Which AFib Patients Should Resume Warfarin After Intracranial Hemorrhage?

MedicalResearch.com Interview with:
Peter Brønnum Nielsen MD PhD
Aalborg Thrombosis Research Unit
Department of Clinical Medicine
Faculty of Health
Department of Cardiology, Atrial Fibrillation Study Group
Aalborg University Hospital
Aalborg, Denmark
 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response:   Patients who sustain an intracranial hemorrhage (ICH) event are often excluded from randomized trials investigating stroke prevention in atrial fibrillation (AF) by use of oral anticoagulant treatment.

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Food Insecurity Common Among Inner City Stroke Patients

MedicalResearch.com Interview with:

Dr. Lakshmi Warrior MD Assistance Professor, Neurology Cook County Health & Hospitals System Chicago

Dr. Lakshmi Warrior

Dr. Lakshmi Warrior MD
Assistance Professor, Neurology
Cook County Health & Hospitals System
Chicago

MedicalResearch.com: What is the background for this study?

Response: In 2015, 42.2 million Americans lived in food insecure households. Food insecurity is defined as “limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways”. Previous work has demonstrated associations between food insecurity and chronic diseases such as hypertension, diabetes, hyperlipidemia.

Cook County Health and Hospitals System serves a population of largely uninsured and underinsured patients. This pilot study sought determine the prevalence of food insecurity in our population of patients who were recently discharged home from the hospital with the diagnosis of stroke.

MedicalResearch.com: What are the main findings?

Response: We found that food insecurity is a prevalent problem in our patient population with more than 1 in 5 identifying as food insecure. It also appears that food insecure stroke patients had a higher prevalence of diabetes (54% vs 28%)and hypertension (86% vs. 67%) as compared to food secure patients.

MedicalResearch.com: What should readers take away from your report?

Response: Food insecurity is a prevalent issue in our patient population. There should be consideration for food insecurity screening in high-risk populations as food insecurity can complicate the management of diet-related diseases such as hypertension and diabetes. For patients with food insecurity, a multi-disciplinary approach using case and social workers in addition to medical management should be considered.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Further study of this topic is needed. A larger, retrospective review of our stroke patients is currently underway. We are also planning for a prospective study of our inpatient stroke patients to evaluate if these patients are at higher risk for not only vascular risk factors but also re-hospitalization and poor outcomes.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation: Abstract presented at the  AHA/ASA International Stroke Conference February 2017

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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ASTER Trial Supports Aspiration Of Clots in Acute Ischemis Stroke

MedicalResearch.com Interview with:

Michel Piotin, MD PhD Principal investigator and interventional neuroradiologis Rothschild Fondation Hospital Paris

Dr. Michel Piotin

Michel Piotin, MD PhD
Principal investigator and Interventional Neuroradiologist
Rothschild Fondation Hospital, Paris 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Mechanical thrombectomy (MT) with a stent retriever (SR), in association with intravenous rtPA, is now the standard of care in anterior circulation ischemic stroke caused by large vessel occlusion

Thrombectomy (MT) with a stent retriever (SR), in association with intravenous (IV) rtPA, is now the standard of care in anterior circulation ischemic stroke caused by large vessel occlusion. Favorable outcome is strongly associated with the successful reperfusion status. New techniques for MT such as ADAPT (A Direct first pass Aspiration Technique) is promising to increase reperfusion status and clinical outcome in retrospective studies. Our study objective was to determine which technique should be used in frontline strategy (ADAPT or Stent Retriever) to achieve maximum reperfusion. The ASTER study is the first independent large randomized controlled trial focusing on ADAPT technique with blinded assessment data.

