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Bortman LV, Mitchell F, Naveiro S, Pérez Morales J, Gonzalez CD, Di Girolamo G, Giorgi MA. Direct Oral Anticoagulants: An Updated Systematic Review of Their Clinical Pharmacology and Clinical Effectiveness and Safety in Patients With Nonvalvular Atrial Fibrillation. J Clin Pharmacol 2023; 63:383-396. [PMID: 36433678 DOI: 10.1002/jcph.2184] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 11/09/2022] [Indexed: 11/27/2022]
Abstract
Direct oral anticoagulants have been an increasingly used class of drugs in the setting of nonvalvular atrial fibrillation, defying vitamin K antagonists' monopoly when it comes to anticoagulation due to its several limitations. Direct oral anticoagulants (DOACs) have entered the market as a noninferior and safer option in comparison with vitamin K antagonists, as their respective phase III clinical trials proved. The aim of this article was to update and summarize data on their clinical pharmacology and to review real-world data to know their comparative effectiveness and safety. We performed a systematic review using PubMed, Google Scholar, Embase, and Web of Science as search engines. Regarding pharmacodynamics, there were no substantial changes reported from their original profile. There were many advances in the knowledge about clinical pharmacokinetics of DOACs that have had a direct impact on their clinical use, mainly related to drug-drug interactions. In a real-world setting, DOACs have shown to be noninferior in preventing thromboembolic events compared to vitamin K antagonists. In regards to safety, DOACs have shown a lower bleeding risk relative to warfarin. Comparison between DOACs has demonstrated rivaroxaban to have the highest bleeding risk. Overall, the evidence gathered showed few changes from the original data presented in phase III clinical trials, concluding that their real-world use coincides greatly with them.
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Affiliation(s)
- Lucia Victoria Bortman
- Department of Pharmacology, School of Medicine, Instituto Universitario CEMIC, Buenos Aires, Argentina
| | - Florencia Mitchell
- Department of Pharmacology, School of Medicine, Instituto Universitario CEMIC, Buenos Aires, Argentina
| | - Sofia Naveiro
- Department of Pharmacology, School of Medicine, Instituto Universitario CEMIC, Buenos Aires, Argentina
| | - Juana Pérez Morales
- Department of Pharmacology, School of Medicine, Instituto Universitario CEMIC, Buenos Aires, Argentina
| | - Claudio Daniel Gonzalez
- Department of Pharmacology, School of Medicine, Instituto Universitario CEMIC, Buenos Aires, Argentina.,Health Economics and Technology Assessment, Unit. Instituto Universitario CEMIC, Buenos Aires, Argentina
| | - Guillermo Di Girolamo
- Department of Pharmacology, School of Medicine, Universidad de Buenos Aires, Buenos Aires, Argentina.,Instituto Alberto C. Taquini de Investigaciones en Medicina Traslacional (IATIMET), Universidad de Buenos Aires - CONICET, Facultad de Medicina, Buenos Aires, Argentina
| | - Mariano Anibal Giorgi
- Department of Pharmacology, School of Medicine, Instituto Universitario CEMIC, Buenos Aires, Argentina.,Health Economics and Technology Assessment, Unit. Instituto Universitario CEMIC, Buenos Aires, Argentina
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Predicting 10-year stroke mortality: development and validation of a nomogram. Acta Neurol Belg 2022; 122:685-693. [PMID: 34406610 PMCID: PMC9170668 DOI: 10.1007/s13760-021-01752-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 07/12/2021] [Indexed: 11/02/2022]
Abstract
Predicting long-term stroke mortality is a clinically important and unmet need. We aimed to develop and internally validate a 10-year ischaemic stroke mortality prediction score. In this UK cohort study, 10,366 patients with first-ever ischaemic stroke between January 2003 and December 2016 were followed up for a median (interquartile range) of 5.47 (2.96-9.15) years. A Cox proportional-hazards model was used to predict 10-year post-admission mortality. The predictors associated with 10-year mortality included age, sex, Oxfordshire Community Stroke Project classification, estimated glomerular filtration rate (eGFR), pre-stroke modified Rankin Score, admission haemoglobin, sodium, white blood cell count and comorbidities (atrial fibrillation, coronary heart disease, heart failure, cancer, hypertension, chronic obstructive pulmonary disease, liver disease and peripheral vascular disease). The model was internally validated using bootstrap resampling to assess optimism in discrimination and calibration. A nomogram was created to facilitate application of the score at the point of care. Mean age (SD) was 78.5 ± 10.9 years, 52% female. Most strokes were partial anterior circulation syndromes (38%). 10-year mortality predictors were: total anterior circulation stroke (hazard ratio, 95% confidence intervals) (2.87, 2.62-3.14), eGFR < 15 (1.97, 1.55-2.52), 1-year increment in age (1.04, 1.04-1.05), liver disease (1.50, 1.20-1.87), peripheral vascular disease (1.39, 1.23-1.57), cancers (1.37, 1.27-1.47), heart failure (1.24, 1.15-1.34), 1-point increment in pre-stroke mRS (1.20, 1.17-1.22), atrial fibrillation (1.17, 1.10-1.24), coronary heart disease (1.09, 1.02-1.16), chronic obstructive pulmonary disease (1.13, 1.03-1.25) and hypertension (0.77, 0.72-0.82). Upon internal validation, the optimism-adjusted c-statistic was 0.76 and calibration slope was 0.98. Our 10-year mortality model uses routinely collected point-of-care information. It is the first 10-year mortality score in stroke. While the model was internally validated, further external validation is also warranted.
