Search

Your search keyword '"Levine, Steven R."' showing total 1,097 results
Start Over Author "Levine, Steven R."
1,097 results on '"Levine, Steven R."'

205. Combined Approach to Lysis Utilizing Eptifibatide and rt-PA in Acute Ischemic Stroke-Full Dose Regimen (CLEAR-FDR Stroke Trial)

Author

Adeoye, Opeolu, Sucharew, Heidi, Khoury, Jane, Vagal, Achala, Schmit, Pamela A., Ewing, Irene, Levine, Steven R., Demel, Stacie, Eckerle, Bryan, Katz, Brian, Kleindorfer, Dawn, Stettler, Brian, Woo, Daniel, Khatri, Pooja, Broderick, Joseph P., and Pancioli, Arthur M.

Subjects
Adult, Aged, 80 and over, Male, Eptifibatide, Middle Aged, Article, Brain Ischemia, Stroke, Treatment Outcome, Fibrinolytic Agents, Tissue Plasminogen Activator, Humans, Drug Therapy, Combination, Female, Thrombolytic Therapy, Peptides, Platelet Aggregation Inhibitors, Aged, Cerebral Hemorrhage
Abstract

The Combined Approach to Lysis Utilizing Eptifibatide and Recombinant Tissue-Type Plasminogen Activator (r-tPA; CLEAR) in Acute Ischemic Stroke (AIS) and CLEAR-Enhanced Regimen (CLEAR-ER) trials demonstrated safety of reduced dose r-tPA plus the glycoprotein 2b/3a inhibitor, eptifibatide, in AIS compared with r-tPA alone. The objective of the CLEAR-Full Dose Regimen (CLEAR-FDR) trial was to estimate the rate of symptomatic intracerebral hemorrhage (sICH) in AIS patients treated with the combination of full-dose r-tPA plus eptifibatide.CLEAR-FDR was a single-arm, prospective, open-label, multisite study. Patients aged 18 to 85 years treated with 0.9 mg/kg IV r-tPA within 3 hours of symptom onset were enrolled. After obtaining consent, eptifibatide (135 μg/kg bolus and 2-hour infusion at 0.75 μg/kg per minute) was administered. The primary end point was the proportion of patients who experienced sICH within 36 hours. An independent clinical monitor adjudicated if an sICH had occurred and an independent neuroradiologist reviewed all images. The stopping rule was 3 sICHs within the first 19 patients or 4 sICHs within 29 patients.From October 2013 to December 2014, 27 patients with AIS were enrolled. Median age was 73 years (range, 34-85; interquartile range, 65-80) and median National Institute of Health stroke scale score was 12 (range, 6-26; interquartile range, 9-16). One sICH (3.7%; 95% confidence interval, 0.7%-18%) was observed.These results demonstrate comparable safety of full-dose r-tPA plus eptifibatide with historical rates of sICH with r-tPA alone and support proceeding with a phase 3 trial evaluating full-dose r-tPA combined with eptifibatide to improve outcomes after AIS.

Published
2015

214. Abstract WP248: Comparison of Large Vessel Occlusion Prediction Scores

Author

Gropen, Toby, primary, Boehme, Amelia, additional, Martin-Schild, Sheryl, additional, Albright, Karen, additional, Perrin, Brian, additional, Samai, Alyana, additional, Pishanidar, Sammy, additional, Janjua, Nazli, additional, Levine, Steven R, additional, Brandler, Ethan S, additional, and Rosenbaum, Dov, additional

Published
2016
Full Text
View/download PDF

217. Effect of Alteplase vs Aspirin on Functional Outcome for Patients With Acute Ischemic Stroke and Minor Nondisabling Neurologic Deficits: The PRISMS Randomized Clinical Trial.

Author

Khatri, Pooja, Kleindorfer, Dawn O., Devlin, Thomas, Sawyer, Robert N., Starr, Matthew, Mejilla, Jennifer, Broderick, Joseph, Chatterjee, Anjan, Jauch, Edward C., Levine, Steven R., Romano, Jose G., Saver, Jeffrey L., Vagal, Achala, Purdon, Barbara, Devenport, Jenny, Pavlov, Andrey, Yeatts, Sharon D., Sawyer, Robert N Jr, and PRISMS Investigators

Subjects
THERAPEUTIC use of fibrinolytic agents, FIBRINOLYTIC agents, ASPIRIN, CEREBRAL ischemia, COMPARATIVE studies, INTRAVENOUS therapy, RESEARCH methodology, MEDICAL care, MEDICAL cooperation, NEUROLOGICAL disorders, ORAL drug administration, PATIENTS, PROBABILITY theory, RESEARCH, STROKE, EVALUATION research, TISSUE plasminogen activator, RANDOMIZED controlled trials, TREATMENT effectiveness, BLIND experiment, SEVERITY of illness index, DISEASE complications, THERAPEUTICS
Abstract

