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Source: JAMA
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Total 276 results found since Jan 2013.
Intra-arterial Alteplase vs Placebo After Successful Thrombectomy and Functional Outcomes in Patients With Large Vessel Occlusion Acute Ischemic Stroke —Reply
In Reply In response to the comments by Dr Mai and colleagues about the change in the primary outcome of the CHOICE trial, we would like to provide several clarifications. First, the definition of the primary outcome in the original protocol was submitted for publication on July 15, 2019. Second, the registered protocol (NCT03876119) was first posted on March 15, 2019, but the primary outcome definition was changed and posted on March 19, 2021. Third, the summary of the history of these protocol changes was included in Supplement 2 of the article. As required by Spanish law, these changes were also communicated to the Span...
Source: JAMA - June 28, 2022 Category: General Medicine Source Type: research
Use of Oral Anticoagulants and Intracranial Hemorrhage Among Patients With Acute Ischemic Stroke
To the Editor A recent article suggested that the use of non –vitamin K antagonist oral anticoagulants (NOACs) within 7 days of intravenous alteplase was not associated with an increased risk of intracranial hemorrhage. However, we are concerned that some readers may interpret these results as an endorsement of the use of alteplase in patients with acute st roke who were taking NOACs, irrespective of the time frame of last use. Based on dose-finding studies, the drug half-life is 12 hours for apixaban, 11 to 13 hours for rivaroxaban, 10 to 14 hours for edoxaban, and 12 to 17 hours for dabigatran in patients with normal k...
Source: JAMA - June 21, 2022 Category: General Medicine Source Type: research
Use of Oral Anticoagulants and Intracranial Hemorrhage Among Patients With Acute Ischemic Stroke —Reply
In Reply We agree that conclusions drawn from our observational cohort study should be interpreted within the context of the study design and its inherent limitations. One such limitation is the lack of granular data on the time of last NOAC dose. The GWTG-Stroke registry defines NOAC use as documentation that a patient was taking dabigatran, rivaroxaban, apixaban, or edoxaban within 7 days before hospital arrival. We attempted to overcome this limitation by including additional data from the ARAMIS registry.
Source: JAMA - June 21, 2022 Category: General Medicine Source Type: research
Broca ’s Aphasia
The stroke took much but left her three words;
Source: JAMA - June 14, 2022 Category: General Medicine Source Type: research
Incorrect Data
This article was corrected online.
Source: JAMA - June 14, 2022 Category: General Medicine Source Type: research
Ischemic Stroke in Patients With Asymptomatic Severe Carotid Stenosis
This retrospective cohort study estimated stroke outcomes among 3737 adult participants with asymptomatic severe carotid stenosis who did not undergo surgical intervention.
Source: JAMA - May 24, 2022 Category: General Medicine Source Type: research
Early vs Standard Approach to Tracheostomy and Functional Outcome in Patients With Severe Stroke
This multicenter clinical trial investigated potential benefits of early vs standard tracheostomy in patients with severe stroke receiving mechanical ventilation.
Source: JAMA - May 17, 2022 Category: General Medicine Source Type: research
Strategic Opportunities to Improve Stroke Systems of Care
Restoring reperfusion to the brain as quickly as possible during acute ischemic stroke is important to reduce long-term disability and optimize clinical outcomes for patients, although hospital and resource availability are frequently not well matched with patient location. Accordingly, many patients who may have large-vessel occlusion (LVO) lack rapid access to endovascular thrombectomy (EVT), a highly efficacious procedure with a number needed to treat of approximately 3 to 7 for regaining independence among carefully selected patients. Therefore, accurate out-of-hospital diagnosis and ensuring that the patient and the n...
Source: JAMA - May 10, 2022 Category: General Medicine Source Type: research
Transportation to Thrombectomy-Capable Center vs Local Stroke Center and Neurological Outcomes of Stroke
This randomized trial assesses the effect of transportation to a local stroke center vs directly to a thrombectomy-capable referral center on 90-day disability among patients with acute large-vessel occlusion stroke attended by emergency medical services in areas where the closest local stroke center was not capable of performing thrombectomy.
Source: JAMA - May 10, 2022 Category: General Medicine Source Type: research
Self-monitoring of Blood Pressure During Pregnancy
The COVID-19 pandemic has led to the frequent use of telemedicine and the common recommendation for self-monitoring of blood pressure (SMBP) during pregnancy for individuals at risk for or with hypertensive disorders of pregnancy, as an adjunct to or substitute for some aspects of in-person prenatal care visits. BP monitoring is a critical aspect of prenatal care to screen for preeclampsia. The maternal and neonatal morbidities associated with hypertension in pregnancy are well-established, including risks of preterm delivery, low birth weight, preeclampsia, and rare risks of maternal stroke, seizure, and death. It is unce...
Source: JAMA - May 3, 2022 Category: General Medicine Source Type: research
Treatment Effects in Analysis of Pooled Individual Patient Data From Randomized Trials of Device Closure of Patent Foramen Ovale
To the Editor In a recent study, Dr Kent and colleagues used previously developed scoring systems to estimate the risk of recurrent ischemic stroke in patients with patent foramen ovale (PFO) and concluded that the risk reduction for recurrent ischemic events with device closure varied across groups classified by their probabilities that the stroke was causally related to the PFO. Although these findings are interesting, they should be considered cautiously because other than right-to-left shunt and atrial septal aneurysm, no groups were stratified using anatomical and/or functional PFO variables. However, the magnitude of...
Source: JAMA - April 12, 2022 Category: General Medicine Source Type: research
Treatment Effects in Analysis of Pooled Individual Patient Data From Randomized Trials of Device Closure of Patent Foramen Ovale —Reply
In Reply We agree with Drs Rigatelli and Zuin that the PFO-Associated Stroke Causal Likelihood (PASCAL) Classification System used in our study does not include every attribute of potential relevance to the causal relatedness of a discovered PFO to an index stroke, such as Eustachian valve prominence or tunnel length. We would add to their list of PASCAL-omitted variables with a putative association with paradoxical embolism: Valsalva at stroke onset, recent history of prolonged immobility, history of sleep apnea, and presence of venous thrombophilia, to mention only a few.
Source: JAMA - April 12, 2022 Category: General Medicine Source Type: research
Rivaroxaban vs Apixaban and Ischemic or Hemorrhagic Events in Patients With Atrial Fibrillation —Reply
In Reply Dr Gu questions whether the differences in outcomes reported in our study of rivaroxaban vs apixaban are clinically significant. A widely accepted measure of clinical impact is the number needed to harm, estimated as the reciprocal of the rate difference. We found 1 additional major ischemic or hemorrhagic event for every 370 patients treated with rivaroxaban compared with apixaban. Given the severity of the study events —stroke, other intracranial hemorrhage, and fatal bleeding—we disagree with the contention that the difference is not clinically important. Furthermore, the number needed to harm for nonfatal ...
Source: JAMA - April 5, 2022 Category: General Medicine Source Type: research
Atrial Myopathy and Dementia
Dementia is a leading cause of disability and death with an estimate of more than 50 million people living with the disease worldwide, a number that is projected to triple by 2050. Unlike Alzheimer disease, a degenerative condition without proven cure or treatment, vascular dementia is the second most common etiology and opens up opportunities for dementia prevention through treatment of known risk factors such as hypertension and atrial fibrillation (AF). The latter is a known risk factor for dementia through cerebral embolism and ischemic stroke primarily but also through nonstroke mechanisms. Thus, prevention, detection...
Source: JAMA - March 22, 2022 Category: General Medicine Source Type: research