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Zhang C, Zhang W, Huang Y, Qiu J, Huang ZX. A Dynamic Nomogram to Predict the 3-Month Unfavorable Outcome of Patients with Acute Ischemic Stroke. Healthc Policy 2022; 15:923-934. [PMID: 35547649 PMCID: PMC9084510 DOI: 10.2147/rmhp.s361073] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/01/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Despite receiving standard-of-care treatments, a significant proportion of patients with acute ischemic stroke (AIS) are left with long-term functional impairment. Therefore, an easy-to-use tool for predicting of unfavorable outcome following AIS plays an important role in clinical practice. This study was aimed to develop a dynamic nomogram to predict the 3-month unfavorable outcome for AIS patients. Methods This was a prospective observational study conducted in consecutive patients with AIS admitted to our stroke center between September 2019 and June 2020. Baseline demographic, clinical, and laboratory information were obtained. The primary outcome was evaluated with modified Rankin Scale (mRS) scores at 3 months. Least absolute shrinkage and selection operator regression was used to select the optimal predictive factors. Multiple logistics regression was performed to establish the nomogram. Decision curve analysis (DCA) was applied to assess the clinical utility of the nomogram. The calibration and discrimination property of the nomogram was validated by calibration plots and concordance index. Results A total of 93 eligible patients were enrolled: 28 (30.1%) patients had unfavorable outcome (mRS >2). Glycosylated hemoglobin (OR, 1.541; 95% CI, 1.051–2.261), the Alberta Stroke Program Early Computed Tomography Score (ASPECTS) (OR, 0.635; 95% CI, 0.463–0.871), and National Institute of Health Stroke Scale (NIHSS) (OR 1.484; 95% CI, 1.155–1.907) were significant predictors of the poor outcome of patients with AIS and included into the nomogram model. The nomogram showed good calibration and discrimination. C-index was 0.891 (95% CI, 0.854–0.928). DCA confirmed the clinical usefulness of the model. The dynamic nomogram can be obtained at the website: https://odywong.shinyapps.io/DBT_21/. Conclusion The dynamic nomogram, comprised of glycosylated hemoglobin, ASPECTS, and NIHSS score at day 14, may be able to predict the 3-month unfavorable outcome for AIS patients.
