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Editorial Stroke —acting FAST at all ages
On Feb 1, Public Health England released new estimates for the incidence of first stroke in England and relaunched its Act FAST campaign. FAST is aimed at the public, encouraging them to call 999 —the UK's emergency number—if there are tell-tale signs of stroke in themselves or anyone they see. FAST stands for face, arms, speech, and time (to call). The new estimates showed that about 57 000 new strokes and 32 000 stroke-related deaths occur every year in England. Of those who have e xperienced a stroke, about a quarter leave hospital with moderate or severe disability.
Source: LANCET - February 9, 2018 Category: General Medicine Authors: The Lancet Tags: Editorial Source Type: research
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 A global coalition for the fight against heart disease and stroke
As political leaders prepare for the third UN High-level Meeting on Non-communicable Diseases (NCDs) in 2018, the World Heart Federation (WHF) is bringing together a global coalition of international, regional, and national stakeholders in cardiovascular diseases (CVDs) to drive the urgent action needed to combat heart disease and stroke.
Source: LANCET - October 16, 2017 Category: General Medicine Authors: David Wood, Jean-Luc Eisel é Tags: Comment Source Type: research
Correspondence Intensive speech and language therapy after stroke
Caterina Breitenstein and colleagues (April 15, p 1528)1 reported that 3 weeks of intensive speech and language therapy significantly enhanced verbal communication in people aged 70 years or younger with chronic aphasia after stroke. The primary outcome measure was assessed using the Amsterdam-Nijmegen Everyday Language Test (ANELT) A-scale, and the mean difference of the ANELT A-scale score improved 2 ·61 (SD 4·94) points from baseline to after intensive speech and language therapy, but not from baseline to after treatment deferral.
Source: LANCET - July 14, 2017 Category: General Medicine Authors: Ryo Sakamoto, Asaka Higuchi, Kenji Tsuda, Tetsuya Tanimoto, Masahiro Kami Tags: Correspondence Source Type: research
Correspondence Intensive speech and language therapy after stroke – Authors' reply
We thank Ryo Sakamoto and colleagues for their Correspondence regarding our FCET2EC trial on the effectiveness of intensive speech and language therapy in chronic post-stroke aphasia.1 Their point regarding the minimal clinically important difference of the primary outcome measure (Amsterdam-Nijmegen Everyday Language Test [ANELT] A-scale) is of major concern, as already acknowledged in our Article ( “To our knowledge, no previously published studies exist on the association of change in ANELT scores with clinical effect.”).
Source: LANCET - July 14, 2017 Category: General Medicine Authors: Caterina Breitenstein, Peter Martus, Klaus Willmes, Wolfram Ziegler, Annette Baumgaertner Tags: Correspondence Source Type: research
Correspondence Unmet challenges for rehabilitation after stroke in China
Stroke is an important public health problem in China, and is one of the leading causes of death and disability. About 2 500 000 people have a stroke in China every year, and 70–80% of patients lose the ability to perform routine activities and require care, resulting in an economic burden for both the country and their family.1 Japan has a similar incidence of stroke because of similar ancestry, but outcomes a fter stroke are better in Japan than in China. In Japan, 64·2% of young patients (age
Source: LANCET - July 7, 2017 Category: General Medicine Authors: Tetsuya Asakawa, Liang Zong, Liang Wang, Ying Xia, Hiroki Namba Tags: Correspondence Source Type: research
Articles Family-led rehabilitation after stroke in India (ATTEND): a randomised controlled trial
Although task shifting is an attractive solution for health-care sustainability, our results do not support investment in new stroke rehabilitation services that shift tasks to family caregivers, unless new evidence emerges. A future avenue of research should be to investigate the effects of task shifting to health-care assistants or team-based community care.
