Abstract T P139: Prevalence and Predictors of Mood Disorders among a National Sample of Individuals with Stroke or Transient Ischemic Attack

Intro: Depression is an independent stroke risk factor, yet little is known about comorbid mood disorders prevalence in stroke survivors. Data regarding association between mood disorders and transient ischemic attack (TIA) are scarce. Objective: To determine prevalence and predictors of comorbid mood disorders among individuals hospitalized with TIA, ischemic stroke, and hemorrhagic stroke in a national US sample. Methods: Using Nationwide Inpatient Sample (NIS) data (2000-2010), we identified individuals discharged with a primary diagnosis of acute ischemic stroke, hemorrhagic stroke, or TIA. We determined the weighted proportion of stroke hospitalizations with comorbid mood disorders (bipolar affective disorder, depression, anxiety disorders). We used survey weighted Poisson regression to estimate risk ratios. The first multivariable model adjusted for sociodemographic and hospital factors. The second model also adjusted for comorbid conditions. Results: Among 2,057,799 hospital discharges for stroke or TIA (corresponding to 10.1 million individuals in US), 83,705 (4.07%) had mood disorders. Compared to those without mood disorders, individuals with mood disorders were younger and more likely to be female, White, and had higher income and private insurance. Individuals 84 years (RR 3.61, 95% CI 3.50-3.72) after adjustment for sociodemographic and hospital factors. Further adjustment for comorbidities slightly attenuated the association (RR 3.30, 95% CL 3.19-3.40). Women were twice as likely to have mood disorders (RR 1.94, 95% CI 1.91-1.97), after adjusting for sociodemographic and hospital factors. Further adjustment for comorbidities did not affect the association. Compared to Whites, all other races were less likely to have mood disorders. Conclusions: In this national sample of individuals admitted with stroke or TIA, 4% had mood disorders. This is likely an underestimate, given lack of systematic screening for comorbid psychiatric disease. Women, younger individuals, and Whites appear to be a population at risk; however, further studies are needed to determine the true prevalence of mood disorders among individuals with TIA/stroke, to determine impact on stroke recovery and optimal treatment options.

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Clinical Effects of Dual Antiplatelet Therapy or Aspirin Monotherapy after Acute Minor Ischemic Stroke or Transient Ischemic Attack, a Meta-Analysis

Current Pharmaceutical Design ◽

10.2174/1381612827666210728102459 ◽

2021 ◽

Vol 27 ◽

Author(s):

Francesco Condello ◽

Gaetano Liccardo ◽

Giuseppe Ferrante

Keyword(s):

Ischemic Stroke ◽

Major Bleeding ◽

Transient Ischemic Attack ◽

Hemorrhagic Stroke ◽

Dual Antiplatelet Therapy ◽

Meta Analysis ◽

Stroke Recurrence ◽

Controlled Trials ◽

Minor Ischemic Stroke ◽

Ischemic Attack

Background: Evidence about the use of dual antiplatelet therapy (DAPT) with aspirin and P2Y12 inhibitors in patients with acute minor ischemic stroke or transient ischemic attack (TIA) is emerging. The aim of our study was to provide an updated and comprehensive analysis about the risks and benefits of DAPT versus aspirin monotherapy in this setting. Methods: The PubMed, Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov databases, main international conference proceedings were searched for randomized controlled trials comparing DAPT versus aspirin monotherapy in patients with acute ischemic stroke or TIA not eligible for thrombolysis or thrombectomy presenting in the first 24 hours after the acute event. Data were pooled by meta-analysis using a random-effects model. The primary efficacy endpoint was ischemic stroke recurrence, and the primary safety outcome was major bleeding. Secondary endpoints were intracranial hemorrhage, hemorrhagic stroke, and all-cause death. Results: A total of 4 studies enrolling 21,459 patients were included. DAPT with clopidogrel was used in 3 studies, DAPT with ticagrelor in one study. DAPT duration was 21 days in one study, 1 month in one study, and 3 months in the remaining studies. DAPT was associated with a significant reduction in the risk of ischemic stroke recurrence (relative risk [RR], 0.74; 95% confidence interval [CI], 0.67-0.82, P<0.001, number needed to treat 50 [95% CI 40-72], while it was associated with a significantly higher risk of major bleeding (RR, 2.59; 95% CI 1.49-4.53, P=0.001, number needed to harm 330 [95% CI 149-1111]), of intracranial hemorrhage (RR 3.06, 95% CI 1.41-6.66, P=0.005), with a trend towards higher risk of hemorrhagic stroke (RR 1.83, 95% CI 0.83-4.05, P=0.14), and a slight tendency towards higher risk of all-cause death (RR 1.30, 95% CI 0.89-1.89, P=0.16). Conclusions: Among patients with acute minor ischemic stroke or TIA, DAPT, as compared with aspirin monotherapy, might offer better effectiveness in terms of ischemic stroke recurrence at the expense of a higher risk of major bleeding. The trade-off between ischemic benefits and bleeding risks should be assessed in tailoring the therapeutic strategies.

