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1.
Zh Nevrol Psikhiatr Im S S Korsakova ; 121(3. Vyp. 2): 10-15, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-33908226

RESUMEN

The frequency of perioperative stroke in cardiosurgical practice may reach up to 10%. The risk of stroke is especially high after coronary artery bypass surgery and valve replacement. Perioperative stroke is related to embolism with the fragments of atherosclerotic plaque, arterial hypotension, cardiac arrhythmias, hypercoagulation, etc. The likelihood of stroke can be reduced by preoperative assessment of the patient. It is important to control blood pressure and saturation during the surgery. The manipulation on aorta should be minimized in order to reduce the risk of perioperative stroke. Important role belongs to timely identification of those who developed stroke after surgery. The only possible method of reperfusion therapy in perioperative stroke is mechanical thrombectomy.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Placa Aterosclerótica , Accidente Cerebrovascular , Aorta , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Puente de Arteria Coronaria , Humanos , Factores de Riesgo , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología
2.
Zh Nevrol Psikhiatr Im S S Korsakova ; 121(3. Vyp. 2): 38-45, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-33908231

RESUMEN

OBJECTIVE: To analyze hospital and long-term results of stenting of the V1 segment of the vertebral artery (VA) in the first hours after acute cerebral hemopoiesis/transient ischemic attack (stroke/TIA) in the vertebrobasilar territory (VT). MATERIAL AND METHODS: The current retrospective study from 2012 to 2019 included 169 patients with hemodynamically significant stenosis of the V1 segment of the VA, who underwent emergency stenting in the first hours after the onset of stroke. The mean time between the development of stroke and correction was 368.5±129.8 minutes. The average time between admission to the medical institution and submission to the X-ray operating room was 89.2±10.7 minutes. VA stenting was performed through the transfemoral approach. In 118 cases (69.8%) a drug eluting stent was implanted, in 51 (30.2%) a bare metal stent was implanted. 90% of VA segment V1 stenosis was diagnosed in 48 patients before the onset of stroke. Of these, 33 received conservative therapy for vertebrobasilar insufficiency (VBI) for 2.5±1.0 months in anticipation of regression of the disease. The remaining 15 did not have VBI symptoms and did not need active drug treatment. Ultimately, within this sample, the time interval between the visualization of stenosis and the onset of stroke was 3.0±1.0 months. In 17 patients, stroke/TIA in VT became recurrent. The period between two neurological events was 1.5±0.5 months. Nine patients did not wait for the planned intervention due to the development of an adverse neurological event before the appointed date of hospitalization. The other 8 did not appear for the interventional correction on time due to subjective reasons and were again admitted to the medical facility on an urgent basis. RESULTS: During the hospital follow-up period, no adverse cardiovascular events were recorded. When assessing the dynamics in the neurological status, there was a significant regression of the deficit by the time of discharge from the hospital. In the long-term follow-up period (38.2±20.4 months), a fatal outcome was recorded in 2.4% of cases (n=4). Non-fatal myocardial infaction was diagnosed in 5 patients (2.9%). Restenosis of the stent in the VA was visualized in 56 patients (33.1%). In 17 cases, it became symptomatic (10.0%). All patients underwent repeated stenting with a successful result of the procedure. CONCLUSION: Emergency stenting of hemodynamically significant stenosis of the V1 segment of the VA in the acute period of stroke in VT is a safe and effective method of revascularization characterized by the absence of adverse cardiovascular events at the hospital stage of observation.


Asunto(s)
Isquemia Encefálica , Stents Liberadores de Fármacos , Accidente Cerebrovascular , Insuficiencia Vertebrobasilar , Isquemia Encefálica/etiología , Estudios de Seguimiento , Humanos , Estudios Retrospectivos , Stents , Accidente Cerebrovascular/etiología , Resultado del Tratamiento , Insuficiencia Vertebrobasilar/diagnóstico por imagen , Insuficiencia Vertebrobasilar/cirugía
3.
Rev Med Suisse ; 17(736): 816-821, 2021 Apr 28.
Artículo en Francés | MEDLINE | ID: mdl-33908717

RESUMEN

COVID-19 patients are at a higher risk of stroke. This observation is in apparent contradiction with the reduced number of stroke patient admissions during the first wave of the COVID-19 pandemic, seen worldwide. The SARS-CoV-2 can affect the endothelium, favour a procoagulant state and involves the heart, leading to an increased risk of developing a stroke. The pandemic and confinement influence the behaviour of the population, perhaps more reticent to contact emergency departments flooded with COVID-19 patients and likely to have modified levels of stress. In addition, it was shown that confinement during the pandemic reduced air pollution, thought to affect stroke risk. These indirect effects of SARS-CoV-2 probably also impact the number of hospital admissions for stroke. These different aspects are presented here as a controversy.


