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Sample records for experimental thromboembolic stroke

  1. Experimental thromboembolic stroke in cynomolgus monkey.

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    Kito, G; Nishimura, A; Susumu, T; Nagata, R; Kuge, Y; Yokota, C; Minematsu, K

    2001-01-30

    To develop an experimental model of thromboembolic stroke without intracranial surgery, an autologous blood clot was delivered to the middle cerebral artery (MCA) via the internal carotid artery in cynomolgus monkeys. Male cynomolgus monkeys, in which a chronic catheter had been earlier implanted in the left internal carotid artery, were used. The clot was flushed into the internal carotid artery under sevofluorane anesthesia. A neurologic deficit score was assigned after MCA embolization. After 24 h, cerebral infarct size and location were determined by the TTC staining method. Cerebral blood flow (CBF) was measured prior to and after MCA embolization, using positron emission tomography (PET). After embolization, long-lasting and profound extensor hypotonia of the contralateral upper and lower limbs, and mild to severe incoordination were observed. Contralateral hemiplegia was observed over the following 24 h. In gross morphologic observation of the brain, the lesions involved mostly the caudate nucleus, putamen, globus pallidus and insular cortex. CBF was maximally reduced in the left MCA territory, but not in the right MCA territory. This model is relevant to thromboembolic stroke in human in neurologic dysfunction and histopathologic brain damage.

  2. Spontaneous reperfusion after in situ thromboembolic stroke in mice.

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    Anne Durand

    Full Text Available Injection of thrombin into the middle cerebral artery (MCA of mice has been proposed as a new model of thromboembolic stroke. The present study used sequential multiparametric Magnetic Resonance Imaging (MRI, including Magnetic Resonance Angiography (MRA, Diffusion-Weighted Imaging (DWI and Perfusion-Weighted Imaging (PWI, to document MCA occlusion, PWI-DWI mismatch, and lesion development. In the first experiment, complete MCA occlusion and reproducible hypoperfusion were obtained in 85% of animals during the first hour after stroke onset. In the second experiment, 80% of animals showed partial to complete reperfusion during a three-hour follow-up. Spontaneous reperfusion thus contributed to the variability in ischemic volume in this model. The study confirmed the value of the model for evaluating new thrombolytic treatments, but calls for extended MRI follow-up at the acute stage in therapeutic studies.

  3. In vivo near-infrared imaging of fibrin deposition in thromboembolic stroke in mice.

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    Yi Zhang

    Full Text Available OBJECTIVES: Thrombus and secondary thrombosis plays a key role in stroke. Recent molecular imaging provides in vivo imaging of activated factor XIII (FXIIIa, an important mediator of thrombosis or fibrinolytic resistance. The present study was to investigate the fibrin deposition in a thromboembolic stroke mice model by FXIIIa-targeted near-infrared fluorescence (NIRF imaging. MATERIALS AND METHODS: The experimental protocol was approved by our institutional animal use committee. Seventy-six C57B/6J mice were subjected to thromboembolic middle cerebral artery occlusion or sham operation. Mice were either intravenously injected with the FXIIIa-targeted probe or control probe. In vivo and ex vivo NIRF imaging were performed thereafter. Probe distribution was assessed with fluorescence microscopy by spectral imaging and quantification system. MR scans were performed to measure lesion volumes in vivo, which were correlated with histology after animal euthanasia. RESULTS: In vivo significant higher fluorescence intensity over the ischemia-affected hemisphere, compared to the contralateral side, was detected in mice that received FXIIIa-targeted probe, but not in the controlled mice. Significantly NIRF signals showed time-dependent processes from 8 to 96 hours after injection of FXIIIa-targeted probes. Ex vivo NIRF image showed an intense fluorescence within the ischemic territory only in mice injected with FXIIIa-targeted probe. The fluorescence microscopy demonstrated distribution of FXIIIa-targeted probe in the ischemic region and nearby micro-vessels, and FXIIIa-targeted probe signals showed good overlap with immune-fluorescent fibrin staining images. There was a significant correlation between total targeted signal from in vivo or ex vivo NIRF images and lesion volume. CONCLUSION: Non-invasive detection of fibrin deposition in ischemic mouse brain using NIRF imaging is feasible and this technique may provide an in vivo experimental tool in

  4. Thromboembolic ischemic stroke and the presence of necrotic platelets: a scanning electron microscopy investigation.

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    Pretorius, Etheresia; Engelbrecht, Mia-Jeanne; Duim, Wiebren

    2012-02-01

    Stroke is one of the most debilitating diseases worldwide, with its occurrence increasing in Western societies. Central to the pathogenesis of thromboembolic stroke is the involvement of platelets. During thromboembolic events, nucleated cells undergo cell death, and platelets are also affected by parameters causing these incidents. Particularly, initiation of necrotic cell death at sites of vascular injury may play an important role in inducing inflammatory and repair processes. In the current research, the authors investigate whether a changed platelet ultrastructure is visible in thromboembolic stroke and whether it might be visible in platelets as apoptosis or necrosis. Therefore, in the current investigation, the authors study smears of platelet-rich plasma (PRP) from thromboembolic ischemic stroke patients to investigate whether a changed morphology is visible in distressed platelets. Scanning electron microscopy is used and platelets are viewed at up to 200,000× machine magnification. Results indicate that thromboembolic ischemic stroke causes membrane tears and swollen platelets, and this is indicative of necrosis. It is therefore concluded that this morphology might be due to the pro-coagulant activity characteristic of the disease.

  5. Low-Molecular-Weight Heparin Use in a Case of Noncardiogenic Multifocal Perinatal Thromboembolic Stroke

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    Matthew A. Saxonhouse

    2009-01-01

    Full Text Available A full-term neonate suffered multifocal cerebral infarctions due to multiple large vessel thrombi. Thrombophilia and cardiovascular assessments were negative, but due to the severity of the lesions and the concern for expansion of the thrombi or future embolic events, treatment with low-molecular-weight heparin (LMWH was initiated. No complications from treatment were experienced. We present this severe case in order to highlight difficult management decisions for newborns with multifocal perinatal thromboembolic stroke and to stress the need for further practice guidelines and research in this area.

  6. Neutrophil/lymphocyte ratio is associated with thromboembolic stroke in patients with non-valvular atrial fibrillation.

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    Ertaş, Gökhan; Sönmez, Osman; Turfan, Murat; Kul, Seref; Erdoğan, Ercan; Tasal, Abdurrahman; Bacaksiz, Ahmet; Vatankulu, Mehmet Akif; Altıntaş, Ozge; Uyarel, Hüseyin; Göktekin, Omer

    2013-01-15

    Neutrophil/lymphocyte ratio (NLR) has been associated with poor outcomes in patients with cardiovascular diseases. However, little is known about the role of NLR in patients with thromboembolic stroke due to atrial fibrillation (AF). We aimed to compare the NLR ratios between non-valvular AF patients with or without thromboembolic stroke. A total of 126 non-valvular AF patients with or without stroke were included in the study; 126 consecutive patients (52 males and 74 females), mean age, 70 ± 10.2 years old. No patient had a recent history of an acute infection or an inflammatory disease. Baseline NLR was measured by dividing neutrophil count to lymphocyte count. WBC count>12.000 cells per μL or 38 º are excluded from the study. Mean NLR was significantly higher among persons with stroke compared to individuals without a stroke (5.6 ± 3.4 vs. 3.1 ± 2.1, p=0.001). There were no significant differences in RDW levels between the two groups (p>0.05). HAS-BLED and CHADS(2) scores were significantly higher in the stroke group. Higher NLR, an emerging marker of inflammation, is associated with thromboembolic stroke in non-valvular AF patients. Copyright © 2012 Elsevier B.V. All rights reserved.

  7. Effect of recombinant human prourokinase on thrombolysis in a rabbit model of thromboembolic stroke

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    Hao, Chunhua; Ding, Wenxia; Xu, Xiangwei; Sun, Qian; Li, Xinxin; Wang, Weiting; Zhao, Zhuanyou; Tang, Lida

    2018-01-01

    The aim of the present study was to investigate the efficacy of recombinant human prourokinase (rhPro-UK) on thromboembolic stroke in rabbits. A total of 210 rabbits were used in experiments. The 180 thromboembolic stroke rabbits were divided into three therapeutic time windows with six groups in each time window (n=10). The model group was administered saline, the reagent groups were administered rhPro-UK (2.5×, 5× and 10×104 U/kg), and the positive control groups were administered 5×104 urokinase (UK) U/kg and 4.5 mg/kg recombinant human tissue plasminogen activator via intravenous infusion at 3, 4.5 and 6 h after embolism. The remaining 30 rats (that had not undergone occlusion by autologous blood clots) served as a sham group and were administered saline. The radioactive intensity was detected using a medical gamma counter before and after the administration of the drug for 15, 30, 45, 60, 75, 90, 105 and 120 min. At 24 h after treatment, the brain samples were coronally sliced into 5 mm sections and hemorrhage was estimated used a semiquantitative method by counting the number of section faces with hemorrhaging. The plasma was collected for prothrombin time, activated partial thromboplastin time, fibrinogen and thrombin time tests using a solidification method with a blood coagulation factor analyzer. In addition, α2-antiplasmin (α2-AP) was evaluated using ELISA methods using a RT-6100 microplate reader. At the 3 h time point, the thrombolysis rate of rhPro-UK(2.5×, 5× and 10×104 U/kg) was 21.5% (P0.05), 40% (P0.05), 5.3% (P>0.05) and 18.1% (P0.05), 30% (P0.05), 6.5% (P>0.05) and 17.8% (P0.05), 30% (P0.05), 12.7% (P>0.05) and 22.2% (P0.05) were identified between rhPro-UK (2.5×, 5× and 10×104 U/kg) and the model group regarding hemorrhage type, size and blood coagulation factors at the different time points. Thus, rhPro-UK promoted thrombolysis and recanalization (patency rate), with reduced risk of cerebral hemorrhage, and thus exerted protective

  8. Hypertension and experimental stroke therapies

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    O'Collins, Victoria E; Donnan, Geoffrey A; Macleod, Malcolm R; Howells, David W

    2013-01-01

    Hypertension is an established target for long-term stroke prevention but procedures for management of hypertension in acute stroke are less certain. Here, we analyze basic science data to examine the impact of hypertension on candidate stroke therapies and of anti-hypertensive treatments on stroke outcome. Methods: Data were pooled from 3,288 acute ischemic stroke experiments (47,899 animals) testing the effect of therapies on infarct size (published 1978–2010). Data were combined using meta-analysis and meta-regression, partitioned on the basis of hypertension, stroke model, and therapy. Results: Hypertensive animals were used in 10% of experiments testing 502 therapies. Hypertension was associated with lower treatment efficacy, especially in larger infarcts. Overall, anti-hypertensives did not provide greater benefit than other drugs, although benefits were evident in hypertensive animals even when given after stroke onset. Fifty-eight therapies were tested in both normotensive and hypertensive animals: some demonstrated superior efficacy in hypertensive animals (hypothermia) while others worked better in normotensive animals (tissue plasminogen activator, anesthetic agents). Discussion: Hypertension has a significant effect on the efficacy of candidate stroke drugs: standard basic science testing may overestimate the efficacy which could be reasonably expected from certain therapies and for hypertensive patients with large or temporary occlusions. PMID:23736641

  9. New photoacoustic platform for early detection of circulating clots to prevent stroke and other fatal thromboembolic complications (Conference Presentation)

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    Carey, Kai A.

    2017-03-01

    Nearly 800,000 people in the U.S. experience an incident of stroke each year; 80% of these are first time occurrences and 87% are ischemic in nature. Someone dies of a stroke every few minutes in the U.S. but despite its prevalence there have been minimal advances in the early detection and screening of thromboembolic events, especially during patient post-operative periods or in genetically predisposed individuals. Environmental or genetic factors may disrupt the balance between coagulation and lysis of micro-thrombi in circulation and increase the risk of stroke. We introduced here a novel in vivo multicolor negative-contrast photoacoustic (PA) flow cytometry (PAFC ) platform with many innovations including customized high pulse repetition rate 1064 laser from IPG Photonics Corporation, powerful laser diode array, multichannel optical schematic, and time-resolved recording system. Using animal models, we verified the potential of this technology to detect small clots in relatively large vessels in vivo. If future clinical trials using a cost-effective, easy-to-use, safe, watch-like, wearable PA probe are successful, PAFC could provide breakthroughs in early monitoring of the growth in size and number of small clots that may predict and potentially prevent fatal thromboembolic complications. We also believe that this technology could be utilized to assess therapeutic benefits of anticoagulants and develop more efficient dosage in treatments by analyzing changes in the composition and frequency of micro-thrombi

  10. The effect of ultrasound on thromboembolic model of brain stroke in rat

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    Shabanzadeh A

    2007-08-01

    Full Text Available Background: Ultrasound (US has been used in neuroprotection after cerebral ischemia; however, its use is controversial. Application of US in combination with fibrinolytic agents may improve fibrinolytic effects. In this study the effects of US, alone or in combination with tissue plasminogen activator (tPA, on brain ischemic injury were examined and we studied whether US is protective in the brain injured by ischemia under normothermic conditions. Methods: We performed two studies. In the first study, rectal and brain temperatures were compared. In the second study, we studied whether US alone or in combination with tPA is neuroprotective in thromboembolic stroke. To induce focal cerebral ischemia, a clot was formed in a catheter. Once the clot had formed, the catheter was advanced 17 mm in the internal carotid artery until its tip was 1-2 mm away from the origin of the middle cerebral artery (MCA. The preformed clot in the catheter was then injected, and the catheter was removed. The wound was then closed and the infarction volume, edema and neurological deficits were measured after MCA occlusion. Results: The temperature in the brain was approximately 0.50 ºC lower than the rectal temperature. In the control, US+low tPA, low tPA, US+high tPA and, high tPA groups, the infarct volume (% was 34.56±4.16, 17.09±6.72, 21.25±7.8, 13.5±10.72 and 20.61±6.17 (mean ±SD at 48 h after MCA occlusion, respectively. The results indicate that US alone reduces the infarct volume by 30% compared to that of the control group (P<0.05. US improved neurological deficits and reduced brain edema significantly (p<0.05. Conclusions: This study indicate that US appears to have a protective effect, alone and in combination with tPA, in an embolic model of stroke.

  11. Predictors of 30-day mortality and the risk of recurrent systemic thromboembolism in cancer patients suffering acute ischemic stroke.

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    Ki-Woong Nam

    Full Text Available Stroke in cancer patients is not rare but is a devastating event with high mortality. However, the predictors of mortality in stroke patients with cancer have not been well addressed. D-dimer could be a useful predictor because it can reflect both thromboembolic events and advanced stages of cancer.In this study, we evaluate the possibility of D-dimer as a predictor of 30-day mortality in stroke patients with active cancer.We included 210 ischemic stroke patients with active cancer. The 30-day mortality data were collected by reviewing medical records. We also collected follow-up D-dimer levels in 106 (50% participants to evaluate the effects of treatment response on D-dimer levels.Of the 210 participants, 30-day mortality occurred in 28 (13% patients. Higher initial NIHSS scores, D-dimer levels, and CRP levels as well as frequent cryptogenic mechanism, systemic metastasis, multiple vascular territory lesion, hemorrhagic transformation, and larger infarct volume were related to 30-day mortality. In the multivariate analysis, D-dimer [adjusted OR (aOR = 2.19; 95% CI, 1.46-3.28, P < 0.001] predicted 30-day mortality after adjusting for confounders. The initial NIHSS score (aOR = 1.07; 95% CI, 1.00-1.14, P = 0.043 and hemorrhagic transformation (aOR = 3.02; 95% CI, 1.10-8.29, P = 0.032 were also significant independent of D-dimer levels. In the analysis of D-dimer changes after treatment, the mortality group showed no significant decrease in D-dimer levels, despite treatment, while the survivor group showed the opposite response.D-dimer levels may predict 30-day mortality in acute ischemic stroke patients with active cancer.

  12. [1-{sup 11}C]octanoate as a PET tracer for studying ischemic stroke. Evaluation in a canine model of thromboembolic stroke with positron emission tomography

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    Kuge, Yuji; Kawashima, Hidefumi [Inst. for Biofunctional Research Co., Inc., Osaka (Japan); Minematsu, Kazuo [and others

    2000-08-01

    Octanoate is taken up by the brain and converted in astrocytes to glutamine through the TCA cycle after {beta}-oxidation. Consequently, [1-{sup 11}C]octanoate might serve as a useful positron emission tomography (PET) probe for studying cerebral oxidative metabolism and/or astroglial functions. The present study attempted to evaluate the utility of using [1-{sup 11}C]octanoate as a PET tracer for imaging and evaluating the pathophysiology of ischemic stroke. We used a canine model of thromboembolic stroke. Five male beagle dogs were implanted with an indwelling catheter in the left internal carotid artery. A single autologous blood clot was injected into the left internal carotid artery through the catheter. The brain distribution of [1-{sup 11}C]octanoate and cerebral blood flow (CBF) were determined 24 h after insult using a high resolution PET scanner. Post mortem brain regions unstained with 2, 3, 5-triphenyltetrazolium chloride (TTC) were defined as infarcts. In the region of an infarct, accumulation of [1-{sup 11}C]octanoate decreased concurrently with CBF reduction. In contrast, normal accumulation of [1-{sup 11}C]octanoate was observed in ischemic but vital regions, suggesting that an increased accumulation of [1-{sup 11}C]octanoate relative to CBF takes place in these regions. In conclusion, [1-{sup 11}C]octanoate accumulated in ischemic but vital regions, indicating that [1-{sup 11}C]octanoate is a potentially useful PET tracer for imaging and evaluating the pathophysiology of ischemic stroke. (author)

  13. Modelling projections for the uptake of edoxaban in an European population to 2050: effects on stroke, thromboembolism, and health economics perspectives.

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    Blann, Andrew D; Boriani, Giuseppe; Lip, Gregory Y H

    2016-10-01

    In the coming decades, the number of Europeans with atrial fibrillation (AF) is set to rise as the population ages, and so with it will the number of strokes. The risk of thromboembolism (principally stroke and systemic embolism) and death can be reduced by the use of the vitamin K antagonists (VKA, e.g. warfarin) and more so by non-VKA oral anticoagulants (NOACs) such as edoxaban. We modelled the effect of the increasing use of edoxaban in preference to warfarin in a European AF population from both clinical and economic perspectives. We estimate that the introduction of NOACs in 2010 eliminated over 88 000 thromboembolisms and deaths annually, of which over 17 000 were ischaemic strokes. At a 1-year cost of €30k per ischaemic stroke, this strategy saved €510 million annually. Should the use of edoxaban increase from 11% in 2013 to 75% by 2030, we expect that rate of thromboembolism and death will fall from 5.67 to 5.42 total events per million patients per year, which will further eliminate over 12 000 of these events annually. At an inflation-adjusted 1-year cost of approximately €35k per ischaemic stroke, this will save €44.5 million each year. At a conservative rate of increase in the AF population of 2.2-fold from 2005, in 2050 there will be around 180 000 AF-related ischaemic strokes that, at an inflation-adjusted cost of around €62k per stroke, sums to €11 116 million. Should the rate of AF rise 2.6-fold from 2005, then in 2050 there will be 214 500 ischaemic strokes that will cost around €13 300 million. Our data point to a substantial increase in the human and economic cost burden of AF and so emphasize the need to reduce this burden. This may be achieved by the increased use of oral anticoagulants, particularly with the NOACs such as edoxaban. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

  14. Of mice and men: modelling post-stroke depression experimentally

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    Kronenberg, G; Gertz, K; Heinz, A; Endres, M

    2014-01-01

    At least one-third of stroke survivors suffer from depression. The development of comorbid depression after stroke is clinically highly significant because post-stroke depression is associated with increased mortality, slows recovery and leads to worse functional outcomes. Here, we review the evidence that post-stroke depression can be effectively modelled in experimental rodents via a variety of approaches. This opens an exciting new window onto the neurobiology of depression and permits probing potential underlying mechanisms such as disturbed cellular plasticity, neuroendocrine dysregulation, neuroinflammation, and neurodegeneration in a novel context. From the point of view of translational stroke research, extending the scope of experimental investigations beyond the study of short-term end points and, in particular, acute lesion size, may help improve the relevance of preclinical results to human disease. Furthermore, accumulating evidence from both clinical and experimental studies offers the tantalizing prospect of 5-hydroxytryptaminergic antidepressants as the first pharmacological therapy for stroke that would be available during the subacute and chronic phases of recovery. Interdisciplinary neuropsychiatric research will be called on to dissect the mechanisms underpinning the beneficial effects of antidepressants on stroke recovery. Linked Articles This article is part of a themed section on Animal Models in Psychiatry Research. To view the other articles in this section visit http://dx.doi.org/10.1111/bph.2014.171.issue-20 PMID:24838087

  15. Sleep deprivation attenuates experimental stroke severity in rats

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    Moldovan, Mihai; Constantinescu, Alexandra Oana; Balseanu, Adrian

    2010-01-01

    Indirect epidemiological and experimental evidence suggest that the severity of injury during stroke is influenced by prior sleep history. The aim of our study was to test the effect of acute sleep deprivation on early outcome following experimental stroke. Young male Sprague-Dawley rats (n=20......) were subjected to focal cerebral ischemia by reversible right middle cerebral artery occlusion (MCAO) for 90 min. In 10 rats, MCAO was performed just after 6-h of total sleep deprivation (TSD) by "gentle handling", whereas the other rats served as controls. Neurological function during the first week...... after stroke was monitored using a battery of behavioral tests investigating the asymmetry of sensorimotor deficit (tape removal test and cylinder test), bilateral sensorimotor coordination (rotor-rod and Inclined plane) and memory (T-maze and radial maze). Following MCAO, control rats had impaired...

  16. Hyperbaric oxygen therapy in experimental and clinical stroke

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    Wei-wei Zhai

    2016-01-01

    Full Text Available Stroke, which is defined as a neurologic deficit caused by sudden impaired blood supply, has been considered as a common cause of death and disability for decades. The World Health Organization has declared that almost every 5 seconds a new stroke occurs, placing immense socioeconomic burdens. However, the effective and available treatment strategies are still limited. Additionally, the most effective therapy, such as thrombolysis and stenting for ischemic stroke, generally requires a narrow therapeutic time window after the event. A large majority of patients cannot be admitted to hospital and receive these effective treatments for reperfusion timely. Hyperbaric oxygen therapy (HBOT has been frequently applied and investigated in stroke since 1960s. Numerous basic and clinical studies have shown the beneficial efficacy for neurological outcome after stroke, and meanwhile many underlying mechanisms associated with neuroprotection have been illustrated, such as cerebral oxygenation promotion and metabolic improvement, blood-brain barrier protection, anti-inflammation and cerebral edema, intracranial pressure modulation, decreased oxidative-stress and apoptosis, increased vascular and neural regeneration. However, HBOT in human stroke is still not sufficiently evidence-based, due to the insufficient randomized double-blind controlled clinical studies. To date, there are no uniform criteria for the dose and session duration of HBOT in different strokes. Furthermore, the additional effect of HBOT combined with drugs and other treatment strategies are being investigated recently. Therefore, more experimental and clinical research is imperative to identify the mechanisms more clearly and to explore the best protocol of HBOT in stroke treatment.

  17. Sex Differences in Caspase Activation after Experimental Stroke

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    Liu, Fudong; Li, Zhong; Li, Jun; Siegel, Chad; Yuan, Rongwen; McCullough, Louise D.

    2009-01-01

    Background and purpose Over the past five years, experimental data has emerged that ischemia-induced cell death pathways may differ in males and females. Cell death in males is triggered by Poly(ADP-ribose) polymerase (PARP) activation and nuclear translocation of apoptosis-inducing factor (AIF). We have previously shown that interference with this pathway benefits males but not females after an experimental stroke. In contrast caspase activation may be the major pathway activated after ischemic injury in females. The aim of this study is to examine whether sex differences exist in caspase activation in adult mice after stroke and to determine if interference with stroke-induced caspase activation preferentially protects females. Methods Focal stroke was induced by reversible middle cerebral artery occlusion (MCAO; 90 minutes) in young and aging C57BL6 mice of both sexes. The pan-caspase inhibitor, quinoline-Val-Asp(Ome)-CH2-O-phenoxy (Q-VD-OPh) was administered at reperfusion. Histological outcomes was assessed 48 hours after MCAO. Separate cohorts were utilized for protein analysis of key cell death proteins including caspase-3, caspase-8, cytochrome C and Apoptosis Inducing Factor (AIF). Results Drug-treated female mice had significantly decreased infarct volumes and improved neurological deficits after stroke compared to vehicle-treated mice. Q-VD-OPh administration had no effect in male mice. The expression of cytochrome C and nuclear caspase-8 levels were increased in females after stroke. Conclusions Female mice had an early release of cytochrome C and enhanced caspase activation after MCAO. Caspase inhibition benefited females but not males. Sex differences exist in both the response to ischemic injury and the efficacy of neuroprotective agents. PMID:19265047

  18. NADPH Oxidase-Related Pathophysiology in Experimental Models of Stroke

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    Hiroshi Yao

    2017-10-01

    Full Text Available Several experimental studies have indicated that nicotinamide adenine dinucleotide phosphate (NADPH oxidases (Nox exert detrimental effects on ischemic brain tissue; Nox-knockout mice generally exhibit resistance to damage due to experimental stroke following middle cerebral artery occlusion (MCAO. Furthermore, our previous MCAO study indicated that infarct size and blood-brain barrier breakdown are enhanced in mice with pericyte-specific overexpression of Nox4, relative to levels observed in controls. However, it remains unclear whether Nox affects the stroke outcome directly by increasing oxidative stress at the site of ischemia, or indirectly by modifying physiological variables such as blood pressure or cerebral blood flow (CBF. Because of technical problems in the measurement of physiological variables and CBF, it is often difficult to address this issue in mouse models due to their small body size; in our previous study, we examined the effects of Nox activity on focal ischemic injury in a novel congenic rat strain: stroke-prone spontaneously hypertensive rats with loss-of-function in Nox. In this review, we summarize the current literature regarding the role of Nox in focal ischemic injury and discuss critical issues that should be considered when investigating Nox-related pathophysiology in animal models of stroke.

  19. Xenon is an inhibitor of tissue-plasminogen activator: adverse and beneficial effects in a rat model of thromboembolic stroke

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    David, Hélène N; Haelewyn, Benoît; Risso, Jean-Jacques; Colloc'h, Nathalie; Abraini, Jacques H

    2010-01-01

    Preclinical evidence in rodents has proven that xenon may be a very promising neuroprotective agent for treating acute ischemic stroke. This has led to the general thinking that clinical trials with xenon could be initiated in acute stroke patients in a next future. However, an unappreciated physicochemical property of xenon has been that this gas also binds to the active site of a series of serine proteases. Because the active site of serine proteases is structurally conserved, we have hypothesized and investigated whether xenon may alter the catalytic efficiency of tissue-type plasminogen activator (tPA), a serine protease that is the only approved therapy for acute ischemic stroke today. Here, using molecular modeling and in vitro and in vivo studies, we show (1) xenon is a tPA inhibitor; (2) intraischemic xenon dose dependently inhibits tPA-induced thrombolysis and subsequent reduction of ischemic brain damage; (3) postischemic xenon virtually suppresses ischemic brain damage and tPA-induced brain hemorrhages and disruption of the blood–brain barrier. Taken together, these data indicate (1) xenon should not be administered before or together with tPA therapy; (2) xenon could be a golden standard for treating acute ischemic stroke if given after tPA-induced reperfusion, with both unique neuroprotective and antiproteolytic (anti-hemorrhaging) properties. PMID:20087367

  20. REDUCTION DEGREE OF LOW-DENSITY LIPOPROTEINS CHOLESTEROL LEVELS ACCORDING TO DIFFERENT DOSES OF STATINS; ITS EFFECT ON THE RISK OF ISCHEMIC HEART DISEASE ACUTE EPISODES DEPENDING ON TREATMENT DURATION; AND RISK OF ISCHEMIC AND THROMBOEMBOLIC STROKE. COMMENT ON THE PAPER OF LAW M.R., WALD N.J., RUDNICKA A.R. QUANTIFYING EFFECT OF STATINS ON LOW DENSITY LIPOPROTEIN CHOLESTEROL, ISCHAEMIC HEART DISEASE, AND STROKE: SYSTEMATIC REVIEW AND META-ANALYSIS. BMJ 2003; 326:1423-1427

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    N. V. Perova

    2011-01-01

    Full Text Available Comparative dose-dependent ability of different statins to lower serum low-density lipoproteins (LDL cholesterol was determined in three large meta-analysis. Besides, it was found that standardized decrease in LDL cholesterol levels on 1.0 or 1.8 mmol/l leads to rate reduction in ischemic heart disease acute episodes as well as stroke depending on treatment duration. Effect of LDL cholesterol reduction on stroke occurrence was more significant in studies, which included a major share of patients with vascular disease, because these patients have a higher risk of thromboembolic stroke (rather than haemorrhagic stroke in comparison with the general population.

  1. Splenectomy reduces infarct volume and neuroinflammation in male but not female mice in experimental stroke

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    Dotson, Abby L.; Wang, Jianming; Saugstad, Julie; Murphy, Stephanie J.; Offner, Halina

    2014-01-01

    The peripheral immune response contributes to neurodegeneration after stroke yet little is known about how this process differs between males and females. The current study demonstrates that splenectomy prior to experimental stroke eliminates sex differences in infarct volume and activated brain monocytes/microglia. In the periphery of both sexes, activated T cells correlate directly with stroke outcome while monocytes are reduced by splenectomy only in males. This study provides new information about the sex specific mechanisms of the peripheral immune response in neurodegeneration after stroke and demonstrates the need for representation of both sexes in basic and clinical stroke research. PMID:25434281

  2. Successfully Climbing the “STAIRs”: Surmounting Failed Translation of Experimental Ischemic Stroke Treatments

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    Michael P. Kahle

    2012-01-01

    Full Text Available The Stroke Therapy Academic Industry Roundtable (STAIR provided initial (in 1999 and updated (in 2009 recommendations with the goal of improving preclinical stroke therapy assessment and to increase the translational potential of experimental stroke treatments. It is important for preclinical stroke researchers to frequently consider and revisit these concepts, especially since promising experimental stroke treatments continue to fail in human clinical trials. Therefore, this paper will focus on considerations for several key aspects of preclinical stroke studies including the selection and execution of the animal stroke model, drug/experimental treatment administration, and outcome measures to improve experimental validity and translation potential. Specific points of interest discussed include the incorporation of human comorbid conditions and drugs, the benefits of defining a proposed mechanism of action, replication of results using multiple methods, using clinically relevant routes of administration and treatment time windows, and performing and reporting good experimental methods to reduce bias such as, as suggested by the updated STAIR recommendations, sample size calculations, randomization, allocation concealment, blinding, and appropriate inclusion/exclusion criteria. It is our hope that reviewing and revisiting these considerations will benefit researchers in their investigations of stroke therapies and increase the likelihood of translational success in the battle against stroke.

  3. Apixaban in Comparison With Warfarin in Patients With Atrial Fibrillation and Valvular Heart Disease: Findings From the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) Trial.

    Science.gov (United States)

    Avezum, Alvaro; Lopes, Renato D; Schulte, Phillip J; Lanas, Fernando; Gersh, Bernard J; Hanna, Michael; Pais, Prem; Erol, Cetin; Diaz, Rafael; Bahit, M Cecilia; Bartunek, Jozef; De Caterina, Raffaele; Goto, Shinya; Ruzyllo, Witold; Zhu, Jun; Granger, Christopher B; Alexander, John H

    2015-08-25

    Apixaban is approved for the prevention of stroke and systemic embolism in patients with nonvalvular atrial fibrillation. However, the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial included a substantial number of patients with valvular heart disease and only excluded patients with clinically significant mitral stenosis or mechanical prosthetic heart valves. We compared the effect of apixaban and warfarin on rates of stroke or systemic embolism, major bleeding, and death in patients with and without moderate or severe valvular heart disease using Cox proportional hazards modeling. Of the 18 201 patients enrolled in ARISTOTLE, 4808 (26.4%) had a history of moderate or severe valvular heart disease or previous valve surgery. Patients with valvular heart disease had higher rates of stroke or systemic embolism and bleeding than patients without valvular heart disease. There was no evidence of a differential effect of apixaban over warfarin in patients with and without valvular heart disease in reducing stroke and systemic embolism (hazard ratio [HR], 0.70; 95% confidence interval [CI], 0.51-0.97 and HR, 0.84; 95%, CI 0.67-1.04; interaction P=0.38), causing less major bleeding (HR, 0.79; 95% CI, 0.61-1.04 and HR, 0.65; 95% CI, 0.55-0.77; interaction P=0.23), and reducing mortality (HR, 1.01; 95% CI, 0.84-1.22 and HR, 0.84; 95% CI, 0.73-0.96; interaction P=0.10). More than a quarter of the patients in ARISTOTLE with nonvalvular atrial fibrillation had moderate or severe valvular heart disease. There was no evidence of a differential effect of apixaban over warfarin in reducing stroke or systemic embolism, causing less bleeding, and reducing death in patients with and without valvular heart disease. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00412984. © 2015 American Heart Association, Inc.

  4. Stroke

    National Research Council Canada - National Science Library

    Pollack, Allan; Harrison, Christopher; Henderson, Joan; Miller, Graeme

    2014-01-01

    In 2012, about 50,000 Australians had a stroke (cerebrovascular accident (CVA)). The risk of stroke is associated with increased age, previous stroke or transient ischaemic attack, hypertension, smoking, diabetes mellitus (DM...

  5. The two-stroke poppet valve engine. Part 1: Intake and exhaust ports flow experimental assessments

    Science.gov (United States)

    Kamili Zahidi, M.; Razali Hanipah, M.; Ramasamy, D.; Noor, M. M.; Kadirgama, K.; Rahman, M. M.

    2017-10-01

    A two-stroke poppet valve engine is developed to overcome the common problems in conventional two-stroke engine designs. However, replacing piston control port with poppet valve will resulted different flow behaviour. This paper is looking at experimental assessment on a two-stroke poppet valve engine configuration to investigate the port flow performance. The aims are to evaluate the intake and exhaust coefficient of discharge and assess the twostroke capability of the cylinder head. The results has shown comparable coefficient of discharge values as production engine for the intake while the exhaust has higher values which is favourable for the two-stroke cycle operation.

  6. Remote post-conditioning reduces hypoxic damage early after experimental stroke

    DEFF Research Database (Denmark)

    Hasseldam, Henrik; Hansen-Schwartz, Jacob; Munkholm, Nina

    2013-01-01

    Given that reliable markers for early ischemic brain damage are lacking, we set out to test whether pimonidazole can be used as a reliable tool in the quantification of hypoxic insults, at early time points following experimental stroke....

  7. Targeting neutrophils in ischemic stroke: translational insights from experimental studies

    OpenAIRE

    Jickling, Glen C; Liu, DaZhi; Ander, Bradley P; Stamova, Boryana; Zhan, Xinhua; Sharp, Frank R

    2015-01-01

    Neutrophils have key roles in ischemic brain injury, thrombosis, and atherosclerosis. As such, neutrophils are of great interest as targets to treat and prevent ischemic stroke. After stroke, neutrophils respond rapidly promoting blood–brain barrier disruption, cerebral edema, and brain injury. A surge of neutrophil-derived reactive oxygen species, proteases, and cytokines are released as neutrophils interact with cerebral endothelium. Neutrophils also are linked to the major processes that c...

  8. Dyslipidemia and Risk of Cardiovascular Events in Patients With Atrial Fibrillation Treated With Oral Anticoagulation Therapy: Insights From the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) Trial.

    Science.gov (United States)

    Pol, Tymon; Held, Claes; Westerbergh, Johan; Lindbäck, Johan; Alexander, John H; Alings, Marco; Erol, Cetin; Goto, Shinya; Halvorsen, Sigrun; Huber, Kurt; Hanna, Michael; Lopes, Renato D; Ruzyllo, Witold; Granger, Christopher B; Hijazi, Ziad

    2018-02-01

    Dyslipidemia is a major risk factor for cardiovascular events. The prognostic importance of lipoproteins in patients with atrial fibrillation is not well understood. We aimed to explore the association between apolipoprotein A1 (ApoA1) and B (ApoB) and cardiovascular events in patients with atrial fibrillation receiving oral anticoagulation. Using data from the ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation) trial, ApoA1 and ApoB plasma levels were measured at baseline in 14 884 atrial fibrillation patients. Median length of follow-up was 1.9 years. Relationships between continuous levels of ApoA1 and ApoB and clinical outcomes were evaluated using Cox models adjusted for cardiovascular risk factors, medication including statins, and cardiovascular biomarkers. A composite ischemic outcome (ischemic stroke, systemic embolism, myocardial infarction, and cardiovascular death) was used as the primary end point. Median (25th, 75th) ApoA1 and ApoB levels were 1.10 (0.93, 1.30) and 0.70 g/L (0.55, 0.85), respectively. In adjusted analyses, higher levels of ApoA1 were independently associated with a lower risk of the composite ischemic outcome (hazard ratio, 0.81; PURL: http://www.clinicaltrials.gov. Unique identifier: NCT00412984. © 2018 The Authors and Bristol‐Myers Squibb. Published on behalf of the American Heart Association, Inc., by Wiley.

  9. Sex differences in regulatory cells in experimental stroke.

    Science.gov (United States)

    Seifert, Hilary A; Benedek, Gil; Liang, Jian; Nguyen, Ha; Kent, Gail; Vandenbark, Arthur A; Saugstad, Julie A; Offner, Halina

    2017-08-01

    Stroke is the leading cause of disability in the United States. Sex differences, including smaller infarcts in females and greater involvement of immune-mediated inflammation in males may affect the efficacy of immune-modulating interventions. To address these differences, we sought to identify distinct stroke-modifying mechanisms in female vs. male mice. The current study demonstrated smaller infarcts and increased levels of regulatory CD19+CD5+CD1dhi B10 cells as well as anti-inflammatory CD11b+CD206+ microglia/macrophages in the ipsilateral vs. contralateral hemisphere of female but not male mice undergoing 60min middle cerebral artery occlusion followed by 96h of reperfusion. Moreover, female mice with MCAO had increased total spleen cell numbers but lower B10 levels in spleens. These results elucidate differing sex-dependent regulatory mechanisms that account for diminished stroke severity in females and underscore the need to test immune-modulating therapies for stroke in both males and females. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Dissolution of emboli in rats with experimental cerebral thromboembolism by recombinant human tissue plasminogen activator (TD-2061)

    Energy Technology Data Exchange (ETDEWEB)

    Hara, T.; Iwamoto, M.; Ogawa, H.; Yamamoto, A.; Tomikawa, M. (Research Institute, Daiichi Pharmaceutical Co., Ltd., Tokyo, (Japan))

    1990-08-15

    Tissue plasminogen activator (t-PA) is frequently administered clinically as thrombolytic therapy. We injected recombinant t-PA into rats with cerebral {sup 125}I-labeled blood clot emboli to evaluate the dissolutive effect of recombinant human single-chain t-PA (rt-PA; TD-2061) on such emboli and to examine the possibility of improving neurological damage in patients with cerebral thrombosis. When rt-PA was given intravenously at a dose of 350,000 IU/kg 2 minutes before embolization, radioactivity in the affected cerebral hemisphere decreased to 20% of that in the vehicle control 2 hours after embolization. A significant decrease in radioactivity in the cerebral hemisphere was also found on the administration of 700,000 IU/kg of rt-PA 30 or 60 minutes after embolization, but not when rt-PA was administered 2 minutes after embolization. Marked inhibition of abnormal behavior such as hemiplegia was seen on treatment with rt-PA 2 minutes before embolization, but not at all when rt-PA treatment was given 30 or 60 minutes after embolization. The findings suggest that rt-PA can dissolve blood clot emboli in cerebral vessels and that prompt thrombolytic therapy is important to minimize neurological dysfunction in cases of cerebral thromboembolism.

  11. Recurrent Stroke

    DEFF Research Database (Denmark)

    Andersen, Søren Due; Gorst-Rasmussen, Anders; Lip, Gregory Y H

    2015-01-01

    Background and Purpose—The CHA2DS2VASc score and the Essen Stroke Risk Score are respectively used for risk stratification in patients with atrial fibrillation and in patients with cerebrovascular incidents. We aimed to test the ability of the 2 scores to predict stroke recurrence, death......, and cardiovascular events (stroke, transient ischemic attack, myocardial infarction, or arterial thromboembolism) in a nationwide Danish cohort study, among patients with incident ischemic stroke and no atrial fibrillation. Methods—We conducted a registry-based study in patients with incident ischemic stroke...... and no atrial fibrillation. Patients were stratified according to the CHA2DS2VASc score and the Essen Stroke Risk Score and were followed up until stroke recurrence or death. We estimated stratified incidence rates and hazard ratios and calculated the cumulative risks. Results—42 182 patients with incident...

  12. Thrombotic and Thromboembolic Complications in Patients with Adult Congenital Heart Disease

    Directory of Open Access Journals (Sweden)

    Behnood Bikdeli

    2017-02-01

    Full Text Available Improved medical and surgical interventions have increased the longevity of patients with congenital heart defects and most such patients live into adulthood. Thrombotic and thromboembolic complications constitute a major cause of mortality and morbidity in patients with adult congenital heart disease (ACHD. Such events include acute coronary syndromes, ischemic stroke (cardioembolic due to thrombus formation in the systemic ventricle, secondary to atrial arrhythmias, or due to paradoxical embolism, and venous thromboembolism. Some thrombotic phenomena are also specific to patients with ACHD, such as those related to Fontan circulation. We provide a succinct overview of thrombotic and thromboembolic complications in patients with ACHD, focusing on stroke and venous thromboembolic events.

  13. T-cells and macrophages peak weeks after experimental stroke

    DEFF Research Database (Denmark)

    Vindegaard, Nina; Muñoz-Briones, Clara; El Ali, Henrik H.

    2017-01-01

    The activities of the central and peripheral immune systems impact neurological outcome after ischemic stroke. However, studies investigating the temporal profile of leukocyte infiltration, especially T-cell recruitment, are sparse. Our aim was to investigate leukocyte infiltration at different...... performed. A recently introduced F-19 MR probe (V-sense), designed to track macrophages, was furthermore tested. Fourteen and 28 days after permanent middle cerebral artery occlusion a significant increase in CD3+ T-cells was found within the ipsilateral hemisphere compared to controls, especially within...

  14. Cell therapy centered on IL-1Ra is neuroprotective in experimental stroke

    DEFF Research Database (Denmark)

    Clausen, Bettina Hjelm; Lambertsen, Kate Lykke; Dagnæs-Hansen, Frederik

    2016-01-01

    irradiated mice with IL-1Ra-producing bone marrow cells is associated with neuroprotection and recruitment of IL-1Ra-producing leukocytes after stroke. Neuroprotection is also achieved by therapeutic injection of IL-1Ra-producing bone marrow cells 30 min after stroke onset, additionally improving...... production of IL-1Ra and IL-1α/β identifies microglia, not infiltrating leukocytes, as the major sources of IL-1Ra after experimental stroke, and shows IL-1Ra and IL-1β to be produced by segregated subsets of microglia with a small proportion of these cells co-expressing IL-1α. Reconstitution of whole body...... by demonstration of IL-1Ra-producing cells in the human cortex early after ischemic stroke. Taken together, our results attribute distinct neuroprotective or neurotoxic functions to segregated subsets of microglia and suggest that treatment strategies increasing the production of IL-1Ra by infiltrating leukocytes...

  15. Case-control study of oral contraceptives and risk of thromboembolic stroke: results from International Study on Oral Contraceptives and Health of Young Women.

    Science.gov (United States)

    Heinemann, L A; Lewis, M A; Thorogood, M; Spitzer, W O; Guggenmoos-Holzmann, I; Bruppacher, R

    1997-12-06

    To determine the influence of oral contraceptives (particularly those containing modern progestins) on the risk for ischaemic stroke in women aged 16-44 years. Matched case-control study. 16 Centres in the United Kingdom, Germany, France, Switzerland, and Austria. Cases were 220 women aged 16-44 who had an incident ischaemic stroke. Controls were 775 women (at least one hospital and one community control per case) unaffected by stroke who were matched with the corresponding case for 5 year age band and for hospital or community setting. Information on exposure and confounding variables were collected in a face to face interview. Odds ratios derived with stratified analysis and unconditional logistic regression to adjust for potential confounding. Adjusted odds ratios (95% confidence intervals) for ischaemic stroke (unmatched analysis) were 4.4 (2.0 to 9.9), 3.4 (2.1 to 5.5), and 3.9 (2.3 to 6.6) for current use of first, second, and third generation oral contraceptives, respectively. The risk ratio for third versus second generation was 1.1 (0.7 to 2.0) and was similar in the United Kingdom and other European countries. The risk estimates were lower if blood pressure was checked before prescription. Although there is a small relative risk of occlusive stroke for women of reproductive age who currently use oral contraceptives, the attributable risk is very small because the incidence in this age range is very low. There is no difference between the risk of oral contraceptives of the third and second generation; only first generation oral contraceptives seem to be associated with a higher risk. This small increase in risk may be further reduced by efforts to control cardiovascular risk factors, particularly high blood pressure.

  16. Stroke

    Science.gov (United States)

    ... cause to help prevent a future stroke. Medical History and Physical Exam Your doctor will ask you ... clots from getting larger. Two common medicines are aspirin and clopidogrel. Medical Procedures If you have carotid ...

  17. Immunomodulatory effect of Hawthorn extract in an experimental stroke model.

    Science.gov (United States)

    Elango, Chinnasamy; Devaraj, Sivasithambaram Niranjali

    2010-12-30

    Recently, we reported a neuroprotective effect for Hawthorn (Crataegus oxyacantha) ethanolic extract in middle cerebral artery occlusion-(MCAO) induced stroke in rats. The present study sheds more light on the extract's mechanism of neuroprotection, especially its immunomodulatory effect. After 15 days of treatment with Hawthorn extract [100 mg/kg, pretreatment (oral)], male Sprague Dawley rats underwent transient MCAO for 75 mins followed by reperfusion (either 3 or 24 hrs). We measured pro-inflammatory cytokines (IL-1β, TNF-α, IL-6), ICAM-1, IL-10 and pSTAT-3 expression in the brain by appropriate methods. We also looked at the cytotoxic T cell sub-population among leukocytes (FACS) and inflammatory cell activation and recruitment in brain (using a myeloperoxidase activity assay) after ischemia and reperfusion (I/R). Apoptosis (TUNEL), and Bcl-xL- and Foxp3- (T(reg) marker) positive cells in the ipsilateral hemisphere of the brain were analyzed separately using immunofluorescence. Our results indicate that occlusion followed by 3 hrs of reperfusion increased pro-inflammatory cytokine and ICAM-1 gene expressions in the ipsilateral hemisphere, and that Hawthorn pre-treatment significantly (p ≤ 0.01) lowered these levels. Furthermore, such pre-treatment was able to increase IL-10 levels and Foxp3-positive cells in brain after 24 hrs of reperfusion. The increase in cytotoxic T cell population in vehicle rats after 24 hrs of reperfusion was decreased by at least 40% with Hawthorn pretreatment. In addition, there was a decrease in inflammatory cell activation and infiltration in pretreated brain. Hawthorn pretreatment elevated pSTAT-3 levels in brain after I/R. We also observed an increase in Bcl-xL-positive cells, which in turn may have influenced the reduction in TUNEL-positive cells compared to vehicle-treated brain. In summary, Hawthorn extract helped alleviate pro-inflammatory immune responses associated with I/R-induced injury, boosted IL-10 levels, and

  18. Immunomodulatory effect of Hawthorn extract in an experimental stroke model

    Directory of Open Access Journals (Sweden)

    Devaraj Sivasithambaram

    2010-12-01

    Full Text Available Abstract Background Recently, we reported a neuroprotective effect for Hawthorn (Crataegus oxyacantha ethanolic extract in middle cerebral artery occlusion-(MCAO induced stroke in rats. The present study sheds more light on the extract's mechanism of neuroprotection, especially its immunomodulatory effect. Methods After 15 days of treatment with Hawthorn extract [100 mg/kg, pretreatment (oral], male Sprague Dawley rats underwent transient MCAO for 75 mins followed by reperfusion (either 3 or 24 hrs. We measured pro-inflammatory cytokines (IL-1β, TNF-α, IL-6, ICAM-1, IL-10 and pSTAT-3 expression in the brain by appropriate methods. We also looked at the cytotoxic T cell sub-population among leukocytes (FACS and inflammatory cell activation and recruitment in brain (using a myeloperoxidase activity assay after ischemia and reperfusion (I/R. Apoptosis (TUNEL, and Bcl-xL- and Foxp3- (Treg marker positive cells in the ipsilateral hemisphere of the brain were analyzed separately using immunofluorescence. Results Our results indicate that occlusion followed by 3 hrs of reperfusion increased pro-inflammatory cytokine and ICAM-1 gene expressions in the ipsilateral hemisphere, and that Hawthorn pre-treatment significantly (p ≤ 0.01 lowered these levels. Furthermore, such pre-treatment was able to increase IL-10 levels and Foxp3-positive cells in brain after 24 hrs of reperfusion. The increase in cytotoxic T cell population in vehicle rats after 24 hrs of reperfusion was decreased by at least 40% with Hawthorn pretreatment. In addition, there was a decrease in inflammatory cell activation and infiltration in pretreated brain. Hawthorn pretreatment elevated pSTAT-3 levels in brain after I/R. We also observed an increase in Bcl-xL-positive cells, which in turn may have influenced the reduction in TUNEL-positive cells compared to vehicle-treated brain. Conclusions In summary, Hawthorn extract helped alleviate pro-inflammatory immune responses associated

  19. A novel therapeutic strategy for experimental stroke using docosahexaenoic acid complexed to human albumin

    Directory of Open Access Journals (Sweden)

    Belayev Ludmila

    2016-01-01

    Full Text Available Despite tremendous efforts in ischemic stroke research and significant improvements in patient care within the last decade, therapy is still insufficient. There is a compelling, urgent need for safe and effective neuroprotective strategies to limit brain injury, facilitate brain repair, and improve functional outcome. Recently, we reported that docosahexaenoic acid (DHA; 22:6, n-3 complexed to human albumin (DHA-Alb is highly neuroprotective after temporary middle cerebral artery occlusion (MCAo in young rats. This review highlights the potency of DHA-Alb therapy in permanent MCAo and aged rats and whether protection persists with chronic survival. We discovered that a novel therapy with DHA-Alb improved behavioral outcomes accompanied by attenuation of lesion volumes even when animals were allowed to survive three weeks after experimental stroke. This treatment might provide the basis for future therapeutics for patients suffering from ischemic stroke.

  20. Experimental and numerical investigation of sprays in two stroke diesel Engines

    DEFF Research Database (Denmark)

    Dam, Bjarke Skovgård

    2007-01-01

    The control of the injected spray is important when optimizing performance and reducing emissions from diesel engines. The research community has conducted extensive research especially on smaller four stroke engines, but so far only little has been done on sprays in large two stroke engines...... have different scales and other designs than those used in the literature, so extending results from the literature will require experiments on this particular type of setup. Numerical investigations of diesel sprays are performed using the Eulerian/Lagrangian engine CFD code Kiva. In agreement...... and an injection system identical to those of large two stroke diesel engines. Specially designed single hole nozzles enables in nozzle pressure measurements. A number of experimental methods are successfully tested, including a high speed imaging system using reflected light, a low cost shadowgraph system...

  1. Experimental Investigation on Operational Performance of PAFS for CIV Opening Stroke

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Seok; Bae, Byoung-Uhn; Park, Yusun; Kang, Kyoung-Ho [Korea Atomic Energy Research Institute, Daejeon (Korea, Republic of)

    2015-10-15

    The test facility, ATLAS-PAFS was constructed to experimentally investigate the thermal hydraulic behavior in the primary and secondary systems of the APR+ during a transient when PAFS is actuated. In this study, PAFS-CIV-01 test was performed for validating the cooling rate of the reactor according to the CIV opening stroke at the FLB accident, which was analyzed as the most severe case in the APR+ SSAR (Standard Safety Analysis Report). With an aim of simulating a FLB+CIV accident of the APR+ as realistically as possible, the three-level scaling methodology was taken into account to determine the test conditions of the steady-state and the transient. The main objectives of this test were not only to provide physical insight into the system response of the APR+ during changes of CIV opening stroke but also to produce an integral effect test data to validate a thermal hydraulic safety analysis code. The initial steady-state conditions and the sequence of event in the FLB scenario for the APR+ were successfully simulated with the ATLAS-PAFS facility. The pressure and the temperature gradient of the primary system was reduced as the stroke of the CIV was decreased during the heat removal by PAFS operation. The mean temperature gradient of the core was reduced as the stroke of the CIV was decreased. The cooling rate of the core under 60% stroke (70.4 mm{sup 2}) of the CIV met the criteria. The water in the PCCT was heated up to the saturation condition by the heat transfer from the PCHX tube surface. In PAFS-CIV-01 test, the major sequence of events was ended before the water level decrease in the PCCT. From the present experimental result, it could be concluded that the cooling rate of the core was controlled by the adjustment of the CIV opening stroke when the APR+ PAFS was operating.

  2. Blood Pressure Control and Risk of Stroke or Systemic Embolism in Patients With Atrial Fibrillation: Results From the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) Trial.

    Science.gov (United States)

    Rao, Meena P; Halvorsen, Sigrun; Wojdyla, Daniel; Thomas, Laine; Alexander, John H; Hylek, Elaine M; Hanna, Michael; Bahit, M Cecilia; Lopes, Renato D; De Caterina, Raffaele; Erol, Cetin; Goto, Shinya; Lanas, Fernando; Lewis, Basil S; Husted, Steen; Gersh, Bernard J; Wallentin, Lars; Granger, Christopher B

    2015-12-01

    Patients with atrial fibrillation (AF) and hypertension are at high risk for stroke. Previous studies have shown elevated risk of stroke in patients with AF who have a history of hypertension (regardless of blood pressure [BP] control) and in patients with elevated BP. We assessed the association of hypertension and BP control on clinical outcomes. In ARISTOTLE (n=18 201), BP was evaluated as history of hypertension requiring treatment and elevated BP (systolic ≥140 and/or diastolic ≥90 mm Hg) at study entry and any point during the trial. Hazard ratios (HRs) were derived from Cox proportional hazards models including BP as a time-dependent covariate. A total of 15 916 (87.5%) patients had a history of hypertension requiring treatment. In patients with elevated BP measurement at any point during the trial, the rate of stroke or systemic embolism was significantly higher (HR, 1.53; 95% confidence interval [CI], 1.25-1.86), as was hemorrhagic stroke (HR 1.85; 95% CI, 1.26-2.72) and ischemic stroke (HR, 1.50; 95% CI, 1.18-1.90). Rates of major bleeding were lower in patients with a history of hypertension (HR, 0.80; 95% CI, 0.66-0.98) and nonsignificantly lower in patients with elevated BP at study entry (HR, 0.89; 95% CI, 0.77-1.03). The benefit of apixaban versus warfarin on preventing stroke or systemic embolism was consistent among patients with and without a history of hypertension (P interaction=0.27), BP control at baseline (P interaction=0.43), and BP control during the trial (P interaction=0.97). High BP measurement at any point during the trial was independently associated with a substantially higher risk of stroke or systemic embolism. These results strongly support efforts to treat elevated BP as an important strategy to optimally lower risk of stroke in patients with AF. URL: https://ClinicalTrials.gov/. Unique identifier: NCT00412984. © 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  3. Therapeutic targets and limits of minocycline neuroprotection in experimental ischemic stroke

    Directory of Open Access Journals (Sweden)

    Kaneko Yuji

    2009-10-01

    Full Text Available Abstract Background Minocycline, a second-generation tetracycline with anti-inflammatory and anti-apoptotic properties, has been shown to promote therapeutic benefits in experimental stroke. However, equally compelling evidence demonstrates that the drug exerts variable and even detrimental effects in many neurological disease models. Assessment of the mechanism underlying minocycline neuroprotection should clarify the drug's clinical value in acute stroke setting. Results Here, we demonstrate that minocycline attenuates both in vitro (oxygen glucose deprivation and in vivo (middle cerebral artery occlusion experimentally induced ischemic deficits by direct inhibition of apoptotic-like neuronal cell death involving the anti-apoptotic Bcl-2/cytochrome c pathway. Such anti-apoptotic effect of minocycline is seen in neurons, but not apparent in astrocytes. Our data further indicate that the neuroprotection is dose-dependent, in that only low dose minocycline inhibits neuronal cell death cascades at the acute stroke phase, whereas the high dose exacerbates the ischemic injury. Conclusion The present study advises our community to proceed with caution to use the minimally invasive intravenous delivery of low dose minocycline in order to afford neuroprotection that is safe for stroke.

  4. Evaluation of a nurse-led intervention to improve adherence to recommended guidelines for prevention of venous thromboembolism for hip and knee arthroplasty patients: A Quasi-experimental study.

    Science.gov (United States)

    Lockwood, Rosemarie; Kable, Ashley; Hunter, Sharyn

    2017-10-27

    The aim of this study was to measure adherence to a nurse-led evidence based venous thromboembolism prevention program (intervention) compared to usual care in hip and knee arthroplasty patients, and associated clinical outcomes. Venous thromboembolism morbidity and mortality of hospitalised patients is a major concern for health professionals. Venous thromboembolism prevention guidelines have been developed, however adherence to guidelines is variable. There were 410 potential participants who were adult patients that were booked for elective hip or knee arthroplasty at the two study sites during a two year period (2011-2013). Of these, 27 did not meet the inclusion criteria, and the remainder were eligible for inclusion in the study (intervention site n=196 and control site n=187, total population n=383). This study adopted a quasi-experimental design, using an intervention and control study site, conducted in two private hospitals in a regional area in Australia. The intervention group had a mean compliance score of 11.09; higher than the control group score of 7.19. This is equivalent to a compliance rate of 85% and 55% respectively, and indicates that adherence at the study site was significantly higher. Patient adherence and outcomes in the post-discharge period were not significantly different between the study sites. This study demonstrated a nurse-led intervention achieved high adherence with translating evidence based guidelines into routine patient care for hip and knee arthroplasty patients. Nurses can be critical to implementing clinical practice guidelines and adopting preventive programs in acute care to improve patient outcomes and reduce postoperative venous thromboembolism in arthroplasty patients. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  5. Increased risk of arterial thromboembolic events after Staphylococcus aureus bacteremia

    DEFF Research Database (Denmark)

    Mejer, N; Gotland, N; Uhre, M L

    2015-01-01

    OBJECTIVES: An association between infection and arterial thromboembolic events (ATE) has been suggested. Here we examined the risk of myocardial infarction (MI), stroke and other ATE after Staphylococcus aureus bacteremia (SAB). METHODS: Danish register-based nation-wide observational cohort study...

  6. Cheating the CHA2DS2-VASc Score: Thromboembolism in Apical Hypertrophic Cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Robin A. P. Weir

    2014-01-01

    Full Text Available Atrial fibrillation increases the risk of systemic thromboembolism in general and stroke in particular. Not all patients who develop atrial fibrillation are at significantly heightened risk of thromboembolic complications, however, with the development of risk scoring systems aiding clinicians in determining whether formal anticoagulation is mandated. The most commonly used contemporary scoring systems—CHADS2 and CHA2DS2-VASc—provide a reliable means of assessing stroke risk, but certain cardiac conditions are associated with an increased incidence of thromboembolism without impacting on these risk scores. Hypertrophic cardiomyopathy, with its apical variant, is such a condition. We present a case of a patient with apical hypertrophic cardiomyopathy and atrial fibrillation who suffered dire thromboembolic consequences despite a reassuringly low CHA2DS2-VASc score and suggest that this scoring system is modified to incorporate the thromboembolic risk inherent to certain cardiomyopathies irrespective of impairment of left ventricular systolic dysfunction or clinical heart failure.

  7. Multicenter Evaluation of Geometric Accuracy of MRI Protocols Used in Experimental Stroke.

    Directory of Open Access Journals (Sweden)

    Xenios Milidonis

    Full Text Available It has recently been suggested that multicenter preclinical stroke studies should be carried out to improve translation from bench to bedside, but the accuracy of magnetic resonance imaging (MRI scanners routinely used in experimental stroke has not yet been evaluated. We aimed to assess and compare geometric accuracy of preclinical scanners and examine the longitudinal stability of one scanner using a simple quality assurance (QA protocol. Six 7 Tesla animal scanners across six different preclinical imaging centers throughout Europe were used to scan a small structural phantom and estimate linear scaling errors in all orthogonal directions and volumetric errors. Between-scanner imaging consisted of a standard sequence and each center's preferred sequence for the assessment of infarct size in rat models of stroke. The standard sequence was also used to evaluate the drift in accuracy of the worst performing scanner over a period of six months following basic gradient calibration. Scaling and volumetric errors using the standard sequence were less variable than corresponding errors using different stroke sequences. The errors for one scanner, estimated using the standard sequence, were very high (above 4% scaling errors for each orthogonal direction, 18.73% volumetric error. Calibration of the gradient coils in this system reduced scaling errors to within ±1.0%; these remained stable during the subsequent 6-month assessment. In conclusion, despite decades of use in experimental studies, preclinical MRI still suffers from poor and variable geometric accuracy, influenced by the use of miscalibrated systems and various types of sequences for the same purpose. For effective pooling of data in multicenter studies, centers should adopt standardized procedures for system QA and in vivo imaging.

  8. Hormonal contraception and venous thromboembolism

    DEFF Research Database (Denmark)

    Lidegaard, Øjvind; Milsom, Ian; Geirsson, Reynir Tomas

    2012-01-01

    New studies about the influence of hormonal contraception on the risk of venous thromboembolism (VTE) have been published.......New studies about the influence of hormonal contraception on the risk of venous thromboembolism (VTE) have been published....

  9. High Blood Pressure, Afib and Your Risk of Stroke

    Science.gov (United States)

    ... Peripheral Artery Disease Venous Thromboembolism Aortic Aneurysm More High Blood Pressure, AFib and Your Risk of Stroke Updated:Aug ... have a stroke for the first time have high blood pressure . And an irregular atrial heart rhythm — a condition ...

  10. Thromboembolism in paediatric lupus patients.

    Science.gov (United States)

    Levy, D M; Massicotte, M P; Harvey, E; Hebert, D; Silverman, E D

    2003-01-01

    Paediatric patients with systemic lupus erythematosus (SLE) and antiphospholipid antibodies (aPL), specifically lupus anticoagulants (LAC) are at high risk of developing thromboembolic events (TE). Our objectives were to determine the prevalence of TE in paediatric SLE patients with LAC and to determine if anticoagulation was effective to decrease morbidity, and prevent recurrent TE. We reviewed data on 149 paediatric SLE patients treated over 10 years. In all, 24 patients (16%) were LAC positive, and 21 TE occurred in 13 of these LAC positive patients (54% incidence of TE in LAC positive patients). The events were cerebral venous thrombosis (9), arterial stroke (3), deep venous thrombosis (4), pulmonary embolism (2), other venous event (1) and other arterial events (2). The median duration between SLE diagnosis and first TE was 15.2 months (range 0-62), and the median age at first TE was 15.1 years (range 11.4-18.4). Long-term anticoagulation was prescribed, and eight patients (62%) were transferred to adult care on lifelong oral warfarin; four (31%) remain under our care on lifelong warfarin, and one patient died of causes unrelated to her TE. No patient has been identified with deficiencies of protein C, protein S or antithrombin III. One patient is heterozygous for Factor V Leiden, and one is heterozygous for both the Prothrombin 20210A mutation and the MTHFR (methylene tetrahydrofolate reductase) mutation. Four patients had recurrent TE (31%), and three were not anticoagulated at the time of their second event. One patient had two recurrences on therapeutic anticoagulation. Thromboembolic events are prevalent in the LAC positive paediatric SLE population, and consideration for lifelong anticoagulation must occur after an initial TE.

  11. Experimental Evaluation of a Method for Turbocharging Four-Stroke, Single Cylinder, Internal Combustion Engines

    Science.gov (United States)

    Buchman, Michael; Winter, Amos

    2015-11-01

    Turbocharging an engine increases specific power, improves fuel economy, reduces emissions, and lowers cost compared to a naturally aspirated engine of the same power output. These advantages make turbocharging commonplace for multi-cylinder engines. Single cylinder engineers are not commonly turbocharged due to the phase lag between the exhaust stroke, which powers the turbocharger, and the intake stroke, when air is pumped into the engine. Our proposed method of turbocharging single cylinder engines is to add an ``air capacitor'' to the intake manifold, an additional volume that acts as a buffer to store compressed air between the exhaust and intake strokes, and smooth out the pressure pulses from the turbocharger. This talk presents experimental results from a single cylinder, turbocharged diesel engine fit with various sized air capacitors. Power output from the engine was measured using a dynamometer made from a generator, with the electrical power dissipated with resistive heating elements. We found that intake air density increases with capacitor size as theoretically predicted, ranging from 40 to 60 percent depending on heat transfer. Our experiment was able to produce 29 percent more power compared to using natural aspiration. These results validated that an air capacitor and turbocharger may be a simple, cost effective means of increasing the power density of single cylinder engines.

  12. Thrombotic stroke and myocardial infarction with hormonal contraception

    DEFF Research Database (Denmark)

    Lidegaard, Øjvind; Løkkegaard, Ellen; Jensen, Aksel Karl Georg

    2012-01-01

    Although several studies have assessed the risk of venous thromboembolism with newer hormonal contraception, few have examined thrombotic stroke and myocardial infarction, and results have been conflicting.......Although several studies have assessed the risk of venous thromboembolism with newer hormonal contraception, few have examined thrombotic stroke and myocardial infarction, and results have been conflicting....

  13. Conditional depletion of neurogenesis inhibits long-term recovery after experimental stroke in mice.

    Directory of Open Access Journals (Sweden)

    Xiaomei Wang

    Full Text Available We reported previously that ablation of doublecortin (DCX-immunopositive newborn neurons in mice worsens anatomical and functional outcome measured 1 day after experimental stroke, but whether this effect persists is unknown. We generated transgenic mice that express herpes simplex virus thymidine kinase under control of the DCX promoter (DCX-TK transgenic mice. DCX-expressing and recently divided cells in the rostral subventricular zone (SVZ and hippocampus of DCX-TK transgenic mice, but not wild-type mice, were specifically depleted after ganciclovir (GCV treatment for 14 days. Focal cerebral ischemia was induced by permanent distal middle cerebral artery occlusion (MCAO on day 14 of vehicle or GCV treatment, and mice were killed 12 weeks after MCAO. Infarct volume was significantly increased and neurologic deficits were more severe in GCV- compared to vehicle-treated DCX-TK transgenic mice at first 8 weeks, after depletion of DCX- and bromodeoxyuridine-immunoreactive cells in the SVZ and dentate gyrus following focal ischemia. Our results indicate that endogenous neurogenesis in a critical period following experimental stroke influences the course of long-term recovery.

  14. Human Urinary Kallidinogenase Promotes Angiogenesis and Cerebral Perfusion in Experimental Stroke.

    Directory of Open Access Journals (Sweden)

    Lijuan Han

    Full Text Available Angiogenesisis a key restorative mechanism in response to ischemia, and pro-angiogenic therapy could be beneficial in stroke. Accumulating experimental and clinical evidence suggest that human urinary kallidinogenase (HUK improves stroke outcome, but the underlying mechanisms are not clear. The aim of current study was to verify roles of HUK in post-ischemic angiogenesis and identify relevant mediators. In rat middle cerebral artery occlusion (MCAO model, we confirmed that HUK treatment could improve stroke outcome, indicated by reduced infarct size and improved neurological function. Notably, the 18F-FDG micro-PET scan indicated that HUK enhanced cerebral perfusion in rats after MCAO treatment. In addition, HUK promotespost-ischemic angiogenesis, with increased vessel density as well as up-regulated VEGF andapelin/APJ expression in HUK-treated MCAO mice. In endothelial cell cultures, induction of VEGF and apelin/APJ expression, and ERK1/2 phosphorylation by HUK was further confirmed. These changes were abrogated by U0126, a selective ERK1/2 inhibitor. Moreover, F13A, a competitive antagonist of APJ receptor, significantly suppressed HUK-induced VEGF expression. Furthermore, angiogenic functions of HUK were inhibited in the presence of selective bradykinin B1 or B2 receptor antagonist both in vitro and in vivo. Our findings indicate that HUK treatment promotes post-ischemic angiogenesis and cerebral perfusion via activation of bradykinin B1 and B2 receptors, which is potentially due to enhancement expression of VEGF and apelin/APJ in ERK1/2 dependent way.

  15. What Are Heart Disease and Stroke?

    Science.gov (United States)

    ... Disease Venous Thromboembolism Aortic Aneurysm More What Are Heart Disease and Stroke? Updated:Dec 8,2015 There are ... include: High blood pressure Smoking Diabetes High cholesterol Heart disease Atrial fibrillation (Abnormal heart rhythm) Call 9-1- ...

  16. No influence of dabigatran anticoagulation on hemorrhagic transformation in an experimental model of ischemic stroke.

    Directory of Open Access Journals (Sweden)

    Ferdinand Bohmann

    Full Text Available BACKGROUND: Dabigatran etexilate (DE is a new oral direct thrombin inhibitor. Clinical trials point towards a favourable risk-to-benefit profile of DE compared to warfarin. In this study, we evaluated whether hemorrhagic transformation (HT occurs after experimental stroke under DE treatment as we have shown for warfarin. METHODS: 44 male C57BL/6 mice were pretreated orally with 37.5 mg/kg DE, 75 mg/kg DE or saline and diluted thrombin time (dTT and DE plasma concentrations were monitored. Ischemic stroke was induced by transient middle cerebral artery occlusion (tMCAO for 1 h or 3 h. We assessed functional outcome and HT blood volume 24 h and 72 h after tMCAO. RESULTS: After 1 h tMCAO, HT blood volume did not differ significantly between mice pretreated with DE 37.5 mg/kg and controls (1.5±0.5 µl vs. 1.8±0.5 µl, p>0.05. After 3 h tMCAO, DE-anticoagulated mice did also not show an increase in HT, neither at the dose of 37.5 mg/kg equivalent to anticoagulant treatment in the therapeutic range (1.3±0.9 µl vs. control 2.3±0.5 µl, p>0.05 nor at 75 mg/kg, clearly representing supratherapeutic anticoagulation (1.8±0.8 µl, p>0.05. Furthermore, no significant increase in HT under continued anticoagulation with DE 75 mg/kg could be found at 72 h after tMCAO for 1 h (1.7±0.9 µl vs. control 1.6±0.4 µl, p>0.05. CONCLUSION: Our experimental data suggest that DE does not significantly increase hemorrhagic transformation after transient focal cerebral ischemia in mice. From a translational viewpoint, this indicates that a continuation of DE anticoagulation in case of an ischemic stroke might be safe, but clearly, clinical data on this question are warranted.

  17. New anticoagulants for venous thromboembolism and atrial fibrillation

    DEFF Research Database (Denmark)

    Dimitropoulos, Gerasimos; Rahim, S M Zubair; Moss, Alexandra Sophie

    2018-01-01

    INTRODUCTION: The field of anticoagulation has seen impressive progress over the last decade. The introduction of the Non Vitamin K Oral Anticoagulants (NOACs) has revolutionized practice surrounding thromboprophylaxis, treatment of thromboembolic disease and stroke prevention in atrial fibrillat...... on well-established targets such factor Xa and thrombin remains the mainstay, attention has also shifted to other factors in the coagulation cascade. The evidence emerging from clinical research is growing, generating exciting possibilities in the field of anticoagulation....

  18. Pulmonary thromboembolism diagnosis algorithms

    Energy Technology Data Exchange (ETDEWEB)

    Kasai, Takeshi; Eto, Jun; Hayano, Daisuke; Ohashi, Masaki; Yoneda, Takahiro; Oyama, Hisaya; Inaba, Akira [Kameda General Hospital, Kamogawa, Chiba (Japan). Trauma and Emergency Care Center

    2002-01-01

    Our algorithm for diagnosing pulmonary thromboembolism combines ventilation/perfusion scanning with clinical criteria. Our perfusion scanning criterion states that high probability defines 2 segmental perfusion defects without corresponding radiographic abnormality and indeterminate probability defines less than 2 segmental perfusion defects (low probability: less than one segmental perfusion defect; intermediate: perfusion defects between high and low probability). The clinical criterion is divided into 7 items related to symptoms and signs suggestive of pulmonary thromboembolism. More than 4 items are defined as a highly suspicious clinical manifestation (HSCM), and less than 4 are considered a low suspicious clinical manifestation (LSCM). In 31 cases of high probability, 18 of HSCM did not include pulmonary angiograhy (PAG), and 13 of LSCM included PAG (positive: 11; negative: 2). In 12 cases of indeterminate probability, 7 of LSCM were observed without PAG and 5 of HSCM with PAG (positive: 4; negative: 1). PAG performance thus decreased to 41.9%. The positive prediction of high probability is 93.5%, which is very high, compared to indeterminate probability at 33.3%. (author)

  19. The sigma-1 receptor enhances brain plasticity and functional recovery after experimental stroke

    DEFF Research Database (Denmark)

    Ruscher, Karsten; Shamloo, Mehrdad; Rickhag, Karl Mattias

    2011-01-01

    Stroke leads to brain damage with subsequent slow and incomplete recovery of lost brain functions. Enriched housing of stroke-injured rats provides multi-modal sensorimotor stimulation, which improves recovery, although the specific mechanisms involved have not been identified. In rats housed in ...

  20. Evidence for the use of isoflurane as a replacement for chloral hydrate anesthesia in experimental stroke: an ethical issue.

    Science.gov (United States)

    Maud, Pétrault; Thavarak, Ouk; Cédrick, Lachaud; Michèle, Bastide; Vincent, Bérézowski; Olivier, Pétrault; Régis, Bordet

    2014-01-01

    Since an ethical issue has been raised regarding the use of the well-known anesthetic agent chloral hydrate, owing to its mutagenic and carcinogenic effects in animals, attention of neuroscientists has turned to finding out an alternative agent able to meet not only potency, safety, and analgesic efficacy, but also reduced neuroprotective effect for stroke research. The aim of this study was to compare the potential of chloral hydrate and isoflurane for both modulating the action of the experimental neuroprotectant MK801 and exerting analgesia. After middle cerebral artery occlusion in rats, no difference was observed in 24 h survival rate, success of ischemia, or infarct volume reduction between both anesthetics. However, isoflurane exerted a more pronounced analgesic effect than chloral hydrate as evidenced by formalin test 3 hours after anesthesia onset, thus encouraging the use of isoflurane in experimental stroke models.

  1. Evidence for the Use of Isoflurane as a Replacement for Chloral Hydrate Anesthesia in Experimental Stroke: An Ethical Issue

    Directory of Open Access Journals (Sweden)

    Pétrault Maud

    2014-01-01

    Full Text Available Since an ethical issue has been raised regarding the use of the well-known anesthetic agent chloral hydrate, owing to its mutagenic and carcinogenic effects in animals, attention of neuroscientists has turned to finding out an alternative agent able to meet not only potency, safety, and analgesic efficacy, but also reduced neuroprotective effect for stroke research. The aim of this study was to compare the potential of chloral hydrate and isoflurane for both modulating the action of the experimental neuroprotectant MK801 and exerting analgesia. After middle cerebral artery occlusion in rats, no difference was observed in 24 h survival rate, success of ischemia, or infarct volume reduction between both anesthetics. However, isoflurane exerted a more pronounced analgesic effect than chloral hydrate as evidenced by formalin test 3 hours after anesthesia onset, thus encouraging the use of isoflurane in experimental stroke models.

  2. Clinical overview of venous thromboembolism

    African Journals Online (AJOL)

    circulation, causing either partial or complete obstruction of pulmonary blood flow (in 4–13% of ... Keywords:anticoagulants, deep vein thrombosis, DVT, embolus, NOAC, PE, pulmonary embolism, thromboprophylaxis, thrombus, venous thromboembolism ... Cigarette smoking, including passive smoking. Hypercoagulability ...

  3. Accuracy of the detection of infratentorial stroke lesions using perfusion CT: an experimenter-blinded study

    Energy Technology Data Exchange (ETDEWEB)

    Lee, In Hyouk; Kim, Myung Soon; Kim, Young Ju; Lee, Myeong Sub [Yonsei University, Department of Radiology, Wonju College of Medicine, Wonju (Korea, Republic of); You, Joshua H. [Center for Health, Wellness, Fitness, Prevention, and Healing Across the Life Span, Department of Physical Therapy, Graduate School of Rehabilitation Science, Yonsei University, Center for Movement Impairment Solutions, Wonju City (Korea, Republic of); Lee, Ji Yong [Yonsei University, Department of Neurology, Wonju College of Medicine, Wonju (Korea, Republic of); Whang, Kum [Yonsei University, Department of Neurosurgery, Wonju College of Medicine, Wonju (Korea, Republic of)

    2010-12-15

    Although perfusion CT (PCT) for the detection of supratentorial stroke is well established, there is a dearth of evidence of its effectiveness in the detection of infratentorial stroke. Hence, this study compared sensitivity, specificity, and accuracy of PCT maps between infratentorial and supratentorial stroke lesions. One hundred patients with acute stroke who had successfully undergone near whole-brain PCT with the toggling table technique and follow-up MRI were included. Wilcoxon Mann-Whitney test was performed at P < 0.01. There was no significant statistical difference in the accuracy (91.79% vs. 93.23% in regional cerebral blood volume; 92.26% vs. 95.31% in regional cerebral blood flow; 89.17% vs. 92.71% in mean transit time; 89.76% vs. 92.19% in time to peak; P > 0.01 in all PCT maps) between supratentorial and infratentorial stroke. Also, there was no remarkable difference in both sensitivity and specificity of PCT maps. This was the first study to investigate the accuracy of PCT with the toggling table technique in detection of infratentorial stroke lesions. Clinically, PCT is highly reliable and accurate in detecting infratentorial stroke lesions. (orig.)