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Affiliation(s)
- Cheng Zhang
- Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, People’s Republic of China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Wenli Zhang
- Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, People’s Republic of China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Ying Huang
- Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, People’s Republic of China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People’s Republic of China
| | - Jianxiang Qiu
- Medical Research Center, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, People’s Republic of China
- Correspondence: Jianxiang Qiu, Medical Research Center, Guangdong Second Provincial General Hospital, No. 466 xingang Middle Road, Guangzhou, Guangdong, 510000, People’s Republic of China, Tel +86-02089168114, Email
| | - Zhi-Xin Huang
- Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, People’s Republic of China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, People’s Republic of China
- Jinan University Faculty of Medical Science, Guangzhou, Guangdong, People’s Republic of China
- University of South China, Hengyang, Hunan, People’s Republic of China
- Zhi-Xin Huang, Department of Neurology, Guangdong Second Provincial General Hospital, No. 466 xingang Middle Road, Guangzhou, Guangdong, 510000, People’s Republic of China, Tel +86-02089168080, Email
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Adali MK, Turkoz A, Yilmaz S. The prognostic value of the CHA2DS2-VASc score in coronary collateral circulation and long-term mortality in coronary artery disease. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2022; 68:384-388. [PMID: 35442368 DOI: 10.1590/1806-9282.20211066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/10/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The CHA2DS2-VASc score is used to determine thromboembolic risk in cases of atrial fibrillation. The predictive value of this score in predicting coronary collateral circulation in chronic total occlusion is unknown. OBJECTIVE The aim of this study was to investigate the relationship between the CHA2DS2-VASc score and coronary collateral circulation in patients with chronic total occlusion. METHODS A total of 189 patients, who underwent coronary angiography and had a chronic total occlusion in at least one coronary artery, were enrolled in this study. The Rentrop scoring system was used for grouping the patients, and patients were classified as having poorly developed coronary collateral circulation (Rentrop grade 0 or 1) or well-developed coronary collateral circulation (Rentrop grade 2 or 3). RESULTS The CHA2DS2-VASc score of the good coronary collateral circulation group was significantly lower than the other group (3.1±1.7 vs. 3.7±1.7, p=0.021). During the follow-up period, 30 (32.2%) patients in the poorly developed coronary collateral circulation group and 16 (16.7%) patients in the well-developed coronary collateral circulation group died (p=0.028). According to the multivariable Cox regression model, the CHA2DS2-VASc score [hazard ratio (HR): 1.262, p=0.009], heart rate (HR: 1.049, p=0.003), LVEF (HR: 0.975, p=0.039), mean platelet volume (HR: 1.414, p=0.028), and not taking acetylsalicylic acid during admission (HR: 0.514, p=0.042) were independently associated with a higher risk of mortality. CONCLUSIONS The CHA2DS2-VASc score is closely related to coronary collateral development and predicts mortality in patients with chronic total occlusion.
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Affiliation(s)
- Mehmet Koray Adali
- Pamukkale University, Faculty of Medicine, Cardiology Department - Denizli, Turkey
| | - Anil Turkoz
- Pamukkale University, Faculty of Medicine, Cardiology Department - Denizli, Turkey
| | - Samet Yilmaz
- Pamukkale University, Faculty of Medicine, Cardiology Department - Denizli, Turkey
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Vitturi BK, Gagliardi RJ. The prognostic significance of the lipid profile after an ischemic stroke. Neurol Res 2021; 44:139-145. [PMID: 34396927 DOI: 10.1080/01616412.2021.1967677] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The role that cholesterol levels play in stroke is still uncertain, especially in secondary prevention. The aim was to determine how a comprehensive analysis of the lipid profile can be associated with post-stroke outcomes. Consecutive patients diagnosed with ischemic stroke were included in our cohort and followed up for 24months. Baseline clinical and demographic data were collected as well as a complete lipid profile 6-months after the index stroke. Lipid variables were analyzed quantitatively and qualitatively. Clinical outcomes included stroke recurrence, major cardiovascular events, and functional performance (assessed with the modified Rankin scale). RESULTS The study included 588 patients with an average age of 58.3 years. There were 148 (25.2%) patients with high total cholesterol, 260 (44.2%) with low HDL, 180 (30.6%) with high LDL, and 204 (34.7%) with high triglycerides. There were 164 (27.9%) patients with no abnormalities in the lipid profile. After the follow-up, 108 (18.3%) had another stroke, 32 (5.4%) had major cardiovascular events, and 360 (61.2%) presented good functional outcomes. A higher LDL-C/HDL-C ratio and a low HDL-C level were significantly associated with worse cardiovascular outcomes. The detection of LDL-C > 70 mg/dL was an independent predictor of a higher risk of stroke recurrence and worse functional performance. The greater the number of altered lipid variables, the greater the chance of developing an unfavorable composite outcome and presenting cardiovascular events after the stroke. CONCLUSIONS The complete analysis of the lipid panel allows the determination of the prognosis of patients who suffered a stroke.
