Multicenter Acute Stroke Trial I and E

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Conducted in Italy in 1995, the multicenter acute stroke trial (MAST)-I was a randomized, controlled, multicenter, open trial of 622 patients who had stroke onset within 6 hr (20). The subjects were randomized to 1 of 4 groups: 1-hr IV infusion of 1.5 MU streptokinase, 300 mg/day buffered aspirin for 10 days, both streptokinase and aspirin, or neither. Streptokinase (alone or with aspirin) was associated with numerous 10-day case fatalities (odds ratio: 2.7; p < 0.001). Comparison of groups that received streptokinase with those who did not revealed increased rates of symptomatic ICH. Due to the above results, this trial was also stopped early.

The following year, MAST-E was published (21). This was a double-blinded, controlled trial of 310 patients in France and England that assessed the efficacy and safety of administration of streptokinase within 6 hr of ischemic stroke. Noteworthily, the use of anticoagulants or antiplatelets was allowed during the first 24 hr. The primary outcome endpoint was mortality and severe disability (mRS > 3) at 6 months. Almost an equal number of patients (124 vs. 126) in the streptokinase and placebo groups were either dead or severely disabled, respectively. Again, this trial showed that a 10-day mortality rate was higher in the streptokinase group than in the placebo group (34.0% vs. 18.2%; p = 0.002). The results of the MAST-E trial mirrored the MAST-I trial, and it was also halted early.

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