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1. Neutrophil-to-Lymphocyte Ratio and Response to Intravenous Thrombolysis in Patients with Acute Ischemic Stroke.

Author

Pektezel MY, Yilmaz E, Arsava EM, and Topcuoglu MA

Subjects
Aged, Aged, 80 and over, Brain Ischemia blood, Brain Ischemia diagnosis, Cerebral Hemorrhage blood, Cerebral Hemorrhage chemically induced, Disability Evaluation, Female, Fibrinolytic Agents adverse effects, Humans, Infusions, Intravenous, Leukocyte Count, Male, Middle Aged, Predictive Value of Tests, Recovery of Function, Retrospective Studies, Risk Factors, Stroke blood, Stroke diagnosis, Time Factors, Treatment Outcome, Brain Ischemia drug therapy, Fibrinolytic Agents administration & dosage, Lymphocytes, Neutrophils, Stroke drug therapy, Thrombolytic Therapy adverse effects
Abstract

Background and Aims: The Neutrophil-to-Lymphocyte Ratio (NLR) is suggested as a readily available and inexpensive biomarker to predict prognosis of acute stroke. Experience with intravenous (IV) tissue plasminogen activator (tPA) treatment is limited., Methods: Total 142 (80 female, age: 69 ± 13 yearr) consecutive acute stroke patients treated with IV tPA were evaluated. Admission and 24th hour lymphocyte, neutrophil, and monocyte counts were measured and the NLR was calculated., Results: Average NLR elevated (by 3.47 ± 6.75) significantly from admission to 24th hour (P< .001). Total 52% of patients exerted good response to IV tPA (NIHSS ≤1 or decrease in NIHSS ≥4 at end of 24 hour), while 27% showed dramatic response (decrease in NIHSS ≥8 at end of 24 hour). The patients with "thrombolysis resistance" had significantly higher 24 hour Neutrophil-to-Lymphocyte Ratio (24h NLR) (P= .001). At the end of 3rd month, 46.5% of patients had favorable (modified Rankin's score, mRS 0-2) and 32.4% had excellent (mRS 0-1) outcome. Patients without favorable/excellent outcome had significantly higher 24h NLRs. Regression analysis indicated that post-tPA, but not admission NLR, was an independent negative predictor of excellent (β =-.216, P= .006) and favorable (β = -.179, P= .034) outcome after adjustment for age, hypertension, and admission NIHSS. Nine patients who developed symptomatic intracerebral hemorrhage had elevated pre-tPA (7.6 ± 7.39 versus 3.33 ± 3.07, P< .001) and 24h NLR (26.2 ± 18.6 versus 5.78 ± 4.47, P< .001). Of note, receiver operating characteristics analysis failed to detect any reliable NLR threshold for absence of tPA effectiveness/dramatic response, 3rd month good/excellent outcome or any type tPA-induced hemorrhage., Conclusions: As a marker of stroke-associated acute stress response, the NLR, which increases during the first 24 hours, is an epiphenomenon of poor prognosis. However, pretreatment NLR values have no importance in predicting IV tPA response., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Published
2019
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2. Frontal Intermittent Rhythmic Delta Activity (FIRDA) in the Neurological Intensive Care: Prevalence, Determinants, and Clinical Significance.

Author

Dericioglu N, Khasiyev F, Arsava EM, and Topcuoglu MA

Subjects
Adult, Aged, Aged, 80 and over, Electroencephalography methods, Female, Humans, Male, Middle Aged, Prevalence, Retrospective Studies, Stroke epidemiology, Critical Care, Delta Rhythm physiology, Frontal Lobe physiopathology, Stroke physiopathology
Abstract

