Author Interviews, Boehringer Ingelheim, Clots - Coagulation, Stroke / 05.10.2017

MedicalResearch.com Interview with: Craig Anderson | MD PhD FRACP Executive Director Professor of Neurology and Epidemiology, Faculty of Medicine, UNSW Sydney Neurologist, Neurology Department, Royal Prince Alfred Hospital The George Institute for Global Health at Peking University Health Science Center Haidian District | Beijing, 100088 P.R. China MedicalResearch.com: What is the background for this study? What are the main findings? Response:  There is much controversy over the benefits of a lower dose of intravenous alteplase, particularly in Asia, after the Japanese regulatory authorities approved a dose of 0.6 mg/kg 10 years ago compared to the US FDA and other regulatory authorities approving 0.9 mg/kg 20 years ago.  The investigator inititiated and conducted ENCHANTED trial aimed to determine the effectiveness and safety of these two doses in an international multicentre pragmatic open design. The main results did not confirm the low-dose to be statistically ‘non-inferior’ partly due to the primary outcome measure chosen and partly due to the statistical approach, but it did confirm that the lower dose was safer with less risk of the major complication of this treatment, that of major bleeding in the brain.  However, it would appear that this safety effect was offset by some reduce efficacy in terms of functional recovery. The aim of this secondary analysis of the trial data was to examine in more detail the differences between low and standard dose alteplase according to the participants’ age, ethnicity (Asian vs non-Asian) and severity of neurological deficit at the time of treatment.  We did this because the popular belief is that a lower dose might be preferred in older people, and Asians, because of the potential for more likelihood of bleeding, and preferentially to use the standard dose in those with more severe strokes potentially due to greater ‘clot burden’ from a blocked artery to the brain. The results showed that the main findings on the outcome of surviving free of disability were the same according to age, ethnicity and stroke severity – that is, there was no preferential dose in any of these groups.  Similarly, the safety benefit of low dose alteplase on brain haemorrhage, did not clearly translate into clinical disability outcomes in any of the patient groups studied. (more…)
Author Interviews, Cancer Research, Stroke / 15.09.2017

MedicalResearch.com Interview with: Dr Jacobo Rogado Medical oncology fellow Hospital de La Princesa Madrid, Spain MedicalResearch.com: What is the background for this study? Response: Some publications have suggested that there is an association between stroke and the subsequent diagnosis of cancer, although others have not confirmed this. We have addressed this issue with a study conducted at our hospital during two years. We studied a population of about 1000 patients with stroke. We evaluated the incidence of cancer in this population during the follow-up of 18 months, as well as whether there were factors associated with its occurrence. (more…)
Author Interviews, Stroke, Technology / 01.08.2017

MedicalResearch.com Interview with: Bertrand LAPERGUE, MD, PhD Hôpital Foch, University Versailles Saint Quentin en Yvelynes Department of Stroke Center, Diagnostic and Interventional Neuroradiology Suresnes, France. Michel PIOTIN, MD Department of Diagnostic and Interventional Neuroradiology Fondation Rothschild, Paris, France. on behalf of the ASTER Trial Investigators. 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 (IV) rtPA, is now the standard of care in anterior circulation ischemic stroke caused by large vessel occlusion (LVO). Favorable outcome is strongly associated with the successful reperfusion status (TICI 2b/3= 71% with SR, Hermes Study group). New techniques for MT such as ADAPT (A Direct first pass Aspiration Technique) seem promising to increase reperfusion status and clinical outcome in retrospective studies. (more…)
AHA Journals, Author Interviews, Stroke, Weight Research / 17.07.2017

MedicalResearch.com Interview with: Hugo J. Aparicio, MD, MPH Assistant Professor Vascular Neurology, Department of Neurology Investigator, The Framingham Heart Study www.framinghamheartstudy.org Boston University School of Medicine Boston, MA 02118-2526 MedicalResearch.com: What is the background for this study? Response: The association of body weight with survival after stroke has been studied before and is a controversial topic. Results have varied between studies and have often been contradictory. The observational findings that carrying extra weight can be protective after having a disease, like stroke or heart attack, has been called an obesity paradox, since obesity in itself is a risk factor for cardiovascular disease and mortality in the general population. Stroke research has focused on hospitalized stroke patients with weight measured at the time of the stroke. BMI is often missing in this group of patients, especially when a stroke is severe or the patients cannot report their weight. In the FHS we have data regarding weight prior to stroke, obtained during regularly scheduled research exams, with multiple data points on body weight and vascular risk factors over time. All before the stroke occurs. And have also compared survival outcomes with a group of control participants, those without stroke, to see if the so-called ‘obesity paradox’ is a non-specific finding seen in older adults or seen specifically in stroke patients. (more…)
Author Interviews, NEJM, Stroke / 22.06.2017

