scholarly journals Additional risk factors for in-hospital ischemic stroke. Hypercoagulation syndrome

2021 ◽  
Vol 40 (4) ◽  
pp. 87-94
Author(s):  
Sergey V. Kolomentsev ◽  
Evgeniy I. Shermatyuk ◽  
Nikolay V. Tsygan ◽  
Igor A. Voznyuk ◽  
Stanislav N. Yanishevsky ◽  
...  

The risk of ischemic stroke in inpatients is higher than in the general population. This is due to both the greater comorbidity of inpatients and the presence of additional risk factors, the most studied of which are iatrogenic interventions. At the same time, the higher the probability of developing an ischemic stroke, the more risk factors the patient has. An important link in the pathogenesis of in-hospital ischemic stroke is the activation of the hemostasis system, which is an obligate consequence of a typical pathological process underlying diseases and injuries that led to hospitalization: blood loss, inflammation, mechanical tissue damage, dehydration, etc. In foreign literature, this condition is attributed to the group of acquired thrombophilia, in domestic literature the term hypercoagulation syndrome has become more widespread. Iatrogenic effects can also play an important role in the pathogenesis of hypercoagulation syndrome. It is characterized by increased readiness for thrombosis, clinical and laboratory signs of hypercoagulation, activation of various factors and components of coagulation, decreased fibrinolysis, but without the development of acute thrombosis. Hypercoagulation syndrome is rarely assessed in routine practice as a risk factor for ischemic stroke, however, it can act as an additional and main risk factor for the development of all subtypes of ischemic stroke (according to the TOAST classification), including the ESUS concept. In this regard, it is advisable to distinguish in its structure: chronic (existing before hospitalization: hereditary and/or acquired) and acute (situational, developed as a result of the underlying disease, its complications or iatrogenic effects) hypercoagulation syndromes. To designate a group of acute pathological conditions predisposing to the development of hypercoagulation syndrome, systemic and/or local thrombotic complications, including in-hospital ischemic stroke, and requiring increased preventive measures, it seems pathogenetically justified, understandable and convenient to use the term situational hypercoagulation conditions (1 table, bibliography: 19 refs)

Author(s):  
Khurshidakhon Abduboriyevna Rasulova

Objective: To determine risk factors in different pathogenic subtypes of ischemic stroke in Tashkent hospital registry and to compare with the data of other stroke registers.Design: Prospective observational study.Participants: 300 adults aged 18 years or over who suffered first-ever acute ischemic stroke, of them, the data of 100 patients with atherothrombotic, lacunar and cardioembolic strokes were analyzed.Main outcome measures: Mathematically significant differences and not significant differences but interesting from other point of view. Categorical variables are expressed as frequencies and percentages. Differences were regarded as statistically significant when the P value was less than 0.05 (P<0.05).Results: Of 100 patients with acute first-ever ischemic stroke at the median age of 62.63±4.68 (interquartile range 25-92) years, 57% were men and 43% were women. Depending on aetiology and stroke subtype, all the patients were divided into three groups: 42 patients with atherothrombotic stroke, 41 – with lacunar stroke, and 17 patients with cardioembolic stroke. Atherothrombotic stroke developed often in people over 60 years old, while lacunar stroke prevailed at the younger age. Stroke cases increased in people over 51 years old. Although men were more likely to suffer strokes than women, stroke incidence was equal in both sexes with increasing of age (over 60 years old), especially in atherothrombotic stroke, testifying to that women live longer. Combination of cerebral atherosclerosis and hypertension was the most significant risk factor for stroke. Atherosclerosis was the main aetiological factor for ischemic stroke, independently of its pathogenic heterogeneity. Diabetes mellitus was an independent risk factor for all stroke subtypes, which in most cases worsened the course and outcome of stroke. Hypertension was the leader aetiological factor for lacunar stroke. In these patients, we also should consider the presence of other risk factors, e.g. severe large vessel obstructions, se-triglycerol ≥2 mmol/L, etc. Cardioembolic stroke developed mainly because of cardiac thrombosis and valve pathology, which were often associated with chronic diseases of other organs, worsening the course and outcome of stroke. Despite of high prevalence of myocardial infarction in men, women were more likely to develop cardioembolic stroke.Conclusions: This study found simultaneous influence of many risk factors (multifactorial disease) in the development of ischemic stroke. The more course and influence of the underlying disease and risk factor, the higher stroke risk and severity, especially in the absence or inadequate previous therapy of underlying disease before the stroke index. We have noted a high prevalence of under-diagnosis of vascular risk factors at levels of primary and secondary care. We recommend for improved public awareness of vascular risk factors and better diagnostic and treatment facilities aimed at addressing those factors at levels of primary and secondary healthcare. Larger population-based studies may provide additional data on stroke incidence and outcome among Uzbeks.


