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Acute treatment of stroke (except thrombectomy) (2018)
Journal Article
Venturelli, P. M., Appleton, J. P., Anderson, C. S., & Bath, P. M. (2018). Acute treatment of stroke (except thrombectomy). Current Neurology and Neuroscience Reports, 18(11), doi:10.1007/s11910-018-0883-x

Purpose of Review: The management of patients with acute stroke has been revolutionized in recent years with the advent of new effective treatments. In this rapidly evolving field, we provide an update on the management of acute stroke excluding thro... Read More about Acute treatment of stroke (except thrombectomy).

Impact of hydration status on haemodynamics, effects of acute blood pressure lowering treatment, and prognosis after stroke (2018)
Journal Article
Billington, C. K., Appleton, J. P., Berge, E., Sprigg, N., Glover, M., & Bath, P. M. (2018). Impact of hydration status on haemodynamics, effects of acute blood pressure lowering treatment, and prognosis after stroke. British Journal of Clinical Pharmacology, 84(12), 2914-2922. https://doi.org/10.1111/bcp.13761

Background High blood pressure (BP) is common in acute stroke and associated with poor outcome, but the Efficacy of Nitric Oxide in Stroke (ENOS) trial showed no beneficial effect of antihypertensive treatment in this situation. Antihypertensive a... Read More about Impact of hydration status on haemodynamics, effects of acute blood pressure lowering treatment, and prognosis after stroke.

Triple versus guideline antiplatelet therapy to prevent recurrence after acute ischaemic stroke or transient ischaemic attack: The TARDIS RCT (2018)
Journal Article
Bath, P. M., Woodhouse, L. J., Appleton, J. P., Beridze, M., Christensen, H., Dineen, R. A., …Sprigg, N. (2018). Triple versus guideline antiplatelet therapy to prevent recurrence after acute ischaemic stroke or transient ischaemic attack: The TARDIS RCT. Health Technology Assessment, 22(48), 1-75. https://doi.org/10.3310/hta22480

© Queen’s Printer and Controller of HMSO 2018. Background: Two antiplatelet agents are better than one for preventing recurrent stroke after acute ischaemic stroke or transient ischaemic attack (TIA). Therefore, intensive treatment with three agents... Read More about Triple versus guideline antiplatelet therapy to prevent recurrence after acute ischaemic stroke or transient ischaemic attack: The TARDIS RCT.

Consent procedures and relationship with outcome in the Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial-2 (RIGHT-2) (2018)
Conference Proceeding
Scutt, P., Dixon, M., Appleton, J. P., Howard, H., Havard, D., Woodhouse, L. J., & Bath, P. M. (2018). Consent procedures and relationship with outcome in the Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial-2 (RIGHT-2).

Background: Obtaining consent in emergency situations is challenging. Proxy consent allows patients to be recruited when they lack capacity, a common scenario in stroke patients. The rapid intervention with glyceryl trinitrate in hypertensive stroke... Read More about Consent procedures and relationship with outcome in the Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial-2 (RIGHT-2).

Impact of atrial fibrillation diagnosis or carotid enderterectomy requirement on outcome in patients from the triple antiplatelets for reducing dependency after ischaemic stroke (TARDIS) trial (2018)
Conference Proceeding
Woodhouse, L. J., Appleton, J. P., Flaherty, K., Dineen, R. A., Sprigg, N., & Bath, P. M. (2018). Impact of atrial fibrillation diagnosis or carotid enderterectomy requirement on outcome in patients from the triple antiplatelets for reducing dependency after ischaemic stroke (TARDIS) trial.

Serum amyloid protein is associated with outcome following acute ischaemic stroke: data from the REmote ischaemic Conditioning After Stroke Trial (RECAST) (2018)
Conference Proceeding
Appleton, J. P., Hedstrom, A., O'Sullivan, S., May, J., Sprigg, N., Bath, P. M., & England, T. J. (2018). Serum amyloid protein is associated with outcome following acute ischaemic stroke: data from the REmote ischaemic Conditioning After Stroke Trial (RECAST).

Background: Remote ischaemic per-conditioning (RIC) in experimental ischaemic stroke is neuroprotective. Several neurohumoral, vascular and inflammatory mediators are implicated. Methods: The REmote ischaemic Conditioning After Stroke Trial (RECAS... Read More about Serum amyloid protein is associated with outcome following acute ischaemic stroke: data from the REmote ischaemic Conditioning After Stroke Trial (RECAST).

