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Paciaroni M, Caso V, Romoli M, Becattini C, Salerno A, Rapillo C, Simonnet F, Strambo D, Canavero I, Zedde M, Pascarella R, Sohn SI, Sacco S, Ornello R, Barlinn K, Schoene D, Rahmig J, Mosconi MG, Leone De Magistris I, Alberti A, Venti M, Silvestrelli G, Ciccone A, Padroni M, Laudisi M, Zini A, Gentile L, Kargiotis O, Tsivgoulis G, Tassi R, Guideri F, Acampa M, Masotti L, Grifoni E, Rocco A, Diomedi M, Karapanayiotides T, Engelter ST, Polymeris AA, Zietz A, Bandini F, Caliandro P, Reale G, Moci M, Zauli A, Cappellari M, Emiliani A, Gasparro A, Terruso V, Mannino M, Giorli E, Toni D, Andrighetti M, Falcou A, Palaiodimou L, Ntaios G, Sagris D, Karagkiozi E, Adamou A, Halvatsiotis P, Flomin Y, Scoditti U, Genovese A, Popovic N, Pantoni L, Mele F, Molitierno N, Lochner P, Pezzini A, Del Sette M, Sassos D, Giannopoulos S, Kosmidou M, Ntais E, Lotti EM, Mastrangelo V, Chiti A, Naldi A, Vanacker P, Ferrante M, Volodina V, Mancuso M, Giannini N, Baldini M, Vadikolias K, Kitmeridou S, Saggese CE, Tassinari T, Saia V, Michel P. Anticoagulation in acute ischemic stroke patients with mechanical heart valves: To bridge or not with heparin. The ESTREM study. Eur Stroke J 2023; 8:1030-1040. [PMID: 37452632 PMCID: PMC10683741 DOI: 10.1177/23969873231186863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION The best therapeutic strategy for patients with mechanical heart valves (MHVs) having acute ischemic stroke during treatment with vitamin K antagonists (VKAs) remain unclear. Being so, we compared the outcomes for: (i) full dose heparin along with VKA (bridging therapy group) and (ii) restarting VKA without heparin (nonbridging group). PATIENTS AND METHODS For this multicenter observational cohort study, data on consecutive acute ischemic stroke patients with MHV was retrospectively collected from prospective registries. Propensity score matching (PSM) was adopted to adjust for any treatment allocation confounders. The primary outcome was the composite of stroke, systemic embolism, symptomatic cerebral bleeding, and major extracerebral bleeding at 90 days. RESULTS Overall, 255 out of 603 patients (41.3%) received bridging therapy: 36 (14.1%) had combined outcome, compared with 28 (8.0%) in the nonbridging group (adjusted OR 1.83; 95% CI 1.05-3.18; p = 0.03). Within the bridging group, 13 patients (5.1%) compared to 12 (3.4%) in the nonbridging group had an ischemic outcome (adjusted OR 1.71; 95% CI 0.84-3.47; p = 0.2); major bleedings were recorded in 23 (9.0%) in the bridging group and 16 (4.6%) in the nonbridging group (adjusted OR 1.88; 95% CI 0.95-3.73; p = 0.07). After PSM, 36 (14.2%) of the 254 bridging patients had combined outcome, compared with 23 (9.1%) of 254 patients in the nonbridging group (OR 1.66; 95% CI 0.95-2.85; p = 0.07). CONCLUSION Acute ischemic stroke patients with MHV undergoing bridging therapy had a marginally higher risk of ischemic or hemorrhagic events, compared to nonbridging patients.
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Affiliation(s)
- Maurizio Paciaroni
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Valeria Caso
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Michele Romoli
- Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Cesena, Italy
| | - Cecilia Becattini
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Alexander Salerno
- Stroke Center, Neurology Service,Department of Clinical Neuroscience, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Costanza Rapillo
- Stroke Center, Neurology Service,Department of Clinical Neuroscience, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Stroke Unit, Careggi University Hospital, Florence, Italy
| | - Fanny Simonnet
- Stroke Center, Neurology Service,Department of Clinical Neuroscience, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Davide Strambo
- Stroke Center, Neurology Service,Department of Clinical Neuroscience, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Isabella Canavero
- Emergency Neurology, IRCCS Casimiro Mondino Foundation, Pavia, Italy
- Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico “Carlo Besta,” Milano, Italy
| | - Marialuisa Zedde
- Neurology Unit, AUSL - IRCCS of Reggio Emilia, Reggio Emilia, Italy
| | | | - Sung-Il Sohn
- Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea
| | - Simona Sacco
- Neuroscience Section, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - Raffaele Ornello
- Neuroscience Section, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - Kristian Barlinn
- Department of Neurology, Dresden University Stroke Center, Dresden, Germany
| | - Daniela Schoene
- Department of Neurology, Dresden University Stroke Center, Dresden, Germany
| | - Jan Rahmig
- Department of Neurology, Dresden University Stroke Center, Dresden, Germany
| | - Maria Giulia Mosconi
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | | | - Andrea Alberti
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Michele Venti
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | | | - Alfonso Ciccone
- S.C. di Neurologia e S.S. di Stroke Unit, ASST di Mantova, Mantova, Italy
| | - Marina Padroni
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Michele Laudisi
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Andrea Zini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy
| | - Luana Gentile
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Department of Neurology and Stroke Center, Maggiore Hospital, Bologna, Italy
| | | | - Georgios Tsivgoulis
- Second Department of Neurology, “Attikon” Hospital, National & Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | | | | | | | - Luca Masotti
- Internal Medicine, San Giuseppe Hospital, Empoli, Italy
| | - Elisa Grifoni
- Internal Medicine, San Giuseppe Hospital, Empoli, Italy
| | - Alessandro Rocco
- Stroke Unit, Department of Systems Medicine, University of Tor Vergata, Rome, Italy
| | - Marina Diomedi
- Stroke Unit, Department of Systems Medicine, University of Tor Vergata, Rome, Italy
| | | | - Stefan T Engelter
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
- Neurology and Neurorehabilitation, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
| | - Alexandros A Polymeris
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Annaelle Zietz
- Department of Neurology and Stroke Center, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Fabio Bandini
- Department of Neurology, ASL 3 Genovese, Genova, Italy
| | - Pietro Caliandro
- Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giuseppe Reale
- Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marco Moci
- Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Aurelia Zauli
- Department of Geriatrics, Neurosciences and Orthopedics, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Manuel Cappellari
- Stroke Unit, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Andrea Emiliani
- Stroke Unit, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | | | | | - Elisa Giorli
- Stroke Unit, Department of Neurology, Sant’Andrea Hospital, La Spezia, Italy
| | - Danilo Toni
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Marco Andrighetti
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Anne Falcou
- Stroke Unit – Emergency Department, Policlinico Umberto I, Rome, Italy
| | - Lina Palaiodimou
- Second Department of Neurology, “Attikon” Hospital, National & Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Dimitrios Sagris
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Efstathia Karagkiozi
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Anastasia Adamou
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Panagiotis Halvatsiotis
- Second Department of Internal Medicine-Propaedeutic and Diabetes Center, Medical School, University General Hospital “Attikon,” National and Kapodistrian University of Athens, Greece
| | - Yuriy Flomin
- Stroke and Neurorehabilitation Unit MC ‘Universal Clinic “Oberig” Kyiv, Kyiv, Ukraine
| | - Umberto Scoditti
- Stroke Unit, Emergency Department, University of Parma, Parma, Italy
| | - Antonio Genovese
- Stroke Unit, Emergency Department, University of Parma, Parma, Italy
| | - Nemanja Popovic
- Clinic of Neurology, University Clinical Center of Vòsvodina, University of Novi Sad, Novi Sad, Serbia
| | - Leonardo Pantoni
- Department of Biomedical and Clinical Sciences, University of Milano, Milano, Italy
| | - Francesco Mele
- Department of Biomedical and Clinical Sciences, University of Milano, Milano, Italy
| | - Nicola Molitierno
- Department of Biomedical and Clinical Sciences, University of Milano, Milano, Italy
| | - Piergiorgio Lochner
- Department of Neurology, Saarland University, Medical Center, Homburg, Germany
| | - Alessandro Pezzini
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Brescia, Italy
| | | | - Davide Sassos
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Sotirios Giannopoulos
- Department of Neurology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Maria Kosmidou
- Department of Neurology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Evangelos Ntais
- Department of Neurology, University of Ioannina School of Medicine, Ioannina, Greece
| | | | | | | | - Andrea Naldi
- Neurology Unit, San Giovanni Bosco Hospital, Turin, Italy
| | - Peter Vanacker
- NeuroVascular Center and Stroke Unit Antwerp, Department of Neurology, Antwerp University Hospital, Antwerp, Belgium
- Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Groeninge Hospital, Kortrijk, Belgium
| | - Mario Ferrante
- Operative Research Unit of Neurology, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Vera Volodina
- Municipal Budgetary Healthcare Institution of Novosibirsk, City Clinical Hospital # 1, Novosibirsk (Russia) at the Novosibirsk State Medical University, Novosibirsk, Russia
| | - Michelangelo Mancuso
- Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Pisa, Italy
| | - Nicola Giannini
- Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Pisa, Italy
| | - Marco Baldini
- Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Pisa, Italy
| | - Kostantinos Vadikolias
- Department of Neurology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Sofia Kitmeridou
- Department of Neurology, Democritus University of Thrace, University Hospital of Alexandroupolis, Alexandroupolis, Greece
| | | | - Tiziana Tassinari
- Department of Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure (Savona), Italy
| | - Valentina Saia
- Department of Neurology and Stroke Unit, Santa Corona Hospital, Pietra Ligure (Savona), Italy
| | - Patrik Michel
- Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Cesena, Italy
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Noor H, Verdiales C, Moser M. Protective Effect of Subcutaneous Drains on Wound Infections in Kidney Transplantation. Transplant Proc 2023; 55:2110-2113. [PMID: 37752015 DOI: 10.1016/j.transproceed.2023.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/16/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Wound infections following kidney transplantation are common, with a reported incidence of 5%-19%. In the first few days after surgery, these patients receive extremely high doses of immunosuppression and high volumes of intravenous fluids, and they represent a specific subgroup of surgical patients that may benefit from using prophylactic subcutaneous drains. METHODS We analyzed a nonrandomized series of 112 consecutive kidney transplants between January 2017 and December 2019: those who received a subcutaneous drain in addition to the standard retroperitoneal drain (SQ drain group) vs those with a retroperitoneal drain alone (standard group). RESULTS The SQ drain group had a significantly higher median BMI (31.2 vs 25.8, P < .0001) and a trend towards more patients having diabetes and receiving thymoglobulin on induction. Nonetheless, 1/36 (3%) of patients in the SQ drain group had a documented wound infection requiring packing compared to the standard group 13/73 (17%) (P = .032). When multivariate regression analysis accounted for the potential confounders BMI, thymoglobulin use, and diabetes, the protective effect of the SQ drain was more significant (P = .001). CONCLUSIONS An SQ drain may be a simple and inexpensive method to reduce the rate of wound complications in kidney transplant recipients; prospective studies are warranted.