Source: LANCET - June 27, 2017 Category: General Medicine Authors: The ATTEND Collaborative Group Tags: Articles Source Type: research
Correspondence Stroke in ICD-11: the end of a long exile
In 1955, cerebrovascular diseases were reclassified as circulatory system diseases in the 7th edition of the International Classification of Diseases and Related Health Problems (ICD). WHO's idea then was that stroke is a condition affecting blood vessels. This decision to reclassify cerebrovascular diseases seemed contrary to the pathophysiology and symptoms leading to mortality and morbidity, which are those of brain dysfunction. Moreover, the decision deviated from the principle of ischaemia of other organs (such as the intestines, kidneys, and the eye), which were listed under their respective organs in ICD-7.
Source: LANCET - June 16, 2017 Category: General Medicine Authors: Raad Shakir, Bo Norrving Tags: Correspondence Source Type: research
Correspondence Risk of mortality and stroke after atrial fibrillation
Jeff Healey and colleagues (Sept 17, p 1161)1 should take credit for their study about mortality and stroke 1 year after a diagnosis of atrial fibrillation. The main findings of the study were the almost two-times higher mortality in South America (17%) and Africa (20%) compared with North America, western Europe, and Australia (10%), and the higher stroke frequency in Africa (8%) and China (7%) compared with the aforementioned regions (3%).
Source: LANCET - March 3, 2017 Category: Journals (General) Authors: Constantinos Mihas, Anargiros Mariolis, Konstantinos P Letsas, Maria Kantzanou Tags: Correspondence Source Type: research
Correspondence Risk of mortality and stroke after atrial fibrillation – Authors' reply
On behalf our colleagues, we would like to thank Zitian Huo and Constantinos Mihas and colleagues for their interest in our Article and for their questions. We agree with Mihas and colleagues that it would be informative to examine regional differences in haemorrhagic stroke. However, given the large size of our study,1 we needed to minimise the burden of data collection to keep costs affordable. As a result, we did not collect any data on stroke subtypes. The decision not to collect these data was also influenced by the fact that not all participating regions in this study had equal access to advanced neurological imaging...
Source: LANCET - March 3, 2017 Category: Journals (General) Authors: Jeff S Healey, Jonas Oldgren, RE-LY Atrial Fibrillation and Cohort Study Investigators Tags: Correspondence Source Type: research
Articles Intensive speech and language therapy in patients with chronic aphasia after stroke: a randomised, open-label, blinded-endpoint, controlled trial in a health-care setting
3 weeks of intensive speech and language therapy significantly enhanced verbal communication in people aged 70 years or younger with chronic aphasia after stroke, providing an effective evidence-based treatment approach in this population. Future studies should examine the minimum treatment intensity required for meaningful treatment effects, and determine whether treatment effects cumulate over repeated intervention periods.
Source: LANCET - February 27, 2017 Category: Journals (General) Authors: Caterina Breitenstein, Tanja Grewe, Agnes Fl öel, Wolfram Ziegler, Luise Springer, Peter Martus, Walter Huber, Klaus Willmes, E Bernd Ringelstein, Karl Georg Haeusler, Stefanie Abel, Ralf Glindemann, Frank Domahs, Frank Regenbrecht, Klaus-Jürgen Schlenc Tags: Articles Source Type: research
Correspondence The INTERSTROKE study on risk factors for stroke
In a large case-control study in 32 countries, O'Donnell and colleagues (Aug 20, p 761) 1 sought to quantify the importance of potentially modifiable risk factors for stroke in different regions of the world. They found that ten potentially modifiable risk factors are collectively associated with about 90% of the population attributable risks of stroke in each major region of the world.
Source: LANCET - January 6, 2017 Category: Journals (General) Authors: Xianwei Zeng, Aijun Deng, Yi Ding Tags: Correspondence Source Type: research
Correspondence The INTERSTROKE study on risk factors for stroke – Authors' reply
Xianwei Zeng and collagues suggest our analysis of the INTERSTROKE study1 overestimated the population attributable for ten risk factors of stroke due to the selection of variables included. Although we did not include a variable for metabolic syndrome, we did include the key domains for metabolic syndrome, namely obesity, diabetes, hypertension, and apolipoproteins. Our analysis also included a measure of dietary quality, namely modified alternative healthy index (mAHEI). Variables for health education and hormones were not included, because these were not measured, although certain hormones could be measured in future an...
