Abstract WP359: Microembolic Signals Are Associated With Stroke Readmission in Patients With Ischemic Stroke

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Nasir Fakhri ◽  
Simin Mahinrad ◽  
Arth Srivastava ◽  
Eric Liotta ◽  
Richard Bernstein ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Recurrent Stroke ◽  
Incidence Rates ◽  
High Risk Population ◽  
Stroke Patients ◽  
Entire Cohort ◽  
Cox Proportional Hazard ◽  
Stroke Population ◽  
Cox Proportional Hazard Models ◽  
Ischemic Attack

Background: Microembolic signals (MES) identified by transcranial Doppler (TCD) are strong predictors of recurrent stroke in patients with carotid disease. In this study, we investigated the association of MES with transient ischemic attack (TIA) or stroke readmission among ischemic stroke patients. Methods: We included a total of 789 patients (mean age 62±17 years, 55% male) who were consecutively admitted to Northwestern Memorial hospital with a diagnosis of stroke. All patients who underwent TCD studies within the first 48 hours of admission were included. Using an electronic database warehouse, patients were followed during 12 months for any hospital readmission due to ischemic stroke or TIA. Risk of stroke readmission was estimated using multivariate Cox proportional hazard models. Results: MES were detected in 95 patients on admission. During 12 months of follow-up, incidence rates for stroke and TIA readmission, and stroke readmission alone were 23.0 and 7.0 per 100 person-years across the entire cohort, respectively. In multivariate adjusted models, patients with MES, as compared to patients without MES, had 1.80-fold (95% CI=1.07, 2.53; p =0.008) higher risk of stroke and TIA readmission, and 2.30-fold (95% CI=1.13, 4.67, p =0.021) higher risk of readmission due to stroke alone. Conclusion: We showed that the presence of MES early after stroke admission is associated with higher risk of stroke and TIA readmission in stroke patients. This not only highlights the importance of identifying MES in the stroke population upon first admission, but also the need to further identify and implement therapeutic strategies to reduce stroke burden and prevent readmission in this high-risk population.

410 Sleep and Stroke: Improved OSA Time to Diagnosis for Stroke Patients Using an Inpatient Diagnostic and Treatment Strategy

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A163-A163
Author(s):  
Sree Naik ◽  
Ramin Zand ◽  
Nada El Andary ◽  
Anne Marie Morse
Keyword(s):  
Ischemic Stroke ◽  
Sleep Apnea ◽  
Recurrent Stroke ◽  
Statistical Significance ◽  
Screening Method ◽  
Stroke Patients ◽  
Stroke Population ◽  
Obstructive Sleep ◽  
Time To Diagnosis ◽  
Home Sleep Apnea Testing

Abstract Introduction Obstructive sleep apnea (OSA) is an independent risk for development of stroke. Despite this known relationship there is insufficient screening of sleep apnea in many recognized stroke centers, including Geisinger. In 2016, 68 patients were admitted to Geisinger Wyoming Valley (GWV) with ischemic stroke. Less than 10% had a Sleep Medicine Referral. When referred, average time to CPAP initiation was 9–12 months. An ongoing quality improvement (QI) study implemented inpatient home sleep apnea testing (HSAT) for stroke patients and subsequent autoPAP, if positive. Interim analysis demonstrates high rates of OSA using this screening method, suggesting a viable mechanism for improved time to OSA diagnosis. Methods All patients at GWV evaluated by neurology due to acute neurologic change were considered for enrollment (9/1/2019-10/10/2020). Only patients 18 years and older hospitalized with diagnosis of ischemic stroke were included. Patients were consented for participation. The evening of enrollment an Alice NightOne HSAT device was applied by a respiratory technician. If OSA was identified, the patient was placed on APAP the following evening. Results A total of 302 patients were screened with 82 patients meeting criteria for enrollment (27%) and 64 consenting for participation and attempting HSAT (21%). 18 of the 82 (22%) eligible patients refused participation. 12 patients (19%) had insufficient HSAT studies to determine OSA diagnosis. Of the patients who successfully completed an adequate HSAT study 85% (44/52) had OSA identified. Conclusion OSA is highly prevalent in patients with ischemic stroke and represents a modifiable risk factor for recurrent stroke. At baseline, rate of and time to diagnosis of OSA was poor with less than 10% of stroke patients receiving a sleep referral and time to initiation of CPAP was approximately 1 year. Standard universal in hospital surveillance for OSA using an HSAT in admitted stroke patients appears to allow for an increased rate of capture, but perhaps also a shorter time to diagnosis. This data may also suggest that prevalence of OSA in this stroke population is similar to slightly higher than previously reported. Further analysis of this program is required to evaluate for statistical significance and impact of APAP use. Support (if any) Geisinger Health Plan