MedicalResearch.com Interview with: Craig Anderson | MD PhD FRACP Executive Director Professor of Neurology and Epidemiology, Faculty of Medicine, UNSW Sydney Neurologist, Neurology Department, Royal Prince Alfred Hospital The George Institute for Global Health at Peking University Health Science Center Haidian District | Beijing, 100088 P.R. China MedicalResearch.com: What is the background for this study? What are the main findings? Response: Preliminary small studies indicate that lying flat increases blood flow and oxygenation to the brain.  Thus, patients with acute ischemic stroke may benefit from lying flat in bed.  Conversely, sitting up in bed, with the head elevated to at least 30 degrees, may reduce swelling in the brain for patients who have large ischemic or hemorrhagic forms of stroke.  The optimal head position to produce the best outcome from acute stroke, and avoid potential risks, such as aspiration pneumonia, is unknown.  We undertook a large scale multicentre randomized controlled trial where 114 hospitals were randomised to sequentially apply lying flat or sitting up head positioning as a policy of care to a consecutive series of patients, that overall totalled over 11000 patients, presenting with acute stroke.  The study showed there was no difference in the chance of good physical recovery for patients between the two head positions but also that there were no excessive harms for either. In other words, head positioning alone didn’t produce any benefits or harms in patients with acute stroke (more…)
Author Interviews, Blood Pressure - Hypertension, Brigham & Women's - Harvard, Neurological Disorders, Stroke / 22.06.2017

MedicalResearch.com Interview with: Andrea Morotti, M.D. Research Fellow in Neurology Massachusetts General Hospital Harvard Medical School MedicalResearch.com: What is the background for this study? What are the main findings? Response: The CT angiography (CTA) spot sign is a validated marker of Intracerebral Hemorrhage (ICH) expansion and may identify those subjects more likely to benefit from intensive blood pressure reduction. We observed that less than 20% of ICH patients received a CTA as part of their diagnostic workup in a large, international randomized clinical trial. The performance of the spot sign in predicting ICH growth was suboptimal compared with what was reported in previous studies. Intensive blood pressure reduction did not improve functional outcome in spot sign positive patients. (more…)
AHA Journals, Author Interviews, Race/Ethnic Diversity, Stroke / 18.06.2017

MedicalResearch.com Interview with: George Howard, Dr.PH PI of the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study Department of Biostatistics University of Alabama at Birmingham Birmingham, AL MedicalResearch.com: What is the background for this study? What are the main findings? Response: Rural areas have been known to have a higher death rate than urban, and higher death from stroke in rural areas is a major contributor to this disparity. The goal of the research was to assess if the higher deaths from stroke was because rural people are more likely to have a stroke, or more likely to die from a stroke once it occurs.   This distinction is critically important, since intervention to reduce stroke deaths in rural area would focus on stroke prevention if the former, but would focus on improving stroke care (after the stroke) if the latter. We found that the higher mortality from stroke appears to be almost completely due to more people having stroke.   As such, we need to focus on efforts to reduce the risk of rural areas.   While there are well-documented differences in stroke care between urban and rural areas, resolving these differences will not be likely reduce the rural excess death from stroke. It would seem that the higher risk of having a stroke could be due to the observation that those in rural areas are more likely to have major stroke risk factors, including hypertension, diabetes and cigarette smoking; however, the higher prevalence of these risk factors don’t seem to explain the higher risk.   So what causes the higher risk remains a mystery. (more…)
Author Interviews, Heart Disease, JAMA, Stroke / 15.06.2017

