PIAST — Platelet inhibition assessment in stroke trial multiplate analyzer based assessment of the efficacy of antithrombotic medication in stroke patients

2015 ◽  
Vol 357 ◽  
pp. e101
Author(s):  
S. Menon ◽  
T. Jun ◽  
U. Meyding-Lamadé ◽  
A. Grabowski
Keyword(s):  
Platelet Inhibition ◽  
Stroke Patients ◽  
Antithrombotic Medication ◽  
Stroke Trial ◽  
Multiplate Analyzer

Abstract TP292: Effect of Improved Management Strategies on Study Retention Rates

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Michael Dela Cruz ◽  
Kinga Aitken ◽  
Ka-Ho Wong ◽  
Theodore Rock ◽  
Jennifer J Majersik
Keyword(s):  
Clinical Research ◽  
Research Team ◽  
Retention Rate ◽  
Management Strategies ◽  
Retention Rates ◽  
Stroke Patients ◽  
Trial Duration ◽  
Implementation Period ◽  
Stroke Center ◽  
Stroke Trial

Introduction: Average national dropout rates of participants enrolled in a research trial are reported to be 30%. Factors contributing to loss of stroke patient retention include the lack of understanding of study expectations, lack of relationship building between patient and clinical research team, and inefficient management processes. There has been little research into interventions to improve retention. Focusing on these 3 factors may increase the likelihood of stroke patients adhering to and completing participation in stroke trials. The University of Utah Stroke Center became a StrokeNet regional coordinating center in October 2013. As study trials increased, we recognized the need to implement new trial management strategies and did so in January 2016. Methods: Stroke trial metrics were compared between the pre-implementation period (7/1/2012 - 12/31/2015) and a post-implementation period (1/7/2016 - 7/1/2019). The size of clinical research team personnel remained the same across the two periods: 4 coordinators and 9 physicians. Standardization of enrollment processes in stroke trials occurred during the post-implementation period. Three key aspects addressed in the post-implementation period were building rapport, setting realistic expectations, and properly educating patient and family members. The clinical research team incorporated these factors when approaching patients regardless of type of stroke trial (acute, subacute, or observational). Results: During the pre-implementation period, the Stroke Center research team managed 8 stroke studies with 52 patients consented with average trial duration of 23 months (SD); in the post-implementation period, there were 15 studies with 99 patients consented, with average trial duration of 22 months (SD). Retention improved after the intervention from a mean (SD) retention rate of 79.5 (29.7) %. to 90.8 (17.2) %. Although this difference was not significant, it represented meaningful change to the research staff and helped us achieve StrokeNet retention goals. Conclusion: Implementation of effective management strategies leads to higher retention rates of stroke patients despite no change in the size of the clinical research team.

scholarly journals Triglyceride glucose index influences platelet reactivity in acute ischemic stroke patients

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yinping Guo ◽  
Jing Zhao ◽  
Yi Zhang ◽  
Lingshan Wu ◽  
Zhiyuan Yu ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Platelet Reactivity ◽  
Multivariate Logistic Regression Analysis ◽  
Platelet Inhibition ◽  
Inhibition Rate ◽  
Stroke Patients ◽  
Tyg Index ◽  
Significant Difference

Abstract Aim Insulin resistance was reported to increase the risk of ischemic stroke, which can be assessed by the triglyceride glucose (TyG) index. However, it remains unclear whether the TyG index influences the platelet reactivity during the treatment of ischemic patients. Methods Ischemic stroke patients receiving dual antiplatelet therapy (DAPT) within 48 h onset were consecutively included. The TyG index was calculated as ln (fasting triglyceride [mg/dL] × fasting glucose [mg/dL]/2). The top quartile of TyG index was defined as insulin resistance. The platelet reactivity was assessed by thromboelastography. The platelet inhibition rate induced by arachidonic acid (AA) or adenosine diphosphate (ADP) was used to confirm the high residual on-treatment platelet reactivity (HRPR) to aspirin or clopidogrel, respectively. The association between TyG index and platelet reactivity was assessed by Kruskal–Wallis test. The independent risk factors of HRPR were determined by multivariate logistic regression analysis. Results A total of 1002 patients were included and divided into 4 groups by quartiles of the TyG index (< 2.02; 2.02–2.27; 2.27–2.52; ≥2.52). The findings demonstrated that the maximum intensity of the clot increased, but the AA-induced platelet inhibition rate decreased, depending on the TyG index quartiles. No significant difference was found in the ADP-induced platelet inhibition rate among groups. The prevalence of aspirin HRPR increased depending on the TyG index quartile. Unlike the non-insulin resistance group, the insulin resistance group was independently associated with aspirin HRPR (OR = 1.689, 95% CI 1.14 to 2.51, P = 0.009). Conclusions In acute ischemic stroke patients taking DAPT, the elevation of the TyG index is associated with enhanced platelet reactivity and higher prevalence of aspirin HRPR. Insulin resistance assessed by the TyG index could be an independent risk factor for aspirin HRPR.

