scholarly journals Reducing the severity of stroke

2019 ◽  
Vol 95 (1123) ◽  
pp. 271-278 ◽  
Author(s):  
Georgina Meredith ◽  
Anthony Rudd
Keyword(s):  
Ischaemic Stroke ◽  
Intracerebral Haemorrhage ◽  
Acute Treatment ◽  
Causes Of Death ◽  
Stroke Care ◽  
Stroke Patients ◽  
Advanced Imaging ◽  
Effective Prevention

Stroke remains one of the most important causes of death and disability worldwide. Effective prevention could reduce the burden of stroke dramatically. The management of stroke has undergone a revolution over the last few decades, particularly with the development of techniques for revascularisation of patients with ischaemic stroke. Advanced imaging able to identify potentially salvageable brain is further increasing the potential for effective acute treatment. However, the majority of stroke patients won’t benefit from these treatments and will need effective specialist stroke care and ongoing rehabilitation to overcome impairments and adapt to living with a disability. There are still many unanswered questions about the most effective way of delivering rehabilitation. Likewise, research into how to manage primary intracerebral haemorrhage has yet to transform care.

scholarly journals Stroke Patients’ Characteristics and Clinical Outcomes: A Pre-Post COVID-19 Comparison Study

Medicina ◽  
2021 ◽  
Vol 57 (5) ◽  
pp. 507
Author(s):  
Hong Chuan Loh ◽  
Kar Keong Neoh ◽  
Angelina Siing Ngi Tang ◽  
Chen Joo Chin ◽  
Purnima Devi Suppiah ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Intravenous Thrombolysis ◽  
Stroke Care ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Acute Stroke Care ◽  
Cross Sectional ◽  
Scan Time ◽  
Care Systems ◽  
Stroke Centre

Background and Objectives: The Coronavirus disease 2019 (COVID-19) pandemic caused significant disruption to established medical care systems globally. Thus, this study was aimed to compare the admission and outcome variables such as number of patient and its severity, acute recanalisation therapy given pre-post COVID-19 at a primary stroke centre located in Malaysia. Methods: This cross-sectional hospital-based study included adult ischaemic stroke patients. Variables of the study included the number of ischaemic stroke patients, the proportions of recanalisation therapies, stroke severity during admission based on the National Institutes of Health Stroke Scale, functional outcome at discharge based on the modified Rankin Scale, and relevant workflow metrics. We compared the outcome between two six-month periods, namely the pre-COVID-19 period (March 2019 to September 2019) and the COVID-19 period (March 2020 to September 2020). Results: There were 131 and 156 patients, respectively, from the pre-COVID-19 period and the COVID-19 period. The median door-to-scan time and the median door-to-reperfusion time were both significantly shorter in the COVID-19 period (24.5 min versus 12.0 min, p = 0.047) and (93.5 min versus 60.0 min, p = 0.015), respectively. There were also significantly more patients who received intravenous thrombolysis (7.6% versus 17.3%, p = 0.015) and mechanical thrombectomy (0.8% versus 6.4%, p = 0.013) in the COVID-19 period, respectively. Conclusions: The COVID-19 pandemic may not have caused disruptions of acute stroke care in our primary stroke centre. Our data indicated that the number of ischaemic stroke events remained stable, with a significant increase of recanalisation therapies and better in-hospital workflow metrics during the COVID-19 pandemic period. However, we would like to highlight that the burden of COVID-19 cases in the study area was very low. Therefore, the study may not have captured the true burden (and relevant delays in stroke patient management) during the COVID-19 pandemic. The effect of the pandemic crisis is ongoing and both pre-hospital and in-hospital care systems must continue to provide optimal, highly time-dependent stroke care services.

scholarly journals Rationale and design of the Registry of Acute Stroke Under Novel Oral Anticoagulants-prime (RASUNOA-prime)

2018 ◽  
Vol 4 (2) ◽  
pp. 181-188 ◽  
Author(s):  
Kirsten Haas ◽  
Jan C Purrucker ◽  
Timolaos Rizos ◽  
Peter U Heuschmann ◽  
Roland Veltkamp
Keyword(s):  
Atrial Fibrillation ◽  
Ischaemic Stroke ◽  
Vitamin K ◽  
Intracerebral Haemorrhage ◽  
Acute Ischaemic Stroke ◽  
Emergency Treatment ◽  
Clinical Course ◽  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Stroke Patients

