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1.
Medicine (Baltimore) ; 99(40): e22465, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019438

RESUMO

The present study aimed to investigate the predictive value of free fatty acid (FFA) in embolic stroke of undetermined source (ESUS) according to the presence of potential embolic sources (PES) after extensive etiologic evaluation.This was a retrospective observational study based on a single-center registry from January 2011 to July 2017. Stroke subtypes were determined through laboratory findings, brain, and angiographic imaging, carotid ultrasonography, transthoracic echocardiography, and 24-hour Holter monitoring. If ESUS was suspected, transesophageal echocardiography was additionally performed. Patients were classified into ESUS with PES and ESUS without PES. PES included mitral annular calcification, mitral valve prolapse, patent foramen ovale, atrial septal aneurysm, spontaneous echo contrast, ventricular aneurysm, and high-risk plaques of aortic arch, or carotid bulb. We compared clinical and laboratory findings between the two groups.Of a total of 110 ESUS patients, 61 patients (55.5%) had no PES. Patients with ESUS without PES had higher levels of serum FFA, systolic blood pressure, diastolic blood pressure (DBP), and left atrial (LA) enlargement compared with those of ESUS with PES. Multivariable analysis demonstrated that the FFA level, DBP, and LA volume index were associated with ESUS without PES [odds ratio (OR) 1.038, 95% confidence interval (CI) 1.019-1.058 for FFA/10 µEq/L, OR 1.414, 95% CI 1.037-1.928 for DBP/10 mm Hg, and OR 1.073, 95% CI 1.009-1.141 for LA volume index].Higher levels of FFA, DBP, and LA volume index are associated with ESUS without PES, highlighting the need to identify the role of these markers in ESUS through further large-scale, multi-center and prospective studies.


Assuntos
Ácidos Graxos não Esterificados/sangue , Embolia Intracraniana/sangue , Acidente Vascular Cerebral/sangue , Idoso , Biomarcadores/sangue , Feminino , Humanos , Embolia Intracraniana/complicações , Embolia Intracraniana/diagnóstico , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Sistema de Registros , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia
2.
Medicine (Baltimore) ; 99(40): e22353, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33019412

RESUMO

INTRODUCTION: Increasing evidences showed differential expression of circulating microRNAs (miRNAs) in patients with acute ischemic stroke (AIS), indicating that miRNAs might serve as promising biomakers in the diagnosis of AIS. However, their accuracy has not been systematically evaluated, so it is necessary to conducted a meta-analysis to evaluate the diagnostic value of miRNAs in AIS patients. METHODS: PubMed, EMBASE, Cochrane Library, Web of Science, Medline, China National Knowledge Infrastructure (CNKI) will be searched for the relevant studies that explored the potential diagnostic values of miRNAs in AIS patients from inception to August 2020. Data will be extracted by two researchers independently; risk of bias of the meta-analysis will be evaluated by the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Data will be synthesised and heterogeneity will be evaluated. All of the above statistical analysis will be performed using Stata V.15.0 and Meta-disc V.1.4. RESULTS: This study will assess the pooled diagnostic performance of circulating miRNAs in AIS. CONCLUSION: This study will clarify confusions about the specificity and sensitivity of circulating miRNAs in diagnosing AIS, which could further guide the promotion and application of them.Open Science Framework (OSF) registration number: 2020, August 19. https://osf.io/6tjf3.


Assuntos
Isquemia Encefálica/sangue , Isquemia Encefálica/diagnóstico , MicroRNA Circulante/sangue , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/diagnóstico , Isquemia Encefálica/patologia , Humanos , Projetos de Pesquisa , Sensibilidade e Especificidade , Acidente Vascular Cerebral/patologia
3.
J Stroke Cerebrovasc Dis ; 29(11): 105202, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33066924

RESUMO

INTRODUCTION AND OBJECTIVES: Motor evoked potentials (MEPs) have been postulated to be useful in predicting recovery in patients with motor impairment. We aimed to investigate whether MEPs elicited by transcranial magnetic stimulation (TMS), serum brain derived neurotrophic factor (BDNF) and its genotype have prognostic value on stroke recovery in patients with hand paresis due to stroke. METHODS: This was an observational cohort study. Patients underwent TMS with MEPs from abductor digiti minimi evaluation between 2-14 (D0) and 30 days (D30) after stroke and their impact on motor function of the upper limb and general outcome was assessed after 3 months (D90). The presence of a BDNF gene polymorphism was determined and serum BDNF concentrations were measured at D0, D30 and D90. RESULTS: The presence of MEPs and their amplitude at rest and in effort significantly correlated with improvement of upper-limb paresis and general outcome after 3 months. Resting motor threshold did not have prognostic value. Central motor conduction time and MEP latency less consistently predicted stroke outcome or motor deficit improvement. Neither BDNF polymorphisms nor BDNF concentration at D0, D30 and D90 corresponded with the degree of paresis or the independence of patients 3 months after stroke. CONCLUSIONS: The presence of MEPs and their amplitude are useful predictors of upper-limb motor function recovery and general outcome after stroke. BDNF concentration and its genotype had no prognostic value. Further studies conducted on large cohorts are necessary to determine the usefulness of these methods in motor recovery and stroke outcome prediction.


