Effects of IgG from the serum of ischemic stroke patients on hemostasis

2021 ◽  
Author(s):  
Tetiana Katrii ◽  
Nataliia Raksha ◽  
Tetiana Halenova ◽  
Tetiana Vovk ◽  
Olga Kravchenko ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Healthy Subjects ◽  
Protein A ◽  
Factor Xa ◽  
Modern Medicine ◽  
First Year ◽  
Thrombin Time ◽  
Stroke Patients ◽  
One Year ◽  
Hemostasis Factors

Ischemic stroke is among the top diseases leading to mortality and disability in the world. The detailed investigation of the mechanisms underlying this pathology and especially mediating the tendency to relapse during the first year after stroke incident undoubtedly belongs to important tasks of modern medicine and biology. The current study aims to analyze the influence of IgG derived from the blood serum of ischemic stroke patients on some hemostasis factors. In total, 123 participants with IS, 62 with atherothrombotic ischemic stroke, 61 with cardioembolic ischemic stroke, and 57 subjects as control have been examined. The same patients have participated in the research a year after stroke. IgG from serum was isolated by affinity chromatography on protein A Sepharose column. The activity of key hemostasis factors under the influence of IgG was analyzed. Obtained results revealed that IgG of stroke patients but not healthy subjects caused the inhibition of the amidolytic activity of endogenously generated thrombin, protein C, factor Xa, and led to an increase in the degree of ADP-induced platelet aggregation. The reduction of clotting time in the test "Thrombin time" by IgG of patients at the acute phase of disease was also observed; IgG of healthy subjects mediated the opposite effect. In contrast to acute ischemic stroke IgG, IgG of patients one year after both atherothrombotic and cardioembolic ischemic stroke influenced only the activity of endogenously generated thrombin and factor Xa resulting in inhibition of their activities. It was also established that IgG of ischemic stroke patients, as well as healthy subjects, stimulated the secretion of tissue plasminogen activator by endotheliocytes.

scholarly journals Impact of Disability Status on Ischemic Stroke Costs in Canada in the First Year

2012 ◽  
Vol 39 (6) ◽  
pp. 793-800 ◽  
Author(s):  
Nicole Mittmann ◽  
Soo Jin Seung ◽  
Michael D. Hill ◽  
Stephen J. Phillips ◽  
Vladimir Hachinski ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Annual Cost ◽  
Emergency Services ◽  
Fold Increase ◽  
Clinical History ◽  
First Year ◽  
Stroke Patients ◽  
Average Annual Cost ◽  
One Year ◽  
The Impact

Background:Longitudinal, patient-level data on resource use and costs after an ischemic stroke are lacking in Canada. The objectives of this analysis were to calculate costs for the first year post-stroke and determine the impact of disability on costs.Methodology:The Economic Burden of Ischemic Stroke (BURST) Study was a one-year prospective study with a cohort of ischemic stroke patients recruited at 12 Canadian stroke centres. Clinical history, disability, health preference and resource utilization information was collected at discharge, three months, six months and one year. Resources included direct medical costs (2009 CAN$) such as emergency services, hospitalizations, rehabilitation, physician services, diagnostics, medications, allied health professional services, homecare, medical/assistive devices, changes to residence and paid caregivers, as well as indirect costs. Results were stratified by disability measured at discharge using the modified Rankin Score (mRS): non-disabling stroke (mRS 0-2) and disabling stroke (mRS 3-5).Results:We enrolled 232 ischemic stroke patients (age 69.4 ± 15.4 years; 51.3% male) and 113 (48.7%) were disabled at hospital discharge. The average annual cost was $74,353; $107,883 for disabling strokes and $48,339 for non-disabling strokes.Conclusions:An average annual cost for ischemic stroke was calculated in which a disabling stroke was associated with a two-fold increase in costs compared to NDS. Costs during the hospitalization to three months phase were the highest contributor to the annual cost. A “back of the envelope” calculation using 38,000 stroke admissions and the average annual cost yields $2.8 billion as the burden of ischemic stroke.