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Affiliation(s)
- Hifsa Noor
- College of Medicine, University of Saskatchewan, Saskatoon, SK
| | - Carlos Verdiales
- Department of Surgery, University of Saskatchewan, Saskatoon, SK
| | - Michael Moser
- Department of Surgery, University of Saskatchewan, Saskatoon, SK.
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Kolin DA, Landy DC, Watkins A, Fabricant PD, Chalmers BP. The Terms "Multivariate" and "Multivariable" Are Used Incorrectly and Interchangeably in Orthopaedic Publications: Should We Care About the Distinction? J Bone Joint Surg Am 2022; 105:00004623-990000000-00708. [PMID: 36728776 DOI: 10.2106/jbjs.22.00598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
ABSTRACT Orthopaedic surgery research increasingly utilizes statistical models to adjust for confounding, provide additional precision, and describe complex relationships. Traditionally, a statistical model is termed "multivariable" if it examines the relationship between multiple independent variables (e.g., covariables). The term "multivariate" is used to describe statistical models with multiple dependent variables (e.g., outcomes). The precise use of statistical terminology is important for study appraisal and reproducibility. The term "multivariate" is frequently used incorrectly in the orthopaedic literature to describe statistical models with a single dependent variable. In our analysis, we found that the term "multivariate" was used frequently, and in >90% of cases, the term was used to describe models that contain only a single dependent variable. Consistent with our perception, the terms "multivariable" and "multivariate" are not used with optimal precision. Below, we discuss the impact of the misuse of statistical terminology and present suggestions for improving statistical reporting.
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Affiliation(s)
| | | | - Adam Watkins
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania
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Grisic A, Venkatakrishnan K, French J, Khandelwal A. Variable or variate? A conundrum in pharmacometrics exposure-response models. CPT Pharmacometrics Syst Pharmacol 2022; 12:144-147. [PMID: 36537836 PMCID: PMC9931432 DOI: 10.1002/psp4.12905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/15/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022] Open
Abstract
Key elements of scientific writing-consistency and clarity-can be compromised in case of inaccurate use of methodological terms, especially in complex and multidisciplinary scientific fields. Such is the case in reports of pharmacometrics exposure-response analyses with the use of the terms univariate/multivariate and univariable/multivariable. This perspective outlines the issues in the use of these terms, clarifies their definitions, provides examples, and makes recommendations for authors, reviewers, and journals in the fields of clinical pharmacology and pharmacometrics.
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Nagargoje VP, James KS, Muhammad T. Moderation of marital status and living arrangements in the relationship between social participation and life satisfaction among older Indian adults. Sci Rep 2022; 12:20604. [PMID: 36446850 PMCID: PMC9708669 DOI: 10.1038/s41598-022-25202-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 11/28/2022] [Indexed: 12/02/2022] Open
Abstract
Social participation is considered one of the central components of successful and healthy aging. This study aimed to examine the moderating role of marital status and living arrangement with social participation and its association with life satisfaction of older Indian adults. Samples of 31,464 individuals aged ≥ 60 years were extracted from the Longitudinal Ageing Study in India, wave-1. Descriptive statistics, bivariate analysis, and multivariable linear regression were performed for the analysis. The moderation effect of marital status and living arrangements on the relationship between social participation and level of life satisfaction among Indian older adults were also analyzed. Overall, life satisfaction among older men was relatively higher than older women in this study. Older adults' involvement in social participation [β = 0.39, p < 0.05], being in marital union [β = 0.68, p < 0.001] and co-residing either with spouse [β = 1.73, p < 0.001] or with other family members [β = 2.18, p < 0.001] were positively related to their greater life satisfaction. Interaction of social participation with marital status showed that participating in social activities can boost life satisfaction only among married older people. Further, moderation effect of social participation with living arrangements showed that older adults who were not involved in social participation but living with a spouse or any other household members had higher life satisfaction, and again participation in social activities increased their life satisfaction to a greater level. The establishment of social clubs and advocating social policies oriented toward meaningful social connections are highly needed, especially for older Indians living alone or currently not in a marital union, which will help to enhance their overall life satisfaction.
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Affiliation(s)
- Varsha P. Nagargoje
- grid.419349.20000 0001 0613 2600International Institute for Population Sciences (IIPS), Mumbai, 400088 India
| | - K. S. James
- grid.419349.20000 0001 0613 2600International Institute for Population Sciences (IIPS), Mumbai, 400088 India
| | - T. Muhammad
- grid.419349.20000 0001 0613 2600International Institute for Population Sciences (IIPS), Mumbai, 400088 India
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Paciaroni M, Caso V, Agnelli G, Mosconi MG, Giustozzi M, Seiffge DJ, Engelter ST, Lyrer P, Polymeris AA, Kriemler L, Zietz A, Putaala J, Strbian D, Tomppo L, Michel P, Strambo D, Salerno A, Remillard S, Buehrer M, Bavaud O, Vanacker P, Zuurbier S, Yperzeele L, Loos CMJ, Cappellari M, Emiliani A, Zedde M, Abdul-Rahim A, Dawson J, Cronshaw R, Schirinzi E, Del Sette M, Stretz C, Kala N, Reznik M, Schomer A, Grory BM, Jayaraman M, McTaggart R, Yaghi S, Furie KL, Masotti L, Grifoni E, Toni D, Risitano A, Falcou A, Petraglia L, Lotti EM, Padroni M, Pavolucci L, Lochner P, Silvestrelli G, Ciccone A, Alberti A, Venti M, Traballi L, Urbini C, Kargiotis O, Rocco A, Diomedi M, Marcheselli S, Caliandro P, Zauli A, Reale G, Antonenko K, Rota E, Tassinari T, Saia V, Palmerini F, Aridon P, Arnao V, Monaco S, Cottone S, Baldi A, D'Amore C, Ageno W, Pegoraro S, Ntaios G, Sagris D, Giannopoulos S, Kosmidou M, Ntais E, Romoli M, Pantoni L, Rosa S, Bertora P, Chiti A, Canavero I, Saggese CE, Plocco M, Giorli E, Palaiodimou L, Bakola E, Tsivgoulis G, Bandini F, Gasparro A, Terruso V, Mannino M, Pezzini A, Ornello R, Sacco S, Popovic N, Scoditti U, Genovese A, Denti L, Flomin Y, Mancuso M, Ferrari E, Caselli MC, Ulivi L, Giannini N, De Marchis GM. Recurrent Ischemic Stroke and Bleeding in Patients With Atrial Fibrillation Who Suffered an Acute Stroke While on Treatment With Nonvitamin K Antagonist Oral Anticoagulants: The RENO-EXTEND Study. Stroke 2022; 53:2620-2627. [PMID: 35543133 DOI: 10.1161/strokeaha.121.038239] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In patients with atrial fibrillation who suffered an ischemic stroke while on treatment with nonvitamin K antagonist oral anticoagulants, rates and determinants of recurrent ischemic events and major bleedings remain uncertain. METHODS This prospective multicenter observational study aimed to estimate the rates of ischemic and bleeding events and their determinants in the follow-up of consecutive patients with atrial fibrillation who suffered an acute cerebrovascular ischemic event while on nonvitamin K antagonist oral anticoagulant treatment. Afterwards, we compared the estimated risks of ischemic and bleeding events between the patients in whom anticoagulant therapy was changed to those who continued the original treatment. RESULTS After a mean follow-up time of 15.0±10.9 months, 192 out of 1240 patients (15.5%) had 207 ischemic or bleeding events corresponding to an annual rate of 13.4%. Among the events, 111 were ischemic strokes, 15 systemic embolisms, 24 intracranial bleedings, and 57 major extracranial bleedings. Predictive factors of recurrent ischemic events (strokes and systemic embolisms) included CHA2DS2-VASc score after the index event (odds ratio [OR], 1.2 [95% CI, 1.0-1.3] for each point increase; P=0.05) and hypertension (OR, 2.3 [95% CI, 1.0-5.1]; P=0.04). Predictive factors of bleeding events (intracranial and major extracranial bleedings) included age (OR, 1.1 [95% CI, 1.0-1.2] for each year increase; P=0.002), history of major bleeding (OR, 6.9 [95% CI, 3.4-14.2]; P=0.0001) and the concomitant administration of an antiplatelet agent (OR, 2.8 [95% CI, 1.4-5.5]; P=0.003). Rates of ischemic and bleeding events were no different in patients who changed or not changed the original nonvitamin K antagonist oral anticoagulants treatment (OR, 1.2 [95% CI, 0.8-1.7]). CONCLUSIONS Patients suffering a stroke despite being on nonvitamin K antagonist oral anticoagulant therapy are at high risk of recurrent ischemic stroke and bleeding. In these patients, further research is needed to improve secondary prevention by investigating the mechanisms of recurrent ischemic stroke and bleeding.
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Affiliation(s)
- Maurizio Paciaroni
- Neurology, Stroke Unit, IRCCS MultiMedica, Milano, Italy (M. Paciaroni).,Stroke Unit, Division of Cardiovascular Medicine, University of Perugia, Italy (M. Paciaroni, V.C., G.A., M.G.M., M.G., A.A., M.V., L.T., C.U.)
| | - Valeria Caso
- Stroke Unit, Division of Cardiovascular Medicine, University of Perugia, Italy (M. Paciaroni, V.C., G.A., M.G.M., M.G., A.A., M.V., L.T., C.U.)
| | - Giancarlo Agnelli
- Stroke Unit, Division of Cardiovascular Medicine, University of Perugia, Italy (M. Paciaroni, V.C., G.A., M.G.M., M.G., A.A., M.V., L.T., C.U.)
| | - Maria Giulia Mosconi
- Stroke Unit, Division of Cardiovascular Medicine, University of Perugia, Italy (M. Paciaroni, V.C., G.A., M.G.M., M.G., A.A., M.V., L.T., C.U.)
| | - Michela Giustozzi
- Stroke Unit, Division of Cardiovascular Medicine, University of Perugia, Italy (M. Paciaroni, V.C., G.A., M.G.M., M.G., A.A., M.V., L.T., C.U.)
| | - David Julian Seiffge
- Department of Neurology, Stroke Center, University Hospital Basel, University of Basel, Switzerland (D.J.S., S.T.E., P. Lyrer, A.A.P., L.K., A. Zietz, G.M.D.M.).,Department of Neurology, Inselspital University Hospital, University of Bern, Switzerland (D.J.S.)
| | - Stefan T Engelter
- Department of Neurology, Stroke Center, University Hospital Basel, University of Basel, Switzerland (D.J.S., S.T.E., P. Lyrer, A.A.P., L.K., A. Zietz, G.M.D.M.)
| | - Philippe Lyrer
- Department of Neurology, Stroke Center, University Hospital Basel, University of Basel, Switzerland (D.J.S., S.T.E., P. Lyrer, A.A.P., L.K., A. Zietz, G.M.D.M.)
| | - Alexandros A Polymeris
- Department of Neurology, Stroke Center, University Hospital Basel, University of Basel, Switzerland (D.J.S., S.T.E., P. Lyrer, A.A.P., L.K., A. Zietz, G.M.D.M.)
| | - Lilian Kriemler
- Department of Neurology, Stroke Center, University Hospital Basel, University of Basel, Switzerland (D.J.S., S.T.E., P. Lyrer, A.A.P., L.K., A. Zietz, G.M.D.M.)
| | - Annaelle Zietz
- Department of Neurology, Stroke Center, University Hospital Basel, University of Basel, Switzerland (D.J.S., S.T.E., P. Lyrer, A.A.P., L.K., A. Zietz, G.M.D.M.)