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Affiliation(s)
- Bruno Kusznir Vitturi
- Department of Neurology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
| | - Rubens José Gagliardi
- Department of Neurology, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil
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Vitturi BK, Mitre LP, Kim AIH, Gagliardi RJ. Prevalence and Predictors of Fatigue and Neuropsychiatric Symptoms in Patients with Minor Ischemic Stroke. J Stroke Cerebrovasc Dis 2021; 30:105964. [PMID: 34245946 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105964] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 05/14/2021] [Accepted: 06/20/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Patients who are victims of a mild stroke are vulnerable to several invisible and neglected neurological sequelae. In parallel, it is known that fatigue and neuropsychiatric symptoms are common complications after a stroke in general. Our aim was to describe the prevalence and the factors associated with these two outcomes after a minor stroke. MATERIALS AND METHODS We conducted a prospective observational cohort study that included consecutive patients diagnosed with minor ischemic stroke between 2015 and 2019. Minor stroke was defined as NIHSS < 4 and modified Rankin Scale (mRS) < 2. Patients were followed for 12 months after the index stroke. The primary endpoints included fatigue and neuropsychiatric impairment, which were evaluated with the Fatigue Severity Scale (FSS) and the Hospital Anxiety Depression Scale (HADS), respectively. RESULTS A total of sixty patients were followed in our cohort. The mean age was 53.0 (SD 15.0) and 51.7% were male. There were 32 (53.3%) and 25 (41.7%) patients who developed PSF and post-stroke neuropsychiatric symptoms, respectively. The use of antidepressants and statins were associated with post-stroke fatigue, while women and younger patients were more likely to develop neuropsychiatric symptoms after the stroke (p < 0.05). Eighteen (30.0%) patients were diagnosed with both post-stroke fatigue and psychiatric disorders. CONCLUSIONS Post-stroke fatigue and neuropsychiatric symptoms are prevalent in minor stroke and should be independently addressed as a part of the recovery goal.
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Affiliation(s)
- Bruno Kusznir Vitturi
- Department of Neurology, Santa Casa de São Paulo School of Medical Sciences, Dr. Cesário Motta Júnior Street 112, São Paulo 01221-020, Brazil.
| | - Lucas Pari Mitre
- Department of Neurology, Santa Casa de São Paulo School of Medical Sciences, Dr. Cesário Motta Júnior Street 112, São Paulo 01221-020, Brazil
| | - Alexandre In Han Kim
- Department of Neurology, Santa Casa de São Paulo School of Medical Sciences, Dr. Cesário Motta Júnior Street 112, São Paulo 01221-020, Brazil
| | - Rubens José Gagliardi
- Department of Neurology, Santa Casa de São Paulo School of Medical Sciences, Dr. Cesário Motta Júnior Street 112, São Paulo 01221-020, Brazil
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The influence of statin withdrawal and adherence on stroke outcomes. Neurol Sci 2020; 42:2317-2323. [DOI: 10.1007/s10072-020-04790-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 10/03/2020] [Indexed: 10/23/2022]
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Zhang XX, Wei M, Shang LX, Lu YM, Zhang L, Li YD, Zhang JH, Xing Q, Tu-Erhong ZK, Tang BP, Zhou XH. LDL-C/HDL-C is associated with ischaemic stroke in patients with non-valvular atrial fibrillation: a case-control study. Lipids Health Dis 2020; 19:217. [PMID: 33028331 PMCID: PMC7542146 DOI: 10.1186/s12944-020-01392-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 09/24/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND This study explored the relationships between the low-/high-density lipoprotein cholesterol ratio (LDL-C/HDL-C) and other clinical indicators and ischaemic stroke (IS) in patients with non-valvular atrial fibrillation (NVAF) in Xinjiang. The findings could provide a theoretical and therapeutic basis for NVAF patients. METHODS NVAF patients who were admitted to 10 medical centres across Xinjiang were divided into stroke (798 patients) and control (2671 patients) groups according to the occurrence of first acute IS. Univariate and multivariate logistic regression analysis were used to examine the independent risk factors for IS in NVAF patients. Factor analysis and principal component regression analysis were used to analyse the main factors influencing IS. Receiver operating characteristic (ROC) curve analysis was used to evaluate the discriminatory ability of LDL-C/HDL-C for predicting the occurrence of IS. RESULTS The stroke group had an average age of 71.64 ± 9.96 years and included 305 females (38.22%). The control group had a mean age of 67.30 ± 12.01 years and included 825 females (30.89%). Multivariate logistic regression showed that the risk of IS in the highest LDL-C/HDL-C quartile (≥2.73) was 16.23-fold that of the lowest quartile (< 1.22); IS risk was 2.27-fold higher in obese patients than in normal-weight subjects; IS risk was 3.15-fold higher in smoking patients than in non-smoking patients. The area under the ROC curve of LDL-C/HDL-C was 0.76, the optimal critical value was 2.33, the sensitivity was 63.53%, and the specificity was 76.34%. Principal component regression analysis showed that LDL-C/HDL-C, age, smoking, drinking, LDL-C and hypertension were risk factors for IS in NVAF patients. CONCLUSIONS LDL-C/HDL-C > 1.22, smoking, BMI ≥24 kg/m2 and CHA2DS2-VASc score were independent risk factors for IS in NVAF patients; LDL-C/HDL-C was the main risk factor.
