmacists. These include hypertension/lipids, angina, asthma, chronic obstructive pulmonary disease, chronic sinusitis, hip replacement, hip fracture, depression, low back pain, osteoarthritis, alcohol abuse, stroke, rheumatoid arthritis, and prostatism (Appendix 4). The Health Outcomes Institute is located at 2001 Killebrew Drive, Suite 122, Bloomington, MN 55425 telephone (612) 858-9188. 

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