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Stroke Guideline

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https://www.readbyqxmd.com/read/29226693/higher-pulse-pressure-and-risk-for-cardiovascular-events-in-patients-with-essential-hypertension-the-campania-salute-network
#1
Costantino Mancusi, Maria A Losi, Raffaele Izzo, Grazia Canciello, Maria V Carlino, Giovanni Albano, Nicola De Luca, Bruno Trimarco, Giovanni de Simone
Background Increased pulse pressure is associated with structural target organ damage, especially in elderly patients, increasing cardiovascular risk. Design In this analysis, we investigated whether high pulse pressure retains a prognostic effect also when common markers of target organ damage are taken into account. Methods We analysed an unselected cohort of treated hypertensive patients from the Campania Salute Network registry ( n = 7336). Participants with available cardiac and carotid ultrasound were required to be free of prevalent cardiovascular disease, with ejection fraction ≥50%, and no more than stage III Chronic Kidney Disease...
January 1, 2017: European Journal of Preventive Cardiology
https://www.readbyqxmd.com/read/29224652/primary-percutaneous-coronary-intervention-at-centers-with-and-without-on-site-surgical-support-insights-from-the-blue-cross-blue-shield-of-michigan-cardiovascular-consortium-bmc2
#2
Majed Afana, Hitinder S Gurm, Milan Seth, Kathleen M Frazier, Sheryl Fielding, Gerald C Koenig
BACKGROUND: Primary percutaneous coronary intervention (PPCI) is being increasingly performed nationally at sites without on-site cardiac surgery; however, recent guidelines only provide a Class IIa recommendation for this practice. The state of Michigan has permitted PPCI without on-site surgery under a closely monitored system that mandates auditing of all procedures and quarterly feedback on quality and outcomes. This study sought to compare outcomes of patients undergoing PPCI at centers with and without on-site surgery in the state of Michigan...
January 2018: American Heart Journal
https://www.readbyqxmd.com/read/29224408/oral-anticoagulation-therapy-upon-discharge-in-hospitalized-patients-with-nonvalvular-atrial-fibrillation-a-retrospective-cohort-study
#3
Devada Singh-Franco, Genevieve Hale, Robin J Jacobs
OBJECTIVES: Availability of direct oral anticoagulants and CHA2DS2VASc/HAS-BLED scoring tools underscore the importance of appropriate and safe use of oral anticoagulation therapy (OACT). The purpose of this study was to evaluate stroke prevention pharmacotherapy in adult patients with nonvalvular atrial fibrillation (NVAF) discharged from a large, community-based hospital. METHODS: A retrospective cohort study was conducted using a de-identified data collection sheet for data extraction (demographics, admitting diagnosis, OACT prior to admission and at discharge, concomitant medications that could increase bleed risk and/or acid-suppressive therapies)...
December 11, 2017: Hospital Practice (Minneapolis)
https://www.readbyqxmd.com/read/29220421/optimal-dose-of-dabigatran-for-the-prevention-of-thromboembolism-with-minimal-bleeding-risk-in-korean-patients-with-atrial-fibrillation
#4
Ki Hong Lee, Hyung Wook Park, Nuri Lee, Dae Young Hyun, Jumin Won, Sung Sik Oh, Hyuk Jin Park, Yongcheol Kim, Jae Yeong Cho, Min Chul Kim, Doo Sun Sim, Hyun Joo Yoon, Nam Sik Yoon, Kye Hun Kim, Young Joon Hong, Ju Han Kim, Youngkeun Ahn, Myung Ho Jeong, Jong Chun Park, Jeong Gwan Cho
Aims: We aim to determine the optimal dose of dabigatran in Korean patients with atrial fibrillation (AF). Methods and results: We analysed 1834 patients with non-valvular AF, classified into a warfarin group (n = 990), dabigatran 150 mg group (D150, n = 294), and 110 mg group (D110, n = 550). The D110 group was further classified into patients concordant (co-D110, n = 367) and patients discordant (di-D110, n = 183) with guidelines to dose reduction...
December 1, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/29220386/does-cognitive-impairment-impact-adherence-a-systematic-review-and-meta-analysis-of-the-association-between-cognitive-impairment-and-medication-non-adherence-in-stroke
#5
Daniela Rohde, Niamh A Merriman, Frank Doyle, Kathleen Bennett, David Williams, Anne Hickey
BACKGROUND: While medication adherence is essential for the secondary prevention of stroke, it is often sub-optimal, and can be compromised by cognitive impairment. This study aimed to systematically review and meta-analyse the association between cognitive impairment and medication non-adherence in stroke. METHODS: A systematic literature search of longitudinal and cross-sectional studies of adults with any stroke type, which reported on the association between any measure of non-adherence and cognitive impairment, was carried out according to PRISMA guidelines...
