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Total 186 results found since Jan 2013.
Correspondence The ABC risk score for patients with atrial fibrillation
The study by Ziad Hijazi and colleagues (June 4, p 2302)1 provides a comprehensive validation of the age, biomarkers, and clinical history (ABC)-bleeding score, using age, three biomarkers (haemoglobin, cardiac troponin T, and GDF-15), and clinical history of bleeding to predict major bleeding events in anticoagulated patients with atrial fibrillation. Although the clinical usefulness of this approach to tailor stroke and bleeding risk in individual patients awaits further validation in real-world cohorts, the study by Hijazi and colleagues1 is a great leap forward in precision medicine and risk stratification in atrial fibrillation.
Source: LANCET - October 21, 2016 Category: Journals (General) Authors: Andreas Charidimou Tags: Correspondence Source Type: research
Correspondence Revising the ICD: stroke is a brain disease
The tenth revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) was long overdue. The ICD-10 was based on outdated medical knowledge and concepts from the 1980s. Since then, science and practice have changed beyond recognition. The WHO neurology topic advisory group (TAG) for the revision of the ICD-10 was formed in 2009. In the ICD-10, cerebrovascular diseases were inconsistently and confusingly spread over several different chapters. In March, 2011, the Neurology and Circulatory TAGs, with contribution of WHO classification representatives and relevant WHO departments, ...
Source: LANCET - October 13, 2016 Category: Journals (General) Authors: Raad Shakir, Steve Davis, Bo Norrving, Wolfgang Grisold, William M Carroll, Valery Feigin, Vladimir Hachinski Tags: Correspondence Source Type: research
Department of Error Department of Error
Healey JS, Oldgren J, Ezekowitz M, et al. Occurrence of death and stroke in patients in 47 countries 1 year after presenting with atrial fibrillation: a cohort study. Lancet 2016; 388: 1161 –69—In this Article, the author's name Albertino Demasceno should have been spelled Albertino Damasceno. This correction has been made to the online version as of Oct 4, 2016.
Source: LANCET - October 3, 2016 Category: Journals (General) Tags: Department of Error Source Type: research
Seminar Stroke
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 12, 2016 Category: Journals (General) Authors: Graeme J Hankey Tags: Seminar Source Type: research
Seminar Spontaneous subarachnoid haemorrhage
Subarachnoid haemorrhage is an uncommon and severe subtype of stroke affecting patients at a mean age of 55 years, leading to loss of many years of productive life. The rupture of an intracranial aneurysm is the underlining cause in 85% of cases. Survival from aneurysmal subarachnoid haemorrhage has increased by 17% in the past few decades, probably because of better diagnosis, early aneurysm repair, prescription of nimodipine, and advanced intensive care support. Nevertheless, survivors commonly have cognitive impairments, which in turn affect patients' daily functionality, working capacity, and quality of life.
Source: LANCET - September 12, 2016 Category: Journals (General) Authors: R Loch Macdonald, Tom A Schweizer Tags: Seminar Source Type: research
Correspondence Treating sickle cell anaemia: the TWiTCH trial
We read with interest the results of the TWiTCH trial1 comparing hydroxyurea with transfusions for the treatment of sickle cell disease. As a patient-support charity, we acknowledge the potential of this study to inform and change clinical practice geared towards reducing the risk of childhood stroke associated with sickle cell disease. As strong advocates for patient's choice, we believe informed choice should remain key to the use and interpretation of this research in clinical practice.
Source: LANCET - September 2, 2016 Category: Journals (General) Authors: Maureen Gwam, Carol Nwosu Tags: Correspondence Source Type: research
Comment Should blood pressure reduction be aggressive in patients with hypertension and coronary artery disease?
In The Lancet, Emmanuelle Vidal-Petiot and colleagues1 show that in patients with hypertension and stable coronary artery disease included in the multicountry CLARIFY registry, non-fatal and fatal outcomes decreased as blood pressure was reduced to a 120 –139 mm Hg systolic or a 70–79 mm Hg diastolic range over 5 years of treatment. Blood pressure reductions to less than 120/70 mm Hg, however, were accompanied by a marked increase of cardiovascular risk that involved cause-specific events such as myocardial infarction and heart failure, only spa ring stroke, whose risk remained similar to that seen at the higher blood pressure values.
Source: LANCET - August 29, 2016 Category: Journals (General) Authors: Giuseppe Mancia Tags: Comment 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 7, 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 7, 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 2, 2016 Category: Journals (General) Authors: Cesar V Borlongan Tags: Comment Source Type: research