Introduction: Frontal intermittent rhythmic delta activity (FIRDA), a transient rhythmic slow wave pattern over the anterior EEG leads, has been reported in a wide variety of cerebral lesions and different metabolic disturbances. Few authors have analyzed the frequency and clinical significance of FIRDA in the critical care setting. We aimed to better understand these issues in our intensive care cohort and if possible, try to delineate its underlying mechanisms., Methods: Video-EEG reports of consecutive adult patients in the neurological intensive care unit (NICU) since 2009 were retrospectively reviewed to identify cases with FIRDA. Demographic, clinical, and laboratory data were obtained from EEG reports and patient charts. Age- and sex-matched patients with acute stroke, hospitalized in NICU and no FIRDA on video-EEG monitoring served as the control group., Results: Among 162 patients who underwent video-EEG monitoring, FIRDA was documented in 17%. Female prevalence was 50% and age ranged from 23 to 82 years. Twenty-three (82%) of patients with FIRDA had a diagnosis of stroke. Comparison of demographic characteristics, EEG findings, metabolic disturbances and prognoses revealed no differences between stroke cases with and without FIRDA, except for higher frequency of acute and chronic isolated posterior circulation infarcts in patients with FIRDA., Conclusion: FIRDA is more commonly encountered in the neurocritical care setting as compared with outpatient EEG clinics. Our findings in stroke patients indicate that involved vascular territories may be related to the generation of FIRDA.

Published
2018
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4. Plasma levels of coagulation and fibrinolysis markers in acute ischemic stroke patients with lone atrial fibrillation.

Author

Topcuoglu MA, Haydari D, Ozturk S, Ozcebe OI, and Saribas O

Subjects
Acute Disease, Aged, Arteriosclerosis complications, Atrial Fibrillation blood, Blood Coagulation Disorders blood, Brain Ischemia blood, Brain Ischemia physiopathology, Female, Humans, Male, Middle Aged, Plasminogen Inactivators blood, Risk Factors, Stroke blood, Stroke physiopathology, Tissue Plasminogen Activator blood, Atrial Fibrillation complications, Blood Coagulation Disorders complications, Brain Ischemia etiology, Fibrinolysis physiology, Stroke etiology
Abstract

Atrial fibrillation (AF) is a well-defined risk factor for ischemic stroke. Patients with lone AF represent a subgroup of AF patients with the lowest lifelong stroke risk. Nonvalvular atrial fibrillation (NVAF) confers a hypercoagulable state resulting in an increased risk of thromboembolism. This study was performed to determine the contributory role of alteration in the hemostatic markers of thrombin generation and fibrinolysis in patients with lone AF during acute ischemic stroke episode. We studied thrombin-antithrombin complexes (TAT), prothrombin fragments 1+2 (F1+2), tissue-type plasminogen activator (tPA) and plasminogen activator inhibitor type-1 (PAI-1) concentrations in patients with acute middle cerebral artery ischemic stroke due to atherosclerotic large artery disease (n=50), lone AF (n=24) and cardioembolism (n=21). The values were compared with those of age-matched control subjects with lone AF and sinus rhythm (n=21 and 15, respectively). The mean F1+2 concentration was higher in the control subjects with lone AF in comparison with those without AF (p=0.014). Patients with stroke due to possible cardioembolism, from lone AF or other causes, had higher TAT (and marginally higher F1+2) concentrations than those with atherosclerotic stroke (p<0.001). tPA concentrations were not different among groups (p=0.89). PAI-I levels were marginally higher in stroke patients with lone AF and atherothrombotic large artery disease compared to the controls without AF (p=0.05). These results suggest that in the acute period of ischemic stroke secondary to lone AF, enhancement of the coagulatory activity occurs as a result of increased thrombin generation, similar to other possible sources of cardioembolism. Observed hemostatic alterations in acute ischemic stroke associated with lone AF may indicate some therapeutic and prognostic implications.

