The cost of treating an acute ischaemic stroke event and follow-up at a teaching hospital in Malaysia: a Casemix costing analysis

Objective: To investigate the incidence of clopidogrel resistance in patients with acute ischaemic stroke and to evaluate whether there is an association between clopidogrel resistance and the occurrence of a further cerebrovascular ischaemic event using the vasodilator-stimulated phosphoprotein (VASP) index as a marker of clopidogrel resistance. Methods: It is a prospective cohort study that recruited 120 patients from the acute stroke unit at the Royal Liverpool University Hospital. All patients with confirmed acute ischaemic stroke had clopidogrel 75mg/day at discharge or after 14 days of acute stroke if deemed by the direct clinical team to be the most appropriate treatment. After at least 7 days of clopidogrel 75mg/day, all those patients fulfilling inclusion/exclusion criteria had phosphorylation of vasodilator-stimulated phosphoprotein (VASP) measured. If VASP measured ≥50% after ≥7 days of clopidogrel maintenance, these patients were deemed as ‘clopidogrel resistant’, while those with VASP <50% were deemed as ‘clopidogrel responder’. Statistical analysis was by univariable analysis which considered the association of each variable – diagnosis, age, duration of clopidogrel, VASP, days to VASP, and number of comorbidities – with the outcome. Risk of second stroke after a first at 6, 12 and 24 months was estimated using logistic regression. Results: No variables were significantly associated with risk of stroke at 6 months with clopidogrel resistance having no significant effect on likelihood of a further stroke compared to the no clopiodgrel resistance cohort (p value= 0.39). Results were similar at 12 months follow up. However, at 24 months VASP index was significantly associated with risk of a further stroke; each one unit increase in VASP was associated with a 3% increase in risk of stroke at 24 months (p value = 0.05, CI Interval of 1.00- 1.06). Conclusion: No variables were significantly associated with risk of further stroke at 6 months and 12 months after a first stroke. However, VASP was significantly associated with risk of further stroke at 24 months with increasing VASP leading to a higher risk of further stroke.

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Oral anticoagulation in patients with atrial fibrillation and acute ischaemic stroke: design and baseline data of the prospective multicentre Berlin Atrial Fibrillation Registry

EP Europace ◽

10.1093/europace/euz199 ◽

2019 ◽

Vol 21 (11) ◽

pp. 1621-1632 ◽

Cited By ~ 3

Author(s):

Karl Georg Haeusler ◽

Serdar Tütüncü ◽

Claudia Kunze ◽

Johannes Schurig ◽

Carolin Malsch ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischaemic Stroke ◽

Hospital Discharge ◽

Vitamin K ◽

Acute Ischaemic Stroke ◽

Oral Anticoagulation ◽

Endovascular Thrombectomy ◽

Stroke Units ◽

Ischaemic Attack

Abstract Aims The Berlin Atrial Fibrillation Registry was designed to analyse oral anticoagulation (OAC) prescription in patients with atrial fibrillation (AF) and acute ischaemic stroke. Methods and results This investigator-initiated prospective multicentre registry enrolled patients at all 16 stroke units located in Berlin, Germany. The ongoing telephone follow-up is conducted centrally and will cover 5 years per patient. Within 2014 and 2016, 1080 patients gave written informed consent and 1048 patients were available for analysis. Median age was 77 years [interquartile range (IQR) 72–83], 503 (48%) patients were female, and 254 (24%) had a transient ischaemic attack (TIA). Overall, 470 (62%) out of 757 patients with known AF and a (pre-stroke) CHA2DS2-VASc ≥ 1 were anticoagulated at the time of stroke. At hospital discharge, 847 (81.3%) of 1042 patients were anticoagulated. Thereof 710 (68.1%) received a non-vitamin K-dependent oral anticoagulant (NOAC) and 137 (13.1%) a vitamin K antagonist (VKA). Pre-stroke intake of a NOAC [odds ratio (OR) 15.6 (95% confidence interval, 95% CI 1.97–122)] or VKA [OR 0.04 (95% CI 0.02–0.09)], an index TIA [OR 0.56 (95% CI 0.34–0.94)] rather than stroke, heart failure [OR 0.49 (95% CI 0.26–0.93)], and endovascular thrombectomy at hospital admission [OR 12.9 (95% CI 1.59–104)] were associated with NOAC prescription at discharge. Patients’ age or AF type had no impact on OAC or NOAC use, respectively. Conclusion About 60% of all registry patients with known AF received OAC at the time of stroke or TIA. At hospital discharge, more than 80% of AF patients were anticoagulated and about 80% of those were prescribed a NOAC.

