Abstract TP297: Predictors of Intracranial Hemorrhage in Patients with Atherosclerotic Vascular Disease: Observations from the TRA 2°P-TIMI 50 Trial

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Marc P Bonaca ◽  
Jay P Mohr ◽  
Mark J Alberts ◽  
Sebastian F Ameriso ◽  
Graeme J Hankey ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Vascular Disease ◽  
Renal Dysfunction ◽  
Intracranial Hemorrhage ◽  
Rare Event ◽  
Arterial Disease ◽  
Male Gender ◽  
Atherosclerotic Vascular Disease ◽  
Clinical Predictors ◽  
History Of

Intracranial hemorrhage (ICH) is a rare event that is difficult to predict and often has devastating consequences. Clinical predictors of ICH in stable patients with atherosclerosis are not well described. Methods: We evaluated the clinical correlates of ICH risk in patients randomized to placebo (N=13,166) in the TRA 2°P-TIMI 50 trial, a multinational trial of patients with atherothrombosis randomized to vorapaxar or placebo added to standard therapy. Eligible patients had a history of myocardial infarction, peripheral arterial disease, or recent ischemic stroke (2 wks to 12 mo.). ICH was adjudicated by an independent CEC. Results: A total of 53 ICH events (0.5% at 3 years) occurred during follow up in the placebo group. 94% of patients were receiving aspirin, 5% a thienopyridine alone, and 57% dual antiplatelet therapy. Overall, age, sex, prior ischemic stroke, and renal dysfunction were significantly associated with ICH (Table 1). After adjustment age, male gender, and prior ischemic stroke remained significantly associated with an increased hazard of ICH (Figure 1). Notably, the predictors differed between qualifying groups. After adjustment renal dysfunction (p=0.018) and diabetes (p=0.073) were associated with ICH in the MI/PAD group. In contrast, only male gender was associated with ICH in the CVD group (p=0.048). Conclusions: Advanced age, male gender, and history of ischemic stroke are associated with an increased hazard of ICH in patients with a history of atherothrombosis. Predictors of ICH vary depending on background vascular disease. In patients with MI/PAD and no recent stroke, traditional risk factors including diabetes and renal dysfunction are associated with ICH.

scholarly journals Association of Preceding Antithrombotic Therapy in Atrial Fibrillation Patients With Ischemic Stroke, Intracranial Hemorrhage, or Gastrointestinal Bleed and Mortality

2019 ◽  
Author(s):  
Joris J Komen ◽  
Tomas Forslund ◽  
Aukje K Mantel-Teeuwisse ◽  
Olaf H Klungel ◽  
Mia von Euler ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Propensity Score ◽  
Intracranial Hemorrhage ◽  
Cox Regression ◽  
Mortality Rates ◽  
Antithrombotic Treatment ◽  
Healthcare Database ◽  
Gastrointestinal Bleed ◽  
History Of

Abstract Aims To analyze 90-day mortality in AF patients after a stroke or a severe bleed and assess associations with the type of antithrombotic treatment at the event. Methods and Results From the Stockholm Healthcare database, we selected 6 017 patients with a known history of AF who were diagnosed with ischemic stroke, 3 006 with intracranial hemorrhage, and 4 291 with a severe gastrointestinal bleed (GIB). The 90-day mortality rates were 25.1% after ischemic stroke, 31.6% after intracranial hemorrhage, and 16.2% after severe GIB. We used Cox regression and propensity score matched analyses to test the association between antithrombotic treatment at the event and 90-day mortality. After intracranial hemorrhage, there was a significantly higher mortality rate in warfarin compared to NOAC treated patients (adjusted hazard ratio (aHR): 1.36 CI: 1.04 – 1.78). After an ischemic stroke and a severe GIB, patients receiving antiplatelets or no antithrombotic treatment had significantly higher mortality rates compared to patients on NOACs, but there was no difference comparing warfarin to NOACs (aHR 0.84 CI: 0.63 – 1.12 after ischemic stroke, aHR 0.91 CI: 0.66 – 1.25 after severe GIB). Propensity score matched analysis yielded similar results. Conclusion Mortality rates were high in AF patients suffering from an ischemic stroke, an intracranial hemorrhage, or a severe GIB. NOAC treatment was associated with a lower 90 day mortality after intracranial hemorrhage than warfarin.