Published
2000
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5. The state of stroke services across the globe: Report of World Stroke Organization–World Health Organization surveys

Author

Thrift A. G., Martins S., Johnson W., Pandian J., Abd-Allah F., Varghese C., Mahal A., Yaria J., Phan H. T., Roth G., Gall S. L., Beare R., Phan T. G., Mikulik R., Norrving B., Feigin V. Abera S. F., Addissie A., Adeleye A., Adilbekov Y., Adilbekova B., Adoukonou T. A. Aguiar de Sousa D., Akhmetzhanova Z., Akinyemi R. O., Akpalu A. MB. ChB, Ameriso S. F., Andonova S., Abanto C., Awoniyi F. E., Bakhiet M., Basri H., Bath P. M., Bereczki D., Beretta S., Berkowitz A. L., Bernhardt J., Berzina G., Bhavsar B., Bisharyan M. S., Bovet P., Brainin M., Budincevic H., Cabral N. L., Cadilhac D A. , Caso V., Chen C., Chin J. H., Christensen H, Chwojnicki K., Conforto A. B., Cruz V. T., D'Amelio M., Danielyan K. E., Davis S., Demarin V, Dempsey R. J., Dichgans M., Dokova Donnan, G. Duran, Elizondo M. A. B., Elkind M. S., Endres M., Etedal I., Faris M. E., Fischer U., Gankpe F., Gavidia M., GayeSaavedra A., Giroud M., Gongora-Rivera F., Hachinski V., Hacke W., Hamadeh R. R., Hamzat T. K., Hankey G. J., Heldner M. R., Ibrahim N. M., Inoue M., Jee S., Jiann-Shing J., Johnston S. C., Kalkonde Y., Kamenova S., Kelly P., Khan T., Kiechl S., Kondybayeva A., Kõrv J., Kravchenko M., Krishnamurthi R., Langhorne P., Kang Z. L., Kruja J., Lavados P. M., Lebedynets D., Leung T. W., Liebeskind D. S., Lindsay P., Liu L., López-Jaramillo P., Lotufo P. A., Machline-Carrion J. M., Markus H. S., Marquez-Romero J. M., Medina M. T., Medukhanova S., Mehndiratta M. M., Mirrakhimov E., Mohl S., Murphy S., Musa K. I., Nasreldein A, Nogueira R., Nolte C. H., Noubiap J. J., Novarro-Escudero N., O'Donnell M., Ogun Y., Oraby M. I., Ovbiagele B., Ōrken D. N., Ōzdemir A. O., Ozturk S., Paccot M., Peters A., Piradov M., Platz T., Potpara T., Ranta A., Rathore F. A., Sacco R. L., Sahathevan R., Santos I. C., Saposnik G., Sarfo F. S., Sharma M., Sheth K. N., Shobhana A., Silva S. N., Suwanwela N. C., Sylaja P. N., Thakur K., Toni D., Topcuoglu M. A., Torales J., Towfighi A., Truelsen T., Tsiskaridze A., Tsong-Hai L., Tulloch-Reid M., Useche J. N., Vanacker P., Vassilopoulou S., Venketasubramanian N., Vukorepa G., Vuletic V., Wahab K. W., Wang W., Wijeratne T., Wolfe C, Yifru M. Y., YockCorrales A., Yonemoto N., Yperzeele L., Owolabi, MO, Thrift, AG, Martins, S, Johnson, W, Pandian, J, Abd-Allah, F, Varghese, C, Mahal, A, Yaria, J, Phan, HT, Roth, G, Gall, SL, Beare, R, Phan, TG, D'Amelio M, Mikulik, R, Norrving, B, Feigin, VL, and Thrift A. G., Martins S., Johnson W., Pandian J., Abd-Allah F., Varghese C., Mahal A., Yaria J., Phan H. T., Roth G., Gall S. L., Beare R., Phan T. G., Mikulik R., Norrving B., Feigin V. Abera S.F., Addissie A., Adeleye A., Adilbekov Y., Adilbekova B., Adoukonou T.A. Aguiar de Sousa D., Akhmetzhanova Z., Akinyemi R.O., Akpalu A. MB. ChB , Ameriso S.F. , Andonova S., Abanto C., Awoniyi F.E., Bakhiet M., Basri H., Bath, P.M., Bereczki D., Beretta S., Berkowitz A.L., Bernhardt J., Berzina G., Bhavsar B., Bisharyan M.S., Bovet P., Brainin, M., Budincevic H., Cabral N.L., , Cadilhac D A. , Caso V., , Chen C., Chin J.H. , Christensen H, , Di, Chwojnicki K., Conforto A.B., Cruz V.T., D'Amelio M., Danielyan K.E., Davis, S., Demarin V, Dempsey R.J., Dichgans M., Dokova, Donnan, G., Duran, J., Elizondo M.A.B., Elkind M.S., Endres M., Etedal I., Faris M.E., Fischer U., Gankpe F., Gavidia M., GayeSaavedra A., Giroud M., Gongora-Rivera F., Hachinski V. , Hacke, W., Hamadeh R.R., Hamzat T.K., Hankey G.J., Heldner M.R., Ibrahim, N.M., Inoue M., Jee S., Jiann-Shing J., Johnston S. C., Kalkonde Y., Kamenova S., Kelly P., Khan T., Kiechl S., Kondybayeva A., Kõrv J., Kravchenko M., Krishnamurthi R., Langhorne, P., Kang Z.L., Kruja, J., Lavados P.M., Lebedynets D., Leung T.W., Liebeskind D.S., Lindsay P., Liu, L., López-Jaramillo P., Lotufo P.A., Machline-Carrion J.M., Markus, H.S., Marquez-Romero J.M., Medina M.T., Medukhanova S., Mehndiratta M.M., Mirrakhimov E., Mohl S., Murphy S., Musa K.I., Nasreldein A, Nogueira R., Nolte C.H., Norrving B., Noubiap J.J., Novarro-Escudero N., O'Donnell M., Ogun Y., Oraby M.I., Ovbiagele B., Ōrken D.N., Ōzdemir A.O., Ozturk S., Paccot M., Peters A., Piradov, M., Platz T., Potpara T., Ranta A., Rathore F.A., Roth G., Sacco R.L., Sahathevan R., Santos I.C., Saposnik G., Sarfo F.S., Sharma M., Sheth K.N., Shobhana A., Silva, S.N., Suwanwela N. C., Sylaja P.N., Thakur K., Toni D., Topcuoglu M.A., Torales J., Towfighi A., Truelsen, T., Tsiskaridze A., Tsong-Hai L., Tulloch-Reid M., Useche J.N., Vanacker P., Vassilopoulou S., Venketasubramanian N., Vukorepa G., Vuletic V., Wahab K.W., Wang W., Wijeratne T., Wolfe C, Yifru M.Y., YockCorrales A., Yonemoto N., Yperzeele L.

