Publications
162 results found
Laible M, Jenetzky E, Beynon C, et al., 2016, Adverse events following international normalized ratio reversal in intracerebral hemorrhage, Cerebrovascular Diseases, Vol: 42, Pages: 446-454, ISSN: 1015-9770
Background: Prothrombin complex concentrates (PCCs) are frequently used to reverse the effect of vitamin K antagonists (VKAs) in patients with non-traumatic intracerebral hemorrhage (ICH). However, information on the rate of thromboembolic events (TEs) and allergic events after PCC therapy in VKA-ICH patients is limited. Methods: Consecutive VKA-ICH patients treated with PCC at our institution between December 2004 and June 2014 were included into this retrospective observational study. We recorded international normalized ratio (INR) values before and after PCC treatment, baseline clinical characteristics including the premorbid modified Rankin Scale (pmRS) score, TE and allergic event that occurred during the hospital stay. All events were classified by 3 reviewers as being ‘related', ‘probably related', ‘possibly related', ‘unlikely related' or ‘not related' to treatment with PCC. To identify factors associated with TEs, log-rank analyses were applied. Results: Two hundred and five patients were included. Median INR was 2.8 (interquartile range (IQR) 2.2-3.8) before and 1.3 (IQR 1.2-1.4) after PCC treatment and a median of 1,500 IU PCC (IQR 1,000-2,500) was administered. Nineteen TEs were observed (9.3%); none were classified ‘related' but 9 were classified as ‘possibly' or ‘probably related' to PCC infusion (4.4%). One allergic reaction (0.5%), ‘unlikely related' to PCC, was observed. In the whole cohort, PCC doses >2,000-3,000 IU, ICH volumes >40 ml, National Institute of Health Stroke Scale values >10 and a pmRS >2 were associated with the development of TEs (p = 0.031, p = 0.034, p = 0.050 and p = 0.036, respectively). Conclusions: Overall, INR reversal with PCC appears safe. Though no clear relationship between higher PCC dosing and TEs was observed, PCC doses between >2,000 and 3,000 IU and higher morbidity at ICH onset were associated with TEs. Hence, individual titration of PCC to avoid
Laible M, Horstmann S, Moehlenbruch M, et al., 2016, Preexisting cognitive impairment in intracerebral hemorrhage, Acta Neurologica Scandinavica, Vol: 135, Pages: 628-634, ISSN: 1600-0404
ObjectivesPreexisting cognitive impairment is a predictor of cognitive decline after ischemic stroke, but evidence in intracerebral hemorrhage (ICH) is limited. We aimed to determine the prevalence of premorbid cognitive impairment in patients with ICH.Materials and MethodsWe included patients with acute ICH. Pre-ICH cognitive impairment was determined based on the results of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) that uses information from close relatives. Patients were assessed as having been cognitively impaired with an IQCODE score of ≥3.44; an IQCODE ≥4.00 indicated pre-ICH dementia. CT and MRI images were reviewed to determine the extent of white matter lesions and to measure the radial width of the temporal horn as marker of brain atrophy. We investigated differences of cardiovascular risk factors and imaging data between patients with and without pre-ICH cognitive impairment using correlation analyses, uni- and multivariable regression models. Functional neurological state was assessed using the modified Rankin Scale (mRS). The mRS was dichotomized at the level of 3, and a premorbid mRS of 0–2 was considered as functional independency.ResultsAmong the 89 participants, median age was 70 years (interquartile range 58–78) and 52 (58.4%) were male. IQCODE indicated pre-ICH cognitive impairment in 18.0% (16 of 89), and 83.1% were functionally independent before ICH. Cognitive impairment was associated with a premorbid mRS≥3 (chi squared test, P=0.009). In multivariable analysis, prior stroke/transient ischemic attack (OR 18.29, 95%-CI 1.945–172.033, P=.011) and hematoma volume (OR 0.90, 95%-CI 0.812–0.991, P=.033) were independently associated with pre-ICH cognitive impairment.ConclusionsIn conclusion, cognitive impairment frequently precedes ICH. A higher frequency of cerebrovascular events suggests a role of vascular processes in the development of cognitive impairment before ICH.
