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Comment Learning from TARDIS: time for more focused trials in stroke prevention
Antithrombotic therapy immediately following stroke is important to minimise the risk of recurrence, but the optimum choice and number of drugs to use are unclear, and efficacy in preventing thrombosis needs to be weighed against bleeding risk. In The Lancet, the TARDIS investigators report findings from a randomised trial1 that tested intensive antiplatelet therapy with three agents (aspirin, clopidogrel, and dipyridamole) against therapy based on current UK guidelines2 (either clopidogrel, or aspirin plus dipyridamole) for 30 days in patients with transient ischaemic attack (TIA) or ischaemic stroke.
Source: LANCET - December 20, 2017 Category: General Medicine Authors: Pierre Amarenco Tags: Comment Source Type: research

Comment Bioprosthetic surgical and transcatheter heart valve thrombosis
Excellent outcomes of transcatheter aortic valve replacement (TAVR) have been experienced by patients with aortic stenosis at high and intermediate risk of surgery.1 Findings from large randomised trials1,2 have shown survival with TAVR that is similar to or improved compared with bioprosthetic surgical aortic valve replacement (SAVR), and very low stroke rates have been observed with new-generation devices. Investigators of echocardiographic follow-up studies3 have consistently reported low transvalvular gradients up to 5 years after TAVR and SAVR, with slightly greater aortic valve areas after TAVR than after SAVR.
Source: LANCET - March 19, 2017 Category: General Medicine Authors: Jeroen J Bax, Gregg W Stone Tags: Comment Source Type: research

Correspondence Risk of mortality and stroke after atrial fibrillation
Jeff Healey and colleagues1 reported that patients with rheumatic heart disease had a lower risk of stroke compared with patients without the disease, and that when risk factors and age were adjusted, their stroke risks were similar, which is contrary to traditional opinion. However, the order of events between rheumatic heart disease and atrial fibrillation might not have been considered properly in this paper. In patients with atrial fibrillation, stroke is mostly caused by red thrombus, whereas verrucous vegetation causes stroke in rheumatic heart disease; generally speaking, old red thrombus is more likely to fall off and cause stroke.
Source: LANCET - March 3, 2017 Category: Journals (General) Authors: Zitian Huo Tags: Correspondence Source Type: research

Articles Outcomes after thrombus aspiration for ST elevation myocardial infarction: 1-year follow-up of the prospective randomised TOTAL trial
Routine thrombus aspiration during PCI for STEMI did not reduce longer-term clinical outcomes and might be associated with an increase in stroke. As a result, thrombus aspiration can no longer be recommended as a routine strategy in STEMI.
Source: LANCET - October 13, 2015 Category: Journals (General) Authors: Sanjit S Jolly, John A Cairns, Salim Yusuf, Michael J Rokoss, Peggy Gao, Brandi Meeks, Sasko Kedev, Goran Stankovic, Raul Moreno, Anthony Gershlick, Saqib Chowdhary, Shahar Lavi, Kari Niemela, Ivo Bernat, Warren J Cantor, Asim N Cheema, Philippe Gabriel S Tags: Articles Source Type: research

Correspondence Alteplase for ischaemic stroke—responses
In his Correspondence Roger Shinton raises concerns about the benefits of alteplase to treat acute ischaemic stroke. He refers to the Cochrane review of thrombolysis in acute ischaemic stroke, published in 2009, with data for 3977 patients treated with alteplase in randomised controlled trials (RCTs). Since then, the Third International Stroke Trial (IST-3) and an updated systematic review of all alteplase trials (7012 patients) have been published, and a complete update of all RCTs of all thrombolytic agents in acute ischaemic stroke (10 187 patients) in the Cochrane Database of Systematic Reviews has been very recently published.
Source: LANCET - August 23, 2014 Category: Journals (General) Authors: Joanna M Wardlaw, Veronica Murray, Eivind Berge, Gregory J Del Zoppo Tags: Correspondence Source Type: research

Seminar Intracranial atherosclerosis
Atherosclerotic disease often involves the intracranial arteries including those encased by cranial bones and dura, and those located in the subarachnoid space. Age, hypertension, and diabetes mellitus are independent risk factors for intracranial atherosclerosis. Intracranial atherosclerosis can result in thromboembolism with or without hypoperfusion leading to transient or permanent cerebral ischaemic events. High rates of recurrent ischaemic stroke and other cardiovascular events mandate early diagnosis and treatment.
Source: LANCET - March 14, 2014 Category: Journals (General) Authors: Adnan I Qureshi, Louis R Caplan Tags: Seminar Source Type: research

