Secondary Prevention of Childhood Arterial Ischemic Stroke

2017 ◽  
Vol 32 (5) ◽  
pp. 488-493 ◽  
Author(s):  
Stéphane Darteyre ◽  
Cyrille Renaud ◽  
Joel Fluss ◽  
Silvy Laporte ◽  
Laurent Bertoletti ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Online Survey ◽  
Point Of View ◽  
Preventive Strategy ◽  
Arterial Ischemic Stroke ◽  
Adherence To Guidelines ◽  
Know How ◽  
Dedicated Networks ◽  
Historical Controls

This study aimed to know how frontline physicians in France, Belgium, and Switzerland implement guidelines regarding the secondary prevention of childhood arterial ischemic stroke and to introduce physicians’ point of view on a clinical trial assessing the efficacy of aspirin as a preventive strategy. The authors conducted an online survey directed at specialists throughout dedicated networks and used a mixed method for data analysis. Overall, 63 physicians responded, and 88% prescribe aspirin when sickle cell disease, cardio-embolic stroke, and dissection of cervical arteries are excluded. Prescribing habits vary among respondents with respect to their specialty. A majority would choose placebo or a treatment given to historical controls to compare with an aspirin arm in a trial. In studied countries, there seems to be good adherence to guidelines regarding the secondary prevention of childhood stroke. A trial assessing the efficacy of aspirin could be well accepted if several factors regarding study design were taken into account.

ANTIPLATELET AGENTS IN THE TREATMENT AND SECONDARY PREVENTION OF PEDIATRIC ARTERIAL ISCHEMIC STROKE: THE STATE OF THE PROBLEM

2021 ◽  
Vol 100 (5) ◽  
pp. 151-159
Author(s):  
I.B. Komarova ◽  
Keyword(s):  
Ischemic Stroke ◽  
Clinical Practice ◽  
Secondary Prevention ◽  
Acetylsalicylic Acid ◽  
Antiplatelet Agents ◽  
First Year ◽  
Evidence Based ◽  
Arterial Ischemic Stroke ◽  
Level Of Evidence ◽  
Low Level

Arterial ischemic stroke (AIS) in children is a potentially disabling disease with cumulative rates of relapse in the first year of 12–16%, necessitating secondary prevention of the disease. Both in adults and in pediatric clinical practice, acetylsalicylic acid is most commonly used, much less often – clopidogrel. However, the validity of the use of antiplatelet agents in children with ischemic stroke is still controversial, due to the low level of evidence-based studies and the paucity of publications. The article analyzes and summarizes data on the possibilities and limitations of the use of antiplatelet agents for secondary prevention of AIS in children.

Recurrent arterial ischemic stroke in childhood: the role of prothrombotic disorders and underlying conditions

2004 ◽  
Vol 35 (01) ◽  
Author(s):  
R Sträter ◽  
F Kirkham ◽  
G deVeber ◽  
A Chan ◽  
V Ganesan ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Arterial Ischemic Stroke

Racial differences in persistence to secondary prevention medication regimens after ischemic stroke

2021 ◽  
pp. 1-13
Author(s):  
Orla C. Sheehan ◽  
Mandip S. Dhamoon ◽  
Janet Prvu Bettger ◽  
Jin Huang ◽  
Chelsea Liu ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Secondary Prevention ◽  
Racial Differences

Pediatric Hyperacute Arterial Ischemic Stroke Pathways at Canadian Tertiary Care Hospitals

2021 ◽  
pp. 1-8
Author(s):  
Maria Gladkikh ◽  
Hugh J. McMillan ◽  
Andrea Andrade ◽  
Cyrus Boelman ◽  
Ishvinder Bhathal ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Tertiary Care ◽  
Pediatric Stroke ◽  
Arterial Ischemic Stroke ◽  
Pediatric Hospitals ◽  
First Choice ◽  
Similarities And Differences ◽  
Pre Treatment ◽  
Magnetic Resonance Imaging Mri ◽  
Iv Tpa

