Query: stroke

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Source: The Lancet

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Total 181 results found since Jan 2013.

Stroke: the doctor as patient
Publication date: Available online 28 October 2019Source: The LancetAuthor(s): Udo Kischka
Source: The Lancet - October 29, 2019 Category: General Medicine Source Type: research

Don't be the one: individual responsibility in stroke prevention
Publication date: 26 October–1 November 2019Source: The Lancet, Volume 394, Issue 10208Author(s): The Lancet
Source: The Lancet - October 26, 2019 Category: General Medicine Source Type: research

Comprehensive comparative effectiveness and safety of first-line antihypertensive drug classes: a systematic, multinational, large-scale analysis
Publication date: Available online 24 October 2019Source: The LancetAuthor(s): Marc A Suchard, Martijn J Schuemie, Harlan M Krumholz, Seng Chan You, RuiJun Chen, Nicole Pratt, Christian G Reich, Jon Duke, David Madigan, George Hripcsak, Patrick B RyanSummaryBackgroundUncertainty remains about the optimal monotherapy for hypertension, with current guidelines recommending any primary agent among the first-line drug classes thiazide or thiazide-like diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, dihydropyridine calcium channel blockers, and non-dihydropyridine calcium channel blockers, in ...
Source: The Lancet - October 26, 2019 Category: General Medicine Source Type: research

Preventing unnecessary disability after stroke in Scotland
Publication date: 5–11 October 2019Source: The Lancet, Volume 394, Issue 10205Author(s): Shelagh B Coutts
Source: The Lancet - October 5, 2019 Category: General Medicine Source Type: research

Safety and efficacy of a self-expanding versus a balloon-expandable bioprosthesis for transcatheter aortic valve replacement in patients with symptomatic severe aortic stenosis: a randomised non-inferiority trial
Publication date: Available online 27 September 2019Source: The LancetAuthor(s): Jonas Lanz, Won-Keun Kim, Thomas Walther, Christof Burgdorf, Helge Möllmann, Axel Linke, Simon Redwood, Christian Thilo, Michael Hilker, Michael Joner, Holger Thiele, Lars Conzelmann, Lenard Conradi, Sebastian Kerber, Gerhard Schymik, Bernard Prendergast, Oliver Husser, Stefan Stortecky, Dik Heg, Peter JüniSummaryBackgroundTranscatheter aortic valve replacement (TAVR) is the preferred treatment option for older patients with symptomatic severe aortic stenosis. Differences in the properties of available TAVR systems can affect clinical outcom...
Source: The Lancet - September 28, 2019 Category: General Medicine Source Type: research

Modifiable risk factors, cardiovascular disease, and mortality in 155 722 individuals from 21 high-income, middle-income, and low-income countries (PURE): a prospective cohort study
We describe the prevalence, hazard ratios (HRs), and population-attributable fractions (PAFs) for cardiovascular disease and mortality associated with a cluster of behavioural factors (ie, tobacco use, alcohol, diet, physical activity, and sodium intake), metabolic factors (ie, lipids, blood pressure, diabetes, obesity), socioeconomic and psychosocial factors (ie, education, symptoms of depression), grip strength, and household and ambient pollution. Associations between risk factors and the outcomes were established using multivariable Cox frailty models and using PAFs for the entire cohort, and also by countries grouped ...
Source: The Lancet - September 3, 2019 Category: General Medicine Source Type: research

Ticagrelor in patients with diabetes and stable coronary artery disease with a history of previous percutaneous coronary intervention (THEMIS-PCI): a phase 3, placebo-controlled, randomised trial
Publication date: Available online 1 September 2019Source: The LancetAuthor(s): Deepak L Bhatt, Philippe Gabriel Steg, Shamir R Mehta, Lawrence A Leiter, Tabassome Simon, Kim Fox, Claes Held, Marielle Andersson, Anders Himmelmann, Wilhelm Ridderstråle, Jersey Chen, Yang Song, Rafael Diaz, Shinya Goto, Stefan K James, Kausik K Ray, Alexander N Parkhomenko, Mikhail N Kosiborod, Darren K McGuire, Robert A HarringtonSummaryBackgroundPatients with stable coronary artery disease and diabetes with previous percutaneous coronary intervention (PCI), particularly those with previous stenting, are at high risk of ischaemic events. T...
Source: The Lancet - September 2, 2019 Category: General Medicine Source Type: research

