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Specialty: General Medicine
Condition: Bleeding

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Total 566 results found since Jan 2013.

Use of antiplatelet drugs in stroke prevention: time for a rethink?
Worldwide, 15 million people suffer stroke each year from which a third die and a further third sustain severe disability, with ischaemic events accounting for ~80% of all strokes.1 The annual estimated economic burden of stroke is 64.1 billion in Europe alone.2 While recent major investments in acute stroke services have focused on thrombolysis and hospitalisation in dedicated stroke wards, we believe that primary and secondary stroke prevention should remain of utmost importance in a disease that carries such serious permanent neurological sequelae. Antiplatelet agents such as aspirin, diypridamole or clodpidogrel are ph...
Source: Postgraduate Medical Journal - May 17, 2013 Category: Journals (General) Authors: Loke, Y. K., White, J. R., Bettencourt-Silva, J. H., Potter, J. F., Myint, P. K. Tags: GI bleeding, Drugs: cardiovascular system, Stroke, Ischaemic heart disease, Epidemiology Editorials Source Type: research

Stroke prevention.
Abstract Patients who have had a stroke are at high risk for recurrent stroke, myocardial infarction, and vascular death. Prevention of these events should be initiated promptly after stroke, because many recurrent events occur early, and should be tailored to the precise cause of stroke, which may require specific treatment. Lifestyle advice including abstinence from smoking, regular exercise, Mediterranean-style diet, and reduction of salt intake and alcohol consumption are recommended for all patients with stroke. For most patients with ischemic stroke or TIA, control of risk factors, including lowering blood p...
Source: Presse Medicale - November 1, 2016 Category: Journals (General) Authors: Isabel C, Calvet D, Mas JL Tags: Presse Med Source Type: research

Closure versus medical therapy for preventing recurrent stroke in patients with patent foramen ovale and a history of cryptogenic stroke or transient ischemic attack.
CONCLUSIONS: The combined data from recent RCTs have shown no statistically significant differences between TDC and medical therapy in the prevention of recurrent ischemic stroke. TDC closure was associated with an increased risk of atrial fibrillation but not with serious adverse events. PMID: 26346232 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - September 8, 2015 Category: Journals (General) Authors: Li J, Liu J, Liu M, Zhang S, Hao Z, Zhang J, Zhang C Tags: Cochrane Database Syst Rev Source Type: research

Thrombolysis for acute ischaemic stroke.
CONCLUSIONS: Thrombolytic therapy given up to six hours after stroke reduces the proportion of dead or dependent people. Those treated within the first three hours derive substantially more benefit than with later treatment. This overall benefit was apparent despite an increase in symptomatic intracranial haemorrhage, deaths at seven to 10 days, and deaths at final follow-up (except for trials testing rt-PA, which had no effect on death at final follow-up). Further trials are needed to identify the latest time window, whether people with mild stroke benefit from thrombolysis, to find ways of reducing symptomatic intracrani...
Source: Cochrane Database of Systematic Reviews - August 3, 2014 Category: Journals (General) Authors: Wardlaw JM, Murray V, Berge E, Del Zoppo GJ Tags: Cochrane Database Syst Rev Source Type: research

Prevalence, main determinants, and early outcome of patients with atrial fibrillation hospitalized with ischemic stroke: evaluation of the value of risk assessment scores for predicting risk of stroke or major bleeding following anticoagulation therapy.
CONCLUSION: The patients with atrial fibrillation hospitalized with ischemic stroke showed an important absolute risk of further stroke and early mortality. Despite substantiated advantages of warfarin prophylaxis, its limited application is still very common. PMID: 26422431 [PubMed - in process]
Source: Acta Bio-Medica : Atenei Parmensis - October 4, 2015 Category: Journals (General) Authors: Sadeghi R, Parsa Mahjoob M, Asadollahi M, Abbasi Z Tags: Acta Biomed Source Type: research

Marine-derived n-3 fatty acids therapy for stroke.
CONCLUSIONS: We are very uncertain of the effect of marine-derived n-3 PUFAs therapy on functional outcomes and dependence after stroke as there is insufficient high-quality evidence. More well-designed RCTs are needed, specifically in acute stroke, to determine the efficacy and safety of the intervention.Studies assessing functionality might consider starting the intervention as early as possible after the event, as well as using standardised clinically-relevant measures for functional outcomes, such as the modified Rankin Scale. Optimal doses remain to be determined; delivery forms (type of lipid carriers) and mode of ad...
Source: Cochrane Database of Systematic Reviews - June 25, 2019 Category: General Medicine Authors: Alvarez Campano CG, Macleod MJ, Aucott L, Thies F Tags: Cochrane Database Syst Rev Source Type: research

Marine-derived n-3 fatty acids therapy for stroke
CONCLUSIONS: We are very uncertain of the effect of marine-derived n-3 PUFAs therapy on functional outcomes and dependence after stroke as there is insufficient high-certainty evidence. More well-designed RCTs are needed, specifically in acute stroke, to determine the efficacy and safety of the intervention. Studies assessing functional outcome might consider starting the intervention as early as possible after the event, as well as using standardised, clinically relevant measures for functional outcomes, such as the modified Rankin Scale. Optimal doses remain to be determined; delivery forms (type of lipid carriers) and m...
Source: Cochrane Database of Systematic Reviews - June 29, 2022 Category: General Medicine Authors: Celia Gabriela Alvarez Campano Mary Joan Macleod Lorna Aucott Frank Thies Source Type: research