Source: LANCET - January 6, 2017 Category: Journals (General) Authors: Martin O'Donnell, Salim Yusuf Tags: Correspondence Source Type: research
In the past decade, the definition of stroke has been revised and major advances have been made for its treatment and prevention. For acute ischaemic stroke, the addition of endovascular thrombectomy of proximal large artery occlusion to intravenous alteplase increases functional independence for a further fifth of patients. The benefits of aspirin in preventing early recurrent ischaemic stroke are greater than previously recognised. Other strategies to prevent recurrent stroke now include direct oral anticoagulants as an alternative to warfarin for atrial fibrillation, and carotid stenting as an alternative to endarterect...
Source: LANCET - September 13, 2016 Category: Journals (General) Authors: Graeme J Hankey Tags: Seminar Source Type: research
Editorial Atrial fibrillation and stroke: unrecognised and undertreated
When did you or your primary care physician last palpate your wrist to check for a regular heart rate? This simple action, followed by an electrocardiogram if the heart rate is irregular, might be crucial in preventing death and disability from ischaemic stroke, heart failure, or myocardial infarction. In this week's issue, we publish a clinical Series of three papers on atrial fibrillation ahead of the annual European Society of Cardiology (ESC) meeting held in Rome, Italy, Aug 27 –31. Atrial fibrillation is estimated to affect 33 million people worldwide.
Source: LANCET - August 19, 2016 Category: Journals (General) Authors: The Lancet Tags: Editorial Source Type: research
Correspondence Telemedicine expedites access to optimal acute stroke care
In their meta-analysis of patient-level data from five randomised trials, Mayank Goyal and colleagues1 (April 23, p 1723) reported that endovascular thrombectomy was effective for patients with acute ischaemic stroke caused by large-vessel occlusions (number needed to treat, 2 ·6). Individuals that will benefit include older patients (age>80 years), those ineligible to receive tissue plasminogen activator (tPA), and those with internal carotid artery or M1 occlusion. We agree with the authors that the findings “have global implications on structuring systems of care”1 to ensure no eligible patient is missed under these expanded criteria.
Source: LANCET - August 19, 2016 Category: Journals (General) Authors: Kathleen L Bagot, Dominique A Cadilhac, Peter J Hand, Michelle Vu, Christopher F Bladin Tags: Correspondence Source Type: research
Series Stroke prevention in atrial fibrillation
Atrial fibrillation is found in a third of all ischaemic strokes, even more after post-stroke atrial fibrillation monitoring. Data from stroke registries show that both unknown and untreated or under treated atrial fibrillation is responsible for most of these strokes, which are often fatal or debilitating. Most could be prevented if efforts were directed towards detection of atrial fibrillation before stroke occurs, through screening or case finding, and treatment of all patients with atrial fibrillation at increased risk of stroke with well-controlled vitamin K antagonists or non-vitamin K antagonist anticoagulants.
Source: LANCET - August 19, 2016 Category: Journals (General) Authors: Ben Freedman, Tatjana S Potpara, Gregory Y H Lip Tags: Series Source Type: research
Comment Stroke and mortality after atrial fibrillation —a global struggle
Atrial fibrillation is a widely recognised health-care challenge with increasing prevalence across the world. Epidemiological observations mainly attribute this increase to an ageing population and better prognosis in distinguishing it from other cardiac disorders such as myocardial infarction.1 Research into atrial fibrillation has focused on antithrombotic management for stroke prevention and mortality, in the era of non-vitamin K antagonist oral anticoagulants.2 However, although these large, phase 3 trials enrolled patients from many centres in different countries and included broad populations, regional differences an...
