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Summary of evidence-based guideline update: Prevention of stroke in nonvalvular atrial fibrillation: Report of the Guideline Development Subcommittee of the American Academy of Neurology
Objective: To update the 1998 American Academy of Neurology practice parameter on stroke prevention in nonvalvular atrial fibrillation (NVAF). How often do various technologies identify previously undetected NVAF? Which therapies reduce ischemic stroke risk with the least risk of hemorrhage, including intracranial hemorrhage? The complete guideline on which this summary is based is available as an online data supplement to this article. Methods: Systematic literature review; modified Delphi process recommendation formulation. Major conclusions: In patients with recent cryptogenic stroke, cardiac rhythm monitoring probabl...
Source: Neurology - February 24, 2014 Category: Neurology Authors: Culebras, A., Messe, S. R., Chaturvedi, S., Kase, C. S., Gronseth, G. Tags: All Cerebrovascular disease/Stroke SPECIAL ARTICLE Source Type: research

Does Smoking Status Influence the Effect of Clopidogrel on Secondary Stroke Prevention? (S31.005)
Conclusions:Compared to patients who never smoked, current smokers with a recent minor stroke or TIA derive a greater benefit in stroke prevention at 90 days from clopidogrel.Disclosure: Dr. Ovbiagele has nothing to disclose. Dr. Wang has nothing to disclose. Dr. Johnston received research support from AstraZeneca. Dr. Wang has nothing to disclose. Dr. Wang has nothing to disclose. Dr. Zhao has nothing to disclose. Dr. Wang has nothing to disclose.
Source: Neurology - February 7, 2016 Category: Neurology Authors: Ovbiagele, B., Wang, J., S. Claiborne, J., Wang, A., Wang, Y., Zhao, X., Wang, Y. Tags: Stroke Risk, Outcomes, and Complications Source Type: research

Risks and benefits of clopidogrel-aspirin in minor stroke or TIA: Time course analysis of CHANCE
Conclusions: Clopidogrel–aspirin treatment may have a benefit of reducing stroke risk outweighing the potential risk of increased bleeding especially within the first 2 weeks compared with aspirin alone in patients with minor stroke or TIA. Clinicaltrials.gov identifier: NCT00979589. Classification of evidence: This study provides Class II evidence that for patients with minor stroke or TIA, the reduction of stroke risk from clopidogrel plus aspirin within the first 2 weeks outweighs the risk of bleeding compared with aspirin alone.
Source: Neurology - May 15, 2017 Category: Neurology Authors: Pan, Y., Jing, J., Chen, W., Meng, X., Li, H., Zhao, X., Liu, L., Wang, D., Johnston, S. C., Wang, Y., Wang, Y., On behalf of the CHANCE investigators Tags: All Cerebrovascular disease/Stroke, Clinical trials Randomized controlled (CONSORT agreement) ARTICLE Source Type: research

Glycated albumin predicts the effect of dual and single antiplatelet therapy on recurrent stroke
Conclusions: GA could be a potential biomarker to predict the effects of dual and single antiplatelet therapy in patients with minor stroke or TIA.
Source: Neurology - March 30, 2015 Category: Neurology Authors: Li, J., Wang, Y., Wang, D., Lin, J., Wang, A., Zhao, X., Liu, L., Wang, C., Wang, Y., On behalf of the CHANCE Investigators Tags: Other cerebrovascular disease/ Stroke, Prognosis, All Cerebrovascular disease/Stroke, Infarction ARTICLE Source Type: research

Association of multiple infarctions and ICAS with outcomes of minor stroke and TIA
Conclusions: The presence of multiple infarctions and ICAS were both associated with an increased risk of 90-day ischemic stroke in patients with minor stroke or TIA, while the presence of both imaging features had a combined effect. ClinicalTrials.gov identifier: NCT00979589.
Source: Neurology - March 12, 2017 Category: Neurology Authors: Pan, Y., Meng, X., Jing, J., Li, H., Zhao, X., Liu, L., Wang, D., Johnston, S. C., Wang, Y., Wang, Y., On behalf of the CHANCE Investigators Tags: All Cerebrovascular disease/Stroke, Clinical trials Observational study (Cohort, Case control) ARTICLE Source Type: research

