1
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Oraby MI, Gomaa R, Abdel-Aal AA, Hussein M. Cerebral microbleeds in acute ischemic stroke after intravenous thrombolysis and their impact on short term outcome of stroke. Int J Neurosci 2024:1-9. [PMID: 39159153 DOI: 10.1080/00207454.2024.2394779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 06/19/2024] [Accepted: 08/16/2024] [Indexed: 08/21/2024]
Abstract
OBJECTIVES Strong evidence suggests the occurrence of cerebral microbleeds (CMBs) in 5-13% of stroke patients within the first week after stroke onset. The aim of this work was to study risk factors associated with occurrence of CMBs in patients with stroke who received intravenous thrombolysis, and to clarify their impact on the clinical outcome. METHODS This prospective observational study was conducted on 61 acute ischemic stroke patients eligible for treatment with recombinant tissue plasminogen activator (rt-PA). Assessment of stroke-related neurologic deficit was done using National Institute of Health Stroke Scale (NIHSS). Assessment of stroke related disability after 3 months from stroke onset was done using Modified Rankin Scale (mRS). CMBs were detected by T2*-weighed gradient-recalled echo (T2*-GRE) and susceptibility-weighted imaging (SWI) magnetic resonance imaging (MRI) sequences. RESULTS There was a statistically significant impact of age, mean arterial pressure (MAP) at stroke onset, history of hypertension (HTN), and white matter changes assessed by Fazekas scale on the occurrence of CMBs in the included stroke patients (P-value= 0.002, <0.001, <0.001, 0.008 respectively). There was no statistically significant difference between patients with favorable and those with unfavorable outcome regarding the total number of CMBs (P-value =0.542). There was also no statistically significant difference between patients who developed complications from rt-PA and those who didn't develop regarding the total number of CMBs (P-value =0.186). CONCLUSION Cerebral microbleeds are more likely to occur in older stroke patients and in those who had high MAP at stroke onset, history of HTN, and white matter changes.
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Affiliation(s)
| | - Rana Gomaa
- Neurology Department, Beni-Suef University, Beni-Suef, Egypt
| | | | - Mona Hussein
- Neurology Department, Beni-Suef University, Beni-Suef, Egypt
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2
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Aziz YN, Khatri P. Intravenous Thrombolysis to Dissolve Acute Stroke Thrombi: Reflections on the Past Decade. Stroke 2024; 55:186-189. [PMID: 38134255 PMCID: PMC11003301 DOI: 10.1161/strokeaha.123.044211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Affiliation(s)
- Yasmin N Aziz
- University of Cincinnati, Department of Neurology and Rehabilitation Medicine, Cincinnati, Ohio
| | - Pooja Khatri
- University of Cincinnati, Department of Neurology and Rehabilitation Medicine, Cincinnati, Ohio
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3
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Sablot D, Leibinger F, Dutray A, Van Damme L, Nguyen Them L, Farouil G, Jebali C, Arquizan C, Ibanez-Julia MJ, Laverdure A, Allou T, Chaabane W, Fadat B, Olivier N, Smadja P, Tardieu M, Lachcar M, Mas J, Ousji A, Jurici S, Mourand I, Ferraro A, Dumitrana A, Bensalah ZM, Damon F, Tincau OA, Valverde D, Mekue-Fotso V, Bonafe A, Ortega L, Gaillard N. Is off-label thrombolysis safe and effective in a real-life primary stroke center? A retrospective analysis of data from a 5-year prospective database. Rev Neurol (Paris) 2022; 178:1079-1089. [PMID: 36336491 DOI: 10.1016/j.neurol.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 07/21/2022] [Accepted: 08/13/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Intravenous thrombolysis (IVT) use for acute ischemic stroke (AIS) varies among countries, partly due to guidelines and product labeling changes. The study aim was to identify the characteristics of patients with AIS treated with off-label IVT and to determine its safety when performed in a primary stroke center (PSC). METHODS This observational, single-center study included all consecutive patients admitted to Perpignan PSC for AIS and treated with IVT and patients transferred for EVT, between January 1, 2015 and December 31, 2019. Data of patients treated with IVT according to ("in-label group") or outside ("off-label") the initial guidelines and manufacturer's product specification were compared. Safety was assessed using symptomatic intracerebral hemorrhage (SIH) as the main adverse event. RESULTS Among the 892 patients in the database (834 screened by MRI, 93.5%), 746 were treated by IVT: 185 (24.8%) "in-label" and 561 (75.2%) "off-label". In the "off-label" group, 316 (42.4% of the cohort) had a single criterion for "off-label" use, 197 (26.4%) had two, and 48 (6.4%) had three or more criteria, without any difference in IVT safety pattern among them. SIH rates were comparable between the "off-label" and "in-label" groups (2.7% vs. 1.1%, P=0.21); early neurological deterioration and systematic adverse event due to IVT treatment were similar in the 2 groups. "Off-label" patients had higher in-hospital (8.7% vs. 3.8%, P=0.05) and 3-month mortality rates (12.1% vs 5.4%, P<0.01), but this is explained by confounding factors as they were older (76 vs 67 years, P<0.0001) and more dependent (median modified Rankin scale score 0.4 vs 0.1, P<0.0001) at admission. CONCLUSIONS "Off-label" thrombolysis for AIS seems to be safe and effective in the routine setting of a primary stroke center.
