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management of stroke

Kara J Walters, Anna Meador, John A Galdo, Katharine Ciarrocca
Coagulation disorders account for a high incidence of death in the U.S. due to stroke, myocardial infarction, and venous thromboembolism. In the past few years, numerous agents have been brought to market for the treatment of thromboembolism or prevention of thromboembolism. Similar to warfarin, these agents can cause bleeding disorders, which may exacerbate dental care treatment plans. This literature review examines the newer agents for the treatment of thromboembolism disorders, common side effects and drug interactions, the specific medical conditions each agent treats, and the dental perspective on how to medically management patients prescribed these medications...
October 22, 2016: Special Care in Dentistry
Jason Mackey, Jane C Khoury, Kathleen Alwell, Charles J Moomaw, Brett M Kissela, Matthew L Flaherty, Opeolu Adeoye, Daniel Woo, Simona Ferioli, Felipe De Los Rios La Rosa, Sharyl Martini, Pooja Khatri, Joseph P Broderick, Mario Zuccarello, Dawn Kleindorfer
OBJECTIVE: To characterize temporal trends in subarachnoid hemorrhage (SAH) incidence and outcomes over 5 time periods in a large population-based stroke study in the United States. METHODS: All SAHs among residents of the Greater Cincinnati/Northern Kentucky region at least 20 years of age were identified and verified via study physician review in 5 distinct year-long study periods between 1988 and 2010. We abstracted demographics, care patterns, and outcomes, and we compared incidence and case-fatality rates across the study periods...
October 21, 2016: Neurology
Mahnaz Ashoorkhani, Ali Bozorgi, Reza Majdzadeh, Hamed Hosseini, Ali Yoonessi, Ali Ramezankhani, Hassan Eftekhar
BACKGROUND: Hypertension is one of the most important and well-known risk factors for cardiovascular diseases. Unfortunately, in spite of effective treatments, adherence to the regular use of drugs and other nondrug treatments, such as lifestyle improvement, is often poor. This study evaluates the effectiveness of an educational, supportive intervention - in the form of a Blood Pressure Management Application (BPMAP) - on self-management in patients with primary hypertension on controlling the determinant factors of hypertension, and on adherence to treatment...
October 21, 2016: Trials
Ramesh Kumar, Frederic W B Deleyiannis, Corbett Wilkinson, Brent R O'Neill
OBJECTIVE The authors' goals in this study were to describe a series of dog attacks on children that required neurosurgical consultation and to better understand the pattern of injuries inflicted, the circumstances that place children at risk for attack, and the dog breeds involved. In addition, the authors review the surgical and medical management of these patients. METHODS The authors performed a retrospective review of all children requiring neurosurgical consultation for dog bite at a regional Level 1 pediatric trauma center over a 15-year period...
October 21, 2016: Journal of Neurosurgery. Pediatrics
T A Tomsick, J Carrozzella, L Foster, M D Hill, R von Kummer, M Goyal, A M Demchuk, P Khatri, Y Palesch, J P Broderick, S D Yeatts, D S Liebeskind
BACKGROUND AND PURPOSE: Uncertainty persists regarding the safety and efficacy of endovascular therapy of M2 occlusions following IV tPA. We reviewed the impact of revascularization on clinical outcomes in 83 patients with M2 occlusions in the Interventional Management of Stroke III trial according to specific M1-M2 segment anatomic features. MATERIALS AND METHODS: Perfusion of any M2 branch distinguished M2-versus-M1 occlusion. Prespecified modified TICI and arterial occlusive lesion revascularization and clinical mRS 0-2 end points at 90 days for endovascular therapy-treated M2 occlusions were analyzed...
October 20, 2016: AJNR. American Journal of Neuroradiology
Sami Al Kasab, Michael J Lynn, Tanya N Turan, Colin P Derdeyn, David Fiorella, Bethany F Lane, L Scott Janis, Marc I Chimowitz
BACKGROUND: An American Heart Association/American Stroke Association (AHA/ASA) writing committee has recently recommended that tissue evidence of cerebral infarction associated with temporary symptoms (CITS) lasting <24 hours should be considered a stroke. We analyzed the impact of considering CITS as equivalent to stroke on the results of the Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis (SAMMPRIS) trial. METHODS: We compared outcomes in the medical (n = 227) and stenting (n = 224) groups in SAMMPRIS using the following primary end point (new components in bold): any stroke, CITS, or death within 30 days after enrollment or within 30 days after a revascularization procedure for the qualifying lesion during follow-up; or ischemic stroke or CITS in the territory of the qualifying artery beyond 30 days...
October 17, 2016: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Andrew J Beamish, Torsten Olbers, Aaron S Kelly, Thomas H Inge
Obesity is a major global health problem, and its multisystem effects are inextricably linked with elevated cardiovascular risk and adverse outcomes. The cardiovascular benefits of reversing obesity in adults are well-established. Compared with other weight-loss strategies, programmes that incorporate bariatric surgery for weight loss are beneficial for sustained BMI reduction. A marked improvement in cardiovascular risk factors, including hypertension, dyslipidaemia, inflammation, and type 2 diabetes mellitus, has been observed after bariatric surgery...
