scholarly journals The Clinical Efficacy of Clopidogrel Bisulfate Tablets Combined with Olmesartan Medoxomil for Ischemic Stroke with Hypertension and the Effect of Angiotensin II Type 1 Receptor Level on Prognosis

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Jia Yu ◽  
Wei Fang ◽  
Xing Guo ◽  
Haiyang Jiang ◽  
Peng Sun ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Angiotensin Ii ◽  
Clinical Efficacy ◽  
Olmesartan Medoxomil ◽  
Continuous Treatment ◽  
Stroke Recurrence ◽  
Stroke Patients ◽  
Clopidogrel Bisulfate ◽  
Barthel Score

Background. Ischemic stroke combined with hypertension can increase risks of stroke recurrence and death. Aim. The aim of this study is to investigate the clinical efficacy of clopidogrel bisulfate tablets combined with olmesartan medoxomil in the treatment of ischemic stroke patients with hypertension and the effect of angiotensin II type 1 receptor (AT1R) level on prognosis. Methods. Ninety ischemic stroke patients with hypertension were chosen for continuous treatment with clopidogrel bisulfate tablets and olmesartan medoxomil for 12 months. The Modified Edinburgh Scandinavian Stroke Scale (MESSS) score, Brunnstrom score, Barthel score, death, recurrence, and progression of cerebrovascular residual lesions were observed and recorded during the treatment period. According to the plasma AT1R expression of the patients before treatment, the patients were divided into a high-AT1R group and low-AT1R group. Then, survival analysis was performed. Results. Compared with pretreatment, the MESSS scores of the patients at the first, second, third, sixth, ninth, and twelfth months after treatment were reduced ( p < 0.01 ) while the Brunnstrom score and Barthel score were prominently boosted ( p < 0.01 ). Compared with the low-AT1R group, patients in the high-AT1R group had higher rates of stroke recurrence and progression of residual cerebrovascular lesions ( p < 0.05 ). Conclusion. Clopidogrel bisulfate tablets combined with olmesartan medoxomil has prominent clinical effects in the treatment of ischemic stroke patients with hypertension, evidently improving the prognosis. In addition, the level of AT1R may be a vital factor affecting the prognosis.

scholarly journals Sex disparity in long-term stroke recurrence and mortality in a rural population in the United States

2020 ◽  
Vol 13 ◽  
pp. 175628642097189
Author(s):  
Clare Lambert ◽  
Durgesh Chaudhary ◽  
Oluwaseyi Olulana ◽  
Shima Shahjouei ◽  
Venkatesh Avula ◽  
...  
Keyword(s):  
United States ◽  
Ischemic Stroke ◽  
Rural Population ◽  
The United States ◽  
Competing Risk ◽  
Stroke Recurrence ◽  
Composite Outcome ◽  
Stroke Patients ◽  
Central Pennsylvania ◽  
All Cause Mortality

Background: Several studies suggest women may be disproportionately affected by poorer stroke outcomes than men. This study aims to investigate whether women have a higher risk of all-cause mortality and recurrence after an ischemic stroke than men in a rural population in central Pennsylvania, United States. Methods: We analyzed consecutive ischemic stroke patients captured in the Geisinger NeuroScience Ischemic Stroke research database from 2004 to 2019. Kaplan–Meier (KM) estimator curves stratified by gender and age were used to plot survival probabilities and Cox Proportional Hazards Ratios were used to analyze outcomes of all-cause mortality and the composite outcome of ischemic stroke recurrence or death. Fine–Gray Competing Risk models were used for the outcome of recurrent ischemic stroke, with death as the competing risk. Two models were generated; Model 1 was adjusted by data-driven associated health factors, and Model 2 was adjusted by traditional vascular risk factors. Results: Among 8900 adult ischemic stroke patients [median age of 71.6 (interquartile range: 61.1–81.2) years and 48% women], women had a higher crude all-cause mortality. The KM curves demonstrated a 63.3% survival in women compared with a 65.7% survival in men ( p = 0.003) at 5 years; however, the survival difference was not present after controlling for covariates, including age, atrial fibrillation or flutter, myocardial infarction, diabetes mellitus, dyslipidemia, heart failure, chronic lung diseases, rheumatic disease, chronic kidney disease, neoplasm, peripheral vascular disease, past ischemic stroke, past hemorrhagic stroke, and depression. There was no adjusted or unadjusted sex difference in terms of recurrent ischemic stroke or composite outcome. Conclusion: Sex was not an independent risk factor for all-cause mortality and ischemic stroke recurrence in the rural population in central Pennsylvania.