  4. Arginine-Vasopressin Receptor Blocker Conivaptan Reduces Brain Edema and Blood-Brain Barrier Disruption after Experimental Stroke in Mice.

    Directory of Open Access Journals (Sweden)

    Emil Zeynalov

    Full Text Available Stroke is a major cause of morbidity and mortality. Stroke is complicated by brain edema and blood-brain barrier (BBB disruption, and is often accompanied by increased release of arginine-vasopressin (AVP. AVP acts through V1a and V2 receptors to trigger hyponatremia, vasospasm, and platelet aggregation which can exacerbate brain edema. The AVP receptor blockers conivaptan (V1a and V2 and tolvaptan (V2 are used to correct hyponatremia, but their effect on post-ischemic brain edema and BBB disruption remains to be elucidated. Therefore, we conducted this study to investigate if these drugs can prevent brain edema and BBB disruption in mice after stroke.Experimental mice underwent the filament model of middle cerebral artery occlusion (MCAO with reperfusion. Mice were treated with conivaptan, tolvaptan, or vehicle. Treatments were initiated immediately at reperfusion and administered IV (conivaptan or orally (tolvaptan for 48 hours. Physiological variables, neurological deficit scores (NDS, plasma and urine sodium and osmolality were recorded. Brain water content (BWC and Evans Blue (EB extravasation index were evaluated at the end point.Both conivaptan and tolvaptan produced aquaresis as indicated by changes in plasma and urine sodium levels. However plasma and urine osmolality was changed only by conivaptan. Unlike tolvaptan, conivaptan improved NDS and reduced BWC in the ipsilateral hemisphere: from 81.66 ± 0.43% (vehicle to 78.28 ± 0.48% (conivaptan, 0.2 mg, p < 0.05 vs vehicle. Conivaptan also attenuated the EB extravasation from 1.22 ± 0.08 (vehicle to 1.01 ± 0.02 (conivaptan, 0.2 mg, p < 0.05.Continuous IV infusion with conivaptan for 48 hours after experimental stroke reduces brain edema, and BBB disruption. Conivaptan but not tolvaptan may potentially be used in patients to prevent brain edema after stroke.

  5. Reduced infarct size in neuroglobin-null mice after experimental stroke in vivo

    DEFF Research Database (Denmark)

    Raida, Zindy; Hundahl, Christian Ansgar; Kelsen, Jesper

    2012-01-01

    BACKGROUND: Neuroglobin is considered to be a novel important pharmacological target in combating stroke and neurodegenerative disorders, although the mechanism by which this protection is accomplished remains an enigma. We hypothesized that if neuroglobin is directly involved in neuroprotection,...

  6. Xenon neuroprotection in experimental stroke: interactions with hypothermia and intracerebral hemorrhage.

    Science.gov (United States)

    Sheng, Siyuan P; Lei, Beilei; James, Michael L; Lascola, Christopher D; Venkatraman, Talaignair N; Jung, Jin Yong; Maze, Mervyn; Franks, Nicholas P; Pearlstein, Robert D; Sheng, Huaxin; Warner, David S

    2012-12-01

    Xenon has been proven to be neuroprotective in experimental brain injury. The authors hypothesized that xenon would improve outcome from focal cerebral ischemia with a delayed treatment onset and prolonged recovery interval. Rats were subjected to 70 min temporary focal ischemia. Ninety minutes later, rats were treated with 0, 15, 30, or 45% Xe for 20 h or 0 or 30% Xe for 8, 20, or 44 h. Outcome was measured after 7 days. In another experiment, after ischemia, rats were maintained at 37.5° or 36.0°C for 20 h with or without 30% Xe. Outcome was assessed 28 days later. Finally, mice were subjected to intracerebral hemorrhage with or without 30% Xe for 20 h. Brain water content, hematoma volume, rotarod function, and microglial activation were measured. Cerebral infarct sizes (mean±SD) for 0, 15, 30, and 45% Xe were 212±27, 176±55, 160±32, and 198±54 mm, respectively (P=0.023). Neurologic scores (median±interquartile range) followed a similar pattern (P=0.002). Infarct size did not vary with treatment duration, but neurologic score improved (P=0.002) at all xenon exposure durations (8, 20, and 44 h). Postischemic treatment with either 30% Xe or subtherapeutic hypothermia (36°C) had no effect on 28-day outcome. Combination of these interventions provided long-term benefit. Xenon improved intracerebral hemorrhage outcome measures. Xenon improved focal ischemic outcome at 7, but not 28 days postischemia. Xenon combined with subtherapeutic hypothermia produced sustained recovery benefit. Xenon improved intracerebral hemorrhage outcome. Xenon may have potential for clinical stroke therapy under carefully defined conditions.

  7. History of bleeding and outcomes with apixaban versus warfarin in patients with atrial fibrillation in the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation trial.

    Science.gov (United States)

    De Caterina, Raffaele; Andersson, Ulrika; Alexander, John H; Al-Khatib, Sana M; Bahit, M Cecilia; Goto, Shinya; Hanna, Michael; Held, Claes; Hohnloser, Stefan; Hylek, Elaine M; Lanas, Fernando; Lopes, Renato D; López-Sendón, José; Renda, Giulia; Horowitz, John; Granger, Christopher B; Wallentin, Lars

    2016-05-01

    History of bleeding strongly influences decisions for anticoagulation in atrial fibrillation (AF). We analyzed outcomes in relation to history of bleeding and randomization in ARISTOTLE trial patients. The on-treatment safety population included 18,140 patients receiving at least 1 dose of study drug (apixaban) or warfarin. Centrally adjudicated outcomes in relation to bleeding history were analyzed using a Cox proportional hazards model adjusted for randomized treatment and established risk factors. Efficacy end points were analyzed on the randomized (intention to treat) population. A bleeding history was reported at baseline in 3,033 patients (16.7%), who more often were male, with a history of prior stroke/transient ischemic attack/systemic embolism and diabetes; higher CHADS2 scores, age, and body weight; and lower creatinine clearance and mean systolic blood pressure. Major (but not intracranial) bleeding occurred more frequently in patients with versus without a history of bleeding (adjusted hazard ratio 1.35, 95% CI 1.14-1.61). There were no significant interactions between bleeding history and treatment for stroke/systemic embolism, hemorrhagic stroke, death, or major bleeding, with fewer outcomes with apixaban versus warfarin for all of these outcomes independent of the presence/absence of a bleeding history. In patients with AF in a randomized clinical trial of oral anticoagulants, a history of bleeding is associated with several risk factors for stroke and portends a higher risk of major-but not intracranial-bleeding, during anticoagulation. However, the beneficial effects of apixaban over warfarin for stroke, hemorrhagic stroke, death, or major bleeding remains consistent regardless of history of bleeding. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  8. Venous Thromboembolism in Adolescents

    Directory of Open Access Journals (Sweden)

    Aneta Samková

    2012-01-01

    Full Text Available The incidence of venous thromboembolism (VTE during childhood is low with two peaks – neonatal and adolescent age. This retrospective study is focused on clinical characteristics of VTE during adolescence. The main goals are to assess the most frequent inherited and acquired risk factors and to evaluate the benefit of D-dimers in diagnostics of venous thromboemblism. The data of 18 adolescents were analysed – 16 girls (88.9%, 2 boys (11.1%. In 9 patients (50% thrombosis of the lower limb deep veins was diagnosed, six patients (33.3% suffered from symptomatic pulmonary embolism (PE and 3 patients (16.7% from thrombosis at unusual sites. One patient had an idiopathic VTE, the mean number of the inherited and acquired risk factors was 2.6. The most frequent inherited risk factor was Leiden mutation of factor V (27.8%. The most frequent acquired risk factor was oral contraception (OC in 12 out of 16 girls (75%. All of our patients on oral contraception had one or more additional risk factors. 10 out of 18 (55.6% patients with VTE had elevated activity of factor VIII. The sensitivity of D-dimers was low (50% in patients with distal lower limb thrombosis, but very high (100% in patients with PE.

  9. Pulmonary thromboembolism in children

    Energy Technology Data Exchange (ETDEWEB)

    Babyn, Paul S.; Gahunia, Harpal K. [Hospital for Sick Children, Department of Pediatric Diagnostic Imaging, Toronto, ON (Canada); Massicotte, Patricia [Stollery Children' s Hospital and University of Alberta, Departments of Pediatric Hematology and Cardiology, Edmonton, AB (Canada)

    2005-03-01

    Pulmonary thromboembolism (PTE) is uncommonly diagnosed in the pediatric patient, and indeed often only discovered on autopsy. The incidence of pediatric PTE depends upon the associated underlying disease, diagnostic tests used, and index of suspicion. Multiple risk factors can be found including: peripartum asphyxia, dyspnea, haemoptysis, chest pain, dehydration, septicemia, central venous lines (CVLs), trauma, surgery, ongoing hemolysis, vascular lesions, malignancy, renal disease, foreign bodies or, uncommonly, intracranial venous sinus thrombosis, burns, or nonbacterial thrombotic endocarditis. Other types of embolism can occur uncommonly in childhood and need to be recognized, as the required treatment will vary. These include pulmonary cytolytic thrombi, foreign bodies, tumor and septic emboli, and post-traumatic fat emboli. No single noninvasive test for pulmonary embolism is both sensitive and specific. A combination of diagnostic procedures must be used to identify suspect or confirmed cases of PTE. This article reviews the risk factors, clinical presentation and treatment of pulmonary embolism in children. It also highlights the current diagnostic tools and protocols used to evaluate pulmonary embolism in pediatric patients. (orig.)

  10. Stroke and bleeding in atrial fibrillation with chronic kidney disease

    DEFF Research Database (Denmark)

    Olesen, Jonas Bjerring; Lip, Gregory Y.H.; Kamper, Anne-Lise

    2012-01-01

    Both atrial fibrillation and chronic kidney disease increase the risk of stroke and systemic thromboembolism. However, these risks, and the effects of antithrombotic treatment, have not been thoroughly investigated in patients with both conditions.......Both atrial fibrillation and chronic kidney disease increase the risk of stroke and systemic thromboembolism. However, these risks, and the effects of antithrombotic treatment, have not been thoroughly investigated in patients with both conditions....

  11. Effects of melatonin in experimental stroke models in acute, sub-acute, and chronic stages

    Directory of Open Access Journals (Sweden)

    Hsiao-Wen Lin

    2009-03-01

    Full Text Available Hsiao-Wen Lin, E-Jian LeeNeurophysiology Laboratory, Neurosurgical Service, Department of Surgery, National Cheng Kung University Medical Center and Medical School, Tainan, TaiwanAbstract: Melatonin (N-acetyl-5-methoxy-tryptamine, a naturally occurring indole produced mainly by the pineal gland, is a well known antioxidant. Stroke (cerebral ischemia is the second leading cause of death worldwide. To date, however, effective and safe treatment for stroke remains unavailable. Melatonin is both lipid- and water-soluble and readily crosses the blood–brain barrier (BBB. Increasing evidence has shown that, in animal stroke models, administering melatonin significantly reduces infarct volume, edema, and oxidative damage and improves electrophysiological and behavioral performance. Here, we reviewed studies that assess effects of melatonin on cerebral ischemia in acute, sub-acute, and chronic stages. In addition to its potent antioxidant properties, melatonin exerts antiapoptotic, antiexcitotoxic, anti-inflammatory effects and promotes mitochondrial functions in animals with cerebral ischemia. Given that melatonin shows almost no toxicity to humans and possesses multifaceted protective capacity against cerebral ischemia, it is valuable to consider using melatonin in clinical trials on patients suffering from stroke.Keywords: cerebral ischemia, melatonin, stroke, neuroprotection

  12. Acupuncture for neurogenesis in experimental ischemic stroke: a systematic review and meta-analysis.

    Science.gov (United States)

    Lu, Lin; Zhang, Xiao-guang; Zhong, Linda L D; Chen, Zi-xian; Li, Yan; Zheng, Guo-qing; Bian, Zhao-xiang

    2016-01-20

    Acupuncture has been used for patients with stroke and post-stroke rehabilitation for thousands of years. Previous studies reported that acupuncture enhanced stroke recovery through neurogenesis. Hence, we conducted a systematic review and meta-analysis for preclinical studies to assess the current evidence for acupuncture effect on neurogenesis in treating ischaemic stroke. Studies were obtained from six databases, including PubMed, EMBASE, Cochrane Library, Chinese National Knowledge Infrastructure, VIP information database, and Chinese Biomedical Literature Database, Ultimately, 34 studies containing 1617 animals were identified. Neurogenesis markers of Brdu, Nestin, PSA-NCAM, NeuN and GFAP were selected as major outcomes. The pooled results of 15 studies marked with Brdu showed significant effects of acupuncture for improving proliferation when compared with control groups (P acupuncture for increasing proliferation when compared with control groups (P acupuncture for enhancing migration when compared with control groups (P acupuncture for stimulating differentiation when compared with control groups (P acupuncture is a prospective therapy targeting neurogenesis for ischemic stroke.

  13. Acquired Immunoglobulin G deficiency in stroke patients and experimental brain ischemia.

    Science.gov (United States)

    Liesz, Arthur; Roth, Stefan; Zorn, Markus; Sun, Li; Hofmann, Kerstin; Veltkamp, Roland

    2015-09-01

    Acute brain injuries induce a systemic immune depression syndrome (SIDS) that predisposes patients to bacterial infections. While cellular compartments of this syndrome have been well characterized, the contribution of humoral immune mechanisms and particularly immunoglobulins to SIDS has not been investigated so far. We determined serum immunoglobulin levels and infectious complications at several time points in 159 ischemic and hemorrhagic stroke patients. Additionally, findings were verified in a transient middle cerebral artery occlusion model. A novel immunoassay was established to analyze the IgG excretion ratio in mice. We identified a transient IgG reduction in patients suffering from substantial ischemic or hemorrhagic brain injuries. The IgG-reduction was associated with subsequent bacterial infections. Similarly, transient hypogammaglobulinemia was detected in a murine stroke model. We then used this animal model to further distinguish the mechanism of the IgG reduction by an IgG transfer paradigm. Excretional loss rather than deficient production of IgG was demonstrated to underlay hypogammaglobulinemia. This is the first report of transient hypogammaglobulinemia after ischemic and hemorrhagic stroke suggesting involvement in infectious complications. These findings pave the road for further studies investigating post-stroke hypogammaglobulinemia as a druggable target for stroke-induced complications. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Therapeutic outcomes of transplantation of amniotic fluid-derived stem cells in experimental ischemic stroke

    Directory of Open Access Journals (Sweden)

    Naoki eTajiri

    2014-08-01

    Full Text Available Accumulating preclinical evidence suggests the use of amnion as a source of stem cells for investigations of basic science concepts related to developmental cell biology, but also for stem cells’ therapeutic applications in treating human disorders. We previously reported isolation of viable rat amniotic fluid-derived stem (AFS cells. Subsequently, we recently reported the therapeutic benefits of intravenous transplantation of AFS cells in a rodent model of ischemic stroke. Parallel lines of investiagtions have provided safety and efficacy of stem cell therapy for treating stroke and other neurological disorders. This review article highlights characterization of AFS cells’ phenotype and their transplant-mediated functional effects, the need for investigations of mechanisms underlying AFS cells’ therapeutic benefits and discusses lab-to-clinic translational gating items in an effort to optimize the clinical application of cell transplantation for stroke.

  15. Drug-induced Hypothermia by 5HT1A Agonists Provide Neuroprotection in Experimental Stroke

    DEFF Research Database (Denmark)

    Johansen, Flemming Fryd; Hasseldam, Henrik; Nybro Smith, Matthias

    2014-01-01

    BACKGROUND: Drug-induced hypothermia reduces brain damage in animal stroke models and is an undiscovered potential in human stroke treatment. We studied hypothermia induced by the serotonergic agonists S14671 (1-[2-(2-thenoylamino)ethyl]-4[1-(7- methoxynaphtyl)]piperazine) and ipsapirone in a rat...... controls of the S14761 effect in MCAO were performed as previously mentioned (n = 10) but with rats kept normothermic by a heating lamp for 22 hours. Finally, a meta-analysis of ipsapirone-induced hypothermia in man was included. RESULTS: Infarct volumes were reduced by 50% in hypothermic rats versus...... therapeutic hypothermia....

  16. New oral antithrombotics: focus on dabigatran, an oral, reversible direct thrombin inhibitor for the prevention and treatment of venous and arterial thromboembolic disorders

    Directory of Open Access Journals (Sweden)

    Dahl OE

    2012-01-01

    Full Text Available Ola E Dahl1,21Department of Orthopaedics, Innlandet Hospital Trust, Elverum Central Hospital, Elverum, Norway; 2Thrombosis Research Institute, London, UKAbstract: Venous thromboembolism, presenting as deep vein thrombosis or pulmonary embolism, is a major challenge for health care systems. It is the third most common vascular disease after coronary heart disease and stroke, and many hospitalized patients have at least one risk factor. In particular, patients undergoing hip or knee replacement are at risk, with an incidence of asymptomatic deep vein thrombosis of 40%–60% without thromboprophylaxis. Venous thromboembolism is associated with significant mortality and morbidity, with patients being at risk of recurrence, post-thrombotic syndrome, and chronic thromboembolic pulmonary hypertension. Arterial thromboembolism is even more frequent, and atrial fibrillation, the most common embolic source (cardiac arrhythmia, is associated with a five-fold increase in the risk of stroke. Strokes due to atrial fibrillation tend to be more severe and disabling and are more often fatal than strokes due to other causes. Currently, recommended management of both venous and arterial thromboembolism involves the use of anticoagulants such as coumarin and heparin derivatives. These agents are effective, although have characteristics that prevent them from providing optimal anticoagulation and convenience. Hence, new improved oral anticoagulants are being investigated. Dabigatran is a reversible, direct thrombin inhibitor, which is administered as dabigatran etexilate, the oral prodrug. Because it is the first new oral anticoagulant that has been licensed in many countries worldwide for thromboprophylaxis following orthopedic surgery and for stroke prevention in patients with atrial fibrillation, this compound will be the main focus of this review. Dabigatran has been investigated for the treatment of established venous thromboembolism and prevention of

  17. Propensity of Withania somnifera to Attenuate Behavioural, Biochemical, and Histological Alterations in Experimental Model of Stroke.

    Science.gov (United States)

    Sood, Abhilasha; Kumar, Aditya; Dhawan, Devinder K; Sandhir, Rajat

    2016-10-01

    The present study was designed to evaluate the beneficial effects of Withania somnifera (WS) pre-supplementation on middle cerebral artery occlusion (MCAO) model of ischemic stroke. Ischemic stroke was induced in the rats by inserting intraluminal suture for 90 min, followed by reperfusion injury for 24 h. The animals were assessed for locomotor functions (by neurological deficit scores, narrow beam walk and rotarod test), cognitive and anxiety-like behavioural functions (by morris water maze and elevated plus maze test). MCAO animals showed significant impairment in locomotor and cognitive functions. Neurobehavioural changes were accompanied by decreased acetylcholinesterase activity, increased oxidative stress in terms of enhanced lipid peroxidation and lowered thiol levels in the MCAO animals. In addition, MCAO animals had cerebral infarcts and the presence of pycnotic nuclei. Single-photon emission computerized tomography (SPECT) of MCAO animals revealed a cerebral infarct as a hypoactive area. On the other hand, pre-supplementation with WS (300 mg/kg body weight) for 30 days to MCAO animals was effective in restoring the acetylcholinesterase activity, lipid peroxidation, thiols and attenuated MCAO induced behavioural deficits. WS significantly reduced the cerebral infarct volume and ameliorated histopathological alterations. Improved blood flow was observed in the SPECT images from the brain regions of ischemic rats pre-treated with WS. The results of the study showed a protective effect of WS supplementation in ischemic stroke and are suggestive of its potential application in stroke management.

  18. Neonatal Venous Thromboembolism

    Directory of Open Access Journals (Sweden)

    Kristina M. Haley

    2017-06-01

    Full Text Available Neonates are the pediatric population at highest risk for development of venous thromboembolism (VTE, and the incidence of VTE in the neonatal population is increasing. This is especially true in the critically ill population. Several large studies indicate that the incidence of neonatal VTE is up almost threefold in the last two decades. Central lines, fluid fluctuations, sepsis, liver dysfunction, and inflammation contribute to the risk profile for VTE development in ill neonates. In addition, the neonatal hemostatic system is different from that of older children and adults. Platelet function, pro- and anticoagulant proteins concentrations, and fibrinolytic pathway protein concentrations are developmentally regulated and generate a hemostatic homeostasis that is unique to the neonatal time period. The clinical picture of a critically ill neonate combined with the physiologically distinct neonatal hemostatic system easily fulfills the criteria for Virchow’s triad with venous stasis, hypercoagulability, and endothelial injury and puts the neonatal patient at risk for VTE development. The presentation of a VTE in a neonate is similar to that of older children or adults and is dependent upon location of the VTE. Ultrasound is the most common diagnostic tool employed in identifying neonatal VTE, but relatively small vessels of the neonate as well as frequent low pulse pressure can make ultrasound less reliable. The diagnosis of a thrombophilic disorder in the neonatal population is unlikely to change management or outcome, and the role of thrombophilia testing in this population requires further study. Treatment of neonatal VTE is aimed at reducing VTE-associated morbidity and mortality. Recommendations for treating, though, cannot be extrapolated from guidelines for older children or adults. Neonates are at risk for bleeding complications, particularly younger neonates with more fragile intracranial vessels. Developmental alterations in the

  19. Spontaneous ischaemic stroke in dogs

    DEFF Research Database (Denmark)

    Gredal, Hanne Birgit; Skerritt, G. C.; Gideon, P.

    2013-01-01

    Translation of experimental stroke research into the clinical setting is often unsuccessful. Novel approaches are therefore desirable. As humans, pet dogs suffer from spontaneous ischaemic stroke and may hence offer new ways of studying genuine stroke injury mechanisms.......Translation of experimental stroke research into the clinical setting is often unsuccessful. Novel approaches are therefore desirable. As humans, pet dogs suffer from spontaneous ischaemic stroke and may hence offer new ways of studying genuine stroke injury mechanisms....

  20. Pulmonary thrombo-embolic disease

    African Journals Online (AJOL)

    In addition, a number of new and exciting anticoagulant therapies are being developed for this disease. Definition. Pulmonary thrombo-embolic diseases can be either acute or chronic. Pulmonary embolism (PE) occurs with partial or complete obstruction of the central or peripheral pulmonary arteries by emboli. Incidence.

  1. Experimental investigation of CAI combustion in a two-stroke poppet valve DI engine

    OpenAIRE

    Zhang, Yan

    2015-01-01

    This thesis was submitted for the award of Doctor of Philosophy and was awarded by Brunel University London Due to their ability to simultaneously reduce fuel consumption and NOx emissions, Controlled Auto Ignition (CAI) and HCCI combustion processes have been extensively researched over the last decade and adopted on prototype gasoline engines. These combustion processes were initially achieved on conventional two-stroke ported gasoline engines, but there have been significantly fewer stu...

  2. Brain metabolic pattern analysis using a magnetic resonance spectra classification software in experimental stroke.

    Science.gov (United States)

    Jiménez-Xarrié, Elena; Davila, Myriam; Candiota, Ana Paula; Delgado-Mederos, Raquel; Ortega-Martorell, Sandra; Julià-Sapé, Margarida; Arús, Carles; Martí-Fàbregas, Joan

    2017-01-13

    Magnetic resonance spectroscopy (MRS) provides non-invasive information about the metabolic pattern of the brain parenchyma in vivo. The SpectraClassifier software performs MRS pattern-recognition by determining the spectral features (metabolites) which can be used objectively to classify spectra. Our aim was to develop an Infarct Evolution Classifier and a Brain Regions Classifier in a rat model of focal ischemic stroke using SpectraClassifier. A total of 164 single-voxel proton spectra obtained with a 7 Tesla magnet at an echo time of 12 ms from non-infarcted parenchyma, subventricular zones and infarcted parenchyma were analyzed with SpectraClassifier ( http://gabrmn.uab.es/?q=sc ). The spectra corresponded to Sprague-Dawley rats (healthy rats, n = 7) and stroke rats at day 1 post-stroke (acute phase, n = 6 rats) and at days 7 ± 1 post-stroke (subacute phase, n = 14). In the Infarct Evolution Classifier, spectral features contributed by lactate + mobile lipids (1.33 ppm), total creatine (3.05 ppm) and mobile lipids (0.85 ppm) distinguished among non-infarcted parenchyma (100% sensitivity and 100% specificity), acute phase of infarct (100% sensitivity and 95% specificity) and subacute phase of infarct (78% sensitivity and 100% specificity). In the Brain Regions Classifier, spectral features contributed by myoinositol (3.62 ppm) and total creatine (3.04/3.05 ppm) distinguished among infarcted parenchyma (100% sensitivity and 98% specificity), non-infarcted parenchyma (84% sensitivity and 84% specificity) and subventricular zones (76% sensitivity and 93% specificity). SpectraClassifier identified candidate biomarkers for infarct evolution (mobile lipids accumulation) and different brain regions (myoinositol content).

  3. Proper housing conditions in experimental stroke studies—special emphasis on environmental enrichment

    Science.gov (United States)

    Mering, Satu; Jolkkonen, Jukka

    2015-01-01

    Environmental enrichment provides laboratory animals with novelty and extra space, allowing different forms of multisensory stimulation ranging from social grouping to enhanced motor activity. At the extreme end of the spectrum, one can have a super-enriched environment. Environmental enrichment is believed to result in improved cognitive and sensorimotor functions both in naïve rodents and in animals with brain lesions such as those occurring after a stroke. Robust behavioral effects in animals which have suffered a stroke are probably related not only to neuronal plasticity in the perilesional cortex but also in remote brain areas. There is emerging evidence to suggest that testing restorative therapies in an enriched environment can maximize treatment effects, e.g., the perilesional milieu seems to be more receptive to concomitant pharmacotherapy and/or cell therapy. This review provides an updated overview on the effect of an enriched environment in stroke animals from the practical points to be considered when planning experiments to the mechanisms explaining why combined therapies can contribute to behavioral improvement in a synergistic manner. PMID:25870536

  4. Proper housing conditions in experimental stroke studies – special emphasis on environmental enrichment

    Directory of Open Access Journals (Sweden)

    Satu eMering

    2015-03-01

    Full Text Available Environmental enrichment provides laboratory animals with novelty and extra space, allowing different forms of multisensory stimulation ranging from social grouping to enhanced motor activity. At the extreme end of the spectrum, one can have a super-enriched environment. Environmental enrichment is believed to result in improved cognitive and sensorimotor functions both in naïve rodents and in animals with brain lesions such as those occurring after a stroke. Robust behavioral effects in animals which have suffered a stroke are probably related not only to neuronal plasticity in the perilesional cortex but also in remote brain areas. There is emerging evidence to suggest that testing restorative therapies in an enriched environment can maximize treatment effects, e.g., the perilesional milieu seems to be more receptive to concomitant pharmacotherapy and/or cell therapy. This review provides an updated overview on the effect of an enriched environment in stroke animals from the practical points to be considered when planning experiments to the mechanisms explaining why combined therapies can contribute to behavioral improvement in a synergistic manner.

  5. Multiparametric magnetic resonance imaging including oxygenation mapping of experimental ischaemic stroke.

    Science.gov (United States)

    Boisserand, Ligia Simões Braga; Lemasson, Benjamin; Hirschler, Lydiane; Moisan, Anaïck; Hubert, Violaine; Barbier, Emmanuel L; Rémy, Chantal; Detante, Olivier

    2017-06-01

    Recent advances in MRI methodology, such as microvascular and brain oxygenation (StO 2 ) imaging, may prove useful in obtaining information about the severity of the acute stroke. We assessed the potential of StO 2 to detect the ischaemic core in the acute phase compared to apparent diffusion coefficient and to predict the final necrosis. Sprague-Dawley rats (n = 38) were imaged during acute stroke (D0) and 21 days after (D21). A multiparametric MRI protocol was performed at 4.7T to characterize brain damage within three region of interest: 'LesionD0' (diffusion), 'Mismatch' representing penumbra (perfusion/diffusion) and 'Hypoxia' (voxels < 40% of StO 2 within the region of interest LesionD0). Voxel-based analysis of stroke revealed heterogeneity of the region of interest LesionD0, which included voxels with different degrees of oxygenation decrease. This finding was supported by a dramatic decrease of vascular and perfusion parameters within the region of interest hypoxia. This zone presented the lowest values of almost all parameters analysed, indicating a higher severity. Our study demonstrates the potential of StO 2 magnetic resonance imaging to more accurately detect the ischaemic core without the inclusion of any reversible ischaemic damage. Our follow-up study indicates that apparent diffusion coefficient imaging overestimated the final necrosis while StO 2 imaging did not.

  6. Risks of thromboembolism and bleeding with thromboprophylaxis in patients with atrial fibrillation: A net clinical benefit analysis using a 'real world' nationwide cohort study

    DEFF Research Database (Denmark)

    Olesen, Jonas Bjerring; Lip, Gregory Y H; Lindhardsen, Jesper

    2011-01-01

    . There was a neutral or positive net clinical benefit (ischaemic stroke vs. intracranial haemorrhage) with VKA alone in patients with a CHADS2 score of = 0, and CHA2DS2-VASc score of = 1. This large cohort study confirms the efficacy of VKA and no effect of ASA treatment on the risk of stroke/thromboembolism. Also......, the risk of bleeding was increased with both VKA and ASA treatment, but the net clinical benefit was clearly positive, in favour of VKA in patients with increased risk of stroke/thromboembolism....

  7. Ultrasonic vocalization in murine experimental stroke: A mechanistic model of aphasia.

    Science.gov (United States)

    Palmateer, Julie; Pan, Jie; Pandya, Arushi; Martin, Lianna; Kumar, Sungita; Ofomata, Adaora; Jones, Theresa A; Gore, Andrea C; Schallert, Timothy; Hurn, Patricia D

    2016-01-01

    Approximately one-fourth of stroke survivors are aphasic. Speech therapy is the main treatment approach but leaves most patients with chronic disability. Attempts to improve this situation are hampered by a lack of mechanistic understanding of the disability and treatments, reflecting the neglect of this impairment modality in pre-clinical research. Accordingly, we devised a novel murine model of speech-related impairment after stroke to investigate the role of language- and plasticity-associated molecules. Rodents communicate socially with ultrasonic vocalizations (USVs), conveying semantic and semiotic information with complex frequency modulated "songs" and alarm calls. Transient focal cerebral ischemia was induced in male C57BL6 mice via either 30 or 45 minutes of reversible right MCAO using the intraluminal filament technique. Nine days post-operatively brains are stained with TTC and analyzed for infarct volume. For behavioral measures health scores are taken (days 1-4), cylinder tests and USV recordings performed at days 3 and 7 post operatively. Real time PCR was performed at 24 and 48 hour and 7 day time points to quantify mRNA expression of communication-related genes (Foxp2, Foxp1, Srpx2, Cntnap2 and Gapdh). Immunohistochemistry was performed to localize FOXP2 protein. After middle cerebral artery occlusion of either 30 or 45 minutes duration, mice demonstrate profoundly impaired socially evoked USVs. In addition, there is suppression of the language-associated transcription factor, Forkhead box protein 2 (Foxp2), and its downstream binding partner, contactin-associated protein 2 (Cntnap2). These findings set a foundation for further studies of mechanisms and novel treatment strategies for post-stroke vocalization impairments.

  8. Experimental treatment of stroke in spontaneously hypertensive rats by CD34+ and CD34- cord blood cells

    Directory of Open Access Journals (Sweden)

    Egger, Dietmar

    2005-11-01

    Full Text Available Human umbilical cord blood as a source of stem cells has recently been reported in experimental treatment of cerebral disorders. However, little is known about the nature of cells and cellular mechanisms leading to neurofunctional improvement. Here we investigated the potential of separated CD34+ versus CD34- human umbilical cord blood cells (HUCBC to promote functional recovery following stroke. The experiments were performed in spontaneously hypertensive (SH rats, known for a risk profile comparable to stroke patients. After three weeks of behavioral training in the RotaRod and Beamwalk test arrays, stroke was induced by permanent middle cerebral artery occlusion (MCAO. For cell therapy, 1x106 cryopreserved cells were administered systemically between 8 and 10 hours after MCAO. The behavioral tests were performed together with a neurological severity score (mNSS until day 29 to assess neurofunctional disabilities. Nearly complete functional remission was observed with both subpopulations CD34+ as well as CD34- cells. To localize cells histologically, they were labeled with a fluorescence dye (CFSE before injection. Again, after administration of CD34+ as well as CD34- cells, CFSE labelled cells were found that accumulated in the border zone between the central necrosis of the ischemic lesion and functional brain tissue, thus indicating active attraction towards the lesion for both cell populations. Immunohistology with anti-CD68 and antibodies to human neuronal markers (NF-L, chromogranin indicated an accumulation of human and rat monocytes in the border zone of the lesion while neuronal cells of human origin could not be detected in host brains.

  9. XingNaoJing, prescription of traditional Chinese medicine, prevents autophagy in experimental stroke by repressing p53-DRAM pathway.

    Science.gov (United States)

    Wei, Gang; Huang, YueChun; Li, Fei; Zeng, FeiJian; Li, YiWei; Deng, RuDong; Lai, YingTao; Zhou, JianHong; Huang, GuiHua; Chen, DongFeng

    2015-10-19

    Xingnaojing (XNJ), a well known prescription in traditional Chinese medicine, has been used for treatment of stroke in China. However, the effects and mechanisms of XNJ on autophagy are not clear. Here, we used the cell models of autophagy induced by serum-free condition and ischemia stroke in rats to further investigate whether the p53-DRAM pathway is involved in the effects of XNJ on autophagy. We used the cell model of autophagy induced by serum-free condition and the rat model of ischemia caused by a middle cerebral artery occlusion (MCAO). The effects of XNJ on p53 transcriptional activity of PC12 cells were evaluated by the luciferase activity assay. The mRNA levels and the expression of p53 and its target autophagy gene DRAM (damage-regulated autophagy modulator) were analyzed respectively by Quantitative-RTPCR and Western blot assay. The activation of autophagy was detected by the levels of autophagy markers, microtubule associated protein light chain 3 (LC3) and p62 by Immunofluorescence and Western blot. p53 inhibitor was used to determine whether p53 is responsible for the effects of XNJ on preventing autophagy. The assay for luciferase activity of p53 promoter indicated that XNJ inhibited p53 transcriptional activity. XNJ reduced the expression of p53 and its target autophagy gene DRAM (damage-regulated autophagy modulator) in serum-free condition PC12 cells and the cortex in MCAO rats. XNJ reduced autophagy of PC12 cells induced by serum-free condition and the cortex in MCAO rats. Furthermore, suppression of p53 by p53 inhibitor significantly reduced the effects of XNJ on the autophagy of PC12 cells in serum-free condition. XNJ prevents autophagy in experimental stroke by repressing p53/DRAM pathway. Our findings are therefore of considerable therapeutic significance and provide the novel and potential application of XNJ for the treatment of brain diseases.

  10. The nonthiazolidinedione PPARgamma agonist L-796,449 is neuroprotective in experimental stroke.

    Science.gov (United States)

    Pereira, Marta P; Hurtado, Olivia; Cárdenas, Antonio; Alonso-Escolano, David; Boscá, Lisardo; Vivancos, José; Nombela, Florentino; Leza, Juan C; Lorenzo, Pedro; Lizasoain, Ignacio; Moro, María A

    2005-09-01

    Some agonists of the peroxisome proliferator-activated receptor gamma (PPARgamma) belonging to the thiazolidinedione (TZD) family, as well as the cyclopentenone prostaglandin 15-dPGJ2, have been shown to cause neuroprotection in animal models of stroke. We have tested whether the TZD-unrelated PPARgamma agonist L-796,449 is neuroprotective after permanent middle cerebral artery occlusion (MCAO) in the rat brain. Our results show that L-796,449 decreases MCAO-induced infarct size and improves neurologic scores. This protection is concomitant to inhibition of MCAO-induced brain expression of inducible NO synthase (iNOS) and the matrix metalloproteinase MMP-9 and to upregulation of the cytoprotective stress protein heme oxygenase-1 (HO-1). Analysis of the NF-kappaB p65 monomer and the NF-kappaB inhibitor IkappaBalpha protein levels as well as gel mobility shift assays indicate that L-796,449 inhibits NF-kappaB signaling, and that it may be recruiting both PPARgamma-dependent and independent pathways. In summary, our results provide new insights for stroke treatment.

  11. Sequential Therapy with Minocycline and Candesartan Improves Long-Term Recovery After Experimental Stroke.

    Science.gov (United States)

    Soliman, Sahar; Ishrat, Tauheed; Fouda, Abdelrahman Y; Patel, Ami; Pillai, Bindu; Fagan, Susan C

    2015-08-01

    Minocycline and candesartan have both shown promise as candidate therapeutics in ischemic stroke, with multiple, and somewhat contrasting, molecular mechanisms. Minocycline is an anti-inflammatory, antioxidant, and anti-apoptotic agent and a known inhibitor of matrix metalloproteinases (MMPs). Yet, minocycline exerts antiangiogenic effects both in vivo and in vitro. Candesartan promotes angiogenesis and activates MMPs. Aligning these therapies with the dynamic processes of injury and repair after ischemia is likely to improve success of treatment. In this study, we hypothesize that opposing actions of minocycline and candesartan on angiogenesis, when administered simultaneously, will reduce the benefit of candesartan treatment. Therefore, we propose a sequential combination treatment regimen to yield a better outcome and preserve the proangiogenic potential of candesartan. In vitro angiogenesis was assessed using human brain endothelial cells. In vivo, Wistar rats subjected to 90-min middle cerebral artery occlusion (MCAO) were randomized into four groups: saline, candesartan, minocycline, and sequential combination of minocycline and candesartan. Neurobehavioral tests were performed 1, 3, 7, and 14 days after stroke. Brain tissue was collected on day 14 for assessment of infarct size and vascular density. Minocycline, when added simultaneously, decreased the proangiogenic effect of candesartan treatment in vitro. Sequential treatment, however, preserved the proangiogenic potential of candesartan both in vivo and in vitro, improved neurobehavioral outcome, and reduced infarct size. Sequential combination therapy with minocycline and candesartan improves long-term recovery and maintains candesartan's proangiogenic potential.

  12. Sequential Therapy with Minocycline and Candesartan Improves Long Term Recovery after Experimental Stroke

    Science.gov (United States)

    Soliman, Sahar; Ishrat, Tauheed; Fouda, Abdelrahman Y.; Patel, Ami; Pillai, Bindu; Fagan, Susan C.

    2015-01-01

    Background Minocycline and candesartan have both shown promise as candidate therapeutics in ischemic stroke, with multiple, and somewhat contrasting, molecular mechanisms. Minocycline is an anti-inflammatory, antioxidant and anti-apoptotic agent and a known inhibitor of matrix metalloproteinases (MMPs). Yet, minocycline exerts antiangiogenic effects both in vivo and in vitro. Candesartan promotes angiogenesis and activates MMPs. Aligning these therapies with the dynamic processes of injury and repair after ischemia is likely to improve success of treatment. Objective In this study, we hypothesize that opposing actions of minocycline and candesartan on angiogenesis, when administered simultaneously, will reduce the benefit of candesartan treatment. Therefore, we propose a sequential combination treatment regimen to yield a better outcome and preserve the proangiogenic potential of candesartan. Methods In vitro angiogenesis was assessed using human brain endothelial cells. In vivo, Wistar rats subjected to 90-minute middle cerebral artery occlusion (MCAO) were randomized into 4 groups: saline, candesartan, minocycline and sequential combination of minocycline and candesartan. Neurobehavioral tests were performed 1, 3, 7 and 14 days after stroke. Brain tissue was collected on day 14 for assessment of infarct size and vascular density. Results Minocycline, when added simultaneously, decreased the proangiogenic effect of candesartan treatment in vitro. Sequential treatment, however, preserved the proangiogenic potential of candesartan both in vivo and in vitro, improved neurobehavioral outcome and reduced infarct size. Conclusion Sequential combination therapy with minocycline and candesartan improves long term recovery and maintains candesartan’s proangiogenic potential. PMID:26004281

  13. Angiotensin AT2-receptor stimulation improves survival and neurological outcome after experimental stroke in mice

    DEFF Research Database (Denmark)

    Schwengel, Katja; Namsolleck, Pawel; Lucht, Kristin

    2016-01-01

    /BL6J or AT2R-knockout mice (AT2-KO) underwent MCAO for 30 min followed by reperfusion. Starting 45 min after MCAO, mice were treated once daily for 4 days with either vehicle or C21 (0.03 mg/kg ip). Neurological deficits were scored daily. Infarct volumes were measured 96 h post-stroke by MRI. C21......This study investigated the effect of post-stroke, direct AT2-receptor (AT2R) stimulation with the non-peptide AT2R-agonist compound 21 (C21) on infarct size, survival and neurological outcome after middle cerebral artery occlusion (MCAO) in mice and looked for potential underlying mechanisms. C57...... significantly improved survival after MCAO when compared to vehicle-treated mice. C21 treatment had no impact on infarct size, but significantly attenuated neurological deficits. Expression of brain-derived neurotrophic factor (BDNF), tyrosine kinase receptor B (TrkB) (receptor for BDNF) and growth...

  14. Pediatric Stroke

    Science.gov (United States)

    ... News About Neurology Image Library Search The Internet Stroke Center Patients & Families About Stroke Stroke Diagnosis Stroke ... communicate with your child’s doctor. Symptoms of a Stroke Stroke is an injury to part of the ...

  15. Hyperhomocysteinemia and venous thromboembolic disease.

    Science.gov (United States)

    D'Angelo, A; Mazzola, G; Crippa, L; Fermo, I; Viganò D'Angelo, S

    1997-01-01

    In spite of the large number of reports showing that hyperhomocysteinemia (HHcy) is an independent risk factor for atherosclerosis and arterial occlusive disease, this metabolite of the methionine pathway is measured in relatively few laboratories and its importance is not fully appreciated. Recent data strongly suggest that mild HHcy is also involved in the pathogenesis of venous thromboembolic disease. The aim of this paper is to analyze the most recent advances in this field. The material examined in the present review includes articles and abstracts published in journals covered by the Science Citation Index and Medline. In addition the authors of the present article have been working in the field of mild HHcy as cause of venous thromboembolic disease. The studies examined provide very strong evidence supporting the role of moderate HHcy in the development of premature and/or recurrent venous thromboembolic disease. High plasma homocysteine levels are also a risk factor for deep vein thrombosis in the general population. Folic acid fortification of food has been proposed as a major tool for reducing coronary artery disease mortality in the United States. Vitamin supplementation may also reduce recurrence of venous thromboembolic disease in patients with HHcy. At the present time, however, the clinical efficacy of this approach has not been tested. In addition, the bulk of evidence indicates that fasting total homocysteine determinations can identify up to 50% of the total population of hyperhomocysteinemic subjects. Patients with isolated methionine intolerance may benefit from vitamin B6 supplementation. Homocysteine-lowering vascular disease prevention trials are urgently needed. Such controlled studies, however, should not focus exclusively on fasting homocysteine determinations and folic acid monotherapy.

  16. [Venous thromboembolic disease: presentation of a case].

    Science.gov (United States)

    Mirpuri-Mirpuri, P G; Álvarez-Cordovés, M M; Pérez-Monje, A

    2013-01-01

    Venous thromboembolic disease in its clinical spectrum includes both deep vein thrombosis and pulmonary thromboembolism, which is usually a complication of deep vein thrombosis. It is a relatively common disease with significant morbidity and requires an accurate diagnosis. They are numerous risk factors for venous thromboembolism, and there is evidence that the risk of thromboembolic disease increases proportionally to the number of predisposing risk factors present. The primary care physician should know the risk factors and suspect the presence of venous thromboembolic disease when there is a compatible clnical picture. The treatment for this pathology is anticoagulation. We report a patient with cardiovascular risk factors who was seen with pain in the right leg and shortness of breath and referred to the hospital with suspected venous thromboembolism, atrial fibrillation and pleural effusion. Copyright © 2012 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  17. A Mobitz type II atrioventricular block in multicentric ischemic stroke

    Science.gov (United States)

    Kalafat, Utku Murat; Akman, Canan; Karaboga, Turker; Ocak, Tarik

    2016-01-01

    Cardiac and cerebrovascular illnesses are major causes of mortality and morbidity. Thromboembolisms, which are the result of cardiac arrhythmia, are important causes of ischemic stroke. In this study, we present a rare case of multicentric ischemic stroke induced by Mobitz type II atrioventricular block. PMID:28154620

  18. Guidelines for the Primary Prevention of Stroke

    Science.gov (United States)

    Meschia, James F.; Bushnell, Cheryl; Boden-Albala, Bernadette; Braun, Lynne T.; Bravata, Dawn M.; Chaturvedi, Seemant; Creager, Mark A.; Eckel, Robert H.; Elkind, Mitchell S.V.; Fornage, Myriam; Goldstein, Larry B.; Greenberg, Steven M.; Horvath, Susanna E.; Iadecola, Costantino; Jauch, Edward C.; Moore, Wesley S.; Wilson, John A.

    2016-01-01

    The aim of this updated statement is to provide comprehensive and timely evidence-based recommendations on the prevention of stroke among individuals who have not previously experienced a stroke or transient ischemic attack. Evidence-based recommendations are included for the control of risk factors, interventional approaches to atherosclerotic disease of the cervicocephalic circulation, and antithrombotic treatments for preventing thrombotic and thromboembolic stroke. Further recommendations are provided for genetic and pharmacogenetic testing and for the prevention of stroke in a variety of other specific circumstances, including sickle cell disease and patent foramen ovale. PMID:25355838

  19. Accelerometer Detects Pump Thrombosis and Thromboembolic Events in an In vitro HVAD Circuit.

    Science.gov (United States)

    Schalit, Itai; Espinoza, Andreas; Pettersen, Fred-Johan; Thiara, Amrit P S; Karlsen, Hilde; Sørensen, Gro; Fosse, Erik; Fiane, Arnt E; Halvorsen, Per S

    2017-10-27

    Pump thrombosis and stroke are serious complications of left ventricular assist device (LVAD) support. The aim of this study was to test the ability of an accelerometer to detect pump thrombosis and thromboembolic events (TEs) using real-time analysis of pump vibrations. An accelerometer sensor was attached to a HeartWare HVAD and tested in three in vitro experiments using different pumps for each experiment. Each experiment included thrombi injections sized 0.2-1.0 mL and control interventions: pump speed change, afterload increase, preload decrease, and saline bolus injections. A spectrogram was calculated from the accelerometer signal, and the third harmonic amplitude was used to test the sensitivity and specificity of the method. The third harmonic amplitude was compared with the pump energy consumption. The acceleration signals were of high quality. A significant change was identified in the accelerometer third harmonic during the thromboembolic interventions. The third harmonic detected thromboembolic events with higher sensitivity/specificity than LVAD energy consumption: 92%/94% vs. 72%/58%, respectively. A total of 60% of thromboembolic events led to a prolonged third harmonic amplitude change, which is indicative of thrombus mass residue on the impeller. We concluded that there is strong evidence to support the feasibility of real-time continuous LVAD monitoring for thromboembolic events and pump thrombosis using an accelerometer. Further in vivo studies are needed to confirm these promising findings.

  20. Ginsenoside rd in experimental stroke: superior neuroprotective efficacy with a wide therapeutic window.

    Science.gov (United States)

    Ye, Ruidong; Kong, Xiangwei; Yang, Qianzi; Zhang, Yunxia; Han, Junliang; Li, Ping; Xiong, Lize; Zhao, Gang

    2011-07-01

    Ginsenoside Rd (Rd), one of the main active ingredients in Panax ginseng, has been demonstrated to protect against ischemic cerebral damage in vitro and in vivo. In this study, we aimed to further define the preclinical characteristics of Rd. We show that Rd passes the intact blood-brain barrier and exerts protection in both transient and permanent middle cerebral artery occlusion (MCAO) in rats. In the dose-response study, Rd (10-50 mg/Kg) significantly reduced the infarct volume on postoperative days (PODs) 1, 3, and 7. This protection was associated with an improved neurological outcome for as many as 6 weeks after transient MCAO, as assessed by modified neurological severity score, modified sticky-tape test, and corner test. For comparison, Rd was significantly more effective than edaravone and slightly more effective than N-tert-butyl-alpha-phenylnitrone (PBN). In the therapeutic window study, Rd exhibited remarkable neuroprotection, even when administered for as many as 4 h after the recirculation of transient MCAO or after the onset of permanent MCAO. Furthermore, in female rats or 16-month-old male rats, the salutary effects of Rd were also observed. These findings suggest Rd is a promising neuroprotectant and provide support for future clinical studies to confirm whether Rd is beneficial in ischemic stroke.

  1. Transcranial direct-current stimulation induced in stroke patients with aphasia: a prospective experimental cohort study

    Directory of Open Access Journals (Sweden)

    Michele Devido Santos

    Full Text Available CONTEXT AND OBJECTIVE: Previous animal and human studies have shown that transcranial direct current stimulation can induce significant and lasting neuroplasticity and may improve language recovery in patients with aphasia. The objective of the study was to describe a cohort of patients with aphasia after stroke who were treated with transcranial direct current stimulation. DESIGN AND SETTING: Prospective cohort study developed in a public university hospital. METHODS: Nineteen patients with chronic aphasia received 10 transcranial direct current stimulation sessions lasting 20 minutes each on consecutive days, using a current of 2 mA. The anode was positioned over the supraorbital area and the cathode over the contralateral motor cortex. The following variables were analyzed before and after the 10 neuromodulation sessions: oral language comprehension, copying, dictation, reading, writing, naming and verbal fluency. RESULTS: There were no adverse effects in the study. We found statistically significant differences from before to after stimulation in relation to simple sentence comprehension (P = 0.034, naming (P = 0.041 and verbal fluency for names of animals (P = 0.038. Improved scores for performing these three tasks were seen after stimulation. CONCLUSIONS: We observed that excitability of the primary motor cortex through transcranial direct current stimulation was associated with effects on different aspects of language. This can contribute towards future testing in randomized controlled trials.

  2. Xenon neuroprotection in experimental stroke: interactions with hypothermia and intracerebral hemorrhage

    National Research Council Canada - National Science Library

    Sheng, Siyuan P; Lei, Beilei; James, Michael L; Lascola, Christopher D; Venkatraman, Talaignair N; Jung, Jin Yong; Maze, Mervyn; Franks, Nicholas P; Pearlstein, Robert D; Sheng, Huaxin; Warner, David S

    2012-01-01

    Xenon has been proven to be neuroprotective in experimental brain injury. The authors hypothesized that xenon would improve outcome from focal cerebral ischemia with a delayed treatment onset and prolonged recovery interval...

  3. Intravenously Infused F3.Olig2 Improves Memory Deficits via Restoring Myelination in the Aged Hippocampus Following Experimental Ischemic Stroke.

    Science.gov (United States)

    Ahn, Ji Hyeon; Chen, Bai Hui; Shin, Bich Na; Cho, Jeong Hwi; Kim, In Hye; Park, Joon Ha; Lee, Jae Chul; Tae, Hyun Jin; Lee, Yun Lyul; Lee, Jaesuk; Byun, Kyunghee; Jeong, Goo-Bo; Lee, Bonghee; Kim, Seung U; Kim, Young-Myeong; Won, Moo-Ho; Choi, Soo Young

    2016-12-13

    Oligodendrocytes play a crucial role in creating the myelin sheath that is an important component in neural transmission. In an animal model of transient cerebral ischemia, application of oligodendrocyte progenitor cells (OPCs) has not yet been reported. In this study, the effects of F3.Olig2 transplantation on memory and cognitive dysfunction were investigated in the aged gerbil in which ischemic stroke was induced. To investigate the possible mechanisms underlying repair, changes in the expression of myelin basic protein (MBP), oligodendrocyte-specific protein (OSP), and brain-derived neurotrophic factor (BDNF) were examined. Experimental ischemic stroke was induced by occlusion of bilateral common carotid arteries in aged gerbils. Gerbils (n=31 per group) were randomly divided into three groups: (1) vehicle sham group, (2) vehicle ischemia group, and (3) F3.Olig2 ischemia group. After 1, 3, and 7 days of ischemiareperfusion (I-R), saline or F3.Olig2 cells (1106 cells in 100 l) were injected into the gerbils intravenously. The gerbils were sacrificed 10 days after I-R for identification of grafted F3.Olig2 cells, and 15 and 30 days after I-R for tissue analysis after conducting passive avoidance and novel object recognition test. Injected F3.Olig2 cells and MBP, OSP, and BDNF were detected by specific antibodies using immunohistochemistry and/or Western blots. Memory and cognition were significantly increased in the F3.Olig2 ischemia group compared with the vehicle ischemia group. In the F3.Olig2 ischemia group, the neurons were not protected from ischemic damage; however, MBP, OSP, and BDNF expressions were significantly increased. Our results show that injection of F3.Olig2 cells significantly improved impaired memory and cognition, which might be related to increased MBP expression via increasing OSP and BDNF expression in the aged gerbil hippocampus following transient cerebral ischemia.

  4. FELINE AORTIC THROMBOEMBOLISM: CASE REPORT

    OpenAIRE

    Figueroa A., Lizbeth; Facultad de Medicina Veterinaria, Universidad Nacional Mayor de San Marcos, Lima, Perú.; Paz M., Ricardo; Facultad de Medicina Veterinaria, Universidad Nacional Mayor de San Marcos, Lima, Perú.; Díaz C., Diego; Facultad de Medicina Veterinaria, Universidad Nacional Mayor de San Marcos, Lima, Perú.; Dávila F., Roberto; Facultad de Medicina Veterinaria, Universidad Nacional Mayor de San Marcos, Lima, Perú.

    2014-01-01

    Se presenta el caso de un felino Siamés de 13 años con tromboembolismo aórtico. Esta es una complicación asociada a una cardiomiopatía hipertrófica (CMH), enfermedad cardiaca más común del gato y que se caracteriza por la hipertrofia concéntrica ventricular izquierda. A case of a 13 year old Siamese cat whit feline aortic thromboembolism is presented. This is a devastating complication associated to hypertrophic cardiomyopathy (HCM), one of the most common heart disease in cats characteriz...

  5. Thromboembolic Complications in Fontan Patients

    DEFF Research Database (Denmark)

    Idorn, L; Jensen, A S; Juul, K

    2013-01-01

    After the Fontan procedure, patients face an increased risk for thromboembolic events (TE). The etiology for this increased thrombogenecity is incompletely understood. This study aimed to determine the prevalence of TE in Danish Fontan patients and to bring new insights into the etiology of TE...... patients and plasma was analyzed in 76 patients for biomarkers reflecting endothelial-, glycocalyx-, platelet-, and fibrinolysis function (histone-complexed DNA fragments, Protein C, soluble CD40 ligand, soluble thrombomodulin, syndecan-1, tissue-type plasminogen activator). The results were compared...

  6. VENOUS THROMBOEMBOLISM PROPHYLAXIS – THE OTHER ...

    African Journals Online (AJOL)

    VENOUS THROMBOEMBOLISM PROPHYLAXIS – THE OTHER SIDE OF THE COIN: A REVIEW OF LITERATURE ... Background: There are no local guidelines for prophylaxis against Venous Thrombo-Embolism (VTE). In the absence of any .... of leg ulceration in the age matched general population. (9.6% to 12.6%).

  7. Stroke Treatments

    Science.gov (United States)

    ... Month Infographic Stroke Hero F.A.S.T. Quiz Stroke Treatment Stroke used to rank fourth in leading causes of ... type of treatment depends on the type of stroke. Ischemic stroke happens when a clot blocks a ...

  8. Hibernation-like state induced by an opioid peptide protects against experimental stroke

    Directory of Open Access Journals (Sweden)

    Su Tsung-Ping

    2009-06-01

    Full Text Available Abstract Background Delta opioid peptide [D-ala2,D-leU5]enkephalin (DADLE induces hibernation in summer ground squirrels, and enhances preservation and survival of isolated or transplanted lungs and hearts. In the present study, we investigated the protective effect of DADLE in the central nervous system. Results Adult Sprague-Dawley rats were pretreated with DADLE (4 mg/kg every 2 h × 4 injections, i.p. or saline prior to unilateral occlusion of the middle cerebral artery (MCA. Daily behavioral tests revealed that ischemic animals treated with DADLE did not show any significant behavioral dysfunctions compared with saline-treated ischemic animals. Opioid antagonists only transiently inhibited the protective effect of DADLE, indicating the participation of non-opioid mechanisms in DADLE neuroprotection. Histological examination using triphenyltetrazolium chloride (TTC revealed that brains from ischemic animals treated with DADLE, either alone or with adjuvant opioid blockers, exhibited almost completely intact striata. In contrast, brains from ischemic animals that received saline showed significant infarction in the lateral striatum. Analyses of apoptotic cell death revealed a significant increase in the p-53 mRNA expression in the striatum of ischemic animals that received saline, while those that received DADLE exhibited near normal striatal p-53 expression. This protective effect was accompanied by significant increments in protein levels of glial cell line-derived neurotrophic factor in the striatum of DADLE-treated ischemic animals. Conclusion These results indicate that DADLE protected against necrotic and apoptotic cell death processes associated with ischemia-reperfusion injury. The present study demonstrates that delta opioids are crucially involved in stroke, suggesting that the opioid system is important in the study of brain injury and protection.

  9. Vascular disease and stroke risk in atrial fibrillation

    DEFF Research Database (Denmark)

    Olesen, Jonas Bjerring; Lip, Gregory Y.H.; Lane, Deirdre A

    2012-01-01

    Vascular disease (including myocardial infarction and peripheral artery disease) has been proposed as a less well-validated risk factor for stroke in patients with atrial fibrillation. We investigated whether vascular disease is an independent risk factor of stroke/thromboembolism in atrial fibri...... fibrillation and whether adding vascular disease improves Congestive heart failure, Hypertension, Age 75 years, Diabetes, previous Stroke (CHADS(2)) risk stratification....

  10. Enriched housing enhances recovery of limb placement ability and reduces aggrecan-containing perineuronal nets in the rat somatosensory cortex after experimental stroke.

    Directory of Open Access Journals (Sweden)

    Alexandre Madinier

    Full Text Available Stroke causes life long disabilities where few therapeutic options are available. Using electrical and magnetic stimulation of the brain and physical rehabilitation, recovery of brain function can be enhanced even late after stroke. Animal models support this notion, and housing rodents in an enriched environment (EE several days after experimental stroke stimulates lost brain function by multisensory mechanisms. We studied the dynamics of functional recovery of rats with a lesion to the fore and hind limb motor areas induced by photothrombosis (PT, and with subsequent housing in either standard (STD or EE. In this model, skilled motor function is not significantly enhanced by enriched housing, while the speed of recovery of sensori-motor function substantially improves over the 9-week study period. In particular, this stroke lesion completely obliterates the fore and hind limb placing ability when visual and whisker guidance is prevented, a deficit that persists for up to 9 weeks of recovery, but that is markedly restored within 2 weeks by enriched housing. Enriched housing after stroke also leads to a significant loss of perineuronal net (PNN immunoreactivity; detection of aggrecan protein backbone with AB1031 antibody was decreased by 13-22%, and labelling of a glycan moiety of aggrecan with Cat-315 antibody was reduced by 25-30% in the peri-infarct area and in the somatosensory cortex, respectively. The majority of these cells are parvalbumin/GABA inhibitory interneurons that are important in sensori-information processing. We conclude that damage to the fore and hind limb motor areas provides a model of loss of limb placing response without visual guidance, a deficit also seen in more than 50% of stroke patients. This loss is amenable to recovery induced by multiple sensory stimulation and correlates with a decrease in aggrecan-containing PNNs around inhibitory interneurons. Modulating the PNN structure after ischemic damage may provide new

  11. Postpartum venous thromboembolism: incidence and risk factors.

    Science.gov (United States)

    Tepper, Naomi K; Boulet, Sheree L; Whiteman, Maura K; Monsour, Michael; Marchbanks, Polly A; Hooper, W Craig; Curtis, Kathryn M

    2014-05-01

    To calculate incidence of postpartum venous thromboembolism by week after delivery and to examine potential risk factors for venous thromboembolism overall and at different times during the postpartum period. A deidentified health care claims information database from employers, health plans, hospitals, and Medicaid programs across the United States was used to identify delivery hospitalizations among women aged 15-44 years during the years 2005-2011. International Classification of Diseases, 9th Revision, Clinical Modification diagnosis and procedure codes were used to identify instances of venous thromboembolism and associated characteristics and conditions among women with recent delivery. Incidence proportions of venous thromboembolism by week postpartum through week 12 were calculated per 10,000 deliveries. Logistic regression was used to calculate odds ratios for selected risk factors among women with postpartum venous thromboembolism and among women with venous thromboembolism during the early or later postpartum periods. The incidence proportion of postpartum venous thromboembolism was highest during the first 3 weeks after delivery, dropping from nine per 10,000 during the first week to one per 10,000 at 4 weeks after delivery and decreasing steadily through the 12th week. Certain obstetric procedures and complications such as cesarean delivery, preeclampsia, hemorrhage, and postpartum infection conferred an increased risk for venous thromboembolism (odds ratios ranging from 1.3 to 6.4), which persisted over the 12-week period compared with women without these risk factors. Risk for postpartum venous thromboembolism is highest during the first 3 weeks after delivery. Women with obstetric complications are at highest risk for postpartum venous thromboembolism, and this risk remains elevated throughout the first 12 weeks after delivery. II.

  12. Key performance indicators for stroke from the Ministry of Health of Brazil: benchmarking and indicator parameters.

    Science.gov (United States)

    Lange, Marcos C; Braga, Gabriel Pereira; Nóvak, Edison M; Harger, Rodrigo; Felippe, Maria Justina Dalla Bernardina; Canever, Mariana; Dall'Asta, Isabella; Rauen, Jordana; Bazan, Rodrigo; Zetola, Viviane

    2017-06-01

    All 16 KPIs were analyzed, including the percentage of patients admitted to the stroke unit, venous thromboembolism prophylaxis in the first 48 hours after admission, pneumonia and hospital mortality due to stroke, and hospital discharge on antithrombotic therapy in patients without cardioembolic mechanism. Both centers admitted over 80% of the patients in their stroke unit. The incidence of venous thromboembolism prophylaxis was > 85%, that of in-hospital pneumonia was 70%. Our results suggest using the parameters of all of the 16 KPIs required by the Ministry of Health of Brazil, and the present results for the two stroke units for future benchmarking.

  13. [Venous thromboembolism's risk assessment: rationale, objectives, and methodology--the ARTE study].

    Science.gov (United States)

    França, Ana; De Sousa, Joaquim Abreu; Felicíssimo, Paulo; Ferreira, Daniel

    2011-12-01

    Venous thromboembolism is a frequent clinical condition with high impact on both morbidity and mortality. Venous thromboembolism risk is particularly high in hospitalized patients as well as in oncologic patients, being a factor of poor prognosis for the oncologic disease. Several clinical studies have shown the need to develop effective hospital strategies using a systematic and individualized assessment of venous thromboembolism risk, and additionally to optimize the institution of prophylaxis treatment and its proper use in the context of in-hospital and outpatient management. The ARTE national study is a non-interventional, multicentre, prospective study which is divided in two phases. In the first phase patients are followed in the hospital; in the second phase patients are followed in ambulatory context for a period of 6 months after discharge. Four thousand patients will be included, equally distributed over medical, surgical, oncologic and orthopaedic patients. Data will be collected from the patient's clinical files and through direct clinical evaluation of risk factors for venous thromboembolism, in the departments of medicine, oncology, surgery, and orthopaedics of the participating centres. The main objectives of the study are to assess the risk profile of venous thromboembolism of the study population using a risk assessment model adapted from the Caprini and Khorana et al models, and the validation of the score for the Portuguese population. Simultaneously, the secondary objectives are as follows: to determine the proportion of patients with venous thromboembolism risk, according to the risk assessment model, that are doing prophylaxis; to determine the duration of prophylaxis during the hospitalization; to determine the proportion of patients doing long-term prophylaxis, at the moment of the discharge; to determine the incidence of thromboembolic events (deep venous thrombosis; stroke; pulmonary thromboembolism; transient ischemic attack

  14. Cardiovascular thromboembolic events associated with febuxostat: investigation of cases from the FDA adverse event reporting system database.

    Science.gov (United States)

    Gandhi, Pranav K; Gentry, William M; Bottorff, Michael B

    2013-06-01

    Uloric (Febuxostat) has been linked with cardiovascular thromboembolic events in gout patients. However, no post-marketing data analysis has investigated these drug-associated adverse event reports. The study objective was to identify febuxostat-associated cardiovascular thromboembolic event reports in the US using the Food and Drug Administration adverse event reporting system (AERS) database. Reports listing uloric and febuxostat as the suspect drug and cardiovascular thromboembolic events (combined in a single term based on adverse event reports of myocardial infarction, stroke, among others) as the adverse event were extracted from the drug's approval date through the fourth quarter of 2011. Bayesian statistics within the neural network architecture was implemented to identify potential signals of febuxostat-associated cardiovascular thromboembolic events. A potential signal for the drug-adverse event combination reports is generated when the lower limit of the 95% two-sided confidence interval of the information component (IC), denoted by IC025 is greater than zero. Twenty-one combination reports of febuxostat-associated cardiovascular thromboembolic events were identified in gout patients in the US. The mean age of combination cases was 64 years. Potential signals (IC025 = 4.09) was generated for combination reports of febuxostat-associated cardiovascular thromboembolic events. AERS indicated potential signals of febuxostat-associated cardiovascular thromboembolic events. AERS is not capable of establishing the causal link and detecting the true frequency of an adverse event associated with a drug. The positive IC value found in this study merits continued surveillance and assessment of cardiovascular thromboembolic events associated with Febuxostat. Copyright © 2013 Elsevier Inc. All rights reserved.

  15. Mental Practice Combined with Motor Rehabilitation to Treat Upper Limb Hemiparesis of Post-Stroke Patients: Clinical and Experimental Evidence.

    Science.gov (United States)

    Machado, Sergio; Lattari, Eduardo; Paes, Flávia; Rocha, Nuno B F; Nardi, Antonio E; Arias-Carrión, Oscar; Mura, Gioia; Yuan, Ti-Fei; Carta, Mauro G; Campos, Carlos

    2016-01-01

    Stroke is one of the major causes of disability in the world. Due to the extended lifetime of the world's population, the number of people affected by stroke has increased substantially over the last years. Stroke may lead to sensorimotor deficits, usually causing hemiplegia or hemiparesia. In order to reduce motor deficits and accelerate functional recovery, MP combined with motor rehabilitation was introduced to the rehabilitation process of post-stroke patients. Evidence has shown that MP combining with motor rehabilitation based on activities of daily living was more effective than conventional motor rehabilitation used per se. This combination proved very useful and effective, with significant results in improvement of motor deficits in post-stroke patients. However, further studies must be conducted to determine specific parameters, such as type of imagery, frequency or duration.

  16. Mental Practice Combined with Motor Rehabilitation to Treat Upper Limb Hemiparesis of Post-Stroke Patients: Clinical and Experimental Evidence

    Science.gov (United States)

    Machado, Sergio; Lattari, Eduardo; Paes, Flávia; Rocha, Nuno B.F.; Nardi, Antonio E.; Arias-Carrión, Oscar; Mura, Gioia; Yuan, Ti-Fei; Carta, Mauro G.; Campos, Carlos

    2016-01-01

    Stroke is one of the major causes of disability in the world. Due to the extended lifetime of the world's population, the number of people affected by stroke has increased substantially over the last years. Stroke may lead to sensorimotor deficits, usually causing hemiplegia or hemiparesia. In order to reduce motor deficits and accelerate functional recovery, MP combined with motor rehabilitation was introduced to the rehabilitation process of post-stroke patients. Evidence has shown that MP combining with motor rehabilitation based on activities of daily living was more effective than conventional motor rehabilitation used per se. This combination proved very useful and effective, with significant results in improvement of motor deficits in post-stroke patients. However, further studies must be conducted to determine specific parameters, such as type of imagery, frequency or duration. PMID:27346996

  17. Familial Clustering of Venous Thromboembolism

    DEFF Research Database (Denmark)

    Sindet-Pedersen, Caroline; Oestergaard, Louise Bruun; Gundlund, Anna

    2016-01-01

    BACKGROUND: Identification of risk factors for venous thromboembolism (VTE) is of utmost importance to improve current prophylactic regimes and treatment guidelines. The extent to which a family history contributes to the risk of VTE needs further exploration. OBJECTIVES: To examine the relative...... rate of VTE in first-degree relatives compared with the general population. METHODS: By crosslinking Danish nationwide registries we identified patients with VTE between 1978 and 2012, and their familial relations. The first member in a family to acquire VTE was defined as the proband. All first...... regression models, with the general population as a fixed reference. RESULTS: We identified 70,767 children of maternal probands, 66,065 children of paternal probands, and 29,183 siblings to sibling probands. Having a maternal proband or a paternal proband were associated with a significantly increased VTE...

  18. [Pulmonary thromboembolism in Occupational Medicine].

    Science.gov (United States)

    Reinoso-Barbero, Luis; Díaz-Garrido, Ramón; Fernández-Fernández, Miguel; Capapé-Aguilar, Ana; Romero-Paredes, Carmen; Aguado-Benedí, María-José

    2015-01-01

    Occupational physicians should be familiar with the risk factors and clinical presentation of pulmonary thromboembolism (PTE). PTE belongs to the group ofis a cardiovascular diseases, which are the main cause (40%) of death in Spanish workplaces; at present, they may be considered a work-related injury because of the doctrinal evolution in the legal interpretation of the presumption of iuris tantum. We present the case of a hypertensive and obese adult male who suffered a PTE at his workplace. The availability of a portable pulse oximeter (room air SpO2, 92%) was critical in guiding the decision to refer him urgently to the hospital, where the diagnosis was confirmed. We can conclude that, independently of whether this event is later deemed to be work-related (in this case it was not), occupational physicians must know how to correctly manage and refer affected workers. Copyright belongs to the Societat Catalana de Salut Laboral.

  19. Ischemic Stroke

    Science.gov (United States)

    A stroke is a medical emergency. There are two types - ischemic and hemorrhagic. Ischemic stroke is the most common type. It is usually ... are at risk for having a more serious stroke. Symptoms of stroke are Sudden numbness or weakness ...

  20. CT evaluation of chronic thromboembolic pulmonary hypertension

    Energy Technology Data Exchange (ETDEWEB)

    Willemink, M.J. [Department of Radiology, St Antonius Hospital, Nieuwegein (Netherlands); Es, H.W. van, E-mail: h.es@antoniusziekenhuis.nl [Department of Radiology, St Antonius Hospital, Nieuwegein (Netherlands); Koobs, L. [Department of Radiology, St Antonius Hospital, Nieuwegein (Netherlands); Morshuis, W.J. [Department of Cardio-Thoracic Surgery, St Antonius Hospital, Nieuwegein (Netherlands); Snijder, R.J. [Department of Pulmonary Disease, St Antonius Hospital, Nieuwegein (Netherlands); Heesewijk, J.P.M. van [Department of Radiology, St Antonius Hospital, Nieuwegein (Netherlands)

    2012-03-15

    The educational objectives of this article are to provide an overview of the computed tomography (CT) findings in chronic thromboembolic pulmonary hypertension. This article reviews the key imaging findings at CT in patients with chronic thromboembolic pulmonary hypertension. After reading this article, the reader should have an improved awareness of the condition, its imaging features, and the CT imaging features associated with surgically accessible disease.

  1. Diagnostic value of plasma signal peptide-Cub-Egf domain-containing protein-1 (SCUBE-1) in an experimental model of acute ischemic stroke.

    Science.gov (United States)

    Turkmen, Suha; Eryigit, Umut; Karaca, Yunus; Mentese, Ahmet; Sumer, Uzun Aysegul; Yulug, Esin; Aksut, Nurhak; Gazioglu, Sibel; Gunduz, Abdulkadir

    2015-02-01

    This study was intended to examine possible diagnostic value of plasma Signal Peptide-Cub-Egf domain-containing protein-1 (SCUBE1) levels in an experimental model of acute ischemic stroke. Twenty-four female Sprague Dawley rats were divided into four groups. Blood and brain tissue specimens were collected immediately following artery ligation (control; Group 1), 1h after ligation (Group 2), 2 h after ligation (Group 3) and 6h after ligation (Group 4). SCUBE1 levels were investigated in the serum specimens. The brain samples were examined histopathologically. Correlation analysis was performed between the values. Median SCUBE1 values were 1.75 ng/ml in the control group, 3.80 ng/ml, 3.71 ng/ml and 4.19 ng/ml in the groups 2, 3 and 4, respectively (n=6 for each, P=0.004, for each group compared to control values). Histopathological analysis revealed median atrophic neuron percentages of 16% (in group 1), 42%, 55% and 76% in group 2, 3 and 4 respectively (n=6 for each, P=0.004, for each group compared to control group). A higly significant correlation was determined between SCUBE-1 levels and percentage of atrophic neurons (r=0.744 P=0.000). In this experimental model of acute ischemic stroke plasma SCUBE1 levels rose from the 1st hour of induced stroke and remained high up to 6th hour tested. Results of this experimental study has a potential to become the basis for a clinical study to confirm whether SCUBE1 can be used as a biomarker in the early diagnosis of acute ischemic stroke patients. Copyright © 2014 Elsevier Inc. All rights reserved.

  2. The use of aspirin for primary and secondary prevention in venous thromboembolism and other cardiovascular disorders.

    Science.gov (United States)

    Cohen, A T; Imfeld, S; Markham, J; Granziera, S

    2015-02-01

    Cardiovascular disease (CVD) includes a number of conditions such as myocardial infarction, coronary heart disease, stroke, and venous thromboembolism. CVD is a leading health problem worldwide and a major cause of mortality, morbidity, and disability; it is also associated with high healthcare costs. The incidence of CVD is predicted to increase in the forthcoming years, and thus it is crucial that physicians are aware of the benefits and limitations of the available therapies to ensure patients receive optimized treatment. Current clinical practice guidelines provide recommendations on the use of anticoagulants and antiplatelets for both the prevention and treatment of CVD. Aspirin is the most studied antiplatelet agent in this context. The benefits of aspirin are well documented and supported by data from robust clinical trials for CVD conditions, such as acute coronary syndrome and stroke prevention in patients with atrial fibrillation. However, the clinical benefits of aspirin are less clear for other conditions, namely for primary prevention of venous thromboembolism after major orthopaedic surgery, particularly in comparison with newer drugs such as the direct oral anticoagulants. This article provides an outline of the current guidelines and a critical assessment of the efficacy and safety data supporting the recommendations for the use of aspirin in the treatment and prevention of venous thromboembolism and other cardiovascular disorders. Copyright © 2015 Elsevier Ltd. All rights reserved.

  3. Promoter Polymorphism (−174, G/C) of Interleukin-6 and Arterial Thromboembolic Events: A Meta-Analysis

    Science.gov (United States)

    Kim, Su Kang; Chung, Joo-Ho; Kwon, Oh Young

    2016-01-01

    Background Ischemic stroke and myocardial infarction are fatal diseases and are among the top 10 causes of death in Korea, including arterial thromboembolic events. Many previous studies have described the function of interleukin-6 (IL-6) in arterial thromboembolic events and the association between promoter single-nucleotide polymorphism (SNP) (rs1800795; −174, G/C) of the IL-6 gene. However, these results were controversial. Therefore, we performed a meta-analysis to more precisely assess the association between the SNP of the IL-6 gene and susceptibility to arterial thromboembolic events. Material/Methods We used PubMed, Embase, Google Scholar, and Korean Studies Information Service System (KISS) electronic databases. Comprehensive Meta-analysis software (Corporation, NJ) was used to evaluate the relationship between rs1800795 SNP of IL-6 gene and risk of arterial thromboembolic events. Odds ratio (OR), 95% confidence interval (CI), and P value were also calculated. The 13 eligible studies were analyzed in the meta-analysis. Results The present meta-analysis found that rs1800795 SNP of IL-6 gene is not significantly associated with susceptibility to arterial thromboembolic events (C allele vs. G allele, OR=1.04, 95% CI=0.91–1.19, P=0.619; CC vs. CG+GG, OR=1.09, 95% CI=0.91–1.31, P=0.364; CC+CG vs. GG, OR=0.97, 95% CI=0.78–1.21, P=0.763, respectively), and the SNP of IL-6 gene also did not show any significant association with ischemic stroke or myocardial infarction (P>0.05 in each model). Conclusions We found that rs1800795 SNP of IL-6 gene was not related to arterial thromboembolic events. However, further study will be needed to confirm these results. PMID:27840402

  4. Promoter Polymorphism (-174, G/C) of Interleukin-6 and Arterial Thromboembolic Events: A Meta-Analysis.

    Science.gov (United States)

    Kim, Su Kang; Chung, Joo-Ho; Kwon, Oh Young

    2016-11-14

    BACKGROUND Ischemic stroke and myocardial infarction are fatal diseases and are among the top 10 causes of death in Korea, including arterial thromboembolic events. Many previous studies have described the function of interleukin-6 (IL-6) in arterial thromboembolic events and the association between promoter single-nucleotide polymorphism (SNP) (rs1800795; -174, G/C) of the IL-6 gene. However, these results were controversial. Therefore, we performed a meta-analysis to more precisely assess the association between the SNP of the IL-6 gene and susceptibility to arterial thromboembolic events. MATERIAL AND METHODS We used PubMed, Embase, Google Scholar, and Korean Studies Information Service System (KISS) electronic databases. Comprehensive Meta-analysis software (Corporation, NJ) was used to evaluate the relationship between rs1800795 SNP of IL-6 gene and risk of arterial thromboembolic events. Odds ratio (OR), 95% confidence interval (CI), and P value were also calculated. The 13 eligible studies were analyzed in the meta-analysis. RESULTS The present meta-analysis found that rs1800795 SNP of IL-6 gene is not significantly associated with susceptibility to arterial thromboembolic events (C allele vs. G allele, OR=1.04, 95% CI=0.91-1.19, P=0.619; CC vs. CG+GG, OR=1.09, 95% CI=0.91-1.31, P=0.364; CC+CG vs. GG, OR=0.97, 95% CI=0.78-1.21, P=0.763, respectively), and the SNP of IL-6 gene also did not show any significant association with ischemic stroke or myocardial infarction (P>0.05 in each model). CONCLUSIONS We found that rs1800795 SNP of IL-6 gene was not related to arterial thromboembolic events. However, further study will be needed to confirm these results.