Assuntos
Fator Neurotrófico Derivado do Encéfalo/sangue , Potencial Evocado Motor , Mãos/inervação , Paresia/terapia , Acidente Vascular Cerebral/terapia , Estimulação Transcraniana por Corrente Contínua , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Fator Neurotrófico Derivado do Encéfalo/genética , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora , Paresia/diagnóstico , Paresia/fisiopatologia , Polimorfismo Genético , Valor Preditivo dos Testes , Tempo de Reação , Recuperação de Função Fisiológica , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
4.
J Stroke Cerebrovasc Dis ; 29(11): 105203, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33066933

RESUMO

OBJECTIVES: We investigate the relationship between the severity of vascular disease and epicardial adipose tissue thickness(EAT-t) and the neutrophil/lymphocyte (NEU/LY) ratio in acute stroke patients. METHODS: Seventy-six patients and 38 healthy controls were included in the study. Strokes were divided into three groups: lacunar infarction, middle cerebral artery infarction (MCA), and other arterial infarcts. Patients were assessed using the GCS (Glasgow coma scale) and NIHSS (National Institutes of Health Stroke Scale) scales. In addition to laboratory measurements, EAT-t was evaluated in all patients by using echocardiography. RESULTS: The EAT-t value and NEU/LY ratio were higher in the patient group than in the control group. The MCA group was found to have a significantly higher NEU/LY ratio than the lacuna group (p = 0.017) as well as the other patient (p = 0.025) group. There was a positive correlation of NIHSS score with EAT-t (r = 0.291; p = 0.013), and NEU/LY ratio (r = 0.289; p = 0.014). CONCLUSION: The EAT-t and NEU/LY ratio were high in patients with acute ischemic stroke patients. The higher ratio of NEU/LY compared to other infarcts in the MCA group. These findings support the relationship between acute ischemic stroke severity and inflammation .


Assuntos
Tecido Adiposo/diagnóstico por imagem , Isquemia Encefálica/sangue , Isquemia Encefálica/diagnóstico por imagem , Ecocardiografia , Linfócitos , Neutrófilos , Pericárdio/diagnóstico por imagem , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/diagnóstico por imagem , Tecido Adiposo/fisiopatologia , Adiposidade , Idoso , Isquemia Encefálica/fisiopatologia , Estudos de Casos e Controles , Estudos Transversais , Feminino , Humanos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Pericárdio/fisiopatologia , Valor Preditivo dos Testes , Fatores de Risco , Índice de Gravidade de Doença , Acidente Vascular Cerebral/fisiopatologia
5.
J Stroke Cerebrovasc Dis ; 29(10): 105149, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912541

RESUMO

BACKGROUND AND AIMS: Experimental studies demonstrated that netrin-1 (NT-1) is an important factor influencing the recovery after ischemic stroke. However, whether NT-1 levels were associated with the post-stroke depression (PSD) remains unclear. We aimed to evaluate the relationship between NT-1 levels and PSD at 3 months in patients with ischemic stroke. METHODS: From January 2018 to December 2019, consecutive Chinese patients with first-ever ischemic stroke were prospectively recruited. Serum NT-1 levels were measured at admission. Patients with a 17-item Hamilton Depression Scale score of ≥7 were given the Structured Clinical Interview of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, for diagnosis of PSD. RESULTS: A total of 238 patients (mean age, 62.5 years; 45.4% female) were enrolled. The median NT-1 concentrations were 467.8 pg/mL (interquartile range, 351.8-581.0 pg/mL). During the 3-month follow-up period, 64 patients (26.9%) experienced PSD. Serum NT-1 levels were significantly lower in PSD patients than in patients without PSD (median, 380.3 pg/mL versus 478.5 pg/mL; P = 0.001). After adjusting for demographic characteristic, National Institutes of Health stroke score, and other potential confounders by multiple logistic regression analysis, patients with NT-1 levels in the first quartile were more likely to have 3-month PSD (as compared with the fourth quartile, odds ratio 3.83, 95% confidence intervals, 1.53-9.63, P = 0.004). Similar significant findings were observed when the NT-1 levels were added as a continuous variable. CONCLUSIONS: Our data demonstrated that decreased serum NT-1 levels, in a Chinese population, were significantly associated with PSD at 3 months.


