Prevention of cerebrovascular and cardiovascular Events of ischaemic origin with teRutroban in patients with a history oF ischaemic strOke or tRansient ischaeMic attack

Background The relationship between different patterns of atrial fibrillation and early recurrence after an acute ischaemic stroke is unclear. Purpose In a prospective cohort study, we evaluated the rates of early ischaemic recurrence after an acute ischaemic stroke in patients with paroxysmal atrial fibrillation or sustained atrial fibrillation which included persistent and permanent atrial fibrillation. Methods In patients with acute ischaemic stroke, atrial fibrillation was categorised as paroxysmal atrial fibrillation or sustained atrial fibrillation. Ischaemic recurrences were the composite of ischaemic stroke, transient ischaemic attack and symptomatic systemic embolism occurring within 90 days from acute index stroke. Results A total of 2150 patients (1155 females, 53.7%) were enrolled: 930 (43.3%) had paroxysmal atrial fibrillation and 1220 (56.7%) sustained atrial fibrillation. During the 90-day follow-up, 111 ischaemic recurrences were observed in 107 patients: 31 in patients with paroxysmal atrial fibrillation (3.3%) and 76 with sustained atrial fibrillation (6.2%) (hazard ratio (HR) 1.86 (95% CI 1.24–2.81)). Patients with sustained atrial fibrillation were on average older, more likely to have diabetes mellitus, hypertension, history of stroke/ transient ischaemic attack, congestive heart failure, atrial enlargement, high baseline NIHSS-score and implanted pacemaker. After adjustment by Cox proportional hazard model, sustained atrial fibrillation was not associated with early ischaemic recurrences (adjusted HR 1.23 (95% CI 0.74–2.04)). Conclusions After acute ischaemic stroke, patients with sustained atrial fibrillation had a higher rate of early ischaemic recurrence than patients with paroxysmal atrial fibrillation. After adjustment for relevant risk factors, sustained atrial fibrillation was not associated with a significantly higher risk of recurrence, thus suggesting that the risk profile associated with atrial fibrillation, rather than its pattern, is determinant for recurrence.

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Secondary prevention medication persistence and prognosis of acute ischaemic stroke or transient ischaemic attack

Stroke and Vascular Neurology ◽

10.1136/svn-2020-000471 ◽

2021 ◽

pp. svn-2020-000471

Author(s):

Lei Zhang ◽

Junfeng Shi ◽

Yuesong Pan ◽

Zixiao Li ◽

Hongyi Yan ◽

...

Keyword(s):

Secondary Prevention ◽

Ischaemic Stroke ◽

Acute Ischaemic Stroke ◽

Transient Ischaemic Attack ◽

Recurrent Stroke ◽

Medication Persistence ◽

Level Ii ◽

Composite Events ◽

Ischaemic Attack ◽

Level I

IntroductionThe risk of disability and mortality is high among recurrent stroke, which highlights the importance of secondary prevention measures. We aim to evaluate medication persistence for secondary prevention and the prognosis of acute ischaemic stroke or transient ischaemic attack (TIA) in China.MethodsPatients with acute ischaemic stroke or TIA from the China National Stroke Registry II were divided into 3 groups based on the percentage of persistence in secondary prevention medication classes from discharge to 3 months after onset (level I: persistence=0%, level II: 0%<persistence<100%, level III: persistence=100%). The primary outcome was recurrent stroke. The secondary outcomes included composite events (stroke, myocardial infarction or death from cardiovascular cause), all-cause death and disability (modified Rankin Scale score=3–5) from 3 months to 1 year after onset. Recurrent stroke, composite events and all-cause death were performed using Cox regression model, and disability was identified through logistic regression model using the generalised estimating equation method.Results18 344 patients with acute ischaemic stroke or TIA were included, 315 (1.7%) of whom experienced recurrent strokes. Compared with level I, the adjusted HR of recurrent stroke for level II was 0.41 (95% CI 0.31 to 0.54) and level III 0.37 (0.28 to 0.48); composite events for level II 0.41 (0.32 to 0.53) and level III 0.38 (0.30 to 0.49); all-cause death for level II 0.28 (0.23 to 0.35) and level III 0.20 (0.16–0.24). Compared with level I, the adjusted OR of disability for level II was 0.89 (0.77 to 1.03) and level III 0.82 (0.72 to 0.93).ConclusionsPersistence in secondary prevention medications, especially in all classes of medications prescribed by the physician, was associated with lower hazard of recurrent stroke, composite events, all-cause death and lower odds of disability in patients with acute ischaemic stroke or TIA.