Effectiveness of polypill for primary and secondary prevention of cardiovascular diseases (PolyIran): a pragmatic, cluster-randomised trial
Publication date: 24–30 August 2019Source: The Lancet, Volume 394, Issue 10199Author(s): Gholamreza Roshandel, Masoud Khoshnia, Hossein Poustchi, Karla Hemming, Farin Kamangar, Abdolsamad Gharavi, Mohammad Reza Ostovaneh, Alireza Nateghi, Masoud Majed, Behrooz Navabakhsh, Shahin Merat, Akram Pourshams, Mahdi Nalini, Fatemeh Malekzadeh, Masoumeh Sadeghi, Noushin Mohammadifard, Nizal Sarrafzadegan, Mohammad Naemi-Tabiei, Abdolreza Fazel, Paul BrennanSummaryBackgroundA fixed-dose combination therapy (polypill strategy) has been proposed as an approach to reduce the burden of cardiovascular disease, especially in low-income ...
Source: The Lancet - August 23, 2019 Category: General Medicine Source Type: research

Medium and long-term risks of specific cardiovascular diseases in survivors of 20 adult cancers: a population-based cohort study using multiple linked UK electronic health records databases
In this study, we used large-scale electronic health records data from multiple linked UK databases to address these evidence gaps.MethodsFor this population-based cohort study, we used linked primary care, hospital, and cancer registry data from the UK Clinical Practice Research Datalink to identify cohorts of survivors of the 20 most common cancers who were 18 years or older and alive 12 months after diagnosis and controls without history of cancer, matched for age, sex, and general practice. We compared risks for a range of cardiovascular disease outcomes using crude and adjusted Cox models. We fitted interactions to in...
Source: The Lancet - August 21, 2019 Category: General Medicine Source Type: research

Uncovering covert stroke in surgical patients
Publication date: Available online 15 August 2019Source: The LancetAuthor(s): Phillip E Vlisides, Michael S Avidan, George A Mashour
Source: The Lancet - August 17, 2019 Category: General Medicine Source Type: research

Perioperative covert stroke in patients undergoing non-cardiac surgery (NeuroVISION): a prospective cohort study
Publication date: Available online 15 August 2019Source: The LancetAuthor(s): Marko Mrkobrada, Matthew T.V. Chan, David Cowan, Douglas Campbell, Chew Yin Wang, David Torres, German Malaga, Robert D. Sanders, Manas Sharma, Carl Brown, Alben Sigamani, Wojciech Szczeklik, Mukul Sharma, Gordon Guyatt, Eric E. Smith, Ronit Agid, Adam A. Dmytriw, Jessica Spence, Nikesh R. Adunuri, Flavia K. BorgesSummaryBackgroundIn non-surgical settings, covert stroke is more common than overt stroke and is associated with cognitive decline. Although overt stroke occurs in less than 1% of adults after non-cardiac surgery and is associated with ...
Source: The Lancet - August 17, 2019 Category: General Medicine Source Type: research

An artificial intelligence-enabled ECG algorithm for the identification of patients with atrial fibrillation during sinus rhythm: a retrospective analysis of outcome prediction
Publication date: Available online 1 August 2019Source: The LancetAuthor(s): Zachi I Attia, Peter A Noseworthy, Francisco Lopez-Jimenez, Samuel J Asirvatham, Abhishek J Deshmukh, Bernard J Gersh, Rickey E Carter, Xiaoxi Yao, Alejandro A Rabinstein, Brad J Erickson, Suraj Kapa, Paul A FriedmanSummaryBackgroundAtrial fibrillation is frequently asymptomatic and thus underdetected but is associated with stroke, heart failure, and death. Existing screening methods require prolonged monitoring and are limited by cost and low yield. We aimed to develop a rapid, inexpensive, point-of-care means of identifying patients with atrial ...
Source: The Lancet - August 2, 2019 Category: General Medicine Source Type: research

Sphenopalatine ganglion stimulation after stroke, promising but not yet ready for adoption
Publication date: 20–26 July 2019Source: The Lancet, Volume 394, Issue 10194Author(s): Else Charlotte Sandset, Gary A Ford
Source: The Lancet - July 19, 2019 Category: General Medicine Source Type: research

Mortality, morbidity, and risk factors in China and its provinces, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017
Publication date: Available online 24 June 2019Source: The LancetAuthor(s): Maigeng Zhou, Haidong Wang, Xinying Zeng, Peng Yin, Jun Zhu, Wanqing Chen, Xiaohong Li, Lijun Wang, Limin Wang, Yunning Liu, Jiangmei Liu, Mei Zhang, Jinlei Qi, Shicheng Yu, Ashkan Afshin, Emmanuela Gakidou, Scott Glenn, Varsha Sarah Krish, Molly Katherine Miller-Petrie, W Cliff Mountjoy-VenningSummaryBackgroundPublic health is a priority for the Chinese Government. Evidence-based decision making for health at the province level in China, which is home to a fifth of the global population, is of paramount importance. This analysis uses data from the...
Source: The Lancet - June 25, 2019 Category: General Medicine Source Type: research

