Abstract TP170: Persistently Elevated Factor VIII In Acute Ischemic Stroke Is Associated With Higher CRP, Lower Baseline NIHSS, And Longer Length Of Hospital Stay

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Adrianne M Dorsey ◽  
Amelia K Boehme ◽  
Laurie Schluter ◽  
Karen C Albright ◽  
Tiffany R Chang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Factor Viii ◽  
Hospital Stay ◽  
Acute Ischemic Stroke ◽  
Acute Phase ◽  
Clinical Course ◽  
Length Of Hospital Stay ◽  
Lower Baseline ◽  
Persistent Elevation

Objective: We sought to determine the proportion of patients with elevated factor VIII (FVIII) levels whose FVIII levels remain elevated after the acute phase of stroke, and the patient characteristics that predict sustained elevation of FVIII levels. Background: Factor VIII plays a major role in the fluid phase of blood coagulation. Elevated FVIII has been shown to increase risk of venous and arterial thrombosis. The importance of screening for elevated FVIII after a first thrombotic event especially acute ischemic stroke (AIS) has not been adequately investigated. Design/Methods: We reviewed FVIII levels taken at baseline and follow-up in patients with AIS treated at our stroke center from July 2008 to June 2012. Elevated FVIII was defined as >150%. Baseline demographics, laboratory data, clinical course, outcomes, and time to follow-up were collected in patients with elevated FVIII at baseline and data was compared in patients who had normalized FVIII with patients whose FVIII remained elevated at least 7 days later. Results: Repeat FVIII levels were available for 34/111 patients with elevated FVIII level with AIS. FVIII remained elevated in 68% after a median interval of 110 days. Factors associated with persistent elevation included higher baseline FVIII level (239 vs 185%, p=0.015), elevated CRP (73.3 vs 12.5%, p=0.008), lower baseline NIHSS (4 vs 8, p=0.046), and longer length of hospital stay (8 vs. 3, p=0.0063). Normalization of FVIII was associated with tPA use (54.5% vs 13%, p=0.016). No relationship was found between persistently elevated FVIII and baseline demographics, clinical course and outcomes. Conclusion: Persistently elevated FVIII after AIS may be predicted by higher baseline levels and elevations in CRP. Despite worse baseline stroke severity, patient with normalization of FVIII had similar outcomes as those with persistent elevation, which may be explained by the higher use of tPA in the normalized group. The relevance of elevated FVIII in stroke is not well understood. Our preliminary results suggest elevations persist in the majority and may not merely represent an acute phase reactant.

Abstract 2642: Prevalence and Importance of Cardiac Arrhythmias after Acute Ischemic Stroke

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Jesper K Jensen ◽  
James L Januzzi ◽  
Dan Atar ◽  
Hans Mickley
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Acute Phase ◽  
Heart Rhythm ◽  
Torsades De Pointes ◽  
Holter Monitoring ◽  
Stroke Severity ◽  
Potential Threat ◽  
True Rate

Although heart rhythm monitoring following acute ischemic stroke is widely practiced, the prevalence of arrhythmia during the acute phase of ischemic stroke is debated. Several studies have claimed the potential threat of QT prolongation possibly leading to Torsades de Pointes ventricular tachycardia (VT) or ventricular fibrillation (VF). Furthermore, knowledge of the true rate of occult atrial fibrillation (AF) among ischemic stroke patients is sparse. 224 consecutive patients with acute ischemic stroke underwent daily 12-lead ECG during the first 5 days after hospital admission; as well as 24 hour Holter monitoring was performed in all patients. Patients with prior AF, established ischemic heart disease and heart failure were excluded. Patients were followed for 40 months for vital status. The mean age of the patients was 69 years. No patient had VT or VF. Previously unsuspected AF could be demonstrated in only 13 of 224 patients (6%). All 13 were detected by Holter monitoring, while nearly half were missed by ECG. During follow-up 53 (24 %) patients died. The presence of AF was significantly associated with mortality (log-rank p <0.0001; Figure ). In Cox analysis, patients with AF had an increased mortality compared to patients without AF (HR=2.44; [95 % CI, 1.00 – 6.00], P = 0.05) with adjustment for age and stroke severity and renal failure. The fear of serious ventricular arrhythmias in the acute phase of ischemic stroke appears to be groundless. However, new onset AF can be demonstrated in one of 20 patients with acute ischemic stroke and seems to be associated with an increased mortality during long-term follow-up.

scholarly journals Impact of intravenous thrombolysis on length of hospital stay in cases of acute ischemic stroke

