scholarly journals Association of Antiplatelet Therapy With Lower Risk of Death and Recurrent Cerebrovascular Events After Ischemic Stroke

2009 ◽  
Vol 73 (12) ◽  
pp. 2342-2347 ◽  
Author(s):  
Ding Ding ◽  
Chuan-Zhen Lu ◽  
Jian-Hui Fu ◽  
Zhen Hong ◽  
The China Ischemic Stroke Registry
Keyword(s):  
Ischemic Stroke ◽  
Antiplatelet Therapy ◽  
Lower Risk ◽  
Risk Of Death ◽  
Cerebrovascular Events

scholarly journals Comparative effectiveness of bisoprolol and carvedilol among patients receiving maintenance hemodialysis

2021 ◽  
Author(s):  
Ping-Hsun Wu ◽  
Yi-Ting Lin ◽  
Jia-Sin Liu ◽  
Yi-Chun Tsai ◽  
Mei-Chuan Kuo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ischemic Stroke ◽  
Lower Risk ◽  
Cox Model ◽  
Major Adverse Cardiovascular Events ◽  
Maintenance Hemodialysis ◽  
Risk Of Death ◽  
Relative Safety ◽  
Dialysis Vintage ◽  
All Cause Mortality

Abstract Background Despite widespread use, there is no trial evidence to inform β-blocker’s (BB) relative safety and efficacy among patients undergoing hemodialysis (HD). We herein compare health outcomes associated with carvedilol or bisoprolol use, the most commonly prescribed BBs in these patients. Methods We created a cohort study of 9305 HD patients who initiated bisoprolol and 11 171 HD patients who initiated carvedilol treatment between 2004 and 2011. We compared the risk of all-cause mortality and major adverse cardiovascular events (MACEs) between carvedilol and bisoprolol users during a 2-year follow-up. Results Bisoprolol initiators were younger, had shorter dialysis vintage, were women, had common comorbidities of hypertension and hyperlipidemia and were receiving statins and antiplatelets, but they had less heart failure and digoxin prescriptions than carvedilol initiators. During our observations, 1555 deaths and 5167 MACEs were recorded. In the multivariable-adjusted Cox model, bisoprolol initiation was associated with a lower all-cause mortality {hazard ratio [HR] 0.66 [95% confidence interval (CI) 0.60–0.73]} compared with carvedilol initiation. After accounting for the competing risk of death, bisoprolol use (versus carvedilol) was associated with a lower risk of MACEs [HR 0.85 (95% CI 0.80–0.91)] and attributed to a lower risk of heart failure [HR 0.83 (95% CI 0.77–0.91)] and ischemic stroke [HR 0.84 (95% CI 0.72–0.97)], but not to differences in the risk of acute myocardial infarction [HR 1.03 (95% CI 0.93–1.15)]. Results were confirmed in propensity score matching analyses, stratified analyses and analyses that considered prescribed dosages or censored patients discontinuing or switching BBs. Conclusions Relative to carvedilol, bisoprolol initiation by HD patients was associated with a lower 2-year risk of death and MACEs, mainly attributed to lower heart failure and ischemic stroke risk.

scholarly journals Atrial Fibrillation, Oral Anticoagulants, and Concomitant Active Cancer: Benefits and Risks

TH Open ◽  
2021 ◽  
Vol 05 (02) ◽  
pp. e176-e182
Author(s):  
Adriano Atterman ◽  
Leif Friberg ◽  
Kjell Asplund ◽  
Johan Engdahl
Keyword(s):  
Atrial Fibrillation ◽  
Cancer Patients ◽  
Lower Risk ◽  
Cox Regression ◽  
Oral Anticoagulants ◽  
Bleeding Events ◽  
Risk Of Death ◽  
Cerebrovascular Events ◽  
Increased Risk ◽  
Active Cancer

Abstract Aim To determine to what extent active cancer influences the benefit–risk relationship among patients with atrial fibrillation receiving oral anticoagulants for stroke prevention. Methods In this cohort study of all patients with atrial fibrillation in the Swedish Patient register during 2006 to 2017, 8,228 patients with active cancer and 323,394 without cancer were followed up to 1 year after initiation of oral anticoagulants. Cox regression models, adjusting for confounders and the competing risk of death, were used to assess risk of cerebrovascular and bleeding events. Results Among patients treated with oral anticoagulants, the risk for cerebrovascular events did not differ between cancer patients and noncancer patients (subhazard ratio [sHR]: 1.12, 95% confidence interval [CI]: 0.98–1.29). Cancer patients had a higher risk for bleedings (sHR: 1.69, CI: 1.56–1.82), but not for fatal bleedings (sHR: 1.17, CI: 0.80–1.70). Use of nonvitamin K oral anticoagulants was associated with lower risk of both cerebrovascular events and bleedings compared with warfarin. Conclusion Patients with atrial fibrillation and active cancer appear to have similar net cerebrovascular benefit of oral anticoagulant treatment to patients without cancer, despite an increased risk of nonfatal bleedings. Use of nonvitamin K oral anticoagulants was associated with lower risk of all studied outcomes.

