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Costru-Tasnic E, Gavriliuc M, Manole E. Serum biomarkers to predict hemorrhagic transformation and ischemic stroke outcomes in a prospective cohort study. J Med Life 2023; 16:908-914. [PMID: 37675160 PMCID: PMC10478654 DOI: 10.25122/jml-2023-0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 05/11/2023] [Indexed: 09/08/2023] Open
Abstract
Ischemic stroke (IS) remains one of the most frequent causes of death and disability worldwide. Identifying possible prognosis factors for IS outcomes, including hemorrhagic transformation (HT), could improve patients' recovery. This study aimed to investigate the potential prognosis role of non-specific laboratory data at admission and baseline MMP-2 and MMP-9 serum levels in predicting HT risk, discharge, and 3-month follow-up status of IS patients. Data from 150 successive acute cerebral infarction patients were analyzed in a prospective cohort study. The active group included patients who developed HT during hospitalization (55 persons). There were no significant differences in age, gender distribution, time to admission, or time to blood sample collection for MMPs measurement between patients in the active and control groups. IS patients from the active group had a significantly higher rate of AF (atrial fibrillation) in the past (p=0.003), while differences in other factors such as diabetes, hypertension, myocardial infarction, previous stroke, obesity, smoking, and alcohol were not significant. Admission NIHSS score and mRS (modified Rankin Scale) values (at discharge and 90 days) were significantly worse in the active group (p<0.001). Among the analyzed admission laboratory factors (glycemia, lipid profile, coagulation panel, inflammatory reaction parameters, MMP-2, MMP-9), INR presented an inverse correlation, with lower values in the HT cohort (univariate analysis - p=0.01, OR=0.11; multivariate analysis - p=0.03, OR=0.09). Further research on larger cohorts is warranted to determine the specific laboratory biomarkers for predicting hemorrhagic transformation and ischemic stroke outcomes.
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Affiliation(s)
- Elena Costru-Tasnic
- Neurology Department no. 1, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
| | - Mihail Gavriliuc
- Neurology Department no. 1, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
- Diomid Gherman Institute of Neurology and Neurosurgery, Chisinau, Republic of Moldova
| | - Elena Manole
- Neurology Department no. 1, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
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Pracoń R, Zieliński K, Bangalore S, Konka M, Kruk M, Kępka C, Trochimiuk P, Dębski M, Przyłuski J, Kaczmarska E, Dzielińska Z, Kurowski A, Witkowski A, Demkow M. Residual stroke risk after left atrial appendage closure in patients with prior oral anticoagulation failure. Int J Cardiol 2022; 354:17-21. [PMID: 35219744 DOI: 10.1016/j.ijcard.2022.02.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/19/2022] [Accepted: 02/22/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Patients with atrial fibrillation (AF) and oral anticoagulation (OAC) failure may benefit from left atrial appendage closure (LAAC), however, the evidence is scarce. We report outcomes of LAAC in patients with OAC failure compared to those with classic indications of OAC contraindications. METHODS Prospective registry of LAAC with Amplatzer or WATCHMAN device followed by dual antiplatelet therapy (DAPT) was analyzed (05.2014-11.2019). The study group included patients with OAC failure defined as stroke/TIA/PE/LAA thrombus (n = 39) during OAC, whereas the control group consisted of patients with OAC contraindications (n = 156). Structured follow-up at 3, 6, and 12 months was done. RESULTS The study group compared to controls was younger [73 (IQR, 62-77) vs 74 (IQR, 68-81) years, P = 0.046], with higher CHA2DS2-VASc [5.0 (IQR, 3.0-6.0) vs 4.0 (IQR, 3.0-5.0), P = 0.001)], lower HAS-BLED [2.0 (IQR, 1.0-3.0) vs 3.0 (IQR, 2.0-3.0), P = 0.006] and similar proportion of WATCHMAN implantations (43.6% vs 44.2%, P = 1.000). The reduction from CHA2DS2-VASc predicted to observed annual stroke/TIA/PE rate was markedly smaller in the study vs control group (14% vs 77%) with 10.3% vs 1.9% stroke/TIA/PE respectively (P = 0.031). The reduction from HAS-BLED predicted to observed annual major nonprocedural bleeding rate was higher (100% vs 7.4%) with 0.0% vs 5.1% major bleedings respectively (P = 0.361). The device-related thrombosis remained similar (13.2% vs 11.3%, P = 0.778). CONCLUSIONS Patients after LAAC for OAC failure and unremarkable prior bleeding history presented with high residual stroke and low bleeding risks. Therefore concomitant long-term OAC or prolonged DAPT should strongly be considered in this population.
