Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · Mar 2015
Modest association between the discharge modified rankin scale score and symptomatic intracerebral hemorrhage after intravenous thrombolysis.
Thirty- and 90-day modified Rankin Scale (mRS) scores are used to monitor adverse outcome or symptomatic intracerebral hemorrhage (sICH) in ischemic stroke patients after intravenous (IV) thrombolytic therapy. Discharge mRS scores are more readily available and could serve as a proxy for 30- or 90-day mRS data. Our goal was to evaluate agreement between the discharge mRS score and sICH. Additionally, we tested for correlations between the discharge mRS score and 8 clinical scores developed to predict sICH or adverse outcomes based on 90-day mRS data. ⋯ The discharge mRS score shows only modest agreement with sICH and therefore cannot be recommended as a proxy for 30- or 90-day mRS data. However, the discharge mRS score correlates strongly with clinical scores predicting long-term adverse outcome; therefore, assessment of discharge mRS scores may be of some clinical benefit.
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J Stroke Cerebrovasc Dis · Mar 2015
Comparative StudyCardiac troponin I after carotid endarterectomy in different cardiac risk patients.
We compared postoperative cardiac damage, defined as cardiac troponin I (cTnI) elevation, in low, medium, and high cardiac risk patients, after carotid endarterectomy (CEA). ⋯ CEA is followed by a high incidence of asymptomatic cTnI increase that is associated with late cardiac events. However, high cardiac risk patients as defined by the VSG-CRI criteria do not seem to suffer higher cardiac damage after CEA compared with low and medium cardiac risk patients.
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J Stroke Cerebrovasc Dis · Mar 2015
Case ReportsIntravenous thrombolysis for acute ischemic stroke in a patient receiving rivaroxaban.
Rivaroxaban is an oral direct factor Xa inhibitor increasingly used in stroke prevention in nonvascular atrial fibrillation, primary prevention and treatment of venous thromboembolism, and secondary prevention in acute coronary syndromes. ⋯ This case underlines the need for further studies on the safety of thrombolysis in stroke patients taking rivaroxaban. Our case emphasizes the urgent need for sensitive coagulation bed-side tests during stroke emergencies.
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J Stroke Cerebrovasc Dis · Feb 2015
Observational StudyProspective evaluation of blood coagulability and effect of treatment in patients with stroke using rotational thromboelastometry.
Stroke is the second largest cause of death worldwide. Abnormalities in hemostasis play an important role in the pathophysiology of ischemic stroke (IS). These hemostatic defects can be detected using rotational thromboelastometry (ROTEM) as a global method of measuring coagulation. This study assessed the effects of IS on blood hypercoagulability using ROTEM method, before and subsequent to therapeutic interventions. ⋯ ROTEM testing does not seem to detect a hypercoagulable state in patients with IS. Nonetheless, some ROTEM parameters had a small change after antiplatelet therapy or thrombolysis.
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J Stroke Cerebrovasc Dis · Feb 2015
Gaps and hurdles deter against following stroke guidelines for thrombolytic therapy in Iran: exploring the problem.
Insufficient information is available on the barriers that explain low rates of thrombolytic therapy for acute ischemic stroke (AIS) in developing countries compared with rates in developed societies. By the present study, we aimed to assess the implementation of thrombolytic therapy in the northeast of Iran to explore the gaps and hurdles against thrombolysis as the generally accepted treatment for AIS. ⋯ Access to thrombolytic therapy for AIS in Iran is less than in most developed countries but comparable with other developing countries. Awareness campaigns are needed to minimize barriers and improve access to thrombolysis and specialized stroke care in Iran.