Source: LANCET - August 8, 2016 Category: Journals (General) Authors: Torben Bjerregaard Larsen, Peter Br ønnum Nielsen Tags: Comment Source Type: research
Articles Occurrence of death and stroke in patients in 47 countries 1 year after presenting with atrial fibrillation: a cohort study
Marked unexplained inter-regional variations in the occurrence of stroke and mortality suggest that factors other than clinical variables might be important. Prevention of death from heart failure should be a major priority in the treatment of atrial fibrillation.
Source: LANCET - August 8, 2016 Category: Journals (General) Authors: Jeff S Healey, Jonas Oldgren, Michael Ezekowitz, Jun Zhu, Prem Pais, Jia Wang, Patrick Commerford, Petr Jansky, Alvaro Avezum, Alben Sigamani, Albertino Demasceno, Paul Reilly, Alex Grinvalds, Juliet Nakamya, Akinyemi Aje, Wael Almahmeed, Andrew Moriarty, Tags: Articles Source Type: research
Comment Age of PISCES: stem-cell clinical trials in stroke
Laboratory studies and limited clinical trials over the past two decades have shown feasibility and safety, and have revealed potential mechanisms of action of stem-cell therapy in ischaemic stroke. Despite consistent efficacy in animal studies, functional benefits after transplantation of stem cells remain to be shown unequivocally in stroke patients.1 Translation of stem-cell therapy from the laboratory to the clinic has been approached with ample caution, in part due to the largely negative outcomes for several stroke therapeutics in human beings compared with those in animals.
Source: LANCET - August 3, 2016 Category: Journals (General) Authors: Cesar V Borlongan Tags: Comment Source Type: research
Articles Human neural stem cells in patients with chronic ischaemic stroke (PISCES): a phase 1, first-in-man study
Single intracerebral doses of CTX-DP up to 20 million cells induced no adverse events and were associated with improved neurological function. Our observations support further investigation of CTX-DP in stroke patients.
Source: LANCET - August 3, 2016 Category: Journals (General) Authors: Dheeraj Kalladka, John Sinden, Kenneth Pollock, Caroline Haig, John McLean, Wilma Smith, Alex McConnachie, Celestine Santosh, Philip M Bath, Laurence Dunn, Keith W Muir Tags: Articles Source Type: research
Comment Stroke is largely preventable across the globe: where to next?
Despite the ever-increasing disease burden of stroke in the world,1 accurate data on stroke risk factors are still scarce. In the first phase of the INTERSTROKE study,2 more than 90% of strokes (ischaemic stroke and intracerebral haemorrhage) were attributed to just ten risk factors. However, the study was restricted to developing countries only, and was not powered to explore age, sex, ethnicity, and regional variations in the effect of risk factors or pathological type of stroke, such as ischaemic stroke and intracerebral haemorrhage.
Source: LANCET - July 15, 2016 Category: Journals (General) Authors: Valery L Feigin, Rita Krishnamurthi Tags: Comment Source Type: research
Articles Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study
Ten potentially modifiable risk factors are collectively associated with about 90% of the PAR of stroke in each major region of the world, among ethnic groups, in men and women, and in all ages. However, we found important regional variations in the relative importance of most individual risk factors for stroke, which could contribute to worldwide variations in frequency and case-mix of stroke. Our findings support developing both global and region-specific programmes to prevent stroke.
Source: LANCET - July 15, 2016 Category: Journals (General) Authors: Martin J O'Donnell, Siu Lim Chin, Sumathy Rangarajan, Denis Xavier, Lisheng Liu, Hongye Zhang, Purnima Rao-Melacini, Xiaohe Zhang, Prem Pais, Steven Agapay, Patricio Lopez-Jaramillo, Albertino Damasceno, Peter Langhorne, Matthew J McQueen, Annika Rosengre Tags: Articles Source Type: research
Comment The benefits of aspirin in early secondary stroke prevention
Aspirin is considered an affordable and widely available, if only modestly effective, thromboprophylactic for secondary stroke prevention. The two large randomised controlled trials of aspirin in acute ischaemic stroke reported that aspirin reduced the odds of early recurrent stroke at 2 –4 weeks by about 12% (odds ratio [OR] 0·88, 95% CI 0·79–0·97) and the odds of death or dependency at the end of follow-up by about 5% (OR 0·95, 0·91–0·99).1 The ten trials of aspirin for long-term secondary prevention in patients with previous transient ischaemic attack (TIA) or ischaem ic stroke reported that aspirin reduced ...
