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  • 1
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    Online Resource
    Combined Approach to Lysis Utilizing Eptifibatide and Recombinant Tissue Plasminogen Activator in Acute Ischemic Stroke–Enhanced Regimen Stroke Trial
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Stroke Vol. 44, No. 9 ( 2013-09), p. 2381-2387
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. 9 ( 2013-09), p. 2381-2387
    Abstract: In a previous study, 0.3 and 0.45 mg/kg of intravenous recombinant tissue plasminogen activator (rt-PA) were safe when combined with eptifibatide 75 mcg/kg bolus and a 2-hour infusion (0.75 mcg/kg per minute). The Combined Approach to Lysis Utilizing Eptifibatide and rt-PA in Acute Ischemic Stroke–Enhanced Regimen (CLEAR-ER) trial sought to determine the safety of a higher-dose regimen and to establish evidence for a phase III trial. Methods— CLEAR-ER was a multicenter, double-blind, randomized safety study. Ischemic stroke patients were randomized to 0.6 mg/kg rt-PA plus eptifibatide (135 mcg/kg bolus and a 2-hour infusion at 0.75 mcg/kg per minute) versus standard rt-PA (0.9 mg/kg). The primary safety end point was the incidence of symptomatic intracranial hemorrhage within 36 hours. The primary efficacy outcome measure was the modified Rankin Scale (mRS) score ≤1 or return to baseline mRS at 90 days. Analysis of the safety and efficacy outcomes was done with multiple logistic regression. Results— Of 126 subjects, 101 received combination therapy, and 25 received standard rt-PA. Two (2%) patients in the combination group and 3 (12%) in the standard group had symptomatic intracranial hemorrhage (odds ratio, 0.15; 95% confidence interval, 0.01–1.40; P =0.053). At 90 days, 49.5% of the combination group had mRS ≤1 or return to baseline mRS versus 36.0% in the standard group (odds ratio, 1.74; 95% confidence interval, 0.70–4.31; P =0.23). After adjusting for age, baseline National Institutes of Health Stroke Scale, time to intravenous rt-PA, and baseline mRS, the odds ratio was 1.38 (95% confidence interval, 0.51–3.76; P =0.52). Conclusions— The combined regimen of intravenous rt-PA and eptifibatide studied in this trial was safe and provides evidence that a phase III trial is warranted to determine efficacy of the regimen. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00894803.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.113.001059
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
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  • 2
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    C-Reactive Protein as a Prognostic Marker After Lacunar Stroke : Levels of Inflammatory Markers in the Treatment of Stroke Study
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Stroke Vol. 45, No. 3 ( 2014-03), p. 707-716
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. 3 ( 2014-03), p. 707-716
    Abstract: Inflammatory biomarkers predict incident and recurrent cardiac events, but their relationship to stroke prognosis is uncertain. We hypothesized that high-sensitivity C-reactive protein (hsCRP) predicts recurrent ischemic stroke after recent lacunar stroke. Methods— Levels of Inflammatory Markers in the Treatment of Stroke (LIMITS) was an international, multicenter, prospective ancillary biomarker study nested within Secondary Prevention of Small Subcortical Strokes (SPS3), a phase III trial in patients with recent lacunar stroke. Patients were assigned in factorial design to aspirin versus aspirin plus clopidogrel, and higher versus lower blood pressure targets. Patients had blood samples collected at enrollment and hsCRP measured using nephelometry at a central laboratory. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for recurrence risks before and after adjusting for demographics, comorbidities, and statin use. Results— Among 1244 patients with lacunar stroke (mean age, 63.3±10.8 years), median hsCRP was 2.16 mg/L. There were 83 recurrent ischemic strokes (including 45 lacunes) and 115 major vascular events (stroke, myocardial infarction, and vascular death). Compared with the bottom quartile, those in the top quartile (hsCRP 〉 4.86 mg/L) were at increased risk of recurrent ischemic stroke (unadjusted HR, 2.54; 95% CI, 1.30–4.96), even after adjusting for demographics and risk factors (adjusted HR, 2.32; 95% CI, 1.15–4.68). hsCRP predicted increased risk of major vascular events (top quartile adjusted HR, 2.04; 95% CI, 1.14–3.67). There was no interaction with randomized antiplatelet treatment. Conclusions— Among recent lacunar stroke patients, hsCRP levels predict the risk of recurrent strokes and other vascular events. hsCRP did not predict the response to dual antiplatelets. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00059306.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.113.004562
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
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  • 3
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    Abstracts
    Springer Science and Business Media LLC ; 2000
    In:  Rechtsmedizin Vol. 10, No. S1 ( 2000-1), p. S1-S51
    Details
    In: Rechtsmedizin, Springer Science and Business Media LLC, Vol. 10, No. S1 ( 2000-1), p. S1-S51
    Type of Medium: Online Resource
    ISSN: 0937-9819 , 1434-5196
    URL: Article
    DOI: 10.1007/BF03215853
    RVK:
    PH 141
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2000
    detail.hit.zdb_id: 1463037-0
    SSG: 2
    SSG: 2,1
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  • 4
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    Can Comprehensive Stroke Centers Erase the ‘Weekend Effect’?