  5. Observationally and Genetically High YKL-40 and Risk of Venous Thromboembolism in the General Population: Cohort and Mendelian Randomization Studies.

    Science.gov (United States)

    Kjaergaard, Alisa D; Johansen, Julia S; Bojesen, Stig E; Nordestgaard, Børge G

    2016-05-01

    High baseline YKL-40 is associated with later development of ischemic stroke, but not with myocardial infarction. Whether high YKL-40 levels are associated with increased risk of venous thromboembolism is presently unknown. We tested the hypothesis that observationally and genetically high YKL-40 is associated with increased risk of venous thromboembolism in the general population. Cohort and Mendelian randomization studies in 96 110 individuals from the Danish general population, with measured plasma levels of YKL-40 (N=21 647) and CHI3L1 rs4950928 genotype (N=94 579). From 1977 to 2013, 1489 individuals developed pulmonary embolism, 2647 developed deep vein thrombosis, and 3750 developed venous thromboembolism (pulmonary embolism and deep vein thrombosis). For the 91% to 100% versus 0% to 33% YKL-40 percentile category, the multifactorially adjusted hazard ratio was 2.38 (95% confidence interval, 1.25-4.55) for pulmonary embolism, 1.98 (1.09-3.59) for deep vein thrombosis, and 2.13 (1.35-3.35) for venous thromboembolism. Compared with rs4950928 GG homozygosity, presence of C-allele was associated with a doubling (CG) or tripling (CC) in YKL-40 levels, but not with risk of venous thromboembolism. A doubling in YKL-40 was associated with a multifactorially adjusted observational hazard ratio for pulmonary embolism of 1.17 (1.00-1.38) and a genetic odds ratio of 0.97 (0.76-1.23). Corresponding risk estimates were 1.28 (1.12-1.47) observationally and 1.11 (0.91-1.35) genetically for deep vein thrombosis and 1.23 (1.10-1.38) observationally and 1.08 (0.92-1.27) genetically for venous thromboembolism. High YKL-40 levels were associated with a 2-fold increased risk of venous thromboembolism, but the association was not causal. © 2016 American Heart Association, Inc.

  6. [Atrial fibrillation and stroke].

    Science.gov (United States)

    Aamodt, Anne Hege; Sandset, Per Morten; Atar, Dan; Tveit, Arnljot; Russell, David

    2013-08-06

    More than 70,000 Norwegians have atrial fibrillation, which is a major risk factor for ischemic stroke. A large proportion of ischemic strokes caused by atrial fibrillation could be prevented if patients receive optimal prophylactic treatment. This article describes the risk for ischemic stroke in patients with atrial fibrillation, and discusses who should receive prophylactic treatment and which therapy provides the best prevention. The article is based on recently published European, American and Canadian guidelines, a search in PubMed and the authors' own clinical experience. The new risk score CHA2DS2-VASc is better than the CHADS2 score for identifying patients with atrial fibrillation who have a truly low risk of ischemic stroke and are not in need of antithrombotic treatment. Oral anticoagulation therapy is recommended for patients with two or more risk factors for thromboembolism in addition to atrial fibrillation (CHA2DS2-VASc ≥ 2). Patients with atrial fibrillation and a single additional risk factor (CHA2DS2-VASc =1) an individual assessment should be made as to who should receive oral anticoagulants, and for patients with CHA2DS2-VASc = 0 antithrombotic treatment is not recommended. New oral anticoagulants are at least as effective as warfarin for preventing ischemic stroke in patients with nonvalvular atrial fibrillation, they carry a lower risk of cerebral haemorrhage, especially intracranial haemorrhage and are more practical in use. Platelet inhibitors have a minimal role in stroke prevention in patients with atrial fibrillation. Risks stratifying patients using the CHA2DS2-VASc score is a better method for assessing which patients with atrial fibrillation who should receive oral anticoagulation. The introduction of new oral anticoagulants will simplify preventive treatment and hopefully lead to a more efficient anticoagulation treatment in a larger number of patients with atrial fibrillation.

  7. Use of the SAMe-TT2R2 score to predict anticoagulation control in atrial fibrillation and venous thromboembolism patients treated with vitamin K antagonists

    DEFF Research Database (Denmark)

    Zulkifly, Hanis; Lip, Gregory Y H; Lane, Deirdre A

    2017-01-01

    Identifying patients who are likely to achieve and maintain a therapeutic INR when prescribed a vitamin K antagonist (VKA) for stroke prevention in atrial fibrillation (AF) and venous thromboembolism (VTE) is challenging. The SAMe-TT2R2 score was developed based on common clinical factors that can...

  8. Progestin-only contraception and thromboembolism: A systematic review.

    Science.gov (United States)

    Tepper, Naomi K; Whiteman, Maura K; Marchbanks, Polly A; James, Andra H; Curtis, Kathryn M

    2016-12-01

    Women with medical conditions associated with increased risk for thrombosis generally should not use estrogen-containing contraceptives; however, less is known about progestin-only contraceptives (POCs) and thrombosis risk. The objective was to identify evidence regarding the risk of venous thromboembolism (VTE) or arterial thromboembolism [stroke or acute myocardial infarction (AMI)] among women using POCs. We searched the PubMed database for all articles published from database inception through January 2016 for studies examining thrombosis among women using POCs. We included studies which examined women with medical conditions associated with thrombosis risk, as well as studies of women in the general population (either without these conditions or who were not specified to have these conditions). Hormonal contraceptives of interest included progestin-only pills (POPs), injectables, implants and levonorgestrel-releasing intrauterine devices (LNG-IUDs). Outcomes of interest included VTE, stroke and AMI. There were 26 articles of good to poor quality that met inclusion criteria; 9 studies examined women with medical conditions and 20 examined women in the general population. Two studies found that, among smokers and women with certain thrombogenic mutations, use of depot medroxyprogesterone acetate (DMPA) had elevated odds of VTE compared with nonsmokers or those without mutations, although confidence intervals were wide and overlapped with odds among nonusers. One study found that, among women with previous VTE, use of POCs (including DMPA) was associated with a nonsignificant increased odds of recurrent VTE (all of which were among DMPA users); two other studies that examined POCs other than DMPA did not observe an association with recurrent VTE. Two studies found that use of DMPA among healthy women was also associated with increased odds of VTE. Two studies found that use of POCs for therapeutic indications was associated with increased odds of VTE. Studies did

  9. Atrial fibrillation and thromboembolism in patients with hypertrophic cardiomyopathy: systematic review.

    Science.gov (United States)

    Guttmann, Oliver P; Rahman, M Shafiqur; O'Mahony, Constantinos; Anastasakis, Aris; Elliott, Perry M

    2014-03-01

    HCM is commonly associated with AF. Current guidelines for AF management omit detailed advice for HCM because of a lack of clinical prediction tools that estimate the risk of developing AF and an absence of adequately powered treatment studies. To critically review current literature on atrial fibrillation (AF) and thromboembolism in hypertrophic cardiomyopathy (HCM) and meta-analyse prevalence and incidence. PubMed and Web of Science. Studies investigating AF and stroke in HCM as primary or secondary endpoint. Two investigators independently reviewed and extracted data from the identified articles. A random effect meta-regression model and I(2) statistics were used for analysis. A population of 7381 patients (33 studies) revealed overall AF prevalence of 22.45% (95% CI 20.13% to 24.77%), I(2)=78.9% (p<0.001). Overall prevalence of thromboembolism in HCM patients with AF was 27.09% (95% CI 20.94% to 33.25%), I(2)=61.4% ( p<0.01). Overall AF incidence was 3.08% per 100 patients per year (95% CI 2.63% to 3.54%, I(2)=86.5%, p<0.001) and incidence of thromboembolism in HCM patients with AF was 3.75% per 100 patients per year (95% CI 2.88% to 4.61%), I(2)=37.9% (p=0.1). Left atrial (LA) dimension and age were common predictors for AF and thromboembolism. Meta-analysis revealed an LA diameter of 38.03 mm (95% CI 34.62% to 41.44%) in sinus rhythm and 45.37 mm (95% CI 41.64% to 49.04%) in AF. There were no randomised controlled trials of therapy; anticoagulation was associated with lower stroke incidence but data on other interventions were limited and contradictory. AF is common in HCM and associated with high thromboembolic risk. LA dimension and age are independently associated with AF but the literature is insufficient to create robust clinical tools to predict AF or thromboembolism. Most data suggest that AF patients should be anticoagulated.

  10. In vivo experimental stroke and in vitro organ culture induce similar changes in vasoconstrictor receptors and intracellular calcium handling in rat cerebral arteries

    DEFF Research Database (Denmark)

    Povlsen, Gro Klitgaard; Waldsee, Roya; Ahnstedt, Hilda

    2012-01-01

    after stroke. Here, we evaluate changes of ET(B) and 5-HT(1B) receptors, intracellular calcium levels, and calcium channel expression in rat middle cerebral artery (MCA) after focal cerebral ischemia and in vitro organ culture, a proposed model of vasoconstrictor receptor changes after stroke. Rats were...... subjected to 2 h MCA occlusion followed by reperfusion for 1 or 24 h. Alternatively, MCAs from naïve rats were cultured for 1 or 24 h. ET(B) and 5-HT(1B) receptor-mediated contractions were evaluated by wire myography. Receptor and channel expressions were measured by real-time PCR and immunohistochemistry....... Intracellular calcium was measured by FURA-2. Expression and contractile functions of ET(B) and 5-HT(1B) receptors were strongly upregulated and slightly downregulated, respectively, 24 h after experimental stroke or organ culture. ET(B) receptor-mediated contraction was mediated by calcium from intracellular...

  11. The effect of a haptic biofeedback system on postural control in patients with stroke: An experimental pilot study.

    Science.gov (United States)

    Yasuda, Kazuhiro; Kaibuki, Naomi; Harashima, Hiroaki; Iwata, Hiroyasu

    2017-06-01

    Impaired balance in patients with hemiparesis caused by stroke is frequently related to deficits in the central integration of afferent inputs, and traditional rehabilitation reinforces excessive visual reliance by focusing on visual compensation. The present study investigated whether a balance task involving a haptic biofeedback (BF) system, which provided supplementary vibrotactile sensory cues associated with center-of-foot-pressure displacement, improved postural control in patients with stroke. Seventeen stroke patients were assigned to two groups: the Vibrotactile BF and Control groups. During the balance task (i.e., standing on a foam mat), participants in the Vibrotactile BF group tried to stabilize their postural sway while wearing the BF system around the pelvic girdle. In the Control group, participants performed an identical postural task without the BF system. Pre- and post-test measurements of postural control using a force plate revealed that the stability of bipedal posture in the Vibrotactile BF group was markedly improved compared with that in the Control group. A balance task involving a vibrotactile BF system improved postural stability in patients with stroke immediately. This confirms the potential of a haptic-based BF system for balance training, both in routine clinical practice and in everyday life.

  12. Tuberculosis and Venous Thromboembolism: a case series.

    Science.gov (United States)

    Goncalves, Ivone M; Alves, Daniela Costa; Carvalho, Aurora; do Ceu Brito, Maria; Calvario, Fernando; Duarte, Raquel

    2009-12-16

    Tuberculosis remains an infectious disease with a high prevalence worldwide and represents a major public health issue. Although venous thromboembolism is a rare complication of this disease, it may be a potentially life-threatening event. We report two cases of severe pulmonary tuberculosis associated with venous thromboembolism. A 38 year-old caucasian male that had a thromboembolic event as an unsual presentation form of tuberculosis and a 51 year-old caucasian male that developed deep venous thrombosis later in the course of the disease. An association between inflamation induced by tuberculosis and a hypercoagulable state has been described. Therefore, the occurence of deep venous thrombosis or pulmonary embolic episods, should be considered in patients with tuberculosis particulary during the first weeks of treatment. The physician's awarness of these phenomena is important to an early diagnostic suspicion and prompt treatment in order to prevent fatal outcomes.

  13. Thromboembolism prophylaxis practices in orthopaedic arthroplasty patients.

    LENUS (Irish Health Repository)

    Cawley, D

    2010-10-01

    Thromboembolic events are a post-operative complication of arthroplasty surgery for up to 3 months. The incidence however, is not fully known. Some form of prophylaxis should be provided to all arthroplasty patients. Clinicians are wary of side effects, compliance profile and the associated cost. The objective of this study is to investigate practice patterns and their relevance to 3 risk groups. Ninety questionnaires were sent to orthopaedic surgeons with 3 hypothetical clinical scenarios and 10 prophylaxis regimes for thromboembolism across different risk groups. The response rate was 81\\/90 (90%). The most popular options in all 3 cases were early mobilisation, thrombo-embolism deterrant (TED) stockings and low molecular weight heparin (LMWH) (51\\/81, 62% of all cases). An inconsistent relationship exists between preferred practice and relevant guidelines. Preferred practice does not correlate with each level of risk.

  14. Diagnosing chronic thromboembolic pulmonary hypertension: current perspectives

    Directory of Open Access Journals (Sweden)

    Hadinnapola C

    2014-09-01

    Full Text Available Charaka Hadinnapola, Deepa Gopalan, David P Jenkins Papworth Hospital National Health Service Foundation Trust, Papworth Everard, Cambridge, United Kingdom Abstract: Chronic thromboembolic pulmonary hypertension is a rare and relatively poorly understood disease. It remains underdiagnosed and is often not recognized in primary and secondary care, as its symptoms are nonspecific and there are few clinical signs until late in the disease process. However, pulmonary endarterectomy (PEA offers a potential cure for patients with this type of pulmonary hypertension; therefore, it is important that they are identified and diagnosed in a timely manner. PEA is associated with a 2.2%–5% risk of significant morbidity and mortality, even in experienced PEA centers. Therefore, once chronic thromboembolic pulmonary hypertension is diagnosed, further assessment of operability and patient selection is crucial. Assessment of operability involves determining the distribution and burden of chronic thromboembolic disease, assessing pulmonary hemodynamics, and assessing the functional impairment of the patient. Ventilation perfusion scintigraphy is of value in screening for the presence of chronic thromboembolic disease. However, computer tomography pulmonary angiography and magnetic resonance pulmonary angiography are now increasingly used to image the vascular occlusions directly. This allows assessment of the surgically accessible disease burden. Some centers still advocate conventional selective pulmonary angiography for the latter. Right-heart catheterization remains the gold standard for assessing pulmonary hemodynamics. Higher pulmonary vascular resistances are associated with poorer outcomes as well as increased risks at the time of surgery. This is in part because of the presence of more distal chronic thromboembolic material and distal pulmonary artery remodeling. However, in experienced centers, these patients are being operated on safely and with good

  15. Enriched environment reduces apolipoprotein E (ApoE) in reactive astrocytes and attenuates inflammation of the peri-infarct tissue after experimental stroke

    DEFF Research Database (Denmark)

    Ruscher, Karsten; Johannesson, Emelie; Brugiere, Elena

    2009-01-01

    that differentially improve recovery after occlusion of the middle cerebral artery occlusion (MCAO). We found that after MCAO the ApoE levels increased in the injured hemisphere over a 30 days recovery period. The exception was a proximal narrow peri-infarct rim, in which ApoE was solely localized in S100beta...... lower in animals housed in an enriched environment. We propose that during the subacute phase after experimental stroke a zone for tissue reorganization with low cellular ApoE levels is formed. We conclude that the strong sensori-motor stimulation provided by enriched housing conditions mitigates...

  16. A Mobitz type II atrioventricular block in multicentric ischemic stroke ...

    African Journals Online (AJOL)

    A Mobitz type II atrioventricular block in multicentric ischemic stroke. Utku Murat Kalafat, Canan Akman, Turker Karaboga, Tarik Ocak. Abstract. Cardiac and cerebrovascular illnesses are major causes of mortality and morbidity. Thromboembolisms, which are the result of cardiac arrhythmia, are important causes of ischemic ...

  17. Hemorrhagic Stroke

    Science.gov (United States)

    A stroke is a medical emergency. There are two types - ischemic and hemorrhagic. Hemorrhagic stroke is the less common type. It happens when ... an artery wall that breaks open. Symptoms of stroke are Sudden numbness or weakness of the face, ...

  18. Stroke Rehabilitation

    Science.gov (United States)

    A stroke can cause lasting brain damage. People who survive a stroke need to relearn skills they lost because of ... them relearn those skills. The effects of a stroke depend on which area of the brain was ...

  19. Edoxaban in Atrial Fibrillation and Venous Thromboembolism-Ten Key Questions and Answers: A Practical Guide.

    Science.gov (United States)

    De Caterina, Raffaele; Ageno, Walter; Boriani, Giuseppe; Colonna, Paolo; Ghirarduzzi, Angelo; Patti, Giuseppe; Rossini, Roberta; Rubboli, Andrea; Schinco, Piercarla; Agnelli, Giancarlo

    2017-03-01

    Edoxaban is the fourth non-vitamin K antagonist oral anticoagulant now available for clinical use in the prevention of stroke/systemic embolism in atrial fibrillation (AF) and in the treatment of venous thromboembolism (VTE), after the completion of large-scale randomized comparative clinical trials with the vitamin K antagonist warfarin. Edoxaban has some peculiar pharmacological properties and outcome data. Here a group of experts in AF and VTE answers a set of questions on its practical use, trying to define the profile of patients that would be most appropriate for its use.

  20. Low-level light emitting diode (LED) therapy suppresses inflammasome-mediated brain damage in experimental ischemic stroke.

    Science.gov (United States)

    Lee, Hae In; Lee, Sae-Won; Kim, Nam Gyun; Park, Kyoung-Jun; Choi, Byung Tae; Shin, Yong-Il; Shin, Hwa Kyoung

    2017-11-01

    Use of photostimulation including low-level light emitting diode (LED) therapy has broadened greatly in recent years because it is compact, portable, and easy to use. Here, the effects of photostimulation by LED (610 nm) therapy on ischemic brain damage was investigated in mice in which treatment started after a stroke in a clinically relevant setting. The mice underwent LED therapy (20 min) twice a day for 3 days, commencing at 4 hours post-ischemia. LED therapy group generated a significantly smaller infarct size and improvements in neurological function based on neurologic test score. LED therapy profoundly reduced neuroinflammatory responses including neutrophil infiltration and microglia activation in the ischemic cortex. LED therapy also decreased cell death and attenuated the NLRP3 inflammasome, in accordance with down-regulation of pro-inflammatory cytokines IL-1β and IL-18 in the ischemic brain. Moreover, the mice with post-ischemic LED therapy showed suppressed TLR-2 levels, MAPK signaling and NF-kB activation. These findings suggest that by suppressing the inflammasome, LED therapy can attenuate neuroinflammatory responses and tissue damage following ischemic stroke. Therapeutic interventions targeting the inflammasome via photostimulation with LED may be a novel approach to ameliorate brain injury following ischemic stroke. Effect of post-ischemic low-level light emitting diode therapy (LED-T) on infarct reduction was mediated by inflammasome suppression. © 2017 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

  1. Venous Thromboembolism in Patients With Thrombocytopenia

    DEFF Research Database (Denmark)

    Bælum, Jens Kristian; Ellingsen Moe, Espen; Nybo, Mads

    2017-01-01

    BACKGROUND: Venous thromboembolism (VTE) is a frequent and potentially lethal condition. Venous thrombi are mainly constituted of fibrin and red blood cells, but platelets also play an important role in VTE formation. Information about VTE in patients with thrombocytopenia is, however, missing. O...

  2. Apixaban for Extended Treatment of Venous Thromboembolism

    NARCIS (Netherlands)

    Agnelli, Giancarlo; Buller, Harry R.; Cohen, Alexander; Curto, Madelyn; Gallus, Alexander S.; Johnson, Margot; Porcari, Anthony; Raskob, Gary E.; Weitz, Jeffrey I.; Gallus, Alexander; Raskob, Gary; Weitz, Jeffrey; Prins, Martin; Brandjes, Dees; Kolbach, Dinanda; Limburg, Martinus; Mac Gillavry, Melvin; Otten, Johannes Martinus; Peters, Ron; Roos, Yvo; Segers, Annelise; Slagboom, Ton; Bounameaux, Henry; Hirsh, Jack; Samama, Meyer Michel; Wedel, Hans; Masiukiewicz, Urszula; Pak, Raphael; Sanders, Paul; Sisson, Melanie; Sullivan, Beth; Thompson, John; Auerbach, Jennifer; Cesario, Lynne; Gamero, Miguel; Gordon, Margot; Griffiths, Angela; Noble, Melanie; Ott, Jana; Pennington, Ann; Peffer, Allison; Reinhold, Peggy; Simmons, Melanie; Urwin, Keri; Ceresetto, Jose; McRae, Simon; Pabinger, Ingrid; Pereira, Adamastor Humberto; Spencer, Fred; Gorican, Karel; Husted, Steen Elkiaer; Mottier, Dominique; Harenberg, Job; Pinjala, Ramakrishna; Zeltser, David; Imberti, Davide; Sandset, Morten; Torbicki, Adam; Fijalkowska, Anna; Albino, Jose Pereira; Kirienko, Alexander; Shvarts, Yury; Monreal, Manuel; Jacobson, Barry; Dolan, Gerry; Gudz, Ivan; Ortel, Tom; Spyropoulos, Alex; Torbicki, A.; Fijalkowska, A.; Skupyy, O.; Beryer-Westendorf, J.; de Pellegrin, A.; Prasol, V.; Schellong, S.; Jacobson, B.; Falvo, N.; Abramov, I.; Cizek, V.; Husted, S.; Desai, S.; Gudz, I.; Barillari, G.; Sergeev, O.; Chetter, I.; Inbal, A.; McCollum, C.; Shvalb, P.; Torp-Pedersen, C.; Vasylyuk, S.; Kraemmer Nielsen, H.; Pernod, G.; Schmidt, J.; Bova, C.; Gerasymov, V.; Pabinger-Fasching, I.; Skalicka, L.; Zaichuk, A.; Achkar, A.; Bremmelgaard, A.; Chochola, J.; Gould, T.; Khalafallah, A.; Jakobsen, T.; Rose, P.; Zhukov, B.; Dedek, V.; Mirete Ferrer, J.; Pesant, Y.; Repin, A.; Salem, H.; Solis Morales, L.; Spacek, R.; Cannon, K.; Grzelakowski, P.; Jindal, R.; Pereira, A.; Zidkova, E.; Ambrosio, G.; Cardozo, M.; Dunaj, M.; Gallus, A.; Gavish, D.; Ghanima, W.; Harenberg, J.; Leduc, J. J.; Mismetti, P.; Panico, M.; Porreca, E.; Riera, A.; Bareford, D.; Chong, B.; Dvoryashina, I.; Gómez Cerezo, J.; Kobza, I.; Nielsen, T.; Pendleton, R.; Pullman, J.; Schiffman, G.; Stanbro, M.; Zwettler, U.; Aquilanti, S.; Bratsch, H.; Cohen, K.; Elias, D.; Gan, E.; Holaj, R.; Klinke, W.; Liu, H. S. Y.; Sandset, P. M.; van Nieuwenhuizen, E.; Álvarez-Sala, L. A.; Basson, M.; Braester, A.; Bura-Riviere, A.; Calvo Vargas, C.; Cohen, A.; Correa, J.; Elias, M.; Frost, L.; Imberti, D.; Landolfi, R.; Marschang, P.; Moreira, R.; Mottier, D.; Natarajan, S.; Pottier, P.; Tosetto, A.; Tuxen, C.; Vöhringer, H. F.; Alexander, A.; Barbarash, O.; Fajardo Campos, P.; Graham, M.; Gubka, O.; Hudcovic, M.; Hussein, O.; Jackson, D.; Katelnitskiy, I.; Lawall, H.; Monreal, M.; Palareti, G.; Poggio, R.; Roos, J.; Simonneau, G.; Smith, S. W.; Szopinski, P.; Ortel, T.; Zimlichman, R.; Bridgers, D.; Colan, D.; Czekalski, P.; de Jong, D.; Fortinez, J. T.; Garcia Bragado, F.; Harrington, D.; Izbicki, G.; Kadr, H.; Koslow, A.; Loftus, I.; Marais, H.; Neumeister, A.; Oliven, A.; Palla, A.; Pop, C.; Prandoni, P.; Puskas, A.; Sanchez Llamas, F.; Shotan, A.; Shvarts, Y.; Singh, P.; Tveit, A.; Baker, R.; Borja, V.; Brenner, B.; Brown, H.; Ceresetto, J.; Cha, T. J.; Cohen, Y.; D'Angelo, A.; Dhar, A.; Friis, E.; Hueur, H.; Jiménez Rodríguez Madridejos, R.; Karl, J.; Karrasch, J.; Lishner, M.; Manenti, E.; McRae, S.; Meneveau, N.; Nguyen, D.; Sanchez-Escalante, L.; Santoscoy Ibarra, J.; Sokurenko, G.; Staroverov, I.; Stein, R.; Abdullah, I.; Agnelli, G.; Alcocer Gamba, M.; Balanda, J.; Bruckner, I.; Calabuig Alborch, J.; Caraco, Y.; Comerota, A.; Cromer, M.; de Araujo Filho, J.; de los Rios Ibarra, M.; Diaz-Castañon, J.; Doshi, A.; Ebrahim, I.; Fessel, W. J.; Fletcher, E.; Fourie, N.; Fu, C.; Gutowski, P.; Haddad, G.; Hoffman, U.; Jardula, M.; Kvasnicka, T.; Lewczuk, J.; Leyden, M.; Livneh, A.; Lodigiani, C.; Lovell, C.; Miekus, P.; Paloma, M. J.; Parakh, R.; Raval, M.; Schmidt-Lucke, J.; Shtutin, O.; Soroka, V.; Stevens, D.; Sulik, P.; Tay, J. C.; Vejby-Christensen, H.; Vinereanu, D.; Baghestanian, M.; Bono, J.; Cerana, S.; Freire, A.; Gibson, K.; Giumelli, C.; Iastrebner, C.; Karpenko, A.; Kelly, A.; Lacroix, P.; LaFata, J.; Lobo, S.; Macik, B. G.; Marchena Yglesias, P.; Nishinari, K.; Pinjala, R.; Podczeck-Schweighofer, A.; Raby, K.; Sirpal, S.; Solymoss, S.; Spencer, F.; van Zyl, L.; Vargas Núñez, J. A.; von Bilderling, P.; Warr, T.; Wronski, J.; Wurster, M.; Albino, J. A.; Albuquerque, L.; Averill, F.; Baek, S. H.; Bello, F.; Bergoeing, M.; Blanc, F. X.; Bloomberg, R.; Bolster, D.; Brockmyre, A.; Calimano, C.; Checketts, D.; Cieplinski, W.; Chervu, A.; Collado, F.; Denaro, C.; Gaciong, Z.; Game, M.; Iskander, A.; Kaatz, S.; Kim, D. I.; Koura, F.; Laguna, F.; Lanas Zanetti, F.; Lindhoff-Last, E.; Melaniuk, M.; Meade, A.; Murphy, T.; Ng, H. J.; Páramo Fernández, J. A.; Patil, C.; Piovella, F.; Prisco, D.; Pruszczyk, P.; Reimers, G.; Rivera, E.; Rodriguez-Cintron, W.; Rosenthal, S.; Salbach, P.; Salvador, D.; Schuller, D.; Siragusa, S.; Staniszewski, R.; Torp, R.; Vora, K.; Yip, G.; Alfieri, A.; Belaji, V.; Bhagavan, N.; Carnovali, M.; Cobos Segarra, J.; Di Todaro, F.; Dowell, A.; Corder, C.; Crispin, P.; Cuadrado, J.; Flippo, G.; Fraiz, J.; Guillaumon, A.; Gvora, T.; Hakki, S.; Harris, L.; Ison, R.; Htun, P. T.; Jasani, R.; Kates, M.; Kaminski, L.; Kamerkar, D.; Kirienko, A.; Kroger, K.; LaPerna, L.; Leiva, J.; Luber, J.; McCann, A.; McKenzie, W.; Menna Barreto, S.; Moran, J.; Nikulnikov, P.; Paliwal, Y.; Patel, M.; Pilger, E.; Renwick, W.; Shevela, A.; Starosiliz, D.; Stringam, S.; Spyropoulos, A.; To, R.; Updegrove, J.; van Bellen, B.; Waintrub, M.; White, J.; Yeo, E.; Zangroniz, P.; Zeltser, D.

    2013-01-01

    BACKGROUND Apixaban, an oral factor Xa inhibitor that can be administered in a simple, fixed-dose regimen, may be an option for the extended treatment of venous thromboembolism. METHODS In this randomized, double-blind study, we compared two doses of apixaban (2.5 mg and 5 mg, twice daily) with

  3. Acute Thrombo-embolic Renal Infarction

    Directory of Open Access Journals (Sweden)

    Haijiang Zhou

    2016-07-01

    Full Text Available A 65-year-old woman was admitted for acute onset of right lower abdominal pain. She was taking anticoagulant medication regularly for rheumatic valvular disease and atrial fibrillation. Physical examination revealed no obvious abdominal or flank tenderness. Right thrombo-embolic renal infarction was diagnosed after performing computed tomography angiography (CTA.

  4. The Multifactorial Nature of Thromboembolic and Bleeding ...

    African Journals Online (AJOL)

    Background: Thromboembolic and bleeding complications are the main causes of morbidity and mortality in patients with mechanical heart valves1. The risk factors for these complications in Tanzania have not been established. Methods: A retrospective cohort study was conducted among patients with mechanical heart ...

  5. Surgical Embolectomy for Acute Pulmonary Thromboembolism

    Science.gov (United States)

    Fukuda, Ikuo; Daitoku, Kazuyuki

    2017-01-01

    Acute pulmonary thromboembolism is a catastrophic event, especially for hospitalized patients. The prognosis of pulmonary thromboembolism depends on the degree of pulmonary arterial occlusion. The mortality of massive pulmonary embolism is reportedly as high as 25% without cardiopulmonary arrest and 65% with cardiopulmonary arrest. In patients with unstable hemodynamics due to pulmonary thromboembolism, surgical pulmonary embolectomy is indicated for patients with a contraindication to thrombolysis, failed catheter therapy, or failed thrombolysis. Thrombolytic therapy adds an additional burden on patients who are at risk of potential hemorrhagic complications. It is also indicated if patients are already on a veno-arterial extra-corporate membrane oxygenator for circulatory collapse or cardiopulmonary arrest. The outcome for patients who require cardiopulmonary resuscitation for longer than 30 minutes is poor. Therefore, early triage for massive and sub-massive pulmonary embolism is crucial. A team approach including a cardiovascular surgeon may be effective to save critically ill patients. Prompt removal of emboli reduces the right ventricular load with quick recovery of cardiopulmonary function in the early postoperative period. A recent series reported excellent results, with in-hospital mortality of less than 10%. Surgical pulmonary embolectomy is an effective, safe, and easy procedure to save critical patients due to pulmonary thromboembolism. PMID:29034035

  6. Venous thromboembolism: Risk profile and management of ...

    African Journals Online (AJOL)

    Objectives. This study aims to describe the venous thromboembolism (VTE) risk profile of women undergoing elective gynaecological surgery in a tertiary hospital and to audit the VTE prophylaxis prescribed. Methods. One hundred and nine women who underwent elective gynaecological surgery at Kalafong Provincial ...

  7. Clinical overview of venous thromboembolism | Schellack | South ...

    African Journals Online (AJOL)

    Venous thromboembolism (VTE) encompasses two vascular conditions that are of significant importance, namely deep vein thrombosis (DVT) and pulmonary embolism (PE). DVT is also the most common cause of PE. Medical and surgical patients, and individuals who are at increased risk of developing VTE through a ...

  8. Venous thromboembolism: awareness and practice of ...

    African Journals Online (AJOL)

    However, the high level of thromboprophylaxis practice appears doubtful because only a few of these physicians carry out VTE risk assessment for their patients as well as follow clinical guidelines on VTE thromboprophylaxis. Key words: Venous thromboembolism, deep vein thrombosis, pulmonary embolism, risk factor, ...

  9. Predictors and Outcomes of Recurrent Venous Thromboembolism in Elderly Patients.

    Science.gov (United States)

    Lauber, Sandro; Limacher, Andreas; Tritschler, Tobias; Stalder, Odile; Méan, Marie; Righini, Marc; Aschwanden, Markus; Beer, Jürg Hans; Frauchiger, Beat; Osterwalder, Josef; Kucher, Nils; Lämmle, Bernhard; Cornuz, Jacques; Angelillo-Scherrer, Anne; Matter, Christian M; Husmann, Marc; Banyai, Martin; Staub, Daniel; Mazzolai, Lucia; Hugli, Olivier; Rodondi, Nicolas; Aujesky, Drahomir

    2018-01-04

    Little is known about predictors and outcomes of recurrent venous thromboembolism in elderly patients. We prospectively followed up 991 patients aged ≥65 years with acute venous thromboembolism in a multicenter Swiss cohort study. The primary outcome was symptomatic recurrent venous thromboembolism. We explored the association between baseline characteristics and treatments and recurrent venous thromboembolism using competing risk regression, adjusting for periods of anticoagulation as a time-varying co-variate. We also assessed the clinical consequences (case-fatality, localization) of recurrent venous thromboembolism. During a median follow-up period of 30 months, 122 patients developed recurrent venous thromboembolism, corresponding to a 3-year cumulative incidence of 14.8%. The case-fatality of recurrence was high (20.5%), particularly in patients with unprovoked (23%) and cancer-related venous thromboembolism (29%). After adjustment, only unprovoked venous thromboembolism (sub-hazard ratio [SHR] 1.67 compared to provoked venous thromboembolism; 95% confidence interval [CI] 1.00-2.77) and proximal deep vein thrombosis (SHR 2.41 compared to isolated distal deep vein thrombosis; 95% CI 1.07-5.38) were significantly associated with recurrence. Patients with initial pulmonary embolism were more likely to have another pulmonary embolism as a recurrent event than patients with deep vein thrombosis. Elderly patients with acute venous thromboembolism have a substantial long-term risk of recurrent venous thromboembolism and recurrence carries a high case-fatality rate. Only two factors, unprovoked venous thromboembolism and proximal deep vein thrombosis, were independently associated with recurrent venous thromboembolism, indicating that traditional risk factors for venous thromboembolism recurrence (e.g., cancer) may be less relevant in the elderly. Copyright © 2018. Published by Elsevier Inc.

  10. Where Have All the Rodents Gone? The Effects of Attrition in Experimental Research on Cancer and Stroke.

    Directory of Open Access Journals (Sweden)

    Constance Holman

    2016-01-01

    Full Text Available Given small sample sizes, loss of animals in preclinical experiments can dramatically alter results. However, effects of attrition on distortion of results are unknown. We used a simulation study to analyze the effects of random and biased attrition. As expected, random loss of samples decreased statistical power, but biased removal, including that of outliers, dramatically increased probability of false positive results. Next, we performed a meta-analysis of animal reporting and attrition in stroke and cancer. Most papers did not adequately report attrition, and extrapolating from the results of the simulation data, we suggest that their effect sizes were likely overestimated.

  11. Matrix metalloproteinase-10 effectively reduces infarct size in experimental stroke by enhancing fibrinolysis via a thrombin-activatable fibrinolysis inhibitor-mediated mechanism.

    Science.gov (United States)

    Orbe, J; Barrenetxe, J; Rodriguez, J A; Vivien, D; Orset, C; Parks, W C; Birkland, T P; Serrano, R; Purroy, A; Martinez de Lizarrondo, S; Angles-Cano, E; Páramo, J A

    2011-12-20

    The fibrinolytic and matrix metalloproteinase (MMP) systems cooperate in thrombus dissolution and extracellular matrix proteolysis. The plasminogen/plasmin system activates MMPs, and some MMPs have been involved in the dissolution of fibrin by targeting fibrin(ogen) directly or by collaborating with plasmin. MMP-10 has been implicated in inflammatory/thrombotic processes and vascular integrity, but whether MMP-10 could have a profibrinolytic effect and represent a promising thrombolytic agent is unknown. The effect of MMP-10 on fibrinolysis was studied in vitro and in vivo, in MMP-10-null mice (Mmp10(-/-)), with the use of 2 different murine models of arterial thrombosis: laser-induced carotid injury and ischemic stroke. In vitro, we showed that MMP-10 was capable of enhancing tissue plasminogen activator-induced fibrinolysis via a thrombin-activatable fibrinolysis inhibitor inactivation-mediated mechanism. In vivo, delayed fibrinolysis observed after photochemical carotid injury in Mmp10(-/-) mice was reversed by active recombinant human MMP-10. In a thrombin-induced stroke model, the reperfusion and the infarct size in sham or tissue plasminogen activator-treated animals were severely impaired in Mmp10(-/-) mice. In this model, administration of active MMP-10 to wild-type animals significantly reduced blood reperfusion time and infarct size to the same extent as tissue plasminogen activator and was associated with shorter bleeding time and no intracranial hemorrhage. This effect was not observed in thrombin-activatable fibrinolysis inhibitor-deficient mice, suggesting thrombin-activatable fibrinolysis inhibitor inactivation as one of the mechanisms involved in the MMP-10 profibrinolytic effect. A novel profibrinolytic role for MMP-10 in experimental ischemic stroke is described, opening new pathways for innovative fibrinolytic strategies in arterial thrombosis.

  12. Neuroprotective Effects of Oxytocin Hormone after an Experimental Stroke Model and the Possible Role of Calpain-1.

    Science.gov (United States)

    Etehadi Moghadam, Sepideh; Azami Tameh, Abolfazl; Vahidinia, Zeinab; Atlasi, Mohammad Ali; Hassani Bafrani, Hassan; Naderian, Homayoun

    2018-03-01

    Different mechanisms will be activated during ischemic stroke. Calpain proteases play a pivotal role in neuronal death after ischemia damage through apoptosis. Anti-apoptotic activities of the oxytocin (OT) in different ischemic tissues were reported in previous studies. Recently, a limited number of studies have noted the protective effects of OT in the brain. In the present study, the neuroprotective potential of OT in an animal model of transient middle cerebral artery occlusion (tMCAO) and the possible role of calpain-1 in the penumbra region were assessed. Adult male Wistar rats underwent 1 hour of tMCAO and were treated with nasal administration of OT. After 24 hours of reperfusion, infarct size was evaluated by triphenyltetrazolium chloride. Immunohistochemical staining and Western blotting were used to examine the expression of calpain-1. Nissl staining was performed for brain tissue morphology evaluation. OT reduced the infarct volume of the cerebral cortex and striatum compared with the ischemia control group significantly (P < .05). Calpain-1 overexpression, which was caused by ischemia, decreased after OT administration (P < .05). The number of pyknotic nuclei in neurons increased dramatically in the ischemic area and OT attenuated the apoptosis of neurons in the penumbra region (P < .01). We provided evidence for the neuroprotective role of OT after tMCAO through calpain-1 attenuation. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  13. Atrial fibrillation and risk of stroke

    DEFF Research Database (Denmark)

    Christiansen, Christine Benn; Gerds, Thomas A.; Olesen, Jonas Bjerring

    2016-01-01

    AIM: Although the relation between stroke risk factors and stroke in patients with atrial fibrillation (AF) has been extensively examined, only few studies have explored the association of AF and the risk of ischaemic stroke/systemic thromboembolism/transient ischaemic attack (stroke....../TE/TIA) in the presence of concomitant stroke risk factors. METHODS AND RESULTS: From nationwide registries, all persons who turned 50, 60, 70, or 80 from 1997 to 2011 were identified. Persons receiving warfarin were excluded. The absolute risk of stroke/TE/TIA was reported for a 5-year period, as was the absolute risk...... ratios for AF vs. no AF according to prior stroke and the number of additional risk factors. The study cohort comprised of 3 076 355 persons without AF and 48 189 with AF. For men aged 50 years, with no risk factors, the 5-year risk of stroke was 1.1% (95% confidence interval 1.1-1.1); with AF alone 2...

  14. Modified constraint-induced therapy for the lower extremity in elderly persons with chronic stroke: single-subject experimental design study.

    Science.gov (United States)

    Kallio, Katja; Nilsson-Wikmar, Lena; Thorsén, Ann-Mari

    2014-01-01

    Studies have demonstrated improvements in arm motor function after constraint-induced (CI) therapy. Few studies of CI therapy for lower extremity conditions have been done. Our purpose was to evaluate the effect of modified CI therapy for the lower extremity in terms of motor control in elderly persons with chronic stroke. A single-subject experimental AB design was used, with 3 months of follow-up. The A phase consisted of a baseline period of 2 weeks with 6 measurements, and the B phase was a 4-week intervention with 8 measurements. Two men and 1 woman were included. The intervention consisted of intensive rehabilitation of the affected leg for 2 hours each weekday. A whole-leg orthosis was used to immobilize the nonaffected leg. The following tests were conducted: a step test for dynamic balance, Fugl-Meyer assessment for lower-extremity motor function, the Timed Up and Go test for mobility, and the 6-minute and 10-meter walk tests for walking ability. Statistical significance was analyzed by using Shewhart charts with a 2-standard deviation band method. A positive change was observed in 14 of 18 variables. Significant improvements existed in 7 of the 14 positively changed variables. Positive changes remained in 13 of 14 variables at the 3-month follow-up evaluation. Modified CI therapy may result in positive changes in balance and motor function in elderly persons with chronic stroke.

  15. Key performance indicators for stroke from the Ministry of Health of Brazil: benchmarking and indicator parameters

    Directory of Open Access Journals (Sweden)

    Marcos C Lange

    Full Text Available ABSTRACT The present study aimed to analyze the stroke units in two centers for the key performance indicators (KPIs required by the Ministry of Health in Brazil. Methods All 16 KPIs were analyzed, including the percentage of patients admitted to the stroke unit, venous thromboembolism prophylaxis in the first 48 hours after admission, pneumonia and hospital mortality due to stroke, and hospital discharge on antithrombotic therapy in patients without cardioembolic mechanism. Results Both centers admitted over 80% of the patients in their stroke unit. The incidence of venous thromboembolism prophylaxis was > 85%, that of in-hospital pneumonia was 70%. Conclusion Our results suggest using the parameters of all of the 16 KPIs required by the Ministry of Health of Brazil, and the present results for the two stroke units for future benchmarking.

  16. Can catheter ablation reduce the incidence of thromboembolic events in patients with atrial fibrillation?: Protocol for a systematic review and meta-analysis.

    Science.gov (United States)

    Liu, Menghui; Wang, Yuanping; Chen, Xiaohong; Li, Xiaohui; Zhuang, Xiaodong; Wang, Lichun

    2017-12-01

    Atrial fibrillation (AF), the most common cardiac arrhythmia, is a major risk factor for thromboembolic events, especially ischemic stroke. Catheter ablation is an effective method to maintain sinus rhythm in patients with AF. Although some observational studies have shown a relatively lower stroke rate after catheter ablation, whether catheter ablation can reduce the thromboembolic risk in patients with AF remains unclear. We aim to perform a systematic review to determine whether catheter ablation can prevent thromboembolism in patients with AF.PubMed, Embase, the Web of Science, and the Cochrane Library will be searched from January 2000 to the present for randomized controlled trials (RCTs) and non-randomized studies on catheter ablation in patients with AF. Other relevant sources, such as the references and conference proceedings, will also be manually retrieved. All studies will be limited to publication in English. The primary outcome will be thromboembolic events, including stroke, transient ischemic attack, and systemic embolic events. Study screening, data collection, and study quality assessment will be independently performed by 2 researchers. Disagreements will be resolved through team discussion or consultation with a third arbitrator. The risk of bias will be appraised using the Cochrane Collaboration tool and the Newcastle-Ottawa scale according to the different study designs, and a meta-analysis will be performed using RevMan V.5.3 software. The results will be presented as risk ratios and 95% confidence intervals for dichotomous data and continuous outcomes.Catheter ablation is an effective method to cure atrial fibrillation and maintain sinus rhythm. Although it is intuitive that if AF is eliminated, the thromboembolism in the heart would be abolished, and sequently the incidence of thromboembolic events would be decreased, this in fact has not yet been clarified. This systematic review and meta-analysis will be performed with the aim of

  17. Therapeutic effects of oral dimethyl fumarate on stroke induced by middle cerebral artery occlusion: An animal experimental study.

    Science.gov (United States)

    Safari, Anahid; Fazeli, Mehdi; Namavar, Mohammad Reza; Tanideh, Nader; Jafari, Peyman; Borhani-Haghighi, Afshin

    2017-01-01

    Dimethyl fumarate (DMF) has immune-modulatory and neuro-protective characteristics that can be used for treatment of acute ischemic stroke. To investigate the therapeutic effects of DMF on histological and functional recovery of rats after transient middle cerebral artery (MCA) occlusion. 22 Sprague-Dawley male rats weighing 275-300 g were randomized into three groups by block randomization. In the sham group (n = 7), the neck was opened, but neither MCA was occluded, nor any drug was administered.The control group (n = 7) was treated with vehicle (methocel) by gavage for 14 days after MCA occlusion. In the DMF-treated group (n = 8), treatment was performed with 15 mg/kg body weight dimethyl fumarate twice a day for 14 days after MCA occlusion. Transient occlusion of the right MCA was performed by intraluminal thread method in the DMF-treated and the control group. Neurological deficit score (NDS), pole test, and adhesive removal test were performed before the surgery, and on post-operative Days 0, 3, 5, 7, 10, and 14. After the final behaviour test, the animals' brains were perfused and removed. Brains were frozen and sectioned serially and coronally using a cryostat. Infract volume and brain volume were estimated by stereology. The percentage of infarct volume was significantly lower in DMF-treated animals (5.76%) than in the control group (22.39%) (P < 0.0001). Regarding behavioural tests, the DMF-treated group showed better function in NDS on Days 7 (P = 0.041) and 10 (P = 0.046), but not in pole and adhesive removal tests. There was no significant correlation between behavioural tests and histological results. Dimethyl fumarate could be beneficial as a potential neuroprotective agent in the treatment of stroke.

  18. Protective Effects of Angiotensin II AT1 Receptors Blockade against Brain Injury in Experimental Model of Stroke in Rat

    Directory of Open Access Journals (Sweden)

    Hamdollah Panahpour

    2014-06-01

    Full Text Available Background & objectives: Ischemic stroke remains the third leading cause of invalidism and death in industrialized countries. It is suggested that renin–angiotensin system (RAS may contribute in stroke related pathogenic mechanisms and involve in the ischemic brain damage. This study designed to investigate the role of angiotensin II (Ang II in conjunction with AT1 receptors in treatment of the brain injuries following transient focal cerebral ischemia in rats.   Methods: Forty eight male Sprague-Dawley rats were studied in four groups. Sham group, ischemic control group and two ischemic groups that received candesartan (0.1mg/kg, or 0.5mg/kg at the beginning of reperfusion period. Transient focal cerebral ischemia was induced by 60 minutes occlusion of the middle cerebral artery, followed by 24 hours reperfusion. At the end of the reperfusion period, neurological deficit score (NDS was performed. Total cortical and striatal infarct volumes were determined using triphenyltetrazolium chloride (TTC staining technique.   Results: Animals in sham operated group had normal motor function and no ischemic lesions were observed in cortical or striatal regions. Occurring ischemia in ischemic control group that received vehicle produced considerable infarction in cortex (253±15mm3 and striatum (92±7mm3, as well as these animals had sever impaired motor dysfunctions. Blocking of AT1 receptors with candesartan (0.1mg/kg or 0.5mg/kg improved neurological outcome and significantly lowered cortical and striatal infarct volumes relative to ischemic control group.   Conclusion: The findings of the present study indicated that stimulation of AT1 receptors by Ang II involved in ischemia/reperfusion injuries and blocking of AT1 receptors can decrease ischemic brain injury and improve neurological outcome.

  19. [Venous thromboembolism in patients with acute tuberculosis].

    Science.gov (United States)

    Ben Amar, J; Dahri, B; Aouina, H; Bouacha, H

    2015-12-01

    Studies have demonstrated a link between tuberculosis and hypercoagulable state, with reported rates of 0,6%-10% venous thromboembolism (VTE) in all adults with tuberculosis. The present study aimed to evaluate the current incidence and characteristics of VTE in a large sample of patients with acute tuberculosis. We report a retrospective study about 26 patients who have confirmed tuberculosis complicated with VTE disease. Sixteen men and ten women were brought together. The mean age was 42.58 years. The thromboembolic complication revealed tuberculosis among 5 patients, appearing during hospitalization of 21 patients among which 16 of them receiving antituberculosis drug. We have listed 10 cases of immediate pulmonary thromboembolism and 16 cases of deep vein thrombosis complicated with pulmonary embolism in 6 cases. Oral anticoagulation drug were associated with heparin after a mean of 4.57 days. Duration average of achievement of an effective dose was of 21.05 days and we prescribe low molecular weight heparin for 6 months on 2 cases. There was favorable evolution among 14 patients, 4 of them have lost sight and the evolution was fatal by cataclysmic haemoptysis in one case, a patient died hepatocellular insufficiency and 6 died by pulmonary embolism. Immunological and hematological abnormalities are incriminated in the genesis of VTE disease during tuberculosis by creating hypercoagulate state. The accumulation of morbidity of these two affections as well as the difficulty of therapeutic care made by medical interaction ifampicin-anticoagulants aggravate the prognostic. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  20. Prevention and treatment ofvenous thromboembolism. Case report

    Directory of Open Access Journals (Sweden)

    Andrzej Kolbuszewski

    2015-06-01

    Full Text Available The problem of thromboembolic complications concerns nearly all orthopaedic and trauma patients. However, risk factors are different and prophylaxis slightly varies depending on the complication. The presence of thrombosis of complex and insidious clinical picture, which is presented in this case report, is alarming. The article reports a case of a 64-year-old male patient with risk factors of thromboembolism. The patient underwent high tibial osteotomy for varus deformity correction due to gonarthrosis. Venus thrombosis and pulmonary embolism developed in the postoperative period. Additionally, symptoms of infection appeared during the treatment in the form of inappropriate wound healing, which was an indication for surgical revision of the wound. The authors present the manner of safe perioperative management of a patient, which is consistent with the standards, taking into account the risk of recurrence of thromboembolism.

  1. Therapeutic hypothermia for acute stroke

    DEFF Research Database (Denmark)

    Olsen, Tom Skyhøj; Weber, Uno Jakob; Kammersgaard, Lars Peter

    2003-01-01

    Experimental evidence and clinical experience show that hypothermia protects the brain from damage during ischaemia. There is a growing hope that the prevention of fever in stroke will improve outcome and that hypothermia may be a therapeutic option for the treatment of stroke. Body temperature...... is directly related to stroke severity and outcome, and fever after stroke is associated with substantial increases in morbidity and mortality. Normalisation of temperature in acute stroke by antipyretics is generally recommended, although there is no direct evidence to support this treatment. Despite its...... obvious therapeutic potential, hypothermia as a form of neuroprotection for stroke has been investigated in only a few very small studies. Therapeutic hypothermia is feasible in acute stroke but owing to serious side-effects--such as hypotension, cardiac arrhythmia, and pneumonia--it is still thought...

  2. Pregnancy-related venous thromboembolism and risk of occult cancer

    DEFF Research Database (Denmark)

    Veres, Katalin; Horváth-Puhó, Erzsébet; Ehrenstein, Vera

    2017-01-01

    The cancer risk during the first year after a pregnancy-related venous thromboembolism episode is higher than expected.An aggressive search for cancer in women with pregnancy-related venous thromboembolism is probably not warranted, due to low absolute risk.......The cancer risk during the first year after a pregnancy-related venous thromboembolism episode is higher than expected.An aggressive search for cancer in women with pregnancy-related venous thromboembolism is probably not warranted, due to low absolute risk....

  3. Ischemic Stroke

    Science.gov (United States)

    ... Workplace Giving Fundraise Planned Giving Corporate Giving Cause Marketing Join your team, your way! The Stroke Challenge team is a great way to get active ... to Expect at the Hospital Key Questions to Ask Learn More About Stroke ...

  4. Stroke - slideshow

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/presentations/100218.htm Stroke - series—Part 1 To use the sharing features ... M. Editorial team. Related MedlinePlus Health Topics Ischemic Stroke A.D.A.M., Inc. is accredited by ...

  5. Preventing stroke

    Science.gov (United States)

    Stroke - prevention; CVA - prevention; Cerebral vascular accident - prevention; TIA - prevention; Transient ischemic attack - prevention ... something that increases your chance of having a stroke. You can't change some risk factors for ...

  6. Know Stroke

    Science.gov (United States)

    ... Home Current Issue Past Issues Special Section Know Stroke Past Issues / Summer 2007 Table of Contents For ... D. Director, National Institute of Neurological Disorders and Stroke Photo courtesy of NIH/NINDS Welcome to this ...

  7. Stroke Rehabilitation

    Science.gov (United States)

    ... one, especially during the first year following the original stroke. The following factors increase the risk of having another stroke: High blood pressure (hypertension) Cigarette smoking Diabetes Having had a TIA (transient ischemic attack) Heart ...

  8. Huge Left Ventricular Thrombus and Apical Ballooning associated with Recurrent Massive Strokes in a Septic Shock Patient

    Directory of Open Access Journals (Sweden)

    Hyun-Jung Lee

    2016-02-01

    Full Text Available The most feared complication of left ventricular thrombus (LVT is the occurrence of systemic thromboembolic events, especially in the brain. Herein, we report a patient with severe sepsis who suffered recurrent devastating embolic stroke. Transthoracic echocardiography revealed apical ballooning of the left ventricle with a huge LVT, which had not been observed in chest computed tomography before the stroke. This case emphasizes the importance of serial cardiac evaluation in patients with stroke and severe medical illness.

  9. Stroke Fact Sheet

    Science.gov (United States)

    ... Disease and Stroke email updates Enter email Submit Stroke A stroke happens when blood flow to the ... recovery Stroke recovery steps Stroke diagnosis View more Stroke resources Related information Heart-healthy eating Stress and ...

  10. Recovering after stroke

    Science.gov (United States)

    Stroke rehabilitation; Cerebrovascular accident - rehabilitation; Recovery from stroke; Stroke - recovery; CVA - recovery ... WHERE TO LIVE AFTER A STROKE Most people will need stroke ... after they leave the hospital. Stroke rehab will help you ...

  11. Use of Vitamins K antagonists in non-valvular atrial fibrillation thromboembolic risk prevention in Burkina Faso.

    Science.gov (United States)

    Yameogo, Aristide Relwendé; Kologo, Jonas Koudougou; Mandi, Germain; Kabore, Hervé Poko; Millogo, Georges Rosario Christian; Seghda, Arthur André Taryetba; Samadoulougou, André Koudnoaga; Zabsonre, Patrice

    2016-01-01

    Atrial fibrillation is the commonest cardiac rythm disorder. Thromboembolic accidents are common complications that should be prevented by anticoagulant treatment. The aim of our study is to assess the use of vitamins K antagonists in the prevention of thromboembolic risk in atrial fibrillation. It was a descriptive retrospective study of patients folders, performed in the cardiology department from January 1st 2010 to December 31st 2011. The study included all patients with non valvular atrial fibrillation. Thromboembolic risk was assessed through the CHA2DS2VASc score, and hemorrhagic risk through the HAS-BLED score. Atrial fibrillation accounted for 10.6% of all hospitalizations (103/970). Five patients had contra indication to anticoagulants. Non valvular AF was noticed in 68 cases (66%). The non valvular AF was chronic in 40 cases (59%) and paroxystic in eight cases (12%). The median age of the population was 64.5+13.8 years old. Median CHA2DS2VASc score was 3.9 + 1.6. Two patients had a score 65, and cardiac failure did not interfere with prescription of vitamins K antagonists. Ischemic stroke and intra cavity thrombus were the indications for vitamins K antagonists' prescriptions. The median HAS-BLED score was 3.5 + 1.5. The rate of vitamins K antagonists use was 35.3%. One case of death due to hemorrhagic stroke was noticed. Guidelines on thromboembolic risk prevention are poorly used in the cardiology department. But the use of scoring systems allows the assessment of vitamins K antagonists treatment benefit/risk in atrial fibrillation, and minimizes the hemorrhagic risk.

  12. Anemia predicts thromboembolic events, bleeding complications and mortality in patients with atrial fibrillation: insights from the RE-LY trial.

    Science.gov (United States)

    Westenbrink, B D; Alings, M; Connolly, S J; Eikelboom, J; Ezekowitz, M D; Oldgren, J; Yang, S; Pongue, J; Yusuf, S; Wallentin, L; van Gilst, W H

    2015-05-01

    Anemia may predispose to thromboembolic events or bleeding in anticoagulated patients with atrial fibrillation (AF). To investigate whether anemia is associated with thromboembolic events and bleeding in patients with AF. We retrospectively analyzed the RE-LY trial database, which randomized 18 113 patients with AF and a risk of stroke to receive dabigatran or warfarin for a median follow-up of 2 years. Cox regression analysis was used to determine whether anemia predicted cardiovascular events and bleeding complications in these patients. Anemia was present in 12% of the population at baseline, and the presence of anemia was associated with a higher risk of thromboembolic cardiovascular events, including the composite endpoint of all-cause mortality or myocardial infarction (adjusted hazard ratio [HR] 1.50, 95% confidence interval [CI] 1.32-1.71) and the primary RE-LY outcome of stroke or systemic embolism (adjusted HR 1.41, 95% CI 1.12-1.78). Anemia was also associated with a higher risk of major bleeding complications (adjusted HR 2.14, 95% CI 1.87-2.46) and discontinuation of anticoagulants (adjusted HR 1.40, 95% CI 1.28-1.79). The association between anemia and outcome was similar irrespective of cardiovascular comorbidities, randomized treatment allocation, or prior use of warfarin. The incidence of events was lower in patients with transient anemia than in patients in whom anemia was sustained (adjusted HR 0.66, 95% CI 0.49-0.91). Anemia is associated with an increased risk of thromboembolic events, bleeding complications and mortality in anticoagulated patients with AF. These findings suggest that patients with anemia should be monitored closely during all types of anticoagulant treatment. © 2015 International Society on Thrombosis and Haemostasis.

  13. Cryptogenic Stroke

    Directory of Open Access Journals (Sweden)

    Mohammad Saadatnia

    2017-02-01

    Full Text Available Cryptogenic stroke is defined as brain infarction that is not attributable to a source of definite embolism, large artery atherosclerosis, or small artery disease despite a thorough vascular, cardiac, and serologic evaluation. Despite many advances in our understanding of ischemic stroke, cryptogenic strokes remain a diagnostic and therapeutic challenge. The pathophysiology of cryptogenic stroke is likely various. Probable mechanisms include cardiac embolism secondary to occult paroxysmal atrial fibrillation, aortic atheromatous disease or other cardiac sources, paradoxical embolism from atrial septal abnormalities such as patent foramen ovale, hypercoagulable states, and preclinical or subclinical cerebrovascular disease.  Cryptogenic stroke is one-fourth among cerebral infarction, but most of them could be ascribed to embolic stroke. A significant proportion of cryptogenic strokes adhere to embolic infarct topography on brain imaging and improvement in our ability to detect paroxysmal atrial fibrillation in patients with cryptogenic stroke has strengthened the idea that these strokes are embolic in nature. a significant proportion of cryptogenic strokes adhere to embolic infarct topography on brain imaging.embolic stroke of undetermined sources(ESUS was planned for unifying embolic stroke of undetermined source.  The etiologies underlying ESUS included minor-risk potential cardioembolic sources, covert paroxysmal atrial fibrillation, cancer-associated coagulopathy and embolism, arteriogenic emboli, and paroxysmal embolism. Extensive evaluation including transesophageal echocardiography and cardiac monitoring for long time could identify the etiology of these patients. Therefore cryptogenic stroke is a diagnosis of exclusion. Compared with other stroke subtypes, cryptogenic stroke tends to have a better prognosis and lower long-term risk of recurrence.

  14. Upregulation of DSCR1 (RCAN1 or Adapt78) in the peri-infarct cortex after experimental stroke.

    Science.gov (United States)

    Cho, Kyung-Ok; Kim, Young Sun; Cho, Young-Jin; Kim, Seong Yun

    2008-07-01

    Down syndrome candidate region 1 (DSCR1; also known as RCAN1 or Adapt78) has been shown to be induced by calcium overload and oxidative stress which are included in the pathogenic hallmarks of the ischemic diseases. After ischemic stroke, inflammatory responses play an important role in the exacerbation of neuronal loss. In this study, we investigated the expression pattern of DSCR1 in the mouse cortex after transient middle cerebral artery occlusion (MCAO). Then, in vitro studies were taken to address whether inflammatory mediators could induce DSCR1. Male C57BL/6 mice were subjected to transient MCAO for 35 min and sacrificed at 6, 24, and 72 h after the reperfusion. The expression of DSCR1 began to increase in layer VI of the peri-infarct cortex at 24 h and was prominently enhanced at 72h after transient MCAO. Moreover, real-time reverse transcriptase-polymerase chain reaction and immunohistochemistry showed that the induction of the DSCR1 isoform 4 (DSCR1-4) mRNA preceded the expression of the DSCR1 protein. In in vitro studies, tumor necrosis factor alpha and interleukin-1beta (IL-1beta) were found to induce strong upregulation of DSCR1-4 mRNA. Furthermore, western blot analysis revealed that overexpression of DSCR1-4 in SK-N-SH neuroblastoma cells attenuated IL-1beta-induced cyclooxygenase 2 and intercellular adhesion molecule 1 expression. These results demonstrate upregulation of DSCR1 in the mouse peri-infarct cortex following transient MCAO. In addition, our results suggest that inflammatory mediators such as TNFalpha and IL-1beta can induce DSCR1-4 transcription, which may be associated with the alleviation of inflammatory processes.

  15. The Neuroprotective Effect of Rosemary (Rosmarinus officinalis L.) Hydro-alcoholic Extract on Cerebral Ischemic Tolerance in Experimental Stroke

    Science.gov (United States)

    Seyedemadi, Parisa; Rahnema, Mehdi; Bigdeli, Mohammad Reza; Oryan, Shahrebano; Rafati, Hassan

    2016-01-01

    The prevention of BBB breakdown and the subsequent vasogenic edema are important parts of the medical management of ischemic stroke. The purpose of this study was to investigate the ischemic tolerance effect of Rosmarinus officinalis leaf hydro-alcoholic extract (RHE). Five groups of animals were designed: sham (underwent surgery without MCAO) and MCAO groups, the MCAO groups were pretreated orally by gavages with RHE (50, 75, and 100 mg/Kg/day), daily for 30 days. Two hours after the last dose, serum lipid levels were determined and then the rats were subjected to 60 min of middle cerebral artery occlusion followed by 24 h of reperfusion. Subsequently, brain infarct size, brain edema and Evans Blue dye extravasations were measured and neurological deficits were scored. Dietary RHE could significantly reduce cortical and sub-cortical infarct volumes (211.55 ± 24.88 mm3 vs. 40.59 ± 10.04 mm3 vs. 29.96 ± 12.19 mm3vs. 6.58 ± 3.2 mm3), neurologic deficit scores, cerebral edema (82.34 ± 0.42% vs. 79.92 ± 0.49% vs. 79.45 ± 0.26% vs. 79.30 ± 0.19%), blood–brain barrier (BBB) permeability (7.73 ± 0.4 μg/g tissue vs. 4.1 ± 0.23 μg/g tissue vs. 3.58 ± 0.3 μg/g tissue vs. 3.38 ± 0.25 μg/g tissue) in doses of 50, 75 and 100 mg/Kg/day as compared with the control group in the transient model of focal cerebral ischemia. Although pretreatment with RHE plays an important role in the generation of tolerance against cerebral I/R injury, further studies are needed to clarify the mechanism of the ischemic tolerance. PMID:28243285

  16. Direct oral anticoagulants and venous thromboembolism

    Directory of Open Access Journals (Sweden)

    Massimo Franchini

    2016-09-01

    Full Text Available Venous thromboembolism (VTE, consisting of deep vein thrombosis and pulmonary embolism, is a major clinical concern associated with significant morbidity and mortality. The cornerstone of management of VTE is anticoagulation, and traditional anticoagulants include parenteral heparins and oral vitamin K antagonists. Recently, new oral anticoagulant drugs have been developed and licensed, including direct factor Xa inhibitors (e.g. rivaroxaban, apixaban and edoxaban and thrombin inhibitors (e.g. dabigatran etexilate. This narrative review focusses on the characteristics of these direct anticoagulants and the main results of published clinical studies on their use in the prevention and treatment of VTE.

  17. Awareness of Venous thromboembolism among doctors in a ...

    African Journals Online (AJOL)

    Background: Venous thromboembolic (VTE) is a preventable leading cause of morbidity and mortality worldwide and is a cause of sudden death. Awareness of VTE among doctors will reduce the incidence of unexpected deaths in hospitalised patients. Objective: To assess doctors' awareness of venous thromboembolism ...

  18. Edoxaban versus Warfarin for the Treatment of Symptomatic Venous Thromboembolism

    NARCIS (Netherlands)

    Büller, Harry R.; Décousus, Hervé; Grosso, Michael A.; Mercuri, Michele; Middeldorp, Saskia; Prins, Martin H.; Raskob, Gary E.; Schellong, Sebastian M.; Schwocho, Lee; Segers, Annelise; Shi, Minggao; Verhamme, Peter; Wells, Phil; Agnelli, Giancarlo; Angchaisuksiri, Pantep; Banyai, Martin; Bauersachs, Rupert; van Bellen, Bonno; Blüguermann, Julio; Boda, Zoltán; Bounameaux, Henri; Brenner, Benjamin; Brighton, Tim; Castañon, Javier Diaz; Chechulov, Pavel; Chlumský, Yaromir; Cohen, Alexander; Davidson, Bruce; Decousus, Hervé; Eriksson, Henry; Gallus, Alexander; Gudz, Ivan; Jacobson, Barry; Heng, Lee Lai; Lyons, Roger; Meijer, Karina; Minar, Erich; Monreal, Manuel; Nakamura, Mashio; Oh, Doyeun; Öngen, Gül; Parakh, Rajiv; Piovella, Franco; Raskob, Gary; Rehm, Jeffery; Sandset, Per Morten; Schellong, Sebastian; Smith, Mark; Sokurenko, German; Tomkowski, Witold; Torp-Pedersen, Christian; Wang, Chen; Wang, Yuqi; Weitz, Jeff; Yanushko, Vyacheslav; Yin, Wei-Hsian; Prins, Martin; Beenen, Ludo; Brandjes, Dees; MacGillavry, Melvin; Kaplowitz, Neil; Otten, Hans-Martin; Pessayre, Dominique; Peters, Ron; Roos, Yvo; Slagboom, Ton; Eikelboom, John; Crowther, Mark; Roberts, Robin; Vanassche, Thomas; Vandenbriele, Christophe; Debaveye, Barbara; Dani, Viddhi; van Bergen, Petro; Gerrits, Paul; van Kranen, Robbert; Lanz, Hans; Grosso, Michael; Kappelhoff, John; Franc, John; Zhang, George; Lin, Min; Crerand, William; Giordano, Chris; Skinner, Maureen; Hurley, Steve; Lovelace, Gregg; Barrier, Robert; Betcher, Josh; Alvarez, C.; Amuchastegui, L. M.; Blüguermann, J.; Cassettari, A.; Ceressetto, J.; Hrabar, NN; Macin, S.; Mahuad, C.; Oberti, P.; Santini, F.; Baker, R. I.; Blombery, P.; Brighton, T.; Carroll, P.; Chong, B.; Coughlin, P.; Crispin, P.; Fletcher, J.; Gallus, A.; Serisier, D. J.; Tran, H.; Chan, N.; Stafford, L.; Ward, C.; Baghestanian, M.; Kyrle, P. A.; Eischer, L.; Traby, L.; Marschang, P.; Mathies, R.; Pilger, E.; Brodmann, M.; Roithinger, F.; Weltermann, A.; Adzerikho, I.; Davidovskaya, E.; Gorokhovsky, S.; Maslianski, B.; Kulik, A.; Yanushka, A.; de Vleeschauwer, P.; Debing, E.; Duchateau, J.; Gustin, M.; Hainaut, P.; Vandekerkhof, J.; Verhamme, P.; Peerlinck, K.; Verstraeten, P.; Wautrecht, J. C.; Motte, S.; Annichino-Bizzacchi, J. M.; Mello, T. B. T.; Menezes, F. H.; Burihan, M.; Cavalcanti, M.; Correa, J.; Correa de Carvalho, F.; Cukier, A.; Manenti, E.; Manenti, E. R.; Sacilotto, R.; Timi, J. M.; van Bellen, B.; Kahn, S. R.; Kovacs, M.; Langner, A. Lazo; VanSpronsen, H.; Ritchie, B.; Shafai-Sarshar, R.; Shivakumar, S.; Anderson, D.; Robinson, K.; Gallant, B.; Wells, P.; Karovitch, A.; Scarvelis, D.; Carrier, M.; Bai, C. X.; Chen, R. C.; Cheng, Z. Z.; Du, Y. C.; Hu, X. Y.; Gu, Y. Q.; Hao, Q. L.; Sun, S. B.; Wang, C.; Jiang, L.; Liu, C. J.; Liu, C. W.; Liu, S.; Wang, X. X.; Ye, X. F.; Ma, Z.; Qin, Z. Q.; Qin, X. J.; Tian, H. Y.; Wang, Y. Q.; Shi, Z. Y.; Wen, F. Q.; Wu, Q.; Yang, Y. H.; Kuang, T. G.; Yang, H.; Ying, K. J.; Ma, G. F.; Yuan, Y. D.; Yu, J.; Gong, X. W.; Zhang, F. X.; Zhang, J.; Zhang, S. X.; Zhang, J. W.; Zhang, L.; Zhao, J. C.; Huang, B.; Zhao, J.; Chlumsky, J.; Hola, D.; Hirmerova, J.; Hutyra, M.; Klimsa, Z.; Holub, M.; Kovarova, K.; Lang, P.; Ryba, M.; Podoubský, R.; Matoska, P.; Mayer, O.; Patek, F.; Tupa, M.; Spacek, R.; Urbanova, R.; Blazejova, S.; Vitovec, M.; Andersen, B.; Brønnum-Schou, J.; Dominguez, H.; Egstrup, K.; Auscher, S.; Jeppesen, J.; Asferg, C.; Vishram, J.; Nielsen, H.; Galsgaard, I.; Michaelsen, M.; Haugaard-Nielsen, B.; Ostergaard, O.; Poulsen, S. H.; Torp-Pedersen, C.; Masik, S.; Kadarik, M.; Meriste, S.; Paumets, M.; Laheäär, M.; Raidjuk, L.; Accassat, S.; Buchmuller, A.; Mismetti, P.; Achkar, A.; Aquilanti, S.; Rifaï, A.; Breuil, N.; Schmidt, J.; Brisot, D.; Brousse, C.; de la Fuentes, P. Tarodo; Chakra, M.; Crestani, B.; Desormais, I.; Lacroix, P.; Diamand, J. M.; El Kouri, D.; Clairand, R.; Elias, A.; Ferrari, E.; Doyen, D.; Chiche, O.; Grange, C.; Guenneguez, H.; Lacut, K.; Couturaud, F.; Mottier, D.; Leroux, L.; Lorcerie, B.; de Maistre, E.; Berthier, S.; Mahe, I.; Martin, M.; Meneveau, N.; Meyer, G.; Sanchez, O.; Montaclair, K.; Pavic, M.; Pernod, G.; Imbert, B.; Quere, I.; Galanaud, J. P.; Roy, P. M.; Sevestre, M. A.; Simoneau, G.; Stephan, D.; Aleil, B.; Mirea, C.; Trinh-Duc, A.; von Bilderling, P. Baron; Beyer-Westendorf, J.; Werth, S.; Köhler, C.; Halbritter, K.; Diehm, C.; Espinola-Klein, C.; Weisser, G.; Franke, D.; Heuer, H.; Horacek, T.; Kahrmann, G.; Kroening, R.; Lawall, H.; Roecken, M.; Schellong, S. M.; Pomper, L.; Voigts, B.; Bernhard, S.; Frommhold, R.; Stellbrink, C.; Boda, Z.; Ilonczai, P.; Olah, Z.; Razso, K.; Schlammadinger, A.; Farkas, K.; Kolossváry, E.; Szabó, I.; Frankfurter, Z.; Gasztonyi, B.; Gurzó, M.; Klucsik, Z.; Kovacs, A.; Szigeti, S.; Varga, C.; Landi, A.; Nyirati, G.; Pecsvarady, Zs; Riba, M.; Sámson, Z.; Sipos, Gy; Szigyártó, M.; Sebő, N.; Szabó, T. Janossikné; Toth, K.; Agarwal, S.; Arneja, J.; Babhulkar, S.; Balaji, R.; Banker, D.; Bhagavan, N. K.; Bhonagiri, S.; Mehta, A.; Dayasagar Rao, V.; Desai, P.; Desai, S. C.; Chandrashekar, A. R.; Singh, R.; Deshpande, A.; Dharmadhikari, A.; Durairaj, N.; Ghaisas, N.; Gupta, S.; Jain, R.; Jindal, R.; Kamerkar, D.; Kothiwale, V. A.; Kothurkar, A.; Kulkarni, R.; Kumar, S.; Mody, B.; Nagabhushan, K. N.; Pandharpurkar, H. K.; Joshi, S.; Parakh, R.; Grover, T.; Patel, J.; Patel, K.; Dudhagra, N.; Pawar, N.; Penurkar, M.; Pinjala, R.; Rai, K.; Rao, B.; Raval, M.; Raval, A.; Mehta, P.; Ravi Kishore, A. G.; Saravanan, S.; Shetty, P.; Srinivas, A.; Suresh, K. R.; Sumanthraj, K.; Girija, K. R.; Vinod, M. Vijan; Gavish, D.; Ashkenazy, B.; Braester, A.; Caraco, Y.; Elias, M.; Goldstein, L.; Grossman, E.; Lahav, M.; Lishner, M.; Lugassy, G.; Oliven, A.; Rachmilevitz, R.; Tzoran, I.; Brenner, B.; Yeganeh, S.; Zeltser, D.; Zimlichman, R.; Ageno, W.; Barillari, G.; Pasca, S.; Bortoluzzi, C.; Cattaneo, M.; Falanga, A.; Ghirarduzzi, A.; Lodigiani, C.; Picchi, C.; Iosub, D. I.; Porreca, E.; Prandoni, P.; Quintavalla, R.; Siragusa, S.; Akita, T.; Aoyama, T.; Fujimoto, K.; Hanzawa, K.; Ikeda, U.; Iwata, H.; Kobayashi, T.; Kondo, K.; Kurimoto, T.; Maeda, H.; Mo, M.; Munemasa, M.; Murakami, H.; Nishi, Y.; Nishibe, T.; Nishigami, K.; Nunohiro, T.; Obayashi, T.; Satoh, T.; Satokawa, H.; Shimizu, K.; Shiroma, H.; Sonoda, M.; Suzuki, Y.; Taniguchi, S.; Tsujita, K.; Yamada, N.; Yasuda, C.; Yoshida, H.; Chang, H. J.; Choi, W. I.; Kwon, K. Y.; Rho, B. H.; Choi, J. S.; Hong, Y. S.; Joh, J. H.; Kim, D. J.; Kim, H. S.; Kim, S. H.; Kim, Y. K.; Kim, K. U.; Kim, J. Y.; Kwon, T. W.; Lee, T. S.; Lim, S. Y.; Mun, Y. C.; Oh, D. Y.; Park, K. H.; Yun, W. S.; Yoon, H. I.; Diaz-Castañon, J.; Flota, L. F.; Galindo, J.; Gomez Lara, J.; Jerjes-Sanchez, C.; Palomar-Lever, A.; Rodriguez, D.; Higareda, I.; Boersma, W. G.; de Graaff, C. S.; Oudeman, L.; Brans, E.; Bredie, S. J. H.; Dees, A.; Erdkamp, F.; Peters, F.; Fijnheer, R.; Gerdes, V. E. A.; Griffioen, A.; Jie, K.-S. G.; Meijer, K.; Kooistra, H.; Wiewel-Verschueren, S.; Kamphuisen, P. W.; van Es, J.; Eerenberg, E. S.; Swart Heikens, J.; ten Cate, H.; ten Wolde, M.; Hes, R.; Atalay, S.; Harper, P.; Merriman, E.; Ockelford, P.; Hulton, M. H.; Phillips, J.; Royle, G.; Ford, A.; Smith, M.; Ghanima, W.; Amundsen, H.; Sandset, P. M.; Abola, M. T.; Ganzon, M. S.; Germar, A.; Checinski, P.; Kwasniewski, A.; Tomkowski, W.; Zechowicz, T.; Apartsin, K.; Arutyunov, G.; Barbarash, O.; Burov, Y.; Chechulov, P.; Varaksina, E.; Chernyatina, M.; Gladchenko, M.; Belikov, L.; Fokin, A.; Gubenko, A.; Igor, K.; Olga, M.; Kazakov, Y.; Kazakov, A.; Krasavin, V.; Linev, K.; Plechev, V.; Shesternya, P.; Shkurin, V.; Shvalb, P.; Sokurenko, G.; Sonkin, I.; Remizov, A.; Chernykh, K.; Staroverov, I.; Subbotin, Y.; Zeltser, M.; Seletsky, A.; Iliynykh, A.; Zilber, A.; Zubareva, N.; Tkachenko, I.; Pakhomova, A.; Raghuram, J.; Ng, H. J.; Sin, K.; Adler, D.; Weber, F.; van der Jagt, R.; Basson, M.; Becker, J.; Ellis, G.; Isaacs, R.; Jacobson, B.; Louw, S.; van Rensburg, Jansen; Siebert, H.; Skosana, F.; van Marle, J.; van Zyl, L.; le Roux, R.; Williams, P.; Cereto, F.; Garcia-Bragado, F.; Miranda, R. Tirado; Carlsson, A.; Eriksson, H.; Villegas-Scivetti, M.; Ottosson, E.; Sjalander, A.; Torstensson, I.; Banyai, M.; Afarideh, R.; Gallino, A.; Mazzolai, L.; Righini, M.; Staub, D.; Chen, C. J.; Chiang, C. E.; Wang, K. L.; Chiu, K. M.; Huang, J. H.; Lai, W. T.; Pai, P. Y.; Lin, K. H.; Wang, J. H.; Wu, C. C.; Yin, W. H.; Huang, C. L.; Angchaisuksiri, P.; Kulpraneet, M.; Rojnuckarin, P.; Öngen, G.; Duman, B.; Ozkan, S.; Savas, I.; Selçuk, T.; Tuncay, E.; Gerasymov, V.; Gubka, O.; Gudz, I.; Voloshyn, M.; Nikulnikov, P.; Danylets, A.; Prasol, V.; Rusyn, V.; Sergeev, O.; Shtutin, O.; Skupyy, O.; Tatarin, A.; Venger, I.; Cohen, A. T.; Patel, R.; Hunt, B. J.; Kesteven, P.; Robson, L.; MacCallum, P.; Nokes, T.; Rose, P.; Acs, P.; Gordan, L.; Bhatia, A.; Ali, M.; Amin, D.; Masson, J.; Gavi, E.; Ayele, E.; Ayeni, O.; Canosa, R.; Chavous, D.; Chen, D.; Comerota, A.; Concha, M.; Cunanan-Bush, M.; Daboul, N.; Daggubati, S.; Dang, N.; DiBella, N.; Driver, A.; Dulgeroff, A.; Fraiz, J.; Friedlander, A.; Galvez, A.; Jani, C.; Johnson, S.; Khandelwal, P.; Kingsley, E.; Kingsley, J.; Hutchinson, L.; Lavender, R.; Lyons, R.; Guzley, G.; Martinez, R.; Metjian, A.; Moran, J.; Nadar, V.; Pish, R.; Pullman, J.; Quaranta, A. J.; Ravi, C.; Refaai, M.; Rehm, J.; Richards, D.; Richwine, R.; Sachdeva, S.; Seibert, A.; Sharma, A.; Stricklin, D.; Tannenbaum, A.; Tin-U, C.; Vora, K.; Watkins, D.; Willms, D.