2018 ◽  
Vol Volume 14 ◽  
pp. 259-264 ◽  
Author(s):  
Narongrit Kasemsap ◽  
Nisa Vorasoot ◽  
Kannikar Kongbunkiat ◽  
Udomlack Peansukwech ◽  
Somsak Tiamkao ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Hospital Stay ◽  
Acute Ischemic Stroke ◽  
Length Of Hospital Stay ◽  
Intravenous Thrombolysis

scholarly journals Eosinophil-to-Neutrophil Ratio Predicts Poor Prognosis of Acute Ischemic Stroke Patients Treated With Intravenous Thrombolysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Haoye Cai ◽  
Honghao Huang ◽  
Chenguang Yang ◽  
Junli Ren ◽  
Jianing Wang ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Inflammatory Marker ◽  
Intravenous Thrombolysis ◽  
Poor Outcome ◽  
Risk Of Mortality ◽  
Lower Baseline ◽  
To Come ◽  
Lost To Follow Up

Background and Purpose: The eosinophil-to-neutrophil ratio (ENR) was recently reported as a novel inflammatory marker in acute ischemic stroke (AIS). However, few studies reported the predictive value of ENR in AIS patients, especially for those with intravenous thrombolysis.Methods: Two hundred sixty-six AIS patients receiving intravenous thrombolysis were retrospectively recruited in this study and followed up for 3 months and 1 year. The Modified Rankin Scale (mRS) and the time of death were recorded. Poor outcome was defined as mRS 3–6. After excluding patients who were lost to follow-up, the remaining 250 patients were included in the 3-month prognosis analysis and the remaining 223 patients were included in the 1-year prognosis analysis.Results: ENR levels in the patients were lower than those in the healthy controls. The optimal cutoff values for the ability of ENR × 102 to predict 3-month poor outcome were 0.74 with 67.8% sensitivity and 77.3% specificity. Patients with ENR × 102 ≥ 0.74 have a lower baseline National Institutes of Health Stroke Scale (NIHSS) score (median: 7 vs. 11, p &lt; 0.001). After multivariate adjustment, patients with ENR × 102 ≥ 0.74 were more likely to come to a better 3-month outcome (OR = 0.163; 95% CI, 0.076–0.348, p &lt; 0.001). At the 1-year follow-up, the patients with ENR × 102 ≥ 0.74 showed a lower risk of mortality (HR = 0.314; 95% CI, 0.135–0.731; p = 0.007).Conclusions: A lower ENR is independently associated with a 3-month poor outcome and a 3-month and 1-year mortality in AIS patients treated with intravenous thrombolysis.

scholarly journals A Model for Predicting Persistent Elevation of Factor VIII among Patients with Acute Ischemic Stroke

2016 ◽  
Vol 25 (2) ◽  
pp. 428-435 ◽  
Author(s):  
Alyana A. Samai ◽  
Amelia K. Boehme ◽  
Amir Shaban ◽  
Alexander J. George ◽  
Lauren Dowell ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Factor Viii ◽  
Acute Ischemic Stroke ◽  
Persistent Elevation

Depressed TSH level as a predictor of poststroke fatigue in patients with acute ischemic stroke

Neurology ◽  
2018 ◽  
Vol 91 (21) ◽  
pp. e1971-e1978 ◽  
Author(s):  
Jinjing Wang ◽  
Fengli Li ◽  
Lulu Xiao ◽  
Feng Peng ◽  
Wen Sun ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Confidence Interval ◽  
Acute Ischemic Stroke ◽  
Acute Phase ◽  
Odds Ratio ◽  
Serum Levels ◽  
Severity Scale ◽  
Index Stroke ◽  
Fatigue Severity

ObjectiveTo investigate whether thyroid function profiles can predict poststroke fatigue (PSF) in patients with acute ischemic stroke.MethodsPatients with stroke were consecutively recruited within 3 days of onset in Jinling Hospital. Serum levels of thyroid hormones, thyroid antibodies, hematologic indexes, and biochemical indexes were measured on admission. Fatigue was scored using the Fatigue Severity Scale. Associations were analyzed with multivariate regression and restricted cubic splines.ResultsOf the 704 patients with stroke, 292 (41.5%) were diagnosed with fatigue in the acute stage and 224 (35.3%) 6 months after the index stroke. The serum levels of thyroid-stimulating hormone (TSH) were inversely associated with the risk of PSF in both the acute phase and at follow-up evaluations after adjusting for potential confounders (odds ratio 0.30, 95% confidence interval 0.24–0.37 in the acute phase, and odds ratio 0.70, 95% confidence interval 0.58–0.84 at follow-up). The subgroup analysis indicated that in the acute phase of ischemic stroke, TSH was associated with severity of PSF in the groups with euthyroidism (β = −0.70, p < 0.001), subclinical hypothyroidism (β = −0.44, p < 0.001), and low-T3 syndrome (β = −0.34, p = 0.008). Higher TSH was associated with better Fatigue Severity Scale scores in patients with low-T3 syndrome 6 months after the index stroke (β = −0.35, p = 0.01). Furthermore, in the group with low-T3 syndrome, FT3 serum level could also indicate a higher risk of PSF (β = −2.54, p < 0.001 in the acute phase, and β = −2.67, p < 0.001 at follow-up).ConclusionThyroid function profiles may predict fatigue after acute ischemic stroke, suggesting that neuroendocrine responses could have a role in PSF.