October 20, 2016: Nature Reviews. Cardiology
Michael B Boffa
PURPOSE OF REVIEW: Elevated plasma concentrations of lipoprotein(a) (Lp(a)) are an independent and causal risk factor for cardiovascular diseases including coronary artery disease, ischemic stroke, and calcific aortic valve stenosis. This review summarizes the rationale for Lp(a) lowering and surveys relevant clinical trial data using a variety of agents capable of lowering Lp(a). RECENT FINDINGS: Contemporary guidelines and recommendations outline populations of patients who should be screened for elevated Lp(a) and who might benefit from Lp(a) lowering...
December 2016: Current Atherosclerosis Reports
Sanna L Lahtinen, Janne H Liisanantti, Meri M Poukkanen, Päivi A Laurila
BACKGROUND: Goal-directed fluid management using stroke volume variation (SVV) analysis is not well studied in free flap reconstruction surgery in patients with head and neck cancer. METHODS: Patients operated due to cancer of the head and neck with free flap reconstruction during 2008-2010 and 2012-2014 in Oulu University Hospital were retrospectively evaluated to determine the impact of SVV-guided fluid management on perioperative fluid balance, postoperative complications and hospital length of stay (LOS)...
October 19, 2016: Minerva Anestesiologica
Shannon Kelly, Keith Quirolo, Anne Marsh, Lynne Neumayr, Alicia Garcia, Brian Custer
BACKGROUND: Chronic red blood cell (RBC) transfusion therapy (CTT) is an integral component of the management of severe sickle cell disease (SCD) and can prevent complications, such as stroke. RBC units can be administered via simple transfusion or exchange transfusion, and erythrocytapheresis (automated RBC exchange transfusion [aRBX]), is increasingly used for CTT. Comparisons of simple and aRBX transfusions are limited, and the current scope of aRBX use is not known. STUDY DESIGN AND METHODS: We administered a survey to define current transfusion practices for CTT and performed a review of the erythrocytapheresis literature...
October 19, 2016: Transfusion
Zixiao Li, Chunjuan Wang, Xingquan Zhao, Liping Liu, Chunxue Wang, Hao Li, Haipeng Shen, Li Liang, Janet Bettger, Qing Yang, David Wang, Anxin Wang, Yuesong Pan, Yong Jiang, Xiaomeng Yang, Changqing Zhang, Gregg C Fonarow, Lee H Schwamm, Bo Hu, Eric D Peterson, Ying Xian, Yilong Wang, Yongjun Wang
BACKGROUND AND PURPOSE: Stroke is a leading cause of death in China. Yet the adherence to guideline-recommended ischemic stroke performance metrics in the past decade has been previously shown to be suboptimal. Since then, several nationwide stroke quality management initiatives have been conducted in China. We sought to determine whether adherence had improved since then. METHODS: Data were obtained from the 2 phases of China National Stroke Registries, which included 131 hospitals (12 173 patients with acute ischemic stroke) in China National Stroke Registries phase 1 from 2007 to 2008 versus 219 hospitals (19 604 patients) in China National Stroke Registries phase 2 from 2012 to 2013...
October 6, 2016: Stroke; a Journal of Cerebral Circulation
Petra Rust, Cem Ekmekcioglu
Excessive dietary salt (sodium chloride) intake is associated with an increased risk for hypertension, which in turn is especially a major risk factor for stroke and other cardiovascular pathologies, but also kidney diseases. Besides, high salt intake or preference for salty food is discussed to be positive associated with stomach cancer, and according to recent studies probably also obesity risk. On the other hand a reduction of dietary salt intake leads to a considerable reduction in blood pressure, especially in hypertensive patients but to a lesser extent also in normotensives as several meta-analyses of interventional studies have shown...
October 19, 2016: Advances in Experimental Medicine and Biology
Giovanni Filardo, Gorav Ailawadi, Benjamin D Pollock, Briget da Graca, Danielle M Sass, Teresa K Phan, Debbie E Montenegro, Vinod Thourani, Ralph Damiano
BACKGROUND: New-onset atrial fibrillation (AF) after coronary artery bypass graft surgery (CABG) is associated with increased morbidity and poorer long-term survival. Although many studies show differences in outcome in women versus men after CABG, little is known about the sex-specific incidence and characteristics of post-CABG AF. METHODS AND RESULTS: Overall, 11 236 consecutive patients without preoperative AF underwent isolated CABG from 2002 to 2010 at 4 US academic medical centers and 1 high-volume specialty cardiac hospital...
