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Total 3777 results found since Jan 2013.
Vitamin K antagonist-experienced patients with a history of stroke/transient ischaemic attack who switched from warfarin to dabigatran increased their rate of recurrent stroke/transient ischaemic attack compared with those on warfarin
Commentary on: Larsen TB, Rasmussen LH, Gorst-Rasmussen A, et al. Dabigatran and warfarin for secondary prevention of stroke in atrial fibrillation patients: a nationwide cohort study. Am J Med 2014;127:1172–8 . Context Randomised trials have shown that patients with atrial fibrillation (AF) who are treated with a non-vitamin K antagonist oral anticoagulant (NOAC), compared with warfarin, have similar or lower rates of stroke and major bleeding, markedly reduced rates of intracranial bleeding and a consistent pattern of reduced mortality.1 Dabigatran 150 mg two times a day is the only NOAC that can significantly...
Source: Evidence-Based Medicine - May 22, 2015 Category: Internal Medicine Authors: Eikelboom, J. W., Bosch, J. Tags: Epidemiologic studies, Time-to-event methods, Drugs: cardiovascular system, Stroke, Arrhythmias Aetiology/Harm Source Type: research
Risk of vascular events is lower than expected in patients with transient ischaemic attack or minor stroke treated promptly by stroke specialists
Commentary on: Amarenco P, Lavallée PC, Labreuche J, et al.., TIAregistry.org Investigators. One-year risk of stroke after transient ischemic attack or minor stroke. N Engl J Med 2016;374:1533–42. Context Previous studies estimated the risk of subsequent vascular events in patients with transient ischaemic attack (TIA) or minor stroke at 10–20% within 3 months.1 2 Prevention strategies have been adjusted since. Up-to-date numbers would help to detect a possible temporal trend in risk and to prospectively evaluate risk-scoring tools and specific risk factors in current patient populations. The TIA re...
Source: Evidence-Based Medicine - July 25, 2016 Category: Internal Medicine Authors: Nolte, C. H. Tags: EBM Prognosis, Drugs: cardiovascular system, Stroke, Hypertension, Ischaemic heart disease Source Type: research
Seven days of non-invasive cardiac monitoring early postischaemic stroke or TIA increases atrial fibrillation detection rate compared with current guideline-based practice
Commentary on: Higgins P, Macfarlane PW, Dawson J, et al.. Non-invasive cardiac event monitoring to detect atrial fibrillation after ischemic stroke: a randomized, controlled trial. Stroke 2013;44:2525–31. Context Atrial fibrillation (AF) is an established risk factor for stroke, and anticoagulation treatment is effective in reducing recurrent stroke risk. Guidelines recommend the use of clinical prediction tools to select patients with AF for anticoagulation therapy. It has long been recognised that paroxysmal AF (PAF) may pose a similar stroke risk to persistent AF, but the association between the duration of PAF a...
Source: Evidence-Based Medicine - July 18, 2014 Category: Internal Medicine Authors: Coutts, S. B., Choi, P. M. C. Tags: EBM Diagnosis, Clinical trials (epidemiology), Drugs: cardiovascular system, Stroke, Radiology, Clinical diagnostic tests, Radiology (diagnostics), Screening (epidemiology), Screening (public health) Source Type: research
For patients who underwent elective non-cardiac surgery, a history of stroke is associated with an increased risk of major adverse cardiovascular events and death, particularly if time elapsed between stroke and surgery is less than 9 months
Commentary on: Jørgensen ME, Torp-Pedersen C, Gislason GH, et al.. Time elapsed after ischemic stroke and risk of adverse cardiovascular events and mortality following elective noncardiac surgery. JAMA 2014;312:269–77. Context Non-cardiac surgeries (NCS) performed in patients with a recent myocardial infarction or coronary stent implantation have been associated with increased risk of perioperative cardiac events and bleeding compared with patients with more distant myocardial infarction or stent placement.1 2 Whether a similar time-dependent relationship exists for stroke is not known, and recommendations on ...
Source: Evidence-Based Medicine - January 21, 2015 Category: Internal Medicine Authors: Biteker, M. Tags: EBM Prognosis, Epidemiologic studies, Drugs: cardiovascular system, Stroke, Ophthalmology, Ischaemic heart disease, Radiology, Clinical diagnostic tests Source Type: research
Timing of thrombolysis for acute ischaemic stroke: the earlier the treatment the better the outcome, irrespective of age or stroke severity
This study looked at how treatment delay, patient age and stroke severity influence the effect of t-PA in AIS in terms of functional outcome, mortality and intracranial haemorrhage (ICH). Methods This was a preplanned meta-analysis of individual patient data from nine randomised clinical trials of intravenous alteplase for AIS. The primary efficacy measure was the proportion of patients who achieved a 3–6 month...
