Clopidogrel resistance in stroke patients (The CRISP Trial)

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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Clopidogrel resistance in stroke patients (The CRISP Trial)

Journal of Neurology & Stroke ◽

10.15406/jnsk.2021.11.00444 ◽

2021 ◽

Vol 11 (1) ◽

pp. 1-5

Author(s):

E Qazi, ◽

Syed AH Zaidi ◽

Olukolade O Owojori ◽

LJ Bonnett ◽

PR Fitzsimmons ◽

...

Keyword(s):

Ischaemic Stroke ◽

Acute Stroke ◽

Acute Ischaemic Stroke ◽

University Hospital ◽

P Value ◽

Clopidogrel Resistance ◽

Appropriate Treatment ◽

Unit Increase ◽

Acute Stroke Unit

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Enhancing acute stroke services: a quality improvement project

BMJ Open Quality ◽

10.1136/bmjoq-2017-000258 ◽

2018 ◽

Vol 7 (3) ◽

pp. e000258 ◽

Cited By ~ 1

Author(s):

Keith McGrath ◽

Nora Cunningham ◽

Elizabeth Moloney ◽

Margaret O’Connor ◽

John McManus ◽

...

Keyword(s):

Quality Improvement ◽

Ischaemic Stroke ◽

Acute Stroke ◽

Acute Ischaemic Stroke ◽

Intravenous Thrombolysis ◽

University Hospital ◽

Acute Stroke Care ◽

Improvement Project ◽

Stroke Team ◽

Stroke Services

BackgroundIn a busy stroke centre in Ireland, care for acute stroke was provided by a mixture of general physicians. In acute ischaemic stroke, speed is essential for good outcomes.AimTo improve acute stroke services and decrease door-to-needle (DTN) time to less than 60 min by December 2016 in patients with acute ischaemic stroke who are eligible for intravenous thrombolysis.Design: A quality improvement (QI) project was undertaken in a 438 bed, acute, university hospital.MethodsMixture of qualitative and quantitative data collected. A process map and driver diagram were created. Interventions tested with Plan-Do-Study-Act cycles. Times compared between July and December 2015, January and July 2016, July and December 2016, when a new stroke team and pathway were introduced.ResultsBetween July and December 2015, the total number of ischaemic strokes was 216. 17 were thrombolysed (7.8%). Median door-to-CT (DTCT) time was 36 min (range 21–88). Median DTN time was 99 min (range 52–239). Between July and December 2016, there were 214 ischaemic strokes. 29 were thrombolysed (13.5%). 9 were seen directly by the stroke team during normal hours. With stroke team involvement, median DTCT time was 34 min (range 14–60) and DTN time was 43.5 min (range 24–65).ConclusionsThis project led to a significant and sustained improvement in acute stroke care in our hospital with the use of quality improvement techniques. A comprehensive protocol, recurrent and ongoing staff education, and good communication helped to mitigate delays and further enhance care provided to patients presenting with stroke. The approach described may be valuable to the improvement of other services.’

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Pleural infection—an indicator of morbidity and increased burden on health care

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivaa147 ◽

2020 ◽

Vol 31 (4) ◽

pp. 513-518

Author(s):

Antti I Lehtomäki ◽

Riikka M Nevalainen ◽

Vesa J Toikkanen ◽

Emilia S Pohja ◽

Jaakko J Nieminen ◽

...

Keyword(s):