Source: LANCET - May 18, 2016 Category: Journals (General) Authors: Graeme J Hankey Tags: Comment Source Type: research
Articles Effects of aspirin on risk and severity of early recurrent stroke after transient ischaemic attack and ischaemic stroke: time-course analysis of randomised trials
Our findings confirm that medical treatment substantially reduces the risk of early recurrent stroke after TIA and minor stroke and identify aspirin as the key intervention. The considerable early benefit from aspirin warrants public education about self-administration after possible TIA. The previously unrecognised effect of aspirin on severity of early recurrent stroke, the diminishing benefit with longer-term use, and the contrasting time course of effects of dipyridamole have implications for understanding mechanisms of action.
Source: LANCET - May 18, 2016 Category: Journals (General) Authors: Peter M Rothwell, Ale Algra, Zhengming Chen, Hans-Christoph Diener, Bo Norrving, Ziyah Mehta Tags: Articles Source Type: research
Articles Weekly variation in health-care quality by day and time of admission: a nationwide, registry-based, prospective cohort study of acute stroke care
The weekend effect is a simplification, and just one of several patterns of weekly variation occurring in the quality of stroke care. Weekly variation should be further investigated in other health-care settings, and quality improvement should focus on reducing temporal variation in quality and not only the weekend effect.
Source: LANCET - May 10, 2016 Category: Journals (General) Authors: Benjamin D Bray, Geoffrey C Cloud, Martin A James, Harry Hemingway, Lizz Paley, Kevin Stewart, Pippa J Tyrrell, Charles D A Wolfe, Anthony G Rudd, SSNAP collaboration Tags: Articles Source Type: research
Correspondence IST-3 stroke trial data available
The third International Stroke Trial1 was the largest ever randomised controlled trial of intravenous thrombolysis treatment for patients with acute ischaemic stroke. In accordance with our published protocol and statistical analysis plan, we made the patient data available for an individual patient data meta-analysis.2 We now wish to announce that the IST-3 collaborative group has lodged an anonymised version of the dataset with University of Edinburgh DataShare,3 to enable bona fide researchers to obtain access to the data.
Source: LANCET - May 6, 2016 Category: Journals (General) Authors: Peter Sandercock, Joanna Wardlaw, Richard Lindley, William Whiteley, Geoff Cohen Tags: Correspondence Source Type: research
Comment Can biomarkers balance stroke and bleeding risk?
Age and previous stroke, together with other clinical risk factors (often summarised in the CHA2DS2VASc score), identify patients with atrial fibrillation at high risk for stroke. Dose-adjusted warfarin prevents ischaemic strokes, prolongs life, and maintains autonomy in such patients.1,2 Hence, oral anticoagulation is currently recommended for all patients with atrial fibrillation with two of the CHA2DS2VASc risk factors, and should be considered in those with one of them.1,2 Although even reinitiation of anticoagulation after an intracerebral bleed seems to be associated with improved outcomes,3,4 bleeding is a major rea...
Source: LANCET - April 4, 2016 Category: Journals (General) Authors: Paulus Kirchhof, Larissa Fabritz Tags: Comment Source Type: research
Comment HERMES: messenger for stroke interventional treatment
The treatment approach for acute ischaemic stroke is straightforward: restore blood flow as soon as possible and do it as safely and completely as possible. The overlong path to confirming this simple and intuitive treatment plan leads to the HERMES collaboration, the meta-analysis from Mayank Goyal and colleagues—including principal investigators from the selected trials—published in The Lancet, which combines individual patient data from five trials of endovascular mechanical thrombectomy published in 2015.