Rost NS, Giugliano RP, Ruff CT, et al., 2016, Outcomes With Edoxaban Versus Warfarin in Patients With Previous Cerebrovascular Events Findings From ENGAGE AF-TIMI 48 (Effective Anticoagulation With Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis in Myocardial Infarction 48), STROKE, Vol: 47, Pages: 2075-2082, ISSN: 0039-2499
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- Citations: 67
Veltkamp R, Gill D, 2016, Clinical trials of immunomodulation in ischemic stroke, Neurotherapeutics, Vol: 13, Pages: 791-800, ISSN: 1933-7213
Inflammatory mechanisms are currently considered as a prime target for stroke therapy. There is evidence from animal studies that immune signals and mediators can have both detrimental and beneficial effects in particular stages of the disease process. Moreover, several of these mechanisms are turned on with sufficient delay after ischemia onset to make them amenable to therapeutic intervention. Several clinical proof-of concept trials have investigated the efficacy of different immunomodulatory approaches in patients with stroke. Trials targeting the innate immune system have focused on reduction of microglial activation, inhibition of neutrophil migration, and interleukin-1 receptor blockade, suggesting that interleukin-1 receptor blockade may be a promising strategy. Studies aiming at halting T-cell migration have also been undertaken with controversial findings regarding prevention of infarct growth in neuroimaging studies. Consistently, recent proof-of-concept trials targeting lymphocytes with drugs such as natalizumab and fingolimod have yielded some promising results on clinical endpoints, but confirmation in larger trials is needed. At present, the understanding of the role of immune mechanisms in neurorepair and neurodegeneration is limited. Improving long-term brain function by mitigating prolonged neuroinflammation that was triggered by acute brain injury could be a strategy in addition to neuroprotection.
Gill D, Baheerathan A, Aravind A, et al., 2016, Severe hemorrhagic transformation after thrombolysis for acute ischemic stroke prevents early neurological improvement, Journal of Stroke & Cerebrovascular Diseases, Vol: 25, Pages: 2232-2236, ISSN: 1532-8511
BackgroundIntravenous thrombolysis can improve neurological outcomes after acute ischemic stroke (AIS), but hemorrhagic transformation (HT) of the infarct remains a risk. Current definitions for symptomatic intracerebral hemorrhage (ICH) all entail that there be some degree of associated neurological deterioration. However, early deleterious effects of secondary ICH might also be manifested as reduced neurological improvement. This study aims to investigate whether there are any independent associations between different radiological subtypes of HT and the degree of neurological improvement 24 hours after thrombolysis.MethodsThis study is a retrospective analysis of a single-center database of consecutive thrombolysis cases for AIS. Multivariate regression analysis was undertaken to explore the relationship between different subtypes of HT with changes in National Institutes of Health Stroke Scale (NIHSS) score 24 hours after thrombolysis, after adjusting for potential confounders.ResultsAs compared to cases with no HT, occurrence of the parenchymal hematoma 2 (PH2) subtype of secondary ICH was independently associated with reduced improvement or worsening in the NIHSS score, with an average effect size of 7 points (95% confidence interval −10 to −4, P < .001). In the absence of PH2, thrombolysis for AIS was generally associated with an improvement in the neurological status at 24 hours.ConclusionsThe PH2 subtype of HT is associated with reduced neurological improvement or deterioration 24 hours after thrombolysis for AIS.
