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1. Prevalence of orthostatic hypertension and its association with cerebrovascular diagnoses in patients with suspected TIA and minor stroke

Author

Farzaneh Barzkar, Phyo K. Myint, Chun Shing Kwok, Anthony Kneale Metcalf, John F. Potter, and Hamid Reza Baradaran

Subjects
Stroke, Transient ischemic attack, Cerebrovascular disease, Orthostatic hypertension, Blood pressure, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Abstract Purpose We aimed to compare the rate of stroke, transient ischemic attack, and cerebrovascular disease diagnoses across groups of patients based on their orthostatic blood pressure response in a transients ischemic attack clinic setting. Materials and Methods We retrospectively analysed prospectively collected data from 3201 patients referred to a transient ischemic attack (TIA)/minor stroke outpatients clinic. Trained nurses measured supine and standing blood pressure using an automated blood pressure device and the patients were categorized based on their orthostatic blood pressure change into four groups: no orthostatic blood pressure rise, systolic orthostatic hypertension, diastolic orthostatic hypertension, and combined orthostatic hypertension. Then, four stroke physicians, who were unaware of patients' orthostatic BP response, assessed the patients and made diagnoses based on clinical and imaging data. We compared the rate of stroke, TIA, and cerebrovascular disease (either stroke or TIA) diagnoses across the study groups using Pearson's χ2 test. The effect of confounders was adjusted using a multivariate logistic regression analysis. Results Cerebrovascular disease was significantly less common in patients with combined systolic and diastolic orthostatic hypertension compared to the "no rise" group [OR = 0.56 (95% CI 0.35–0.89]. The odds were even lower among the subgroups of patients with obesity [OR = 0.31 (0.12–0.80)], without history of smoking [OR 0.34 (0.15–0.80)], and without hypertension [OR = 0.42 (95% CI 0.19–0.92)]. We found no significant relationship between orthostatic blood pressure rise with the diagnosis of stroke. However, the odds of TIA were significantly lower in patients with diastolic [OR 0.82 (0.68–0.98)] and combined types of orthostatic hypertension [OR = 0.54 (0.32–0.93)]; especially in patients younger than 65 years [OR = 0.17 (0.04–0.73)] without a history of hypertension [OR = 0.34 (0.13–0.91)], and patients who did not take antihypertensive therapy [OR = 0.35 (0.14–0.86)]. Conclusion Our data suggest that orthostatic hypertension may be a protective factor for TIA among younger and normotensive patients.

Published
2022
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2. Determinants of Length of Stay Following Total Anterior Circulatory Stroke

Author

James P. Curtain, Man Yu, Allan B. Clark, Nicholas D. Gollop, Joao H. Bettencourt-Silva, Anthony Kneale Metcalf, Kristian M. Bowles, Marcus D. Flather, John F. Potter, and Phyo Kyaw Myint

Subjects
haemorrhagic stroke, ischaemic stroke, length of stay, mortality, total anterior circulatory stroke, Geriatrics, RC952-954.6
Abstract

Identification of factors that determine length of stay (LOS) in total anterior circulatory stroke (TACS) has potential for targeted intervention to reduce the associated health care burden. This study aimed to determine which factors predict LOS following either ischaemic or haemorrhagic TACS. The study sample population was drawn from the Norfolk and Norwich Stroke and Transient Ischemic Attack (TIA) Register (1996–2012), a prospective registry. 2965 patients admitted with TACS verified by a stroke specialist team were included. Primary analysis identified predictors of length of stay (LOS) in either haemorrhagic or ischaemic TACS. Secondary analyses identified predictors of LOS in patients who were discharged alive or who died during admission separately. Moderate (p = 0.014) to severe disability (p = 0.015) and history of congestive heart failure (p = 0.027) in the primary analysis and pre-stroke residence in a care facility among patients who survived to discharge (p = 0.013) were associated with a shorter length of stay. Factors associated with increased length of stay included presence of neurological lateralisation in the primary analysis (p = 0.004) and amongst patients who died (p = 0.003 and p = 0.014 for ischaemic and haemorrhagic stroke, respectively). Patients with advanced age (≥85 years) with haemorrhagic stroke had longer LOS regardless of mortality outcome. Patients with low pre-morbid disability (modified Rankin score ≤2 who died following haemorrhagic TACS also had longer LOS. Our study found predictors of LOS following TACS include neurological lateralisation, pre-stroke disability status, congestive heart failure, pre-morbid residence and age. The identification of such factors would assist in resource allocation and discharge planning.

Published
2017
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3. The Changing Landscape for Stroke Prevention in AF

