scholarly journals Myocardial infarction after acute ischaemic stroke: Incidence, mortality and risk factors

2019 ◽  
Vol 140 (3) ◽  
pp. 219-228 ◽  
Author(s):  
Tiberiu A. Pana ◽  
Adrian D. Wood ◽  
Mamas A. Mamas ◽  
Allan B. Clark ◽  
Joao H. Bettencourt‐Silva ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Stroke Incidence

Dabigatran in real-world atrial fibrillation

2016 ◽  
Vol 116 (10) ◽  
pp. 754-763 ◽  
Author(s):  
Francisco Moscoso Costa ◽  
Jorge Ferreira ◽  
Miguel Mendes ◽  
João Carmo
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Ischaemic Stroke ◽  
Major Bleeding ◽  
Real World ◽  
Vitamin K Antagonists ◽  
Intracranial Bleeding ◽  
Gi Bleeding ◽  
Stroke Incidence ◽  
Significant Difference

SummaryIn the RE-LY clinical trial, dabigatran presented a better effectiveness/ safety profile when compared to warfarin. However, clinical trials are not very representative of the real-world setting. We aimed to assess the performance of dabigatran in real-world patients with atrial fibrillation (AF) by means of a systematic review and meta-analysis of observational comparison studies with vitamin K antagonists (VKA). We searched PubMed, Embase and Scopus databases until November 2015 and selected studies according to the following criteria: observational study performed with nonvalvular AF patients; reporting adjusted hazard ratios (HR) of clinical events in a follow-up period; for dabigatran 75 mg, 110 mg or 150 mg versus VKA. Twenty studies were selected which included 711,298 patients, 210,279 of which were treated with dabigatran and the remaining 501,019 with VKA. Ischaemic stroke incidence was of 1.65 /100 patient-years for dabigatran and 2.85/100 patient-years for VKA (HR 0.86, 95 % confidence interval of 0.74–0.99). Major bleeding rate was 3.93/100 patient-years for dabigatran and 5.61/100 patient-years for VKA (0.79, 0.69–0.89). Risk of mortality (0.73, 0.61–0.87) and intracranial bleeding (0.45, 0.38–0.52) were significantly lower in patients treated with dabigatran when compared to patients on VKA. Risk of gastrointestinal (GI) bleeding was significantly higher in patients treated with dabigatran (1.13, 1.00–1.28). No significant difference was observed in risk of myocardial infarction (0.99, 0.89–1.11). In this combined analysis of real-world observational comparison studies with VKA, dabigatran was associated with a lower risk of ischaemic stroke, major bleeding, intracranial bleeding and mortality, higher risk of GI bleeding and a similar risk of myocardial infarction.Supplementary Material to this article is available online at www.thrombosis-online.com.

Childhood arterial ischaemic stroke incidence, presenting features, and risk factors: a prospective population-based study

2014 ◽  
Vol 13 (1) ◽  
pp. 35-43 ◽  
Author(s):  
Andrew A Mallick ◽  
Vijeya Ganesan ◽  
Fenella J Kirkham ◽  
Penny Fallon ◽  
Tammy Hedderly ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischaemic Stroke ◽  
Population Based ◽  
Population Based Study ◽  
Stroke Incidence ◽  
Arterial Ischaemic Stroke

scholarly journals Hyperhomocysteinaemia among Acute Ischaemic Stroke Patients in a Tertiary Care Centre in Thiruvananthapuram, Kerala – A Cross-Sectional Study

2021 ◽  
Vol 8 (19) ◽  
pp. 1326-1331
Author(s):  
Deepa Gopalakrishna ◽  
Rupa Gopinathan ◽  
Saboora Beegum ◽  
Thomas Iype
Keyword(s):  
Risk Factors ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Homocysteine Level ◽  
Statistical Tests ◽  
Tertiary Care ◽  
Care Hospital ◽  
Stroke Patients ◽  
Cross Sectional ◽  
Total Homocysteine

BACKGROUND Over the last three decades, prevalence of stroke has been high in India, while the Western countries have witnessed a downward slide. Epidemiological studies suggest that hyperhomocysteinaemia might be a potentially modifiable nonlipid risk factor associated with stroke, in addition to the long-recognized factors like hypertension, diabetes mellitus, hyperlipidaemia and smoking. Hyperhomocysteinaemia occurs due to deviation in the metabolic pathway of methionine, attributed by deficiency of vitamins, enzymes and other factors. The present study was undertaken to assess the proportion of hyperhomocysteinaemia in patients with acute ischemic stroke. We also compared the risk factors associated with stroke and serum levels of homocysteine. METHODS This is a cross sectional observational study conducted in a tertiary care hospital. The sample size was 140. Both male and female consecutive patients of age more than 18 years, with first attack of acute ischaemic stroke admitted in the Department of Neurology were selected. Baseline fasting serum samples were obtained for testing serum homocysteine levels. Statistical tests used were proportion, chi square and logistic regression. RESULTS Among 140 acute ischaemic stroke patients, total homocysteine level was raised in 83.6 % cases. The prevalence of moderate hyperhomocysteinaemia in our study was 65.4 % and intermediate hyperhomocysteinaemia was 17.9 % among stroke patients. The mean (± SD) homocysteine level was 22.75 (± 8.19). CONCLUSIONS A strong association was found between hyperhomocysteinaemia and acute ischaemic stroke. We could not find any significant correlation between total homocysteine level and most risk factors of stroke. KEYWORDS Stroke, Homocysteine, Risk Factors, Endothelial Dysfunction, Atherosclerosis, B Vitamins

scholarly journals Risk Factors for Pneumonia in Patients with Acute Ischaemic Stroke- A Retrospective Study