Source: Evidence-Based Medicine - May 22, 2015 Category: Internal Medicine Authors: Lorenzano, S. Tags: Epidemiologic studies, Stroke, Radiology, Clinical diagnostic tests Therapeutics/Prevention Source Type: research
Migraine is a marker for risk of both ischaemic and haemorrhagic stroke
This study summarises the available evidence. Methods Sacco...
Source: Evidence-Based Medicine - July 18, 2014 Category: Internal Medicine Authors: Kurth, T. Tags: EBM Aetiology, Epidemiologic studies, Headache (including migraine), Pain (neurology), Stroke Source Type: research
Prolonged cardiac monitoring after cryptogenic stroke superior to 24 h ECG in detection of occult paroxysmal atrial fibrillation
Commentary on: Gladstone DJ, Spring M, Dorian P, et al.. Atrial fibrillation in patients with cryptogenic stroke. N Eng J Med 2014;370:2467–77. Context Stroke remains a prevalent and devastating condition for many people across the world, it is a leading cause of disability and is associated with significant monetary and social losses, yet is considered to be a largely preventable disease. One-third of all strokes are considered cryptogenic after initial diagnostic evaluations. Cryptogenic stroke has been identified, only recently, as an important area of additional investigation. Part of the EMBRACE trial, Gladstone...
Source: Evidence-Based Medicine - November 19, 2014 Category: Internal Medicine Authors: Miller, D. J. Tags: EBM Diagnosis, Drugs: cardiovascular system, Stroke, Arrhythmias Source Type: research
Aspirin plus clopidogrel in acute minor ischaemic stroke or transient ischaemic attack is superior to aspirin alone for stroke risk reduction: CHANCE trial
Commentary on: Wang Y, Wang Y, Zhao X, et al.. Clopidogrel with aspirin in acute minor stroke or transient ischemic attack. N Engl J Med 2013;369:11–19. Context Combination therapy with aspirin added to clopidogrel has had a disappointing record in the prevention of recurrent stroke. The management of atherothrombosis with clopidogrel in high-risk patients (MATCH)1 and the secondary prevention of small subcortical strokes (SPS3)2 randomised controlled trials (RCTs) showed that combination therapy was not more effective than clopidogrel or aspirin alone, but was associated with two to three times the risk of major or ...
Source: Evidence-Based Medicine - March 19, 2014 Category: Internal Medicine Authors: Gorelick, P. B., Farooq, M. U. Tags: Smoking and tobacco, Clinical trials (epidemiology), Genetics, Stroke, Hypertension, Diabetes, Health education, Smoking Therapeutics Source Type: research
Meta-analysis finds benefit for dual antiplatelet therapy but limitations preclude changing standard mono antiplatelet therapy approach for acute non-cardioembolic ischaemic stroke or transient ischaemic attack
Commentary on: Wong KSL, Wang Y, Leng X, et al.. Early dual versus mono antiplatelet therapy for acute non-cardioembolic ischemic stroke or transient ischemic attack. An updated systematic review and meta-analysis. Circulation 2013;128:1656–66. Context Current guidelines recommend aspirin, aspirin plus clopidogrel or aspirin plus extended-release dipyridamole for treatment of acute ischaemic stroke (IS) or transient ischaemic attack (TIA) to prevent recurrent stroke, myocardial infarction and cardiovascular death.1 The Clopidogrel in High-risk patients with Acute Non-disabling Cerebrovascular Events (CHANCE) trial ra...
Source: Evidence-Based Medicine - May 19, 2014 Category: Internal Medicine Authors: Aronow, W. S. Tags: Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Ischaemic heart disease Therapeutics Source Type: research
Overenthusiastic stroke risk factor modification in the over-80s: Are we being disingenuous to ourselves, and to our oldest patients?
Statins and antihypertensive therapy are widely used in our oldest patients (ie, those aged over 80 years). The epidemiology suggests that, by this age, hypertension is not an attributable risk factor for stroke, and hypercholesterolaemia has little effect on stroke risk overall. The largest trials of antihypertensive therapy and statins in this age group show at best a marginal clinical reduction in stroke and very modest clinical reductions in other cardiovascular end points. Older patients have very diverse views on the relative importance of stroke and death as end points, and these differ from physicians’ views....