Asunto(s)
Accidente Cerebrovascular , Humanos , Pandemias , Admisión del Paciente , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología
4.
BMJ ; 373: n379, 2021 04 12.
Artículo en Inglés | MEDLINE | ID: mdl-33846159

RESUMEN

Atrial fibrillation is a common chronic disease seen in primary care offices, emergency departments, inpatient hospital services, and many subspecialty practices. Atrial fibrillation care is complicated and multifaceted, and, at various points, clinicians may see it as a consequence and cause of multi-morbidity, as a silent driver of stroke risk, as a bellwether of an acute medical illness, or as a primary rhythm disturbance that requires targeted treatment. Primary care physicians in particular must navigate these priorities, perspectives, and resources to meet the needs of individual patients. This includes judicious use of diagnostic testing, thoughtful use of novel therapeutic agents and procedures, and providing access to subspecialty expertise. This review explores the epidemiology, screening, and risk assessment of atrial fibrillation, as well as management of its symptoms (rate and various rhythm control options) and stroke risk (anticoagulation and other treatments), and offers a model for the integration of the components of atrial fibrillation care.


Asunto(s)
Fibrilación Atrial/diagnóstico , Tamizaje Masivo/normas , Guías de Práctica Clínica como Asunto , Atención Primaria de Salud/normas , Accidente Cerebrovascular/prevención & control , Antiarrítmicos/administración & dosificación , Anticoagulantes/uso terapéutico , Fibrilación Atrial/complicaciones , Fibrilación Atrial/epidemiología , Fibrilación Atrial/terapia , Cateterismo Cardíaco , Electrocardiografía , Carga Global de Enfermedades , Estilo de Vida Saludable , Frecuencia Cardíaca/efectos de los fármacos , Frecuencia Cardíaca/fisiología , Humanos , Incidencia , Tamizaje Masivo/métodos , Prevalencia , Atención Primaria de Salud/métodos , Medición de Riesgo/métodos , Factores de Riesgo , Accidente Cerebrovascular/etiología
5.
Medicine (Baltimore) ; 100(15): e25557, 2021 Apr 16.
Artículo en Inglés | MEDLINE | ID: mdl-33847685

RESUMEN

ABSTRACT: The heterogeneity of brain perfusion is related to the risk factors of thromboembolic events such as antiphospholipid syndrome. However, the effectiveness of brain perfusion heterogeneity as a marker to predict thromboembolic events has not been confirmed. Our objective was to evaluate the effectiveness of brain perfusion heterogeneity as a marker to predict the development of cerebrovascular accidents. In this retrospective cohort study, patients who underwent Tc-99m ECD brain SPECT from January 1, 2006 through December 31, 2008 were included. Each study was reoriented with the Talairach space provided by the NeuroGam Software package. Heterogeneity of brain perfusion was measured as the coefficient of variation. The study outcome was the risk of cerebral vascular accidents in patients with increased heterogeneity of brain perfusion between January 1, 2006 and December 31, 2015. A multiple Cox proportional hazards model was applied to evaluate the risk of cerebrovascular accidents. A total of 70 patients were included in this study. The median age was 39 years (range, 28 - 59 years). There were 55 (78.6%) women. For increased heterogeneity of brain perfusion, the hazard ratio of cerebrovascular accidents was 2.68 (95% CI, 1.41 - 5.09; P = .003) after adjusting for age, sex, hypertension, diabetes mellitus, and dyslipidemia. Our study suggests that increased heterogeneity of brain perfusion is associated with an increased risk of cerebrovascular accidents.