Subjects
Gerontology, medicine.medical_specialty, medicine.medical_treatment, media_common.quotation_subject, Globe, Commission, stroke quadrangle, Global Health, World Health Organization, World health, Article, Stroke service, rehabilitation, low and middle-income countrie, 03 medical and health sciences, 0302 clinical medicine, State (polity), prevention, Acute care, Surveys and Questionnaires, medicine, Humans, 030212 general & internal medicine, high-income countrie, Stroke, Developing Countries, media_common, Stroke services, Rehabilitation, business.industry, Stroke Rehabilitation, medicine.disease, 3. Good health, medicine.anatomical_structure, Neurology, low- and middle-income countrie, Settore MED/26 - Neurologia, acute care, business, 030217 neurology & neurosurgery
Abstract

Background Improving stroke services is critical for reducing the global stroke burden. The World Stroke Organization–World Health Organization– Lancet Neurology Commission on Stroke conducted a survey of the status of stroke services in low and middle-income countries (LMICs) compared to high-income countries. Methods Using a validated World Stroke Organization comprehensive questionnaire, we collected and compared data on stroke services along four pillars of the stroke quadrangle (surveillance, prevention, acute stroke, and rehabilitation) in 84 countries across World Health Organization regions and economic strata. The World Health Organization also conducted a survey of non-communicable diseases in 194 countries in 2019. Results Fewer surveillance activities (including presence of registries, presence of recent risk factors surveys, and participation in research) were reported in low-income countries than high-income countries. The overall global score for prevention was 40.2%. Stroke units were present in 91% of high-income countries in contrast to 18% of low-income countries (p Conclusions There is an urgent need to improve access to stroke units and services globally especially in LMICs. Countries with less stroke services can adapt strategies from those with better services. This could include establishment of a framework for regular monitoring of stroke burden and services, implementation of integrated prevention activities and essential acute stroke care services, and provision of interdisciplinary care for stroke rehabilitation.

