Design and implementation of Pharyngeal electrical Stimulation for early de-cannulation in TRACheotomized (PHAST-TRAC) stroke patients with neurogenic dysphagia: a prospective randomized single-blinded interventional study

2016 ◽  
Vol 12 (4) ◽  
pp. 430-437 ◽  
Author(s):  
Rainer Dziewas ◽  
Satish Mistry ◽  
Shaheen Hamdy ◽  
Jens Minnerup ◽  
Ingeborg Van Der Tweel ◽  
...  
Keyword(s):  
Electrical Stimulation ◽  
Stroke Severity ◽  
Tracheotomy Tube ◽  
Neurogenic Dysphagia ◽  
Stroke Patients ◽  
Time Period ◽  
Maximum Sample Size ◽  
Tube Removal ◽  
Dysphagia Rehabilitation

Rationale Ongoing dysphagia in stroke patients weaned from mechanical ventilation often requires long-term tracheotomy to protect the airway from aspiration. In a recently reported single-centre pilot study, a significantly larger proportion (75%) of tracheotomized dysphagic stroke patients regained sufficient control of airway management allowing tracheotomy tube removal (decannulation) 24–72 h after pharyngeal electrical stimulation (PES) compared to controls who received standard therapy over the same time period (20%). Aim To assess the safety and efficacy of PES in accelerating dysphagia rehabilitation and enabling decannulation of tracheotomized stroke patients. Design International multi-centre prospective randomized controlled single-blind trial in approximately 126 ICU patients (the 90th percentile of the calculated maximum sample size). Study outcomes Primary outcome: proportion of stroke patients considered safe for decannulation 24–72 h after PES compared to control patients who do not receive PES. Key secondary outcomes focus on: dysphagia severity, decannulation rates, decannulation rate after a repeat PES treatment in patients persistently dysphagic after an initial PES treatment, stroke severity, duration of ICU-stay, occurrence of adverse events including pneumonia and need for recannulation over 30 days or until hospital discharge (if earlier). Discussion Dysphagia and related airway complications are reported as one of the main reasons for stroke patients remaining tracheotomized once successfully weaned from ventilation. This study will evaluate if PES can improve airway safety sufficiently enough to allow earlier tracheotomy tube removal.

Effect of Neuromuscular Electrical Stimulation on Swallowing Process in Stroke Patient with Neurogenic Dysphagia

1970 ◽  
Vol 1 (1) ◽  
pp. 44-53
Author(s):  
Ruth Ariyani ◽  
Widjajalaksmi ◽  
Luh K Wahyuni ◽  
Susyana Tamin ◽  
Saptawati Bardosono
Keyword(s):  
Electrical Stimulation ◽  
Voice Quality ◽  
Neuromuscular Electrical Stimulation ◽  
Neurogenic Dysphagia ◽  
Stroke Patients ◽  
Cough Reflex ◽  
Voluntary Cough ◽  
Pharyngeal Phase ◽  
Significant Difference ◽  
Quasi Experimental

Objective: The aim of this study to determine the therapeutic effect of Neuromuscular Electrical Stimulation (NMES) on pharyngeal phase of swallowing for stroke patients with neurogenic dysphagia,and to see the effect of NMES in reducing the incidence of standing secretion, residue, penetration and aspiration.Methods: It is a quasi-­experimental study design. 10 stroke patients with neurogenic dysphagia in Cipto Mangunkusumo hospital, Jakarta, 40-­80 years old with hemodynamically stable, cooperative and will be get NMES therapy for 4 weeks. Pre and Post treatment assessment caompared using a modified MASA test (The Mann Assessment of Swallowing Ability) and FEES examination (Flexible Endoscophic Evaluation of Swallowing). Analysis of change scores using Wilcoxon test.Results:The obtain average age of patients 59.80+9.705 years. Significant difference seen in the pharyngeal phase of swallowing increased score of gag reflex, velum elevation, cough reflex, voluntary cough, voice quality, pharynx response, pharyngeal constrictor contraction and vocal cord adduction (p<0.005).Also seen significant reduction in the incidence of standing secretion, residue and penetration (p<0.005), but not significantly in the incidence of aspiration (p=0083).Conclusions: NMES increased the pharyngeal phase of swallowing, reduced the incidence of standing secretion, residue and penetration of stroke patients with neurogenic dysphagia, but have not able to reduced aspiration.Keywords :Neuromuscular Electrical Stimulation (NEMS), neurogenic dysphagia, MASA test (The Mann Assessment of Swallow ing Ability), FEES examination (Flexible Endoscophic Evaluation of Swallowing), swallowing process.