Emergency Room ◽

Survival Data ◽

Healthcare Services ◽

University Hospital ◽

P Value ◽

Term Survival ◽

Frequent Use ◽

Clinic Visits

Abstract OBJECTIVES Patients with pleural infections frequently have several comorbidities and inferior long-term survival. We hypothesized that these patients represent a vulnerable cohort with high rates of hospitalization and frequent use of healthcare services. This study aims to ascertain the need for and causes of treatment episodes after pleural infections during long-term follow-up. METHODS Patients treated for pleural infections at Tampere University Hospital between January 2000 and December 2008 (n = 191, 81% males, median age 58 years) were included and compared to a demographically matched population-based random sample of 1910 controls. Seventy percent of the pleural infections were caused by pneumonias and 80% of the patients underwent surgery. Information regarding later in-hospital periods and emergency room and out-patient clinic visits, as well as survival data, was obtained from national registries and compared between patients and controls. RESULTS Patients treated for pleural infections had significantly higher rates of hospitalizations (8.19 vs 2.19), in-hospital days (88.5 vs 26.6), emergency room admissions (3.18 vs 1.45), out-patient clinic visits (41.1 vs 11.8) and procedures performed (1.26 vs 0.55) per 100 patient-months when compared to controls during 5-year follow-up, in addition to having increased mortality (30% vs 11%), P-value <0.00001 each. Particularly, episodes due to respiratory and digestive diseases, malignancies and mental disorders were more frequent. The patients’ comorbidities, such as alcoholism or chronic pulmonary disease, were associated with more frequent use of healthcare services. CONCLUSIONS Patients treated for pleural infections have high rates of hospitalizations, emergency room admissions and out-patient clinic visits during follow-up.

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Sex differences in risk factors, treatment, and prognosis in acute stroke

Women s Health ◽

10.1177/1745506520952039 ◽

2020 ◽

Vol 16 ◽

pp. 174550652095203

Author(s):

Solveig Dahl ◽

Clara Hjalmarsson ◽

Björn Andersson

Keyword(s):

Risk Factors ◽

Sex Differences ◽

Acute Stroke ◽

Functional Outcome ◽

Independent Living ◽

University Hospital ◽

Stroke Severity ◽

Stroke Registry ◽

Study Population

Objectives: Stroke is a major cause of long-term disability and death worldwide. Several studies have shown that women in general have more severe symptoms at arrival to hospital and are less likely to return home and independent living. Our aim with the present study was to update previous results concerning sex differences in baseline characteristics, stroke management, and outcome in a population study from Sahlgrenska University Hospital, Gothenburg, Sweden. Methods: This study included patients with acute ischemic and hemorrhagic stroke in 2014 at Sahlgrenska University Hospital. All data were collected from The Swedish National Stroke Registry (Riksstroke). Results: The study population consisted of 1453 patients, with 46.7% females. Women were 5 years older than men. There was no sex difference in acute stroke severity. Frequency of revascularization was equal between men and women. The stroke mortality rate was the same between the sexes. At 3-months follow-up, women had a worse functional outcome and a higher frequency of depression and post-stroke fatigue. Conclusion: Our results show that there are no sex differences in management of acute stroke. However, the cause of worse functional outcome in women at 3-months follow-up, independent of other risk factors, is not clear and warrants further investigations.

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A pragmatic approach to sonothrombolysis in acute ischaemic stroke: the Norwegian randomised controlled sonothrombolysis in acute stroke study (NOR-SASS)

BMC Neurology ◽

10.1186/s12883-015-0359-4 ◽

2015 ◽

Vol 15 (1) ◽

Cited By ~ 11

Author(s):

Aliona Nacu ◽

Christopher E. Kvistad ◽

Nicola Logallo ◽

Halvor Naess ◽

Ulrike Waje-Andreassen ◽

...

Keyword(s):

Ischaemic Stroke ◽

Acute Stroke ◽

Acute Ischaemic Stroke ◽

Pragmatic Approach ◽

Stroke Study ◽

Randomised Controlled

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Micro-albuminuria in non-diabetic acute ischaemic stroke: prevalence and its co-relation with stroke severity

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20170647 ◽

2017 ◽

Vol 5 (3) ◽

pp. 982 ◽

Cited By ~ 1

Author(s):

Sumeet Singh ◽

Harpreet Singh ◽

Tarsem Pal Singh

Keyword(s):