Gill D, Sivakumaran P, Wilding P, et al., 2016, Trends in C-reactive protein levels are associated with neurological change Twenty-four hours after thrombolysis for acute ischemic stroke, Journal of Stroke & Cerebrovascular Diseases, Vol: 25, Pages: 1966-1969, ISSN: 1532-8511
BACKGROUND: Elevated inflammatory markers such as C-reactive protein (CRP) are associated with worse outcomes in patients thrombolysed for acute ischemic stroke (AIS). AIMS: To investigate whether changes in CRP levels are associated with neurological change after thrombolysis for AIS. METHODS: Retrospective analysis of a single-center database of consecutive thrombolysis cases for AIS from October 18, 2011, to June 15, 2015, inclusive. Multivariate regression analysis was used to investigate the relationship between change in CRP 12-24 hours after thrombolysis and change in NIHSS (National Institutes of Health Stroke Scale) score 24 hours after thrombolysis. The other potentially confounding predictor variables included in the model were CRP on admission and NIHSS score before thrombolysis. RESULTS: Complete data were available for 108 out of possible 435 eligible patients. Increases in CRP levels 12-24 hours after thrombolysis were negatively associated with reduction in NIHSS score 24 hours after thrombolysis (coefficient .08, 95% confidence interval .031-.129, P = .002). Thus, on average, for every 12.5 mg/L additional increase in CRP 12-24 hours after thrombolysis, NIHSS score at 24 hours improved by 1 point less. CONCLUSION: While it was previously known that elevated CRP levels are associated with worse outcomes in patients thrombolysed for AIS, the current work demonstrates that changes in CRP levels after thrombolysis also relate to neurological change, and thus may have scope for use as prognostic markers.
Hertle DN, Heer M, Santos E, et al., 2016, Changes in electrocorticographic beta frequency components precede spreading depolarization in patients with acute brain injury, Clinical Neurophysiology, Vol: 127, Pages: 2661-2667, ISSN: 1872-8952
ObjectiveSpreading depolarization (SD) occurs after traumatic brain injury, subarachnoid hemorrhage, malignant hemispheric stroke and intracranial hemorrhage. SD has been associated with secondary brain injury, which can be reduced by ketamine. In this present study frequency bands of electrocorticographic (ECoG) recordings were investigated with regards to SDs.MethodsA total of 43 patients after acute brain injury were included in this retrospective and explorative study. Relative delta 0.5–4 Hz, theta 4–8 Hz, alpha 8–13 Hz and beta 13–40 Hz bands were analyzed with regards to SD occurrence and analgesic and sedative administration. Higher frequencies, including gamma 40–70 Hz, fast gamma 70–100 Hz and high frequency oscillations 100–200 Hz were analyzed in a subset of patients with a sampling rate of up to 400 Hz.ResultsA close association of relative beta frequency and SD was found. Relative beta frequency was suppressed up to two hours prior to SD when compared to hours with no SD. This finding was partially explained by administration of ketamine. Even after removal of all patient data during administration of ketamine, SDs occurred predominantly during times with low relative beta frequency in a patient-independent analysis.ConclusionSuppression of beta frequency by ketamine or without ketamine is associated with low SD counts.SignificanceAlteration of beta frequency might help to predict occurrence of SDs in acutely brain injured patients.