Asunto(s)
Encéfalo/diagnóstico por imagen , Circulación Cerebrovascular , Medición de Riesgo/métodos , Accidente Cerebrovascular/etiología , Tomografía Computarizada de Emisión de Fotón Único/estadística & datos numéricos , Adulto , Biomarcadores/análisis , Encéfalo/fisiopatología , Cisteína/análogos & derivados , Femenino , Humanos , Masculino , Persona de Mediana Edad , Compuestos de Organotecnecio , Valor Predictivo de las Pruebas , Modelos de Riesgos Proporcionales , Radiofármacos , Estudios Retrospectivos , Tomografía Computarizada de Emisión de Fotón Único/métodos
6.
J Am Coll Cardiol ; 77(16): 1994-2003, 2021 04 27.
Artículo en Inglés | MEDLINE | ID: mdl-33888249

RESUMEN

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has impacted many aspects of ST-segment elevation myocardial infarction (STEMI) care, including timely access to primary percutaneous coronary intervention (PPCI). OBJECTIVES: The goal of the NACMI (North American COVID-19 and STEMI) registry is to describe demographic characteristics, management strategies, and outcomes of COVID-19 patients with STEMI. METHODS: A prospective, ongoing observational registry was created under the guidance of 3 cardiology societies. STEMI patients with confirmed COVID+ (group 1) or suspected (person under investigation [PUI]) (group 2) COVID-19 infection were included. A group of age- and sex-matched STEMI patients (matched to COVID+ patients in a 2:1 ratio) treated in the pre-COVID era (2015 to 2019) serves as the control group for comparison of treatment strategies and outcomes (group 3). The primary outcome was a composite of in-hospital death, stroke, recurrent myocardial infarction, or repeat unplanned revascularization. RESULTS: As of December 6, 2020, 1,185 patients were included in the NACMI registry (230 COVID+ patients, 495 PUIs, and 460 control patients). COVID+ patients were more likely to have minority ethnicity (Hispanic 23%, Black 24%) and had a higher prevalence of diabetes mellitus (46%) (all p < 0.001 relative to PUIs). COVID+ patients were more likely to present with cardiogenic shock (18%) but were less likely to receive invasive angiography (78%) (all p < 0.001 relative to control patients). Among COVID+ patients who received angiography, 71% received PPCI and 20% received medical therapy (both p < 0.001 relative to control patients). The primary outcome occurred in 36% of COVID+ patients, 13% of PUIs, and 5% of control patients (p < 0.001 relative to control patients). CONCLUSIONS: COVID+ patients with STEMI represent a high-risk group of patients with unique demographic and clinical characteristics. PPCI is feasible and remains the predominant reperfusion strategy, supporting current recommendations.


Asunto(s)
/epidemiología , Intervención Coronaria Percutánea/estadística & datos numéricos , Infarto del Miocardio con Elevación del ST/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Canadá/epidemiología , Femenino , Mortalidad Hospitalaria , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , América del Norte/epidemiología , Estudios Prospectivos , Recurrencia , Sistema de Registros/estadística & datos numéricos , Reoperación/estadística & datos numéricos , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/mortalidad , Infarto del Miocardio con Elevación del ST/terapia , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Estados Unidos/epidemiología , Adulto Joven
8.
Angiol Sosud Khir ; 27(1): 97-106, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-33825735

RESUMEN

Surgical revascularization of the carotid basin in the acutest period of ischaemic stroke, i.e., within 72 hours, will make it possible to prevent the development of recurrent stroke by removing an embologenically dangerous atherosclerotic plaque of the symptomatic carotid artery and to improve cerebral blood supply, having eliminated haemodynamic stenosis of the carotid artery. However, the problem of safety of carotid endarterectomy in patients during the acutest period of ischaemic stroke still remains debatable. PURPOSE: To comparatively analyse safety of eversion carotid endarterectomy performed in the acutest (0-72 hours) and acute (4-14 days) periods of minor ischaemic stroke. PATIENTS AND METHODS: Between January 2015 and December 2019, specialists of the Department of Vascular Surgery of Municipal Clinical Hospital # 7 of Kazan performed a total of 80 eversion carotid reconstructions in the period of minor ischaemic stroke within 14 days. The patients were divided into 2 groups depending on the terms of performing carotid endarterectomy. The first group comprised 32 (40.0%) patients operated on in the acutest period of ischaemic stroke, i.e., within 72 hours from the onset of first symptoms of neurological deficit. The second group included 48 (60.0%) patients subjected to carotid endarterectomy within 4 to 14 days from the onset of first signs of neurological deficit. RESULTS: According to the obtained findings, haemorrhagic transformation in the early postoperative period occured in 2 Group Two patients, with one lethal outcome on POD 3. Cerebral ischaemia increased in one patient of each group without enlargement of the ischaemic zone according to brain computed tomography, with residual neurological deficit in Group I in remote period (Rankin scale score 1) and complete restoration in Group II (Rankin scale score 0). Recurrent minor ischaemic stroke on POD 1 developed in Group II with formation of a new lacunar region of ischaemia of the brain in the operated carotid basin and was verified by the findings of cerebral MRI with persisting neurological deficit for 6 months (Rankin scale score 2). The comparative assessment of severity of stroke on the day of operation and at discharge, as well as that of neurological symptomatology during the 1st and 6th months of follow up in both groups proved positive. No events of acute coronary syndrome, recurrent strokes or lethal outcomes were observed during the follow-up period. CONCLUSION: According to the findings of our study, patients with acute cerebral circulation impairment caused by embologenically dangerous lesions of internal carotid arteries should be operated on within the first 72 hours, if there are no accompanying changes requiring time for correction thereof.