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Affiliation(s)
- Radosław Pracoń
- Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland
| | - Kamil Zieliński
- Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland.
| | | | - Marek Konka
- Congenital Cardiac Defects Department, National Institute of Cardiology, Warsaw, Poland
| | - Mariusz Kruk
- Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland
| | - Cezary Kępka
- Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland
| | - Piotr Trochimiuk
- Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland
| | - Mariusz Dębski
- Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland
| | - Jakub Przyłuski
- Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland
| | - Edyta Kaczmarska
- Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland
| | - Zofia Dzielińska
- Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland
| | - Andrzej Kurowski
- Anesthesiology Department, National Institute of Cardiology, Warsaw, Poland
| | - Adam Witkowski
- Interventional Cardiology and Angiology Department, National Institute of Cardiology, Warsaw, Poland
| | - Marcin Demkow
- Coronary and Structural Heart Diseases Department, National Institute of Cardiology, Warsaw, Poland
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Cruz-González I, González-Ferreiro R, Freixa X, Gafoor S, Shakir S, Omran H, Berti S, Santoro G, Kefer J, Landmesser U, Nielsen-Kudsk JE, Kanagaratnam P, Nietlispach F, Gloekler S, Aminian A, Danna P, Rezzaghi M, Stock F, Stolcova M, Paiva L, Costa M, Millán X, Ibrahim R, Tichelbäcker T, Schillinger W, Park JW, Sievert H, Meier B, Tzikas A. Cierre de la orejuela izquierda por ictus pese a la anticoagulación oral (ictus resistente): resultados del registro Amplatzer Cardiac Plug. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2019.02.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Yavelov IS, Okshina EY. Atherothrombotic stroke in non-valvular atrial fibrillation. NEUROLOGY, NEUROPSYCHIATRY, PSYCHOSOMATICS 2019. [DOI: 10.14412/2074-2711-2019-3s-78-81] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The review analyzes data on the detection rate of and the abilities to predict and prevent non-cardioembolic strokes in non-valvular atrial fibrillation. According to accumulated facts, vitamin K antagonists in non-valvular atrial fibrillation are noted to be inferior to antiplatelet drugs in efficiency in preventing non-cardioembolic (atherothrombotic in particular) strokes, and the widespread use of oral anticoagulants in combination with antiplatelet drugs does not generally reduce the incidence of poor outcomes, markedly increasing the risk of serious bleeding. Nevertheless, it is conceivable that this combination antithrombotic therapy may be useful for certain categories of patients at the highest risk for atherothrombotic stroke and at relatively low risk for hemorrhagic complications. Cohorts of patients, to whom such an approach should be reasonable considered to be applied, have not yet been identified.