Importance: More than half of patients with acute ischemic stroke have minor neurologic deficits (National Institutes of Health Stroke Scale [NIHSS] score of 0-5) at presentation. Although prior major trials of alteplase included patients with low NIHSS scores, few without clearly disabling deficits were enrolled.Objective: To evaluate the efficacy and safety of alteplase in patients with NIHSS scores of 0 to 5 whose deficits are not clearly disabling.Design, Setting, and Participants: The PRISMS trial was designed as a 948-patient, phase 3b, double-blind, double-placebo, multicenter randomized clinical trial of alteplase compared with aspirin for emergent stroke at 75 stroke hospital networks in the United States. Patients with acute ischemic stroke whose deficits were scored as 0 to 5 on the NIHSS and judged not clearly disabling and in whom study treatment could be initiated within 3 hours of onset were eligible and enrolled from May 30, 2014, to December 20, 2016, with final follow-up on March 22, 2017.Interventions: Participants were randomized to receive intravenous alteplase at the standard dose (0.9 mg/kg) with oral placebo (n = 156) or oral aspirin, 325 mg, with intravenous placebo (n = 157).Main Outcomes and Measures: The primary outcome was the difference in favorable functional outcome, defined as a modified Rankin Scale score of 0 or 1 at 90 days via Cochran-Mantel-Haenszel test stratified by pretreatment NIHSS score, age, and time from onset to treatment. Because of early termination of the trial, prior to unblinding or interim analyses, the plan was revised to examine the risk difference of the primary outcome by a linear model adjusted for the same factors. The primary safety end point was symptomatic intracranial hemorrhage (sICH) within 36 hours of intravenous study treatment.Results: Among 313 patients enrolled at 53 stroke networks (mean age, 62 [SD, 13] years; 144 [46%] women; median NIHSS score, 2 [interquartile range {IQR}, 1-3]; median time to treatment, 2.7 hours [IQR, 2.1-2.9]), 281 (89.8%) completed the trial. At 90 days, 122 patients (78.2%) in the alteplase group vs 128 (81.5%) in the aspirin group achieved a favorable outcome (adjusted risk difference, -1.1%; 95% CI, -9.4% to 7.3%). Five alteplase-treated patients (3.2%) vs 0 aspirin-treated patients had sICH (risk difference, 3.3%; 95% CI, 0.8%-7.4%).Conclusions and Relevance: Among patients with minor nondisabling acute ischemic stroke, treatment with alteplase vs aspirin did not increase the likelihood of favorable functional outcome at 90 days. However, the very early study termination precludes any definitive conclusions, and additional research may be warranted.Trial Registration: ClinicalTrials.gov Identifier: NCT02072226. [ABSTRACT FROM AUTHOR]

Published
2018
Full Text
View/download PDF

218. Strokes with Minor Symptoms: An Exploratory Analysis of the NINDS rt-PA Trials

Author

Khatri, Pooja, Kleindorfer, Dawn O, Yeatts, Sharon D, Saver, Jeffrey L., Levine, Steven R., Lyden, Patrick, Moomaw, Charles J., Palesch, Yuko Y, Jauch, Edward, and Broderick, Joseph P

Subjects
Male, Middle Aged, Severity of Illness Index, Article, Recombinant Proteins, United States, Stroke, Disability Evaluation, Treatment Outcome, Tissue Plasminogen Activator, Humans, Female, National Institute of Neurological Disorders and Stroke (U.S.), Cognition Disorders, Aged, Retrospective Studies
Abstract

The pivotal National Institute of Neurological Disorders and Stroke recombinant tissue plasminogen activator trials excluded patients with ischemic stroke with specific minor presentations or rapidly improving symptoms. The recombinant tissue plasminogen activator product label notes that its use for minor neurological deficit or rapidly improving stroke symptoms has not been evaluated. As a result, patients with low National Institutes of Health Stroke Scale scores are not commonly treated in clinical practice. We sought to further characterize the patients with minor stroke who were included in the National Institute of Neurological Disorders and Stroke trials.Minor strokes were defined as National Institutes of Health Stroke Scale score ≤ 5 at baseline for this retrospective analysis, because this subgroup is most commonly excluded from treatment in clinical practice and trials. Clinical stroke syndromes were defined based on prespecified National Institutes of Health Stroke Scale item score clusters. Clinical outcomes were reviewed generally and within these cluster subgroups.Only 58 cases had National Institutes of Health Stroke Scale scores of 0 to 5 in the National Institute of Neurological Disorders and Stroke trials (42 recombinant tissue plasminogen activator and 16 placebo), and 2971 patients were excluded from the trials due to "rapidly improving" or "minor symptoms" as the primary reason. No patients were enrolled with isolated motor symptoms, isolated facial droop, isolated ataxia, dysarthria, isolated sensory symptoms, or with only symptoms/signs not captured by the National Institutes of Health Stroke Scale score (ie, National Institutes of Health Stroke Scale=0). There were ≤ 3 patients with each of the other isolated deficits enrolled in the trial.The National Institute of Neurological Disorders and Stroke trials excluded a substantial number of strokes with minor presentations, those that were included were small in number, and conclusions about outcomes based on specific syndromes cannot be drawn. Further prospective, systematic study of this subgroup is needed.