2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T.J Jernberg ◽  
E.O Omerovic ◽  
E.H Hamilton ◽  
K.L Lindmark ◽  
L.D Desta ◽  
...  

Abstract Background Left ventricular dysfunction after an acute myocardial infarction (MI) is associated with poor outcome. The PARADISE-MI trial is examining whether an angiotensin receptor-neprilysin inhibitor reduces the risk of cardiovascular death or worsening heart failure (HF) in this population. The aim of this study was to examine the prevalence and prognosis of different subsets of post-MI patients in a real-world setting. Additionally, the prognostic importance of some common risk factors used as risk enrichment criteria in the PARADISE-MI trial were specifically examined. Methods In a nationwide myocardial infarction registry (SWEDEHEART), including 87 177 patients with type 1 MI between 2011–2018, 3 subsets of patients were identified in the overall MI cohort (where patients with previous HF were excluded); population 1 (n=27 568 (32%)) with signs of acute HF or an ejection fraction (EF) &lt;50%, population 2 (n=13 038 (15%)) with signs of acute HF or an EF &lt;40%, and population 3 (PARADISE-MI like) (n=11 175 (13%)) with signs of acute HF or an EF &lt;40% and at least one risk factor (Age ≥70, eGFR &lt;60, diabetes mellitus, prior MI, atrial fibrillation, EF &lt;30%, Killip III-IV and STEMI without reperfusion therapy). Results When all MIs, population 1 (HF or EF &lt;50%), 2 (HF or EF &lt;40%) and 3 (HF or EF &lt;40% + additional risk factor (PARADISE-MI like)) were compared, the median (IQR) age increased from 70 (61–79) to 77 (70–84). Also, the proportion of diabetes (22% to 33%), STEMI (38% to 50%), atrial fibrillation (10% to 24%) and Killip-class &gt;2 (1% to 7%) increased. After 3 years of follow-up, the cumulative probability of death or readmission because of heart failure in the overall MI population and in population 1 to 3 was 17.4%, 26.9%, 37.6% and 41.8%, respectively. In population 2, all risk factors were independently associated with death or readmission because of HF (Age ≥70 (HR (95% CI): 1.80 (1.66–1.95)), eGFR &lt;60 (1.62 (1.52–1.74)), diabetes mellitus (1.35 (1.26–1.44)), prior MI (1.16 (1.07–1.25)), atrial fibrillation (1.35 (1.26–1.45)), EF &lt;30% (1.69 (1.58–1.81)), Killip III-IV (1.34 (1.19–1.51)) and STEMI without reperfusion therapy (1.34 (1.21–1.48))) in a multivariable Cox regression analysis. The risk increased with increasing number of risk factors (Figure 1). Conclusion Depending on definition, post MI HF is present in 13–32% of all MI patients and is associated with a high risk of subsequent death or readmission because of HF. The risk increases significantly with every additional risk factor. There is a need to optimize management and improve outcomes for this high risk population. Figure 1 Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Novartis


Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Vishal Shah ◽  
Ashrai Gudlavalleti ◽  
Julius G Latorre

Introduction: In patients with acute stroke, part of the acute management entails identifying the risk factors; modifiable or non modifiable. Early recognition of these factors is essential for optimizing therapeutic procedures, especially those with a known effective treatment. In this sense, Sleep Disordered Breathing (SDB) has also been suggested as a modifiable and independent risk factor for stroke as defined by international guidelines and some studies have demonstrated that patients with stroke and particularly Obstructive Sleep Apnea (OSA) have an increased risk of death or new vascular events. Pathogenesis of ischemic stroke in SDB is probably related to worsening of existing cardiovascular risk factors such as hypertension and hypoxia driven cardiac arrhythmia leading to higher prevalence of ischemic stroke in patients with sleep disordered breathing disease. Despite strong evidence linking SDB to ischemic stroke, evaluation for SDB is rarely performed in patients presenting with an acute ischemic stroke. Hypothesis: Evaluation of SDB is rarely performed in patients presenting with acute ischemic stroke. Methods: We performed a retrospective review of all patients above the age of 18 who were admitted to the acute stroke service at University Hospital July 2014 to December 2014. Demographic data, etiology of stroke as identified per TOAST criteria, modifiable risk factors, presenting NIHSS and frequency of testing for SDB and their results were collected. The data was consolidated and tabulated by using STATA version 14. Results: Total of 240 patients satisfied our inclusion criteria. Only 24 patients ie 10% of those who satisfied our inclusion criteria received evaluation for SDB. Out of those evaluated, 62.5% ie 15 patients out of 24 patients had findings concerning for significant desaturation. Only 2 providers out of 8 stroke physicians ie 25% tested for SDB in more than 5 patients. Conclusions: Our observations highlight the paucity in evaluation for SDB in acute ischemic stroke in a tertiary care setting. Being a modifiable risk factor, greater emphasis must be placed on evaluation for SDB in patients in patients with acute stroke. Education must be provided to all patients and providers regarding identification of these factors.


Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Dinesh V Jillella ◽  
Sara Crawford ◽  
Anne S Tang ◽  
Rocio Lopez ◽  
Ken Uchino

Introduction: Regional disparities exist in stroke incidence and stroke related mortality in the United States. We aimed to elucidate the stroke risk factor prevalence trends based on urban versus rural location. Methods: From the National Inpatient Sample database the comorbid stroke risk factors were collected among hospitalized ischemic stroke patients during 2000-2016. Crude and age-and sex-standardized prevalence estimates were calculated for each risk factor during the time periods 2000-2008 and 2009-2016. We compared risk factor prevalence over the defined time periods using regression models, and differences in risk factor trends based on patient location categorized as urban (metropolitan with population of ≥ 1 million) and rural (neither micropolitan or metropolitan) using interaction terms in the regression models. Results: Stroke risk factor prevalence significantly increased from 2000-2008 to 2009-2016. When stratified based on patient location, most risk factors increased in both urban and rural groups. In the crude model, the urban to rural trend difference across 2000-08 and 2009-16 was significant in hypertension (p<0.0001), hyperlipidemia (p=0.0008), diabetes mellitus (p<0.0001), coronary artery disease (p<0.0001), smoking (p<0.0001) and alcohol (p=0.02). With age and sex standardization, the urban to rural trend difference was significant in hypertension (p<0.0001), hyperlipidemia (p=0.0007), coronary artery disease (p=0.01) and smoking (p<0.0001). Conclusion: The prevalence of vascular risk factors among ischemic stroke patients has increased over the last two decades. There exists an urban-rural divide, with rural patients showing larger increases in prevalence of several risk factors compared to urban patients.


2019 ◽  
Vol 147 ◽  
Author(s):  
S. Dirmesropian ◽  
B. Liu ◽  
J. G. Wood ◽  
C. R. MacIntyre ◽  
P. McIntyre ◽  
...  

AbstractCommunity-acquired pneumonia (CAP) results in substantial numbers of hospitalisations and deaths in older adults. There are known lifestyle and medical risk factors for pneumococcal disease but the magnitude of the additional risk is not well quantified in Australia. We used a large population-based prospective cohort study of older adults in the state of New South Wales (45 and Up Study) linked to cause-specific hospitalisations, disease notifications and death registrations from 2006 to 2015. We estimated the age-specific incidence of CAP hospitalisation (ICD-10 J12-18), invasive pneumococcal disease (IPD) notification and presumptive non-invasive pneumococcal CAP hospitalisation (J13 + J18.1, excluding IPD), comparing those with at least one risk factor to those with no risk factors. The hospitalised case-fatality rate (CFR) included deaths in a 30-day window after hospitalisation. Among 266 951 participants followed for 1 850 000 person-years there were 8747 first hospitalisations for CAP, 157 IPD notifications and 305 non-invasive pneumococcal CAP hospitalisations. In persons 65–84 years, 54.7% had at least one identified risk factor, increasing to 57.0% in those ⩾85 years. The incidence of CAP hospitalisation in those ⩾65 years with at least one risk factor was twofold higher than in those without risk factors, 1091/100 000 (95% confidence interval (CI) 1060–1122) compared with 522/100 000 (95% CI 501–545) and IPD in equivalent groups was almost threefold higher (18.40/100 000 (95% CI 14.61–22.87) vs. 6.82/100 000 (95% CI 4.56–9.79)). The CFR increased with age but there were limited difference by risk status, except in those aged 45 to 64 years. Adults ⩾65 years with at least one risk factor have much higher rates of CAP and IPD suggesting that additional risk factor-based vaccination strategies may be cost-effective.


