The benefits of aspirin on myocardial infarction and ischemic stroke outweigh its adverse effects on risk of hemorrhagic stroke

1999 ◽  
Vol 3 (3) ◽  
pp. 72-73
Author(s):  
Gord Gubitz
Keyword(s):  
Myocardial Infarction ◽  
Ischemic Stroke ◽  
Adverse Effects ◽  
Hemorrhagic Stroke

scholarly journals Cilostazol Mono and Combination Treatments in Ischemic Stroke

Stroke ◽  
2019 ◽  
Vol 50 (12) ◽  
pp. 3503-3511 ◽  
Author(s):  
Seung Min Kim ◽  
Jin-Man Jung ◽  
Bum Joon Kim ◽  
Ji-Sung Lee ◽  
Sun U. Kwon
Keyword(s):  
Myocardial Infarction ◽  
Systematic Review ◽  
Ischemic Stroke ◽  
Hemorrhagic Stroke ◽  
Recurrent Stroke ◽  
Meta Analysis ◽  
Significant Heterogeneity ◽  
Randomized Controlled ◽  
Combination Treatments ◽  
Composite Outcomes

Background and Purpose— We performed a systematic review and meta-analysis to explore the efficacy and safety of cilostazol as a mono or combination (plus aspirin or clopidogrel) treatments compared to conventional single antiplatelet therapy (SAPT, mainly aspirin) for secondary stroke prevention. Methods— Randomized controlled trial studies were searched across multiple comprehensive databases (MEDLINE, EMBASE, and Cochrane) for review. The primary outcome was recurrent stroke comprising ischemic and hemorrhagic stroke. Secondary outcomes included ischemic stroke, hemorrhagic stroke, myocardial infarction, and composite outcomes. We performed an updated systematic review and meta-analysis of the identified reports, including 2 recently published randomized controlled trials. In addition, network meta-analysis was performed to compare the relative effects of mono versus combination cilostazol treatments. Results— Ten studies were included in this review, 5 of which were assigned to the cilostazol mono group (n=5429) and the other 5 to the combination group (n=2456). The relative risks of recurrent stroke, ischemic stroke, and composite outcomes with cilostazol mono as well as combination treatments were significantly lower than with SAPT without any significant heterogeneity. An indirect comparison of these 3 outcomes revealed the cilostazol combination approach to be superior. The cilostazol mono treatment diminished hemorrhagic stroke more significantly than SAPT and the cilostazol combination did not increase hemorrhagic stroke compared to SAPT. The outcomes from the 2 cilostazol regimens were comparable to SAPT in the case of myocardial infarction. Conclusions— Cilostazol is a more effective and safer treatment option than SAPT approaches using mainly aspirin. Cilostazol regimens can also be modified to clinical situations as this drug reduces recurrent and ischemic stroke more efficiently as a combination therapy but is more beneficial for hemorrhagic stroke as a monotherapy.

scholarly journals Changes in clinical features and outcomes in three major critical diseases after COVID-19 pandemic: acute myocardial infarction, stroke, and cardiac arrest

2021 ◽  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Arrest ◽  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Hemorrhagic Stroke ◽  
Moving Average ◽  
Multivariable Logistic Regression Analysis ◽  
Number Of Patients ◽  
Post Period

A few months after the onset of the coronavirus Disease 2019 (COVID-19) pandemic, the worse prognoses of acute myocardial infarction, ischemic and hemorrhagic stroke, and cardiac arrest were reported. This study aimed to investigate the changes in the characteristics and prognoses of these diseases in the emergency department (ED) over a year after pandemic’s onset. This was a retrospective observational study. The year 2019 was defined as the pre-period, while the year from February 2020 to January 2021 was defined as the post-period. Adult patients diagnosed with acute myocardial infarction, ischemic stroke, hemorrhagic stroke, or cardiac arrest during the study period were included. The primary outcome was in-hospital mortality. Time series analyses using autoregressive integrated moving average (ARIMA)(p,d,q) model were performed to evaluate the changes between periods. A multivariable logistic regression analysis of factors affecting in-hospital mortality was performed. The proportions of patients with acute myocardial infarction (0.8% vs. 1.1%, p < 0.001), hemorrhagic stroke (1.0%vs. 1.2%, p = 0.011), and cardiac arrest (0.9% vs. 1.1%, p = 0.012) increased in the post-period. The post-period was independently associated with in-hospital mortality in acute myocardial infarction (adjusted odds ratio (aOR) 2.54, 95% confidence interval (95% CI) 1.06–6.08, p = 0.037) and hemorrhagic stroke (aOR 1.74, 95% CI 1.11–2.73, p = 0.016), but not for ischemic stroke or cardiac arrest. Over a year after onset of the COVID-19 pandemic in Korea, the number of patients with acute myocardial infarction, hemorrhagic stroke, and cardiac arrest in the ED increased. An independent association between the post-period and mortality was observed for acute myocardial infarction, and hemorrhagic stroke. This study provides important information for future studies and policies.