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Medtronic Pipeline Embolization Device Found Safe For Smaller Aneurysms

MedicalResearch.com Interview with:

Ricardo A Hanel, MD PhD Endovascular and Skull Base Neurosurgery Director, Baptist Neurological Institute Endowed Chair, Stroke and Cerebrovascular Surgery Jacksonville, FL

Dr. Hanel

Ricardo A Hanel, MD PhD
Endovascular and Skull Base Neurosurgery
Director, Baptist Neurological Institute
Endowed Chair, Stroke and Cerebrovascular Surgery
Jacksonville, FL

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Medtronic Pipeline Embolization Device has been approved for carotid artery aneurysms over 10mm in size, from the petrous to clinoid segment but given the efficacy of results on these larger lesions, it has been widely utilized for treatment of smaller lesions. PREMIER came from the need of assessing the results , safety and efficacy, of pipeline for use of aneurysms under 12mm, located on the carotid artery, all segments, and V3 segment of the vertebral artery.
PREMIER enrolled 141 patients treated at 22 centers (21 US, 1 Canada). Primary Safety effectiveness defined as total aneurysm occlusion, core lab adjudicated , at 1 year was 83.5%; with safety endpoint of major stroke/death at 30 days of 1.4% (2 patients), with 1-year major stroke and death rate of 2.1%.

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Cerebral Microinfarcts Associated With Cardiac Biomarkers and Heart Disease

 

Christopher Chen, FRCP Department of Pharmacology Yong Loo Lin School of Medicine Memory Aging and Cognition Center National University Health System Singapore Saima Hilal, PhD Department of Pharmacology, National University of Singapore Department of Radiology, Epidemiology and Nuclear Medicine Erasmus Medical Center, Rotterdam, the Netherlands

 

 

MedicalResearch.com Interview with:
Christopher Chen, FRCP

Department of Pharmacology
Yong Loo Lin School of Medicine
Memory Aging and Cognition Center
National University Health System
Singapore
Saima Hilal, PhD
Department of Pharmacology, National University of Singapore
Department of Radiology, Epidemiology and Nuclear Medicine
Erasmus Medical Center, Rotterdam, the Netherlands

MedicalResearch.com: What is the background for this study?

Response: Cerebral microinfarcts (CMIs) are defined as small (usually <1 mm) regions of ischemic change found in the brain which are not readily visible on gross examination or on standard 1.5-T magnetic resonance imaging (MRI). On microscopy they appear as foci of neuronal loss, gliosis, pallor, or cysts.

Previous post mortem studies have shown that the presence of CMIs is relatively common in elderly individuals without dementia (24%) but more common in patients diagnosed with Alzheimer disease (43%) or vascular dementia (62%).

Whilst a single CMI is likely to be “silent” as the region of brain affected is probably too small to produce symptoms or neurologic deficits, however, as a large number of CMIs exist in many individuals, especially in the cerebral cortex and watershed areas, the overall effect has clinical importance – as shown by neuropathologic studies which demonstrate an important role of CMIs in cognitive dysfunction and dementia. However in vivo studies have been hampered by the inability to detect CMIs reliably on neuroimaging, leading to CMIs being termed “invisible” during life.

The advent of high spatial-definition 7-T MRI enabled the identification of cortical  Cerebral microinfarcts in-vivo and importantly a study that directly compared 7-T and 3-T MRIs in the same patients reported that 3-T MRI detected about 1/3 of the lesions found on 7-T MRIs, suggesting that 3-T MRIs, which are more accessible than 7-T, may be able to detect larger cortical CMIs with a lower limit of approximately 1 mm in diameter.

Our group has made major contributions recently on the clinical associations of 3T MRI detected cortical CMIs in patients from memory clinics as well as in community based subjects. Associations were found with age, vascular risk factors, other MRI markers of cerebrovascular disease as well as cognition. However, the causes of CMIs remain unclear and may be heterogeneous with microembolism, microthrombosis, and foci of inflammation as possible causative factors.

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Migraine Increases Risk of Perioperative Stroke and Hospital Readmission

MedicalResearch.com Interview with:

Dr. Matthias Eikermann, MD, PhD Associate Professor of Anaesthesia, Harvard Medical School Clinical Director, Critical Care Division

Dr. Matthias Eikermann

Dr. Matthias Eikermann, MD, PhD
Associate Professor of Anaesthesia
Harvard Medical School
Clinical Director, Critical Care Division 

MedicalResearch.com: What is the background for this study?