Results from the tranexamic acid for primary intracerebral haemorrhage-2 (TICH-2) trial (2018)
Conference Proceeding
Sprigg, N., Flaherty, K., Law, Z. K., Appleton, J. P., Scutt, P., Krishnan, K., & Bath, P. M. (2018). Results from the tranexamic acid for primary intracerebral haemorrhage-2 (TICH-2) trial.

Background: Haematoma expansion leads to worse outcome in intracerebral haemorrhage (ICH). Tranexamic acid (TXA) is a promising haemostatic agent to prevent haematoma expansion and improve outcome after ICH. Methods: TICH-2 is a multicentre prospect... Read More about Results from the tranexamic acid for primary intracerebral haemorrhage-2 (TICH-2) trial.

Platelet and haemoglobin levels in patients on isosorbide mononitrate and/or cilostazol with lacunar ischaemic stroke: data from the LACI-1 trial (2018)
Conference Proceeding
Appleton, J. P., Flaherty, K., Blair, G. W., Law, Z. K., Doubal, F., Sprigg, N., …Wardlaw, J. M. (2018). Platelet and haemoglobin levels in patients on isosorbide mononitrate and/or cilostazol with lacunar ischaemic stroke: data from the LACI-1 trial.

Background: Cilostazol and isosorbide mononitrate (ISMN) have properties that may be of benefit in the context of cerebral small vessel disease and lacunar ischaemic stroke. As both drugs may influence platelet and haemoglobin levels, we sought to as... Read More about Platelet and haemoglobin levels in patients on isosorbide mononitrate and/or cilostazol with lacunar ischaemic stroke: data from the LACI-1 trial.

Tranexamic acid for hyperacute primary IntraCerebral Haemorrhage (TICH-2): an international randomised, placebo-controlled, phase 3 superiority trial (2018)
Journal Article
Sprigg, N., Flaherty, K., Appleton, J. P., Al-Shahi Salman, R., Bereczki, D., Beridze, M., …Bath, P. M. (2018). Tranexamic acid for hyperacute primary IntraCerebral Haemorrhage (TICH-2): an international randomised, placebo-controlled, phase 3 superiority trial. Lancet, 391(10135), 2107-2115. https://doi.org/10.1016/S0140-6736%2818%2931033-X

Background Tranexamic acid (TXA) reduces death due to bleeding after trauma and post-partum haemorrhage. The aim was to assess if tranexamic acid reduces haematoma expansion and improves outcome in adults with stroke due to intracerebral 6 haemorrha... Read More about Tranexamic acid for hyperacute primary IntraCerebral Haemorrhage (TICH-2): an international randomised, placebo-controlled, phase 3 superiority trial.

Characteristics and outcomes of patients with or without a bleeding event: results from the triple antiplatelets for reducing dependency in ischaemic stroke (TARDIS) trial (2018)
Conference Proceeding
Woodhouse, L. J., Flaherty, K., Appleton, J. P., Sprigg, N., & Bath, P. M. (2018). Characteristics and outcomes of patients with or without a bleeding event: results from the triple antiplatelets for reducing dependency in ischaemic stroke (TARDIS) trial.

Background: Several studies showed that hyperglycaemia is associated with poorer prognosis in intracerebral haemorrhage. We explored the characteristics and outcomes of patients with hyperglycaemia in the Tranexamic acid in IntraCerebral Haemorrhage-... Read More about Characteristics and outcomes of patients with or without a bleeding event: results from the triple antiplatelets for reducing dependency in ischaemic stroke (TARDIS) trial.

Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial-2 (RIGHT-2): safety and efficacy of transdermal glyceryl trinitrate, a nitric oxide donor, and of the feasibility of a multicentre ambulance-based stroke trial (2018)
Conference Proceeding
Dixon, M., Appleton, J. P., Scutt, P., England, T., Havard, D., Howard, H., …Bath, P. M. (2018). Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial-2 (RIGHT-2): safety and efficacy of transdermal glyceryl trinitrate, a nitric oxide donor, and of the feasibility of a multicentre ambulance-based stroke trial.