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital and Neurosciences University of Helsinki, Finland (J.P., D. Strbian, L.T.)
| | - Daniel Strbian
- Department of Neurology, Helsinki University Hospital and Neurosciences University of Helsinki, Finland (J.P., D. Strbian, L.T.)
| | - Liisa Tomppo
- Department of Neurology, Helsinki University Hospital and Neurosciences University of Helsinki, Finland (J.P., D. Strbian, L.T.)
| | - Patrik Michel
- Stroke Center, Neurology Service, Department of Clinical Neuroscience, Lausanne University Hospital, University of Lausanne, Switzerland (P.M., D. Strambo, A. Salerno, S.R., M.B., O.B.)
| | - Davide Strambo
- Stroke Center, Neurology Service, Department of Clinical Neuroscience, Lausanne University Hospital, University of Lausanne, Switzerland (P.M., D. Strambo, A. Salerno, S.R., M.B., O.B.)
| | - Alexander Salerno
- Stroke Center, Neurology Service, Department of Clinical Neuroscience, Lausanne University Hospital, University of Lausanne, Switzerland (P.M., D. Strambo, A. Salerno, S.R., M.B., O.B.)
| | - Suzette Remillard
- Stroke Center, Neurology Service, Department of Clinical Neuroscience, Lausanne University Hospital, University of Lausanne, Switzerland (P.M., D. Strambo, A. Salerno, S.R., M.B., O.B.)
| | - Manuela Buehrer
- Stroke Center, Neurology Service, Department of Clinical Neuroscience, Lausanne University Hospital, University of Lausanne, Switzerland (P.M., D. Strambo, A. Salerno, S.R., M.B., O.B.)
| | - Odessa Bavaud
- Stroke Center, Neurology Service, Department of Clinical Neuroscience, Lausanne University Hospital, University of Lausanne, Switzerland (P.M., D. Strambo, A. Salerno, S.R., M.B., O.B.)
| | - Peter Vanacker
- NeuroVascular Center, Stroke Unit Antwerp, Department of Neurology, Antwerp University Hospital, Belgium (P.V., S.Z., L.Y., C.M.J.L.).,Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium (P.V., S.Z., L.Y., C.M.J.L.).,Groeninge Hospital, Kortrijk, Belgium (P.V.)
| | - Susanna Zuurbier
- NeuroVascular Center, Stroke Unit Antwerp, Department of Neurology, Antwerp University Hospital, Belgium (P.V., S.Z., L.Y., C.M.J.L.).,Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium (P.V., S.Z., L.Y., C.M.J.L.)
| | - Laetitia Yperzeele
- NeuroVascular Center, Stroke Unit Antwerp, Department of Neurology, Antwerp University Hospital, Belgium (P.V., S.Z., L.Y., C.M.J.L.).,Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium (P.V., S.Z., L.Y., C.M.J.L.)
| | - Caroline M J Loos
- NeuroVascular Center, Stroke Unit Antwerp, Department of Neurology, Antwerp University Hospital, Belgium (P.V., S.Z., L.Y., C.M.J.L.).,Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium (P.V., S.Z., L.Y., C.M.J.L.)
| | - Manuel Cappellari
- Stroke Unit, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Verona, Italy (M.C., A.E.)
| | - Andrea Emiliani
- Stroke Unit, DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Verona, Italy (M.C., A.E.)
| | | | - Azmil Abdul-Rahim
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (A.A.-R., J.D., R.C.)
| | - Jesse Dawson
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (A.A.-R., J.D., R.C.)
| | - Robert Cronshaw
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (A.A.-R., J.D., R.C.)
| | - Erika Schirinzi
- Struttura Complessa di Neurologia, Ente Ospedaliero Ospedali Galliera, Genoa, Italy (E.S., M.D.S.)
| | - Massimo Del Sette
- Struttura Complessa di Neurologia, Ente Ospedaliero Ospedali Galliera, Genoa, Italy (E.S., M.D.S.)
| | - Christoph Stretz
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI (C.S., N.K., M. Reznik, A. Schomer, B.M.G., M.J., R.M., S.Y., K.L.F.)
| | - Narendra Kala
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI (C.S., N.K., M. Reznik, A. Schomer, B.M.G., M.J., R.M., S.Y., K.L.F.)
| | - Michael Reznik
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI (C.S., N.K., M. Reznik, A. Schomer, B.M.G., M.J., R.M., S.Y., K.L.F.)
| | - Ashley Schomer
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI (C.S., N.K., M. Reznik, A. Schomer, B.M.G., M.J., R.M., S.Y., K.L.F.)
| | - Brian Mac Grory
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI (C.S., N.K., M. Reznik, A. Schomer, B.M.G., M.J., R.M., S.Y., K.L.F.).,Department of Neurology, Duke University School of Medicine, Durham, NC (B.M.G.)
| | - Mahesh Jayaraman
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI (C.S., N.K., M. Reznik, A. Schomer, B.M.G., M.J., R.M., S.Y., K.L.F.)
| | - Ryan McTaggart
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI (C.S., N.K., M. Reznik, A. Schomer, B.M.G., M.J., R.M., S.Y., K.L.F.)
| | - Shadi Yaghi
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI (C.S., N.K., M. Reznik, A. Schomer, B.M.G., M.J., R.M., S.Y., K.L.F.)
| | - Karen L Furie
- Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI (C.S., N.K., M. Reznik, A. Schomer, B.M.G., M.J., R.M., S.Y., K.L.F.)
| | - Luca Masotti
- Internal Medicine, San Giuseppe Hospital, Empoli, Italy (L.M., E. Grifoni)
| | - Elisa Grifoni
- Internal Medicine, San Giuseppe Hospital, Empoli, Italy (L.M., E. Grifoni)
| | - Danilo Toni
- Department of Human Neurosciences, Sapienza University of Rome, Italy (D.T., A. Risitano, L. Petraglia)
| | - Angela Risitano
- Department of Human Neurosciences, Sapienza University of Rome, Italy (D.T., A. Risitano, L. Petraglia)
| | - Anne Falcou
- Stroke Unit, Emergency Department, Policlinico Umberto I, Rome, Italy (A.F.)
| | - Luca Petraglia
- Department of Human Neurosciences, Sapienza University of Rome, Italy (D.T., A. Risitano, L. Petraglia)
| | - Enrico Maria Lotti
- U.O. Neurologia Presidio Ospedaliero di Ravenna Azienda USL della Romagna, Italy (E.M.L., M. Padroni, L. Pavolucci)
| | - Marina Padroni
- U.O. Neurologia Presidio Ospedaliero di Ravenna Azienda USL della Romagna, Italy (E.M.L., M. Padroni, L. Pavolucci)
| | - Lucia Pavolucci
- U.O. Neurologia Presidio Ospedaliero di Ravenna Azienda USL della Romagna, Italy (E.M.L., M. Padroni, L. Pavolucci)
| | - Piergiorgio Lochner
- Department of Neurology, Saarland University, Medical Center, Homburg, Germany (P. Lochner)
| | - Giorgio Silvestrelli
- S.C. di Neurologia e S.S. di Stroke Unit, ASST di Mantova, Italy (G.S., A. Ciccone)
| | - Alfonso Ciccone
- S.C. di Neurologia e S.S. di Stroke Unit, ASST di Mantova, Italy (G.S., A. Ciccone)
| | - Andrea Alberti
- Stroke Unit, Division of Cardiovascular Medicine, University of Perugia, Italy (M. Paciaroni, V.C., G.A., M.G.M., M.G., A.A., M.V., L.T., C.U.)
| | - Michele Venti
- Stroke Unit, Division of Cardiovascular Medicine, University of Perugia, Italy (M. Paciaroni, V.C., G.A., M.G.M., M.G., A.A., M.V., L.T., C.U.)
| | - Laura Traballi
- Stroke Unit, Division of Cardiovascular Medicine, University of Perugia, Italy (M. Paciaroni, V.C., G.A., M.G.M., M.G., A.A., M.V., L.T., C.U.)
| | - Chiara Urbini
- Stroke Unit, Division of Cardiovascular Medicine, University of Perugia, Italy (M. Paciaroni, V.C., G.A., M.G.M., M.G., A.A., M.V., L.T., C.U.)
| | | | - Alessandro Rocco
- Stroke Unit, Department of Systems Medicine, University of Tor Vergata, Rome, Italy (A. Rocco, M.D.)
| | - Marina Diomedi
- Stroke Unit, Department of Systems Medicine, University of Tor Vergata, Rome, Italy (A. Rocco, M.D.)
| | - Simona Marcheselli
- Humanitas Clinical and Research Center - IRCCS, Rozzano, Milano, Italy (S. Marcheselli)
| | - Pietro Caliandro
- Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy (P.C.)
| | - Aurelia Zauli
- Department of Geriatrics, Neurosciences and Orthopedics, Università Cattolica del Sacro Cuore, Rome, Italy (A. Zauli, G.R.)
| | - Giuseppe Reale
- Department of Geriatrics, Neurosciences and Orthopedics, Università Cattolica del Sacro Cuore, Rome, Italy (A. Zauli, G.R.)
| | - Kateryna Antonenko
- Department of Neurology, Bogomolets National Medical University, Kyiv, Ukraine (K.A.)
| | - Eugenia Rota
- S.C. Neurologia-Stroke Unit, Novi Ligure/Tortona, ASL Alessandria, Italy (E.R.)
| | - Tiziana Tassinari
- Department of Neurology, Stroke Unit, Santa Corona Hospital, Pietra Ligure (Savona), Italy (T.T., V.S.)
| | - Valentina Saia
- Department of Neurology, Stroke Unit, Santa Corona Hospital, Pietra Ligure (Savona), Italy (T.T., V.S.)
| | | | - Paolo Aridon
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Italy (P.A.)
| | - Valentina Arnao
- Neurologia-Stroke Unit ARNAS Civico, Palermo, Italy (V.A., S. Monaco, S.C.)
| | - Serena Monaco
- Neurologia-Stroke Unit ARNAS Civico, Palermo, Italy (V.A., S. Monaco, S.C.)
| | - Salvatore Cottone
- Neurologia-Stroke Unit ARNAS Civico, Palermo, Italy (V.A., S. Monaco, S.C.)
| | - Antonio Baldi
- Stroke Unit, Ospedale di Portogruaro, Venice, Italy (A.B., C.D.)
| | - Cataldo D'Amore
- Stroke Unit, Ospedale di Portogruaro, Venice, Italy (A.B., C.D.)
| | - Walter Ageno
- Department of Medicine, University of Insubria, Ospedale di Circolo, Varese, Italy (W.A., S.P.)
| | - Samuela Pegoraro
- Department of Medicine, University of Insubria, Ospedale di Circolo, Varese, Italy (W.A., S.P.)