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Effect of thrombolysis with alteplase within 6 h of acute ischaemic stroke on long-term outcomes (the third International Stroke Trial [IST-3]): 18-month follow-up of a randomised controlled trial

The Lancet Neurology ◽

10.1016/s1474-4422(13)70130-3 ◽

2013 ◽

Vol 12 (8) ◽

pp. 768-776 ◽

Cited By ~ 85

Keyword(s):

Randomised Controlled Trial ◽

Ischaemic Stroke ◽

Acute Ischaemic Stroke ◽

Controlled Trial ◽

Long Term Outcomes ◽

The Third ◽

Randomised Controlled ◽

Stroke Trial

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Blood pressure in the initial phase of acute ischaemic stroke: Evolution and its role as an independent prognosis factor at discharge and after 3 months of follow‐up

Blood Pressure ◽

10.1080/08037050802565320 ◽

2008 ◽

Vol 17 (5-6) ◽

pp. 284-290 ◽

Cited By ~ 8

Author(s):

Pedro Armario ◽

Montserrat MartÍn‐Baranera ◽

Luis Miguel Ceresuela ◽

Raquel Hernández Del Rey ◽

Eduardo Iribarnegaray ◽

...

Keyword(s):

Blood Pressure ◽

Ischaemic Stroke ◽

Acute Ischaemic Stroke ◽

Initial Phase ◽

Prognosis Factor ◽

Stroke Evolution

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Secondary prevention by stroke subtype: a nationwide follow-up study in 46 108 patients after acute ischaemic stroke

European Heart Journal ◽

10.1093/eurheartj/eht185 ◽

2013 ◽

Vol 34 (35) ◽

pp. 2760-2767 ◽

Cited By ~ 17

Author(s):

Dohoung Kim ◽

Seung-Hoon Lee ◽

Beom Joon Kim ◽

Keun-Hwa Jung ◽

Kyung-Ho Yu ◽

...

Keyword(s):

Secondary Prevention ◽

Ischaemic Stroke ◽

Acute Ischaemic Stroke ◽

Stroke Subtype ◽

Follow Up Study ◽

Subtype A

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Follow up studies of the haemorheologic profile in acute ischaemic stroke

Clinical Hemorheology and Microcirculation ◽

10.3233/ch-1986-6102 ◽

2016 ◽

Vol 6 (1) ◽

pp. 3-9 ◽

Cited By ~ 1

Author(s):

H. Lechner ◽

E. Ott ◽

N. Ossama ◽

F. Fazekas

Keyword(s):

Ischaemic Stroke ◽

Acute Ischaemic Stroke ◽

Follow Up Studies

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Safety and efficacy of thrombectomy in acute ischaemic stroke (REVASCAT): 1-year follow-up of a randomised open-label trial

The Lancet Neurology ◽

10.1016/s1474-4422(17)30047-9 ◽

2017 ◽

Vol 16 (5) ◽

pp. 369-376 ◽

Cited By ~ 33

Author(s):

Antoni Dávalos ◽

Erik Cobo ◽

Carlos A Molina ◽

Angel Chamorro ◽

M Angeles de Miquel ◽

...

Keyword(s):

Ischaemic Stroke ◽

Acute Ischaemic Stroke ◽

Open Label ◽

Safety And Efficacy ◽

Open Label Trial

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Symmetric dimethylarginine is a marker of detrimental outcome in the acute phase after ischaemic stroke: role of renal function

Clinical Science ◽

10.1042/cs20110013 ◽

2011 ◽

Vol 122 (3) ◽

pp. 105-111 ◽

Cited By ~ 37

Author(s):

Nicole Lüneburg ◽

Rouven-Alexander von Holten ◽

Rudolf F. Töpper ◽

Edzard Schwedhelm ◽

Renke Maas ◽

...

