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Stroke management

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https://www.readbyqxmd.com/read/28917562/an-updated-meta-analysis-of-novel-oral-anticoagulants-versus-vitamin-k-antagonists-for-uninterrupted-anticoagulation-in-atrial-fibrillation-catheter-ablation
#1
Rhanderson Cardoso, Leonardo Knijnik, Aditya Bhonsale, Guilherme Nasi, Manuel Rivera, Vanessa Blumer, Hugh Calkins
BACKGROUND: Catheter ablation is recommended as a first or second-line rhythm control therapy for selected patients with atrial fibrillation (AF). There is a wide variability in the periprocedural management of oral anticoagulation for patients undergoing AF ablation. OBJECTIVE: We aimed to perform an updated meta-analysis of novel oral anticoagulants (NOACs) vs. vitamin K antagonists (VKAs) as uninterrupted anticoagulation for patients undergoing AF ablation. METHODS: Databases and conference abstracts were searched...
September 13, 2017: Heart Rhythm: the Official Journal of the Heart Rhythm Society
https://www.readbyqxmd.com/read/28914273/patterns-and-appropriateness-of-thrombophilia-testing-in-an-academic-medical-center
#2
Nicholas Cox, Stacy A Johnson, Sara Vazquez, Ryan P Fleming, Matthew T Rondina, David Kaplan, Stephanie Chauv, Gabriel V Fontaine, Scott M Stevens, Scott Woller, Daniel M Witt
BACKGROUND: Clinical guidelines recommend against routine use of thrombophilia testing in patients with acute thromboembolism. Thrombophilia testing rarely changes acute management of a thrombotic event. OBJECTIVE: To determine appropriateness of thrombophilia testing in a teaching hospital. DESIGN: Retrospective cohort study. SETTING: One academic medical center in Utah. PARTICIPANTS: All patients who received thrombophilia testing between July 1, 2014, and December 31, 2014...
September 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28914077/decision-algorithms-for-direct-oral-anticoagulant-use-in-patients-with-nonvalvular-atrial-fibrillation-a-practical-guide-for-neurologists
#3
Isabella Canavero, Giuseppe Micieli, Maurizio Paciaroni
Direct oral anticoagulants (DOACs) are valid alternative options to vitamin K antagonists due to their limited interactions with drugs or food and the fact that they do not require regular coagulation monitoring. To this regard, recent practice guidelines recommend that DOACs should be considered as first-line anticoagulant therapy for stroke prevention in patients with nonvalvular atrial fibrillation (NVAF). This review (1) outlines current international guidelines for the management of DOACs to prevent stroke in patients with NVAF, (2) outlines indications for elderly patients as well as specific settings including acute coronary syndromes and intracranial hemorrhage, and (3) offers a practical guide for the use of DOACs in neurological settings...
January 1, 2017: Clinical and Applied Thrombosis/hemostasis
https://www.readbyqxmd.com/read/28913755/management-and-clinical-outcome-of-stable-coronary-artery-disease-in-austria-results-from-5%C3%A2-years-of-the-clarify-registry
#4
Irene M Lang, Roza Badr-Eslam, Nicola Greenlaw, Robin Young, Philippe Gabriel Steg
BACKGROUND: The population of patients with established coronary artery disease (CAD) is growing because of an improvement in outcomes and survival from acute disease episodes. Nevertheless, these patients remain at high risk of cardiovascular events. Thus, CAD management is important in prevention of disease progression. The objective of this analysis was to describe disease management and clinical outcome of Austrian outpatients with stable CAD over 5 years by using data from the international CLARIFY registry...
September 14, 2017: Wiener Klinische Wochenschrift
https://www.readbyqxmd.com/read/28913708/emergency-neurological-life-support-intracerebral-hemorrhage
#5
J Claude Hemphill, Arthur Lam
Intracerebral hemorrhage (ICH) is a subset of stroke due to spontaneous bleeding within the parenchyma of the brain. It is potentially lethal, and survival depends on ensuring an adequate airway, proper diagnosis, and early management of several specific issues such as blood pressure, coagulopathy reversal, and surgical hematoma evacuation for appropriate patients. ICH was chosen as an Emergency Neurological Life Support (ENLS) protocol because intervention within the first hours may improve outcome, and it is critical to have site-specific protocols to drive care quickly and efficiently...
