Monoclonal Antibody Idarucizumab Reverses Anticoagulant Effect of Dabigatran In Patients With Brain Bleed

MedicalResearch.com Interview with:

Richard A. Bernstein MD, PhD Director, Northwestern Stroke Program Professor of Neurology Feinberg School of Medicine of Northwestern University

Dr. Richard Bernstein

Richard A. Bernstein MD, PhD
Director, Northwestern Stroke Program
Professor of Neurology
Feinberg School of Medicine of Northwestern University

Medical Research: What is the background for this study?

Dr. Bernstein: Patients on blood thinners, including dabigatran, have an increased risk of bleeding including in the brain.  We believe that reversing the blood thinning effects of dabigatran in the setting of bleeding might improve outcome by helping the bleeding to stop.

Medical Research: What are the main findings?

Dr. Bernstein: We found that in 18 patients taking dabigatran  with intracranial bleeding, Idarucizumab completely and nearly instantaneously reversed the blood thinning effect of dabigatran.

Medical Research: What should clinicians and patients take away from your report?

Dr. Bernstein: Patients taking dabigatran with intracranial bleeding can have the anticoagulant effect of dabigatran rapidly and completely reversed with Idarucizumab.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Bernstein: My presentation is derived from a cohort of the first 90 patients enrolled in reverse-AD. We will publish a similar analysis from the complete reverse ad cohort of 500 patients when we are finished enrolling.

Citation:

International Stroke Conference Oral Abstracts – Session Title: Intracerebral Hemorrhage Oral Abstracts II:Abstract 213: Effect of Idarucizumab on Intracranial Bleeding in Dabigatran-treated Patients: Initial Results From RE-VERSE AD

Richard A Bernstein, Charles V Pollack, Jr., Jeffrey I Weitz, Paul A Reilly, John Eikelboom, Menno V Huisman, Pieter W Kamphuisen, Jörg Kreuzer, Jerrold H Levyand Thorsten Steiner

Richard A. Bernstein MD, PhD (2016). Monoclonal Antibody Idarucizumab Reverses Anticoagulant Effect of Dabigatran In Patients With Brain Bleed MedicalResearch.com

Mail Order Pharmacies Linked To Better Compliance With Stroke Medications

MedicalResearch.com Interview with:
Dr-William-Patrick-Neil

William P. Neil, MD

Vascular Neurologist
SCPMG Regional Stroke Champion
Neurology   

Medical Research: What is the background for this study?

Dr. Neil: Stroke survivors are less likely to have a recurrent stroke, or other complications if they take their medications as prescribed by their doctor. Mail order pharmacies are increasingly being used to deliver medications for a variety of diseases, and their use is associated with better medication adherence.  We wanted to see whether stroke patients who use mail-order pharmacies were more likely to have good medication adherence than those who used  local pharmacies.

Medical Research: What are the main findings?

Dr. Neil: We looked through a large electronic medical database in California, and found a total of 48,746 people discharged from the hospital with a stroke, and who also filled either a cholesterol medication or an anticoagulant (blood thinner). Of these, 136,722 refills were from a local pharmacy and 68,363 were by mail. Overall, patients were adherent to the medications 46.5% of the time if they picked up the medication from the pharmacy and 74% of the time if they had prescriptions mailed to them.

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Atrial Fibrillation In Stroke Patients Deemed Underestimated

MedicalResearch.com Interview with:

Dr. Rolf Wachter Head Senior physician University of Goettingen Göttingen, Germany

Dr. Rolf Wachter

Dr. Rolf Wachter
Head Senior physician
University of Goettingen
Göttingen, Germany

Medical Research: What is the background for this study? What are the main findings?

Dr. Wachter: Atrial Fibrillation is a known risk factor for stroke, and in stroke patients, it is a strong predictor of adverse outcome, if it is not adequately treated (e.g. by anticoagulation). However, in its paroxysmal form, Atrial Fibrillation (AF) may escape routine diagnostics. We aimed to show that we can increase the number of patients with detected AF if we do more monitoring for atrial fibrillation. As a unique feature of our study, we did not focus on a certain stroke subtype (i.e. cryptogenic stroke), but we aimed to consider all patients >= 60 years in whom the detection of  Atrial Fibrillation has a clinical relevance.