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece (G.N., D.S.)
| | - Dimitrios Sagris
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece (G.N., D.S.)
| | - Sotirios Giannopoulos
- Department of Neurology, University of Ioannina School of Medicine, Greece (S.G., M.K., E.N.)
| | - Maria Kosmidou
- Department of Neurology, University of Ioannina School of Medicine, Greece (S.G., M.K., E.N.)
| | - Evangelos Ntais
- Department of Neurology, University of Ioannina School of Medicine, Greece (S.G., M.K., E.N.)
| | - Michele Romoli
- Neurology and Stroke Unit, Department of Neuroscience, Bufalini Hospital, Cesena, Italy (M. Romoli)
| | - Leonardo Pantoni
- L. Sacco' Department of Biomedical and Clinical Sciences, University of Milan, Italy (L. Pantoni, P.B.)
| | - Silvia Rosa
- Neurology Unit, ASST Fatebenefratelli - Sacco, Milan, Italy (S.R.)
| | - Pierluigi Bertora
- L. Sacco' Department of Biomedical and Clinical Sciences, University of Milan, Italy (L. Pantoni, P.B.)
| | - Alberto Chiti
- Neurologia, Ospedale Apuano, Massa Carrara, Italy (A. Chiti)
| | - Isabella Canavero
- Emergency Neurology, IRCCS Casimiro Mondino Foundation, Pavia, Italy (I.C.).,Cerebrovascular Unit, Fondazione IRCCS Istituto Neurologico "Carlo Besta," Milano, Italy (I.C.)
| | - Carlo Emanuele Saggese
- Unità di Terapia Neurovascolare. Ospedale "Fabrizio Spaziani," Frosinone, Italy (C.E.S., M.P.)
| | - Maurizio Plocco
- Unità di Terapia Neurovascolare. Ospedale "Fabrizio Spaziani," Frosinone, Italy (C.E.S., M.P.)
| | - Elisa Giorli
- Stroke Unit, Department of Neurology, Sant'Andrea Hospital, La Spezia, Italy (E. Giorli)
| | - Lina Palaiodimou
- Second Department of Neurology, "Attikon" University Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece (L. Palaiodimou, E.B., G.T.)
| | - Eleni Bakola
- Second Department of Neurology, "Attikon" University Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece (L. Palaiodimou, E.B., G.T.)
| | - Georgios Tsivgoulis
- Second Department of Neurology, "Attikon" University Hospital, National and Kapodistrian University of Athens, School of Medicine, Greece (L. Palaiodimou, E.B., G.T.)
| | - Fabio Bandini
- Department of Neurology, Ospedale San Paolo, Savona, Italy (F.B.)
| | - Antonio Gasparro
- Neurologia, Ospedali Riuniti, Palermo, Italy (A. Gasparro, V.T., M. Mannino)
| | - Valeria Terruso
- Neurologia, Ospedali Riuniti, Palermo, Italy (A. Gasparro, V.T., M. Mannino)
| | - Marina Mannino
- Neurologia, Ospedali Riuniti, Palermo, Italy (A. Gasparro, V.T., M. Mannino)
| | - Alessandro Pezzini
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Italy (A.P.)
| | - Raffaele Ornello
- Neuroscience Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy (R.O., S.S.)
| | - Simona Sacco
- Neuroscience Section, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, Italy (R.O., S.S.)
| | - Nemanja Popovic
- Clinic of Neurology, Clinical Center of Vòsvodina, University of Novi Sad, Serbia (N.P.)
| | - Umberto Scoditti
- Emergency Department, Stroke Unit, University of Parma, Italy. (U.S., A. Genovese)
| | - Antonio Genovese
- Emergency Department, Stroke Unit, University of Parma, Italy. (U.S., A. Genovese)
| | - Licia Denti
- Dipartimento Geriatrico Riabilitativo, Stroke Unit, University of Parma, Italy. (L.D.)
| | - Yuriy Flomin
- Stroke and Neurorehabilitation Unit, MC Universal Clinic 'Oberig' Kyiv, Ukraine (Y.F.)
| | - Michelangelo Mancuso
- Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Italy (M. Mancuso, E.F., M.C.C., L.U., N.G.)
| | - Elena Ferrari
- Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Italy (M. Mancuso, E.F., M.C.C., L.U., N.G.)
| | - Maria Chiara Caselli
- Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Italy (M. Mancuso, E.F., M.C.C., L.U., N.G.)
| | - Leonardo Ulivi
- Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Italy (M. Mancuso, E.F., M.C.C., L.U., N.G.)
| | - Nicola Giannini
- Department of Clinical and Experimental Medicine, Neurological Institute, University of Pisa, Italy (M. Mancuso, E.F., M.C.C., L.U., N.G.)
| | - Gian Marco De Marchis
- Department of Neurology, Stroke Center, University Hospital Basel, University of Basel, Switzerland (D.J.S., S.T.E., P. Lyrer, A.A.P., L.K., A. Zietz, G.M.D.M.)
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Wei C, Liu J, Guo W, Jin Y, Song Q, Wang Y, Ye C, Li J, Zhang S, Liu M. Development and Validation of a Predictive Model for Spontaneous Hemorrhagic Transformation After Ischemic Stroke. Front Neurol 2021; 12:747026. [PMID: 34867730 PMCID: PMC8634397 DOI: 10.3389/fneur.2021.747026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/30/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Hemorrhagic transformation (HT) after reperfusion therapy for acute ischemic stroke (AIS) has been well studied; however, there is scarce research focusing on spontaneous HT (sHT). Spontaneous HT is no less important with a relatively high incidence and could be associated with neurological worsening. We aimed to develop and validate a simple and practical model to predict sHT after AIS (SHAIS) and compared the predictive value of the SHAIS score against the models of post-Reperfusion HT for sHT. Methods: Patients with AIS admitted within 24 h of onset were prospectively screened to develop and validate the SHAIS score. The primary outcome was sHT during hospitalization (within 30 days after onset), and the secondary outcomes were symptomatic sHT and parenchymal hematoma (PH). Clinical information, laboratory, and neuroimaging data were screened to construct the SHAIS score. We selected six commonly used scales for predicting HT after reperfusion therapy and compared their predictive ability for sHT with the SHAIS score using Delong's test. Results: The derivation cohort included 539 patients (mean age, 68.1 years; men, 61.4%), of whom 91 (16.9%) patients developed sHT with 25.3% (23/91) being symptomatic sHT and 62.6% (57/91) being PH. Five variables (atrial fibrillation, NIHSS score ≥ 10, hypodensity > 1/3 of middle cerebral artery territory, hyperdense artery sign, and anterior circulation infarction) composed the SHAIS score, which ranged from 0 to 11 points. The area under the receiver-operating characteristic curve (AUC) was 0.86 (95% CI 0.82–0.91, p < 0.001) for the overall sHT, 0.85 (95% CI 0.76–0.92, p < 0.001) for symptomatic sHT, and 0.89 (95% CI 0.85–0.94, p < 0.001) for PH. No evidence of miscalibration of the SHAIS score was found to predict the overall sHT (p = 0.19), symptomatic sHT (p = 0.44), and PH (p = 0.22). The internal (n = 245) and external validation cohorts (n = 200) depicted similar predictive performance compared to the derivation cohort. The SHAIS score had a higher AUC to predict sHT than any of the six pre-Existing models (p < 0.05). Conclusions: The SHAIS score provides an easy-to-use model to predict sHT, which could help providers with decision-making about treatments with high bleeding risk, and to counsel patients and families on the baseline risk of HT, aligning expectations with probable outcomes.
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Affiliation(s)
- Chenchen Wei
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.,Department of Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Junfeng Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Wen Guo
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuxi Jin
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Quhong Song
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yanan Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Chen Ye
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Li
- Department of Neurology, The First People's Hospital of Ziyang, Ziyang, China
| | - Shanshan Zhang
- Department of Neurology, Mianyang Central Hospital, Mianyang, China
| | - Ming Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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9
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Paciaroni M, Bandini F, Agnelli G, Tsivgoulis G, Yaghi S, Furie KL, Tadi P, Becattini C, Zedde M, Abdul-Rahim AH, Lees KR, Alberti A, Venti M, Acciarresi M, D'Amore C, Mosconi MG, Cimini LA, Altavilla R, Volpi G, Bovi P, Carletti M, Rigatelli A, Cappellari M, Putaala J, Tomppo L, Tatlisumak T, Marcheselli S, Pezzini A, Poli L, Padovani A, Masotti L, Vannucchi V, Sohn SI, Lorenzini G, Tassi R, Guideri F, Acampa M, Martini G, Ntaios G, Athanasakis G, Makaritsis K, Karagkiozi E, Vadikolias K, Liantinioti C, Chondrogianni M, Mumoli N, Consoli D, Galati F, Sacco S, Carolei A, Tiseo C, Corea F, Ageno W, Bellesini M, Colombo G, Silvestrelli G, Ciccone A, Lanari A, Scoditti U, Denti L, Mancuso M, Maccarrone M, Ulivi L, Orlandi G, Giannini N, Gialdini G, Tassinari T, De Lodovici ML, Bono G, Rueckert C, Baldi A, D'Anna S, Toni D, Letteri F, Giuntini M, Lotti EM, Flomin Y, Pieroni A, Kargiotis O, Karapanayiotides T, Monaco S, Maimone Baronello M, Csiba L, Szabó L, Chiti A, Giorli E, Del Sette M, Imberti D, Zabzuni D, Doronin B, Volodina V, Michel P, Vanacker P, Barlinn K, Pallesen LP, Barlinn J, Deleu D, Melikyan G, Ibrahim F, Akhtar N, Gourbali V, Caso V. Hemorrhagic Transformation in Patients With Acute Ischemic Stroke and Atrial Fibrillation: Time to Initiation of Oral Anticoagulant Therapy and Outcomes. J Am Heart Assoc 2019; 7:e010133. [PMID: 30571487 PMCID: PMC6404429 DOI: 10.1161/jaha.118.010133] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background In patients with acute ischemic stroke and atrial fibrillation, early anticoagulation prevents ischemic recurrence but with the risk of hemorrhagic transformation (HT). The aims of this study were to evaluate in consecutive patients with acute stroke and atrial fibrillation (1) the incidence of early HT, (2) the time to initiation of anticoagulation in patients with HT, (3) the association of HT with ischemic recurrences, and (4) the association of HT with clinical outcome at 90 days. Methods and Results HT was diagnosed by a second brain computed tomographic scan performed 24 to 72 hours after stroke onset. The incidence of ischemic recurrences as well as mortality or disability (modified Rankin Scale scores >2) were evaluated at 90 days. Ischemic recurrences were the composite of ischemic stroke, transient ischemic attack, or systemic embolism. Among the 2183 patients included in the study, 241 (11.0%) had HT. Patients with and without HT initiated anticoagulant therapy after a mean 23.3 and 11.6 days, respectively, from index stroke. At 90 days, 4.6% (95% confidence interval, 2.3–8.0) of the patients with HT had ischemic recurrences compared with 4.9% (95% confidence interval, 4.0–6.0) of those without HT; 53.1% of patients with HT were deceased or disabled compared with 35.8% of those without HT. On multivariable analysis, HT was associated with mortality or disability (odds ratio, 1.71; 95% confidence interval, 1.24–2.35). Conclusions In patients with HT, anticoagulation was initiated about 12 days later than patients without HT. This delay was not associated with increased detection of ischemic recurrence. HT was associated with increased mortality or disability.