    2013-01-01

    BackgroundWhether the oral factor Xa inhibitor edoxaban can be an alternative to warfarin in patients with venous thromboembolism is unclear. MethodsIn a randomized, double-blind, noninferiority study, we randomly assigned patients with acute venous thromboembolism, who had initially received

  19. Epidemiology of the contraceptive pill and venous thromboembolism.

    Science.gov (United States)

    Hannaford, Philip C

    2011-02-01

    Current users of combined oral contraceptives have an increased risk of venous thromboembolism. The risk appears to be higher during the first year of use and disappears rapidly once oral contraception is stopped. There is a strong interaction between hereditary defects of coagulation, combined oral contraceptive use and venous thromboembolism. Nevertheless, the routine screening of women before they use combined oral contraception is not recommended. Venous thromboembolism seems to be higher in overweight users, and after air, and possibly other forms of, travel. Both the oestrogen and progestogen content of combined oral contraceptives have been implicated in differences in venous thrombotic risk between products. Even if real, the absolute difference in risk between products is small, because the background incidence of venous thromboembolism in young women is low. All currently available combined oral contraceptives are safe. Progestogen-only oral contraceptives are not associated with an increased risk of venous thromboembolism. © 2011 Elsevier Ltd. All rights reserved.

  20. Stroke treatment outcomes in hospitals with and without Stroke Units.

    Science.gov (United States)

    Masjuan, J; Gállego Culleré, J; Ignacio García, E; Mira Solves, J J; Ollero Ortiz, A; Vidal de Francisco, D; López-Mesonero, L; Bestué, M; Albertí, O; Acebrón, F; Navarro Soler, I M

    2017-10-23

    Organisational capacity in terms of resources and care circuits to shorten response times in new stroke cases is key to obtaining positive outcomes. This study compares therapeutic approaches and treatment outcomes between traditional care centres (with stroke teams and no stroke unit) and centres with stroke units. We conducted a prospective, quasi-experimental study (without randomisation of the units analysed) to draw comparisons between 2 centres with stroke units and 4 centres providing traditional care through the neurology department, analysing a selection of agreed indicators for monitoring quality of stroke care. A total of 225 patients participated in the study. In addition, self-administered questionnaires were used to collect patients' evaluations of the service and healthcare received. Centres with stroke units showed shorter response times after symptom onset, both in the time taken to arrive at the centre and in the time elapsed from patient's arrival at the hospital to diagnostic imaging. Hospitals with stroke units had greater capacity to respond through the application of intravenous thrombolysis than centres delivering traditional neurological care. Centres with stroke units showed a better fit to the reference standards for stroke response time, as calculated in the Quick study, than centres providing traditional care through the neurology department. Copyright © 2017 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. Therapeutic hypothermia for acute stroke

    DEFF Research Database (Denmark)

    Olsen, Tom Skyhøj; Weber, Uno Jakob; Kammersgaard, Lars Peter

    2003-01-01

    Experimental evidence and clinical experience show that hypothermia protects the brain from damage during ischaemia. There is a growing hope that the prevention of fever in stroke will improve outcome and that hypothermia may be a therapeutic option for the treatment of stroke. Body temperature...... obvious therapeutic potential, hypothermia as a form of neuroprotection for stroke has been investigated in only a few very small studies. Therapeutic hypothermia is feasible in acute stroke but owing to serious side-effects--such as hypotension, cardiac arrhythmia, and pneumonia--it is still thought...

  2. Individualized Risk Model for Venous Thromboembolism After Total Joint Arthroplasty.

    Science.gov (United States)

    Parvizi, Javad; Huang, Ronald; Rezapoor, Maryam; Bagheri, Behrad; Maltenfort, Mitchell G

    2016-09-01

    Venous thromboembolism (VTE) after total joint arthroplasty (TJA) is a potentially fatal complication. Currently, a standard protocol for postoperative VTE prophylaxis is used that makes little distinction between patients at varying risks of VTE. We sought to develop a simple scoring system identifying patients at higher risk for VTE in whom more potent anticoagulation may need to be administered. Utilizing the National Inpatient Sample data, 1,721,806 patients undergoing TJA were identified, among whom 15,775 (0.9%) developed VTE after index arthroplasty. Among the cohort, all known potential risk factors for VTE were assessed. An initial logistic regression model using potential predictors for VTE was performed. Predictors with little contribution or poor predictive power were pruned from the data, and the model was refit. After pruning of variables that had little to no contribution to VTE risk, using the logistic regression, all independent predictors of VTE after TJA were identified in the data. Relative weights for each factor were determined. Hypercoagulability, metastatic cancer, stroke, sepsis, and chronic obstructive pulmonary disease had some of the highest points. Patients with any of these conditions had risk for postoperative VTE that exceeded the 3% rate. Based on the model, an iOS (iPhone operating system) application was developed (VTEstimator) that could be used to assign patients into low or high risk for VTE after TJA. We believe individualization of VTE prophylaxis after TJA can improve the efficacy of preventing VTE while minimizing untoward risks associated with the administration of anticoagulation. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Hormone replacement therapy and risk of non-fatal stroke

    DEFF Research Database (Denmark)

    Pedersen, A T; Lidegaard, O; Kreiner, S

    1997-01-01

    BACKGROUND: The effect of postmenopausal hormone replacement therapy (HRT) on the risk of subtypes of stroke is as yet unclear. To investigate the effect of oestrogen and combined oestrogen-progestagen therapy on the risk of non-fatal haemorrhagic and thromboembolic stroke, we carried out a case......-control study. METHODS: From the Danish National Patient Register we identified all Danish women aged 45-64 years who had a non-fatal, first-ever cerebrovascular attack during 1990-92. Two age-matched controls were randomly selected for each case from the Danish National Person Register. Important correlates...... therapy and non-fatal subarachnoid haemorrhage (odds ratio 0.52 [95% CI 0.23-1.22]), intracerebral haemorrhage (0.15 [0.02-1.09]), or thromboembolic infarction (1.16 [0.86-1.58]), respectively, compared with never use. Current use of combined oestrogen-progestagen replacement therapy had no significant...

  4. Major stroke in a 19-year-old patient with a univentricular heart

    DEFF Research Database (Denmark)

    Riemann, Mads; Idorn, Lars; Wagner, Aase

    2013-01-01

    Patients with univentricular heart malformations are at increased risk of suffering from thromboembolic events. We present a case of a 19-year-old woman born with a univentricular heart who suffered a major stroke while being treated with only salicylic acid. At least 20% of patients...

  5. Experimental study and analysis of lubricants dispersed with nano Cu and TiO2 in a four-stroke two wheeler

    Science.gov (United States)

    Sarma, Pullela K.; Srinivas, Vadapalli; Rao, Vedula Dharma; Kumar, Ayyagari Kiran

    2011-12-01

    The present investigation summarizes detailed experimental studies with standard lubricants of commercial quality known as Racer-4 of Hindustan Petroleum Corporation (India) dispersed with different mass concentrations of nanoparticles of Cu and TiO2. The test bench is fabricated with a four-stroke Hero-Honda motorbike hydraulically loaded at the rear wheel with proper instrumentation to record the fuel consumption, the load on the rear wheel, and the linear velocity. The whole range of data obtained on a stationery bike is subjected to regression analysis to arrive at various relationships between fuel consumption as a function of brake power, linear velocity, and percentage mass concentration of nanoparticles in the lubricant. The empirical relation correlates with the observed data with reasonable accuracy. Further, extension of the analysis by developing a mathematical model has revealed a definite improvement in brake thermal efficiency which ultimately affects the fuel economy by diminishing frictional power in the system with the introduction of nanoparticles into the lubricant. The performance of the engine seems to be better with nano Cu-Racer-4 combination than the one with nano TiO2.

  6. Experimental study and analysis of lubricants dispersed with nano Cu and TiO2 in a four-stroke two wheeler

    Directory of Open Access Journals (Sweden)

    Rao Vedula

    2011-01-01

    Full Text Available Abstract The present investigation summarizes detailed experimental studies with standard lubricants of commercial quality known as Racer-4 of Hindustan Petroleum Corporation (India dispersed with different mass concentrations of nanoparticles of Cu and TiO2. The test bench is fabricated with a four-stroke Hero-Honda motorbike hydraulically loaded at the rear wheel with proper instrumentation to record the fuel consumption, the load on the rear wheel, and the linear velocity. The whole range of data obtained on a stationery bike is subjected to regression analysis to arrive at various relationships between fuel consumption as a function of brake power, linear velocity, and percentage mass concentration of nanoparticles in the lubricant. The empirical relation correlates with the observed data with reasonable accuracy. Further, extension of the analysis by developing a mathematical model has revealed a definite improvement in brake thermal efficiency which ultimately affects the fuel economy by diminishing frictional power in the system with the introduction of nanoparticles into the lubricant. The performance of the engine seems to be better with nano Cu-Racer-4 combination than the one with nano TiO2.

  7. Recurrent Stroke: The Value of the CHA2DS2VASc Score and the Essen Stroke Risk Score in a Nationwide Stroke Cohort.

    Science.gov (United States)

    Andersen, Søren Due; Gorst-Rasmussen, Anders; Lip, Gregory Y H; Bach, Flemming W; Larsen, Torben Bjerregaard

    2015-09-01

    The CHA2DS2VASc score and the Essen Stroke Risk Score are respectively used for risk stratification in patients with atrial fibrillation and in patients with cerebrovascular incidents. We aimed to test the ability of the 2 scores to predict stroke recurrence, death, and cardiovascular events (stroke, transient ischemic attack, myocardial infarction, or arterial thromboembolism) in a nationwide Danish cohort study, among patients with incident ischemic stroke and no atrial fibrillation. We conducted a registry-based study in patients with incident ischemic stroke and no atrial fibrillation. Patients were stratified according to the CHA2DS2VASc score and the Essen Stroke Risk Score and were followed up until stroke recurrence or death. We estimated stratified incidence rates and hazard ratios and calculated the cumulative risks. 42 182 patients with incident ischemic stroke with median age 70.1 years were included. The overall 1-year incidence rates of recurrent stroke, death, and cardiovascular events were 3.6%, 10.5%, and 6.7%, respectively. The incidence rates, the hazard ratios, and the cumulative risk of all outcomes increased with increasing risk scores. C-statistics for both risk scores were around 0.55 for 1-year stroke recurrence and cardiovascular events and correspondingly for death around 0.67 for both scores. In this cohort of non-atrial fibrillation patients with incident ischemic stroke, increasing CHA2DS2VASc score and Essen Stroke Risk Score was associated with increasing risk of recurrent stroke, death, and cardiovascular events. Their discriminatory performance was modest and further refinements are required for clinical application. © 2015 American Heart Association, Inc.

  8. Idiopathic versus secondary venous thromboembolism. Findings of the RIETE registry.

    Science.gov (United States)

    Pedrajas, J M; Garmendia, C; Portillo, J; Gabriel, F; Mainez, C; Yera, C; Monreal, M

    2014-10-01

    The Computerized Registry of Patients with Venous Thromboembolism (RIETE) is a prospective registry that consecutively includes patients diagnosed with venous thromboembolism. We compared the clinical presentation and response to anticoagulant treatment in patients with idiopathic venous thromboembolism (IVT) versus secondary venous thromboembolism (SVT, associated with a risk factor). We analyzed the differences in clinical characteristics, comorbidity, treatment and events during the first 3months after the diagnosis of venous thromboembolism in patients with IVT or SVT and according to their initial clinical presentation. A total of 39,921 patients with IVT (n=18,029; 45.1%) or SVT (n=21,892; 54.9%) were enrolled. The patients with IVT had a greater history of venous thromboembolism than those diagnosed with SVT (pSVT group (pSVT group than in the IVT group. At 90days, bleeding, death and the recurrence of venous thromboembolism were significantly more frequent in the SVT group. The multivariate analysis confirmed that IVT was associated with fewer major (OR, 0.60; 95%CI, 0.50-0.61; pSVT at 90days of the diagnosis. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  9. Venous thromboembolism and subsequent hospitalisation due to acute arterial cardiovascular events: a 20-year cohort study

    DEFF Research Database (Denmark)

    Sørensen, Henrik Toft; Horvath-Puho, Erzsebet; Pedersen, Lars

    2007-01-01

    of myocardial infarction and stroke in 25,199 patients with deep venous thrombosis, 16,925 patients with pulmonary embolism, and 163,566 population controls. FINDINGS: For patients with deep venous thrombosis, the relative risks varied from 1.60 for myocardial infarction (95% CI 1.35-1.91) to 2.19 (1.......85-2.60) for stroke in the first year after the thrombotic event. For patients with pulmonary embolism, the relative risks in that year were 2.60 (2.14-3.14) for myocardial infarction and 2.93 (2.34-3.66) for stroke. The relative risks were also raised, though less markedly, during the subsequent 20 years of follow......-up, with 20-40% increases in risk for arterial cardiovascular events. Relative risks were similar for those with provoked and unprovoked deep venous thrombosis and pulmonary embolism. INTERPRETATION: Patients with venous thromboembolism have a substantially increased long-term risk of subsequent arterial...

  10. Interventional Radiology: Stroke

    Science.gov (United States)

    ... AND REIMBURSEMENT Diseases and conditions Home Patient Center Stroke Stroke What is stroke? A stroke occurs when blood flow to the brain is ... reduced or cut off. Within minutes of a stroke, brain cells begin to die and cause the ...

  11. Ischemic Strokes (Clots)

    Science.gov (United States)

    ... Month Infographic Stroke Hero F.A.S.T. Quiz Ischemic Strokes (Clots) Updated:Apr 26,2017 Ischemic stroke ... stroke. Let's Talk Numbers Updated Guidelines for Acute Ischemic Strokes Infographic : Attacking Brain Clots to Save Lives ...

  12. Stroke Rehabilitation.

    Science.gov (United States)

    Belagaje, Samir R

    2017-02-01

    Rehabilitation is an important aspect of the continuum of care in stroke. With advances in the acute treatment of stroke, more patients will survive stroke with varying degrees of disability. Research in the past decade has expanded our understanding of the mechanisms underlying stroke recovery and has led to the development of new treatment modalities. This article reviews and summarizes the key concepts related to poststroke recovery. Good data now exist by which one can predict recovery, especially motor recovery, very soon after stroke onset. Recent trials have not demonstrated a clear benefit associated with very early initiation of rehabilitative therapy after stroke in terms of improvement in poststroke outcomes. However, growing evidence suggests that shorter and more frequent sessions of therapy can be safely started in the first 24 to 48 hours after a stroke. The optimal amount or dose of therapy for stroke remains undetermined, as more intensive treatments have not been associated with better outcomes compared to standard intensities of therapy. Poststroke depression adversely affects recovery across a variety of measures and is an important target for therapy. Additionally, the use of selective serotonin reuptake inhibitors (SSRIs) appears to benefit motor recovery through pleiotropic mechanisms beyond their antidepressant effect. Other pharmacologic approaches also appear to have a benefit in stroke rehabilitation. A comprehensive rehabilitation program is essential to optimize poststroke outcomes. Rehabilitation is a process that uses three major principles of recovery: adaptation, restitution, and neuroplasticity. Based on these principles, multiple different approaches, both pharmacologic and nonpharmacologic, exist to enhance rehabilitation. In addition to neurologists, a variety of health care professionals are involved in stroke rehabilitation. Successful rehabilitation involves understanding the natural history of stroke recovery and a

  13. Current issues in patient adherence and persistence: focus on anticoagulants for the treatment and prevention of thromboembolism

    Directory of Open Access Journals (Sweden)

    Patrick P Kneeland

    2010-03-01

    Full Text Available Patrick P Kneeland, Margaret C FangThe University of California, San Francisco Division of Hospital Medicine, San Francisco, CA, USAAbstract: Warfarin therapy reduces morbidity and mortality related to thromboembolism. Yet adherence to long-term warfarin therapy remains challenging due to the risks of anticoagulantassociated complications and the burden of monitoring. The aim of this paper is to review determinants of adherence and persistence on long-term anticoagulant therapy for atrial fibrillation and venous thromboembolism. We evaluate what the current literature reveals about the impact of warfarin on quality of life, examine warfarin trial data for patterns of adherence, and summarize known risk factors for warfarin discontinuation. Studies suggest only modest adverse effects of warfarin on quality of life, but highlight the variability of individual lifestyle experiences of patients on warfarin. Interestingly, clinical trials comparing anticoagulant adherence to alternatives (such as aspirin show that discontinuation rates on warfarin are not consistently higher than in control arms. Observational studies link a number of risk factors to warfarin non-adherence including younger age, male sex, lower stroke risk, poor cognitive function, poverty, and higher educational attainment. In addition to differentiating the relative impact of warfarin-associated complications (such as bleeding versus the lifestyle burdens of warfarin monitoring on adherence, future investigation should focus on optimizing patient education and enhancing models of physician–patient shared-decision making around anticoagulation.Keywords: anticoagulation, warfarin, adherence, persistence, thromboembolism

  14. Venous thromboembolism: have we made headway?

    Science.gov (United States)

    Fitzgerald, Jan

    2010-01-01

    Venous thromboembolism (VTE) is a primary cause of preventable hospital death. The need for effective VTE prophylaxis has been recognized by the Surgical Care Improvement Program (SCIP) and the Joint Commission, which is offering VTE prevention as a core measure set, starting October 1, 2009. The adoption of SCIP VTE measures and mandate to publicly report these rates offers the opportunity to improve the use of prophylaxis in surgical patients and reduce VTE-related morbidity, mortality, and costs. Essential to this reduction is a team approach to implementing real-time interventions. Crucial to the success of the team is early identification of each patient's VTE risk and a mechanism to provide key information to ensure that the physician prescribes appropriate prophylaxis. In addition, it may be the nurse who is responsible for ensuring that a patient receives the appropriate prophylaxis, as well as being the first clinician to observe the clinical signs of a VTE event.

  15. Post-Operative Multiple Thrombosis Associated with Patent Foramen Ovale: Embolic Stroke, Right Atrial Thrombi, Pulmonary Embolism and Deep Vein Thrombosis.

    Science.gov (United States)

    Cho, Sun-Young; Youn, Ho-Joong; Park, Mi-Youn; Shim, Byung-Ju; Lee, Seung-Jae; Kim, Jeong-Ho; Park, Jung-Ku; Oh, Chang-Yul; Ahn, So-Hyun; Cho, Woo-Hyun

    2015-09-01

    Patients undergoing total joint arthroplasty frequently develop post-operative complication, such as deep vein thrombosis and pulmonary thromboembolism. However, it is not common coexisting deep vein thrombosis, pulmonary thromboembolisms, right atrial thrombus and acute cerebral infarction raised by thrombus through patent foramen ovale. We reported the patient who had multiple thrombi which were accompanied with a cryptogenic ischemic stroke and associated with patent foramen ovale after operation.

  16. [Oral anticoagulat treatment in venous thromboembolic disease].

    Science.gov (United States)

    Fontcuberta, Jordi

    2008-11-01

    Coumarin or anti-vitamin K oral anticoagulants have been used in anticoagulation therapy for more than 50 years. Well-designed studies have demonstrated the effectiveness of these drugs in the primary and secondary prevention of venous thromboembolic disease (VTD). Because of greater life expectancy and the increase in the indications for oral anticoagulation therapy (OAT), more and more patients are receiving this type of treatment. In Spain, approximately 1% of the population receives OAT. The mechanism of action of coumarin anticoagulants is based on inhibition of the interconversion of vitamin K and its 2,3-epoxide (vitamin K epoxide, which modulates gamma-carboxylation of the glutamic acid residues in the N-terminal regions of vitamin-K-dependent factors, namely, II, VII, IX, X, protein C, protein S and protein Z). Due to the lack of gamma-carboxylation, these factors lose their procoagulant activity. Major hemorrhagic complications of OAT in VTD after 3-6 months of treatment, with an INR of 2-3, occur in nearly 2% of patients. The hemorrhagic complications of OAT are related to the intensity of anticoagulation, patient characteristics, the concomitant use of drugs that interfere with hemostasis, and treatment duration. The risk of VTD recurrence after 3-6 months of OAT is high and can be more than 10% in patients with idiopathic thromboembolism or irreversible risk factors such as thrombophilia, cancer and other situations conferring permanent risk. The risk of recurrence is more frequent in men, in patients with thrombophilia especially in antithrombin deficiency, and in patients with cancer, residual venous obstruction, or elevated D dimer.

  17. Descriptive Data of Patients with Venous Thromboembolism

    Directory of Open Access Journals (Sweden)

    Gul Ilhan

    2013-08-01

    Full Text Available Purpose: This study was designed for collecting descriptive data about diagnosis and treatment of patients diagnosed with venous thromboembolism (VTE in an university hospital and for reflecting approach to VTE in such a reference hospital in this way. Material and Methods: We evaluated archive records of patients disgnosed with deep vein thrombosis (DVT and pulmonary thromboembolism (PTE between 2000 an 2005. Age average of patients was advanced and most of them were women. They had DVT, PTE, DVT and PTE respectively. Most common diagnostic method used for PTE was computed thomogrphy (CT, for DVT was ultrasonography (USG. VTE was diagnosed most frequently in emergency services and policlinics. Most common chronic risk factors for VTE were cancer, heart failure/romathismal cardiac disease, hyperlipidemia/atherosclerosis and obesity. Risk factors spesific to the attacks (or temporary were immobilization, surgery, pregnancy, taking oral contraseptive drugs and trauma. Results: In patients investigated for hemostatic risk factors, Factor V Leiden, Prothrombin 20210 A , and MTHFR mutations were found respectively. Symptoms and findings of patients admitted with PTE were dyspnea-tachipnea, tachycardia, palpitation, pleural pain, caugh, fever, anginal pain, hemopthysis, diaphoresis and wheezing . Echocardiography gave positive results for the most of PTE cases. D-dimer test was found high sensitive. Treatments during accute attacks were low moleculer weight heparin (LMWH, standart heparin, thrombolytic therapy, surgery, aspirine and vena cava inferior filter placement. Acute term complications were death, bleeding and heparin induced thrombocytopenia. Conclusion: This retrospective study reflects the approach of VTE diagnosis and treatment in a reference hospital and it may guide for prospective studies. [Cukurova Med J 2013; 38(4.000: 610-616

  18. Apixaban: Effective and Safe in Preventing Thromboembolic Events in Patients with Atrial Fibrillation and Renal Failure.

    Science.gov (United States)

    Cortese, Francesca; Scicchitano, Pietro; Gesualdo, Michele; Ricci, Gabriella; Carbonara, Santa; Franchini, Carlo; Pia Schiavone, Brigida Immacolata; Corbo, Filomena; Ciccone, Marco Matteo

    2017-11-17

    Thromboembolic events, principally stroke, represent one of the leading causes of morbidity and mortality among subjects with atrial fibrillation. Chronic kidney disease determines a further increase of thromboembolic events, bleeding and mortality and complicates the pharmacological management of patients with atrial fibrillation, mainly due to the side effects of antiarrhythmic and anticoagulant drugs with renal excretion. Apixaban is a new oral anticoagulant characterized by good bioavailability and renal elimination accounting for only 25%, showing a safety profile and effectiveness in patients with renal impairment. In this manuscript, we reviewed literature data on the use of apixaban in the management of non-valvular atrial fibrillation in patients with renal failure, in order to clarify an often-debated topic in clinical practice. A PubMed search was performed on the terms atrial fibrillation, apixaban and renal failure with the aim of identifying relevant manuscripts, large randomized clinical trials, meta-analyses, and current guidelines. Literature data show that apixaban could represent an interesting alternative to warfarin and other selective antagonists of coagulation factors in patients with impaired renal function. About the risk of major bleeding, apixaban appears to be safer than warfarin in the presence of any degree of renal failure. Apixaban show to be an effective anticoagulant in patients with atrial fibrillation, even superior to warfarin in reducing the risk of stroke and systemic embolism regardless of the presence of renal insufficiency. Moreover, Food and Drug Administration allows the use of apixaban in patients with end stage renal disease on hemodialysis. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  19. Risk of thromboembolism in heart failure: an analysis from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT).

    Science.gov (United States)

    Freudenberger, Ronald S; Hellkamp, Anne S; Halperin, Jonathan L; Poole, Jeanne; Anderson, Jill; Johnson, George; Mark, Daniel B; Lee, Kerry L; Bardy, Gust H

    2007-05-22

    In patients with heart failure, rates of clinically apparent stroke range from 1.3% to 3.5% per year. Little is known about the incidence and risk factors in the absence of atrial fibrillation. In the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT), 2521 patients with moderate heart failure were randomized to receive amiodarone, implanted cardioverter-defibrillators (ICDs), or placebo. We determined the incidence of stroke or peripheral or pulmonary embolism in patients with no history of atrial fibrillation (n=2114), predictors of thromboembolism and the relationship to left ventricular ejection fraction. Median follow-up was 45.5 months. Kaplan-Meier estimates (95% CIs) for the incidence of thromboembolism by 4 years were 4.0% (3.0% to 4.9%), with 2.6% (1.1% to 4.1%) in patients randomized to amiodarone, 3.2% (1.8% to 4.7%) in patients randomized to ICD, and 6.0% (4.0% to 8.0%) in patients randomized to placebo (approximate rates of 0.7%, 0.8%, and 1.5% per year, respectively). By multivariable analysis, hypertension (P=0.021) and decreasing left ventricular ejection fraction (P=0.023) were significant predictors of thromboembolism; treatment with amiodarone or ICD treatment was a significant predictor of thromboembolism-free survival (P=0.014 for treatment effect; hazard ratio [95% CI] versus placebo, 0.57 [0.33 to 0.99] for ICD; 0.44 [0.24 to 0.80] for amiodarone). Inclusion of atrial fibrillation during follow-up in the multivariable model did not affect the significance of treatment assignment as a predictor of thromboembolism. In the SCD-HeFT patient cohort, which reflects contemporary treatment of patients with moderately symptomatic systolic heart failure, patients experienced thromboembolism events at a rate of 1.7% per year without antiarrhythmic therapy. Those treated with amiodarone or ICDs had lower risk of thromboembolism than those given placebo. Hypertension at baseline and lower ejection fraction were independent predictors of risk.

  20. Processes of early stroke care and hospital costs

    DEFF Research Database (Denmark)

    Svendsen, Marie Louise; Ehlers, Lars H.; Hundborg, Heidi H.

    2014-01-01

    Background: The relationship between processes of early stroke care and hospital costs remains unclear. Aims: We therefore examined the association in a population-based cohort study. Methods: We identified 5909 stroke patients who were admitted to stroke units in a Danish county between 2005...... and 2010. The examined recommended processes of care included early admission to a stroke unit, early initiation of antiplatelet or anticoagulant therapy, early computed tomography/magnetic resonance imaging (CT/MRI) scan, early physiotherapy and occupational therapy, early assessment of nutritional risk......, constipation risk and of swallowing function, early mobilization, early catheterization, and early thromboembolism prophylaxis. Hospital costs were assessed for each patient based on the number of days spent in different in-hospital facilities using local hospital charges. Results: The mean costs...

  1. The pathogenesis of venous thromboembolism : Evidence for multiple interrelated causes

    NARCIS (Netherlands)

    Brouwer, Jan-Leendert P.; Veeger, Nic J. G. M.; Kluin-Nelemans, Hanneke C.; van der Meer, Jan

    2006-01-01

    Background: Venous thromboembolism (VTE) is thought to result from interactions between multiple genetic and environmental risk factors. Objective: To assess the contribution of multiple thrombophilic defects and exogenous risk factors to the absolute risk for VTE. Design: Retrospective family

  2. [Importance of risk factors in the extension of pulmonary thromboembolism].

    Science.gov (United States)

    García-Rodeja, M E; Gamallo, C; Arribas, J R; Monereo, A; Lahoz, C; Arnalich, F

    1990-06-16

    The cases of pulmonary thromboembolism (PTE) diagnosed in the clinical autopsies performed in our hospital during a 15-year period were reviewed. The incidence was 2.7% (63 cases). The most common disease associated with thromboembolism was cancer (41%). In 30 cases, thromboembolism involved more than 60% of the pulmonary circulation (group I), between 40% and 60% in 18 cases (group II), and less than 40% in 15 cases (group III). 30% of the embolisms were recurrent. A statistically significant correlation between the extension of the involved pulmonary circulation and the condition associated with thromboembolism was found. Whereas in patients with neoplasia the extension of pulmonary circulation involved by PTE was quite variable, the patients with cardiovascular disease or thrombophlebitis had PTE with invariably severe compromise of pulmonary vasculature (groups I and II).

  3. New anticoagulants for the prevention and treatment of venous thromboembolism

    Directory of Open Access Journals (Sweden)

    Simon J McRae

    2005-04-01

    Full Text Available Simon J McRae, Jeffrey S GinsbergDepartment of Medicine, McMaster University, Hamilton, ON, CanadaAbstract: Anticoagulant therapy is effective at preventing the development of venous thromboembolism in high-risk patients, and reduces morbidity and mortality in individuals with established thromboembolic disease. Vitamin K antagonists and heparins are currently the most commonly used anticoagulant drugs, but they have practical limitations. Therefore, new antithrombotic agents with predictable dose-responses (thereby decreasing the need for monitoring without compromising efficacy or safety, ideally available in an oral formulation and with a rapidly reversible anticoagulant effect, are needed. New drugs fulfilling some of the above criteria have been developed and have proven to be effective agents for the treatment and prevention of venous thromboembolism.Keywords: venous thromboembolism, anticoagulants, antithrombotic

  4. ABO Blood Group and Risk of Thromboembolic and Arterial Disease

    DEFF Research Database (Denmark)

    Vasan, Senthil K; Rostgaard, Klaus; Majeed, Ammar

    2016-01-01

    BACKGROUND: ABO blood groups have been shown to be associated with increased risks of venous thromboembolic and arterial disease. However, the reported magnitude of this association is inconsistent and is based on evidence from small-scale studies. METHODS AND RESULTS: We used the SCANDAT2...... (Scandinavian Donations and Transfusions) database of blood donors linked with other nationwide health data registers to investigate the association between ABO blood groups and the incidence of first and recurrent venous thromboembolic and arterial events. Blood donors in Denmark and Sweden between 1987......-up. Compared with blood group O, non-O blood groups were associated with higher incidence of both venous and arterial thromboembolic events. The highest rate ratios were observed for pregnancy-related venous thromboembolism (incidence rate ratio, 2.22; 95% confidence interval, 1.77-2.79), deep vein thrombosis...

  5. The up-to-date management of venous thromboembolism.

    Science.gov (United States)

    Chakrabarti, Anob M

    2015-08-01

    There have been a number of developments in the management of venous thromboembolism over the past few years. Old questions, such as thrombolysis, have been revisited in recent trials. New initiatives, such as ambulatory care pathways, are being established across the country. This conference brought together doctors from the UK, USA, Spain and Australia to review the up-to-date management of venous thromboembolism. © Royal College of Physicians 2015. All rights reserved.

  6. How a Stroke Is Diagnosed

    Science.gov (United States)

    ... News About Neurology Image Library Search The Internet Stroke Center Patients & Families About Stroke Stroke Diagnosis Stroke ... Diagnosis » How a Stroke is Diagnosed How a Stroke is Diagnosed How a Stroke is Diagnosed Lab ...

  7. Post stroke dementia and Post stroke depression

    OpenAIRE

    Trkanjec, Zlatko

    2012-01-01

    Stroke is the rapid loss of brain function due to disturbance in the blood supply to the brain causing predominantly motor and sensory symptoms. However, stroke can cause some other symptoms. Post stroke dementia and depression are probably the most important non-motor consequences of stroke. Post stroke dementia and depression are important and often overlooked symptoms following stroke. Treatment options for Post stroke dementia and depression are still limited, therefore diagnosis of Post ...

  8. Correlation of venous thromboembolism prophylaxis and electronic medical record alerts with incidence among surgical patients.

    Science.gov (United States)

    Ramanathan, Rajesh; Lee, Nathaniel; Duane, Therese M; Gu, Zirui; Nguyen, Natalie; Potter, Teresa; Rensing, Edna; Sampson, Renata; Burrows, Mandy; Banas, Colin; Hartigan, Sarah; Grover, Amelia

    2016-11-01

    Venous thromboembolism events are potentially preventable adverse events. We investigated the effect of interruptions and delays in pharmacologic prophylaxis on venous thromboembolism incidence. Additionally, we evaluated the utility of electronic medical record alerts for venous thromboembolism prophylaxis. Venous thromboembolisms were identified in surgical patients retrospectively through Core Measure Venous ThromboEmbolism-6-6 and Patient Safety Indicator 12 between November 2013 and March 2015. Venous thromboembolism pharmacologic prophylaxis and prescriber response to electronic medical record alerts were recorded prospectively. Prophylaxis was categorized as continuous, delayed, interrupted, other, and none. Among 10,318 surgical admissions, there were 131 venous thromboembolisms; 23.7% of the venous thromboembolisms occurred with optimal continuous prophylaxis. Prophylaxis, length of stay, age, and transfer from another hospital were associated with increased venous thromboembolism incidence. Compared with continuous prophylaxis, interruptions were associated with 3 times greater odds of venous thromboembolism. Delays were associated with 2 times greater odds of venous thromboembolism. Electronic medical record alerts occurred in 45.7% of the encounters and were associated with a 2-fold increased venous thromboembolism incidence. Focus groups revealed procedures as the main contributor to interruptions, and workflow disruption as the main limitation of the electronic medical record alerts. Multidisciplinary strategies to decrease delays and interruptions in venous thromboembolism prophylaxis and optimization of electronic medical record tools for prophylaxis may help decrease rates of preventable venous thromboembolism. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. THROMBOTIC AND THROMBOEMBOLIC COMPLICATIONS IN SYSTEMIC VASCULITIS

    Directory of Open Access Journals (Sweden)

    E. V. Arseniev

    2017-01-01

    Full Text Available Nowadays, there is no doubt about the relationship between immune inflammation and the development of thrombosis due to the similarity of many pathogenetic machanisms underlying both pathological processes. Systemic vasculitis, along with other immuno- mediated inflammatory diseases, represent one of the most clear examples of such interaction. Thrombotic complications remain one of the most serious and life-threatening conditions that occur in patients with autoimmune diseases, in particular systemic vasculitis. This serves as powerful stimulus for studing the problem of hypercoagulation, which often accompanies the course of systemic vasculitis. Of interest are thrombosis that occure both in the injury of large vessel and in the involvement of medium and small vessels in the pathological process. According to the literature, thrombotic and thromboembolic complications are most common in ANCA-associated vasculitis and Behçet’s disease. This review discusses current studies regarding features of clinical picture and mechanisms of thrombosis development in systemic vasculitis. Because of these studies it became clear that for some vasculitis a high frequency of both arterial and venous thrombosis is characteristic. At the same time, other vasculitis are accompanied by high risk of only venous thrombosis. Finally, thrombosis and thromboembolism are quite rare complications for some vasculitis. Among the presented mechanisms of thrombosis involvement, disruptions of the hemostasis are widely considered. For examples, the presents the results of researches, which is actively discussed the role of neutrophil extracellular traps and antiendothelial cell antibodies in the development on thrombotic complictions. Special attention is paid to the possible role of some disorders of hemostasis, such as polymorphism V coagulation factor G1691FA and prothrombin G20210A. To search for literature sources, the following queries were used: “vasculitis”,

  10. Embolic Stroke Diagnosed by Elevated D-Dimer in a Patient With Negative TEE for Cardioembolic Source

    Directory of Open Access Journals (Sweden)

    Irina Y. Sazonova PhD

    2014-12-01

    Full Text Available We report a case of cerebrovascular accident with thromboembolic stroke etiology in a patient who had atrial flutter and negative transesophageal echocardiography (TEE results. The increased D-dimer levels (1877 ng/mL initiated referral for magnetic resonance imaging and magnetic resonance angiography of the brain that showed classic recanalization of an embolic thrombus in the angular branch of the left middle cerebral distribution. The D-dimer level of this patient was normalized after 3 months of anticoagulation therapy. Although TEE is considered the gold standard for evaluation of cardiac source of embolism, exclusion of intracardiac thrombus with TEE alone does not eliminate the risk of thromboembolic events. This case highlights the utility of D-dimer as a potential adjunct in the decision-making process to guide investigation of thromboembolism, determine subsequent therapy, and hence reduce the risk of embolic stroke recurrence.

  11. The pathophysiology of chronic thromboembolic pulmonary hypertension

    Directory of Open Access Journals (Sweden)

    Gérald Simonneau

    2017-03-01

    Full Text Available Chronic thromboembolic pulmonary hypertension (CTEPH is a rare, progressive pulmonary vascular disease that is usually a consequence of prior acute pulmonary embolism. CTEPH usually begins with persistent obstruction of large and/or middle-sized pulmonary arteries by organised thrombi. Failure of thrombi to resolve may be related to abnormal fibrinolysis or underlying haematological or autoimmune disorders. It is now known that small-vessel abnormalities also contribute to haemodynamic compromise, functional impairment and disease progression in CTEPH. Small-vessel disease can occur in obstructed areas, possibly triggered by unresolved thrombotic material, and downstream from occlusions, possibly because of excessive collateral blood supply from high-pressure bronchial and systemic arteries. The molecular processes underlying small-vessel disease are not completely understood and further research is needed in this area. The degree of small-vessel disease has a substantial impact on the severity of CTEPH and postsurgical outcomes. Interventional and medical treatment of CTEPH should aim to restore normal flow distribution within the pulmonary vasculature, unload the right ventricle and prevent or treat small-vessel disease. It requires early, reliable identification of patients with CTEPH and use of optimal treatment modalities in expert centres.

  12. Venous Thromboembolism in Pediatric Vascular Anomalies

    Directory of Open Access Journals (Sweden)

    Taizo A. Nakano

    2017-07-01

    Full Text Available The presence of a vascular anomaly suggests that capillaries, veins, arteries, and/or lymphatic vessels have demonstrated abnormal development and growth. Often dilated and misshaped, these vessels augment normal flow of blood and lymphatic fluids that increases the overall risk to develop intralesional thrombosis. Abnormal endothelial and lymphoendothelial cells activate hemostasis and hyperfibrinolytic pathways through poorly understood mechanisms, which contribute to the development of localized intravascular coagulopathy. Vascular malformations, tumors, and complex combined syndromes demonstrate varying degrees of prothrombotic activity and consumptive coagulopathy depending on the vessels involved and the pattern and extent of abnormal growth. The clinical impact of venous thromboembolism in pediatric vascular anomalies varies from painful syndromes that disrupt quality of life to life-threatening embolic disease. There remains little literature on the study, evaluation, and treatment of thrombosis in pediatric vascular anomalies. However, there have been great advances in our ability to image complex lesions, to surgically and interventionally augment disease, and to provide enhanced supportive care including patient education, compression therapy, and strategic use of anticoagulation.

  13. Perioperative venous thromboembolic disease and the emerging role of the novel oral anticoagulants: An analysis of the implications for perioperative management

    Directory of Open Access Journals (Sweden)

    Martina Mookadam

    2015-01-01

    Full Text Available Venous thromboembolism includes 2 inter-related conditions: Deep venous thrombosis and pulmonary embolism. Heparin and low-molecular-weight heparin followed by oral anticoagulation with vitamin K agonists is the first line and current accepted standard therapy with good efficacy. However, this therapeutic strategy has many limitations including the significant risk of bleeding and drug, food and disease interactions that require frequent monitoring. Dabigatran, rivaroxaban, apixaban, and edoxaban are the novel oral anticoagulants that are available for use in stroke prevention in atrial fibrillation and for the treatment and prevention of venous thromboembolism (HYPERLINK\\l "1. Recent prospective randomized trials comparing the NOACs with warfarin have shown similar efficacy between the treatment strategies but fewer bleeding episodes with the NOACs. This paper presents an evidence-based review describing the efficacy and safety of the new anticoagulants compared to warfarin.

  14. Perioperative venous thromboembolic disease and the emerging role of the novel oral anticoagulants: an analysis of the implications for perioperative management.

    Science.gov (United States)

    Mookadam, Martina; Shamoun, Fadi E; Ramakrishna, Harish; Obeid, Hiba; Rife, Renee L; Mookadam, Farouk

    2015-01-01

    Venous thromboembolism includes 2 inter-related conditions: Deep venous thrombosis and pulmonary embolism. Heparin and low-molecular-weight heparin followed by oral anticoagulation with vitamin K agonists is the first line and current accepted standard therapy with good efficacy. However, this therapeutic strategy has many limitations including the significant risk of bleeding and drug, food and disease interactions that require frequent monitoring. Dabigatran, rivaroxaban, apixaban, and edoxaban are the novel oral anticoagulants that are available for use in stroke prevention in atrial fibrillation and for the treatment and prevention of venous thromboembolism (HYPERLINK\\l "1). Recent prospective randomized trials comparing the NOACs with warfarin have shown similar efficacy between the treatment strategies but fewer bleeding episodes with the NOACs. This paper presents an evidence-based review describing the efficacy and safety of the new anticoagulants compared to warfarin.

  15. Preventing Stroke Deaths

    Science.gov (United States)

    ... Press Kit Read the MMWR Science Clips Preventing Stroke Deaths Progress Stalled Language: English (US) Español (Spanish) ... 4 states. 80% of strokes are preventable. Problem Stroke deaths have stopped declining. Strokes are common and ...

  16. Heart Disease and Stroke

    Science.gov (United States)

    ... email updates Enter email Submit Heart Disease and Stroke Heart disease and stroke are important health issues ... Stroke risk factors View more Heart Disease and Stroke resources Related information Heart-healthy eating Stress and ...

  17. Stroke (For Kids)

    Science.gov (United States)

    ... Kids With Special Needs Glasses and Contact Lenses Stroke KidsHealth > For Kids > Stroke Print A A A ... get help quickly. continue What Happens During a Stroke? A stroke usually happens suddenly, and a person ...

  18. High risk of pregnancy-related venous thromboembolism in women with multiple thrombophilic defects

    NARCIS (Netherlands)

    Folkeringa, Nienke; Leendert, Jan; Brouwer, P.; Korteweg, Fleurisca J.; Veeger, Nic J. G. M.; Erwich, Jan Jaap H. M.; van der Meer, Jan

    Pregnancy is associated with an increased risk of venous thromboembolism, which probably varies according to the presence of single or multiple thrombophilic defects. This retrospective family cohort study assessed the risk of venous thromboembolism during pregnancy and puerperium, and the

  19. Is treatment of atrial fibrillation in primary care based on thromboembolic risk assessment?

    NARCIS (Netherlands)

    Rutten, F.H.; Hak, E.; Stalman, W.A.B.; Verheij, T.J.M.; Hoes, A.W.

    2003-01-01

    Background. Antithrombotic treatment in atrial fibrillation should be guided by the risk of thromboembolic events. Although practice studies have shown underutilization of antithrombotics, it is not clear whether physicians make use of thromboembolic risk stratification in their treatment decisions,

  20. Oral contraceptives and venous thromboembolism: a five-year national case-control study

    DEFF Research Database (Denmark)

    Lidegaard, Øjvind; Edström, Birgitte; Kreiner, Svend

    2002-01-01

    Venous thromboembolism; Oral contraceptives; Pulmonary embolism; Third-generation; Second-generation; Pill Scare......Venous thromboembolism; Oral contraceptives; Pulmonary embolism; Third-generation; Second-generation; Pill Scare...

  1. Risk of a venous thromboembolic episode due to caesarean section and BMI

    DEFF Research Database (Denmark)

    Colmorn, Lotte Berdiin; Ladelund, S; Rasmussen, S

    2014-01-01

    BMI significantly influences the risk of venous thromboembolism after emergency caesarean delivery compared with vaginal delivery.......BMI significantly influences the risk of venous thromboembolism after emergency caesarean delivery compared with vaginal delivery....

  2. Prospective cardiopulmonary screening program to detect chronic thromboembolic pulmonary hypertension in patients after acute pulmonary embolism.

    NARCIS (Netherlands)

    Klok, F.A.; Kralingen, K.W. van; Dijk, A.P.J. van; Heyning, F.H.; Vliegen, H.W.; Huisman, M.V.

    2010-01-01

    BACKGROUND: Chronic thromboembolic pulmonary hypertension after pulmonary embolism is associated with high morbidity and mortality. Understanding the incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism is important for evaluating the need for screening but is also a

  3. Is thromboembolism prophylaxis necessary for low and moderate risk patients in maxillofacial trauma? A retrospective analysis

    NARCIS (Netherlands)

    Skorpil, N.E.; van den Bergh, B.; Heymans, M.W.; Forouzanfar, T.

    2012-01-01

    This study was designed to investigate retrospectively the incidence of venous thromboembolism (VTE) and the need for thromboembolism prophylaxis in patients undergoing surgery for oral and maxillofacial trauma. Data were obtained from all patients treated under general anaesthesia for maxillofacial

  4. [Maternal death by venous thromboembolic disease].

    Science.gov (United States)

    Rossignol, M; Morau, E; Dreyfus, M

    2017-12-01

    Pregnancy and postpartum are very high-risk periods for venous thromboembolism events (TEE), which seems to extend far beyond the classical 6-8 weeks after childbirth. Pulmonary embolism (PE) is one of the 3 main causes of direct maternal death in western countries. Between 2010 an 2012 in France, 24 deaths were related to PE giving a maternal mortality ratio of 1/100,000, which is not different from the former report (2007-2009). PE is responsible of 9% of maternal deaths, in equal position with postpartum hemorrhage and amniotic fluid embolism. Four deaths (16%) occurred after pregnancy interruption (1 abortion, 3 medical interruptions), 7 (30%) during ongoing pregnancy (before 22 weeks of pregnancy) and 13 (54%) in the postpartum period (9 to 60 days after childbirth). Among these deaths, 9 occurred in extra hospital setting (at home or in the street). Fifty percent of these deaths seem to be avoidable, as it was in the former report. Main avoidability criteria were: diagnostic delay; mobilization before effective anticoagulation of proximal deep venous thrombosis; insufficient preventive treatment with low molecular weight heparin [duration and/or dose (obesity)]; unjustified induction of labor. Analyzing those deaths allow to remind that in case of high suspicion of TEE, effective anticoagulation should be started without delay, and that angio-TDM is not contraindicated in pregnant women. Low molecular weight heparin regiment should be adapted to real weight. Monitoring of anti-Xa activity, if not routinely recommended, is probably useful in case of obesity or renal insufficiency. Anticipating birth by induction of labor, in the absence of abnormal fetal heart rhythm, should not delay effective anticoagulation of near-term TEE. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  5. Review of the cost of venous thromboembolism

    Science.gov (United States)

    Fernandez, Maria M; Hogue, Susan; Preblick, Ronald; Kwong, Winghan Jacqueline

    2015-01-01

    Background Venous thromboembolism (VTE) is the second most common medical complication and a cause of excess length of hospital stay. Its incidence and economic burden are expected to increase as the population ages. We reviewed the recent literature to provide updated cost estimates on VTE management. Methods Literature search strategies were performed in PubMed, Embase, Cochrane Collaboration, Health Economic Evaluations Database, EconLit, and International Pharmaceutical Abstracts from 2003–2014. Additional studies were identified through searching bibliographies of related publications. Results Eighteen studies were identified and are summarized in this review; of these, 13 reported data from the USA, four from Europe, and one from Canada. Three main cost estimations were identified: cost per VTE hospitalization or per VTE readmission; cost for VTE management, usually reported annually or during a specific period; and annual all-cause costs in patients with VTE, which included the treatment of complications and comorbidities. Cost estimates per VTE hospitalization were generally similar across the US studies, with a trend toward an increase over time. Cost per pulmonary embolism hospitalization increased from $5,198–$6,928 in 2000 to $8,764 in 2010. Readmission for recurrent VTE was generally more costly than the initial index event admission. Annual health plan payments for services related to VTE also increased from $10,804–$16,644 during the 1998–2004 period to an estimated average of $15,123 for a VTE event from 2008 to 2011. Lower costs for VTE hospitalizations and annualized all-cause costs were estimated in European countries and Canada. Conclusion Costs for VTE treatment are considerable and increasing faster than general inflation for medical care services, with hospitalization costs being the primary cost driver. Readmissions for VTE are generally more costly than the initial VTE admission. Further studies evaluating the economic impact of new

  6. MRA for diagnosis of venous thromboembolism

    Energy Technology Data Exchange (ETDEWEB)

    Sostman, H. D. [Cornell University, Weill Medical College, Chair of Radiology, New York (United States)

    2001-12-01

    Direct imaging of pulmonary embolism (PE) and deep vein thrombosis (DVT) with CT, and potentially with MR, will continue to replace V/Q scintigraphy. Venous imaging with MR far detecting DVT is used in a few centers, and their published accuracy figures are impressive. Recent studies of MR pulmonary angiography for PE reported that sensitivity of MRA was 85-100%, specificity 95-96%, but this data must be confirmed in other centers and patient populations. MR has advantages compared with CT, which make it worthwhile to continue MR development. Ionizing radiation and iodinated contrast material are not used. Imaging the pulmonary arteries and then imaging whichever venous region is of clinical interest is practical in a single examination. Repeated examinations can be performed safely. New contrast materials will facilitate the practically and accuracy of the MR technique and perfusion imaging may increase sensitivity. MR also has disadvantages compared with CT. It does not image effectively the non-vascular compartment of the lungs. It is more expensive, patient monitoring is more cumbersome, and a routine technique, which embodies all of MR's potential advantages, has not been packaged and tested. Accordingly, helical CT is a realistic option in clinical management of patients with suspected PE in most centers, while clinical application of MR is limited to centers with appropriate MR expertise and technology. However, MR has a number of fundamental characteristics that make it potentially ideal modality for evaluating patients with suspected acute venous thromboembolic disease and further clinical research with MRA is warranted.

  7. Heat Stroke

    DEFF Research Database (Denmark)

    Mørch, Sofie Søndergaard; Andersen, Johnny Dohn Holmgren; Bestle, Morten Heiberg

    2017-01-01

    Heat stroke is an acute, life-threatening emergency characterized clinically by elevated body temperature and central nervous system dysfunction. Early recognition and treatment including aggressive cooling and management of life-threatening systemic complications are essential to reduce morbidity...... and mortality. This case report describes two Danish patients diagnosed with heat stroke syndrome during a heat wave in the summer of 2014. Both patients were morbidly obese and had several predisposing illnesses. However since heat stroke is a rare condition in areas with temperate climate, they were...... not diagnosed until several days after admittance; hence treatment with cooling was delayed. Both patients were admitted to the intensive care unit, where they were treated with an external cooling device and received treatment for complications. Both cases ended fatally. As global warming continues, more heat...

  8. Dual antiplatelet therapy versus oral anticoagulation plus dual antiplatelet therapy in patients with atrial fibrillation and low-to-moderate thromboembolic risk undergoing coronary stenting: design of the MUSICA-2 randomized trial.

    Science.gov (United States)

    Sambola, Antonia; Montoro, J Bruno; Del Blanco, Bruno García; Llavero, Nadia; Barrabés, José A; Alfonso, Fernando; Bueno, Héctor; Cequier, Angel; Serra, Antonio; Zueco, Javier; Sabaté, Manel; Rodríguez-Leor, Oriol; García-Dorado, David

    2013-10-01

    Oral anticoagulation (OAC) is the recommended therapy for patients with atrial fibrillation (AF) because it reduces the risk of stroke and other thromboembolic events. Dual antiplatelet therapy (DAPT) is required after percutaneous coronary intervention and stenting (PCI-S). In patients with AF requiring PCI-S, the association of DAPT and OAC carries an increased risk of bleeding, whereas OAC therapy or DAPT alone may not protect against the risk of developing new ischemic or thromboembolic events. The MUSICA-2 study will test the hypothesis that DAPT compared with triple therapy (TT) in patients with nonvalvular AF at low-to-moderate risk of stroke (CHADS2 score ≤2) after PCI-S reduces the risk of bleeding and is not inferior to TT for preventing thromboembolic complications. The MUSICA-2 is a multicenter, open-label randomized trial that will compare TT with DAPT in patients with AF and CHADS2 score ≤2 undergoing PCI-S. The primary end point is the incidence of stroke or any systemic embolism or major adverse cardiac events: death, myocardial infarction, stent thrombosis, or target vessel revascularization at 1 year of PCI-S. The secondary end point is the combination of any cardiovascular event with major or minor bleeding at 1 year of PCI-S. The calculated sample size is 304 patients. The MUSICA-2 will attempt to determine the most effective and safe treatment in patients with nonvalvular AF and CHADS2 score ≤2 after PCI-S. Restricting TT for AF patients at high risk for stroke may reduce the incidence of bleeding without increasing the risk of thromboembolic complications. © 2013.

  9. Questions and Answers about Stroke

    Science.gov (United States)

    ... Stroke: Hope Through Research Questions and Answers About Stroke What is a stroke? A stroke occurs when blood flow to the ... need to function. What are the types of strokes? A stroke can occur in two ways. In ...

  10. Chronic thromboembolic pulmonary hypertension - assessment by magnetic resonance imaging.

    Science.gov (United States)

    Kreitner, Karl-Friedrich; Kunz, R Peter; Ley, Sebastian; Oberholzer, Katja; Neeb, Daniel; Gast, Klaus K; Heussel, Claus-Peter; Eberle, Balthasar; Mayer, Eckhard; Kauczor, Hans-Ulrich; Düber, Christoph

    2007-01-01

    Chronic thromboembolic pulmonary hypertension (CTEPH) is a severe disease that has been ignored for a long time. However, with the development of improved therapeutic modalities, cardiologists and thoracic surgeons have shown increasing interest in the diagnostic work-up of this entity. The diagnosis and management of chronic thromboembolic pulmonary hypertension require a multidisciplinary approach involving the specialties of pulmonary medicine, cardiology, radiology, anesthesiology and thoracic surgery. With this approach, pulmonary endarterectomy (PEA) can be performed with an acceptable mortality rate. This review article describes the developments in magnetic resonance (MR) imaging techniques for the diagnosis of chronic thromboembolic pulmonary hypertension. Techniques include contrast-enhanced MR angiography (ce-MRA), MR perfusion imaging, phase-contrast imaging of the great vessels, cine imaging of the heart and combined perfusion-ventilation MR imaging with hyperpolarized noble gases. It is anticipated that MR imaging will play a central role in the initial diagnosis and follow-up of patients with CTEPH.

  11. Prevention of thromboembolism during radiosynoviorthesis?; Thromboseprophylaxe bei der Radiosynoviorthese?

    Energy Technology Data Exchange (ETDEWEB)

    Fischer, M. [Inst. fuer Nuklearmedizin, Klinikum Kassel (Germany); Ritter, B. [Klinik fuer Haematologie und Onkologie, Klinikum Kassel (Germany)

    2006-03-15

    The question of pharmacological prevention of thromboembolic disease during radiosynoviorthesis with concomitant immobilization of the treated joint is discussed by means of a recent case report. The possible advantages must be balanced against the potential risks of hemorrhage and heparine-induced thrombocytopenia in every patient. The intraarticular radionuclide therapy might be ranked as ''low risk'', comparable to small or medium interventions with minor trauma according to surgical and perioperative classifications, provided that there are no individual risk factors. With respect to the possible side effects, a general thromboembolic prophylaxis is not recommended in these patients. After radiosynoviorthesis of the knee and an additional joint of the same limb which requires an immobilization spanning both joints, a ''medium risk'' of thromboembolic disease must be assumed. In these cases, as well as with two or more predisposing risk factors, a pharmacological prevention of thromboembolism is mandatory. Ready-to-use syringes containing low-molecular-weight heparine are available for this purpose. Although serious side effects from LMW heparine are rare, monitoring of the thrombocyte counts prior to and 1-2 times during heparine application are advisable. Pharmacological prophylaxis of thromboembolic disease is strictly contraindicated in patients with acute bleeding, cerebral aneurysms and known aortic dissections. In case of concomitant treatment with NSAIDs, antagonists of platelet aggregation or valproic acid, the indication for heparine treatment should be discussed very seriously. Both the verbal and written information of each patient must be complete and precise with respect to possible advantages and potential risks of pharmacological prevention of thromboembolic disease. (orig.)

  12. Stroke awareness in Denmark

    DEFF Research Database (Denmark)

    Truelsen, Thomas; Krarup, Lars-Henrik

    2010-01-01

    This is the first study to examine the awareness of major stroke symptoms and stroke risk factors among the general population in Denmark. Early recognition of stroke warning signs and means of reducing stroke occurrence could improve the treatment and prevention of stroke.......This is the first study to examine the awareness of major stroke symptoms and stroke risk factors among the general population in Denmark. Early recognition of stroke warning signs and means of reducing stroke occurrence could improve the treatment and prevention of stroke....

  13. Pulmonary thromboembolism after long car travel (Tromboembolismo pulmonar tras viaje prolongado en automóvil).

    Science.gov (United States)

    Bertos-Polo, Juan; Ortega-Carnicer, Julian; Gutiérrez-Tirado, Carlos; Ambros-Checa, Alfonso

    2003-06-01

    Prolonged immobility, especially bed rest for medical or surgical processes, constitutes one of the main risk factors for developing pulmonary thromboembolism. Immobility during extended plane or coach journeys (economy class syndrome) is not a frequent cause of serious pulmonary thromboembolism in healthy travellers. We report a case of serious pulmonary thromboembolism after a prolonged journey by car.

  14. Thromboembolism complicating the treatment of lupus anticoagulant hypoprothrombinemia syndrome.

    Science.gov (United States)

    Vinet, Evelyne; Rich, Eric; Senécal, Jean-Luc

    2006-10-01

    Lupus anticoagulant hypoprothrombinemia syndrome (LAHPS) is a rare disorder characterized by a bleeding tendency due to factor II deficiency associated with the presence of lupus anticoagulant (LAC) autoantibodies. We describe a patient with systemic lupus erythematosus and LAHPS in whom successful treatment of central nervous system bleeding due to severe factor II deficiency was followed by a major thromboembolic complication. Literature review revealed 2 other patients with LAHPS who developed thrombosis resulting from the treatment of factor II deficiency. We suggest that factor II deficiency counterbalances the prothrombotic effect of LAC in LAHPS, and correcting this deficiency may promote thromboembolism.

  15. Review of the cost of venous thromboembolism

    Directory of Open Access Journals (Sweden)

    Fernandez MM

    2015-08-01

    Full Text Available Maria M Fernandez,1 Susan Hogue,1 Ronald Preblick,2 Winghan Jacqueline Kwong2 1RTI-Health Solutions, Market Access and Outcomes Strategy, Research Triangle Park, NC, 2Daiichi Sankyo, Inc., Health Economics & Outcomes Research, Parsippany, NJ, USA Background: Venous thromboembolism (VTE is the second most common medical complication and a cause of excess length of hospital stay. Its incidence and economic burden are expected to increase as the population ages. We reviewed the recent literature to provide updated cost estimates on VTE management. Methods: Literature search strategies were performed in PubMed, Embase, Cochrane Collaboration, Health Economic Evaluations Database, EconLit, and International Pharmaceutical Abstracts from 2003–2014. Additional studies were identified through searching bibliographies of related publications. Results: Eighteen studies were identified and are summarized in this review; of these, 13 reported data from the USA, four from Europe, and one from Canada. Three main cost estimations were identified: cost per VTE hospitalization or per VTE readmission; cost for VTE management, usually reported annually or during a specific period; and annual all-cause costs in patients with VTE, which included the treatment of complications and comorbidities. Cost estimates per VTE hospitalization were generally similar across the US studies, with a trend toward an increase over time. Cost per pulmonary embolism hospitalization increased from $5,198–$6,928 in 2000 to $8,764 in 2010. Readmission for recurrent VTE was generally more costly than the initial index event admission. Annual health plan payments for services related to VTE also increased from $10,804–$16,644 during the 1998–2004 period to an estimated average of $15,123 for a VTE event from 2008 to 2011. Lower costs for VTE hospitalizations and annualized all-cause costs were estimated in European countries and Canada. Conclusion: Costs for VTE treatment are

  16. Sex differences in stroke therapies.

    Science.gov (United States)

    Sohrabji, Farida; Park, Min Jung; Mahnke, Amanda H

    2017-01-02

    Stroke is the fifth leading cause of death and acquired disability in aged populations. Women are disproportionally affected by stroke, having a higher incidence and worse outcomes than men. Numerous preclinical studies have discovered novel therapies for the treatment of stroke, but almost all of these have been shown to be unsuccessful in clinical trials. Despite known sex differences in occurrence and severity of stroke, few preclinical or clinical therapeutics take into account possible sex differences in treatment. Reanalysis of data from studies of tissue plasminogen activator (tPA), the only currently FDA-approved stroke therapy, has shown that tPA improves stroke outcomes for both sexes and also shows sexual dimorphism by more robust improvement in stroke outcome in females. Experimental evidence supports the inclusion of sex as a variable in the study of a number of novel stroke drugs and therapies, including preclinical studies of anti-inflammatory drugs (minocycline), stimulators of cell survival (insulin-like growth factor-1), and inhibitors of cell death pathways (pharmacological inhibition of poly[ADP-ribose] polymerase-1, nitric oxide production, and caspase activation) as well as in current clinical trials of stem cell therapy and cortical stimulation. Overall, study design and analysis in clinical trials as well as in preclinical studies must include both sexes equally, consider possible sex differences in the analyses, and report the differences/similarities in more systematic/structured ways to allow promising therapies for both sexes and increase stroke recovery. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  17. Female Sex Is a Risk Modifier Rather Than a Risk Factor for Stroke in Atrial Fibrillation

    DEFF Research Database (Denmark)

    Nielsen, Peter Brønnum; Skjøth, Flemming; Overvad, Thure Filskov

    2018-01-01

    BACKGROUND: Stroke risk in atrial fibrillation is assessed by using the CHA2DS2-VASc score. Sex category (Sc, ie, female sex) confers 1 point on CHA2DS2-VASc. We hypothesized that female sex is a stroke risk modifier, rather than an overall risk factor, when added to a CHA2DS2-VA (sex-independent......BACKGROUND: Stroke risk in atrial fibrillation is assessed by using the CHA2DS2-VASc score. Sex category (Sc, ie, female sex) confers 1 point on CHA2DS2-VASc. We hypothesized that female sex is a stroke risk modifier, rather than an overall risk factor, when added to a CHA2DS2-VA (sex...... of treatment initiation (if any). CHA2DS2-VA scores were calculated for men and women, and were followed for up to 1 year in the Danish National Patient Registry. The primary outcome was a primary hospital code for ischemic stroke or systemic embolism (thromboembolism). We calculated crude event rates for risk...... strata as events per 100 person-years. For quantifying absolute risk of stroke, we calculated risks based on the pseudovalue method. Female sex as a prognostic factor was investigated by inclusion as an interaction term on the CHA2DS2-VA score to calculate the thromboembolic risk ratio for different...

  18. Dabigatran versus warfarin in the treatment of acute venous thromboembolism

    NARCIS (Netherlands)

    Schulman, Sam; Kearon, Clive; Kakkar, Ajay K.; Mismetti, Patrick; Schellong, Sebastian; Eriksson, Henry; Baanstra, David; Schnee, Janet; Goldhaber, Samuel Z.; Schulman, S.; Eriksson, H.; Goldhaber, S.; Kakkar, A.; Kearon, C.; Mismetti, P.; Schellong, S.; Minar, E.; Bergqvist, D.; Tijssen, J.; Prins, M. [=Martin H.; Büller, H.; Otten, J.; Peters, R.; Mac Gillavry, M.; Pol, S.; Burroughs, A.; Gilmore, I.; Bluguermann, J.; Carlevaro, O.; Dipaola, L.; Gitelman, P.; Santos, D.; Schygiel, P.; Baker, R.; Blombery, P.; Gallus, A.; Gan, E.; Gibbs, H.; Salem, H.; Baghestanian, M.; Pilger, E.; Sturm, W.; Debing, E.; Gadisseur, A.; Hainaut, P.; Verhamme, P.; Wautrecht, J.-C.; Zicot, M.; Bizzachi, J. M. Annichino; Araujo, G.; de Araujo, J. Dalmo; Panico, F. M. Duarte Brandão; Nagato, Y.; Pereira, A. H.; Leao, P. Puech; Ramaciotti, E.; Moreira, R. C. Rocha; Timi, J.; Anderson, D.; Crowther, M.; Dolan, S.; Eikelboom, J.; Spencer, F.; Game, M.; Kahn, S.; Kassis, J.; Klinke, P.; Kovacs, M.; Milot, A.; Ritchie, B.; Rodger, M.; Solymoss, S.; Villeneuve, J.; Yeo, E.; Cervinka, P.; Homza, M.; Hrdy, P.; Klimsa, Z.; Lang, P.; Maly, R.; Oral, I.; Reichert, P.; Spinar, J.; Varejka, P.; Vladimir, J.; Brønnum-Schou, J.; Jensen, S.; Jensen, S. E.; Kristensen, K. S.; Nielsen, H.; Wiemann, O.; Bost, V.; Buchmuller, A.; Guillot, K.; Laurent, P.; Lecomte, F.; Mottier, D.; Quere, I.; Wahl, D.; Beyer, J.; Dormann, A.; Hoffmann, U.; Maier, M.; Mietaschk, A.; Katsenis, K.; Klonaris, C.; Liappis, C.; Acsady, G.; Berhes, I.; Boda, Z.; Farkas, K.; Jakucs, J.; Kollar, L.; Matyas, L.; Riba, M.; Sereg, M.; Aggarwal, R.; Banker, D.; Bharani, A.; Gadkari, M.; Hiremath, J.; Jain, A.; Kareem, S.; Lyengar, S.; Parakh, R.; Sekar, N.; Srinivas, A.; Suresh, K.; Vujay, T.; Brenner, B.; Efrati, S.; Elias, M.; Gavish, D.; Grossman, E.; Lahav, M.; Lishner, M.; Zeltser, D.; Agnelli, G.; Cimminiello, C.; Palareti, G.; Prandoni, P.; Santonastaso, M.; Silingardi, M.; Lee, E. Aldrett; Andrade, J. M. Fontes; Valles, J. Jaurrieta; Biesma, D.; Dees, A.; Fijnheer, R.; Hamulyak, K.; Kramer, M. H. H.; Leebeek, F. W. G.; Lieverse, L.; Nurmohamed, M. T.; Chunilal, S.; Jackson, S.; Ockelford, P.; Smith, M.; Njaastad, A. M.; Sandseth, P. M.; Tveit, A.; Waage, A.; Barata, J.; Capitao, M.; Fernandes, F. E.; Leitão, A.; Providência, L.; Alohin, D. I.; Belentsov, S.; Chernyatina, M.; Chernyavsky, A.; Fokin, A.; Gubenko, A.; Guz, V. Alexander V.; Katelnitsky, I.; Khamitov, A. A. A.; Khitaryan, A.; Khubulava, G.; Mikhailov, I.; Shkurin, V.; Staroverov, I.; Tchumakov, A.; Zaporozhsky, A.; Duris, T.; Poliacik, P.; Spisak, V.; Szentivanyi, M.; Zubek, V.; Adler, D.; Kelbe, D.; Le Roux, D.; Pieterse, A.; Routier, R.; Siebert, R.; Sloane, B.; Smith, C.; van Rensburg, H.; del Toro, J.; García-Fuster, M. J.; Mateo, J.; Monreal, M.; Nieto, J. A.; Sánchez-Molini, P.; Sedano, C.; Trujillo, J.; Valle, R.; Villalta, J.; Aagesen, J.; Carlsson, A.; Johansson, L.; Lärfars, G.; Lindmarker, P.; Säfvenberg, U.; Själander, A.; Bengisun, U.; Calkavur, T.; Guney, M. R.; Karahan, S.; Kurtoglu, M.; Sakinci, U.; Gubka, A.; Mishalov, V.; Skupyy, O.; Cohen, A.; Keeling, D.; Kesteven, P.; MacCallum, P.; Maclean, R.; Shah, P.; Watson, H.; Bartkowiak, A.; Bolster, E.; Botnick, W. C.; Burnett, B.; Chervu, A.; Comerota, A. J.; Dy, N. M.; Fulco, F. A.; Gossage, J. R.; Kaatz, S.; Lahiri, B.; Lerner, R. G.; Masson, J. A.; Moll, S.; Morganroth, M.; Patel, K.; Paulson, R.; Powell, R.; Samson, R.; Seibert, A.; Spyropoulos, A.; Vrooman, P. S.

    2009-01-01

    BACKGROUND: The direct oral thrombin inhibitor dabigatran has a predictable anticoagulant effect and may be an alternative therapy to warfarin for patients who have acute venous thromboembolism. METHODS: In a randomized, double-blind, noninferiority trial involving patients with acute venous

  19. Extended use of dabigatran, warfarin, or placebo in venous thromboembolism

    NARCIS (Netherlands)

    Schulman, Sam; Kearon, Clive; Kakkar, Ajay K.; Schellong, Sebastian; Eriksson, Henry; Baanstra, David; Kvamme, Anne Mathilde; Friedman, Jeffrey; Mismetti, Patrick; Goldhaber, Samuel Z.; Schulman, S.; Eriksson, H.; Goldhaber, S.; Kakkar, A.; Kearon, C.; Mismetti, P.; Schellong, S.; Minar, E.; Bergqvist, D.; Tijssen, J.; Prins, M. [=Martin H.; Büller, H.; Otten, J.; Mac Gillavry, M.; Brandjes, D.; Otten, H.; Peters, R.; Pol, S.; Burroughs, A.; Gilmore, I.; Bluguermann, J.; Bustos, B.; Carlevaro, O.; Cartasegna, L.; Cuello, J.; Gabito, A.; Gitelman, P.; Gutierrez Carrillo, N.; Hrabar, A.; Mackinon, I.; Santos, D.; Schygiel, P.; Sosa Liprandi, M.; Baker, R.; Blombery, P.; Gallus, A.; Gan, E.; McCann, A.; Salem, H.; Koppensteiner, R.; Kyrle, P.; Pilger, E.; Sturm, W.; Hainaut, P.; Verhamme, P.; Wautrecht, J.-C.; Zicot, M.; Bizzachi, J. Annichino; Joyce, M.; Araújo, G.; de Araújo Filho, J. Dalmo; Panico, M. Duarte Brandão; Pereira, A.; Rocha Moreira, R.; Timi, J.; Yamashita, E.; Anastasov, V.; Georgiev, G.; Guirov, K.; Lozev, I.; Milanov, S.; Peneva, M.; Petrov, V.; Yordanov, Y.; Anderson, D.; Crowther, M.; Dolan, S.; Eikelboom, J.; Game, M.; Kahn, S.; Kassis, J.; Klinke, P.; Ritchie, B.; Rodger, M.; Solymoss, S.; Spencer, F.; Yeo, E.; Bai, C.; Liu, C.; Liu, J.; Shen, H.; Wan, H.; Wang, C.; Wang, Y.; Wen, F.; Ying, K.; Yuan, Y.; Zhang, J.; Zhang, L.; Zheng, Q.; Zhong, N.; Bercikova, J.; Cervinka, P.; Cizek, V.; Jirka, V.; Lang, P.; Maly, R.; Oral, I.; Prochazka, P.; Spinar, J.; Brønnum-Schou, J.; Friis, E.; Jensen, S.; Nielsen, H.; Skødebjerg Kristensen, K.; Wiemann, O.; Husted, S.; Kuusisto, A.; Lassila, R.; Melin, J.; Nikkilä, M.; Nousiainen, T.; Bost, V.; Buchmuller, A.; Guillot, K.; Lecomte, F.; Mottier, D.; Wahl, D.; Beyer-Westendorf, J.; Dormann, A.; Harenberg, J.; Hoffmann, U.; Maier, M.; Mietaschk, A.; Salbach, P.; Cohen, A.; Keeling, D.; Kesteven, P.; Maclean, M. R.; Shah, P.; Katsenis, K.; Klonaris, C.; Liappis, C.; Mihailidis, D.; Acsady, G.; Boda, Z.; Farkas, K.; Jakucs, J.; Kollar, L.; Matyas, L.; Muranyi, A.; Riba, M.; Sereg, M.; Banker, D.; Durairaj, N.; Gadkari, M.; Grant, P.; Hiremath, J.; Kareem, S.; Mahajan, R.; Naik, A.; Parakh, R.; Rai, K.; Santhosh, M.; Sekar, N.; Srinivas, A.; Suresh, K.; Vijayaraghavan, G.; Brenner, B.; Efrati, S.; Mazen, E.; Gavish, D.; Grossman, E.; Lahav, M.; Lishner, M.; Lugassy, G.; Zeltser, D.; Barillari, G.; D' Angelo, A.; Palareti, G.; Santonasto, M.; Schenone, A.; Silingardi, M.; Testa, S.; Aldrett Lee, E.; Fontes Andrade, J.; Jaurrieta Valles, J.; Montaño-González, E.; Sánchez-Escalante, L.-R.; Dees, A.; Hamulyak, K.; Jie, A.; Kamphuisen, P.; Leebeek, F.; Nurmohamed, M.; Pruijt, J.; Wittebol, S.; Hanna, M.; Jackson, S.; Ockelford, P.; Smith, M.; Njaastad, A.; Sandseth, P.; Tveit, A.; Waage, A.; Czarnobilski, K.; Gaciong, Z.; Gluszek, S.; Krolczyk, J.; Zawilska, K.; Barata, J.; Capitao, M.; e Fernandes, F.; Martinez, J.; Providência, L.; Sarmento, P.; Belentsov, S.; Chernyatina, M.; Chernyavsky, A.; Degterev, M.; Fokin, A.; Gubenko, A.; Guz, V.; Katelnitsky, I.; Khamitov, A.; Khitaryan, A.; Khubulava, G.; Koulikovsky, V.; Nelaev, V.; Shkurin, V.; Smirnov, G.; Sokurenko, G.; Soroka, V.; Staroverov, I.; Zaporozhsky, S.; Duris, T.; Poliacik, P.; Spisak, V.; Szentivanyi, M.; Zubek, V.; Adler, D.; Le Roux, D.; Routier, R.; Siebert, R.; Sloane, B.; Smith, C.; del Toro, J.; García-Fuster, M.; Marco, P.; Mateo, J.; Monreal, M.; Nieto J, J.; Sedano, C.; Trujillo, J.; Villalta, J.; Aagesen, J.; Carlsson, A.; Lärfars, G.; Lindmarker, P.; Säfwenberg, U.; Själander, A.; Aslim, E.; Bengisun, U.; Calkavur, T.; Eren, E.; Karahan, S.; Karatepe, O.; Kurtoglu, M.; Sakinci, U.; Gubka, O.; Karpovych, D.; Mishalov, V.; Skupyy, O.; Bartkowiak, A.; Bolster, E.; Burnett, B.; Comerota, A.; Fulco, F.; Gleeson, J.; Gossage, J.; Kaatz, S.; Kuehl, S.; Lahiri, B.; Masson, J.; Moll, S.; Nathanson, A.; Paulson, R.; Powell, R.; Seibert, A.; Vrooman, P.; Sandgren, G.; Wallin, J.; Kälebo, P.; Angerås, U.; Falk, A.; Eriksson, B.; Dellborg, M.; Eriksson, P.; Johansson, P.; Hansson, P. O.; Nicol, A.; Jeffries, B.; Benson, M.; Kyrle, P. A.; Hirschl, M.; Böhler, K.; de Vleeschauwer, P.; Haerens, M.; Duchateau, J.; Verstraeten, P.; Milot, A.; Kotik, L.; Roztocil, K.; Joerg, I.; Holy, M.; Cernosek, B.; Kasalova, Z.; Mandakova, E.; Povolny, J.; Matoska, P.; Hulinsky, V.; Podoubsky, R.; Votocek, S.; Zarubova, D.; Ellervee, T.; Lind, J.; Sukles, K.; Uebel, P.; Bauersachs, R.; Kemkes-Matthes, B.; Beyer, J.; Siragusa, S.; Bova, C.; Cortellaro, M.; Falanga, A.; Palla, A.; Pini, M.; Poggio, R.; Porro, F.; Prisco, D.; Tiraferri, E.; Villalta, S.; Visona, A.; Zanatta, N.; Mazzucconi, M. G.; Porreca, E.; Cattaneo, M.; Di Minno, G.; Oh, D.; Kim, C. S.; Kwon, T. W.; Lee, T. S.; Park, J. S.; Hong, Y. S.; Yoon, S. S.; Kim, Y. K.; Laucevicius, A.; Miliauskas, S.; Novikovs, N.; Zvirgzdins, V.; Meijer, K.; Nijziel, M. R.; van Guldener, C.; van Essen, G. G.; Ouwehand, M. E.; Jie, K. S. G.; Swart-Heikens, J.; Viergever, P. P.; Dullemond, A. C.; Tomkowski, W.; Torbicki, A.; Psuja, P.; Staszkiewicz, W.; Szopinski, P.; Pruszczyk, P.; Ciostek, P.; Windyga, J.; Stepien, J.; Khamitov, A. A.; Ng, H. J.; Elf, J.; Engquist, L.; Sharo, S.; Holmström, M.; Lapidus, L.; Cederin, B.; Brack, T.; Binkert, M.; Canova, C.; Franzeck, U.; Allmann, J. K.; Zehnder, T.; Jeanneret, C.; Jäger, K.; Erni, D.; Banyai, M.; Rödel, C.; Engelbrecht, J.; Bruning, A.; van Rensburg, H.; Vermooten, I. H.; Norasetthada, L.; Thungthong, P.; Angchaisuksiri, P.; Numbenjapon, T.; Cook, R.; Deck, K.; Evans, B.; Hearne, S.; Kaelin, T.; Kuno, R.; Pendelton, R.; Speer, J.; Yood, R.; Kahn, R.; Sheehan, K.; Feldman, G.; Chen, Y. C. J.; Fanning, J.; Hartley, P.; Kulback, S.; McIvor, M. E.; LaPerna, L.; Gibson, K.; Vaid, B. R.; Changlani, M.