scholarly journals Risk of recurrent stroke for Asian stroke patients treated with non-vitamin K antagonist oral anticoagulant and warfarin

2020 ◽  
Vol 11 ◽  
pp. 204062232097485
Author(s):  
Sheng-Feng Lin ◽  
Yi-Hsuan Lu ◽  
Chyi-Huey Bai
Keyword(s):  
Ischemic Stroke ◽  
Vitamin K ◽  
Hemorrhagic Stroke ◽  
Recurrent Stroke ◽  
Oral Anticoagulants ◽  
Vitamin K Antagonist ◽  
Stroke Recurrence ◽  
Research Database ◽  
Stroke Patients ◽  
Stroke Population

Aim: The aim of this study was to establish whether non-vitamin K antagonist oral anticoagulants (NOACs) are superior to warfarin in preventing stroke recurrence for atrial fibrillation (AF) patients with an ischemic or hemorrhagic stroke at the baseline. Methods: From 1 January 2009 to 31 December 2017, stroke patients with AF treated with oral anticoagulants in the National Health Insurance Research Database in Taiwan were enrolled. The study was retrospective cohort design. Outcome measures were ischemic and hemorrhagic stroke recurrence. The Cox proportional hazard model was used to obtain the hazard ratio (HR). Results: In total, 39,840 stroke patients with AF treated with NOAC and 42,583 treated with warfarin were identified. NOACs were superior to warfarin in preventing all recurrent stroke [adjusted HR: 0.67, 95% confidence interval (CI), 0.63–0.71, p < 0.001]. Results for the ischemic stroke population were the same as that for all types for stroke (adjusted HR: 0.66, 95% CI, 0.62–0.70, p < 0.001). For the hemorrhagic stroke population, NOACs were equivalent to warfarin in preventing ischemic stroke (adjusted HR: 1.11, 95% CI, 0.86–0.43, p < 0.001), but NOACs were superior to warfarin in preventing hemorrhagic stroke (adjusted HR: 0.64, 95% CI, 0.55–0.74, p < 0.001). Conclusions: NOACs were generally superior to warfarin in terms of efficacy and safety in previous stroke patients. The robustness of our findings was verified and should add new information to current recommendations for Asian stroke patients in selecting NOACs.

scholarly journals Ischemic stroke with a preceding Trans ischemic attack(TIA) less than 24 hours and  thrombolytic therapy

2020 ◽  
Author(s):  
Nicolas Poupore ◽  
Dan Strat ◽  
Tristan Mackey ◽  
Ashley Snell ◽  
Thomas Nathaniel
Keyword(s):  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Older Patients ◽  
Receiver Operating Curve ◽  
Stroke Patients ◽  
Stroke Population ◽  
Lemeshow Test ◽  
History Of ◽  
Clinical Risks ◽  
Ischemic Attack