Published
2021

6. Extended-Duration Betrixaban Reduces the Risk of Stroke Versus Standard-Dose Enoxaparin Among Hospitalized Medically Ill Patients

Author

Legkonogov, O., Ramacciotti, E., Mikhailova, E., Koryk, V., Adzerikho, I., Schoenerr, H., Mathies, R., Konig, J., Huber, K., Rubinfeld, A., Finfer, S., Manenti, E., Bott, M., Blessing, E., Beyer-Westendorf, J., Coughlin, P., Baker, R., Poy, C., Dengler, T., Parody, M., Oliva, M., Macin, S., Jure, H., Ferrari, A. E., Dziewas, R., Genth-Zotz, S., Hamann, F., Horacek, T., Klimpe, S., Mitkovskaya, N., Kroning, R., Lapp, H., Lawall, H., Licka, M., Rizos, T., Tiefenbacher, C., Weimar, C., Alkonyi, B., Falukozy, J., Futo, L., Katona, A., Berrouschot, J., Kirschner, R., Amann, B., Paposhvili, K., Pagava, Z., Kristof, P., Lakatos, F., Laszlo, Z., Freire, A., Lupkovics, G., Megreladze, I., Kobulia, B., Khintibidze, I., Khabeishvili, G., Datikashvili-David, I., Simoneau, G., Merkely, B., Andras, C. Nagy, Nemeth, L., Papp, A., Soltesz, P., Fiss, E., Schmidt, J., Roy, P-M., Quere, I., Proust, A., Pottier, P., Pernod, G., Payot, L., Bizzacchi, J. Annichino, Lienart, F., Paleiron, N., Montaclair, K., Mismetti, P., Messas, E., Lacroix, P., Grange, C., Falvo, N., El Kouri, D., Decoulx, E., Debourdeau, P., De Geeter, G., Brisot, D., Belhassane, A., Aquilanti, S., Agraou, B., Vikman, S., Tatlisumak, T., Saarinen, J., Kaaja, R., Honkaniemi, J., Airaksinen, J., Uuetoa, T., Lember, M., Urhammer, S., Tuxen, C., Storgaard, M., Lassen, M., Christensen, H., Vyhnanek, M., Vejvoda, J., Spacek, R., Reiterer, P., Podpera, I., Mikulova, J., Lang, P., Jajtner, P., Hubac, J., Horny, I., Holaj, R., Herold, M., Havelka, J., Francek, L., Dusek, J., Dunaj, M., Cizek, V., Chochola, J., Chlumsky, J., Cermak, O., Skerk, V., Vagic, J. Sikic, Marusic, S., Knezevic, A., Kalinic-Grgorinic, H., Jakopovic, M., Francetic, I., Ciglenecki, N., Car, S., Butkovic-Soldo, S., Cardenas, S. Potthoff, Lazcano, M. Opazo, Alarcon, M. Arias, Verreault, S., Provencher, S., Pearce, M., Le Gal, G., Douketis, J., Dhar, A., Tokmakova, M., Todorov, G., Syulemzova, S., Raymuno, S., Rocha, A., Dimov, B., Grigorov, M., Kalpachki, R., Kamenova, Z., Bello, F., Harrington, Robert A., Bandman, Olga, Kostadinova, M., Milanova, M., Dive, A., Pencheva, G., Sudar, Z., Szabo, G., Szegedi, N., Timar, G., Valco, J., Delforge, M., Vertes, A., Efrati, S., Elias, M., Gafter, A., Nazliel, BİJEN, Hayek, T., Hussein, O., Lishner, M., Lugassy, G., Cerveri, I., D'Angelo, A., De Pellegrin, A., Imberti, D., Landolfi, R., Runev, N., Lembo, G., Lodigiani, C., Moia, M., Molteni, M., Mumoli, N., Novo, S., Orlandini, F., Stoeva, N., Parisi, R., Pizzini, A., Pomero, F., Salvi, A., Schenone, A., Gold, Alex, Visona, A., Martinova, V., Pontaga, N., Rozitis, V., Stukena, I., Alekniene, B., Basijokiene, V., Butkiene, Z., Griskeviciene, V., Naudziunas, A., Stoyanov, M., Norvaisiene, R., Norviliene, R., Petrauskiene, R., Poskiene, R., Susinskiene, D., Valavicius, A., Castillo