Abstract P683: Thrombin Generation in Plasma of Stroke Patients With Atrial Fibrillation

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Sarina Falcione ◽  
Gina Sykes ◽  
Joseph Kamtchum Tatuene ◽  
Danielle Munsterman ◽  
Twinkle Joy ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Thrombin Generation ◽  
Thrombus Formation ◽  
Lag Time ◽  
Thrombin Time ◽  
Stroke Patients ◽  
Time To Peak ◽  
Generation Capacity

Background and Purpose: Thrombus formation is central to pathophysiology of stroke in patients with atrial fibrillation. Whether factors in plasma contribute to thrombus generation in patients with atrial fibrillation remains unclear. In this study we sought to determine whether plasma contributes to thrombin generation in patients with atrial fibrillation. Methods: There were 78 acute ischemic strokes with atrial fibrillation and 37 non-stroke controls. Plasma thrombin generation was measured by thrombin generation assay, resulting lag time, peak thrombin, time to peak and area under the curve was assessed. Thrombin generation capacity was compared in stroke patients with atrial fibrillation to non-stroke controls. The relationship to anticoagulation was assessed. In vitro, the effect of anticoagulation on plasma thrombin generation was determined. Results: Thrombin generation capacity was increased (shorter lag time and time to peak) in ischemic stroke patients with atrial fibrillation compared to non-stroke atrial-fibrillation controls (p<0.05 and p<0.01, respectively). Anticoagulation decreased plasma induced thrombin generation. Ischemic stroke patients with atrial fibrillation treated with anticoagulation (DOAC or warfarin) had lower plasma induced thrombin generation compared to atrial-fibrillation patients not on anticoagulation (p<0.05). Thrombin generation by plasma could be further reduced by DOAC in an in-vitro assay. Conclusions: Stroke patients with atrial fibrillation have a higher plasma induced thrombin generation compared to atrial fibrillation controls. Factors in plasma such as leukocyte derived tissue factor likely contribute to thrombus formation in patients with atrial fibrillation. As such, components in plasma may represent new targets to reduce thrombus formation and stroke risk in patients with atrial fibrillation.

Abstract TP251: Onset-to-Door Times and Means of Transportation for Acute Ischemic Stroke Patients Attending a Public Hospital in Bogota DC, Colombia. Is an Ambulance the Fastest Way to Reach the Hospital?

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Javier Vicini-Parra ◽  
Jenny Ospina ◽  
Cristian Correa ◽  
Natalia Gomez ◽  
Stephania Bohorquez ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Public Transportation ◽  
Public Hospital ◽  
Descriptive Analysis ◽  
First Year ◽  
Stroke Patients ◽  
Health Authorities ◽  
Public Health Authorities ◽  
Ischemic Attack

Introduction: A prospective stroke database was implemented as part of a still-growing comprehensive stroke centre (CSC). This CSC is located within a referral public hospital (Hospital Occidente de Kennedy) in Bogota DC, Colombia , that serves 2.3 million people of mainly low economic income. In this abstract, we present the data pertaining patients who were thrombolysed in our institution during the first year of data collection, and specify onset-to-door (OTD) times as they relate to the means of transportation used. Hypothesis: Acute stroke patients who arrive in ambulance have the shortest onset-to-door times. Methods: Printed forms were filled for every patient who arrived with diagnosis of acute ischemic stroke (AIS) or transient ischemic attack (TIA). Data was transcribed to an electronic database (Numbers, Apple Inc.) and analyzed with SPSS Statistics version 23 (IBM Corporation). A retrospective descriptive analysis was performed for central tendency and dispersion measures. Results: Since August 1st 2014 until July 31st 2015, 39 patients (17.7% of AIS patients) were thrombolysed. Mean onset-to-door times are shown in table 1. Prenotification was received for only 1 patient. All patients came from their homes. Conclusions: Almost half of our thrombolysed patients arrived in taxi to our institution. Taxi was the fastest means of transportation, ambulance was the slowest and private cars were in the middle of those. This confirmed our suspicion that the state-owned emergency medical services (SEMD) are suboptimal and that stroke patients prefer to use public transportation rather than SEMD. This should warn public health authorities on he urgent need to improve our SEMD. In the meantime, this finding prompts us to include taxi drivers in our periodic stroke campaigns.