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Affiliation(s)
- D Sablot
- Neurology Department, Perpignan, France; Regional Health agency of Occitanie, Montpellier, France.
| | | | - A Dutray
- Neurology Department, Perpignan, France
| | | | | | - G Farouil
- Radiology Department, Perpignan, France
| | - C Jebali
- Emergency Department, Perpignan, France
| | - C Arquizan
- Neurology Department, Montpellier, France
| | | | | | - T Allou
- Neurology Department, Perpignan, France
| | | | - B Fadat
- Neurology Department, Perpignan, France
| | - N Olivier
- Neurology Department, Perpignan, France
| | - P Smadja
- Radiology Department, Perpignan, France
| | - M Tardieu
- Radiology Department, Perpignan, France
| | - M Lachcar
- Emergency Department, Perpignan, France
| | - J Mas
- Neurology Department, Perpignan, France
| | - A Ousji
- Emergency Department, Perpignan, France
| | - S Jurici
- Neurology Department, Perpignan, France
| | - I Mourand
- Neurology Department, Montpellier, France
| | - A Ferraro
- Neurology Department, Perpignan, France
| | | | | | - F Damon
- Neurology Department, Perpignan, France; Emergency Department, Perpignan, France
| | | | | | | | - A Bonafe
- Radiology Department, Perpignan, France; Neuroradiology Department, Montpellier, France
| | - L Ortega
- Emergency Department, Perpignan, France
| | - N Gaillard
- Neurology Department, Perpignan, France; Neurology Department, Montpellier, France
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4
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Yu P, Wang Y, Yuan J, Chen J, Lei Y, Han Z, Liu D, Zhao Y, Wang P, Luo F. Observation for the effect of rTMS combined with magnetic stimulation at Neiguan (PC6) and Sanyinjiao (SP6) points on limb function after stroke: A study protocol. Medicine (Baltimore) 2020; 99:e22207. [PMID: 32957353 PMCID: PMC7505310 DOI: 10.1097/md.0000000000022207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Stroke is the primary cause of adult disability in China, which causes serious personal, family, and social burden. "Central peripheral central" closed-loop rehabilitation theory is proved to be an effective neural rehabilitation model. Based on this theory, repetitive transcranial magnetic stimulation (rTMS) combined with magnetic stimulation of Neiguan (PC6) and Sanyinjiao (SP6) may be an effective treatment for limb dysfunction after stroke. However, the efficacy and mechanism of repetitive magnetic stimulation of M1 region combined with magnetic stimulation of Neiguan and Sanyinjiao points on limb dysfunction after stroke has not been confirmed. METHODS/DESIGN This study is a prospective, randomized, controlled, open trial. We randomly divided 42 subjects, aged 35 to 80 years, diagnosed with ischemic stroke within 1 month, into 2 groups with a ratio of 1:1. On the basis of this medical treatment, patients in the experimental group received 1 Hz rTMS in M1 area on the contralateral side, and 3 Hz rTMS treatment at Neiguan point and Sanyinjiao point on the affected side. The control group was treated with acupuncture (body acupuncture). All patients were treated once a day and followed up for 10 days. The National Institute of Health Stroke Scale score, simplified fulg Meyer, modified Barthel index, and cortical excitability were evaluated on the day of enrollment and the 10th day of treatment respectively. The modified Barthe index was followed up on the 30th day of treatment, and the adverse reactions were recorded at any time. The mechanism of rTMS will be revealed by Barthe index before treatment, on the 10th day of treatment and on the 30th day of follow-up. The results were analyzed by spss19.0 software, and the quantitative indexes were analyzed by t test and rank sum test. χ test was used for non-grade counting, and rank sum test was used for grade counting. All statistical tests were performed with bilateral test. If P value is less than or equal to .05, the difference will be considered statistically significant. CONCLUSION The purpose of this study was to determine the effect of repetitive magnetic stimulation of M1 region combined with magnetic stimulation of Neiguan and Sanyinjiao points on limb function after stroke. Through this study, we expect to explore a new scheme for the treatment of poststroke dyskinesia, and prove that compared with rTMS and acupuncture alone, the closed-loop rehabilitation theory based on "center peripheral center" can be more efficient and safe in the treatment of poststroke limb dysfunction. TRIAL REGISTRATION The trial was registered in China clinical trial registry (http://www.chictr.org.cn/index.aspx), ID: ChiCTR1900026890 (October 25, 2019).
