Three Considerations Should Certainly Be Asked Regarding TRIB1

To observe an absolute reduction of 10% in the rate of poor outcomes, a mean difference of greater than 3 ml may be required between the intensive and standard Selleckchem ZD6474 BP treatment groups which was seen in INTERACT I if analysis confined to only patients recruited within 4 h of symptom onset (3.4 ml) similar to ATACH II. Summary INTRERACT II as a definitive trial The writing group considered the results as hypothesis generating but not compelling to change standard of care based on the following observations: Statistical significance was not achieved in primary analysis and the impact was further reduced after adjustment for confounders such as NIHSS score, hematoma volume, and IVH. Statistical significance was achieved in secondary analysis, but not after adjustment for confounders such as National Institutes of Health Stroke Scale (NIHSS) score, hematoma volume, and IVH. Intensive SBP reduction as applied in INTERACT II resulted in benefit of small magnitude with no effect on hematoma expansion. Similarly, the benefit was of small magnitude (absolute benefit of 3.6%) on rate of severe disability and death. Antihypertensive treatment in the intensive see more SBP reduction group did not achieve the target SBP value of less than 140 mm Hg in a large proportion of patients. The risk benefit profile maybe different with greater magnitude of SBP reduction if implemented into clinical practice. There is discordance between the proposed and observed therapeutic benefit of intensive SBP reduction in INTERACT II. The lack of early reduction in hematoma expansion (at 24 h) and death and disability (both at 7 days or 1 month) in subjects randomized to intensive SBP reduction suggests possible therapeutic effect of variable impact on other differences TRIB1 in treatment groups such as post-24-h SBP reduction. The safety or benefit of intensive SBP reduction was not tested in patients with large volumes hemotomas; a group most likely at risk for global cerebral perfusion compromise due to high ICP. The lack of a clear cut off for hematoma size in INTRERACT II prevents implementation of a reproducible method to exclude such patients in clinical practice. Without a more focused therapeutic measure, such as the one adopted by ATACH II in which only IV nicardioie is the antihypertensive therapy, it is difficult to define the most optimal antihyptersensive therapy based on INTERACT II findings. Implications for ATACH II trial The ATACH II writing group identified certain aspects of trial design and conduct to be implemented or monitored in the ATACH II trial. These are summarized below: Efforts are undertaken to ensure that intensive SBP reduction meets the SBP goals (