Author

Mercedes Samson, Siegfried Frickel, Hirosi Meno, Niels Gadsbøll, Sébastien Prévôt, Sorin Alexandru Antonescu, Xiaodong Li, Tetsuya Haruna, Zicheng Li, Catarina Fonseca, Ralf Zahn, Shahid Aziz, Takashi Tsutsui, Galal Kerfes, Elisabeth Louise Zeuthen, Lluís Mont, Angelika Tamm, Bogdan Minescu, Eric Lo, Gerardo Ansalone, Malcolm Foster, Tristan Mirault, Nabil Andrawis, Apostolos Katsivas, Imad Kreidieh, Juliano Novaes Cardoso, Margaret Ikpoh, Dimitar Raev, Said Chaaban, Dan Tesloianu, Philippe Loiselet, Joachim Gmehling, Joseph Hakas, Steven Forman, Ernst Günter Vester, Bettina Schmitz, Hassan El-Sayed, Hiroshi Tsutsui, Salvatore Pirelli, Jens Taggeselle, Arnljot Tveit, David Smith, Manuel De Los Rios Ibarra, Rafael Salguero, Jindrich Spinar, Vanja Bašić Kes, Jose Walter Cabrera Honorio, Adrien Salem, Gavino Casu, Jean Michel Quedillac, Ana Fruntelata, Peter Siostrzonek, Dmitry Napalkov, Luthando Adams, Valeria Calvi, Jeff S. Healey, Magnus Forsgren, Larisa Kalinina, Ratika Parkash, P. F.M.M. Bergen van, Carmen Manuela Muresan, H. Gorka, Andreas Mügge, Gustavo Maid, Serge Yvorra, Alexander Paraschos, Bernhard Witzenbichler, Viktor Peršić, Jeong Su Kim, Dong Jin Oh, Yutaka Furukawa, Steve Compton, Ravikiran Korabathina, Tammam Al-Joundi, Muzahir H. Tayebjee, Robert Betzu, David J. Cislowski, Alon Steinberg, Carisi Anne Polanczyk, Sanjiv Petkar, Andy Lam, Mingsheng Wang, Galina Ivanchura, Ruediger Seebass, Thomas Guarnieri, Seth H. Baker, Paula Carvalho, Brian First, Konstantinos Makaritsis, Alex C. Spyropoulos, Mohiburrahman Sirajuddin, Richard Bala, David Goldscher, G. Larsen Kneller, Ki Seok Kim, Sherman Tang, Venkat Iyer, Payman Sattar, Yamile Porro, Gregory Y.H. Lip, Christa Raters, Olivier Gartenlaub, Elizaveta Panchenko, Niccolo' Marcionni, Ole Nyvad, Sibel Zehra Aydin, Kenji Kawajiri, Dipankar Dutta, Gabriel Contreras Buenostro, Shaival Kapadia, Harry J.G.M. Crijns, Miroslav Rubacek, Myriam Brunehaut, Igor Diemberger, Kyle Rickner, Katsumi Tanaka, Moon Hyoung Lee, Pamela Nerheim, Jose Carlos Moura Jorge, Michael Gumbley, Katie Randall, Francesco Melandri, Sunil Chand, Harukazu Iseki, Thalie Traissac, Ningfu Wang, Ghiath Mikdadi, Peter D. Schellinger, Andrew M. Rubin, Conrad Genz, Karl Heinz Seidl, Maurice Pye, Giorgio Annoni, Adalberto Menezes Lorga Filho, William H. Pentz, Lisa Schmitz, Gary Miller, Didier Smadja, Elena Khludeeva, David Hargroves, Hans-Christoph Diener, Tiziano Moccetti, Azlisham Mohd Nor, Kai Koenig, F. A. Rooyer, Kiyoo Mori, Carlos Gonzalez Juanatey, Jan Beyer-Westendorf, Charles Landau, Steven B Eisenberg, Hugh F. McIntyre, Emilio Gonzalez Cocina, Erik May, Gyo-Seung Hwang, Alberto Giniger, Karl-Heinz Kuck, Yan Carlos Duarte Vera, Vladimir Gorbunov, Priya Nair, Shih Ann Chen, Beat J. Meyer, Donghui Zhang, Feng Wang, Richard J.H. Smith, Michele Massimo Gulizia, Darko Pocanic, Abul Azim, Jose Maria Lobos, Patrick Leprince, Peter Vanacker, Marica Bracic Kalan, James Crenshaw, Ewa Nowalany-Kozielska, Ayham Al-Zoebi, Eiji Hishida, Louis Essandoh, Younghoon Kim, Yanmin Yang, Dhiraj Gupta, Fausto J. Pinto, Arnold Pinter, Stanley Koch, Luis Felipe Pezo, Dzifa Wosornu Abban, Martin S. Green, Chrystalenia Kafkala, Zhitao Liu, Jose Luis Llisterri, Su Mei Angela Koh, Lin Chih-Chan, Ruth Davies, Ursula Rauch-Kroehnert, Julio Tallet, Juan Benezet-Mazuecos, Andreas Kastrup, Rohit Malhotra, Serge Timsit, Thierry Frappé, Kostas Oikonomou, Ameer Kabour, Kishor Vora, Douglas Roberts, Carlos Scherr, Pedro Dionísio, Nicoleta Violeta Miu, Eve Gillespie, Petr Povolny, F.R. Grondin, Philippe Lyrer, Raymond Fisher, Philip O'Donnell, Nima Amjadi, Juan Vazquez, Lynn Corbett, Patrick Peters, Jing Zhou, Thomas Kümler, Danny H.K. Wong, Evaldas Giedrimas, William McGarity, Frank L. Silver, Emmanuel Touzé, Ana Leitão, Suk keun Hong, Marwan Salfity, Constantin Militaru, S T Matskeplishvili, Johannes A. Kragten, Sam Henein, Anthony D'Souza, B. J. Krenning, Francesco Chiarella, Rene Casanova, Stephan Willems, Yong Keun Cho, Tae Joon Cha, Stewart Pollock, Rajendra Moodley, Rosa Ysabel Cotrina Pereyra, Volker Laske, Zhanquan Li, Kenneth B. Harris, Johnny Dy, Gabriele Guardigli, Hisham Kashou, Norberto Matadamas Hernandez, Zdravka Poljaković, E. Decoulx, Paul Wakefield, Sung Ho Her, Fatma Qaddoura, Giuseppe Boriani, Younus Ismail, Franz Goss, Shigeru Fujii, J. R. Groot de, Ming Shien Wen, Rui Candeias, Thomas Rebane, Juan Carlos Arias, Robert Jobe, Nicolas Ley, Taishi Sasaoka, Luigi Ria, Jonathan Banayan, Paul McLaughlin, Sergei Zenin, Luis E. Martinez, Thuraia Nageh, Fabrizio Ammirati, M. E.W. Hemels, Yutaka Shimizu, Elina Trendafilova, Maxime Fayard, Randeep Suneja, Attilia Maria Pizzini, Mark B. Abelson, Rabih R. Azar, Jian Zhou, Valerie Bockisch, Martin Koschutnik, James Hitchcock, Vlad Ciobotaru, Didier Irles, Patrik Michel, Witold Streb, John F. Corrigan, Ajit Singh Khaira, Marco Antônio Mota Gomes, Richard Tytus, Christian Hall, Antonius Ziekenhuis, Catherine Mallecourt, David J. Williams, Doo Il Kim, Brian Gordon, Salvatore Novo, Soufian Al Mahameed, Anil Shah, N. Joseph Deumite, Brent T. McLaurin, Ruth H. Strasser, Somnath Kumar, Genshan Ma, Aurel Cracan, Rajiv Mallik, Anthony Vlastaris, Francesco Perticone, Julio Alberto Aguilar Linares, Angel Moya, William Ashcraft, Steven Lupovitch, Renate Weinrich, Ralph F. Bosch, Gerald Ukrainski, Jon Arne Sparby, Norbert Schön, Pierre Jean Scala, Steven E. Hearne, Mark Roman, Ramin Farsad, Werner Rieker, Guillaume Cayla, Ramon Freixa, Hidemitsu Nakagawa, Kunihiro Nishida, Thomas J. Mulhearn, Tak W. Kwan, Jeffrey Shanes, Tiziana Tassinari, Ka Sing Lawrence Wong, Kneale Metcalf, Dominique Lejay, Daniel Savard, Pierre Chevallereau, Gilles O'Hara, Milan Mikus, Hiroshi