Dulaglutide and renal outcomes in type 2 diabetes: an exploratory analysis of the REWIND randomised, placebo-controlled trial
Publication date: Available online 9 June 2019Source: The LancetAuthor(s): Hertzel C Gerstein, Helen M Colhoun, Gilles R Dagenais, Rafael Diaz, Mark Lakshmanan, Prem Pais, Jeffrey Probstfield, Fady T Botros, Matthew C Riddle, Lars Rydén, Denis Xavier, Charles Messan Atisso, Leanne Dyal, Stephanie Hall, Purnima Rao-Melacini, Gloria Wong, Alvaro Avezum, Jan Basile, Namsik Chung, Ignacio CongetSummaryBackgroundTwo glucagon-like peptide-1 (GLP-1) receptor agonists reduced renal outcomes in people with type 2 diabetes at risk for cardiovascular disease. We assessed the long-term effect of the GLP-1 receptor agonist dulaglutide...
Source: The Lancet - June 10, 2019 Category: General Medicine Source Type: research

Dulaglutide and cardiovascular outcomes in type 2 diabetes (REWIND): a double-blind, randomised placebo-controlled trial
This study is registered with ClinicalTrials.gov, number NCT01394952.FindingsBetween Aug 18, 2011, and Aug 14, 2013, 9901 participants (mean age 66·2 years [SD 6·5], median HbA1c 7·2% [IQR 6·6–8·1], 4589 [46·3%] women) were enrolled and randomly assigned to receive dulaglutide (n=4949) or placebo (n=4952). During a median follow-up of 5·4 years (IQR 5·1–5·9), the primary composite outcome occurred in 594 (12·0%) participants at an incidence rate of 2·4 per 100 person-years in the dulaglutide group and in 663 (13·4%) participants at an incidence rate of 2·7 per 100 person-years in the placebo group (hazard ...
Source: The Lancet - June 10, 2019 Category: General Medicine Source Type: research

An injectable implant to stimulate the sphenopalatine ganglion for treatment of acute ischaemic stroke up to 24 h from onset (ImpACT-24B): an international, randomised, double-blind, sham-controlled, pivotal trial
Publication date: Available online 24 May 2019Source: The LancetAuthor(s): Natan M Bornstein, Jeffrey L Saver, Hans Christoph Diener, Philip B Gorelick, Ashfaq Shuaib, Yoram Solberg, Lisa Thackeray, Milan Savic, Tamar Janelidze, Natia Zarqua, David Yarnitsky, Carlos A Molina, Ashfaq Shuaib, Michael Hill, Daniel Vaclavik, David Skoloudik, Jan Fiksa, Grethe Andersen, Pekka Jakala, Turgut TatlisumakSummaryBackgroundSphenopalatine ganglion stimulation increased cerebral collateral blood flow, stabilised the blood–brain barrier, and reduced infarct size, in preclinical models of acute ischaemic stroke, and showed potential be...
Source: The Lancet - May 25, 2019 Category: General Medicine Source Type: research

The rise and fall of aspirin in the primary prevention of cardiovascular disease
Publication date: 25–31 May 2019Source: The Lancet, Volume 393, Issue 10186Author(s): Inbar Raber, Cian P McCarthy, Muthiah Vaduganathan, Deepak L Bhatt, David A Wood, John G F Cleland, Roger S Blumenthal, John W McEvoySummaryAspirin is one of the most frequently used drugs worldwide and is generally considered effective for the secondary prevention of cardiovascular disease. By contrast, the role of aspirin in primary prevention of cardiovascular disease is controversial. Early trials evaluating aspirin for primary prevention, done before the turn of the millennium, suggested reductions in myocardial infarction and stro...
Source: The Lancet - May 25, 2019 Category: General Medicine Source Type: research

Upadacitinib as monotherapy in patients with active rheumatoid arthritis and inadequate response to methotrexate (SELECT-MONOTHERAPY): a randomised, placebo-controlled, double-blind phase 3 study
This study is active but not recruiting and is registered with ClinicalTrials.gov, number NCT02706951.FindingsPatients were screened between Feb 23, 2016, and May 19, 2017 and 648 were randomly assigned to treatment. 598 (92%) completed week 14. At week 14, an ACR20 response was achieved by 89 (41%) of 216 patients (95% CI 35–48) in the continued methotrexate group, 147 (68%) of 217 patients (62–74) receiving upadacitinib 15 mg, and 153 (71%) of 215 patients (65–77) receiving upadacitinib 30 mg (p<0·0001 for both doses vs continued methotrexate). DAS28(CRP) 3·2 or lower was met by 42 (19%) of 216 (95% CI 14–2...
Source: The Lancet - May 25, 2019 Category: General Medicine Source Type: research