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Affiliation(s)
- Penglong Yu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province
| | - Yuan Wang
- Department of Encephalopathy, Shaanxi Provincial Hospital of Traditional Chinese Medicine
- Insomnia Research Center of Shanxi Administration of Traditional Chinese Medicine, Xi’an
- School of Clinical Medical, Shannxi University of Chinese Medicine, Xianyang
| | - Jie Yuan
- Department of Encephalopathy, Shaanxi Provincial Hospital of Traditional Chinese Medicine
- Insomnia Research Center of Shanxi Administration of Traditional Chinese Medicine, Xi’an
- School of Basic Medical Sciences, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jie Chen
- Department of Encephalopathy, Shaanxi Provincial Hospital of Traditional Chinese Medicine
- Insomnia Research Center of Shanxi Administration of Traditional Chinese Medicine, Xi’an
| | - Yaling Lei
- Department of Encephalopathy, Shaanxi Provincial Hospital of Traditional Chinese Medicine
- Insomnia Research Center of Shanxi Administration of Traditional Chinese Medicine, Xi’an
| | - Zucheng Han
- Department of Encephalopathy, Shaanxi Provincial Hospital of Traditional Chinese Medicine
- Insomnia Research Center of Shanxi Administration of Traditional Chinese Medicine, Xi’an
| | - Dongling Liu
- Department of Encephalopathy, Shaanxi Provincial Hospital of Traditional Chinese Medicine
- Insomnia Research Center of Shanxi Administration of Traditional Chinese Medicine, Xi’an
| | - Yuan Zhao
- Department of Encephalopathy, Shaanxi Provincial Hospital of Traditional Chinese Medicine
- Insomnia Research Center of Shanxi Administration of Traditional Chinese Medicine, Xi’an
| | - Pei Wang
- Department of Encephalopathy, Shaanxi Provincial Hospital of Traditional Chinese Medicine
- Insomnia Research Center of Shanxi Administration of Traditional Chinese Medicine, Xi’an
| | - Fan Luo
- Department of Encephalopathy, Shaanxi Provincial Hospital of Traditional Chinese Medicine
- Insomnia Research Center of Shanxi Administration of Traditional Chinese Medicine, Xi’an
- School of Clinical Medical, Shannxi University of Chinese Medicine, Xianyang
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5
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Marko M, Posekany A, Szabo S, Scharer S, Kiechl S, Knoflach M, Serles W, Ferrari J, Lang W, Sommer P, Greisenegger S. Trends of r-tPA (Recombinant Tissue-Type Plasminogen Activator) Treatment and Treatment-Influencing Factors in Acute Ischemic Stroke. Stroke 2020; 51:1240-1247. [PMID: 32114931 DOI: 10.1161/strokeaha.119.027921] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background and Purpose- Frequencies of treatment with r-tPA (recombinant tissue-type plasminogen activator) are increasing over the past 15 years. However, published data on the influence of various demographic and clinical factors on r-tPA treatment as well as estimates of future trajectories are limited. We evaluated time trends and future trajectories of r-tPA treatment in patients with acute stroke and the influence of various factors on r-tPA treatment by analyzing data of 103 970 patients enrolled in the Austrian Stroke Unit Registry from 2006 to 2018, of which 18 953 were treated with r-tPA. Methods- Time trends of r-tPA-treatment were investigated in predefined subgroups (minor/major stroke, age, anterior/posterior circulation stroke); limited exponential time series models were calculated to estimate future trends of r-tPA-treatment. Logistic regression models were calculated to estimate the influence of clinical variables on r-tPA-treatment. Results- Overall, r-tPA treatment frequencies increased from 9.9% in 2006 to 21.8% in 2018. We observed a particular increase in patients >80 years, patients presenting with a National Institutes of Health Stroke Scale Score of 2 to 3, patients with posterior circulation stroke, patients with wake-up stroke, and patients without atrial fibrillation. Forecast of overall r-tPA frequencies predicted a further but flattened increase up to 24% by 2025. Logistic regression of time-dependent associations of clinical variables with r-tPA-treatment revealed increasing odds of r-tPA-treatment in patients with a posterior circulation stroke and decreasing odds of r-tPA-treatment in patients with atrial fibrillation. Conclusions- We observed a positive development of r-tPA-treatment frequencies mirroring increasing confidence with intravenous thrombolysis in clinical practice; however, decreasing odds of r-tPA-treatment over time in patients with atrial fibrillation deserve particular attention.
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Affiliation(s)
- Martha Marko
- From the Department of Neurology, Medical University of Vienna, Austria (M.M., S. Szabo, S. Scharer, W.S., S.G.)
| | - Alexandra Posekany
- Institute of Statistics and Mathematical Methods in Economics, Vienna University of Technology, Austria (A.P.)
| | - Simon Szabo
- From the Department of Neurology, Medical University of Vienna, Austria (M.M., S. Szabo, S. Scharer, W.S., S.G.)
| | - Sebastian Scharer
- From the Department of Neurology, Medical University of Vienna, Austria (M.M., S. Szabo, S. Scharer, W.S., S.G.)
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Austria (S.K., M.K.)
| | - Michael Knoflach
- Department of Neurology, Medical University of Innsbruck, Austria (S.K., M.K.)
| | - Wolfgang Serles
- From the Department of Neurology, Medical University of Vienna, Austria (M.M., S. Szabo, S. Scharer, W.S., S.G.)
| | - Julia Ferrari
- Department of Neurology, Krankenhaus Barmherzige Brüder, Vienna, Austria (J.F., W.L.)
| | - Wilfried Lang
- Department of Neurology, Krankenhaus Barmherzige Brüder, Vienna, Austria (J.F., W.L.)
| | - Peter Sommer
- Department of Neurology, Krankenanstalt Rudolfstiftung Vienna, Austria (P.S.)
| | - Stefan Greisenegger
- From the Department of Neurology, Medical University of Vienna, Austria (M.M., S. Szabo, S. Scharer, W.S., S.G.)
