Magnesium given at stroke onset didn’t improve functional outcomes
BY MICHELE G. SULLIVAN
FROM THE NEW ENGLAND JOURNAL OF MEDICINE
Magnesium sulfate infused within 2 hours of stroke symptom onset failed to improve clinical outcomes, according to results from the randomized, placebo-controlled Field Administration of Stroke Therapy-Magnesium (FAST-MAG) trial.
The drug did not shift functional outcomes at 3 months in FAST-MAG to a more favorable distribution nor, in secondary endpoints, did it change outcome scores as measured by the modified Rankin Scale or National Institutes of Health Stroke Scale.
Vitals Key clinical point: Magnesium infusion soon after stroke onset did not improve functional outcomes at 3 months. Major finding: At 3 months, a little more than half of the magnesium and placebo groups had a modified Rankin Scale score of 2 or lower and about 65% of each group had a National Institutes of Health Stroke Scale score of 8 or lower. Data source: The randomized, placebo-controlled FAST-MAG trial of 1,700 patients with suspected stroke. Disclosures: The study was funded by the National Institute of Neurological Disorders and Stroke. Dr. Saver has served as an unpaid consultant on a number of trials conducted by pharmaceutical companies. He had no other financial declarations with regard to the FAST-MAG study. |
At 3 months, a little more than half of each group had a modified Rankin Scale score of 2 or lower and about 65% of each group had a National Institutes of Health Stroke Scale score of 8 or lower, both of which indicate good functional recovery. About 15% of each group had died, Dr. Jeffrey L. Saver and his colleagues reported (N. Engl. J. Med. 2015;372:528-36).
The trial randomized 1,700 patients with suspected ischemic stroke to either magnesium sulfate or placebo infusions while en route to a hospital in an emergency vehicle.
In animal models of stroke, magnesium sulfate has been shown to exert vasodilatory and direct neuroprotective and glioprotective effects, said Dr. Saver, director of the clinical stroke program at the University of California, Los Angeles, and his coauthors.
Slow transport of magnesium across the blood-brain barrier may explain why FAST-MAG didn’t replicate these earlier findings. Magnesium levels in the cerebrospinal fluid peak 4 hours after parenteral administration in the presence of an intact blood-brain barrier and more quickly in regions of focal ischemia where the blood-brain barrier is disrupted. Despite a rapid increase in serum levels, brain tissue levels may not have risen quickly enough to yield a benefit, the researchers speculated.
msullivan@frontlinemedcom.com
Glucose level may predict mortality in acute heart failure
BY MARY ANN MOON
FROM THE EUROPEAN HEART JOURNAL
Blood glucose level may predict 30-day mortality in adults who present with acute heart failure, regardless of whether the patients have preexisting diabetes, based on a study by Dr. Maneesh Sud of the University of Toronto and his associates.
Hyperglycemia occurs in up to 40% of acute heart failure patients. If prognostic, blood glucose levels at ED presentation “may serve as a screen to identify high-risk patients who warrant formal testing for diabetes, allowing for prompt referral to prevent further morbidity and mortality,” the researchers said.
Vitals Key clinical point: A high glucose level at presentation for acute heart failure may identify patients at increased risk for death within 30 days. Major finding: Regardless of a preexisting diagnosis of diabetes, risk of death at 30 days was about 1.5 times higher in acute heart failure patients who had blood glucose levels exceeding 11.1 mmol/L at presentation in the emergency department. Data source: A secondary analysis of data from two population-based cohorts comprising 16,524 patients. Disclosures: This study was supported by the Canadian Institutes of Health Research and the Heart and Stroke Foundation of Ontario. Dr. Sud and his associates reported having no relevant financial disclosures. |
The researchers analyzed data from two large population-based cohorts of patients hospitalized for acute HF during a 3-year period. Of the 16,524 patients, 44% had preexisting diabetes (Eur. Heart J. 2015 [doi:10.1093/eurheartj/ehu462].
Among patients with established diabetes, a blood glucose level exceeding 11.1 mmol/L was associated with significantly increased all-cause 30-day mortality with a hazard ratio (HR) of 1.48. Among patients without established diabetes, a blood glucose level exceeding 6.1 mmol/L increased all-cause 30-day mortality with an HR of 1.26; that risk rose in a dose-dependent fashion with increasing glucose levels and reached 1.5 at the level of 11.1 mmol/L.
In severe trauma, 1:1:1 transfusion protocol linked to less exsanguination
BY MARY ANN MOON
FROM JAMA
Among profoundly injured trauma patients with major bleeding, early (24 hour) and late (30 day) mortality were similar between those who received transfusions of plasma, platelets, and red blood cells in a 1:1:1 ratio and those who received transfusions in a 1:1:2 ratio in a phase III clinical trial of 680 adults.