Asunto(s)
Isquemia Encefálica , Estenosis Carotídea , Endarterectomía Carotidea , Accidente Cerebrovascular , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/etiología , Isquemia Encefálica/prevención & control , Estenosis Carotídea/complicaciones , Estenosis Carotídea/diagnóstico , Estenosis Carotídea/cirugía , Endarterectomía Carotidea/efectos adversos , Humanos , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/prevención & control , Resultado del Tratamiento
9.
Rev Port Cir Cardiotorac Vasc ; 28(1): 69-70, 2021 Apr 08.
Artículo en Inglés | MEDLINE | ID: mdl-33834646

RESUMEN

59-year-old women with permanent atrial fibrillation and previous haemorrhagic stroke was admitted for percutaneous left atrial appendage occlusion. Shortly after, AmplatzerTM device migration into the left ventricular outflow tract was confirmed. Unsuccessful transcatheter mobilization led to an emergent surgery for device retrieval and LAA closure. No events at 6-month follow-up.


Asunto(s)
Apéndice Atrial , Fibrilación Atrial , Accidente Cerebrovascular , Apéndice Atrial/diagnóstico por imagen , Apéndice Atrial/cirugía , Fibrilación Atrial/cirugía , Cateterismo Cardíaco , Femenino , Humanos , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/prevención & control , Resultado del Tratamiento
10.
Artículo en Ruso | MEDLINE | ID: mdl-33834736

RESUMEN

Cardioembolic stroke (CS) is the one of the most severe and requiring dynamic monitoring among the all subtypes of ischemic stroke. Patients with CS require joint treatment with cardiologists. CS is characterized by a greater severity of neurological deficits, a high risk of repeated acute cerebral circulatory disorders and fatal outcomes. This review considers the main causes of CS, the etiopathogenesis of thrombus formation in the heart chambers, current verification criteria and therapeutic aspects of CS, recommendations for the prescription of anticoagulant therapy for primary and secondary preventive treatment.


Asunto(s)
Accidente Cerebrovascular , Anticoagulantes/uso terapéutico , Humanos , Prevención Secundaria , Accidente Cerebrovascular/tratamiento farmacológico , Accidente Cerebrovascular/etiología
11.
Artículo en Inglés | MEDLINE | ID: mdl-33809125

RESUMEN

Although previous studies have discussed the association between trajectories of blood pressure (BP) and risk of cardiovascular diseases (CVDs), the association among the non-hypertensive general population of youth and middle age has not been elucidated. We used the growth mixture model to explore the trajectories of BP among the non-hypertensive Chinese population and applied Cox regression to evaluate the association between trajectories of BP and the risk of stroke or myocardial infarction (MI). Systolic blood pressure (SBP) and diastolic blood pressure (DBP) were categorized into three classes, respectively. Statistically significant associations were observed between SBP trajectories and stroke (range of adjusted hazard ratios (aHR): 1.369-3.837) or MI (rang of aHR = 6.047-13.017). Association between DBP trajectories and stroke (aHR: 3.685) or MI (range of aHR = 1.312-2.821) were also observed, although they did not reach statistical significance. Trajectories of SBP were more important risk factors than that of DBP in stroke and MI in our study population. BP management is important among pre-hypertensive adults to prevent stroke and MI when they age. Well-designed research with a larger sample size is required to confirm our findings and develop efficient methods to prevent CVDs.