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6
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Keselman B, Gdovinová Z, Jatuzis D, Melo TPE, Vilionskis A, Cavallo R, Frol S, Jurak L, Koyuncu B, Nunes AP, Petrone A, Lees KR, Mazya MV. Safety and Outcomes of Intravenous Thrombolysis in Posterior Versus Anterior Circulation Stroke: Results From the Safe Implementation of Treatments in Stroke Registry and Meta-Analysis. Stroke 2020; 51:876-882. [PMID: 31914885 DOI: 10.1161/strokeaha.119.027071] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- Posterior circulation stroke (PCS) accounts for 5% to 19% of patients with acute stroke receiving intravenous thrombolysis. We aimed to compare safety and outcomes following intravenous thrombolysis between patients with PCS and anterior circulation stroke (ACS) and incorporate the results in a meta-analysis. Methods- We included patients in the Safe Implementation of Treatments in Stroke Thrombolysis Registry 2013 to 2017 with computed tomography/magnetic resonance angiographic occlusion data. Outcomes were parenchymal hematoma, symptomatic intracerebral hemorrhage (SICH) per SITS-MOST (Safe Implementation of Thrombolysis in Stroke Monitoring Study), ECASS II (Second European Co-operative Stroke Study) and NINDS (Neurological Disorders and Stroke definition), 3-month modified Rankin Scale score, and death. Adjustment for SICH risk factors (age, sex, National Institutes of Health Stroke Scale, blood pressure, glucose, and atrial fibrillation) and center was done using inverse probability treatment weighting, after which an average treatment effect (ATE) was calculated. Meta-analysis of 13 studies comparing outcomes in PCS versus ACS after intravenous thrombolysis was conducted. Results- Of 5146 patients, 753 had PCS (14.6%). Patients with PCS had lower median National Institutes of Health Stroke Scale: 7 (interquartile range, 4-13) versus 13 (7-18), P<0.001 and fewer cerebrovascular risk factors. In patients with PCS versus ACS, parenchymal hematoma occurred in 3.2% versus 7.9%, ATE (95% CI): -4.7% (-6.3% to 3.0%); SICH SITS-MOST in 0.6% versus 1.9%, ATE: -1.4% (-2.2% to -0.7%); SICH NINDS in 3.1% versus 7.8%, ATE: -3.0% (-6.3% to 0.3%); SICH ECASS II in 1.8% versus 5.4%, ATE: -2.3% (-5.3% to 0.7%). In PCS versus ACS, 3-month outcomes (70% data availability) were death 18.5% versus 20.5%, ATE: 6.0% (0.7%-11.4%); modified Rankin Scale score 0-1, 45.2% versus 37.5%, ATE: 1.7% (-6.6% to 3.2%); modified Rankin Scale score 0-2, 61.3% versus 49.4%, ATE: 2.4% (3.1%-7.9%). Meta-analysis showed relative risk for SICH in PCS versus ACS being 0.49 (95% CI, 0.32-0.75). Conclusions- The risk of bleeding complications after intravenous thrombolysis in PCS was half that of ACS, with similar functional outcomes and higher risk of death, acknowledging limitations of the National Institutes of Health Stroke Scale for stroke severity or infarct size adjustment.
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Affiliation(s)
- Boris Keselman
- From the Department of Neurology, Karolinska University Hospital, Solna, Sweden (B. Keselman, M.V.M.).,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden (B. Keselman, M.V.M.)
| | - Zuzana Gdovinová
- Department of Neurology, Faculty of Medicine, Pavol Jozef Šafárik University, Košice, Slovak Republic (Z.G.)
| | - Dalius Jatuzis
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Lithuania (D.J., A.V.).,Centre of Neurology, Vilnius University Hospital Santaros Klinikos, Lithuania (D.J.)
| | | | - Aleksandras Vilionskis
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Lithuania (D.J., A.V.).,Department of Neurology, Republican Vilnius University Hospital, Vilnius University, Lithuania (A.V.)
| | - Roberto Cavallo
- Neurology and Stroke Unit, Ospedale San Giovanni Bosco, Torino, Italy (R.C.)
| | - Senta Frol
- Department of Vascular Neurology and Neurological Intensive Care, University Medical Center Ljubljana, Slovenia (S.F.)
| | - Lubomir Jurak
- Neurocentre, Regional Hospital Liberec, Czech Republic (L.J.)
| | - Bahar Koyuncu
- Acute Stroke Center, Memorial Hizmet Hospital, Istanbul, Turkey (B. Koyuncu)
| | - Ana Paiva Nunes
- Stroke Unit, Centro Hospitalar Lisboa Central, Portugal (A.P.N.)
| | | | - Kennedy R Lees
- School of Medicine, Dentistry and Nursing, University of Glasgow, United Kingdom (K.R.L.)
| | - Michael V Mazya
- From the Department of Neurology, Karolinska University Hospital, Solna, Sweden (B. Keselman, M.V.M.).,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden (B. Keselman, M.V.M.)