scholarly journals Impacts of treatments on recurrence and 28-year survival of ischemic stroke patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Ting-Ann Wang ◽  
Tzy-Haw Wu ◽  
Shin-Liang Pan ◽  
Hsiu-Hsi Chen ◽  
Sherry Yueh-Hsia Chiu
Keyword(s):  
Ischemic Stroke ◽  
Cerebrovascular Disease ◽  
Cox Regression ◽  
Controlled Trial ◽  
Stroke Recurrence ◽  
Long Term Effects ◽  
Stroke Patients ◽  
Double Blind ◽  
Term Survival

AbstractAspirin and nicametate are well-established therapies for preventing recurrence and mortality from stroke in patients diagnosed as ischemic stroke. However, their respective effects on the recurrence, making allowance for the duration of recurrence and death without the occurrence of recurrence, and long-term survival have not been well elucidated. We aimed to evaluate long-term effect of two kinds of treatment on cerebrovascular death among ischemic stroke patients with or without the recurrence of stroke. Data used in this study were derived from the cohort based on a multicenter randomized double-blind controlled trial during 1992 to 1995 with the enrollment of a total of 466 patients with first-time non-cardioembolic ischemic stroke who were randomly allocated to receive aspirin (n = 222) or nicametate (n = 244). The trial cohort was followed up over time to ascertain the date of recurrence within trial period and death until Sep of 2019. The time-dependent Cox regression model was used to estimate the long-term effects of two treatments on death from cerebrovascular disease with and without recurrence. A total of 49 patients experienced stroke recurrence and 89 cerebrovascular deaths was confirmed. Patients treated with nicametate were more likely, but non statistically significantly, to have recurrence (aHR: 1.73, 95% CI 0.96–3.13) as compared with those treated by aspirin. Nicametate reduced the risk of cerebrovascular death about 37% (aHR: 0.63, 95% CI 0.41–0.97) compared with aspirin. The aspirin group had a lower recurrence rate than the nicametate group even with recurrence after 1–2 years of follow-up of first stroke but the latter had significantly reduced death from cerebrovascular disease for nicametate group, which requires more research to verify.

Abstract P32: Potential Underuse of Antidepressants in Post Stroke Depression: Data From the AVAIL Registry

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Nada El Husseini ◽  
Daniel T Laskowitz ◽  
Amanda C Guidon ◽  
DaiWai M Olson ◽  
Xin Zhao ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cognitive Status ◽  
Stroke Recurrence ◽  
Stroke Patients ◽  
Living Situation ◽  
Factors Associated ◽  
Post Stroke ◽  
Depression Status ◽  
Post Stroke Depression ◽  
Antidepressant Use