Rizos T, Veltkamp R, 2016, Response to Letter Regarding Article, "Preexisting Heart Disease Underlies Newly Diagnosed Atrial Fibrillation After Acute Ischemic Stroke", Stroke, Vol: 47, Pages: e89-e89, ISSN: 0039-2499
Lobotesis K, Veltkamp R, Carpenter IH, et al., 2016, Cost-effectiveness of stent-retriever thrombectomy in combination with IV t-PA compared with IV t-PA alone for acute ischemic stroke in the UK, Journal of Medical Economics, Vol: 19, Pages: 785-794, ISSN: 1941-837X
Objective: To evaluate the cost-effectiveness of neurothrombectomy with a stent retriever (Solitaire**Solitaire Revascularization Device is a registered trademark of Medtronic (Irvine, CA).View all notesRevascularization Device) in treating acute ischemic stroke patients from the UK healthcare provider perspective.Methods: A Markov model was developed to simulate health outcomes and costs of two therapies over a lifetime time horizon: stent-retriever thrombectomy in combination with intravenous tissue-type plasminogen activator (IV t-PA), and IV t-PA alone. The model incorporated an acute phase (0–90 days) and a rest of life phase (90+ days). Health states were defined by the modified Rankin Scale score. During the rest of life phase, patients remained in the same health state until a recurrent stroke or death. Clinical effectiveness and safety data were taken from the SWIFT PRIME study. Resource use and health state utilities were informed by published data.Results: Combined stent-retriever thrombectomy and IV t-PA led to improved quality-of-life and increased life expectancy compared to IV t-PA alone. The higher treatment costs associated with the use of stent-retriever thrombectomy were offset by long-term cost savings due to improved patient health status, leading to overall cost savings of £33 190 per patient and a net benefit of £79 402. Deterministic and probabilistic sensitivity analyses demonstrated that the results were robust to a wide range of parameter inputs.Limitations: The acute and long-term costs resource use data were taken from a study based on a patient population that was older and may have had additional comorbidities than the SWIFT PRIME population, resulting in costs that may not be representative of the cohort within this model. In addition, the estimates may not reflect stroke care today as no current evidence is available; however, the cost estimates were deemed reasonable by clinical opinion.Conclusions: Combined stent-
Steiner T, Poli S, Griebe M, et al., 2016, Fresh frozen plasma versus prothrombin complex concentrate in patients with intracranial haemorrhage related to vitamin K antagonists (INCH): a randomised trial, LANCET NEUROLOGY, Vol: 15, Pages: 566-573, ISSN: 1474-4422
Elkins J, Elkind M, Veltkamp R, et al., 2016, Natalizumab Versus Placebo in Patients with Acute Ischemic Stroke (AIS): Results from ACTION, a Multicenter, Double-Blind, Placebo-Controlled, Randomized Phase 2 Clinical Trial, 68th Annual Meeting of the American-Academy-of-Neurology (AAN), Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0028-3878
Elkins J, Elkind M, Veltkamp R, et al., 2016, Natalizumab Versus Placebo in Patients with Acute Ischemic is Stroke (AIS): Results fro ACTION, a Multicenter, Double-Blind, Placebo-Controlled, Randomized Phase 2 Clinical Trial, 68th Annual Meeting of the American-Academy-of-Neurology (AAN), Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0028-3878
Gill D, Cox T, Aravind A, et al., 2016, A fall in systolic blood pressure 24 hours after thrombolysis for acute ischemic stroke is associated with early neurological recovery, JOURNAL OF STROKE & CEREBROVASCULAR DISEASES, Vol: 25, Pages: 1539-1543, ISSN: 1052-3057