Keyword(s):

Renal Function ◽

Clinical Outcome ◽

Ischaemic Stroke ◽

Acute Ischaemic Stroke ◽

Plasma Levels ◽

Recurrent Stroke ◽

Composite Endpoint ◽

Adverse Clinical Outcome ◽

Symmetric Dimethylarginine ◽

Stroke Event

Methylarginines have been shown to interfere with NO (nitric oxide) formation by inhibiting NOS (NO synthase)–ADMA (asymmetric dimethylarginine) and cellular L-arginine uptake into the cell [ADMA and SDMA (symmetric dimethylarginine)]. In a recent study, elevation of SDMA was related to long-term mortality in patients recruited 30 days after a stroke event. In the present study, we aimed at investigating the association of SDMA and adverse clinical outcome in the early phase (first 30 days) after acute ischaemic stroke. A total of 137 patients were recruited immediately upon admission to the emergency unit with an acute ischaemic stroke. Plasma levels of methylarginines were determined by a validated LC–MS/MS (liquid chromatography–tandem MS) method. Patients were prospectively followed for 30 days. A total of 25 patients (18.2%) experienced the primary composite endpoint [death, recurrent stroke, MI (myocardial infarction) and rehospitalization]. SDMA plasma levels were significantly higher in stroke patients compared with patients without event (0.89±0.80 compared with 0.51±0.24 μmol/l; P<0.001). SDMA levels were significantly correlated with markers of renal function. Kaplan–Meier survival analysis demonstrated that cumulative survival decreased significantly with ascending tertiles of SDMA (P<0.001). Our study provides the first data indicating that SDMA is strongly associated with adverse clinical outcome during the first 30 days after ischaemic stroke. Our results strengthen the prognostic value of renal function in patients with stroke and confirm the hypothesis that SDMA is a promising marker for renal function.

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Acute ischaemic stroke: a systematic review of the cost-effectiveness of emergency endovascular therapy using mechanical thrombectomy

Irish Journal of Medical Science (1971 -) ◽

10.1007/s11845-018-1946-3 ◽

2018 ◽

Vol 188 (3) ◽

pp. 751-759

Author(s):

Conor Teljeur ◽

Patricia Harrington ◽

Ronan W. Glynn ◽

Máirín Ryan

Keyword(s):

Systematic Review ◽

Cost Effectiveness ◽

Ischaemic Stroke ◽

Endovascular Therapy ◽

Acute Ischaemic Stroke ◽

Mechanical Thrombectomy ◽

The Cost

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A literature review of cost-effectiveness of intravenous recombinant tissue plasminogen activator for treating acute ischaemic stroke

Stroke and Vascular Neurology ◽

10.1136/svn-2016-000063 ◽

2017 ◽

Vol 2 (2) ◽

pp. 73-83 ◽

Cited By ~ 6

Author(s):

Heesoo Joo ◽

Guijing Wang ◽

Mary G George

Keyword(s):

Cost Effectiveness ◽

Ischaemic Stroke ◽

Plasminogen Activator ◽

Tissue Plasminogen Activator ◽

Acute Ischaemic Stroke ◽

Cost Effective ◽

Recombinant Tissue Plasminogen Activator ◽

Tissue Plasminogen ◽

The Cost ◽

Effectiveness Studies

BackgroundIntravenous recombinant tissue plasminogen activator (IV rtPA) is recommended treatment for patients with acute ischaemic stroke, but the cost-effectiveness of IV rtPA within different time windows after the onset of acute ischaemic stroke is not well reviewed.AimsTo conduct a literature review of the cost-effectiveness studies about IV rtPA by treatment times.Summary of reviewA literature search was conducted using MEDLINE, EMBASE, CINAHL and Cochrane Library, with the keywords acute ischemic stroke, tissue plasminogen activator, cost, economic benefit, saving and incremental cost-effectiveness analysis. The review is limited to original research articles published during 1995–2016 in English-language peer-reviewed journals. We found 16 studies meeting our criteria for this review. Nine of them were cost-effectiveness studies of IV rtPA treatment within 0–3 hours after stroke onset, 2 studies within 3–4.5 hours, 3 studies within 0–4.5 hours and 2 studies within 0–6 hours. IV rtPA is a cost-saving or a cost-effectiveness strategy from most of the study results. Only one study showed incremental cost-effectiveness ratio of IV rtPA within 1 year was marginally above US$50 000 per quality-adjusted life year threshold. IV rtPA within 0–3 hours after stroke led to cost savings for lifetime or 30 years and IV rtPA within 3–4.5 hours after stroke increased costs but still was cost-effective.ConclusionsThe literature generally showed that IV rtPA was a dominant or a cost-effective strategy compared with traditional treatment for patients with acute ischaemic stroke without IV rtPA. The findings from the literature lacked generalisability because of limited data and various assumptions.

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