Background: Post-stroke depression is common, yet little is known about factors associated with antidepressant use in this population Methods: Data from the multicenter, prospective Adherence eValuation After Ischemic stroke-Longitudinal (AVAIL) registry was used to identify patients with post-stroke depression and to describe factors associated with antidepressant use. The analysis was performed after 3 months in 1751 ischemic stroke patients who had been admitted to 97 hospitals nationwide; 12 month follow-up was available for 1637 patients. The Get with the Guidelines-Stroke database was used to collect baseline data. Patients were classified as depressed based on a self-report scale (the Patient Health Questionnaire-8; score range 0 to 24, score ≥10 indicating depression). Frequencies were compared with Pearson X 2 and unadjusted ORs were calculated. Results: The prevalence of post stroke depression was similar at 3 and 12 months (19% [331/1751] vs 17% [280/1637], respectively, p=0.17). Regardless of depression status, antidepressant use was higher at 12 months (16% [287/1751] vs 20% [334/1637], p=0.002). Antidepressant use was also higher at 12 months in depressed patients (25% [84/331] vs 35% [98/280], p=0.009). The odds of antidepressant use at 3 months was higher in women than men (OR 1.6, 95% CI 1.2-2.1), Whites vs. Blacks (OR 1.7, 95% CI 1.1-2.8), in patients with vs. without cognitive deficits (OR 1.6, 95% CI 1.2-2.1) and in those with more severe disabilities (mRS≥3 vs. mRS<3, OR 1.7, 95% CI 1.3-2.3). Use did not vary with educational level, marital status, living situation, medication insurance coverage, or stroke recurrence. Similar trends were present at 12 months, except with higher use in those with recurrent stroke or TIA (OR 2.1, 95% CI 1.4-3.1). Conclusion: Three-quarters of depressed stroke patients at 3-months and nearly two-thirds at 12 months were not receiving antidepressants. Regardless of depression status, utilization of antidepressants after 3 and 12 months varied based on gender, race/ethnicity, cognitive status, disability level, and after 12-months, stroke recurrence. The reasons for the apparent underuse of antidepressants in patients with prevalent post-stroke depression require further study.

Abstract P72: The Obesity Paradox: Association Between Body Mass Index (BMI) and Disability After Stroke

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Brianna R Helms
Keyword(s):  
Body Mass Index ◽  
Ischemic Stroke ◽  
Functional Status ◽  
Hospital Discharge ◽  
Body Mass ◽  
Obesity Paradox ◽  
Normal Weight ◽  
Stroke Recurrence ◽  
Inverse Association ◽  
Stroke Patients

Background: Present rise in the incidence of obesity has led to several opposing reports regarding the association between obesity and stroke outcomes. The objective of this study was to investigate a proposed paradoxical relationship between body mass index (BMI) and functional status in ischemic stroke patients at time of hospital discharge. Methods: Saint Francis Hospital Comprehensive Stroke Center patient databases were utilized in identifying 948 patients eligible for retrospective chart review over a period of 15 months. Subjects were divided into 4 groups according to BMI: underweight (BMI < 18.5 kg/m 2 ), normal weight (BMI 18.5-24.9 kg/m 2 ), overweight (BMI 25.0-29.9 kg/m 2 ), and obese (BMI ≥ 30.0 kg/m 2 ). Covariates, such as age, gender, prior to event modified Rankin scale (mRS), stroke recurrence, and smoking, were considered. Functional status and disability of stroke patients was scored via mRS at hospital discharge. Ordered logistic regression, Pearson’s chi-squared test, and Pearson’s r correlation were used for analysis to assess the association of BMI and functional status in ischemic strokes. Results: Of 948 eligible subjects, 49.9% were female and mean (SD) age was 69.4 (14.5) years. According to BMI, 22 (2.3%) were underweight, 247 (26.1%) normal weight, 319 (33.7%) overweight, and 360 (37.9%) obese. After adjusting for covariates, ischemic stroke patients with an increased BMI (OR, 0.98; 95% CI, 0.96-0.99) were not associated with increased disability risk upon discharge. Obese (16.2%) and overweight (14.1%) patients discharged with a mRS of 0 (back to baseline) or 1 more frequently compared to normal weight (6.1%) and underweight (0.21%) patients ( P <0.001). Furthermore, an inverse association between BMI status and disability was significantly evident ( r = -0.17, P < 0.001). Conclusion: Obese and overweight stroke patients discharge with a lower risk of disability than normal weight and underweight patients, supporting the existence of the “obesity paradox” in stroke. An inverse association between obesity status and functional outcome was identified and remained significant regardless of covariates.