Abstract WP198: Sex Differences in Outcomes After Stroke in Patients With Diabetes in Ontario, Canada

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Mandip S Dhamoon ◽  
John W Liang ◽  
Limei Zhou ◽  
Melissa Stamplecoski ◽  
Moira Kapral ◽  
...  
Keyword(s):  
Risk Factors ◽  
Sex Differences ◽  
Ischemic Stroke ◽  
Lower Risk ◽  
Disease Risk ◽  
Population Coverage ◽  
Risk Of Death ◽  
Increased Risk ◽  
Patients With Diabetes ◽  
Full Population

Background: Diabetes is a cardiovascular disease risk factor that exerts a higher risk for coronary heart disease and stroke among females compared to males. Outcomes after first stroke in those with diabetes are not well characterized, especially by sex and age, and studies have been limited by short follow-up and biased samples. We sought to calculate the sex- and age-specific risk of cardiovascular outcomes after ischemic stroke among those with diabetes using a study with full population coverage. Methods: Using population-based demographic and administrative health care databases in Ontario, Canada, we selected all patients with diabetes hospitalized with first ischemic stroke between 4/1/2002 and 3/31/2012. Participants were followed for death, stroke, and myocardial infarction (MI). Kaplan-Meier survival analysis and Fine-Gray competing risk models were used to estimate hazards and adjusted hazards of outcomes by sex and age strata. Models were adjusted for demographics and vascular risk factors. Sensitivity analysis including adjustment for medication use was performed in those aged >=65 years. Results: There were 25495 ischemic stroke patients with diabetes. The incidence of death was higher in women than in men (14.08 per 100 person-years [95% CI 13.73-14.44] vs. 11.89 [11.60-12.19]), but was lower after adjustment for age and other risk factors (adjusted hazard ratio [HR] 0.95 [0.92-0.99]). The incidence of recurrent stroke was similar in women and men, but men were more likely to be readmitted for MI (1.99 per 100 person-years [1.89-2.10] vs 1.58 [1.49-1.68] among females). In multivariable models, females had a lower risk of readmission for any event (HR 0.96 [95% CI 0.93-0.99]). Conclusions: In this retrospective study with full population coverage among diabetics with index stroke in Ontario, there was a higher unadjusted rate of death among females compared to males, and higher unadjusted incidence of MI among males. In adjusted models, females had a lower risk of death compared to males, although the increased risk of MI among males persisted. These findings confirm and quantify sex differences in outcomes after stroke in patients with diabetes.

Sex Differences in the Risk of 30-Day Death After Acute Ischemic Stroke

2021 ◽  
pp. 10.1212/CPJ.0000000000001087
Author(s):  
Fumi Irie ◽  
Ryu Matsuo ◽  
Kuniyuki Nakamura ◽  
Yoshinobu Wakisaka ◽  
Tetsuro Ago ◽  
...  
Keyword(s):  
Sex Differences ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Lower Risk ◽  
Stroke Patients ◽  
Risk Models ◽  
Risk Of Death ◽  
Acute Infections ◽  
Competing Risk Models ◽  
Early Stroke

AbstractObjective:To examine sex differences in early stroke deaths according to cause of death.Methods:We investigated 30-day deaths in acute ischemic stroke patients enrolled in a multicenter stroke registry between 2007 and 2019 in Fukuoka, Japan. We estimated the multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of cause-specific deaths for women vs. men using Cox proportional hazards models and competing risk models. The risk of acute infections during hospitalization and the associated case fatality rates were also compared between the sexes.Results:Among 17,956 acute ischemic stroke patients (women: 41.3%), the crude 30-day death rate after stroke was higher in women than men. However, adjusting for age and stroke severity resulted in a lower risk of death among women (HR [95% CI]: 0.76 [0.62–0.92]). Analyses using competing risk models revealed that women were less likely to die from acute infections (subdistribution HR [95% CI]: 0.33 [0.20–0.54]). Further analyses showed that women were associated with a lower risk of acute infections during hospitalization (odds ratio [95% CI]: 0.62 [0.52–0.74]), and a lower risk of death due to these infections (subdistribution HR [95% CI]: 052 [0.33–0.83]).Conclusions:When adjusting for confounders, the female sex was associated with a lower risk of 30-day death after stroke, which could be explained by a female survival advantage in poststroke infections. Sex-specific strategies are needed to reduce early stroke deaths.Classification of Evidence:This is a Class I prognostic study because it is a prospective population based cohort with objective outcomes. Female gender appears to be protective for 30 mortality and post stroke infections.