September 14, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28913687/non-atherosclerotic-vascular-disease-in-women
#6
REVIEW
Lee Joseph, Esther S H Kim
Takayasu arteritis, fibromuscular dysplasia (FMD), spontaneous arterial dissection, Raynaud's phenomenon, and chilblains are vascular conditions that are associated with an increased predisposition in women and are often underdiagnosed. Takayasu arteritis has an incidence rate of 2.6 cases per million individuals per year in the USA and predominantly affects women of childbearing age. HLA-B5 genetic locus is linked with Takayasu arteritis susceptibility. Methods to determine active disease are limiting; currently utilized clinical and imaging findings and laboratory tests are of limited value for this purpose...
September 14, 2017: Current Treatment Options in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28912200/development-and-validation-of-electronic-quality-measures-to-assess-care-for-patients-with-transient-ischemic-attack-and-minor-ischemic-stroke
#7
Dawn M Bravata, Laura J Myers, Eric Cheng, Mathew Reeves, Fitsum Baye, Zhangsheng Yu, Teresa Damush, Edward J Miech, Jason Sico, Michael Phipps, Alan Zillich, Jason Johanning, Seemant Chaturvedi, Curt Austin, Jared Ferguson, Bailey Maryfield, Kathy Snow, Susan Ofner, Glenn Graham, Rachel Rhude, Linda S Williams, Greg Arling
BACKGROUND: Despite interest in using electronic health record (EHR) data to assess quality of care, the accuracy of such data is largely unknown. We sought to develop and validate transient ischemic attack and minor ischemic stroke electronic quality measures (eQMs) using EHR data. METHODS AND RESULTS: A random sample of patients with transient ischemic attack or minor ischemic stroke, cared for in Veterans Health Administration facilities (fiscal year 2011), was identified...
September 2017: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/28910463/use-of-acetylsalicylic-acid-in-the-prehospital-setting-for-suspected-acute-ischemic-stroke
#8
John M Levri, Armando Ocon, Paul Schunk, Cord W Cunningham
Acute ischemic stroke (AIS) treatment guidelines include various recommendations for treatment once the patient arrives at the hospital. Prehospital care recommendations, however, are limited to expeditious transport to a qualified hospital and supportive care. The literature has insufficiently considered prehospital antiplatelet therapy. An otherwise healthy 30-year-old black man presented with headache for about 3 hours, left-sided facial and upper extremity numbness, slurred speech, miosis, lacrimation, and general fatigue and malaise...
2017: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
https://www.readbyqxmd.com/read/28906541/roadmap-to-achieve-25-hypertension-control-in-africa-by-2025
#9
Anastase Dzudie, Brian Rayner, Dike Ojji, Aletta E Schutte, Marc Twagirumukiza, Albertino Damasceno, Seringe Abdou Ba, Abdoul Kane, Euloge Kramoh, Jean Baptiste Kacou, Basden Onwubere, Ruth Cornick, Karen Sliwa, Benedict Anisiuba, Ana Olga Mocumbi, Elijah Ogola, Mohamed Awad, George Nel, Harun Otieno, Ali Ibrahim Toure, Samuel Kingue, Andre Pascal Kengne, Pablo Perel, Alma Adler, Neil Poulter, Bongani Mayosi
BACKGROUND AND AIM: The Pan-African Society of Cardiology (PASCAR) has identified hypertension as the highest area of priority for action to reduce heart disease and stroke on the continent. The aim of this PASCAR roadmap on hypertension was to develop practical guidance on how to implement strategies that translate existing knowledge into effective action and improve detection, treatment and control of hypertension and cardiovascular health in sub-Saharan Africa (SSA) by the year 2025...
July 2017: Cardiovascular Journal of Africa
https://www.readbyqxmd.com/read/28903854/controversies-in-management-of-hemorrhagic-stroke-and-rehabilitation-challenges-in-pakistan
#10
Maria Adnan Parekh, Atta Ul Aleem Bhatti
No abstract text is available yet for this article.