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7
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Al-Rukn S, Mazya M, Akhtar N, Hashim H, Mansouri B, Faouzi B, Aref H, Abdulrahman H, Kesraoui S, Hentati F, Gebelly S, Ahmed N, Wahlgren N, Abd-Allah F, Almekhlafi M, Moreira T. Stroke in the Middle-East and North Africa: A 2-year prospective observational study of intravenous thrombolysis treatment in the region. Results from the SITS-MENA Registry. Int J Stroke 2019; 15:980-987. [PMID: 31594533 DOI: 10.1177/1747493019874729] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND METHODS Intravenous thrombolysis for acute ischemic stroke in the Middle-East and North African (MENA) countries is still confined to the main urban and university hospitals. This was a prospective observational study to examine outcomes of intravenous thrombolysis-treated stroke patients in the MENA region compared to the non-MENA stroke cohort in the SITS International Registry. RESULTS Of 32,160 patients with ischemic stroke registered using the SITS intravenous thrombolysis protocol between June 2014 and May 2016, 500 (1.6%) were recruited in MENA. Compared to non-MENA (all p < 0.001), median age in MENA was 55 versus 73 years, NIH Stroke Scale score 12 versus 9, onset-to-treatment time 138 versus 155 min and door-to-needle time 54 min versus 64 min. Hypertension was the most reported risk factor, but lower in MENA (51.7 vs. 69.7%). Diabetes was more frequent in MENA (28.5 vs. 20.8%) as well as smoking (20.8 vs. 15.9%). Hyperlipidemia was less observed in MENA (17.6 vs. 29.3%). Functional independence (mRS 0-2) at seven days or discharge was similar (53% vs. 52% in non-MENA), with mortality slightly lower in MENA (2.3% vs. 4.8%). SICH rates by SITS-MOST definition were low (<1.4%) in both groups. CONCLUSIONS Intravenous thrombolysis patients in MENA were younger, had more severe strokes and more often diabetes. Although stroke severity was higher in MENA, short-term functional independency and mortality were not worse compared to non-MENA, which could partly be explained by younger age and shorter OTT in MENA. Decreasing the burden of stroke in this young population should be prioritized.
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Affiliation(s)
- S Al-Rukn
- Department of Neurology, 62743Rashid Hospital - Dubai Health Authority, Dubai, United Arab Emirates
| | - M Mazya
- Department of Neurology, 59562Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neurosciences, 27106Karolinska Institutet, Stockholm, Sweden
| | - N Akhtar
- 62849Hamad General Hospital, Section of Neurology, Doha, Qatar
| | - H Hashim
- Department of Neurology, 62743Rashid Hospital - Dubai Health Authority, Dubai, United Arab Emirates
| | - B Mansouri
- Department of Neurology, Imam Husain Hospital, Tehran, Iran
| | - B Faouzi
- Department of Neurology, Hassan II University Hospital, Fez, Morocco
| | - H Aref
- 68791Ain Shams University, Stroke Unit, Cairo, Egypt
| | - H Abdulrahman
- Department of Neurology, 48168King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - S Kesraoui
- Department of Neurology, CHU de Blida - Hôpital Franz Fanon, Blida, Algeria
| | - F Hentati
- Department of Neurology, Mongi Ben Hamida National Institute of Neurology, Tunis, Tunisia
| | - S Gebelly
- Faculty of Medical Sciences - Lebanese University, Neurology Division, Hadath, Lebanon
| | - N Ahmed
- Department of Neurology, 59562Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neurosciences, 27106Karolinska Institutet, Stockholm, Sweden
| | - N Wahlgren
- Department of Clinical Neurosciences, 27106Karolinska Institutet, Stockholm, Sweden
| | - F Abd-Allah
- Department of Neurology, Cairo University, Cairo, Egypt
| | - M Almekhlafi
- Department of Neurology, 37848King Abdulaziz University, Jeddah, Saudi Arabia
| | - T Moreira
- Department of Neurology, 59562Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neurosciences, 27106Karolinska Institutet, Stockholm, Sweden
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8
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Keselman B, Cooray C, Vanhooren G, Bassi P, Consoli D, Nichelli P, Peeters A, Sanak D, Zini A, Wahlgren N, Ahmed N, Mazya MV. Intravenous thrombolysis in stroke mimics: results from the
SITS
International Stroke Thrombolysis Register. Eur J Neurol 2019; 26:1091-1097. [DOI: 10.1111/ene.13944] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 02/19/2019] [Indexed: 11/27/2022]
Affiliation(s)
- B. Keselman
- Department of Neurology Karolinska University Hospital and Department of Clinical Neuroscience Karolinska Institutet StockholmSweden
| | - C. Cooray
- Department of Neurology Karolinska University Hospital and Department of Clinical Neuroscience Karolinska Institutet StockholmSweden
| | - G. Vanhooren
- Department of Neurology AZ Sint‐Jan Brugge‐Oostende Brugge Belgium
| | - P. Bassi
- Neurological Department San Giuseppe Hospital Milan
| | - D. Consoli
- Department of Neurology Iazzolino Hospital Vibo Valentia
| | - P. Nichelli
- Stroke Unit Neurology Clinic Department of Neuroscience Ospedale Civile S. Agostino Estense Modena University Hospital University of Modena and Reggio Emilia Modena Italy
| | - A. Peeters
- Department of Neurology Cliniques Universitaires St‐Luc Brussels Belgium
| | - D. Sanak
- Comprehensive Stroke Centre Department of Neurology Palacký University Hospital Olomouc Czech Republic
| | - A. Zini
- Stroke Unit Neurology Clinic Department of Neuroscience Ospedale Civile S. Agostino Estense Modena University Hospital University of Modena and Reggio Emilia Modena Italy
| | - N. Wahlgren
- Department of Neurology Karolinska University Hospital and Department of Clinical Neuroscience Karolinska Institutet StockholmSweden