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The decrease in hospitalizations for transient ischemic attack and ischemic stroke, especially in mild cases, during the COVID-19 epidemic in Japan

10.1101/2020.11.17.20233692 ◽

2020 ◽

Author(s):

Hiroyuki Nagano ◽

Daisuke Takada ◽

Jung-ho Shin ◽

Tetsuji Morishita ◽

Susumu Kunisawa ◽

...

Keyword(s):

Ischemic Stroke ◽

Transient Ischemic Attack ◽

Hemorrhagic Stroke ◽

Hospital Admissions ◽

Health Care Systems ◽

Number Of Patients ◽

Stroke Diagnosis ◽

Before And After ◽

Ischemic Attack ◽

The Impact

AbstractBackground and PurposeThe epidemic of the coronavirus disease 2019 (COVID-19) has affected health care systems globally. The aim of our study was to assess the impact of the COVID-19 epidemic on hospital admissions for stroke in Japan.MethodsWe analyzed administrative (Diagnosis Procedure Combination) data for cases of inpatients aged 18 years and older who were diagnosed with stroke (ischemic stroke, transient ischemic attack (TIA), hemorrhagic stroke, or subarachnoid hemorrhage (SAH)) and discharged from hospital during the period July 1, 2018 to June 30, 2020. The number of patients with each stroke diagnosis, various patient characteristics, and treatment approaches were compared before and after the epidemic. Changes in the trend of the monthly number of inpatients with each stroke diagnosis were assessed using interrupted time-series analyses.ResultsA total of 111,922 cases (ischemic stroke: 74,897 cases; TIA: 5,374 cases; hemorrhagic stroke: 24,779 cases; SAH: 6,872 cases) in 253 hospitals were included. The number of cases for all types of stroke decreased (ischemic stroke: -13.9%; TIA: -21.4%; hemorrhagic stroke: -9.9%; SAH: -15.2%) in April and May 2020, compared to the number of cases in 2019. Ischemic stroke and TIA cases, especially mild cases (modified Rankin Scale = 0), decreased, with a statistically significant change in trend between the before- and after-epidemic periods.ConclusionsThese data showed a marked reduction in the number of hospital admissions due to stroke during the COVID-19 epidemic. The change in Ischemic stroke and TIA cases, especially mild cases, was statistically significant.

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Lipid-Lowering Therapy and Hemorrhagic Stroke Risk: Comparative Meta-Analysis of Statins and PCSK9 Inhibitors

Stroke ◽

10.1161/strokeaha.121.034576 ◽

2021 ◽

Author(s):

Borja E. Sanz-Cuesta ◽

Jeffrey L. Saver

Keyword(s):

Clinical Trials ◽

Ischemic Stroke ◽

Relative Risk ◽

Transient Ischemic Attack ◽

Hemorrhagic Stroke ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Lipid Lowering ◽

Medication Dose ◽

Ischemic Attack

Background and Purpose: Statins were shown to increase hemorrhagic stroke (HS) in patients with a first cerebrovascular event in 2006 (SPARCL), likely due to off-target antithrombotic effects, but continued to sometimes be used in patients with elevated HS risk due to absence of alternative medications. Recently, the PCSK9Is (proprotein convertase subtilisin kexin 9 inhibitors) have become available as a potent lipid-lowering class with potentially less hemorrhagic propensity. Methods: We performed a systematic comparative meta-analysis assessing HS rates across all completed statin and PCSK9I randomized clinical trials with treatment >3 months, following PRISMA guidelines. In addition to HS rates across all trials, causal relation was probed by evaluating for dose-response relationships by medication (low versus high medication dose/potency) and by presence and type of preceding brain vascular events at inception (none versus ischemic stroke/transient ischemic attack versus HS). Results: The systematic review identified 36 statin randomized clinical trials (204 918 patients) and 5 PCSK9I randomized clinical trials (76 140 patients). Across all patient types and all medication doses/potencies, statins were associated with increased HS: relative risk 1.15, P =0.04; PCSK9Is were not ( P =0.77). In the medication dose/potency analysis, higher dose/potency statins (7 trials, 62 204 patients) were associated with magnified HS risk: relative risk, 1.53; P =0.002; higher dose/potency PCSK9Is (1 trial, 27 564 patients) were not ( P =0.99). In the type of index brain vascular injury analysis for statins (5 trials, 9772 patients), prior ischemic stroke/transient ischemic attack was associated with a magnified risk of HS: relative risk, 1.43; P =0.04; and index intracerebral hemorrhage was associated with an extremely high effect estimate of risk of recurrent HS: hazard ratio, 4.06. For PCSK9Is, prior ischemic stroke/transient ischemic attack (1 trial, 5337 patients) was not associated with increased HS risk ( P =0.97). Conclusions: Statins increase the risk of HS in a medication dose- and type of index brain vascular injury-dependent manner; PCSK9Is do not increase HS risk. PCSK9Is may be a preferred lipid-lowering medication class in patients with elevated HS risk, including patients with prior HS.