Abstract P132: Clinical Outcomes In Ischemic Stroke Patients With Uncontrolled Hypertension

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Zahra Abuzaid ◽  
Sara Almuslem ◽  
Farah Aleisa
Keyword(s):  
Blood Pressure ◽  
Ischemic Stroke ◽  
Clinical Outcomes ◽  
Recurrent Stroke ◽  
Uncontrolled Hypertension ◽  
Stroke Recurrence ◽  
Stroke Patients ◽  
Stroke Event ◽  
Uncontrolled Blood Pressure

Background: Hypertension is considered major risk factor for incidence of ischemic stroke, controlling blood pressure reduces this risk, the relationship of uncontrolled blood pressure and stroke outcomes is complex, post stroke uncontrolled blood pressure remains one of the major contributing factors for stroke recurrence and mortality, in our study we studied the long term effects of uncontrolled hypertension in modern health care setting. Methodology: Patients in the study were admitted to the neurology department at KFSH-D between March 2015- August 2019, we included 102 acute ischemic stroke patients whom had hypertension, all patients had follow up appointments at stroke clinic a minimum of 2 visits over 4 years. We retrospectively compared blood pressure data from stroke patients with recurrent ischemic stroke events vs. patients with initial stroke event, and recurrent stroke, also we studied blood pressure readings for different stroke severity groups, patients who had severe stroke with mRS>4, compared to milder stroke group of mRS<4. Results: We found 48 patients identified with recurrent stroke event, those with uncontrolled hypertension had significantly higher stroke recurrence events (P=0.002), despite acute stroke treatment, patients who had history of uncontrolled hypertension were found to have more severe stroke deficits than those who had controlled blood pressure (P=0.029). We found significant difference in the long term stroke clinical outcomes between patients who had uncontrolled blood pressure and patients who had controlled blood pressure recordings within the same hospital setting (P=0.064). Conclusion: Based on our findings, uncontrolled hypertension was associated with higher risk of stroke recurrence, it also increased susceptibility to worse stroke clinical outcomes up to 1 year after initial stroke event, which deserved further close attention and better blood pressure control.

Cancer-Associated Hypercoagulation Increases the Risk of Early Recurrent Stroke in Patients with Active Cancer

2018 ◽  
Vol 46 (1-2) ◽  
pp. 46-51 ◽  
Author(s):  
Jun Fujinami ◽  
Tomoyuki Ohara ◽  
Fukiko Kitani-Morii ◽  
Yasuhiro Tomii ◽  
Naoki Makita ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Recurrent Stroke ◽  
Stroke Recurrence ◽  
Multivariable Logistic Regression Analysis ◽  
Stroke Patients ◽  
Recurrent Cancer ◽  
Systemic Metastasis ◽  
D Dimer ◽  
Active Cancer

Background: This study assessed the incidence and predictors of short-term stroke recurrence in ischemic stroke patients with active cancer, and elucidated whether cancer-associated hypercoagulation is related to early recurrent stroke. Methods: We retrospectively enrolled acute ischemic stroke patients with active cancer admitted to our hospital between 2006 and 2017. Active cancer was defined as diagnosis or treatment for any cancer within 12 months before stroke onset, known recurrent cancer or metastatic disease. The primary clinical outcome was recurrent ischemic stroke within 30 days. Results: One hundred ten acute ischemic stroke patients with active cancer (73 men, age 71.3 ± 10.1 years) were enrolled. Of those, recurrent stroke occurred in 12 patients (11%). When patients with and without recurrent stroke were compared, it was found that those with recurrent stroke had a higher incidence of pancreatic cancer (33 vs. 10%), systemic metastasis (75 vs. 39%), multiple vascular territory infarctions (MVTI; 83 vs. 40%), and higher ­D-dimer levels (16.9 vs. 2.9 µg/mL). Multivariable logistic regression analysis showed that each factor mentioned above was not significantly associated with stroke recurrence independently, but high D-dimer (hDD) levels (≥10.4 µg/mL) and MVTI together were significantly associated with stroke recurrence (OR 6.20, 95% CI 1.42–30.7, p = 0.015). Conclusions: Ischemic stroke patients with active cancer faced a high risk of early recurrent stroke. The concurrence of hDD levels (≥10.4 µg/mL) and MVTI was an independent predictor of early recurrent stroke in active cancer patients. Our findings suggest that cancer-associated hypercoagulation increases the early recurrent stroke risk.