Effect of clopidogrel with aspirin on functional outcome in TIA or minor stroke: CHANCE substudy
Conclusions: In patients with minor stroke or TIA, the combination of clopidogrel and aspirin appears to be superior to aspirin alone in improving the 90-day functional outcome, and this is consistent with a reduction in the rate of disabling stroke in the dual antiplatelet arm. Classification of evidence: This study provides Class II evidence that for patients with acute minor stroke or TIA, clopidogrel plus aspirin compared to aspirin alone improves 90-day functional outcome (absolute reduction of poor outcome 1.70%, 95% confidence interval 0.03%–3.42%).
Source: Neurology - August 17, 2015 Category: Neurology Authors: Wang, X., Zhao, X., Johnston, S. C., Xian, Y., Hu, B., Wang, C., Wang, D., Liu, L., Li, H., Fang, J., Meng, X., Wang, A., Wang, Y., Wang, Y., For the CHANCE investigators Tags: Stroke prevention, Clinical trials Randomized controlled (CONSORT agreement), Class II, Infarction ARTICLE Source Type: research

Safety and Effectiveness of Intravenous Recombinant Tissue Plasminogen Activator in Acute Ischemic Stroke Patients on Aspirin and Clopidogrel (P4.284)
CONCLUSIONS: Compared with patients on no antiplatelet treatment, acute ischemic stroke patients who are actively using aspirin and clopidogrel appear to have similar risks and benefits with IV rt-PA treatment.Disclosure: Dr. Qureshi has nothing to disclose. Dr. Khan has nothing to disclose. Dr. Jahangir has nothing to disclose. Dr. Malik has nothing to disclose. Dr. Thampson has nothing to disclose. Dr. Khan has nothing to disclose. Dr. Suri has nothing to disclose. Dr. Qureshi has nothing to disclose.
Source: Neurology - April 8, 2015 Category: Neurology Authors: Qureshi, M., Khan, S., Jahangir, N., Malik, A., Thampson, M., Khan, A., Suri, M., Qureshi, A. Tags: Cerebrovascular Disease and Interventional Neurology: Acute Ischemic Stroke Care Source Type: research

Predicting major bleeding in patients with noncardioembolic stroke on antiplatelets: S2TOP-BLEED
Conclusions: The S2TOP-BLEED score can be used to estimate 3-year major bleeding risk in patients with a TIA or ischemic stroke who use antiplatelet agents, based on readily available characteristics. The discriminatory performance may be improved by identifying stronger predictors of major bleeding.
Source: Neurology - August 28, 2017 Category: Neurology Authors: Hilkens, N. A., Algra, A., Diener, H.-C., Reitsma, J. B., Bath, P. M., Csiba, L., Hacke, W., Kappelle, L. J., Koudstaal, P. J., Leys, D., Mas, J.-L., Sacco, R. L., Amarenco, P., Sissani, L., Greving, J. P., For the Cerebrovascular Antiplatelet Trialists' Tags: Stroke prevention, All Cerebrovascular disease/Stroke, Risk factors in epidemiology, Infarction ARTICLE Source Type: research

Association of Lp-PLA2-A and early recurrence of vascular events after TIA and minor stroke
Conclusions: Higher levels of Lp-PLA2-A in the acute period are associated with increased short-term risk of recurrent vascular events.
Source: Neurology - November 2, 2015 Category: Neurology Authors: Lin, J., Zheng, H., Cucchiara, B. L., Li, J., Zhao, X., Liang, X., Wang, C., Li, H., Mullen, M. T., Johnston, S. C., Wang, Y., Wang, Y., On behalf of the CHANCE investigators Tags: Other cerebrovascular disease/ Stroke ARTICLE Source Type: research

Acute Ischemic Stroke as a Presenting Feature of Multiple Myeloma (P3.279)
Conclusions:Stroke is a leading and preventable cause of disability in the US adult population. The majority of strokes are due to atherosclerotic vascular or cardioembolic disease. Understanding the diagnostic work up of stroke and recognizing rare etiologies like MM is important for stroke prevention. This brings to light the importance of recognizing stroke as an initial presenting feature of multiple myeloma and of multiple myeloma as an important treatable etiology of stroke.Disclosure: Dr. Chung has nothing to disclose. Dr. Ramamoorthy has nothing to disclose. Dr. Kar has nothing to disclose.
Source: Neurology - April 17, 2017 Category: Neurology Authors: Chung, S., Ramamoorthy, R., Kar, J. Tags: Cerebrovascular Disease Case Reports II Source Type: research