Abstract P670: Obesity and Mortality After the First Ischemic Stroke: Is Obesity Paradox Real?

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Durgesh Chaudhary ◽  
Ayesha Khan ◽  
Mudit Gupta ◽  
Yirui Hu ◽  
Jiang Li ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Proportional Hazards Model ◽  
Obesity Paradox ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Obese Patients ◽  
Stroke Patients ◽  
Stroke Event ◽  
One Year ◽  
First Time

Introduction: Obesity is an established risk factor for ischemic stroke but the association of increased body mass index (BMI) with survival after ischemic stroke remains controversial. Many studies have shown that increased BMI has a “protective” effect on survival after stroke while other studies have debunked the obesity paradox. This study aimed at examining the relationship between BMI and all-cause mortality at one year in first-time ischemic stroke patients using data extracted from different resources including electronic health records. Methods: We analyzed consecutive ischemic stroke patients captured in the Geisinger NeuroScience Ischemic Stroke (GNSIS) database. Survival in first-time ischemic stroke patients was analyzed using Kaplan-Meier estimator, stratified by different BMI categories. The predictors of mortality at one-year were assessed using a multivariate Cox proportional hazards model. Results: Among 6,703 first-time adult ischemic stroke patients, mean age was 70.2 ±13.5 years and 52% were men. Of these patients, 24% patients were non-overweight (BMI < 25), 34% were overweight (BMI 25-29.9) and 41% were obese (BMI ≥ 30). One-year survival probability was significantly higher in overweight patients (87%, 95% CI: [85.6 - 88.4], p<0.001) and obese patients (89.5%, 95% CI: [88.4 - 90.7], p<0.001) compared to non-overweight patients (78.1%, 95% CI: [76.0 - 80.1]). In multivariate analysis, one-year mortality was significantly lower in overweight and obese patients (overweight patients- HR = 0.61 [95% CI, 0.52 - 0.72]; obese patients- HR = 0.56 [95% CI, 0.48 - 0.67]). Other significant predictors of one-year mortality were age at the ischemic stroke event (HR = 1.04 [95% CI, 1.03 - 1.04]), history of neoplasm (HR = 1.59 [95% CI, 1.38 - 1.85]), atrial fibrillation or flutter (HR = 1.26 [95% CI, 1.09 - 1.46]), heart failure (HR = 1.68 [95% CI, 1.42 - 1.98]), diabetes mellitus (HR = 1.27 [95% CI, 1.1 - 1.47]), rheumatic disease (HR = 1.37 [95% CI, 1.05 - 1.78]) and myocardial infarction ((HR = 1.23 [95% CI, 1.02 - 1.48]). Conclusion: Our results support the obesity paradox in ischemic stroke patients as shown by a significantly decreased hazard ratio for one-year mortality among overweight and obese patients in comparison to non-overweight patients.

Abstract TP160: Predicting Bone Fracture After Stroke—The Fracture Risk After Ischemic Stroke (FRAC-Stroke) Score

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Eric E Smith ◽  
Jiming Fang ◽  
Shabbir M Alibhai ◽  
Peter M Cram ◽  
Angela M Cheung ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Fracture Risk ◽  
Risk Score ◽  
Cumulative Incidence ◽  
Population Based ◽  
World Health ◽  
Stroke Severity ◽  
Stroke Patients ◽  
One Year ◽  
Low Trauma Fracture