Background: Outcomes are worse in patients who underwent thrombolysis for acuteischemic stroke (AIS) with persistent hypertension. The objective of this study is to investigate whether fall in systolic blood pressure (SBP) has any relationship with neurological outcome 24 hours after thrombolysis, after adjusting for potentially confounding factors. Methods: Retrospective analysis of a single-center database of consecutive thrombolysis cases for AIS. Multivariate regression analysiswas used to explore the relationship between fall in SBP and reduction in National Institutes of Health Stroke Scale (NIHSS) score 24 hours after thrombolysis. Other potentially confounding predictor variables used in the model were SBP on thrombolysis, blood glucose level on thrombolysis, NIHSS score on thrombolysis, administration of antihypertensive medications, and the time to thrombolysis after symptom onset. Results: A fall in SBP 24 hours after thrombolysis is independently associated with greater improvement in NIHSS score 24 hours after thrombolysis (coefficient .051, 95% confidence interval .023-.078, P < .001). Thus, a reduction of 10 mmHg in SBP after 24 hours is associated with a .51 point reduction in the NIHSS score. Conclusions: Restoration of SBP toward normal limits after thrombolysis for AIS is associated with greater early neurological improvement
Purrucker JC, Wolf M, Haas K, et al., 2016, Safety of endovascular thrombectomy in patients receiving non-vitamin K antagonist oral anticoagulants, Stroke, Vol: 47, Pages: 1127-1130, ISSN: 1524-4628
Background and Purpose—Prospective data on the safety of endovascular thrombectomy in acute stroke patients on non–vitamin K antagonist oral anticoagulants are lacking.Methods—Prospective multicenter observational study. Patients with ischemic stroke undergoing thrombectomy with orwithout preceding thrombolysis were enrolled into the Registry of Acute Ischemic Stroke Under New Oral Anticoagulants.Baseline characteristics and functional outcome at 3 months were assessed. Hemorrhagic transformation and symptomaticintracranial hemorrhage were analyzed. Reperfusion was graded using the modified Thrombolysis in Cerebral Infarctionscore.Results—Of 28 patients treated with thrombectomy, 5 had received also systemic thrombolysis (18%). Intracranialhemorrhage was observed in 46%, but symptomatic intracranial hemorrhage occurred only in 1 patient. Successfulreperfusion (Thrombolysis in Cerebral Infarction score, 2b–3) was achieved in 59%. At 3 months, 19% had a modifiedRankin Scale score of 0 to 2, and mortality was 26%.Conclusions—Thrombectomy in non–vitamin K antagonist oral anticoagulant patients seems safe although a comparativelyhigh rate of asymptomatic hemorrhagic transformation was noted. Confirmation in larger prospective controlled cohortsis necessary
Ringleb PA, Hamann GF, Roether J, et al., 2016, Therapy of Acute Ischemic Stroke - Recanalisation Therapy Guideline Update 2015, AKTUELLE NEUROLOGIE, Vol: 43, Pages: 82-91, ISSN: 0302-4350
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Diener H-C, Aisenberg J, Ansell J, et al., 2016, Choosing a particular oral anticoagulant and dose for stroke prevention in individual patients with non-valvular atrial fibrillation: part 2, EUROPEAN HEART JOURNAL, Vol: 38, Pages: 860-868, ISSN: 0195-668X
The choice of oral anticoagulant (OAC) for patients with atrial fibrillation (AF) may be influenced by individual clinical features or by patterns of risk factors and comorbidities. We reviewed analyses of subgroups of patients from trials of vitamin K antagonists vs. non-vitamin K oral anticoagulants (NOACs) for stroke prevention in AF with the aim to identify patient groups who might benefit from a particular OAC more than from another. In addition, we discuss the timing of initiation of anticoagulation. In the second of a two-part review, we discuss the use of NOAC for stroke prevention in the following subgroups of patients with AF: (vii) secondary stroke prevention in patients after stroke or transient ischaemic attack (TIA), (viii) patients with acute stroke requiring thrombolysis or thrombectomy, (ix) those initiating or restarting OAC treatment after stroke or TIA, (x) those with renal impairment on dialysis, (xi) the elderly, (xii) those at high risk of gastrointestinal bleeding, and (xiii) those with hypertension. In addition, we discuss adherence and compliance. Finally, we present a summary of treatment suggestions. In specific subgroups of patients with AF, evidence supports the use of particular NOACs and/or particular doses of anticoagulant. The appropriate choice of treatment for these subgroups will help to promote optimal clinical outcomes.