2017 ◽  
Vol 13 (1) ◽  
pp. 83-86 ◽  
Author(s):  
Alijan A Ahangar ◽  
Payam Saadat ◽  
Behzad Heidari ◽  
Seyedeh T Taheri ◽  
Shayan Alijanpour

Background Stroke is the second leading cause of death worldwide and is associated with several risk factors with variable risk factor distribution by population. We report the types and frequency of the associated factors of stroke in north Iran. Methods Consecutive patients with stroke were recruited from 2014 to 2015. The two groups of ischemic and hemorrhagic stroke were compared with respect to age, sex, the prevalence, and distribution of the risk factors. Results Among 230 patients (84.3% ischemic stroke) with mean age of 61.2 years, hypertension (73%), diabetes mellitus (53%), cardiovascular disease (51%), and dyslipidemia (47%) were the most frequent risk factors. Hypertension was significantly more prevalent in males compared with females (88% vs. 60%, OR = 4.91, 95% CI: 2.48–9.71). Hypertension, smoking, and opioid consumption were associated with hemorrhagic stroke. Dyslipidemia was significantly higher in ischemic stroke (OR = 2.65, 95% CI: 1.21–5.8). Overall, 84.3% of stroke occurred in patients aged >50 years (92.8% of women vs. 74.5% of the men, OR = 4.43, 95% CI: 1.93–10.16, p = 0.001). Conclusion Stroke was more prevalent in females; hypertension was more prevalent in males. In the age group less than 50 years old, stroke is more prevalent in men.


Cephalalgia ◽  
2015 ◽  
Vol 35 (14) ◽  
pp. 1252-1260 ◽  
Author(s):  
Amy A Gelfand ◽  
Heather J Fullerton ◽  
Alice Jacobson ◽  
Stephen Sidney ◽  
Peter J Goadsby ◽  
...  

Importance Our understanding of risk factors for childhood stroke is incomplete. In adults, migraine with aura is associated with a two-fold increase in ischemic stroke risk. Objective In this cohort study we examine the association between migraine and stroke among children in Kaiser Permanente Northern California (KPNC). Design, setting, and participants Children ages 2–17 years who were members of KPNC for ≥6 months between 1997 and 2007 were included. Migraine cohort members had one or more of: an ICD-9 code for migraine, migraine listed as a significant health problem, or a prescription for a migraine-specific medication. The comparison group was children with no evidence of headache. Main outcome measures Main outcome measures included stroke incidence rates and incidence rate ratios (IR). Results Among the 1,566,952 children within KPNC during the study period, 88,164 had migraine, and 1,323,142 had no evidence of headache. Eight migraineurs had a stroke (three (38%) hemorrhagic; five (63%) ischemic). Eighty strokes occurred in children without headache (53 (66%) hemorrhagic; 27 (34%) ischemic). The ischemic stroke incidence rate was 0.9/100,000 person-years in migraineurs vs. 0.4/100,000 person-years in those without headache; IR 2.0 (95% CI 0.8–5.2). A post-hoc analysis of adolescents (12–17 years) showed an increased risk of ischemic stroke among those with migraine; IR 3.4 (95% CI 1.2–9.5). The hemorrhagic stroke incidence rate was 0.5/100,000 person-years in migraineurs and 0.9/100,000 person-years in those without headache; IR 0.6 (95% CI 0.2–2.0). Conclusions There was no statistically significant increase in hemorrhagic or ischemic stroke risk in pediatric migraineurs in this cohort study. A post-hoc analysis found that ischemic stroke risk was significantly elevated in adolescents with migraine. Future studies should focus on identifying risk factors for ischemic stroke among adolescent migraineurs. Based on adult data, we recommend that migraine aura status should be studied as a possible risk factor for ischemic stroke among adolescent migraineurs.