Source: LANCET - February 18, 2016 Category: Journals (General) Authors: Keith W Muir, Philip White Tags: Comment Source Type: research
Articles Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials
Endovascular thrombectomy is of benefit to most patients with acute ischaemic stroke caused by occlusion of the proximal anterior circulation, irrespective of patient characteristics or geographical location. These findings will have global implications on structuring systems of care to provide timely treatment to patients with acute ischaemic stroke due to large vessel occlusion.
Source: LANCET - February 18, 2016 Category: Journals (General) Authors: Mayank Goyal, Bijoy K Menon, Wim H van Zwam, Diederik W J Dippel, Peter J Mitchell, Andrew M Demchuk, Antoni Dávalos, Charles B L M Majoie, Aad van der Lugt, Maria A de Miquel, Geoffrey A Donnan, Yvo B W E M Roos, Alain Bonafe, Reza Jahan, Hans-Christoph Tags: Articles Source Type: research
Articles Association between age and risk of stroke or death from carotid endarterectomy and carotid stenting: a meta-analysis of pooled patient data from four randomised trials
In these RCTs, CEA was clearly superior to CAS in patients aged 70–74 years and older. The difference in older patients was almost wholly attributable to increasing periprocedural stroke risk in patients treated with CAS. Age had little effect on CEA periprocedural risk or on postprocedural risk after either procedure.
Source: LANCET - February 12, 2016 Category: Journals (General) Authors: George Howard, Gary S Roubin, Olav Jansen, Jeroen Hendrikse, Alison Halliday, Gustav Fraedrich, Hans-Henning Eckstein, David Calvet, Richard Bulbulia, Leo H Bonati, Jean-Pierre Becquemin, Ale Algra, Martin M Brown, Peter A Ringleb, Thomas G Brott, Jean-Lo Tags: Articles Source Type: research
Correspondence Prophylactic antibiotics to reduce pneumonia after acute stroke
The STROKE-INF trial (Nov 7, p1835)1 reported outcomes that were different from those initially included in the ISRCTN registry (number ISRCTN37118456). There were two pre-specified primary outcomes, of which one was reported in the Article, and the other (“total hospital costs”) was not reported anywhere in the paper. In addition, the Article reported a new co-primary outcome (“physician diagnosed post-stroke pneumonia”) that was not pre-specified, without declaring it as such. Of the 14 pre-specified secondary outcomes, six were reported in the paper, and eight were unreported anywhere in the paper.
Source: LANCET - January 30, 2016 Category: Journals (General) Authors: Ioan Milosevic, Aaron Dale, Henry Drysdale, Kamal Mahtani, COMPare project team Tags: Correspondence Source Type: research
Correspondence Prophylactic antibiotics to reduce pneumonia after acute stroke – Author's reply
Ioan Milosevic and colleagues pointed out that the outcomes presented in our Article1 were different from those in the ISRCTN registry (number ISRCTN37118456). They stated that one pre-specified primary outcome (“hospital costs”) was not reported, and a new co-primary outcome (“physician diagnosed post-stroke pneumonia”) added. We have clarified in the Methods section that physician diagnosed pneumonia was not a primary outcome but was presented as an alternative to algorithm-based diagnosis to harmonise with diagnostic criteria used in previous studies.
Source: LANCET - January 30, 2016 Category: Journals (General) Authors: Lalit Kalra Tags: Correspondence Source Type: research
Editorial Postacute stroke care: same standards as acute care?
The Sentinel Stroke National Audit Programme (SSNAP), led by the Royal College of Physicians, has released the first comprehensive audit into 604 of 756 postacute stroke care services throughout the UK. Although vast improvements have been achieved in acute stroke care in recent years, progress in postacute care for long-term rehabilitation has been left behind in comparison.
Source: LANCET - December 11, 2015 Category: Journals (General) Authors: The Lancet Tags: Editorial Source Type: research
Comment New option for primary stroke prevention in sickle cell anaemia
The results of the TWiTCH trial1 establish a new standard of care for primary stroke prevention in children with sickle cell anaemia and high transcranial doppler (TCD) flow velocities (≥200 cm/s). In this high-risk group, the incidence of strokes per year is about
Source: LANCET - December 6, 2015 Category: Journals (General) Authors: Michael R DeBaun, Fenella J Kirkham Tags: Comment Source Type: research
Correspondence Could upright posture be harmful in the early stages of stroke?