MedicalResearch.com Interview with: Gregory Y. H. Lip, MD Professor of Cardiovascular Medicine University of Birmingham Adjunct Professor of Cardiovascular Sciences, Thrombosis Research Unit, Aalborg University, Denmark National Institute for Health Research (NIHR) Senior Investigator. Visiting Professor of Haemostasis Thrombosis & Vascular Sciences, Aston University, Birmingham, UK Institute of Cardiovascular Sciences City Hospital Birmingham England UK MedicalResearch.com: What is the background for this study? What are the main findings? Response: The randomized clinical trials comparing non-Vitamin K antagonist oral anticoagulants (NOACs) vs warfarin largely focused on recruitment of high risk atrial fibrillation(AF) patients with >2 stroke risk factors, with only the trials testing dabigatran or apixaban including a minority of patients with 1 stroke risk factor. Despite this, regulatory approvals of all NOACs have been for stroke prevention in AF patients with ≥1 stroke risk factors. No difference between NOACs compared to warfarin in risk of ischemic stroke/systemic embolism, was seen but for ‘any bleeding’, this was lower for apixaban and dabigatran compared to warfarin. (more…)
AHA Journals, Author Interviews, Hepatitis - Liver Disease, Stroke / 05.06.2017

MedicalResearch.com Interview with: Neal S. Parikh, M.D. Administrative Chief Resident Department of Neurology Weill Cornell Medicine & NewYork-Presbyterian Hospital MedicalResearch.com: What is the background for this study? What are the main findings? Response: In contrast to the gastrointestinal and systemic hemorrhagic and thrombotic complications of cirrhosis, little was known about the risk of cerebrovascular complications. In this analysis of Medicare beneficiaries' claims data, we found cirrhosis to be associated with stroke, with associations appearing to be stronger for hemorrhagic stroke than for ischemic stroke. We controlled for demographic variables and stroke risk factors and relevant comorbidities, and our results were essentially unchanged in multiple sensitivity analyses. (more…)
AHA Journals, Author Interviews, Depression, Stroke / 04.06.2017

MedicalResearch.com Interview with: Chung-Yen Lu, MD, PhD Assistant Professor Department of Sport and Health Management, Da-Yeh University, Changhua, Taiwan; Department of Chinese Medicine, Taipei Hospital, Ministry of Health and Welfare, New Taipei, Taiwan  MedicalResearch.com: What is the background for this study? Response: Post-stroke depression is a common mood complication of patients with stroke and may deteriorate motor function and cognitive function. Acupuncture therapy is an alternative and supplementary medical care often used worldwide. Previous studies have reported that acupuncture therapy for post-stroke depression may involve multiple therapeuticeffects including treating neurological disorders and physical disabilities following stroke, which are predictors of post-stroke depression. However, population-based evaluations on the association between acupuncture treatment and prevention of post-stroke depression are rare.  (more…)
AHA Journals, Author Interviews, Blood Pressure - Hypertension, OBGYNE, Stroke / 27.05.2017

MedicalResearch.com Interview with: Eliza Miller, M.D. Vascular neurology fellow New York-Presbyterian Hospital/Columbia University Medical Center New York City  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Preeclampsia is a common disorder that causes high blood pressure during pregnancy. It affects about 1 in 20 pregnant women. Women with preeclampsia are at higher risk for stroke during pregnancy and post-partum, but it’s very difficult to predict who is going to have a stroke. Our study looked at a large dataset of billing data from New York State, and compared women who had preeclampsia and strokes to women who had preeclampsia but did not have a stroke. We found that preeclamptic women with urinary tract infections, bleeding or clotting disorders, or preexisting high blood pressure were at higher risk of having strokes during pregnancy or postpartum. (more…)
Author Interviews, Emergency Care, JAMA, Stroke / 18.05.2017

MedicalResearch.com Interview with: Ryan A. McTaggart M.D. Assistant Professor of Diagnostic Imaging, Neurology, and Neurosurgery @mobilestroke4U Warren Alpert School of Medicine Brown University Rhode Island Hospital MedicalResearch.com: What is the background for this study? Response: Stroke is the #1 cause of disability and 5th leading cause of death. Mechanical thrombectomy (direct mechanical removal of the obstructing blood clot) is a dramatically effective treatment for the most devastating of all acute ischemic strokes – emergency large vessel occlusion (ELVO). Access to this treatment can be optimized with the use of 1) mobile stroke unit technology, 2) changing our Emergency medical services triage algorithms so that stroke matches that of trauma (using field severity to transport the right patient, to the right hospital, the first time, whenever possible), and 3) improving in-hospital processes at Primary Stroke Centers (PSCs) so that patients with suspected ELVO who present to a PSC (a hospital that does not offer mechanical thrombectomy) do not get left behind and untreated. This study reflects an effort to address and improve the third item. (more…)
Author Interviews, JACC, Stroke, Surgical Research / 03.05.2017