Ischaemic Stroke ◽

Acute Ischaemic Stroke ◽

Urinary Albumin ◽

P Value ◽

Stroke Severity ◽

Stroke Patients ◽

Urine Albumin Excretion ◽

Albumin Excretion ◽

Urine Albumin ◽

History Of

Background: Microalbuminuria is not only a predictor of subsequent kidney disease, but also an indicator of generalised endothelial injury and a manifestation of endothelial dysfunction. The present study is aimed to determine the prevalence of microalbuminuria among non–diabetic ischaemic stroke patients and find its correlation with ischaemic stroke which eventually will aid us in coming up with potent strategies to provide better prevention and cure.Methods: The present study was conducted in Department of Medicine in collaboration with Department of Biochemistry and Department of Radiology, Guru Nanak Dev Hospital, Amritsar, Punjab, India after taking approval from institutional thesis and ethical committee. The study included 60 patients (30 Cases + 30 Controls) in age group 20-80 years diagnosed as stroke and haemorrhage ruled out by NCCT Brain/MRI Brain at admission. Cases were patients with history of hypertension with acute ischaemic stroke. Controls were age and sex matched patients with no history of hypertension with acute ischaemic stroke. The microalbuminuria was assayed by immunoturbimetry. The stroke severity was assessed by NIH Stroke Severity scale. P value less than 0.05 was considered the level of significance.Results: The overall prevalence of microalbuminuria in acute ischaemic stroke patients was 41.67%. When comparing NIH SS (National Institutes of Health Stroke Scale) score with the levels of albumin in urine, there was a significant positive correlation with urinary albumin levels and stroke severity in the patients having urinary albumin levels in microalbuminuria range both in Case group and Control group with P value less than 0.05.Conclusions: Urine albumin excretion had a positive correlation with the NIH SS Score of the patient in acute ischemic stroke. Those with a higher NIH SS Score had a higher rate of urine albumin excretion and vice versa. Therefore, measurement of microalbuminuria may help to assess those who are at increased risk of severe stroke and may require a more aggressive management.

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Increased Risk of Graves´ophthalmopathy in Patients With Increasing TRAb After Radioiodine Treatment and the Impact of CTLA4 on TRAb Titres

10.21203/rs.3.rs-883457/v1 ◽

2021 ◽

Author(s):

Bushra Shahida ◽

Kleoniki Tsoumani ◽

Tereza Planck ◽

Vijayachitra Modhukur ◽

Pernilla Asp ◽

...

Keyword(s):

Previous Treatment ◽

University Hospital ◽

P Value ◽

Graves Ophthalmopathy ◽

Increased Risk ◽

Orbital Tissue ◽

One Year ◽

The Impact ◽

The Relationship

Abstract Introduction. Treatment of Graves´ disease (GD) with radioiodine increases the risk of developing Graves´ ophthalmopathy (GO) but the link between thyroid and orbital tissue remains undefined.The aim was to investigate the relationship between GO and TRAb after treatment with radioiodine and to define the impact of risk genes.Methods. GD patients without ophthalmopathy or previous treatment with radioiodine were prospectively included at treatment with radioiodine for hyperthyroidism. A follow-up was performed one year later for registration of GO development. The study was performed at a University Hospital Clinic; referral center of all patients treated with radioiodine in the south of Sweden. The main outcome measures were development of TRAb, anti-TPO, anti-TG after three months and GO after 12 months and relationship to the genetic background (HLA, CTLA-4, CYR61).Results. Three months of radioiodine TRAb increased in two thirds of patients (p<0.0005) but not in the other third. Anti-TPO was associated with TRAb (R=0.362, p <0.0001) but not anti-TG. At follow-up one year later (n=204) 32 patients developed GO with a proportion of 70% in the group increasing in TRAb and 30 % in the group with unchanged or lower TRAb (p-value <0.0005). Patients with GO had higher levels of TRAb than patients without GO. CTLA-4 (rs231775 SNP) was significantly (p<0.005) associated with TRAb levels above the median three months after radioiodine.Conclusions. The increase in TRAb after treatment with radioiodine is associated with GO and a genetic variation in CTLA-4 is associated with higher levels of TRAb.

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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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