Fukunaga, Olga Korennova, Xavier Ducrocq, Edvard Berngard, Mario Bo, Hoi Fan Chow, E. Ronner, Yuriy Grinshstein, Amparo Mena, Sidiqullah Rahimi, Axel Brandes, Shigenobu Bando, Freddy Del-Carpio Munoz, Jonathan L. Halperin, Ronald D. Jenkins, Carlos Rodríguez Pascual, Alain Lacroix, Sergio Agosti, Franklin Handel, Aylmer Tang, Nan Jiang, Diana A. Gorog, Dimitrios Stakos, Gerald Greer, Dudley Goulden, Martin Grond, Oran Corey, Stellan Bandh, Efrain Gonzalez, Alexander Klein, Jacques Scemama, Amelie Elsaesser, Nathan Foster, Francesco Fedele, Dinesh Mistry, Alberto Caccavo, Bjørn Bratland, Jean Marc Davy, D. J. Boswijk, Abdullah Al Ali, Muhammad Khalid, Terry McCormack, Clare Seamark, Enrico Passamonti, Zoran Olivari, Simon W Dubrey, Wlodzimierz Musial, Antonio Martín Santana, Jianqiu Liang, Manuel de Mora, Dmitry Dupljakov, Nicholas Jones, Mohamed Alshehri, Paul Charbel, John Bullinga, Petr Polasek, Hossein Almassi, Reza Mehzad, Gamal Hussein, Marcus Wiemer, Ali Sharareh, Alexandra Finsen, David Huckins, Denis Angoulvant, Matthias Leschke, Craig Vogel, Stefan Schuster, Juan E. Mesa, Yong Seog Oh, Axel De La Briolle, Jacek Kowalczyk, Louise Shaw, Eduardo de Teresa, Stefan Naydenov, Hubert Vial, Ian I Joffe, Christoph Kleinschnitz, Takeshi Yamashita, A. Salvioni, Aman M. Shah, Michael Renzi, Claude Brunschwig, Ioannis Styliadis, Ravi Bhagwat, Julian Coronel, Asok Venkataraman, Zayd Eldadah, Dinesh Singal, Byung Chun Jung, Michael Lillestol, Mirza S. Baig, Jose Polo, Ira Dauber, Olga Barbarash, Kristina Zint, Pavel Galin, P. J. A. M. Brouwers, Ki Byeong Nam, Andrey Ezhov, Kevin F. Browne, Iveta Sime, Tetsuo Sakai, Jean Louis Georges, Manish Jain, Alexey Nizov, Jean Dillinger, Arif Elvan, John Barton, Rainer Zimmermann, Junji Kanda, Clare Holmes, Werner Jung, Aurélien Miralles, Tatiana Novikova, Steven Georgeson, Yorihiko Higashino, Akira Yamada, David Sprigings, Haroon Rashid, J. W.M. Eck van, Bernard Erickson, Barry Seidman, Koji Kajiwara, Kannappan Krishnaswamy, Daniel Ferreira, Sébastien Armero, Brian Wong, Dong Gu Shin, Ludovic Chartier, Priit Kampus, Francisco Marín, Rickey Manning, Martin Köhrmann, Edward J. Kosinski, Bengt Johansson, Y. S. Tuininga, Simon Cattan, Sergio Dubner, Imran Dotani, Wenchi Kevin Tsai, Gregorio Sanchez, Edwin Blumberg, Charles Crump, Frank Jäger, Christoforos Olympios, Matthew Hoghton, Xinwen Zhao, Derek Muse, Alexandre Guignier, Toby Black, Yuichiro Takagi, Phil Keeling, Richard A. Bernstein, Omar Elhag, Jean Ernst Poulard, Fernando Gabriel Manzur Jattin, James Hampsey, Shahid Mahmood, Steffen Behrens, Tianlun Yang, Elena Dotcheva, Krishnan Challappa, Nam Ho Kim, Claudio Cavallini, Eric Espaliat, Martin James, June Soo Kim, Marc Roelke, Harold Thomas, Charles A. Shoultz, Rami El Mahmoud, José Francisco Kerr Saraiva, Jürgen vom Dahl, Xuebo Liu, Dong Ju Choi, Sergio Mondillo, Ian Parker, Kazuya Yamamoto, Rafael Martin Suarez, Karla M. Kurrelmeyer, Akber Mohammed, Nikitas Moschos, Benoit Coutu, Georgios Hananis, Hamed M. Zuhairy, Giovanni Baula, Suchdeep Bains, Menno V. Huisman, Heng Jiang, Jaroslaw Sek, Yoto Yotov, Malik Ali, Dalmo Antonio Ribeiro Moreira, Torben Larsen, Raed Osman, Marie Paule Houppe Nousse, Shulin Wu, Arturo Raisaro, Efrain Alonso Gomez Lopez, Violeta Cindea Nica, Eduardo Julián José Roberto Chuquiure Valenzuela, Wladmir Faustino Saporito, Changsheng Ma, Francesco Romeo, Jorge Martínez, M. Shakil Aslam, Kenneth J. Rothman, Kamal Al Ghalayini, Magdy Mikhail, Charles Augenbraun, Andreas Wilke, Peter Goethals, John D. McClure, Humberto Rodriguez Reyes, Peter Schoeniger, Nabil Jarmukli, Elizabeth S. Kaufman, Nathalie Duvilla, Jens Wicke, Kausik Chatterjee, Philippe Audouin, Dragan Kovacic, Xingwei Zhang, Brad Frandsen, Alberto Conti, Francisco Aguilar, Sasalu Deepak, Geir Heggelund, David S. Rosenbaum, Sergey P. Golitsyn, Alessandro Capucci, Rodolfo Sotolongo, Begoña Sevilla, François Poulain, Thomas Ronzière, Naseem Jaffrani, Dominik Michalski, Jose Lopez-Sendon, Silvia Di Legge, Bernard Jouve, Chang Sheng Ma, Robert Parris, Sumeet K. Mainigi, Jing Yao, Lars Udo Krause, Ulrich Tebbe, Quansan Zhang, Mathieu Amelot, Peter Crean, Benzy J. Padanilam, Nicolas Breton, Fernando Tomas Lanas Zanetti, Subhash Banerjee, Andrew I. Cohen, Michel Galinier, Jacek Miarka, Gerian Grönefeld, Vicente Bertomeu, Mariusz Gierba, Danny, Anna Ferrier, Luciano Marcelo Backes, Lianqun Cui, Eun-Seok Shin, Andreas Meinel, Jay Koons, Jen Yuan Kuo, Brett Graham, Antonio Garcia Quintana, Michael Hill, Sylvain Destrac, Janko Szavits-Nossan, Shanglang Cai, Joaquín Osca, Luis Aguinaga, Hemal M. Nayak, Chander Arora, Shinji Tayama, Diana Delić Brkljačić, Tiemin Jiang, Miguel Agustin Reyes Rocha, Ronan Collins, Davide Imberti, Kwang Soo Cha, Matthias Gabelmann, Alfredo Astesiano, Christian Weimar, William Eaves, Tatiana Ionova, Khalid Almuti, Thierry Schaupp, Bernhard Paul Lodde, Darlene Elias, Yuichiro Nakamura, Raed Al-Dallow, Eric Parrens, Weihua Li, Alan Bell, Noah Israel, Nadezda Rozkova, Nediljko Pivac, Nooshin Bazargani, Armando Pineda-Velez, Hyung Wook Park, Amin Karim, Clemens Steinwender, Davor Milicic, Gonzalo Barón, Robert Topkis, Mehrdad Ariani, Craig S. Barr, Paulo Bettencourt, Roberto Zanini, Andrew Moriarty, Pascal Goube, Fausto Rigo, Irene Madariaga, Atsushi Sueyoshi, Małgorzata Lelonek, Kevin R. Wheelan, Richard Huntley, Donald Brautigam, Jacek Gniot, Ido Lori, Dragos Vinereanu, Daniel Lee, Kouki Watanabe, Michael Vargas, Natalya Koziolova, James S. Zebrack, Basel Hanbali, Cesare Greco, José Luis Zamorano, Rajesh Patel, Fernando Carvalho Neuenschwander, Sergio Luiz Zimmermann, Shuiping Zhao, Pedro Adragão, Karl Heinz Schmitz, Abdelfatah Alasfar, Olga Ferreira de Souza, David