Asunto(s)
Enfermedades Cardiovasculares , Hipertensión , Accidente Cerebrovascular , Adolescente , Adulto , Presión Sanguínea , Enfermedades Cardiovasculares/epidemiología , China/epidemiología , Estudios de Cohortes , Humanos , Hipertensión/epidemiología , Persona de Mediana Edad , Factores de Riesgo , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología
12.
Artículo en Ruso | MEDLINE | ID: mdl-33864670

RESUMEN

Common carotid artery (CCA) thrombosis is a rare cause of ischemic stroke. In available literature, we found no studies devoted to cerebral revascularization for CCA occlusion in acute period of ischemic stroke. Successful treatment of concomitant occlusion of CCA, internal (ICA) and external carotid arteries (ECA) with microvascular anastomoses is very interesting for various specialists. To demonstrate the possibility of contralateral cerebral revascularization in a patient with CCA, ECA and ICA occlusion in acute period of ischemic stroke. Two-stage intervention was performed in a patient with ischemic stroke and carotid artery occlusion. At the first stage, EICMA was formed between the right superficial temporal artery and the M4 branch of the middle cerebral artery (MCA), at the second stage - anastomosis between the right and left ECAs using an autologous arterial graft from the radial artery. There is no generally accepted surgical strategy for CCA occlusion. Contralateral revascularization with blood flow redirecting from the right carotid artery to the left one makes it possible to avoid thrombectomy from the affected CCA and ECA. We have undertaken this method for the first time. We have not found such an approach in the available literature. This report demonstrates the possibility of successful cerebral revascularization in acute period of ischemic stroke in patients with combined occlusion of CCA, ICA and ECA.


Asunto(s)
Isquemia Encefálica , Estenosis Carotídea , Revascularización Cerebral , Accidente Cerebrovascular , Anastomosis Quirúrgica , Isquemia Encefálica/diagnóstico por imagen , Isquemia Encefálica/etiología , Isquemia Encefálica/cirugía , Arteria Carótida Interna/cirugía , Humanos , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/cirugía
14.
Curr Cardiol Rep ; 23(5): 45, 2021 03 15.
Artículo en Inglés | MEDLINE | ID: mdl-33721116

RESUMEN

PURPOSE OF REVIEW: Coronary revascularization is a commonly performed major procedure in the hospitals. Stroke is one of the dreaded complications after coronary revascularization procedures. The focus of this review is to understand the stroke risk in percutaneous cutaneous intervention (PCI) and coronary artery bypass grafting (CABG) procedures. RECENT FINDINGS: Available data show that PCI offers less procedural stroke risk compared to CABG although the survival benefits of CABG are better in certain scenarios. Innovative advancements in techniques, pre-procedural optimum medical therapy (OMT), intraoperative neuro-monitoring, and multidisciplinary post procedural care are the few strategies in early detection and reduce stroke risk. Despite several innovations and strategies, it is evident that there is not enough data available to make concrete conclusions related to stroke risk after coronary revascularization, which warrants further investigation.


Asunto(s)
Enfermedad de la Arteria Coronaria , Isquemia Miocárdica , Intervención Coronaria Percutánea , Accidente Cerebrovascular , Puente de Arteria Coronaria , Humanos , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/prevención & control , Resultado del Tratamiento
15.
Evid Based Dent ; 22(1): 10-11, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33772120

RESUMEN

Data sources PubMed, Scopus, Web of Science, The Cochrane Library, LILACS, OpenGrey and Google Scholar. No language restriction applied; studies conducted until September 2018.Study selection Observational studies in humans exposed and not exposed to periodontitis, in which the primary outcome was the risk of cerebrovascular accident, including haemorrhagic and ischaemic attacks (transient ischaemic attack and ischaemic stroke).Data extraction and synthesis Three examiners conducted a literature search. Duplicates, opinion articles, technical articles, guides and animal studies were excluded. Quality assessment was carried out followed by assessment of risk of bias. The extracted data were analysed using RevMan software. The meta-analysis looked for odds ratio (OR) in case-control studies and risk ratio (RR) in cohort studies as well as their 95% confidence intervals.Results Ten studies were included, all showing low risk of bias. The number of patients ranged from 80 to 15,792 with follow-up duration from 0 to 15 years. The studies showed variable heterogeneity. For stroke in case-control studies (seven studies), the overall heterogeneity was considerable (I2 = 77%). For ischaemic stroke in case-control studies (five studies), the overall heterogeneity was considerable (I2 = 72%), but after an outlying study was removed (I2 = 78%), it reduced significantly (I2 = 4%). For stroke in cohort studies (three studies), null heterogeneity was observed (I2 = 0%). The meta-analysis informed the three main outcomes: 1) individuals with periodontitis were twice as likely to suffer stroke (OR 2.31 [1.39, 3.84], p = 0.001, I2 = 77%); 2) individuals with periodontitis were twice as likely to suffer ischaemic stroke (OR 2.72 [2.00, 3.71], p <0.00001, I2 = 4%); and 3) individuals with periodontitis had a higher risk of experiencing stroke (RR 1.88 [1.55, 2.28], p <0.00001). Overall, the authors found that stroke events were associated with periodontitis.Conclusions The meta-analysis suggests an association between risk of stroke and periodontal disease. However, there is a need for prospective studies to ascertain the relationship between periodontal disease severity and stroke severity; whether there is an impact of periodontal treatment and to review whether periodontal disease impacts on stroke survival.