scholarly journals BCI-Based Rehabilitation on the Stroke in Sequela Stage

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Yangyang Miao ◽  
Shugeng Chen ◽  
Xinru Zhang ◽  
Jing Jin ◽  
Ren Xu ◽  
...  
Keyword(s):  
Motor Function ◽  
The Body ◽  
Control Group ◽  
Stroke Patients ◽  
Time Period ◽  
Average Improvement ◽  
Study Results ◽  
Electroencephalogram Eeg ◽  
Positive Effect

Background. Stroke is the leading cause of serious and long-term disability worldwide. Survivors may recover some motor functions after rehabilitation therapy. However, many stroke patients missed the best time period for recovery and entered into the sequela stage of chronic stroke. Method. Studies have shown that motor imagery- (MI-) based brain-computer interface (BCI) has a positive effect on poststroke rehabilitation. This study used both virtual limbs and functional electrical stimulation (FES) as feedback to provide patients with a closed-loop sensorimotor integration for motor rehabilitation. An MI-based BCI system acquired, analyzed, and classified motor attempts from electroencephalogram (EEG) signals. The FES system would be activated if the BCI detected that the user was imagining wrist dorsiflexion on the instructed side of the body. Sixteen stroke patients in the sequela stage were randomly assigned to a BCI group and a control group. All of them participated in rehabilitation training for four weeks and were assessed by the Fugl-Meyer Assessment (FMA) of motor function. Results. The average improvement score of the BCI group was 3.5, which was higher than that of the control group (0.9). The active EEG patterns of the four patients in the BCI group whose FMA scores increased gradually became centralized and shifted to sensorimotor areas and premotor areas throughout the study. Conclusions. Study results showed evidence that patients in the BCI group achieved larger functional improvements than those in the control group and that the BCI-FES system is effective in restoring motor function to upper extremities in stroke patients. This study provides a more autonomous approach than traditional treatments used in stroke rehabilitation.

scholarly journals Predicting Early Mortality of Acute Ischemic Stroke

Stroke ◽  
2019 ◽  
Vol 50 (2) ◽  
pp. 349-356 ◽  
Author(s):  
Thomas Gattringer ◽  
Alexandra Posekany ◽  
Kurt Niederkorn ◽  
Michael Knoflach ◽  
Birgit Poltrum ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Stroke Unit ◽  
Functional Disability ◽  
Area Under The Curve ◽  
Early Mortality ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Derivation Cohort ◽  
Temporal Validation

Background and Purpose— Several risk factors are known to increase mid- and long-term mortality of ischemic stroke patients. Information on predictors of early stroke mortality is scarce but often requested in clinical practice. We therefore aimed to develop a rapidly applicable tool for predicting early mortality at the stroke unit. Methods— We used data from the nationwide Austrian Stroke Unit Registry and multivariate regularized logistic regression analysis to identify demographic and clinical variables associated with early (≤7 days poststroke) mortality of patients admitted with ischemic stroke. These variables were then used to develop the Predicting Early Mortality of Ischemic Stroke score that was validated both by bootstrapping and temporal validation. Results— In total, 77 653 ischemic stroke patients were included in the analysis (median age: 74 years, 47% women). The mortality rate at the stroke unit was 2% and median stay of deceased patients was 3 days. Age, stroke severity measured by the National Institutes of Health Stroke Scale, prestroke functional disability (modified Rankin Scale >0), preexisting heart disease, diabetes mellitus, posterior circulation stroke syndrome, and nonlacunar stroke cause were associated with mortality and served to build the Predicting Early Mortality of Ischemic Stroke score ranging from 0 to 12 points. The area under the curve of the score was 0.879 (95% CI, 0.871–0.886) in the derivation cohort and 0.884 (95% CI, 0.863–0.905) in the validation sample. Patients with a score ≥10 had a 35% (95% CI, 28%–43%) risk to die within the first days at the stroke unit. Conclusions— We developed a simple score to estimate early mortality of ischemic stroke patients treated at a stroke unit. This score could help clinicians in short-term prognostication for management decisions and counseling.