August 2017: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
https://www.readbyqxmd.com/read/28903613/a-survey-to-explore-what-information-advice-and-support-community-dwelling-people-with-stroke-currently-receive-to-manage-instability-and-falls
#11
Eleanor Shovlin, Dorit Kunkel
PURPOSE: To describe and determine the benefits of the information and support services currently offered to people with stroke experiencing instability and falls. METHODS: A cross-sectional survey study. Two hundred and fifty-six surveys were sent out to community stroke groups in Hampshire and the Isle of Wight, as well as to people with stroke on a patient register. RESULTS: One hundred and twenty-five surveys were returned. A total of 107 participants (86%) reported instability and 62 (50%) had experienced a fall in the preceding year; 29 (28%) had reportedly received information on falls prevention...
September 13, 2017: Disability and Rehabilitation
https://www.readbyqxmd.com/read/28902821/-outcomes-of-open-endovascular-operations-on-the-internal-carotid-artery-in-acute-stage-of-ischaemic-stroke
#12
A I Khripun, A D Priamikov, A B Mironkov, I N Tiurin, S A Asratian, V S Suriakhin, O V Simonov, O A Sazhina, V P Mikhaĭlenko
INTRODUCTION: The authors share their experience in diagnosis and treatment of patients with acute ischaemic stroke. PATIENTS AND METHODS: The study included a total of 33 patients. Of these, 20 patients (Study Group) were operated on at terms ranging from 2 to 7 days after onset of acute cerebral circulatory impairment. The Control Group was composed of 13 patients with ischaemic stroke, having refused surgical prevention of recurrent stroke. Both groups were matched by age, gender, level of neurological deficiency and size of cerebral ischaemic foci...
2017: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
https://www.readbyqxmd.com/read/28901543/role-of-mhealth-in-overcoming-the-occurrence-of-post-stroke-depression
#13
REVIEW
J J Miranda, M G Moscoso, M Toyama, V Cavero, F Diez-Canseco, B Ovbiagele
Depression associated with stroke affects roughly one-third of stroke survivors. Post-stroke depression (PSD) is thought to adversely influence functional outcome by limiting participation in rehabilitation, decreasing physical, social, and cognitive function, and affecting neuroplasticity thereby placing stroke survivors at high risk for future vascular events. PSD has also been associated with higher mortality rates after stroke. In Peru, a country where there is no national stroke program and mental health disorders are largely underdiagnosed and untreated, people with PSD are likely to be further challenged by dependency and impoverished conditions that will limit their use of ambulatory services, leading to inadequate clinical follow-up...
September 13, 2017: Acta Neurologica Scandinavica
https://www.readbyqxmd.com/read/28901219/primary-prevention-of-stroke-and-cardiovascular-disease-in-the-community-prevents-methodology-of-a-health-wellness-coaching-intervention-to-reduce-stroke-and-cardiovascular-disease-risk-a-randomized-clinical-trial
#14
Susan Mahon, Rita Krishnamurthi, Alain Vandal, Emma Witt, Suzanne Barker-Collo, Priya Parmar, Alice Theadom, Alan Barber, Bruce Arroll, Elaine Rush, Hinemoa Elder, Jesse Dyer, Valery Feigin
Rationale Stroke is a major cause of death and disability worldwide, yet 80% of strokes can be prevented through modifications of risk factors and lifestyle and by medication. While management strategies for primary stroke prevention in high cardiovascular disease risk individuals are well established, they are underutilized and existing practice of primary stroke prevention are inadequate. Behavioral interventions are emerging as highly promising strategies to improve cardiovascular disease risk factor management...
January 1, 2017: International Journal of Stroke: Official Journal of the International Stroke Society
https://www.readbyqxmd.com/read/28901120/perioperative-stroke-incidence-etiologic-factors-and-prevention
#15
Sher-Lu Pai, R Doris Wang, Stephen Aniskevich
INTRODUCTION: Stroke is a devastating complication that is difficult to diagnose in the perioperative setting because of the effects of anesthetic and analgesic agents. Lingering anesthesia effects hinder clinicians in identifying stroke symptoms, frequently resulting in a delay in diagnosis and treatment and in unfavorable outcomes. EVIDENCE ACQUISITION: The authors performed a systematic search in PubMed and the Cochrane Central Register. The search aimed to identify studies published between January 1990 and December 2015 related to the common etiologic factors, incidence, risk factors, risk modifiers, and early management of perioperative stroke...