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Affiliation(s)
- Maurizio Paciaroni
- 1 Stroke Unit and Division of Cardiovascular Medicine University of Perugia Italy
| | - Fabio Bandini
- 2 Department of Neurology Ospedale San Paolo Savona Italy
| | - Giancarlo Agnelli
- 1 Stroke Unit and Division of Cardiovascular Medicine University of Perugia Italy
| | - Georgios Tsivgoulis
- 3 Department of Neurology University of Tennessee Health Science Center Memphis TN.,4 Second Department of Neurology School of Medicine "Attikon" University Hospital National & Kapodistrian University of Athens Greece
| | - Shadi Yaghi
- 5 Division of Stroke and Cerebrovascular Diseases Department of Neurology The Warren Alpert Medical School of Brown University Providence RI
| | - Karen L Furie
- 5 Division of Stroke and Cerebrovascular Diseases Department of Neurology The Warren Alpert Medical School of Brown University Providence RI
| | - Prasanna Tadi
- 5 Division of Stroke and Cerebrovascular Diseases Department of Neurology The Warren Alpert Medical School of Brown University Providence RI
| | - Cecilia Becattini
- 1 Stroke Unit and Division of Cardiovascular Medicine University of Perugia Italy
| | - Marialuisa Zedde
- 6 Neurology Unit, Stroke Unit Arcispedale Santa Maria Nuova Azienda Unità Sanitaria Locale-IRCCS Reggio Emilia Italy
| | - Azmil H Abdul-Rahim
- 7 Medical School and Institute of Cardiovascular and Medical Sciences University of Glasgow United Kingdom
| | - Kennedy R Lees
- 7 Medical School and Institute of Cardiovascular and Medical Sciences University of Glasgow United Kingdom
| | - Andrea Alberti
- 1 Stroke Unit and Division of Cardiovascular Medicine University of Perugia Italy
| | - Michele Venti
- 1 Stroke Unit and Division of Cardiovascular Medicine University of Perugia Italy
| | - Monica Acciarresi
- 1 Stroke Unit and Division of Cardiovascular Medicine University of Perugia Italy
| | - Cataldo D'Amore
- 1 Stroke Unit and Division of Cardiovascular Medicine University of Perugia Italy
| | - Maria Giulia Mosconi
- 1 Stroke Unit and Division of Cardiovascular Medicine University of Perugia Italy
| | - Ludovica Anna Cimini
- 1 Stroke Unit and Division of Cardiovascular Medicine University of Perugia Italy
| | - Riccardo Altavilla
- 1 Stroke Unit and Division of Cardiovascular Medicine University of Perugia Italy
| | - Giacomo Volpi
- 1 Stroke Unit and Division of Cardiovascular Medicine University of Perugia Italy
| | - Paolo Bovi
- 8 SSO Stroke Unit, UO Neurologia DAI di Neuroscienze AOUI Verona Italy
| | - Monica Carletti
- 8 SSO Stroke Unit, UO Neurologia DAI di Neuroscienze AOUI Verona Italy
| | - Alberto Rigatelli
- 8 SSO Stroke Unit, UO Neurologia DAI di Neuroscienze AOUI Verona Italy
| | - Manuel Cappellari
- 8 SSO Stroke Unit, UO Neurologia DAI di Neuroscienze AOUI Verona Italy
| | - Jukka Putaala
- 9 Department of Neurology Helsinki University Central Hospital Helsinki Finland
| | - Liisa Tomppo
- 9 Department of Neurology Helsinki University Central Hospital Helsinki Finland
| | - Turgut Tatlisumak
- 9 Department of Neurology Helsinki University Central Hospital Helsinki Finland.,10 Department of Clinical Neuroscience Institute of Neuroscience and Physiology Sahlgrenska Academy at University of Gothenburg Sweden.,11 Department of Neurology Sahlgrenska University Hospital Gothenburg Sweden
| | - Simona Marcheselli
- 12 Neurologia d'urgenza e Stroke Unit Istituto Clinico Humanitas Milano Italy
| | - Alessandro Pezzini
- 13 Department of Clinical and Experimental Sciences Neurology Unit University of Brescia Italy
| | - Loris Poli
- 13 Department of Clinical and Experimental Sciences Neurology Unit University of Brescia Italy
| | - Alessandro Padovani
- 13 Department of Clinical and Experimental Sciences Neurology Unit University of Brescia Italy
| | - Luca Masotti
- 14 Internal Medicine Santa Maria Nuova Hospital Firenze Italy
| | - Vieri Vannucchi
- 14 Internal Medicine Santa Maria Nuova Hospital Firenze Italy
| | - Sung-Il Sohn
- 15 Department of Neurology Keimyung University School of Medicine Daegu South Korea
| | - Gianni Lorenzini
- 16 SC Medicina e Chirurgia d'Accettazione e d'Urgenza Ospedale Lotti Pontedera Azienda USL Toscana Nordovest Pontedera Italy
| | | | | | | | | | - George Ntaios
- 18 Department of Medicine University of Thessaly Larissa Greece
| | | | | | | | - Konstantinos Vadikolias
- 19 Department of Neurology Democritus University of Thrace University Hospital of Alexandroupolis Greece
| | - Chrissoula Liantinioti
- 4 Second Department of Neurology School of Medicine "Attikon" University Hospital National & Kapodistrian University of Athens Greece
| | - Maria Chondrogianni
- 4 Second Department of Neurology School of Medicine "Attikon" University Hospital National & Kapodistrian University of Athens Greece
| | - Nicola Mumoli
- 20 Department of Internal Medicine Ospedale Civile di Livorno Italy
| | | | - Franco Galati
- 21 Stroke Unit Jazzolino Hospital Vibo Valentia Italy
| | - Simona Sacco
- 22 Department of Neurology Avezzano Hospital University of L'Aquila Avezzano Italy
| | - Antonio Carolei
- 22 Department of Neurology Avezzano Hospital University of L'Aquila Avezzano Italy
| | - Cindy Tiseo
- 22 Department of Neurology Avezzano Hospital University of L'Aquila Avezzano Italy
| | - Francesco Corea
- 23 UO Gravi Cerebrolesioni San Giovanni Battista Hospital Foligno Italy
| | - Walter Ageno
- 24 Department of Internal Medicine Insubria University Varese Italy
| | - Marta Bellesini
- 24 Department of Internal Medicine Insubria University Varese Italy
| | - Giovanna Colombo
- 24 Department of Internal Medicine Insubria University Varese Italy
| | | | - Alfonso Ciccone
- 26 S.C. di Neurologia e S.S. di Stroke Unit ASST di Mantova Italy
| | - Alessia Lanari
- 26 S.C. di Neurologia e S.S. di Stroke Unit ASST di Mantova Italy
| | - Umberto Scoditti
- 27 Stroke Unit Neuroscience Department University of Parma Italy
| | - Licia Denti
- 28 Stroke Unit Dipartimento Geriatrico Riabilitativo University of Parma Italy
| | | | | | - Leonardo Ulivi
- 29 Clinica Neurologica-Azienda Ospedaliero-Universitaria Pisa Italy
| | - Giovanni Orlandi
- 29 Clinica Neurologica-Azienda Ospedaliero-Universitaria Pisa Italy.,30 Neurologia Ospedale Apuano Massa Carrara Italy
| | - Nicola Giannini
- 29 Clinica Neurologica-Azienda Ospedaliero-Universitaria Pisa Italy
| | - Gino Gialdini
- 29 Clinica Neurologica-Azienda Ospedaliero-Universitaria Pisa Italy
| | - Tiziana Tassinari
- 31 Stroke Unit-Department of Neurology Santa Corona Hospital Pietra Ligure Italy
| | | | - Giorgio Bono
- 25 Stroke Unit, Neurology Insubria University Varese Italy
| | | | | | | | - Danilo Toni
- 34 Department of Neurology and Psychiatry Sapienza University of Rome Italy
| | - Federica Letteri
- 34 Department of Neurology and Psychiatry Sapienza University of Rome Italy
| | | | - Enrico Maria Lotti
- 35 U.O. Neurologia Presidio Ospedaliero di Ravenna Azienda USL della Romagna Italy
| | - Yuriy Flomin
- 36 Stroke and Neurorehabilitation Unit MC 'Universal Clinic 'Oberig' Kyiv Ukraine
| | - Alessio Pieroni
- 34 Department of Neurology and Psychiatry Sapienza University of Rome Italy
| | | | | | | | | | | | - Lilla Szabó
- 40 Stroke Unit University of Debrecen Hungary
| | - Alberto Chiti
- 29 Clinica Neurologica-Azienda Ospedaliero-Universitaria Pisa Italy.,41 Stroke Unit Department of Neurology Sant'Andrea Hospital La Spezia Italy
| | - Elisa Giorli
- 41 Stroke Unit Department of Neurology Sant'Andrea Hospital La Spezia Italy
| | - Massimo Del Sette
- 41 Stroke Unit Department of Neurology Sant'Andrea Hospital La Spezia Italy.,42 Divisione di Neurologia Ospedale Galliera Genoa Italy
| | - Davide Imberti
- 43 Department of Internal Medicine Ospedale Civile di Piacenza Italy
| | - Dorjan Zabzuni
- 43 Department of Internal Medicine Ospedale Civile di Piacenza Italy
| | - Boris Doronin
- 44 Municipal Budgetary Healthcare Institution of Novosibirsk City Clinical Hospital # 1 Novosibirsk State Medical University Novosibirsk Russia
| | - Vera Volodina
- 44 Municipal Budgetary Healthcare Institution of Novosibirsk City Clinical Hospital # 1 Novosibirsk State Medical University Novosibirsk Russia
| | - Patrik Michel
- 45 Centre Cérébrovasculaire Service de Neurologie Département des Neurosciences Cliniques Centre Hopitalier Universitaire Vaudois Lausanne Switzerland
| | - Peter Vanacker
- 46 Department of Neurology Born Bunge Institute Antwerp University Hospital Antwerp Belgium
| | - Kristian Barlinn
- 47 Department of Neurology Dresden University Stroke Center Dresden Germany
| | | | - Jessica Barlinn
- 47 Department of Neurology Dresden University Stroke Center Dresden Germany
| | - Dirk Deleu
- 48 Neurology, Hamad Medical Corporation Doha Qatar
| | | | | | | | | | - Valeria Caso
- 1 Stroke Unit and Division of Cardiovascular Medicine University of Perugia Italy
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10
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Niu PP, Xu YM. Letter by Niu and Xu Regarding Article, "S100B Serum Elevation Predicts In-Hospital Mortality After Brain Arteriovenous Malformation Rupture". Stroke 2019; 50:e257. [PMID: 31390966 DOI: 10.1161/strokeaha.119.025983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Peng-Peng Niu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, China
| | - Yu-Ming Xu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, China
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11
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da Silveira F, Luis Nedel W. Response to comments. J Crit Care 2019; 51:226. [PMID: 30827824 DOI: 10.1016/j.jcrc.2019.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 02/06/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Fernando da Silveira
- Hospital Nossa Senhora da Conceição, Avenida Francisco Trein, 596, Porto Alegre - RS, Brazil
| | - Wagner Luis Nedel
- Hospital Nossa Senhora da Conceição, Avenida Francisco Trein, 596, Porto Alegre - RS, Brazil.