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Affiliation(s)
- Xiao-Xue Zhang
- Department of Cardiac Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan Road, Urumqi, 830054, P R China.,Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, P R China
| | - Meng Wei
- Department of Cardiac Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan Road, Urumqi, 830054, P R China.,Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, P R China
| | - Lu-Xiang Shang
- Department of Cardiac Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan Road, Urumqi, 830054, P R China.,Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, P R China
| | - Yan-Mei Lu
- Department of Cardiac Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan Road, Urumqi, 830054, P R China.,Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, P R China
| | - Ling Zhang
- Department of Cardiac Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan Road, Urumqi, 830054, P R China.,Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, P R China
| | - Yao-Dong Li
- Department of Cardiac Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan Road, Urumqi, 830054, P R China.,Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, P R China
| | - Jiang-Hua Zhang
- Department of Cardiac Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan Road, Urumqi, 830054, P R China.,Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, P R China
| | - Qiang Xing
- Department of Cardiac Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan Road, Urumqi, 830054, P R China.,Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, P R China
| | - Zu Kela Tu-Erhong
- Department of Cardiac Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan Road, Urumqi, 830054, P R China.,Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, P R China
| | - Bao-Peng Tang
- Department of Cardiac Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan Road, Urumqi, 830054, P R China. .,Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, P R China.
| | - Xian-Hui Zhou
- Department of Cardiac Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, No. 137, Liyushan Road, Urumqi, 830054, P R China. .,Xinjiang Key Laboratory of Cardiac Electrophysiology and Remodeling, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, P R China.
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Sanchez Fernandez JJ, Ortiz MR, Ballesteros FM, Luque CO, Penas ER, Ortega MD, Rubio DM. CHA 2DS 2-VASc score as predictor of stroke and all-cause death in stable ischaemic heart disease patients without atrial fibrillation. J Neurol 2020; 267:3061-3068. [PMID: 32529579 DOI: 10.1007/s00415-020-09961-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/23/2020] [Accepted: 05/29/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cerebrovascular and coronary artery disease share risk factors. The aim was to study CHA2DS2-VASc score as predictor of stroke incidence and death in a sample of patients with sinus rhythm and stable ischemic heart disease (sIHD) during long-term follow-up. METHODS 1184 patients with sIHD and without atrial fibrillation were included in this single-centre prospective cohort study between February 2000 and January 2004. Stroke and death prediction abilities of CHA2DS2-VASc score in this population were investigated. RESULTS The median age was 66 (interquartile range (IQR), 60-73 years). The mean follow-up was 11.2 ± 10 years (maximum 17 years). Along this period, 137 patients (11.6% of the sample) suffered a stroke. The mean value of CHA2DS2-VASc score was 3.04 ± 1.36, with CHA2DS2-VASc score ≤ 4 in 85.5% of the sample. Higher CHA2DS2-VASc score at baseline was associated with higher risk of suffering stroke (Hazard Ratio = 1.36, 95% CI 1.20-1.54, p < 0,001) and all-cause death during follow-up (Hazard Ratio = 1.49, 95% CI 1.40-1.58, p < 0,001). CONCLUSIONS Higher CHA2DS2-VASc score values were associated with higher risk of stroke and all-cause mortality during long-term follow-up in this real-world sample of patients with sIHD in sinus rhythm.