Background: Risk for low trauma fracture is increased by >30% after ischemic stroke. Additionally, in the IRIS trial pioglitazone therapy prevented ischemic stroke but increased fracture risk. We derived a risk score to predict risk of fracture one year after ischemic stroke. Methods: The Fracture Risk after Ischemic Stroke (FRAC-Stroke) Score was derived in 20,435 ischemic stroke patients from the Ontario Stroke Registry discharged from 2003-2012, using Fine-Gray competing risk regression. Candidate variables were medical conditions included in the validated World Health Organization FRAX risk score complemented by variables related to stroke severity. Registry patients were linked to population-based Ontario health administrative data to identify low trauma fractures (defined as any fracture of the femur, forearm, humerus, pelvis or vertebrae, excluding fractures resulting from trauma, motor vehicle accidents, falls from a height or in people with active cancer). The score was externally validated in 13,698 other ischemic stroke patients in the population-based Ontario stroke audit (2002-2012). Results: Mean age was 72; 42% were women. Low trauma fracture occurred within 1 year of discharge in 741/20435 (3.6%); cumulative incidence increased linearly throughout follow-up. Age, discharge modified Rankin score (mRS), and history of arthritis, osteoporosis, falls and previous fracture contributed significantly to the model. Model discrimination was good (c statistic 0.72). Including discharge mRS significantly improved discrimination (relative integrated discrimination index 8.7%). Fracture risk was highest in patients with mRS 3 and 4 but lowest in bedbound patients (mRS 5). From the lowest to the highest FRAC-Stroke quintile the cumulative incidence of 1-year low trauma fracture increased from 1% to 9%. Predicted and observed rates of fracture were similar in the external validation cohort. Conclusion: The FRAC-Stroke score allows the clinician to identify ischemic stroke patients at higher risk of low trauma fracture within one year. This information might be used to target patients for early bone densitometry screening to diagnose and manage osteoporosis, and to estimate baseline risk prior to starting pioglitazone therapy.

scholarly journals Abnormal EEG Complexity and Functional Connectivity of Brain in Patients with Acute Thalamic Ischemic Stroke

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Shuang Liu ◽  
Jie Guo ◽  
Jiayuan Meng ◽  
Zhijun Wang ◽  
Yang Yao ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Functional Connectivity ◽  
Healthy Subjects ◽  
Brain Network ◽  
Control Group ◽  
Stroke Patients ◽  
Cerebral Disease ◽  
Essential Information ◽  
Stroke Group ◽  
The Brain

Ischemic thalamus stroke has become a serious cardiovascular and cerebral disease in recent years. To date the existing researches mostly concentrated on the power spectral density (PSD) in several frequency bands. In this paper, we investigated the nonlinear features of EEG and brain functional connectivity in patients with acute thalamic ischemic stroke and healthy subjects. Electroencephalography (EEG) in resting condition with eyes closed was recorded for 12 stroke patients and 11 healthy subjects as control group. Lempel-Ziv complexity (LZC), Sample Entropy (SampEn), and brain network using partial directed coherence (PDC) were calculated for feature extraction. Results showed that patients had increased mean LZC and SampEn than the controls, which implied the stroke group has higher EEG complexity. For the brain network, the stroke group displayed a trend of weaker cortical connectivity, which suggests a functional impairment of information transmission in cortical connections in stroke patients. These findings suggest that nonlinear analysis and brain network could provide essential information for better understanding the brain dysfunction in the stroke and assisting monitoring or prognostication of stroke evolution.

Abstract 251: The Association Between Receipt of Healthcare Services and Post-stroke Hypertension Control

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Dhanashri Kohok ◽  
Jason J Sico ◽  
Fitsum Baye ◽  
Laura Myers ◽  
Kamalesh Masoor ◽  
...  
Keyword(s):  
Primary Care ◽  
Ischemic Stroke ◽  
Recurrent Stroke ◽  
Hypertension Management ◽  
Stroke Patients ◽  
Post Discharge ◽  
Post Stroke ◽  
Care Services ◽  
One Year ◽  
The One