Asunto(s)
Isquemia Encefálica , Periodontitis , Accidente Cerebrovascular , Humanos , Periodontitis/complicaciones , Estudios Prospectivos , Factores de Riesgo , Accidente Cerebrovascular/etiología
16.
Medicine (Baltimore) ; 100(11): e25216, 2021 Mar 19.
Artículo en Inglés | MEDLINE | ID: mdl-33726018

RESUMEN

BACKGROUND: Non-vitamin K antagonist oral anticoagulants (NOACs) have been widely used for stroke prevention in atrial fibrillation (AF) and the treatment and prevention of venous thromboembolism. There is an issue with safety, especially in clinically relevant bleeding. We performed a network meta-analysis to evaluate the risk of major gastrointestinal (GI) bleeding associated with NOACs. METHODS: Interventions were warfarin, enoxaparin, apixaban, dabigatran, edoxaban, and rivaroxaban. The primary outcome was the incidence of major GI bleeding. A subgroup analysis was performed according to the following indications: AF, deep venous thrombosis/pulmonary embolism, and postsurgical prophylaxis. RESULTS: A total of 29 randomized controlled trials (RCTs) and 4 large observation population studies were included. Compared with warfarin, apixaban showed a decreased the risk of major GI bleeding (relative risk [RR] 0.54, 95% confidence interval [CI] 0.25-0.76), and rivaroxaban tended to increase this risk (RR 1.40, 95% CI 1.06-1.85). Dabigatran (RR 1.25, 95% CI 0.98-1.60), edoxaban (RR 1.07, 95% CI 0.69-1.65), and enoxaparin (RR 1.24, 95% CI 0.63-2.43) did not significantly increase the risk of GI bleeding than did warfarin. In the subgroup analysis, according to indications, apixaban showed a decreased risk of major GI bleeding (RR 0.50, 95% CI 0.34-0.74) than did warfarin in AF studies. Dabigatran (RR 2.36, 95% CI 1.55-3.60, and rivaroxaban (RR 1.75, 95% CI 1.10-6.41) increased the risk of major GI bleeding than did apixaban. An analysis of studies on venous thromboembolism or pulmonary embolism showed that no individual NOAC or enoxaparin was associated with an increased risk of major GI bleeding compared to warfarin. CONCLUSION: Individual NOACs had varying profiles of GI bleeding risk. Results of analyses including only RCTs and those including both RCTs and population studies showed similar trends, but also showed several differences.


Asunto(s)
Anticoagulantes/efectos adversos , Fibrilación Atrial/tratamiento farmacológico , Hemorragia Gastrointestinal/inducido químicamente , Embolia Pulmonar/tratamiento farmacológico , Tromboembolia Venosa/tratamiento farmacológico , Administración Oral , Adulto , Anciano , Fibrilación Atrial/complicaciones , Dabigatrán/efectos adversos , Enoxaparina/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Metaanálisis en Red , Estudios Observacionales como Asunto , Embolia Pulmonar/complicaciones , Pirazoles/efectos adversos , Piridinas/efectos adversos , Piridonas/efectos adversos , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Riesgo , Rivaroxabán/efectos adversos , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/prevención & control , Tiazoles/efectos adversos , Tromboembolia Venosa/complicaciones , Warfarina/efectos adversos
17.
Medicine (Baltimore) ; 100(10): e24616, 2021 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-33725825