Published
2010

222. Comparative effectiveness of home blood pressure telemonitoring (HBPTM) plus nurse case management versus HBPTM alone among Black and Hispanic stroke survivors: study protocol for a randomized controlled trial

Author

Spruill, Tanya M, primary, Williams, Olajide, additional, Teresi, Jeanne A, additional, Lehrer, Susan, additional, Pezzin, Liliana, additional, Waddy, Salina P, additional, Lazar, Ronald M, additional, Williams, Stephen K, additional, Jean-Louis, Girardin, additional, Ravenell, Joseph, additional, Penesetti, Sunil, additional, Favate, Albert, additional, Flores, Judith, additional, Henry, Katherine A, additional, Kleiman, Anne, additional, Levine, Steven R, additional, Sinert, Richard, additional, Smith, Teresa Y, additional, Stern, Michelle, additional, Valsamis, Helen, additional, and Ogedegbe, Gbenga, additional

Published
2015
Full Text
View/download PDF

224. Abstract T P202: Implementation of a 24/7 Enrollment Process Improves Recruitment Rate in a Multi-Center, Randomized Clinical Trial

Author

Shen, Loren F, primary, Jacobs, Amber N, additional, Rahbar, Mohammad H, additional, Ford, Gary A, additional, Macdonald, Claire, additional, Piechowski, Bart, additional, Roffe, Christine, additional, Alexandrov, Andrei V, additional, Levine, Steven R, additional, Sangha, Navdeep S, additional, Ajani, Zahra G, additional, Mullen, Michael, additional, Pandurengan, Renganayaki, additional, Grotta, James C, additional, and Barreto, Andrew D, additional

Published
2015
Full Text
View/download PDF

232. Scleroderma

Author

Marchidann, Adrian, primary, Law, Susan W., additional, and Levine, Steven R., additional

Full Text
View/download PDF

245. Combined Approach to Lysis Utilizing Eptifibatide and Recombinant Tissue Plasminogen Activator in Acute Ischemic Stroke–Enhanced Regimen Stroke Trial