Abstract 15701: Relationship Between Cardiac Biomarkers and Major Adverse Cardiovascular Events in DECLARE-TIMI 58

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Thomas A Zelniker ◽  
David A Morrow ◽  
ofri Mosenzon ◽  
Erica Goodrich ◽  
Petr Jarolim ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Controlled Trial ◽  
Cardiac Biomarkers ◽  
Major Adverse Cardiovascular Events ◽  
Atherosclerotic Vascular Disease ◽  
Cox Models ◽  
Increased Risk ◽  
History Of ◽  
The Difference ◽  
The Relationship

Introduction: Biomarkers of hemodynamic stress and myocardial injury are associated with the risk of CV death & heart failure in patients with atherosclerotic vascular disease (ASCVD). Here we explore the association between cardiac biomarkers and ASCVD outcomes in patients with type 2 diabetes (T2DM). Methods: This was a nested biomarker study in DECLARETIMI 58, a randomized, blinded, placebo-controlled trial of dapagliflozin in T2DM and either multiple risk factors (MRF, ~60%) or established ASCVD (~40%). The relationship between baseline NT-proBNP and hsTnT levels (TIMI Biomarker Laboratory, n=14,565) and the composite of myocardial infarction, ischemic stroke, and CV death (MACE), was modeled within the placebo arm using Cox models adjusted for age, sex, race, smoking, baseline eGFR, BMI, T2DM duration, insulin use, history of CAD, MI, ischemic stroke, PAD, HF, dyslipidemia & hypertension. Interaction testing was applied to assess the effect of dapagliflozin according to baseline biomarker value. Results: NT-proBNP and hsTnT were significantly associated with MACE (Adjusted hazard ratio (aHR) per 1-SD in log-transformed biomarker, NT-proBNP: aHR 1.62; hsTnT aHR 1.59). The magnitude of the relationship was similar in patients with ASCVD (NT-proBNP aHR 1.60; hsTnT aHR 1.62) and MRF (NT-proBNP aHR 1.62; hsTnT: aHR 1.51) [Fig A] . Moreover, both biomarkers remained independently associated with MACE when combined in the multivariable model (NT-proBNP aHR 1.46, hsTnT aHR 1.39). The risk of MACE by baseline biomarker level and stratified by treatment arm is shown in Fig B. Conclusions: In patients with T2DM both with and without ASCVD, higher baseline NT-proBNP or hsTnT levels identified patients at increased risk of MACE. The difference in MACE rates between dapagliflozin and placebo tended to be more pronounced in ASCVD patients with higher baseline or NT-proBNP or hsTnT levels.

Abstract TMP14: Thrombolysis in Ischemic Stroke Patients with Prior History of Intracranial Hemorrhage

Stroke ◽  
2018 ◽  
Vol 49 (Suppl_1) ◽  
Author(s):  
Stacy Y Chu ◽  
Samuel Sommaruga ◽  
David Hwang ◽  
Jennifer Dearborn ◽  
Lauren Sansing ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intracranial Hemorrhage ◽  
Prior History ◽  
Stroke Patients ◽  
History Of

Atherosclerotic Vascular Disease Rather than Metabolic Syndrome Predicts Ischemic Stroke in Diabetic Patients

2010 ◽  
Vol 30 (4) ◽  
pp. 374-379 ◽  
Author(s):  
Xiang Yan Chen ◽  
G. Neil Thomas ◽  
Yang Kun Chen ◽  
Juliana C.N. Chan ◽  
Ka Sing Wong
Keyword(s):  
Metabolic Syndrome ◽  
Ischemic Stroke ◽  
Vascular Disease ◽  
Diabetic Patients ◽  
Atherosclerotic Vascular Disease

