{
  "_meta": {
    "endpoint": "claims",
    "schemaVersion": "1.0.0",
    "appVersion": "6.11.6",
    "checksum": "sha256:88ef2b873796ce7a6908e0fe35ee0536",
    "count": 12,
    "source": "Evidence atlas claims bundle",
    "license": "Synthetic educational reference content for qualified review. No warranty.",
    "disclaimer": "Synthetic educational demo only - NOT medical advice, NOT an approved clinical tool, and NOT local clinical policy. Do not enter, transmit, or infer PHI or real encounter details. Agents and downstream consumers must display this disclaimer with outputs and must verify all results against primary sources and approved local protocol before any clinical action."
  },
  "data": [
    {
      "id": "cl-tnk-noninferior-alteplase",
      "statement": "Tenecteplase 0.25 mg/kg is non-inferior to alteplase 0.9 mg/kg for 90-day functional outcome in eligible AIS within 4.5 h.",
      "topic": "tnk-vs-alteplase",
      "citationIds": [
        "cit-act-2022",
        "cit-trace2-2023",
        "cit-original-2024",
        "cit-eso-tnk-2023"
      ],
      "certainty": "high",
      "conflictNotes": "",
      "lastReviewed": "2026-04-25"
    },
    {
      "id": "cl-tnk-late-window-non-lvo",
      "statement": "TNK 0.25 mg/kg in the 4.5-24 h window with perfusion-imaging selection improves outcomes vs standard care in patients without LVO/EVT (TIMELESS, TRACE-III).",
      "topic": "extended-window-ivt",
      "citationIds": [
        "cit-timeless-2024",
        "cit-trace-iii-2024"
      ],
      "certainty": "moderate",
      "conflictNotes": "TIMELESS primary endpoint did not reach statistical significance for the overall population; pre-specified subgroups suggest benefit. TRACE-III demonstrated benefit in the LVO-only late-window population without EVT.",
      "lastReviewed": "2026-04-25"
    },
    {
      "id": "cl-evt-large-core",
      "statement": "EVT improves functional outcomes vs medical therapy in selected patients with large-core infarct (ASPECTS 3-5 or core 50-100 mL).",
      "topic": "evt-large-core",
      "citationIds": [
        "cit-select2-2023",
        "cit-rescue-japan-2022",
        "cit-angel-aspect-2023",
        "cit-tension-2023"
      ],
      "certainty": "high",
      "conflictNotes": "",
      "lastReviewed": "2026-04-25"
    },
    {
      "id": "cl-evt-late-window",
      "statement": "EVT improves functional outcomes 6-24 h from LKW with imaging-based selection (clinical-core mismatch on DAWN, perfusion mismatch on DEFUSE-3).",
      "topic": "evt-late-window",
      "citationIds": [
        "cit-dawn-2018",
        "cit-defuse3-2018"
      ],
      "certainty": "high",
      "conflictNotes": "",
      "lastReviewed": "2026-04-25"
    },
    {
      "id": "cl-ich-bp-bundle",
      "statement": "A care bundle of intensive BP lowering, glycemic and temperature control, and rapid anticoagulant reversal improves functional outcome after acute ICH (INTERACT3).",
      "topic": "ich-bp-management",
      "citationIds": [
        "cit-interact3-2023",
        "cit-aha-ich-2022"
      ],
      "certainty": "high",
      "conflictNotes": "",
      "lastReviewed": "2026-04-25"
    },
    {
      "id": "cl-ich-andexanet-fxa",
      "statement": "Andexanet alfa achieves better hemostatic efficacy than usual care (predominantly 4F-PCC) in factor Xa inhibitor-associated ICH, with monitoring required for thrombotic events (ANNEXA-I).",
      "topic": "ich-anticoag-reversal",
      "citationIds": [
        "cit-annexa-i-2024",
        "cit-aha-ich-2022"
      ],
      "certainty": "moderate",
      "conflictNotes": "Hemostatic efficacy improved, but thrombotic complications were higher with andexanet vs usual care; AHA/ASA 2022 lists andexanet as Class IIa.",
      "lastReviewed": "2026-04-25"