RESUMEN

ABSTRACT: Major adverse cardiac and cerebral events (MACCE) are common complications, which prolong hospitalization and increase mortality rate in end-stage renal disease (ESRD) patients who underwent continuous ambulatory peritoneal dialysis (CAPD). Therefore, this study aimed to investigate MACCE occurrence and its potential predictive factors in those patients.In this prospective cohort study, 196 diagnosis of ESRD patients who underwent CAPD treatment in our hospital were eligible, and their clinical data (including demographic data and biochemical indexes) were documented. Besides, their MACCE occurrence was assessed within 3-year follow-up period.In patients, 1-, 2-, and 3-year MACCE occurrence rates were 5.1%, 11.7%, and 14.8%, respectively. Meanwhile, the mean duration of accumulating MACCE occurrence was 33.1 (95% confidence interval: 32.0-34.2) months. Furthermore, age, peritoneal dialysis duration (PDD), C-reactive protein (CRP), fasting blood glucose (FBG) and total cholesterol high correlated with increased accumulating MACCE occurrence, while high-density lipoprotein cholesterol (HDL-C) high correlated with decreased accumulating MACCE occurrence. Notably, by further multivariate Cox's proportional hazard regression analysis, age, PDD, CRP, serum uric acid, and FBG high were independent predictive factors for raised accumulating MACCE occurrence, while HDL-C high was an independent predictive factor for attenuated accumulating MACCE occurrence.MACCE are common; besides, age, peritoneal dialysis duration, C-reactive protein, serum uric acid, fasting blood glucose, and high-density lipoprotein cholesterol serve as potential markers for indicating MACCE in ESRD patients who underwent CAPD.


Asunto(s)
Fallo Renal Crónico/terapia , Isquemia Miocárdica/epidemiología , Diálisis Peritoneal Ambulatoria Continua/efectos adversos , Accidente Cerebrovascular/epidemiología , Adulto , Factores de Edad , Anciano , Biomarcadores/sangre , Femenino , Estudios de Seguimiento , Humanos , Fallo Renal Crónico/sangre , Fallo Renal Crónico/complicaciones , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/etiología , Estudios Prospectivos , Factores de Riesgo , Accidente Cerebrovascular/etiología , Factores de Tiempo
18.
Medicine (Baltimore) ; 100(10): e25121, 2021 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-33725910

RESUMEN

BACKGROUND: It is unclear whether there are false positive or negative results in the effects of sodium-glucose transporter 2 (SGLT2) inhibitors on various cardiovascular and renal outcomes in patients with type 2 diabetes. We aimed to explore this issue by a meta-analysis with trial sequential analysis. METHODS: We included randomized trials evaluating the effects of SGLT2 inhibitors on cardiorenal endpoints in type 2 diabetic patients. Eight endpoints evaluated in the study were fatal or nonfatal myocardial infarction (MI), fatal or nonfatal stroke, major adverse cardiovascular events (MACE), cardiovascular death or hospitalization for heart failure (CVD or HHF), all-cause death (ACD), cardiovascular death (CVD), hospitalization for heart failure (HHF), and kidney function progression (KFP). Meta-analysis and trial sequential analysis was conducted for each endpoint. RESULTS: Seven randomized trials of SGLT2 inhibitors were included for pooled analysis. Compared with placebo, SGLT2 inhibitors significantly reduced the risk of MACE (HR 0.89, 95% confidence interval [CI] 0.84-0.94), MI (HR 0.91, 95% CI 0.84-0.99), CVD (HR 0.86, 95% CI 0.79-0.93), CVD or HHF (HR 0.77, 95% CI 0.73-0.82), HHF (HR 0.67, 95% CI 0.62-0.74), KFP (HR 0.63, 95% CI 0.56-0.70), and ACD (HR 0.88, 95% CI 0.83-0.94), whereas SGLT2 inhibitors did not have significant effects on stroke (HR 0.98, 95% CI 0.88-1.09). Trial sequential analyses for MI and stroke showed that cumulative Z curve did not cross trial sequential monitoring boundary and required information size, whereas those for the other 6 endpoints showed that cumulative Z curve crossed trial sequential monitoring boundary and/or required information size. CONCLUSIONS: Compared with placebo, SGLT2 inhibitors conclusively reduce the risk of MACE, CVD or HHF, ACD, CVD, HHF, and KFP in patients with type 2 diabetes, whereas the effects of SGLT2 inhibitors on MI and stroke are not conclusive and need to be further assessed in future studies with the adequate sample size to reject or accept the effect size.