Background Anticoagulation with vitamin K antagonists and non-vitamin K antagonists oral anticoagulants (NOAC) is effective in stroke prevention in patients with atrial fibrillation. However, anticoagulation also poses a major challenge for emergency treatment of patients suffering ischaemic stroke or intracerebral haemorrhage. Aim The registry RASUNOA-prime is designed to describe current patterns of emergency management, clinical course and outcome of patients with atrial fibrillation experiencing an acute ischaemic stroke or intracerebral haemorrhage under different anticoagulation schemes prior to stroke (NOAC, vitamin K antagonists or no anticoagulation). Methods and design RASUNOA-prime (ClinicalTrials.gov, NCT02533960) is a prospective, investigator-initiated, multicentre, observational cohort study aiming to recruit 3000 patients with acute ischaemic stroke and atrial fibrillation, and 1000 patients with acute intracerebral haemorrhage and atrial fibrillation with different anticoagulation schemes pre-stroke. It is a non-interventional triple-armed study aiming at a balanced inclusion of ischaemic stroke and intracerebral haemorrhage patients according to the different anticoagulation schemes. Patients will be followed up for clinical course, management and outcome up to three months after the event. Findings in ischaemic stroke and intracerebral haemorrhage patients on NOAC will be compared with patients taking vitamin K antagonists or no anticoagulant pre-stroke. Study outcomes Primary endpoint for ischaemic stroke patients: occurrence of symptomatic intracerebral haemorrhage, for intracerebral haemorrhage patients: occurrence of secondary haematoma expansion. Secondary endpoints include assessment of coagulation, use of thrombolysis and/or mechanical thrombectomy, occurrence of complications, implementation of secondary prevention. Summary Describing the current patterns of early management as well as outcome of stroke patients with atrial fibrillation will help guide physicians to develop recommendations for emergency treatment of stroke patients under different anticoagulation schemes.

scholarly journals Low dose statins improve prognosis of ischemic stroke patients with intravenous thrombolysis

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chaohua Cui ◽  
Yanbo Li ◽  
Jiajia Bao ◽  
Shuju Dong ◽  
Lijie Gao ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Intracerebral Haemorrhage ◽  
Acute Ischaemic Stroke ◽  
Low Dose ◽  
Intravenous Thrombolysis ◽  
Gastrointestinal Haemorrhage ◽  
Lower Percentage ◽  
Stroke Patients ◽  
Statin Group ◽  
Risk Of Bleeding

Abstract Background For acute ischaemic stroke patients, it is uncertain whether intravenous thrombolysis combined with statins might increase the therapeutic effect. Additionally, using high-intensity statins after thrombolysis may increase the risk of bleeding in patients. Asian stroke patients often take low-dose statins. It is speculated that reducing the dose of statins may improve the risk of bleeding. Methods Data from consecutive acute ischaemic stroke patients with intravenous thrombolysis were prospectively collected. Efficacy outcomes included NIHSS (National Institutes of Health Stroke Scale) score improvement at 7 days after admission and mRS (Modified Rankin Scale) improvement at 90 days. Safety outcomes included haemorrhage events (intracerebral haemorrhage and gastrointestinal haemorrhage) in the hospital and death events within 2 years. Results The study finally included 215 patients. The statin group had a higher percentage of NIHSS improvement at 7 days (p < 0.001) and a higher percentage of a favourable functional outcome (FFO, mRS <  = 2) (p < 0.001) at 90 days. The statin group had a lower percentage of intracerebral haemorrhage (p < 0.001) and gastrointestinal haemorrhage (p = 0.003) in the hospital and a lower percentage of death events (p < 0.001) within 2 years. Logistic regression indicated that statin use was significantly related to NIHSS improvement (OR = 4.697, p < 0.001), a lower percentage of intracerebral haemorrhage (OR = 0.372, p = 0.049) and gastrointestinal haemorrhage (OR = 0.023, p = 0.016), and a lower percentage of death events (OR = 0.072, p < 0.001). Conclusion For acute ischaemic stroke patients after intravenous thrombolysis, the use of low-dose statins was related to NIHSS improvement at 7 days and inversely related to haemorrhage events in the hospital and death events within 2 years, especially for moderate stroke or noncardioembolic stroke patients.

scholarly journals Low and Medium dose Statins Improve Function and Prognosis of Asian Ischemic Stroke Patients with Intravenous Thrombolysis