2017: PloS One
https://www.readbyqxmd.com/read/29218822/european-academy-of-neurology-european-stroke-organisation-consensus-statement-and-practical-guidance-for-pre-hospital-management-of-stroke
#6
A Kobayashi, A Czlonkowska, G A Ford, A C Fonseca, G J Luijckx, J Korv, N Pérez de la Ossa, C Price, D Russell, A Tsiskaridze, M Messmer-Wullen, J De Keyser
Reduction of delay between onset and hospital arrival and adequate pre-hospital care of persons with acute stroke are important for improving chances of a favorable outcome. The objective is to recommend evidence-based practices for the management of patients with suspected stroke in the pre-hospital setting. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to define the key clinical questions. An expert panel then reviewed the literature, established the quality of the evidence, and made recommendations...
December 7, 2017: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/29216243/the-obesity-paradox-and-incident-cardiovascular-disease-a-population-based-study
#7
Virginia W Chang, Kenneth M Langa, David Weir, Theodore J Iwashyna
BACKGROUND: Prior work suggests that obesity may confer a survival advantage among persons with cardiovascular disease (CVD). This obesity "paradox" is frequently studied in the context of prevalent disease, a stage in the disease process when confounding from illness-related weight loss and selective survival are especially problematic. Our objective was to examine the association of obesity with mortality among persons with incident CVD, where biases are potentially reduced, and to compare these findings with those based on prevalent disease...
2017: PloS One
https://www.readbyqxmd.com/read/29214153/alzheimer-s-disease-diagnosis-discrepancy-between-clinical-neuroimaging-and-cerebrospinal-fluid-biomarkers-criteria-in-an-italian-cohort-of-geriatric-outpatients-a-retrospective-cross-sectional-study
#8
Giulia A M Dolci, Sarah Damanti, Valeria Scortichini, Alessandro Galli, Paolo D Rossi, Carlo Abbate, Beatrice Arosio, Daniela Mari, Andrea Arighi, Giorgio G Fumagalli, Elio Scarpini, Silvia Inglese, Maura Marcucci
Background: The role of cerebrospinal fluid (CSF) biomarkers, and neuroimaging in the diagnostic process of Alzheimer's disease (AD) is not clear, in particular in the older patients. Objective: The aim of this study was to compare the clinical diagnosis of AD with CSF biomarkers and with cerebrovascular damage at neuroimaging in a cohort of geriatric patients. Methods: Retrospective analysis of medical records of ≥65-year-old patients with cognitive impairment referred to an Italian geriatric outpatient clinic, for whom the CSF concentration of amyloid-β (Aβ), total Tau (Tau), and phosphorylated Tau (p-Tau) was available...
2017: Frontiers in Medicine
https://www.readbyqxmd.com/read/29213212/implementation-and-feasibility-of-the-stroke-nursing-guideline-in-the-care-of-patients-with-stroke-a-mixed-methods-study
#9
Ingibjörg Bjartmarz, Helga Jónsdóttir, Thóra B Hafsteinsdóttir
Background: Nurses often have difficulties with using interdisciplinary stroke guidelines for patients with stroke as they do not focus sufficiently on nursing. Therefore, the Stroke Nursing Guideline (SNG) was developed and implemented. The aim of this study was to determine the implementation and feasibility of the SNG in terms of changes in documentation and use of the guideline in the care of stroke patients on Neurological and Rehabilitation wards, barriers and facilitators, and nurses' and auxiliary nurses' view of the implementation...
2017: BMC Nursing
https://www.readbyqxmd.com/read/29213030/acute-bilateral-ophthalmoplegia-due-to-vertebrobasilar-dolichoectasia-a-report-of-two-cases
#10
Haifa Alabri, Whitfield D Lewis, Sunil Manjila, Ayham M Alkhachroum, Michael A De Georgia
BACKGROUND Vertebrobasilar dolichoectasia (VBD) is a complex progressive arterial disease characterized by dilation, elongation, and tortuosity of the vertebral and basilar arteries, and may be congenital or acquired. VBD may lead to progressive compression of the brainstem, cranial nerve abnormalities, and intracranial hemorrhage, but may also be associated with arterial thrombosis, with ischemic stroke as the most common clinical outcome. CASE REPORT Two cases of VBD are presented, both with acute bilateral ophthalmoplegia and cranial nerve palsies, and vertebrobasilar arterial thrombosis that resulted in ischemic stroke...