Assuntos
Depressão/sangue , Netrina-1/sangue , Acidente Vascular Cerebral/sangue , Idoso , Biomarcadores/sangue , China , Depressão/diagnóstico , Depressão/etiologia , Regulação para Baixo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Fatores de Risco , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico , Fatores de Tempo
7.
Medicine (Baltimore) ; 99(36): e21792, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899007

RESUMO

Major lipids making effects on the occurrence of acute ischemic stroke (AIS) is well recognized, but their roles on stroke severity remain uncertain. To explore the exact roles of lipids playing on stroke severity and the possible mechanism, we conduct this observational study.Data was collected from patients with AIS from February 2008 to May 2012. The level of major lipids was compared among AIS groups with different severity and investigated the correlation. Also, the relationship existed between major lipids and bilirubin. Mechanism of major lipids playing on stroke severity was researched to determine if oxidative stress reflected by bilirubin.Lower triglyceride (TG) and higher high density lipoprotein cholesterol (HDL-C) were observed in severe stroke, and obvious correlation existed between TG and stroke severity or HDL-C and stroke severity. TG was associated negatively with direct bilirubin (DBIL) and total bilirubin (TBIL), and lower level of DBIL and TBIL were related to higher quartiles of TG. There was no obvious difference of DBIL and TBIL among the groups of quartiles of HDL-C. TG was the influence factor of stroke severity in severe stroke through multiple univariable logistic regression. But it was not the independent influence factor after multivariable logistic regression adjusted by DBIL or TBIL. However, HDL-C was the influence factor of stroke severity through both univariable and multivariable logistic regression.Lower TG or higher HDL-C predicted severer stroke. The effect of TG on stroke severity was mediated by bilirubin, not HDL-C.


Assuntos
Bilirrubina/sangue , HDL-Colesterol/sangue , Acidente Vascular Cerebral/sangue , Triglicerídeos/sangue , Idoso , Biomarcadores/sangue , Feminino , Humanos , Masculino , Estresse Oxidativo , Índice de Gravidade de Doença
8.
Stroke ; 51(9): 2810-2816, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32811390

RESUMO

BACKGROUND AND PURPOSE: Identification of acute ischemic stroke (AIS) cause is crucial for guidance of secondary prevention. Previous studies have yielded inconsistent results regarding possible correlations between AIS cause and thrombus composition, as assessed by semiquantitative histological analysis. Here, we performed a correlation analysis between AIS cause and AIS thrombus cellular composition and content, as assessed using quantitative biochemical assays. METHODS: Homogenates of 250 patients with AIS thrombi were prepared by mechanical grinding. Platelet, red blood cell, and leukocyte content of AIS thrombi were estimated by quantification of GP (glycoprotein) VI, heme, and DNA in thrombus homogenates. AIS cause was defined as cardioembolic, noncardioembolic, or embolic stroke of undetermined source, according to the TOAST classification (Trial of ORG 10172 in Acute Stroke Treatment). RESULTS: Cardioembolic thrombi were richer in DNA (35.8 versus 13.8 ng/mg, P<0.001) and poorer in GPVI (0.104 versus 0.117 ng/mg, P=0.045) than noncardioembolic ones. The area under the receiver operating characteristic curve of DNA content to discriminate cardioembolic thrombi from noncardioembolic was 0.72 (95% CI, 0.63-0.81). With a threshold of 44.7 ng DNA/mg thrombus, 47% of thrombi from undetermined cause would be classified as cardioembolic with a specificity of 90%. CONCLUSIONS: Thrombus DNA content may provide an accurate biomarker for identification of cardioembolic thrombi in patients with AIS with embolic stroke of undetermined source. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT03268668.


Assuntos
Isquemia Encefálica/genética , DNA/genética , Embolia/genética , Cardiopatias/genética , Trombose Intracraniana/genética , Acidente Vascular Cerebral/genética , Idoso , Idoso de 80 Anos ou mais , Contagem de Células Sanguíneas , Plaquetas/patologia , Isquemia Encefálica/sangue , Diagnóstico Diferencial , Embolia/complicações , Feminino , Cardiopatias/complicações , Humanos , Trombose Intracraniana/sangue , Trombose Intracraniana/etiologia , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Sensibilidade e Especificidade , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/etiologia
9.
Am J Emerg Med ; 38(9): 1772-1777, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32739847

RESUMO

BACKGROUND: Thromboelastography (TEG) provides a rapid assessment of the hemostatic processes of a patient in emergency settings. There are limited data on TEG as a predictive tool for hemorrhagic transformation in patients with acute ischemic stroke. We investigated whether TEG values on admission could predict hemorrhagic transformation in patients with acute ischemic stroke. METHODS: TEG was performed prospectively in 772 patients who satisfied the criteria of the critical pathway for acute stroke that have neurologic symptoms in 6 h at the emergency department between March and December 2018. After excluding 114 patients, 628 patients were evaluated, and finally, 205 patients with acute ischemic stroke were included. The primary outcome is hemorrhagic transformation, defined as the presence of blood in brain on follow-up imaging study and secondary outcome is neurological deterioration, defined as a 2-point increase on the National Institutes of Health Stroke Scale (NIHSS) within 72 h of stroke onset. RESULTS: Of the 205 ischemic stroke patients (mean age 67 ±â€¯13 years, 66.3% male), hemorrhagic transformation was identified in 28 (13.7%) patients, and neurological deterioration was occurred in 24 (11.7%), and both events in 9 (4.4%). The TEG value of R (reaction time) <5 min was significantly higher in patients with hemorrhagic transformation than in patients without hemorrhagic transformation (81.1% vs. 60.5%, p = 0.027), and based on multivariable analysis, this was an independent predictor of hemorrhagic transformation (odds ratio 3.215 [95% confidence interval: 1.153-8.969]). CONCLUSIONS: In patients with acute ischemic stroke, TEG value of R < 5 min can identify patients who have an increased risk of hemorrhagic transformation during hospitalization.