2021 ◽  
Author(s):  
Chaohua Cui ◽  
Jiajia Bao ◽  
Lijie Gao ◽  
Li He
Keyword(s):  
Ischaemic Stroke ◽  
Intracerebral Haemorrhage ◽  
Acute Ischaemic Stroke ◽  
Intravenous Thrombolysis ◽  
Gastrointestinal Haemorrhage ◽  
Lower Percentage ◽  
Stroke Patients ◽  
Statin Group ◽  
Score Improvement ◽  
Medium Dose

Abstract Background: For acute ischaemic stroke, intravenous thrombolysis combined with statins might increase the therapeutic effect; however, it is uncertain whether this is effective. Additionally, statins can increase the risk of intracerebral haemorrhage in ischaemic stroke patients, further raising doubts regarding the safety of this combination. Methods: Data from consecutive acute ischaemic stroke patients with intravenous thrombolysis were prospectively collected. Efficacy outcomes included NIHSS (National Institutes of Health Stroke Scale) score improvement at 7 days after admission and mRS (Modified Rankin Scale) improvement at 90 days. Safety outcomes included haemorrhage events in the hospital and death events within 2 years. Results: The study finally included 222 patients. The statin group had a higher percentage of NIHSS improvement at 7 days (p<0.001) and a higher percentage of a favourable functional outcome (FFO) (p<0.001) at 90 days. The statin group had a lower percentage of intracerebral haemorrhage (p<0.001) and gastrointestinal haemorrhage (p=0.004) in the hospital and a lower percentage of death events (p<0.001) within 2 years. Logistic regression indicated that statin use was significantly related to NIHSS improvement (OR=2.291, p=0.014), a lower percentage of intracerebral haemorrhage (OR=0.379, p=0.008) and gastrointestinal haemorrhage (OR=0.027, p=0.023), and a lower percentage of death events (OR=0.196, p<0.001). Conclusion: For Asian acute ischaemic stroke patients after intravenous thrombolysis, the use of low- and medium-dose statins was related to NIHSS improvement of moderate stroke patients at 7 days, with a reduced percentage of haemorrhage events in the hospital and a lower percentage of death events within 2 years, especially for moderate stroke or noncardioembolic stroke patients.

scholarly journals Population-based stroke surveillance using Big Data: epidemiological trends in admissions and mortality in Australia

2020 ◽  
Author(s):  
Melina Gattellari ◽  
Chris Goumas ◽  
Bin Jalaludin ◽  
John M. Worthington
Keyword(s):  
Confidence Interval ◽  
Subarachnoid Haemorrhage ◽  
Ischaemic Stroke ◽  
Intracerebral Haemorrhage ◽  
Negative Binomial ◽  
Stroke Care ◽  
Percentage Change ◽  
Post Discharge ◽  
Average Percentage ◽  
Epidemiological Trends

AbstractBackgroundEpidemiological trends for major causes of death and disability, such as stroke, may be monitored using administrative data to guide public health initiatives and service delivery.MethodsWe calculated admissions rates for ischaemic stroke, intracerebral haemorrhage or subarachnoid haemorrhage between January 1, 2005 and December 31st, 2013 and rates of 30-day mortality and 365-day mortality in 30-day survivors to December 31st 2014 for patients aged 15 years or older from New South Wales, Australia (population 7.99 million). Annual Average Percentage Change in rates was estimated using negative binomial regression.ResultsOf 81,703 eligible admissions, 64,047 (78.4%) were ischaemic strokes and 13,302 (16.3%) and 4,778 (5.8%) were intracerebral and subarachnoid haemorrhages, respectively. Intracerebral haemorrhage admissions significantly declined by an average of 2.2% annually (95% Confidence Interval=-3.5% to −0.9%) (p<0.001). Thirty-day mortality rates significantly declined for ischaemic stroke (Average Percentage Change −2.9%, 95% Confidence Interval=-5.2% to −1.0%) (p=0.004) and subarachnoid haemorrhage (Average Percentage Change=-2.6%, 95% Confidence Interval=-4.8% to −0.2%) (p=0.04). Mortality at 365-days amongst 30-day survivors of ischaemic stroke and intracerebral haemorrhage was stable over time and increased in 30-day survivors of subarachnoid haemorrhage (Annual Percentage Change 6.2%, 95% Confidence Interval=-0.1% to 12.8%), although the increase was not statistically significant (p=0.05).ConclusionImproved prevention may have underpinned declining intracerebral haemorrhage rates while gains in survival suggest that innovations in stroke care are being successfully translated. Longer-term mortality in patients surviving the acute period is unchanged and may be increasing for subarachnoid haemorrhage warranting investment in post-discharge care and secondary prevention.

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