scholarly journals Temporal Trends and Patient Characteristics Associated With Drug Utilisation After First-Ever Stroke: Insights From Chronic Disease Registry Data in Singapore

2020 ◽  
Vol 49 (3) ◽  
pp. 137-154
Author(s):  
See-Hwee Yeo ◽  
Matthias Paul HS Toh ◽  
Sze Haur Lee ◽  
Raymond CS Seet ◽  
Lai Yin Wong ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Chronic Disease ◽  
Ischaemic Stroke ◽  
Drug Utilisation ◽  
Temporal Trends ◽  
Patient Characteristics ◽  
Haemorrhagic Stroke ◽  
Stroke Patients ◽  
Thrombolytic Agents ◽  
Combined Use

Introduction: Data on drug utilisation among stroke patients of Asian ethnicities are lacking. The objectives of the study were to examine the temporal trends and patient characteristics associated with prescription of thrombolytic, antithrombotic and statin medications among patients with first-ever stroke. Materials and Methods: First-ever ischaemic and haemorrhagic stroke patients admitted to 2 Singapore tertiary hospitals between 2010‒2014 were included. Data were extracted from the National Healthcare Group Chronic Disease Management System. Association between drug utilisation and admission year, as well as characteristics associated with drug use, were explored using multivariable logistic regression. Results: There was an increasing trend in the combined use of all 3 guideline medications in ischaemic stroke patients (P<0.001) ―specifically thrombolytic agents (P <0.001), oral antithrombotics (P = 0.002) and statins (P = 0.003) at discharge. Among antithrombotics, the use of clopidogrel (P <0.001) and aspirinclopidogrel (P <0.001) had increased, whereas prescription of dipyridamole (P <0.001) and aspirin-dipyridamole (P <0.001) had declined. For statins, the increase in atorvastatin prescription (P <0.001) was accompanied by decreasing use of simvastatin (P <0.001). Age, ethnicity and certain comorbidities (hyperlipidaemia, atrial fibrillation and chronic kidney disease) were associated with the combined use of all 3 guideline medications (P <0.05). In haemorrhagic stroke, prescription of statins at discharge were comparatively lower. Conclusion: This study reveals changes in prescription behaviour over time in a multiethnic Asian population with first-ever stroke. Patient characteristics including younger age, Malay ethnicity and certain comorbidities (i.e. hyperlipidaemia, atrial fibrillation) were associated with the combined use of all 3 guideline medications among ischaemic stroke patients. Key words: Antithrombotics, Asian, Statins, Thrombolytic agents

Timing of anticoagulation therapy in patients with acute ischaemic stroke and atrial fibrillation

2016 ◽  
Vol 116 (09) ◽  
pp. 410-416 ◽  
Author(s):  
Maurizio Paciaroni ◽  
Giancarlo Agnelli ◽  
Walter Ageno ◽  
Valeria Caso
Keyword(s):  
Atrial Fibrillation ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Substantial Reduction ◽  
Anticoagulation Therapy ◽  
Early Recurrence ◽  
Optimal Time ◽  
Optimal Timing ◽  
Stroke Patients ◽  
Haemorrhagic Transformation

SummaryIn patients with acute stroke and atrial fibrillation (AF), the risk of early recurrence has been reported to range between 0.1% and 1.3% per day. Anticoagulants are the most effective therapy for the prevention of recurrent ischaemic stroke in these patients, but randomised clinical trials have failed to produce any evidence supporting the administration of heparin within 48 hours from stroke onset as it has been associated with a non-significant reduction in the recurrence of ischaemic stroke, no substantial reduction in death and disability, and an increase in intracranial bleeding. As early haemorrhagic transformation is a major concern in the acute phase of stroke patients with AF, determining the optimal time to start anticoagulant therapy is essential. This review which focuses on the epidemiology of recurrent ischaemic stroke and haemorrhagic transformation in patients with acute ischaemic stroke and AF, proposes a model for decision making on optimal timing for initiating anticoagulation, based on currently available evidence.

scholarly journals Electrocardiographic Abnormalities in Hospitalized acute Cerebrovascular Events

2020 ◽  
Vol 38 (4) ◽  
pp. 166-171
Author(s):  
Abu Saleh Mohammed Sirajum Munir ◽  
Quazi Tarikul Islam ◽  
Mahmudur Rahman Siddiqui
Keyword(s):  
Hospital Mortality ◽  
Ischaemic Stroke ◽  
Acute Stroke ◽  
Haemorrhagic Stroke ◽  
Qt Prolongation ◽  
Stroke Patients ◽  
Ecg Changes ◽  
College Hospital ◽  
Medical College ◽  
St Depression