Asunto(s)
Diabetes Mellitus Tipo 2/tratamiento farmacológico , Nefropatías Diabéticas/diagnóstico , Tasa de Filtración Glomerular/efectos de los fármacos , Insuficiencia Cardíaca/epidemiología , Infarto del Miocardio/epidemiología , Inhibidores del Cotransportador de Sodio-Glucosa 2/administración & dosificación , Accidente Cerebrovascular/epidemiología , Causas de Muerte , Diabetes Mellitus Tipo 2/complicaciones , Nefropatías Diabéticas/etiología , Nefropatías Diabéticas/fisiopatología , Nefropatías Diabéticas/prevención & control , Progresión de la Enfermedad , Tasa de Filtración Glomerular/fisiología , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/prevención & control , Hospitalización/estadística & datos numéricos , Humanos , Incidencia , Infarto del Miocardio/etiología , Infarto del Miocardio/prevención & control , Ensayos Clínicos Controlados Aleatorios como Asunto , Medición de Riesgo , Índice de Severidad de la Enfermedad , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/prevención & control , Resultado del Tratamiento
19.
Neurosci Lett ; 751: 135811, 2021 04 23.
Artículo en Inglés | MEDLINE | ID: mdl-33727129

RESUMEN

The purpose of this study was to evaluate CatWalk's capability for assessing the functional outcome after photothrombotic stroke affecting the motor cortex of mice. Mice were tested up to 21 days after photothrombosis or sham surgery using CatWalk, and a composite score assessing functional deficits (neuroscore). The neuroscore demonstrated deficits of the contralateral forelimb for more than two weeks after stroke. There were no asymmetric or coordinative dysfunctions of limbs detected by CatWalk. However, CatWalk data revealed impairment of locomotion speed and its depending parameters for one-week after stroke in strong correlation to the neuroscore. Data suggest that the composite neuroscore allows to more sensitively and precisely specify and quantify photothrombosis-induced hemisyndromes than CatWalk.


Asunto(s)
Modelos Animales de Enfermedad , Marcha , Programas Informáticos , Accidente Cerebrovascular/fisiopatología , Trombosis/fisiopatología , Animales , Extremidades/fisiopatología , Luz/efectos adversos , Masculino , Ratones , Ratones Endogámicos C57BL , Corteza Motora/fisiopatología , Accidente Cerebrovascular/etiología , Trombosis/complicaciones , Trombosis/etiología
20.
Khirurgiia (Mosk) ; (3): 50-56, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-33710826

RESUMEN

OBJECTIVE: To determine the most optimal period of surgical treatment after previous stroke. MATERIAL AND METHODS: There were 186 patients with significant ICA stenosis and previous unilateral stroke for the period 2008-2014 at the Pletnev Hospital (Moscow). Surgical approach was used in 136 (73.1%) patients (group I), conservative treatment at the neurological department - in 50 (26.9%) patients (group II). We analyzed neurological and cognitive status in both groups, regression of symptoms depending on the period after stroke, early and long-term postoperative outcomes. RESULTS: In early postoperative period, 7 (5.1%) cerebral ischemic events (transient ischemic attack (TIA) and stroke) occurred in the 1st group. No correlation of neurological complications and type of intervention was revealed. In long-term period, stroke occurred in 3.6% in the first group and in 14% in the second group over the same period. Surgical treatment was followed by more complete recovery of neurological functions (NIHSS score 6.2±0.5 versus 7.0±0.8; modified Rankin score 1.5±0.2 versus 2.1±0.5, p<0.05) and cognitive mechanisms (MoCA score 22.04±1.48 versus 20.04±1.48, p<0.05). CONCLUSION: Carotid endarterectomy and carotid artery stenting are effective for prevention of recurrent stroke. Carotid artery repair accelerates recovery of cognitive functions and regression of neurological symptoms in these patients.


Asunto(s)
Implantación de Prótesis Vascular , Estenosis Carotídea , Endarterectomía Carotidea , Ataque Isquémico Transitorio , Accidente Cerebrovascular , Estenosis Carotídea/complicaciones , Estenosis Carotídea/diagnóstico , Estenosis Carotídea/cirugía , Tratamiento Conservador , Endarterectomía Carotidea/efectos adversos , Humanos , Ataque Isquémico Transitorio/diagnóstico , Ataque Isquémico Transitorio/etiología , Factores de Riesgo , Stents , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/etiología , Resultado del Tratamiento
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