Forty-year Seasonality Trends in Occurrence of Myocardial Infarction, Ischemic Stroke, and Hemorrhagic Stroke

Epidemiology ◽  
2018 ◽  
Vol 29 (6) ◽  
pp. 777-783 ◽  
Author(s):  
Nils Skajaa ◽  
Erzsébet Horváth-Puhó ◽  
Jens Sundbøll ◽  
Kasper Adelborg ◽  
Kenneth J. Rothman ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ischemic Stroke ◽  
Hemorrhagic Stroke

scholarly journals Matrix metalloproteinase-3 (MMP3) and MMP9 genes and risk of myocardial infarction, ischemic stroke, and hemorrhagic stroke

2008 ◽  
Vol 201 (1) ◽  
pp. 130-137 ◽  
Author(s):  
Robert C. Kaplan ◽  
Nicholas L. Smith ◽  
Stanley Zucker ◽  
Susan R. Heckbert ◽  
Kenneth Rice ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ischemic Stroke ◽  
Matrix Metalloproteinase ◽  
Hemorrhagic Stroke ◽  
Matrix Metalloproteinase 3

scholarly journals Factor XII as a Risk Marker for Hemorrhagic Stroke: A Prospective Cohort Study

2017 ◽  
Vol 7 (1) ◽  
pp. 84-94 ◽  
Author(s):  
Kristina Johansson ◽  
Jan-Håkan Jansson ◽  
Lars Johansson ◽  
Ingemar Bylesjö ◽  
Torbjörn K. Nilsson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Body Mass Index ◽  
Regression Analysis ◽  
Cohort Study ◽  
Ischemic Stroke ◽  
Hemorrhagic Stroke ◽  
Cox Regression ◽  
Factor Xii ◽  
Cox Regression Analysis

Background: Coagulation factor XII (FXII) is involved in pathological thrombus formation and is a suggested target of anticoagulants. It is unclear whether FXII levels are correlated with cardiovascular risk factors and whether they are associated with myocardial infarction or ischemic or hemorrhagic stroke. The aim of this study was to investigate the correlation between FXII and cardiovascular risk factors in the general population. We also aimed to study the associations between FXII levels and future myocardial infarction and ischemic and hemorrhagic stroke. Methods: This prospective cohort study measured FXII levels in 1,852 randomly selected participants in a health survey performed in northern Sweden in 1994. Participants were followed until myocardial infarction, stroke, death, or until December 31, 2011. Results: During the median follow-up of 17.9 years, 165 individuals were diagnosed with myocardial infarction, 108 with ischemic stroke, and 30 with hemorrhagic stroke. There were weak correlations between FXII and body mass index, cholesterol, and hypertension. There was no association between FXII and myocardial infarction or ischemic stroke, neither in univariable Cox regression analysis nor after adjustment for age, sex, smoking, body mass index, cholesterol, hypertension, and diabetes. In univariable Cox regression analysis, the hazard ratio for the association between FXII levels and hemorrhagic stroke was 1.42 per SD (95% confidence interval: 0.99–2.05). In the multivariable model, higher levels of FXII were associated with increased risk of hemorrhagic stroke (hazard ratio 1.51 per SD; 95% confidence interval: 1.03–2.21). Conclusion: We found an independent association between FXII levels and the risk of hemorrhagic stroke, but not between FXII levels and ischemic stroke or myocardial infarction.

scholarly journals Clinical Characteristics and In-Hospital Outcomes of Varying Definitions of Minor Stroke

Stroke ◽  
2021 ◽  
Author(s):  
Yunyun Xiong ◽  
Hongqiu Gu ◽  
Xing-Quan Zhao ◽  
Xin Yang ◽  
Chunjuan Wang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Ischemic Stroke ◽  
Clinical Characteristics ◽  
Large Scale ◽  
Hemorrhagic Stroke ◽  
Recurrent Stroke ◽  
Clinical Trial Design ◽  
Minor Stroke ◽  
Nihss Score ◽  
All Cause Mortality

