Albumin Treatment for Acute Stroke: An Exercise in Futility?
Albumin Treatment for Acute Stroke: An Exercise in Futility?
Ginsberg MD, Palesch YY, Hill MD, et al; ALIAS and Neurological Emergencies Treatment Trials (NETT) Investigators
Lancet Neurol. 2013;12:1049-1058
Albumin has been suggested in animal models and some human studies to improve outcomes in acute stroke. The authors of this study sought to determine whether hyperoncotic (25%) albumin would improve neurologic function after stroke.
In this study, 422 patients with acute stroke in multiple countries were randomly assigned to receive either 2 g/kg of 25% albumin or the equivalent volume of normal saline. The study intended to enroll more participants, but was stopped early for futility: There was no difference in outcomes between the 2 groups, in terms of the primary outcome of Rankin score or National Institutes of Health Stroke Scale score at 90 days.
Pulmonary edema was more common in albumin-treated patients, as was symptomatic intracranial hemorrhage within 24 hours. The authors concluded that there is no clinical benefit to 25% albumin therapy in patients with acute stroke.
Recovery from stroke remains a difficult part of clinical management, and unfortunately this fluid-based therapy failed to improve outcomes.
The suggested mechanisms of reducing brain edema or improving inflammation and oxidative stress were insufficient to increase overall neurologic recovery. Although the side effect of pulmonary edema is troublesome, it is the more frequent occurrence of intracranial hemorrhage in the albumin-treated patients that may have limited the chance of improvement in neurologic recovery.
Abstract
High-Dose Albumin Treatment for Acute Ischaemic Stroke (ALIAS) Part 2: A Randomised, Double-Blind, Phase 3, Placebo-Controlled Trial
Ginsberg MD, Palesch YY, Hill MD, et al; ALIAS and Neurological Emergencies Treatment Trials (NETT) Investigators
Lancet Neurol. 2013;12:1049-1058
Summary
Albumin has been suggested in animal models and some human studies to improve outcomes in acute stroke. The authors of this study sought to determine whether hyperoncotic (25%) albumin would improve neurologic function after stroke.
In this study, 422 patients with acute stroke in multiple countries were randomly assigned to receive either 2 g/kg of 25% albumin or the equivalent volume of normal saline. The study intended to enroll more participants, but was stopped early for futility: There was no difference in outcomes between the 2 groups, in terms of the primary outcome of Rankin score or National Institutes of Health Stroke Scale score at 90 days.
Pulmonary edema was more common in albumin-treated patients, as was symptomatic intracranial hemorrhage within 24 hours. The authors concluded that there is no clinical benefit to 25% albumin therapy in patients with acute stroke.
Viewpoint
Recovery from stroke remains a difficult part of clinical management, and unfortunately this fluid-based therapy failed to improve outcomes.
The suggested mechanisms of reducing brain edema or improving inflammation and oxidative stress were insufficient to increase overall neurologic recovery. Although the side effect of pulmonary edema is troublesome, it is the more frequent occurrence of intracranial hemorrhage in the albumin-treated patients that may have limited the chance of improvement in neurologic recovery.
Abstract
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