Assuntos
Isquemia Encefálica/sangue , Hemorragia Cerebral/sangue , Acidente Vascular Cerebral/sangue , Tromboelastografia , Idoso , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos
10.
J Stroke Cerebrovasc Dis ; 29(9): 105055, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32807461

RESUMO

BACKGROUND: To investigate the value of plasma high mobility group box protein 1 (HMGB1) in evaluating the prognosis of cerebral ischemia-reperfusion injury (CIRI) in ischemic stroke patients. METHODS: 132 ischemic stroke patients were recruited. Before and after thrombolytic therapy at 2 h, 6 h, 12 h, 24 h, and 36 h, the Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS) were recorded. The Modified Rankin scale (mRS) was used to assess the prognosis at 3 months. RESULTS: The NIHSS score, GCS score and plasma HMGB1 level peaked at 6 h after thrombolytic therapy, and plasma HMGB1 level was positively correlated with infarct volume and NIHSS score, and negatively correlated with GCS score. Plasma HMGB1 level at 6 h had the highest value in identifying patients with poor unfavorable functional outcome after 3 months, with a sensitivity of 86.8% and a specificity of 74.0%. Logistic regression results showed that plasma HMGB1 had a strong association with unfavorable functional outcome [odds ratio (OR) =1.621, P<0.001]. After adjusting for infarct volume and NIHSS score did not attenuate the association (OR=1.381, P=0.005). Finally, we found that plasma HMGB1 at 6 h had the highest value in identifying patients with non-survival after 3 months (χ2=28.655, P<0.001). Logistic regression results showed that plasma HMGB1 had a strong association with non-survival (OR=2.315, P<0.001). After adjusting for infarct volume and NIHSS score did not attenuate the association (OR=2.013, P<0.001). CONCLUSION: Plasma HMGB1 exerts a good predictive value for CIRI in ischemic stroke patients, and its increased expression is correlated with worse prognosis.


Assuntos
Isquemia Encefálica/tratamento farmacológico , Fibrinolíticos/efeitos adversos , Proteína HMGB1/sangue , Traumatismo por Reperfusão/sangue , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica/efeitos adversos , Ativador de Plasminogênio Tecidual/efeitos adversos , Administração Intravenosa , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Isquemia Encefálica/sangue , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/fisiopatologia , Avaliação da Deficiência , Feminino , Fibrinolíticos/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Traumatismo por Reperfusão/induzido quimicamente , Traumatismo por Reperfusão/diagnóstico , Traumatismo por Reperfusão/fisiopatologia , Fatores de Risco , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo , Ativador de Plasminogênio Tecidual/administração & dosagem , Resultado do Tratamento
11.
Medicine (Baltimore) ; 99(34): e21541, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846763

RESUMO

The influences of hyperhomocysteinemia on cardiovascular diseases (CVDs), stroke and new-onset hypertension are unclear. The aim of the study is to explore the associations of homocysteine levels with stroke, CVDs, and new-onset hypertension in Chinese individuals.This retrospective cohort study included outpatients and inpatients from the Department of Geriatrics at Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine from January to December 2000. They were divided based on their homocysteine (Hcy) levels in 2000: Q1 (<10 µmol/L), Q2 (10-15 µmol/L), and Q3 (>15 µmol/L) and according to whether they had hypertension at baseline. Information about stroke, mortality and major adverse cardiac events, and newly onset hypertension was gathered in December each year until 2017. The effects of Hcy levels on the risk for stroke and CVDs among all patients, and new-onset hypertension among patients without hypertension at baseline were evaluated.After adjustment for confounders, compared with the Q1 group (Hcy <10 µmol/L), when the Hcy increased to 10 to 15 µmol/L, the risks for stroke, CVDs, and new-onset hypertension significantly increased, and the hazard ratio and 95% confidence interval were 2.02 (1.35-3.05, P = .001), 2.22 (1.32-3.76, P = .003), and 7.20 (4.52-11.48, P < .001), respectively. Hcy improved the predictive capability of traditional risk factors for stroke. The optimal cut-off value of Hcy for predicting stroke was 13.4 µmol/L (sensitivity: 70.9%, specificity: 62.2%).Hcy 10 to 15 µmol/L is significantly associated with the risks for stroke, mortality and major adverse cardiac events, and hypertension. The best cut-off point of Hcy for predicting stroke is 13.4 µmol/L.