N. Pham, Mark Dayer, Thomas Davee, Yoshiki Hata, Mika Skeppholm, Martin O'Donnell, David Molony, Joe Hargrove, Hani Sabbour, Pascal Defaye, Jochen Bott, Dora Ines Molina de Salazar, Anthony Clay, Giancarlo Landini, Michael McGuire, Dae Kyeong Kim, A. Shekhar Pandey, Bouziane Benhalima, Serge Cohen, Aamir Cheema, Matthias Claus, Marcus L. Williams, Qiangsun Zheng, Karim Bakhtiar, Hailong Lin, Sergio Berti, David Hartley, Libor Nechvatal, Rami Mihail Chreih, Domingo Pozzer, James Capo, John Floyd, Bhola Rama, Harald Darius, Ioannis Mantas, Pareed Aliyar, Carlos Barrera, Galina Ketova, Mark Chang, Alan J. Bank, José Ferreira Santos, Samir Turk, Lakshmanan Sekaran, Adam Ellery, Aurélie Buhl, Naomasa Miyamoto, Kuo Ho Yeh, Nicolas Mousallem, Hassan Soda, Dimitrios J. Richter, Zhaohui Wu, Tim Edwards, Kai Sukles, Koji Maeno, Huanyi Zhang, Paolo Verdecchia, Alexandros Gkotsis, Joe Pouzar, Philippe Berdagué, Edoardo Gronda, Olesya Rubanenko, Cristian Podoleanu, Mariano Ruiz Borret, Guillermo Llamas Esperon, Iveta Mintale, Hideki Shimomura, Dadong Zhang, Angelo Amato Vicenzo de Paola, Kenneth Butcher, Pascal Tessier, Minang Turakhia, Peter Svensson, Shabbir Reza, Herbert Pardell, Wilfried Lang, Holger Poppert, Alan Ackermann, Olivier Citerne, Emil Hayek, Yang Zheng, Jin bae Kim, Lorenzo Fácila, Tetsuo Hisadome, Li Sun, Panagiotis Vardas, Angel Grande, Piers Clifford, C. Zwaan van der, Nicki Law, Ilsbe Salecker, Steven Isserman, Shozo Tanaka, Dorothee B. Bartels, Yann Hemery, Susanna Cary, Mehiar El-Hamdani, Indira Natarajan, Miney Paquette, C. Wilson Sofley, Charles C. Gornick, Fu-Tien Chiang, Ellen Bøhmer, Hiroki Yamanoue, Toru Nakayama, Chakri Yarlagadda, Ciro Indolfi, Narendra Singh, Juan Carlos Nunez Fragoso, Eisho Kyo, Laurent Deluche, Andreas Götte, Stephen Phlaum, Jong Sung Park, Paresh Mehta, Terrence C. Hack, Fred Cucher, Olivier Dibon, Chia Theng Daniel Oh, Shannon Twiddy, Sean Connors, Edo Bottacchi, Beata Wożakowska-Kapłon, Ronald B. Goldberg, Jordi Bruguera, James J. Kmetzo, Jeanne Wei, John Kazmierski, Pilar Mazón, M Frais, Kazuya Kawai, Dimitrios Alexopoulos, Abayomi Osunkoya, Wanda Sudnik, Ramon Horacio Limon Rodriguez, William J. French, Ira Lieber, Rajesh Aggarwal, Stuart W. Zarich, John A. Puleo, David Cudmore, Jost Henner Wirtz, Ute Altmann, Kyung Tae Jung, Jennifer Litchfield, Jei Keon Chae, Rainer Dziewas, James Neiman, Karin Rybak, Galina Chumakova, Riccardo Pini, Richard Oliver, Benoit Lequeux, Athanasios J. Manolis, Luisa Fonseca, César A. Jardim, Katsuhiro Matsuda, Paul Hermany, Ming Luo, Ronnie Garcia, Oscar Pereira Dutra, John Culp, Amrit Pal Singh Takhar, Victor Howard, Oyidie Igbokidi, Kuo Yang Wang, Britta Goldmann, Thomas Walter, Mohamed K. Al-Obaidi, Antonio Pose, Christine Teutsch, Arthur J. Labovitz, Thomas Folk, Nell Wyatt, A. Huizenga, Benhur Henz, Konstantin Protasov, Petra Maskova, Ioannis Goudevenos, Kier Huehnergarth, Elena Kinova, Georgios Stergiou, Guohai Su, Hüseyin Ince, Chi Hung Huang, Winfried Haerer, Saad Al Ismail, Michael Gabris, Brian Carlson, Feng Liu, Yansheng Li, Luis Gustavo Gomes Ferreira, Radosław Lenarczyk, Ruben Omar Iza Villanueva, Nandkishore Ranadive, Yong Xu, Oscar Saenz Morales, Wayne Turner, Aleksey Khripun, Paul G. Grena, Yusuke Fujino, Abraham Salacata, Aleksandar Knezevic, Fouad Elghelbazouri, Hamid Bayeh, Mikhail Torosoff, Martin Cooper, Alenka Mavri, Marina Freydlin, Vassilios Vassilikos, Naresh Ranjith, Laurent Prunier, E. Hoffer, George Mitchell, Javier León Jiménez, S.S. Kabbani, Waldemar Krysiak, Emmanuel Nsah, John Ip, Charles B. Eaton, Jérome Thevenin, Dimitrios Chrysos, Asaad Bakbak, L. Steven Zukerman, Maria Grazia Bongiorni, Matthias von Mering, Lisa Alderson, Jean Joseph Muller, Yann Jamon, Roger Moore, Harinath Chandrashekar, Athanasios Pras, Venkatesh Nadar, B. J. Berg van den, Tomas Ripoll, Eric Van De Graaff, Patrick Dary, Peter L. Schwimmbeck, James Poock, Robert Schnitzler, Rohit Arora, Vuong DuThinh, Uwe Gremmler, Nuno Raposo, Chirag Sandesara, Ping Yen Bryan Yan, Junya Shite, Andrea Berz, Isabel Egocheaga, Karine Lavandier, Jose M. Teixeira, Ewart Jackson-Voyzey, Mayar Jundi, Ignacio Iglesias, Stephen Bloom, Hans Rickli, Rudolph Evonich, Giulio Molon, Vinay Shah, Salvador Bruno Valdovinos Chavez, Walter Ageno, Mauro Esteves Hernandes, Ali Ghanbasha, Stefan Regner, Luc De Wolf, Abdel El Hallak, Mohammad Shoukfeh, Francesco Musumeci, Pablo Andres Sepulveda Varela, Gershan Davis, Xianyan Jiang, Matthew Ebinger, Xiangdong Xu, Andreas Winkler, T. A. Simmers, Olivier Dascotte, Dominique Magnin, Karen Mahood, Carolina Guevara Caiedo, Zulu Wang, Hung-Fat Tse, John Camm, Didier Cadinot, Javier Aguila Marin, Juan Jose Olalla, Tamara Everington, Sherryn Roth, Feliz Alvaro Medina Palomino, Gregg Coodley, Wenhui Liu, G. Y. H. Lip, Ricky Ganim, Paul Ainsworth, Luiz Eduardo Fonteles Ritt, Yalin Liu, Sung Won Jang, Percy Berrospi, Dhananjai Menzies, Julien Pineau, Robert J. Jeanfreau, Hervé Buathier, John D. Osborne, Ted S. N. Lo, Li Fern Hsu, Xi Su, Beate Wild, Alvaro Rabelo Alves, Tomas Cieza-Lara, Neeraj Prasad, Yoshinori Seko, Jaydutt Patel, Malte Kuniss, Guy Chouinard, Jacek Morka, Frank Rubalcava, Fran Adams, Ignacio Rodriguez Briones, Vivek Sharma, Xinhua Wang, Amir Malik, Walid Amara, Adnan El Jabali, José Arturo Maldonado Villalon, Frederic Georger, Hong Ma, Steffen Schnupp, Nolan Mayer, Adam Sokal, Nasser Abdul, Gérald Phan Cao Phai, Jorge Hugo Blanco Ibaceta, Ramakrishnan Iyer, Yves Cottin, Barry Troyan, Achim Küppers, Anastas Stoikov, Jasjit Walia, Bruce Iteld, Abdul Alawwa, Christos Milonas, Frank Mibach, Mahfouz El Shahawy, H.William Stites, Neerav Shah, Clifford Ehrlich, Zia Ahmad, Furio Colivicchi, and Laszlo Karolyi