Purrucker JC, Haas K, Rizos T, et al., 2016, Early Clinical and Radiological Course, Management, and Outcome of Intracerebral Hemorrhage Related to New Oral Anticoagulants, JAMA Neurology, Vol: 73, Pages: 169-177, ISSN: 2168-6149
Importance Intracerebral hemorrhage (ICH) is the most devastating adverse event in patients receiving oral anticoagulation. There is only sparse evidence regarding ICH related to the use of non–vitamin K antagonist oral anticoagulant (NOAC) agents.Objective To evaluate the early clinical and radiological course, acute management, and outcome of ICH related to NOAC use.Design, Setting, and Participants Prospective investigator-initiated, multicenter observational study. All diagnostic and treatment decisions, including administration of hemostatic factors (eg, prothrombin complex concentrate), were left to the discretion of the treating physicians. The setting was 38 stroke units across Germany (February 1, 2012, to December 31, 2014). The study included 61 consecutive patients with nontraumatic NOAC-associated ICH, of whom 45 (74%) qualified for the hematoma expansion analysis.Main Outcomes and Measures Hematoma expansion, intraventricular hemorrhage, and reversal of anticoagulation during the acute phase. Recorded were the 3-month functional outcome, factors associated with an unfavorable outcome (modified Rankin Scale score, 3-6), any new intraventricular extension or an increase in the modified Graeb score by at least 2 points, and the frequency of substantial hematoma expansion (defined as relative [≥33%] or absolute [≥6-mL] volume increase).Results In total, 41% (25 of 61) of patients with NOAC-associated ICH were female, and the mean (SD) patient age was 76.1 (11.6) years. At admission, the median National Institutes of Health Stroke Scale score was 10 (interquartile range, 4-18). The mean (SD) baseline hematoma volume was 23.7 (31.3) mL. In patients with sequential imaging for the hematoma expansion analysis, substantial hematoma expansion occurred in 38% (17 of 45). New or increased intraventricular hemorrhage was observed in 18% (8 of 45). Overall mortality was 28% (17 of 60 [follow-up data were missing in 1 patient]) at 3 months, and 65% (
Gill D, Veltkamp R, 2016, Dynamics of T cell responses after stroke, Current Opinion in Pharmacology, Vol: 26, Pages: 26-32, ISSN: 1471-4892
Rizos T, Horstmann S, Dittgen F, et al., 2016, Preexisting Heart Disease Underlies Newly Diagnosed Atrial Fibrillation After Acute Ischemic Stroke, Stroke, Vol: 47, Pages: 336-341, ISSN: 0039-2499
Background and Purpose—Whether newly diagnosed atrial fibrillation (nAF) after stroke reflects underlying heart disease and represents an increased risk of cardioembolic stroke, or whether it is triggered by neurogenic mechanisms remains uncertain. We investigated, whether cardiovascular risk factors and echocardiographic parameters in patients with nAF are similar to patients with known AF (kAF) and differ from patients without AF.Methods—Consecutive acute ischemic stroke patients were enrolled into a prospective stroke database. All patients with echocardiography were included and univariable and multivariable testing was applied to compare clinical characteristics and echocardiographic findings among patients with nAF, kAF, and no AF.Results—A total of 1397 patients were included (male, 62.3%; median age, 71 years). AF was present in 320 (22.9%) patients. Of those, nAF was present in 36.2% (116/320) and kAF in 63.8% (204/320). No clinical or echocardiographic factor was independently associated with detection of nAF compared with kAF but a trend toward larger left atrial diameters in patients with kAF was observed (P=0.070). In contrast, patients with nAF were more often female (P<0.001), older (P<0.001) and had a larger left atrial diameters (P<0.001) compared with patients without AF. While stroke severity in patients with nAF and kAF was similar, patients without AF had less severe strokes.Conclusions—Stroke patients with nAF and with kAF share common cardiovascular risk factors, have similar echocardiographic findings and suffer equally severe strokes. We conclude that preexisting heart disease is the major cause of AF that is first diagnosed after stroke.