Author

Pancioli, Arthur M., primary, Adeoye, Opeolu, additional, Schmit, Pamela A., additional, Khoury, Jane, additional, Levine, Steven R., additional, Tomsick, Thomas A., additional, Sucharew, Heidi, additional, Brooks, Claudette E., additional, Crocco, Todd J., additional, Gutmann, Laurie, additional, Hemmen, Thomas M., additional, Kasner, Scott E., additional, Kleindorfer, Dawn, additional, Knight, William A., additional, Martini, Sharyl, additional, McKinney, James S., additional, Meurer, William J., additional, Meyer, Brett C., additional, Schneider, Alexander, additional, Scott, Phillip A., additional, Starkman, Sidney, additional, Warach, Steven, additional, Broderick, Joseph P., additional, Pancioli, Arthur M., additional, Broderick, Joseph, additional, Janis, Scott, additional, Tomsick, Thomas, additional, Crocco, Todd, additional, Hemmen, Thomas, additional, Schneider, Alex, additional, Levine, Steven, additional, Moy, Claudia, additional, Welch, K. Michael, additional, Tietjen, Gretchen, additional, Clarke, William R., additional, Bonomo, Jordan, additional, McDonough, Erin, additional, Ferioli, Simona, additional, De la Rosa, Felipe de los Rios, additional, Woo, Daniel, additional, Garvin, Rachel, additional, Khatri, Pooja, additional, Gensic, Anna, additional, Flaherty, Matthew, additional, Kanter, Daniel, additional, Kissela, Brett, additional, Stettler, Brian, additional, Mackey, Jason, additional, Cadena, Rhonda, additional, Kohake, Shannon, additional, Heitsch, Laura, additional, Belagaje, Samir, additional, Vagal, Achala, additional, Hallenbeck, John, additional, Benson, Richard, additional, Hsia, Amie, additional, Jaitly, Rakesh, additional, Latour, Lawrence, additional, Lynch, John, additional, Merino, Jose, additional, Menon, Ravi, additional, Freeman, Jason, additional, Magadan, Alejandro, additional, Magaraja, Nandakumar, additional, Jothen, Jennifer, additional, Famakin, Bonanle, additional, Song, Shlee, additional, Katcheves, Alex, additional, Nadareishvili, Zurab, additional, Ritter, Carsen, additional, Barsan, William, additional, Brown, Devin, additional, Morgenstern, Lewis, additional, Silbergleit, Robert, additional, Rajajee, Venkatakrishna, additional, Rusche-Skolarus, Lesli, additional, Burke, Jim, additional, Fletcher, Jeffrey, additional, Adelman, Eric, additional, Wang, Michael, additional, Zahuranec, Darin, additional, Cucchiara, Brett, additional, Messe, Steven, additional, Wilson, Christina, additional, Ishida, Koto, additional, Mullen, Michael, additional, Raser, Jonathan, additional, Pawar, Swaroop, additional, Rose, David, additional, Shafi, Neelofer, additional, Rybinnik, Igor, additional, McGavery, Michael, additional, Beslow, Lauren, additional, Sansing, Lauren, additional, Ali, Latisha, additional, Abcede, Hermelinda, additional, Adamczyk, Peter, additional, Buxton, William, additional, Froehler, Michael, additional, Kim, Doojin, additional, Liebeskind, David, additional, Ovbiagele, Bruce, additional, Porter, Verna, additional, Rao, Neal, additional, Raychev, Radoslav, additional, Song, Sarah, additional, Saver, Jeffrey, additional, Tenser, Matthew, additional, Velani, Shamsha, additional, Yallapragada, Anil, additional, Meyer, Brett, additional, Guzik, Any, additional, Loc, Kiet, additional, Meyer, Dawn, additional, Tafreshi, Gilda, additional, Choe, Jessica, additional, Sodhi, Ajeet, additional, Delaney, Patrick, additional, Evans, Sean, additional, Ghausi, Omar A., additional, Bruce, Nhu, additional, Neil, Will, additional, Huisa, Brank, additional, Stemer, Andrew, additional, Taylor, Reid, additional, Larson, Jeanette, additional, Larson, Seth, additional, Leacock, Rodney, additional, Dash, Subasisni, additional, Eisenstein, Robert, additional, Kapitanyan, Raffi, additional, Paolucci, Ugo, additional, Shah, Chirag, additional, Toe, Win, additional, Brick, John, additional, Lander, Owen, additional, Larrabee, Hollynn, additional, Minardi, Joseph, additional, Tadros, Allison, additional, Tillotson, Roger, additional, Whiteman, Charles, additional, Paulson, Debra, additional, Sikora, Rosanna, additional, Cummings, Christopher, additional, Foster, John, additional, Carrozzella, Janice, additional, Doellman, Traci, additional, Ewing, Irene, additional, Frasure, Jamey, additional, Goodall, Emily, additional, Kimmel, Pamela, additional, Spilker, Judith, additional, Tamer, Robert, additional, Waymeyer, Peggy, additional, Zeigler, Joyce, additional, Davis, Lisa, additional, Farsad, Saman, additional, Morella, Teresa, additional, Kade, Allison, additional, Frederiksen, Shirley, additional, Liz, Mary, additional, Luciano, Jean, additional, Guzy, Judy, additional, Grunberg, Ileana, additional, Rzesiewicz, Teresa, additional, Rapp, Karen, additional, Nanney, Tracy, additional, Shell, Leslie, additional, Perkins, Margaret, additional, Benton, Cindy, additional, Jones, Robin, additional, Hampton, Lynne, additional, Cuento, Claudine, additional, Alosky, Rachel, additional, Shepard, Stephanie, additional, Moccio, Michelle, additional, Albrecht, Catherine, additional, Rosario, Yaritza, additional, Caputo, Deborah, additional, Davis, Stephen, additional, Altemus, Patricia, additional, Power, Martha, additional, VanGilder, Reyna, additional, Sherman, Jay, additional, and Barr, Taura, additional

Published
2013
Full Text
View/download PDF

249. Amino Terminal Pro–B-Type Natriuretic Peptide, Secondary Stroke Prevention, and Choice of Antithrombotic Therapy

Author

Longstreth, W.T., primary, Kronmal, Richard A., additional, Thompson, John L.P., additional, Christenson, Robert H., additional, Levine, Steven R., additional, Gross, Rebecca, additional, Brey, Robin L., additional, Buchsbaum, Richard, additional, Elkind, Mitchell S.V., additional, Tirschwell, David L., additional, Seliger, Stephen L., additional, Mohr, J.P., additional, and deFilippi, Christopher R., additional

Published
2013
Full Text
View/download PDF

Catalog

Books, media, physical & digital resources
See catalog results