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.

scholarly journals Developing a multivariable prediction model for functional outcome after reperfusion therapy for acute ischaemic stroke: study protocol for the Targeting Optimal Thrombolysis Outcomes (TOTO) multicentre cohort study

BMJ Open ◽  
2020 ◽  
Vol 10 (4) ◽  
pp. e038180 ◽  
Author(s):  
Elizabeth Holliday ◽  
Thomas Lillicrap ◽  
Timothy Kleinig ◽  
Philip M C Choi ◽  
Jane Maguire ◽  
...  
Keyword(s):  
Cohort Study ◽  
Ischaemic Stroke ◽  
Functional Outcome ◽  
Acute Ischaemic Stroke ◽  
Significant Risk ◽  
Intravenous Thrombolysis ◽  
Reperfusion Therapy ◽  
Stroke Severity ◽  
Local Health ◽  
Predictive Algorithms

IntroductionIntravenous thrombolysis (IVT) with recombinant tissue plasminogen activator (rt-PA) is the only approved pharmacological reperfusion therapy for acute ischaemic stroke. Despite population benefit, IVT is not equally effective in all patients, nor is it without significant risk. Uncertain treatment outcome prediction complicates patient treatment selection. This study will develop and validate predictive algorithms for IVT response, using clinical, radiological and blood-based biomarker measures. A secondary objective is to develop predictive algorithms for endovascular thrombectomy (EVT), which has been proven as an effective reperfusion therapy since study inception.Methods and analysisThe Targeting Optimal Thrombolysis Outcomes Study is a multicenter prospective cohort study of ischaemic stroke patients treated at participating Australian Stroke Centres with IVT and/or EVT. Patients undergo neuroimaging using multimodal CT or MRI at baseline with repeat neuroimaging 24 hours post-treatment. Baseline and follow-up blood samples are provided for research use. The primary outcome is good functional outcome at 90 days poststroke, defined as a modified Rankin Scale (mRS) Score of 0–2. Secondary outcomes are reperfusion, recanalisation, infarct core growth, change in stroke severity, poor functional outcome, excellent functional outcome and ordinal mRS at 90 days. Primary predictive models will be developed and validated in patients treated only with rt-PA. Models will be built using regression methods and include clinical variables, radiological measures from multimodal neuroimaging and blood-based biomarkers measured by mass spectrometry. Predictive accuracy will be quantified using c-statistics and R2. In secondary analyses, models will be developed in patients treated using EVT, with or without prior IVT, reflecting practice changes since original study design.Ethics and disseminationPatients, or relatives when patients could not consent, provide written informed consent to participate. This study received approval from the Hunter New England Local Health District Human Research Ethics Committee (reference 14/10/15/4.02). Findings will be disseminated via peer-reviewed publications and conference presentations.

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

2017 ◽  
Vol 5 (3) ◽  
pp. 982 ◽  
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.

scholarly journals Hyperhomocysteinaemia among Acute Ischaemic Stroke Patients in a Tertiary Care Centre in Thiruvananthapuram, Kerala – A Cross-Sectional Study

2021 ◽  
Vol 8 (19) ◽  
pp. 1326-1331
Author(s):  
Deepa Gopalakrishna ◽  
Rupa Gopinathan ◽  
Saboora Beegum ◽  
Thomas Iype
Keyword(s):  
Risk Factors ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Homocysteine Level ◽  
Statistical Tests ◽  
Tertiary Care ◽  
Care Hospital ◽  
Stroke Patients ◽  
Cross Sectional ◽  
Total Homocysteine

BACKGROUND Over the last three decades, prevalence of stroke has been high in India, while the Western countries have witnessed a downward slide. Epidemiological studies suggest that hyperhomocysteinaemia might be a potentially modifiable nonlipid risk factor associated with stroke, in addition to the long-recognized factors like hypertension, diabetes mellitus, hyperlipidaemia and smoking. Hyperhomocysteinaemia occurs due to deviation in the metabolic pathway of methionine, attributed by deficiency of vitamins, enzymes and other factors. The present study was undertaken to assess the proportion of hyperhomocysteinaemia in patients with acute ischemic stroke. We also compared the risk factors associated with stroke and serum levels of homocysteine. METHODS This is a cross sectional observational study conducted in a tertiary care hospital. The sample size was 140. Both male and female consecutive patients of age more than 18 years, with first attack of acute ischaemic stroke admitted in the Department of Neurology were selected. Baseline fasting serum samples were obtained for testing serum homocysteine levels. Statistical tests used were proportion, chi square and logistic regression. RESULTS Among 140 acute ischaemic stroke patients, total homocysteine level was raised in 83.6 % cases. The prevalence of moderate hyperhomocysteinaemia in our study was 65.4 % and intermediate hyperhomocysteinaemia was 17.9 % among stroke patients. The mean (± SD) homocysteine level was 22.75 (± 8.19). CONCLUSIONS A strong association was found between hyperhomocysteinaemia and acute ischaemic stroke. We could not find any significant correlation between total homocysteine level and most risk factors of stroke. KEYWORDS Stroke, Homocysteine, Risk Factors, Endothelial Dysfunction, Atherosclerosis, B Vitamins

scholarly journals Risk Factors for Pneumonia in Patients with Acute Ischaemic Stroke- A Retrospective Study