    2013-01-01

    Dabigatran, which is administered in a fixed dose and does not require laboratory monitoring, may be suitable for extended treatment of venous thromboembolism. In two double-blind, randomized trials, we compared dabigatran at a dose of 150 mg twice daily with warfarin (active-control study) or with

  20. Is extensive screening for cancer in idiopathic venous thromboembolism warranted?

    NARCIS (Netherlands)

    van Doormaal, F. F.; Terpstra, W.; van der Griend, R.; Prins, M. H.; Nijziel, M. R.; van de Ree, M. A.; Büller, H. R.; Dutilh, J. C.; ten Cate-Hoek, A.; van den Heiligenberg, S. M.; van der Meer, J.; Otten, J. M.

    2011-01-01

    Background: Patients with a first episode of idiopathic venous thromboembolism (IVTE) have an estimated 10% incidence of cancer within 12 months after diagnosis. However, the utility of screening for cancer in this population is controversial. Methods: In this prospective concurrently controlled

  1. Rivaroxaban or Aspirin for Extended Treatment of Venous Thromboembolism

    NARCIS (Netherlands)

    Weitz, Jeffrey I.; Lensing, Anthonie W. A.; Prins, Martin H.; Bauersachs, Rupert; Beyer-Westendorf, Jan; Bounameaux, Henri; Brighton, Timothy A.; Cohen, Alexander T.; Davidson, Bruce L.; Decousus, Hervé; Freitas, Maria C. S.; Holberg, Gerlind; Kakkar, Ajay K.; Haskell, Lloyd; van Bellen, Bonno; Pap, Akos F.; Berkowitz, Scott D.; Verhamme, Peter; Wells, Philip S.; Prandoni, Paolo; Bianchi, Alessandra; Brighton, Tim; Carroll, Patrick; Chong, Beng; Chunilal, Sanjeev; Coughlin, Paul; Curnow, Jennifer; Jackson, David; Tran, Huyen; Ward, Chris; Brodmann, Marianne; Kyrle, Paul; Marschang, Peter; Petkov, Ventzislav; Hainaut, Philippe; Jordens, Paul; Vandekerkhof, Jos; Wautrecht, Jean-Claude; Annichino-Bizzacchi, Joyce; Correa, Joao; Cukier, Alberto; Freire, Antonio; Pereira, Adamastor; Porto, Carmen; Sacilotto, Roberto; Vasconcelos Costa, Agenor; Della Siega, Anthony; Dolan, Sean; Le Gal, Gré goire; Gross, Peter; Kahn, Susan; Kassis, Jeannine; Kovacs, Michael; Pesant, Yves; Ritchie, Bruce; Schulman, Sam; Shivakumar, Sudeep; Solymoss, Susan; Chang, Shu; Chen, Rongchang; Chen, Zhong; Chen, Hong; Dai, Xiangchen; Fang, Baoming; Fu, Weiguo; Gao, Xinglin; Huang, Jinhua; Lai, Yanping; Li, Li; Li, Xiaoqiang; Li, Yiqing; Liu, Jinming; Liu, Shuang; Ma, Wenjiang; Ni, Songshi; Qin, Zhiqiang; Shi, Guochao; Tian, Hongyan; Wang, Shenming; Wang, Lie; Xiao, Wei; Ying, Kejing; Yu, Guanfeng; Yuan, Yadong; Zhang, Jie; Zhang, Jin; Zhang, Xinri; Zhang, Liyan; Zhu, Lei; Chlumský , Jaromir; Chochola, Jiri; Dunaj, Milna; Kovarova, Katerina; Lang, Pavel; Matoš ka, Petr; Podpera, Ivo; Spacek, Rudolf; Stehlikova, Olga; Brø nnum-Schou, Jens; Egstrup, Kenneth; Gislason, Gunnar; Jeppesen, Jorgen; May, Ole; Nielsen, Henrik; Wiggers, Henrik; Achkar, Antoine; Aquilanti, Sandro; Benhamou, Ygal; Brisot, Dominique; Bura-Riviere, Alessandra; Castella, Nadine; Elias, Antoine; Falvo, Nicolas; Ferrari, Emile; Lacroix, Philippe; Mahe, Isabelle; Meneveau, Nicolas; Messas, Emmanuel; Mismetti, Patrick; Montaclair, Karine; Mottier, Dominique; Moumneh, Thomas; Paleiron, Nicolas; Parent, Florence; Pernod, Gilles; Sanchez, Olivier; Schmidt, Jeannot; Simoneau, Guy; Stephan, Dominique; Amann, Berthold; Blessing, Erwin; Czihal, Michael; Espinola-Klein, Christine; Kahrmann, Gerd; Licka, Manuela; Neumeister, Axel; Schellong, Sebastian; Boda, Zoltan; Farkas, Katalin; Gurzo, Mihaly; Katona, Andras; Riba, Maria; Sipos, Gyula; Tó th, Kalman; Braester, Andrei; Elias, Mazen; Gafter-Gvili, Anat; Gavish, Dov; Hussein, Osamah; Lishner, Michael; Schiff, Elad; Spectre, Galia; Tzoran-Rozenthal, Inna; Zimlichman, Reuven; Ageno, Walter; Agnelli, Giancarlo; Bova, Carlo; Garbelotto, Raffaella; Ghirarduzzi, Angelo; Imberti, Davide; Pesavento, Raffaele; Porreca, Ettore; Visonà , Adriana; Flota Cervera, Luis; Llamas Esperó n, Guillermo; Rodriguez-Gonzalez, Daniel; Solis Morales, Lucas; Boersma, Willem; ten Cate, Hugo; Erdkamp, Franciscus; Grifioen-Keijzer, Anita; Marwijk Kooy, Marinus; Meijer, Karina; Middeldorp, Saskia; Swart-Heikens, Janneke; ten Wolde, Marije; Westerweel, Peter; Braithwaite, Irene; Harper, Paul; Merriman, Eileen; Ockelford, Paul; Royle, Gordon; Smith, Mark; Ghanima, Waleed; Sandset, Per Morten; Abola, Maria; Chę ciń ski, Pawel; Grzelakowski, Pawel; Lewczuk, Jerzy; Sobkowicz, Bozena; Tomkowski, Witold; Abramov, Igor; Chechulov, Pavel; Karpenko, Andrey; Katelnitskiy, Ivan; Kazakov, Andrey; Makarova, Olga; Panchenko, Elizaveta; Sergeeva, Elena; Subbotin, Yuriy; Suchkov, Igor; Zeltser, Mikhail; Adler, David; Breedt, Johannes; Fourie, Nyda; Isaacs, Rashid; Jacobson, Barry; Siebert, Heidi; van Zyl, Louis; Choi, Jung-Hyun; Kang, Seok-Min; Kim, Kye-Hun; Kim, Hyo-Soo; Kim, Dong-Ik; Min, Seung-Kee; Park, Ki Hyuk; Garcí a-Bragado Dalmau, Fernando; Gó mez Cerezo, Jorge; Mirete, Jose Carlos Ferrer; Riera, Antonio; del Toro, Jorge; Eriksson, Henry; Torstensson, Ingemar; Banyai, Martin; Baumgartner, Iris; Mazzolai, Lucia; Periard, Daniel; Righini, Marc; Staub, Daniel; Chiang, Chern-En; Chiu, Kuan-Ming; Pai, Pei-Ying; Angchaisuksiri, Pantep; Chansung, Kanchana; Ö ngen, Gul; Tuncay, Esin; Alikhan, Raza; Chetter, Ian; Kesteven, Patrick; Nokes, Tim; Bauer, Kenneth; Comerota, Anthony; Elias, Darlene; Garcia, David; Gibson, Kathleen; Ginsberg, Daniel; Jenkins, Jeffrey; Kingsley, Edwin; Lambert, Richard; Lyons, Roger; Pullman, John; Shah, Vinay; Smith, S. Wayne; Stein, Robert; Tapson, Victor; Walsh, John; Wang, Tzu-Fei; Do Loi, Doan; Do Quang, Huan; Pham, Nguyen

    2017-01-01

    BACKGROUND Although many patients with venous thromboembolism require extended treatment, it is uncertain whether it is better to use full- or lower-intensity anticoagulation therapy or aspirin. METHODS In this randomized, double-blind, phase 3 study, we assigned 3396 patients with venous

  2. Venous thromboembolism associated with protein S deficiency due ...

    Indian Academy of Sciences (India)

    Home; Journals; Journal of Genetics; Volume 96; Issue 6. Venous thromboembolism associated with protein S deficiency due to Arg451∗ mutation in PROS1 gene: a case report and a literature review. EWA WYPASEK MAREK KARPINSKI MARTINE ALHENC-GELAS ANETTA UNDAS. REVIEW ARTICLE Volume 96 Issue ...

  3. Venous thromboembolism: What pharmacists know? What do they need?

    Science.gov (United States)

    Rey, Jean-Baptiste; Jovenin, Nicolas; Kreit, Pierre; Sicard, Jérôme; Parent, Damien; Hettler, Dominique; Nguyen, Philippe; Ducrocq, Jean-Luc

    2016-02-01

    Venous thromboembolism is common in cancer. Low-molecular weight heparins are recommended for prolonged treatment (3-6 months or more if the cancer is active) and prevention of recurrence of venous thromboembolism in cancer. Community pharmacists are often faced with questions from patients. The main objective of this study was to describe the organization, practices and knowledge of pharmacists in care of venous thromboembolism in cancer patients. A descriptive survey was conducted electronically in October and November 2013 with pharmacists in the Champagne-Ardenne region. The questionnaire collected data on the general organization of the pharmacy, management of outpatients with cancer and thrombosis, and the level of knowledge regarding recommendations on the management of thrombosis in patients with cancer. The participation rate was 31.6%. In 93% of cases, pharmacists had no particular expertise in oncology and/or supportive care. In addition, 96% did not know the existence of recommendations for "thrombosis in cancer." Finally, 49% gave the correct answer to the case report (low-molecular weight heparins). Training sessions on the management of venous thromboembolism in cancer are currently available to pharmacists in the region. A new assessment of knowledge will be performed at the end of the year 2014. This regional experience is now extended to a national level (all French regions). © The Author(s) 2014.

  4. Clinical and neurological characteristics of aortic thromboembolism in dogs.

    Science.gov (United States)

    Gonçalves, R; Penderis, J; Chang, Y P; Zoia, A; Mosley, J; Anderson, T J

    2008-04-01

    To characterise the clinical presentation and neurological abnormalities in dogs affected by aortic thromboembolism. The medical records of 13 dogs diagnosed with aortic thromboembolism as the cause of the clinical signs, and where a complete neurological examination was performed, were reviewed retrospectively. The onset was acute in only four dogs, chronic in five dogs (with all of these presenting as exercise intolerance) or chronic with acute deterioration in four dogs. Dogs with an acute onset of clinical signs were more severely affected exhibiting neurological deficits, while dogs with a chronic onset of disease predominantly presented with the exercise intolerance and minimal deficits. The locomotor deficits included exercise intolerance with pelvic limb weakness (five of 13), pelvic limb ataxia (one of 13), monoparesis (two of 13), paraparesis (two of 13), non-ambulatory paraparesis (two of 13) and paraplegia (one of 13). There was an apparent male predisposition and the cavalier King charles spaniel was overrepresented. The rate of onset of clinical signs appears to segregate dogs affected by aortic thromboembolism into two groups, with different clinical characteristics and outcomes. Dogs with an acute onset of the clinical signs tend to be more severely affected, while dogs with a chronic onset predominantly present with exercise intolerance. It is therefore important to consider aortic thromboembolism as a differential diagnosis in dogs with an acute onset of pelvic limb neurological deficits and in dogs with longer standing exercise intolerance.

  5. Nadroparin therapy in pediatric patients with venous thromboembolic disease

    NARCIS (Netherlands)

    van Ommen, C. Heleen; van den Dool, Erik-Jan; Peters, Marjolein

    2008-01-01

    Low-molecular-weight heparins are increasingly used for treatment of pediatric venous thromboembolic disease (VTE). Pediatric data about therapeutic doses of nadroparin are not available. To evaluate pharmacodynamics and safety of therapeutic doses of nadroparin, consecutive patients (age 0 to 18 y)

  6. Statin treatment and risk of recurrent venous thromboembolism

    DEFF Research Database (Denmark)

    Nguyen, Cu Dinh; Andersson, Charlotte; Jensen, Thomas Bo

    2013-01-01

    Objectives Statins may decrease the risk of primary venous thromboembolism (VTE), that is, deep vein thrombosis (DVT) and pulmonary embolism (PE) but the effect of statins in preventing recurrent VTE is less clear. The aim of this study was therefore to investigate the association between statin...

  7. Oral Apixaban for the Treatment of Acute Venous Thromboembolism

    NARCIS (Netherlands)

    Agnelli, Giancarlo; Buller, Harry R.; Cohen, Alexander; Curto, Madelyn; Gallus, Alexander S.; Johnson, Margot; Masiukiewicz, Urszula; Pak, Raphael; Thompson, John; Raskob, Gary E.; Weitz, Jeffrey I.; Gallus, Alexander; Raskob, Gary; Weitz, Jeffrey; Prins, Martin; Brandjes, Dees; Kolbach, Dinanda; Limburg, Martinus; Mac Gillavry, Melvin; Otten, Johannes Martinus; Peters, Ron; Roos, Yvo; Segers, Annelise; Slagboom, Ton; Bounameaux, Henry; Hirsh, Jack; Samama, Meyer Michel; Wedel, Hans; Porcari, Anthony; Sanders, Paul; Sisson, Melanie; Sullivan, Beth; Auerbach, Jennifer; Cesario, Lynne; Crawford, Jennifer; Gordon, Margot; Noble, Melanie; Pennington, Ann; Reinhold, Peggy; Simmons, Melanie; Urwin, Keri; Ceresetto, Jose; McRae, Simon; Pabinger, Ingrid; Pereira, Adamastor Humberto; Spencer, Fred; Wang, Chen; Zhang, Jiwei; Gorican, Karel; Husted, Steen Elkiaer; Mottier, Dominique; Harenberg, Job; Vértes, András; Pinjala, Ramakrishna; Zeltser, David; Prandoni, Pablo; Sandset, Morten; Torbicki, Adam; Fijalkowska, Anna; Alvares, Jose Pereira; Kirienko, Alexander; Shvarts, Yury; Sala, Luis Alvarez; Jacobson, Barry; Gudz, Ivan; Ortel, Tom; Spyropoulos, Alex; Beyer-Westendorf, J.; Sipos, G.; Bredikhin, R.; Della Siega, A.; Klinke, W.; Lawall, H.; Zwettler, U.; Prasol, V.; Cannon, K.; Vasylyuk, S.; Jin, B.; Prandoni, P.; Desai, S.; Zaichuk, A.; Katelnitskiy, I.; de Pellegrin, A.; Santonastaso, M.; Skupyy, O.; Pesant, Y.; Shvalb, P.; Spacek, R.; Visonà, A.; Alvarez Sala, L.; Borja, V.; Gudz, I.; Noori, E.; Sereg, M.; Ortel, T.; Braester, A.; Falvo, N.; Mottier, D.; Jacobson, B.; Vöhringer, H.; LaPerna, L.; Oliven, A.; Skalicka, L.; Bolster, D.; Haidar, A.; Schellong, S.; Vértes, A.; Smith, S.; Sergeev, O.; Pullman, J.; Torp-Pedersen, C.; Zimlichman, R.; Elias, M.; Fourie, N.; Pernod, G.; Panchenko, E.; Pendleton, R.; van Nieuwenhuizen, E.; Vinereanu, D.; Agnelli, G.; Becattini, C.; Manina, G.; Leduc, J.; Dunaj, M.; Frost, L.; Gavish, D.; Jakobsen, T.; Lishner, M.; Morales, L. Solis; Chochola, J.; Gubka, O.; Holaj, R.; Hussein, O.; Katona, A.; Sergeeva, E.; Bova, C.; Cepeda, J.; Cohen, K.; Sobkowicz, B.; Grzelakowski, P.; Husted, S.; Lupkovics, G.; Spencer, F.; Dedek, V.; Liu, C.; Puskas, A.; Ritchie, B.; Ambrosio, G.; Parisi, R.; Heuer, H.; Livneh, A.; Podpera, I.; Stanbro, M.; Caraco, Y.; Fulmer, J.; Ghirarduzzi, A.; Schmidt-Lucke, J.; Bergmann, J.; Cizek, V.; Leyden, M.; Stein, R.; Abramov, I.; Chong, B.; Colan, D.; Jindal, R.; Liu, S.; Pereira, A.; Porreca, E.; Salem, H.; Welker, J.; Yusen, R.; Dhar, A.; Gallus, A.; Podczeck-Schweighofer, A.; Shtutin, O.; Vital Durand, D.; Zeltser, D.; Zhang, J.; Balaji, V.; Correa, J.; Harenberg, J.; Kline, J.; Runyon, M.; Laszlo, Z.; Martelet, M.; Parakh, R.; Sandset, P. M.; Schmidt, J.; Yeo, E.; Bhagavan, N.; Bura-Riviere, A.; Ferrer, J. Mirete; Lacroix, P.; Lewczuk, J.; Pilger, E.; Sokurenko, G.; Yu, H.; Nikulnikov, P.; Pabinger-Fasching, I.; Sanchez-Diaz, C.; Schuller, D.; Shvarts, Y.; Suresh, K.; Wang, C.; Lobo, S.; Lyons, R.; Marschang, P.; Palla, A.; Schulman, S.; Spyropoulous, A.; Fraiz, J.; Gerasymov, V.; Lerner, R.; Llamas Esperón, G.; Manenti, E.; Masson, J.; Moreira, R.; Poy, C.; Rodoman, G.; Bruckner, I.; Gurghean, A.; Carrier, M.; Freire, A.; Gan, E.; Gibson, K.; Herold, M.; Hudcovic, M.; Kamath, G.; Koslow, A.; Meneveau, N.; Roos, J.; Zahn, R.; Balanda, J.; Bratsch, H.; Dolan, S.; Gould, T.; Hirschl, M.; Hoffmann, U.; Kaatz, S.; Shah, V.; Kadapatti, K.; Kræmmer Nielsen, H.; Lahav, M.; Natarajan, S.; Tuxen, C.; Tveit, A.; Alves, C.; Formiga, A.; Brudevold, R.; Cardozo, M.; Gorican, K.; Lorch, D.; Marais, H.; Mismetti, P.; Panico, M.; Pop, C.; Quist-Paulsen, P.; Stevens, D.; Tarleton, G.; Yoshida, W.; Cox, M.; Crispin, P.; Czekalski, P.; Ebrahim, I.; Game, M.; Ghanima, W.; Harrington, D.; Jackson, D.; Lee, A.; Matoska, P.; Meade, A.; Camargo, A. C.; Nishinari, K.; Sanchez Llamas, F.; Tosetto, A.; Vejby-Christensen, H.; Basson, M.; Blombery, P.; Fu, G.; Jha, V.; Keltai, K.; Le Jeunne, C.; Lodigiani, C.; Ma, Y.; Nagy, A.; Neumeister, A.; Pinjala, R.; Shotan, A.; Wong, T.; Ying, K.; Anderson, S.; Brenner, B.; Carnovali, M.; Cerana, S.; Cunha, C.; Diaz-Castañon, J.; Graham, M.; Kirenko, A.; Palareti, G.; Rodriguez-Cintron, W.; Nathanson, A.; Rosenthal, S.; Sanders, D.; Scheinberg, P.; Schjesvold, F.; Torp, R.; van Zyl, L.; Venher, I.; Xia, G.; Brockmyre, A.; Chen, Z.; Hakki, S.; Hanefield, C.; Mügge, A.; Janczak, D.; Karpovych, D.; Lancaster, G.; Lavigne, C.; Lugassy, G.; Melaniuk, M.; Moran, J.; Oliver, M.; Schattner, A.; Staroverov, I.; Timi, J.; Vöhringer, F.; von Bilderling, P.; Warr, T.; White, R.; Wronski, J.; Wu, C.; Almeida, C.; Blum, A.; Bono, J.; Durán, M.; Erzinger, F.; Fu, W.; Jagadesan, R.; Jurecka, W.; Korban, E.; Nguyen, D.; Raval, M.; Willms, D.; Zevin, S.; Zhu, H.; Abdullah, I.; Achkar, A.; Albuquerque, L.; Ali, M.; Bai, C.; Bloomfield, D.; Chen, J.; Fajardo Campos, P.; Garcia Bragado, F.; Kobza, I.; Lindhoff-Last, E.; Lourenço, A.; Marchena Yglesias, P.; Marshall, P.; Siegel, M.; Mikhailova, O.; Oliva, M.; Pottier, P.; Pruszczyk, P.; Sauer, M.; Baloira, A.; Cromer, M.; D'Angelo, A.; Faucher, J.; Gutowski, P.; Hong, S.; Lissauer, M.; Lopes, A.; Lopes, R.; Maholtz, M.; Mesquita, E.; Miekus, P.; Mohan, B.; Ng, H.; Peterson, M.; Piovella, F.; Siragusa, S.; Srinivas, R.; Tiberio, G.; van Bellen, B.; Arutyunov, G.; Assi, N.; Baker, R.; Blanc, F.; Curnow, J.; Fu, C.; Gonzalez-Porras, J.; Guijarro Merino, R.; Gunasingam, S.; Gupta, P.; Laule, M.; Liu, Z.; Luber, J.; Serifilippi, G.; Paulson, R.; Shevela, A.; Simonneau, G.; Siu, D.; Sosa Liprandi, M.; Takács, J.; Tay, J.; Vora, K.; Witkiewicz, W.; Zhao, L.; Aquilanti, S.; Dabbagh, O.; Dellas, C.; Denaro, C.; Doshi, A.; Fijalkowska, A.; Flippo, G.; Giumelli, C.; Gomez Cerezo, J.; Han, D.; Harris, L.; Hofmann, L.; Kamerkar, D.; Kaminski, L.; Kazimir, M.; Kloczko, J.; Ko, Y.; Koura, F.; Lavender, R.; Maly, J.; Margolis, B.; McRae, S.; Mos, L.; Sanchez-Escalante, L.; Solvang, A.; Soroka, V.; Szopinski, P.; Thawani, H.; Vickars, L.; Yip, G.; Zangroniz, P.

    2013-01-01

    Background Apixaban, an oral factor Xa inhibitor administered in fixed doses, may simplify the treatment of venous thromboembolism. Methods In this randomized, double-blind study, we compared apixaban (at a dose of 10 mg twice daily for 7 days, followed by 5 mg twice daily for 6 months) with

  8. The Risk of Thromboembolism in Users of Antidepressants and Antipsychotics

    DEFF Research Database (Denmark)

    Adelborg, Kasper; Sundbøll, Jens; Videbech, Poul Bror Hemming

    2017-01-01

    of thromboembolism through genetic, behavioral, and biological mechanisms. Treatment of psychiatric patients with psychotropic drugs is imperative to improve quality of life and to reduce morbidity and mortality. However, studies have shown that psychotropic drugs themselves may modify the risk of arterial...

  9. Thrombo-embolic and bleeding complications in patients with ...

    African Journals Online (AJOL)

    Background and objectives. Long-term anticoagulation therapy is essential to prevent thrombo-embolic events in patients with mechanical valve replacements. In order to offer indigent patients mechanical heart valve replacement surgery, dedicated anticoagulation clinics are necessary for follow-up. This study assessed ...

  10. Stroke awareness in Denmark

    DEFF Research Database (Denmark)

    Truelsen, Thomas; Krarup, Lars-Henrik

    2010-01-01

    This is the first study to examine the awareness of major stroke symptoms and stroke risk factors among the general population in Denmark. Early recognition of stroke warning signs and means of reducing stroke occurrence could improve the treatment and prevention of stroke....

  11. Bronchogenic adenocarcinoma presenting as a synchronous solitary lytic skull lesion with ischaemic stroke--case report and literature review.

    LENUS (Irish Health Repository)

    O'Connell, David

    2011-01-01

    The authors describe a rare case of metastatic bronchogenic adenocarcinoma in a 55-year-old man presenting with concomittant solitary lytic skull lesion and ischaemic stroke. Metastatic bronchogenic carcinoma is known to present as lytic skull lesions. Primary brain tumours are also known to cause ischaemic brain injury. An underlying stroke risk may be exagerated by cranial tumour surgery. Patients with brain tumours are well known to be predisposed to an increased risk of developing thromboembolic disease. It is unusual to see metastatic bronchogenic adenocarcinoma presenting as ischaemic stroke with a background of concomittant cerebral metastasis. The aetio-pathogenesis of this rare occurrence is discussed with a review of literature.

  12. Multiple Strokes

    Directory of Open Access Journals (Sweden)

    Obododimma Oha

    2008-09-01

    Full Text Available This poem playfully addresses the slippery nature of linguistic signification, employing humour and sarcasm in presenting a wide range of human experience. It ironical twists -- and "strokes" (read ambiguously as both a giving a punishment and erotic pleasuring -- move from the naming of location through international discourse of capital to the crumbling relationships between nation states. It reading of the signs of language is tied to the unease and fracture in cultural and political experience.

  13. Which Patent Foramen Ovales Need Closure to Prevent Cryptogenic Strokes?

    Science.gov (United States)

    Dalen, James E; Alpert, Joseph S

    2018-03-01

    Patients with cryptogenic strokes are more likely to have a patent foremen ovale than in the general population. It is speculated that these strokes are due to paradoxical embolism, that is, passage of a venous thrombus across the patent foremen ovale to enter the arterial circulation, resulting in an embolic stroke. Venous thromboembolism is rarely present in these cases of cryptogenic stroke. Thousands of patients with cryptogenic strokes have undergone transcatheter closure of their patent foremen ovale via a variety of devices. The first 3 randomized clinical trials comparing patent foremen ovale closure with medical therapy failed to show a significant advantage of patent foremen ovale closure. Three additional trials reported in 2017 had longer years of follow-up and demonstrated an advantage of patent foremen ovale closure versus medical therapy. Analysis of their data indicated that patent foremen ovale closure in patients with an atrial septal aneurysm in addition to a patent foremen ovale had a very significant decrease in cryptogenic strokes (P patent foremen ovale closure (P = .37). Aneurysms of the atrial septum are easily recognized by echocardiography and are present in approximately one-third of patients with patent foremen ovales. These data suggest that closure of patent foremen ovales in patients with an atrial septal aneurysm is indicated. In patients with a patent foremen ovale without an aneurysm of the atrial septum, patent foremen ovale closure is not indicated. Copyright © 2018 Elsevier Inc. All rights reserved.

  14. The provision of a cane provides greater benefit to community-dwelling people after stroke with a baseline walking speed between 0.4 and 0.8 metres/second: an experimental study.

    Science.gov (United States)

    Nascimento, Lucas R; Ada, Louise; Teixeira-Salmela, Luci F

    2016-12-01

    To investigate the effect of the provision of a cane on walking ability in ambulatory people with chronic stroke. Experimental study. Clinics within the community. Twenty-four people on average 6 years after a stroke, who were not regular users of walking sticks. Participants were categorized as slow (0.8 metres/second) on the basis of their baseline walking ability. Walking with and without a cane. Walking ability was measured using the 10-m Walk Test and reported as speed (metres/second), step length (metres), and cadence (steps/minute). Overall, the provision of a cane produced no significant change in speed (0.05 metres/second, 95% CI -0.01 to 0.11) or cadence (-3 steps/minute; 95% CI -8 to 3), but a small increase in step length (0.04 metres, 95% CI 0.03 to 0.06). For the intermediate walkers, the cane increased speed by 0.18 metres/second (95% CI 0.11 to 0.24), step length by 0.07 metres (95% CI 0.05 to 0.09), but not cadence. The provision of a cane to the intermediate walkers also produced 0.27 metres/second (95% CI 0.18 to 0.36) more increase in speed compared with the fast walkers, and 0.12 metres/second (95% CI 0.03 to 0.21) more increase compared with the slow walkers. The provision of a cane produced most benefit to a subgroup of intermediate walkers in a group of community-dwelling people with chronic stroke whose walking had stabilized, without detriment to quality of walking. Copyright © 2016. Published by Elsevier Ltd.

  15. Two Kinds of Stroke

    Science.gov (United States)

    ... Issue Past Issues Special Section Two Kinds of Stroke Past Issues / Summer 2007 Table of Contents For ... are often a warning sign for future strokes. Stroke Can Affect Anyone Award-winning actress Julie Harris ...

  16. Atherosclerosis and Stroke

    Science.gov (United States)

    ... Inspirational Stories Stroke Heroes Among Us Atherosclerosis and Stroke Updated:Oct 24,2016 Excerpted and adapted from " ... it can cause difficulty walking and eventually gangrene. Stroke and atherosclerosis There are two types of ischemic ...

  17. Healthy Living after Stroke

    Science.gov (United States)

    ... Stories Stroke Heroes Among Us Healthy Living After Stroke Nutrition Good nutrition is one way to reduce ... the hospital. Thank goodness, she did. Subscribe to Stroke Connection Get quarterly digital issues plus our monthly ...

  18. The "Know Stroke" Campaign

    Science.gov (United States)

    ... Current Issue Past Issues Special Section The "Know Stroke" Campaign Past Issues / Summer 2007 Table of Contents ... campaign for the U.S. Hispanic community. 1 Know Stroke A stroke occurs when the blood supply to ...

  19. Left atrial appendage occlusion for stroke prevention in atrial fibrillation in Europe

    DEFF Research Database (Denmark)

    Lip, Gregory Y.H.; Dagres, Nikolaos; Proclemer, Alessandro

    2013-01-01

    was 10.6 per year and most (73%) centres performed ≤10 procedures per year. We found that LAAO was being performed for stroke prevention in AF, for the most common indication being 'the patient has absolute contraindication to long term oral anticoagulants'. Among survey respondents, LAAO procedures...... are most often performed by interventional cardiologists. Experience varied widely, and this was reflected in the wide range of thromboembolic and procedural (tamponade, bleeding) complications reported by the respondents to this EP wire survey....

  20. The immunology of acute stroke

    NARCIS (Netherlands)

    Chamorro, Angel; Meisel, Andreas; Planas, Anna M.; Urra, Xabier; van de Beek, Diederik; Veltkamp, Roland

    2012-01-01

    Recent clinical and experimental studies have highlighted a complex role for the immune system in the pathophysiological changes that occur after acute stroke. Sensors of the innate immune system such as Toll-like receptors, or effectors such as the lectin pathway of complement activation and innate

  1. Using Stroke Removal to Investigate Chinese Character Identification during Reading: Evidence from Eye Movements

    Science.gov (United States)

    Yan, Guoli; Bai, Xuejun; Zang, Chuanli; Bian, Qian; Cui, Lei; Qi, Wei; Rayner, Keith; Liversedge, Simon P.

    2012-01-01

    We explored the effect of stroke removal from Chinese characters on eye movements during reading to examine the role of stroke encoding in character identification. Experimental sentences were comprised of characters with different proportions of strokes removed (15, 30, and 50%), and different types of strokes removed (beginning, ending, and…

  2. Elevated risk of venous thromboembolic events in patients with inflammatory myopathies

    Directory of Open Access Journals (Sweden)

    Nowak M

    2016-06-01

    Full Text Available Michał Nowak, Katarzyna Królak-Nowak, Aleksandra Sobolewska-Włodarczyk, Jakub Fichna, Marcin Włodarczyk Department of Biochemistry, Faculty of Medicine, Medical University of Lodz, Lodz, Poland Abstract: Venous thromboembolism (VTE is a multifactorial disease manifesting as either deep vein thrombosis or pulmonary embolism. Its prevalence makes VTE a significant issue for both the individual – as a negative factor influencing the quality of life and prognosis – and the society due to economic burden. VTE is the third most common vascular disorder in Western countries, after myocardial infarction and stroke, making it a major cause of in-hospital mortality, responsible for 5%–10% of hospital deaths. Despite many studies conducted, only 50%–60% provoking factors have been identified, while the remaining 40%–50% have been classified as idiopathic or unprovoked. Chronic inflammatory disorders, with their underlying prothrombotic state, reveal an increased risk of VTE (six to eight times compared with the general population. Among the inflammatory disorders, we can identify inflammatory myopathies – a group of rare, chronic diseases featuring weakness and inflammation of muscles with periods of exacerbation and remission; their main classes are polymyositis and dermatomyositis. The objective of this review is to emphasize the need of VTE prophylaxis in individuals with inflammatory myopathies in order to reduce morbidity and mortality rates among those patients and improve their quality of life and prognosis. Keywords: deep vein thrombosis, pulmonary embolism, inflammation, polymyositis, dermatomyositis, prothrombotic state

  3. Improving venous thromboembolic disease prophylaxis in medical inpatients: a role for education and audit.

    LENUS (Irish Health Repository)

    Kent, B D

    2012-02-01

    BACKGROUND: Venous thromboembolic disease (VTED) prophylaxis is a key strategy in reducing preventable deaths in medical inpatients. We assessed compliance with internationally published guidelines for VTED prophylaxis in at-risk medical patients before and 1 month after an educational intervention to enhance compliance with such guidelines. RESULTS: One hundred and fifty patients were assessed on each occasion. Pre-intervention, VTED prophylaxis was prescribed in only 48% of at-risk cases. Compliance was best among patients under stroke services and worst for those under acute medical teams. Patients within specialist units were more likely to be prescribed prophylaxis than those in general wards (75 vs. 53%; p = 0.0019). Post-intervention, overall compliance improved to 63% (p = 0.041 for comparison). There was a significant improvement among general medical teams (48 vs. 75%; p = 0.001), and in general wards (52 vs. 74%; p = 0.003). CONCLUSIONS: Thromboprophylaxis is under-prescribed in medical inpatients, but compliance with international guidelines can be significantly enhanced with targeted educational intervention.

  4. The risk of potential thromboembolic, renal and cardiac complications of sickle cell trait.

    Science.gov (United States)

    Bucknor, Matthew D; Goo, Jeanna S; Coppolino, Michael L

    2014-01-01

    Many complications of sickle cell trait have been well-established, but associations with additional disease states remain controversial. We conducted a retrospective cohort study to examine the frequency of receiving a diagnosis of thromboembolism, pulmonary embolism (PE), ischemic stroke, renal disease (acute, chronic), coronary artery disease (CAD) and congestive heart failure (CHF) in patients with sickle cell trait. A total of 13,964 adult African Americans registered in the Kaiser Permanente Northern California (KPNC) health system (Oakland, CA, USA), were included based on laboratory and diagnostic code data for the years 1995-2008: 2642 with sickle cell trait, 11,183 with normal hemoglobin (Hb) and 139 with sickle cell disease. Disease outcomes were obtained from coded diagnoses. The adjusted relative risk of PE and chronic kidney disease in sickle cell trait patients compared to patients with normal Hb were 1.37 [95% confidence interval (CI) 1.07-1.75] and 1.13 (95% CI 1.03-1.23), respectively. There were no other significant differences in the outcomes for sickle cell trait patients compared to patients with normal Hb.

  5. Sex Disparities in Stroke

    DEFF Research Database (Denmark)

    Dehlendorff, Christian; Andersen, Klaus Kaae; Olsen, Tom Skyhøj

    2015-01-01

    BACKGROUND: Uncertainty remains about whether stroke affects men and women similarly. We studied differences between men and women with regard to stroke severity and survival. METHODS AND RESULTS: We used the Danish Stroke Registry, with information on all hospital admissions for stroke in Denmark...... between 2003 and 2012 (N=79 617), and the Danish Register of Causes of Death. Information was available on age, sex, marital status, stroke severity, stroke subtype, socioeconomic status, and cardiovascular risk profile. We studied only deaths due to the index stroke, with the assumption that death...... reported on death certificates as due to stroke was related to the index stroke if death occurred within the first week or month after stroke. Multivariate Cox regression analysis and multiple imputation were applied. Stroke was the cause of death for 4373 and 5512 of the 79 617 patients within 1 week (5...

  6. Prevention Of Stroke

    Directory of Open Access Journals (Sweden)

    Nagaraja D

    2005-01-01

    Full Text Available Stroke is an important cause for neurological morbidity and mortality. Prevention of ischemic stroke involves identification and prevention of risk factors and optimal use of pharmacotherapy. Risk factors have been classified as modifiable and non-modifiable; control of modifiable factors should prevent stroke occurrence. Stroke prevention has been described at three levels: primary, secondary and tertiary. Prolonged hypertension increases an individual′s risk for developing fatal or nonfatal stroke by three times and its control has been shown to prevent stroke. Diabetes mellitus is an important cause for microangiopathy and predisposes to stroke. Statin trials have shown significant reduction in stroke in those who were treated with statins. Stroke risk can be reduced by avoiding tobacco use, control of obesity and avoiding sedentary life style. Anti platelet medications are effective for secondary prevention of stroke. Educating society regarding modifiable risk factors and optimal use of pharmacotherapy form the cornerstone for the prevention of stroke.

  7. Effects of the Treatment with ‍Nigella sativa Oil on Brain Injury and Edema in Experimental Model of Stroke in Rats

    Directory of Open Access Journals (Sweden)

    H Panahpour

    2015-09-01

    Full Text Available Background & objectives: Stroke is third leading cause of death and disability in the most of human communities. The use of herbs and medicinal plants in different countries is increasing. Today, herbal medicine is used as alternative or complementary therapies with a fewer side effects. Nigella sativa has a rich medical and religious history. Oxidative stress has important role in the pathophysiology of stroke. As Nigella sativa has antioxidant effects, its administration may produce a protective effect against complications of this disease. We examined the effects of the treatment with Nigella sativa oil on the cerebral infarction and edema. Methods: 48 Male Sprague-Dawley rats were divided into three groups, sham, control ischemic and Nigella sativa oil treated (2 ml/kg ischemic groups. Transient focal cerebral ischemia was induced by 90-min-long occlusion of the left middle cerebral artery followed by 24-h-long reperfusion. Neurological deficit score was evaluated at the end of the reperfusion period. Thereafter, the animals were randomly selected and used for two projects: (i Measurement of the infarct volumes and neurological outcome (ii investigation of ischemic brain edema formation using a wet/dry method. Results: Induction of cerebral ischemia in the control group produced considerable brain infarction in conjunction with impaired motor functions and severely brain edema. Treatment with Nigella sativa oil significantly reduced the infarct volume and improved the motor functions. The water content in the left (lesioned hemisphere was considerably elevated in the control ischemic group. Administration of the Nigella sativa oil significantly lowered the water content in the ischemic lesioned hemisphere. Conclusion: Treatment with Nigella sativa oil can noticeably decrease the ischemic brain injury, attenuate edema formation and improve motor disabilities.

  8. Rivaroxaban or Aspirin for Extended Treatment of Venous Thromboembolism

    DEFF Research Database (Denmark)

    Weitz, Jeffrey I; Lensing, Anthonie W A; Prins, Martin H

    2017-01-01

    BACKGROUND: Although many patients with venous thromboembolism require extended treatment, it is uncertain whether it is better to use full- or lower-intensity anticoagulation therapy or aspirin. METHODS: In this randomized, double-blind, phase 3 study, we assigned 3396 patients with venous...... thromboembolism to receive either once-daily rivaroxaban (at doses of 20 mg or 10 mg) or 100 mg of aspirin. All the study patients had completed 6 to 12 months of anticoagulation therapy and were in equipoise regarding the need for continued anticoagulation. Study drugs were administered for up to 12 months...... in 17 of 1107 patients (1.5%) receiving 20 mg of rivaroxaban and in 13 of 1127 patients (1.2%) receiving 10 mg of rivaroxaban, as compared with 50 of 1131 patients (4.4%) receiving aspirin (hazard ratio for 20 mg of rivaroxaban vs. aspirin, 0.34; 95% confidence interval [CI], 0.20 to 0.59; hazard ratio...

  9. RESULTS OF TENEKTEPLASE USE IN MASSIVE PULMONARY THROMBOEMBOLISM. CLINICAL CASE

    Directory of Open Access Journals (Sweden)

    R. Rajan

    2011-01-01

    Full Text Available Pulmonary thromboembolism (PTE — a life-threatening condition that can lead to death at any age. PTE — is not an independent disease, but it is a complication of venous thromboembolism. Conflicting opinions about the possibility of using tissue plasminogen activator (tenekteplase expressed in the literature. Clinical case of the tenekteplase use in 42 years old woman with acute massive PTE and its results are described. PTE in the case was observed simultaneously with diabetic ketoacidosis. Full resolution of this thrombus according to computer pulmonary angiography was observed in patient hospitalized within 24 hours after symptom onset. This is one of the first cases of effective application of the tenekteplase in patients with massive PTE and diabetic ketoacidosis.

  10. [What factors make the diagnosis of pulmonary thromboembolism difficult?].

    Science.gov (United States)

    Arribas, J R; Arnalich, F; García-Rodeja, M E; Monereo, A; Lahoz, C; Gamallo, C; Vázquez, J J

    1990-04-14

    A series of 63 cases of fatal acute pulmonary thromboembolism (PTE) with available necropsy study was evaluated The diagnosis was established ante mortem in 20 cases (predictive index 31%). The diagnosis was only suspected in 2 of the 16 patients in whom PTE was associated with pneumonia (predictive index 12.5%, p less than 0.01), in 3 of the 26 cases if PTE associated with neoplasia (predictive index 11.5% p less than 0.01) and in 8 of the 41 cases with terminal disease (predictive index 19.5%, p less than 0.01). On the contrary, thrombophlebitis and relapsing PTE had a significative facilitation effect on the diagnosis (predictive indexes 53.3% and 52.6%, respectively; p less than 0.01). It was concluded that the presence of neoplasia, pneumonia or terminal illness make the diagnosis of pulmonary thromboembolism difficult.

  11. The role of factor Xa inhibitors in venous thromboembolism treatment

    Science.gov (United States)

    Cabral, Katherine P; Ansell, Jack E

    2015-01-01

    Three factor Xa inhibitors have been studied in the treatment of venous thromboembolism, both for acute therapy and as extended therapy to prevent recurrent events. Rivaroxaban, apixaban, and edoxaban have all proven to be effective in Phase III clinical trials for this indication when compared to current standard of therapy with similar or less bleeding. Nevertheless, the agents all offer different pharmacological profiles, which have an impact on patient selection and potential advantages in clinical practice. PMID:25673997

  12. Hypereosinophilia with Multiple Thromboembolic Cerebral Infarcts and Focal Intracerebral Hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Eun Ju; Lee, Young Jun; Lee, Seung Ro; Park, Dong Woo; Kim, Hyun Young [Hanyang University College of Medicine, Seoul (Korea, Republic of)

    2009-10-15

    We report a case of hypereosinophilia causing multiple areas of cerebral infarcts. A 52-year-old Korean man presented with dysarthria and weakness in both arms. A brain MRI revealed multiple acute infarcts in the distal border zone with focal intracerebral hemorrhage, whereas a cerebral angiogram was not remarkable. The eosinophil count was 5,500/{mu}L and was accompanied by elevated cardiac enzyme levels. The pattern of cerebral infarcts and laboratory results suggest a thromboembolic infarction associated with hypereosinophilia.

  13. Venous thromboembolism incidence in upper limb orthopedic surgery: do these procedures increase venous thromboembolism risk?

    Science.gov (United States)

    Hastie, Graham R; Pederson, Amanda; Redfern, Daniel

    2014-10-01

    In 2005, the House of Commons (HoC) Health Committee stated deaths attributed to preventable, hospital-acquired venous thromboembolism (VTE) numbered upwards of 25,000 per annum. Nationwide prevention of VTE became the topic of a major health campaign. The HoC Health Committee stated there was an unstratified VTE risk of between 45% and 51% associated with orthopedic surgery. VTE research in orthopedic surgery has been concentrated on lower limb procedures. Experience suggests that this kind of relation does not hold true for upper limb orthopedic procedures. This project aimed to estimate the incidence of postoperative VTE in upper limb orthopedic surgery. The incidence of postoperative VTE was assessed in 3357 consecutive upper limb orthopedic operations performed by 4 surgeons in Lancashire Teaching Hospitals National Health Service (NHS) Trust (LTHTR) between July 1, 2009, and July 31, 2012. Four pulmonary embolisms and 2 deep vein thromboses occurred. Incidence of postoperative VTE was 0.0018%, significantly lower than rates reported in the literature. Five of 6 patients who developed a VTE reported a personal or family history of VTE. Three patients would not have been identified as at risk under the current VTE screening guidelines. Three of these patients received appropriate anticoagulation according to present guidelines, yet VTE events still occurred. These results indicate VTE risk in orthopedic upper limb surgery is much lower than reported in the literature. The necessity for screening for VTE in upper limb surgery is contested. The efficacy of VTE screening and current VTE prophylaxis is discussed, and an alternative and much simplified method of screening is suggested. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  14. Abnormal P-Wave Axis and Ischemic Stroke: The ARIC Study (Atherosclerosis Risk In Communities).

    Science.gov (United States)

    Maheshwari, Ankit; Norby, Faye L; Soliman, Elsayed Z; Koene, Ryan J; Rooney, Mary R; O'Neal, Wesley T; Alonso, Alvaro; Chen, Lin Y

    2017-08-01

    Abnormal P-wave axis (aPWA) has been linked to incident atrial fibrillation and mortality; however, the relationship between aPWA and stroke has not been reported. We hypothesized that aPWA is associated with ischemic stroke independent of atrial fibrillation and other stroke risk factors and tested our hypothesis in the ARIC study (Atherosclerosis Risk In Communities), a community-based prospective cohort study. We included 15 102 participants (aged 54.2±5.7 years; 55.2% women; 26.5% blacks) who attended the baseline examination (1987-1989) and without prevalent stroke. We defined aPWA as any value outside 0 to 75° using 12-lead ECGs obtained during study visits. Each case of incident ischemic stroke was classified in accordance with criteria from the National Survey of Stroke by a computer algorithm and adjudicated by physician review. Multivariable Cox regression was used to estimate hazard ratios and 95% confidence intervals for the association of aPWA with stroke. During a mean follow-up of 20.2 years, there were 657 incident ischemic stroke cases. aPWA was independently associated with a 1.50-fold (95% confidence interval, 1.22-1.85) increased risk of ischemic stroke in the multivariable model that included atrial fibrillation. When subtyped, aPWA was associated with a 2.04-fold (95% confidence interval, 1.42-2.95) increased risk of cardioembolic stroke and a 1.32-fold (95% confidence interval, 1.03-1.71) increased risk of thrombotic stroke. aPWA is independently associated with ischemic stroke. This association seems to be stronger for cardioembolic strokes. Collectively, our findings suggest that alterations in atrial electric activation may predispose to cardiac thromboembolism independent of atrial fibrillation. © 2017 American Heart Association, Inc.

  15. [Posttraumatic thromboembolic complications: Incidence, risk factors, pathophysiology and prevention].

    Science.gov (United States)

    Bahloul, M; Regaieg, K; Chtara, K; Turki, O; Baccouch, N; Chaari, A; Bouaziz, M

    2017-04-01

    Venous thromboembolism (VTE) remains a major challenge in critically ill patients. Subjects admitted in intensive care unit (ICU), in particular trauma patients, are at high-risk for both deep vein thrombosis (DVT) and pulmonary embolism (PE). The rate of symptomatic PE in injured patients has been reported previously ranging from 1 to 6%. The high incidence of posttraumatic venous thromboembolic events is well known. In fact, major trauma is a hypercoagulable state. Several factors placing the individual patient at a higher risk for the development of DVT and PE have been suggested: high ISS score, meningeal hemorrhage and spinal cord injuries have frequently been reported as a significant risk factor for VTEs after trauma. Posttraumatic pulmonary embolism traditionally occurs after a period of at least 5 days from trauma. The prevention can reduce the incidence and mortality associated with the pulmonary embolism if it is effective. There is no consensus is now available about the prevention of venous thromboembolism in trauma patients. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  16. Prognostic value of computed tomography in acute pulmonary thromboembolism.

    Science.gov (United States)

    Plasencia-Martínez, J M; Carmona-Bayonas, A; Calvo-Temprano, D; Jiménez-Fonseca, P

    2016-01-01

    In addition to being the standard reference for the diagnosis of acute pulmonary thromboembolism, CT angiography of the pulmonary arteries can also provide valuable information about the patient's prognosis. Although which imaging findings are useful for prognosis remains controversial, signs of right ventricular dysfunction on CT are now included in clinical algorithms for the management of pulmonary thromboembolism. However, the optimal method for obtaining these measurements while maintaining a balance between the ease of use necessary to include their evaluation in our daily activity and the loss of precision in its predictive capacity remains to be determined. Moreover, other variables associated with pulmonary thromboembolism that often go unobserved can complement the prognostic information we can offer to clinicians. This review aims to clarify some of the more controversial aspects related to the prognostic value of CT in patients with pulmonary embolisms according to the available evidence. Knowing which variables are becoming more important in the prognosis, how to detect them, and why it is important to include them in our reports will help improve the management of patients with pulmonary embolism. Copyright © 2016 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. Chronic thromboembolic pulmonary hypertension: a distinct disease entity

    Directory of Open Access Journals (Sweden)

    Irene Lang

    2015-06-01

    Full Text Available Chronic thromboembolic pulmonary hypertension (CTEPH is a distinct subtype of pulmonary hypertension (PH. One disease hypothesis is that CTEPH results from the non-resolution of venous thromboembolism. CTEPH is characterised by the presence of obstructive fibrotic thromboembolic material in the major pulmonary vessels, with concomitant microvascular arteriopathy, resulting in progressive PH. The clinical presentation of CTEPH is similar to pulmonary arterial hypertension with nonspecific symptoms, but it is distinguished from pulmonary arterial hypertension by the presence of mismatched segmental defects on the ventilation/perfusion scan. The exact prevalence and incidence of CTEPH are unknown, but are thought to have been underestimated in the past. CTEPH is unique among the subgroups of PH in that it is potentially curable with pulmonary endarterectomy, a surgical intervention intended to remove the occlusive material from the pulmonary vasculature. However, in some patients the obstructions are technically inaccessible or the risk/benefit ratios are unfavourable, making the condition inoperable. It is thought that the involvement of the smaller, more distal vessels is a target for medical treatment. Untreated, CTEPH may result in right heart failure and death. The pathophysiological mechanisms which cause CTEPH are complex and have not yet been fully elucidated.

  18. Prospective study of sickle cell trait and venous thromboembolism incidence.

    Science.gov (United States)

    Folsom, A R; Tang, W; Roetker, N S; Kshirsagar, A V; Derebail, V K; Lutsey, P L; Naik, R; Pankow, J S; Grove, M L; Basu, S; Key, N S; Cushman, M

    2015-01-01

    Sickle cell trait may increase risk of venous thromboembolism, but this is not fully established. We sought to determine the association of sickle cell trait with deep vein thrombosis and pulmonary embolism. Middle-aged African Americans participating in a prospective, population-based cohort investigation, the Atherosclerosis Risk in Communities Study, were followed from 1987 through 2011 for incident hospitalized pulmonary embolism (n = 111) or isolated deep vein thrombosis (n = 138), verified by physician review of medical records. Sickle cell trait (heterozygosity for hemoglobin S, n = 268) was compared with no sickle cell trait (n = 3748). Over a median of 22 years of follow-up, 249 participants had an incident venous thromboembolism. The hazard ratio of venous thromboembolism was 1.50 (95% confidence interval [CI] 0.96-2.36) for participants with vs. without sickle cell trait, after adjustment for age, sex, ancestry, hormone replacement therapy (women), body mass index, diabetes, and estimated glomerular filtration rate. This hazard ratio was 2.05 (95% CI 1.12-3.76) for pulmonary embolism and 1.15 (95% CI 0.58-2.27) for deep vein thrombosis without pulmonary embolism. Sickle cell trait in African Americans carries a 2-fold increased risk of pulmonary embolism but does not elevate deep vein thrombosis risk. Because neonatal screening for sickle hemoglobin is being conducted in the United States, consideration should be paid to the increased pulmonary embolism risk of individuals with sickle cell trait. © 2014 International Society on Thrombosis and Haemostasis.

  19. Stroke: First Aid

    Science.gov (United States)

    First aid Stroke: First aid Stroke: First aid By Mayo Clinic Staff A stroke occurs when there's bleeding into your brain or when blood flow to your ... cells start dying. Seek immediate medical assistance. A stroke is a true emergency. The sooner treatment is ...

  20. Leukocytosis in acute stroke

    DEFF Research Database (Denmark)

    Kammersgaard, L P; Jørgensen, H S; Nakayama, H

    1999-01-01

    Leukocytosis is a common finding in the acute phase of stroke. A detrimental effect of leukocytosis on stroke outcome has been suggested, and trials aiming at reducing the leukocyte response in acute stroke are currently being conducted. However, the influence of leukocytosis on stroke outcome has...

  1. Adapting the Home After a Stroke

    Science.gov (United States)

    ... News About Neurology Image Library Search The Internet Stroke Center Patients & Families About Stroke Stroke Diagnosis Stroke ... after a Stroke Adapting the Home after a Stroke Caregiver Introduction What is Aphasia? Stroke Recovery Guides ...

  2. Intensive virtual reality-based training for upper limb motor function in chronic stroke: a feasibility study using a single case experimental design and fMRI.

    Science.gov (United States)

    Schuster-Amft, Corina; Henneke, Andrea; Hartog-Keisker, Birgit; Holper, Lisa; Siekierka, Ewa; Chevrier, Edith; Pyk, Pawel; Kollias, Spyros; Kiper, Daniel; Eng, Kynan

    2015-01-01

    To evaluate feasibility and neurophysiological changes after virtual reality (VR)-based training of upper limb (UL) movements. Single-case A-B-A-design with two male stroke patients (P1:67 y and 50 y, 3.5 and 3 y after onset) with UL motor impairments, 45-min therapy sessions 5×/week over 4 weeks. Patients facing screen, used bimanual data gloves to control virtual arms. Three applications trained bimanual reaching, grasping, hand opening. Assessments during 2-week baseline, weekly during intervention, at 3-month follow-up (FU): Goal Attainment Scale (GAS), Chedoke Arm and Hand Activity Inventory (CAHAI), Chedoke-McMaster Stroke Assessment (CMSA), Extended Barthel Index (EBI), Motor Activity Log (MAL). Functional magnetic resonance imaging scans (FMRI) before, immediately after treatment and at FU. P1 executed 5478 grasps (paretic arm). Improvements in CAHAI (+4) were maintained at FU. GAS changed to +1 post-test and +2 at FU. P2 executed 9835 grasps (paretic arm). CAHAI improvements (+13) were maintained at FU. GAS scores changed to -1 post-test and +1 at FU. MAL scores changed from 3.7 at pre-test to 5.5 post-test and 3.3 at FU. The VR-based intervention was feasible, safe, and intense. Adjustable application settings maintained training challenge and patient motivation. ADL-relevant UL functional improvements persisted at FU and were related to changed cortical activation patterns. Implications for Rehabilitation YouGrabber trains uni- and bimanual upper motor function. Its application is feasible, safe, and intense. The control of the virtual arms can be done in three main ways: (a) normal (b) virtual mirror therapy, or (c) virtual following. The mirroring feature provides an illusion of affected limb movements during the period when the affected upper limb (UL) is resting. The YouGrabber training led to ADL-relevant UL functional improvements that were still assessable 12 weeks after intervention finalization and were related to changed cortical

  3. Stroke pathways.

    Science.gov (United States)

    Venketasubramanian, N

    2001-07-01

    Stroke pathways are task-orientated structured multidisciplinary care plans which detail essential steps and interventions during the period of care of a "typical" stroke patient. Pathway development and implementation are best achieved by an appointed champion leading a multidisciplinary team of health care workers and administrators, who will also be the end users of the pathway. Pathway development involves reviews of existing clinical practice guidelines and pathways, followed by documentation, interdigitation and prioritization of care requirements at different time points in the various spheres, taking into consideration local philosophies and practices. These spheres could include investigations, pharmacologic treatment, rehabilitative therapy, nursing measures, and patient education. This would result in evidence-based holistic quality care, wide support base, efficient service provision, reduced costs and length of stay, less practice variation, improved communication among disciplines, enhanced patient-staff relationship, ease of audit and research opportunities. Components of the pathway could include a patient summary sheet, multidisciplinary record of the various activities structured on a day-to-day basis, sign-off columns for staff responsible for performing those activity, variance sheet, and separate protocols for specific issues. Implementation requires training of users, pilot runs, feedback, regular revisions, monitoring of compliance, and analysis of variances. Widespread implementation of pathways may be hindered by lack of support, and concerns about increased time requirements and costs, stifling of innovation, restriction of application of clinical judgement, lack of applicability to all patients, misuse and legal issues. However, a well-designed pathway will ensure quality care in a cost-efficient manner, benefiting the patient, carer and the health care service.

  4. Splenectomy is associated with hypercoagulable thrombelastography values and increased risk of thromboembolism.

    Science.gov (United States)

    Pommerening, Matthew J; Rahbar, Elaheh; Minei, Kristin; Holcomb, John B; Wade, Charles E; Schreiber, Martin A; Cohen, Mitchell J; Underwood, Samantha J; Nelson, Mary; Cotton, Bryan A

    2015-09-01

    Previous investigators have demonstrated that postinjury thrombocytosis is associated with an increase in thromboembolic (TE) risk. Increased rates of thrombocytosis have been found specifically in patients after splenectomy for trauma. We hypothesized that patients undergoing splenectomy (1) would demonstrate a more hypercoagulable profile during their hospital stay and (2) that this hypercoagulable state would be associated with increased TE events. This was a 14-month, prospective, observational trial evaluating serial rapid thrombelastography (rTEG) at 3 American College of Surgeons-verified, level 1 trauma centers. Inclusion criteria were highest-level trauma activation and arrival within 6 hours of injury. Exclusion criteria were 20% total body surface area. Serial rTEG (activated clotting time, k-time, α-angle, MA, lysis) and traditional coagulation testing (prothrombin time, partial thromboplastin time, fibrinogen and platelet count) were obtained at admission and then at 3, 6, 12, 24, 48, 72, 96, and 120 hours. Thromboembolic complications were defined as the development of deep-vein thrombosis, pulmonary embolism, acute myocardial infarction, or ischemic stroke during hospitalization. Patients were stratified into splenectomy versus nonsplenectomy cohorts. Univariate analysis was then conducted followed by longitudinal analysis using generalized estimating equations to evaluate the effects of time, splenectomy, and group-time interactions on changes in rTEG and traditional coagulation testing. We used an adjusted generalized estimating equation model to control for age, sex, ISS, admission blood pressure, base deficit, and hemoglobin. A total of 1,242 patients were enrolled; 795 had serial rTEG data. Of these, 605 had serial values >24 hours and made up the study population. Splenectomy patients were younger, more hypotensive, and in shock on arrival. Although there was no difference in 24-hour or 30-day mortality, splenectomy patients were more

  5. Experimental evaluation of tool wear throughout a continuous stroke blanking process of quenched 22MnB5 ultra-high-strength steel

    Science.gov (United States)

    Vogt, S.; Neumayer, F. F.; Serkyov, I.; Jesner, G.; Kelsch, R.; Geile, M.; Sommer, A.; Golle, R.; Volk, W.

    2017-09-01

    Steel is the most common material used in vehicles’ chassis, which makes its research an important topic for the automotive industry. Recently developed ultra-high-strength steels (UHSS) provide extreme tensile strength up to 1,500 MPa and combine great crashworthiness with good weight reduction potential. However, in order to reach the final shape of sheet metal parts additional cutting steps such as trimming and piercing are often required. The final trimming of quenched metal sheets presents a huge challenge to a conventional process, mainly because of the required extreme cutting force. The high cutting impact, due to the materials’ brittleness, causes excessive tool wear or even sudden tool failure. Therefore, a laser is commonly used for the cutting process, which is time and energy consuming. The purpose of this paper is to demonstrate the capability of a conventional blanking tool design in a continuous stroke piercing process using boron steel 22MnB5 sheets. Two different types of tool steel were tested for their suitability as active cutting elements: electro-slag remelted (ESR) cold work tool steel Bohler K340 ISODUR and powder-metallurgic (PM) high speed steel Bohler S390 MICROCLEAN. A FEM study provided information about an optimized punch design, which withstands buckling under high cutting forces. The wear behaviour of the process was assessed by the tool wear of the active cutting elements as well as the quality of cut surfaces.

  6. An experimental test of stroke recovery by implanting a hyaluronic acid hydrogel carrying a Nogo receptor antibody in a rat model

    Energy Technology Data Exchange (ETDEWEB)

    Ma Jun [Biomaterials Laboratory, Department of Materials Science and Engineering, Tsinghua University, Beijing 100084 (China); Tian Weiming [Biomaterials Laboratory, Department of Materials Science and Engineering, Tsinghua University, Beijing 100084 (China); Hou Shaoping [Beijing Institute of Neuroscience, Capital University of Medical Sciences, Beijing 100054 (China); Xu Qunyuan [Beijing Institute of Neuroscience, Capital University of Medical Sciences, Beijing 100054 (China); Spector, Myron [Tissue Engineering, VA Boston Healthcare System, Harvard Medical School, Boston, MA (United States); Cui Fuzhai [Biomaterials Laboratory, Department of Materials Science and Engineering, Tsinghua University, Beijing 100084 (China)

    2007-12-15

    The objective of the study was to determine the effects of a hyaluronic-acid-based (HA-based) hydrogel implant, carrying a polyclonal antibody to the Nogo-66 receptor (NgR), on adult rats that underwent middle cerebral artery occlusion (MCAO). Behavioral tests of a forelimb-reaching task suggested that the disabled function of the impaired forelimb in this stroke model was ameliorated by the implant to a certain extent. These behavioral findings were correlated with immunohistochemical results of investigating the distribution of NgR antibody, neurofilaments (NF) and neuron-specific class III {beta}-tubulin (TuJ1) in the brain sections. The porous hydrogel functioned as a scaffold to deliver the NgR antibody, support cell migration and development. In addition, it was found NF-positive and TuJ1-positive expressions were distributed in the implanted hydrogel. Collectively, the results demonstrate the promise of the HA hydrogel as a scaffold material and the delivery vehicle of the NgR antibody for the repair of defects and the support of neural regeneration in the brain.

  7. Correlation between clot density and recanalization success or stroke etiology in acute ischemic stroke patients.

    Science.gov (United States)

    Jagani, Manoj; Kallmes, David F; Brinjikji, Waleed

    2017-06-01

    Background Predicting recanalization success for patients undergoing endovascular treatment for acute ischemic stroke is of significant interest. Studies have previously correlated the success of recanalization with the density of the clot. We evaluated clot density and its relationship to revascularization success and stroke etiology. Methods We conducted a retrospective review of 118 patients undergoing intra-arterial therapy for acute ischemic stroke. Mean and maximum thrombus density was measured by drawing a circular region of interest on an axial slice of a non-contrast computed tomography scan. T-tests were used to compare clot density to recanalization success or to stroke etiology, namely large artery atherosclerosis and cardioembolism. Recanalization success was compared in four device groups: aspiration, stent retriever, aspiration and stent retriever, and all other. Results There was no significant difference in the mean clot density in patients with successful ( n = 80) versus unsuccessful recanalization ( n = 38, 50.1 ± 7.4 Hounsfield unit (HU) vs. 53 ± 12.7 HU; P = 0.17). Comparing the large artery thromboembolism ( n = 35) to the cardioembolic etiology group ( n = 56), there was no significant difference in mean clot density (51.5 ± 7.7 HU vs. 49.7 ± 8.5 HU; P = 0.31). A subgroup analysis of middle cerebral artery occlusions ( n = 65) showed similar, non-statistically significant differences between groups. There was no difference in the rate of recanalization success in patients with a mean clot density greater than 50 HU or less than 50 HU in each of the four device groups. Conclusions There was no relationship between clot density and revascularization success or stroke etiology in our study. More research is needed to determine if clot density can predict recanalization rates or indicate etiology.

  8. Current Canadian And American Experiences In The Treatment Of Acute Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Parviz Dolati

    2017-02-01

    Full Text Available Stroke remains one of the main public health issues worldwide. It is the third leading cause of death in the United States, with more than 200,000 people dying from strokes each year. Approximately 80% of all acute ischemic strokes are due to intracranial artery occlusion, most commonly thromboembolic clot occlusion. Revascularization of occluded territories is the cornerstone of acute ischemic stroke and Thrombolysis for ischemic stroke has been systematically studied in large randomized trials only since the 1990s. To date, thrombolytic therapy for ischemic stroke has been investigated in 21 randomized controlled clinical trials enrolling more than 7,000 patients. The advent of modern imaging and endovascular tools and technology has revolutionized treatment of stroke. In this talk, I will review current clinical trials published in The NEJM (ESCAPE, MR Clean, EXTENDED IA, …. regarding superiority of the endovascular treatments, especially, the stent retrievers, over Iv tPA. I will also go over all endovascular techniques used in the endovascular treatment of acute stroke using my Canadian and American experiences.

  9. Current Canadian And American Experiences In The Treatment Of Acute Ischemic Stroke

    Directory of Open Access Journals (Sweden)

    Parviz Dolati

    2017-02-01

    Full Text Available Stroke remains one of the main public health issues worldwide. It is the third leading cause of death in the United States, with more than 200,000 people dying from strokes each year. Approximately 80% of all acute ischemic strokes are due to intracranial artery occlusion, most commonly thromboembolic clot occlusion. Revascularization of occluded territories is the cornerstone of acute ischemic stroke and Thrombolysis for ischemic stroke has been systematically studied in large randomized trials only since the 1990s. To date, thrombolytic therapy for ischemic stroke has been investigated in 21 randomized controlled clinical trials enrolling more than 7,000 patients. The advent of modern imaging and endovascular tools and technologyhas revolutionized treatment of stroke. In this talk, I will review current clinical trials published in The NEJM (ESCAPE, MR Clean, EXTENDED IA, …. regarding superiority of the endovascular treatments, especially, the stent retrievers, over Iv tPA. I will also go over all endovascular techniques used in the endovascular treatment of acute stroke using my Canadian and American experiences.

  10. Pediatric stroke; Stroke im Kindesalter

    Energy Technology Data Exchange (ETDEWEB)

    Grunwald, I. [Abt. fuer Neuroradiologie, Radiologische Universitaetsklinik Homburg/Saar (Germany); Reinhard, H. [Abt. fuer Allgemeine Paediatrie, Klinik fuer Kinder- und Jugendmedizin Homburg/Saar (Germany); Reith, W. [Abt. fuer Neuroradiologie, Radiologische Universitaetsklinik Homburg/Saar (Germany); Abt. fuer Neuroradiologie, Radiologische Universitaetsklinik, 66421, Homburg/Saar (Germany)

    2003-11-01

    About 3% of cerebral infarcts occur in children and young individuals, and pediatric stroke is even less common. Cerebral infarcts in children have different etiologies compared to adults. The common causes are described, as well as sinus venous occlusions. Cerebral venoocclusive disease is an elusive, often underdiagnosed cause of acute neurologic deterioration. (orig.) [German] Circa 3% aller Schlaganfaelle treten im Kindesalter auf, bei juengeren Erwachsenen ist das Vorkommen eines Schlaganfalls sogar noch seltener. Zerebrale Infarkte im Kindesalter haben meist eine andere Aetiologie, verglichen mit der von Erwachsenen. Die unterschiedlichsten Ursachen werden diskutiert. Die Sinus-Venen-Thrombose ist ein Krankheitsbild, das haeufig nicht rechtzeitig diagnostiziert wird; dieses wird ebenfalls in diesem Artikel beschrieben. (orig.)

  11. Airplane stroke syndrome.

    Science.gov (United States)

    Humaidan, Hani; Yassi, Nawaf; Weir, Louise; Davis, Stephen M; Meretoja, Atte

    2016-07-01

    Only 37 cases of stroke during or soon after long-haul flights have been published to our knowledge. In this retrospective observational study, we searched the Royal Melbourne Hospital prospective stroke database and all discharge summaries from 1 September 2003 to 30 September 2014 for flight-related strokes, defined as patients presenting with stroke within 14days of air travel. We hypothesised that a patent foramen ovale (PFO) is an important, but not the only mechanism, of flight-related stroke. We describe the patient, stroke, and flight characteristics. Over the study period, 131 million passengers arrived at Melbourne airport. Our centre admitted 5727 stroke patients, of whom 42 (0.73%) had flight-related strokes. Flight-related stroke patients were younger (median age 65 versus 73, p<0.001), had similar stroke severity, and received intravenous thrombolysis more often than non-flight-related stroke patients. Seven patients had flight-related intracerebral haemorrhage. The aetiology of the ischaemic strokes was cardioembolic in 14/35 (40%), including seven patients with confirmed PFO, one with atrial septal defect, four with atrial fibrillation, one with endocarditis, and one with aortic arch atheroma. Paradoxical embolism was confirmed in six patients. Stroke related to air travel is a rare occurrence, less than one in a million. Although 20% of patients had a PFO, distribution of stroke aetiologies was diverse and was not limited to PFO and paradoxical embolism. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. Randomized Clinical Trials in Stroke Research

    OpenAIRE

    Ahn, Chul; Ahn, Daniel

    2010-01-01

    A randomized clinical trial (RCT) is widely regarded as the most rigorous study design to determine the efficacy of intervention since spurious causality and bias associated with other experimental designs can be avoided. The purpose of this article is to provide clinicians and clinical researchers with the types of randomized clinical trials used in stroke studies and to discuss the advantages and limitations in each type of randomized stroke clinical trials.

  13. Difficulty Swallowing After Stroke (Dysphagia)

    Science.gov (United States)

    ... Stroke Heroes Among Us Difficulty Swallowing After Stroke (Dysphagia) Updated:Nov 15,2016 Excerpted and adapted from "Swallowing Disorders After a Stroke," Stroke Connection Magazine July/August ...

  14. Cardioembolic Stroke and Postmyocardial Infarction Stroke.

    Science.gov (United States)

    Hornung, Marius; Franke, Jennifer; Gafoor, Sameer; Sievert, Horst

    2016-05-01

    Ischemic stroke following acute myocardial infarction (AMI) is a rare but serious complication due to left ventricular thrombus formation and atrial fibrillation. Early revascularization of the culprit coronary lesion is essential. Treatment trends may affect the risk. Conversely, the greater use of antiplatelet agents to reduce the risk of ischemic stroke could increase the risk of hemorrhagic stroke. The risk of stroke after AMI has decreased significantly with more use of percutaneous coronary intervention and antithrombotic therapies in the acute setting, and statins, antihypertensive medications, and dual antiplatelet therapy as secondary prevention strategies. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Pulmonary endarterectomy outputs in chronic thromboembolic pulmonary hypertension.

    Science.gov (United States)

    López Gude, María Jesús; Pérez de la Sota, Enrique; Pérez Vela, Jose Luís; Centeno Rodríguez, Jorge; Muñoz Guijosa, Christian; Velázquez, María Teresa; Alonso Chaterina, Sergio; Hernández González, Ignacio; Escribano Subías, Pilar; Cortina Romero, José María

    2017-07-07

    Pulmonary thromboendarterectomy surgery is the treatment of choice for patients with chronic thromboembolic pulmonary hypertension; extremely high pulmonary vascular resistance constitutes a risk factor for hospital mortality. The objective of this study was to analyze the immediate and long-term results of the surgical treatment of chronic thromboembolic pulmonary hypertension in patients with very severe pulmonary hypertension. Since February 1996, we performed 160 pulmonary thromboendarterectomies. We divided the patient population in 2 groups: group 1, which included 40 patients with pulmonary vascular resistance≥1090dyn/sec/cm -5 , and group 2, which included the remaining 120 patients. Hospital mortality (15 vs. 2.5%), reperfusion pulmonary edema (33 vs. 14%) and heart failure (23 vs. 3.3%) were all higher in group 1; however, after one year of follow-up, there were no significant differences in the clinical, hemodynamic and echocardiographic conditions of both groups. Survival rate after 5 years was 77% in group 1 and 92% in group 2 (P=.033). After the learning curve including the 46 first patients, there was no difference in hospital mortality (3.8 vs. 2.3%) or survival rate after 5 years (96.2% in group 1 and 96.2% in group 2). Pulmonary thromboendarterectomy is linked to significantly higher morbidity and mortality rates in patients with severe chronic thromboembolic pulmonary hypertension. Nevertheless, these patients benefit the same from the procedure in the mid-/long-term. In our experience, after the learning curve, this surgery is safe in severe pulmonary hypertension and no level of pulmonary vascular resistance should be an absolute counter-indication for this surgery. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  16. Syncope as the Clinical Presentation of Pulmonary Thromboembolism

    Directory of Open Access Journals (Sweden)

    Abbasali Rafighdoust

    2007-06-01

    Full Text Available Pulmonary thromboembolism (PTE has a wide spectrum of presentations, and its cardinal manifestations include chest pain, dyspnea, and syncope. Syncope as an initial presentation of PTE occurs in 10-14% of patients and is not restricted to massive PTEs. It can also occur in the setting of non- massive cases probably due to a vasovagal mechanism or the occurrence of conduction disturbances in preexisting complete left bundle-branch block. The next point discussed here is the use of thrombolytic therapy for submassive PTE with a normal blood pressure while marked right ventricular dyskinesia or dysfunction occurs.

  17. Association of Traditional Cardiovascular Risk Factors with Venous Thromboembolism

    DEFF Research Database (Denmark)

    Mahmoodi, Bakhtawar K; Cushman, Mary; Næss, Inger Anne

    2017-01-01

    Background: Much controversy surrounds the association of traditional cardiovascular disease risk factors with venous thromboembolism (VTE). Methods: We performed an individual level random-effect meta-analysis including 9 prospective studies with measured baseline cardiovascular disease risk...... factors and validated VTE events. Definitions were harmonized across studies. Traditional cardiovascular disease risk factors were modeled categorically and continuously using restricted cubic splines. Estimates were obtained for overall VTE, provoked VTE (ie, VTE occurring in the presence of 1 or more...... is potentially mediated through comorbid conditions such as cancer, the modifiable traditional cardiovascular disease risk factors are not associated with increased VTE risk. Higher systolic blood pressure showed an inverse association with VTE....