Hypertension is a known risk factor for primary as well as recurrent stroke. Improving blood pressure (BP) control has been associated with decreased risk of recurrent stroke. Several factors have been associated with poor BP control among stroke patients such as non-compliance and clinical inertia. We examined the receipt of health care services by patients in the one-year period following discharge for ischemic stroke. This was a retrospective cohort study of patients who were admitted for acute ischemic stroke at a Veterans Affairs hospital during year 2011 and who were discharged with a BP >140/90 mmHg. The following were reviewed: primary care visits; sub-specialty clinic visits; emergency department (ED) visits; hospitalizations; utilization of ancillary care (i.e., telehealth, pharmacy, nutrition services); medications upon discharge; adherence to medications and occurrence of recurrent stroke during the one-year post-discharge period. The cohort included 124 patients with an average age of 66.4 years (± standard deviation of10.3); 123 were male; 62.9% were white; diabetes mellitus was present in 32.5%; and 13.0% had history of coronary artery disease. The average BP at the time of discharge from the index stroke hospitalization was 149.5/82.6 (±11.3/9.8) mmHg. Only 38.7% of patients had an average BP over the one year period of <140/90 mmHg. The average number of primary care visits during this period was 2.8 (±1.6). The overwhelming majority of patients had at least one primary care visit (N=119, 95.9%) however the median time from discharge to the first primary clinic visit was 32 days (IQR 59). Forty four percent of patients were seen as outpatient by neurology, 19.4% by cardiology, 9.7% by nephrology, 5.7% by nutrition, 23.4% by clinical pharmacy, and 9.7% by the telehealth service. BP monitors were issued to or being used by 39.5% patients. Non-adherence was documented in the medical record as an interfering issue in 25.8% of patients. More than two antihypertensive agents were prescribed at discharge in 50.8% patients. During the one-year post-discharge period 29.0% of patients were hospitalized at least once and 24.2% had at least one ED visit. Recurrent stroke occurred in 3.2% of patients. The stroke rate was 4.23% among patients with uncontrolled BP compared with 2.08% among patients with well-controlled BP (p=0.40). This indicates that patients with elevated BP at the time of discharge from an ischemic stroke hospitalization remain with poorly controlled BP in the year post-discharge. Although patients appear to be receiving primary care services, these visits are not successfully achieving BP control. Relative underuse of certain resources for hypertension management such as ancillary services and home BP monitoring is observed.Future intervention studies seeking to improve the hypertension management of post-stroke patients should address these observed gaps in care.

Abstract MP26: Medicaid Expansion Did Not Reduce Stroke Readmissions After One Year

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Blake T McGee ◽  
Seiyoun Kim
Keyword(s):  
Ischemic Stroke ◽  
Fixed Effects ◽  
Secondary Analysis ◽  
First Year ◽  
Medicaid Expansion ◽  
Targeted Interventions ◽  
Quasi Experimental ◽  
Treatment Interaction ◽  
One Year ◽  
Primary Payer

Introduction: Up to 21% of stroke survivors are re-hospitalized within 30 days. Health insurance promotes access to follow-up care that can mitigate the risk of readmission, but 12 states do not participate in the Affordable Care Act’s Medicaid expansion. Hypothesis: The probability of 30-day hospital readmission after acute ischemic stroke was lower in Medicaid expansion states than in non-expansion states. Methods: A retrospective, quasi-experimental study using six inpatient databases from AHRQ’s Healthcare Cost and Utilization Project: four from expansion states (AR, MD, NM and WA) and two non-expansion (FL and GA). The sample comprised all patients hospitalized in 2012-14 with a principal diagnosis of ischemic stroke (ICD-9-CM 433.x1, 434.x1 or 436) who were aged 19-64; resided in the state where admitted; had a primary payer of Medicaid, self-pay or no charge; and were discharged alive ( N =18,766). Mixed effects logit models with a time-by-treatment interaction were built to test if the probability of readmission changed differentially between expansion and non-expansion states from 2012-13 (before expansion) to 2014. Any in-state hospitalization within 30 days of discharge (except for rehabilitation, psychiatry, or cancer treatment) was considered a readmission. A secondary analysis of unplanned, potentially preventable readmissions (adapted from the AHRQ Prevention Quality Indicators) was also conducted. Models included race, sex, age, number of diagnoses, median household income quartile of patient ZIP code, and metropolitan residence as fixed effects, with random intercepts for hospital and state. Results: In 2012-13, 8.9% of the expansion state patients were readmitted compared to 9.0% in non-expansion states; in 2014, 11.1% were readmitted in expansion states versus 10.5% in non-expansion states. In multivariable models, the time-by-treatment interaction was not statistically significant: β=0.072, p= .541, for all readmissions, β=0.168, p =.683, for unplanned, potentially preventable readmissions. Conclusions: Medicaid expansion did not reduce 30-day readmissions after stroke in the first year of implementation in four diverse states. Stroke readmissions among non-elderly adults require more targeted interventions.

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