Late thrombolysis for stroke works, but how do we do it?
Publication date: Available online 22 May 2019Source: The LancetAuthor(s): Shelagh B Coutts, Bijoy K Menon
Source: The Lancet - May 24, 2019 Category: General Medicine Source Type: research

Robot assisted training for the upper limb after stroke (RATULS): a multicentre randomised controlled trial
This study is registered with the ISRCTN registry, number ISRCTN69371850.FindingsBetween April 14, 2014, and April 30, 2018, 770 participants were enrolled and randomly assigned to either robot-assisted training (n=257), EULT (n=259), or usual care (n=254). The primary outcome of ARAT success was achieved by 103 (44%) of 232 patients in the robot-assisted training group, 118 (50%) of 234 in the EULT group, and 85 (42%) of 203 in the usual care group. Compared with usual care, robot-assisted training (adjusted odds ratio [aOR] 1·17 [98·3% CI 0·70–1·96]) and EULT (aOR 1·51 [0·90–2·51]) did not improve upper limb f...
Source: The Lancet - May 24, 2019 Category: General Medicine Source Type: research

Robotic-assisted training after stroke: RATULS advances science
Publication date: Available online 22 May 2019Source: The LancetAuthor(s): Julie Bernhardt, Jan Mehrholz
Source: The Lancet - May 24, 2019 Category: General Medicine Source Type: research

Extending thrombolysis to 4·5–9 h and wake-up stroke using perfusion imaging: a systematic review and meta-analysis of individual patient data
This study is registered with PROSPERO, number CRD42019128036.FindingsWe identified three trials that met eligibility criteria: EXTEND, ECASS4-EXTEND, and EPITHET. Of the 414 patients included in the three trials, 213 (51%) were assigned to receive alteplase and 201 (49%) were assigned to receive placebo. Overall, 211 patients in the alteplase group and 199 patients in the placebo group had mRS assessment data at 3 months and thus were included in the analysis of the primary outcome. 76 (36%) of 211 patients in the alteplase group and 58 (29%) of 199 patients in the placebo group had achieved excellent functional outcome a...
Source: The Lancet - May 24, 2019 Category: General Medicine Source Type: research

Intensive blood pressure reduction with intravenous thrombolysis therapy for acute ischaemic stroke (ENCHANTED): an international, randomised, open-label, blinded-endpoint, phase 3 trial
Publication date: Available online 7 February 2019Source: The LancetAuthor(s): Craig S Anderson, Yining Huang, Richard I Lindley, Xiaoying Chen, Hisatomi Arima, Guofang Chen, Qiang Li, Laurent Billot, Candice Delcourt, Philip M Bath, Joseph P Broderick, Andrew M Demchuk, Geoffrey A Donnan, Alice C Durham, Pablo M Lavados, Tsong-Hai Lee, Christopher Levi, Sheila O Martins, Veronica V Olavarria, Jeyaraj D PandianSummaryBackgroundSystolic blood pressure of more than 185 mm Hg is a contraindication to thrombolytic treatment with intravenous alteplase in patients with acute ischaemic stroke, but the target systolic blood pressu...
Source: The Lancet - February 8, 2019 Category: General Medicine Source Type: research

Prehospital transdermal glyceryl trinitrate in patients with ultra-acute presumed stroke (RIGHT-2): an ambulance-based, randomised, sham-controlled, blinded, phase 3 trial
Publication date: Available online 6 February 2019Source: The LancetAuthor(s): Philip M Bath, Polly Scutt, Craig S Anderson, Jason P Appleton, Evind Berge, Lesley Cala, Mark Dixon, Timothy M England, Peter J Godolphin, Diane Havard, Lee Haywood, Trish Hepburn, Kailash Krishnan, Grant Mair, Alan A Montgomery, Keith Muir, Stephen J Phillips, Stuart Pocock, John Potter, Chris PriceSummaryBackgroundHigh blood pressure is common in acute stroke and is a predictor of poor outcome; however, large trials of lowering blood pressure have given variable results, and the management of high blood pressure in ultra-acute stroke remains ...
Source: The Lancet - February 7, 2019 Category: General Medicine Source Type: research