December 7, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/29212743/successful-reperfusion-with-intravenous-thrombolysis-preceding-mechanical-thrombectomy-in-large-vessel-occlusions
#11
Georgios Tsivgoulis, Aristeidis H Katsanos, Peter D Schellinger, Martin Köhrmann, Panayiotis Varelas, Georgios Magoufis, Maurizio Paciaroni, Valeria Caso, Anne W Alexandrov, Edip Gurol, Andrei V Alexandrov
BACKGROUND AND PURPOSE: Although current guidelines advocate pretreatment with intravenous thrombolysis (IVT) in all eligible patients with acute ischemic stroke with large-vessel occlusion before mechanical thrombectomy, there are observational data questioning the efficacy of this approach. One of the main arguments in favor of IVT pretreatment is the potential for tissue-type plasminogen activator-induced successful reperfusion (SR) before the onset of endovascular procedure. METHODS: We performed a systematic review and meta-analysis of randomized controlled clinical trials and observational cohorts providing rates of SR with IVT in patients with large-vessel occlusion before the initiation of mechanical thrombectomy...
December 6, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/29210130/home-setting-after-stroke-facilitators-and-barriers-a-systematic-literature-review
#12
REVIEW
Elizabeth Marcheschi, Lena Von Koch, Hélène Pessah-Rasmussen, Marie Elf
This paper seeks to improve the understanding of the interaction between patients with stroke and the physical environment in their home settings. Stroke care is increasingly performed in the patient's home. Therefore, a systematic review was conducted to identify the existing knowledge about facilitators and barriers in the physical environment of home settings for the stroke rehabilitation process. Based upon Arksey and O'Malley's framework, a Boolean search strategy was performed in the databases; CINAHL, Medline, Web of Science and Scopus...
December 5, 2017: Health & Social Care in the Community
https://www.readbyqxmd.com/read/29207946/achieved-systolic-blood-pressure-in-older-people-a-systematic-review-and-meta-analysis
#13
Aline A I Moraes, Cristina P Baena, Taulant Muka, Arjola Bano, Adriana Buitrago-Lopez, Ana Zazula, Bruna O Erbano, Nicolle A Schio, Murilo H Guedes, Wichor M Bramer, Oscar H Franco, José Rocha Faria-Neto
BACKGROUND: It remains unclear into which level the systolic blood pressure (SBP) should be lowered in order to provide the best cardiovascular protection among older people. Hypertension guidelines recommendation on attaining SBP levels <150 mmHg in this population is currently based on experts' opinion. To clarify this issue, we systematically reviewed and quantified available evidence on the impact of achieving different SBP levels <150 mmHg on various adverse outcomes in subjects aged ≥60 years old receiving antihypertensive drug treatment...
December 5, 2017: BMC Geriatrics
https://www.readbyqxmd.com/read/29205297/meta-analysis-of-the-procedural-risks-of-carotid-endarterectomy-and-carotid-artery-stenting-over-time
#14
REVIEW
K Lokuge, D D de Waard, A Halliday, A Gray, R Bulbulia, B Mihaylova
BACKGROUND: Stroke/death rates within 30 days of carotid endarterectomy (CEA) and carotid artery stenting (CAS) in RCTs inform current clinical guidelines. However, the risks may have changed in recent years with wider use of effective stroke prevention therapies, especially statins, improved patient selection and growing operator expertise. The aim of this study was to investigate whether the procedural stroke/death risks from CEA and CAS have changed over time. METHODS: MEDLINE and Embase were searched systematically from inception to May 2016 for observational cohort studies of CEA and CAS...
December 4, 2017: British Journal of Surgery
https://www.readbyqxmd.com/read/29204949/-stroke-prevention-in-atrial-fibrillation-in-germany-situational-analysis-of-treatment-reality-based-on-retrospective-data
#15
Ulrike Mergenthaler, Karel Kostev, Sven Moosmang, Inga-Marion Thate-Waschke, Sylvia Haas
BACKGROUND: Guideline-based, risk-adjusted therapy with anticoagulants reduce thromboembolic stroke risk in patients with atrial fibrillation (AF). METHOD: This study analyzed use of oral anticoagulation in German AF-patients. Access to anonymized patient records was made via IMS Health Disease Analyzer database (sample size: 113,619 patients with ICD-10 Code I48.-; observation period: 11/2010-10/2013). Results were subsequently extrapolated to all general practitioners' (GPs) and cardiological practices in Germany...
