Stroke; a journal of cerebral circulation
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Letter Comparative Study Controlled Clinical Trial
The effect of activated factor VII for intracerebral hemorrhage beyond 3 hours versus within 3 hours.
Recombinant-activated factor VII (rFVIIa) is an investigational treatment for intracerebral hemorrhage (ICH). We have evaluated the drug's treatment effect based on time to treatment. ⋯ In our off-label with rFVIIa, we did not find evidence of a treatment effect based on time to treatment. Other criteria should be sought to identify patients who might benefit clinically from rFVIIa.
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One important criterion for hospitalizing patients after transient ischemic attack (TIA) is the short-term risk of stroke. Before publication of prediction rules for stroke after TIA, physician judgment was required to make a decision about hospitalization. We sought to identify factors associated with the decision to admit patients with TIA from the emergency department (ED) and to see whether those at highest risk of stroke were selected for admission. ⋯ In this cohort of patients with TIA, the decision to admit was weakly correlated with risk of subsequent stroke as measured by the ABCD(2) score, and several risk factors for stroke were not important for the decision to admit. Before publication of prediction rules for stroke after TIA, physicians were not identifying the majority of patients at highest risk of stroke for admission.
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Previous studies have reported a low, approximately 1% to 3%, rate of detection of occult atrial fibrillation (AF) with Holter monitor in patients with acute stroke. Furthermore, at least one study has reported that Holter monitoring could not always corroborate initial electrocardiographic (ECG) detection of AF suggesting underestimation of AF by Holter. We compare the detection of new-onset AF by serial ECG assessments and Holter after acute ischemic stroke. ⋯ Serial ECG assessments within the first 72 hours of an acute stroke significantly improve detection of AF. The discordance regarding the corroboration of AF by Holter in ECG-positive patients with AF supports previous observations and suggests a high incidence of paroxysmal AF as a cause of ischemic stroke.