Correspondence Intermittent pneumatic compression in patients with stroke
We read with great interest the Article by the CLOTS (Clots in Legs Or sTockings after Stroke) Trials Collaboration (Aug 10, p 516) that assessed intermittent pneumatic compression (IPC) in immobile patients with acute stroke. Patients were allocated to receive either IPC or no IPC. The authors conclude that IPC is an effective method of reducing the risk of deep vein thrombosis (DVT) and possibly improving survival in patients who are immobile after stroke.
Source: LANCET - November 2, 2013 Category: Journals (General) Authors: Johann Auer, Robert Berent, Franz Gurtner Tags: Correspondence Source Type: research

Correspondence Intermittent pneumatic compression in patients with stroke – Authors' reply
Johann Auer and colleagues question whether intermittent pneumatic compression (IPC) would be as effective if used with prophylactic anticoagulants. The CLOTS 3 trial was done in the UK, where the evidence-based national guidelines do not recommend routine use of anticoagulants for deep vein thrombosis (DVT) prophylaxis after stroke. David Barer highlights that although anticoagulants reduce (mainly asymptomatic) DVT, effects on pulmonary embolism are unclear and the increase in bleeds offsets any benefits, so there is no significant effect on survival or functional outcomes.
Source: LANCET - November 2, 2013 Category: Journals (General) Authors: Martin Dennis, Peter Sandercock, Gordon Murray, John Forbes Tags: Correspondence Source Type: research

Department of Error Department of Error
CLOTS (Clots in Legs Or sTockings after Stroke) Trials Collaboration. Effectiveness of intermittent pneumatic compression in reduction of risk of deep vein thrombosis in patients who have had a stroke (CLOTS 3): a multicentre randomised controlled trial. Lancet 2013;382:516–24— In this Article, in Table 4 the corrected numbers for “Any death, DVT or PE” within 6 months of randomisation should have been: 526 (36·6%) events in the IPC group and 626 (43·5%) events in the no-IPC group, the absolute risk difference −7·0 (95% CI −10·5 to −3·4), the risk ratio 0·83 (95% CI 0·75 to 0·92), the odds ratio 0·74...
Source: LANCET - September 21, 2013 Category: Journals (General) Authors: The Lancet Tags: Department of Error Source Type: research

Comment Intermittent pneumatic compression in patients with stroke
A patient with acute stroke has just been admitted who is immobile, and cannot walk to the bathroom without help. Looking at the patient's unmoving legs the risk of thrombosis is clear, but a low molecular weight heparin (LMWH) might lead to bleeding, and elastic compression stockings cause skin problems. So you settle on intermittent pneumatic compression devices (IPCs)—but do they actually prevent blood clots?
Source: LANCET - August 10, 2013 Category: Journals (General) Authors: Scott M Stevens, Scott C Woller Tags: Comment Source Type: research

Department of Error Department of Error
CLOTS (Clots in Legs Or sTockings after Stroke) Trials Collaboration. Effectiveness of intermittent pneumatic compression in reduction of risk of deep vein thrombosis in patients who have had a stroke (CLOTS 3): a multicentre randomised controlled trial. Lancet 2013; published online May 31. doi:10.1016/S0140-6736(13)61050-8—In this Article, the sentence relating to skin breaks in the Findings section of the Summary should have read “skin breaks on the legs were reported in 44 (3%) patients allocated IPC and in 20 (1%) patients allocated no IPC (p=0·002).
Source: LANCET - August 10, 2013 Category: Journals (General) Authors: The Lancet Tags: Department of Error Source Type: research

Articles Effectiveness of intermittent pneumatic compression in reduction of risk of deep vein thrombosis in patients who have had a stroke (CLOTS 3): a multicentre randomised controlled trial
IPC is an effective method of reducing the risk of DVT and possibly improving survival in a wide variety of patients who are immobile after stroke.
Source: LANCET - August 10, 2013 Category: Journals (General) Authors: CLOTS (Clots in Legs Or sTockings after Stroke) Trials Collaboration Tags: Articles Source Type: research