Source: Evidence-Based Medicine - July 18, 2014 Category: Internal Medicine Authors: Byatt, K. Tags: Geriatric medicine, Clinical trials (epidemiology), Editor's choice, Press releases, Drugs: cardiovascular system, Stroke, Hypertension, Ethics, Legal and forensic medicine, Lipid disorders Perspective Source Type: research
Risk of warfarin-associated intracerebral haemorrhage after ischaemic stroke is low and unchanged during the 2000s
Commentary on: Asberg A, Erisksson M, Henriksson KM, et al.. Warfarin-associated intracerebral hemorrhage after ischemic stroke. Stroke 2014;45:2118–20. Context Since its isolation during the early half of the 20th century from the mouldy hay responsible for ‘sweet clover disease’ in cattle, warfarin has become the most widely used oral anticoagulant.1 Indications include atrial fibrillation (AF), mechanical prosthetic valves and venous thromboembolism treatment.2 Warfarin reduces stroke risk in patients with AF by nearly two-thirds; AF accounts for 20% of ischaemic strokes, which tend to be more severe t...
Source: Evidence-Based Medicine - January 21, 2015 Category: Internal Medicine Authors: Ruland, S., Biller, J. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Hypertension, Alcohol-related disorders, Drugs misuse (including addiction), Arrhythmias, Alcohol, Health education Aetiology/Harm Source Type: research
Intra-arterial thrombectomy improves functional outcome when administered up to 6 h after stroke
Commentary on: Berkhemer OA, Fransen PS, Beumer D, et al., MR CLEAN Investigators. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015;372:11–20 . Context Ischaemic stroke is a common cause of death and disability worldwide. Intravenous tissue plasminogen activator (tPA) reduces disability when administered up to 4.5 h after symptom onset. In severe strokes, when a proximal large vessel occlusion is present, recanalisation rates with tPA are low. Intra-arterial (IA) thrombectomy techniques, particularly stent-retriever devices, have much higher recanalisation rates. IA ther...
Source: Evidence-Based Medicine - November 24, 2015 Category: Internal Medicine Authors: Mullen, M. Tags: Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Interventional cardiology Therapeutics/Prevention Source Type: research
The success of mechanical thrombectomy in acute ischaemic stroke is strictly dependent on ischaemic core size and time to treatment
Commentary on: Jovin TG, Chamorro A, Cobo E, et al., REVASCAT Trial Investigators. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 2015;372:2296–306; Saver JL, Goyal M, Bonafe A, et al., SWIFT PRIME Investigators. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015;372:2285–95 . Context Three trials showing no difference in clinical outcome between patients with acute ischaemic stroke (AIS) treated by mechanical thrombectomy (MT) and those treated by intravenous thrombolysis (IVT) had the effect of reducing the number of patients with ...
Source: Evidence-Based Medicine - November 24, 2015 Category: Internal Medicine Authors: Sallustio, F., Di Legge, S. Tags: Stroke, Interventional cardiology, Radiology, Clinical diagnostic tests, Radiology (diagnostics) Therapeutics/Prevention Source Type: research
Stroke: causes and clinical features
This article reviews risk factors for stroke, and the different pathologies that can cause stroke. Approximately 20% of strokes are due to cerebral haemorrhage, most of which is intracerebral, with a significant minority caused by subarachnoid haemorrhage. The remaining 80% are ischaemic, including large artery disease, cardioembolic and small vessel disease. Differentiation of cerebral ischaemia from haemorrhage is impossible without brain imaging.
Source: Medicine - July 28, 2016 Category: Internal Medicine Authors: Hugh Markus Tags: Stroke Source Type: research
Pitfalls of administrative database analysis are evident when assessing the 'weekend effect in stroke
Commentary on: Li L, Rothwell PM. Biases in detection of apparent "weekend effect" on outcome with administrative coding data: population based study of stroke. BMJ 2016;353:i2648 . Context Multiple studies attempt to clarify the role of weekend admissions in stroke.1 2 Recent studies have leveraged large populations in administrative databases to retrospectively evaluate hypotheses. While these studies disagree as to whether weekend admissions are associated with increased stroke mortality, concern exists regarding inherent limitations of administrative coding databases, including accuracy of patient and disease variables...
Source: Evidence-Based Medicine - January 23, 2017 Category: Internal Medicine Authors: Attenello, F. J., Mack, W. J. Tags: EBM Prognosis, Journalology, Epidemiologic studies, Stroke Source Type: research
