Nonaspirin NSAIDs: no increase in haemorrhagic stroke risk?

2003 ◽  
Vol &NA; (943) ◽  
pp. 5
Author(s):  
&NA;
Keyword(s):  
Stroke Risk ◽  
Haemorrhagic Stroke

Advances in Atrial Fibrillation-related Stroke Prevention

2015 ◽  
Vol 9 (2) ◽  
pp. 122
Author(s):  
Pierre Amarenco ◽  
Werner Hacke ◽  
Bo Norrving ◽  
Natalia Rost ◽  
◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Anticoagulant Therapy ◽  
Stroke Prevention ◽  
Stroke Risk ◽  
Oral Anticoagulants ◽  
Factor Xa ◽  
Haemorrhagic Stroke ◽  
Bleeding Events ◽  
Patients At Risk

In patients with atrial fibrillation (AF) the risk of stroke is substantially increased, especially in those who are elderly (over 75 years) or have risk factors such as previous stroke, heart failure or hypertension. Stroke outcomes are also generally much worse in those with AF. Current guidelines indicate that any patient with AF and risk factors for stroke should receive anticoagulant therapy to limit their stroke risk. Despite these established recommendations, only 50 % of patients at risk receive anticoagulation with a vitamin K antagonist (VKA) and only 50 % of those are within the therapeutic range, indicating lack of adherence to the guidelines. Withholding anticoagulant therapy is mainly left to an individual physician’s choice, as shown in the ongoing GARFIELD registry of AF stroke prevention practice. Many physicians fear the risk of intracranial haemorrhage (ICH) for which outcomes remain poor. Recent clinical studies have shown that the non-VKA oral anticoagulants (NOACs) (apixaban, rivaroxaban, dabigatran and edoxaban) significantly reduce the risk of ICH and other bleeding events, while having non-inferior stroke prevention to warfarin. Use of these drugs, limiting exposure to aspirin and alcohol and controlling blood pressure have been shown to minimise ICH risk in large clinical trials and meta-analyses. Recent data from the Effective aNticoaGulation with factor xA next GEneration in Atrial Fibrillation (ENGAGE AF)-TIMI 48 study showed that the factor Xa inhibitor edoxaban was non-inferior to well-managed warfarin for reducing all stroke risk, and significantly reduced haemorrhagic stroke, major bleeding, ICH and death. These findings further support the case for using NOAC therapy for stroke prevention in patients with AF and risk factors for stroke.

scholarly journals Prevention of stroke in patients with chronic coronary syndromes or peripheral arterial disease

2020 ◽  
Vol 22 (Supplement_M) ◽  
pp. M26-M34
Author(s):  
William A E Parker ◽  
Diana A Gorog ◽  
Tobias Geisler ◽  
Gemma Vilahur ◽  
Dirk Sibbing ◽  
...  
Keyword(s):  
Antiplatelet Therapy ◽  
Antithrombotic Therapy ◽  
Stroke Risk ◽  
Density Lipoprotein ◽  
Bleeding Risk ◽  
Haemorrhagic Stroke ◽  
Major Adverse Cardiovascular Events ◽  
Full Dose ◽  
Increased Risk ◽  
Coronary Syndromes

Abstract Stroke is a common and devastating condition caused by atherothrombosis, thromboembolism, or haemorrhage. Patients with chronic coronary syndromes (CCS) or peripheral artery disease (PAD) are at increased risk of stroke because of shared pathophysiological mechanisms and risk-factor profiles. A range of pharmacological and non-pharmacological strategies can help to reduce stroke risk in these groups. Antithrombotic therapy reduces the risk of major adverse cardiovascular events, including ischaemic stroke, but increases the incidence of haemorrhagic stroke. Nevertheless, the net clinical benefits mean antithrombotic therapy is recommended in those with CCS or symptomatic PAD. Whilst single antiplatelet therapy is recommended as chronic treatment, dual antiplatelet therapy should be considered for those with CCS with prior myocardial infarction at high ischaemic but low bleeding risk. Similarly, dual antithrombotic therapy with aspirin and very-low-dose rivaroxaban is an alternative in CCS, as well as in symptomatic PAD. Full-dose anticoagulation should always be considered in those with CCS/PAD and atrial fibrillation. Unless ischaemic risk is particularly high, antiplatelet therapy should not generally be added to full-dose anticoagulation. Optimization of blood pressure, low-density lipoprotein levels, glycaemic control, and lifestyle characteristics may also reduce stroke risk. Overall, a multifaceted approach is essential to best prevent stroke in patients with CCS/PAD.