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KARAKTERISTIK DAN OUTCOME PASIEN-PASIEN PENYAKIT NEUROLOGIS

Jurnal Kedokteran Syiah Kuala ◽

10.24815/jks.v17i3.9155 ◽

2017 ◽

Vol 17 (3) ◽

pp. 168-173

Author(s):

Imran Imran

Keyword(s):

Ischemic Stroke ◽

Brain Tumor ◽

Head Injury ◽

Ct Scan ◽

Data Base ◽

Transient Ischemic Attack ◽

Severe Head Injury ◽

Hemorrhagic Stroke ◽

Ischemic Attack ◽

Guillain Barré

Abstrak. Penyakit neurologis merupakan salah satu masalah kesehatan masyarakat yang memerlukan kebijakan khusus dalam upaya penanganannya sehingga diperlukan data yang lengkap mengenai penyebab, perkembangan dan outcome.Penelitian ini bertujuan untuk mengetahui karakteristik, diagnosis klinis, hasil pemeriksaan penunjang (laboratorium, foto Rontgen, CT-scan, MRI), keadaaan klinis (saat masuk dan keluar rumah sakit), dan outcome pasien yang dirawat inap di ruang saraf RS Zainoel AbidinBanda Aceh. Ini merupakan penelitian observasional deskriptif. Sampel penelitian adalah semua pasien yang dirawat inap di ruang saraf.Data karakteristik sampel dan semua varibel data penelitian ditabulasi menggunakan software data base rumah sakit. Pasien yang dirawat selama periode penelitian adalah 406 orang terdiri atas 227(55.9%) pria dan 179(44.1%)wanita. Terdapat 20 jenis penyakit secara berurutan yaitu: stroke iskemik, cedera kepala ringan, cedera kepala sedang, cedera kepala berat, stroke hemoragik, sefalgia, mielopati, vertigo, brain tumor, epilepsi, radikulopati lumbal, Sindroma Guillain Barre, meningitis, hipertensi emergensi, hidrosefalus, ensefalitis, Transient Ischemic Attack, demensia, meningoensefalitis, trauma medulla spinalis.Terdapat 2 macam penyakit yang merupakan penyakit-penyakit yang dominan yang menyebabkan pasien dirawat di ruang saraf secara yaitu 1. Stroke iskemik dan hemoragik, dan 2. Cedera kepala (ringan,sedang,berat). Umumnya didominasi oleh pasien cedera kepala dan stroke.Berdasarkan outcome klinis pasien yang bertahan hidup sebanyak 385 (94.8) dan yang meninggal dunia sebanyak 21 (5.2%) orang terdiri atas 7 (1.7%)pasien stroke iskemik, 6(1.5%) pasien stroke hemoragik,3(0.7%) pasien cedera kepala berat dan masing-masing 1(0.2%) pasien meningitis, sefalgia, hidrosefalus, dan ensefalitis. Kata kunci:data neurobase, penyakit neurologis, outcome, RSZainoel Abidin. Abstract. Neurological disease is one of the public health problems that require special policies in the handling effort so that complete data on causes, developments and outcomes are needed. This study aims to determine the characteristics, clinical diagnosis, results of investigations (laboratory, X-ray, CT-scan, MRI), clinical conditions (admission and exit the hospital), and inpatients outcome of the Zainoel Abidin Hospital Banda Aceh. This is a descriptive observational study. The sample were all inpatients.The sample characteristic data and all variables of the study data were tabulated using hospital data base software. Neurologic inpatients during the study period were 406 consisting of 227 (55.9%) men and 179 (44.1%) women. There are 20 types of neurologic diseases patients, sequentially: ischemic stroke, mild head injury, moderate head injury, severe head injury, hemorrhagic stroke, cephalgia, myelopathy, vertigo, brain tumor, epilepsy, lumbar radiculopathy, Guillain Barre syndrome, meningitis, emergency hypertension, hydrocephalus, encephalitis, Transient Ischemic Attack, dementia, meningoencephalitis, spinal cord injury. There are 2 kinds of diseases which are the dominant diseases sequently is ischemic hemorrhagic stroke, simple, moderate,and severe head injury. Based on the clinical outcome of survival patients were 385 (94.8) and those who died as many as 21 (5.2%)consisted of 7(1.7%) ischemic stroke, 6(1.5%) hemorrhagic stroke, 3(0.7%) severe head injuries and 1(0.2%) meningitis, cephalgia, hydrocephalus, and encephalitis.

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