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12
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Tariq S, d’Esterre CD, Sajobi TT, Smith EE, Longman RS, Frayne R, Coutts SB, Forkert ND, Barber PA. A longitudinal magnetic resonance imaging study of neurodegenerative and small vessel disease, and clinical cognitive trajectories in non demented patients with transient ischemic attack: the PREVENT study. BMC Geriatr 2018; 18:163. [PMID: 30012102 PMCID: PMC6048817 DOI: 10.1186/s12877-018-0858-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 07/09/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Late-life cognitive decline, caused by progressive neuronal loss leading to brain atrophy years before symptoms are detected, is expected to double in Canada over the next two decades. Cognitive impairment in late life is attributed to vascular and lifestyle related risk factors in mid-life in a substantial proportion of cases (50%), thereby providing an opportunity for effective prevention of cognitive decline if incipient disease is detected earlier. Patients presenting with transient ischemic attack (TIA) commonly display some degree of cognitive impairment and are at a 4-fold increased risk of dementia. In the Predementia Neuroimaging of Transient Ischemic Attack (PREVENT) study, we will address what disease processes (i.e., Alzheimer's vs. vascular disease) lead to neurodegeneration, brain atrophy, and cognitive decline, and whether imaging measurements of brain iron accumulation using quantitative susceptibility mapping predicts subsequent brain atrophy and cognitive decline. METHODS A total of 440 subjects will be recruited for this study with 220 healthy subjects and 220 TIA patients. Early Alzheimer's pathology will be determined by cerebrospinal fluid samples (including tau, a marker of neuronal injury, and amyloid β1-42) and by MR measurements of iron accumulation, a marker for Alzheimer's-related neurodegeneration. Small vessel disease will be identified by changes in white matter lesion volume. Predictors of advanced rates of cerebral and hippocampal atrophy at 1 and 3 years will include in vivo Alzheimer's disease pathology markers, and MRI measurements of brain iron accumulation and small vessel disease. Clinical and cognitive function will be assessed annually post-baseline for a period of 5-years using a clinical questionnaire and a battery of neuropsychological tests, respectively. DISCUSSION The PREVENT study expects to demonstrate that TIA patients have increased early progressive rates of cerebral brain atrophy after TIA, before cognitive decline can be clinically detected. By developing and optimizing high-level machine learning models based on clinical data, image-based (quantitative susceptibility mapping, regional brain, and white matter lesion volumes) features, and cerebrospinal fluid biomarkers, PREVENT will provide a timely opportunity to identify individuals at greatest risk of late-life cognitive decline early in the course of disease, supporting future therapeutic strategies for the promotion of healthy aging.
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Affiliation(s)
- Sana Tariq
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, 1403 - 29 Street NW, Calgary, AB Canada
- Seaman Family MR Center, Foothills Medical Centre, 1403 29th Street NW, Calgary, AB Canada
- Hotchkiss Brain Institute, Foothills Medical Center, Room 1A10 Health Research Innovation Center, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
| | - Christopher D. d’Esterre
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, 1403 - 29 Street NW, Calgary, AB Canada
- Hotchkiss Brain Institute, Foothills Medical Center, Room 1A10 Health Research Innovation Center, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
| | - Tolulope T. Sajobi
- Seaman Family MR Center, Foothills Medical Centre, 1403 29th Street NW, Calgary, AB Canada
- Department of Community Health Sciences & O’Brien Institute for Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, AB Canada
| | - Eric E. Smith
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, 1403 - 29 Street NW, Calgary, AB Canada
- Seaman Family MR Center, Foothills Medical Centre, 1403 29th Street NW, Calgary, AB Canada
- Hotchkiss Brain Institute, Foothills Medical Center, Room 1A10 Health Research Innovation Center, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
| | - Richard Stewart Longman
- Hotchkiss Brain Institute, Foothills Medical Center, Room 1A10 Health Research Innovation Center, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
| | - Richard Frayne
- Seaman Family MR Center, Foothills Medical Centre, 1403 29th Street NW, Calgary, AB Canada
- Hotchkiss Brain Institute, Foothills Medical Center, Room 1A10 Health Research Innovation Center, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
- Department of Radiology and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - Shelagh B. Coutts
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, 1403 - 29 Street NW, Calgary, AB Canada
- Seaman Family MR Center, Foothills Medical Centre, 1403 29th Street NW, Calgary, AB Canada
- Department of Community Health Sciences & O’Brien Institute for Public Health, University of Calgary, 3280 Hospital Drive NW, Calgary, AB Canada
- Hotchkiss Brain Institute, Foothills Medical Center, Room 1A10 Health Research Innovation Center, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
| | - Nils D. Forkert
- Seaman Family MR Center, Foothills Medical Centre, 1403 29th Street NW, Calgary, AB Canada
- Hotchkiss Brain Institute, Foothills Medical Center, Room 1A10 Health Research Innovation Center, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
- Department of Radiology and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - Philip A. Barber
- Calgary Stroke Program, Department of Clinical Neurosciences, Foothills Medical Centre, 1403 - 29 Street NW, Calgary, AB Canada
- Seaman Family MR Center, Foothills Medical Centre, 1403 29th Street NW, Calgary, AB Canada
- Hotchkiss Brain Institute, Foothills Medical Center, Room 1A10 Health Research Innovation Center, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
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13
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Paciaroni M, Agnelli G, Falocci N, Tsivgoulis G, Vadikolias K, Liantinioti C, Chondrogianni M, Bovi P, Carletti M, Cappellari M, Zedde M, Ntaios G, Karagkiozi E, Athanasakis G, Makaritsis K, Silvestrelli G, Lanari A, Ciccone A, Putaala J, Tomppo L, Tatlisumak T, Abdul-Rahim AH, Lees KR, Alberti A, Venti M, Acciarresi M, D'Amore C, Becattini C, Mosconi MG, Cimini LA, Soloperto R, Masotti L, Vannucchi V, Lorenzini G, Tassi R, Guideri F, Acampa M, Martini G, Sohn SI, Marcheselli S, Mumoli N, De Lodovici ML, Bono G, Furie KL, Tadi P, Yaghi S, Toni D, Letteri F, Tassinari T, Kargiotis O, Lotti EM, Flomin Y, Mancuso M, Maccarrone M, Giannini N, Bandini F, Pezzini A, Poli L, Padovani A, Scoditti U, Denti L, Consoli D, Galati F, Sacco S, Carolei A, Tiseo C, Gourbali V, Orlandi G, Giuntini M, Chiti A, Giorli E, Gialdini G, Corea F, Ageno W, Bellesini M, Colombo G, Monaco S, Maimone Baronello M, Karapanayiotides T, Caso V. Early Recurrence and Major Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation Treated With Non-Vitamin-K Oral Anticoagulants (RAF-NOACs) Study. J Am Heart Assoc 2017; 6:JAHA.117.007034. [PMID: 29220330 PMCID: PMC5779022 DOI: 10.1161/jaha.117.007034] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The optimal timing to administer non-vitamin K oral anticoagulants (NOACs) in patients with acute ischemic stroke and atrial fibrillation is unclear. This prospective observational multicenter study evaluated the rates of early recurrence and major bleeding (within 90 days) and their timing in patients with acute ischemic stroke and atrial fibrillation who received NOACs for secondary prevention. METHODS AND RESULTS Recurrence was defined as the composite of ischemic stroke, transient ischemic attack, and symptomatic systemic embolism, and major bleeding was defined as symptomatic cerebral and major extracranial bleeding. For the analysis, 1127 patients were eligible: 381 (33.8%) were treated with dabigatran, 366 (32.5%) with rivaroxaban, and 380 (33.7%) with apixaban. Patients who received dabigatran were younger and had lower admission National Institutes of Health Stroke Scale score and less commonly had a CHA2DS2-VASc score >4 and less reduced renal function. Thirty-two patients (2.8%) had early recurrence, and 27 (2.4%) had major bleeding. The rates of early recurrence and major bleeding were, respectively, 1.8% and 0.5% in patients receiving dabigatran, 1.6% and 2.5% in those receiving rivaroxaban, and 4.0% and 2.9% in those receiving apixaban. Patients who initiated NOACs within 2 days after acute stroke had a composite rate of recurrence and major bleeding of 12.4%; composite rates were 2.1% for those who initiated NOACs between 3 and 14 days and 9.1% for those who initiated >14 days after acute stroke. CONCLUSIONS In patients with acute ischemic stroke and atrial fibrillation, treatment with NOACs was associated with a combined 5% rate of ischemic embolic recurrence and severe bleeding within 90 days.