Findings from the AVERT trial (July 4, p 46)1 have effectively slain a long cherished theory of stroke unit enthusiasts, that the sooner mobilisation and active rehabilitation begin after stroke, the better. In fact, evidence of a small, but significant, harmful effect of early mobilisation was found. After adjusting for age and stroke severity, and applying the prespecified cutoff for favourable outcome on the modified Rankin scale, we estimate that one in 13 patients (95% CI 8–40) had worse outcome with early mobilisation than with standard treatment.
Source: LANCET - October 30, 2015 Category: Journals (General) Authors: David Barer, Caroline Watkins Tags: Correspondence Source Type: research
Correspondence Could upright posture be harmful in the early stages of stroke? – Author's reply
The AVERT trial1 delivered a surprising result; higher dose of out-of-bed activity soon after stroke (very early mobilisation) led to a less favourable outcome than lower dose, but still early, out-of-bed activity. This finding will prompt revision of current guidelines,2 which have increasingly recommended early mobilisation. Precisely what should be recommended, however, is less clear at this point. Usual care did not consist of prolonged bed rest; 623 (59%) of 1050 patients in the usual care group started out-of-bed activity within 24 h of stroke onset, 525 (50%) patients had little or no disability (modified Rankin sca...
Source: LANCET - October 30, 2015 Category: Journals (General) Authors: Julie Bernhardt, AVERT investigators Tags: Correspondence Source Type: research
Articles Prophylactic antibiotics after acute stroke for reducing pneumonia in patients with dysphagia (STROKE-INF): a prospective, cluster-randomised, open-label, masked endpoint, controlled clinical trial
Antibiotic prophylaxis cannot be recommended for prevention of post-stroke pneumonia in patients with dysphagia after stroke managed in stroke units.
Source: LANCET - September 3, 2015 Category: Journals (General) Authors: Lalit Kalra, Saddif Irshad, John Hodsoll, Matthew Simpson, Martin Gulliford, David Smithard, Anita Patel, Irene Rebollo-Mesa, STROKE-INF Investigators Tags: Articles Source Type: research
Comment Prevention of stroke-associated pneumonia: where next?
Prevention and treatment of complications, such as infection, are a mainstay of post-stroke care.1,2 However, even with dedicated care in a stroke unit, disorders such as stroke-associated pneumonia are a major challenge;2,3 and since this disorder is a substantial contributor to mortality and morbidity after stroke, new therapeutic approaches are urgently needed.3,4 Experimental studies and phase 2b randomised controlled trials5,6 raised hope that preventive anti-infective treatment with antibiotics might not only control infections, but also improve outcomes after stroke.
Source: LANCET - September 3, 2015 Category: Journals (General) Authors: Andreas Meisel, Craig J Smith Tags: Comment Source Type: research
Articles Long working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published and unpublished data for 603 838 individuals
Employees who work long hours have a higher risk of stroke than those working standard hours; the association with coronary heart disease is weaker. These findings suggest that more attention should be paid to the management of vascular risk factors in individuals who work long hours.
Source: LANCET - August 19, 2015 Category: Journals (General) Authors: Mika Kivimäki, Markus Jokela, Solja T Nyberg, Archana Singh-Manoux, Eleonor I Fransson, Lars Alfredsson, Jakob B Bjorner, Marianne Borritz, Hermann Burr, Annalisa Casini, Els Clays, Dirk De Bacquer, Nico Dragano, Raimund Erbel, Goedele A Geuskens, Mark H Tags: Articles Source Type: research
Correspondence Parenteral antibiotics are not enough to prevent pneumonia in stroke
The Preventive Antibiotics in Stroke Study (PASS; April 18, p 1519)1 reported that parenteral ceftriaxone did not significantly reduce pneumonia. We would like to comment on these results.