Effects of fluoxetine on functional outcomes after acute stroke (FOCUS): a pragmatic, double-blind, randomised, controlled trial
Publication date: Available online 5 December 2018Source: The LancetAuthor(s): Martin Dennis, Gillian Mead, John Forbes, Catriona Graham, Maree Hackett, Graeme J Hankey, Allan House, Stephanie Lewis, Erik Lundström, Peter Sandercock, Karen Innes, Carol Williams, Jonathan Drever, Aileen Mcgrath, Ann Deary, Ruth Fraser, Rosemary Anderson, Pauli Walker, David Perry, Connor McgillSummaryBackgroundResults of small trials indicate that fluoxetine might improve functional outcomes after stroke. The FOCUS trial aimed to provide a precise estimate of these effects.MethodsFOCUS was a pragmatic, multicentre, parallel group, double-b...
Source: The Lancet - December 5, 2018 Category: General Medicine Source Type: research

Prevention of stroke: a global perspective
Publication date: 6–12 October 2018Source: The Lancet, Volume 392, Issue 10154Author(s): Jeyaraj D Pandian, Seana L Gall, Mahesh P Kate, Gisele S Silva, Rufus O Akinyemi, Bruce I Ovbiagele, Pablo M Lavados, Dorcas B C Gandhi, Amanda G ThriftSummaryAlong with the rising global burden of disability attributed to stroke, costs of stroke care are rising, providing the impetus to direct our research focus towards effective measures of stroke prevention. In this Series paper, we discuss strategies for reducing the risk of the emergence of disease (primordial prevention), preventing the onset of disease (primary prevention), an...
Source: The Lancet - October 5, 2018 Category: General Medicine Source Type: research

Current practice and future directions in the diagnosis and acute treatment of ischaemic stroke
Publication date: 6–12 October 2018Source: The Lancet, Volume 392, Issue 10154Author(s): Charlotte Zerna, Götz Thomalla, Bruce C V Campbell, Joung-Ho Rha, Michael D HillSummaryEven though stroke presents as a variety of clinical syndromes, neuroimaging is the most important biomarker to help differentiate between stroke subtypes and assess treatment eligibility. Therapeutic advances have led to intravenous thrombolysis with tissue-type plasminogen activator and endovascular treatment for proximal vessel occlusion in the anterior cerebral circulation being standard care for acute ischaemic stroke. Providing access to thi...
Source: The Lancet - October 5, 2018 Category: General Medicine Source Type: research

Practice patterns and outcomes after stroke across countries at different economic levels (INTERSTROKE): an international observational study
Publication date: 19–25 May 2018 Source:The Lancet, Volume 391, Issue 10134 Author(s): Peter Langhorne, Martin J O'Donnell, Siu Lim Chin, Hongye Zhang, Denis Xavier, Alvaro Avezum, Nandini Mathur, Melanie Turner, Mary Joan MacLeod, Patricio Lopez-Jaramillo, Albertino Damasceno, Graeme J Hankey, Antonio L Dans, Ahmed Elsayed, Charles Mondo, Mohammad Wasay, Anna Czlonkowska, Christian Weimar, Afzal Hussein Yusufali, Fawaz Al Hussain, Liu Lisheng, Hans-Christoph Diener, Danuta Ryglewicz, Nana Pogosova, Romana Iqbal, Rafael Diaz, Khalid Yusoff, Aytekin Oguz, Xingyu Wang, Ernesto Penaherrera, Fernando Lanas, Okechukwu S Ogah...
Source: The Lancet - May 18, 2018 Category: General Medicine Source Type: research

Ischaemic stroke management at Al-Shifa Hospital in the Gaza Strip: a clinical audit
Publication date: 21 February 2018 Source:The Lancet, Volume 391, Supplement 2 Author(s): Amir Abukaresh, Rami Al-Abadlah, Bettina Böttcher, Khamis El-Essi Background In the 2014 Palestinian annual health report, cerebrovascular accident was ranked as the third leading cause of death in the occupied Palestinian territory. Cerebrovascular accident is also one the most common causes of disability worldwide. Good management decreases mortality and morbidity. The aim of this study was to assess the current management of patients with ischaemic stroke at the Al-Shifa Hospital and to compare this with international guidelines....
Source: The Lancet - February 23, 2018 Category: General Medicine Source Type: research