Selective serotonin reuptake inhibitors (SSRIs) for stroke recovery.
CONCLUSIONS SSRIs appeared to improve dependence, disability, neurological impairment, anxiety and depression after stroke, but there was heterogeneity between trials and methodological limitations in a substantial proportion of the trials. Large, well-designed trials are now needed to determine whether SSRIs should be given routinely to patients with stroke. PMID: 23903272 [PubMed - in process]
Source: Sao Paulo Medical Journal - August 3, 2013 Category: Journals (General) Authors: Mead GE, Hsieh CF, Lee R, Kutlubaev MA, Claxton A, Hankey GJ, Hacklett ML Tags: Sao Paulo Med J Source Type: research

Stroke prevention of thoracoscopic left atrial appendage clipping in patients with non-valvular atrial fibrillation at high risk of stroke and bleeding: study protocol for a non-randomised controlled clinical trial
Introduction Non-valvular atrial fibrillation (NVAF) is a high-risk factor for ischaemic stroke. The 2016 European Society of Cardiology Atrial Fibrillation Management guidelines recommend oral anticoagulants (OACs) to prevent stroke in men with CHA2DS2-VASc scores ≥2 and women ≥3. However, in patients with a high risk of stroke and a high risk of bleeding (HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly (> 65 years), Drugs/alcohol concomitantly) score≥3), OAC had a higher risk of bleeding. Left atrial appendage cl...
Source: BMJ Open - October 28, 2022 Category: General Medicine Authors: Ye, C., Han, X., Chen, Y., Liu, F., Ma, H., Yang, Y., Liu, Y., Hu, Q., Yao, Q., Xie, W., Xu, D. Tags: Open access, Surgery Source Type: research

Stroke management in a Swiss community hospital - in close collaboration with a stroke centre
CONCLUSION: Our findings support further education of the population in recognition of stroke symptoms and assessment of cardiovascular risk factors according to guidelines. Telemedical cooperation with a local stroke centre can result in adequate quality of care in these patients.PMID:34098584 | DOI:10.4414/smw.2021.20490
Source: Swiss Medical Weekly - June 7, 2021 Category: General Medicine Authors: Rolf Erlebach Esther B ächli Esther Gerrits Mich èle Hess Source Type: research

Anticoagulants for acute ischaemic stroke
CONCLUSIONS: Since the last version of this review, four new relevant studies have been published, and conclusions remain consistent. People who have early anticoagulant therapy after acute ischaemic stroke do not demonstrate any net short- or long-term benefit. Treatment with anticoagulants reduced recurrent stroke, deep vein thrombosis, and pulmonary embolism but increased bleeding risk. Data do not support the routine use of any of the currently available anticoagulants for acute ischaemic stroke.PMID:34676532 | DOI:10.1002/14651858.CD000024.pub5
Source: Cochrane Database of Systematic Reviews - October 22, 2021 Category: General Medicine Authors: Xia Wang Menglu Ouyang Jie Yang Lili Song Min Yang Craig S Anderson Source Type: research

Anticoagulants for acute ischaemic stroke.
CONCLUSIONS: Since the last version of the review, no new relevant studies have been published and so there is no additional information to change the conclusions. Early anticoagulant therapy is not associated with net short- or long-term benefit in people with acute ischaemic stroke. Treatment with anticoagulants reduced recurrent stroke, deep vein thrombosis and pulmonary embolism, but increased bleeding risk. The data do not support the routine use of any of the currently available anticoagulants in acute ischaemic stroke. PMID: 25764172 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - March 12, 2015 Category: Journals (General) Authors: Sandercock PA, Counsell C, Kane EJ Tags: Cochrane Database Syst Rev Source Type: research

Attitudes and Practices on the Consent Process and Decision-making for Intravenous Stroke Thrombolysis: Physicians' Perspective.
Conclusion: The next-of-kin is usually the decision-maker for stroke thrombolysis in practice for a mentally incapacitated patient despite most doctors considering thrombolysis an emergency treatment. This, together with the lack of consensus and variance in decision-making and consent practice amongst neurologists for stroke thrombolysis, demonstrates the need to develop best practice guidelines to standardise healthcare practices for greater consistency in health service delivery. PMID: 24356652 [PubMed - in process]
Source: Annals of the Academy of Medicine, Singapore - November 1, 2013 Category: Journals (General) Authors: Talabucon LP, Menon S, Toh AJ, Oh DC, De Silva DA Tags: Ann Acad Med Singapore Source Type: research

Advances in stroke medicine.
Authors: Campbell BC Abstract In recent years, reperfusion therapies such as intravenous thrombolysis and endovascular thrombectomy for ischaemic stroke have dramatically reduced disability and revolutionised stroke management. Thrombolysis with alteplase is effective when administered to patients with potentially disabling stroke, who are not at high risk of bleeding, within 4.5 hours of the time the patient was last known to be well. Emerging evidence suggests that other thrombolytics such as tenecteplase may be even more effective. Treatment may be possible beyond 4.5 hours in patients selected using brain imagi...
Source: Medical Journal of Australia - May 6, 2019 Category: General Medicine Tags: Med J Aust Source Type: research