Participants have their medication adjusted to reach the recommended levels for cholesterol and blood pressure, and receive advice about healthy lifestyle. Half of the patients are randomly allocated to have surgery or stenting as soon as possible, and the other half continue on medical treatment alone until such time, if ever, that revascularisation surgery becomes clearly indicated. Participants are seen regularly for several years to check their cholesterol and blood pressure remain on target and to record any surgical complications and the occurrence of strokes or heart attacks.
This study employs a modified continual reassessment method (mCRM) design to estimate the maximum tolerated dose (MTD) of PF-05230907, defined as a target toxicity rate of 15% based on treatment emergent thromboembolic and/or ischemic events (TIEs). The mCRM design utilizes Bayesian methodology to continuously learn the dose-toxicity relationship, which is characterized by a parametric model.
The primary objective of this study is to test the hypothesis that patients with acute hemispheric ischaemic stroke who have a penumbra on perfusion CT or MRI within 4.5 hours of symptom onset will have less disability at 3 months when treated with IV TNK compared to IV tPA.
Participants are randomly allocated to one of three groups. Participants in the first group receive four sessions of LSVT for four weeks. Participants in the second group receive traditional NHS SLT. The frequency of sessions varies but there is typically be one session per week for six to eight weeks. Participants in the third group do not receive any SLT for the duration of the study. Participants in all groups complete a number of questionnaires at the start of the study, and then again by post after 3, 6 and 12 months.
Primary research question: For adults surviving spontaneous (non-traumatic) symptomatic intracranial haemorrhage with persistent/paroxysmal atrial fibrillation/flutter (AF), does starting full treatment dose oral anticoagulation (OAC) result in a beneficial net reduction of all serious vascular events compared with not starting OAC?
In patients with acute clots (deep vein thrombosis or pulmonary embolism) the investigators will collect real world data on their short and long term outcomes. The investigators hypothesise that in patients treated from the outset with rivaroxaban that: 1. treatment will be non-inferior to treatment with conventional anticoagulants (heparins and warfarin); 2. there will be less bleeding than when patients are on conventional anticoagulants; 3. there will be a lower long-term incidence of morbidity from chronic thromboembolic pulmonary hypertension and post-thrombotic limb syndrome.