Subjects
medicine.medical_specialty, business.industry, Atrial fibrillation, 030204 cardiovascular system & hematology, medicine.disease, Dabigatran, 03 medical and health sciences, 0302 clinical medicine, Stroke prevention, Antithrombotic, Emergency medicine, medicine, In patient, 030212 general & internal medicine, Cardiology and Cardiovascular Medicine, Intensive care medicine, Prospective cohort study, business, Stroke, Fibrinolytic agent, medicine.drug
Abstract

Background: GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic t...

Published
2017
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4. Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Author

Rustam Al-Shahi Salman, David P Minks, Dipayan Mitra, Mark A Rodrigues, Priya Bhatnagar, Johann C du Plessis, Yogish Joshi, Martin S Dennis, Gordon D Murray, David E Newby, Peter A G Sandercock, Nikola Sprigg, Jacqueline Stephen, Cathie L M Sudlow, David J Werring, William N Whiteley, Joanna M Wardlaw, Philip M White, Colin Baigent, Daniel Lasserson, Frank Sullivan, Johanna Carrie, Javier Rojas, Shannon Amoils, John Bamford, Jane Armitage, Gabriel Rinkel, Gordon Lowe, Jonathan Emberson, Karen Innes, Lynn Dinsmore, Jonathan Drever, Carol Williams, David Perry, Connor McGill, David Buchanan, Allan Walker, Aidan Hutchison, Christopher Matthews, Ruth Fraser, Aileen McGrath, Ann Deary, Rosemary Anderson, Pauli Walker, Christian Hansen, Richard Parker, Aryelly Rodriguez, Malcolm Macleod, Thomas Gattringer, Jeb Palmer, Eleni Sakka, Jennifer Adil-Smith, David Minks, Johannes du Plessis, Christine Lerpiniere, Richard O'Brien, Seona Burgess, Gillian Mead, Ruth Paulton, Fergus Doubal, Katrina McCormick, Neil Hunter, Pat Taylor, Ruwan Parakramawansha, Jack Perry, Gordon Blair, Allan MacRaild, Adrian Parry-Jones, Mary Johnes, Stephanie Lee, Kelly Marie Shaw, Ilse Burger, Martin Punter, Andrea Ingham, Jane Perez, Zin Naing, Jordi Morell, Tracy Marsden, Andrea Hall, Sally Marshall, Louise Harrison, Rowilson Jarapa, Edith Wood, Victoria O'Loughlin, David Cohen, Silvie Davies, Kelechi Njoku, Mushiya Mpelembue, Laura Burgess, Radim Licenik, Mmua Ngwako, Nabeela Nisar, Rangah Niranchanan, Tatjana Roganova, Rajaram Bathula, Joseph Devine, Anette David, Anne Oshodi, Fenglin Guo, Emmanuelle Owoyele, Varthi Sukdeo, Robert Ballantine, Mudhar Abbdul-saheb, Angela Chamberlain, Aberami Chandrakumar, Philip Poku, Kirsty Harkness, Catrin Blank, Emma Richards, Ali Ali, Faith Kibutu, Olesia Balitska, Kathryn Birchall, Pauline Bayliss, Clare Doyle, Kathy Stocks, Arshad Majis, Jo Howe, Christine Kamara, Luke Barron, Ahmad Maatouk, Ralf Lindert, Katy Dakin, Jessica Redgrave, Biju Bhaskaran, Isam Salih, Debs Kelly, Susan Szabo, Dawn Tomlin, Helen Bearne, Jean Buxton, Pauline Fitzell, Georgina Ayres, Afaq Saulat, Kathleen Horan, Joanne Garfield-Smith, Harbens Bhakri, Paul Guyler, Devesh Sinha, Thayalini Loganathan, Amber Siddiqui, Anwer Siddiqui, Lucy Coward, Swapna Kunhunny, Sharon Tysoe, Rajalakshmi Orath Prabakaran, Shyam Kelavkar, Sindhu Rashmi, David Ngo, Kheng Xiong Ng, Nisha Menon, Sweni Shah, Mark Barber, Derek Esson, Fiona Brodie, Talat Anjum, Mushtaq Wani, Manju Krishnan, Leanne Quinn, Jayne Spencer, Terry Jones, Helen Thompson-Jones, Lynne Dacey, Srikanth Chenna, Sharon Storton, Sarah Thomas, Teresa Beaty, Shelley Treadwell, Caroline Davies, Susan Tucker, Lynda Connor, Peter Slade, Glyn Gainard, Girish Muddegowda, Ranjan Sanyal, Alda Remegoso, Nenette Abano, Chelsea Causley, Racquel Carpio, Stephanie Stevens, Adrian Butler, Resti Varquez, Hayley Denic, Francis Alipio, Andrew Moores, Adrian Barry, Holly Maguire, Jeanette Grocott, Kay Finney, Sue Lyjko, Christine Roffe, Joanne Hiden, Phillip Ferdinand, Vera Cvoro, Khalil Ullah, Nicola Chapman, Mandy Couser, Susan Pound, Sean Mcauley, Senthil Raghunathan, Faye Shelton, Amanda Hedstrom, Margi Godfrey, Diane Havard, Amanda Buck, Kailash Krishnan, Nicola Gilzeane, Jack Roffe, Judith Clarke, Katherine Whittamore, Saima Sheikh, Rekha Keshvara, Carla Jordan, Benjamin Jackson, Gwendoline Wilkes, Jason Appleton, Zhe Law, Oliver Matias, Evangelos Vasileiadis, Cathy Mason, Anthea Parry, Geraldine Landers, Melinda Holden, Basaam Aweid, Khalid Rashed, Linda Balian, Carinna Vickers, Elizabeth Keeling, Sarah Board, Joanna Allison, Clare Buckley, Barbara Williams-Yesson, Joanne Board, Tressy Pitt-Kerby, Alfonso Tanate, Diane Wood, Manohar Kini, Dinesh Chadha, Deborah Walstow, Rosanna Fong, Robert Luder, Tolu Adesina, Jill Gallagher, Hayley Bridger, Elodie Murali, Maneesh Bhargava, Chloe van Someren, Frances Harrington, Abhijit Mate, Ali James, Gillian Courtauld, Christine Schofield, Katja Adie, Linda Lucas, Kirsty Bond, Bev Maund, Sam Ellis, Paul Mudd, Martin James, Samantha Keenan, Angela Bowring, Julie Cageao, Hayley Kingwell, Caroline Roughan, Anthony Hemsley, Jane Sword, David Strain, Keniesha Miller, Anita Goff, Karin Gupwell, Kevin Thorpe, Hedley Emsley, Shuja Punekar, Alison McLoughlin, Sulaiman Sultan, Bindu Gregory, Sonia Raj, Donna Doyle, Keith Muir, Wilma Smith, Angela Welch, Fiona Moreton, Bharath Kumar Cheripelli, Salwa El Tawil, Dheeraj Kalladka, Xuya Huang, Nicola Day, Sankaranarayanan Ramachandran, Caroline