Variability of stroke patients meeting endovascular stroke trial criteria in a non-clinical trial setting

2018 ◽  
Vol 45 (3) ◽  
pp. 192-195 ◽  
Author(s):  
Jennifer E. Fugate ◽  
Waleed Brinjikji ◽  
Harry Cloft ◽  
David F. Kallmes ◽  
Alejandro A. Rabinstein
Keyword(s):  
Clinical Trial ◽  
Stroke Patients ◽  
Clinical Trial Setting ◽  
Stroke Trial ◽  
Trial Setting

Predictors for Mortality after Mechanical Thrombectomy of Acute Basilar Artery Occlusion

2018 ◽  
Vol 45 (1-2) ◽  
pp. 61-67 ◽  
Author(s):  
Benjamin Gory ◽  
Mikael Mazighi ◽  
Julien Labreuche ◽  
Raphael Blanc ◽  
Michel Piotin ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Basilar Artery ◽  
Strong Predictor ◽  
Intravenous Thrombolysis ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Stroke Patients ◽  
Clinical Registry ◽  
Intermediate Outcomes ◽  
Antithrombotic Medication

Background: Modern endovascular thrombectomy (MET), using stent retrievers or large-bore distal aspiration catheters in stroke patients with acute basilar artery occlusion (BAO), is routinely performed to date. However, more than 35% of BAO patients treated with MET die within 90 days despite high recanalization rates. The purpose of this study is to investigate the parameters associated with 90-day mortality in patients with BAO after MET. Methods: We analyzed 117 consecutive BAO patients included in the Endovascular Treatment in Ischemic Stroke prospective clinical registry of consecutive acute ischemic stroke patients treated with MET (60 patients [51.3%] treated with a stent retriever as first-line technique) between March 2010 and April 2017. Successful recanalization was defined as modified thrombolysis In cerebral infarction scores 2b-3 at the end of MET, and mortality was defined as modified Rankin Scale 6 at 90 days. Associations of baseline characteristics (patient and treatment characteristics) and intermediate outcomes (recanalization, complications) with 90-day mortality were investigated in univariate and multivariate analyses. Results: Overall successful recanalization rate was 79.5, and 41.9% (95% CI 32.8–51.0%) of patients died within 90 days after MET. Patients with successful recanalization had a lower mortality rate (32.9 vs. 74.4%; p < 0.001). Failure of successful recanalization was an independent predictor of mortality (OR 5.1; 95% CI 1.34–19.33). In multivariate analysis, age ≥60 years (OR 6.37; 95% CI 1.74–23.31), admission National Institute of Health Stroke Scale (NIHSS) ≥13 (OR 4.62; 95% CI 1.42–15.03), lower posterior circulation-Alberta Stroke Program Early CT Score (pc-ASPECTS; OR 1.71; 95% CI 1.19–2.44), use of antithrombotic medication prior to stroke onset (OR 3.38; 95% CI 1.03–11.08), absence of intravenous thrombolysis (OR 3.36; 95% CI 1.12–10.03), and angioplasty/stenting of the basilar artery (OR 4.71; 95% CI 1.34–16.54) were independent predictors for mortality after MET. Conclusions: Failure of successful recanalization was a strong predictor for mortality. In the setting of recanalization, age, admission NIHSS, pc-ASPECTS, absence of intravenous thrombolysis, and angioplasty/stenting of the basilar artery were also independent predictors for mortality after MET of BAO patients.

Abstract TP376: Effect of Organized Stroke Education Program of Stroke Unit for Acute Stroke Patients to Increase Medication Compliance after Discharge

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Hee Seon Yu ◽  
Hyeseon Jeong ◽  
Nayoung Yoon ◽  
Hee-Jung Song ◽  
Jei Kim
Keyword(s):  
Education Program ◽  
Stroke Prevention ◽  
Stroke Unit ◽  
Medication Compliance ◽  
Stroke Patients ◽  
Education Group ◽  
Stroke Education ◽  
Education Effects ◽  
Antithrombotic Medication

Background and purpose: Interdicipinary education program of stroke unit might be important to improve secondary prevention by increase of medication compliance and maintenance of relationship with physician. The present study evaluated that our education program of stroke unit including education materials for stroke prevention and man-to-man education schedule of stroke unit is helpful to increase the medication compliance and future follow-up rate for first-ever stroke patients. Methods: We first developed education materials, which were consisted of mechanisms and clinical characteristics of stroke, and importance of medication maintenance for secondary stroke prevention. Then man-to-man education was provided for patients who admitted stroke unit (Education group) from January to June of 2012. Medication maintenance rate at 3 months and follow-up rates checked 1 and 3 months after discharge were evaluated. Then, to evaluate the education effects, the rates of Education group were compared ones of No-Education group who were treated in general ward with no organized stroke education from January to June of 2010. Results: Total 392 patients (178; No-Education, 214; Education group) were enrolled. Among patients who admitted to stroke unit, 96.7% were educated by 2 stroke coordinators during admission period. The follow-up rates after discharge were slightly higher in Education group within 1month (89% vs 82%, p <0.05). Maintenance of the follow-up was significantly higher in Education group after 3months (83% vs 61%, p <0.05) than No-Education group. Maintenance rates of antithrombotic medication was highly achieved in the Education group (98% vs 89%, p <0.05) during follow-up period of 3 months. Conclusions: We observed that the educational effect of stroke unit is well maintained till 3 months after discharge. The high follow-up rate and good medication compliance could be obvious benefits of interdisciplinary working stroke unit.

