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Effect of intravenous nimodipine on blood pressure and outcome after acute stroke
KTH, Tidigare Institutioner                               , Infrastruktur.ORCID-id: 0000-0001-7606-8771
2000 (engelsk)Inngår i: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 31, nr 6, s. 1250-1255Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Background and Purpose-The Intravenous Nimodipine West European Stroke Trial (INWEST) found a correlation between nimodipine-induced reduction in blood pressure (BP) and an unfavorable outcome in acute stroke. We sought to confirm this correlation with and without adjustment for prognostic variables and to investigate outcome in subgroups with increasing levels of BP reduction. Methods-Patients with a clinical diagnosis of ischemic stroke (within 24 hours) were consecutively allocated to receive placebo (n=100), 1 mg/h (low-dose) nimodipine (n=101), or 2 mg/h (high-dose) nimodipine (n=94). The correlation between average BP change during the first 2 days and the outcome at day 21 was analysed. Results-Two hundred sixty-five patients were included in this analysis (n=92, 93, and 80 for placebo, low dose, and high dose. respectively). Nimodipine treatment resulted in a statistically significant reduction in systolic BP (SBP) and diastolic BP (DBP) from baseline compared with placebo during the first few days. In multivariate analysis, a significant correlation between DBP reduction and worsening of the neurological score was round for the high-close group (beta=0.49, P=0.048). Patients with a DBP reduction of greater than or equal to 20% in the high-dose group had a significantly increased adjusted OR for the compound outcome variable death or dependency (Barthel Index <60) (n/N=25/26, OR 10.16, 95% CI 1.02 to 101.74) and death alone (n/N=9/26, OR 4.3361 95% CI 1.131 16.619) compared with all placebo patients (n/N=62/92 and 14/92. respectively). There was no correlation between SEP change and outcome. Conclusions-DBP, but not SEP, reduction was associated with neurological worsening after the intravenous administration of high-dose nimodipine after acute stroke. For low-dose nimodipine, the results were not conclusive. These results do not confirm or exclude a neuroprotective property of nimodipine.

sted, utgiver, år, opplag, sider
2000. Vol. 31, nr 6, s. 1250-1255
Emneord [en]
blood pressure, cerebral ischemia, nimodipine, stroke, acute, acute ischemic stroke, cerebrovascular-disease, cerebral infarction, glucose-metabolism, controlled trial, hypertension, flow, thresholds, tomography, treat
Identifikatorer
URN: urn:nbn:se:kth:diva-19793ISI: 000087335200008OAI: oai:DiVA.org:kth-19793DiVA, id: diva2:338485
Merknad
QC 20100525Tilgjengelig fra: 2010-08-10 Laget: 2010-08-10 Sist oppdatert: 2017-12-12bibliografisk kontrollert
Inngår i avhandling
1. Risk, Risk Analysis and Decision-making with Reference to Biostatistics and the Field of Medicine
Åpne denne publikasjonen i ny fane eller vindu >>Risk, Risk Analysis and Decision-making with Reference to Biostatistics and the Field of Medicine
2010 (engelsk)Doktoravhandling, med artikler (Annet vitenskapelig)
Abstract [en]

Risk, risk analysis and decision-making are essential aspects of health care andmedicine, for patients as well as for physicians and for society as a whole, andthe concept of risk and risk analysis in decision-making has a long history. Theword risk has many different interpretations and has no commonly accepteddefinition. In this thesis, we shall let risk stand for the combination of randomor uncertain events with negative consequences for human health, life and/orwelfare and/or the environment together with some measures of the likelihoodof such events. We believe this is the dominant concept and understanding ofrisk, the risk being the likelihood or probability of an event followed by somenegative consequences or activities of that event.

In this doctoral thesis, we focus on biostatistics, risks and risk analysis in thefield of medicine, a science which has been using methods from the area of riskanalysis for a long time. The seven papers (paper I - paper VII) presented inthis thesis, together with a general introduction to risk, risk analysis anddecision-making, will be used to illustrate and discuss risk analysis as a tool fordecision-making in the field of medicine. From my point a view, risk analysisin the field of medicine aims to reduce pain, raise the quality of life, reduce therisk of adverse events, compare cost efficiency between different treatmentregimes and prolong a healthy life. Based on results presented in the thesis, weconclude that biostatistics, risks and risk analysis used in the field of medicineare valuable methods for evaluation of hypotheses within the health care areaand a good basis for decision-making.

sted, utgiver, år, opplag, sider
Stockholm: KTH Royal Institute of Technology, 2010. s. 51
Serie
TRITA-TEC-PHD, ISSN 1653-4468 ; 10:004
Emneord
risk analysis, risk, consequence, system, biostatistics, decision, decision-making, health care, medicine
HSV kategori
Identifikatorer
urn:nbn:se:kth:diva-24304 (URN)978-91-85539-62-8 (ISBN)
Disputas
2010-09-15, F3, Lindstedtsvägen 26, KTH, Stockholm, 10:15 (engelsk)
Opponent
Veileder
Merknad

QC 20100901

Tilgjengelig fra: 2010-09-01 Laget: 2010-09-01 Sist oppdatert: 2017-02-22bibliografisk kontrollert

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