MedicalResearch.com Interview with: Jay S. Giri, MD, MPH Director, Peripheral Intervention Assistant Professor of Clinical Medicine Penn Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: We analyzed data from 6,526 patients in the 5 most recent randomized trials comparing carotid artery stenting to carotid endarterectomy.  These procedures are performed to prevent long-term stroke in patients with severe narrowings of their carotid arteries.  We learned that the procedures are equally effective in preventing stroke over the long-term.  However, the procedures have quite different safety profiles, defined as adverse events that the patients experienced within 30 days of their procedure. Carotid artery stenting was associated with a higher risk of stroke in the initial 30 days after the procedure.  Carotid endarterectomy was associated with greater risks of myocardial infarction (heart attack) and cranial nerve palsy, a variable condition that most often results in difficulty with swallowing or speaking, over this timeframe. (more…)
Author Interviews, Blood Pressure - Hypertension, Sleep Disorders, Stroke / 30.04.2017

MedicalResearch.com Interview with: Shyam Prabhakaran, MD, MS Department of Neurology Feinberg School of Medicine Northwestern University Chicago, IL MedicalResearch.com: What is the background for this study? What are the main findings? Response: Wake-up stroke, or stroke onset during sleep, accounts for one-quarter of stroke presentations. Yet, there are few studies exploring mechanisms or triggers of onset during sleep. We explored whether blood pressure variability which is known to have circadian patterns could trigger wake-up stroke. We found that in the first 24 hours after stroke, those with wake-up stroke had greater blood pressure variability than non-wake up stroke patients. (more…)
Author Interviews, Heart Disease, JAMA, Lipids, Nutrition, Stroke, Yale / 13.04.2017

MedicalResearch.com Interview with: Eric J. Brandt, MD Yale University Cardiovascular Disease Fellow MedicalResearch.com: What is the background for this study? What are the main findings? Response: From previous studies we know that industrial trans fatty acid (trans fat) consumption is linked to elevated risk for cardiovascular disease. Even small amounts of consumption can be deleterious to cardiovascular health. In New York state, there were 11 counties that restricted the use of trans fatty acids in eateries. We compared hospitalization for heart attacks and stroke from 2002 through 2013 in counties that did and did not have restrictions. Our study found that when comparing populations within New York state that restricted the use of trans fat, compared to those that did not, there was an associated additional decline beyond temporal trends for heart attacks and stroke events combined by 6.2%. (more…)
Author Interviews, CDC, JAMA, Stroke / 10.04.2017

MedicalResearch.com Interview with: Mary G. George, MD, MSPH Division for Heart Disease and Stroke Prevention National Center for Chronic Disease Prevention and Health Promotion Centers for Disease Control and Prevention Atlanta, Georgia MedicalResearch.com: What is the background for this study? Response: Stroke is the fifth leading cause of death in the United States, killing more than 130,000 Americans each year—that’s 1 of every 20 deaths—and costs the nation $33 billion annually, including the cost of health care services, medications, and lost productivity. And, stroke is leading cause of serious disability. An ischemic stroke, sometimes called a brain attack, is a stroke that occurs when there is a blockage of the blood supply to the brain. (more…)
Author Interviews, Compliance, Primary Care, Stroke / 09.04.2017

MedicalResearch.com Interview with: Anna De Simoni NIHR Academic Clinical Lecturer in Primary Care Research Centre for Primary Care and Public Health Barts and The London School of Medicine and Dentistry London E1 2AB MedicalResearch.com: What is the background for this study? Response: Three in 10 stroke survivors will go on to have a further stroke, which causes greater disability or even death. Secondary prevention medications, including antihypertensives, blood thinning and lipid lowering agents, such as statins, can reduce risk of stroke recurrence by up to 75 per cent. However, patients’ persistence with these medications decreases over time because a minority of people experience side effects, which are mild in most cases. The analysis, involving Queen Mary University of London and the University of Cambridge and published in the journal Family Practice, was performed on the archives from TalkStroke, a UK online forum hosted by the Stroke Association. The forum is used by patients with stroke and their carers, and generated 21,596 posts during 2004-2011. 50 participants were found to discuss GP advice on prevention medications in 43 discussion threads. (more…)
Author Interviews, Heart Disease, Insomnia / 31.03.2017