September 13, 2017: Minerva Anestesiologica
https://www.readbyqxmd.com/read/28895998/-effects-of-an-intensive-thalassotherapy-and-aquatic-therapy-program-in-stroke-patients-a-pilot-study
#16
C Morer, C Boestad, P Zuluaga, A Alvarez-Badillo, F Maraver
INTRODUCTION: Stroke remains the leading cause of acquired disability. Health and social planning and management may vary and although prevention is crucial, having better treatments and strategies to reduce disability is needed. AIM: To determine the effect of an intensive program of thalassotherapy and aquatic therapy in stroke patients, valuing clinical parameters and functional validated scales. PATIENTS AND METHODS: A quasi-experimental prospective study consisting of a specific program assessed pre- and post- 3 weeks treatment to 26 stroke patients with a mild-moderate disability...
September 16, 2017: Revista de Neurologia
https://www.readbyqxmd.com/read/28895447/early-experience-with-endovascular-aneurysm-sealing-in-combination-with-parallel-grafts-for-the-treatment-of-complex-abdominal-aneurysms-the-ascend-registry
#17
Matt Thompson, Marwan Youssef, Rudolf Jacob, Sebastian Zerwes, Michel Reijnen, Piotr Szopinski, Patrick Berg, Grzegorz Oszkinis, Andrew Holden
PURPOSE: To report the results of the ASCEND Registry of cases involving endovascular aneurysm sealing (EVAS) in combination with chimney grafts (chEVAS) for the treatment of para- and juxtarenal aortic aneurysms (AAA). METHODS: A retrospective, multicenter registry established in 8 vascular centers between 2013 and 2016 recorded the treatment results and follow-up of chEVAS procedures for nonruptured AAAs; data were analyzed using standardized outcome measures...
September 1, 2017: Journal of Endovascular Therapy
https://www.readbyqxmd.com/read/28894947/thalamic-transitory-ischemic-attacks-presenting-as-jacksonian-sensory-march
#18
Victoria Schubert, Stephan Lauxmann, Benjamin Bender, Holger Lerche
Spreading somatosensory symptoms appearing as Jacksonian sensory march are usually considered to be due to an epileptic seizure. We report on three cases in which these symptoms were caused by thalamic ischemia. Two patients presented with stereotypically recurring hemiparesthesias lasting 2-5 min that gradually spread from the face to the arm and leg on one side. A first cerebral magnetic resonance imaging including DWI was negative in both cases, whereas new thalamic infarctions appeared on repeated imaging when clinical symptoms remained...
September 11, 2017: Journal of Neurology
https://www.readbyqxmd.com/read/28894887/-endovascular-thrombectomy-for-ischemic-stroke
#19
REVIEW
B Kallmünzer, M Köhrmann
The standard of care for patients with acute stroke of the anterior circulation and large vessel occlusion is the combined treatment with intravenous rt-PA (recombinant tissue-type plasminogen activator) and endovascular thrombectomy. The therapy is highly effective while reducing functional deficits and long-term disability. International guidelines recommend thrombectomy during the first 6 h after symptom onset, but new evidence supports its use in selected patients within a time window of up to 24 h...
September 11, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28893706/hypertension-acute-stent-thrombosis-and-paraplegia-6-months-after-tevar-for-blunt-thoracic-aortic-injury-in-a-22-year-old-patient
#20
O Martinelli, F Faccenna, A Malaj, J Jabbour, S Venosi, R Gattuso, B Gossetti, L Irace
TEVAR is a less invasive option for managing traumatic injuries of the descending aorta in polytraumatized patients. Concerns arise when treating young patients with TEVAR. A 22-year old male was admitted to the Emergency Department following a high-impact road traffic collision. Whole body CT scan documented multiple injuries, including rupture of descending thoracic aorta just below the isthmus. There was no evidence of paraplegia or stroke. We decided to treat him in an endovascular fashion with a Zenith Cook (Cook Incorporated, Bloomington, IN) endograft...
September 8, 2017: Annals of Vascular Surgery
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