Pilonidal Sinus: How to Choose Between Excision and Open Granulation Versus Excision and Primary Closure?

Swiss Surgery ◽  
2002 ◽  
Vol 8 (6) ◽  
pp. 255-258 ◽  
Author(s):  
Perruchoud ◽  
Vuilleumier ◽  
Givel
Keyword(s):  
Hospital Stay ◽  
Pilonidal Sinus ◽  
Primary Closure ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Healing Time ◽  
Incision And Drainage ◽  
The Mean ◽  
Primary Healing

Aims: The purpose of this study was to evaluate excision and open granulation versus excision and primary closure as treatments for pilonidal sinus. Subjects and methods: We evaluated a group of 141 patients operated on for a pilonidal sinus between 1991 and 1995. Ninety patients were treated by excision and open granulation, 34 patients by excision and primary closure and 17 patients by incision and drainage, as a unique treatment of an infected pilonidal sinus. Results: The first group, receiving treatment of excision and open granulation, experienced the following outcomes: average length of hospital stay, four days; average healing time; 72 days; average number of post-operative ambulatory visits, 40; average off-work delay, 38 days; and average follow-up time, 43 months. There were five recurrences (6%) in this group during the follow-up period. For the second group treated by excision and primary closure, the corresponding outcome measurements were as follows: average length of hospital stay, four days; average healing time, 23 days; primary healing failure rate, 9%; average number of post-operative ambulatory visits, 6; average off-work delay, 21 days. The average follow-up time was 34 months, and two recurrences (6%) were observed during the follow-up period. In the third group, seventeen patients benefited from an incision and drainage as unique treatment. The mean follow-up was 37 months. Five recurrences (29%) were noticed, requiring a new operation in all the cases. Discussion and conclusion: This series of 141 patients is too limited to permit final conclusions to be drawn concerning significant advantages of one form of treatment compared to the other. Nevertheless, primary closure offers the advantages of quicker healing time, fewer post-operative visits and shorter time off work. When a primary closure can be carried out, it should be routinely considered for socio-economical and comfort reasons.

Mechanical thrombectomy using a Solitaire stent retriever in the treatment of pediatric acute ischemic stroke

2019 ◽  
Vol 23 (3) ◽  
pp. 363-368 ◽  
Author(s):  
Bing Zhou ◽  
Xiao-Chuan Wang ◽  
Jun-Yi Xiang ◽  
Ming-Zhao Zhang ◽  
Bo Li ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Balloon Dilation ◽  
Stent Retriever ◽  
National Institutes Of Health ◽  
Clinical Prognosis ◽  
Nihss Score ◽  
Grade 3

OBJECTIVEMechanical thrombectomy using a Solitaire stent retriever has been widely applied as a safe and effective method in adult acute ischemic stroke (AIS). However, due to the lack of data, the safety and effectiveness of mechanical thrombectomy using a Solitaire stent in pediatric AIS has not yet been verified. The purpose of this study was to explore the safety and effectiveness of mechanical thrombectomy using a Solitaire stent retriever for pediatric AIS.METHODSBetween January 2012 and December 2017, 7 cases of pediatric AIS were treated via mechanical thrombectomy using a Solitaire stent retriever. The clinical practice, imaging, and follow-up results were reviewed, and the data were summarized and analyzed.RESULTSThe ages of the 7 patients ranged from 7 to 14 years with an average age of 11.1 years. The preoperative National Institutes of Health Stroke Scale (NIHSS) scores ranged from 9 to 22 with an average of 15.4 points. A Solitaire stent retriever was used in all patients, averaging 1.7 applications of thrombectomy and combined balloon dilation in 2 cases. Grade 3 on the modified Thrombolysis In Cerebral Infarction scale of recanalization was achieved in 5 cases and grade 2b in 2 cases. Six patients improved and 1 patient died after thrombectomy. The average NIHSS score of the 6 cases was 3.67 at discharge. The average modified Rankin Scale score was 1 at the 3-month follow-up. Subarachnoid hemorrhage after thrombectomy occurred in 1 case and that patient died 3 days postoperatively.CONCLUSIONSThis study shows that mechanical thrombectomy using a Solitaire stent retriever has a high recanalization rate and excellent clinical prognosis in pediatric AIS. The safety of mechanical thrombectomy in pediatric AIS requires more clinical trials for confirmation.