Family-led rehabilitation after stroke in India (ATTEND): a randomised controlled trial
Publication date: Available online 27 June 2017 Source:The Lancet Author(s): The ATTEND Collaborative GroupR ILindleyC SAndersonLBillotAForsterM LHackettL AHarveySJanQLiHLiuPLanghorneP KMaulikG V SMurthyM FWalkerJ DPandianMAlimCFelixASyrigapuD KTugnawatS JVermaB RShamannaGHankeyJBernhardtM MMehndirattaLJeyaseelanPDonnellyDByrneSSteleyVSanthoshSChilappagariJMysoreJRoyM VPadmaLJohnSAaronN CBorahPVijayaSKaulDKhuranaP NSylajaD SHalprashanthB KMadhusudhanVNambiarSSureshbabuM CKhannaG SNarangDChakrabortyS SChakrabortyBBiswasSKauraHKoundalPSinghAAndriasD SThambuIRamyaJGeorgeA TPrabhakarPKirubakaranPAnbalaganMGhoseKBordoloiPGohai...
Source: The Lancet - June 28, 2017 Category: General Medicine Source Type: research

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
This study is registered with ClinicalTrials.gov, number NCT01540383. Results We randomly assigned 158 patients between April 1, 2012, and May 31, 2014. The modified intention-to-treat population comprised 156 patients (78 per group). Verbal communication was significantly improved from baseline to after intensive speech and language treatment (mean difference 2·61 points [SD 4·94]; 95% CI 1·49 to 3·72), but not from baseline to after treatment deferral (−0·03 points [4·04]; −0·94 to 0·88; between-group difference Cohen's d 0·58; p=0·0004). Eight patients had adverse events during therapy or treatment deferra...
Source: The Lancet - March 2, 2017 Category: Journals (General) Source Type: research

Thrombolytic removal of intraventricular haemorrhage in treatment of severe stroke: results of the randomised, multicentre, multiregion, placebo-controlled CLEAR III trial
This study is registered with ClinicalTrials.gov, NCT00784134. Findings Between Sept 18, 2009, and Jan 13, 2015, 500 patients were randomised: 249 to the alteplase group and 251 to the saline group. 180-day follow-up data were available for analysis from 246 of 249 participants in the alteplase group and 245 of 251 participants in the placebo group. The primary efficacy outcome was similar in each group (good outcome in alteplase group 48% vs saline 45%; risk ratio [RR] 1·06 [95% CI 0·88–1·28; p=0·554]). A difference of 3·5% (RR 1·08 [95% CI 0·90–1·29], p=0·420) was found after adjustment for intraventricular ...
Source: The Lancet - January 10, 2017 Category: Journals (General) Source Type: research

Stroke prevention in atrial fibrillation
Publication date: 20–26 August 2016 Source:The Lancet, Volume 388, Issue 10046 Author(s): Ben Freedman, Tatjana S Potpara, Gregory Y H Lip 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 wi...
Source: The Lancet - August 19, 2016 Category: Journals (General) Source Type: research

Occurrence of death and stroke in patients in 47 countries 1 year after presenting with atrial fibrillation: a cohort study
Publication date: Available online 8 August 2016 Source:The Lancet Author(s): 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, Lars Wallentin, Salim Yusuf, Stuart J Connolly Background Atrial fibrillation is an important cause of morbidity and mortality worldwide, but scant data are available for long-term outcomes in individuals outside North America or Europe, especially in primary care settings. Methods We did a coh...
Source: The Lancet - August 9, 2016 Category: Journals (General) Source Type: research

Human neural stem cells in patients with chronic ischaemic stroke (PISCES): a phase 1, first-in-man study
Publication date: Available online 3 August 2016 Source:The Lancet Author(s): Dheeraj Kalladka, John Sinden, Kenneth Pollock, Caroline Haig, John McLean, Wilma Smith, Alex McConnachie, Celestine Santosh, Philip M Bath, Laurence Dunn, Keith W Muir Background CTX0E03 is an immortalised human neural stem-cell line from which a drug product (CTX-DP) was developed for allogeneic therapy. Dose-dependent improvement in sensorimotor function in rats implanted with CTX-DP 4 weeks after middle cerebral artery occlusion stroke prompted investigation of the safety and tolerability of this treatment in stroke patients. Methods We did ...
Source: The Lancet - August 4, 2016 Category: Journals (General) Source Type: research

Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study
Publication date: Available online 16 July 2016 Source:The Lancet Author(s): 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 Rosengren, Mahshid Dehghan, Graeme J Hankey, Antonio L Dans, Ahmed Elsayed, Alvaro Avezum, Charles Mondo, Hans-Christoph Diener, Danuta Ryglewicz, Anna Czlonkowska, Nana Pogosova, Christian Weimar, Romaina Iqbal, Rafael Diaz, Khalid Yusoff, Afzalhussein Yusufali, Aytekin O...
Source: The Lancet - July 16, 2016 Category: Journals (General) Source Type: research