scholarly journals The safety of electrical stimulation in patients with pacemakers and implantable cardioverter defibrillators: A systematic review

2017 ◽  
Vol 4 ◽  
pp. 205566831774549 ◽  
Author(s):  
James Badger ◽  
Paul Taylor ◽  
Ian Swain
Keyword(s):  
Systematic Review ◽  
Electrical Stimulation ◽  
Electromagnetic Interference ◽  
Accurate Estimate ◽  
Implantable Cardioverter Defibrillators ◽  
Time Period ◽  
Number Of Patients ◽  
Safety Studies ◽  
Cardioverter Defibrillators

Introduction A number of patients are excluded from electrical stimulation treatment because there is concern that electrical stimulation could cause electromagnetic interference with pacemakers and implanted cardioverter defibrillators. The decision to use electrical stimulation in these patients needs to be supported by an assessment of benefit and harm. Methods We conducted a systematic review of the risk of electromagnetic interference between electrical stimulation and pacemakers or implanted cardioverter defibrillators. We included the electronic databases MEDLINE and EMBASE in the time period between 1966 and 26 August 2016. Results 18 papers fulfilled the inclusion criteria (eight safety studies and ten case studies). Although we were unable to accurately estimate the risk of electromagnetic interference, the studies revealed that patients having electrical stimulation of the lower limb are less susceptible to electromagnetic interference. Conclusions The results suggest that electrical stimulation could be used safely to help drop foot in patients with pacemakers or implanted cardioverter defibrillators. However, in order to obtain an accurate estimate of the risk of electromagnetic interference, a large, long-term, and intervention-specific safety study is required. Until such a study is undertaken, electrical stimulation should be used with caution in patients with pacemakers and implanted cardioverter defibrillators.

scholarly journals A cutlery set for stroke

2021 ◽  
Author(s):  
◽  
Lin Chen
Keyword(s):  
Assistive Technology ◽  
Upper Limb ◽  
Stroke Patient ◽  
The United States ◽  
Stroke Severity ◽  
Muscle Control ◽  
Stroke Patients ◽  
Muscle Contracture ◽  
And Function

<p>Stroke is a common problem that affects approximately 700,000 patients annually in the United States alone and can cause long-term disabilities (Mallory, 2006, p.33). The long-term effects of a stroke can impact on the patient’s ability to use one side of their body. Upper limb, lower limb, postural and communication difficulties are common factors that patients experience after a stroke (Perry, 2004), which can affect the patient’s ability to eat (McLaren, 1997).  After a stroke, the impairment of an upper limb can lead to problems that make it difficult for people to use cutlery, and include poor grip, decreased muscle control, tremors and upper limb weakness (Brackenrige, 2016). Currently, there are some assistive technology (AT) cutlery sets aimed to help patients who have difficulty in eating and muscle control. Several reasons why stroke patients abandon AT cutlery are cost, appearance, and function (Vaes, 2014). However, an experiment (Torrens, 2013) in to adaptive cutlery products and previous research suggest that there is a large space to improve this, such as appearance and function.  AT cutlery sets have been criticized because of their appearance and inferior functions (Torrens, 2013). This then leads to a disconnection between the user and the AT cutlery products, in which the user experiences visible stigma and links the cutlery to an undesirable characteristic (Vaes, 2012). There are some limitations of the current AT cutlery sets that have been identified in the evaluation (Torren & Smith, 2013), such as poor friction material, stereotypical shapes, and skin-tone handle colour. The limitations create an opportunity for the designers to improve the AT cutlery set to be a selected object and a pleasurable product to use in everyday life.  The purpose of this research is to explore how human-centred design can reduce the stigma of using AT cutlery for stroke patients through addressing the appearance and interactions of spoons, forks and knives. The research involves the following steps: observing videos of stroke patients eating, interviewing clinicians, interviewing stroke patients, and iterative design with the supervision of clinicians.  Some of the main issues identified surrounding stroke patient eating and using cutlery include grip weakness, muscle contracture, and difficulty of flexion. Based on the product intervention model for stigma (PIMS) (Vaes, 2014), this study utilized existing research surrounding the evaluation of assistive technology. To help understand each stage of the user needs, previous feedback from health-care clinicians and patients will ensure the validity of ergonomic interventions and stigma strategy as a substitute for traditional cutlery design.  The output of this research includes a set of cutlery as well as assistive components. The design addresses a patient’s difficulty in using cutlery through an adaptive ring to help the patients’ grip. The utensils allow the user to either carry out eating activities at home or in a restaurant.  The feedback from occupational therapists and physiotherapists indicates that the cutlery should accommodate different levels of stroke severity. Based on the findings of literature reviews and feedback, I have focused my design on addressing the stroke patients’ grip weakness, muscle contracture, and difficulty of hand flexion, whilst minimizing stigma, based on the PIMS strategies (Vaes, 2014). The design principle suggests that current cutlery designs with an integrated shape cannot meet all requirements of a stroke patient. Therefore, a combination of additional wearing components needs to be used to help dietary intake.</p>