Abstract Background Acute ischemic stroke attack with and without a recent TIA within or less than 24 hours may differ in clinical risk factors, and this may affect treatment outcomes following thrombolytic therapy. We examined whether the odds of exclusion or inclusion for thrombolytic therapy are greater in ischemic stroke with TIA less than 24 hours preceding ischemic stroke(TIA-24hr-ischemic stroke patients) as compared to those without recent TIA or non-TIA <24 hours. Methods A retrospective hospital-based analysis was conducted on 6,315 ischemic stroke patients, of whom 846 had proven brain diffusion-weighted magnetic resonance imaging (DW-MRI) of an antecedent TIA within 24 hours prior to ischemic stroke. The logistic regression model was developed to generate odds ratios (OR) to determine clinical factors that may increase the likelihood of exclusion or inclusion for thrombolytic therapy. The validity of the model was tested using a Hosmer-Lemeshow test, while the Receiver Operating Curve (ROC) was used to test the sensitivity of our model. Results In TIA-24hr-ischemic stroke population, patients with a history of alcohol abuse (OR = 5.525, 95% CI, 1.003-30.434, p = 0.05), migraine (OR=4.277, 95% CI, 1.095-16.703, p=0.037), and increasing NIHSS score (OR=1.156, 95% CI, 1.058-1.263, p = 0.001) were associated with the increasing odds of receiving rtPA, while older patients (OR = 0.965, 95% CI, 0.934‐0.997, P = 0.033) were associated with the increasing odds of not receiving rtPA. Conclusion In TIA-24hr-ischemic stroke patients, older patients with higher INR values are associated with increasing odds of exclusion from thrombolytic therapy. Our findings demonstrate clinical risks factors that can be targeted to improve the use and eligibility for rtPA in in TIA-24hr-ischemic stroke patients.

Hyperresponsiveness of platelets in ischemic stroke

2007 ◽  
Vol 97 (06) ◽  
pp. 974-978 ◽  
Author(s):  
Bernd Tomandl ◽  
Dirk Sander ◽  
Konstantinos Stellos ◽  
Tobias Geisler ◽  
Harald Langer ◽  
...  
Keyword(s):  
Arachidonic Acid ◽  
Ischemic Stroke ◽  
Platelet Activation ◽  
Acute Phase ◽  
Recurrent Stroke ◽  
Cerebrovascular Diseases ◽  
Stroke Patients ◽  
Severity Of The Disease ◽  
Ischemic Attack

SummaryPlatelet activation and aggregation are critical in the pathogenesis of acute ischemic cerebrovascular diseases. The aim of our study was to characterize platelet function in patients with acute ischemic stroke or transient ischemic attack (TIA), and to evaluate the effect of platelet activation on clinical outcome. One hundred thirty-eight consecutive patients with TIA (n=74) or stroke (n=64) were enrolled in this study. Platelet aggregation in response to ADP, epinephrine, arachidonic acid, or collagen, and expression of platelet activation receptors (CD62P, CD63, LIBS-1 and PAC-1) in the acute phase and at three months follow-up were evaluated. Platelets derived from stroke patients were more hyperaggregable in response to agonists in the acute phase compared to TIA patients (p[ADP]=0.002, p[arachidonic acid]=0.047, p[epinephrine]=0.020). Platelet activation was enhanced in the acute phase irrespective of the severity of the disease (stroke or TIA) and returned to baseline levels three months later. Persistent elevated platelet activation at three months follow-up (PAC-1) was associated with increased incidence of recurrent stroke (median, [interquartile range] 3.4, [3.0–5.2] versus 2.9, [2.3–4.0], p=0.048). In conclusion, platelets are hyperactive in acute stroke compared with TIA. A more intensified dual antiplatelet therapy may be of benefit for stroke patients.

scholarly journals Ischemic stroke with a preceding Trans ischemic attack(TIA) less than 24 hours and  thrombolytic therapy

2020 ◽  
Author(s):  
Nicolas Poupore ◽  
Dan Strat ◽  
Tristan Mackey ◽  
Ashley Snell ◽  
Thomas Nathaniel
Keyword(s):  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Older Patients ◽  
Receiver Operating Curve ◽  
Stroke Patients ◽  
Stroke Population ◽  
Lemeshow Test ◽  
History Of ◽  
Clinical Risks ◽  
Ischemic Attack