2021 ◽  
Author(s):  
Roy Thomas
Keyword(s):  
Risk Factors ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Test Score ◽  
Neurological Complication ◽  
Tertiary Care ◽  
Significant Risk ◽  
Chronic Obstructive ◽  
Stroke Severity ◽  
Increased Risk

Introduction: The most common non-neurological complication of stroke is infection. Stroke, associated with pneumonia is one among them. A few studies have identified prognostic predictors of pneumonia in stroke. Aim: To identify the risk factors of pneumonia in acute ischaemic stroke patients. Materials and Methods: This retrospective cohort study included medical records of 470 adult patients with acute ischaemic stroke between June 2015 to June 2020 (five years) in a Tertiary Care Medical College and Hospital. Among them, 173 had stroke associated with pneumonia. The clinical parameters-age, gender, lesion location, stroke severity (Glasgow Coma Scale (GCS)) , National Institute of Health Stroke Scale (NIHSS), Modified Barthel Activities of Daily Living (ADL) index, water swallow test, vascular risk factors and co-existing conditions (pre-existent Chronic Obstructive Pulmonary Disease (COPD), atrial fibrillation, renal electrolyte dysfunction, hypoproteinaemia) were compared. Chi-square test and logistic regression analysis were used for statistical analysis. Results: In this study, the following factors were associated with increased risk of developing pneumonia-age >70 years, bed ridden status, GCS ≤13, NIHSS ≥5, water swallow test score ≤2. Among them, multivariate analysis identified bed ridden status and water swallow test as independent predictors. Conclusion: Bed ridden status and water swallow test score were significant risk factors of ischaemic stroke associated with pneumonia. Hence, an early identification of these factors and a better knowledge of them may help in better care and prevention of pneumonia in acute ischaemic stroke.

1349Effect of bariatric surgery on long-term cardiovascular outcomes in patients with obesity: a nation-wide nested cohort study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Ardissino ◽  
O M Moussa ◽  
A R Tang ◽  
T Heaton ◽  
P Ziprin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Bariatric Surgery ◽  
Cohort Study ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
All Cause Mortality ◽  
Secondary Endpoints ◽  
Fatal Myocardial Infarction

Abstract Background Obesity is a cardinal risk factor for the development of atherosclerotic cardiovascular disease. Bariatric surgery is an effective method of achieving weight reduction and improving control of cardiovascular risk factors in patients with obesity. However, the effect of bariatric surgery on long-term cardiovascular outcomes has yet to be defined. Purpose The aim of this study is to evaluate the effect of bariatric surgery on long-term risk of major adverse cardiovascular events in a large population of patients with obesity. Methods A nested cohort study was carried out; including the 3,701 patients of the Clinical Practice Research Datalink database who had undergone bariatric surgery, and 3,701 age, gender and BMI matched controls. The primary endpoint was the composite of fatal or non-fatal myocardial infarction; and fatal or non-fatal acute ischaemic stroke. Secondary endpoints included all-cause mortality, new diagnosis of heart failure, fatal or non-fatal myocardial infarction, and fatal or non-fatal acute ischaemic stroke. Data was analysed using a Cox proportional hazards model to account for multiple covariates. Results Patients were followed up for a median of 11.2 years; 20.3% of the population were female, the median age was 36 years and median BMI was 40.4 kg/m2. Patients who had undergone bariatric surgery had a significantly lower occurrence of the primary composite outcome (HR 0.450; 95% CI 0.312–0.671, p<0.001, NNT=62); this was driven by a reduction in myocardial infarction (HR 0.444; 95% CI 0.302–0.654, p<0.001, NNT=64) and not in acute ischaemic stroke (HR 0.528; 95% CI 0.159–1.751, p=0.296). A significant reduction was observed in rates all-cause mortality (HR 0.254; 95% CI 0.183–0.353; p<0.001, NNT=27) and of new diagnosis of heart failure (HR 0.519; 95% CI 0.311–0.864, p=0.012, NNT=153). Table 1. Primary and secondary endpoints during follow-up Events No Bariatric Surgery Bariatric Surgery HR 95% CI p (n=3,701) (n=3,701) Primary endpoint 93 37 0.458 0.312–0.671 <0.001 Secondary endpoints   All-cause mortality 182 45 0.254 0.183–0.353 <0.001   Heart failure 46 22 0.519 0.311–0.864 0.012   Fatal or non-fatal myocardial infarction 93 36 0.444 0.302–0.654 <0.001   Fatal or non-fatal ischaemic stroke 9 4 0.528 0.159–1.751 0.296 Adjusted primary endpoint rates Conclusion The results of this large, nation-wide nested cohort study support the role of bariatric surgery in reducing the risk of major cardiovascular events, all-cause mortality and new onset of heart failure in patients with obesity.

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