October 18, 2016: Circulation. Cardiovascular Quality and Outcomes
Sandy Middleton, Chris Levi, Simeon Dale, N Wah Cheung, Elizabeth McInnes, Julie Considine, Catherine D'Este, Dominique A Cadilhac, Jeremy Grimshaw, Richard Gerraty, Louise Craig, Verena Schadewaldt, Patrick McElduff, Mark Fitzgerald, Clare Quinn, Greg Cadigan, Sonia Denisenko, Mark Longworth, Jeanette Ward
BACKGROUND: Internationally recognised evidence-based guidelines recommend appropriate triage of patients with stroke in emergency departments (EDs), administration of tissue plasminogen activator (tPA), and proactive management of fever, hyperglycaemia and swallowing before prompt transfer to a stroke unit to maximise outcomes. We aim to evaluate the effectiveness in EDs of a theory-informed, nurse-initiated, intervention to improve multidisciplinary triage, treatment and transfer (T(3)) of patients with acute stroke to improve 90-day death and dependency...
October 18, 2016: Implementation Science: IS
Steven Swiryn, Michael V Orlov, David G Benditt, John P DiMarco, Donald M Lloyd-Jones, Edward Karst, Fujian Qu, Mara T Slawsky, Melanie Turkel, Albert L Waldo
BACKGROUND: The RATE Registry (Registry of Atrial Tachycardia and Atrial Fibrillation Episodes) is a prospective, outcomes-oriented registry designed to document the prevalence of atrial tachycardia and/or fibrillation (AT/AF) of any duration in patients with pacemakers and implantable cardioverter defibrillators (ICDs) and evaluate associations between rigorously adjudicated AT/AF and predefined clinical events, including stroke. The appropriate clinical response to brief episodes of AT/AF remains unclear...
October 18, 2016: Circulation
Yu Hasegawa, Shokei Kim-Mitsuyama
OBJECTIVE: Although hypertensive patients show significant elevation of blood pressure (BP) in acute phase after cerebral infarction, it is still unknown how it should be managed to carry the best prognosis. To address this issue, we investigated the effect of acute control of elevated BP by bilateral renal denervation (RD) against ischemic stroke in SHRSP rats with 90 minutes transient middle cerebral arterial occlusion (MCAO). DESIGN AND METHOD: Seventy-five male SHRSP rats of 15 weeks of age were assigned to sham-operated (control, n = 15) and MCAO + sham (sham, n = 30), and MCAO + RD (RD, n = 30)...
September 2016: Journal of Hypertension
Sun Uck Kwon, Dalia Wajsbrot, Bum Joon Kim, Ja-Seong Koo, Jong Moo Park, Barrett Jeffers
OBJECTIVE: To evaluate differences in blood pressure variability (BPV) between patients who experience a recurrent (secondary) stroke or transient ischemic attack (TIA) compared with patients who do not have recurrent stroke. DESIGN AND METHOD: Data were extracted from the ALLHAT and ASCOT-BPLA databases. BPV was defined as the within-subject standard deviation of systolic BP measurements across visits from 12-weeks (or 3-months [84 days]) onwards. BPV was analyzed using a generalized linear model with terms for treatment, prior stroke, interaction between treatment group and prior stroke, and baseline systolic BP...
September 2016: Journal of Hypertension
Clive Rosendorff
Many guidelines for the management of hypertension have recommended that the goal of antihypertensive treatment in the elderly (usually specified as 80 years or above) should be less than 150/90 mmHg. SPRINT included subjects 50 years or above, and a substantial proportion of subjects 75 years and older. These are individuals at high risk for adverse cardiovascular events because of high prevalence of hypertension and atherosclerotic disease. The less stringent BP goals have been based on a percieved danger of lowering BP to levels that threaten vital organ pefusion (myocardium, brain, kidney)...
September 2016: Journal of Hypertension
Louise Burrell
The renin-angiotensin system (RAS) plays a major role in the pathogenesis of hypertension, a major risk factor for stroke, coronary events, heart failure and kidney disease. Within the RAS, angiotensin converting enzyme (ACE) converts angiotensin (Ang) I into the vasoconstrictor Ang II, which mediates its effects via the angiotensin type 1 receptor (AT1R). An "alternate" arm of the RAS is now known to exist in which the monocarboxypeptidase ACE2 counterbalances the effects of the classic RAS through degradation of the vasoconstrictor peptide, Ang II, and generation of the vasodilatory peptide, Ang 1-7...
September 2016: Journal of Hypertension
Sunhee Kim, Nam-Kyoo Lim, Jung Hoon Lee, Hyun-Young Park
OBJECTIVE: Hypertension has been discussed as a key role in developing cardiovascular diseases. The stroke incidence is relatively high in South Korea compared to other countries. In our research, we quantified the impact of hypertension by estimating population attributable-risk in the development of stroke. DESIGN AND METHOD: We selected 154,786 people aged over 40 among National Health Insurance Service-National sample cohort who have not diagnosed either stroke or TIA within baseline periods (2002-2005)...
September 2016: Journal of Hypertension
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