| | - N. Ahmed
- Department of Neurology Karolinska University Hospital and Department of Clinical Neuroscience Karolinska Institutet StockholmSweden
| | - M. V. Mazya
- Department of Neurology Karolinska University Hospital and Department of Clinical Neuroscience Karolinska Institutet StockholmSweden
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9
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Rukn SA, Mazya MV, Hentati F, Sassi SB, Nabli F, Said Z, Faouzi B, Hashim H, Abd-Allah F, Mansouri B, Kesraoui S, Gebeily S, Abdulrahman H, Akhtar N, Ahmed N, Wahlgren N, Aref H, Almekhlafi M, Moreira T. Stroke in the Middle-East and North Africa: A 2-year prospective observational study of stroke characteristics in the region-Results from the Safe Implementation of Treatments in Stroke (SITS)-Middle-East and North African (MENA). Int J Stroke 2019; 14:715-722. [PMID: 30860454 DOI: 10.1177/1747493019830331] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND METHODS Stroke incidence and mortality are reported to have increased in the Middle-East and North African (MENA) countries during the last decade. This was a prospective observational study to examine the baseline characteristics of stroke patients in the MENA region and to compare the MENA vs. the non-MENA stroke cohort in the Safe Implementation of Treatments in Stroke (SITS) International Registry. RESULTS Of the 13,822 patients with ischemic and hemorrhagic stroke enrolled in the SITS-All Patients Protocol between June 2014 and May 2016, 5897 patients (43%) were recruited in MENA. The median onset-to-door time was 5 h (IQR: 2:20-13:00), National Institutes of Health Stroke Scale (NIHSS) score was 8 (4-13) and age was 65 years (56-76). Hypertension (66%) and diabetes (38%) were the prevailing risk factors; large artery stenosis > 50% (25.3%) and lacunar strokes (24.1%) were the most common ischemic stroke etiologies. In comparison, non-MENA countries displayed an onset-to-door time of 5:50 h (2:00-18:45), a median of NIHSS 6 (3-14), and a median age of 66 (56-76), with other large vessel disease and cardiac embolism as the main ischemic stroke etiologies. Hemorrhagic strokes (10%) were less common compared to non-MENA countries (13.9%). In MENA, only a low proportion of patients (21%) was admitted to stroke units. CONCLUSIONS MENA patients are slightly younger, have a higher prevalence of diabetes and slightly more severe ischemic strokes, commonly of atherosclerotic or microvascular etiology. Admission into stroke units and long-term follow-up need to be improved. It is suspected that cardiac embolism and atrial fibrillation are currently underdiagnosed in MENA countries.
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Affiliation(s)
- Suhail Al Rukn
- Department of Neurology, Rashid Hospital, Dubai Health Authority, Dubai, UAE
| | - Michael V Mazya
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Faycal Hentati
- Department of Neurology; Mongi Ben Hamida National Institute of Neurology, Tunis, Tunisia
| | - Samia Ben Sassi
- Department of Neurology; Mongi Ben Hamida National Institute of Neurology, Tunis, Tunisia
| | - Fatma Nabli
- Department of Neurology; Mongi Ben Hamida National Institute of Neurology, Tunis, Tunisia
| | - Zakharia Said
- Department of Neurology; Mongi Ben Hamida National Institute of Neurology, Tunis, Tunisia
| | - Belahsen Faouzi
- Department of Neurology, Hassan II University Hospital, Fez, Morocco
| | - Husnain Hashim
- Department of Neurology, Rashid Hospital, Dubai Health Authority, Dubai, UAE
| | | | | | | | - Souheil Gebeily
- Neurosciences Research Center, Faculty of Medical Sciences, The Lebanese University, Hadath, Lebanon
| | - Husen Abdulrahman
- Department of Neurology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | | | - Niaz Ahmed
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Nils Wahlgren
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Hany Aref
- Stroke unit, Ain Shams University, Cairo, Egypt
| | | | - Tiago Moreira
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Mazya MV, Ahmed N, Azevedo E, Davalos A, Dorado L, Karlinski M, Lorenzano S, Neumann J, Toni D, Moreira TP. Impact of Transcranial Doppler Ultrasound on Logistics and Outcomes in Stroke Thrombolysis. Stroke 2018; 49:1695-1700. [DOI: 10.1161/strokeaha.118.021485] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 04/23/2018] [Accepted: 05/04/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Michael V. Mazya
- From the Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (M.V.M., N.A., T.P.M.)
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (M.V.M., N.A., T.P.M.)
| | - Niaz Ahmed
- From the Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (M.V.M., N.A., T.P.M.)
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (M.V.M., N.A., T.P.M.)
| | - Elsa Azevedo
- Department of Neurology, Hospital São João, University of Porto, Portugal (E.A.)
| | - Antoni Davalos
- Department of Neurosciences, Stroke Unit, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain (A.D., L.D.)
| | - Laura Dorado
- Department of Neurosciences, Stroke Unit, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain (A.D., L.D.)
| | - Michal Karlinski
- Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (M.K.)
| | - Svetlana Lorenzano
- Department of Neurology and Psychiatry, University of Rome–La Sapienza, Italy (S.L., D.T.)
| | - Jiří Neumann
- Department of Neurology and Stroke Center, County Hospital Chomutov, Czech Republic (J.N.)
| | - Danilo Toni
- Department of Neurology and Psychiatry, University of Rome–La Sapienza, Italy (S.L., D.T.)
| | - Tiago P. Moreira
- From the Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (M.V.M., N.A., T.P.M.)