Lobotesis K, Veltkamp R, Carpenter I, et al., 2015, The cost-effectiveness of Solitaire™ revascularisation device as an adjunct to IV-tPA compared to IV-tPA alone for acute ischaemic stroke in the United Kingdom, INTERNATIONAL JOURNAL OF STROKE, Vol: 10, Pages: 10-10, ISSN: 1747-4930
Singh V, Roth S, Veltkamp R, et al., 2015, HMGB1 as a Key Mediator of Immune Mechanisms in Ischemic Stroke, Antioxidants & Redox Signaling, Vol: 24, Pages: 635-651, ISSN: 1557-7716
Diener H-C, Aisenberg J, Ansell J, et al., 2015, Choosing a particular oral anticoagulant and dose for stroke prevention in individual patients with non-valvular atrial fibrillation: part 1, EUROPEAN HEART JOURNAL, Vol: 38, Pages: 852-859, ISSN: 0195-668X
Patients with atrial fibrillation (AF) have a high risk of stroke and mortality, which can be considerably reduced by oral anticoagulants (OAC). Recently, four non-vitamin-K oral anticoagulants (NOACs) were compared with warfarin in large randomized trials for the prevention of stroke and systemic embolism. Today's clinician is faced with the difficult task of selecting a suitable OAC for a patient with a particular clinical profile or a particular pattern of risk factors and concomitant diseases. We reviewed analyses of subgroups of patients from trials of vitamin K antagonists vs. NOACs for stroke prevention in AF with the aim to identify patient groups who might benefit from a particular OAC more than from another. In the first of a two-part review, we discuss the choice of NOAC for stroke prevention in the following subgroups of patients with AF: (i) stable coronary artery disease or peripheral artery disease, including percutaneous coronary intervention with stenting and triple therapy; (ii) cardioversion, ablation and anti-arrhythmic drug therapy; (iii) mechanical valves and rheumatic valve disease, (iv) patients with time in therapeutic range of >70% on warfarin; (v) patients with a single stroke risk factor (CHA2DS2VASc score of 1 in males, 2 in females); and (vi) patients with a single first episode of paroxysmal AF. Although there are no major differences in terms of efficacy and safety between the NOACs for some clinical scenarios, in others we are able to suggest that particular drugs and/or doses be prioritized for anticoagulation.
Haeusler KG, Kirchhof P, Heuschmann PU, et al., 2015, Impact of standardized MONitoring for detection of atrial fibrillation in ischemic stroke (MonDAFIS): rationale and design of a prospective randomized multicenter study, American Heart Journal, Vol: 172, Pages: 19-25, ISSN: 0002-8703
BackgroundAtrial fibrillation (AF) is estimated to account for approximately every fifth ischemic stroke. In routineclinical practice, detection of undiagnosed, clinically silent AF represents a major diagnostic challenge, and in up to 30% ofpatients with ischemic stroke, AF remains undetected. The MonDAFIS study has been designed to quantify the diagnostic yieldand clinical relevance of systematic electrocardiogram (ECG) monitoring for patients with acute ischemic stroke during thesubsequent in hospital stay.Study DesignA prospective randomized multicenter study in 3,470 patients with acute ischemic stroke or transientischemic attack and without known AF on hospital admission. Over a period of approximately 2 years, patients will beenrolled in about 30 German-certified stroke units and randomized 1:1 to receive either usual stroke unit diagnosticprocedures for detection of AF (control group) or usual stroke unit diagnostic procedures plus standardized and centrallyanalyzed Holter ECG recording for up to 7 days in hospital (intervention group). Results of the ECG core laboratory analysiswill be provided to the patients and treating physicians. All patients will be followed up for treatment and cardiovascularoutcomes at 6, 12, and 24 months after enrollment.OutcomesThe primary outcome of the randomized MonDAFIS study is the proportion of patients who receiveanticoagulation therapy 12 months after the index stroke. Secondary outcomes include the number of stroke patients withnewly detected AF in hospital and the rate of recurrent stroke, major bleedings, myocardial infarction, or death 6, 12, and24 months after the index event. MonDAFIS will also explore patient-reported adherence to anticoagulants, the clinical elevance of short atrial tachycardia, or excessive supraventricular ectopic activity as well as cost-effectiveness of prolonged,centrally analyzed ECG recordings.ConclusionMonDAFIS will be the largest study to date to evaluate whether a prolonged and systemati