scholarly journals 248 An Evaluation of Patient Education Post-Stroke

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Laura Morrison ◽  
Claire McAteer ◽  
Lisa Donaghy ◽  
Marie O'Connor ◽  
Eamon Dolan
Keyword(s):  
Risk Factors ◽  
Stroke Risk ◽  
Haemorrhagic Stroke ◽  
University Teaching ◽  
Post Stroke ◽  
Stroke Risk Factors ◽  
Written Information ◽  
Stroke Diagnosis ◽  
Brain Scan ◽  
Discharge Letter

Abstract Background In 2018, 212 acute strokes were diagnosed in our university teaching hospital. Our stroke service is evolving to meet the needs of this growing population. The aim of this study was to evaluate the knowledge patients have about their stroke diagnosis and identify how to improve education given post-stroke. Methods Thirty consecutive patients attending stroke clinic completed a questionnaire, including questions regarding aetiology of their stroke, medications started, driving and education received as an inpatient. Results The thirty patients were a median of 16 months post-stroke. One had a haemorrhagic stroke, all others ischaemic stroke. Only 33% correctly described the type of stroke they had. 50% correctly identified all the risk factors they had been diagnosed with, including atrial fibrillation, hypertension, hypercholesterolaemia and carotid stenosis. 70% of patients reported receiving education in hospital post-stroke. Of these, 13% received written information. 30% of patients were shown their brain scan and the majority (89%) found it beneficial. 71% of those who did not see their scan would have liked to. 52% reported knowing which medications had been started post-stroke but only 23% of patients listed new medications correctly. 43% of patients felt they did not receive enough information about new medications and 27% reported either sometimes or frequently missing medications. 77% of patients drove before their stroke. 74% of these reported that they were advised not to drive post-stroke. Of these, 35% correctly identified how long they were advised not to drive for. Only 26% of those driving before their stroke had driving advice in their discharge letter. Conclusion These results illustrate areas in which we can improve education post-stroke, including ensuring patients receive individualised information about the aetiology of their stroke, risk factors and the importance of new medications. It also highlights the importance of ensuring advice regarding driving is clearly explained and documented.

Stroke in CT-scan Department of Khartoum Hospital, Sudan

2007 ◽  
Vol 37 (4) ◽  
pp. 244-245 ◽  
Author(s):  
Ahmed M El Zein ◽  
Elfateh A Bukhari ◽  
Susan Homeida ◽  
Ishag Adam
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Computed Tomography ◽  
Clinical Characteristics ◽  
Stroke Risk ◽  
Haemorrhagic Stroke ◽  
Computed Tomography Scan ◽  
Prospective Data ◽  
Stroke Risk Factors ◽  
Tomography Scan

Prospective data were collected on consecutive patients admitted to Khartoum Teaching Hospital with a diagnosis of stroke. Risk factors and clinical characteristics were assessed by neurological examination and computed tomography scan. A total of 128 patients were enrolled in the study, of whom 74 (57.8%) were men. The age (mean±standard deviation) of the patients was 53±18.5 years. Eighty-five (66.4%) and 43 (33.6%) patients had ischaemic and haemorrhagic stroke, respectively. Hypertension, diabetes mellitus, smoking, heart disease and hypercholesterolaemia were the risk factors for stroke. Thus, further studies are needed on stroke. Hypertension should be discovered early and treated effectively.