Leon, R., Pimanov, S., Polonetsy, L., Pereyra, R. Cotrina, Karlo, L. Farjardo, Horna, M., Soroka, N., Salas, M., Yanez, L. Toche, Fryze, W., Gaciong, Z., Gniot, J., Gorecka, D., Gruenpeter, P., Grzelakowski, P., Jastrzebski, D., Kucharski, L., Mirek-Bryniarska, E., Pulkowski, G., Sobkowicz, B., Sulik, P., Walasek, L., Blockmans, D., Waldemar, K., Wrzesinski, K., Balogh, Z. E., Bojinca, M., Marin, I., Musetescu, R., Podoleanu, C., Popescu, M., Stamate, S., Stanciulescu, G., Vida-Simiti, L., Abashev, A., Andreev, D., Apartsin, K., Arkhipov, M., Averkov, O., Barbarash, O., Belskaya, G., Bogdanov, E., Boldueva, S., Chefranova, Z., Dovgalevskiy, Y., Ershova, O., Goloshchekin, B., Khachatryan, N., Klein, G., Kobalava, Z., Kosmacheva, E., Kostenko, V., Malygin, A., Martynenko, T., Martynenko, V., Maslova, N., Mordovin, V., Nikolaev, K., Nilk, R., Popov, D., Privalova, E., Reshetko, O., Shapovalova, Y., Shpagina, L., Shvarts, Y., Simanenkov, V., Solovyov, O., Vishneva, E., Vishnevskiy, A., Apostolovic, S., Celic, V., Ilic, S., Kovacevic-Kuzmanovic, A., Miloradovic, V., Bodikova, S., Cervenakova, A., Dvorak, M., Herman, O., Hrubon, A., Kokles, M., Krastev, G., Payer, J., Prokop, D., Spisakova, M., Adler, D., Basson, M., Breedt, J., Engelbrecht, J., Mitha, I., Van Dyk, C., Alvarez Sala, L. A., Barbagelata Lopez, C., Bisbe, J., Castro Guardiola, A., Cepeda, J. M., Cereto, F., Diaz Santos, E., Ferrer, R., Gomez Cerezo, J., Hernandez, Adrian F., Gonzales-Porras, J. R., Grandes, J., Cohen, Alexander T., Gibson, C. Michael, Chi, Gerald, Halaby, Rim, Korjian, Serge, Daaboul, Yazan, Jain, Purva, Arbetter, Douglas, Goldhaber, Samuel Z., Hull, Russel, Jimenez, D., Mellibovsky, L., Richart, C., Riera, A., Trujillo, J., Vargas Nunez, J. A., Villalta, J., Akgul, O., Guneri, S., Kilichesmez, K., Kirma, C., Kutluk, H., Okumus, G., Tigen, K., Topcuoglu, M., Tuncay, E., Abrahamovych, O., Batushkin, V., Brozhyk, J., Burmak, I., Godlevska, O., Goloborodko, A., Goloborodko, B., Goncharova, Y., Gryb, V., Karpenko, O., Kopytsya, M., Zakai, N., Yousef, K., Wichman, T., Whitman, B., Welker, J., Welch, M., Warner, A., Updegrove, J., Tuck, M., Stoltz, S., Sokol, S., Sharma, S., Shammas, N., Saba, F., Rodriguez, W., Rees, C., Rastogi, P., Rajan, R., Quintana, O., Pullman, J., Pratt, R., Pineda, L., Pearl, R., Parthiban, K., Overcash, J., Ortel, T., Ohaju, V., Nadar, V., Mittal, M., Milling, T., McLaren, G., Margolis, B., Mahal, S., Macchiavelli, A., Lopez, J., Lerner, R., Kung, M., Kouras, F., Kazimir, M., Kao, C-K., Kabler, H., Ioachimescu, O., Hazelrigg, M., Hamad, A., Haidar, A., Hahn, B., Goytia-Leos, D., Gaggin, H., Fulmer, J., Koshlia, V., Fraiz, J., Krakhmalova, O., Fermann, G., Farley, B., Doshi, A., Dhingra, R., Cornell, J., Concha, M., Clark, C., Chang, H., Carman, T., Bidair, M., Bercz, P., Bastani, A., Barney, J., Baker, S., Anderson, C., Amin, M., Almasri, E., Natarajan, I., McCollum, C., MacCallum, P., Davis, M., Body, R., Yagensky, A., Voronkov, L., Vishnivestsky, I., Vakaliuk, I., Ursol, G., Tseluyko, V., Kyrychenko, I., Svyshchenko, Y., Svyridova, I., Ryabichenko, T., Rudenko, L., Reshotko, D., Perepeliuk, M., Parkhomenko, O., Nikonov, V., Maslovaskyi, V., Malynovsky, Y., Sergeeva, E., and Kolman, P.