Horstmann S, Moehlenbruch M, Wegele C, et al., 2015, Prevalence of atrial fibrillation and association of previous antithrombotic treatment in patients with cerebral microbleeds, EUROPEAN JOURNAL OF NEUROLOGY, Vol: 22, Pages: 1355-1362, ISSN: 1351-5101
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Laible M, Horstmann S, Moehlenbruch M, et al., 2015, Renal dysfunction is associated with deep cerebral microbleeds but not white matter hyperintensities in patients with acute intracerebral hemorrhage, JOURNAL OF NEUROLOGY, Vol: 262, Pages: 2312-2322, ISSN: 0340-5354
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- Citations: 13
Liesz A, Roth S, Zorn M, et al., 2015, Acquired Immunoglobulin G deficiency in stroke patients and experimental brain ischemia, EXPERIMENTAL NEUROLOGY, Vol: 271, Pages: 46-52, ISSN: 0014-4886
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Hametner C, Stanarcevic P, Stampfl S, et al., 2015, Noninvasive cerebral oximetry during endovascular therapy for acute ischemic stroke: an observational study, Journal of Cerebral Blood Flow and Metabolism, Vol: 35, Pages: 1722-1728, ISSN: 1559-7016
Implementing endovascular stroke care often impedes neurologic assessment in patients who need sedation or general anesthesia. Cerebral near-infrared spectroscopy (NIRS) may help physicians monitor cerebral tissue viability, but data in hyperacute stroke patients receiving endovascular treatment are sparse. In this observational study, the NIRS index regional oxygen saturation (rSO2) was measured noninvasively before, during, and after endovascular therapy via bilateral forehead NIRS optodes. During the study period, 63 patients were monitored with NIRS; 43 qualified for analysis. Before recanalization, 10 distinct rSO2 decreases occurred in 11 patients with respect to time to intubation. During recanalization, two kinds of unilateral rSO2 changes occurred in the affected hemisphere: small peaks throughout the treatment (n = 14, 32.6%) and sustained increases immediately after recanalization (n = 2, 4.7%). Lower area under the curve 10% below baseline was associated with better reperfusion status (thrombolysis in cerebral infarction ≥ 2b, P = 0.009). At the end of the intervention, lower interhemispheric rSO2 difference predicted death within 90 days (P = 0.037). After the intervention, higher rSO2 variability predicted poor outcome (modified Rankin scale > 3, P = 0.032). Our findings suggest that bi-channel rSO2-NIRS has potential for guiding neuroanesthesia and predicting outcome. To better monitor local revascularization, an improved stroke-specific set-up in future studies is necessary.
Na S-Y, Mracsko E, van Ryn J, et al., 2015, Idarucizumab Improves Outcome in Murine Brain Hemorrhage Related to Dabigatran, ANNALS OF NEUROLOGY, Vol: 78, Pages: 137-141, ISSN: 0364-5134
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Haeusler KG, Heuschmann PU, Kirchhof P, et al., 2015, Studienkonzept MonDAFIS: impact of standardized MONitoring for detection of atrial fibrillation in ischemic stroke, Deutsche Medizinische Wochenschrift, Vol: 140, Pages: S5-S6, ISSN: 0012-0472
Etwa jeder fünfte ischämische Schlaganfall wird durch eine kardiale Embolie aufgrund eines oft nicht dauerhaft bestehenden und daher häufig nicht detektierten Vorhofflimmerns (VHF) bedingt. Das Ziel der MonDAFIS-Studie ist es, auf deutschen Stroke Units die Relevanz einer verlängerten stationären EKG-Überwachung für die Detektion eines bis dato nicht bekannten Vorhofflimmerns und die konsekutive medikamentöse Sekundärprävention zu untersuchen.
Veltkamp R, Heuschmann PU, Haas K, et al., 2015, Register for acute Strokes under new oral Anticoagulants (RASUNOAprime), DEUTSCHE MEDIZINISCHE WOCHENSCHRIFT, Vol: 140, Pages: S10-S10, ISSN: 0012-0472
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