2021 ◽  
Author(s):  
Roy Thomas
Keyword(s):  
Risk Factors ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Test Score ◽  
Neurological Complication ◽  
Tertiary Care ◽  
Significant Risk ◽  
Chronic Obstructive ◽  
Stroke Severity ◽  
Increased Risk

Introduction: The most common non-neurological complication of stroke is infection. Stroke, associated with pneumonia is one among them. A few studies have identified prognostic predictors of pneumonia in stroke. Aim: To identify the risk factors of pneumonia in acute ischaemic stroke patients. Materials and Methods: This retrospective cohort study included medical records of 470 adult patients with acute ischaemic stroke between June 2015 to June 2020 (five years) in a Tertiary Care Medical College and Hospital. Among them, 173 had stroke associated with pneumonia. The clinical parameters-age, gender, lesion location, stroke severity (Glasgow Coma Scale (GCS)) , National Institute of Health Stroke Scale (NIHSS), Modified Barthel Activities of Daily Living (ADL) index, water swallow test, vascular risk factors and co-existing conditions (pre-existent Chronic Obstructive Pulmonary Disease (COPD), atrial fibrillation, renal electrolyte dysfunction, hypoproteinaemia) were compared. Chi-square test and logistic regression analysis were used for statistical analysis. Results: In this study, the following factors were associated with increased risk of developing pneumonia-age >70 years, bed ridden status, GCS ≤13, NIHSS ≥5, water swallow test score ≤2. Among them, multivariate analysis identified bed ridden status and water swallow test as independent predictors. Conclusion: Bed ridden status and water swallow test score were significant risk factors of ischaemic stroke associated with pneumonia. Hence, an early identification of these factors and a better knowledge of them may help in better care and prevention of pneumonia in acute ischaemic stroke.

scholarly journals Effect of Serum Uric Acid Level on Acute Ischaemic Stroke Patients in South Indian Population: A Prospective Cohort Study

2021 ◽  
Author(s):  
Karri Vijaya Phani Vardhan Reddy ◽  
Subramaniam Murugesan ◽  
Thangavelu Arun Prakash ◽  
Balasubramani Soorya Narayanan
Keyword(s):  
Uric Acid ◽  
Cohort Study ◽  
Clinical Outcome ◽  
Ischaemic Stroke ◽  
Serum Uric Acid ◽  
Acute Ischaemic Stroke ◽  
Elevated Serum ◽  
Acid Group ◽  
Stroke Patients ◽  
Short Term

Introduction: Stroke is one of the most common causes of morbidity and mortality in the world. Various studies have shown the correlation between the uric acid levels and acute ischaemic stroke. There are several studies which project the cerebro-protective effect of uric acid in acute ischaemic stroke patients by its antioxidant effect. However, still it is a wide area of controversy. Aim: To assess the short term (14 days) clinical outcomes in acute ischaemic stroke patients with reference to their serum uric acid levels on day of admission day. Materials and Methods: This prospective cohort study, which included a total of 74 acute ischaemic stroke patients who presented to Emergency Department in a Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidyapeeth University, Pondicherry (a tertiary care hospital in South India) within 48 hours from the month of April 2018 and June 2019. The severity of stroke was quantified in all patients using National Institute of Health Stroke Scale (NIHSS) during admission and serum uric acid levels and other routine investigations were measured in all cases. All patients were managed as per American Heart Association (AHA) guidelines and at the end of 14 days their outcome was reassessed by modified Rankin Scale (mRS). The correlation between severity of stroke and the clinical outcome on 14 days with reference to admission day serum uric acid was analysed. Results: A total of 74 patients were analysed, 51 were male and 23 were females and mean serum uric acid was 6.07±0.78 (mg/dL), and mean NIHSS score at admission was 18.32±3.8. Severity assessment by NIHSS scoring system showed majority percentage of population in elevated serum uric acid group were in moderate and severe categories (73.7%, 62.9%, respectively) in adjunct with normal uric acid group. Outcome assessment by mRS showed major percentage population in elevated uric acid group with score 2,3 (score 2-89.3%, score 3-80%) in relation to normal uric acid group. Conclusion: The present study supported the hypothesis that acute ischaemic stroke patients with elevated serum uric acid levels at the time of admission had reduced severity and favourable short term clinical outcome due to its neuroprotective effect secondary to antioxidant property.

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