  18. Hormone Therapy and Venous Thromboembolism in a Transgender Adolescent.

    Science.gov (United States)

    Stanley, Kaitlin; Cooper, James

    2018-01-01

    Venous thromboembolism can be precipitated by both genetic and acquired factors, but the role of testosterone therapy is less clear. Here, we present a 17-year-old transgender adolescent, transitioning from female to male, receiving both estrogen and testosterone therapy, who developed a pulmonary embolism without an underlying genetic thrombophilic condition. As transgender medical care evolves, the use of testosterone as cross-sex hormone therapy in adolescents is likely to increase. Our review suggests that care must be taken when initiating treatment with testosterone, and modification of other thrombophilic risks should be explored before starting therapy in this population.

  19. The risk of venous thromboembolism in patients with multiple sclerosis

    DEFF Research Database (Denmark)

    Peeters, P J H L; Bazelier, M T; Uitdehaag, B M J

    2014-01-01

    BACKGROUND: In patients with multiple sclerosis (MS), disability and autoinflammatory processes may result in an increased risk of venous thromboembolism (VTE) OBJECTIVE: To evaluate the risk of VTE associated with MS. METHODS: We conducted an observational-cohort study within the Clinical Practice...... to be associated with an increased risk of VTE within the MS population. Moreover, the risk of VTE was increased in MS patients with recent records indicating immobility, spasticity, glucocorticoid use, or disability. CONCLUSIONS: Patients with MS had an increased risk of VTE. Furthermore, our results provide...

  20. Epidemiological study of venous thromboembolism in a big Danish cohort

    DEFF Research Database (Denmark)

    Severinsen, Marianne Tang; Kristensen, Søren Risom; Overvad, Kim

    Introduction: Epidemiological data on venous thromboembolism (VT), i.e. pulmonary emboli (PE) and deep venous thrombosis (DVT) are sparse. We have examined VT-diagnoses registered in a big Danish Cohort study.  Methods: All first-time VT diagnoses in The Danish National Patient Register were...... identified among participants in the Danish cohort study "Diet, Cancer and Health" in which 57,053 50-64 years old persons were included 1993-7. Medical records were retrieved and reviewed by an experienced physician using a detailed standardized form, and information on the diagnostic work-up and presence...

  1. Venous thromboembolism in HIV-positive women during puerperium : a case series

    NARCIS (Netherlands)

    Jansen, J.M.; Lijfering, W.M.; Sprenger, H.G.; van der Meer, J.; van Pampus, M.G.

    Several studies in the past few years suggested that HIV-infection is associated with an increased risk of venous thromboembolism. No data have been reported, however, on pregnancy and the postpartum period as possible additional risk factors for venous thromboembolism in HIV-infected women. We

  2. [Actual questions about the prevention of venous thromboembolism in cancer patients receiving chemotherapy].

    Science.gov (United States)

    Losonczy, Hajna; Nagy, Ágnes; Tar, Attila

    2016-02-07

    Cancer patients have a 2-7 fold increased risk of venous thromboembolism compared with the general population and, since 1990, this is associated with significant morbidity and mortality. This review summarizes the current knowledge on venous thromboembolism and cancer. Notably, the risk of venous thromboembolism varies depending on the type and stage of cancer. For instance, pancreatic and brain cancer patients have a higher risk of venous thromboembolism than breast and prostate cancer patients. Moreover, patients with metastatic disease have a higher risk than those with localized tumors. Tumor-derived procoagulant factors, cytokines and growth factors may directly and indirectly enhance venous thromboembolism. Chemotherapy produces ~6,5 fold increase in venous thromboembolism incidence in cancer patients compared to the general population. Prevention of this complication is challenging. The authors review the development of guidelines concerning venous thromboembolism prevention in hospitalized and also in ambulatory cancer patients treated with chemotherapy. Current guidelines recommend the use of low-molecular-weight heparin. Understanding the underlying mechanisms may allow the development of new therapies to safely prevent venous thromboembolism in cancer patients.

  3. Venous thromboembolism in pregnancy and the puerperal period: a study of 1210 events

    DEFF Research Database (Denmark)

    Virkus, Rie Adser; Løkkegaard, Ellen Cl; Lidegaard, Ojvind

    2013-01-01

    The aim of this study was to describe venous thromboembolism (VTE) in pregnancy and the puerperal period and to validate diagnoses of VTE.......The aim of this study was to describe venous thromboembolism (VTE) in pregnancy and the puerperal period and to validate diagnoses of VTE....

  4. Geometrical Effects on the Electromagnetic Radiation from Lightning Return Strokes

    Science.gov (United States)

    Willett, J. C.; Smith, D. A.; LeVine, D. M.; Zukor, Dorothy J. (Technical Monitor)

    2001-01-01

    The morphological difference between the electromagnetic radiation-field waveforms of "first" and "subsequent" return strokes in cloud-to-ground lightning flashes is well known and can be used to identify the formation of new channels to ground. This difference is generally believed due to the existence of branches on first-stroke channels, whereas subsequent strokes re-illuminate only the main channel of a previous stroke; but experimental evidence for this hypothesis is relatively weak. It has been argued for the influence of channel geometry on the fine structure of radiation from subsequent return strokes by comparing the field-change waveforms recorded at the same station from strokes within the same flash and between different flashes of both natural and triggered lightning. The present paper introduces new evidence for both of these hypotheses from a comparison of waveforms between sensors in different directions from the same stroke.

  5. Risk of Venous Thromboembolism Following Hemorrhagic Fever With Renal Syndrome: A Self-controlled Case Series Study.

    Science.gov (United States)

    Connolly-Andersen, Anne-Marie; Whitaker, Heather; Klingström, Jonas; Ahlm, Clas

    2018-01-06

    Bleeding is associated with viral hemorrhagic fevers; however, thromboembolic complications have received less attention. Hemorrhagic fever with renal syndrome (HFRS) is a mild viral hemorrhagic fever caused by Puumala hantavirus. We previously identified HFRS as a risk factor for myocardial infarction and stroke, but the risk for venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is unknown. Personal identity numbers from the Swedish HFRS database were cross-linked with the National Patient register to obtain information on all causes for hospitalization during 1964 to 2013. The self-controlled case series method was used to calculate the incidence rate ratio (IRR) for first VTE, DVT, and PE during 1998 to 2013. From 7244 HFRS patients, there were 146 with a first VTE of which 74 were DVT and 78 were PE, and 6 patients had both DVT and PE. The overall risk for a VTE was significantly higher during the first 2 weeks following HFRS onset, with an IRR of 64.3 (95% confidence interval [CI], 36.3-114). The corresponding risk for a DVT was 45.9 (95% CI, 18-117.1) and for PE, 76.8 (95% CI, 37.1-159). Sex interacted significantly with the association between HFRS and VTE, with females having a higher risk compared with males. A significantly increased risk for VTE was found in the time period following HFRS onset. It is important to keep this in mind and monitor HFRS patients, and possibly other viral hemorrhagic fever patients, for early symptoms of VTE.

  6. Major stroke in a 19-year-old patient with a univentricular heart

    Directory of Open Access Journals (Sweden)

    Riemann M

    2013-01-01

    Full Text Available Mads Riemann,1,2 Lars Idorn,3 Aase Wagner,4 Lars Søndergaard,3 Jørgen K Kanters1,21Department of Internal Medicine, Elsinore Hospital, Elsinore, Denmark; 2Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark; 3Department of Cardiology, Copenhagen University Hospital, Section 2014, Rigshospitalet, Copenhagen, Denmark; 4Department of Radiology, Copenhagen University Hospital, Section 3023, Rigshospitalet, Copenhagen, DenmarkAbstract: Patients with univentricular heart malformations are at increased risk of suffering from thromboembolic events. We present a case of a 19-year-old woman born with a univentricular heart who suffered a major stroke while being treated with only salicylic acid. At least 20% of patients with univentricular hearts have been reported to experience thromboembolic events, of which 25% are fatal. Despite the high incidence of thromboembolic events, no consensus has been reached regarding the role of long-term anti-thrombotic treatment in this group of patients. This lack of consensus warrants future studies that compare the different therapeutic strategies.Keywords: univentricle, stroke, antithrombotic treatment

  7. Thromboembolism in Dogs with Protein-Losing Enteropathy with Non-Neoplastic Chronic Small Intestinal Disease.

    Science.gov (United States)

    Jacinto, Ana M L; Ridyard, Alison E; Aroch, Itamar; Watson, Penny J; Morrison, Linda R; Chandler, Marge L; Kuzi, Sharon

    Dogs with protein-losing enteropathy (PLE) are suggested to be at increased risk of developing thromboembolic events. However, with some exceptions, there are very few reports of thromboembolism in such dogs. This multicentre retrospective observational study describes a case series of thromboembolism (TE) in eight dogs with PLE secondary to non-neoplastic, chronic small intestinal disease. Seven dogs had poorly controlled PLE when the thromboembolic event occurred. Pulmonary thromboembolism (PTE) occurred in six dogs, while one dog developed splenic vein thrombosis and another had concurrent splenic vein and aortic TE. Six dogs died, all with PTE. Antithrombin activity was decreased in one of two dogs in which it was measured. Serum cobalamin and folate concentrations were measured in three dogs and cobalamin was subnormal in all three. Serum magnesium, measured in two dogs, was low in both. Dogs with uncontrolled chronic small intestinal disease and PLE are at risk for developing serious life-threatening TE, mostly PTE.

  8. Brain Basics: Preventing Stroke

    Science.gov (United States)

    ... You are here Home » Disorders » Patient & Caregiver Education Brain Basics: Preventing Stroke Table of Contents Introduction What ... Americans are protecting their most important asset—their brain. Are you? Stroke ranks as the fourth leading ...

  9. Stroke: Hope through Research

    Science.gov (United States)

    ... approaches to stroke prevention for people with a history of small subcortical strokes. The trial was designed to compare: 1) aspirin alone vs. combined antiplatelet therapy (aspirin and clopidogrel), ...

  10. National Stroke Association

    Science.gov (United States)

    ... Virginia Washington West Virginia Wisconsin Wyoming Go National Stroke Association Our mission is to reduce the incidence ... presentation. Watch Video Now Featured Story Faces of Stroke All Kathryn could hear were faint voices as ...

  11. Stroke Trials Registry

    Science.gov (United States)

    ... News About Neurology Image Library Search The Internet Stroke Center Trials Registry Clinical Trials Interventions Conditions Sponsors ... a clinical trial near you Welcome to the Stroke Trials Registry Our registry of clinical trials in ...

  12. Perinatal and Childhood Stroke

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2002-03-01

    Full Text Available The epidemiology, risk factors, outcome and prognosis of perinatal and childhood stroke were reviewed at a workshop sponsored by the National Institute of Neurological Disorders and Stroke in Bethesda, MD, on Sept 18 and 19, 2000.

  13. Stroke - risk factors

    Science.gov (United States)

    ... Council on Cardiovascular and Stroke Nursing; Council on Clinical Cardiology; Council on Functional Genomics and Translational Biology; Council on Hypertension. Guidelines for the primary prevention of stroke: a statement ...

  14. Risk-assessment algorithm and recommendations for venous thromboembolism prophylaxis in medical patients

    Directory of Open Access Journals (Sweden)

    Ana T Rocha

    2007-09-01

    Full Text Available Ana T Rocha1, Edison F Paiva2, Arnaldo Lichtenstein2, Rodolfo Milani Jr2, Cyrillo Cavalheiro-Filho3, Francisco H Maffei41Hospital Universitario Professor Edgard Santos da Universidade Federal da Bahia, Salvador, Bahia, Brazil; 2Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil; 3Instituto do Coracao do Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil; 4Faculdade de Medicina de Botucatu, Botucatu, Sao Paulo, BrazilAbstract: The risk for venous thromboembolism (VTE in medical patients is high, but risk assessment is rarely performed because there is not yet a good method to identify candidates for prophylaxis.Purpose: To perform a systematic review about VTE risk factors (RFs in hospitalized medical patients and generate recommendations (RECs for prophylaxis that can be implemented into practice.Data sources: A multidisciplinary group of experts from 12 Brazilian Medical Societies searched MEDLINE, Cochrane, and LILACS.Study selection: Two experts independently classified the evidence for each RF by its scientific quality in a standardized manner. A risk-assessment algorithm was created based on the results of the review.Data synthesis: Several VTE RFs have enough evidence to support RECs for prophylaxis in hospitalized medical patients (eg, increasing age, heart failure, and stroke. Other factors are considered adjuncts of risk (eg, varices, obesity, and infections. According to the algorithm, hospitalized medical patients ≥40 years-old with decreased mobility, and ≥1 RFs should receive chemoprophylaxis with heparin, provided they don’t have contraindications. High prophylactic doses of unfractionated heparin or low-molecular-weight-heparin must be administered and maintained for 6–14 days.Conclusions: A multidisciplinary group generated evidence-based RECs and an easy-to-use algorithm to facilitate VTE prophylaxis in medical patients

  15. Stratifying the Risk of Venous Thromboembolism in Otolaryngology

    Science.gov (United States)

    Shuman, Andrew G.; Hu, Hsou Mei; Pannucci, Christopher J.; Jackson, Christopher R.; Bradford, Carol R.; Bahl, Vinita

    2015-01-01

    Objective The consequences of perioperative venous thromboembolism (VTE) are devastating; identifying patients at risk is an essential step in reducing morbidity and mortality. The utility of perioperative VTE risk assessment in otolaryngology is unknown. This study was designed to risk-stratify a diverse population of otolaryngology patients for VTE events. Study Design Retrospective cohort study. Setting Single-institution academic tertiary care medical center. Subjects and Methods Adult patients presenting for otolaryngologic surgery requiring hospital admission from 2003 to 2010 who did not receive VTE chemoprophylaxis were included. The Caprini risk assessment was retrospectively scored via a validated method of electronic chart abstraction. Primary study variables were Caprini risk scores and the incidence of perioperative venous thromboembolic outcomes. Results A total of 2016 patients were identified. The overall 30-day rate of VTE was 1.3%. The incidence of VTE in patients with a Caprini risk score of 6 or less was 0.5%. For patients with scores of 7 or 8, the incidence was 2.4%. Patients with a Caprini risk score greater than 8 had an 18.3% incidence of VTE and were significantly more likely to develop a VTE when compared to patients with a Caprini risk score less than 8 (P otolaryngology patients for 30-day VTE events and allows otolaryngologists to identify patient subgroups who have a higher risk of VTE in the absence of chemoprophylaxis. PMID:22261490

  16. Managing chronic thromboembolic pulmonary hypertension: pharmacological treatment options

    Directory of Open Access Journals (Sweden)

    I. M. Lang

    2009-03-01

    Full Text Available Chronic thromboembolic pulmonary hypertension (CTEPH is a life-threatening condition in which organised thrombi obstruct the pulmonary vessels, causing increased pulmonary vascular resistance, progressive pulmonary hypertension (PH and right heart failure. The treatment of choice is pulmonary endarterectomy, which restores pulmonary haemodynamics with acceptable periprocedural mortality rates in the majority of suitable patients. However, CTEPH may be inoperable owing to surgically inaccessible thrombi or comorbid diseases that confer an unacceptably high risk. Pharmacotherapies, although not yet approved, may be useful in this situation or for treating residual or recurrent PH following surgery. Vasodilator drugs for PH are attracting growing interest as potential treatments for CTEPH because this disease has recently been labelled as a "dual" pulmonary vascular disorder: major vessel obstruction and remodelling is combined with a small vessel arteriopathy that is histologically indistinguishable from the classical pulmonary arteriopathy observed in pulmonary arterial hypertension. Of three completed randomised controlled trials in patients with CTEPH, only one was powered to detect a treatment effect. The BENEFIT trial employed the dual endothelin-receptor antagonist bosentan. Although haemodynamics improved significantly, the second component of the primary end-point, exercise capacity, was not met. More evidence is required to resolve whether vasodilator treatments are beneficial for inoperable chronic thromboembolic pulmonary hypertension.

  17. Pulmonary thromboendarterectomy in 106 patients with chronic thromboembolic pulmonary hypertension.

    Science.gov (United States)

    López Gude, María Jesús; Pérez de la Sota, Enrique; Forteza Gil, Alberto; Centeno Rodríguez, Jorge; Eixerés, Andrea; Velázquez, María Teresa; Sánchez Nistal, María Antonia; Pérez Vela, José Luis; Ruiz Cano, María José; Gómez Sanchez, Miguel Ángel; Escribano Subías, Pilar; Cortina Romero, José María

    2015-10-01

    Pulmonary thromboendarterectomy is the treatment of choice in chronic thromboembolic pulmonary hypertension. We report our experience with this technique. Between February 1996 and June 2014, we performed 106 pulmonary thromboendarterectomies. Patient population, morbidity and mortality and the long-term results of this technique (survival, functional improvement and resolution of pulmonary hypertension) are described. Subjects' mean age was 53±14 years. A total of 89% were WHO functional class III-IV, presurgery mean pulmonary pressure was 49±13mmHg and mean pulmonary vascular resistance was 831±364 dynes.s.cm(-5). In-hospital mortality was 6.6%. The most important post-operative morbidity was reperfusion pulmonary injury, in 20% of patients; this was an independent risk factor (p=0.015) for hospital mortality. With a 31-month median follow-up (interquartile range: 50), 3- and 5-year survival was 90 and 84%. At 1 year, 91% were WHO functional class I-II; mean pulmonary pressure (27±11mmHg) and pulmonary vascular resistance (275±218 dynes.s.cm(-5)) were significantly lower (p<0.05) than before the intervention. Although residual pulmonary hypertension was detected in 14 patients, their survival at 3 and 5 years was 91 and 73%, respectively. Pulmonary thromboendarterectomy offers excellent results in chronic thromboembolic pulmonary hypertension. Long-term survival is good, functional capacity improves, and pulmonary hypertension is resolved in most patients. Copyright © 2014 SEPAR. Published by Elsevier Espana. All rights reserved.

  18. Acute stroke differential diagnosis: Stroke mimics.

    Science.gov (United States)

    Vilela, Pedro

    2017-11-01

    Stroke mimics (SM) are non-vascular conditions that present with an acute neurological deficit simulating acute ischemic stroke and represent a significant percentage of all acute stroke hospital admissions. The most common clinical SM includes conversion/functional (psychiatric disorder); seizures and postictal paralysis; toxic-metabolic disturbances; brain tumours; infections, and migraine. Imaging is essential for SM recognition, being Diffusion weighted imaging (DWI), perfusion imaging and angiographic studies very useful. There are several disorders that may have imaging features that simulate acute ischemic stroke, mainly presenting with cytotoxic oedema and/or perfusion deficits. The imaging features of the most frequent clinical and imaging stroke mimics are reviewed. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. Intravenous xenotransplantation of human placental mesenchymal stem cells to rats: comparative analysis of homing in rat brain in two models of experimental ischemic stroke.

    Science.gov (United States)

    Kholodenko, I V; Yarygin, K N; Gubsky, L V; Konieva, A A; Tairova, R T; Povarova, O V; Kholodenko, R V; Burunova, V V; Yarygin, V N; Skvortsova, V I

    2012-11-01

    Mesenchymal stem cells from human placenta obtained after term natural delivery were cultured and labeled with vital dye Dil of magnetic fluorescing microparticles. The labeled cells were transplanted intravenously to rats with occlusion of the median cerebral artery. Penetration of cells through the brain-blood barrier and their distribution in the brain of experimental animals were studied on serial cryostat sections. Two models of cerebral artery occlusion associated with different traumatic consequences were used. The efficiency of crossing the blood-brain barrier by transplanted cells, the number of mesenchymal cells attaining the ischemic focus and neurogenic zones, and the time of death of transplanted cells largely depended on the degree and nature of injury to the central nervous system, which should be taken into account when planning the experiments for evaluation of the effects of cell therapy on the models of neurological diseases and in clinical studies in the field of regenerative neurology.

  20. [Neuroprotective and antiamnesic effects of GK-2h dipeptide HNGF mimetic on a model of experimental ischemic stroke of brain cortex prefrontal areas].

    Science.gov (United States)

    Gudasheva, T A; Romanova, G A; Shakova, F M; Kotel'nikova, S O; Barskov, I V; Stel'mashuk, E V; Seredenin, S B

    2012-01-01

    Neuroprotective and antiamnesic effects of human nerve growth factor (HNGF) synthetic dipeptide mimetic bis-(N-monosuccinyl-glycyl-lysine)hexamethylenediamide (GK-2h) has been studied on a model of bilateral photochemically induced focal ischemical brain injury in prefrontal cortex of rats. It is established that a single intraperitoneal injection of GK-2h (0.1 mg/kg) 1 h or 4 h after operation, followed by injections on the 2nd, 4th and 8th days after operation, results (on the 9th day) in reduction of the cortical infarction volume by 47 or 65%, and leads to restoration of the passive avoidance reflex (acquired before experimental ischemic insult) by 42 and 60%, respectively. It is concluded that GK-2h possesses significant neuroprotective properties.

  1. Psychoneuroimmunology of stroke.

    Science.gov (United States)

    Skinner, Robert; Georgiou, Rachel; Thornton, Peter; Rothwell, Nancy

    2009-05-01

    Stroke is the major cause of disability in the Western world and is the third greatest cause of death, but there are no widely effective treatments to prevent the devastating effects of stroke. Extensive and growing evidence implicates inflammatory and immune processes in the occurrence of stroke and particularly in the subsequent injury. Several inflammatory mediators have been identified in the pathogenesis of stroke including specific cytokines, adhesion molecules, matrix metalloproteinases, and eicosanoids. An early clinical trial suggests that inhibiting interleukin-1 may be of benefit in the treatment of acute stroke.

  2. Prospective study of γ′ fibrinogen and incident venous thromboembolism: the Longitudinal Investigation of Thromboembolism Etiology (LITE)

    Science.gov (United States)

    Folsom, Aaron R.; Tang, Weihong; George, Kristen M.; Heckbert, Susan R.; MacLehose, Richard F.; Cushman, Mary; Pankow, James S.

    2016-01-01

    Introduction Epidemiological studies generally have not found plasma total fibrinogen to be a risk factor for venous thromboembolism (VTE), but several have reported associations between variants in the fibrinogen gamma gene (FGG) and VTE. A case-control study in whites suggested plasma γ′ fibrinogen concentration may be associated inversely with VTE, but this was not replicated in African Americans. Objective To examine the prospective association between γ′ fibrinogen concentrations and occurrence of VTE. Methods We used the Longitudinal Investigation of Thromboembolism Etiology (LITE), involving two pooled population-based cohorts in the United States including 16,234 participants. The cohorts comprised white and African American men and women, aged 50 years and older at study onset in the early 1990s. We identified VTEs during follow-up and documented they met standardized diagnostic criteria. Results During two decades of follow-up, neither γ′ fibrinogen nor total fibrinogen nor their ratio was associated with VTE overall (n = 521 VTEs), in subgroups defined by race, or in other subgroups. In both race groups, the minor allele of FGG rs2066865 was associated with lower γ′ fibrinogen concentrations, but this allele was not associated with VTE. Conclusions A lower plasma concentration of γ′ fibrinogen in healthy adults does not appear to increase VTE risk. PMID:26916295

  3. Clinical Epidemiology Of Stroke

    Directory of Open Access Journals (Sweden)

    Nagaraja D

    2005-01-01

    Full Text Available Stroke is a huge public health problem because of its high morbidity and disability. The epidemiology of stroke is of relevance to construct practical paradigms to tackle this major health issue in the community. Recent data have shown that about 72-86% of strokes are ischemic, 9-18% are due to hemorrhage (intracerebral of subarachnoid and the rest are undefined. The risk factors for stroke are multiple and combined. At present, stroke is no more considered as unavoidable and untreatable. It is an emergency and specialized units and teams improve outcome and lower costs. Death related to stroke is declining in many countries and in both sexes. This decrease in multifactorial. The detection and more effective treatment of hypertension may play an important factor, as well as the improved medical care and improvement in diagnostic procedures. While stroke incidence appears stable and stroke mortality is slowly declining, the absolute magnitude of stroke is likely to grow over the next 30 years. as the population ages, the absolute number of stroke victims and demands on healthcare and other support systems is likely to increase substantially in the future. Keeping this in perspective, this chapter shall focus on the epidemiology of stroke in the world and in Indian, in particular.

  4. Registration of acute stroke

    DEFF Research Database (Denmark)

    Wildenschild, Cathrine; Mehnert, Frank; Thomsen, Reimar Wernich

    2014-01-01

    BACKGROUND: The validity of the registration of patients in stroke-specific registries has seldom been investigated, nor compared with administrative hospital discharge registries. The objective of this study was to examine the validity of the registration of patients in a stroke-specific registry...... (The Danish Stroke Registry [DSR]) and a hospital discharge registry (The Danish National Patient Registry [DNRP]). METHODS: Assuming that all patients with stroke were registered in either the DSR, DNRP or both, we first identified a sample of 75 patients registered with stroke in 2009; 25 patients...... in the DSR, 25 patients in the DNRP, and 25 patients registered in both data sources. Using the medical record as a gold standard, we then estimated the sensitivity and positive predictive value of a stroke diagnosis in the DSR and the DNRP. Secondly, we reviewed 160 medical records for all potential stroke...

  5. Review of the Association between Splenectomy and Chronic Thromboembolic Pulmonary Hypertension.

    Science.gov (United States)

    Kimmig, Lucas M; Palevsky, Harold I

    2016-06-01

    Recent evidence suggests that there may be a link between splenectomy and the later development of pulmonary hypertension, in particular World Health Organization group IV pulmonary hypertension (chronic thromboembolic pulmonary hypertension). Epidemiological studies have demonstrated an odds ratio as high as 18 for the development of chronic thromboembolic pulmonary hypertension after splenectomy in comparison with matched control subjects who have not undergone splenectomy. The mechanisms governing the association between removal of the spleen and the subsequent development of chronic thromboembolic pulmonary hypertension remain incompletely understood; however, recent advances in understanding of coagulation homeostasis have shed some light on this association. Splenectomy increases the risk of venous thromboembolic disease, a necessary precursor of chronic thromboembolic pulmonary hypertension, by generating a prothrombotic state. This prothrombotic state likely results from a reduction in the removal of circulating procoagulant factors from the bloodstream after splenectomy. Although much is to be learned, circulating microparticles have emerged as the most likely mediator for the development of thrombosis after splenectomy. Apparently because of a reduction in reticuloendothelial cell clearance, microparticle levels are elevated in patients after splenectomy. Elevated circulating microparticle levels have been linked to thromboembolism and pulmonary hypertension in a dose-dependent fashion. It is important for health care providers to be aware of the link between splenectomy and chronic thromboembolic pulmonary hypertension. We are optimistic that clarification of the exact mechanisms that govern this association will yield clinical guidelines and potential treatments.

  6. Feasibility and safety of rehabilitation after venous thromboembolism

    Directory of Open Access Journals (Sweden)

    Noack F

    2015-07-01

    Full Text Available Frank Noack,1,2 Bernd Schmidt,1 Mroawan Amoury,2 Dietrich Stoevesandt,3 Stephan Gielen,4 Birgit Pflaumbaum,5 Christiane Girschick,5 Heinz Völler,6 Axel Schlitt5,7 1Department of Medicine I, 2Department of Emergency Medicine, 3Department of Diagnostic Radiology, 4Department of Medicine III, University Clinic Halle (Saale, Halle, Germany; 5Department of Cardiology and Pulmology, Paracelsus-Harz-Clinic Bad Suderode, Quedlinburg, Germany; 6Klinik am See, Rüdersdorf, Germany; 7Medical Faculty, Martin Luther University Halle, Wittenberg, Germany Background: Venous thromboembolism is a life-threatening disease. In survivors, different degrees of functional complaints need to be restored or prevented (eg, post-thrombotic syndrome, pulmonary hypertension. Therefore, rehabilitation after venous thromboembolism is recommended in Germany. However, a structured rehabilitation program has not been defined for this indication. Here, we present the experience of a single rehabilitation center. Methods: Data from consecutive pulmonary embolism (PE patients who were referred for a 3-week inpatient rehabilitation program from 2006 to 2014 were retrospectively evaluated. Results: In all, 422 patients were identified. The mean age was 63.9±13.5 years, the mean body mass index (BMI was 30.6±6.2 kg/m2, and 51.9% were female. Deep vein thrombosis according to PE was known for 55.5% of all patients. We applied a wide range of therapeutic interventions such as bicycle training with monitored heart rate in 86.7%, respiratory training in 82.5%, aquatic therapy/swimming in 40.1%, and medical training therapy in 14.9% of all patients. Adverse events (AEs occurred in 57 patients during the 3-week rehabilitation period. The most common AEs were cold (n=6, diarrhea (n=5, and infection of the upper or lower respiratory tract that was treated with antibiotics (n=5. However, three patients under anticoagulation therapy suffered from bleeding, which was clinically relevant in

  7. Real-World Use of Apixaban for Stroke Prevention in Atrial Fibrillation: A Systematic Review and Meta-Analysis.

    Science.gov (United States)

    Proietti, Marco; Romanazzi, Imma; Romiti, Giulio Francesco; Farcomeni, Alessio; Lip, Gregory Y H

    2018-01-01

    The use of oral anticoagulant therapy for stroke prevention in atrial fibrillation has been transformed by the availability of the nonvitamin K antagonist oral anticoagulants. Real-world studies on the use of nonvitamin K antagonist oral anticoagulants would help elucidate their effectiveness and safety in daily clinical practice. Apixaban was the third nonvitamin K antagonist oral anticoagulants introduced to clinical practice, and increasing real-world studies have been published. Our aim was to summarize current evidence about real-world studies on apixaban for stroke prevention in atrial fibrillation. We performed a systematic review and meta-analysis of all observational real-world studies comparing apixaban with other available oral anticoagulant drugs. From the original 9680 results retrieved, 16 studies have been included in the final meta-analysis. Compared with warfarin, apixaban regular dose was more effective in reducing any thromboembolic event (odds ratio: 0.77; 95% confidence interval: 0.64-0.93), but no significant difference was found for stroke risk. Apixaban was as effective as dabigatran and rivaroxaban in reducing thromboembolic events and stroke. The risk of major bleeding was significantly lower for apixaban compared with warfarin, dabigatran, and rivaroxaban (relative risk reduction, 38%, 35%, and 46%, respectively). Similarly, the risk for intracranial hemorrhage was significantly lower for apixaban than warfarin and rivaroxaban (46% and 54%, respectively) but not dabigatran. The risk of gastrointestinal bleeding was lower with apixaban when compared with all oral anticoagulant agents (Preal-life is associated with an overall similar effectiveness in reducing stroke and any thromboembolic events when compared with warfarin. A better safety profile was found with apixaban compared with warfarin, dabigatran, and rivaroxaban. © 2017 American Heart Association, Inc.

  8. Comparison of idraparinux with vitamin K antagonists for prevention of thromboembolism in patients with atrial fibrillation: a randomised, open-label, non-inferiority trial

    DEFF Research Database (Denmark)

    Bousser, M.G.; Bouthier, J.; Buller, H.R.

    2008-01-01

    BACKGROUND: Vitamin K antagonists, the current standard treatment for prophylaxis against stroke and systemic embolism in patients with atrial fibrillation, require regular monitoring and dose adjustment; an unmonitored, fixed-dose anticoagulant regimen would be preferable. The aim...... of this randomised, open-label non-inferiority trial was to compare the efficacy and safety of idraparinux with vitamin K antagonists. METHODS: Patients with atrial fibrillation at risk for thromboembolism were randomly assigned to receive either subcutaneous idraparinux (2.5 mg weekly) or adjusted-dose vitamin K...... to treat; the non-inferiority hazard ratio was set at 1.5. This trial is registered with ClinicalTrials.gov, number NCT00070655. FINDINGS: The trial was stopped after randomisation of 4576 patients (2283 to receive idraparinux, 2293 to receive vitamin K antagonists) and a mean follow-up period of 10.7 (SD...

  9. Prevalence of venous thromboembolism in patients with secondary polycythemia.

    Science.gov (United States)

    Nadeem, Omar; Gui, Jiang; Ornstein, Deborah L

    2013-01-01

    To investigate an association between secondary polycythemia and venous thromboembolism (VTE) risk, we performed a case-control study to compare the prevalence of VTE in participants with secondary polycythemia due to chronic obstructive pulmonary disease (COPD; N = 86) to that in age- and sex-matched controls with COPD without secondary polycythemia (N = 86). Although there was a significant difference in mean hematocrit between cases and controls (53.5% vs 43.6%, respectively; P polycythemia alone may not be a significant risk factor for VTE but that VTE risk in this population may be related to known risk factors such as obesity. The role of phlebotomy for VTE risk reduction secondary polycythemia is therefore questionable.

  10. Oral contraception and menstrual bleeding during treatment of venous thromboembolism

    DEFF Research Database (Denmark)

    Klok, F A; Schreiber, K; Stach, K

    2017-01-01

    INTRODUCTION: The optimal management of oral contraception and menstrual bleeding during treatment of venous thromboembolism (VTE) is largely unknown. We aimed to elicit expert opinion and compare that to current practice as assessed by a world-wide international web-based survey among physicians....... METHODS: 10 international thrombosis experts and 10 abnormal uterine bleeding experts independently completed a questionnaire containing three hypothetical patient cases each with four different scenarios, and additional queries covering different severities of VTE, patient circumstances, hormonal...... contraceptives and both thrombotic and bleeding complications. The consensus percentage was set a priori at ≥70%. The same questionnaire with randomized case scenarios was presented to international physicians via newsletters of the ISTH and national scientific communities. Differences between the expert groups...

  11. Successful selective arterial thrombolysis in patient with acute abdominal thromboembolism

    Directory of Open Access Journals (Sweden)

    Christo Tsekov

    2016-06-01

    Full Text Available The paper reports successful thrombolysis conducted in 64 years old woman admitted to the clinic with clinical and angiographic data for acute surgical abdomen caused by acute tromboembolia of arteria mesenterica superior (AMS. The therapeutic approach required to undertake lifesaving decision on i.e. surgical vs. invasive treatment in conditions of emergency. Finally, it was decided to undertake invasive treatment with successful restoration of blood flow in the related artery. The patient was discharged from the clinic with considerable clinical improvement on the fifth day of her stay. The case report includes discussion on issues relating the consequence of the diagnostic and interventional procedures in such patients, opportunities for conducting emergency thrombolysis in acute embolia of AMS and preventive measures in patients with high tromboembolic risk. Keywords: Mesenterial circulation, Abdominal thromboembolism, Arterial thrombolysis

  12. Update on the risk stratification of acute symptomatic pulmonary thromboembolism.

    Science.gov (United States)

    Maestre Peiró, A; Gonzálvez Gasch, A; Monreal Bosch, M

    Early mortality in patients with pulmonary thromboembolism (PTE) varies from 2% in normotensive patients to 30% in patients with cardiogenic shock. The current risk stratification for symptomatic PTE includes 4 patient groups, and the recommended therapeutic strategies are based on this stratification. Patients who have haemodynamic instability are considered at high risk. Fibrinolytic treatment is recommended for these patients. In normotensive patients, risk stratification helps differentiate between those of low risk, intermediate-low risk and intermediate-high risk. There is currently insufficient evidence on the benefit of intensive monitoring and fibrinolytic treatment in patients with intermediate-high risk. For low-risk patients, standard anticoagulation is indicated. Early discharge with outpatient management may be considered, although its benefit has still not been firmly established. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  13. Venous thromboembolism associated with pregnancy and hormonal therapy.

    Science.gov (United States)

    Jacobsen, Anne Flem; Sandset, Per Morten

    2012-09-01

    Venous thromboembolism (VTE) is a major cause of maternal morbidity and mortality during or early after pregnancy and in women taking hormonal therapy for contraception or for replacement therapy. Post-thrombotic syndrome, including leg oedema and leg pain, is an unrecognized burden after pregnancy-related VTE, which will affect more than two of five women. Women with a prior VTE, a family history of VTE, certain clinical risk factors and thrombophilia are at considerably increased risk both for pregnancy-related VTE and for VTE on hormonal therapy. This review critically assesses the epidemiology and risk factors for pregnancy-related VTE and current guidelines for prophylaxis and treatment. We also provide information on the risk of VTE related to hormonal contraception and replacement therapy. Copyright © 2012 Elsevier Ltd. All rights reserved.

  14. Radiological (scintigraphic) evaluation of patients with suspected pulmonar thromboembolism

    Energy Technology Data Exchange (ETDEWEB)

    Biello, D.R.

    1987-06-19

    The optimal strategy for diagnostic evaluation of patients with suspected pulmonary thromboembolism (PE) is subject of controversial and often conflicting opinions. If untreated, as many as 30% of patients with PE may die. Conversely, anticoagulant therapy significantly decreases mortality from PE, but bleeding complications occur. Underdiagnosis may result in a preventable death, and overdiagnosis may lead to significant hemorrhage from unnecessary anticoagulant therapy. This article outlines a practical guide for the use of pulmonary ventilation-perfusion (V-P) scintigraphy in patients with suspected PE. Perfusion imaging involves the intravenous injection of radiolabeled particles ranging from 10 to 60 ..mu..m in diameter (technetium Tc 99m macroaggregated albumin or technetium Tc 99m serum albumin microspheres); these particles are trapped in the capillaries and precapillary arterioles of the lung. The radiolabeled particles are distributed to the lungs in proportion to regional pulmonary blood flow. The correspondence of perfusion defects to bronchopulmonary segments is best appreciated in the posterior oblique views.

  15. Are Underlying Assumptions of Current Animal Models of Human Stroke Correct: from STAIRs to High Hurdles?

    Science.gov (United States)

    Turner, Renée J; Jickling, Glen C; Sharp, Frank R

    2011-06-01

    Animal models of acute ischemic stroke have been criticized for failing to translate to human stroke. Nevertheless, animal models are necessary to improve our understanding of stroke pathophysiology and to guide the development of new stroke therapies. The rabbit embolic clot model is one animal model that has led to an effective therapy in human acute ischemic stroke, namely tissue plasminogen activator (tPA). We propose that potential compounds that demonstrate efficacy in non-rabbit animal models of acute ischemic stroke should also be tested in the rabbit embolic blood clot model and, where appropriate, compared to tPA prior to investigation in humans. Furthermore, the use of anesthesia needs to be considered as a major confounder in animal models of acute ischemic stroke, and death should be included as an outcome measure in animal stroke studies. These steps, along with the current STAIRs recommendations, may improve the successful translation of experimental therapies to clinical stroke treatments.

  16. Stroke And Substance Abuse

    Directory of Open Access Journals (Sweden)

    A Chitsaz

    2017-02-01

    Full Text Available Introduction: stroke in recreational substance users can be an indirect complication, like endocarditis and cardio embolism in parenteral drug users. With some drug like cocaine, stroke appear to be the result of a direct effect. In young subjects without other risk factors provide persuasive evidence for causality . OPIATES: Heroine is the most abused opiate drug, which is administered by injection, by snorting or by smoking. Stroke affects heroin users by diverse mechanisms,. Injectors are at risk of infections endocarditis, which carries risk for both ischemic and hemorrhagic stroke. Cerebral or subarachnoid hemorrhage usually occurs after rupture of a septic (mycotic aneurysm. Heroine users can are also at risk for hemorrhagic stroke secondary to liver failure with deranged clotting and to heroin nephropathy with uremia or malignant hypertension. In some heroin users the drug it self is directly causal due to vasculitis, hypersensitivity and immunologic changes. Embolization of foreign material to brain due to mixed of heroine with quinine can cause cerebral embolism. AMPHETAMINE AND other psychostimulants: In abuser of amphetamine hemorrhagic stroke can occur, oral, intravenous, nasal, and inhalational routes of administration have been reported. Most were chronic user, but in several patients, stroke followed a first exposure. Some of amphetamine induced intracranial hemorrhages are secondary to acute hypertension, some to cerebral vacuities, and some to a combination of two. Decongestants and diet pills: Phenylpropanolamine (PPA, an amphetamine – like drug, in decongestants and diet pills, induce acute hypertension, sever headache, psychiatric symptoms, seizures and hemorrhagic stroke. Ephedrine and pseudo ephedrine are present in decongestants and bronchodilators and induce headache, tachyarrhythmia, hypertensive emergency, and hemorrhagic and occlusive stroke. Ecstasy, 3,4 Methylenedioxymethamphetamin (MDMA with amphetamine like can

  17. Peripheral to central: Organ interactions in stroke pathophysiology.

    Science.gov (United States)

    Ma, Shubei; Zhao, Haiping; Ji, Xunming; Luo, Yumin

    2015-10-01

    Stroke is associated with a high risk of disability and mortality, and with the exception of recombinant tissue-type plasminogen activator for acute stroke, most treatments have proven ineffective. Clinical translation of promising experimental therapeutics is limited by inadequate stroke models and a lack of understanding of the mechanisms underlying acute stroke and how they affect outcome. Bidirectional communication between the ischemic brain and peripheral immune system modulates stroke progression and tissue repair, while epidemiological studies have provided evidence of an association between organ dysfunction and stroke risk. This crosstalk can determine the fate of stroke patients and must be taken into consideration when investigating the pathophysiological mechanisms and therapeutic options for stroke. This review summarizes the current evidence for interactions between the brain and other organs in stroke pathophysiology in basic and clinic studies, and discusses the role of these interactions in the progression and outcome of stroke and how they can direct the development of more effective treatment strategies. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Blood Pressure Control: Stroke and Stroke Prevention

    Directory of Open Access Journals (Sweden)

    Hans-Christoph Diener

    2005-03-01

    Full Text Available Hypertension is the most important modifiable risk factor for primary and secondary stroke prevention.All antihypertensive drugs are effective in primary prevention: the risk reduction for stroke is 30—42%. However, not all classes of drugs have the same effects: there is some indication that angiotensin receptor blockers may be superior to other classes of antihypertensive drugs in stroke prevention.Seventy-five percent of patients who present to hospital with acute stroke have elevated blood pressure within the first 24—48 hours. Extremes of systolic blood pressure (SBP increase the risk of death or dependency. The aim of treatment should be to achieve and maintain the SBP in the range 140—160 mmHg. However, fast and drastic blood pressure lowering can have adverse consequences.The PROGRESS trial of secondary prevention with perindopril + indapamide versus placebo + placebo showed a decrease in numbers of stroke recurrences in patients given both active antihypertensive agents, more impressive for cerebral haemorrhage.There were also indications that active treatment might decrease the development of post-stroke dementia.

  19. Budget impact analysis of apixaban versus other NOACs for the prevention of stroke in Italian atrial fibrillation patients

    Directory of Open Access Journals (Sweden)

    Lorenzo Pradelli

    2014-12-01

    Full Text Available OBJECTIVE: This study aims to perform a budget impact analysis of the use of three available novel oral anticoagulant agents (NOACs for preventing thromboembolic events in Italian patients with non‑valvular atrial fibrillation (NVAF.METHODS: Estimated Italian population of patients was run through a previously published lifetime decision tree/Markov model simulating their treatment with the available therapeutic options: dabigatran at two dose levels (110 mg/bid for the over 80 years old, 150 mg/bid for younger NVAF patients, rivaroxaban (20 mg/uid, and apixaban (5 mg/bid. Effectiveness and safety estimates derive from an adjusted indirect treatment comparison using warfarin as link. The main clinical events considered in the model are ischemic and hemorrhagic stroke, systemic thromboembolism, bleeds (both major and clinically relevant minor and cardiovascular hospitalizations, besides treatment discontinuations. Epidemiological data and unit costs, actualized to 2013, are collected from Italian published sources. The budget impact analysis evaluates the financial impact of apixaban introduction by comparing expected 1,2, and 3 years costs in hypothetical scenarios: with and without apixaban. Italian NVAF patient population estimation is based on official apixaban reimbursement criteria, applying the characteristics of the trial population to national epidemiologic data. Numbers of patients for each regimen are estimated by projecting share evolution. Sensitivity analysis is performed on an alternative non‑experimental population of NVAF patients.RESULTS: Among available NOACs, apixaban was expected to be the least expensive in an estimated patient population of 364,000 Italian patients, allowing for savings of € 1,180,549, € 3,841,429 and € 5,368,918 at 1,2, and 3 years, respectively. Results of the simulation run on an alternative non‑experimental population of NVAF patients yields comparable estimates.CONCLUSIONS: The different

  20. Initial strides for invent-VTE: Towards global collaboration to accelerate clinical research in venous thromboembolism

    NARCIS (Netherlands)

    Rodger, Marc; Langlois, Nicole; Middeldorp, Saskia; Kahn, Susan; Sandset, Per Morten; Brighton, Timothy; Huisman, Menno; Meyer, Guy; Konstantinides, Stavros; Ageno, Walter; Morange, Pierre; Garcia, David; Kreuziger, Lisa Baumann; Young, Laura; Key, Nigel; Monreal, Manuel; Jiménez, David

    2018-01-01

    Venous thromboembolism (VTE) represents a major global burden of disease and requires collaborative efforts to conduct large, high-quality investigator-initiated and academically sponsored studies addressing the most relevant clinical questions. Owing to increasing regulatory requirements, the

  1. Endogenous sex hormones and risk of venous thromboembolism in women and men

    DEFF Research Database (Denmark)

    Holmegard, Haya N; Nordestgaard, B G; Schnohr, P

    2014-01-01

    BACKGROUND: Use of oral contraceptives with estrogen and hormone replacement therapy with estrogen or testosterone are associated with increased risk of venous thromboembolism (VTE). However, whether endogenous estradiol and testosterone concentrations are also associated with risk of VTE...

  2. Risk factors of arterial cardiovascular complications in patients with prior venous thromboembolism

    NARCIS (Netherlands)

    Roshani, S.; Lijfering, W. M.; Coppens, M.; Hamulyák, K.; Prins, M. H.; Büller, H. R.; Middeldorp, S.

    2011-01-01

    Background. The effect of cardiovascular risk factors (CVRs) and thrombophilic defects on the risk of arterial cardiovascular complications in patients with prior venous thromboembolism (VTE) is unclear. Objective. We investigated whether the risk of arterial cardiovascular complications is

  3. Risk factors of arterial cardiovascular complications in patients with prior venous thromboembolism

    NARCIS (Netherlands)

    Roshani, S.; Lijfering, W. M.; Coppens, M.; Hamulyak, K.; Prins, M. H.; Buller, H. R.; Middeldorp, S.

    Background. The effect of cardiovascular risk factors (CVRs) and thrombophilic defects on the risk of arterial cardiovascular complications in patients with prior venous thromboembolism (VTE) is unclear. Objective. We investigated whether the risk of arterial cardiovascular complications is

  4. Increased risk of venous thromboembolism and arterial cardiovascular events in patients with inflammatory bowel disease

    DEFF Research Database (Denmark)

    Kristensen, Søren Lund; Ahlehoff, Ole; Lindhardsen, Jesper

    2012-01-01

    This focused review describes the current knowledge of the association between inflammatory bowel disease (IBD) and cardiovascular disease. Atherosclerosis is a chronic inflammatory disease, and as well as venous thromboembolism this disease shares inflammatory mechanisms with IBD. Patients...

  5. Use of bisphosphonates and raloxifene and risk of deep venous thromboembolism and pulmonary embolism

    DEFF Research Database (Denmark)

    Vestergaard, P; Schwartz, K; Pinholt, E M

    2010-01-01

    Prior studies have associated raloxifene and strontium ranelate with deep venous thromboembolism and pulmonary embolism. In a cohort study, we observed an increased risk also with the bisphosphonates. However, the increase was present already before the start of bisphosphonates pointing...

  6. [Advances in Pathogenesis and Related Clinical Research of Thromboembolism in Patients with Thalassemia after Splenectomy].

    Science.gov (United States)

    Sun, Na; Cheng, Peng; Deng, Dong-Hong

    2016-06-01

    Thalassemia is the most common human hereditary hemolytic anemia. Due to splenomegaly and hypersp-lenism, splenectomy can be used as a means of treatment for thalassemia. Various complications following splenectomy, however, especially thromboembolic complications are remarkable. This review summarizes the incidence, clinical manifestations and development time of thromboembolism. The pathogenesis of thromboembolism after splenectomy in thalassemia, such as abnormal platelet number and function, changes in red cell membrane, endothelial cell damage, dysfunction of other procoagulant and anticoagulant factors, and local factors associated with splenectomy are elaborated and the trategies to prevent and treat the thromboembolic events in thalassemia after splenectomy, including the attention to risk factors associated with splenectomy, a reassessment of splenectomy, regular blood transfusion to reduce the ratio of abnormal red blood cells, treatment with anticoagulant and antiplatelet drugs, application of hydroxyurea and stem cell transplantation are discussed.

  7. International clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer

    NARCIS (Netherlands)

    Farge, D.; Debourdeau, P.; Beckers, M.; Baglin, C.; Bauersachs, R. M.; Brenner, B.; Brilhante, D.; Falanga, A.; Gerotzafias, G. T.; Haim, N.; Kakkar, A. K.; Khorana, A. A.; Lecumberri, R.; Mandala, M.; Marty, M.; Monreal, M.; Mousa, S. A.; Noble, S.; Pabinger, I.; Prandoni, P.; Prins, M. H.; Qari, M. H.; Streiff, M. B.; Syrigos, K.; Bounameaux, H.; Buller, H. R.

    . Background: Guidelines addressing the management of venous thromboembolism (VTE) in cancer patients are heterogeneous and their implementation has been suboptimal worldwide. Objectives: To establish a common international consensus addressing practical, clinically relevant questions in this

  8. International clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer

    NARCIS (Netherlands)

    Farge, D.; Debourdeau, P.; Beckers, M.; Baglin, C.; Bauersachs, R. M.; Brenner, B.; Brilhante, D.; Falanga, A.; Gerotzafias, G. T.; Haim, N.; Kakkar, A. K.; Khorana, A. A.; Lecumberri, R.; Mandala, M.; Marty, M.; Monreal, M.; Mousa, S. A.; Noble, S.; Pabinger, I.; Prandoni, P.; Prins, M. H.; Qari, M. H.; Streiff, M. B.; Syrigos, K.; Bounameaux, H.; Büller, H. R.

    2013-01-01

    Guidelines addressing the management of venous thromboembolism (VTE) in cancer patients are heterogeneous and their implementation has been suboptimal worldwide. To establish a common international consensus addressing practical, clinically relevant questions in this setting. An international

  9. Systemic thromboembolism in endomyocardial fibrosis (EMF): clinical observations, aetio-pathogenesis and treatment.

    Science.gov (United States)

    Andy, J J; Ekott, J U; Ansa, V O

    2010-09-01

    Mural thrombi and thromboemboli are very common in idiopathic hypereosinophilic syndrome (HES), whose cardiac pathology is indistinguishable from endomyocardial fibrosis (EMF). Although mural thrombi are common in EMF cases, and post mortem embolic infarcts are frequently seen; clinical recognition of thromboembolism in EMF is unusual. We report here 4 cases of clinically recognized thromboembolism among 106 consecutive cases of EMF (including a case with a sudden onset of vascular occlusion and a below knee infarction and auto-amputation of the right leg). Two of the 4 cases had hypereosinophilia that was probably induced by microfilaria. The mechanisms of mural thrombosis and thromboembolic infarcts in EMF cases are discussed, and the possibility shown that helminth induced eosinophilic myocarditis can induce similar acute mural thrombosis and thromboembolism. The place of anticoagulant therapy in EMF is discussed.

  10. C-reactive protein and risk of venous thromboembolism in the general population

    DEFF Research Database (Denmark)

    Zacho, Jeppe; Tybjærg-Hansen, Anne; Nordestgaard, Børge G

    2010-01-01

    To examine the robustness of the association between C-reactive protein (CRP) levels and increased risk of venous thromboembolism (VTE) and to examine whether genetically elevated CRP levels cause VTE....

  11. Symptomatic venous thromboembolism in orthognathic surgery and distraction osteogenesis: a retrospective cohort study of 4127 patients

    NARCIS (Netherlands)

    Verlinden, C.R.A.; Tuinzing, D.B.; Forouzanfar, T.

    2014-01-01

    Venous thromboembolism is a common postoperative complication, and orthopaedic procedures are particularly at risk. We designed a retrospective, single centre, observational, cohort study of 4127 patients (mean (SD) age 27 (11) years) who had elective orthognathic operations or distraction

  12. Correlation between Sleep Duration and Risk of Stroke.

    Science.gov (United States)

    Patyar, Sazal; Patyar, Rakesh Raman

    2015-05-01

    Modern lifestyle and job requirements have changed the sleep habits of most of the adult population. Various population-based studies have associated an increase in mortality with either shortened sleep or long sleep duration. Thus a U-shaped relationship between sleep duration and all-cause mortality in both men and women has been suggested. Several studies have found an association between sleep duration and risk of cardiovascular diseases also. Efforts to understand the etiology of stroke have indicated an association between sleep and stroke too. Obstructive sleep apnea, a sleep-related disorder, has been reported to significantly increase the risk of stroke. Moreover, many studies have shown that both short and long sleep durations are related to increased likelihood of diabetes and hypertension, which themselves are risk factors for stroke. Therefore, this review focuses on the correlation between sleep duration and risk of stroke based on the experimental and epidemiologic studies. Although a few experimental studies have reported that partial sleep deprivation may reduce stroke incidence and severity, yet, most experimental and observational studies have indicated a strong association between short/long sleep durations and higher risk of stroke. Copyright © 2015 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  13. Mortality after hemorrhagic stroke

    DEFF Research Database (Denmark)

    González-Pérez, Antonio; Gaist, David; Wallander, Mari-Ann

    2013-01-01

    , 54.6% for 80-89 years; SAH: 20.3% for 20-49 years, 56.7% for 80-89 years; both p-trend stroke patients...... = 0.03). CONCLUSIONS: More than one-third of individuals die in the first month after hemorrhagic stroke, and patients younger than 50 years are more likely to die after ICH than SAH. Short-term case fatality has decreased over time. Patients who survive hemorrhagic stroke have a continuing elevated...

  14. MEMORY SONGS DECREASE DEPRESSION FOR STROKE PATIENTS

    Directory of Open Access Journals (Sweden)

    Harmayetty Harmayetty

    2017-07-01

    Full Text Available Introduction: Biological, physical and phsycosocial changes in stroke patient could be a stressor that induced a depression state. There would be an emotional disturbance in stroke patient and stroke attack would be recurrent, if it was not treated. One of the alternative techniques to reduce depression is musical therapy especially memory songs. Method: This study was used a quasy experimental pre-post test purposive sampling design. The population was stroke patients who treated in Neurological Ward A and Stroke Unit Dr Soetomo Hospital Surabaya. There were 12 respondents divided into 6 respondents for treatment group and 6 respondents for control group. The independent variable was music (memory song and dependent variable was depression. Data were collected by using questionnaire which adapted from Hamilton Depression Rating Scale and Geriatric Depression Rating Scale, then analyzed by using Wilcoxon Signed Rank Test and Mann Whitney U Test with significance level α≤0.05. Result: The result showed that there was a difference between pre test and post test in depression (p=0.0196 and there was a difference in the depression between treatment group and control group (p=0.002. Discussion: It can be concluded that music (memory songs has an effect to the depression of stroke patient. Further studies are needed to concerning other factors that may affect the relaxation technique especially in listening music.

  15. Oral contraception and risk of a cerebral thromboembolic attack: results of a case-control study.

    Science.gov (United States)

    Lidegaard, O

    1993-01-01

    OBJECTIVE--To assess the risk of cerebral thromboembolism in women using low dose oral contraceptives. DESIGN--A retrospective case-control study. SETTING--All Danish medical, neurological, neurosurgical, and gynaecological departments. SUBJECTS--All 794 women in Denmark aged 15-44 who had suffered a cerebral thromboembolic attack during 1985-9 and 1588 age matched randomly selected controls. RESULTS--Of 692/1584 case/control questionnaires sent out, 590/1396 (85.3%/88.1%) were returned. Among the cases, 15 refused to participate, 69 had a revised or unreliable diagnosis, 40 had had thromboembolic disease previously, 13 were pregnant, and 152 had a disease predisposing to a cerebral thromboembolic attack. Of the 323 cases without a known predisposition, 320 reported use or non-use of oral contraception. Among the 1396 controls, eight refused to participate, were mentally retarded, or lived abroad; 18 returned an uncompleted questionnaire; 17 had had thromboembolic disease previously; 31 were pregnant; and 130 had a disease predisposing to a cerebral thromboembolic attack. Thus 1198 non-predisposed controls were available, among whom 1197 reported use or non-use of oral contraception. Among the 320 cases, 116 (36.3%) were oral contraceptive users at the time of the cerebral thromboembolic attack. By comparison there were 191 users (16.0%) among the 1197 controls, giving a crude odds ratio of 3.0. After multivariate analysis, including confounder control for age, smoking, years of schooling, and trend in use of different types of oral contraceptives during 1985-90, pills containing 50 micrograms oestrogen were associated with an odds ratio for cerebral thromboembolic attack of 2.9 (95% confidence interval 1.6 to 5.4), those containing 30-40 micrograms oestrogen an odds ratio of 1.8 (1.1 to 2.9), those containing progestogen only an odds ratio of 0.9 (0.4 to 2.4). The odds ratio did not change with increasing age or with duration of oral contraceptive use. A 50

  16. Oral contraception and risk of a cerebral thromboembolic attack: results of a case-control study.

    Science.gov (United States)

    Lidegaard, O

    1993-04-10

    To assess the risk of cerebral thromboembolism in women using low dose oral contraceptives. A retrospective case-control study. All Danish medical, neurological, neurosurgical, and gynaecological departments. All 794 women in Denmark aged 15-44 who had suffered a cerebral thromboembolic attack during 1985-9 and 1588 age matched randomly selected controls. Of 692/1584 case/control questionnaires sent out, 590/1396 (85.3%/88.1%) were returned. Among the cases, 15 refused to participate, 69 had a revised or unreliable diagnosis, 40 had had thromboembolic disease previously, 13 were pregnant, and 152 had a disease predisposing to a cerebral thromboembolic attack. Of the 323 cases without a known predisposition, 320 reported use or non-use of oral contraception. Among the 1396 controls, eight refused to participate, were mentally retarded, or lived abroad; 18 returned an uncompleted questionnaire; 17 had had thromboembolic disease previously; 31 were pregnant; and 130 had a disease predisposing to a cerebral thromboembolic attack. Thus 1198 non-predisposed controls were available, among whom 1197 reported use or non-use of oral contraception. Among the 320 cases, 116 (36.3%) were oral contraceptive users at the time of the cerebral thromboembolic attack. By comparison there were 191 users (16.0%) among the 1197 controls, giving a crude odds ratio of 3.0. After multivariate analysis, including confounder control for age, smoking, years of schooling, and trend in use of different types of oral contraceptives during 1985-90, pills containing 50 micrograms oestrogen were associated with an odds ratio for cerebral thromboembolic attack of 2.9 (95% confidence interval 1.6 to 5.4), those containing 30-40 micrograms oestrogen an odds ratio of 1.8 (1.1 to 2.9), those containing progestogen only an odds ratio of 0.9 (0.4 to 2.4). The odds ratio did not change with increasing age or with duration of oral contraceptive use. A 50% increased risk of a cerebral thromboembolic attacks

  17. Prevalence of Atrial Fibrillation and Antithrombotic Therapy in Hemodialysis Patients: Cross-Sectional Results of the Vienna InVestigation of AtriaL Fibrillation and Thromboembolism in Patients on HemoDIalysis (VIVALDI).

    Science.gov (United States)

    Königsbrügge, Oliver; Posch, Florian; Antlanger, Marlies; Kovarik, Josef; Klauser-Braun, Renate; Kletzmayr, Josef; Schmaldienst, Sabine; Auinger, Martin; Zuntner, Günther; Lorenz, Matthias; Grilz, Ella; Stampfel, Gerald; Steiner, Stefan; Pabinger, Ingrid; Säemann, Marcus; Ay, Cihan

    2017-01-01

    Atrial fibrillation (AF) adds significant risk of stroke and thromboembolism in patients on hemodialysis (HD). The aim of this study was to investigate the prevalence of AF in a population-based cohort of HD patients and practice patterns of antithrombotic therapy for stroke prevention in AF. The Vienna InVestigation of AtriaL fibrillation and thromboembolism in patients on hemodialysis (VIVALDI), an ongoing prospective observational cohort study, investigates the prevalence of AF and the risk of thromboembolic events in HD patients in Vienna, Austria. We analyzed cross-sectional data of 626 patients (63.4% men, median age 66 years, approx. 73% of HD patients in Vienna), who provided informed consent. A structured interview with each patient was performed, recent and archived ECGs were viewed and medical histories were verified with electronic records. The overall prevalence of AF was 26.5% (166 patients, 71.1% men, median age 72 years) of which 57.8% had paroxysmal AF, 3.0% persistent AF, 32.5% permanent AF, and 6.6% of patients had newly diagnosed AF. The median CHA2DS2-VASc Score was 4 [25th-75th percentile 3-5]. In multivariable analysis, AF was independently associated with age (odds ratio: 1.05 per year increase, 95% confidence interval: 1.03-1.07), male sex (1.7, 1.1-2.6), history of venous thromboembolism (2.0, 1.1-3.6), congestive heart failure (1.7, 1.1-2.5), history of or active cancer (1.5, 1.0-2.4) and time on HD (1.08 per year on HD, 1.03-1.13). Antithrombotic treatment was applied in 84.4% of AF patients (anticoagulant agents in 29.5%, antiplatelet agents in 33.7%, and both in 21.1%). In AF patients, vitamin-K-antagonists were used more often than low-molecular-weight heparins (30.1% and 19.9%). The prevalence of AF is high amongst HD patients and is associated with age, sex, and distinct comorbidities. Practice patterns of antithrombotic treatment indicate a lack of consensus for stroke prevention in HD patients with AF.

  18. Post-stroke dyskinesias

    National Research Council Canada - National Science Library

    Nakawah, Mohammad Obadah; Lai, Eugene C

    2016-01-01

    .... Post-stroke dyskinesias are involuntary hyperkinetic movements arising from cerebrovascular insults and often present with mixed phenotypes of hyperkinesia which can sometimes be difficult to classify...

  19. Let's Talk about Hemorrhagic Stroke

    Science.gov (United States)

    ... of the brain ruptures and bleeds into the space between the brain and the skull. Are often ... StrokeAssociation.org . Sign up to get Stroke Connection magazine, a free magazine for stroke survivors and caregivers ...

  20. Acute stroke imaging research roadmap

    NARCIS (Netherlands)

    Wintermark, Max; Albers, Gregory W.; Alexandrov, Andrei V.; Alger, Jeffry R.; Bammer, Roland; Baron, Jean-Claude; Davis, Stephen; Demaerschalk, Bart M.; Derdeyn, Colin P.; Donnan, Geoffrey A.; Eastwood, James D.; Fiebach, Jochen B.; Fisher, Marc; Furie, Karen L.; Goldmakher, Gregory V.; Hacke, Werner; Kidwell, Chelsea S.; Kloska, Stephan P.; Koehrmann, Martin; Koroshetz, Walter; Lee, Ting-Yim; Lees, Kennedy R.; Lev, Michael H.; Liebeskind, David S.; Ostergaard, Leif; Powers, William J.; Provenzale, James; Schellinger, Peter; Silbergleit, Robert; Sorensen, Alma Gregory; Wardlaw, Joanna; Warach, Steven

    The recent "Advanced Neuroimaging for Acute Stroke Treatment" meeting on September 7 and 8, 2007 in Washington DC, brought together stroke neurologists, neuroradiologists, emergency physicians, neuroimaging research scientists, members of the National Institute of Neurological Disorders and Stroke

  1. Evaluation of the Solitaire system in a canine arterial thromboembolic occlusion model: is it safe for the endothelium?

    Science.gov (United States)

    Park, Soonchan; Hwang, Seon Moon; Song, Joon Seon; Suh, Dae Chul; Lee, Deok Hee

    2013-12-01

    The Solitaire system has recently been increasingly used for acute stroke treatment in which the endothelial safety immediately after its use has not been evaluated. This study was performed to evaluate the endothelial status when using a Solitaire system in a canine arterial occlusion model. Thromboembolic occlusion of both internal maxillary arteries was achieved in five mongrel dogs. In each animal, the Solitaire system (ev3, Irvine, CA, USA) was used for primary thrombectomy on the right side and for temporary stenting on the left side. Efficacy was assessed by comparing the recanalization rates, and safety was assessed using angiographic and microscopic assessments. Endothelial injuries were evaluated with light microscopy (LM) and scanning electron microscopy (SEM). Successful revascularizations were observed following primary thrombectomy in all five animals (100%) and after temporary stenting in two (40%). There was no incidence of vasospasm or vessel perforation in either group. Distal migration of the clot occurred in two animals that underwent primary thrombectomy. Endothelial injury was seen after primary thrombectomy in two animals (40%) and after temporary stenting in one (20%). The lesions presented as defects of the internal elastic lamina on LM and denudation of the wavy endothelial surface on SEM. During mechanical thrombectomy, the Solitaire system can cause endothelial injury both in primary thrombectomy and temporary stenting. Primary thrombectomy is likely to have a higher recanalization rate with increased endothelial injury.

  2. Neutrophil extracellular traps form predominantly during the organizing stage of human venous thromboembolism development.

    Science.gov (United States)

    Savchenko, A S; Martinod, K; Seidman, M A; Wong, S L; Borissoff, J I; Piazza, G; Libby, P; Goldhaber, S Z; Mitchell, R N; Wagner, D D

    2014-06-01

    A growing health problem, venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), requires refined diagnostic and therapeutic approaches. Neutrophils contribute to thrombus initiation and development in experimental DVT. Recent animal studies recognized neutrophil extracellular traps (NETs) as an important scaffold supporting thrombus stability. However, the hypothesis that human venous thrombi involve NETs has not undergone rigorous testing. To explore the cellular composition and the presence of NETs within human venous thrombi at different stages of development. We examined 16 thrombi obtained from 11 patients during surgery or at autopsy using histomorphological, immunohistochemical and immunofluorescence analyses. We classified thrombus regions as unorganized, organizing and organized according to their morphological characteristics. We then evaluated them, focusing on neutrophil and platelet deposition as well as micro-vascularization of the thrombus body. We observed evidence of NET accumulation, including the presence of citrullinated histone H3 (H3Cit)-positive cells. NETs, defined as extracellular diffuse H3Cit areas associated with myeloperoxidase and DNA, localized predominantly during the phase of organization in human venous thrombi. NETs are present in organizing thrombi in patients with VTE. They are associated with thrombus maturation in humans. Dissolution of NETs might thus facilitate thrombolysis. This finding provides new insights into the clinical development and pathology of thrombosis and provides new perspectives for therapeutic advances. © 2014 International Society on Thrombosis and Haemostasis.

  3. Body Mass Index and Stroke

    DEFF Research Database (Denmark)

    Andersen, Klaus Kaae; Olsen, Tom Skyhøj

    2013-01-01

    Although obesity is associated with excess mortality and morbidity, mortality is lower in obese than in normal weight stroke patients (the obesity paradox). Studies now indicate that obesity is not associated with increased risk of recurrent stroke in the years after first stroke. We studied...... the association between body mass index (BMI) and stroke patient's risk of having a history of previous stroke (recurrent stroke)....

  4. Postprandial lipemia is not increased in patients with previous unprovoked venous thromboembolism.

    Science.gov (United States)

    Hald, Erin M; Brækkan, Sigrid K; Vik, Anders; Brodin, Ellen E; Hansen, John-Bjarne

    2013-01-01

    Patients with arterial cardiovascular disease have increased postprandial lipemia, and plasma levels of postprandial remnants are related to the progression of atherosclerosis. Studies have shown that patients with unprovoked venous thromboembolism have increased risk of arterial cardiovascular disease. To investigate whether patients with a history of unprovoked venous thromboembolism have increased postprandial lipemia. A population-based case-control study was performed in 20 patients with a history of unprovoked venous thromboembolism and 20 age- and gender-matched healthy controls. Participants were subjected to a standard fat tolerance test (1 g/kilo body weight) with subsequent blood sampling every second hour for 8 hours. Lipids were measured by traditional methods and lipoprotein subclasses by proton nuclear magnetic resonance. Fasting lipids and lipoprotein subclasses did not differ between groups. The postprandial lipemia, assessed by the incremental area under the triglyceride curve, was not different in venous thromboembolism patients and healthy controls (5.0 ± 3.6 mmol/L∗h vs 5.3 ± 4.4 mmol/L∗h, P = .81). Similarly, the distribution and size of the lipoprotein subclasses obtained 4 hours postprandially did not differ between groups. Patients with a history of unprovoked venous thromboembolism had similar lipoprotein subclasses size, distribution, and postprandial lipemia as healthy controls. Our findings indicate that postprandial lipemia is not a link between unprovoked venous thromboembolism and arterial cardiovascular disease. Copyright © 2013 National Lipid Association. Published by Elsevier Inc. All rights reserved.

  5. Different Finite Durations of Anticoagulation and Outcomes following Idiopathic Venous Thromboembolism: A Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Aaron B. Holley

    2010-01-01

    Full Text Available Introduction. Controversy remains over the optimal length of anticoagulation following idiopathic venous thromboembolism. We sought to determine if a longer, finite course of anticoagulation offered additional benefit over a short course in the initial treatment of the first episode of idiopathic venous thromboembolism. Data Extraction. Rates of deep venous thrombosis, pulmonary embolism, combined venous thromboembolism, major bleeding, and mortality were extracted from prospective trials enrolling patients with first time, idiopathic venous thromboembolism. Data was pooled using random effects meta-regression. Results. Ten trials, with a total of 3225 patients, met inclusion criteria. For each additional month of initial anticoagulation, once therapy was stopped, recurrent venous thromboembolism (0.03 (95% CI: −0.28 to 0.35; =.24, mortality (−0.10 (95% CI: −0.24 to 0.04; =.15, and major bleeding (−0.01 (95% CI: −0.05 to 0.02; =.44 rates measured in percent per patient years, did not significantly change. Conclusions: Patients with an initial idiopathic venous thromboembolism should be treated with 3 to 6 months of secondary prophylaxis with vitamin K antagonists. At that time, a decision between continuing with indefinite therapy can be made, but there is no benefit to a longer (but finite course of therapy.

  6. Administration of eptifibatide during endovascular treatment of ruptured cerebral aneurysms reduces the rate of thromboembolic events.

    Science.gov (United States)

    Sedat, Jacques; Chau, Yves; Gaudard, Jean; Suissa, Laurent; Lachaud, Sylvain; Lonjon, Michel

    2015-02-01

    Thromboembolic complications are the most frequent complications of endovascular treatment of ruptured intracranial aneurysms. The optimal protocol to prevent thromboembolic complications during coil embolization does not yet exist. The aim of this study was to investigate the effectiveness and safety of eptifibatide for the prevention of thromboembolic complications during elective coil embolization of ruptured cerebral aneurysms. A consecutive series of 100 patients (group 1) with ruptured intracranial aneurysm were treated using endovascular coil embolization. At the beginning of the procedure, all patients received an intra-arterial bolus (0.2 mg/kg) of eptifibatide. The following data were collected: degree of aneurysmal occlusion after treatment, thromboembolic and hemorrhagic complications and other intraoperative adverse events. The results were compared with those from a control group (group 2) which were analyzed retrospectively. Group 2 consisted of 100 previous patients with ruptured aneurysm managed with coil embolization who had received heparin and/or aspirin at the beginning of the procedure. (1) Patient populations in groups 1 and 2 were considered statistically comparable, except that group 1 (eptifibatide) included more wide-necked aneurysms (p = 0.011). (2) There were less thromboembolic complications in group 1 (p = 0.011): seven intraoperative complications in group 1 versus 20 in group 2. (3) Intraoperative hemorrhagic complications were statistically comparable in both groups (p = 1). Eptifibatide was effective in lowering the intraoperative thromboembolic complication rate in ruptured aneurysms treated with coil embolization and did not increase the hemorrhagic risk.

  7. Intensive Treatment of Dysarthria Secondary to Stroke

    Science.gov (United States)

    Mahler, Leslie A.; Ramig, Lorraine O.

    2012-01-01

    This study investigated the impact of a well-defined behavioral dysarthria treatment on acoustic and perceptual measures of speech in four adults with dysarthria secondary to stroke. A single-subject A-B-A experimental design was used to measure the effects of the Lee Silverman Voice Treatment (LSVT[R]LOUD) on the speech of individual…

  8. Physiologically based model of acute ischemic stroke.

    Science.gov (United States)

    Duval, Vincent; Chabaud, Sylvie; Girard, Pascal; Cucherat, Michel; Hommel, Marc; Boissel, Jean Pierre

    2002-08-01

    In the treatment of acute ischemic stroke most of the clinical trials have failed, contrasting with promising results in the preclinical stages. This continuing discrepancy suggests some misconceptions in the understanding of acute ischemic stroke. One possible method for identifying the shortcomings of present-day approaches is to integrate all the available knowledge into a single mathematical model and to subject that model to challenges via simulations with available experimental data. As a first stage, then, the authors developed a simplified model, defining the structure and the different parameters that represent the phenomena that occur during the hyperacute phase of ischemic stroke. First, the different critical points of the evolution of ischemic stroke, based on the available evidence on the pathophysiology of stroke, were identified. Those key steps were then related to the quantitative data obtained by magnetic resonance imaging and positron emission tomography scan. These two techniques allow the measurement of diverse key markers of cerebral metabolism: cerebral blood flow (CBF), oxygen extraction factor, cerebral metabolism rate of oxygen, and the apparent diffusion coefficient of water, among others. Those markers were organized together through mathematical equations, and changed over time in order to describe the evolution of an acute ischemic stroke. At each time during the evolution of stroke those parameters are summarized in a parameter called survival delay. This parameter made possible the definition of three different states for tissues-functional, infarcted, salvageable-as end point. Once the model was designed, simulations were performed to explore its internal validity. Simulation results were consistent with the reality of acute ischemic stroke and did not reveal any major drawbacks in the use of the model. The more rapid the decrease in CBF, the larger is the final infarcted area. The model also allowed for the characterization of two

  9. Thalidomide-induced Stroke in a Child With Thalassemia Major.

    Science.gov (United States)

    Gunaseelan, Sushil; Prakash, Anand

    2017-11-01

    β-thalassemia major is a hereditary anemia resulting from defects in β-globin production. It is also characterized by a hypercoagulable state with an increased risk of thrombosis. Thalidomide, a drug known for its immunomodulating and antiangiogenic properties, has recently been demonstrated to induce γ-globin gene expression and to increase the proliferation of erythroid cells. An increasing incidence of thromboembolic events in thalidomide-treated patients has been reported. This is often in the context of thalidomide combinations with other drugs, including steroids and particularly anthracycline-based chemotherapy, and with very low incidence of thrombosis with single-agent thalidomide treatment. We report a case of stroke in a β-thalassemic child who had received a course of thalidomide.

  10. Assessed and Emerging Biomarkers in Stroke and Training-Mediated Stroke Recovery: State of the Art

    Directory of Open Access Journals (Sweden)

    Marialuisa Gandolfi

    2017-01-01

    Full Text Available Since the increasing update of the biomolecular scientific literature, biomarkers in stroke have reached an outstanding and remarkable revision in the very recent years. Besides the diagnostic and prognostic role of some inflammatory markers, many further molecules and biological factors have been added to the list, including tissue derived cytokines, growth factor-like molecules, hormones, and microRNAs. The literatures on brain derived growth factor and other neuroimmune mediators, bone-skeletal muscle biomarkers, cellular and immunity biomarkers, and the role of microRNAs in stroke recovery were reviewed. To date, biomarkers represent a possible challenge in the diagnostic and prognostic evaluation of stroke onset, pathogenesis, and recovery. Many molecules are still under investigation and may become promising and encouraging biomarkers. Experimental and clinical research should increase this list and promote new discoveries in this field, to improve stroke diagnosis and treatment.