scholarly journals A cutlery set for stroke

2021 ◽  
Author(s):  
◽  
Lin Chen
Keyword(s):  
Assistive Technology ◽  
Upper Limb ◽  
Stroke Patient ◽  
The United States ◽  
Stroke Severity ◽  
Muscle Control ◽  
Stroke Patients ◽  
Muscle Contracture ◽  
And Function

<p>Stroke is a common problem that affects approximately 700,000 patients annually in the United States alone and can cause long-term disabilities (Mallory, 2006, p.33). The long-term effects of a stroke can impact on the patient’s ability to use one side of their body. Upper limb, lower limb, postural and communication difficulties are common factors that patients experience after a stroke (Perry, 2004), which can affect the patient’s ability to eat (McLaren, 1997).  After a stroke, the impairment of an upper limb can lead to problems that make it difficult for people to use cutlery, and include poor grip, decreased muscle control, tremors and upper limb weakness (Brackenrige, 2016). Currently, there are some assistive technology (AT) cutlery sets aimed to help patients who have difficulty in eating and muscle control. Several reasons why stroke patients abandon AT cutlery are cost, appearance, and function (Vaes, 2014). However, an experiment (Torrens, 2013) in to adaptive cutlery products and previous research suggest that there is a large space to improve this, such as appearance and function.  AT cutlery sets have been criticized because of their appearance and inferior functions (Torrens, 2013). This then leads to a disconnection between the user and the AT cutlery products, in which the user experiences visible stigma and links the cutlery to an undesirable characteristic (Vaes, 2012). There are some limitations of the current AT cutlery sets that have been identified in the evaluation (Torren & Smith, 2013), such as poor friction material, stereotypical shapes, and skin-tone handle colour. The limitations create an opportunity for the designers to improve the AT cutlery set to be a selected object and a pleasurable product to use in everyday life.  The purpose of this research is to explore how human-centred design can reduce the stigma of using AT cutlery for stroke patients through addressing the appearance and interactions of spoons, forks and knives. The research involves the following steps: observing videos of stroke patients eating, interviewing clinicians, interviewing stroke patients, and iterative design with the supervision of clinicians.  Some of the main issues identified surrounding stroke patient eating and using cutlery include grip weakness, muscle contracture, and difficulty of flexion. Based on the product intervention model for stigma (PIMS) (Vaes, 2014), this study utilized existing research surrounding the evaluation of assistive technology. To help understand each stage of the user needs, previous feedback from health-care clinicians and patients will ensure the validity of ergonomic interventions and stigma strategy as a substitute for traditional cutlery design.  The output of this research includes a set of cutlery as well as assistive components. The design addresses a patient’s difficulty in using cutlery through an adaptive ring to help the patients’ grip. The utensils allow the user to either carry out eating activities at home or in a restaurant.  The feedback from occupational therapists and physiotherapists indicates that the cutlery should accommodate different levels of stroke severity. Based on the findings of literature reviews and feedback, I have focused my design on addressing the stroke patients’ grip weakness, muscle contracture, and difficulty of hand flexion, whilst minimizing stigma, based on the PIMS strategies (Vaes, 2014). The design principle suggests that current cutlery designs with an integrated shape cannot meet all requirements of a stroke patient. Therefore, a combination of additional wearing components needs to be used to help dietary intake.</p>

scholarly journals Hyponatremia And Disability, Prevalence And Prognosis In Babol Stroke Patients.