Background: - Physicians are confronted on having ECG in patients with acute stroke as it can mimic that of myocardial infarction or ischaemia. Repolarization and ischemic-like electrocardiographic (ECG) changes observed during acute phase of stroke may cause diagnostic and management dilemmas for the physicians. Aim:- The aim and objective of this study to identify the prevalence of ECG changes in acute stroke patients admitted to medicine units of Dhaka Medical College Hospital. Materials and Method: - This 6-month period observational study was carried out among 100 of acute stroke patients admitted in different medicine wards of Dhaka Medical College Hospital (DMCH). ECG was done in all patients after their admission to hospital within 48 hours of developing their symptoms. Association of various types of ECG changes were identified and observed. Results: - Among 100 patients,55% had ischaemic stroke and 45% had haemorrhagic stroke. 43.63% aged between 61-70 years had ischaemic stroke and 28.28% aged between 61-80 years had haemorrhagic stroke. Female had higher frequency of ischaemic stroke 52.72% and male had higher frequency of haemorrhagic stroke 75.56%. Abnormal ECG found 84.44% in haemorrhagic stroke and 54.54% in ischaemic stroke. Of all abnormal ECG, ST depression is most frequent and 42.22% in haemorrhagic stroke, T inversion is next 20% in ischaemic stroke, AF is present in 18.18% in ischaemic stroke and QT prolongation is found in 17.77% in hemorrhagic stroke. There considerable variation of ECG changes according to CT scan evidence of particular area of brain involvement like ST depression (28.88%) found in gangliothalamic bleed in haemorrhagic stroke, AF is found (16.36%) in insular area involvement in ischaemic stroke, T inversion is more (12.72%) in large MCA territory infarctive stroke and QT prolongation (11.11%) is found in intracerebral haemorrhage including SAH. Predictable early in hospital mortality is associated with AF 37.5% and with QT prolongation 31.25%. Conclusion:- In haemorrhagic stroke the ECG abnormalities were more frequent then in ischaemic stroke. The most common abnormalities were ST depression, T wave inversion, AF and QT prolongation. AF and QT prolongation has association of early in hospital mortality. J Bangladesh Coll Phys Surg 2020; 38(4): 166-171

Troponin Levels Help Predict New-Onset Atrial Fibrillation in Ischaemic Stroke Patients: A Retrospective Study

2010 ◽  
Vol 63 (1) ◽  
pp. 24-28 ◽  
Author(s):  
Jean-Marc Bugnicourt ◽  
Vincent Rogez ◽  
Marie-Pierre Guillaumont ◽  
Jean-Claude Rogez ◽  
Sandrine Canaple ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Retrospective Study ◽  
Ischaemic Stroke ◽  
Stroke Patients ◽  
Onset Atrial Fibrillation ◽  
New Onset

Which Acute Stroke Patients with Atrial Fibrillation are Prescribed Warfarin Therapy? Results from One-Year's Experience in Dundee

2000 ◽  
Vol 45 (4) ◽  
pp. 110-112 ◽  
Author(s):  
J. Craig ◽  
R.S. MacWalter ◽  
B.M. Goudie
Keyword(s):  
Atrial Fibrillation ◽  
Ischaemic Stroke ◽  
Acute Stroke ◽  
Warfarin Therapy ◽  
Anticoagulation Therapy ◽  
Secondary Prophylaxis ◽  
Stroke Patients ◽  
Clinical Notes ◽  
Recommended Treatment ◽  
Warfarin Sodium

The recommended treatment of ischaemic stroke patients with atrial fibrillation (AF) is anticoagulation therapy with warfarin sodium and if this is contraindicated then aspirin should be used. The management of patients on warfarin therapy can be complicated and there is a risk of intra-cranial haemorrhage in elderly patients. However, these are the patients who stand to gain the most benefit from this treatment and therefore increased use of warfarin for secondary prophylaxis is likely to lead to a lower rate of subsequent admissions and less morbidity. The recommended treatment for these patients has often not been fully instigated in practice. This study was carried out in order to determine whether a group of patients admitted to a teaching hospital with diagnosis of ischaemic stroke and atrial fibrillation received appropriate antithrombotic therapy. Details of patients admitted with acute stroke during 1997 were obtained from the Dundee Stroke Database and information was extracted from the relevant clinical notes. Twenty-five out of 42 patients (60%) were considered eligible for anticoagulation and 14 out of those 25 (56%) were found to be on warfarin either on admission or subsequently. Of patients aged less than 75 years, 8/10 (80%) were on warfarin, whereas only 6/15 (40%) of those aged 75 years and older were being anticoagulated.

scholarly journals Prevalence of Atrial Fibrillation in Patients with Acute Ischaemic Stroke: A Multicentric Cohort Study

2021 ◽  
Author(s):  
Indu Bhana ◽  
Archana Ojha ◽  
Rajendra Kumar Pandey ◽  
Durgvijay Singh ◽  
Mahendra Chourasiya
Keyword(s):  
Atrial Fibrillation ◽  
Cohort Study ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Urban Areas ◽  
Tertiary Care ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Elderly Age ◽  
Female Population

Introduction: India reports high prevalence of stroke, both in rural and urban areas. Secondary prevention is very important in patients with stroke to reduce the morbidity and mortality associated with it. Atrial Fibrillation (AF) is an important risk factor for stroke which can lead to cerebrovascular insult. Aim: To study the prevalence of AF in patients with acute ischaemic stroke and to obtain the association between the parameters such as age, gender, stroke territory and stroke severity by National Institute of Health Stroke Scale (NIHSS). Materials and Methods: In this multicentric cohort study, 150 patients with acute ischaemic stroke (new onset or recurrent) were studied at tertiary care centres located in Indore (Madhya Pradesh), Prayagraj, Moradabad and Lucknow (Uttar Pradesh) from January 2020 to January 2021. Age, gender, stroke territory and stroke severity by NIHSS was recorded and compared between those with and without AF. The Chi-square test was used to assess the association and obtaining significance. Results: Prevalence of AF in patients with stroke was 8% (n=12), which was significantly high in female population (8 out of 12; p=0.025), those with age more than 60 years (10 out of 12; p=0.011), with atrial dilatation (9 out of 12; p=0.124), patients with severe stroke as per NIHSS (7 out of 12; p=0.001) and those with poor outcome (8 out of 12; p=0.012). Conclusion: In the present study, 8% of the stroke patients had AF with stroke. Elderly age, female sex, and large atrial size on Echocardiogram (ECHO) should be intensively investigated for AF in stroke patients.

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