EXTEND was stopped early after WAKE-UP was published due to “lack of clinical equipoise.”
Interesting. Let’s read WAKE-UP then, I thought.
Traditionally, systemic tPA has been reserved for patients with ischemic stroke who can be confirmed to have had onset of symptoms within the last 4.5 hours.
These results are published, and EXTEND stops enrolling patients. What was EXTEND studying?
To investigate this, they enrolled people who were 4.5-9 hours from symptom onset, or who woke up with symptoms and the midpoint of their sleep was within 9 hours.
Was this what WAKE-UP studied? No! Should the results of WAKE-UP ever affect EXTEND? No!
And yet. 😑 #crazypills
I go back to my life. A couple of days pass, and then I stumble across this...
But even after saying that, it again says an important barrier has been *shattered!*
What worries me is that with headlines like “shattered tPA window” that folks may consider changing their practice.
Am I misinterpreting the data?
Are my worries overstated?
Will these trials change your practice or practice at your shop?