2013 ◽  
Vol 2 (2) ◽  
pp. 57
Author(s):  
Cintya Agreayu Dinata ◽  
Yuliarni Safrita Safrita ◽  
Susila Sastri

AbstrakStroke merupakan penyakit akibat gangguan peredaran darah otak yang dipengaruhi oleh banyak faktor risiko terdiri dari yang tidak dapat diubah berupa usia dan jenis kelamin dan yang dapat diubah seperti hipertensi, peningkatan kadar gula darah, dislipidemia, dan pekerjaan. Penelitian ini bertujuan untuk mengetahui distribusi tipe stroke dan faktor risiko yang berpengaruh pada pasien stroke rawat inap di RSUD Kabupaten Solok Selatan. Metode penelitian: Penelitian ini adalah penelitian deskriptif dengan menggunakan data skunder pasien stroke yang dirawat di RSUD Solok Selatan. Data yang diambil meliputi usia, jenis kelamin, tekanan darah, kadar gula darah, profil lipid saat pertama pasien masuk rumah sakit, dan pekerjaan. Sampel penelitian adalah seluruh pasien stroke yang pernah dirawat di Bagian Penyakit Dalam RSUD Kabupaten Solok Selatan pada periode 1 Januari 2010 – 31 Juni 2012 yang memenuhi kriteria inklusi. Hasil penelitian: Hasil penelitian menunjukkan proporsi stroke terbanyak adalah stroke ischemic (61,46%), perempuan (54,17%) yang berusia >50 tahun (81,25%) yang bekerja sebagai ibu rumah tangga (43,75%). Faktor risiko yang dapat diubah tertinggi adalah hipertensi (82,30%) diikuti kolesterol total meningkat (69,79%). Faktor risiko tertinggi pada stroke ischemic adalah gula darah meningkat (47,89%) dan pada stroke hemorrhagic adalah hipertensi (100,00%). Faktor risiko tertinggi pada seluruh pasien adalah hipertensi (82,30%). Kesimpulan: Berdasarkan hasil penelitian ini disimpulkan bahwa stroke tipe ischemic lebih banyak dari tipe hemorrhagic dengan faktor risiko utama hipertensi, sedangkan stroke ischemic terutama dipengaruhi oleh peningkatan gula darah.Kata kunci: stroke ischemic, stroke hemorrhagic, faktor risiko strokeAbstractStroke is a disease caused by disorder of brain blood circulation with many risk factors that contribute in this disease, consist of non modifiable risk factor including age and sex and modifiable risk factors example hypertension, high glucose level, dyslipidemia, and jobs. This study aimed to determine the distribution of the type of stroke and the risk factors that affect to stroke patients who were treat in South Solok hospital.Methods: This research is descriptive research using secondary data, including the patient’s medical record. The data including age, gender, blood pressure, glucose level, lipid profile when the first patient in the hospital, and jobs. The samples were all stroke patients who had been treat in the Department of Internal Medicine of South Solok hospital in the period from January 1st 2010 until June 31th 2012 that meet the inclusion criteria.The results: The results showed the highest proportion of strokes were ischemic stroke (61.46%), women (54.17%) aged> 50 years (81.25%) who work as housewives (43.75%). The highest of modifiable risk factors are hypertension (82.30%) followed by increases in total cholesterol (69.79%). The highest risk factors for ischemic stroke is high glucose level (47.89%) and for hemorrhagic stroke is hypertension (100.00%). The highest risk in both ischemic stroke and hemorrhagic is hypertension (82.30%).Conclusion: Based on the end result, we can concluded that the insidence of ischemic stroke disease is greater than hemorrhagic stroke, and as the main risk factor is hypertension, mean while ischemic stroke is most affected by high glucose level.Keywords: stroke ischemic, stroke hemorrhagic, faktor risiko stroke


Author(s):  
Hari Priya Reddy ◽  
Jaganath A. ◽  
Nagaraj N. ◽  
Visweswara Reddy Y. J.

Background: The aim of the study was to determine the effect of age as a risk factor and a determinant of outcome in elderly ischemic stroke patients.Methods: This is an observational study. One hundred, successive elderly patients aged 60 years and above, admitted with acute ischemic stroke in PESIMSR over a period of 18 months were prospectively studied. Patients with hemorrhagic stroke, neurological deficits following trauma or following infection were excluded. Demographics, risk factors, stroke severity at admission were estimated by NIHSS. Risk factors and clinical profile were noted and compared among male and female patients. Outcome at discharge was measured by-mRS-modified ranking score.Results: Patients in age group 60-75 years presented with less severe stroke and better mRS when compared to >75 years age group. Complications were significantly higher among the older age group.Conclusions: The risk factors identified for ischemic stroke in the present study are diabetes, hypertension, dyslipidaemia, obesity, smoking, and alcohol. Severity of stroke at presentation, clinical outcome and complication rate during the in-hospital stay were all significantly affected by the age, more so in ischemic stroke. Age specific factors of stroke prevention are crucial for successful prevention and implementation of well-organized stroke care.


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