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Efficacy and Safety of Ticagrelor in Relation to Aspirin Use Within the Week Before Randomization in the SOCRATES Trial Clinical Sciences
Conclusions—In this secondary analysis from SOCRATES, fewer primary end points occurred on ticagrelor treatment than on aspirin in patients receiving aspirin before randomization, but there was no significant treatment-by-prior-aspirin interaction. A new study will investigate the benefit-risk of combining ticagrelor and aspirin in patients with acute cerebral ischemia (URL: https://www.clinicaltrials.gov. Unique identifier: NCT03354429).Clinical Trial Registration—URL: https://www.clinicaltrials.gov. Unique identifier: NCT01994720.
Source: Stroke - June 25, 2018 Category: Neurology Authors: K.S. Lawrence Wong, Pierre Amarenco, Gregory W. Albers, Hans Denison, J. Donald Easton, Scott R. Evans, Peter Held, Anders Himmelmann, Scott E. Kasner, Mikael Knutsson, Per Ladenvall, Kazuo Minematsu, Carlos A. Molina, Yongjun Wang, S. Claiborne Johnston Tags: Ischemic Stroke Original Contributions Source Type: research

Rationale and design of the AXIOMATIC-SSP phase II trial: Antithrombotic treatment with factor XIa inhibition to Optimize Management of Acute Thromboembolic events for Secondary Stroke Prevention
Early stroke occurrence after ischemic stroke or transient ischemic attack (TIA) remains a significant risk despite advances in secondary prevention. Ischemic stroke is largely a thromboembolic disease, and major efforts to reduce the early risk of recurrent stroke in patients with non-cardioembolic stroke have focused on antiplatelet strategies.1 Improvements in outcome have been associated with novel antiplatelet strategies, but significant residual risk of ischemic stroke and the potential for major bleeding, including intracranial hemorrhage, limit the effectiveness of these options.
Source: Journal of Stroke and Cerebrovascular Diseases - August 27, 2022 Category: Neurology Authors: Mukul Sharma, Carlos A. Molina, Kazunori Toyoda, Daniel Bereczki, Scott E. Kasner, Helmi L. Lutsep, Georgios Tsivgoulis, George Ntaios, Anna Czlonkowska, Ashfaq Shuaib, Pierre Amarenco, Matthias Endres, Hans Christoph Diener, David Gailani, Anja Kahl, Mar Source Type: research

Antithrombotic Management of Stroke Patients Before Colonoscopy
Conclusions: In this retrospective analysis, there was no significant difference in the occurrence of stroke, myocardial infarction, venous thromboembolism, and major bleeding between patients who had medications continued around the time of colonoscopy versus those who had temporary discontinuation. A prospective, randomized controlled study is warranted to further elucidate this issue.
Source: Journal of Stroke and Cerebrovascular Diseases - January 13, 2012 Category: Neurology Authors: Basel Assaad, Veronica Kemerko Sesi, Renzo Figari, Lonni Schultz, Nithin Thummala, Mohammed Rehman, Arun Chandok, Ann Silverman, Brian Silver Tags: Original Articles Source Type: research

Short-term Bleeding Events Observed with Clopidogrel Loading in Acute Ischemic Stroke Patients
Discussion: Contrary to our original hypothesis, patients with AIS receiving clopidogrel loading doses within 24 hours of symptom onset did not appear to experience a higher rate of new serious bleeding events during acute hospitalization when compared with patients who did not receive loading doses. The Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke trial is expected to provide insight into the safety of clopidogrel loading as an acute intervention after cerebral ischemia.
Source: Journal of Stroke and Cerebrovascular Diseases - April 1, 2013 Category: Neurology Authors: Lester Y. Leung, Karen C. Albright, Amelia K. Boehme, Joseph Tarsia, Kamal R. Shah, James E. Siegler, Erica M. Jones, Gayle R. Pletsch, Timothy M. Beasley, Sheryl Martin-Schild Tags: Original Articles Source Type: research