Source: LANCET - August 14, 2015 Category: Journals (General) Authors: Luciano Silvestri, Hendrick K F van Saene, Marco Milanese, Silvia Ros, Durk F Zandstra Tags: Correspondence Source Type: research
Correspondence Parenteral antibiotics are not enough to prevent pneumonia in stroke – Authors' reply
The susceptibility of patients with stroke to pneumonia has been well recognised,1 and its cause is multifactorial.2 Luciano Silvestri and colleagues rightly point out pathophysiological differences between early pneumonia after stroke, defined as within the first week after stroke onset, and late pneumonia, defined as after the first week. The Pneumonia In Stroke ConsEnsuS (PISCES) group has recently recommended reserving the term stroke-associated pneumonia for the spectrum of lower respiratory tract infections within the first 7 days after stroke onset.
Source: LANCET - August 14, 2015 Category: Journals (General) Authors: Diederik van de Beek, Matthijs Brouwer, Paul Nederkoorn Tags: Correspondence Source Type: research
Correspondence The future of stroke therapy must not be mired by past arguments
Stroke is the leading cause of disability and the fifth leading cause of death in the UK, costing the UK economy more than £7 billion per year.1 At present, the only therapeutic approved by the UK National Institute for Health and Care Excellence (NICE) for the treatment of ischaemic stroke is thrombolysis using recombinant tissue-type plasminogen activator (rtPA). However, rtPA is only effective in patients who present within 4·5 h of stroke onset, with a number needed to treat for benefit of 3·6 before 90 min, rising to 5·9 between 3 h and 4·5 h.
Source: LANCET - August 14, 2015 Category: Journals (General) Authors: Alastair M Buchan, Hasneen G Karbalai, Brad A Sutherland Tags: Correspondence Source Type: research
Comment AVERT: a major milestone in stroke research
Prevention of stroke is, of course, the ideal scenario, but with more than 10 million major strokes every year worldwide, acute treatment and rehabilitation should also be optimised. Organised acute stroke care within dedicated stroke units reduces death and dependency after stroke,1 but which elements of such care confer this benefit is uncertain. Systematic prevention of common complications and more expert nursing care undoubtedly contribute, but in the physiologically unstable setting of acute stroke, the benefits and harms of each specific element of care need to be reliably assessed.
Source: LANCET - May 10, 2015 Category: Journals (General) Authors: Peter M Rothwell Tags: Comment Source Type: research
Articles Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial
First mobilisation took place within 24 h for most patients in this trial. The higher dose, very early mobilisation protocol was associated with a reduction in the odds of a favourable outcome at 3 months. Early mobilisation after stroke is recommended in many clinical practice guidelines worldwide, and our findings should affect clinical practice by refining present guidelines; however, clinical recommendations should be informed by future analyses of dose–response associations.
Source: LANCET - April 16, 2015 Category: Journals (General) Authors: The AVERT Trial Collaboration group Tags: Articles Source Type: research
Correspondence Thrombolysis in acute stroke
In a meta-analysis of data from nine randomised trials, Jonathan Emberson and colleagues1 concluded that, irrespective of age or stroke severity, alteplase delivered within 4·5 h of stroke onset significantly improved the overall odds of a good stroke outcome. Shorter time to treatment was associated with even greater proportional benefits.
Source: LANCET - April 10, 2015 Category: Journals (General) Authors: Valeria Caso, Patrik Michel Tags: Correspondence Source Type: research
Correspondence Thrombolysis in acute stroke – Authors' reply
We thank the correspondents for their interest in our meta-analysis of individual patient data from trials of alteplase for patients with acute ischaemic stroke.1
Source: LANCET - April 10, 2015 Category: Journals (General) Authors: Jonathan Emberson, Kennedy R Lees, Patrick Lyden, Colin Baigent, Peter Sandercock, Werner Hacke, on behalf of the Stroke Treatment Trialists' Collaboration Tags: Correspondence Source Type: research