Subjects
Male, medicine.medical_specialty, Pyridines, Intracranial Hemorrhages, 030204 cardiovascular system & hematology, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Medical illness, Physiology (medical), medicine, Humans, 030212 general & internal medicine, Enoxaparin, Intensive care medicine, Stroke, Aged, business.industry, Anticoagulants, Venous Thromboembolism, medicine.disease, Thrombosis, chemistry, Betrixaban, Benzamides, Emergency medicine, Female, Cardiology and Cardiovascular Medicine, business, Complication, Venous thromboembolism
Abstract

Background: Stroke is a morbid and potentially mortal complication among patients hospitalized with acute medical illness. The potential of extended-duration thromboprophylaxis with the factor Xa inhibitor betrixaban to reduce the risk of stroke compared with standard-dose enoxaparin in this population was assessed in this retrospective APEX trial substudy (Acute Medically Ill Venous Thromboembolism Prevention With Extended Duration Betrixaban). Methods: Hospitalized acutely medically ill subjects (n=7513) were randomized in a double-dummy double-blind fashion to either extended-duration oral betrixaban (80 mg once daily for 35–42 days) or standard-dose subcutaneous enoxaparin (40 mg once daily for 10±4 days) for venous thromboprophylaxis. Stroke events were adjudicated by an independent, blinded event adjudication committee. Results: The mean age of study participants was 76 years; 45% were male; 13% had had a stroke; and 45% had congestive heart failure. There were fewer all-cause strokes (0.54% versus 0.97%; relative risk [RR]=0.56; 95% confidence interval, 0.32–0.96; P =0.032; adjusted RR=0.43%; number needed to treat=233) and ischemic strokes (0.48% versus 0.91%; RR=0.53; 95% confidence interval, 0.30–0.94; P =0.026; adjusted RR=0.43%; number needed to treat=233) among patients treated with betrixaban versus enoxaparin through 77 days of follow-up. Among high-risk subjects, those with congestive heart failure or ischemic stroke as their index event, betrixaban reduced the risk of all-cause stroke (0.72% versus 1.48%; RR=0.49; 95% confidence interval, 0.26–0.90; P =0.019; adjusted RR=0.76%; number needed to treat=132) and ischemic stroke (0.63% versus 1.38%; RR=0.45; 95% confidence interval, 0.24–0.87; P =0.014; adjusted RR=0.75%; number needed to treat=134) compared with enoxaparin. Conclusions: Among hospitalized medically ill patients, extended-duration betrixaban significantly reduced all-cause stroke and ischemic stroke through 77 days of follow-up Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT01583218.

Published
2017
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7. Clinical challenges associated with the endovascular treatment of acute stroke in a patient with infective endocarditis.