scholarly journals Metabolic Syndrome and Stroke Recurrence in Chinese Ischemic Stroke Patients – The ACROSS-China Study

PLoS ONE ◽  
2012 ◽  
Vol 7 (12) ◽  
pp. e51406 ◽  
Author(s):  
Donghua Mi ◽  
Qian Jia ◽  
Huaguang Zheng ◽  
Kolin Hoff ◽  
Xingquan Zhao ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Ischemic Stroke ◽  
Stroke Recurrence ◽  
Stroke Patients ◽  
China Study

scholarly journals Frequency of angiotensin II type 1 receptor gene polymorphism in Turkish acute stroke patients

2013 ◽  
Vol 17 (4) ◽  
pp. 475-481 ◽  
Author(s):  
Kurt Hulyam ◽  
Bayramoglu Aysegul ◽  
Gunes Hasan Veysi ◽  
Ozbabalik Demet ◽  
Degirmenci Irfan ◽  
...  
Keyword(s):  
Angiotensin Ii ◽  
Gene Polymorphism ◽  
Acute Stroke ◽  
Receptor Gene ◽  
Stroke Patients ◽  
Receptor Gene Polymorphism

scholarly journals Study of Outcome of Ischemic Stroke Patient With Atrial Fibrillation

2018 ◽  
Vol 28 (2) ◽  
pp. 1-6
Author(s):  
Achinta Kumar Mallick ◽  
Md Kafil Uddin ◽  
Md Ahmed Ali ◽  
Pijus Kumar Kundu ◽  
Sheikh Mohammad Emdadul Haque ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Risk Factor ◽  
Ischemic Stroke ◽  
Linear Regression Analysis ◽  
Clinical Deterioration ◽  
Stroke Recurrence ◽  
Stroke Severity ◽  
Multivariate Linear Regression Analysis ◽  
Stroke Patients

Atrial fibrillation (AF) is a common arrhythmia and a major risk factor for ischemic stroke, especially in the elderly. Patients with nonvalvular AF have a 5-fold excess risk of stroke. However, population-based data are scarce in patients who have experienced a first-ever ischemic stroke in the presence of AF regarding long-term risk of stroke recurrence and case-fatality rate. Aim of the study is to find out the outcome of ischemic stroke patients with Atrial Fibrillation. It was a descriptive type cross sectional study where 125 diagnosed cases of ischemic stroke were included. Presence of atrial fibrillation was detected by electrocardiogram. They were divided into two groups – those with atrial fibrillation and those without. Comparison was done between the two group in term of recurrence, mortality and clinical improvement. Atrial fibrillation was present in 22 (17.6%) of 125 patients with ischemic stroke. Those with AF were more frequently male, aged 45 years and older. The presence of AF was associated with high 3 months (Χ2 =4.562, df = 1, p<0.05) and 6 months mortality (Χ2 =7.868, df = 1, p<0.05), with a higher stroke recurrence rate within the first 6 months follow-up (22.7% versus 7.8% (<0.05)). At 3 months follow up clinical deterioration was noted in 9.1% patient with atrial fibrillation compared to 2.9% patients who had no arrhythmia(p<0.01) and at 6 months follow up clinical deterioration was noted in 18.2% patient with atrial fibrillation compared to 4.9% patients who had no arrhythmia(p<0.01). Ischemic stroke patients with atrial fibrillation had significant mortality within the study period compared to those without atrial fibrillation. Significant deterioration in clinical outcome was noted in atrial fibrillation group after six months. Recurrence was more in ischemic stroke patients with atrial fibrillation. Multivariate linear regression analysis shows atrial fibrillation as well as CKD, Diabetes mellitus and smoking as independent risk factor for recurrence. In conclusion, patients who had an ischemic stroke with accompanying atrial fibrillation had higher mortality, grave stroke severity, more recurrences and poorer functional status than those without atrial fibrillation.TAJ 2015; 28(2): 1-6