Effects of aspirin on risk and severity of early recurrent stroke after transient ischaemic attack and ischaemic stroke: time-course analysis of randomised trials
Publication date: Available online 18 May 2016 Source:The Lancet Author(s): Peter M Rothwell, Ale Algra, Zhengming Chen, Hans-Christoph Diener, Bo Norrving, Ziyah Mehta Background Aspirin is recommended for secondary prevention after transient ischaemic attack (TIA) or ischaemic stroke on the basis of trials showing a 13% reduction in long-term risk of recurrent stroke. However, the risk of major stroke is very high for only the first few days after TIA and minor ischaemic stroke, and observational studies show substantially greater benefits of early medical treatment in the acute phase than do longer-term trials. ...
Source: The Lancet - May 20, 2016 Category: Journals (General) Source Type: research

Weekly variation in health-care quality by day and time of admission: a nationwide, registry-based, prospective cohort study of acute stroke care
Publication date: Available online 10 May 2016 Source:The Lancet Author(s): 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 Background Studies in many health systems have shown evidence of poorer quality health care for patients admitted on weekends or overnight than for those admitted during the week (the so-called weekend effect). We postulated that variation in quality was dependent on not only day, but also time, of admission, and aimed to describe the pattern and magnitude of variation in the quality of acute s...
Source: The Lancet - May 12, 2016 Category: Journals (General) Source Type: research

Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomised, open-label, phase 3 trial
Publication date: Available online 10 May 2016 Source:The Lancet Author(s): M Irem Baharoglu, Charlotte Cordonnier, Rustam Al-Shahi Salman, Koen de Gans, Maria M Koopman, Anneke Brand, Charles B Majoie, Ludo F Beenen, Henk A Marquering, Marinus Vermeulen, Paul J Nederkoorn, Rob J de Haan, Yvo B Roos Background Platelet transfusion after acute spontaneous primary intracerebral haemorrhage in people taking antiplatelet therapy might reduce death or dependence by reducing the extent of the haemorrhage. We aimed to investigate whether platelet transfusion with standard care, compared with standard care alone, re...
Source: The Lancet - May 12, 2016 Category: Journals (General) Source Type: research

Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials
Publication date: Available online 18 February 2016 Source:The Lancet Author(s): 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 Diener, Lucie A van den Berg, Elad I Levy, Olvert A Berkhemer, Vitor M Pereira, Jeremy Rempel, Mònica Millán, Stephen M Davis, Daniel Roy, John Thornton, Luis San Román, Marc Ribó, Debbie Beumer, Bruce Stouch, Scott Brown, Bruce C V Campbell, Robert J van ...
Source: The Lancet - February 19, 2016 Category: Journals (General) Source Type: research

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
Publication date: Available online 12 February 2016 Source:The Lancet Author(s): 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-Louis Mas Background Age was reported to be an effect-modifier in four randomised controlled trials comparing carotid artery stenting (CAS) and carotid endarterectomy (CEA), with better CEA outcomes than CAS outcomes noted in the more elderly patients. We aimed to describe the ...
Source: The Lancet - February 14, 2016 Category: Journals (General) Source Type: research

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
This study assessed the effectiveness of antibiotic prophylaxis for reducing pneumonia in patients with dysphagia after acute stroke. Methods We did a prospective, multicentre, cluster-randomised, open-label controlled trial with masked endpoint assessment of patients older than 18 years with dysphagia after new stroke recruited from 48 stroke units in the UK, accredited and included in the UK National Stroke Audit. We excluded patients with contraindications to antibiotics, pre-existing dysphagia, or known infections, or who were not expected to survive beyond 14 days. We randomly assigned the units (1:1) by computer to ...
Source: The Lancet - September 5, 2015 Category: Journals (General) Source Type: research

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
Publication date: Available online 19 August 2015 Source:The Lancet Author(s): 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 Hamer, Wendela E Hooftman, Irene L Houtman, Karl-Heinz Jöckel, France Kittel, Anders Knutsson, Markku Koskenvuo, Thorsten Lunau, Ida E H Madsen, Martin L Nielsen, Maria Nordin, Tuula Oksanen, Jan H Pejtersen, Jaana Pentti, Reiner Rugulies, Paula Salo, Martin J S...
Source: The Lancet - August 21, 2015 Category: Journals (General) Source Type: research

Efficacy and safety of very early mobilisation within 24 h of stroke onset (AVERT): a randomised controlled trial
Publication date: Available online 16 April 2015 Source:The Lancet Background Early mobilisation after stroke is thought to contribute to the effects of stroke-unit care; however, the intervention is poorly defined and not underpinned by strong evidence. We aimed to compare the effectiveness of frequent, higher dose, very early mobilisation with usual care after stroke. Methods We did this parallel-group, single-blind, randomised controlled trial at 56 acute stroke units in five countries. Patients (aged ≥18 years) with ischaemic or haemorrhagic stroke, first or recurrent, who met physiological criteria were randomly as...
Source: The Lancet - April 18, 2015 Category: Journals (General) Source Type: research