The effect of transdermal glyceryl trinitrate in acute stroke patients with carotid stenosis: data from the Efficacy of Nitric Oxide in Stroke trial (2018)
Conference Proceeding
Appleton, J., Woodhouse, L., Law, Z., Sprigg, N., & Bath, P. (2018). The effect of transdermal glyceryl trinitrate in acute stroke patients with carotid stenosis: data from the Efficacy of Nitric Oxide in Stroke trial.

Background: There is concern that blood pressure lowering in acute stroke may compromise cerebral perfusion and worsen outcome in the context of carotid stenosis. The effect of glyceryl trinitrate (GTN) on outcome in acute stroke patients with caroti... Read More about The effect of transdermal glyceryl trinitrate in acute stroke patients with carotid stenosis: data from the Efficacy of Nitric Oxide in Stroke trial.

Statistical analysis plan for the ‘Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial-2 (RIGHT-2)’ (2018)
Journal Article
Scutt, P., Appleton, J. P., Dixon, M., Woodhouse, L. J., Sprigg, N., Wardlaw, J. M., …Bath, P. M. (2018). Statistical analysis plan for the ‘Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial-2 (RIGHT-2)’. European Stroke Journal, 3(2), 193-196. https://doi.org/10.1177/2396987318756696

Rationale: Glyceryl trinitrate, a nitric oxide donor, is a candidate treatment for acute stroke; it lowers blood pressure, does not alter cerebral blood flow or platelet function and is neuroprotective in experimental stroke. The ongoing rapid interv... Read More about Statistical analysis plan for the ‘Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial-2 (RIGHT-2)’.

Antiplatelet therapy with aspirin, clopidogrel, and dipyridamole versus clopidogrel alone or aspirin and dipyridamole in patients with acute cerebral ischaemia (TARDIS): a randomised, open-label, phase 3 superiority trial (2017)
Journal Article
Bath, P. M., Christensen, L. M., Woodhouse, L. J., Bentsen, L., Appleton, J. P., Krarup Hansen, C., …Farren, P. (2018). Antiplatelet therapy with aspirin, clopidogrel, and dipyridamole versus clopidogrel alone or aspirin and dipyridamole in patients with acute cerebral ischaemia (TARDIS): a randomised, open-label, phase 3 superiority trial. Lancet, 391(10123), 850-859. https://doi.org/10.1016/S0140-6736%2817%2932849-0

Background: Intensive antiplatelet therapy with three agents might be more effective than guideline treatment for preventing recurrent events in patients with acute cerebral ischaemia. We aimed to compare the safety and efficacy of intensive antiplat... Read More about Antiplatelet therapy with aspirin, clopidogrel, and dipyridamole versus clopidogrel alone or aspirin and dipyridamole in patients with acute cerebral ischaemia (TARDIS): a randomised, open-label, phase 3 superiority trial.

TICH-2 Trial – Tranexamic Acid for Intracerebral Haemorrhage 2 (2017)
Conference Proceeding
Sprigg, N., Bath, P. M., Appleton, J., Law, Z., Flaherty, K., Scutt, P., …Ali, A. (2017). TICH-2 Trial – Tranexamic Acid for Intracerebral Haemorrhage 2.

Rationale: To assess in a pragmatic phase III prospective double blind randomised placebo-controlled trial whether tranexamic acid is safe and reduces death or dependency after spontaneous intracerebral haemorrhage (SICH). The results will determine... Read More about TICH-2 Trial – Tranexamic Acid for Intracerebral Haemorrhage 2.

Assessment of consent models as an ethical consideration in the conduct of prehospital ambulance randomised controlled clinical trials: a systematic review (2017)
Journal Article
Armstrong, S., Langlois, A., Laparidou, D., Dixon, M., Appleton, J. P., Bath, P. M., …Siriwardena, A. N. (2017). Assessment of consent models as an ethical consideration in the conduct of prehospital ambulance randomised controlled clinical trials: a systematic review. BMC Medical Research Methodology, 17(1), Article 142. https://doi.org/10.1186/s12874-017-0423-4

Background We sought to understand the main ethical considerations when conducting clinical trials in the prehospital ambulance based setting. Methods A systematic review of the literature on randomised controlled trials in ambulance setting... Read More about Assessment of consent models as an ethical consideration in the conduct of prehospital ambulance randomised controlled clinical trials: a systematic review.