  11. Assessed and Emerging Biomarkers in Stroke and Training-Mediated Stroke Recovery: State of the Art

    Science.gov (United States)

    Vella, Antonio

    2017-01-01

    Since the increasing update of the biomolecular scientific literature, biomarkers in stroke have reached an outstanding and remarkable revision in the very recent years. Besides the diagnostic and prognostic role of some inflammatory markers, many further molecules and biological factors have been added to the list, including tissue derived cytokines, growth factor-like molecules, hormones, and microRNAs. The literatures on brain derived growth factor and other neuroimmune mediators, bone-skeletal muscle biomarkers, cellular and immunity biomarkers, and the role of microRNAs in stroke recovery were reviewed. To date, biomarkers represent a possible challenge in the diagnostic and prognostic evaluation of stroke onset, pathogenesis, and recovery. Many molecules are still under investigation and may become promising and encouraging biomarkers. Experimental and clinical research should increase this list and promote new discoveries in this field, to improve stroke diagnosis and treatment. PMID:28373915

  12. Recombinant thrombomodulin protects mice against histone-induced lethal thromboembolism.

    Directory of Open Access Journals (Sweden)

    Mayumi Nakahara

    Full Text Available INTRODUCTION: Recent studies have shown that histones, the chief protein component of chromatin, are released into the extracellular space during sepsis, trauma, and ischemia-reperfusion injury, and act as major mediators of the death of an organism. This study was designed to elucidate the cellular and molecular basis of histone-induced lethality and to assess the protective effects of recombinant thrombomodulin (rTM. rTM has been approved for the treatment of disseminated intravascular coagulation (DIC in Japan, and is currently undergoing a phase III clinical trial in the United States. METHODS: Histone H3 levels in plasma of healthy volunteers and patients with sepsis and DIC were measured using enzyme-linked immunosorbent assay. Male C57BL/6 mice were injected intravenously with purified histones, and pathological examinations were performed. The protective effects of rTM against histone toxicity were analyzed both in vitro and in mice. RESULTS: Histone H3 was not detectable in plasma of healthy volunteers, but significant levels were observed in patients with sepsis and DIC. These levels were higher in non-survivors than in survivors. Extracellular histones triggered platelet aggregation, leading to thrombotic occlusion of pulmonary capillaries and subsequent right-sided heart failure in mice. These mice displayed symptoms of DIC, including thrombocytopenia, prolonged prothrombin time, decreased fibrinogen, fibrin deposition in capillaries, and bleeding. Platelet depletion protected mice from histone-induced death in the first 30 minutes, suggesting that vessel occlusion by platelet-rich thrombi might be responsible for death during the early phase. Furthermore, rTM bound to extracellular histones, suppressed histone-induced platelet aggregation, thrombotic occlusion of pulmonary capillaries, and dilatation of the right ventricle, and rescued mice from lethal thromboembolism. CONCLUSIONS: Extracellular histones cause massive

  13. Feasibility and safety of rehabilitation after venous thromboembolism

    Science.gov (United States)

    Noack, Frank; Schmidt, Bernd; Amoury, Mroawan; Stoevesandt, Dietrich; Gielen, Stephan; Pflaumbaum, Birgit; Girschick, Christiane; Völler, Heinz; Schlitt, Axel

    2015-01-01

    Background Venous thromboembolism is a life-threatening disease. In survivors, different degrees of functional complaints need to be restored or prevented (eg, post-thrombotic syndrome, pulmonary hypertension). Therefore, rehabilitation after venous thromboembolism is recommended in Germany. However, a structured rehabilitation program has not been defined for this indication. Here, we present the experience of a single rehabilitation center. Methods Data from consecutive pulmonary embolism (PE) patients who were referred for a 3-week inpatient rehabilitation program from 2006 to 2014 were retrospectively evaluated. Results In all, 422 patients were identified. The mean age was 63.9±13.5 years, the mean body mass index (BMI) was 30.6±6.2 kg/m2, and 51.9% were female. Deep vein thrombosis according to PE was known for 55.5% of all patients. We applied a wide range of therapeutic interventions such as bicycle training with monitored heart rate in 86.7%, respiratory training in 82.5%, aquatic therapy/swimming in 40.1%, and medical training therapy in 14.9% of all patients. Adverse events (AEs) occurred in 57 patients during the 3-week rehabilitation period. The most common AEs were cold (n=6), diarrhea (n=5), and infection of the upper or lower respiratory tract that was treated with antibiotics (n=5). However, three patients under anticoagulation therapy suffered from bleeding, which was clinically relevant in one. Four patients (0.9%) had to be transferred to a primary care hospital for non-PE-associated reasons (acute coronary syndrome, pharyngeal abscess, and acute abdominal problems). No influence of any of the physical activity interventions on the incidence of any AE was found. Conclusion Since PE is a life-threatening disease, it seems reasonable to recommend rehabilitation at least in PE patients with an intermediate or high risk. It is shown for the first time in this study that a standard rehabilitation program after PE is safe. However, efficacy and

  14. VENOUS INSUFFICIENCY AND THROMBOEMBOLIC DISEASE IN BARIATRIC SURGERY PATIENTS

    Directory of Open Access Journals (Sweden)

    Bonno van BELLEN

    2013-09-01

    Full Text Available Context Morbid obesity is associated with various co-morbidities, including chronic venous insufficiency. Bariatric surgery is the only effective treatment for morbid obesity, but with potential risks and possible complications, including venous thromboembolism. Objective To determine the prevalence of clinical and ultrasonographic signs of chronic venous insufficiency in morbid obese patients in preparation for bariatric surgery and the incidence of post-operative venous thromboembolic disease. Methods Patients on work-up for bariatric surgery of Centro Terapêutico Especializado em Fígado (CETEFI and Pro-Gastro surgical teams of the Hospital Beneficência Portuguesa de São Paulo were included. The analysed data were pre-operative findings for venous insufficiency (CEAP - clinical, etiological, anatomical, physiopathologic - classification and venous ultrassonographic findings, type of surgery (open or laparoscopic, abdominal circumference, body mass index (BMI and post-operative ultrassonography search for venous insufficiency and deep venous thrombosis. Results Between March 2007 and December 2009, 95 patients candidates for bariatric surgery had clinical and duplex scan evaluation of the lower limbs venous system. Of the 95 patients, 53 were submitted to the surgical procedure. There was a predominance of women (77.9%, the average age was 38.5 years, average preoperative weight 124.6 kg and average BMI of 45.5 kg/m2. Regarding obesity, 16.8% were obese, and 83.1% were morbidly obese. In relation to the venous findings, 86.3% of the patients did fit CEAP classification less than 3 and 13.7% greater than or equal to 3. Among the post-operative complications, there were four cases of wound infection. Three patients developed post-operative distal venous thrombosis (7.5%, but no one had clinically manifested pulmonary embolism. Conclusion No relation between BMI, CEAP classification and venous ultrassonographic findings were found. Although

  15. Relational Processing Following Stroke

    Science.gov (United States)

    Andrews, Glenda; Halford, Graeme S.; Shum, David; Maujean, Annick; Chappell, Mark; Birney, Damian

    2013-01-01

    The research examined relational processing following stroke. Stroke patients (14 with frontal, 30 with non-frontal lesions) and 41 matched controls completed four relational processing tasks: sentence comprehension, Latin square matrix completion, modified Dimensional Change Card Sorting, and n-back. Each task included items at two or three…

  16. The Optimal Golf Stroke

    DEFF Research Database (Denmark)

    Buchinger, Mikael; Durigen, Susan; Dahl, Johan Rambech

    2006-01-01

    The paper presents a preliminary investigation into aspects of the game of golf. A series of models is proposed for the golf stroke, the momentum transfer between club and ball and the flight of the ball.Numerical and asymptotic solutions are presented reproducing many of the features observed...... in the golf stroke of a professional golfer....

  17. The Danish Stroke Registry.

    Science.gov (United States)

    Johnsen, Søren Paaske; Ingeman, Annette; Hundborg, Heidi Holmager; Schaarup, Susanne Zielke; Gyllenborg, Jesper

    2016-01-01

    The aim of the Danish Stroke Registry is to monitor and improve the quality of care among all patients with acute stroke and transient ischemic attack (TIA) treated at Danish hospitals. All patients with acute stroke (from 2003) or TIA (from 2013) treated at Danish hospitals. Reporting is mandatory by law for all hospital departments treating these patients. The registry included >130,000 events by the end of 2014, including 10,822 strokes and 4,227 TIAs registered in 2014. The registry holds prospectively collected data on key processes of care, mainly covering the early phase after stroke, including data on time of delivery of the processes and the eligibility of the individual patients for each process. The data are used for assessing 18 process indicators reflecting recommendations in the national clinical guidelines for patients with acute stroke and TIA. Patient outcomes are currently monitored using 30-day mortality, unplanned readmission, and for patients receiving revascularization therapy, also functional level at 3 months poststroke. Sociodemographic, clinical, and lifestyle factors with potential prognostic impact are registered. The Danish Stroke Registry is a well-established clinical registry which plays a key role for monitoring and improving stroke and TIA care in Denmark. In addition, the registry is increasingly used for research.

  18. Test Your Stroke Knowledge

    Science.gov (United States)

    ... of these symptoms call 9-1-1 immediately. Stroke symptoms that last only a short time and then disappear (also called transient ischemic attack or TIA) are: Nothing to worry about ... stroke. You should be medically evaluated immediately. Show Answer ...

  19. [Parma Stroke Data Bank: embolic stroke].

    Science.gov (United States)

    Tonelli, C; Catamo, A; Finzi, G; Mombelloni, A; Rossetti, A; Silvestrini, C; Ponari, O

    1995-11-01

    Cerebral infarction is one of the three main causes of death in most countries. It is very frequent and, since it is more often disabiliting rather than fatal, it is of high social impact. The correct classification of patients and the accurate diagnostic definition of the various subtypes of stroke is of great prognostic and therapeutic importance since cerebral infarction is not a single entity. In this study we report our findings concerning 244 patients with embolic infarction recorded in the Parma Stroke Data Bank hospital register. Clinical features were studied (risk factors, symptomatology of the onset, degree of severity within 3 days of the onset, post-stroke complications) as were instruments readings (TAC) and evolution (outcome, mortality, personal performance and environmental integration, both 4 weeks after the clinical onset and after one year).

  20. The Danish Stroke Registry

    DEFF Research Database (Denmark)

    Johnsen, Søren Paaske; Ingeman, Annette; Hundborg, Heidi Holmager

    2016-01-01

    AIM OF DATABASE: The aim of the Danish Stroke Registry is to monitor and improve the quality of care among all patients with acute stroke and transient ischemic attack (TIA) treated at Danish hospitals. STUDY POPULATION: All patients with acute stroke (from 2003) or TIA (from 2013) treated...... at Danish hospitals. Reporting is mandatory by law for all hospital departments treating these patients. The registry included >130,000 events by the end of 2014, including 10,822 strokes and 4,227 TIAs registered in 2014. MAIN VARIABLES: The registry holds prospectively collected data on key processes...... of care, mainly covering the early phase after stroke, including data on time of delivery of the processes and the eligibility of the individual patients for each process. The data are used for assessing 18 process indicators reflecting recommendations in the national clinical guidelines for patients...

  1. Rising statin use and effect on ischemic stroke outcome

    Directory of Open Access Journals (Sweden)

    Haymore Joseph

    2004-03-01

    Full Text Available Abstract Background Statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors have neuroprotective effects in experimental stroke models and are commonly prescribed in clinical practice. The aim of this study was to determine if patients taking statins before hospital admission for stroke had an improved clinical outcome. Methods This was an observational study of 436 patients admitted to the National Institutes of Health Suburban Hospital Stroke Program between July 2000 and December 2002. Self-reported risk factors for stroke were obtained on admission. Stroke severity was determined by the admission National Institutes of Health Stroke Scale score. Good outcome was defined as a Rankin score Results There were 436 patients with a final diagnosis of ischemic stroke; statin data were available for 433 of them. A total of 95/433 (22% of patients were taking a statin when they were admitted, rising from 16% in 2000 to 26% in 2002. Fifty-one percent of patients taking statins had a good outcome compared to 38% of patients not taking statins (p = 0.03. After adjustment for confounding factors, statin pretreatment was associated with a 2.9 odds (95% CI: 1.2–6.7 of a good outcome at the time of hospital discharge. Conclusions The proportion of patients taking statins when they are admitted with stroke is rising rapidly. Statin pretreatment was significantly associated with an improved functional outcome at discharge. This finding could support the early initiation of statin therapy after stroke.

  2. Brain-Heart Interaction: Cardiac Complications After Stroke.

    Science.gov (United States)

    Chen, Zhili; Venkat, Poornima; Seyfried, Don; Chopp, Michael; Yan, Tao; Chen, Jieli

    2017-08-04

    Neurocardiology is an emerging specialty that addresses the interaction between the brain and the heart, that is, the effects of cardiac injury on the brain and the effects of brain injury on the heart. This review article focuses on cardiac dysfunction in the setting of stroke such as ischemic stroke, brain hemorrhage, and subarachnoid hemorrhage. The majority of post-stroke deaths are attributed to neurological damage, and cardiovascular complications are the second leading cause of post-stroke mortality. Accumulating clinical and experimental evidence suggests a causal relationship between brain damage and heart dysfunction. Thus, it is important to determine whether cardiac dysfunction is triggered by stroke, is an unrelated complication, or is the underlying cause of stroke. Stroke-induced cardiac damage may lead to fatality or potentially lifelong cardiac problems (such as heart failure), or to mild and recoverable damage such as neurogenic stress cardiomyopathy and Takotsubo cardiomyopathy. The role of location and lateralization of brain lesions after stroke in brain-heart interaction; clinical biomarkers and manifestations of cardiac complications; and underlying mechanisms of brain-heart interaction after stroke, such as the hypothalamic-pituitary-adrenal axis; catecholamine surge; sympathetic and parasympathetic regulation; microvesicles; microRNAs; gut microbiome, immunoresponse, and systemic inflammation, are discussed. © 2017 American Heart Association, Inc.

  3. Modeling the Link between Left Ventricular Flow and Thromboembolic Risk Using Lagrangian Coherent Structures

    Directory of Open Access Journals (Sweden)

    Karen May-Newman

    2016-11-01

    Full Text Available A thrombus is a blood clot that forms on a surface, and can grow and detach, presenting a high risk for stroke and pulmonary embolism. This risk increases with blood-contacting medical devices, due to the immunological response to foreign surfaces and altered flow patterns that activate the blood and promote thromboembolism (TE. Abnormal blood transport, including vortex behavior and regional stasis, can be assessed from Lagrangian Coherent Structures (LCS. LCS are flow structures that bound transport within a flow field and divide the flow into regions with maximally attracting/repelling surfaces that maximize local shear. LCS can be identified from finite time Lyapunov exponent (FTLE fields, which are computed from velocity field data. In this study, the goal was to use FTLE analysis to evaluate LCS in the left ventricle (LV using velocity data obtained from flow visualization of a mock circulatory loop. A model of dilated cardiomyopathy (DCM was used to investigate the effect of left ventricular assist device (LVAD support on diastolic filling and transport in the LV. A small thrombus in the left ventricular outflow tract was also considered using data from a corresponding LV model. The DCM LV exhibited a direct flow of 0.8 L/cardiac cycle, which was tripled during LVAD support Delayed ejection flow was doubled, further illustrating the impact of LVAD support on blood transport. An examination of the attracting LCS ridges during diastolic filling showed that the increase is due primarily to augmentation of A wave inflow, which is associated with increased vortex circulation, kinetic energy and Forward FTLE. The introduction of a small thrombus in the left ventricular outflow tract (LVOT of the LV had a minimal effect on diastolic inflow, but obstructed systolic outflow leading to decreased transport compared with the unobstructed LVOT geometry. Localized FTLE in the LVOT increased dramatically with the small thrombus model, which reflects

  4. Stroke and Women

    Directory of Open Access Journals (Sweden)

    Gülçin Benbir

    2013-12-01

    Full Text Available OBJECTIVE: We aimed to investigate the differences in vascular risk factor and etiology of stroke in two sexes. METHODS: We reviewed the medical files of 2798 patients being followed-up in our Stroke Clinic between the years 1996-2011. The stroke subtypes and risk factors were recorded on the basis of clinical data, physical and neurological examinations, and neuroimaging findings. Data were collected in SPSS 11.5 system and Pearson chi-square and Mann-Whitney U tests were used for statistical analysis. RESULTS: Of a total of 2798 patients, 2564 patients (91,6% had ischemic stroke, and 234 of them (8,4% had hemorrhagic stroke. The mean follow-up duration was 50.2+42.7 months. Of whole study population, 1289 patients were women (46%, 1509 of them were men (54%. The analysis of stroke subtypes showed that the most common subtype was stroke of unknown etiology in both sexes. Following this, the most common subtype was atherothrombotic stroke in men, and cardioembolic stroke in women. Coronary heart disease was more common in men, while atrial fibrillation and other rhythm anomalies were more common in women. Smoking and alcohol consumption were more common in men. CONCLUSION: Our study showed that there are major differences in stroke subtypes and vascular risk factors. Better knowledge of these differences, as well as influencing factors, is of crucial value – in addition to the need of hormonal changes, pregnancy and depression to be better identified in women – for both primary and secondary prevention.

  5. Perception of stroke among patients with stroke | Ajayi | Nigerian ...

    African Journals Online (AJOL)

    The perception of patients to stroke is variable. The aim of this study was to determine the perception of stroke among stroke patients. The study was carried out between January 2004 - December 2004 on all the patients presenting with features of stroke at the Federal Medical Center Ido, Nigeria. Data were collected by ...

  6. Post-stroke depression among stroke survivors attending two ...

    African Journals Online (AJOL)

    Background: The burden of stroke worldwide is increasing rapidly. There is paucity of data on post-stroke depression (PSD) among stroke survivors in Uganda, despite the high prevalence of PSD reported elsewhere. Methods: In a cross-sectional study, we assessed adult participants with confirmed first stroke with a ...

  7. Explicit motor sequence learning with the paretic arm after stroke.

    Science.gov (United States)

    Fleming, Melanie K; Newham, Di J; Rothwell, John C

    2018-02-01

    Motor sequence learning is important for stroke recovery, but experimental tasks require dexterous movements, which are impossible for people with upper limb impairment. This makes it difficult to draw conclusions about the impact of stroke on learning motor sequences. We aimed to test a paradigm requiring gross arm movements to determine whether stroke survivors with upper limb impairment were capable of learning a movement sequence as effectively as age-matched controls. In this case-control study, 12 stroke survivors (10-138 months post-stroke, mean age 64 years) attempted the task once using their affected arm. Ten healthy controls (mean 66 years) used their non-dominant arm. A sequence of 10 movements was repeated 25 times. The variables were: time from target illumination until the cursor left the central square (onset time; OT), accuracy (path length), and movement speed. OT reduced with training (p  0.1). We quantified learning as the OT difference between the end of training and a random sequence; this was smaller for stroke survivors than controls (p = 0.015). Stroke survivors can learn a movement sequence with their paretic arm, but demonstrate impairments in sequence specific learning. Implications for Rehabilitation Motor sequence learning is important for recovery of movement after stroke. Stroke survivors were found to be capable of learning a movement sequence with their paretic arm, supporting the concept of repetitive task training for recovery of movement. Stroke survivors showed impaired sequence specific learning in comparison with age-matched controls, indicating that they may need more repetitions of a sequence in order to re-learn movements. Further research is required into the effect of lesion location, time since stroke, hand dominance and gender on learning of motor sequences after stroke.

  8. Calcified pulmonary thromboembolism in a child with sickle cell disease: value of multidetector CT in patients with acute chest syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Staser, Jonathan A. [Indiana University Medical Center, Department of Radiology, Indianapolis, IN (United States); Alam, Tariq [Medical College of Ohio, Department of Radiology, Toledo, OH (United States); Applegate, Kimberly [Indiana University Medical Center, Sections of Pediatric Radiology and Health Services Research, Indianapolis, IN (United States); Indiana University Medical Center, Department of Radiology, Riley Hospital for Children, Indianapolis, IN (United States)

    2006-06-15

    The incidence of pulmonary embolism in children is not clearly known, but is believed to be low. Risk factors for pulmonary thromboembolism include central venous catheter, malignancy, surgery, infection, trauma, and congenital hypercoagulable disorders. Children with sickle cell disease are prothrombotic and are at an increased risk of thromboembolism. The incidence of this event is unknown because these children are often not thoroughly imaged. We report here a case of a calcified pulmonary thromboembolism in a child with sickle cell disease and emphasize the use of multidetector CT in detection of pulmonary thromboembolism in children with sickle cell disease. (orig.)

  9. Analysis of Postoperative Venous Thromboembolism in Patients With Chronic Ulcerative Colitis: Is It the Disease or the Operation?

    Science.gov (United States)

    McKenna, Nicholas P; Behm, Kevin T; Ubl, Daniel S; Glasgow, Amy E; Mathis, Kellie L; Pemberton, John H; Habermann, Elizabeth B; Cima, Robert R

    2017-07-01

    Patients with IBD have a higher baseline risk of venous thromboembolism, which further increases with surgery. Therefore, extended venous thromboembolism chemoprophylaxis has been suggested in certain high-risk cohorts. The purpose of this study was to determine whether the underlying diagnosis, operative procedure, or both influence the incidence of postoperative venous thromboembolism. This was a retrospective review. The American College of Surgeons-National Surgical Quality Improvement Project database was analyzed. The NSQIP database was queried for patients with chronic ulcerative colitis and non-IBD undergoing colorectal resections using surgical Current Procedural Terminology codes modeled after the 3 stages used for the surgical management of chronic ulcerative colitis from 2005 to 2013. We measured 30-day postoperative venous thromboembolism risk in patients with chronic ulcerative colitis based on operative stage and risk factors for development of venous thromboembolism. A total of 18,833 patients met inclusion criteria, with an overall rate of venous thromboembolism of 3.8. Among procedure risk groups, venous thromboembolism rates were high risk, 4.4%; intermediate risk, 1.6%; and low risk, 0.7% (across risk groups, p operative procedure are the 2 highest risk factors for postoperative venous thromboembolism. Extended venous thromboembolism prophylaxis might be appropriate for patients undergoing these high-risk procedures or any emergent colorectal procedures. See Video Abstract at http://links.lww.com/DCR/A339.

  10. Pharmacotherapy with oral Xa inhibitors for venous thromboembolism.

    Science.gov (United States)

    Vanassche, Thomas; Vandenbriele, Christophe; Peerlinck, Kathelijne; Verhamme, Peter

    2015-04-01

    Venous thromboembolism (VTE) causes substantial morbidity and mortality worldwide. The traditional treatment of VTE, with an initial therapy with (low molecular weight) heparin or fondaparinux and a continued treatment with vitamin K antagonists, is effective but has limitations. The current review summarizes the results of the Phase III trials with the new oral direct factor Xa inhibitors rivaroxaban, apixaban and edoxaban and provides a meta-analysis of these trials in the subgroups of elderly patients (> 75 years) and patients with impaired renal function. The practical use of direct Xa inhibitors in the treatment of VTE in general and in specific subgroups is discussed. For elderly patients, patients with extremes of body weight, cancer patients or patients with moderate renal impairment, pooled data suggest that the direct oral Xa inhibitors are a reasonable alternative to standard therapy. For other indications, such as treatment of VTE in children, during pregnancy or in the context of heparin-induced thrombocytopenia, further data from clinical trials are needed.

  11. Pulmonary thromboembolism on unenhanced postmortem computed tomography: Feasibility and findings.

    Science.gov (United States)

    Ampanozi, Garyfalia; Held, Ulrike; Ruder, Thomas D; Ross, Steffen G; Schweitzer, Wolf; Fornaro, Juergen; Franckenberg, Sabine; Thali, Michael J; Flach, Patricia M

    2016-05-01

    The purpose of this study was to evaluate the feasibility of diagnosing fatal pulmonary thromboembolism (PTE) with unenhanced postmortem computed tomography (PMCT). Twelve cases with autopsy confirmed PTE and matched controls (n=19) were retrospectively examined for PTE signs on PMCT. The following variables were evaluated: edema of the lower extremities (areal and Hounsfield Unit measurements) and observer dependent patterns of the morphology of the sedimentation in the pulmonary arteries and trunk. The median absolute difference between the areal measurements of the right and left lower leg and thigh and the attenuation of the popliteal adipose tissue did not differ significantly between the groups. In contrast, the categorical assessment of soft tissue edema in the lower extremities was significantly different. A statistically significant difference could also be found in the shape of the vascular content within the pulmonary trunk and arteries. PTE may be assessed on unenhanced PMCT using diagnostic clues such as a distinct pattern of the pulmonary artery content and the presence of perivascular edema in the lower extremities. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  12. Does thromboprophylaxis prevent venous thromboembolism after major orthopedic surgery?

    Directory of Open Access Journals (Sweden)

    Evrim Eylem Akpinar

    2013-06-01

    Full Text Available OBJECTIVE: Pulmonary embolism (PE is an important complication of major orthopedic surgery. The aim of this study was to evaluate the incidence of venous thromboembolism (VTE and factors influencing the development of VTE in patients undergoing major orthopedic surgery in a university hospital. METHODS: Patients who underwent major orthopedic surgery (hip arthroplasty, knee arthroplasty, or femur fracture repair between February of 2006 and June of 2012 were retrospectively included in the study. The incidences of PE and deep vein thrombosis (DVT were evaluated, as were the factors influencing their development, such as type of operation, age, and comorbidities. RESULTS: We reviewed the medical records of 1,306 patients. The proportions of knee arthroplasty, hip arthroplasty, and femur fracture repair were 63.4%, 29.9%, and 6.7%, respectively. The cumulative incidence of PE and DVT in patients undergoing major orthopedic surgery was 1.99% and 2.22%, respectively. Most of the patients presented with PE and DVT (61.5% and 72.4%, respectively within the first 72 h after surgery. Patients undergoing femur fracture repair, those aged ≥ 65 years, and bedridden patients were at a higher risk for developing VTE. CONCLUSIONS: Our results show that VTE was a significant complication of major orthopedic surgery, despite the use of thromboprophylaxis. Clinicians should be aware of VTE, especially during the perioperative period and in bedridden, elderly patients (≥ 65 years of age.

  13. European guidelines on perioperative venous thromboembolism prophylaxis: Aspirin.

    Science.gov (United States)

    Jenny, Jean-Yves; Pabinger, Ingrid; Samama, Charles Marc

    2018-02-01

    : There is a good rationale for the use of aspirin in venous thromboembolism prophylaxis in some orthopaedic procedures, as already proposed by the 9th American College of Chest Physicians' guidelines (Grade 1C). We recommend using aspirin, considering that it may be less effective than or as effective as low molecular weight heparin for prevention of deep vein thrombosis and pulmonary embolism after total hip arthroplasty, total knee arthroplasty and hip fracture surgery (Grade 1C). Aspirin may be less effective than or as effective as low molecular weight heparins for prevention of deep vein thrombosis and pulmonary embolism after other orthopaedic procedures (Grade 2C). Aspirin may be associated with a low rate of bleeding after total hip arthroplasty, total knee arthroplasty and hip fracture surgery (Grade 1B). Aspirin may be associated with less bleeding after total hip arthroplasty, total knee arthroplasty and hip fracture surgery than other pharmacological agents (Grade 1B). No data are available for other orthopaedic procedures. We do not recommend aspirin as thromboprophylaxis in general surgery (Grade 1C). However, this type of prophylaxis could be interesting especially in low-income countries (Grade 2C) and adequate large-scale trials with proper study designs should be carried out (Grade 1C).

  14. [Pulmonary thromboembolism: clinical characteristics and diagnostic and therapeutic approaches].

    Science.gov (United States)

    Arnalich, F; Monereo, A; López, J; Arribas, J R; Jiménez, M; Lahoz, C; Peña, J M; Barbado, F J; Vázquez, J J

    1989-04-08

    In the present study the variability and diagnostic meaning of clinical features and common laboratory investigations were evaluated in a series of 220 patients with pulmonary thromboembolism (PTE) diagnosed by clinical means. The patients were classified into the two following groups: group I consisted of 102 critical patients admitted to an intensive care unit; group II consisted of 118 less-severely ill patients admitted to an ordinary hospital ward. Although clinical and laboratory features were nonspecific, the association of thrombotic risk factors in 88% of the patients permitted us to suspect the diagnosis of PTE within the initial three days in 71%. Chest radiogram was normal in 48%, ECG was normal in 32%, and contrast phlebography did not demonstrate phlebothrombosis in 16.4% of cases. The presumptive diagnosis was earlier (4 +/- 2 days) in group I than in group II patients (8 +/- 5 days) (p less than 0.01), and there was a significantly higher frequency of thoracic symptoms, hypoxemia, hypocapnia and radiologic and electrocardiographic abnormalities in group I patients. Chest radiogram and ECG were normal in only a small minority of these patients (9 and 7%, respectively). Overall mortality rate was 9.4% (20 patients, 14 from group I and 6 from group II). In 10 patients, all from group I, death took place within the first 72 hours after the diagnosis.

  15. Pulmonary endarterectomy in the management of chronic thromboembolic pulmonary hypertension

    Directory of Open Access Journals (Sweden)

    David Jenkins

    2017-03-01

    Full Text Available Chronic thromboembolic pulmonary hypertension (CTEPH is a type of pulmonary hypertension, resulting from fibrotic transformation of pulmonary artery clots causing chronic obstruction in macroscopic pulmonary arteries and associated vascular remodelling in the microvasculature. Pulmonary endarterectomy (PEA offers the best chance of symptomatic and prognostic improvement in eligible patients; in expert centres, it has excellent results. Current in-hospital mortality rates are 90% at 1 year and >70% at 10 years. However, PEA, is a complex procedure and relies on a multidisciplinary CTEPH team led by an experienced surgeon to decide on an individual's operability, which is determined primarily by lesion location and the haemodynamic parameters. Therefore, treatment of patients with CTEPH depends largely on subjective judgements of eligibility for surgery by the CTEPH team. Other controversies discussed in this article include eligibility for PEA versus balloon pulmonary angioplasty, the new treatment algorithm in the European Society of Cardiology/European Respiratory Society guidelines and the definition of an “expert centre” for the management of this condition.

  16. Pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension: pathophysiology

    Directory of Open Access Journals (Sweden)

    M. Humbert

    2010-03-01

    Full Text Available Pulmonary arterial hypertension (PAH and chronic thromboembolic pulmonary hypertension (CTEPH are two of the key subgroups of pulmonary hypertension. They are characterised by different risk factors. PAH can be associated with mutations in the gene encoding bone morphogenetic protein receptor type II (BMPR2, HIV infection, congenital heart disease, connective tissue disease (such as systemic sclerosis, and exposure to particular drugs and toxins including fenfluramine derivatives. In contrast, CTEPH can be associated with anti-phospholipid antibodies, splenectomy and the presence of a ventriculo-atrial shunt or an infected pacemaker. The first-line therapies used to treat PAH and CTEPH also differ. While medical therapy tends to be used for patients with PAH, pulmonary endarterectomy is the treatment of choice for patients with CTEPH. However, there are possible common mechanisms behind the two diseases, including endothelial cell dysfunction and distal pulmonary artery remodelling. Further research into these similarities is needed to assist the development of targeted pharmacological therapies for patients with inoperable CTEPH and patients who have persistent pulmonary hypertension after endarterectomy.

  17. Surgical Removal of a Canine Aortic Thromboembolism Secondary to Pancreatitis

    Directory of Open Access Journals (Sweden)

    Jill Narak

    2015-01-01

    Full Text Available A 7-year-old castrated male Pomeranian was evaluated on emergency for diagnostic work-up and treatment for acute nonpainful paraparesis. The neurologic examination suggested a L4-S3 myelopathy, but physical examination revealed lack of femoral pulses and rectal hypothermia, as well as a grade II/VI systolic heart murmur, so ischemic neuromyopathy was suspected. Clinicopathologic analysis revealed increased muscle enzymes and proteinuria. Abdominal ultrasonography confirmed aortic thromboembolism (ATE, and surgical histopathology diagnosed necrotizing pancreatitis. Surgical aortic thrombectomy was performed, and antithrombotic therapy was instituted. Pancreatitis was treated supportively. The dog was discharged to the owners after 10 days of hospitalization. Recheck examination 6 weeks after initial presentation revealed a normal neurologic examination and normal femoral pulses. The patient has had no further bouts of pancreatitis and remains neurologically normal 5 years after initial presentation. Canine ATE is relatively rare compared to the feline counterpart. Directed therapy for feline ATE is often not recommended, as underlying conditions are oftentimes ultimately fatal. Underlying etiologies for canine ATE include cardiovascular disease and endocrinopathies, but canine ATE secondary to pancreatitis has not yet been reported. Surgical removal of aortic thromboembolus should be considered as curative for pelvic limb dysfunction in the canine patient without a terminal underlying disease.

  18. Prevention of venous thromboembolism in patients undergoing bariatric surgery

    Science.gov (United States)

    Bartlett, Matthew A; Mauck, Karen F; Daniels, Paul R

    2015-01-01

    Bariatric surgical procedures are now a common method of obesity treatment with established effectiveness. Venous thromboembolism (VTE) events, which include deep vein thrombosis and pulmonary embolism, are an important source of postoperative morbidity and mortality among bariatric surgery patients. Due to an understanding of the frequency and seriousness of these complications, bariatric surgery patients typically receive some method of VTE prophylaxis with lower extremity compression, pharmacologic prophylaxis, or both. However, the optimal approach in these patients is unclear, with multiple open questions. In particular, strategies of adjusted-dose heparins, postdischarge anticoagulant prophylaxis, and the role of vena cava filters have been evaluated, but only to a limited extent. In contrast to other types of operations, the literature regarding VTE prophylaxis in bariatric surgery is notable for a dearth of prospective, randomized clinical trials, and current professional guidelines reflect the uncertainties in this literature. Herein, we summarize the available evidence after systematic review of the literature regarding approaches to VTE prevention in bariatric surgery. Identification of risk factors for VTE in the bariatric surgery population, analysis of the effectiveness of methods used for prophylaxis, and an overview of published guidelines are presented. PMID:26316771

  19. [Hormonal contraception and thromboembolic disease--new epidemiologic data].

    Science.gov (United States)

    Unzeitig, V

    2001-07-01

    To sum up the results of studies published between 1996 and 2000 on the venous thromboembolism (VTE) risk at combined oral contraceptives users. Review of literature. 1st Department of Obstetrics and Gynecology, Masaryk University, Brno, Czech Republic. Summary of the results of substantial studies published on this topic. Studies were identified by Medline database search. Four important epidemiological studies published at 1995 and 1996 (WHO, Spitzer et al., Jick et al., Bloemenkamp et al.) demonstrated two fold increased risk of VTE at users of third generation OCs in comparison with second generation OCs. Publication of these studies was followed by critic based on their possible methodological weaknesses (prescribing bias, "healthy user" effect, refferal bias etc.). Other epidemiologists confirmed results of these studies and excluded the possibility of systematic biases. Pathophysiological mechanisms that could explain the different risks were also found. Jick's analysis of GRPD published in 2000 also confirmed the results from 1995 and 1996. The different risk of VTE at users of oral contraceptives with different progestins probably exists. However, the relative risks of VTE demonstrated in recent studies are low.

  20. Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension

    Directory of Open Access Journals (Sweden)

    Irene Lang

    2017-03-01

    Full Text Available Chronic thromboembolic pulmonary hypertension (CTEPH is thought to result from incomplete resolution of pulmonary thromboemboli that undergo organisation into fibrous tissue within pulmonary arterial branches, filling pulmonary arterial lumina with collagenous obstructions. The treatment of choice is pulmonary endarterectomy (PEA in CTEPH centres, which has low post-operative mortality and good long-term survival. For patients ineligible for PEA or who have recurrent or persistent pulmonary hypertension after surgery, medical treatment with riociguat is beneficial. In addition, percutaneous balloon pulmonary angioplasty (BPA is an emerging option, and promises haemodynamic and functional benefits for inoperable patients. In contrast to conventional angioplasty, BPA with undersized balloons over guide wires exclusively breaks intraluminal webs and bands, without dissecting medial vessel layers, and repeat sessions are generally required. Observational studies report that BPA improves haemodynamics, symptoms and functional capacity in patients with CTEPH, but controlled trials with long-term follow-up are needed. Complications include haemoptysis, wire injury, vessel dissection, vessel rupture, reperfusion pulmonary oedema, pulmonary parenchymal bleeding and haemorrhagic pleural effusions. This review summarises the available evidence for BPA, patient selection, recent technical refinements and periprocedural imaging, and discusses the potential future role of BPA in the management of CTEPH.

  1. Prostate Cancer Radiation Therapy and Risk of Thromboembolic Events

    Energy Technology Data Exchange (ETDEWEB)

    Bosco, Cecilia, E-mail: Cecilia.t.bosco@kcl.ac.uk [Translational Oncology & Urology Research (TOUR), Division of Cancer Studies, King' s College London, London (United Kingdom); Garmo, Hans [Translational Oncology & Urology Research (TOUR), Division of Cancer Studies, King' s College London, London (United Kingdom); Regional Cancer Centre, Uppsala, Akademiska Sjukhuset, Uppsala (Sweden); Adolfsson, Jan [CLINTEC Department, Karolinska Institutet, Stockholm (Sweden); Stattin, Pär [Department of Surgical Sciences, Uppsala University, Uppsala (Sweden); Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå (Sweden); Holmberg, Lars [Translational Oncology & Urology Research (TOUR), Division of Cancer Studies, King' s College London, London (United Kingdom); Regional Cancer Centre, Uppsala, Akademiska Sjukhuset, Uppsala (Sweden); Department of Surgical Sciences, Uppsala University, Uppsala (Sweden); Nilsson, Per; Gunnlaugsson, Adalsteinn [Department of Hematology, Oncology and Radiation Physics, Skane University Hospital, Lund University, Lund (Sweden); Widmark, Anders [Department of Radiation Sciences, Oncology, Umeå University, Umeå (Sweden); Van Hemelrijck, Mieke [Translational Oncology & Urology Research (TOUR), Division of Cancer Studies, King' s College London, London (United Kingdom); Institute of Environmental Medicine, Karolinska Institute, Stockholm (Sweden)

    2017-04-01

    Purpose: To investigate the risk of thromboembolic disease (TED) after radiation therapy (RT) with curative intent for prostate cancer (PCa). Patients and Methods: We identified all men who received RT as curative treatment (n=9410) and grouped according to external beam RT (EBRT) or brachytherapy (BT). By comparing with an age- and county-matched comparison cohort of PCa-free men (n=46,826), we investigated risk of TED after RT using Cox proportional hazard regression models. The model was adjusted for tumor characteristics, demographics, comorbidities, PCa treatments, and known risk factors of TED, such as recent surgery and disease progression. Results: Between 2006 and 2013, 6232 men with PCa received EBRT, and 3178 underwent BT. A statistically significant association was found between EBRT and BT and risk of pulmonary embolism in the crude analysis. However, upon adjusting for known TED risk factors these associations disappeared. No significant associations were found between BT or EBRT and deep venous thrombosis. Conclusion: Curative RT for prostate cancer using contemporary methodologies was not associated with an increased risk of TED.

  2. Omega-3 fatty acids predict recurrent venous thromboembolism or total mortality in elderly patients with acute venous thromboembolism.

    Science.gov (United States)

    Reiner, M F; Stivala, S; Limacher, A; Bonetti, N R; Méan, M; Egloff, M; Rodondi, N; Aujesky, D; von Schacky, C; Lüscher, T F; Camici, G G; Beer, J H

    2017-01-01

    Essentials The role of omega-3 fatty acids (n-3 FAs) in recurrent venous thromboembolism (VTE) is unknown. Association of n-3 FAs with recurrent VTE or total mortality was investigated in 826 patients. Whole blood n-3 FAs were inversely correlated with recurrent VTE or total mortality. Major and non-major bleeding was not increased in patients with higher levels of n-3 FAs. Background The role of omega-3 fatty acids (n-3 FAs) in recurrent venous thromboembolism (VTE) remains unknown. Objectives To investigate the association of n-3 FAs with recurrent VTE or total mortality at 6 months and 3 years. Methods N-3 FAs were assessed in 826 patients aged ≥ 65 years, categorized into low, medium and high based on the 25th and 75th percentile. Mean follow-up was 29 months. Results At 6 months, subjects with medium (adjusted hazard ratio [HR], 0.37; 95% confidence interval [CI], 0.22-0.62) and high n-3 FA levels (adjusted HR, 0.36; 95% CI, 0.20-0.67) were less likely to develop recurrent VTE or total mortality, compared with those with low n-3 FAs. At 3 years, medium levels (adjusted HR, 0.67; 95% CI, 0.47-0.96) were associated with lower risk of recurrent VTE or total mortality. As compared with low n-3 FAs, the adjusted sub-hazard ratio [SHR] of recurrent VTE was 0.39 (95% CI, 0.15-0.99) in patients with medium and 0.17 (95% CI, 0.03-0.82) in patients with high n-3 FAs. The cumulative incidence of recurrent VTE was lower in the medium and high n-3 FA groups as compared with the low n-3 FA groups, but seems to have worn off after 3 years. The incidence of major and non-major bleeding was not greater in the high n-3 FA group. Conclusion Higher levels of n-3 FAs were associated with a lower risk of recurrent VTE or total mortality in elderly patients with VTE, but not with greater bleeding risk. © 2016 International Society on Thrombosis and Haemostasis.

  3. Thromboembolism in pregnancy: challenges and controversies in the prevention of pregnancy-associated venous thromboembolism and management of anticoagulation in women with mechanical prosthetic heart valves.

    Science.gov (United States)

    McLintock, Claire

    2014-05-01

    Thromboembolism in pregnancy is an important clinical issue. Despite identification of maternal and pregnancy-specific risk factors for development of pregnancy-associated venous thromboembolism, limited data are available to inform on optimal approaches for prevention. The relatively low overall prevalence of pregnancy-associated venous thromboembolism has prompted debate about the validity of recommendations, which are mainly based on expert opinion, and have resulted in an increased use of pharmacological thromboprophylaxis in pregnancy and postpartum. A pragmatic approach is required in the absence of more robust data. Anticoagulation management of pregnant women with mechanical prosthetic heart valves is particularly challenging. Continuation of therapeutic anticoagulation during pregnancy is essential to prevent valve thrombosis. Warfarin, the most effective anticoagulant, is associated with adverse fetal outcomes, including embryopathy and stillbirth. Fetal outcome is improved with therapeutic-dose low-molecular-weight heparin, but there may be more thromboembolic complications. More intensive anticoagulation, targeting higher trough anti-Xa levels, may reduce the risk of valve thrombosis. Copyright © 2014 Elsevier Ltd. All rights reserved.

  4. The Clinical Course of Venous Thromboembolism May Differ According to Cancer Site.

    Science.gov (United States)

    Mahé, Isabelle; Chidiac, Jean; Bertoletti, Laurent; Font, Carme; Trujillo-Santos, Javier; Peris, Marisa; Pérez Ductor, Cristina; Nieto, Santiago; Grandone, Elvira; Monreal, Manuel

    2017-03-01

    We hypothesized that the clinical course of venous thromboembolism in patients with active cancer may differ according to the specificities of primary tumor site. We used data from RIETE (international registry of patients with venous thromboembolism) to compare the clinical venous thromboembolism-related outcomes during the course of anticoagulation in patients with one of the 4 more frequent cancers (breast, prostate, colorectal, or lung cancer). As of September 2014, 3947 cancer patients were recruited, of whom 938 had breast, 629 prostate, 1189 colorectal, and 1191 lung cancer. Overall, 55% had metastatic disease (42%, 36%, 53%, and 72%, respectively). During the course of anticoagulant therapy (mean duration, 139 days), the rate of thromboembolic recurrences was similar to the rate of major bleeding in patients with breast (5.6 [95% confidence interval (CI), 3.8-8.1] vs 4.1 [95% CI, 2.7-5.9] events per 100 patient-years) or colorectal cancer (10 [95% CI, 7.6-13] vs 12 [95% CI, 9.4-15] per 100 patient-years). In contrast, in patients with prostate cancer, the rate of venous thromboembolic recurrences was half the rate of major bleeding (6.9 [95% CI, 4.4-10] vs 13 [95% CI, 9.2-17] events per 100 patient-years), whereas in those with lung cancer, the rate of thromboembolic recurrences was twofold higher than the rate of major bleeding (27 [95% CI, 22-23] vs 11 [95% CI, 8.6-15] per 100 patient-years). Significant differences in the clinical profile of venous thromboembolic-related outcomes were observed according to the site of cancer. These findings suggest the development of cancer-specific anticoagulant strategies as an area for further research. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. The postoperative venous thromboembolism (TREVO) study - risk and case mortality by surgical specialty.

    Science.gov (United States)

    Amaral, Cristina; Guimarães Pereira, Luís; Moreto, Ana; Sá, Ana Carolina; Azevedo, Ana

    2017-09-01

    Venous thromboembolism, risk of which is increased in surgical patients, is a preventable cause of morbidity and death. The primary objective of this study was to estimate the incidence of symptomatic postoperative venous thromboembolism in adults at a tertiary university hospital, overall and by surgical specialty. The secondary objective was to analyze severity of and mortality from thromboembolic events. We performed a retrospective study to identify cases of in-hospital postoperative venous thromboembolism, encoded by the International Classification of Diseases, Ninth Revision, according to the Joint Commission International criteria. Adult patients admitted for surgery in 2008-2012 were included. Among 67 635 hospitalizations, 90 cases of postoperative symptomatic venous thromboembolism were identified, corresponding to an incidence of 1.33/1000 admissions (95% confidence interval [CI] 1.1-1.6/1000). Neurosurgery had the highest risk (4.07/1000), followed by urological surgery and general surgery (p<0.001). There were 50 cases of pulmonary embolism, 11 of which were fatal. Of the 90 cases, 12.2% occurred under neuraxial anesthesia and 55.1% in patients with American Society of Anesthesiology III physical status. At least 37.7% of patients with events received a prophylactic dose of injectable anticoagulant postoperatively. The overall risk decreased from 2008 to 2012. Venous thromboembolism-associated mortality during hospitalization was 21.1% (95% CI 13.6-30.4). The incidence of postoperative symptomatic venous thromboembolism was 1.33/1000. Neurosurgery showed the greatest risk. Mortality was 21.1%. Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  6. Relationship between neighborhood socioeconomic status and venous thromboembolism: results from a population-based study.

    Science.gov (United States)

    Kort, D; van Rein, N; van der Meer, F J M; Vermaas, H W; Wiersma, N; Cannegieter, S C; Lijfering, W M

    2017-12-01

    Essentials Literature on socioeconomic status (SES) and incidence of venous thromboembolism (VTE) is scarce. We assessed neighborhood SES with VTE risk in a population of over 1.4 million inhabitants. Higher neighborhood SES was associated with lower incidence of VTE. These findings are helpful to inform policy and resource allocation in health systems. Background The association between socioeconomic status and arterial cardiovascular disease is well established. However, despite its high burden of disability-adjusted life years, little research has been carried out to determine whether socioeconomic status is associated with venous thromboembolism. Objective To determine if neighborhood socioeconomic status is associated with venous thromboembolism in a population-based study from the Netherlands. Methods We identified all patients aged 15 years and older with a first event of venous thromboembolism from inhabitants who lived in the urban districts of The Hague, Leiden and Utrecht in the Netherlands in 2008-2012. Neighborhood socioeconomic status was based on the status score, which combines educational level, income and unemployment on a four-digit postal code level. Incidence rate ratios of venous thromboembolism were calculated for different levels of neighborhood socioeconomic status, with adjustments for age and sex. Results A total of 7373 patients with a first venous thromboembolism (median age 61 years; 50% deep vein thrombosis) were identified among more than 1.4 million inhabitants. Higher neighborhood SES was associated with lower incidence of VTE. In the two highest status score groups (i.e. the 95-99th and > 99th percentile), the adjusted incidence rate ratios were 0.91 (95% confidence interval [CI], 0.84-1.00) and 0.80 (95% CI, 0.69-0.93), respectively, compared with the reference status score group (i.e. 30-70th percentile). Conclusions High neighborhood socioeconomic status is associated with a lower risk of first venous thromboembolism. © 2017

  7. Determinants of sexual function and dysfunction in men and women with stroke

    DEFF Research Database (Denmark)

    Dusenbury, Wendy; Palm Johansen, Pernille; Mosack, Victoria

    2017-01-01

    , for studies published between January, 2000 and October, 2016. Included were original research, adult ≥18 years, English language, and experimental and non-experimental designs. Excluded were studies of stroke caused by sexual activity, stroke triggered unusual behaviours, and changes in sexual orientation...... years. Intervention studies were limited, with only two RCTs, thus, firm conclusions cannot be made. Few studies included women or younger stroke patients, indicating the need for further RCTs with larger and more diverse samples....

  8. Burden of stroke in Estonia.

    Science.gov (United States)

    Kõrv, Janika; Vibo, Riina

    2013-07-01

    Estonia is the smallest of the three Baltic countries. The decline in incidence of first-ever stroke during the 1990s has left Tartu, Estonia with a relatively low stroke incidence. However, the incidence rates for younger age groups, and the 28-day case fatality rate are higher compared with several other studies. Developments in the national health care system in recent years have been positive: the decline of mortality rate of stroke in Estonia is greater than the European Union average. However, the mortality of cardiovascular diseases is higher compared with several European countries. The prevalence of most stroke risk factors is comparable with European Union countries, while atrial fibrillation is somewhat more frequent (30%) among the patients having suffered from ischemic stroke. The management of stroke in Estonia has been in accordance with European and national stroke guidelines. Stroke units are organized in regional and central hospitals in bigger cities. A well-developed and free ambulance service, and a high priority of stroke code, enable a quick transportation of patients to the nearest hospital providing thrombolytic therapy. The number of thrombolyzed stroke cases has increased since 2003. The Estonian Stroke Initiative was founded in 2008 to improve stroke care, promote regional networks, and increase stroke knowledge among the general population and medical professionals. Since then, several activities regarding stroke awareness have been organized. © 2013 The Authors. International Journal of Stroke © 2013 World Stroke Organization.

  9. Risks for Heart Disease & Stroke

    Science.gov (United States)

    ... for Heart Disease & Stroke Risks for Heart Disease & Stroke About 1.5 million heart attacks and strokes happen every year in the United States. You ... some of your risks for heart disease and stroke, but you can manage many of your risks ...

  10. Third European Stroke Science Workshop

    NARCIS (Netherlands)

    Dichgans, Martin; Planas, Anna M.; Biessels, Geert Jan|info:eu-repo/dai/nl/165576367; van der Worp, Bart|info:eu-repo/dai/nl/189855010; Sudlow, Cathie; Norrving, B.; Lees, Kennedy; Mattle, Heinrich P.

    2016-01-01

    Lake Eibsee, Garmisch-Partenkirchen, November 19 to 21, 2015: The European Stroke Organization convened >120 stroke experts from 27 countries to discuss latest results and hot topics in clinical, translational, and basic stroke research. Since its inception in 2011, the European Stroke Science

  11. Stroke Risk Factors and Symptoms

    Science.gov (United States)

    ... Version » [ pdf, 433 kb ] Order Materials » Stroke Risk Factors and Symptoms Risk Factors for a Stroke Stroke prevention is ... and can be treated with drugs or surgery. Symptoms of a Stroke If you see or have one or more ...

  12. The Migraine–Stroke Connection

    Science.gov (United States)

    Lee, Mi Ji; Lee, Chungbin; Chung, Chin-Sang

    2016-01-01

    Migraine and stroke are common neurovascular disorders which share underlying physiological processes. Increased risks of ischemic stroke, hemorrhagic stroke, and subclinical ischemic lesions have been consistently found in migraineurs. Three possible associations are suggested. One is that underlying pathophysiology of migraine can lead to ischemic stroke. Second, common comorbidities between migraine and stroke can be present. Lastly, some syndromes can manifest with both migraine-like headache and cerebrovascular disease. Future studies should be targeted on bidirectional influence of migraine on different stroke mechanisms and optimal prevention of stroke in migraine patients. PMID:27283278

  13. Family history of stroke in stroke types and subtypes.

    Science.gov (United States)

    Polychronopoulos, P; Gioldasis, G; Ellul, J; Metallinos, I C; Lekka, N P; Paschalis, C; Papapetropoulos, Th

    2002-03-30

    Many studies have provided data showing that family history of stroke (FHS) is associated with an increased risk of stroke. The association of the FHS with the various stroke subtypes has not been adequately studied. The purpose of this study was to assess the association of the FHS with the two major stroke types (cerebral haematomas and ischaemic strokes) and the four stroke subtypes (cardioembolic, large artery disease, small artery disease, and undetermined) in a Greek population. The FHS was obtained from 421 consecutive acute stroke patients and from 239 matched control subjects. Positive FHS was observed in 49% of all stroke patients compared with 28% of the control subjects [adjusted OR=2.06 (95% confidence intervals (CI) 1.42-3.00)]. Haematomas, ischaemic strokes, and from the ischaemic strokes, both large and small artery disease strokes were strongly associated with positive FHS compared with the control subjects [adjusted OR=2.06 (95% CI 9-3.04), 2.07 (95% CI 1.09-3.91), 2.05 (95% CI 1.24-3.38), and 2.76 (95% CI 1.55-4.91), respectively]. There was no difference between maternal and paternal heritable contribution.In conclusion, FHS was found in this study to be an independent risk factor for all strokes combined, for each stroke type, and for the large and small-artery disease stroke subtypes, but not for the cardioembolic and undetermined stroke subtypes.

  14. Hyperglycemia, Acute Ischemic Stroke and Thrombolytic Therapy

    Science.gov (United States)

    Bruno, Askiel; Fagan, Susan C.; Ergul, Adviye

    2014-01-01

    Ischemic stroke is a leading cause of disability and is considered now the 4th leading cause of death. Many clinical trials have shown that stroke patients with acute elevation in blood glucose at onset of stroke suffer worse functional outcomes, longer in-hospital stay and higher mortality rates. The only therapeutic hope for these patients is the rapid restoration of blood flow to the ischemic tissue through intravenous administration of the only currently proven effective therapy, tissue plasminogen activator (tPA). However, even this option is associated with the increased risk of intracerebral hemorrhage. Nonetheless, the underlying mechanisms through which hyperglycemia (HG) and tPA worsen the neurovascular injury after stroke are not fully understood. Accordingly, this review summarizes the latest updates and recommendations about the management of HG and co-administration of tPA in a clinical setting while focusing more on the various experimental models studying: 1. the effect of HG on stroke outcomes; 2. the potential mechanisms involved in worsening the neurovasular injury; 3. the different therapeutic strategies employed to ameliorate the injury, and finally; 4. the interaction between HG and tPA. Developing therapeutic strategies to reduce the hemorrhage risk with tPA in hyperglycemic setting is of great clinical importance. This can best be achieved by conducting robust preclinical studies evaluating the interaction between tPA and other therapeutics in order to develop potential therapeutic strategies with high translational impact. PMID:24619488

  15. Lupus anticoagulants and anti-phospholipid antibodies as risk factors for a first episode of ischemic stroke.

    Science.gov (United States)

    Saidi, S; Mahjoub, T; Almawi, W Y

    2009-07-01

    Antiphospholipid antibodies (aPLA) and lupus anticoagulant (LAC) were shown to precipitate thromboembolic events. Their association with ischemic stroke remains to be seen. We investigated the contribution of LAC, and antibodies directed against the phospholipids cardiolipin (aCL), phosphatidylserine (aPS), and the phospholipid-dependent cofactors beta2-glycoprotein I and annexin V, to the risk for ischemic stroke. LAC and antibody levels were measured in 208 stroke patients and 203 age- and gender-matched control subjects. Positive LAC resulted in an increased risk for stroke [OR (95% CI) = 8.1 (2.4-27.5)]. Significant elevation in aPS IgG, aCL IgM and aCL IgG titers, and increased prevalence of elevated aPS IgG, aCL IgM and aCL IgG (based on P95 cutoff values of healthy individuals) were seen in patients. aPS IgG was associated with cardioembolic, whereas aCL IgG and IgM were elevated in lacunar, atherosclerotic and cardioembolic, and LAC positivity was documented only in lacunar stroke subtypes. The co-presence of LAC with a positive aCL IgM/IgG or aPS IgG did not affect the overall risk for stroke. Multivariate analysis confirmed the association of positive LAC with stroke [aOR (95% CI) = 9.7 (1.8-52.5)], and demonstrated a clear gradation of increasing risk of stroke associated with the four categories of aCL IgG and aPS IgG, and identified aCL IgM P95 as independent predictors of stroke after adjusting for potentially confounding covariates. Our study demonstrates that the presence of LAC, and elevated aCL IgG and aPS IgG antibodies are risk factors for stroke.

  16. A Case of Miller Fisher Syndrome, Thromboembolic Disease, and Angioedema: Association or Coincidence?

    Science.gov (United States)

    Salehi, Nooshin; Choi, Eric D; Garrison, Roger C

    2017-01-16

    BACKGROUND Miller Fisher Syndrome is characterized by the clinical triad of ophthalmoplegia, ataxia, and areflexia, and is considered to be a variant of Guillain-Barre Syndrome. Miller Fisher Syndrome is observed in approximately 1-5% of all Guillain-Barre cases in Western countries. Patients with Miller Fisher Syndrome usually have good recovery without residual deficits. Venous thromboembolism is a common complication of Guillain-Barre Syndrome and has also been reported in Miller Fisher Syndrome, but it has generally been reported in the presence of at least one prothrombotic risk factor such as immobility. A direct correlation between venous thromboembolism and Miller Fisher Syndrome or Guillain-Barre Syndrome has not been previously described. CASE REPORT We report the case of a 32-year-old Hispanic male who presented with acute, severe thromboembolic disease and concurrently demonstrated characteristic clinical features of Miller Fisher Syndrome including ophthalmoplegia, ataxia, and areflexia. Past medical and family history were negative for thromboembolic disease, and subsequent hypercoagulability workup was unremarkable. During the course of hospitalization, the patient also developed angioedema. CONCLUSIONS We describe a possible association between Miller Fisher Syndrome, thromboembolic disease, and angioedema.

  17. Incidence of pulmonary and venous thromboembolism in pregnancies after in vitro fertilisation: cross sectional study.

    Science.gov (United States)

    Henriksson, Peter; Westerlund, Eli; Wallén, Håkan; Brandt, Lena; Hovatta, Outi; Ekbom, Anders

    2013-01-15

    To estimate the risk of pulmonary embolism and venous thromboembolism in pregnant women after in vitro fertilisation. Cross sectional study. Sweden. 23,498 women who had given birth after in vitro fertilisation between 1990 and 2008 and 116,960 individually matched women with natural pregnancies. Risk of pulmonary embolism and venous thromboembolism (identified by linkage to the Swedish national patient register) during the whole pregnancy and by trimester. Venous thromboembolism occurred in 4.2/1000 women (n=99) after in vitro fertilisation compared with 2.5/1000 (n=291) in women with natural pregnancies (hazard ratio 1.77, 95% confidence interval 1.41 to 2.23). The risk of venous thromboembolism was increased during the whole pregnancy (Pfertilisation versus 0.3/1000 (hazard ratio 4.22, 2.46 to 7.26). The proportion of women experiencing pulmonary embolism during the first trimester was 3.0/10,000 after in vitro fertilisation versus 0.4/10,000 (hazard ratio 6.97, 2.21 to 21.96). In vitro fertilisation is associated with an increased risk of pulmonary embolism and venous thromboembolism during the first trimester. The risk of pulmonary embolism is low in absolute terms but because the condition is a leading cause of maternal mortality and clinical suspicion is critical for diagnosis, an awareness of this risk is important. ClinicalTrials.gov NCT01524393.

  18. Venous thromboembolic events in isolated severe traumatic brain injury

    Directory of Open Access Journals (Sweden)

    Shahin Mohseni

    2012-01-01

    Full Text Available Objective: The purpose of this study was to investigate the effect of prophylactic anticoagulation on the incidence of venous thromboembolic events (VTE in patients suffering from isolated severe traumatic brain injury (TBI. Materials and Methods: Retrospective matched case-control study in adult patients sustaining isolated severe TBI (head AIS ≥3, with extracranial AIS ≤2 receiving VTE prophylaxis while in the surgical intensive care unit from 1/2007 through 12/2009. Patients subjected to VTE prophylaxis were matched 1:1 by age, gender, glasgow coma scale (GCS score at admission, presence of hypotension on admission, injury severity score, and head abbreviated injury scale (AIS score, with patients who did not receive chemical VTE prophylaxis. The primary outcome measure was VTE. Secondary outcomes were SICU and hospital length of stay (HLOS, adverse effects of anticoagulation, and mortality. Results: After propensity matching, 37 matched pairs were analysed. Cases and controls had similar demographics, injury characteristics, rate of craniotomies/craniectomies, SICU LOS, and HLOS. The median time of commencement of VTE prophylaxis was 10 days. The incidence of VTE was increased 3.5-fold in the controls compared to the cases (95% CI 1.0-12.1, P=0.002. The mortality was higher in patients who did not receive anticoagulation (19% vs. 5%, P=0.001. No adverse outcomes were detected in the anticoagulated patients. Conclusion: Prophylactic anticoagulation decreases the overall risk for clinically significant VTE in patients with severe isolated TBI. Prospective validation of the timing and safety of chemical VTE prophylaxis in these instances is warranted.

  19. Venous thromboembolic events in isolated severe traumatic brain injury.

    Science.gov (United States)

    Mohseni, Shahin; Talving, Peep; Lam, Lydia; Chan, Linda S; Ives, Crystal; Demetriades, Demetrios

    2012-01-01

    The purpose of this study was to investigate the effect of prophylactic anticoagulation on the incidence of venous thromboembolic events (VTE) in patients suffering from isolated severe traumatic brain injury (TBI). Retrospective matched case-control study in adult patients sustaining isolated severe TBI (head AIS ≥3, with extracranial AIS ≤2) receiving VTE prophylaxis while in the surgical intensive care unit from 1/2007 through 12/2009. Patients subjected to VTE prophylaxis were matched 1:1 by age, gender, glasgow coma scale (GCS) score at admission, presence of hypotension on admission, injury severity score, and head abbreviated injury scale (AIS) score, with patients who did not receive chemical VTE prophylaxis. The primary outcome measure was VTE. Secondary outcomes were SICU and hospital length of stay (HLOS), adverse effects of anticoagulation, and mortality. After propensity matching, 37 matched pairs were analysed. Cases and controls had similar demographics, injury characteristics, rate of craniotomies/craniectomies, SICU LOS, and HLOS. The median time of commencement of VTE prophylaxis was 10 days. The incidence of VTE was increased 3.5-fold in the controls compared to the cases (95% CI 1.0-12.1, P=0.002). The mortality was higher in patients who did not receive anticoagulation (19% vs. 5%, P=0.001). No adverse outcomes were detected in the anticoagulated patients. Prophylactic anticoagulation decreases the overall risk for clinically significant VTE in patients with severe isolated TBI. Prospective validation of the timing and safety of chemical VTE prophylaxis in these instances is warranted.

  20. Evaluation of an institutional project to improve venous thromboembolism prevention.

    Science.gov (United States)

    Minami, Christina A; Yang, Anthony D; Ju, Mila; Culver, Eckford; Seifert, Kathryn; Kreutzer, Lindsey; Halverson, Terri; O'Leary, Kevin J; Bilimoria, Karl Y

    2016-12-01

    Northwestern Memorial Hospital (NMH) was historically a poor performer on the venous thromboembolism (VTE) outcome measure. As this measure has been shown to be flawed by surveillance bias, NMH embraced process-of-care measures to ensure appropriate VTE prophylaxis to assess healthcare-associated VTE prevention efforts. To evaluate the impact of an institution-wide project aimed at improving hospital performance on VTE prophylaxis measures. A retrospective observational study. NMH, an 885-bed academic medical center in Chicago, Illinois PATIENTS: Inpatients admitted to NMH from January 1, 2013 to May 1, 2013 and from October 1, 2014 to April 1, 2015 were eligible for evaluation. Using the define-measure-analyze-improve-control (DMAIC) process-improvement methodology, a multidisciplinary team implemented and iteratively improved 15 data-driven interventions in 4 broad areas: (1) electronic medical record (EMR) alerts, (2) education initiatives, (3) new EMR order sets, and (4) other EMR changes. The Joint Commission's 6 core measures and the Surgical Care Improvement Project (SCIP) SCIP-VTE-2 measure. Based on 3103 observations (1679 from January 1, 2013 to May 1, 2013, and 1424 from October 1, 2014 to April 1, 2015), performance on the core measures improved. Performance on measure 1 (chemoprophylaxis) improved from 82.5% to 90.2% on medicine services, and from 94.4% to 97.6% on surgical services. The largest improvements were seen in measure 4 (platelet monitoring), with a performance increase from 76.7% adherence to 100%, and measure 5 (warfarin discharge instructions), with a performance increase from 27.4% to 88.8%. A systematic hospital-wide DMAIC project improved VTE prophylaxis measure performance. Sustained performance has been observed, and novel control mechanisms for continued performance surveillance have been embedded in the hospital system. Journal of Hospital Medicine 2016;11:S29-S37. © 2016 Society of Hospital Medicine. © 2016 Society of Hospital

  1. Thromboembolism as an important complication of inflammatory bowel disease.

    Science.gov (United States)

    Bollen, Lize; Vande Casteele, Niels; Ballet, Vera; van Assche, Gert; Ferrante, Marc; Vermeire, Séverine; Gils, Ann

    2016-01-01

    Patients with inflammatory bowel disease (IBD) have a higher risk of developing thromboembolic events (TE) compared with the healthy population. This study aimed to describe a cohort of IBD patients with a history of TE focusing on recurrence of TE, disease activity and IBD medication at the time of TE and surgery before TE. In a retrospective monocentric cohort study, we included IBD patients in whom an arterial and/or venous TE occurred. Eighty-four IBD patients with a history of TE (63% Crohn's disease, 44% men) and a mean age of 45±15 years were included; 25/84 patients (30%) were identified to have recurrent TE. Seventy out of 84 (83%) developed a venous TE, with a deep vein thrombosis as the major manifestation (28/70, 40%), followed by a pulmonary embolism (16/70, 23%). At the time of TE, 60/84 (71%) patients were diagnosed with active disease. In all, 23% patients were on 5-aminosalicylic acids, 36% on steroids, 18% on azathioprine, 5% on methotrexate, 12% on biologicals and 23% were not receiving specific IBD treatment. Moreover, within a 6-month period preceding the TE, 28/84 (33%) patients underwent surgery, of whom 17% received thromboprophylaxis at hospital discharge. We confirm the association between disease activity and the occurrence of TE. A substantial number of patients had additional risk factors such as recurrence of TE. In all, 36% received steroids at the time of TE and 33% underwent recent surgery, of whom only a minority received thromboprophylaxis at hospital discharge. Further efforts are required to increase thromboprophylaxis in at-risk patients.

  2. Thrombin-Activatable Fibrinolysis Inhibitor in Chronic Thromboembolic Pulmonary Hypertension.

    Science.gov (United States)

    Yaoita, Nobuhiro; Satoh, Kimio; Satoh, Taijyu; Sugimura, Koichiro; Tatebe, Shunsuke; Yamamoto, Saori; Aoki, Tatsuo; Miura, Masanobu; Miyata, Satoshi; Kawamura, Takeshi; Horiuchi, Hisanori; Fukumoto, Yoshihiro; Shimokawa, Hiroaki

    2016-06-01

    The pathogenesis of chronic thromboembolic pulmonary hypertension (CTEPH) remains to be elucidated. Thrombin-activatable fibrinolysis inhibitor (TAFI) inhibits fibrinolysis. It remains to be elucidated whether TAFI is directly involved in the pathogenesis of CTEPH. We examined potential involvement of TAFI in the pathogenesis of CTEPH in humans. We enrolled 68 consecutive patients undergoing right heart catheterization in our hospital, including those with CTEPH (n=27), those with pulmonary arterial hypertension (n=22), and controls (non-pulmonary hypertension, n=19). Whole blood clot lysis assay showed that the extent of clot remaining after 4 hours was significantly higher in CTEPH compared with pulmonary arterial hypertension or controls (41.9 versus 26.5 and 24.6%, both P<0.01). Moreover, plasma levels of TAFI were significantly higher in CTEPH than in pulmonary arterial hypertension or controls (19.4±4.2 versus 16.1±4.5 or 16.3±3.3 μg/mL, both P<0.05), which remained unchanged even after hemodynamic improvement by percutaneous transluminal pulmonary angioplasty. Furthermore, the extent of clot remaining after 4 hours was significantly improved with CPI-2KR (an inhibitor of activated TAFI) or prostaglandin E1 (an inhibitor of activation of platelets). Importantly, plasma levels of TAFI were significantly correlated with the extent of clot remaining after 4 hours. In addition, the extent of clot remaining after 4 hours was improved with an activated TAFI inhibitor. These results indicate that plasma levels of TAFI are elevated in patients with CTEPH and are correlated with resistance to clot lysis in those patients. © 2016 American Heart Association, Inc.

  3. SEPSIS-ASSOCIATED DISSEMINATED INTRAVASCULAR COAGULATION AND THROMBOEMBOLIC DISEASE

    Directory of Open Access Journals (Sweden)

    Nicola Semeraro

    2010-08-01

    Full Text Available Sepsis is almost invariably associated with haemostatic abnormalities ranging from subclinical activation of blood coagulation (hypercoagulability, which may contribute to localized venous thromboembolism, to acute disseminated intravascular coagulation (DIC, characterized by massive thrombin formation and widespread microvascular thrombosis, partly responsible of the multiple organ dysfunction syndrome (MODS, and subsequent consumption of platelets and coagulation proteins causing, in most severe cases, bleeding manifestations. There is general agreement that the key event underlying this life-threatening sepsis complication is the overwhelming inflammatory host response to the infectious agent leading to the overexpression of inflammatory mediators. Mechanistically, the latter, together with the micro-organism and its derivatives, causes DIC by 1 up-regulation of procoagulant molecules, primarily tissue factor (TF, which is produced mainly by stimulated monocytes-macrophages and by specific cells in target tissues; 2 impairment of physiological anticoagulant pathways (antithrombin, protein C pathway, tissue factor pathway inhibitor, which is orchestrated mainly by dysfunctional endothelial cells (ECs; and 3 suppression of fibrinolysis due to increased plasminogen activator inhibitor-1 (PAI-1 by ECs and likely also to thrombin-mediated  activation of thrombin-activatable fibrinolysis inhibitor (TAFI. Notably, clotting enzymes non only lead to microvascular thrombosis but can also elicit cellular responses that amplify the inflammatory reactions. Inflammatory mediators can also cause, directly or indirectly, cell apoptosis or necrosis and recent evidence indicates that products released from dead cells, such as nuclear proteins (particularly extracellular histones, are able to propagate further inflammation, coagulation, cell death and MODS. These insights into the pathogenetic mechanisms of DIC and MODS may have important implications for the

  4. Epidemiology of venous thromboembolism in the Framingham Heart Study.

    Science.gov (United States)

    Puurunen, Marja K; Gona, Philimon N; Larson, Martin G; Murabito, Joanne M; Magnani, Jared W; O'Donnell, Christopher J

    2016-09-01

    Reports of the crude incidence of venous thromboembolism (VTE) in Western countries vary widely. Data regarding risk factors, incidence and recurrence of VTE from deeply-phenotyped community-based cohort studies are needed. To study the incidence, associated mortality, and predisposing factors of VTE in the prospective, longitudinal community-based Framingham Heart Study. The study sample consisted of the Framingham Heart Study Original, Offspring, Third Generation, and Omni cohorts (N=9754). Incidence rates (IR) were standardized to the 2000 US population. Cox proportional hazards regression models were used to study risk factor associations. During 1995-2014 (total follow-up time 104,091 person-years [median 9.8 (range 0-20) years]), 297 incident VTE events were observed. Age-adjusted IR of VTE was 20.3/10,000 (95% CI 17.9-22.6). Of the events 120 (40%) were pulmonary embolism (PE) and 177 (60%) were deep venous thrombosis (DVT); 29% were unprovoked, 40% provoked, and 31% cancer-related. Cancer-related VTE was associated with high mortality at 30days (24.2%), 1year (66.3%), and 5years (75.6%). In multivariable models, age and obesity, but no other traditional cardiovascular risk factors, were significantly associated with VTE (hazard ratio [HR] per 10-year increase in age 1.69, 95% CI 1.48-1.92; HR for obesity (BMI≥30kg/m(2)) 1.88, 95% CI 1.44-2.45). We provide data on the epidemiology of VTE. VTE is associated with significant mortality, and prognosis after cancer-related VTE is particularly poor. Traditional cardiovascular risk factors beyond age and obesity are not associated with VTE. Published by Elsevier Ltd.

  5. Predicting perioperative venous thromboembolism in Japanese gynecological patients.

    Directory of Open Access Journals (Sweden)

    Masae Ikeda

    Full Text Available OBJECTIVE: To develop a convenient screening method that can predict perioperative venous thromboembolism (VTE and identify patients at risk of fatal perioperative pulmonary embolism (PE. METHODS: Patients hospitalized for gynecological abdominal surgery (n = 183 underwent hematology tests and multidetector computed tomography (MDCT to detect VTE. All statistical analyses were carried out using the SPSS software program (PASWV19.0J. RESULTS: The following risk factors for VTE were identified by univariate analysis: plasmin-alpha2-plasmin inhibitor complex (PIC, thrombin-antithrombin III complex (TAT, and prolonged immobility (all p<0.001; age, neoadjuvant chemotherapy (NAC, malignancy, hypertension, past history of VTE, and hormone therapy (all p<0.01; and hemoglobin, transverse tumor diameter, ovarian disease, and menopause (all p<0.05. Multivariate analysis using these factors revealed that PIC, age, and transverse tumor diameter were significant independent determinants of the risk of VTE. We then calculated the incidence rate of perioperative VTE using PIC and transverse tumor diameter in patient groups stratified by age. In patients aged ≤40 years, PIC ≥1.3 µg/mL and a transverse tumor diameter ≥10 cm identified the high-risk group for VTE with an accuracy of 93.6%. For patients in their 50 s, PIC ≥1.3 µg/mL identified a high risk of VTE with an accuracy of 78.2%. In patients aged ≥60 years, a transverse tumor diameter ≥15 cm (irrespective of PIC or PIC ≥1.3 µg/mL identified the high-risk group with an accuracy of 82.4%. CONCLUSIONS: We propose new screening criteria for VTE risk that are based on PIC, transverse tumor diameter, and age. Our findings suggest the usefulness of these criteria for predicting the risk of perioperative VTE and for identifying patients with a high risk of fatal perioperative PE.

  6. Cancer-associated venous thromboembolism: Burden, mechanisms, and management.

    Science.gov (United States)

    Ay, Cihan; Pabinger, Ingrid; Cohen, Alexander T

    2017-01-26

    Venous thromboembolism (VTE) is a significant health problem in the general population but especially in cancer patients. In this review, we discuss the epidemiology and burden of the disease, the pathophysiology of cancer-associated VTE, and the clinical treatment options for both primary prevention and acute treatment. Overall, the development of VTE in cancer patients is related to increases in morbidity, mortality, and medical costs. However, the incidence of cancer-associated VTE varies due to patient-related factors (e.g. thrombophilia, comorbidities, performance status, history of venous diseases), tumour-related factors (e.g. cancer site, stage, grade), and treatment-related factors (e.g. surgery, chemotherapy, anti-angiogenesis treatment, hormonal and supportive treatment). Furthermore, blood count parameters (e.g. platelets and leukocytes) and biomarkers (e.g. soluble P-selectin and D-dimer) are predictive markers for the risk of VTE in cancer patients and have been used to enhance risk stratification. Evidence suggests that cancer itself is associated with a state of hypercoagulability, driven in part by the release of procoagulant factors, such as tissue factor, from malignant tissue as well as by inflammation-driven activation of endothelial cells, platelets, and leukocytes. In general, low-molecular-weight heparin (LWMH) monotherapy is the standard of care for the management of cancer-associated VTE, as vitamin K antagonists are less effective in cancer patients. Direct oral anticoagulants (DOACs) offer a potentially promising treatment option for cancer patients with VTE, but recommendations concerning the routine use of DOACs should await head-to-head studies with LMWH.

  7. Venous thromboembolism in centenarians: Findings from the RIETE registry.

    Science.gov (United States)

    Lacruz, Beatriz; Tiberio, Gregorio; Núñez, Manuel Jesús; López-Jiménez, Luciano; Riera-Mestre, Antoni; Tiraferri, Eros; Verhamme, Peter; Mazzolai, Lucia; González, José; Monreal, Manuel

    2016-12-01

    The balance between the efficacy and safety of anticoagulant therapy in patients aged ≥100years receiving anticoagulant therapy for venous thromboembolism (VTE) is uncertain. We used data from the RIETE (Registro Informatizado Enfermedad TromboEmbólica) database to assess the rate of VTE recurrences, bleeding events, and mortality appearing during the course of anticoagulant therapy in VTE patients aged ≥100years. Of 61,173 patients enrolled in RIETE as of January 2016, 47 (0.08%) were aged ≥100years. Of these, 10 (21%) were men, 21 (45%) presented with pulmonary embolism (PE), and 26 with deep vein thrombosis alone. Overall, 35 patients (74%) had severe renal insufficiency, 14 (30%) chronic heart failure, 30 (64%) anemia, 16 (34%) were taking antiplatelets, and 6 (13%) corticosteroids or non-steroidal anti-inflammatory drugs. Most patients (95%) were treated initially with low-molecular-weight heparin (LMWH) (mean daily dose, 168±42IU/kg). Then, 14 (30%) switched to vitamin K antagonists and 29 (62%) kept receiving long-term LMWH therapy (mean, 148±51IU/kg/day). During the course of anticoagulant therapy (mean duration, 139days), mortality was high (15/47; 32%). Two patients died of PE (initial PE one, recurrent PE one) and 5 (11%) had minor bleeding, but no major bleeding was reported. Among patients with acute VTE aged ≥100years, the risk of VTE recurrences during the course of anticoagulation outweighed the risk of bleeding. Our data suggest the use of standard anticoagulant therapy in this patient population, even if they have severe renal insufficiency. Copyright © 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

  8. Mandatory Risk Assessment Reduces Venous Thromboembolism in Bariatric Surgery Patients.

    Science.gov (United States)

    Nimeri, Abdelrahman A; Bautista, Jejomar; Ibrahim, Maha; Philip, Ruby; Al Shaban, Talat; Maasher, Ahmed; Altinoz, Ajda

    2018-02-01

    Bariatric surgery patients are at high risk for venous thromboembolism (VTE), and chemoprophylaxis is recommended. Sheikh Khalifa Medical City (SKMC) is an American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) member since 2009. We report the rates of VTE in bariatric surgery patients from 2010 to 2016 compared to ACS NSQIP bariatric surgery programs before and after switching from heparin to low molecular weight heparin (LMWH), initiating mandatory risk assessment using Caprini scoring for VTE and adopting an aggressive strategy for high-risk patients regarding dosage of LMWH and chemoprophylaxis after discharge. During the study period, there were 1152 cases (laparoscopic Roux-en-Y gastric bypass (LRYGB) 625 and laparoscopic sleeve gastrectomy (LSG) 527) at Bariatric & Metabolic Institute (BMI) Abu Dhabi compared to 65,693 cases (LRYGB 32,130 and LSG 33,563) at ACS NSQIP bariatric surgery programs. VTE rates remained stable at ACS NSQIP bariatric surgery programs from 2010 to 2016 (0.45, 0.45, 0.45, 0.25, 0.35, 0.3, and 0.3%). In contrast, VTE rates at BMI Abu Dhabi decreased from 2.2% in 2011 to 0.35% after we adopted an aggressive strategy to VTE without an increase in bleeding complications. LRYGB patients with VTE had higher OR time, leak, collection, and mortality at ACS NSQIP hospitals compared to those at BMI Abu Dhabi. In contrast, rates were similar in LSG patients with VTE. Changing our approach to VTE management led our VTE rates to decrease and become like those of ACS NSQIP bariatric surgery patients in LSG and LRYGB.

