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Prevention and Treatment of Acute Stroke in the Nonagenarians and Beyond: Medical and Ethical Issues
AbstractPurpose of reviewAs one of the fastest growing portions of the population, nonagenarians will constitute a significant percentage of the stroke patient population in the near future. Nonagenarians are nevertheless not specifically targeted by most clinical guidelines. In this review, we aimed to summarise the available evidence guiding stroke prevention and treatment in this age group.Recent findingsSeveral recent observational studies have shown that the benefits of anticoagulation for the oldest old patients with atrial fibrillation may outweigh the bleeding risk. A sub-analysis of the IST-3 trial has shown for t...
Source: Current Treatment Options in Neurology - May 7, 2019 Category: Neurology Source Type: research

Statins in Ischemic Stroke Prevention: What Have We Learned in the Post-SPARCL (The Stroke Prevention by Aggressive Reduction in Cholesterol Levels) Decade?
We describe the current status of lipid-lowering therapies for ischemic stroke prevention. The SPARCL trial published in 2006 has been a landmark study in vascular neurology. The trial demonstrated that high-dose atorvastatin prevents recurrent stroke, and led the AHA/ASA to recommend statin therapy for patients with stroke or TIA of atherosclerotic origin.Recent findingsRecently, the J-STARS study demonstrated that therapy with low-dose pravastatin reduced atherothrombotic infarction incidence among patients with prior ischemic stroke. Besides, several trials have shown improved stroke outcomes with non-statin lipid-lower...
Source: Current Treatment Options in Neurology - April 7, 2019 Category: Neurology Source Type: research

Novel Treatments in Neuroprotection for Aneurysmal Subarachnoid Hemorrhage
Opinion statement New neuroprotective treatments aimed at preventing or minimizing “delayed brain injury” are attractive areas of investigation and hold the potential to have substantial beneficial effects on aneurysmal subarachnoid hemorrhage (aSAH) survivors. The underlying mechanisms for this “delayed brain injury” are multi-factorial and not fully understood. The most ideal treatment strategies would have the potential for a pleotropic effect positively modulating multiple implicated pathophysiological mechanisms at once. My personal management (RFJ) of patients with aneurysmal subarachnoid hemorrhage...
Source: Current Treatment Options in Neurology - June 19, 2016 Category: Neurology Source Type: research

Prevention of Stroke in Rheumatoid Arthritis
Opinion statement Recognizing that systemic inflammation is a major contributor to the increased risk of cardiovascular disease (CVD), including stroke, in rheumatoid arthritis (RA) serves as the basis for prevention strategies for cerebrovascular disease in RA. In addition to traditional cardiovascular risk factors, recognize that RA may be an independent risk factor for cerebrovascular accident (CVA). The risk of CVD should be assessed in each patient with RA, utilizing modified risk score calculators. Careful monitoring and control of systemic inflammation should be undertaken in conjunction with assessing eac...
Source: Current Treatment Options in Neurology - May 18, 2015 Category: Neurology Source Type: research