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (M.V.M., N.A., T.P.M.)
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11
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Cameron AC, Bogie J, Abdul-Rahim AH, Ahmed N, Mazya M, Mikulik R, Hacke W, Lees KR. Professional guideline versus product label selection for treatment with IV thrombolysis: An analysis from SITS registry. Eur Stroke J 2017; 3:39-46. [PMID: 31008336 DOI: 10.1177/2396987317747737] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 10/30/2017] [Indexed: 11/16/2022] Open
Abstract
Introduction Thrombolysis usage in ischaemic stroke varies across sites. Divergent advice from professional guidelines and product labels may contribute. Patients and methods We analysed SITS-International registry patients enrolled January 2010 through June 2016. We grouped sites into organisational tertiles by number of patients arriving ≤2.5 h and treated ≤3 h, percentage arriving ≤2.5 h and treated ≤3 h, and numbers treated ≤3 h. We assigned scores of 1-3 (lower/middle/upper) per variable and 2 for onsite thrombectomy. We classified sites as lower efficiency (summed scores 3-5), medium efficiency (6-8) or higher efficiency (9-11). Sites were also grouped by adherence with European product label and ESO guideline: 'label adherent' (>95% on-label), 'guideline adherent' (≥5% off-label, ≥95% on-guideline) or 'guideline non-adherent' (>5% off-guideline). We cross-tabulated site-efficiency and adherence. We estimated the potential benefit of universally selecting by ESO guidance, using onset-to-treatment time-specific numbers needed to treat for day 90 mRS 0-1. Results A total of 56,689 patients at 597 sites were included: 163 sites were higher efficiency, 204 medium efficiency and 230 lower efficiency. Fifty-six sites were 'label adherent', 204 'guideline adherent' and 337 'guideline non-adherent'. There were strong associations between site-efficiency and adherence (P < 0.001). Almost all 'label adherent' sites (55, 98%) were lower efficiency. If all patients were treated by ESO guidelines, an additional 17,031 would receive alteplase, which translates into 1922 more patients with favourable three-month outcomes. Discussion Adherence with product labels is highest in lower efficiency sites. Closer alignment with professional guidelines would increase patients treated and favourable outcomes. Conclusion Product labels should be revised to allow treatment of patients ≤4.5 h from onset and aged ≥80 years.
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Affiliation(s)
- Alan C Cameron
- 1Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - James Bogie
- 1Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Azmil H Abdul-Rahim
- 2Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
| | - Niaz Ahmed
- 3Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Michael Mazya
- 3Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Robert Mikulik
- International Clinical Research Centre, Neurology Department, St Anne's Hospital and Masaryk University, Brno, Czech Republic
| | - Werner Hacke
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Kennedy R Lees
- 1Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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12
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Hacke W, Lyden P, Emberson J, Baigent C, Blackwell L, Albers G, Bluhmki E, Brott T, Cohen G, Davis SM, Donnan GA, Grotta JC, Howard G, Kaste M, Koga M, von Kummer R, Lansberg MG, Lindley RI, Olivot JM, Parsons M, Sandercock PAG, Toni D, Toyoda K, Wahlgren N, Wardlaw JM, Whiteley WN, del Zoppo G, Lees KR. Effects of alteplase for acute stroke according to criteria defining the European Union and United States marketing authorizations: Individual-patient-data meta-analysis of randomized trials. Int J Stroke 2017; 13:175-189. [DOI: 10.1177/1747493017744464] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The recommended maximum age and time window for intravenous alteplase treatment of acute ischemic stroke differs between the Europe Union and United States. Aims We compared the effects of alteplase in cohorts defined by the current Europe Union or United States marketing approval labels, and by hypothetical revisions of the labels that would remove the Europe Union upper age limit or extend the United States treatment time window to 4.5 h. Methods We assessed outcomes in an individual-patient-data meta-analysis of eight randomized trials of intravenous alteplase (0.9 mg/kg) versus control for acute ischemic stroke. Outcomes included: excellent outcome (modified Rankin score 0–1) at 3–6 months, the distribution of modified Rankin score, symptomatic intracerebral hemorrhage, and 90-day mortality. Results Alteplase increased the odds of modified Rankin score 0–1 among 2449/6136 (40%) patients who met the current European Union label and 3491 (57%) patients who met the age-revised label (odds ratio 1.42, 95% CI 1.21−1.68 and 1.43, 1.23−1.65, respectively), but not in those outside the age-revised label (1.06, 0.90−1.26). By 90 days, there was no increased mortality in the current and age-revised cohorts (hazard ratios 0.98, 95% CI 0.76−1.25 and 1.01, 0.86–1.19, respectively) but mortality remained higher outside the age-revised label (1.19, 0.99–1.42). Similarly, alteplase increased the odds of modified Rankin score 0-1 among 1174/6136 (19%) patients who met the current US approval and 3326 (54%) who met a 4.5-h revised approval (odds ratio 1.55, 1.19−2.01 and 1.37, 1.17−1.59, respectively), but not for those outside the 4.5-h revised approval (1.14, 0.97−1.34). By 90 days, no increased mortality remained for the current and 4.5-h revised label cohorts (hazard ratios 0.99, 0.77−1.26 and 1.02, 0.87–1.20, respectively) but mortality remained higher outside the 4.5-h revised approval (1.17, 0.98–1.41). Conclusions An age-revised European Union label or 4.5-h-revised United States label would each increase the number of patients deriving net benefit from alteplase by 90 days after acute ischemic stroke, without excess mortality.