Abstract TP353: Glucose on Admission Associated With Post-stroke Outcome

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Faisal Mukarram ◽  
Rebecca F Gottesman ◽  
Elisabeth Marsh
Keyword(s):  
Stroke Severity ◽  
Stroke Outcome ◽  
Stroke Patients ◽  
Acute Phase Reactants ◽  
Stroke Incidence ◽  
Post Stroke ◽  
Poor Outcome ◽  
Elevated Glucose ◽  
Inflammatory Profile ◽  
Antithrombotic Medication

Introduction: Studies suggest that an elevated inflammatory profile is associated with increased stroke incidence and worse post-stroke outcome. It is unclear if an elevated inflammatory profile on admission is a useful prognostic marker of poor outcome after stroke, a reflection of a more severe stroke, or a marker of infection or the comorbidities that caused the stroke. Hypothesis: We hypothesized that elevated acute phase reactants (APRs) are associated with poor outcome post-stroke, independent of stroke severity and infection. Methods: The study used a prospectively collected clinical database of 755 patients admitted for ischemic or hemorrhagic stroke. APRs studied included erythrocyte sedimentation rate (ESR), glucose, platelets, and white blood cell count. Outcome was assessed at discharge using a dichotomous modified Rankin Scale (mRS) score of 3-6 (poor outcome) vs. 0-2 (good outcome), and was evaluated in multivariate logistic regression. Analyses were adjusted for NIHSS, age, sex, race, hypertension, diabetes, and use of antithrombotic medication, and were further stratified by presence/ absence of diabetes, infection (via urinalysis), and by race. Results: Elevated ESR (OR: 1.16, 95% CI: 1.00-1.33) and glucose (OR: 1.04 per 10 mg/dL, 95% CI: 1.00-1.09), were each associated with poor outcome, independent of stroke severity (NIHSS). Even in non-diabetics, elevated glucose was associated with 15% non-significantly higher odds of poor outcome per 10 mg/dL (95% CI: 0.998-1.34). However, subgroup analysis of those without infection showed no association between APRs and poor outcome. In race-stratified models, glucose level was significantly associated with poor outcome in African Americans (OR: 1.13, 95% CI: 1.01-1.26), but not in other races. Conclusion: Our study shows that ESR is associated with poor outcome after stroke, independently of stroke severity, and that elevated glucose may be associated with increased odds of poor outcome in non-diabetic or African American ischemic stroke patients. Glucose and ESR may play a role in determining prognosis of stroke patients, and therefore point to a potential target for improving outcome of stroke patients.

Clopidogrel-Induced Platelet Inhibition Cannot Be Detected by the Platelet Function Analyzer-100 System in Stroke Patients

2007 ◽  
Vol 16 (5) ◽  
pp. 199-202 ◽  
Author(s):  
Nicole Kotzailias ◽  
Kirsten Elwischger ◽  
Thomas Sycha ◽  
Walter Rinner ◽  
Peter Quehenberger ◽  
...  
Keyword(s):  
Platelet Function ◽  
Platelet Inhibition ◽  
Stroke Patients ◽  
Function Analyzer ◽  
Platelet Function Analyzer

Translation Research for the Rehabilitation of Left Spatial Neglect and Associated Disorders of Attention in Stroke Patients

2008 ◽  
Vol 18 (2) ◽  
pp. 55-65 ◽  
Author(s):  
Nkiruka Arene ◽  
Argye E. Hillis
Keyword(s):  
Theoretical Basis ◽  
Attention Bias ◽  
Spatial Neglect ◽  
Clinical Use ◽  
Stroke Patients ◽  
Translation Research ◽  
Unilateral Neglect ◽  
Assessment And Treatment ◽  
Sound Theoretical Basis ◽  
Review Current

Abstract The syndrome of unilateral neglect, typified by a lateralized attention bias and neglect of contralateral space, is an important cause of morbidity and disability after a stroke. In this review, we discuss the challenges that face researchers attempting to elucidate the mechanisms and effectiveness of rehabilitation treatments. The neglect syndrome is a heterogeneous disorder, and it is not clear which of its symptoms cause ongoing disability. We review current methods of neglect assessment and propose logical approaches to selecting treatments, while acknowledging that further study is still needed before some of these approaches can be translated into routine clinical use. We conclude with systems-level suggestions for hypothesis development that would hopefully form a sound theoretical basis for future approaches to the assessment and treatment of neglect.

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