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Affiliation(s)
- Maurizio Paciaroni
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy
| | - Giancarlo Agnelli
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy
| | - Nicola Falocci
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy
| | - Georgios Tsivgoulis
- Second Department of Neurology, National & Kapodistrian University of Athens School of Medicine, "Attikon" University Hospital, Athens, Greece
| | - Kostantinos Vadikolias
- Department of Neurology, Democritus University of Thrace University Hospital of Alexandroupolis, Greece
| | - Chrysoula Liantinioti
- Second Department of Neurology, National & Kapodistrian University of Athens School of Medicine, "Attikon" University Hospital, Athens, Greece
| | - Maria Chondrogianni
- Second Department of Neurology, National & Kapodistrian University of Athens School of Medicine, "Attikon" University Hospital, Athens, Greece
| | - Paolo Bovi
- SSO Stroke Unit, UO Neurologia, DAI di Neuroscienze, AOUI Verona, Verona, Italy
| | - Monica Carletti
- SSO Stroke Unit, UO Neurologia, DAI di Neuroscienze, AOUI Verona, Verona, Italy
| | - Manuel Cappellari
- SSO Stroke Unit, UO Neurologia, DAI di Neuroscienze, AOUI Verona, Verona, Italy
| | - Marialuisa Zedde
- Neurology Unit, Stroke Unit, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy
| | - George Ntaios
- Department of Medicine, University of Thessaly, Larissa, Greece
| | | | | | | | | | - Alessia Lanari
- S.C. di Neurologia e S.S. di Stroke Unit, ASST di Mantova, Mantova, Italy
| | - Alfonso Ciccone
- S.C. di Neurologia e S.S. di Stroke Unit, ASST di Mantova, Mantova, Italy
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Liisa Tomppo
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Turgut Tatlisumak
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland.,Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Azmil H Abdul-Rahim
- Medical School and Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Kennedy R Lees
- Medical School and Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Andrea Alberti
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy
| | - Michele Venti
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy
| | - Monica Acciarresi
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy
| | - Cataldo D'Amore
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy
| | - Cecilia Becattini
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy
| | - Maria Giulia Mosconi
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy
| | - Ludovica Anna Cimini
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy
| | - Rossana Soloperto
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy
| | - Luca Masotti
- Internal Medicine, Santa Maria Nuova Hospital, Firenze, Italy
| | - Vieri Vannucchi
- Internal Medicine, Santa Maria Nuova Hospital, Firenze, Italy
| | | | | | | | | | | | - Sung-Il Sohn
- Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea
| | - Simona Marcheselli
- Neurologia d'urgenza e Stroke Unit, Istituto Clinico Humanitas, Rozzano Milano, Italy
| | - Nicola Mumoli
- Department of Internal Medicine, Ospedale Civile di Livorno, Livorno, Italy
| | | | - Giorgio Bono
- Stroke Unit, Neurology, Insubria University, Varese, Italy
| | - Karen L Furie
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Prasanna Tadi
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Shadi Yaghi
- Division of Stroke and Cerebrovascular Diseases, Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI
| | - Danilo Toni
- Department of Neurology and Psychiatry, Sapienza University of Rome, Italy
| | - Federica Letteri
- Department of Neurology and Psychiatry, Sapienza University of Rome, Italy
| | - Tiziana Tassinari
- Stroke Unit-Department of Neurology, Santa Corona Hospital, Pietra Ligure (Savona), Italy
| | | | - Enrico Maria Lotti
- U.O. Neurologia Presidio Ospedaliero di Ravenna Azienda USL della Romagna, Ravenna, Italy
| | - Yuriy Flomin
- Stroke and Neurorehabilitation Unit MC 'Universal Clinic 'Oberig', Kyiv, Ukraine
| | | | - Miriam Maccarrone
- Clinica Neurologica - Azienda Ospedaliero-Universitaria, Pisa, Italy
| | - Nicola Giannini
- Clinica Neurologica - Azienda Ospedaliero-Universitaria, Pisa, Italy
| | - Fabio Bandini
- Department of Neurology, Ospedale San Paolo, Savona, Italy
| | - Alessandro Pezzini
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Italy
| | - Loris Poli
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Italy
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, Neurology Unit, University of Brescia, Italy
| | - Umberto Scoditti
- Stroke Unit, Neuroscience Department, University of Parma, Italy
| | - Licia Denti
- Stroke Unit, Dipartimento Geriatrico Riabilitativo, University of Parma, Italy
| | | | - Franco Galati
- Stroke Unit, Jazzolino Hospital, Vibo Valentia, Italy
| | - Simona Sacco
- Department of Neurology, Avezzano Hospital, University of L'Aquila, Italy
| | - Antonio Carolei
- Department of Neurology, Avezzano Hospital, University of L'Aquila, Italy
| | - Cindy Tiseo
- Department of Neurology, Avezzano Hospital, University of L'Aquila, Italy
| | | | | | | | - Alberto Chiti
- Stroke Unit, Department of Neurology, Sant'Andrea Hospital, La Spezia, Italy
| | - Elisa Giorli
- Stroke Unit, Department of Neurology, Sant'Andrea Hospital, La Spezia, Italy
| | - Gino Gialdini
- Stroke Unit, Department of Neurology, Sant'Andrea Hospital, La Spezia, Italy
| | - Francesco Corea
- UO Gravi Cerebrolesioni, San Giovanni Battista Hospital, Foligno, Italy
| | - Walter Ageno
- Department of Internal Medicine, Insubria University, Varese, Italy
| | - Marta Bellesini
- Department of Internal Medicine, Insubria University, Varese, Italy
| | - Giovanna Colombo
- Department of Internal Medicine, Insubria University, Varese, Italy
| | | | | | | | - Valeria Caso
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy
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14
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Ishizuka K, Hoshino T, Ashihara K, Mruyama K, Toi S, Mizuno S, Shirai Y, Hagiwara N, Kitagawa K. Associations of Mitral and Aortic Valve Calcifications with Complex Aortic Atheroma in Patients with Embolic Stroke of Undetermined Source. J Stroke Cerebrovasc Dis 2017; 27:697-702. [PMID: 29174290 DOI: 10.1016/j.jstrokecerebrovasdis.2017.09.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 09/22/2017] [Accepted: 09/29/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND This study investigated the associations of mitral and aortic valve calcification with complex aortic atheroma among patients with embolic stroke of undetermined source. METHODS We included 52 consecutive patients (mean age 58.1 years; 75.0% male) with embolic stroke of undetermined source. Mitral annular calcification, aortic annular calcification, and aortic valve sclerosis were assessed by transthoracic echocardiography. Complex aortic atheroma was assessed by transesophageal echocardiography and was defined as plaque protruding greater than or equal to 4 mm into the lumen or with ulcerated or mobile components. RESULTS Ten patients (19.2%) had complex aortic atheroma. Patients with and without complex aortic atheroma showed significant differences in terms of hypertension (80.0% versus 38.1%, P = .017), dyslipidemia (90.0% versus 31.0%, P <.01), chronic kidney disease (60.0% versus 14.3%, P <.01), previous coronary artery disease (30.0% versus 4.8%, P = .013), prior stroke (40.0% versus 7.1%, P <.01), left atrial dimension (4.0 cm versus 3.6 cm, P = .023), aortic valve sclerosis (80.0% versus 26.2%, P <.01), aortic valve calcification (aortic annular calcification or aortic valve sclerosis) (80.0% versus 26.0%, P <.01), and left-sided valve calcification (mitral annular calcification or aortic annular calcification or aortic valve sclerosis) (80.0% versus 28.6%, P <.01). In multivariate analysis, left-sided valve calcification was independently associated with complex aortic atheroma (odds ratio 4.1, 95% confidence interval 1.3-26.1, P = .049). CONCLUSIONS Mitral or aortic valve calcification detected by transthoracic echocardiography can be a useful marker for predicting complex aortic atheroma in patients with embolic stroke of undetermined source.
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Affiliation(s)
- Kentaro Ishizuka
- Department of Neurology, Tokyo Women's Medical University, Tokyo, Japan.
| | - Takao Hoshino
- Department of Neurology, Tokyo Women's Medical University, Tokyo, Japan; Department of Neurology and Stroke Center, Bichat University Hospital, Paris, France
| | - Kyomi Ashihara
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kenji Mruyama
- Department of Neurology, Tokyo Women's Medical University, Tokyo, Japan
| | - Sono Toi
- Department of Neurology, Tokyo Women's Medical University, Tokyo, Japan
| | - Satoko Mizuno
- Department of Neurology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yuka Shirai
- Department of Neurology, Tokyo Women's Medical University, Tokyo, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women's Medical University, Tokyo, Japan
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Antonenko K, Paciaroni M, Agnelli G, Falocci N, Becattini C, Marcheselli S, Rueckert C, Pezzini A, Poli L, Padovani A, Csiba L, Szabó L, Sohn SI, Tassinari T, Abdul-Rahim AH, Michel P, Cordier M, Vanacker P, Remillard S, Alberti A, Venti M, Acciarresi M, D'Amore C, Scoditti U, Denti L, Orlandi G, Chiti A, Gialdini G, Bovi P, Carletti M, Rigatelli A, Putaala J, Tatlisumak T, Masotti L, Lorenzini G, Tassi R, Guideri F, Martini G, Tsivgoulis G, Vadikolias K, Papageorgiou SG, Corea F, Sette MD, Ageno W, Lodovici MLD, Bono G, Baldi A, D'Anna S, Sacco S, Carolei A, Tiseo C, Imberti D, Zabzuni D, Doronin B, Volodina V, Consoli D, Galati F, Pieroni A, Toni D, Monaco S, Baronello MM, Barlinn K, Pallesen LP, Kepplinger J, Bodechtel U, Gerber J, Deleu D, Melikyan G, Ibrahim F, Akhtar N, Mosconi MG, Lees KR, Caso V. Sex-related differences in risk factors, type of treatment received and outcomes in patients with atrial fibrillation and acute stroke: Results from the RAF-study (Early Recurrence and Cerebral Bleeding in Patients with Acute Ischemic Stroke and Atrial Fibrillation). Eur Stroke J 2017; 2:46-53. [PMID: 30886901 PMCID: PMC6377059 DOI: 10.1177/2396987316679577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 10/25/2016] [Indexed: 11/16/2022] Open
Abstract
Introduction Atrial fibrillation is an independent risk factor of thromboembolism. Women
with atrial fibrillation are at a higher overall risk for stroke compared to
men with atrial fibrillation. The aim of this study was to evaluate for sex
differences in patients with acute stroke and atrial fibrillation, regarding
risk factors, treatments received and outcomes. Methods Data were analyzed from the “Recurrence and Cerebral Bleeding in Patients
with Acute Ischemic Stroke and Atrial Fibrillation” (RAF-study), a
prospective, multicenter, international study including only patients with
acute stroke and atrial fibrillation. Patients were followed up for 90 days.
Disability was measured by the modified Rankin Scale (0–2 favorable outcome,
3–6 unfavorable outcome). Results Of the 1029 patients enrolled, 561 were women (54.5%)
(p < 0.001) and younger (p < 0.001)
compared to men. In patients with known atrial fibrillation, women were less
likely to receive oral anticoagulants before index stroke
(p = 0.026) and were less likely to receive
anticoagulants after stroke (71.3% versus 78.4%, p = 0.01).
There was no observed sex difference regarding the time of starting
anticoagulant therapy between the two groups (6.4 ± 11.7 days for men versus
6.5 ± 12.4 days for women, p = 0.902). Men presented with
more severe strokes at onset (mean NIHSS 9.2 ± 6.9 versus 8.1 ± 7.5,
p < 0.001). Within 90 days, 46 (8.2%) recurrent
ischemic events (stroke/TIA/systemic embolism) and 19 (3.4%) symptomatic
cerebral bleedings were found in women compared to 30 (6.4%) and 18 (3.8%)
in men (p = 0.28 and p = 0.74). At 90
days, 57.7% of women were disabled or deceased, compared to 41.1% of the men
(p < 0.001). Multivariate analysis did not confirm
this significance. Conclusions Women with atrial fibrillation were less likely to receive oral
anticoagulants prior to and after stroke compared to men with atrial
fibrillation, and when stroke occurred, regardless of the fact that in our
study women were younger and with less severe stroke, outcomes did not
differ between the sexes.