Mechanical thrombectomy in pediatric stroke: systematic review, individual patient data meta-analysis, and case series

2019 ◽  
Vol 24 (5) ◽  
pp. 558-571 ◽  
Author(s):  
Kartik Bhatia ◽  
Hans Kortman ◽  
Christopher Blair ◽  
Geoffrey Parker ◽  
David Brunacci ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Neurological Outcomes

OBJECTIVEThe role of mechanical thrombectomy in pediatric acute ischemic stroke is uncertain, despite extensive evidence of benefit in adults. The existing literature consists of several recent small single-arm cohort studies, as well as multiple prior small case series and case reports. Published reports of pediatric cases have increased markedly since 2015, after the publication of the positive trials in adults. The recent AHA/ASA Scientific Statement on this issue was informed predominantly by pre-2015 case reports and identified several knowledge gaps, including how young a child may undergo thrombectomy. A repeat systematic review and meta-analysis is warranted to help guide therapeutic decisions and address gaps in knowledge.METHODSUsing PRISMA-IPD guidelines, the authors performed a systematic review of the literature from 1999 to April 2019 and individual patient data meta-analysis, with 2 independent reviewers. An additional series of 3 cases in adolescent males from one of the authors’ centers was also included. The primary outcomes were the rate of good long-term (mRS score 0–2 at final follow-up) and short-term (reduction in NIHSS score by ≥ 8 points or NIHSS score 0–1 at up to 24 hours post-thrombectomy) neurological outcomes following mechanical thrombectomy for acute ischemic stroke in patients < 18 years of age. The secondary outcome was the rate of successful angiographic recanalization (mTICI score 2b/3).RESULTSThe authors’ review yielded 113 cases of mechanical thrombectomy in 110 pediatric patients. Although complete follow-up data are not available for all patients, 87 of 96 (90.6%) had good long-term neurological outcomes (mRS score 0–2), 55 of 79 (69.6%) had good short-term neurological outcomes, and 86 of 98 (87.8%) had successful angiographic recanalization (mTICI score 2b/3). Death occurred in 2 patients and symptomatic intracranial hemorrhage in 1 patient. Sixteen published thrombectomy cases were identified in children < 5 years of age.CONCLUSIONSMechanical thrombectomy may be considered for acute ischemic stroke due to large vessel occlusion (ICA terminus, M1, basilar artery) in patients aged 1–18 years (Level C evidence; Class IIb recommendation). The existing evidence base is likely affected by selection and publication bias. A prospective multinational registry is recommended as the next investigative step.

scholarly journals In-hospital recurrence in a Chinese large cohort with acute ischemic stroke

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Fan Yu ◽  
Xiaolu Liu ◽  
Qiong Yang ◽  
Yu Fu ◽  
Dongsheng Fan
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Acute Ischemic Stroke ◽  
Recurrent Events ◽  
Early Stage ◽  
High Rate ◽  
Large Artery ◽  
Stroke Event

Abstract Acute ischemic stroke (AIS) has a high risk of recurrence, particularly in the early stage. The purpose of this study was to assess the frequency and risk factors of in-hospital recurrence in patients with AIS in China. A retrospective analysis was performed of all of the patients with new-onset AIS who were hospitalized in the past three years. Recurrence was defined as a new stroke event, with an interval between the primary and recurrent events greater than 24 hours; other potential causes of neurological deterioration were excluded. The risk factors for recurrence were analyzed using univariate and logistic regression analyses. A total of 1,021 patients were included in this study with a median length of stay of 14 days (interquartile range,11–18). In-hospital recurrence occurred in 58 cases (5.68%), primarily during the first five days of hospitalization. In-hospital recurrence significantly prolonged the hospital stay (P < 0.001), and the in-hospital mortality was also significantly increased (P = 0.006). The independent risk factors for in-hospital recurrence included large artery atherosclerosis, urinary or respiratory infection and abnormal blood glucose, whereas recurrence was less likely to occur in the patients with aphasia. Our study showed that the patients with AIS had a high rate of in-hospital recurrence, and the recurrence mainly occurred in the first five days of the hospital stay. In-hospital recurrence resulted in a prolonged hospital stay and a higher in-hospital mortality rate.

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