Assuntos
Homocisteína/sangue , Hipertensão/sangue , Acidente Vascular Cerebral/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
12.
PLoS One ; 15(8): e0238312, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32857820

RESUMO

BACKGROUND: We aimed to investigate the correlation between the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), platelet-to-neutrophil ratio (PNR), platelet-to-white blood cell ratio (PWR) and 90-day mortality in patients with acute ischemic stroke (AIS). METHODS: We retrospectively included 633 patients with AIS from January 2017 to May 2018. The correlation between each indicator and the degree of neurologic deficit was assessed. Kaplan-Meier survival curves based on blood cell ratios were used to analyze the 90-day survival rate of patients with AIS. RESULTS: A total of 663 patients with AIS were enrolled, of which 24 (3.6%) experienced recurrence and 13 (2.0%) died. NLR>3.23 (odds ratio; OR = 2.236; 95% confidence interval [CI], 1.472-3.397; P<0.001), PNR<31.14 (OR = 0.471; 95% CI, 0.297-0.749; P = 0.001), and PWR<20.62 (OR = 0.498; 95% CI, 0.309-0.800; P = 0.004) were associated with an unfavorable 90-day prognosis. NLR>3.23, PWR<20.62, and PNR<31.14 were associated with an increased risk of 90-day mortality. CONCLUSION: PNR, PWR, and NLR were associated with the 90-day mortality of patients with AIS. Patients with high NLRs or low PWRs and PNRs may have a greater risk of mortality than other patients. These clinical indicators may help clinicians judge unfavorable prognosis early and implement the appropriate interventions.


Assuntos
Isquemia Encefálica/sangue , Isquemia Encefálica/mortalidade , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Contagem de Células Sanguíneas , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Adulto Jovem
13.
Stroke ; 51(8): 2386-2394, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32640945

RESUMO

BACKGROUND AND PURPOSE: Optimal secondary prevention for patients with embolic stroke of undetermined source (ESUS) remains unknown. We aimed to assess whether high-sensitivity cardiac troponin T (hs-cTnT) levels are associated with major vascular events and whether hs-cTnT may identify patients who benefit from anticoagulation following ESUS. METHODS: Data were obtained from the biomarker substudy of the NAVIGATE ESUS trial, a randomized controlled trial testing the efficacy of rivaroxaban versus aspirin for secondary stroke prevention in ESUS. Patients were dichotomized at the hs-cTnT upper reference limit (14 ng/L, Gen V, Roche Diagnostics). Cox proportional hazard models were computed to explore the association between hs-cTnT, the combined cardiovascular end point (recurrent stroke, myocardial infarction, systemic embolism, cardiovascular death), and recurrent ischemic stroke. RESULTS: Among 1337 patients enrolled at 111 participating centers in 18 countries (mean age 67±9 years, 61% male), hs-cTnT was detectable in 95% and at/above the upper reference limit in 21%. During a median follow-up of 11 months, the combined cardiovascular end point occurred in 68 patients (5.0%/y, rivaroxaban 28 events, aspirin 40 events; hazard ratio, 0.67 [95% CI, 0.41-1.1]), and recurrent ischemic stroke occurred in 50 patients (4.0%/y, rivaroxaban 16 events, aspirin 34 events, hazard ratio 0.45 [95% CI, 0.25-0.81]). Annualized combined cardiovascular end point rates were 8.2% (9.5% rivaroxaban, 7.0% aspirin) for those above hs-cTnT upper reference limit and 4.8% (3.1% rivaroxaban, 6.6% aspirin) below with a significant treatment modification (P=0.04). Annualized ischemic stroke rates were 4.7% above hs-cTnT upper reference limit and 3.9% below, with no suggestion of an interaction between hs-cTnT and treatment (P=0.3). CONCLUSIONS: In patients with ESUS, hs-cTnT was associated with increased cardiovascular event rates. While fewer recurrent strokes occurred in patients receiving rivaroxaban, outcomes were not stratified by hs-cTn results. Our findings support using hs-cTnT for cardiovascular risk stratification but not for decision-making regarding anticoagulation therapy in patients with ESUS. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02313909.


Assuntos
Embolia Intracraniana/sangue , Embolia Intracraniana/diagnóstico , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/diagnóstico , Troponina T/sangue , Idoso , Idoso de 80 Anos ou mais , Aspirina/administração & dosagem , Biomarcadores/sangue , Método Duplo-Cego , Inibidores do Fator Xa/administração & dosagem , Feminino , Seguimentos , Humanos , Internacionalidade , Embolia Intracraniana/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/administração & dosagem , Medição de Risco , Rivaroxabana/administração & dosagem , Acidente Vascular Cerebral/tratamento farmacológico
14.
J Clin Neurosci ; 78: 91-96, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32624366