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Affiliation(s)
- Werner Hacke
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Patrick Lyden
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, USA
| | - Jonathan Emberson
- MRC Population Health Research Unit (PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Colin Baigent
- MRC Population Health Research Unit (PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Lisa Blackwell
- MRC Population Health Research Unit (PHRU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | | | | | - Geoffrey Cohen
- Division of Neuroimaging Sciences, University of Edinburgh, UK
| | - Stephen M Davis
- The Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Geoffrey A Donnan
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia
| | | | - George Howard
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, USA
| | - Markku Kaste
- Clinical Neurosciences, University of Helsinki, Helsinki, Finland
- Department of Neurology, Helsinki University Hospital, Helsinki, Finland
| | - Masatoshi Koga
- National Cerebral and Cardiovascular Centre, Suita, Japan
| | | | | | - Richard I Lindley
- Westmead Hospital Clinical School and George Institute for Global Health, University of Sydney, Sydney, Australia
| | - Jean-Marc Olivot
- Centre Hospitalier Universitaire de Toulouse, Toulouse, France
- Toulouse Neuroimaging Center, Toulouse, France
| | - Mark Parsons
- Department of Neurology, Royal Melbourne Hospital and University of Melbourne, Australia
| | | | - Danilo Toni
- Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
| | | | - Nils Wahlgren
- Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Gregory del Zoppo
- Department of Medicine, Department of Neurology, University of Washington, Seattle, USA
| | - Kennedy R Lees
- Institute of Cardiovascular & Medical Sciences, University of Glasgow, Glasgow, UK
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13
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Anani N, Mazya MV, Chen R, Prazeres Moreira T, Bill O, Ahmed N, Wahlgren N, Koch S. Applying openEHR's Guideline Definition Language to the SITS international stroke treatment registry: a European retrospective observational study. BMC Med Inform Decis Mak 2017; 17:7. [PMID: 28073358 PMCID: PMC5223429 DOI: 10.1186/s12911-016-0401-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 12/15/2016] [Indexed: 11/10/2022] Open
Abstract
Background Interoperability standards intend to standardise health information, clinical practice guidelines intend to standardise care procedures, and patient data registries are vital for monitoring quality of care and for clinical research. This study combines all three: it uses interoperability specifications to model guideline knowledge and applies the result to registry data. Methods We applied the openEHR Guideline Definition Language (GDL) to data from 18,400 European patients in the Safe Implementation of Treatments in Stroke (SITS) registry to retrospectively check their compliance with European recommendations for acute stroke treatment. Results Comparing compliance rates obtained with GDL to those obtained by conventional statistical data analysis yielded a complete match, suggesting that GDL technology is reliable for guideline compliance checking. Conclusions The successful application of a standard guideline formalism to a large patient registry dataset is an important step toward widespread implementation of computer-interpretable guidelines in clinical practice and registry-based research. Application of the methodology gave important results on the evolution of stroke care in Europe, important both for quality of care monitoring and clinical research. Electronic supplementary material The online version of this article (doi:10.1186/s12911-016-0401-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nadim Anani
- Health Informatics Centre, LIME, Karolinska Institutet, Tomtebodavägen 18, Stockholm, SE 17177, Sweden.
| | - Michael V Mazya
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Rong Chen
- Health Informatics Centre, LIME, Karolinska Institutet, Tomtebodavägen 18, Stockholm, SE 17177, Sweden.,Cambio Healthcare Systems, Stockholm, Sweden
| | - Tiago Prazeres Moreira
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Olivier Bill
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Niaz Ahmed
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Nils Wahlgren
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Sabine Koch
- Health Informatics Centre, LIME, Karolinska Institutet, Tomtebodavägen 18, Stockholm, SE 17177, Sweden
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Nascimento KGD, Chavaglia SRR, Pires PDS, Ribeiro SBF, Barbosa MH. Desfechos clínicos de pacientes com acidente vascular cerebral isquêmico após terapia trombolítica. ACTA PAUL ENFERM 2016. [DOI: 10.1590/1982-0194201600091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo Analisar desfechos e fatores associados em pacientes com acidente vascular cerebral isquêmico após terapia trombolítica. Métodos Estudo do tipo coorte retrospectivo de pacientes com acidente vascular cerebral isquêmico submetidos à terapia trombolítica. Foram descritas as comorbidades; os défices neurológicos e os tempos de atendimento. Utilizou-se o teste qui quadrado para associação entre comorbidades, tempos de atendimento e ocorrência de transformação hemorrágica. Resultados Houve elevada frequência de comorbidades. Défices neurológicos pontuaram média de 15 pontos. A janela de tempo obteve média de 98 minutos e o tempo porta-agulha, 89,8 minutos. Observou-se transformação hemorrágica em 20 pacientes. Na análise bivariada, a ocorrência de transformação hemorrágica esteve associada com maior défice neurológico, fibrilação atrial e cardiopatia. Houve redução dos défices neurológicos de 51% para 12,5 entre a admissão e alta. Conclusão A terapia trombolítica apresentou resultados positivos, apesar de tempos de atendimento elevados e pacientes com défices neurológicos com elevada pontuação.
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