Rationale and design of Triple AXEL: trial for early anticoagulation in acute ischemic stroke patients with nonvalvular atrial fibrillation
DiscussionThe results of this proof‐of‐concept trial will guide go/no‐go decision to a large phase 3 confirmatory trial.
Source: International Journal of Stroke - October 26, 2014 Category: Neurology Authors: Keun‐Sik Hong, Yun Jung Choi, Sun U. Kwon, Tags: Protocols Source Type: research

Temporary Discontinuation Of Warfarin For Endovascular Procedures And Risk Of Ischemic Stroke (P4.301)
Conclusions: The risk of ischemic stroke during discontinuation of warfarin is higher than expected and requires a careful evaluation of risk and benefits.Disclosure: Dr. Malik has nothing to disclose. Dr. Qureshi has nothing to disclose. Dr. Zeb has nothing to disclose. Dr. Defillo has nothing to disclose. Dr. Thompson has nothing to disclose. Dr. Suri has nothing to disclose. Dr. Qureshi has nothing to disclose.
Source: Neurology - April 8, 2015 Category: Neurology Authors: Malik, A., Qureshi, M., Zeb, H., Defillo, A., Thompson, M., Suri, M., Qureshi, A. Tags: Cerebrovascular Disease and Interventional Neurology: Acute Interventional Treatment for Ischemic Stroke Source Type: research

Safety and efficacy of intensive vs. guideline antiplatelet therapy in high‐risk patients with recent ischemic stroke or transient ischemic attack: rationale and design of the Triple Antiplatelets for Reducing Dependency after Ischaemic Stroke (TARDIS) trial (ISRCTN47823388)
DiscussionThe trial has recruited more than 50% of its target sample size (latest number: 2399) and is running in 104 sites in 4 countries. One‐third of patients presented with a transient ischemic attack.
Source: International Journal of Stroke - June 16, 2015 Category: Neurology Tags: Protocol Source Type: research

Effectiveness of Left Atrial Appendage Exclusion Procedures to Reduce the Risk of Stroke: A Systematic Review of the Evidence Original Articles
Conclusions— There is limited evidence that the Watchman device may be noninferior to long-term OAC in selected patients. Data on effectiveness of LAA exclusion devices is lacking in patients ineligible for long-term OAC. Percutaneous LAA devices are associated with high rates of procedure-related harms. Although surgical LAA exclusion during heart surgery does not seem to add incremental harm, there is insufficient evidence of benefit.
Source: Circulation: Cardiovascular Quality and Outcomes - July 18, 2016 Category: Cardiology Authors: Noelck, N., Papak, J., Freeman, M., Paynter, R., Low, A., Motuapuaka, M., Kondo, K., Kansagara, D. Tags: Atrial Fibrillation, Anticoagulants, Cardiovascular Surgery, Complications, Ischemic Stroke Original Articles Source Type: research

Rivaroxaban Versus Dabigatran or Warfarin in Real-World Studies of Stroke Prevention in Atrial Fibrillation Clinical Sciences
Conclusions—In this systematic review and meta-analysis, rivaroxaban was as effective as dabigatran, but was more effective than warfarin for the prevention of stroke/thromboembolism in atrial fibrillation patients. Major bleeding risk was significantly higher with rivaroxaban than with dabigatran, as was all-cause mortality and gastrointestinal bleeding. Rivaroxaban was comparable to warfarin for major bleeding, with an increased risk in gastrointestinal bleeding and decreased risk of intracranial hemorrhage.
Source: Stroke - March 27, 2017 Category: Neurology Authors: Ying Bai, Hai Deng, Alena Shantsila, Gregory Y.H. Lip Tags: Meta Analysis, Quality and Outcomes Original Contributions Source Type: research