Assessment of quality of life in patients with the effects of transient ischemic stroke

2016 ◽  
pp. 37-39
Author(s):  
A. Babirad
Keyword(s):  
Quality Of Life ◽  
Ischemic Stroke ◽  
Large Scale ◽  
Cerebrovascular Diseases ◽  
Control Measures ◽  
Sociological Research ◽  
Cerebrovascular Events ◽  
Sf 36 ◽  
Angioplasty And Stenting

Cerebrovascular diseases are a problem of the world today, and according to the forecast, the problem of the near future arises. The main risk factors for the development of ischemic disorders of the cerebral circulation include oblique and aging, arterial hypertension, smoking, diabetes mellitus and heart disease. An effective strategy for the prevention of cerebrovascular events is based on the implementation of large-scale risk control measures, including the use of antiagregant and anticoagulant therapy, invasive interventions such as atheromectomy, angioplasty and stenting. In this connection, the efforts of neurologists, cardiologists, angiosurgery, endocrinologists and other specialists are the basis for achieving an acceptable clinical outcome. A review of the SF-36 method for assessing the quality of life in patients with the effects of transient ischemic stroke is presented. The assessment of quality of life is recognized in world medical practice and research, an indicator that is also used to assess the quality of the health system and in general sociological research.

Effect of age on outcome in patients with cerebral stroke

2020 ◽  
pp. 41-45
Author(s):  
G. R. Kuchava ◽  
E. V. Eliseev ◽  
B. V. Silaev ◽  
D. A. Doroshenko ◽  
Yu. N. Fedulaev
Keyword(s):  
Ischemic Stroke ◽  
Neurological Deficit ◽  
Neurological Status ◽  
Statistical Correlation ◽  
Multiple Organ ◽  
The Body ◽  
Social Adaptation ◽  
Cerebral Stroke ◽  
Septic Complications ◽  
Risk Of Death

The aim of the study was to assess the course and outcome of cerebral infarction, depending on the age factor and duration of stay in the neuroblock. Materials and methods: a dynamic observation of 494 patients, men and women, aged 38–84 years with acute ischemic stroke of hemispheric localization, which were divided into the three groups depending on age, was performed. Group 1 – younger than 60 years old, group 2–60–70 years old, group 3 – older than 60 years. All patients underwent standard therapy, according to the recommendations for the treatment of ischemic stroke. The patients underwent comprehensive clinical and instrumental monitoring, which included assessment of somatic and neurological status according to the NIH‑NINDS scales at 1st, 3rd, 10th days and at discharge or death; assessment of the level of social adaptation according to the Bartel scale on 1st, 3rd, 10th days and at discharge, clinical and biochemical blood tests, computed tomography of the brain. Assessment of the quality of therapy was carried out according to specially developed maps using methods of statistical correlation analysis. Results: the most pronounced positive dynamics of neurological status was in the 1st group of patients. The regression of neurological deficit in the 2nd group was worse. The minimal dynamics of neurological deficit was in the 3rd group of patients with cerebral stroke. Most often, the death of patients with cerebral stroke occurred from the development of multiple organ disorders. Conclusions: patients over 70 years of age have the greatest risk of death, due to: a decrease in the reactivity of the body, the presence of initially severe concomitant somatic pathology in patients with admission to hospital; accession of secondary somatic and purulent‑septic complications.

TWILIGHT: A Randomized Trial of Ticagrelor Monotherapy Versus Ticagrelor Plus Aspirin Beginning at 3 Months in High-risk Patients Undergoing Percutaneous Coronary Intervention

2020 ◽  
Vol 14 ◽  
Author(s):  
Johny Nicolas ◽  
Usman Baber ◽  
Roxana Mehran
Keyword(s):  
Percutaneous Coronary Intervention ◽  
High Risk ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Coronary Intervention ◽  
Bleeding Events ◽  
High Risk Patients ◽  
Risk Of Death ◽  
Percutaneous Coronary ◽  
Risk Patients

A P2Y12 inhibitor-based monotherapy after a short period of dual antiplatelet therapy is emerging as a plausible strategy to decrease bleeding events in high-risk patients receiving dual antiplatelet therapy after percutaneous coronary intervention. Ticagrelor With Aspirin or Alone in High-Risk Patients After Coronary Intervention (TWILIGHT), a randomized double-blind trial, tested this approach by dropping aspirin at 3 months and continuing with ticagrelor monotherapy for an additional 12 months. The study enrolled 9,006 patients, of whom 7,119 who tolerated 3 months of dual antiplatelet therapy were randomized after 3 months into two arms: ticagrelor plus placebo and ticagrelor plus aspirin. The primary endpoint of interest, Bleeding Academic Research Consortium type 2, 3, or 5 bleeding, occurred less frequently in the experimental arm (HR 0.56; 95% CI [0.45–0.68]; p<0.001), whereas the secondary endpoint of ischemic events was similar between the two arms (HR 0.99; 95% CI [0.78–1.25]). Transition from dual antiplatelet therapy consisting of ticagrelor plus aspirin to ticagrelor-based monotherapy in high-risk patients at 3 months after percutaneous coronary intervention resulted in a lower risk of bleeding events without an increase in risk of death, MI, or stroke.

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