Metoclopramide to Prevent Pneumonia in Patients With Stroke and a Nasogastric Tube: Data From the PRECIOUS Trial.

Autor:	Sluis WM; Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, Utrecht University, the Netherlands (W.M.S., J.C.d.J., H.R., H.B.v.d.W.)., de Jonge JC; Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, Utrecht University, the Netherlands (W.M.S., J.C.d.J., H.R., H.B.v.d.W.)., Reinink H; Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, Utrecht University, the Netherlands (W.M.S., J.C.d.J., H.R., H.B.v.d.W.)., Woodhouse LJ; Stroke Trials Unit, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, United Kingdom (L.J.W., P.M.B.)., Westendorp WF; Department of Neurology, Amsterdam University Medical Center, Amsterdam Neuroscience, the Netherlands (W.F.W., D.v.d.B.)., Bath PM; Stroke Trials Unit, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, United Kingdom (L.J.W., P.M.B.)., van de Beek D; Department of Neurology, Amsterdam University Medical Center, Amsterdam Neuroscience, the Netherlands (W.F.W., D.v.d.B.)., van der Worp HB; Department of Neurology and Neurosurgery, Brain Center, University Medical Center Utrecht, Utrecht University, the Netherlands (W.M.S., J.C.d.J., H.R., H.B.v.d.W.).
Jazyk:	angličtina
Zdroj:	Stroke [Stroke] 2024 Oct; Vol. 55 (10), pp. 2402-2408. Date of Electronic Publication: 2024 Aug 12.
DOI:	10.1161/STROKEAHA.124.047582
Abstrakt:	Background: A randomized trial suggested that treatment with metoclopramide reduces the risk of pneumonia in patients with acute stroke and a nasogastric tube. We assessed whether this finding could be replicated in a post hoc analysis of the randomized PRECIOUS trial (Prevention of Complications to Improve Outcome in Elderly Patients With Acute Stroke). Methods: PRECIOUS was an international, 3×2 partial-factorial, randomized controlled, open-label clinical trial with blinded outcome assessment assessing preventive treatment with metoclopramide, paracetamol, and ceftriaxone in patients aged ≥66 years with acute ischemic stroke or intracerebral hemorrhage and a National Institutes of Health Stroke Scale score ≥6. In the present study, we analyzed patients who had a nasogastric tube within 24 hours after randomization. Patients who were allocated to metoclopramide (10 mg TID) were compared with patients who were not. Treatment was started within 24 hours after symptom onset and continued for 4 days or until discharge if earlier. The primary outcome was pneumonia in the first week after stroke. The score on the modified Rankin Scale after 90 days was a secondary outcome and analyzed with ordinal logistic regression. Results: From April 2016 through June 2022, a total of 1493 patients were enrolled with 1376 included in this analysis, of whom 1185 (86%) had ischemic stroke and 191 (14%) had intracerebral hemorrhage. The first day after randomization, 329 (23.9%) patients had a nasogastric tube, of whom 156 were allocated to metoclopramide and 173 to standard care. Metoclopramide was not associated with a reduction of pneumonia (41.0% versus 35.8%; adjusted odds ratio, 1.35 [95% CI, 0.79-2.30]) or with poor functional outcome (adjusted odds ratio, 1.07 [95% CI, 0.71-1.61]). Conclusions: In patients with stroke who had a nasogastric tube shortly after stroke onset, metoclopramide for 4 days did not reduce pneumonia or have an effect on the functional outcome. Competing Interests: Drs Sluis, de Jonge, and Reinink all report grants from the European Union, all paid to their institution. Dr Bath reports having received grants from the UK National Institutes of Health Research and fees as a consultant from CoMind, DiaMedica, Phagenesis, and Roche. In addition, he reports compensation from World Stroke Organisation and the Stroke Association for other services and has stock options in CoMind. Dr van de Beek reports having received research grants from the European Union, The Netherlands Organisation for Health Research and Development, ItsMe Foundation, AMC Foundation, and Roche, none related. Dr van der Worp reports having received grants from the European Union, the Dutch Heart Foundation, and Stryker for research and funding for consultancy from Bayer and TargED, all paid to his institution. The other authors report no conflicts.
Databáze:	MEDLINE
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