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Affiliation(s)
- Kateryna Antonenko
- Department of Neurology, Bogomolets National Medical University, Kyiv, Ukraine
| | - Maurizio Paciaroni
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy
| | - Giancarlo Agnelli
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy
| | - Nicola Falocci
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy
| | - Cecilia Becattini
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy
| | - Simona Marcheselli
- Neurologia d'urgenza e Stroke Unit, Istituto Clinico Humanitas, Rozzano, Milano, Italy
| | | | - Alessandro Pezzini
- Department of Clinical and Experimental Sciences, Neurology Unit, University "Health and Wealth" of Brescia, Italy
| | - Loris Poli
- Department of Clinical and Experimental Sciences, Neurology Unit, University "Health and Wealth" of Brescia, Italy
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, Neurology Unit, University "Health and Wealth" of Brescia, Italy
| | | | - Lilla Szabó
- Stroke Unit, University of Debrecen, Hungary
| | - Sung-Il Sohn
- Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea
| | - Tiziana Tassinari
- Stroke Unit-Department of Neurology, Santa Corona Hospital, Pietra Ligure (Savona), Italy
| | - Azmil H Abdul-Rahim
- Medical School and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Patrik Michel
- Centre Cerebrovasculaire, Service de Neurologie, Department des Neurosciences Cliniques Centre Hopitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Maria Cordier
- Centre Cerebrovasculaire, Service de Neurologie, Department des Neurosciences Cliniques Centre Hopitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Peter Vanacker
- Department of Neurology, Born Bunge Institute, Antwerp University Hospital, Antwerp, Belgium
| | - Suzette Remillard
- Centre Cerebrovasculaire, Service de Neurologie, Department des Neurosciences Cliniques Centre Hopitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Andrea Alberti
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy
| | - Michele Venti
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy
| | - Monica Acciarresi
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy
| | - Cataldo D'Amore
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy
| | - Umberto Scoditti
- Stroke Unit, Neuroscience Department, University of Parma, Italy
| | - Licia Denti
- Stroke Unit, Dipartimento Geriatrico Riabilitativo, University of Parma, Italy
| | - Giovanni Orlandi
- Clinica Neurologica, Azienda Ospedaliero-Universitaria, Pisa, Italy
| | - Alberto Chiti
- Clinica Neurologica, Azienda Ospedaliero-Universitaria, Pisa, Italy
| | - Gino Gialdini
- Clinica Neurologica, Azienda Ospedaliero-Universitaria, Pisa, Italy
| | - Paolo Bovi
- SSO Stroke Unit, UO Neurologia, DAI di Neuroscienze, AOUI Verona, Italy
| | - Monica Carletti
- SSO Stroke Unit, UO Neurologia, DAI di Neuroscienze, AOUI Verona, Italy
| | - Alberto Rigatelli
- SSO Stroke Unit, UO Neurologia, DAI di Neuroscienze, AOUI Verona, Italy
| | - Jukka Putaala
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Turgut Tatlisumak
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.,Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Luca Masotti
- Department of Internal Medicine, Cecina Hospital, Cecina, Livorno, Italy
| | - Gianni Lorenzini
- Department of Internal Medicine, Cecina Hospital, Cecina, Livorno, Italy
| | | | | | | | - Georgios Tsivgoulis
- Department of Neurology, Democritus University of Thrace, University Hospital of Alexandroupolis, Greece.,International Clinic Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic.,Second Department of Neurology, "Attikon" Hospital, University of Athens, School of Medicine, Athens, Greece
| | - Kostantinos Vadikolias
- Department of Neurology, Democritus University of Thrace, University Hospital of Alexandroupolis, Greece
| | - Sokratis G Papageorgiou
- Second Department of Neurology, "Attikon" Hospital, University of Athens, School of Medicine, Athens, Greece
| | - Francesco Corea
- UO Gravi Cerebrolesioni, San Giovanni Battista Hospital, Foligno, Italy
| | - Massimo Del Sette
- Stroke Unit, Department of Neurology, Sant'Andrea Hospital, La Spezia, Italy
| | - Walter Ageno
- Department of Internal Medicine, Insubria University, Varese, Italy
| | | | - Giorgio Bono
- Stroke Unit, Neurology, Insubria University, Varese, Italy
| | - Antonio Baldi
- Stroke Unit, Ospedale di Portogruaro, Portogruaro, Venice, Italy
| | | | - Simona Sacco
- Department of Neurology, University of L'Aquila, Italy
| | | | - Cindy Tiseo
- Department of Neurology, University of L'Aquila, Italy
| | - Davide Imberti
- Department of Internal Medicine, Ospedale Civile di Piacenza, Italy
| | - Dorjan Zabzuni
- Department of Internal Medicine, Ospedale Civile di Piacenza, Italy
| | - Boris Doronin
- Municipal Budgetary Healthcare Institution of Novosibirsk, City Clinical Hospital, Novosibirsk, Russia
| | - Vera Volodina
- Municipal Budgetary Healthcare Institution of Novosibirsk, City Clinical Hospital, Novosibirsk, Russia
| | | | - Franco Galati
- Stroke Unit, Jazzolino Hospital, Vibo Valentia, Italy
| | - Alessio Pieroni
- Department of Neurology and Psychiatry, Sapienza University of Rome, Italy
| | - Danilo Toni
- Department of Neurology and Psychiatry, Sapienza University of Rome, Italy
| | | | | | - Kristian Barlinn
- Department of Neurology, Dresden University Stroke Center, Dresden, Germany
| | | | - Jessica Kepplinger
- Department of Neurology, Dresden University Stroke Center, Dresden, Germany
| | - Ulf Bodechtel
- Department of Neurology, Dresden University Stroke Center, Dresden, Germany
| | - Johannes Gerber
- Department of Neurology, Dresden University Stroke Center, Dresden, Germany
| | - Dirk Deleu
- Neurology, Hamad Medical Corporation, Doha, Qatar
| | | | | | | | - Maria G Mosconi
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy
| | - Kennedy R Lees
- Medical School and Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Valeria Caso
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Italy
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Angeli F, Verdecchia P, Savonitto S, Arraiz G, Zaninotto M, Broccatelli A, Cosma C, De Servi S, Sabino F, Briguori C, Ambrosio G, Cavallini C. Cystatin C and risk of mortality among patients undergoing percutaneous coronary intervention. EUROINTERVENTION 2016; 11:757-64. [PMID: 25136879 DOI: 10.4244/eijy14m08_02] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS We tested the prognostic value of cystatin C in patients with documented coronary artery disease (CAD) who underwent percutaneous coronary artery intervention (PCI). We also tested the hypothesis that the incremental predictive value of cystatin C on all-cause mortality was superior to that of glomerular filtration rate (GFR) by the Modification of Diet in Renal Disease (MDRD) formula. METHODS AND RESULTS Included in the study were 2,757 patients (mean age 63 years, 77% men). Blood samples for cystatin C levels were collected immediately before PCI. During a median follow-up of two years, 114 patients died. In multivariable Cox analyses, after adjustment for several confounders, GFR (p=0.004) and cystatin C concentration (p<0.0001) were independent predictors of all-cause death. Cystatin C predicted all-cause death (c-statistic: 0.794) better than GFR estimate based on creatinine (c-statistic: 0.776, p=0.008 for comparison), and significantly reclassified 15% of patients into categories that reflected their actual likelihood of death more accurately (p=0.005). Adding cystatin C and GFR in the same multivariable survival model, only cystatin C level was a significant predictor of death. CONCLUSIONS This study presents for the first time the incremental predictive value of cystatin C over the creatinine-based MDRD formula on all-cause mortality for CAD patients undergoing PCI.
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Affiliation(s)
- Fabio Angeli
- Azienda Ospedaliera ed Universitaria di Perugia, Perugia, Italy
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17
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Home blood pressure and treatment decisions: caveat emptor. J Hypertens 2016; 34:1494-6. [PMID: 27355997 DOI: 10.1097/hjh.0000000000000999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Angeli F, Cavallini C, Verdecchia P, Morici N, Del Pinto M, Petronio AS, Antonicelli R, Murena E, Bossi I, De Servi S, Savonitto S. A risk score for predicting 1-year mortality in patients ≥75 years of age presenting with non-ST-elevation acute coronary syndrome. Am J Cardiol 2015; 116:208-13. [PMID: 25978978 DOI: 10.1016/j.amjcard.2015.04.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 04/09/2015] [Accepted: 04/09/2015] [Indexed: 11/28/2022]
Abstract
Approximately 1/3 of patients with non-ST-segment elevation (NSTE) acute coronary syndromes (ACS) are ≥75 years of age. Risk stratification in these patients is generally difficult because supporting evidence is scarce. The investigators developed and validated a simple risk prediction score for 1-year mortality in patients ≥75 years of age presenting with NSTE ACS. The derivation cohort was the Italian Elderly ACS trial, which included 313 patients with NSTE ACS aged ≥75 years. A logistic regression model was developed to predict 1-year mortality. The validation cohort was a registry cohort of 332 patients with NSTE ACS meeting the same inclusion criteria as for the Italian Elderly ACS trial but excluded from the trial for any reason. The risk score included 5 statistically significant covariates: previous vascular event, hemoglobin level, estimated glomerular filtration rate, ischemic electrocardiographic changes, and elevated troponin level. The model allowed a maximum score of 6. The score demonstrated a good discriminating power (C statistic = 0.739) and calibration, even among subgroups defined by gender and age. When validated in the registry cohort, the scoring system confirmed a strong association with the risk for all-cause death. Moreover, a score ≥3 (the highest baseline risk group) identified a subset of patients with NSTE ACS most likely to benefit from an invasive approach. In conclusion, the risk for 1-year mortality in patients ≥75 years of age with NSTE ACS is substantial and can be predicted through a score that can be easily derived at the bedside at hospital presentation. The score may help in guiding treatment strategy.
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Affiliation(s)
- Fabio Angeli
- Dipartimento di Cardiologia, Ospedale S. M. Della Misericordia, Perugia, Italy.
| | - Claudio Cavallini
- Dipartimento di Cardiologia, Ospedale S. M. Della Misericordia, Perugia, Italy
| | - Paolo Verdecchia
- Dipartimento di Medicina Interna, Ospedale di Assisi, Assisi, Italy
| | - Nuccia Morici
- Dipartimento cardiotoracovascolare, Ospedale Niguarda Cà Granda, Milano, Italy
| | - Maurizio Del Pinto
- Dipartimento di Cardiologia, Ospedale S. M. Della Misericordia, Perugia, Italy
| | - Anna Sonia Petronio
- Dipartimento cardiotoracovascolare, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | | | - Ernesto Murena
- Dipartimento di Cardiologia, Ospedale S. Maria Delle Grazie, Naples, Italy
| | - Irene Bossi
- Dipartimento cardiotoracovascolare, Ospedale Niguarda Cà Granda, Milano, Italy
| | - Stefano De Servi
- Dipartimento cardiotoracovascolare, IRCCS Policlinico S. Matteo, Pavia, Italy
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19
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Acciarresi M, De Luca P, Caso V, Agnelli G, D'Amore C, Alberti A, Venti M, Paciaroni M. Acute stroke symptoms: do differences exist between sexes? J Stroke Cerebrovasc Dis 2014; 23:2928-2933. [PMID: 25440370 DOI: 10.1016/j.jstrokecerebrovasdis.2014.07.044] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 06/24/2014] [Accepted: 07/20/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Previous studies have reported that women with stroke often present different stroke symptoms than men. The aim of our study was to assess for the relevance of these differences from a large case series. METHODS Consecutive patients admitted to the Stroke Unit at the University of Perugia, with acute stroke or transient ischemic attack between 1 June, 2005, and May 2012, and recorded in Perugia Stroke Registry were prospectively included. Associations between the recorded symptoms and sex were assessed by preliminary cross-tabulations with the Chi-square test or Fisher exact test with Yate correction when appropriate. Multivariable regression analysis was used to identify independent predictors of a single symptom including sex as an independent variable. RESULTS Overall, 1072 men and 811 women were included in this study. Women had a higher average age at onset (75.40 ± 12.90 years in women and 70.14 ± 12.61 years in men) and presented more severe strokes with higher National Institute of Health Stroke Scale scores than men, whereas men were more likely to have a posterior stroke.Regarding symptoms, multivariate analysis revealed correlations between postural instability and male sex and between dysphagia and female sex. CONCLUSIONS We found no differences in the clinical presentation of stroke between the sexes, except that men were more likely to have postural instability and females were more likely to have dysphagia. These findings suggest that stroke locations and stroke severity were associated with sex.
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Affiliation(s)
- Monica Acciarresi
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy.
| | - Pierpaolo De Luca
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Valeria Caso
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Giancarlo Agnelli
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Cataldo D'Amore
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Andrea Alberti
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Michele Venti
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | - Maurizio Paciaroni
- Stroke Unit and Division of Cardiovascular Medicine, University of Perugia, Perugia, Italy
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