Crosbie, Jennifer Elliot, Tony Rudd, Katherine Marks, Ajay Bhalla, Jonathan Birns, Sagal Kullane, Nic Weir, Christopher Allen, Vanessa Pressly, Pam Crawford, Emma Battersby-Wood, Alex Blades, Shuna Egerton, Ashleigh Walters, Sue Evans, James Richard Marigold, Fiona Smith, Gabriella Howard, Imogen Gartrell, Simon Smith, Robyn Creeden, Chloe Cox, Cherish Boxall, Jonathan Hewitt, Claire Nott, Procter Sarah, Jessica Whiteman, Steve Buckle, Rebecca Wallace, Rina Mardania, Jane Gray, Claire Triscott, Anand Nair, Jill Greig, Pratap Rana, Matthew Robinson, Mohammad Irfan Alam, David Werring, Duncan Wilson, Caroline Watchurst, Maria Brezitski, Luci Crook, Ifan Jones, Azra Banaras, Krishna Patel, Renuka Erande, Caroline Hogan, Isabel Hostettler, Amy Ashton, Shez Feerick, Nina Francia, Nnebuife Oji, Emma Elliott, Talal Al-Mayhani, Martin Dennis, Cathie Sudlow, William Whiteley, Dipankar Dutta, Pauline Brown, Deborah Ward, Fiona Davis, Jennifer Turfrey, Chloe Hughes, Kayleigh Collins, Rehana Bakawala, Susan O'Connell, Jon Glass, David Broughton, Dinesh Tryambake, Lynn Dixon, Kath Chapman, Andrew Young, Adrian Bergin, Andrew Sigsworth, Aravind Manoj, Glyn Fletcher, Paula Lopez, Penelope Cox, Mark Wilkinson, Paul Fitzsimmons, Nikhil Sharma, James Choulerton, Denise Button, Lindsey Dow, Lukuman Gbadamoshi, Joanne Avis, Barbara Madigan, Stephanie McCann, Louise Shaw, Deborah Howcroft, Suzanne Lucas, Andrew Stone, Gillian Cluckie, Caroline Lovelock, Brian Clarke, Neha Chopra, Natasha Clarke, Bhavini Patel, Kate Kennedy, Rebecca Williams, Adrian Blight, Joanna O'Reilly, Chukwuka Orefo, Nilofer Dayal, Rita Ghatala, Temi Adedoyin, Fran Watson, Sarah Trippier, Lillian Choy, Barry Moynihan, Usman Khan, Val Jones, Naomi Jeyaraj, Lourda Kerin, Kamy Thavanesan, Divya Tiwari, Chantel Cox, Anja Ljubez, Laura Tucker, Arshi Iqbal, Caroline Bagnall, Marketa Keltos, Josh Roberts, Becky Jupp, Catherine Ovington, Emily Rogers, Owen David, Jo Bell, Barbara Longland, Gail Hann, Martin Cooper, Mohammad Nasar, Anoja Rajapakse, Inez Wynter, Ijaz Anwar, Helen Skinner, Tarn Nozedar, Damian McArdle, Balakrishna Kumar, Susan Crawford, Arunkumar Annamalai, Alex Ramshaw, Clare Holmes, Sarah Caine, Mairead Osborn, Emily Dodd, Peter Murphy, Nicola Devitt, Pauline Baker, Amy Steele, Lucy Belle Guthrie, Samantha Clarke, Ahamad Hassan, Dean Waugh, Emelda Veraque, Linetty Makawa, Mary Kambafwile, Marc Randall, Vasileios Papavasileiou, Claire Cullen, Jenny Peters, Hlaing Thant, Tanya Ingram, Mellor Zoe, Ramesh Durairaj, Melanie Harrison, Sarah Stevenson, Daniela Shackcloth, Jordan Ewing, Victoria Sutton, Mark McCarron, Jacqueline McKee, Mandy Doherty, Ferghal McVerry, Caroline Blair, Mary MacLeod, Janice Irvine, Heather Gow, Jacqueline Furnace, Anu Joyson, Baljit Jagpal, Sarah Ross, Katrina Klaasen, Sandra Nelson, Rebecca Clarke, Nichola Crouch, Beverly MacLennan, Vicky Taylor, Daniel Epstein, Avani Shukla, Vinodh Krishnamurthy, Paul Nicholas, Sammie Qureshi, Adam Webber, Justin Penge, Hawraman Ramadan, Stuart Maguire, Chris Patterson, Ruth Bellfield, Brigid Hairsine, Kelvin Stewart, Michaela Hooley, Outi Quinn, Bella Richard, Sally Moseley, Mandy Edwards, Heidi Lawson, Michelle Tayler, Yogish Pai, Mahesh Dhakal, Bernard Esisi, Sofia Dima, Gemma Marie Smith, Mark Garside, Muhammad Naeem, Vidya Baliga, Gill Rogers, Ellen Brown, David Bruce, Rachel Hayman, Susan Clayton, Ed Gamble, Rebecca Grue, Bethan Charles, Adam Hague, Sujata Blane, Caroline Lambert, Afnan Chaudhry, Thomas Harrison, Kari Saastamoinen, Dionne Hove, Laura Howaniec, Gemma Grimwood, Ozlem Redjep, Fiona Humphries, Lucia Argandona, Larissa Cuenoud, Esther Erumere, Sageet Amlani, Grace Auld, Afraim Salek-Haddadi, Ursula Schulz, James Kennedy, Gary Ford, Philip Mathieson, Ian Reckless, Rachel Teal, Giulia Lenti, George Harston, Eoin O'Brien, Joanne Mcgee, Jennifer Mitchell, Elaine Amis, Dominic Handley, Siobhan Kelly, George Zachariah, Jobbin Francis, Sarah Crisp, Juliana Sesay, Sarah Finlay, Helen Hayhoe, Niamh Hannon, Tom Hughes, Bethan Morse, Henry De Berker, Emma Tallantyre, Ahmed Osman, Susan White, Stefan Schwarz, Benjamin Jelley, Rajendra Yadava, Khalid Azhar, Julie Reddan, Mirriam Sangombe, Samantha Stafford, Ken Fotherby, Debbie Morgan, Farrukh Baig, Karla Jennings-Preece, Donna Butler, Nasar Ahmad, Angela Willberry, Angela Stevens, Baljinder Rai, Prasad Siddegowda, Peter Howard, Lisa Hyatt, Tracey Dobson, David Jarrett, Suheil Ponnambath, Jane Tandy, Yasmin Harrington-Davies, Rebecca Butler, Claire James, Stacey Valentine, Anne Suttling, Peter Langhorne, Gillian Kerr, Fiona Wright, Ruth Graham, Christine McAlpine, Mohammad Shahzad Iqbal, Louise Humphreys, Kath Pasco, Olga Balazikova, Ashraf Nasim, Cassilda Peixoto, Louise Gallagher, Shahrzad Shahmehri, Sandip Ghosh, Elizabeth Barrie, Danielle Gilmour, Margo Henry, Tom Webb, Linda Cowie, Hannah Rudenko, Shanni McDonald, Natasha Schumacher, Susannah Walker, Tracey Cosier, Anna Verrion, Eva Beranova, Audrey Thomson, Marius Venter, Arindam Kar, Sheila Mashate, Kirsten Harvey, Léjeune Gardener, Vinh Nguyen, Omid Halse, Olivia Geraghty, Beth Hazel, Peter Wilding, Victoria Tilley, Tim Cassidy, Beverley McClelland, Maria Bokhari, Timothy England, Mohana