RESUMO

Predicting the effectiveness of antiplatelet drugs is critical to precision antiplatelet therapy. However, there is a lack of an acceptable method, although there are a variety of methods for detecting platelet function. In this study, we compared three major platelet function tests to assess their performance and found better methods for platelet function evaluation after aspirin or clopidogrel treatment in ischemic stroke patients by comparative study. A total of 249 ischemic stroke patients were enrolled who were treated with aspirin or clopidogrel or both. Three platelet function tests including light transmittance aggregometry (LTA), thromboelastography (TEG), platelet function analyzer (PFA) were performed as well as CYP2C19 genotype determination. Correlation analyses and kappa statistics were used. All three methods were effective in evaluating aspirin function. However, only LTA and TEG had good correlation and consistency (r = -0.37, kappa = 0.634). TEG-ADP was the least sensitive for clopidogrel, as the platelet inhibition ratio did not differ between the clopidogrel-user group and the control (P = 0.074), while LTA and PFA were sensitive (P < 0.001). Correlations between platelet assays were poor for clopidogrel (the absolute value of r range from 0.13 to 0.35) and so was the agreement (Kappa from 0.232 to 0.314). LTA and PFA have a good correlation with CYP2C19 genotyping (P = 0.034 and 0.014). In conclusion, all three tests were able to evaluate aspirin effect, LTA-AA and TEG-AA had a good correlation. TEG perform badly for clopidogrel effect detection. The fair-to-modest agreement among assays indicated further study was indispensable.


Assuntos
Plaquetas/efeitos dos fármacos , Isquemia Encefálica/sangue , Inibidores da Agregação de Plaquetas/administração & dosagem , Acidente Vascular Cerebral/sangue , Tromboelastografia/normas , Idoso , Idoso de 80 Anos ou mais , Aspirina/administração & dosagem , Plaquetas/metabolismo , Isquemia Encefálica/tratamento farmacológico , Clopidogrel/administração & dosagem , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes de Função Plaquetária/métodos , Testes de Função Plaquetária/normas , Acidente Vascular Cerebral/tratamento farmacológico , Tromboelastografia/efeitos dos fármacos , Tromboelastografia/métodos
15.
Expert Opin Pharmacother ; 21(15): 1867-1881, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32658596

RESUMO

INTRODUCTION: Oral anticoagulants (OAC) reduce stroke/systemic embolism and mortality risks in atrial fibrillation (AF). However, there is an inherent bleeding risk with OAC, where intracranial hemorrhage (ICH) is the most feared, disabling, and lethal complication of this therapy. Therefore, the optimal management of OAC-associated ICH is not well defined despite multiple suggested strategies. AREAS COVERED: In this review, the authors describe the severity and risk factors for OAC-associated ICH and the associated implications for using DOACs in AF patients. We also provide an overview of the management of OAC-associated ICH and treatment reversal strategies, including specific and nonspecific reversal agents as well as a comprehensive summary of the evidence about the resumption of DOAC and the optimal timing. EXPERT OPINION: In the setting of an ICH, supportive care/measures are needed, and reversal of anticoagulation with specific agents (including administration of vitamin K, prothrombin complex concentrates, idarucizumab and andexanet alfa) should be considered. Most patients will likely benefit from restarting anticoagulation after an ICH and permanently withdrawn of OAC is associated with worse clinical outcomes. Although the timing of OAC resumption is still under debate, reintroduction after 4-8 weeks of the bleeding event may be possible, after a multidisciplinary approach to decision-making.


Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Hemorragias Intracranianas/induzido quimicamente , Acidente Vascular Cerebral/prevenção & controle , Administração Oral , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Fibrilação Atrial/sangue , Fatores de Coagulação Sanguínea/uso terapêutico , Fator Xa/uso terapêutico , Humanos , Hemorragias Intracranianas/prevenção & controle , Proteínas Recombinantes/uso terapêutico , Fatores de Risco , Acidente Vascular Cerebral/sangue , Vitamina K/uso terapêutico
16.
Stroke Vasc Neurol ; 5(2): 198-204, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32606087

RESUMO

Bilirubin, a product of heme metabolism, is the most potent endogenous antioxidant which increases in many oxidative stress conditions such as stroke. It has been widely known to exert neuroprotective effect on stroke through mechanisms involved in development, therefore, it can influence the occurrence and prognosis of ischaemic stroke (IS). In this review, studies were identified by a comprehensive search of Pubmed, Embase, the Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Methodology Register) and Web of Science to examine the correlation between serum bilirubin levels and risks of developing IS as well as IS outcomes. Additional studies were identified by reviewing references and contacting authors.