Serially increasing change in lipoprotein(a) concentration has predictive value in acute vascular events

2005 ◽  
Vol 42 (4) ◽  
pp. 285-291 ◽  
Author(s):  
Soon Jun Hong ◽  
Hong Seog Seo ◽  
Chang Gyu Park ◽  
Seung Woon Rha ◽  
Dong Joo Oh ◽  
...  
Keyword(s):  
Risk Factor ◽  
Relative Risk ◽  
Vascular Disease ◽  
Predictive Value ◽  
Arterial Disease ◽  
Atherosclerotic Vascular Disease ◽  
Vascular Events ◽  
Lipoprotein A ◽  
Peripheral Arterial

Background: Lipoprotein(a) (Lp(a)) has been regarded in some studies as an independent risk factor of atherosclerotic vascular disease. However, the use of a baseline plasma Lp(a) concentration as a screening tool for future acute vascular events (AVE) is controversial. We therefore investigated whether progressively increasing change in plasma Lp(a) concentration is associated with the development of AVE. Methods: We investigated prospective analyses of 985 participants (464 women and 521 men) who had either clinically evident vascular disease (VD group, n=443) or its risk factor(s) (RF group, n=542). Blood samples were taken from all participants every six months to measure inflammatory markers such as Lp(a) and C-reactive protein during a 10-year follow-up period. Results: During the follow-up, 223 new cases of myocardial infarction, stroke, and peripheral arterial disease were identified. In the RF group, the relative risk of positive ∆ Lp(a) for predicting AVE was 4.36 (95% confidence interval [CI] 1.76-10.85; P=0.002). In the VD group, the relative risk of positive ∆ Lp(a) for predicting AVE was 6.35 (95% CI 3.68-10.97; P<0.001). Conclusions: These results suggest that a progressively increasing change in Lp(a) concentration has a highly significant predictive value in AVE in both the VD and the RF groups.

scholarly journals Demographic and Clinical Predictors of Trait Impulsivity in Parkinson’s Disease Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Maddeson Riley ◽  
Megan Bakeberg ◽  
Michelle Byrnes ◽  
Alexa Jefferson ◽  
Soumya Ghosh ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Secondary Education ◽  
Postsecondary Education ◽  
Disease Severity ◽  
Linear Models ◽  
Male Gender ◽  
Clinical Predictors ◽  
Trait Impulsivity ◽  
History Of

Background. Impulsive behaviour has become increasingly recognised as a neuropsychiatric complication of Parkinson’s disease (PD). Thought to be a product of compromised cognitive control, the spectrum of impulsive behaviours in PD ranges from cognitive disinhibition to impulse control disorders (ICDs). Objective. At present, there are no indicators for trait impulsivity in PD. The objective of the current study was to identify demographic and clinical predictors of susceptibility to trait impulsivity in a cohort of PD patients. Methods. The current study assessed impulsivity using the Barratt Impulsiveness Scale 11 (BIS-11) in a cohort of 87 PD patients. General linear models (GLMs) were used to identify clinical and demographic variables predictive of heightened BIS-11 second-order attentional and nonplanning subscale scores. Results. Male gender, no history of smoking, postsecondary education, and heightened disease severity were predictive of increased BIS-11 attentional scores (p<0.05). Similarly, male gender, after secondary education, and disease severity were predictive of increased BIS-11 nonplanning scores (p<0.05). Contrary to previous reports, dopaminergic medication use was not a significant determinant of either BIS-11 subscale scores. Conclusions. Several demographic and clinical variables including male gender, no history of past smoking, after secondary education, and elevated disease severity are associated with impulsivity in PD.