2017 ◽  
pp. 11
Author(s):  
Alijan Ahmadi Ahangar ◽  
Bahareh Bazuiar ◽  
Payam Saadat ◽  
Tahereh Haghshenas ◽  
Hamed Hosseinzadeh ◽  
...  
Keyword(s):  
Latex Particle ◽  
Venous Blood ◽  
Serum Zinc ◽  
Zinc Level ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Normal Range ◽  
Cross Sectional ◽  
Disability Prevalence

Background: Stroke is the leading cause of serious long-term disability. In recent studies hyponatremia as a risk factor for stroke.Methods: This cross-sectional descriptive study was to evaluate serum zinc level in serum sodium over the first 24 hours after the onset of stroke. Different intensities were determined on Stroke Scale NIH (National Institute of Health) (mild 4-1) and (average moderate 15-5) and (moderate to severe 20-16) and (extreme severe 42- 21). Determination intensity of stroke after admission and discharge with Modified Rankin Scale and Barthel index. Blood serum concentrations of sodium 0.5 mL of venous blood were taken and sodium serum level was performed with Latex particle agglutination test in Ayatollah Rouhani Hospital. That normal range was defined 136-146 meq / LFindings: 125 patients were entered into this study; the prevalence of hyponatremia in female was 70% vs 60% in male. Of stroke patients included in this study 66% of them had hyponatremia and the frequency of hyponatremia in ischemic and hemorrhagic was 82% and 63%, respectively. Increase in hyponatremia with disability period of admission had statistically significant (10(12) mild vs 40(32) moderate, 32(25.6) severe, p=0.01) also with disability before discharge (24(19.2) mild, 26(20.8) moderate, 32(25.6) severe, p=0.03).Conclusions: Hyponatremia can effect on severity of the stroke and can be considered as a predictor of increased stroke severity and disability at admission and discharge.     

scholarly journals A Long-Term Follow-Up Programme for Maintenance of Motor Function after Stroke: Protocol of the life after Stroke—The LAST Study

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Torunn Askim ◽  
Birgitta Langhammer ◽  
Hege Ihle-Hansen ◽  
Jon Magnussen ◽  
Torgeir Engstad ◽  
...  
Keyword(s):  
Motor Function ◽  
Controlled Trial ◽  
Intervention Group ◽  
Control Group ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Long Term Follow Up ◽  
Randomised Controlled

Background. There are no evidence-based strategies that have been shown to be superior in maintaining motor function for months to years after the stroke. The LAST study therefore intends to assess the effect of a long-term follow-up program for stroke patients compared to standard care on function, disability and health.Design. This is a prospective, multi-site randomised controlled trial, with blinded assessment 18 months after inclusion. A total of 390 patients will be recruited and randomised to a control group, receiving usual care, or to an intervention group 10 to 16 weeks after onset of stroke. Patients will be stratified according to stroke severity, age above 80, and recruitment site. The intervention group will receive monthly coaching on physical activity by a physiotherapist for 18 consecutive months after inclusion.Outcomes. The primary outcome is motor function (Motor Assessment Scale) 18 months after inclusion. Secondary outcomes are: dependency, balance, endurance, health-related quality of life, fatigue, anxiety and depression, cognitive function, burden on caregivers, and health costs. Adverse events and compliance to the intervention will be registered consecutively during follow-up.

scholarly journals WMH and long-term outcomes in ischemic stroke

Neurology ◽  
2019 ◽  
Vol 92 (12) ◽  
pp. e1298-e1308 ◽  
Author(s):  
Marios K. Georgakis ◽  
Marco Duering ◽  
Joanna M. Wardlaw ◽  
Martin Dichgans
Keyword(s):  
Ischemic Stroke ◽  
Functional Impairment ◽  
Recurrent Stroke ◽  
Meta Analysis ◽  
Sensitivity Analyses ◽  
Stroke Recurrence ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Increased Risk