Saving Vanessa, part 1: A mystery rash, a stroke and an epic rescue
Vanessa’s rash first appeared on her arms and legs when she 3 or 4 months old. It was red and bumpy and went away when she was sick with a virus, which happened often. Then it would come back. The dermatology team she saw at Boston Children’s Hospital was puzzled. “I was expecting they were going to think it was nothing, but they took it very seriously,” says Katherine Bell, one of Vanessa’s mothers. “They took a biopsy and very quickly realized they had no idea what it was.” Vanessa’s case was even featured at a regional dermatology conference where doctors take up mystery patients. “A hundred to 150 der...
Source: Thrive, Children's Hospital Boston - July 25, 2017 Category: Pediatrics Authors: Nancy Fliesler Tags: Diseases & Conditions Our Patients’ Stories Dr. Carolyn Rogers Dr. Pui Lee Dr. Robert Sundel Dr. Scellig Stone Dr. Todd Lyons stroke Source Type: news

Individualized risk prediction of major bleeding in secondary stroke prevention: Are we there yet?
In most patients diagnosed with a TIA or ischemic stroke, secondary stroke prevention relies on antiplatelet therapy unless anticoagulation is indicated. Aspirin has the largest evidence base and reduces the risk of early recurrent ischemic stroke without a major risk of early hemorrhagic complications.1 Because antiplatelet therapy typically continues for many years, clinicians and patients need an estimation of the annual bleeding risk to accurately assess future risk. In a meta-analysis of 25 randomized trials of antiplatelet therapy in primary or secondary prevention of cardiovascular disease, aspirin increased the abs...
Source: Neurology - August 28, 2017 Category: Neurology Authors: Lemmens, R., Al-Shahi Salman, R. Tags: Stroke prevention, All Cerebrovascular disease/Stroke, Risk factors in epidemiology, Infarction EDITORIALS 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

A Narrative Review of Nonvitamin K Antagonist Oral Anticoagulant Use in Secondary Stroke Prevention
The prevalence of atrial fibrillation (AF), the most common cardiac arrhythmia, increases with age, predisposing elderly patients to an increased risk of embolic stroke. With an increasingly aged population the number of people who experience a stroke every year, overall global burden of stroke, and numbers of stroke survivors and related deaths continue to increase. Anticoagulation with vitamin K antagonists (VKAs) reduces the risk of ischemic stroke in patients with AF; however, increased bleeding risk is well documented, particularly in the elderly.
Source: Journal of Stroke and Cerebrovascular Diseases - July 4, 2019 Category: Neurology Authors: Valeria Caso, Florian Masuhr Tags: Review Article Source Type: research

Timing of symptomatic intracerebral hemorrhage after rt-PA treatment in ischemic stroke
Conclusions Our findings suggest that rt-PA patients have the highest risk of post rt-PA sICH within the first 24 hours after treatment. This supports monitoring of rt-PA-treated patients in specialized settings such as neuro-intensive care units or stroke units. Our findings suggest that the probability of sICH is low 36 hours post rt-PA. Future larger studies are warranted to identify the patterns of bleeding after rt-PA administration.
Source: Neurology Clinical Practice - August 11, 2019 Category: Neurology Authors: Chen, P. M., Lehmann, B., Meyer, B. C., Rapp, K., Hemmen, T., Modir, R., Agrawal, K., Hailey, L., Mortin, M., Meyer, D. M. Tags: All Cerebrovascular disease/Stroke, Intracerebral hemorrhage Research Source Type: research

Deferoxamine Treatment Prevents Post-Stroke Vasoregression and Neurovascular Unit Remodeling Leading to Improved Functional Outcomes in Type 2 Male Diabetic Rats: Role of Endothelial Ferroptosis
This study aimed to determine the impact of iron chelation with deferoxamine (DFX) on (1) cerebral vascularization patterns and (2) functional outcomes after stroke in control and diabetic rats. After 8  weeks of type 2 diabetes induced by a combination of high-fat diet and low-dose streptozotocin, male control and diabetic animals were subjected to thromboembolic middle cerebral artery occlusion (MCAO) and randomized to vehicle, DFX, or tPA/DFX and followed for 14 days with behavioral tests. Vas cular indices (vascular volume and surface area), neurovascular remodeling (AQP4 polarity), and microglia activation were meas...
Source: Translational Stroke Research - August 31, 2020 Category: Neurology Source Type: research