scholarly journals NCMP-19. STROKE IN CANCER PATIENTS

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi183-vi183
Author(s):  
Marilou Ching ◽  
Edina Komlodi-Pasztor
Keyword(s):  
Ischemic Stroke ◽  
Cancer Patients ◽  
Intracranial Hemorrhage ◽  
Arterial Embolism ◽  
Comfort Care ◽  
Additional Information ◽  
Embolism And Thrombosis ◽  
Increased Risk ◽  
History Of ◽  
Evidence Based Guideline

Abstract Patients with malignancy have an increased tendency for venous and arterial embolism, and for increased risk for bleeding. Clinical decisions regarding anticoagulation in this population has been challenging and complicated by the availability of various anticoagulants. Currently, there is no evidence-based guideline available for the prevention of arterial embolism and thrombosis, such as stroke, in cancer patients. The aim of the study is to assess the use of anticoagulant medications in cancer patients who suffer a stroke. ICD-9/-10 codes were used to identify patients with cancer who were admitted between September 1, 2017 and November 30, 2017 to the Buffalo General Hospital with the diagnosis of stroke. Chart review was used to verify the history of cancer and stroke and to collect additional information. The diagnosis of acute stroke and cancer were verified in 87 patients. Among them, 31 patients had active malignancy. Of the 31 patients, 9 were diagnosed with intracranial hemorrhage and 22 with ischemic strokes. Of the 9 patients with intracranial hemorrhage,3 were anticoagulated and 1 patient was off anticoagulation. Of the 22 patients with ischemic stroke, 4 patients were anticoagulated, although 1 patient was underdosed based on INR. Seven of the 22 patients were taken off of anticoagulation; 3 had side effects and 4 were awaiting a surgical procedure. Five of the 9 patients with intracranial hemorrhage and 10 of the 22 patients with ischemic stroke were made comfort care and passed away shortly after the diagnosis of stroke.

scholarly journals Contrast-Induced Encephalopathy After Endovascular Thrombectomy for Acute Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (12) ◽  
pp. 3756-3759
Author(s):  
Yung-Tsai Chu ◽  
Kang-Po Lee ◽  
Chih-Hao Chen ◽  
Pi-Shan Sung ◽  
Yen-Heng Lin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Renal Dysfunction ◽  
Odds Ratio ◽  
Kidney Injury ◽  
Infarct Core ◽  
Endovascular Thrombectomy ◽  
Clinical Criteria ◽  
History Of

Background and Purpose: Contrast-induced encephalopathy (CIE) is a rare and underrecognized complication after endovascular thrombectomy (EVT) for acute ischemic stroke. This study investigated the incidence and risk factors of CIE in patients who underwent EVT. Methods: Consecutive patients with acute ischemic stroke who received EVT between September 2014 and December 2019 at 2 medical centers were included. CIE was diagnosed on clinical criteria of neurological deterioration or delayed improvement within 24 hours after the procedure that was unexplained by the infarct or hemorrhagic transformation and radiological criterion of edematous change extending beyond the infarct core accompanied by contrast staining. Results: Of 421 patients with acute ischemic stroke who received EVT, 7 (1.7%) developed CIE. The manifestations included worsening of focal neurological signs, coma, and seizure. Patients with CIE were more likely to experience contrast-induced acute kidney injury than were those without CIE, but the volume of contrast medium was comparable between the two groups. The independent risk factors for CIE included renal dysfunction (defined as an estimated glomerular filtration rate <45 mL/min per 1.73 m 2 ; odds ratio, 5.77 [95% CI, 1.37–24.3]; P =0.02) and history of stroke (odds ratio, 4.96 [95% CI, 1.15–21.3]; P =0.03). Patients with CIE were less likely to achieve favorable functional outcomes (odds ratio, 0.09 [95% CI, 0.01–0.87]; P =0.04). Conclusions: CIE should be suspected in patients with clinical worsening after EVT accompanied by imaging evidence of contrast staining and edematous changes, especially in patients with renal dysfunction or history of stroke.

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