MedicalResearch.com Interview with: Qiao He Master’s degree student China Medical University Shenyang, China MedicalResearch.com: What is the background for this study? Response: Sleep is an important factor for biological recovery functions, but in modern society, more and more people have complained having sleep problems like insomnia, one of the main sleep disorders. It is reported that approximately one-third of the German general population has been suffering from insomnia symptoms. In decades, many researchers have found associations between insomnia and bad health outcomes. Insomnia seems to be a big health issue. However, the results from previous studies regarding the association of insomnia and cardiovascular or cerebrovascular events were inconsistent. Therefore, we conducted this study. (more…)
Author Interviews, Medical Imaging, MRI, Stroke / 30.03.2017

MedicalResearch.com Interview with: Jalal B. Andre M.D., D.A.B.R.® Drector of neurological MRI and MRI safety officer at Harborview Medical Center University of Washington  MedicalResearch.com: What is the background for this study? Response: Acute ischemic stroke (AIS) patients with good collaterals have better clinical outcomes. AIS is characterized by an ischemic penumbra, a region of salvageable brain tissue, that surrounds a core of irreversible ischemic infarct. The penumbra is tenuously perfused by collateral blood vessels which, if extensive enough, can maintain penumbral perfusion, improving the odds that a larger volume of brain tissue will survive. Standard, first-line methods for evaluating collaterals in the acute setting include CT angiography, MR angiography, and (less commonly) digital subtraction angiography. Arterial spin labeling (ASL) is an emerging MRI technique that assesses cerebral perfusion. Its advantages include relatively short scan time (4-6 minutes), lack of ionizing radiation, and independence from an exogenous contrast agent (contraindicated in patients with impaired renal function or documented sensitivity). Collaterals can be identified within ASL images as foci of curvilinear hyperintensity bordering regions of hypoperfusion. We sought to explore a novel relationship between the presence of ASL collaterals (ASLc) and neurological outcome in acute ischemic stroke patients. (more…)
Author Interviews, Lancet, Stroke / 07.03.2017

MedicalResearch.com Interview with: Caterina Breitenstein, PhD Department of General Neurology, University of Muenster, Germany Annette Baumgärtner, PhD Faculty of Health and Social Sciences, Fresenius University of Applied Sciences, Hamburg, Germany MedicalResearch.com : What is the background for this study? What are the main findings? Response: For a long time, it has been assumed that language recovery is limited to the first months after the initial stroke. During the past two decades, however, several clinical studies and systematic reviews have challenged this dogma by demonstrating functional gains in stroke survivors during the chronic post-stroke stage (at least 6 months post the initial stroke) whenever speech and language therapy (SLT) intensity was sufficiently high (i.e., at least 5 h/week for several weeks). These studies, however, lacked the methodological quality required for evidence-based interventions (for criteria, please refer to http://www.cebm.net/ocebm-levels-of-evidence). Until now, this lack in evidence severely hampers stroke survivors’ access to language rehabilitation services . The present multicenter randomized controlled healthcare trial FCET2EC (acronym stands for "From Controlled Experimental Trial to=2 Everyday Communication) is the first study worldwide to compare three weeks of intensive SLT provided under routine clinical conditions to an equally long period of no (or low intensity) SLT. After 3 weeks of intensive individualized therapy, the 156 stroke survivors with chronic aphasia verbally expressed themselves more effectively in daily-life communicative situations, like changing a doctor’s appointment by a telephone call. Additionally, patients and their significant other rated their communication-related quality of life as significantly improved. Last but not least, therapy effects remained stable over a follow-up period of six months after the intensive intervention. (more…)
Author Interviews, Stroke / 06.03.2017