Response: Up to one fifth of the general population have migraine, a primary, chronic-intermittent headache disorder affecting the neuronal and vascular systems and characterized by severe headache accompanied by nausea and/or sensory hypersensitivities such as photophobia and phonophobia. In approximately 20-30% of patients, the headache phase is preceded or accompanied by transient focal neurological disturbances presenting as visual symptoms but also sensory, aphasic, or motor symptoms known as migraine aura.

Stroke is responsible for approximately 6.2 million deaths a year and is a leading global cause of long term disability. Considering that more than 50 million patients in hospital and 53 million ambulatory patients undergo surgical procedures in the United States every year.

We found that patients with migraine, particularly migraine with aura, undergoing a surgical procedure are at increased risk of perioperative ischemic stroke and readmission to hospital within 30 days after discharge.

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tPA Plus Mechanical Thrombectomy in Acute Ischemic Stroke?

MedicalResearch.com Interview with:

Vitor Mendes Pereira MD MSc Division of Neuroradiology - Joint Department of Medical Imaging Division of Neurosurgery - Department of Surgery Toronto Western Hospital - University Health Network Associate Professor of Radiology and Surgery University of Toronto

Dr. Vitor Mendes Pereira

Vitor Mendes Pereira MD MSc
Division of Neuroradiology – Joint Department of Medical Imaging
Division of Neurosurgery – Department of Surgery
Toronto Western Hospital – University Health Network
Associate Professor of Radiology and Surgery
University of Toronto 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Our study is a pooled analysis of two large prospective stroke studies that evaluated the effectiveness of mechanical thrombectomy (MT) using one of the stent retrievers (Solitaire device ) in patients with acute ischemic stroke related to large vessel occlusion(LVO). It is known (after 5 randomized controlled trials in 2015) that IV rtPA alone failed to demonstrated benefit when compared to MT associated or not to rtPA. A question is still open: what it is the real benefit of IV rtPA in the context of LVO, particularly in centres that can offer mechanical thrombectomy within 60 minutes after qualifying imaging?

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Marital History Linked to Survival After Stroke

MedicalResearch.com Interview with:

Matthew E. Dupre, Ph.D. Associate Professor Department of Community and Family Medicine & Duke Clinical Research Institute (DCRI) Duke University

Dr. Mathew Dupre

Matthew E. Dupre, Ph.D.
Associate Professor
Department of Community and Family Medicine &
Duke Clinical Research Institute (DCRI)
Duke University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: There have been a handful of recent studies showing how divorce and widowhood increase one’s risk of suffering a serious health event such as a heart attack or stroke. Our research is the first to show that an individual’s marital history can have significant consequences for their prognosis after having a stroke.

We found that people who never married and those with a history of marital loss were significantly more likely to die after suffering a stroke than those who were stably married. We also found that adults who experienced more than one divorce or widowhood in their lifetime were about 50% more likely to die after having a stroke than those in a long-term stable marriage. We were also somewhat surprised to find that remarriage did not seem to reduce the risks from past marital losses.

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Strong SSRIs Linked To Increase Risk of Intracranial Hemorrhage

MedicalResearch.com Interview with:
Christel Renoux, MD, PhD
Assistant Professor, Dept. of Neurology & Neurosurgery
McGill University
Centre For Clinical Epidemiology
Jewish General Hospital – Lady Davis Research Institute
Montreal  Canada

MedicalResearch.com: What is the background for this study?

Response: Selective serotonin reuptake inhibitors (SSRIs) increase the risk for abnormal bleeding, in particular, gastrointestinal tract bleeding. Previous studies also suggested an increased risk for intracranial hemorrhage (ICH) in patients treated with SSRIs compared to non users. However, even if this risk exists, the comparison with a non-treated group may exaggerate the strength of a potential association and the comparison with a group of patients treated with other antidepressants may help better delineate the risk. The potential bleeding effect of antidepressants is linked to the strength of serotonin inhibition reuptake, and antidepressants that are strong inhibitors of serotonin reuptake have been associated with the risk for gastrointestinal or abnormal bleeding compared with weak inhibitors but the risk of ICH is unclear.