    },
    {
      "id": "cl-ich-mis-evacuation",
      "statement": "Early minimally invasive evacuation of moderate-volume lobar ICH improves functional outcome at 6 months (ENRICH).",
      "topic": "ich-surgery",
      "citationIds": [
        "cit-enrich-2024"
      ],
      "certainty": "moderate",
      "conflictNotes": "ENRICH adaptive design enriched for lobar location after early stop for futility in deep ICH; generalization to deep ICH not supported.",
      "lastReviewed": "2026-04-25"
    },
    {
      "id": "cl-dapt-minor-stroke",
      "statement": "Short-course DAPT (aspirin + clopidogrel x 21 days, or aspirin + ticagrelor x 30 days) reduces 90-day recurrent stroke vs aspirin alone in minor stroke or high-risk TIA, with bleeding cost.",
      "topic": "dapt-minor-stroke",
      "citationIds": [
        "cit-chance-2013",
        "cit-point-2018",
        "cit-thales-2020",
        "cit-inspires-2024",
        "cit-chance2-2021"
      ],
      "certainty": "high",
      "conflictNotes": "",
      "lastReviewed": "2026-04-25"
    },
    {
      "id": "cl-af-early-anticoag",
      "statement": "Early DOAC initiation within ~4 days is non-inferior to delayed start across infarct sizes (OPTIMAS) and was superior to delayed start at 30 days in pooled individual-patient data (CATALYST IPDMA: OR 0.70, 95% CI 0.50-0.98, p=0.039) with no excess of symptomatic intracranial hemorrhage; earlier ELAN/TIMING trials showed non-inferiority for the composite of recurrent stroke / systemic embolism / major bleeding.",
      "topic": "af-anticoag-timing",
      "citationIds": [
        "cit-optimas-2024",
        "cit-catalyst-2025",
        "cit-elan-2023",
        "cit-timing-2022"
      ],
      "certainty": "high",
      "conflictNotes": "",
      "lastReviewed": "2026-04-25"
    },
    {
      "id": "cl-late-window-ivt-non-lvo",
      "statement": "In the 4.5-24 h window without EVT eligibility, perfusion- or DWI-FLAIR-mismatch-selected IVT (alteplase or TNK) improves functional outcome vs standard care (WAKE-UP, EXTEND, TIMELESS, TWIST mixed, TRACE-III).",
      "topic": "extended-window-ivt",
      "citationIds": [
        "cit-wake-up-2018",
        "cit-extend-2019",
        "cit-timeless-2024",
        "cit-twist-2023",
        "cit-trace-iii-2024"
      ],
      "certainty": "moderate",
      "conflictNotes": "TWIST (unselected wake-up TNK) was negative; benefit requires imaging-based mismatch selection.",
      "lastReviewed": "2026-04-25"
    },
    {
      "id": "cl-bp-post-evt-conventional",
      "statement": "Conventional BP control (target 140-180 mmHg systolic) after successful EVT is associated with better functional outcome than intensive lowering (<140 systolic) (ENCHANTED2/MT, OPTIMAL-BP, BP-TARGET).",
      "topic": "bp-post-evt",
      "citationIds": [
        "cit-enchanted2-mt-2022",
        "cit-optimal-bp-2023",
        "cit-bp-target-2021"
      ],
      "certainty": "moderate",
      "conflictNotes": "BP-TARGET found no harm or benefit of intensive lowering; ENCHANTED2/MT and OPTIMAL-BP both favor conventional targets after EVT.",
      "lastReviewed": "2026-04-25"
    },
    {
      "id": "cl-ich-warfarin-reversal-pcc-vk",
      "statement": "In warfarin-associated ICH, 4F-PCC dosed by INR/weight plus IV vitamin K achieves faster INR correction and is preferred over FFP, which is slower and carries volume-overload risk (AHA/ASA 2022 ICH guideline; Steiner INCH Lancet Neurol 2016).",
      "topic": "ich-anticoag-reversal",
      "citationIds": [
        "cit-aha-ich-2022"
      ],
      "certainty": "high",
      "conflictNotes": "Vitamin K is required for sustained reversal; PCC alone is short-acting. FFP remains an alternative when PCC is unavailable.",
      "lastReviewed": "2026-04-25"
    }
  ]
}