Maddula, Richard Donnelly, Paul Findlay, Ashish Macaden, Ian Shread, Charlotte Barr, Azlisham Mohd Nor, Claire Brown, Nicola Persad, Charlotte Eglinton, Marie Weinling, Benjamin Hyams, Alex Shah, John Baker, Anthony Byrne, Caroline McGhee, Amanda Smart, Claire Copeland, Michael Carpenter, Marion Walker, Richard Davey, Ann Needle, Razik Fathima, Gavin Bateman, Prabal Datta, Andrew Stanners, Linda Jackson, Julie Ball, Michelle Davis, Natalie Atkinson, Michelle Fawcett, Teresa Thompson, Helen Guy, Valerie Hogg, Carole Hays, Stephen Woodward, Mohammad Haque, Eluzai Hakim, Stuart Symonds, Mehran Maanoosi, Jane Herman, Toby Black, Skelton Miriam, Caroline Clarke, Alpha Anthony, Michele Tribbeck, Julie Cronin, Denise Mead, Ruth Fennelly, James McIlmoyle, Christina Dickinson, Carol Jeffs, Sajjad Anwar, Joanne Howard, Kirsty Jones, Saikat Dhar, Caroline Clay, Muhammad Siddiq, Simone Ivatts, Yolanda Baird, Moore Sally, Isobel Amey, Sophie Newton, Lisa Clayton-Evans, Indra Chadbourn, Rayessa Rayessa, Charde Naylor, Alicia Rodgers, Lisa Wilson, Sarah Wilson, Emma Clarkson, Ruth Davies, Paula Owings, Graeme Sangster, Valerie Gott, Victoria Little, Pauline Weir, Suja Cherian, Deepa Jose, Helen Moroney, Susan Downham, Angela Dodd, Venetia Vettimootal Johnson, Laura Codd, Naomi Robinson, Ashraf Ahmed, Mo Albazzaz, Sharon Johnson, Carol Denniss, Mishell Cunningham, Tajammal Zahoor, Timothy Webster, Sandra Leason, Syed Haider, Kausic Chatterjee, Arumugam Nallasivan, Charlotte Perkins, Samantha Seagrave, Colin Jenkins, Fiona Price, Claire Hughes, Lily Mercer, Malik Hussain, Sarah Brown, Miriam Harvey, Jane Homan, Mohammad Khan, Robert Whiting, Leanne Foote, Nicholas Hunt, Helen Durman, Lucy Brotherton, Jayne Foot, Corinne Pawley, Eliza Foster, Alison Whitcher, Kneale Metcalf, Jenny Jagger, Susan McDonald, Kelly Waterfield, Patrick Sutton, Naval Shinh, Ajmal Anversha, Garth Ravenhill, Richard Greenwood, Janak Saada, Alison Wiltshire, Rebekah Perfitt, Sreeman Andole, Naveen Gadapa, Karen Dunne, Magdalini Krommyda, Evelyne Burssens, Sam King, Catherine Plewa, Nigel Smyth, Jenny Wilson, Elio Giallombardo, Lucy Sykes, Pradeep Kumar, James Barker, Isabel Huggett, Linda Dunn, Charlotte Culmsee, Philip Thomas, Min Myint, Helen Brew, Nikhil Majmudar, Janice OConnell, George Bunea, Charlotte Fox, Diane Gulliver, Andrew Smith, Betty Mokoena, Naweed Sattar, Ramesh Krishnamurthy, Emily Osborne, David Wilson, Belinda Wroath, Kevin Dynan, Michael Power, Susan Thompson, Victoria Adell, Enoch Orugun, Una Poultney, Rachel Glover, Hannah Crowther, Sarah Thornthwaite, Ivan Wiggam, Aine Wallace, Enda Kerr, Ailsa Fulton, Annemarie Hunter, Suzanne Tauro, Sarah Cuddy, David Mangion, Anne Hardwick, Skarlet Markova, Tara Lawrence, Carmen Constantin, Jo Fletcher, Isobel Thomas, Kerry Pettitt, Lakshmanan Sekaran, Margaret Tate, Kiranjit Bharaj, Rohan Simon, Frances Justin, Sakthivel Sethuraman, Duke Phiri, Niaz Mohammed, Meena Chauhan, Khaled Elfandi, Uzma Khan, David Eveson, Amit Mistri, Lisa Manning, Shagufta Khan, Champa Patel, Mohammed Moqsith, Saira Sattar, Man Yee Lam, Kashif Musarrat, Claire Stephens, Latheef Kalathil, Richard Miller, Maqsud Salehin, Nikki Gautam, Duncan Bailey, Kelly Amor, Julie Meir, Anne Nicolson, Javed Imam, Lisa Wood, Julie White, Mahmud Sajid, George Ghaly, Margaret Ball, Rachel Gascoyne, Harald Proeschel, Simon Sharpe, Sarah Horton, Emily Beaves, Stephanie Jones, Brigitte Yip, Murdina Bell, Linda MacLiver, Brian MacInnes, Don Sims, Jennifer Hurley, Mark Willmot, Claire Sutton, Edward Littleton, Susan Maiden, Rachael Jones, James Cunningham, Carole Green, Michelle Bates, Raj Shekhar, Ellie Gilham, Iman Ahmed, Rachel Crown, Tracy Fuller, Neetish Goorah, Angela Bell, Christine Kelly, Arun Singh, Jamie Walford, Benjamin Tomlinson, Farzana Patel, Stephen Duberley, Ingrid Kane, Chakravarthi Rajkumar, Jane Gaylard, Joanna Breeds, Nicola Gainsborough, Alexandra Pitt-Ford, Emma Barbon, Laura Latter, Philip Thompson, Simon Hervey, Shrivakumar Krishnamoorthy, Joseph Vassallo, Deborah Walter, Helen Cochrane, Meena Srinivasan, Robert Campbell, Denise Donaldson, Nichola Motherwell, Frances Hurford, Indranil Mukherjee, Antony Kenton, Sheila Nyabadza, Irene Martin, Benjamin Hunt, Hardi Hassan, Sarah O'Toole, Bander Dallol, Janet Putterill, Ratneshwari Jha, Rachel Gallifent, Puneet Kakar, Aparna Pusalkar, kelly Chan, Puneet Dangri, Hannah Beadle, Angela Cook, Karen Crabtree, Santhosh Subramonian, Peter Owusu-Agyei, Natalie Temple, Nicola Butterworth-Cowin, Suzanne Ragab, Kerstin Knops, Emma Jinks, Christine Dickson, Laura Gleave, Judith Dube, Jacqui Leggett, Tatiana Garcia, Sissy Ispoglou, Rachel Evans, Sandeep Ankolekar, Anne Hayes, Hlaing Ni, Bithi Rahman, Josette Milligan, Carol Graham, Josin Jose, Breffni Keegan, Jim Kelly, Richard Dewar, James White, Kelly Thomas, Rajkumar, C, University of St Andrews. School of Medicine, University of St Andrews. Sir James Mackenzie Institute for Early Diagnosis, University of St Andrews. Population and Behavioural Science Division, University of St Andrews. Pure Mathematics, University of St Andrews. School of Psychology and Neuroscience, and University of St Andrews. School of Biology

