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Articles Tagged With: stroke

  • PFO Closure Review Shows High Proportion of Off-Label Use

    In this retrospective cohort study using administrative data from a U.S. payor source, only 58.6% of patients undergoing patent foramen ovale closure had the procedure done for the approved indication of stroke or systemic embolism. A significant proportion of patients were outside the recommended age range.

  • Informed Consent Practices for Acute Stroke Treatment Vary

    Currently, the two cornerstones of acute ischemic stroke treatment are intravenous thrombolysis and, for patients with large vessel occlusions, endovascular thrombectomy. For treating clinicians, the question becomes: How do clinicians ensure that patients (or their surrogate decisionmakers) make an informed decision while avoiding treatment delays that can result in worse outcomes?

  • Apixaban Dose in Atrial Fibrillation Patients with Chronic Kidney Disease

    A large nationwide health systems database study comparing 5 mg apixaban vs. 2.5 mg twice daily in patients with stage 4/5 chronic kidney disease not on dialysis shows that the 5 mg dose increases the risk of bleeding compared to 2.5 mg without any improvement in the risk of stroke, systemic emboli, or death.

  • Apixaban vs. Aspirin for Subclinical Atrial Fibrillation

    A randomized controlled trial of apixaban vs. low-dose aspirin therapy for subclinical atrial fibrillation detected by implanted electrophysiologic devices showed that apixaban is associated with fewer strokes, but more major bleeding episodes compared to aspirin.

  • Telestroke Facilitates Care for Rural Stroke Patients

    In the year before the telestroke program was implemented, 11 of 15 eligible patients received thrombolytics in less than one hour, and there was a mean door-to-needle time of 61 minutes. After the telestroke program was implemented, 11 of 12 eligible patients received thrombolytics in less than one hour, with a mean door-to-needle time of just 38 minutes.

  • Searching for a Neuroprotective Agent in Celery Seed Oil

    A Phase III double-blind, placebo-controlled, randomized, controlled trial suggests that early administration of DL-3-n-butylphthalide, when given adjunctively to thrombolysis or endovascular therapy, improves functional outcomes in patients with acute ischemic stroke. Statistically significant results of well-designed analyses are tantalizing, but confidence in the findings is tempered by a lack of generalizability, an unclear mechanism of action, and trial design irregularities.

  • Timing of Anticoagulation Administration Following Atrial Fibrillation-Associated Stroke

    A prospective, blinded, randomized study of early vs. later administration of oral anticoagulation after ischemic stroke in patients with atrial fibrillation calibrated by cerebral imaging showed no significant difference in 30-day outcomes.

  • Blood Pressure Management After Endovascular Thrombectomy: What Is the Best Number?

    Approximately 50% of patients who undergo endovascular therapy for ischemic stroke still have a severe impairment or will die within 90 days. Therefore, additional interventions are being investigated to improve overall outcome. Current guidelines from the American Heart Association suggest maintaining systolic blood pressure below 180 mmHg for patients who were treated both with intravenous thrombolysis and endovascular thrombectomy. A number of centers around the world have tried different systolic blood pressure thresholds ranging from 120 mmHg to 160 mmHg. Many of these studies have been single-center or small non-randomized studies and have not been designed to get a definitive answer.

  • Tenecteplase vs. Alteplase for Treatment of Acute Ischemic Stroke: It Is Time to Make the Change

    Since 1996, when the U.S. Food and Drug Administration approved the use of intravenous alteplase for the treatment of acute ischemic stroke, there has been a steady increase in the adoption of both intravenous thrombolysis as well as endovascular thrombolysis and mechanical thrombectomy for the treatment of patients with acute ischemic stroke and large vessel occlusion. There now is extensive experience with the use of tenecteplase for the treatment of acute ischemic stroke. It has been shown to be equally efficacious, with a similar risk profile as alteplase.

  • Statins Might Lower Risk of Recurrent Stroke

    Patients in Denmark who suffered an intracerebral hemorrhage and were taking cholesterol-lowering medication were less likely to experience another stroke.