Abstract Background Acute ischemic stroke attack with and without a recent TIA within or less than 24 hours may differ in clinical risk factors, and this may affect treatment outcomes following thrombolytic therapy. We examined whether the odds of exclusion or inclusion for thrombolytic therapy are greater in ischemic stroke with TIA less than 24 hours preceding ischemic stroke(TIA-24hr-ischemic stroke patients) as compared to those without recent TIA or non-TIA <24 hours. Methods A retrospective hospital-based analysis was conducted on 6,315 ischemic stroke patients, of whom 846 had proven brain diffusion-weighted magnetic resonance imaging (DW-MRI) of an antecedent TIA within 24 hours prior to ischemic stroke. The logistic regression model was developed to generate odds ratios (OR) to determine clinical factors that may increase the likelihood of exclusion or inclusion for thrombolytic therapy. The validity of the model was tested using a Hosmer-Lemeshow test, while the Receiver Operating Curve (ROC) was used to test the sensitivity of our model. Results In TIA-24hr-ischemic stroke population, patients with a history of alcohol abuse (OR = 5.525, 95% CI, 1.003-30.434, p = 0.05), migraine (OR=4.277, 95% CI, 1.095-16.703, p=0.037), and increasing NIHSS score (OR=1.156, 95% CI, 1.058-1.263, p = 0.001) were associated with the increasing odds of receiving rtPA, while older patients (OR = 0.965, 95% CI, 0.934‐0.997, P = 0.033) were associated with the increasing odds of not receiving rtPA. Conclusion In TIA-24hr-ischemic stroke patients, older patients with higher INR values are associated with increasing odds of exclusion from thrombolytic therapy. Our findings demonstrate clinical risks factors that can be targeted to improve the use and eligibility for rtPA in in TIA-24hr-ischemic stroke patients.

2014 Chinese guidelines for secondary prevention of ischemic stroke and transient ischemic attack

2017 ◽  
Vol 12 (3) ◽  
pp. 302-320 ◽  
Author(s):  
Yongjun Wang ◽  
Ming Liu ◽  
Chuanqiang Pu
Keyword(s):  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Transient Ischemic Attack ◽  
Recurrent Stroke ◽  
Stroke Recurrence ◽  
Evidence Based ◽  
Cerebrovascular Disorder ◽  
Level Of Evidence ◽  
Vascular Stenosis ◽  
Ischemic Attack

Ischemic stroke and transient ischemic attack (TIA) are the most common cerebrovascular disorder and leading cause of death in China. The Effective secondary prevention is the vital strategy for reducing stroke recurrence. The aim of this guideline is to provide the most updated evidence-based recommendation to clinical physicians from the prior version. Control of risk factors, intervention for vascular stenosis/occlusion, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke are all recommended, and the prevention of recurrent stroke in a variety of uncommon causes and subtype provided as well. We modified the level of evidence and recommendation according to part of results from domestic RCT in order to facility the clinical practice.

EXPRESS: Risk factors for delayed-onset dementia after stroke or transient ischemic attack - A 5-year longitudinal cohort study

2021 ◽  
pp. 174749302110265
Author(s):  
Moamina Ismail ◽  
Vincent CT Mok ◽  
Adrian Wong ◽  
Lisa Au ◽  
Brian Yiu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Ischemic Stroke ◽  
Recurrent Stroke ◽  
Early Onset Dementia ◽  
Delayed Onset ◽  
Lower Baseline ◽  
History Of ◽  
Ischemic Attack ◽  
Moca Score

Background Stroke not only substantially increases the risk of incident dementia early after stroke, the risk remains elevated years after. Aim We aimed to determine the risk factors of dementia onset more than 3-6 months after stroke or transient ischemic attack (TIA). Methods This is a single center prospective cohort study. We recruited consecutive subjects with stroke/TIA without early-onset dementia. We conducted an annual neuropsychological assessment for 5 years. We investigated the association between baseline demographic, clinical, genetic (APOEε4 allele), and radiological factors, as well as incident recurrent stroke, with delayed-onset dementia using Cox proportional hazards models. Results 1,007 patients were recruited, of which 88 with early-onset dementia and 162 who lost to follow-ups were excluded. 49 (6.5%) out of 757 patients have incident delayed-onset dementia. The presence of ≥ 3 lacunes, history of ischemic heart disease (IHD), history of ischemic stroke and a lower baseline Hong Kong version of the Montreal Cognitive Assessment (MoCA) score, were significantly associated with delayed-onset dementia. APOEε4 allele, medial temporal lobe atrophy, and recurrent stroke were not predictive. Conclusion The presence of ≥ 3 lacunes, history of IHD, history of ischemic stroke and a lower baseline MoCA score, are associated with delayed-onset dementia after stroke/TIA.