Assuntos
Bilirrubina/sangue , Isquemia Encefálica/sangue , Acidente Vascular Cerebral/sangue , Animais , Biomarcadores/sangue , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/prevenção & controle , Isquemia Encefálica/terapia , Humanos , Prognóstico , Fatores de Proteção , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/prevenção & controle , Acidente Vascular Cerebral/terapia
17.
Medicine (Baltimore) ; 99(28): e21044, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664115

RESUMO

Ischemic stroke subtypes such as patients with large artery atherosclerosis, cardioembolism, and embolic stroke of undetermined source were investigated. This study was performed aimed to determine mean platelet volume (MPV) and mean platelet volume/platelet count (MPV/Plt) ratio in nonvalvular atrial fibrillation (AF) stroke and large artery atherosclerosis (LAA) stroke.We conducted a retrospective study of consecutive patients for treatment of acute ischemic stroke at Ruian People's Hospital from March 2017 to October 2018. The patients with ischemic stroke caused by AF and LAA were recruited to this study. Ischemic stroke was confirmed by magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA), ischemic lesions on diffusion-weighted imaging were measured in terms of size, composition, and pattern. MPV and platelet count were examined and (MPV/Plt) ratio was calculated.Three hundred seventy one patients were enrolled composing of 177 (47.7%) nonvalvular AF and 194 (52.2%) with LAA. The MPV (11.3 ±â€Š1.3 vs 10.8 ±â€Š1.0, P < .001) and MPV/Plt ratio (0.066 ±â€Š0.025 vs 0.055 ±â€Š0.20, P < .001) were much higher in AF group than LAA group. Receiver-operating characteristic (ROC) analysis showed MPV (AUC: 0.624, confidence interval: 0.567-0.68, P < .001) and MPV/Plt (AUC: 0.657, confidence interval: 0.601-0.713, P < .001) predicted AF between the 2 groups. MPV/Plt ratio was negatively associated with lesion volume (r = -0.161, P = .033) in AF. The analyses of subtypes of composition of infarcts and infarct pattern showed that MPV/Plt ratio was almost higher in AF than LAA except for subcortical-only pattern. Multivariable regression analyses demonstrated National Institutes of Health Stroke Scale (NIHSS) score (r = 2.74; P < .001), LAD (r = -1.15; P = .025) and MPV/Plt ratio (r = -180.64; P = .021) were correlated with lesion volume.Our results indicated elevated MPV and MPV/Plt ratio for the identification of difference between AF and LAA in patients with ischemic stroke.


Assuntos
Aterosclerose/complicações , Fibrilação Atrial/complicações , Volume Plaquetário Médio , Contagem de Plaquetas , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/etiologia , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/sangue , Isquemia Encefálica/etiologia , Imagem de Difusão por Ressonância Magnética , Feminino , Humanos , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Fatores de Risco
18.
Cardiovasc Ther ; 2020: 1743927, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32684980

RESUMO

Sex-specific differences have been definitively demonstrated in cardiovascular (CV) diseases. These differences can also impact on the effects of CV therapies. Female sex is recognized as an independent predictor of thromboembolic risk, particularly in older patients. Most of strokes are due to atrial fibrillation (AF). Women affected by AF have higher stroke risk compared to men. The introduction of novel oral anticoagulants (NOACs) for long-term anticoagulation completely changed the anticoagulant therapeutic approach and follow-up of patients affected by nonvalvular atrial fibrillation (NVAF). CHA2DS2-VASc stroke risk scoring in use in the current international guidelines attributes 1 point to "female sex". Besides, no anticoagulation is indicated for AF female patients without other risk factors. Interestingly, NOACs seem to normalize the differences between males and females both in terms of safety and efficacy, whereas residual higher stroke risk and systemic embolism persist in AF women treated with vitamin K antagonist anticoagulants VKA with optimal time in therapeutic range. Based on the CHA2DS2-VASc score, NOACs represent the preferred choice in NVAF patients. Moreover, complete evaluation of apparently lower risk factor along with concomitant clinical conditions in AF patients appears mandatory, particularly for female patients, in order to achieve the most appropriate anticoagulant treatment, either in male or in female patients. The present review was performed to review sex differences in AF-related thromboembolic risk reported in the literature and possibly highlight current knowledge gaps in prevention and management that need further research.


Assuntos
Anticoagulantes/administração & dosagem , Fibrilação Atrial/tratamento farmacológico , Coagulação Sanguínea/efeitos dos fármacos , Inibidores do Fator Xa/administração & dosagem , Acidente Vascular Cerebral/prevenção & controle , Tromboembolia/prevenção & controle , Administração Oral , Anticoagulantes/efeitos adversos , Fibrilação Atrial/sangue , Fibrilação Atrial/epidemiologia , Tomada de Decisão Clínica , Inibidores do Fator Xa/efeitos adversos , Feminino , Humanos , Masculino , Seleção de Pacientes , Medição de Risco , Fatores de Risco , Fatores Sexuais , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/epidemiologia , Tromboembolia/sangue , Tromboembolia/epidemiologia , Resultado do Tratamento , Vitamina K/antagonistas & inibidores
19.
J Stroke Cerebrovasc Dis ; 29(8): 105004, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32689579