MedicalResearch.com Interview with: Jesse Dawson MD, BSc (Hons), FRCP, FESO Clinical Reader / Honorary Consultant Clinical Lead Scottish Stroke Research Network / NRS Stroke Research Champion Chair MVLS Research Ethics Committee Institute of Cardiovascular and Medical Sciences College of Medical, Veterinary & Life Sciences University of Glasgow MedicalResearch.com: What is the background for this study? What are the main findings? Response:    Many patients suffer long term arm weakness after stroke and there are few effective treatments. We are assessing whether stimulation of the vagus nerve can improve recovery after stroke. Stimulation of the vagus nerve, called VNS for short, triggers the release of neurotransmitters in the brain. These neurotransmitters are important for learning and memory. Pre-clinical studies have shown that combining vagus nerve stimulation with movement or rehabilitation tasks enhances brain plasticity, improves motor learning and leads to better recovery after stroke. Based on this, we performed a clinical trial in patients with arm weakness after stroke and found promising changes in the patients treated with VNS paired with rehabilitation compared to rehabilitation alone. In this study we performed a double blind sham stimulation controlled study of VNS paired with rehabilitation vs sham stimulation in patients with long term arm weakness due to ischaemic stroke. All participants were implanted with a VNS device and underwent a course of therapy. We didn’t see a statistically significant difference after 6 weeks of intensive in-clinic therapy but saw a large and significant difference after a further 60 days home exercise treatment with VNS.  There were differences on several measures, including the clinical response rate which was 88% with VNS and 33% with controls. (more…)
Author Interviews, Mental Health Research, Pediatrics, Social Issues, Stroke / 28.02.2017

MedicalResearch.com Interview with: Emily C. Maxwell, Ph.D. Pediatric Neuropsychology Bugher Fellow Division of Neurology Instructor | Department of Pediatrics University of Colorado School of Medicine Aurora, CO 80045  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Previous research has found increased psychological problems and significantly higher rates of psychiatric disorders after pediatric stroke. However, past studies have mainly used global indices, without comparison to age-based norms. Thus, little is known about the discrete symptomatology exhibited by these children and how discrepant these symptoms may be from normative expectations. At the University of Colorado Denver and Children’s Hospital Colorado, we studied 50 patients who suffered an arterial ischemic stroke during childhood. The parents of these patients completed the Child Behavior Checklist, a questionnaire assessing emotional and behavioral problems. We found that children with stroke had higher symptoms of depression, anxiety, physical complaints, and behavioral difficulties compared to a normative sample of same-aged peers. Additionally, levels of anxiety were higher in children who had a stroke at an early age (before 6 years of age) compared to children who had a stroke at a later age (after 10 years of age). (more…)
Author Interviews, Stroke / 26.02.2017

MedicalResearch.com Interview with: Professor Philip Bath Stroke Association Professor of Stroke Medicine/Head of Division of Clinical Neuroscience Faculty of Medicine & Health Sciences University of Nottingham  MedicalResearch.com: What is the background for this study? What are the main findings? Response: Blood thinning (antiplatelets) drugs reduce further strokes (recurrence) after stroke and mini-stroke (TIA). One antiplatelet, such as aspirin, is better than none, and two different drugs are better than one. The question then is whether three would be better still, providing excess bleeding is not problematic. 3096 patients with ischaemic stroke (stroke due to a blood clot) or mini-stroke were enrolled within 48 hours. They were randomised to take intensive separate antiplatelet therapy (three drugs comprising aspirin, clopidogrel and dipyridamole) or guideline therapy (either clopidogrel alone, or combined aspirin and dipyridamole) for 30 days (after which they took guideline treatment). At 90 days we assessed whether patients had had another stroke or mini-stroke, and how dependent or disabled this had left them. There were slightly fewer recurrent strokes and mini-strokes between intensive and guideline treatment but the difference was not different statistically, so a neutral trial. In contrast, major bleeding was significantly increased in the intensive group as compared with guideline treatment. When looking at the net benefit/harm, there was no difference between the treatment groups. (more…)
Author Interviews, Race/Ethnic Diversity, Social Issues, Stroke / 26.02.2017