Background and Purpose: A variety of definitions for minor stroke have been proposed. We aimed to compare the clinical characteristics and outcomes of minor stroke defined as the National Institutes of Health Stroke Scale (NIHSS) score ≤5 versus ≤3. Methods: We retrieved acute ischemic stroke patients with NIHSS score ≤5 in the CSCA study (China Stroke Center Alliance) between August 2015 and 2019. In-hospital clinical outcomes including all-cause mortality, stroke, and myocardial infarction were compared between the NIHSS score ≤5 and NIHSS score ≤3 groups using absolute standardized differences (ASD). Results: A total of 1 006 798 patients were registered in the CSCA program from 1476 hospitals, 472 352 patients had NIHSS score ≤5, of whom 356 314 patients had NIHSS score ≤3. The in-hospital composite events of death, myocardial infarction, or recurrent stroke were not significantly different between the NIHSS score ≤5 and NIHSS score ≤3 groups (5.6% [26 346/472 352] versus 5.2% [18 682/356 314]; ASD, 1.8). The in-hospital all-cause mortality (0.1% [443/472 352] versus 0.1% [255/356 314]; ASD, <0.01), recurrent ischemic stroke (5.3% [25 026/472 352] versus 5.0% [17 777/356 314]; ASD, 1.4), and hemorrhagic stroke (0.5% [2151/472 352] versus 0.4% [1475/356 314]; ASD, 1.5) were not significantly different between both the NIHSS score ≤5 and NIHSS score ≤3 groups. Conclusions: Our large-scale study identified that minor stroke using NIHSS scores ≤5 and ≤3 as the definition was comparable with each other regarding in-hospital all-cause mortality, recurrent stroke, and hemorrhagic stroke. This observation may be useful for future comparison studies and clinical trial design.

scholarly journals Phytochemical analysis and thrombolytic profiling of Costus afer stem fractions

2022 ◽  
Vol 8 (1) ◽  
Author(s):  
Martins Obinna Ogugofor ◽  
Ugochi Olivia Njoku ◽  
Obioma Uzoma Njoku ◽  
Gaber El-Saber Batiha
Keyword(s):  
Myocardial Infarction ◽  
Heart Disease ◽  
Ischemic Stroke ◽  
Adverse Effects ◽  
Cardiac Glycosides ◽  
Clot Lysis ◽  
Phytochemical Analysis ◽  
Antithrombotic Activity ◽  
Stem Extract ◽  
Costus Afer

Abstract Background The most commonly occurring mechanism driving ischemic heart disease, ischemic stroke, and myocardial infarction is thrombosis. It is normally characterized by platelet activation and aggregation. Thrombolytics have been used in the treatment of several forms of thrombosis, but their adverse effects have limited their usefulness. Thus, there is a need to develop alternatives from medicinal plants known to possess antithrombotic activity such as Costus afer. Results The phytochemical evaluations indicated the presence of flavonoids, alkaloids, cardiac glycosides, tannins, terpenoids, and saponins. The antithrombotic profiling showed that streptokinase had the highest percentage clot lysis, followed by ethylacetate fraction of the extract, which was higher than aspirin and other fractions of the extract. Conclusion The present findings show that C. afer stem extract and various fractions possess antithrombotic activities. However, further studies are needed to characterize the antithrombotic bioactive compounds present in the different fractions that are responsible for the activities.

Thrombolytic Therapy in the Current ERA: Myocardial Infarction and Beyond

2018 ◽  
Vol 24 (4) ◽  
pp. 414-426 ◽  
Author(s):  
Patrick Proctor ◽  
Massoud A. Leesar ◽  
Arka Chatterjee
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Disease ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Coronary Intervention ◽  
Evidence Base ◽  
Primary Pci ◽  
Percutaneous Coronary

Thrombolytic therapy kick-started the era of modern cardiology but in the last few decades it has been largely supplanted by primary percutaneous coronary intervention (PCI) as the go-to treatment for acute myocardial infarction. However, these agents remain important for vast populations without access to primary PCI and acute ischemic stroke. More innovative uses have recently come up for the treatment of a variety of conditions. This article summarizes the history, evidence base and current use of thrombolytics in cardiovascular disease.

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