Oral anticoagulants for stroke prevention in atrial fibrillation: current status, special situations, and unmet needs
Publication date: Available online 14 March 2015 Source:The Lancet Author(s): Freek W A Verheugt , Christopher B Granger In patients with non-valvular atrial fibrillation, oral anticoagulation with vitamin K antagonists reduces the risk of stroke by more than 60%. But vitamin K antagonists have limitations, including causing serious bleeding such as intracranial haemorrhage and the need for anticoagulation monitoring. In part related to these limitations, they are used in only about half of patients who should be treated according to guideline recommendations. In the past decade, oral agents have been developed that dire...
Source: The Lancet - March 14, 2015 Category: Journals (General) Source Type: research

Digoxin use in patients with atrial fibrillation and adverse cardiovascular outcomes: a retrospective analysis of the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF)
Publication date: Available online 6 March 2015 Source:The Lancet Author(s): Jeffrey B Washam , Susanna R Stevens , Yuliya Lokhnygina , Jonathan L Halperin , Günter Breithardt , Daniel E Singer , Kenneth W Mahaffey , Graeme J Hankey , Scott D Berkowitz , Christopher C Nessel , Keith A A Fox , Robert M Califf , Jonathan P Piccini , Manesh R Patel Background Digoxin is a widely used drug for ventricular rate control in patients with atrial fibrillation (AF), despite a scarcity of randomised trial data. We studied the use and outcomes of digoxin in patients in the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Com...
Source: The Lancet - March 6, 2015 Category: Journals (General) Source Type: research

Efficacy of nitric oxide, with or without continuing antihypertensive treatment, for management of high blood pressure in acute stroke (ENOS): a partial-factorial randomised controlled trial
This study is registered, number ISRCTN99414122. Findings Between July 20, 2001, and Oct 14, 2013, we enrolled 4011 patients. Mean blood pressure was 167 (SD 19) mm Hg/90 (13) mm Hg at baseline (median 26 h [16–37] after stroke onset), and was significantly reduced on day 1 in 2000 patients allocated to glyceryl trinitrate compared with 2011 controls (difference −7·0 [95% CI −8·5 to −5·6] mm Hg/–3·5 [–4·4 to −2·6] mm Hg; both p&lt;0·0001), and on day 7 in 1053 patients allocated to continue antihypertensive drugs compared with 1044 patients randomised to stop them (difference −9·5 [95% CI −11...
Source: The Lancet - February 13, 2015 Category: Journals (General) Source Type: research

The Preventive Antibiotics in Stroke Study (PASS): a pragmatic randomised open-label masked endpoint clinical trial
Publication date: Available online 20 January 2015 Source:The Lancet Author(s): Willeke F Westendorp , Jan-Dirk Vermeij , Elles Zock , Imke J Hooijenga , Nyika D Kruyt , Hans J L W Bosboom , Vincent I H Kwa , Martijn Weisfelt , Michel J M Remmers , Robert ten Houten , A H C M (Tobien) Schreuder , Sarah E Vermeer , Ewout J van Dijk , Diederik W J Dippel , Marcel G W Dijkgraaf , Lodewijk Spanjaard , Marinus Vermeulen , Tom van der Poll , Jan M Prins , Frederique H Vermeij , Yvo B W E M Roos , Ruud P Kleyweg , Henk Kerkhoff , Matthijs C Brouwer , Aeilko H Zwinderman , Diederik van de Beek , Paul J Nederkoorn Background In a...
Source: The Lancet - January 21, 2015 Category: Journals (General) Source Type: research

Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials
Publication date: 29 November–5 December 2014 Source:The Lancet, Volume 384, Issue 9958 Author(s): Jonathan Emberson , Kennedy R Lees , Patrick Lyden , Lisa Blackwell , Gregory Albers , Erich Bluhmki , Thomas Brott , Geoff Cohen , Stephen Davis , Geoffrey Donnan , James Grotta , George Howard , Markku Kaste , Masatoshi Koga , Ruediger von Kummer , Maarten Lansberg , Richard I Lindley , Gordon Murray , Jean Marc Olivot , Mark Parsons , Barbara Tilley , Danilo Toni , Kazunori Toyoda , Nils Wahlgren , Joanna Wardlaw , William Whiteley , Gregory J del Zoppo , Colin Baigent , Peter Sandercock , Werner Hacke Background Altep...
Source: The Lancet - December 4, 2014 Category: Journals (General) Source Type: research