RESUMO

BACKGROUND AND AIMS: Various reactive oxygen radicals and inflammatory mediators emerge in ischemic stroke, and changes occur in the number of leukocytes and platelets. Variations in the counts and ratios of these cells may be related to the early and late course and prognosis of stroke. In this study, the relationship between changes in counts or ratios of neutrophil, lymphocyte, platelet, and National Health Institute Stroke Scale (NIHSS) scores was investigated in patients who presented with an ischemic stroke and treated with recombinant tissue plasminogen activator (rtPA) and/or thrombectomy. METHODS: Changes in neutrophil, lymphocyte, platelet counts; neutrophil-to-leukocyte ratio (NLR), neutrophil-to-lymphocyte ratio, platelet-to-leukocyte ratio (PLR), and platelet-to- lymphocyte ratio between day of admission (day 0), and 1st, 3rd, and 7th days after application of treatment modalities in 296 patients presented with acute ischemic stroke who underwent rtPA within the first 4,5 hours and / or thrombectomy within 6 hours after stroke and the relationship between these changes and the NIHSS (National Health Institute Stroke Scale) scores were evaluated retrospectively. RESULTS: In our study, leukocyte and neutrophil counts were higher on the first day after acute ischemic stroke. Platelet counts decreased on the 1st and 3rd days relative to baseline values. Lymphocyte values decreased on day 1, 3 and 7 compared to day 0. There was a significant increase in neutrophil-to-lymphocyte ratios at day 1 and 3 compared to day 0. On the 7th day, neutrophil-to-lymphocyte ratios were significantly lower. There was an increase in platelet-to-lymphocyte ratios at day 1 compared to day 0. The increase in NLR values was more evident on day 1. The increase in PLR on the 7th day was also significant. The patients who underwent rtPA and/or thrombectomy had significantly lower NIHSS scores at the 72th hour of the stroke compared to the NIHSS values at hospital admissions. A positive correlation was found between NIHSS difference values and neutrophil-to-lymphocyte and platelet-to-lymphocyte percent changes. CONCLUSIONS: There are dynamic changes in platelet, neutrophil, lymphocyte counts and ratios in early period after treatment with rtPA and/or thrombectomy in acute ischemic stroke. Variations in the counts and ratios of these cells may be related to NIHSS, which determines the degree of neurological damage of stroke.


Assuntos
Plaquetas , Isquemia Encefálica/terapia , Avaliação da Deficiência , Fibrinolíticos/administração & dosagem , Linfócitos , Neutrófilos , Acidente Vascular Cerebral/terapia , Trombectomia , Terapia Trombolítica , Ativador de Plasminogênio Tecidual/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/sangue , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/fisiopatologia , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Estudos Retrospectivos , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/diagnóstico , Trombectomia/efeitos adversos , Terapia Trombolítica/efeitos adversos , Fatores de Tempo , Ativador de Plasminogênio Tecidual/efeitos adversos , Resultado do Tratamento
20.
J Stroke Cerebrovasc Dis ; 29(8): 104971, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32689585

RESUMO

BACKGROUND AND PURPOSE: Mean Platelet Volume (MPV) is a marker of platelet activity and it is an independent predictor for long-term outcome in stroke patients. The aim of this study was to evaluate the association between baseline MPV value and clinical outcome at 90-days in anterior circulation stroke and large vessel occlusion (LVO) patients submitted to mechanical thrombectomy (MT). METHODS: We conducted a prospective observational cohort study in acute ischemic stroke (AIS) patients submitted to MT between January 2017 and May 2018. MPV was measured at admission. Patients were initially stratified into two groups according to the mean MPV level. We also compared groups that were stratified according to the MPV cut-off obtained by Peng F et al (10,4 fL) and performed analyses among MPV terciles. RESULTS: A total of 129 patients were included. Mean level of MPV was 10,9 fL. Patients with embolic stroke of undetermined source (ESUS) had significantly higher rates of good outcome at 3 months compared with large-artery atherosclerotic disease and cardioembolism [(82,9%) vs (78,3%) vs (55,2%); p=0,009]. There were no statistically significant differences in the mean MPV value (p=0,222), successful recanalization (p=0,464) and mortality (p=0,343) when evaluated for all TOAST etiologies. There were no statistically significant differences between the two groups according to the MPV level (10,4 and 10,9 fL) or between the terciles (lowest tertile <10,3 fL, median 10,3 - 11,3 fL, highest >11,3fL) concerning functional outcome at 3 months (p=0,357; p=0,24 and p=0,558, respectively), successful recanalization (p=0,108; p=0,582 and p=0,899, respectively) or mortality at 3 months (p=0,465; p=0,061 and p=0,484, respectively). CONCLUSION: Our study did not find an association between elevated MPV and worse outcome at 3 months in patients with acute anterior circulation stroke and LVO treated with MT. Since ischemic strokes have different pathophysiologic mechanisms, MPV may have distinct prognostic value according to each stroke etiology.


Assuntos
Isquemia Encefálica/terapia , Volume Plaquetário Médio , Acidente Vascular Cerebral/terapia , Trombectomia , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/sangue , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/mortalidade , Bases de Dados Factuais , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Recuperação de Função Fisiológica , Fatores de Risco , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidade , Trombectomia/efeitos adversos , Trombectomia/mortalidade , Fatores de Tempo , Resultado do Tratamento
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