Subjects
Male, MICROBLEEDS, 030204 cardiovascular system & hematology, AMYLOID ANGIOPATHY, Brain Ischemia, law.invention, 0302 clinical medicine, Randomized controlled trial, law, Secondary Prevention, ACUTE ISCHEMIC-STROKE, Aged, 80 and over, Aspirin, Manchester Cancer Research Centre, medicine.diagnostic_test, Hazard ratio, Brain, Magnetic Resonance Imaging, Superficial siderosis, Cerebral Small Vessel Diseases, Stroke, Treatment Outcome, Female, medicine.drug, CT, medicine.medical_specialty, ANTITHROMBOTIC THERAPY, Clinical Neurology, Neuroimaging, Subgroup analysis, 03 medical and health sciences, Internal medicine, medicine, Journal Article, Humans, Aged, Cerebral Hemorrhage, business.industry, ResearchInstitutes_Networks_Beacons/mcrc, DAS, Magnetic resonance imaging, medicine.disease, SIGNS, ASPIRIN, Neurology (clinical), Tomography, X-Ray Computed, business, SUPERFICIAL SIDEROSIS, Platelet Aggregation Inhibitors, 030217 neurology & neurosurgery
Abstract

Background: Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy.Methods: RESTART was a prospective, randomised, open-label, blinded-endpoint, parallel-group trial at 122 hospitals in the UK that assessed whether starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. For this prespecified subgroup analysis, consultant neuroradiologists masked to treatment allocation reviewed brain CT or MRI scans performed before randomisation to confirm participant eligibility and rate features of the intracerebral haemorrhage and surrounding brain. We followed participants for primary (recurrent symptomatic intracerebral haemorrhage) and secondary (ischaemic stroke) outcomes for up to 5 years (reported elsewhere). For this report, we analysed eligible participants with intracerebral haemorrhage according to their treatment allocation in primary subgroup analyses of cerebral microbleeds on MRI and in exploratory subgroup analyses of other features on CT or MRI. The trial is registered with the ISRCTN registry, number ISRCTN71907627.Findings: Between May 22, 2013, and May 31, 2018, 537 participants were enrolled, of whom 525 (98%) had intracerebral haemorrhage: 507 (97%) were diagnosed on CT (252 assigned to start antiplatelet therapy and 255 assigned to avoid antiplatelet therapy, of whom one withdrew and was not analysed) and 254 (48%) underwent the required brain MRI protocol (122 in the start antiplatelet therapy group and 132 in the avoid antiplatelet therapy group). There were no clinically or statistically significant hazards of antiplatelet therapy on recurrent intracerebral haemorrhage in primary subgroup analyses of cerebral microbleed presence (2 or more) versus absence (0 or 1) (adjusted hazard ratio [HR] 0·30 [95% CI 0·08–1·13] vs 0·77 [0·13–4·61]; pinteraction=0·41), cerebral microbleed number 0–1 versus 2–4 versus 5 or more (HR 0·77 [0·13–4·62] vs 0·32 [0·03–3·66] vs 0·33 [0·07–1·60]; pinteraction=0·75), or cerebral microbleed strictly lobar versus other location (HR 0·52 [0·004–6·79] vs 0·37 [0·09–1·28]; pinteraction=0·85). There was no evidence of heterogeneity in the effects of antiplatelet therapy in any exploratory subgroup analyses (all pinteraction>0·05).Interpretation: Our findings exclude all but a very modest harmful effect of antiplatelet therapy on recurrent intracerebral haemorrhage in the presence of cerebral microbleeds. Further randomised trials are needed to replicate these findings and investigate them with greater precision.Funding: British Heart Foundation.

Published
2019
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5. Thrombolysis Delivery by a Regional Telestroke Network—Experience From the UK National Health Service

Author

Anthony O'Brien, Declan O'Kane, Eoin O'Brien, Peter Phillips, Paul Guyler, Patrick J. Barry, Paul E. Cotter, Kneale Metcalf, Elizabeth A. Warburton, Lynda Sibson, Diana J. Day, Raj Shekhar, David Collas, Smriti Agarwal, and Peter Owusu-Agyei

Subjects
Male, thrombolysis, Telemedicine, Time Factors, medicine.medical_treatment, Population, telestroke, Hemorrhage, Health Services Accessibility, Regional Health Planning, State Medicine, Time-to-Treatment, After-Hours Care, Fibrinolytic Agents, NHS, Predictive Value of Tests, Residence Characteristics, Humans, Medicine, Thrombolytic Therapy, education, Stroke, Original Research, Aged, Aged, 80 and over, education.field_of_study, Remote Consultation, business.industry, Stroke mimics, Thrombolysis, Middle Aged, medicine.disease, National health service, Treatment Outcome, England, Female, Rural Health Services, Medical emergency, Cardiology and Cardiovascular Medicine, business, Delivery of Health Care, Fibrinolytic agent
Abstract

Background The majority of established telestroke services are based on “hub‐and‐spoke” models for providing acute clinical assessment and thrombolysis. We report results from the first year of the successful implementation of a locally based telemedicine network, without the need of 1 or more hub hospitals, across a largely rural landscape. Methods and Results Following a successful pilot phase that demonstrated safety and feasibility, the East of England telestroke project was rolled out across 7 regional hospitals, covering an area of 7500 square miles and a population of 5.6 million to enable out‐of‐hours access to thrombolysis. Between November 2010 and November 2011, 142 telemedicine consultations were recorded out‐of‐hours. Seventy‐four (52.11%) cases received thrombolysis. Median ( IQR ) onset‐to‐needle and door‐to‐needle times were 169 (141.5 to 201.5) minutes and 94 (72 to 113.5) minutes, respectively. Symptomatic hemorrhage rate was 7.3% and stroke mimic rate was 10.6%. Conclusions We demonstrate the safety and effectiveness of a horizontal networking approach for stroke telemedicine, which may be applicable to areas where traditional “hub‐and‐spoke” models may not be geographically feasible.

Published
2014
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6. Important factors in predicting mortality outcome from stroke: findings from the Anglia Stroke Clinical Network Evaluation Study.

Author

PHYO KYAW MYINT, BACHMANN, MAX O., YOON KONG LOKE, MUSGRAVE, STANLEY D., PRICE, GILL M., HALE, RACHEL, KNEALE METCALF, ANTHONY, TURNER, DAVID A., DAY, DIANA J., WARBURTON, ELIZABETH A., and POTTER, JOHN F.

Subjects
MORTALITY risk factors, STROKE prognosis, HOSPITALS, MEDICAL quality control, NURSING, PROBABILITY theory, RESEARCH funding, LOGISTIC regression analysis, SECONDARY analysis, PROPORTIONAL hazards models, DATA analysis software, DESCRIPTIVE statistics
Abstract

Background: although variation in stroke service provision and outcomes have been previously investigated, it is less well known what service characteristics are associated with reduced short- and medium-term mortality. Methods: data from a prospective multicentre study (2009-12) in eight acute regional NHS trusts with a catchment population of about 2.6 million were used to examine the prognostic value of patient-related factors and service characteristics on stroke mortality outcome at 7, 30 and 365 days post stroke, and time to death within 1 year. Results: a total of 2,388 acute stroke patients (mean (standard deviation) 76.9 (12.7) years; 47.3% men, 87% ischaemic stroke) were included in the study. Among patients characteristics examined increasing age, haemorrhagic stroke, total anterior circulation stroke type, higher prestroke frailty, history of hypertension and ischaemic heart disease and admission hyper-glycaemia predicted 1-year mortality. Additional inclusion of stroke service characteristics controlling for patient and service level characteristics showed varying prognostic impact of service characteristics on stroke mortality over the disease course during first year after stroke at different time points. The most consistent finding was the benefit of higher nursing levels; an increase in one trained nurses per 10 beds was associated with reductions in 30-day mortality of 11-28% (P < 0.0001) and in 1-year mortality of 8-12% (P < 0.001). Conclusions: there appears to be consistent and robust evidence of direct clinical benefit on mortality up to 1 year after acute stroke of higher numbers of trained nursing staff over and above that of other recognised mortality risk factors. [ABSTRACT FROM AUTHOR]

Published
2017
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