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Association Between Statin Use and Ischemic Stroke or Hemorrhage in Patients Taking Dabigatran for A Fib

MedicalResearch.com Interview with:

Dr-Tony-Antoniou.jpg

Dr. Tony Antoniou

Dr. Tony Antoniou, PhD Research Scholar
Department of Family and Community Medicine and a Scientist
Keenan Research Centre of the Li Ka Shing Knowledge Institute
St. Michael’s Hospital
Assistant Professor in the Department of Family and Community Medicine and
Leslie Dan Faculty of Pharmacy
University of Toronto, Toronto, Ontario

MedicalResearch.com: What is the background for this study?
What are the main findings?

Response: Dabigatran etexilate is an anticoagulant that is commonly used for stroke prevention in patients with atrial fibrillation. Absorption of dabigatran etexilate is opposed by intestinal P-glycoprotein, an efflux transporter. Once absorbed, dabigatran etexilate is converted to its active form by carboxylesterase enzymes. Unlike other statins, simvastatin and lovastatin can inhibit P-glycoprotein and carboxylesterase. This may result in increased absorption of dabigatran etexilate, thereby increasing the risk of bleeding. Conversely, inhibition of carboxylesterase may decrease the effectiveness of dabigatran etexilate.

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Gender-Specific Risk Factors for Stroke Outlined

MedicalResearch.com Interview with:

Catharina J. M. Klijn, MD Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery University Medical Center Utrecht, Utrecht Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience Department of Neurology Radboud University Nijmegen Medical Centre Nijmegen, the Netherlands

Dr. Catharina J. M. Klijn

Catharina J. M. Klijn, MD
Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery
University Medical Center Utrecht, Utrecht
Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience
Department of Neurology
Radboud University Nijmegen Medical Centre
Nijmegen, the Netherlands

MedicalResearch.com: What is the background for this study?

Response: The incidence of stroke is higher in men than in women. This difference attenuates with increasing age. Established risk factors for stroke, such as hypertension, cigarette smoking and ischemic heart disease are more prevalent in men but only partly explain the difference in stroke incidence. The contribution of oral contraceptive use and hormone therapy to stroke risk has been previously reviewed. We aimed to evaluate what is known on other female- and male specific risk factors for ischemic and hemorrhagic stroke incidence and stroke mortality through a systematic review and meta-analysis of 78 studies including over 10 million participants.

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Risk of Pregnancy-Associated Stroke Across Age Groups

MedicalResearch.com Interview with:
Eliza Miller, M.D
.
Vascular Neurology Fellow
New York-Presbyterian Hospital/Columbia University Medical Center
We collaborated with researchers at the Massachusetts General Hospital and with the New York State Department of Health.

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Prior research has found that older women of childbearing age are at higher risk of stroke during pregnancy and postpartum than younger women. We hypothesized that their increased stroke risk might not be due to pregnancy-related factors, but just due to the fact that stroke risk increases with age for all people. We used billing data from New York State hospitals to calculate incidence risk ratios for four age groups: 12-24, 25-34, 35-44 and 45-55. In each age group, we compared the incidence of stroke in women who were pregnant or postpartum to the incidence of stroke in women of the same age who were not pregnant.

As in prior studies, we found that the incidence of pregnancy-associated stroke was higher in older women compared to younger women (about 47/100,000 deliveries in the oldest group, versus 14/100,000 deliveries in the youngest group). However, the incidence ratios showed that pregnancy increased stroke risk significantly in women under 35, but did not appear to increase stroke risk in women over 35. In the youngest group (age 12-24), pregnancy more than doubled the risk of stroke, and in the 25-34 age group, pregnancy increased stroke risk by 60%. In women aged 35 and older, pregnancy did not increase stroke risk. Women who had pregnancy-related strokes tended to have fewer traditional vascular risk factors like hypertension and diabetes, compared to same-aged women with non-pregnancy related strokes.

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