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Affiliation(s)
- I. S. Yavelov
- National Medical Research Center of Preventive Medicine, Ministry of Health of Russia
| | - E. Yu. Okshina
- National Medical Research Center of Preventive Medicine, Ministry of Health of Russia
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Cruz-González I, González-Ferreiro R, Freixa X, Gafoor S, Shakir S, Omran H, Berti S, Santoro G, Kefer J, Landmesser U, Nielsen-Kudsk JE, Kanagaratnam P, Nietlispach F, Gloekler S, Aminian A, Danna P, Rezzaghi M, Stock F, Stolcova M, Paiva L, Costa M, Millán X, Ibrahim R, Tichelbäcker T, Schillinger W, Park JW, Sievert H, Meier B, Tzikas A. Left atrial appendage occlusion for stroke despite oral anticoagulation (resistant stroke). Results from the Amplatzer Cardiac Plug registry. ACTA ACUST UNITED AC 2019; 73:28-34. [PMID: 31036510 DOI: 10.1016/j.rec.2019.02.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/18/2019] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES Despite the efficacy of oral anticoagulant (OAC) therapy, some patients continue to have a high residual risk and develop a stroke on OAC therapy (resistant stroke [RS]), and there is a lack of evidence on the management of these patients. The aim of this study was to analyze the safety and efficacy of left atrial appendage occlusion (LAAO) as secondary prevention in patients with nonvalvular atrial fibrillation who have experienced a stroke/transient ischemic attack despite OAC treatment. METHODS We analyzed data from the Amplatzer Cardiac Plug multicenter registry on 1047 consecutive patients with nonvalvular atrial fibrillation undergoing LAAO. Patientes with previous stroke on OAC therapy as indication for LAAO were identified and compared with patients with other indications. RESULTS A total of 115 patients (11%) with RS were identified. The CHA2DS2-VASc and the HAS-BLED score were significantly higher in the RS group (respectively 5.5±1.5 vs 4.3±1.6; P <.001; 3.9±1.3 vs 3.1±1.2; P <.001). No significant differences were observed in periprocedural major safety events (7.8 vs 4.5%; P=.1). With a mean clinical follow-up of 16.2±12.2 months, the observed annual stroke/transient ischemic attack rate for the RS group was 2.6% (65% risk reduction) and the observed annual major bleeding rate was 0% (100% risk reduction). CONCLUSIONS Patients with RS undergoing LAAO showed similar safety outcomes to patients without RS, with a significant reduction in stroke/transient ischemic attack and major bleeding events during follow-up. Adequately powered controlled trials are needed to further investigate the use of LAAO in RS patients.
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Affiliation(s)
- Ignacio Cruz-González
- Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), CIBERCV, Salamanca, Spain.
| | - Rocío González-Ferreiro
- Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), CIBERCV, Salamanca, Spain
| | - Xavier Freixa
- Servicio de Cardiologia, Hospital Clínico, Universidad de Barcelona, Barcelona, Spain
| | - Sameer Gafoor
- Department of Cardiology, CardioVascular Center Frankfurt, Frankfurt, Germany
| | - Samera Shakir
- Department of Cardiology, University Hospital of Bern, Bern, Switzerland
| | - Heyder Omran
- Department of Cardiology, University Hospital of Bonn, Bonn, Germany
| | - Sergio Berti
- Department of Cardiology, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - Gennaro Santoro
- Department of Cardiology, Ospedale Careggi di Firenze, Florence, Italy
| | - Joelle Kefer
- Department of Cardiology, St-Luc University Hospital, Brussels, Belgium
| | - Ulf Landmesser
- Department of Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | | | - Prapa Kanagaratnam
- Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Fabian Nietlispach
- Department of Cardiology, University Hospital of Bern, Bern, Switzerland; Department of Cardiology, University Hospital of Zurich, Zurich, Switzerland
| | - Steffen Gloekler
- Department of Cardiology, University Hospital of Bern, Bern, Switzerland
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Paolo Danna
- Department of Cardiology Ospedale Luigi Sacco, Milan, Italy
| | - Marco Rezzaghi
- Department of Cardiology, Fondazione Toscana Gabriele Monasterio, Massa, Italy
| | - Friederike Stock
- Department of Cardiology, University Hospital of Bonn, Bonn, Germany
| | | | - Luis Paiva
- Department of Cardiology, Coimbra University Hospital Centre, Coimbra, Portugal
| | - Marco Costa
- Department of Cardiology, Coimbra University Hospital Centre, Coimbra, Portugal
| | - Xavier Millán
- Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Reda Ibrahim
- Department of Cardiology, Montreal Heart Institute, Montreal, Canada
| | - Tobias Tichelbäcker
- Department of Cardiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Heart Center Cologne, Cologne, Germany
| | - Wolfgang Schillinger
- Department of Cardiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Heart Center Cologne, Cologne, Germany
| | - Jai-Wun Park
- Department of Cardiology, Coburg Hospital, Coburg, Germany
| | - Horst Sievert
- Department of Cardiology, CardioVascular Center Frankfurt, Frankfurt, Germany
| | - Bernhard Meier
- Department of Cardiology, University Hospital of Bern, Bern, Switzerland
| | - Apostolos Tzikas
- Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece
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