scholarly journals Karakteristik dan Periode Kekambuhan Stroke pada Pasien dengan Stroke Berulang di Rumah Sakit Margono Soekardjo Purwokerto Kabupaten Banyumas

2018 ◽  
Vol 3 (1) ◽  
Author(s):  
Meida Laely Ramdani
Keyword(s):  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Low Income ◽  
Recurrent Stroke ◽  
Sampling Technique ◽  
Stroke Recurrence ◽  
Stroke Patients ◽  
Cross Sectional ◽  
Post Stroke ◽  
Duration Of Illness

Background: Patients who had stroke recurrence after the first stroke have a high risk of disability as well as high rates of morbidity and mortality. Incidence of stroke recurrence can be prevented by controlling risk factors and secondary prevention among post stroke patient, and also tent of the duration of the occurrence of recurrent stroke after the first attack. Objective: The purpose of this study was to determine the characteristics and stroke recurrence periods of post stroke patients.Methods: Cross sectional study design was used in this study. Total 73 recurrent stroke patients age 18-60 years old were selected using consecutive sampling technique. This study was conducted on patients during their follow up in the outpatient department of unit neurology, Margono Soekardjo Purwokerto Hospital during November-December 2015. The characteristics of the recurrent stroke patients include sex, age, education, occupation, and income. This study also describes type of stroke and duration of illness. The periods of recurrent stroke patients divided in to three time periods (≤ 6-month, 7-12 month, >12 month). Results: 73 recurrent stroke patients showed 56% were female, age group 39-60 years old was 97,5%, 60,3% have low education (below senior high school), 64,7% work as public and private employees. Income of respondents were low income 53,4%. Ischemic stroke was the majority (87,7%), no history family of stroke 64,4%, 1-5 years duration of illness and periods of stroke recurrence >12 month was 45,20%.Conclusion:  Ischemic stroke is the biggest case of recurrent stroke, so that we need to emphasize the importance of secondary prevention including medication and treatment. Background: Patients who had stroke recurrence after the first stroke have a high risk of disability as well as high rates of morbidity and mortality. Incidence of stroke recurrence can be prevented by controlling risk factors and secondary prevention among post stroke patient, and also tent of the duration of the occurrence of recurrent stroke after the first attack. Objective: The purpose of this study was to determine the characteristics and stroke recurrence periods of post stroke patients.Methods: Cross sectional study design was used in this study. Total 73 recurrent stroke patients age 18-60 years old were selected using consecutive sampling technique. This study was conducted on patients during their follow up in the outpatient department of unit neurology, Margono Soekardjo Purwokerto Hospital during November-December 2015. The characteristics of the recurrent stroke patients include sex, age, education, occupation, and income. This study also describes type of stroke and duration of illness. The periods of recurrent stroke patients divided in to three time periods (≤ 6-month, 7-12 month, >12 month). Results: 73 recurrent stroke patients showed 56% were female, age group 39-60 years old was 97,5%, 60,3% have low education (below senior high school), 64,7% work as public and private employees. Income of respondents were low income 53,4%. Ischemic stroke was the majority (87,7%), no history family of stroke 64,4%, 1-5 years duration of illness and periods of stroke recurrence >12 month was 45,20%.Conclusion:  Ischemic stroke is the biggest case of recurrent stroke, so that we need to emphasize the importance of secondary prevention including medication and treatment.

Sign in / Sign up

Export Citation Format

Share Document