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Vitturi BK, Gagliardi RJ. Effects of statin therapy on outcomes of ischemic stroke: a real-world experience in Brazil. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:461-467. [PMID: 32627806 DOI: 10.1590/0004-282x20200027] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/17/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Statin therapy has become one of the most important advances in stroke secondary prevention. OBJECTIVE To provide evidence from real-world data for evaluating detailed associations between secondary prevention of stroke and statin use in Brazil. METHODS We conducted a prospective cohort study including consecutive patients diagnosed with an ischemic stroke. Subjects were classified into non-statin, simvastatin 20 mg, simvastatin 40 mg, and high-potency statin groups. We also registered the onset of statin therapy, previous use of statins, the adherence to medication, and if there was discontinuation of the therapy. After two years, the functional outcome, stroke recurrence, major cardiovascular events, and mortality were assessed. RESULTS Among the 513 patients included in our cohort, there were 96 (18.7%) patients without statins, 169 (32.9%) with simvastatin 20 mg, 202 (39.3%) with simvastatin 40 mg, and 46 (9.0%) with high-potency statins. Patients without statins were at increased risk of stroke recurrence and worse functional outcomes. Concerning etiology, evidence of beneficial use of statins was observed in cases of large-artery atherosclerosis, small-vessel occlusion, and stroke of undetermined cause. Those who presented poor adherence to statins or discontinuation of the treatment had worse prognosis after stroke whereas the early onset of statins use was associated with better outcomes. Patients with simvastatin 40 mg and high-potency statins presented the best functional recovery throughout the follow-up. CONCLUSIONS Statins play an important role in the treatment of ischemic stroke, preventing stroke recurrence and cardiovascular events, and improving functional performance.
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Affiliation(s)
- Bruno Kusznir Vitturi
- Santa Casa de São Paulo, School of Medical Sciences, Department of Neurology, São Paulo SP, Brazil
| | - Rubens José Gagliardi
- Santa Casa de São Paulo, School of Medical Sciences, Department of Neurology, São Paulo SP, Brazil
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11
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The influence of statins on the risk of post-stroke epilepsy. Neurol Sci 2020; 41:1851-1857. [PMID: 32086686 DOI: 10.1007/s10072-020-04298-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 02/13/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Currently, statins are widely used for secondary prevention of stroke due to their pleiotropic neuroprotective effects. Epilepsy is a common complication of cerebrovascular diseases. The purpose of this study was to evaluate the effect of statin therapy on the occurrence of post-stroke epilepsy (PSE). METHODS In this prospective cohort study, patients who suffered an ischemic stroke and without history of epilepsy before stroke were enrolled. At baseline, patients were classified according to the particularities of statin therapy. Statin use onset and adherence to treatment were registered as well. After a follow-up period of 1 year, we assessed the occurrence of seizures and PSE. RESULTS Among the 477 patients included in our cohort, there were 91 (19.1%) patients without statins, 160 (33.5%) with simvastatin 20 mg, 180 (37.7%) with simvastatin 40 mg, and 46 (9.6%) with high-potency statins. Overall, PSE emerged in 53 (11.1%) patients. PSE was significantly more prevalent among those who did not receive statins and those with lower doses of simvastatin. Acute onset of statin use was associated with reduced odds of having PSE. CONCLUSION Adequate treatment with statins after stroke may lower the risk of PSE.
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Kusznir Vitturi B, José Gagliardi R. The role of statins in cardioembolic stroke. J Clin Neurosci 2019; 72:174-179. [PMID: 31874811 DOI: 10.1016/j.jocn.2019.12.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 12/16/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Statin therapy has become one of the most important advances in stroke secondary prevention. Nevertheless, statin therapy in patients with cardioembolic stroke has not been supported by clinical evidence yet. This study aimed to investigate the effect of statins on the neurological outcomes after a cardioembolic stroke. METHODS We conducted a prospective cohort study including consecutive patients with cardioembolic stroke. Subjects were classified into non-statin, simvastatin 20 mg, simvastatin 40 mg, and high-potency statin groups. After 2 years, the functional outcome, stroke recurrence, major cardiovascular events, and mortality were assessed. RESULTS Among the 91 patients included in our cohort, there were 18 (19.8%) patients without statins, 30 (33.0%) with simvastatin 20 mg, 38 (41.7%) with simvastatin 40 mg and 5 (5.5%) with high-potency statins. Using simvastatin 40 mg was associated with a significantly lower incidence of stroke recurrence lower. Patients with simvastatin 40 mg and high-potency statins presented the best functional recovery throughout the follow-up (p < 0.01). CONCLUSIONS The use of statins in patients with cardioembolic stroke may be beneficial in some cases, preventing stroke recurrence and improving functional outcomes.
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Affiliation(s)
- Bruno Kusznir Vitturi
- Department of Neurology, Santa Casa de São Paulo School of Medical Sciences, Dr. Cesário Motta Júnior Street 112 01221-020, São Paulo, Brazil.
| | - Rubens José Gagliardi
- Department of Neurology, Santa Casa de São Paulo School of Medical Sciences, Dr. Cesário Motta Júnior Street 112 01221-020, São Paulo, Brazil
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