December 2017: MMW Fortschritte der Medizin
https://www.readbyqxmd.com/read/29204620/should-this-patient-receive-aspirin-grand-rounds-discussion-from-beth-israel-deaconess-medical-center
#16
Risa B Burns, Kelly Graham, Mandeep S Sawhney, Eileen E Reynolds
Aspirin exerts antiplatelet effects through irreversible inhibition of cyclooxygenase-1, whereas its anticancer effects may be due to inhibition of cyclooxygenase-2 and other pathways. In 2009, the U.S. Preventive Services Task Force endorsed aspirin for primary prevention of cardiovascular disease. However, aspirin's role in cancer prevention is still emerging, and no groups currently recommend its use for this purpose. To help physicians balance the benefits and harms of aspirin in primary disease prevention, the Task Force issued a guideline titled, "Aspirin Use for the Primary Prevention of Cardiovascular Disease and Colorectal Cancer" in 2016...
December 5, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/29198413/is-carotid-revascularization-worthwhile-in-patients-waiting-for-kidney-transplantation
#17
REVIEW
Peter Balaz, Petrut Gogalniceanu, Chris Callaghan
Renal failure and haemodialysis are associated with an increased risk of cardiovascular disease. Patients undergoing renal transplantation undergo rigorous pre-operative vascular assessment, including optimisation of risk factors for stroke. The indication for carotid intervention and the threshold for carotid endarterectomy in asymptomatic patients with incidental carotid disease has not been clarified in the context chronic kidney disease (CKD). This review aims to analyse outcomes following carotid endarterectomy in patients with CKD, in order to ascertain whether general guidelines for carotid artery revascularisation apply to this specific cohort...
November 16, 2017: Transplantation Reviews
https://www.readbyqxmd.com/read/29197413/timing-of-oral-anticoagulant-therapy-in-acute-ischemic-stroke-with-atrial-fibrillation-study-protocol-for-a-registry-based-randomised-controlled-trial
#18
Signild Åsberg, Ziad Hijazi, Bo Norrving, Andreas Terént, Patrik Öhagen, Jonas Oldgren
BACKGROUND: Oral anticoagulation therapy is recommended for the prevention of recurrent ischemic stroke in patients with atrial fibrillation (AF). Current guidelines do not provide evidence-based recommendations on optimal time-point to start anticoagulation therapy after an acute ischemic stroke. Non-vitamin K antagonist oral anticoagulants (NOACs) may offer advantages compared to warfarin because of faster and more predictable onset of action and potentially a lower risk of intracerebral haemorrhage also in the acute phase after an ischemic stroke...
December 2, 2017: Trials
https://www.readbyqxmd.com/read/29197254/utilization-of-lipid-modifying-therapy-and-low-density-lipoprotein-cholesterol-goal-attainment-in-patients-at-high-and-very-high-cardiovascular-risk-real-world-evidence-from-germany
#19
Winfried März, Franz-Werner Dippel, Karlheinz Theobald, Katherine Gorcyca, Şerban R Iorga, David Ansell
BACKGROUND AND AIMS: Elevated low-density lipoprotein cholesterol (LDL-C) is a causal risk factor for cardiovascular (CV) events. European guidelines recommend reducing LDL-C as the primary lipid target to reduce CV risk, using lifestyle modifications and lipid-lowering therapy (LLT). Many European patients do not achieve guideline-recommended LDL-C levels. The present database analysis aimed to assess LLT treatment patterns and LDL-C threshold attainment in Germany in a large, real-world cohort of patients...
November 20, 2017: Atherosclerosis
https://www.readbyqxmd.com/read/29196200/incidental-thrombotic-thrombocytopenic-purpura-during-acute-ischemic-stroke-and-thrombolytic-treatment
#20
İbrahim Acır, Hacı Ali Erdoğan, Vildan Yayla, Nilay Taşdemir, Murat Çabalar
BACKGROUND: Intravenous tissue plasminogen activator (IV tPA) was shown to be an effective treatment for acute ischemic stroke (AIS). According to stroke guidelines, there is no need to wait for the complete blood count (CBC) and coagulation test results before application of IV alteplase if there is no suspected coagulation disorder. In this study, a patient with AIS and thrombotic thrombocytopenic purpura (TTP) symptoms during thrombolytic treatment was presented. CASE: A 33-year-old male patient was admitted at the 2...
November 28, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
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