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Transient ischaemic attack and ischaemic stroke: constructing episodes of care using hospital claims data

BMC Research Notes ◽

10.1186/1756-0500-6-128 ◽

2013 ◽

Vol 6 (1) ◽

Cited By ~ 7

Author(s):

Janet K Sluggett ◽

Gillian E Caughey ◽

Michael B Ward ◽

Elizabeth E Roughead ◽

Andrew L Gilbert

Keyword(s):

Ischaemic Stroke ◽

Transient Ischaemic Attack ◽

Claims Data ◽

Episodes Of Care ◽

Ischaemic Attack

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Anti-inflammatory therapy for preventing stroke and other vascular events after ischaemic stroke or transient ischaemic attack

Cochrane Database of Systematic Reviews ◽

10.1002/14651858.cd012825 ◽

2017 ◽

Cited By ~ 1

Author(s):

Sarah Coveney ◽

Sean Murphy ◽

Martin O'Donnell ◽

Peter J Kelly

Keyword(s):

Ischaemic Stroke ◽

Transient Ischaemic Attack ◽

Vascular Events ◽

Ischaemic Attack ◽

Anti Inflammatory

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Development of imaging-based risk scores for prediction of intracranial haemorrhage and ischaemic stroke in patients taking antithrombotic therapy after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies

The Lancet Neurology ◽

10.1016/s1474-4422(21)00024-7 ◽

2021 ◽

Vol 20 (4) ◽

pp. 294-303

Author(s):

Jonathan G Best ◽

Gareth Ambler ◽

Duncan Wilson ◽

Keon-Joo Lee ◽

Jae-Sung Lim ◽

...

Keyword(s):

Cohort Studies ◽

Ischaemic Stroke ◽

Transient Ischaemic Attack ◽

Antithrombotic Therapy ◽

Intracranial Haemorrhage ◽

Individual Patient Data ◽

Pooled Analysis ◽

Patient Data ◽

Risk Scores ◽

Ischaemic Attack

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Ischaemic stroke and transient ischaemic attack on anticoagulants: outcomes in the era of direct oral anticoagulants

Internal Medicine Journal ◽

10.1111/imj.14652 ◽

2020 ◽

Vol 50 (1) ◽

pp. 110-113

Author(s):

Michael Valente ◽

Shelton Leung ◽

Philip Wu ◽

Danielle H. Oh ◽

Hyuen Tran ◽

...

Keyword(s):

Ischaemic Stroke ◽

Transient Ischaemic Attack ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Ischaemic Attack

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237 Systematic Review of Fibrinogen and Risk of Recurrent Stroke and Vascular Events after Ischaemic Stroke or Transient Ischaemic Attack (TIA)

Age and Ageing ◽

10.1093/ageing/afz102.56 ◽

2019 ◽

Vol 48 (Supplement_3) ◽

pp. iii1-iii16

Author(s):

John J McCabe ◽

Eimear O'Reilly ◽

Sarah Coveney ◽

Ronan Collins ◽

Simon Cronin ◽

...

Keyword(s):

Risk Factors ◽

Ischaemic Stroke ◽

Transient Ischaemic Attack ◽

Prognostic Value ◽

Recurrent Stroke ◽

Multivariable Analysis ◽

Positive Association ◽

Case Control Studies ◽

Vascular Events ◽

Ischaemic Attack

Abstract Background Inflammation is thought to play an important role in atherosclerotic stroke mechanisms. There is growing interest in the prognostic role of inflammatory biomarkers as risk factors for recurrent vascular events, after ischaemic stroke or transient ischaemic attack (TIA). Elevated fibrinogen levels are independently-associated with the risk of first-ever stroke. However, the prognostic value of fibrinogen, after ischaemic cerebrovascular events is uncertain. Methods We searched EMBASE and Ovid Medline, from 1970-January 2019, for any study that measured Fibrinogen after stroke or TIA, and related it to the risk of recurrent stroke or recurrent vascular events. All records were assessed by 2 independent reviewers. Any disagreements between authors regarding eligibility were resolved by consensus. Results We identified 2,520 publications, of which, 15 articles from 16 individual studies were eligible (11 observational cohorts, 3 cohort studies within randomized control trials, 2 case-control studies). The sample size for recurrent stroke and recurrent vascular events was 9,963 and 7,381 patients, in 11 and 10 studies, respectively. The time from event to phlebotomy was <7 days in 5, 7-90 days in 6, and >90 days in 5 studies, respectively. There was marked heterogeneity in statistical methodologies employed to examine the relationship between fibrinogen and outcomes, which did not allow valid meta-analysis (above/below specified threshold (n=4), differences in means/medians (n=5), risk per unit increase (n=1), per standard deviation (n=3), per quartile (n=1), per decile (n=1) or not specified (n=1)). 4 studies adjusted for all conventional vascular risk factors (age, smoking, diabetes, hypercholesterolaemia/statin use, and hypertension). 2 of 11 studies found a positive association with recurrent stroke. 5 of 10 studies found a positive association with recurrent vascular events. Conclusion The prognostic value of Fibrinogen after stroke or TIA remains unclear. Standardised methods and fully-adjusted multivariable analysis are needed in future prognostic studies.

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