  9. A Stroke of Language

    Science.gov (United States)

    Blaisdell, Bob

    2011-01-01

    The author reflects on foreign-language learning by his EFL students as well as his own foreign-language learning. He concludes by musing on the possible and fantastical devastation on language-ability wrought by strokes.

  10. Cost of stroke

    DEFF Research Database (Denmark)

    Jennum, Poul; Iversen, Helle K; Ibsen, Rikke

    2015-01-01

    BACKGROUND: To estimate the direct and indirect costs of stroke in patients and their partners. DESCRIPTION: Direct and indirect costs were calculated using records from the Danish National Patient Registry from 93,047 ischemic, 26,012 hemorrhagic and 128,824 unspecified stroke patients...... and compared with 364,433, 103,741 and 500,490 matched controls, respectively. RESULTS: Independent of age and gender, stroke patients had significantly higher rates of mortality, health-related contacts, medication use and lower employment, lower income and higher social-transfer payments than controls....... The attributable cost of direct net health care costs after the stroke (general practitioner services, hospital services, and medication) and indirect costs (loss of labor market income) were €10,720, €8,205 and €7,377 for patients, and €989, €1,544 and €1.645 for their partners, over and above that of controls...

  11. Post-Stroke Rehabilitation

    Science.gov (United States)

    ... psychological trauma of stroke. Some emotional disturbances and personality changes are caused by the physical effects of brain damage. Clinical depression, which is a sense of hopelessness that disrupts an individual's ability to function, appears to be the emotional ...

  12. Epilepsy after stroke

    DEFF Research Database (Denmark)

    Olsen, T S; Høgenhaven, H; Thage, O

    1987-01-01

    Development of epilepsy was studied prospectively in a group of 77 consecutive stroke patients. Included were stroke patients less than 75 years old admitted within the first 3 days after the stroke. Excluded were patients with subarachnoid hemorrhage, vertebrobasilar stroke, and patients...... with other severe diseases. Cerebral angiography, CT, and EEG were performed in all patients. The patients were followed clinically for 2 to 4 years. Seven patients (9%) developed epilepsy. Of 23 patients with lesions involving the cortex, 6 (26%) developed epilepsy. Of 54 patients in whom the cortex...... was not involved, only 1 (2%) developed epilepsy. Patients with persisting paresis and cortical involvement seem to be at particularly high risk of developing epilepsy, as 50% of such patients (6 of 12) developed the disease....

  13. Stroke Connection Magazine

    Science.gov (United States)

    ... on stroke rehab, we offer guidance for the decision-making process required when it’s time to ... we want to alleviate some of the mystery, fear and anxiety around the inpatient rehab part of ...

  14. Neuropsychology of acute stroke.

    Science.gov (United States)

    Sinanović, Osman

    2010-06-01

    Neuropsychology includes both the psychiatric manifestations of neurological illness (primary brain-based disorders) and neurobiology of "idiopathic" psychiatric disorders. Neurological primary brain disorders provoke broad spectrum of brain pathophysiology that cause deficit sin human behaviour, and the magnitude of neurobehavioral-related problems is a world wide health concern. Speech disorders of aphasic type, unilateral neglect, anosognosia (deficit disorders), delirium and mood disorders (productive disorders) in urgent neurology, first of all in acute phase of stroke are more frequent disorders then it verified in routine exam, not only in the developed and large neurological departments. Aphasia is common consequence of left hemispheric lesion and most common neuropsychological consequence of stroke, with prevalence of one third of all stroke patients in acute phase although exist reports on greater frequency. Unilateral neglect is a disorder that mostly effects the patient after the lesion of the right hemisphere, mostly caused by a cerebrovascular insult (infarct or haemorrhage affecting a large area - up to two thirds of the right hemisphere), and in general the left-side neglect is the most widespread neuropsychological deficit after the lesion of the right cerebral hemisphere. Reports on the incidence of visual neglect vary and they range from 13 to 85%. Anosognosia is on the second place as neuropsychological syndrome of stroke in right hemisphere, characterized by the denial of the motor, visual or cognitive deficit. This syndrome, defined as denial of hemiparesis or hemianopsia, is a common disorder verified in 17-28% of all patents with acute brain stoke. There are different reports on frequency of delirium in acute stroke, from 24 to 48%, and it is more frequent in hemorrhagic then ischemic stoke. Post stroke depression (PSD) is one of the more frequent consequences on the stroke, and the prevalence of PSD has ranged from 5 to 63% of patients in

  15. Towards evidence-based guidelines for the prevention of venous thromboembolism: systematic reviews of mechanical methods, oral anticoagulation, dextran and regional anaesthesia as thromboprophylaxis.

    Science.gov (United States)

    Roderick, P; Ferris, G; Wilson, K; Halls, H; Jackson, D; Collins, R; Baigent, C

    2005-12-01

    major bleeding. Dextran reduced the risk of DVT and of PVT by about half, again irrespective of the type of surgery, but too few studies had reported PE to provide reliable estimates of effect on this outcome. Dextran appeared to be less effective at preventing DVT than the heparin regimens studied. Dextran was associated with an increased risk of bleeding, but too few bleeds had occurred for the size of this excess risk to be estimated reliably. Compared with general anaesthesia, regional anaesthesia reduced the risk of DVT by about half, and this benefit appeared similar in each of the surgical settings studied. Regional anaesthesia was associated with less major bleeding than general anaesthesia. In the absence of a clear contraindication (such as severe peripheral arterial disease), patients undergoing a surgical procedure would be expected to derive net benefit from a mechanical compression method of thromboprophylaxis (such as graduated compression stockings), irrespective of their absolute risk of venous thromboembolism. Patients who are considered to be at particularly high risk of venous thromboembolism may also benefit from a pharmacological thromboprophylactic agent, but since oral anticoagulant and dextran regimens appear less effective at preventing DVT than standard low-dose unfractionated heparin or low molecular weight heparin regimens, they may be less suitable for patients at high risk of venous thromboembolism, even though they are associated with less bleeding. Whenever feasible, the use of regional anaesthesia as an alternative to general anaesthesia may also provide additional protection against venous thromboembolism. There is little information on the prevention of venous thromboembolism among high-risk medical patients (such as those with stroke), so further randomised trials in this area would be helpful.

  16. Mailuoning for acute ischaemic stroke.

    Science.gov (United States)

    Yang, Weimin; Shi, Zhaobo; Yang, Hong-Qi; Teng, Junfang; Zhao, Jun; Xiang, Guoliang

    2015-01-09

    Mailuoning is widely used in the treatment of acute ischaemic stroke in China. Animal experimental studies and clinical pharmacological research indicate that mailuoning might improve blood circulation, prevent ischaemic injury, and protect heart and brain tissue. This review was last published in 2009. As new data have become available, it is necessary to reassess the evidence from randomised controlled trials. To determine the effects and safety of mailuoning agents (injection or oral liquid) in the treatment of people with acute ischaemic stroke. We searched the Cochrane Stroke Group Trials Register (May 2014), the Cochrane Central Register of Controlled Trials (CENTRAL;2014, Issue 4), MEDLINE (1966 to May 2014), Embase (1980 to May 2014), AMED (1985 to May 2014), the Chinese Stroke Trials Register (June 2014), the China Biological Medicine Database (CBM-disc; 1979 to June 2014), China Science and Technology Journal database (CSTJ; 1979 to June 2014), Wanfang Data Chinese databases (1979 to June 2014), and the China National Knowledge Infrastructure (1979 to June 2014). We searched clinical trials and research registers, handsearched 10 Chinese journals including relevant conference proceedings, scanned reference lists, and contacted the pharmaceutical company that manufactures mailuoning. We also attempted to contact trial authors to obtain further data. Randomised controlled trials comparing mailuoning with placebo or mailuoning plus other treatment compared with that other treatment in people with acute ischaemic stroke. Two review authors independently selected trials for inclusion, assessed trial quality, and extracted data. We included 21 trials, involving 1746 participants, in this update; six trials were new. The included trials did not report the numbers of dead and dependent participants at the end of at least three months' follow-up. Of the 12 trials that reported adverse events, five events occurred in two trials. There was no significant difference

  17. Thromboembolic risk stratification of patients hospitalized with heart failure in sinus rhythm

    DEFF Research Database (Denmark)

    Wolsk, Emil; Lamberts, Morten; Hansen, Morten L

    2015-01-01

    AIMS: Patients with heart failure in sinus rhythm are at an increased risk of thromboembolic complications. So far, validated risk stratification tools are lacking for such patients, which makes the decision to initiate anti-thrombotic treatment difficult. METHODS AND RESULTS: We included 136......,545 patients admitted with heart failure in sinus rhythm from national registries from 1999 to 2012. Patients receiving oral anticoagulants were omitted from the study. First, we investigated if the CHA2DS2-VASc score could identify heart failure patients in sinus rhythm with high rates of thromboembolic...... with those with heart failure alone. The incidence rates of thromboembolism were clinically significant, averaging 6.0 (95% confidence interval 5.98-6.02) events per 100 patient years during the first year following diagnosis. Risk factors such as diabetes, age, vascular disease, and especially previous...

  18. Tromboembolia pulmonar após videoartroscopia de ombro Thromboembolic complication after arthroscopic shoulder surgery

    Directory of Open Access Journals (Sweden)

    Fabio Farina Dal Molin

    2010-06-01

    Full Text Available Embora fenômenos tromboembólicos sejam complicações frequentes em cirurgias dos membros inferiores, apenas dois relatos de casos de tromboembolia pulmonar após artroscopia de ombro são encontrados na literatura. É descrito o caso de uma paciente com 76 anos com embolia pulmonar bilateral após artroscopia cirúrgica do ombro. Não foram encontradas anormalidades vasculares e nenhuma origem do trombo foi detectada, ficando desconhecida a causa exata responsável pela tromboembolia.Though thromboembolisms are frequent complications of surgery of the lower extremities, only two cases of pulmonary thromboembolism after shoulder arthroscopy are found in the literature. We describe the case of a 76-year-old patient with pulmonary embolism in both lungs after shoulder arthroscopy. No vascular abnormalities nor the origin of the thrombus was detected. The etiology of the thromboembolism remains unknown.

  19. Risk Factors for Venous Thromboembolism in 1.3 Million Pregnancies

    DEFF Research Database (Denmark)

    Virkus, Rie Adser; Løkkegaard, Ellen; Lidegaard, Øjvind

    2014-01-01

    OBJECTIVE: To quantify risk factors for venous thromboembolism during pregnancy and the puerperal period. DESIGN: In a nationwide prospective cohort study we followed pregnant and puerperal women in Denmark from 1995 to 2009 for venous thromboembolism. Information on risk factors and confounders...... was retrieved from national registries. The diagnosis of venous thromboembolism was confirmed through medical charts. We calculated adjusted incidence rates per 10,000 women years and used Poisson regression to estimate effects during pregnancy and the puerperal period. RESULTS: We studied 1,297,037 pregnancies.......4-4.5)). The incidence rate among women with multiple pregnancies was 18.2/10,000 yr and 6.3/10,000 yr in singletons (adjusted rate ratio: 2.8 (1.9-4.2)). Increased risk was found with hospitalization during pregnancy or the puerperal period with incidence rates of 42.1/10.000 and 54.7/10.000, respectively, (rate ratios...

  20. Thromboembolic complications following aminocaproic acid use in patients with hematologic malignancies.

    Science.gov (United States)

    Juhl, Rebecca C; Roddy, Julianna V F; Wang, Tzu-Fei; Li, Junan; Elefritz, Jessica L

    2018-02-09

    Aminocaproic acid is frequently used in patients with hematologic malignancy that present with thrombocytopenia with or without hemorrhage. We conducted a retrospective study to evaluate the safety of aminocaproic acid in 109 patients with hematologic malignancies. Patients were included if aminocaproic acid had been administered for at least 24 hours for the prevention or treatment of thrombocytopenic hemorrhage. Our primary outcome was thromboembolic complications defined as arterial or venous thrombotic events objectively confirmed by imaging studies. Thromboembolic complications occurred in five patients (4.6%) and all were venous thromboses. Other than the underlying malignancy, these patients also had many concurrent risk factors including indwelling central venous catheters, which could have contributed to thromboses. In conclusion, in our population of patients with a variety of hematological malignancies, aminocaproic acid does not appear to be associated with a high incidence of thromboembolic complications.

  1. Post-stroke dyskinesias

    Directory of Open Access Journals (Sweden)

    Nakawah MO

    2016-11-01

    Full Text Available Mohammad Obadah Nakawah, Eugene C Lai Stanely H. Appel Department of Neurology, Houston Methodist Neurological Institute, Houston, TX, USA Abstract: Strokes, whether ischemic or hemorrhagic, are among the most common causes of secondary movement disorders in elderly patients. Stroke-related (vascular movement disorders, however, are uncommon complications of this relatively common disease. The spectrum of post-stroke movement disorders is broad and includes both hypo- and hyperkinetic syndromes. Post-stroke dyskinesias are involuntary hyperkinetic movements arising from cerebrovascular insults and often present with mixed phenotypes of hyperkinesia which can sometimes be difficult to classify. Nevertheless, identification of the most relevant motor phenotype, whenever possible, allows for a more specific phenomenological categorization of the dyskinesia and thus helps guide its treatment. Fortunately, post-stroke dyskinesias are usually self-limiting and resolve within 6 to 12 months of onset, but a short-term pharmacotherapy might sometimes be required for symptom control. Functional neurosurgical interventions targeting the motor thalamus or globus pallidus interna might be considered for patients with severe, disabling, and persistent dyskinesias (arbitrarily defined as duration longer than 12 months. Keywords: vascular dyskinesia, stroke, movement disorders

  2. Changes of resting cerebral activities in subacute ischemic stroke patients

    Directory of Open Access Journals (Sweden)

    Ping Wu

    2015-01-01

    Full Text Available This study aimed to detect the difference in resting cerebral activities between ischemic stroke patients and healthy participants, define the abnormal site, and provide new evidence for pathological mechanisms, clinical diagnosis, prognosis prediction and efficacy evaluation of ischemic stroke. At present, the majority of functional magnetic resonance imaging studies focus on the motor dysfunction and the acute stage of ischemic stroke. This study recruited 15 right-handed ischemic stroke patients at subacute stage (15 days to 11.5 weeks and 15 age-matched healthy participants. A resting-state functional magnetic resonance imaging scan was performed on each subject to detect cerebral activity. Regional homogeneity analysis was used to investigate the difference in cerebral activities between ischemic stroke patients and healthy participants. The results showed that the ischemic stroke patients had lower regional homogeneity in anterior cingulate and left cerebrum and higher regional homogeneity in cerebellum, left precuneus and left frontal lobe, compared with healthy participants. The experimental findings demonstrate that the areas in which regional homogeneity was different between ischemic stroke patients and healthy participants are in the cerebellum, left precuneus, left triangle inferior frontal gyrus, left inferior temporal gyrus and anterior cingulate. These locations, related to the motor, sensory and emotion areas, are likely potential targets for the neural regeneration of subacute ischemic stroke patients.

  3. Comparison of computed tomography pulmonary angiography and point-of-care tests for pulmonary thromboembolism diagnosis in dogs.

    Science.gov (United States)

    Goggs, R; Chan, D L; Benigni, L; Hirst, C; Kellett-Gregory, L; Fuentes, V L

    2014-04-01

    To evaluate the feasibility of CT pulmonary angiography for identification of naturally occurring pulmonary thromboembolism in dogs using predefined diagnostic criteria and to assess the ability of echocardiography, cardiac troponins, D-dimers and kaolin-activated thromboelastography to predict the presence of pulmonary thromboembolism in dogs. Twelve dogs with immune-mediated haemolytic anaemia and evidence of respiratory distress were prospectively evaluated. Dogs were sedated immediately before CT pulmonary angiography using intravenous butorphanol. Spiral CT pulmonary angiography was performed with a 16 detector-row CT scanner using a pressure injector to infuse contrast media through peripheral intravenous catheters. Pulmonary thromboembolism was diagnosed using predefined criteria. Contemporaneous tests included echocardiography, arterial blood gas analysis, kaolin-activated thromboelastography, D-dimers and cardiac troponins. Based on predefined criteria, four dogs were classified as pulmonary thromboembolism positive, three dogs were suspected to have pulmonary thromboembolism and the remaining five dogs had negative scans. The four dogs identified with pulmonary thromboembolism all had discrete filling defects in main or lobar pulmonary arteries. None of the contemporaneous tests was discriminant for pulmonary thromboembolism diagnosis, although the small sample size was limiting. CT pulmonary angiography can be successfully performed in dogs under sedation, even in at-risk patients with respiratory distress and can both confirm and rule out pulmonary thromboembolism in dogs. © 2014 British Small Animal Veterinary Association.

  4. Anemia predicts thromboembolic events, bleeding complications and mortality in patients with atrial fibrillation : insights from the RE-LY trial

    NARCIS (Netherlands)

    Westenbrink, B. D.; Alings, M.; Connolly, S. J.; Eikelboom, J.; Ezekowitz, M. D.; Oldgren, J.; Yang, S.; Pongue, J.; Yusuf, S.; Wallentin, L.; van Gilst, W. H.

    BackgroundAnemia may predispose to thromboembolic events or bleeding in anticoagulated patients with atrial fibrillation (AF). ObjectivesTo investigate whether anemia is associated with thromboembolic events and bleeding in patients with AF. Patients and methodsWe retrospectively analyzed the RE-LY

  5. Do physicians correctly calculate thromboembolic risk scores? A comparison of concordance between manual and computer-based calculation of CHADS2 and CHA2 DS2 -VASc scores.

    Science.gov (United States)

    Esteve-Pastor, M A; Marín, F; Bertomeu-Martinez, V; Roldán-Rabadán, I; Cequier-Fillat, Á; Badimon, L; Muñiz-García, J; Valdés, M; Anguita-Sánchez, M

    2016-05-01

    Clinical risk scores, CHADS2 and CHA2 DS2 -VASc scores, are the established tools for assessing stroke risk in patients with atrial fibrillation (AF). The aim of this study is to assess concordance between manual and computer-based calculation of CHADS2 and CHA2 DS2 -VASc scores, as well as to analyse the patient categories using CHADS2 and the potential improvement on stroke risk stratification with CHA2 DS2 -VASc score. We linked data from Atrial Fibrillation Spanish registry FANTASIIA. Between June 2013 and March 2014, 1318 consecutive outpatients were recruited. We explore the concordance between manual scoring and computer-based calculation. We compare the distribution of embolic risk of patients using both CHADS2 and CHA2 DS2 -VASc scores The mean age was 73.8 ± 9.4 years, and 758 (57.5%) were male. For CHADS2 score, concordance between manual scoring and computer-based calculation was 92.5%, whereas for CHA2 DS2 -VASc score was 96.4%. In CHADS2 score, 6.37% of patients with AF changed indication on antithrombotic therapy (3.49% of patients with no treatment changed to need antithrombotic treatment and 2.88% of patients otherwise). Using CHA2 DS2 -VASc score, only 0.45% of patients with AF needed to change in the recommendation of antithrombotic therapy. We have found a strong concordance between manual and computer-based score calculation of both CHADS2 and CHA2 DS2 -VASc risk scores with minimal changes in anticoagulation recommendations. The use of CHA2 DS2 -VASc score significantly improves classification of AF patients at low and intermediate risk of stroke into higher grade of thromboembolic score. Moreover, CHA2 DS2 -VASc score could identify 'truly low risk' patients compared with CHADS2 score. © 2016 Royal Australasian College of Physicians.

  6. Nursing care for stroke patients

    DEFF Research Database (Denmark)

    Tulek, Zeliha; Poulsen, Ingrid; Gillis, Katrin

    2017-01-01

    AIMS AND OBJECTIVES: To conduct a survey of the clinical nursing practice in European countries in accordance with the European Stroke Strategies (ESS) 2006, and to examine to what extent the ESS have been implemented in stroke care nursing in Europe. BACKGROUND: Stroke is a leading cause of death...... comprising 61 questions based on the ESS and scientific evidence in nursing practice was distributed to representatives of the European Association of Neuroscience Nurses, who sent the questionnaire to nurses active in stroke care. The questionnaire covered the following areas of stroke care: Organization...... of stroke services, Management of acute stroke and prevention including basic care and nursing, and Secondary prevention. RESULTS: Ninety-two nurses in stroke care in 11 European countries participated in the survey. Within the first 48 hours after stroke onset, 95% monitor patients regularly, 94% start...

  7. CHADS2 and CHA2DS2-VASc scores can predict thromboembolic events after supraventricular arrhythmia in the critically ill patients.

    Science.gov (United States)

    Champion, Sébastien; Lefort, Yannick; Gaüzère, Bernard-Alex; Drouet, Didier; Bouchet, Bruno Julien; Bossard, Guillaume; Djouhri, Sabina; Vandroux, David; Mayaram, Kushal; Mégarbane, Bruno

    2014-10-01

    Prediction of arterial thromboembolic events (ATEs) in relation to supraventricular arrhythmia (SVA) has been poorly investigated in the intensive care unit (ICU). We aimed at evaluating CHADS2 and CHA2DS2-VASc scores to predict SVA-related ATE in the ICU. We conducted a prospective observational study including all the patients except those in the postoperative course of cardiac surgery who presented SVA lasting 30 seconds or longer during their ICU stay. We looked for ATE during ICU stay, at the first and sixth month of follow-up after ICU discharge. During the 15-month study period, 108 (12.8%) of 846 ICU patients experienced SVA with 12 SVA-related ATE occurring 6 days (3; 13) (median, 10%-90% percentiles) after SVA onset. In our SVA patients, CHADS2 score was 2 (0; 5), and CHA2DS2-VASc score 3 (0; 7). Both CHADS2 (odds ratio (OR), 1.6 [1.1; 2.4]; P = .01) and CHA2DS2-VASc scores (OR, 1.4 [1.04; 1.8]; P = .03) were significantly associated with ATE onset. However, the most accurate threshold for predicting ATE was CHADS2 score of 4 or higher. Using a multivariate analysis, only patient's history of stroke was associated with ATE onset (OR, 9.2 [2.4; 35]; P = .001). CHADS2 and CHA2DS2-VASc scores are predictive of SVA-related thromboembolism in the critically ill patient. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. The methylenetetrahydrofolate reductase polymorphism (MTHFR c.677C>T) and elevated plasma homocysteine levels in a U.S. pediatric population with incident thromboembolism.

    Science.gov (United States)

    Joachim, Emily; Goldenberg, Neil A; Bernard, Timothy J; Armstrong-Wells, Jennifer; Stabler, Sally; Manco-Johnson, Marilyn J

    2013-08-01

    Elevated plasma homocysteine (tHcy) and the MTHFR c.677C>T variant have been postulated to increase the risk of venous thromboembolism (VTE), although mechanisms and implications to pediatrics remain incompletely understood. The objectives of this study were to determine the prevalences of elevated tHcy and MTHFR variant in a pediatric population with VTE or arterial ischemic stroke (AIS), and to determine associations with thrombus outcomes. Subjects were enrolled in an institution-based prospective cohort of children with VTE or AIS. Inclusion criteria consisted of objectively confirmed thrombus, ≤21years at diagnosis, tHcy measured and MTHFR c.677C>T mutation analysis. Clinical and laboratory data were collected. Frequencies for elevated tHcy and MTHFR variant were compared with NHANES values for healthy US children and also between study groups (VTE vs AIS, provoked vs idiopathic) and by age. The prevalences of hyperhomocysteinemia or MTHFR variant were not increased in comparison to NHANES. tHcy did not differ between those with wild-type MTHFR versus either c.677C>T heterozygotes or homozygotes. There was no association between tHcy or MTHFR variant and thrombus outcomes. In this cohort of US children with VTE or AIS, neither the prevalence of hyperhomocysteinemia nor that of MTHFR variant was increased relative to reference values, and adverse thrombus outcomes were not definitively associated with either. While it is important to consider that milder forms of pyridoxine-responsive classical homocystinuria will be detected only by tHcy, we suggest that routine testing of MTHFR c.677C>T genotype as part of a thrombophilia evaluation in children with incident thromboembolism is not warranted until larger studies have been performed in order to establish or refute a link between MTHFR and adverse outcomes. Copyright © 2013 Elsevier Ltd. All rights reserved.

  9. Family history of venous thromboembolism and risk of hospitalized thromboembolism in cancer patients: A nationwide family study.

    Science.gov (United States)

    Zöller, Bengt; Palmer, Karolina; Li, Xinjun; Sundquist, Jan; Sundquist, Kristina

    2015-09-01

    The importance of family history of venous thromboembolism (VTE) in cancer patients is unclear. We conducted a nationwide study to determine whether family history of VTE is a risk factor for hospitalized VTE in cancer patients. The Swedish Multi-Generation Register was linked to the Swedish Hospital Discharge Register and the Swedish Cancer Registry. Familial (sibling/parent history of VTE) hazard ratios (HRs) for VTE in 20 cancer types were determined by cause-specific Cox regression for 258877 cancer patients in 1987-2010 without previous VTE. Familial HRs were also determined in 7644203 individuals without cancer or VTE before 1987, with follow-up in 1987-2010. Significant familial HRs for VTE in cancer patients were observed for the following cancer types: cancers of the breast (HR=1.79), lung (HR=1.21), colon (HR=1.30), prostate (HR=1.46), testis (HR=2.02), nervous system (HR=1.31), stomach (HR=1.73), and rectum (HR=1.77), as well as melanoma (HR=1.71), non-Hodgkin lymphoma (HR=1.32), myeloma (HR=1.69), and leukemia (HR=1.44). In a time-dependent analysis the familial HRs for VTE were significant before diagnosis of cancer (p-values cancer the familial HRs VTE were weaker, with significant HRs for 12 cancer types. On an additive scale, the joint effect of cancer and family history was significantly increased compared to separate effects in four cancer types. However, for certain cancers the familial VTE cases were limited. Family history of VTE is a risk factor for VTE in several cancer types. However, familial factors are relatively more important in non-cancer than in cancer patients. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. The relationship between anemia and recurrence of ischemic stroke in patients with Trousseau's syndrome: A retrospective cross-sectional study

    Directory of Open Access Journals (Sweden)

    Mehmet Yigit

    2016-06-01

    Full Text Available Objectives: The relationship between cancer and thrombosis was first recognized by the French internist Armand Trousseau in 1865. Trousseau's syndrome is a spectrum of symptoms that result from recurrent thromboembolism associated with cancer or malignancy-related hypercoagulability. In this study, we investigated whether demographics, clinical features, or laboratory findings were able to predict recurrent stroke episodes in patients with Trousseau's syndrome. Methods: In total, 178 adult patients were enrolled in this retrospective cross-sectional study. All patients had been admitted to the emergency room of our hospital between January 2011 and September 2014 and were diagnosed with acute ischemic stroke. Patients were divided into two groups: patients with malignancy (Trousseau's syndrome, and patients without malignancy. Results: There were several significant differences between the laboratory results of the two patient groups. For patients with Trousseau's, the hemoglobin levels for those with one stroke was 12.29 ± 1.81, while those in patients who had experienced more than one stroke was 10.94 ± 2.14 (p = 0.004. Conclusions: Trousseau's syndrome is a cancer-associated coagulopathy associated with high morbidity and mortality rates. In this study, anemia was associated with increased stroke recurrence in patients with malignancy (Trousseau's syndrome. Keywords: Anemia, Ischemic stroke, Malignancy, Trousseau's syndrome

  11. CITICOLIN IN THE TREATMENT OF STROKE AND VASCULAR COGNITIVE DISORDERS

    Directory of Open Access Journals (Sweden)

    Vladimir Anatol'evich Parfenov

    2009-01-01

    Full Text Available Citicolin (ceraxon is used as a neuroprotector in the treatment of acute stroke and vascular cognitive disorders. Experimental animal studies have demonstrated that citicolin reduces the extent of cerebral infarct and increases the degree of functional recovery. A few clinical trials have provided evidence for the efficacy of intravenous or oral citicolin used within the first 24 hours of ischemic stroke or cerebral hemorrhage in recovery of neurological functions. Citicolin is effective in memory and behavioral disorders in elderly patients with chronic cerebrovascular diseases. The use of citicolin has been found to be safe in stroke and vascular cognitive disorders

  12. Risk factors for venous thromboembolism in 1.3 million pregnancies: a nationwide prospective cohort.

    Directory of Open Access Journals (Sweden)

    Rie Adser Virkus

    Full Text Available OBJECTIVE: To quantify risk factors for venous thromboembolism during pregnancy and the puerperal period. DESIGN: In a nationwide prospective cohort study we followed pregnant and puerperal women in Denmark from 1995 to 2009 for venous thromboembolism. Information on risk factors and confounders was retrieved from national registries. The diagnosis of venous thromboembolism was confirmed through medical charts. We calculated adjusted incidence rates per 10,000 women years and used Poisson regression to estimate effects during pregnancy and the puerperal period. RESULTS: We studied 1,297,037 pregnancies and related puerperal periods, during which there were 748 venous thromboembolisms. The incidence rate for venous thromboembolism during a pregnancy with and without hospitalization for hyperemesis was 15.2/10,000 yr and 6.3/10,000 yr, respectively, (adjusted rate ratio: 2.5 (95%-confidence interval; 1.4-4.5. The incidence rate among women with multiple pregnancies was 18.2/10,000 yr and 6.3/10,000 yr in singletons (adjusted rate ratio: 2.8 (1.9-4.2. Increased risk was found with hospitalization during pregnancy or the puerperal period with incidence rates of 42.1/10.000 and 54.7/10.000, respectively, (rate ratios: 12.2 (8.7-17 and 5.9 (4.0-8.8. Women hospitalized with infections during pregnancy had incidence rates of 25.9/10,000 yr and 29.3/10,000 yr during pregnancy and the puerperal period, respectively, and of 62.7/10,000 yr if hospitalized with infection in the puerperal period. Puerperal venous thromboembolism was associated with hospitalization for preeclampsia and intrauterine growth restriction/fetal death with incidence rates of 45.8/10,000 yr and 18.3/10,000 yr, respectively (rate ratio: 5.0 (3.1-7.8 and 1.9 (0.9-4.4. Additionally puerperal venous thromboembolism was associated with obesity, elective and acute caesarean sections and major postpartum bleeding with incidence rates of 25.5/10,000 yr, 23.2/10,000 yr, 34.0/10,000 yr and 20

  13. Apolipoprotein(a) Kringle-IV Type 2 Copy Number Variation Is Associated with Venous Thromboembolism

    DEFF Research Database (Denmark)

    Sticchi, Elena; Magi, Alberto; Kamstrup, Pia R

    2016-01-01

    In addition to the established association between high lipoprotein(a) [Lp(a)] concentrations and coronary artery disease, an association between Lp(a) and venous thromboembolism (VTE) has also been described. Lp(a) is controlled by genetic variants in LPA gene, coding for apolipoprotein(a), incl......In addition to the established association between high lipoprotein(a) [Lp(a)] concentrations and coronary artery disease, an association between Lp(a) and venous thromboembolism (VTE) has also been described. Lp(a) is controlled by genetic variants in LPA gene, coding for apolipoprotein...

  14. Balloon pulmonary angioplasty: a treatment option for inoperable patients with chronic thromboembolic pulmonary hypertension

    Directory of Open Access Journals (Sweden)

    Aiko eOgawa

    2015-02-01

    Full Text Available In chronic thromboembolic pulmonary hypertension, stenoses or obstructions of the pulmonary arteries due to organized thrombi can cause an elevation in pulmonary artery resistance, which in turn can result in pulmonary hypertension. Chronic thromboembolic pulmonary hypertension can be cured surgically by pulmonary endarterectomy; however, patients deemed unsuitable for pulmonary endarterectomy due to lesion, advanced age, or comorbidities have a poor prognosis and limited treatment options. Recently, advances have been made in balloon pulmonary angioplasty for these patients, and this review highlights this recent progress.

  15. Effects of Music Therapy on Mood in Stroke Patients

    OpenAIRE

    Kim, Dong Soo; Park, Yoon Ghil; Choi, Jung Hwa; Im, Sang-Hee; Jung, Kang Jae; Cha, Young A; Jung, Chul Oh; Yoon, Yeo Hoon

    2011-01-01

    Purpose To investigate the effects of music therapy on depressive mood and anxiety in post-stroke patients and evaluate satisfaction levels of patients and caregivers. Materials and Methods Eighteen post-stroke patients, within six months of onset and mini mental status examination score of over 20, participated in this study. Patients were divided into music and control groups. The experimental group participated in the music therapy program for four weeks. Psychological status was evaluated...

  16. Symptomatic and Palliative Care for Stroke Survivors

    National Research Council Canada - National Science Library

    Creutzfeldt, Claire J; Holloway, Robert G; Walker, Melanie

    2012-01-01

    ... care needs of stroke survivors. Some of the most common and disabling post-stroke symptoms that are reviewed here include central post-stroke pain, hemiplegic shoulder pain, painful spasticity, fatigue, incontinence, post-stroke...

  17. Fibrinogen alpha and gamma genes and factor VLeiden in children with thromboembolism: results from 2 family-based association studies.

    Science.gov (United States)

    Nowak-Göttl, Ulrike; Weiler, Hartmut; Hernandez, Irene; Thedieck, Sabine; Seehafer, Tanja; Schulte, Thomas; Stoll, Monika

    2009-08-27

    Previous case-control studies showed that genetic variation in the fibrinogen gamma gene (FGG) increased the risk for deep vein thrombosis (VT) in adults. We investigated the association between the fibrinogen alpha (FGA) and FGG haplotypes, the factor V(Leiden)-mutation, and pediatric VT and thromboembolic stroke (TS) in 2 independent study samples. Association analysis revealed that the FGA-H1 and FGG-H2 haplotypes were significantly overtransmitted to VT patients (FGA-H1, P = .05; FGG: H2, P = .032). In contrast, the FGG-H3 haplotype was undertransmitted (P = .022). In an independent study sample, FGA-H1 (P = .008) and FGG-H2 (P = .05) were significantly associated with TS. The association of FGA and FGG haplotypes with VT was more pronounced in FV(Leiden)-negative families (FGA-H1, P = .001; FGG-H2, P = .001), indicating a genetic interaction between both risk factors. The risk-conferring FGG-H2 and the protective FGG-H3 haplotypes correlated with low (FGG-H2) and high (FGG-H3) levels of the gamma' chain variant, respectively. These results provide independent and novel evidence that FGA-H1 and FGG-H2 variants are associated with an increased risk of VT and TS in children. The observed negative correlation of genetic VT risk with the plasma levels of the fibrinogen gamma' variant suggests that FGG-H2 and -H3 haplotypes modify thrombosis risk by controlling the level of this FGG splice isoform.

  18. Pathophysiology and Risk of Atrial Fibrillation Detected after Ischemic Stroke (PARADISE): A Translational, Integrated, and Transdisciplinary Approach.

    Science.gov (United States)

    Paquet, Maryse; Cerasuolo, Joshua O; Thorburn, Victoria; Fridman, Sebastian; Alsubaie, Rasha; Lopes, Renato D; Cipriano, Lauren E; Salamone, Paula; Melling, C W James; Khan, Ali R; Sedeño, Lucas; Fang, Jiming; Drangova, Maria; Montero-Odasso, Manuel; Mandzia, Jennifer; Khaw, Alexander V; Racosta, Juan M; Paturel, Justin; Samoilov, Lucy; Stirling, Devin; Balint, Brittany; Jaremek, Victoria; Koschinsky, Marlys L; Boffa, Michael B; Summers, Kelly; Ibañez, Agustín; Mrkobrada, Marko; Saposnik, Gustavo; Kimpinski, Kurt; Whitehead, Shawn N; Sposato, Luciano A

    2018-03-01

    It has been hypothesized that ischemic stroke can cause atrial fibrillation. By elucidating the mechanisms of neurogenically mediated paroxysmal atrial fibrillation, novel therapeutic strategies could be developed to prevent atrial fibrillation occurrence and perpetuation after stroke. This could result in fewer recurrent strokes and deaths, a reduction or delay in dementia onset, and in the lessening of the functional, structural, and metabolic consequences of atrial fibrillation on the heart. The Pathophysiology and Risk of Atrial Fibrillation Detected after Ischemic Stroke (PARADISE) study is an investigator-driven, translational, integrated, and transdisciplinary initiative. It comprises 3 complementary research streams that focus on atrial fibrillation detected after stroke: experimental, clinical, and epidemiological. The experimental stream will assess pre- and poststroke electrocardiographic, autonomic, anatomic (brain and heart pathology), and inflammatory trajectories in an animal model of selective insular cortex ischemic stroke. The clinical stream will prospectively investigate autonomic, inflammatory, and neurocognitive changes among patients diagnosed with atrial fibrillation detected after stroke by employing comprehensive and validated instruments. The epidemiological stream will focus on the demographics, clinical characteristics, and outcomes of atrial fibrillation detected after stroke at the population level by means of the Ontario Stroke Registry, a prospective clinical database that comprises over 23,000 patients with ischemic stroke. PARADISE is a translational research initiative comprising experimental, clinical, and epidemiological research aimed at characterizing clinical features, the pathophysiology, and outcomes of neurogenic atrial fibrillation detected after stroke. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  19. Venous thromboembolic prophylaxis after simultaneous bilateral total knee arthroplasty: aspirinversuswarfarin.

    Science.gov (United States)

    Goel, R; Fleischman, A N; Tan, T; Sterbis, E; Huang, R; Higuera, C; Parvizi, J; Rothman, R H

    2018-01-01

    The aims of this study were to compare the efficacy of two agents, aspirin and warfarin, for the prevention of venous thromboembolism (VTE) after simultaneous bilateral total knee arthroplasty (SBTKA), and to elucidate the risk of VTE conferred by this procedure compared with unilateral TKA (UTKA). A retrospective, multi-institutional study was conducted on 18 951 patients, 3685 who underwent SBTKA and 15 266 who underwent UTKA, using aspirin or warfarin as VTE prophylaxis. Each patient was assigned an individualised baseline VTE risk score based on a system using the Nationwide Inpatient Sample. Symptomatic VTE, including pulmonary embolism (PE) and deep vein thrombosis (DVT), were identified in the first 90 days post-operatively. Statistical analyses were performed with logistic regression accounting for baseline VTE risk. The adjusted incidence of PE following SBTKA was 1.0% (95% confidence interval (CI) 0.86 to 1.2) with aspirin and 2.2% (95% CI 2.0 to 2.4) with warfarin. Similarly, the adjusted incidence of VTE following SBTKA was 1.6% (95% CI 1.1 to 2.3) with aspirin and 2.5% (95% CI 1.9 to 3.3) with warfarin. The risk of PE and VTE were reduced by 66% (odds ratio (OR) 0.44, 95% CI 0.25 to 0.78) and 38% (OR 0.62, 95% CI 0.38 to 1.0), respectively, using aspirin. In addition, the risk of PE was 204% higher for patients undergoing SBTKA relative to those undergoing UTKA. For each ten-point increase in baseline VTE risk, the risk of PE increased by 25.5% for patients undergoing SBTKA compared with 10.5% for those undergoing UTKA. Patients with a history of myocardial infarction or peripheral vascular disease had the greatest increase in risk from undergoing SBTKA instead of UTKA. Aspirin is more effective than warfarin for the prevention of VTE following SBTKA, and serves as the more appropriate agent for VTE prophylaxis for patients in all risk categories. Furthermore, patients undergoing SBTKA are at a substantially increased risk of VTE, even more so for

  20. Aspirin for Prophylaxis Against Venous Thromboembolism After Orthopaedic Oncologic Surgery.

    Science.gov (United States)

    Mendez, Gregory M; Patel, Yash M; Ricketti, Daniel A; Gaughan, John P; Lackman, Richard D; Kim, Tae Won B

    2017-12-06

    Patients who undergo orthopaedic oncologic surgical procedures are at increased risk of developing a venous thromboembolism (VTE). Guidelines from surgical societies are shifting to include aspirin as a postoperative VTE prophylactic agent. The purpose of this study was to review our experience using aspirin as postoperative VTE prophylaxis for orthopaedic oncologic surgical procedures. This study was a retrospective review of patients diagnosed with a primary malignant soft-tissue or bone tumor or metastatic carcinoma. Demographic information, histopathologic diagnosis, VTE history, surgical procedure, and VTE prophylaxis were analyzed. VTE rates in the overall and prophylactic-specific cohorts were recorded and compared. A total of 142 distinct surgical procedures in 130 patients were included. VTE prophylaxis with aspirin was used after 103 procedures, and non-aspirin prophylaxis was used after 39. In 33 cases, imaging was used to investigate for VTE because of clinical signs and symptoms. VTE developed after 7 (4.9%) of the 142 procedures. There were 6 deep venous thromboses (DVTs) and 1 pulmonary embolism, and 2 of the VTEs presented in patients with a VTE history. VTE developed in 2.9% (3) of the 103 aspirin cases and 10.3% (4) of the 39 non-aspirin cases. No patient in the aspirin group who had been diagnosed with metastatic carcinoma, malignant soft-tissue sarcoma, lymphoma, or multiple myeloma developed a VTE. Risk factors for VTE development included diabetes mellitus (odds ratio [OR] = 10.40, 95% confidence interval [CI] = 1.61 to 67.30), a history of VTE (OR = 7.26, 95% CI = 1.19 to 44.25), postoperative transfusion (OR = 34.50, 95% CI = 3.94 to 302.01), and estimated blood losses of 250 mL (OR = 1.50, 95% CI = 1.11 to 2.03), 500 mL (OR = 2.26, 95% CI = 1.23 to 4.13), and 1,000 mL (OR = 5.10, 95% CI = 1.52 to 17.04). Aspirin may be a suitable and effective option for VTE chemoprophylaxis in patients treated with orthopaedic oncologic surgery, especially

  1. Diet as prophylaxis and treatment for venous thromboembolism?

    Directory of Open Access Journals (Sweden)

    Cundiff David K

    2010-08-01

    Full Text Available Abstract Background Both prophylaxis and treatment of venous thromboembolism (VTE: deep venous thrombosis (DVT and pulmonary emboli (PE with anticoagulants are associated with significant risks of major and fatal hemorrhage. Anticoagulation treatment of VTE has been the standard of care in the USA since before 1962 when the U.S. Food and Drug Administration began requiring randomized controlled clinical trials (RCTs showing efficacy, so efficacy trials were never required for FDA approval. In clinical trials of 'high VTE risk' surgical patients before the 1980s, anticoagulant prophylaxis was clearly beneficial (fatal pulmonary emboli (FPE without anticoagulants = 0.99%, FPE with anticoagulants = 0.31%. However, observational studies and RCTs of 'high VTE risk' surgical patients from the 1980s until 2010 show that FPE deaths without anticoagulants are about one-fourth the rate that occurs during prophylaxis with anticoagulants (FPE without anticoagulants = 0.023%, FPE while receiving anticoagulant prophylaxis = 0.10%. Additionally, an FPE rate of about 0.012% (35/28,400 in patients receiving prophylactic anticoagulants can be attributed to 'rebound hypercoagulation' in the two months after stopping anticoagulants. Alternatives to anticoagulant prophylaxis should be explored. Methods and Findings The literature concerning dietary influences on VTE incidence was reviewed. Hypotheses concerning the etiology of VTE were critiqued in relationship to the rationale for dietary versus anticoagulant approaches to prophylaxis and treatment. Epidemiological evidence suggests that a diet with ample fruits and vegetables and little meat may substantially reduce the risk of VTE; vegetarian, vegan, or Mediterranean diets favorably affect serum markers of hemostasis and inflammation. The valve cusp hypoxia hypothesis of DVT/VTE etiology is consistent with the development of VTE being affected directly or indirectly by diet. However, it is less consistent with

  2. "Pathophysiologic mapping" of venous thromboembolism: opportunities for radiolabeled peptides.

    Science.gov (United States)

    Bernarducci, M P

    2003-12-01

    The serious clinical and economic impact of venous thromboembolic (VTE) disease is undisputed. What concerns practitioners and researchers alike is the seeming inability to truly mitigate the ramifications of VTE. Ironically, the current approaches to the diagnostic evaluation of suspected VTE patients tends to favor the application of anatomic modalities, which by virtue of their principles of detection, seemingly ignore the extensive knowledge base of VTE pathophysiology and natural history. In other words, are we seeking the appropriate types of information in patients with suspected VTE? Research in nuclear medicine techniques for detecting VTE began approximately 25 years ago. Recently, the emergence of the radiolabeled peptides as a clinically applicable technology platform has encouraged a different way of evaluating VTE. Many radiolabeled peptide candidates are undergoing preclinical and clinical research. Currently, only one, (99m)Tc-apcitide (AcuTect), has been approved (since 1998) for clinical use, specifically in the United States. Its availability this time has fueled ongoing clinical research to further elucidate the benefits of this unique peptide technology. Consequently, significant insight has been gained from large prospective clinical trials. Furthermore, this insight has kindled increasing interest in (99m)Tc-apcitide and potential new entrants into this special "diagnostic class". Unlike the more popular modalities, radiolabeled peptides circumvent many of the clinical and anatomic challenges to objectively and accurately diagnosing VTE. The importance of an objective and accurate diagnosis is understood, because it is paramount to a cost-effective treatment strategy. In addition to describing the current activities concerning the development for and use of radiolabeled peptides for clinical practice, this manuscript is intended to promulgate a thought-provoking argument for changing our current approach to the diagnostic evaluation of VTE

  3. Mini-Stroke vs. Regular Stroke: What's the Difference?

    Science.gov (United States)

    ... How is a ministroke different from a regular stroke? Answers from Jerry W. Swanson, M.D. When ... brain, spinal cord or retina, which may cause stroke-like symptoms but does not damage brain cells ...

  4. Stroke doctors: Who are we? A World Stroke Organization survey.

    Science.gov (United States)

    Meretoja, Atte; Acciarresi, Monica; Akinyemi, Rufus O; Campbell, Bruce; Dowlatshahi, Dar; English, Coralie; Henninger, Nils; Poppe, Alexandre; Putaala, Jukka; Saini, Monica; Sato, Shoichiro; Wu, Bo; Brainin, Michael; Norrving, Bo; Davis, Stephen

    2017-10-01

    Background Specialist training provides skilled workforce for service delivery. Stroke medicine has evolved rapidly in the past years. No prior information exists on background or training of stroke doctors globally. Aims To describe the specialties that represent stroke doctors, their training requirements, and the scientific organizations ensuring continuous medical education. Methods The World Stroke Organization conducted an expert survey between June and November 2014 using e-mailed questionnaires. All Organization for Economic Co-operation and Development countries with >1 million population and other countries with >50 million population were included ( n = 49, total 5.6 billion inhabitants, 85% of global strokes). Two stroke experts from each selected country were surveyed, discrepancies resolved, and further information on identified stroke-specific curricula sought. Results We received responses from 48 (98%) countries. Of ischemic stroke patients, 64% were reportedly treated by neurologists, ranging from 5% in Ireland to 95% in the Netherlands. Per thousand annual strokes there were average six neurologists, ranging from 0.3 in Ethiopia to 33 in Israel. Of intracerebral hemorrhage patients, 29% were reportedly treated by neurosurgeons, ranging from 5% in Sweden to 79% in Japan, with three neurosurgeons per thousand strokes, ranging from 0.1 in Ethiopia to 24 in South Korea. Most countries had a stroke society (86%) while only 10 (21%) had a degree or subspecialty for stroke medicine. Conclusions Stroke doctor numbers, background specialties, and opportunities to specialize in stroke vary across the globe. Most countries have a scientific society to pursue advancement of stroke medicine, but few have stroke curricula.

  5. Child-Mediated Stroke Communication: findings from Hip Hop Stroke.

    Science.gov (United States)

    Williams, Olajide; DeSorbo, Alexandra; Noble, James; Gerin, William

    2012-01-01

    Low thrombolysis rates for acute ischemic stroke are linked to delays in seeking immediate treatment due to low public stroke awareness. We aimed to assess whether "Child-Mediated Stroke Communication" could improve stroke literacy of parents of children enrolled in a school-based stroke literacy program called Hip Hop Stroke. Parents of children aged 9 to 12 years from 2 public schools in Harlem, New York City, were recruited to participate in stroke literacy questionnaires before and after their child's participation in Hip Hop Stroke, a novel Child-Mediated Stroke Communication intervention delivered in school auditoriums. Parental recall of stroke information communicated through their child was assessed 1-week after the intervention. Fifth and sixth grade students (n=182) were enrolled into Hip Hop Stroke. One hundred two parents were approached in person to participate; 75 opted to participate and 71 completed both the pretest and post-test (74% response rate and 95% retention rate). Parental stroke literacy improved after the program; before the program, 3 parents of 75 (3.9%) were able to identify the 5 cardinal stroke symptoms, distracting symptom (chest pains), and had an urgent action plan (calling 911) compared with 21 of 71 parents (29.6%) postintervention (P<0.001). The FAST mnemonic was known by 2 (2.7%) of participants before the program versus 29 (41%) after program completion (P<0.001). Knowledge of stroke signs and symptoms remains low among residents of this high-risk population. The use of Child-Mediated Stroke Communication suggests that school children aged 9 to 12 years may be effective conduits of critical stroke knowledge to their parents.

  6. Atypical Presentation of Intracardiac Floating Thrombi in Hypereosinophilic Syndrome Complicated With Stroke and Systemic Embolization: A Case Report.

    Science.gov (United States)

    Lai, Chih-Hung; Chang, Szu-Ling; Lin, Wei-Wen; Hsiung, Ming-Chon; Juan, Yu-Hsiang; Wang, Tzu-Lin

    2015-10-01

    Hypereosinophilic syndrome (HES) describes a disorder characterized by persistent peripheral blood eosinophilia with evidence of multiple target organs damage caused by eosinophilia. HES most commonly involves the heart, and cardiac involvement typically presents in the form of endomyocarditis or myocarditis with apical mural thrombus formation.We present a case with atypical cardiac presentation with massive intracardiac fragile thrombi, causing peripheral emboli and strokes.HES can present as floating thrombi with thin attachment to the left ventricle, and clinicians should also be vigilant of thromboembolic complications and initiate early therapy to prevent or reduce the potential complications of HES.

  7. How to unfasten the Spanish Stroke Belt? Andalusia chooses research.

    Science.gov (United States)

    Montaner, J; Jiménez-Hernández, M D; López-Barneo, J

    2014-10-01

    Andalusia in southern Spain, one of the largest regions in the European Union, has made a profound economic and social transformation that has led to establishment of a modern universal public health care system. However, due to its high stroke mortality rates, Andalusia is still known as the 'Spanish Stroke Belt'. To fight these figures, successive initiatives culminated in the launch of the Andalusian Plan for Stroke Care, to be developed during the period of 2011 to 2014. In addition, involved professionals have hypothesized that clinical and experimental research may contribute to improving stroke care in our community. To that end, one of the leading institutes of biomedical research in Andalusia, the Institute of Biomedicine of Seville (IBiS), has selected stroke as a flagship project in the region. Moreover, Seville, the capital of Andalusia, is now conducting a fusion process of its two largest hospitals, with the potential to generate a stroke alliance that will make it one of the main stroke hospitals in Europe (>2000 cases per year). It is anticipated that this will be an excellent platform to facilitate acute-phase clinical trials and speed the translation process from basic research in IBiS laboratories to the clinical setting. Furthermore, the recently created Andalusian Neurovascular Group is ready to develop prospective, collaborative, multicenter research projects that will evaluate interventions in areas of stroke care uncertainty. If we succeed in forging a link between research and health care quality, we may succeed in lowering the incidence of stroke and related mortality in the region in a short period of time. © 2014 World Stroke Organization.

  8. Post-stroke depression among stroke survivors attending two ...

    African Journals Online (AJOL)

    African Health Sci

    . Stroke type. Ischemic stroke. 58 (79.5). Anatomical location of stroke. Right hemisphere. 33 (45.2). Left hemisphere. 36 (49.3). Both hemispheres. 4 (5.5). Dominant hemisphere lesion. 40 (54.8). Brain lobe involvement. Frontal lobe. 19 (26.0).

  9. Child-Mediated Stroke Communication: Findings from Hip Hop Stroke

    Science.gov (United States)

    Williams, Olajide; DeSorbo, Alexandra; Noble, James; Gerin, William

    2011-01-01

    Background and Purpose Low thrombolysis rates for acute ischemic stroke is linked to delays in seeking immediate treatment due to low public stroke awareness. We aimed to assess whether “Child-Mediated Stroke Communication” (CMSC) could improve stroke literacy parents of children enrolled in a school-based stroke literacy program called Hip Hop Stroke (HHS). Methods Parents of children aged 9 to 12 years from two public schools in Harlem, NYC, were recruited to participate in stroke literacy questionnaires before and after their child’s participation in HHS, a novel CMSC intervention delivered in school auditoriums. Parental recall of stroke information communicated through their child was assessed 1-week following the intervention. Results Fifth and Sixth grade students (n =182) were enrolled into HHS. 102 parents were approached in person to participate; 75 opted to participate and 71 completed both pretest and post-test (74% response rate and 95% retention rate). Parental stroke literacy improved after the program: before the program, 3 parents of 75 (3.9%) were able to identify the five cardinal stroke symptoms, distracting symptom (chest pains), and had an urgent action plan (calling 911), compared to 21 of 71 parents (29.6%) post-intervention (pstroke signs and symptoms remains low among residents of this high-risk population. The use of Child-Mediated Stroke Communication suggests that schoolchildren aged 9-12 may be effective conduits of critical stroke knowledge to their Parents. PMID:22033995

  10. From stroke unit care to stroke care unit

    NARCIS (Netherlands)

    De Keyser, J; Sulter, G.

    1999-01-01

    In some stroke units continuous monitoring of blood pressure, electrocardiogram, body temperature, and oxygen saturation has become an integral part of the management of acute stroke. In addition, regular measurements of blood glucose are performed. Stroke units equipped with such monitoring

  11. Stroke risk factors among participants of a world stroke day ...

    African Journals Online (AJOL)

    2015-04-20

    Apr 20, 2015 ... Conclusion: Stroke risk factors such as hypertension and obesity were common among the participants of the world stroke day awareness program in an urban area of Nigeria. Community screening and modification of these risk factors should be intensified in order to reduce stroke morbidity and mortality.

  12. Improving Stroke Management through Specialized Stroke Units in ...

    African Journals Online (AJOL)

    Background: Stroke therapy is aimed at re-opening blocked arteries and increasing the survival of cells that are injured in addition to the early rehabilitation of the stroke patient. The establishment of stroke units has been found to improve the survival of patients and significantly reduce disability by rendering holistic care.

  13. Preventable Pediatric Stroke via Vaccination?

    Directory of Open Access Journals (Sweden)

    Craig A. Press

    2015-11-01

    Full Text Available Investigators from the Vascular Effects of Infection in Pediatric Stroke (VIPS group studied the risk of arterial ischemic stroke (AIS associated with minor infection and routine childhood vaccinations.

  14. Diabetes, Heart Disease, and Stroke

    Science.gov (United States)

    ... Disease, & Other Dental Problems Diabetes & Sexual & Urologic Problems Diabetes, Heart Disease, and Stroke Having diabetes means that ... help to stop. What is the link between diabetes, heart disease, and stroke? Over time, high blood ...

  15. Heart Disease and Stroke Statistics

    Science.gov (United States)

    ... Media for Heart.org Heart and Stroke Association Statistics Each year, the American Heart Association, in conjunction ... health and disease in the population. Heart & Stroke Statistics FAQs What is Prevalence? Prevalence is an estimate ...

  16. SAR: Stroke Authorship Recognition

    KAUST Repository

    Shaheen, Sara

    2015-10-15

    Are simple strokes unique to the artist or designer who renders them? If so, can this idea be used to identify authorship or to classify artistic drawings? Also, could training methods be devised to develop particular styles? To answer these questions, we propose the Stroke Authorship Recognition (SAR) approach, a novel method that distinguishes the authorship of 2D digitized drawings. SAR converts a drawing into a histogram of stroke attributes that is discriminative of authorship. We provide extensive classification experiments on a large variety of data sets, which validate SAR\\'s ability to distinguish unique authorship of artists and designers. We also demonstrate the usefulness of SAR in several applications including the detection of fraudulent sketches, the training and monitoring of artists in learning a particular new style and the first quantitative way to measure the quality of automatic sketch synthesis tools. © 2015 The Eurographics Association and John Wiley & Sons Ltd.

  17. Sleep apnoea and stroke.

    Science.gov (United States)

    Sharma, Sameer; Culebras, Antonio

    2016-12-01

    Sleep disorders have been known to physicians for a long time. In his famous aphorisms, Hippocrates said "Sleep or watchfulness exceeding that which is customary, augurs unfavorably". Modern medicine has been able to disentangle some of the phenomena that disturb sleep. Among the most notable offenders is sleep apnoea that has gained prominence in the past few decades. It is being proposed as one of the potentially modifiable risk factors for vascular diseases including stroke. The pathological mechanisms linking sleep apnoea to vascular risk factors include hypoxia, cardiac arrhythmias, dysautonomia, impaired glucose tolerance, hypertension, dyslipidaemia and inflammation. In this article, we review literature linking sleep apnoea and stroke, including sleep apnoea as a risk factor for primary prevention with the potential to improve outcome after acute stroke and as a secondary risk factor, amenable to modification and hence vascular risk reduction.

  18. Treatment of acute venous thromboembolism with dabigatran or warfarin and pooled analysis

    NARCIS (Netherlands)

    Schulman, Sam; Kakkar, Ajay K.; Goldhaber, Samuel Z.; Schellong, Sebastian; Eriksson, Henry; Mismetti, Patrick; Christiansen, Anita Vedel; Friedman, Jeffrey; Le Maulf, Florence; Peter, Nuala; Kearon, Clive; Schulman, S.; Eriksson, H.; Goldhaber, S.; Kakkar, A.; Kearon, C.; Mismetti, P.; Schellong, S.; Bergqvist, D.; Tijssen, J.; Prins, M. [=Martin H.; Robben, S.; Büller, H.; Otten, H. M.; Brandjes, D.; Peters, R.; Mac Gillavry, M. R.; Gan, E.; Salem, H.; Baker, R.; Blomberry, P.; Curnow, J.; Annichino-Bizzacch, J. M.; Brandao Panico, M. D.; Timi Ribas, J. R.; Fernandes Manenti, E. R.; Miranda, F.; Moraes, J.; Raev, D.; Mollov, M.; Peneva, M.; Milanov, S.; Anderson, D.; Crowther, M.; Dolan, S.; Eikelboom, J.; Game, M.; Kahn, S.; Kassis, J.; Ritchie, B.; Solymoss, S.; Rodger, M.; Yeo, E.; Milot, A.; Klinke, P.; Chen, W.; Zhihong, L.; Chunxue, B.; Jinming, L.; Jiwei, Z.; Jie, C.; Jina, K.; Yuqi, W.; Zhongqi, Y.; Hua, W.; Kejing, Y.; Bonan, L.; Yadong, Y.; Changwei, L.; Jin, Z.; Yongcheng, D.; Spinar, J.; Maly, R.; Cizek, V.; Bercikova, J.; Cervinka, P.; Lang, P.; Jirka, V.; Oral, I.; Reichert, P.; Kotik, L.; Pojsl, S.; Klimovic, T.; Husted, S.; Nielsen, H.; Friis, E.; Skødebjerg Kristensen, K.; Mottier, D.; El Kouri, D.; Bleher, Y.; Leroux, L.; Boda, Z.; Sereg, M.; Riba, M.; Hiremath, J. S.; Kareem, S.; Banker, D. N.; Gadkari, M.; Parakh, R.; Suresh, K. R.; Natarajan, S.; Jain, A.; Aggarwal, P. K.; Patil, C. B.; Durairaj, N.; Seshadri, R.; Thakore, V. M.; Rai, K. M.; Efrati, S.; Elias, M.; Gavish, D.; Grossman, M.; Lishner, M.; Lahavr, M.; Lugassy, G.; Nseir, W.; Zeltser, D.; Brenner, B.; Yeganeh, S.; Zanatta, N.; Pizzini, A. M.; Di Salvo, M.; Novo, S.; Arosio, E.; Campanini, M.; Castellani, S.; Oh, D. Y.; Cho, D. K.; Kim, D. I.; Kwon, T. W.; Yoon, S. S.; Kim, M. H.; Kwon, S. Y.; Cheong, J. W.; Lee, T. S.; Shokri, A. A.; Looi, T. S.; Chon, Y.; Chunn, K. Y.; Salleh, R.; Fijnheer, R.; Veth, G.; Dees, A.; Pruijt, H.; Lieverse, A. G.; Jie, G. K. S.; van Marwijk-Kooij, M.; Simsek, S.; Hanna, M.; Jackson, S.; Ockelford, P.; Smith, M.; Sandset, P. M.; Waage, A.; Fernandez, L.; Ma, A.; de Guia, T.; Ong-Garcia, H.; Lach, L.; Zawilska, K.; Gluszek, S.; Czarnobilski, K.; Gaciong, Z.; Chernyatina, M.; Tchumakov, A.; Staroverov, I.; Belentsov, S.; Katelnitsky, I.; Khamitov, A.; Zaporozhsky, A.; Degterev, M.; Khitaryan, A.; Heng, L. L.; Robless, P. A.; Kenny, S. Y. K.; Poliacik, P.; Duris, T.; Szentivanyi, M.; Zubek, V.; Adler, D.; Smith, C.; Roux, D. Le; van Rensburg, J.; Miller, D.; Ismail, S.; Roodt, A.; Vermooten, I. H.; Villalta, J.; Nieto, J. A.; Trujillo, J.; del Toro, J.; García Fuster, M. J.; Giménez, A.; Lozano, P.; Holmström, M.; Edmark, M.; Carlsson, A.; Torstensson, I.; Huang, C. H.; Shyu, K. G.; Chiang, C. E.; Shen, M. C.; Tsai, C. S.; Wang, S. S.; Sirijerachai, C.; Saetang, S.; Kanitsap, N.; Polprasert, C.; Mutirangura, P.; Boonbaichaiyapruck, S.; Leelasiri, A.; Kurtoglu, M.; Eren, E.; Bengisun, U.; Sakinci, U.; Karahan, S.; Islamoglu, F.; Kurt, N.; Aygun, E.; Skupyy, O.; Keeling, D.; Kesteven, P.; Cohen, A.; Maclean, R.; Thomas, W.; Masson, J. A.; Bolster, E.; Beard, T.; Gasparis, A.; LaPerna, L. M.; Gibson, K.; Curtis, B.; Chu, C. O.; Bass, P.; Lavende, R.

    2014-01-01

    Dabigatran and warfarin have been compared for the treatment of acute venous thromboembolism (VTE) in a previous trial. We undertook this study to extend those findings. In a randomized, double-blind, double-dummy trial of 2589 patients with acute VTE treated with low-molecular-weight or

  19. Update on Edoxaban for the Prevention and Treatment of Thromboembolism: Clinical Applications Based on Current Evidence

    Directory of Open Access Journals (Sweden)

    Ali Zalpour

    2015-01-01

    Full Text Available Vitamin K antagonists (VKA and heparins have been utilized for the prevention and treatment of thromboembolism (arterial and venous for decades. Targeting and inhibiting specific coagulation factors have led to new discoveries in the pharmacotherapy of thromboembolism management. These targeted anticoagulants are known as direct oral anticoagulants (DOACs. Two pharmacologically distinct classes of targeted agents are dabigatran etexilate (Direct Thrombin Inhibitor (DTI and rivaroxaban, apixaban, and edoxaban (direct oral factor Xa inhibitors (OFXaIs. Emerging evidence from the clinical trials has shown that DOACs are noninferior to VKA or low-molecular-weight heparins in the prevention and treatment of thromboembolism. This review examines the role of edoxaban, a recently approved OFXaI, in the prevention and treatment of thromboembolism based on the available published literature. The management of edoxaban in the perioperative setting, reversibility in bleeding cases, its role in cancer patients, the relevance of drug-drug interactions, patient satisfaction, financial impacts, and patient education will be discussed.

  20. Diagnostic and prognostic risk stratification of venous thromboembolism in primary care

    NARCIS (Netherlands)

    Hendriksen, J.M.T.

    2016-01-01

    General practitioners (GPs) play an important role in the diagnosis and management of venous thromboembolic disease (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE). With an incidence of approximately 2-3 cases per 1000 persons annually, GPs are encountered with this

  1. An audit of pressure sores caused by intermittent compression devices used to prevent venous thromboembolism.

    Science.gov (United States)

    Skillman, Joanna; Thomas, Sunil

    2011-12-01

    When intermittent compression devices (ICDs) are used to prevent venous thromboembolism (VTE) they can cause pressure sores in a selected group of women, undergoing long operations. A prospective audit pre and post intervention showed a reduced risk with an alternative device, without increasing the risk of VTE.

  2. Pregnancy-related venous thromboembolism: Risk and the effect of thromboprophylaxis

    NARCIS (Netherlands)

    Lussana, Federico; Coppens, Michiel; Cattaneo, Marco; Middeldorp, Saskia

    2012-01-01

    Venous thromboembolism (VTE) is a leading cause of maternal mortality and morbidity during pregnancy in developed countries. The incidence of VTE per pregnancy-year increases about 4-fold during pregnancy and at least 14-fold during the puerperium. Risk factors include a personal history of VTE,

  3. Efficacy of FDG PET/CT Imaging for Venous Thromboembolic Disorders

    DEFF Research Database (Denmark)

    Hess, Søren; Madsen, Poul Henning; Iversen, Else Dalsgaard

    2015-01-01

    PURPOSE: In recent years, several case reports have described venous thromboembolism (VTE) on FDG PET/CT. In this short communication, we present results from a proof-of-concept pilot study aimed at providing some preliminary data on the efficacy of FDG PET/CT in prospective patients with suspected...

  4. Use of a heparin nomogram for treatment of patients with venous thromboembolism in a community hospital

    NARCIS (Netherlands)

    de Groot, M. R.; Büller, H. R.; ten Cate, J. W.; van Marwijk Kooy, M.

    1998-01-01

    The application of a heparin dosing nomogram in the treatment of patients with venous thromboembolism resulted in improvement of heparin therapy in clinical research settings. In 1992 a heparin nomogram was introduced in our hospital, which is a community hospital where anticoagulant therapy is

  5. Statin treatment and risk of recurrent venous thromboembolism: a nationwide cohort study

    NARCIS (Netherlands)

    Nguyen, Cu Dinh; Andersson, Charlotte; Jensen, Thomas Bo; Gjesing, Anne; Schjerning Olsen, Anne-Marie; Malta Hansen, Carolina; Büller, Harry; Torp-Pedersen, Christian; Gislason, Gunnar H.

    2013-01-01

    Statins may decrease the risk of primary venous thromboembolism (VTE), that is, deep vein thrombosis (DVT) and pulmonary embolism (PE) but the effect of statins in preventing recurrent VTE is less clear. The aim of this study was therefore to investigate the association between statin therapy and

  6. The incidence of venous thromboembolism in commercial airline pilots: a cohort study of 2630 pilots

    NARCIS (Netherlands)

    Kuipers, S.; Venemans-Jellema, A.; Cannegieter, S. C.; van Haften, M.; Middeldorp, S.; Büller, H. R.; Rosendaal, F. R.

    2014-01-01

    Airline pilots may be at increased risk of venous thromboembolism (VTE) because air travel has recently been established as a risk factor for VTE. The aim of this study was to assess the risk of VTE in a cohort of Dutch airline pilots. Airline pilots who had been active members of the Dutch aviation

  7. Analysis of spontaneous reports of thromboembolic adverse drug reactions associated with cyproterone/ethinylestradiol

    NARCIS (Netherlands)

    Van Hunsel, F.; Van Puijenbroek, E.

    Introduction: After media attention on thromboembolic adverse drug reactions (ADRs) and the use of cyproterone/ethinylestradiol [1], the Netherlands Pharmacovigilance Centre Lareb received a high number of reports about this association, which called for a more detailed analyses. Aim: To provide an

  8. Spontaneous reports of thromboembolic events associated with cyproterone/ethinylestradiol after media attention

    NARCIS (Netherlands)

    Van Hunsel, Florence; Van Puijenbroek, Eugene; Kant, Agnes

    2014-01-01

    Background: After extensive media attention on thromboembolic adverse drug reactions (TE-ADRs) and the use of cyproterone/ethinylestradiol (CE), the Netherlands Pharmacovigilance Centre Lareb received a high number of reports about this association, which prompted for detailed analyses. Objectives:

  9. Comparative safety and effectiveness of rivaroxaban versus VKAs in patients with venous thromboembolism

    DEFF Research Database (Denmark)

    Sindet-Pedersen, Caroline; Langtved Pallisgaard, Jannik; Staerk, Laila

    2017-01-01

    The approval of rivaroxaban has changed the landscape of treatment of venous thromboembolism (VTE). Little is known about the effect of rivaroxaban compared with vitamin K antagonists (VKA), when used in the everyday clinical practice. The aim of this study was to investigate the safety and effec...

  10. Venous thromboembolism in ANCA-associated vasculitis - incidence and risk factors

    NARCIS (Netherlands)

    Stassen, P. M.; Derks, R. P. H.; Kallenberg, C. G. M.; Stegeman, C. A.

    Objectives. In patients with ANCA-associated vasculitis (AAV), an increased incidence of venous thromboembolism (VTE), mainly during active disease, has been described. In a large cohort of AAV patients, live assessed the incidence of VTE and its relation with disease activity and classic risk

  11. 77 FR 10748 - Scientific Information Request on Mechanical Prophylaxis of Venous Thromboembolism (VTE)

    Science.gov (United States)

    2012-02-23

    ....ahrq.gov/index.cfm/search-for-guides-reviews-andreports/?pageaction=displayproduct&productid=928#4370... prohibited by law. The draft of this review will be posted on AHRQ's EHC program Web site and available for... Pharmacologic and Mechanical Prophylaxis of Venous Thromboembolism Among Special Populations Review, which is...

  12. Venous thromboembolism in ovarian cancer: incidence, risk factors and impact on survival.

    LENUS (Irish Health Repository)

    Abu Saadeh, Feras

    2013-09-01

    Ovarian cancer has a higher incidence of venous thromboembolism (VTE) than other cancers. Clear cell cancers carry the highest risk at 11-27%. The aim of this study was to identify the predisposing factors for VTE in a population of ovarian cancer patients and to determine the influence of VTE on overall survival.

  13. Venous thromboembolism risk and prophylaxis in the Portuguese hospital care setting: The ARTE study.

    Science.gov (United States)

    Ferreira, Daniel; de Sousa, Joaquim Abreu; Felicíssimo, Paulo; França, Ana

    2017-11-01

    Venous thromboembolism (VTE) is a relatively common complication during hospital stay and determination of VTE risk is critical to choosing the best prophylactic strategy for each patient. In the present study we studied the risk profile for VTE in hospitalized patients in a group of hospitals in Portugal. Based on an open cohort of 4248 patients hospitalized in surgical, internal medicine, orthopedic or oncology departments, we determined thromboembolic risk at admission by applying a new score, modified from the Caprini and Khorana scores. Thrombotic, embolic and bleeding events and death were assessed during hospital stay and at three and six months after discharge. The median duration of hospital stay was five days and thromboembolic prophylaxis was implemented in 67.2% (n=2747) of the patients. A low molecular weight heparin was used as prophylaxis in the majority of cases (88.3%). Most patients were classified as high (68%) or intermediate risk (27%). The overall incidence of thromboembolic events was 1.5%. Major bleeding events were recorded in 3.89% of patients and all-cause mortality was 3.4%. In this study, we propose a modified VTE risk score that effectively risk-stratifies a mixed inpatient population during hospital stay. The use of this score may result in improvement of thromboprophylaxis practices in hospitals. Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. [Adherence to and satisfaction with oral outpatient thromboembolism prophylaxis compared to parenteral: SALTO study].

    Science.gov (United States)

    Peidro-Garcés, L; Otero-Fernandez, R; Lozano-Lizarraga, L

    2013-01-01

    Prolongation of drug-based thromboembolism prophylaxis after discharge from hospital is clearly recommended following total hip and knee replacement. The aim of this study was to evaluate and compare adherence to and satisfaction with outpatient thromboembolism prophylaxis (by injection and oral) under routine clinical practice conditions. We analysed two consecutive cohorts of patients (480 and 366, respectively) who had undergone total hip or knee replacement surgery in 120 Spanish hospitals, and were prescribed outpatient thromboembolism prophylaxis, by injection and orally, respectively. Information on adherence to and satisfaction with both treatments, sociodemographic data and treatment compliance was collected using specific questionnaires. The drop-out rate (9.49 vs. 4.14%), general satisfaction (37 vs. 83.38%), and the TSQM satisfaction scale were better in the oral prophylaxis cohort and, although the differences between the two routes of administration were not significant, treatment compliance was also better in the oral cohort (Morisky-Green test: 53.49 vs. 59.05%). Adherence to and satisfaction with the oral thromboembolism prophylaxis were better than for prophylaxis by injection in the context of outpatient prolongation. Nevertheless, suboptimal treatment compliance was found in both cohorts, which could result in lack of efficacy of the prophylaxis. Both patients and doctors have to be made aware of the importance of post-discharge extension of thromboprophylaxis in orthopaedic surgery with high thrombotic risk. Moreover, strategies should be developed to encourage compliance. Copyright © 2012 SECOT. Published by Elsevier Espana. All rights reserved.

  15. Low molecular weight heparin versus unfractionated heparin in the initial treatment of venous thromboembolism

    NARCIS (Netherlands)

    Hettiarachchi, R. J.; Prins, M. H.; Lensing, A. W.; Buller, H. R.

    1998-01-01

    In this review, we analyze data from randomized trials in which low molecular weight heparin was compared with unfractionated heparin, both to estimate the treatment effect of low molecular weight heparin in the initial treatment of venous thromboembolism and to evaluate the effect of the varied

  16. The incidence of venous thromboembolism in patients with overt hyperthyroidism A retrospective multicentre cohort study

    NARCIS (Netherlands)

    Kootte, Ruud S.; Stuijver, Danka J. F.; Dekkers, Olaf M.; van Zaane, Bregje; Fliers, Eric; Cannegieter, Suzanne C.; Gerdes, Victor E. A.

    2012-01-01

    Hyperthyroidism is associated with several changes in the haemostatic system resulting in a hypercoagulable state. It is uncertain at this stage whether this leads to an increased risk of venous thromboembolism (VIE). The aim of this retrospective cohort study was to determine the risk of VTE in all

  17. Diagnostic Evaluation and Management of Chronic Thromboembolic Pulmonary Hypertension: A Clinical Practice Guideline

    Directory of Open Access Journals (Sweden)

    Sanjay Mehta

    2010-01-01

    Full Text Available BACKGROUND: Pulmonary embolism is a common condition. Some patients subsequently develop chronic thromboembolic pulmonary hypertension (CTEPH. Many care gaps exist in the diagnosis and management of CTEPH patients including lack of awareness, incomplete diagnostic assessment, and inconsistent use of surgical and medical therapies.

  18. Observationally and Genetically High YKL-40 and Risk of Venous Thromboembolism in the General Population

    DEFF Research Database (Denmark)

    Kjaergaard, Alisa D; Johansen, Julia S; Bojesen, Stig E

    2016-01-01

    =94 579). From 1977 to 2013, 1489 individuals developed pulmonary embolism, 2647 developed deep vein thrombosis, and 3750 developed venous thromboembolism (pulmonary embolism and deep vein thrombosis). For the 91% to 100% versus 0% to 33% YKL-40 percentile category, the multifactorially adjusted...... hazard ratio was 2.38 (95% confidence interval, 1.25-4.55) for pulmonary embolism, 1.98 (1.09-3.59) for deep vein thrombosis, and 2.13 (1.35-3.35) for venous thromboembolism. Compared with rs4950928 GG homozygosity, presence of C-allele was associated with a doubling (CG) or tripling (CC) in YKL-40...... and 1.11 (0.91-1.35) genetically for deep vein thrombosis and 1.23 (1.10-1.38) observationally and 1.08 (0.92-1.27) genetically for venous thromboembolism. CONCLUSIONS: High YKL-40 levels were associated with a 2-fold increased risk of venous thromboembolism, but the association was not causal....

  19. Jobs encompassing prolonged sitting in cramped positions and risk of venous thromboembolism

    DEFF Research Database (Denmark)

    Suadicani, Poul; Hannerz, Harald; Bach, Elsa

    2012-01-01

    There is mounting evidence that prolonged cramped sitting in connection with long-lasting air travel increases the risk of deep vein thrombosis of the legs and pulmonary embolism, i.e. venous thromboembolism (VTE). Prolonged cramped sitting may occur even in various jobs unrelated to air travel...

  20. Abnormal vaginal bleeding in women with venous thromboembolism treated with apixaban or warfarin

    NARCIS (Netherlands)

    Brekelmans, Marjolein P. A.; Scheres, Luuk J. J.; Bleker, Suzanne M.; Hutten, Barbara A.; Timmermans, Anne; Büller, Harry R.; Middeldorp, Saskia

    2017-01-01

    Abnormal vaginal bleeding can complicate direct oral anticoagulant (DOAC) treatment. We aimed to investigate the characteristics of abnormal vaginal bleeding in patients with venous thromboembolism (VTE) receiving apixaban or enoxaparin/warfarin. Data were derived from the AMPLIFY trial. We compared