ObjectiveTo investigate the relationship between baseline white matter hyperintensities (WMH) in patients with ischemic stroke and long-term risk of dementia, functional impairment, recurrent stroke, and mortality.MethodsFollowing the Meta-analysis of Observational Studies in Epidemiology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO protocol: CRD42018092857), we systematically searched Medline and Scopus for cohort studies of ischemic stroke patients examining whether MRI- or CT-assessed WMH at baseline are associated with dementia, functional impairment, recurrent stroke, and mortality at 3 months or later poststroke. We extracted data and evaluated study quality with the Newcastle–Ottawa scale. We pooled relative risks (RR) for the presence and severity of WMH using random-effects models.ResultsWe included 104 studies with 71,298 ischemic stroke patients. Moderate/severe WMH at baseline were associated with increased risk of dementia (RR 2.17, 95% confidence interval [CI] 1.72–2.73), cognitive impairment (RR 2.29, 95% CI 1.48–3.54), functional impairment (RR 2.21, 95% CI 1.83–2.67), any recurrent stroke (RR 1.65, 95% CI 1.36–2.01), recurrent ischemic stroke (RR 1.90, 95% CI 1.26–2.88), all-cause mortality (RR 1.72, 95% CI 1.47–2.01), and cardiovascular mortality (RR 2.02, 95% CI 1.44–2.83). The associations followed dose-response patterns for WMH severity and were consistent for both MRI- and CT-defined WMH. The results remained stable in sensitivity analyses adjusting for age, stroke severity, and cardiovascular risk factors, in analyses of studies scoring high in quality, and in analyses adjusted for publication bias.ConclusionsPresence and severity of WMH are associated with substantially increased risk of dementia, functional impairment, stroke recurrence, and mortality after ischemic stroke. WMH may aid clinical prognostication and the planning of future clinical trials.

Abstract W MP106: Clinical Effectiveness of Anticoagulation with Warfarin among Ischemic Stroke Patients with Atrial Fibrillation: Findings from the Patient-Centered Research into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) Study

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Ying Xian ◽  
Jingjing Wu ◽  
Emily C O’Brien ◽  
Gregg C Fonarow ◽  
DaiWai M Olson ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Warfarin Therapy ◽  
Stroke Severity ◽  
Stroke Survivors ◽  
Stroke Patients ◽  
Long Term Outcomes ◽  
Warfarin Treatment

Background: Oral anticoagulation is recommended for ischemic stroke patients with atrial fibrillation, based on clinical trials done in selected populations. However, little is known about whether the clinical benefit of warfarin is preserved outside the clinical trial setting, especially in older patients with ischemic stroke. Methods: PROSPER, a PCORI-funded research program designed by stroke survivors and stakeholders, used American Heart Association Get With The Guidelines (GWTG)-Stroke data linked to Medicare claims to evaluate the association between warfarin treatment at discharge and long-term outcomes among ischemic stroke survivors with atrial fibrillation (AF) and no contraindication to or prior anticoagulation therapy. The primary outcome prioritized by patients was home-time (defined as days spent alive and not in inpatient post-acute care facility) within 2-year follow-up after discharge. Results: Of 12,552 ischemic stroke patients with AF admitted from 2009-2011, 11,039 (88%) received warfarin treatment at discharge. Compared with those not receiving any anticoagulation, warfarin-treated patients were slightly younger (mean 80 vs. 83, p<0.001), less likely to have a history of prior stroke or coronary artery disease, but had similar stroke severity as measured by NIHSS (median 5 [IQR 2-12] vs. 6 [2-13], p=0.09). After adjustment for all observed baseline characteristics using propensity score inverse probability weighting method, patients discharged on warfarin therapy had 45 more days of home-time during 2-year follow-up than those not receiving any oral anticoagulant (513 vs. 468 days, p<0.001). Warfarin use was also associated with a lower risk of all-cause mortality, cardiovascular readmission or death, and ischemic stroke (Table). Conclusions: Among ischemic stroke patients with atrial fibrillation, warfarin therapy was associated with improved long-term outcomes.

Sign in / Sign up

Export Citation Format

Share Document