scholarly journals NeuroAid II (MLC901) in Haemorrhagic Stroke

2020 ◽  
Vol 12 (Suppl. 1) ◽  
pp. 212-217
Author(s):  
Chai-Hoon Nowel Tan ◽  
David Choy ◽  
Narayanaswamy Venketasubramanian
Keyword(s):  
Stroke Risk ◽  
Haemorrhagic Stroke ◽  
Stroke Recovery ◽  
Stroke Risk Factor ◽  
Thalamic Haemorrhage ◽  
Hypertensive Therapy ◽  
Serial Brain ◽  
Field Defect ◽  
Unilateral Weakness ◽  
Intensive Rehabilitation

Stroke is a leading cause of death and disability. NeuroAid (MLC601), which originates from Traditional Chinese Medicine, comprises herbal and animal components, and has been shown to improve the functional status of patients after ischaemic stroke. The use of NeuroAid II (MLC901), which comprises only the herbal components of MLC601, in haemorrhagic stroke has not been previously reported. Our patient is a 63-year-old male with a significant stroke risk factor of hypertension. He developed visual field defect, aphasia, unilateral weakness, and hemisensory loss. CT scan showed a left thalamic haemorrhage. In addition to anti-hypertensive therapy and intensive rehabilitation, he was prescribed MLC901. Over a period of 6 months, he had significant improvements in his motor, sensory, and speech function. There were no adverse events, serial brain CT scans showed resolution of the haemorrhage. MLC901 may have a role in post-stroke recovery after intracranial haemorrhage.

scholarly journals Pay-for-performance programmes reduce stroke risks in patients with type 2 diabetes: a national cohort study

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e026626 ◽  
Author(s):  
Chien-Wen Chou ◽  
Pei-Tseng Kung ◽  
Wen-Yu Chou ◽  
Wen-Chen Tsai
Keyword(s):  
Type 2 Diabetes ◽  
Stroke Risk ◽  
Proportional Hazards Model ◽  
Pay For Performance ◽  
Haemorrhagic Stroke ◽  
Cox Proportional Hazards Model ◽  
Research Database ◽  
Related Factors ◽  
Significant Difference

ObjectivesA pay-for-performance (P4P) programme is a management strategy that encourages healthcare providers to deliver high quality of care. In Taiwan, the P4P programme has been implemented for diabetes, and certified diabetes physicians voluntarily enrol patients with diabetes into the P4P programme. The objectives of this study were to compare the risk of stroke and its related factors in patients with type 2 diabetes who were enrolled in a P4P programme compared with those who were not.Study designThis study is a natural experiment in Taiwan. A retrospective cohort investigation was conducted from 2002 to 2013, which included 459 726 patients with type 2 diabetes, who were grouped according to P4P enrolment status following a propensity score matching process.MethodsWe reviewed patients ≥45 years of age newly diagnosed with type 2 diabetes mellitus (DM) from the National Health Insurance Research Database in Taiwan. A Cox proportional hazards model was used to compare the relative risk of stroke between patients with type 2 DM enrolled in the P4P programme and those who were not enrolled.ResultsCompared with the patients not enrolled, there was a significantly lower stroke risk in P4P participants (HR=0.97, 95% CI 0.95 to 0.99). Although a significantly lower risk of haemorrhagic stroke was observed (HR=0.87, 95% CI 0.82 to 0.93) in P4P participants, no statistically significant difference for the risk of ischaemic stroke between P4P and non-P4P patients (HR=0.99, 95% CI 0.97 to 1.02) was found. Following stratification analysis, a significantly reduced stroke risk was observed in male patients with type 2 diabetes, but not in women.ConclusionsParticipants in Taiwan’s Diabetes P4P programme displayed a significantly reduced stroke risk, especially haemorrhagic stroke. We recommend the continual promotion of this programme to the general public and to physicians.

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