Abstract TMP77: Development of a Collaborative Transition Coaching Program for Reduction of Post-stroke Hospitalizations

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Ann M Leonhardt ◽  
Denise M Burgen ◽  
Jennifer Wolfe ◽  
Kelly Luther
Keyword(s):  
Ischemic Stroke ◽  
Home Care ◽  
Hospital Readmission ◽  
Fiscal Year ◽  
Pilot Program ◽  
Stroke Patients ◽  
Stroke Population ◽  
Essential Components ◽  
Care Agency ◽  
Home Care Agency

Issue: All-cause 30 day hospital readmission rate following discharge for ischemic stroke has been instituted by CMS as a quality measure. Successful readmission reduction planning is a hospital imperative. Purpose: We set out to establish a stroke-specific transitions coaching program with the intention of decreasing readmissions in our ischemic stroke population. Methods: Fiscal year 2013 stroke readmissions to our hospital were individually reviewed for factors leading to readmission. After determining 62.5% of avoidable readmissions were attributed to outpatient factors, a regional home care agency was contacted for collaboration. The agency has proven readmission reductions utilizing the Coleman Care Transitions Model. This model incorporates visits prior to discharge, by telephone, and at home by a trained transitions coach to ensure understanding of medications, follow up visits, and recognition of concerning symptoms. Cost estimates for expanding the program to stroke patients were made using the prior year’s volume based on primary payer, county, and discharge destination. A business plan was established and training and informational sessions planned. Results: Of the outpatient factors contributing to readmission the most common were medication issues, seeking emergency care prematurely, and need for education or support. Based on the data and prior successes of the home care agency a pilot program was developed. The estimated cost for patients not covered by their primary insurance is $52,000 annually. The estimated cost for one hospital readmission is $11,200. Preventing 5 readmissions per year would save $56,000. A successful collaborative was formed resulting in the ability to enroll a larger number of ischemic stroke patients in the transitions coaching program. Conclusions: Solving the problem of readmissions after ischemic stroke is complex and requires extensive planning and collaboration. Identifying our issues and establishing a pilot program took nearly a year. Key stakeholders and a committed team are essential components of establishing a collaborative process of this magnitude. The pilot program will be evaluated by comparting readmission rates in the ischemic stroke population pre and post initiation.

Abstract TP251: Onset-to-Door Times and Means of Transportation for Acute Ischemic Stroke Patients Attending a Public Hospital in Bogota DC, Colombia. Is an Ambulance the Fastest Way to Reach the Hospital?

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Javier Vicini-Parra ◽  
Jenny Ospina ◽  
Cristian Correa ◽  
Natalia Gomez ◽  
Stephania Bohorquez ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Public Transportation ◽  
Public Hospital ◽  
Descriptive Analysis ◽  
First Year ◽  
Stroke Patients ◽  
Health Authorities ◽  
Public Health Authorities ◽  
Ischemic Attack

Introduction: A prospective stroke database was implemented as part of a still-growing comprehensive stroke centre (CSC). This CSC is located within a referral public hospital (Hospital Occidente de Kennedy) in Bogota DC, Colombia , that serves 2.3 million people of mainly low economic income. In this abstract, we present the data pertaining patients who were thrombolysed in our institution during the first year of data collection, and specify onset-to-door (OTD) times as they relate to the means of transportation used. Hypothesis: Acute stroke patients who arrive in ambulance have the shortest onset-to-door times. Methods: Printed forms were filled for every patient who arrived with diagnosis of acute ischemic stroke (AIS) or transient ischemic attack (TIA). Data was transcribed to an electronic database (Numbers, Apple Inc.) and analyzed with SPSS Statistics version 23 (IBM Corporation). A retrospective descriptive analysis was performed for central tendency and dispersion measures. Results: Since August 1st 2014 until July 31st 2015, 39 patients (17.7% of AIS patients) were thrombolysed. Mean onset-to-door times are shown in table 1. Prenotification was received for only 1 patient. All patients came from their homes. Conclusions: Almost half of our thrombolysed patients arrived in taxi to our institution. Taxi was the fastest means of transportation, ambulance was the slowest and private cars were in the middle of those. This confirmed our suspicion that the state-owned emergency medical services (SEMD) are suboptimal and that stroke patients prefer to use public transportation rather than SEMD. This should warn public health authorities on he urgent need to improve our SEMD. In the meantime, this finding prompts us to include taxi drivers in our periodic stroke campaigns.

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