Home › Stroke & neuro › Prehospital magnesium before thrombolysis: no overall benefit

Stroke & neuro

Prehospital magnesium before thrombolysis: no overall benefit

Prehospital neuroprotectant in combination with post-arrival thrombolytic therapy for acute ischemic stroke. Secondary analysis of the FAST-MAG prehospital trial
Journal of Stroke and Cerebrovascular Diseases · Added 31 July 2026

Secondary analysis testing whether prehospital magnesium sulfate followed by thrombolysis improves 90-day outcomes — feasible and safe but no significant overall clinical benefit, though severe stroke patients (NIHSS >15) showed better outcomes in hypothesis-generating subgroup analysis.

Study type

RCT

Design

Secondary analysis of the FAST-MAG phase 3 RCT

Participants

401 patients receiving thrombolysis (214 magnesium, 187 placebo)

Main finding

No significant overall 90-day mRS benefit from prehospital magnesium plus thrombolysis; in severe strokes (NIHSS >15) the magnesium group had higher rates of favourable 90-day outcome (mRS 0-2); median last-known-well to prehospital infusion was 46 min and 93 min pre-thrombolysis exposure

Caveat

Secondary/subgroup analysis of a null trial; subgroup findings hypothesis-generating

Bottom line

Hypothesis-generating

Learning goal

Weigh the role of prehospital neuroprotective therapy in the early management of acute ischaemic stroke.

More

• Topic: Stroke & neuro
• Daily scan: 31 July 2026

Related papers on Stroke & neuro

• IM midazolam non-inferior for prehospital seizures

  Seizure: European Journal of Epilepsy · 27 Aug 2026 · RCT · Hypothesis-generating

  Randomised double-blind non-inferiority trial testing whether IM midazolam is non-inferior to IV clonazepam for prehospital seizures — it was, with 75% treatment success for IM midazolam versus 62.5% for IV clonazepam (risk difference +12.5 percentage points; 95% CI -10.0 to +33.4).

• Over-rapid BP drop worse after ICH

  Annals of Emergency Medicine · 27 Jul 2026 · Cohort · Hypothesis-generating

  Retrospective cohort examining whether rapid systolic BP reduction ≤150 mm Hg after spontaneous intracerebral haemorrhage improved outcomes — early target achievement and overshooting <120 mm Hg were associated with worse functional outcome.

• HEMS dispatch timing matters for LVO stroke thrombectomy

  Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine · 27 Jul 2026 · Modelling · Hypothesis-generating

  The efficacy of endovascular thrombectomy (EVT) for large vessel occlusion (LVO) stroke is highly time-dependent.

• Helicopter + ground transport doubles thrombectomy access

  Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine · 27 Jul 2026 · Modelling · Hypothesis-generating

  A hybrid transportation strategy improved access to MT in a single center study.