The main finding of our study was that enhanced and prolonged Holter ECG monitoring (3×10 days of monitoring, analysed in a dedicated core lab) tripled the number of detected AF cases (from 4.5 to 13.5 %). 11 patients had to undergo enhanced and prolonged monitoring to find one additional case of Atrial Fibrillation.

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Women and Minorities Have Worse Outcomes After Stroke

MedicalResearch.com Interview with:

Cheryl Bushnell, MD, MHS Professor of Neurology Director, Wake Forest Baptist Stroke Center Wake Forest Baptist Health Medical Center Boulevard Winston Salem, NC 27157

Dr. Cheryl Bushnell

Cheryl Bushnell, MD, MHS
Professor of Neurology
Director, Wake Forest Baptist Stroke Center
Wake Forest Baptist Health
Medical Center Boulevard
Winston Salem, NC  27157 

Medical Research: What is the background for this study? What are the main findings?

Dr. Bushnell: The catalyst for the study was to see if comorbidities and the management of them might influence functional status.  But, we pre-specified gender and race because we knew these could be important predictors of outcome.  As it turns out, the results of our analysis did, in fact, show that gender and race were the most significant predictors of poor functional outcome.

Medical Research: What should clinicians and patients take away from your report?

Dr. Bushnell: The take-home message is that women and minorities have poorer functional outcome after stroke, but the reasons for this outcome need to be further explored.  Our model showed that we only explained 31% of the variance in SIS-16 with gender, race/ethnicity, and stroke severity, so unmeasured factors are extremely important.  We could speculate from this dataset and other published data that women may be more likely to have functional deficits prior to stroke, be unmarried/widowed, live alone, or institutionalized after stroke.  Non-white stroke survivors may have poorer access to care, have multiple strokes, and more comorbidities.

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Carotid Stenosis for Stroke Prevention: Both Surgery and Stenting Give Long Lasting Results

MedicalResearch.com Interview with:

Thomas G. Brott, M.D. Professor of neurology and director for research and The Eugene and Marcia Applebaum Professor of Neurosciences and James C. and Sarah K. Kennedy Dean for Research. Mayo Clinic in Jacksonville, Fla

Dr. Thomas Brott

Thomas G. Brott, M.D.
Professor of neurology and director for research and
The Eugene and Marcia Applebaum Professor of Neurosciences and James C. and Sarah K. Kennedy Dean for Research.
Mayo Clinic in Jacksonville, Fla

Medical Research: What is the background for this study? What are the main findings?

Dr. Brott: Revascularization for carotid artery stenosis is the accepted treatment for symptomatic patients with >50% stenosis and for asymptomatic patients with >70% stenosis.  The original CREST report in 2010 showed both surgery and stenting were the safe methods to treat severe carotid stenosis.  But the follow-up averaged 2.5 years and Medicare-age patients live for an average of 18-20 years.  These patients and their families needed to know if surgery and stenting are durable in preventing stroke.

CREST was designed to answer the questions of clinical and anatomic durability for the long-run.

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Fast Stroke Treatment Key To Better Outcomes

MedicalResearch.com Interview with:

Michael D Hill, MD MSc FRCPC Calgary Stroke Program Professor, Dept Clinical Neurosciences Hotchkiss Brain Institute Cumming School of Medicine, University of Calgary Calgary, Canada

Dr. Michael D. Hill

Michael D Hill, MD MSc FRCPC
Calgary Stroke Program
Professor, Dept Clinical Neurosciences
Hotchkiss Brain Institute
Cumming School of Medicine, University of Calgary
Calgary, Canada 

Medical Research: What is the background for this study? What are the main findings?