ASA failure: Does the combination ASA/clopidogrel confer better long-term vascular protection?
Conclusions: In patients with a recent lacunar stroke while taking ASA, the addition of clopidogrel did not result in reduction of vascular events vs continuing ASA only. Classification of evidence: This study provides Class I evidence that for patients with recent lacunar stroke while taking ASA, adding clopidogrel as compared to continuing ASA alone does not reduce the risk of recurrent stroke.
Source: Neurology - February 3, 2014 Category: Neurology Authors: Cote, R., Zhang, Y., Hart, R. G., McClure, L. A., Anderson, D. C., Talbert, R. L., Benavente, O. R. Tags: Stroke prevention, Infarction ARTICLE Source Type: research

PIAST - Platelet Inhibition Assessment in Stroke Trial - The Assessment of Efficacy of Platelet Aggregation Inhibition in Stroke Patients with the Multiplate Analyzer, a Point-of-Care Method (P02.055)
CONCLUSIONS: This trial demonstrates that nearly 1/3 of cerebral ischemia patients are potential aspirin nonresponders, which might have significant implications in the medical treatment of stroke patients.Supported by: Multiplate analyzer(c) placed to our disposal for the trial formerly by Dynabite (Munich, Germany) now by Roche Pharmaceuticals.Disclosure: Dr. Menon has nothing to disclose. Dr. Jun has nothing to disclose. Dr. Meyding-Lamadé has nothing to disclose. Dr. Grabowski has nothing to disclose.
Source: Neurology - February 14, 2013 Category: Neurology Authors: Menon, S., Jun, T., Meyding-Lamade, U., Grabowski, A. Tags: P02 Cerebrovascular Disease II Source Type: research

Evaluation of Antithrombotic Bridging Methods in Acute Ischemic Stroke Patients with Atrial Fibrillation (P6.281)
Conclusions:Preliminary data supports against bridging with parenteral anticoagulation in acute ischemic stroke and AF, with a higher incidence of complications observed overall. Higher incidence of extracranial complications observed with bridging anticoagulation and higher incidence of intracranial complications observed from bridging antiplatelet therapy. This finding may be related to the limited number of patients included. A future goal for this project will be to expand the number of charts reviewed to strengthen the validity of these results.Disclosure: Dr. Swafford has nothing to disclose. Dr. Lee has nothing to disclose.
Source: Neurology - April 17, 2017 Category: Neurology Authors: Swafford, K., Lee, J. Tags: Prevention of Cerebrovascular Disease Source Type: research

Dual antiplatelet therapy for TIA reduces subsequent disability: A CHANCE to improve outcomes?
In this study, they explored the outcomes of functional disability, as measured by the modified Rankin Scale, and quality of life, as measured by the EuroQol-5 Dimension. The published CHANCE trial results demonstrated that the combination of clopidogrel and aspirin (for 21 days, followed by clopidogrel alone until 90 days) was superior to aspirin plus placebo for 90 days in preventing recurrent stroke after TIA or minor stroke.2 The current study demonstrates the superiority of dual antiplatelet therapy compared to aspirin in improving the 90-day functional outcome. The analysis suggests that this is mediated via a reduct...
Source: Neurology - August 17, 2015 Category: Neurology Authors: Alderazi, Y. J. Tags: Stroke prevention, Clinical trials Methodology/study design, Infarction EDITORIALS Source Type: research

Dual antiplatelet therapy in stroke and ICAS: Subgroup analysis of CHANCE
Conclusions: The results indicated higher rate of recurrent stroke in minor stroke or high-risk TIA patients with ICAS than in those without. However, there was no significant difference in the response to the 2 antiplatelet therapies between patients with and without ICAS in the CHANCE trial. Classification of evidence: This study provides Class II evidence that for patients with acute minor stroke or TIA with and without ICAS identified by MRA, clopidogrel plus aspirin is not significantly different than aspirin alone in preventing recurrent stroke.
Source: Neurology - September 28, 2015 Category: Neurology Authors: Liu, L., Wong, K. S. L., Leng, X., Pu, Y., Wang, Y., Jing, J., Zou, X., Pan, Y., Wang, A., Meng, X., Wang, C., Zhao, X., Soo, Y., Johnston, S. C., Wang, Y., For the CHANCE Investigators Tags: ARTICLE Source Type: research

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