Author

Settarzade, Emil, Peker, Ahmet, Topcuoglu, M. Akif, Arsava, E. Murat, Demircin, Metin, and Arat, Anıl

Subjects
ENDOVASCULAR surgery, STROKE patients, MITRAL valve insufficiency, CEREBRAL arteries, INFECTIVE endocarditis
Abstract

Although stroke is common in infective endocarditis (IE), only 26 cases of thrombectomy have been reported to date for IE-related acute stroke. We report a 40-year-old man who presented with left middle cerebral artery occlusion of unknown cause. Multiple attempts of mechanical aspiration thrombectomy and stentrievers failed to recanalize the artery. Effective revascularization was eventually achieved by placing a self-expanding intracranial stent. Post-procedurally the patient was diagnosed with IE with mitral valve insufficiency, mandating emergent valvular replacement while the patient was still on tirofiban infusion. On follow-up, the patient had a modified Rankin's score of 0, had no recurrent stroke, and the intracranial stent remained patent yet stenosed. Based on the use of a self-expanding intracranial stent in the setting of IE, we discuss the consequences of the fibrotic and inflammatory content of the embolus and the associated high risk of intracranial hemorrhage which complicates clinical decision making. [ABSTRACT FROM AUTHOR]

Published
2020
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8. Intravenous Thrombolytic Therapy in Acute Stroke: Problems and Solutions

Author

Topcuoglu, M. Akif, Arsava, E. Murat, Ozdemir, A. Ozcan, Gurkas, Erdem, Orken, Dilek Necioglu, Ozturk, Serefnur, and Selçuk Üniversitesi

Subjects
Stroke, avoidance, training, thrombectomy, contraindication
Abstract

WOS: 000419248500003, Use of intravenous tissue plasminogen activator (tPA) is one of the key elements of acute ischemic stroke management. Its use has not become widespread, and has faced significant problems in our country for more than a quarter of a century most probably due to many unanswered questions about issues related with daily practice. However, recent developments, which adequately focused and found solutions for most of these problems and questions, have led to a major change of point of view and understanding of the hyperacute management of stroke. This article, in the light of the relevant literature, discusses and provides clear recommendations for questions directed by neurologists practicing in Turkey mainly about typical neurologic issues faced in the setting of tPA use for acute stroke.

Published
2017

9. Transcranial Doppler ultrasound in neurovascular diseases: diagnostic and therapeutic aspects.

Author

Akif Topcuoglu, M.

Subjects
*NEUROVASCULAR diseases, *TRANSCRANIAL Doppler ultrasonography, *CEREBRAL circulation, *STROKE, *NONINVASIVE diagnostic tests, *SUBARACHNOID hemorrhage, *THROMBOLYTIC therapy, *THERAPEUTICS
Abstract

Albeit no direct anatomical information can be obtained, neurosonological methods provide real-time determination of velocity, and spectral waveform of blood flow in basal intracranial arteries adds significant benefit to the care of the patients with neurovascular diseases. Several features, such as relative simplicity in terms of interpretation and performance, significantly low cost, totally non-invasiveness, portability, and excellent temporal resolution, make neurosonology increasingly popular tool for evaluation, planning, and monitoring of treatment, and for determining prognosis in various neurovascular diseases. Usefulness of transcranial Doppler in diagnosing/monitoring subarachnoid hemorrhage related vasospasm and sickle cell vasculopathy is already well known. Utility in diagnosis of intracranial arterial stenosis, acute occlusion and recanalization, intracranial hemodynamic effect of the cervical arterial pathologies, intracranial pressure increase, and cerebral circulatory arrest are also well established. Neurosonological determination of vasomotor reactivity, cerebral autoregulation, neurovascular coupling, and micro-embolic signals detection are useful in the assessment of stroke risk, diagnosis of right-to-left shunting, and monitoring during surgery and interventional procedures. Transcranial Doppler is also an evolving ultrasound method with a therapeutic potential such as augmentation of clot lysis and cerebral delivery of thrombolytic or neuroprotective agent loaded nanobubbles in neurovascular diseases. The aim of this study is to give an overview of current usage of the different ultrasound modalities in different neurovascular diseases. [ABSTRACT FROM AUTHOR]

Published
2012
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