ABSTRACT: Background: Childhood acute arterial ischemic stroke (AIS) is diagnosed at a median of 23 hours post-symptom onset, delaying treatment. Pediatric stroke pathways can expedite diagnosis. Our goal was to understand the similarities and differences between Canadian pediatric stroke protocols with the aim of optimizing AIS management. Methods: We contacted neurologists at all 16 Canadian pediatric hospitals regarding AIS management. Established protocols were analyzed for similarities and differences in eight domains. Results: Response rate was 100%. Seven (44%) centers have an established AIS protocol and two (13%) have a protocol under development. Seven centers do not have a protocol; two redirect patients to adult neurology, five rely on a case-by-case approach for management. Analysis of the seven protocols revealed differences in: 1) IV-tPA dosage: age-dependent 0.75–0.9 mg/kg (N = 1) versus age-independent 0.9 mg/kg (N = 6), with maximum doses of 75 mg (N = 1) or 90 mg (N = 6); 2) IV-tPA lower age cut-off: 2 years (N = 5) versus 3 or 10 years (each N = 1); 3) IV-tPA exclusion criteria: PedNIHSS score <4 (N = 3), <5 (N = 1), <6 (N = 3); 4) first choice of pre-treatment neuroimaging: computed tomography (CT) (N = 3), magnetic resonance imaging (MRI) (N = 2) or either (N = 2); 5) intra-arterial tPA use (N = 3) and; 6) mechanical thrombectomy timeframe: <6 hour (N = 3), <24 hour (N = 2), unspecified (N = 2). Conclusions: Although 44% of Canadian pediatric hospitals have established AIS management pathways, several differences remain among centers. Some criteria (dosage, imaging) reflect adult AIS literature. Canadian expert consensus regarding IV-tPA and endovascular treatment should be established to standardize and implement AIS protocols across Canada.

scholarly journals COVID-19 Barometer: Social Opinion – What Do the Portuguese Think in This Time of COVID-19?

2021 ◽  
pp. 1-9
Author(s):  
Ana Rita Pedro ◽  
Ana Gama ◽  
Patrícia Soares ◽  
Marta Moniz ◽  
Pedro A. Laires ◽  
...  
Keyword(s):  
Health Services ◽  
Online Survey ◽  
Well Being ◽  
Point Of View ◽  
Daily Lives ◽  
The People ◽  
Huge Impact ◽  
The Impact ◽  
Continue Monitoring

The COVID-19 pandemic brought new challenges to the global community, reinforcing the role of public health in society. The main measures to combat it had (and still have) a huge impact on the daily lives of citizens. This investigation aimed to identify and monitor the population’s perceptions about how it faced this period and the impact on health, well-being, and daily life. In this study, we describe the main trends observed throughout the COVID-19 pandemic in terms of mental health status, confidence in the capacity of the health services to respond to the pandemic, and the use of health services by participants. The online survey collected responses from 171,947 individuals ≥16 years of age in Portugal, over a period of 15 weeks that started on 21 March 2020. Participants could fill the questionnaire once or weekly, which enabled us to analyse trends and variations in responses. Overall, 81% of the respondents reported having felt agitated, anxious, or sad during the COVID-19 pandemic; 19% did not experience these feelings. During the confinement period, the proportion of participants feeling agitated, anxious, or sad every day/almost every day ranged between 20 and 30%, but since the deconfinement this proportion decreased. Around 30% reported having more difficulty getting to sleep or to sleep all night; 28.4% felt more agitated; 25.5% felt sadder, discouraged, or cried more easily; and 24.7% felt unable to do everything they had to do, women more frequently than men. Overall, 65.8% of the participants reported feeling confident or very confident in the health services’ capacity to respond to the challenges associated with the pandemic, and this confidence increased over time. Concerning the people who needed a consultation, 35.6% had one in person and 20.8% had one remotely, but almost 44% did not have one due to cancellation by the service (27.2%) or their own decision not to go (16.3%). At this unusual time in which we find ourselves and based on our findings, it is essential to continue monitoring how the population is facing the different phases of the pandemic until it officially ends. Analysing the effects of the pandemic from the point of view of citizens allows for anticipating critical trends and can contribute to preventative action.

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