MedicalResearch.com Interview with: Matthew D. Holtkamp, D.O. CPT, MC, USA Medical Director, Intrepid Spirit, Traumatic Brain Injury Clinic Staff Neurologist, Department of Medicine Teaching Fellow, Uniformed Services University Carl R. Darnall Army Medical Center Fort Hood, Texas 76544 MedicalResearch.com: What is the background for this study? Response: Racial and Socioeconomic disparities in the outcomes of stroke patients is well documented in the US Civilian Healthcare system. That Healthcare system has wide variations in access to care and in the levels of available care. In contrast, the Military Healthcare system is a single payer system meaning that every member has the same healthcare benefits. (more…)
Alzheimer's - Dementia, Author Interviews, Brigham & Women's - Harvard, Geriatrics, Heart Disease, Stroke / 26.02.2017

MedicalResearch.com Interview with: Ariela Orkaby, MD, MPH Geriatrics & Preventive Cardiology Associate Epidemiologist Division of Aging, Brigham and Women's Hospital Instructor in Medicine, Harvard Medical School MedicalResearch.com: What is the background for this study? What are the main findings? Response: Atrial Fibrillation is a common heart rhythm that affects 1 in 25 adults over age 60 and 1 in 10 adults over age 80. The feared consequence of atrial fibrillation is stroke, leading to the prescription of blood thinning medications (anticoagulants such as warfarin) to prevent strokes. However, there is an underutilization of these life-saving medications in older adults, and particularly in those who have dementia. In part, this is due to a lack of research and inclusion of older adults with dementia in prior studies. In this study, we used clinical Veterans Administration data, linked to Medicare, to follow 2,572 individuals over age 65 who had atrial fibrillation and until a diagnosis of dementia. The average age was 80 years, and 99% were male. We found that only 16% remained on warfarin. We used statistical methods to account for reasons why a patient would or would not be treated with warfarin and found that those who continued to take warfarin had a significantly lower risk of stroke (HR 0.74, 95% Confidence interval 0.54- 0.99, p=0.47) and death (HR 0.72, 95% CI 0.60-0.87, p<0.01) compared to those who did not continue to take warfarin, without an increased risk of bleeding. (more…)
Author Interviews, Heart Disease, JAMA / 25.02.2017

MedicalResearch.com Interview with: MedicalResearch.com: What is the background for this study? What are the main findings? Response: The incidence of subdural hematoma (SDH; a bleed located within the skull, but outside the brain) has been reported to be on the increase. Previous studies have shown an association between use of antithrombotic drugs and SDH. However, studies with updated estimates of this risk and with focus on current more complex and aggressive regimens of antithrombotic treatment are scarce. We therefore performed this study, where we identified 10,010 patients aged 20-89 years that were admitted with SDH in Denmark in 2000 through 2015. Preadmission use of antithrombotic drugs (low-dose aspirin, clopidogrel, vitamin K antagonist, e.g. warfarin, and direct oral anticoagulants) of these cases was compared to that of 400,380 individuals from the general population with no history of SDH (controls). We found that use of antithrombotic drugs was associated with an increased risk of subdural hematoma . The magnitude of this risk varied by type of antithrombotic, and was, e.g., low for use of low-dose aspirin, and highest for warfarin. Further, with a single exception (low-dose aspirin and dipyridamole), concurrent use of more than one antithrombotic drug was associated with higher risk of SDH, particularly if warfarin was taken along with an antiplatelet drug, e.g., low-dose aspirin or clopidogrel. Increasing use of antithrombotic drugs was observed in the study period. The incidence of subdural hematomas in the Danish population also increased markedly in the years 2000-2015, particularly among those aged 75+ years. Our study indicates that this increased incidence, can, at least partly, be explained by increased use of antithrombotic drugs. (more…)
Author Interviews, Heart Disease, JAMA, Stroke / 25.02.2017

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. (more…)
Author Interviews / 24.02.2017

MedicalResearch.com Interview with: Jonah P. Zuflacht M.D. Candidate | Class of 2017 Columbia University, College of Physicians & Surgeons MedicalResearch.com: What is the background for this study? What are the main findings? Response: Recent evidence suggests that psychological distress, including the symptoms of psychiatric illness, may increase the risk of stroke. However, existing studies have been limited by small sample sizes, methodological bias, and poorly defined criteria for what constitutes psychological distress. We used a case-crossover design to assess the relationship between hospitalization or emergency department visit for a psychiatric condition and stroke in adults. We found that psychiatric hospitalization increases the short-term risk of stroke, particularly within the 15-day period following the diagnosis. This effect is particularly pronounced in younger patients. (more…)