Dr. Hill: The HERMES collaboration is a pooled analysis of 5 randomized controlled trials of endovascular stroke therapy.  The purpose is of this analysis is to assess the relationship between time from stroke onset and effect size.

The main finding is that there is a declining effect size as time elapses from stroke onset.  Shorter onset to reperfusion times are associated with better outcomes.  However, the slope of the decline is shallow compared to past estimates.  We believe this is because imaging selection identifies a group a patients in whom there is slow growth of the core infarct.

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Mouth Bacteria Linked to Stroke And Stroke-Related Dementia

MedicalResearch.com Interview with:

Dr. Robert Friedland MD Mason C. and Mary D. Rudd Endowed Chair In Neurology Professor, Dept. of Neurology University of Louisville Health Care Outpatient Center Louisville, KY 40292

Dr. Robert Friedland

Dr. Robert Friedland MD
Mason C. and Mary D. Rudd Endowed Chair In Neurology
Professor, Dept. of Neurology
University of Louisville Health Care Outpatient Center
Louisville, KY 40292

Medical Research: What is the background for this study? What are the main findings?

Dr. Robert Friedland: Oral infectious diseases are associated with stroke. Previous research by this group has shown that oral bacteria, cnm-positive Streptococcus mutans, was associated with cerebral microbleeds and intracerebral hemorrhage. We developed this study to investigate the roles of this bacteria in patients entering the hospital for all types of stroke. Among the patients who experienced intracerebral hemorrhage (ICH), 26 percent were found to have a specific bacterium in their saliva, cnm-positive S. mutans. Among patients with other types of stroke, only 6 percent tested positive for the bacterium. We also evaluated MRIs of study subjects for the presence of cerebral microbleeds (CMB), small brain hemorrhages which may cause dementia and also often underlie ICH. We found that the number of CMBs was significantly higher in subjects with cnm-positive S. mutans than in those without.
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Risk/Benefits of Sildenafil For Swimming-Induced Pulmonary Edema

MedicalResearch.com Interview with:

Richard Moon, MD, CM, MSc, FRCP(C), FACP, FCC Medical Director, Hyperbaric Center Professor of Anesthesiology Department / Division Anesthesiology / GVTU Division Medicine / Pulmonary Duke University School of Medicine

Dr. Richard Moon

Richard Moon, MD, CM, MSc,
FRCP(C), FACP, FCCP

Medical Director, Hyperbaric Center
Professor of Anesthesiology
Department / Division
Anesthesiology / GVTU Division
Medicine / Pulmonary
Duke University School of Medicine

Medical Research: What is the background for this study? What are the main findings?

Dr. Moon: This study was performed to investigate the reason why young, fit individuals develop a condition usually associated with severe heart disease: pulmonary edema. Immersion pulmonary edema (also known as swimming-induced pulmonary edema, SIPE) develops in certain susceptible individuals while swimming or scuba diving, usually in cold water. Some SIPE-susceptible people include highly conditioned triathletes and Navy SEAL trainees. The prevalence of SIPE in triathletes is around 1.5%, and in open sea swimming trials in naval special forces trainees has been reported to be 1.8-60%. SIPE often requires hospitalization and has caused death.

Medical Research: What should clinicians and patients take away from your report?

Dr. Moon: We directly measured arterial pressure, pulmonary artery pressure (PAP) and PA wedge pressure (PAWP) during submersed exercise in cold water. We found that both PAP and PAWP were higher in swimming-induced pulmonary edema-susceptible individuals compared with a group of volunteers of similar age who had never experienced SIPE. This confirmed that SIPE is a form of hemodynamic pulmonary edema, which is curious since all of the people we studied had normal hearts. We hypothesized that the cause could be differences between the groups in venous tone or LV diastolic compliance. When we retested the SIPE-susceptibles under the same conditions after a dose of sildenafil, pulmonary artery pressures were decreased, with no adverse effects on hemodynamics. We concluded that by dilating pulmonary vessels and systemic venous sildenafil could be an effective prophylaxis against SIPE.  Continue reading