    S. Karger AG ; 2009
    In:  Cerebrovascular Diseases Vol. 27, No. 2 ( 2009), p. 107-113
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 27, No. 2 ( 2009), p. 107-113
    Abstract: 〈 i 〉 Background: 〈 /i 〉 Prior epidemiological work has shown higher mortality in ischemic stroke patients admitted on weekends, which has been termed the ‘weekend effect’. Our aim was to assess stroke patient outcomes in order to determine the significance of the ‘weekend effect’ at 2 comprehensive stroke centers. 〈 i 〉 Methods: 〈 /i 〉 Consecutive stroke patients were identified using prospective databases. Patients were categorized into 4 groups: intracerebral hemorrhage (ICH group), ischemic strokes not treated with IV t-PA (intravenous tissue plasminogen activator; IS group), acute ischemic strokes treated with IV t-PA (AIS-TPA group), and transient ischemic attack (TIA group). Weekend admission was defined as the period from Friday, 17:01, to Monday, 08:59. Patients treated beyond the 3-hour window, receiving intra-arterial therapy, or enrolled in nonobservational clinical trials were excluded. Patient demographics, NIHSS scores, and admission glucose levels were examined. Adverse events, poor functional outcome (modified Rankin scale, mRS, 3–6), and mortality were compared. 〈 i 〉 Results: 〈 /i 〉 A total of 2,211 patients were included (1,407 site 1, 804 site 2). Thirty-six percent (800/2,211) arrived on a weekend. No significant differences were found in the ICH, IS, AIS-TPA, or TIA groups with respect to the rate of symptomatic ICH, mRS on discharge, discharge disposition, 90-day mRS, or 90-day mortality when comparing weekend and weekday groups. Using multivariate logistic regression to adjust for site, age, admission NIHSS, and blood glucose, weekend admission was not a significant independent predictive factor for in-hospital mortality in all strokes (OR = 1.10, 95% CI 0.74–1.63, p = 0.631). 〈 i 〉 Conclusions: 〈 /i 〉 Our results suggest that comprehensive stroke centers (CSC) may ameliorate the ‘weekend effect’ in stroke patients. These results may be due to 24/7 availability of stroke specialists, advanced neuroimaging, or ongoing training and surveillance of specialized nursing care available at CSC. While encouraging, these results require confirmation in prospective studies.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000177916
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2009
    detail.hit.zdb_id: 1482069-9
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  • 5
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    ACCESS : Acute Cerebrovascular Care in Emergency Stroke Systems
    American Medical Association (AMA) ; 2010
    In:  Archives of Neurology Vol. 67, No. 10 ( 2010-10-01)
    Details
    In: Archives of Neurology, American Medical Association (AMA), Vol. 67, No. 10 ( 2010-10-01)
    Type of Medium: Online Resource
    ISSN: 0003-9942
    URL: Article
    DOI: 10.1001/archneurol.2010.250
    RVK:
    XA 10000
    Language: English
    Publisher: American Medical Association (AMA)
    Publication Date: 2010
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  • 6
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    Comprehensive Stroke Centers and the ‘Weekend Effect’: The SPOTRIAS Experience
    S. Karger AG ; 2012
    In:  Cerebrovascular Diseases Vol. 34, No. 5-6 ( 2012), p. 424-429
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 34, No. 5-6 ( 2012), p. 424-429
    Abstract: 〈 b 〉 〈 i 〉 Background and Purpose: 〈 /i 〉 〈 /b 〉 Previous studies have found mortality among ischemic stroke patients to be higher on weekends. We sought to evaluate whether weekend admission was associated with worse outcomes in a large comprehensive stroke center (CSC) cohort. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Consecutive ischemic stroke patients presenting within 6 h of symptom onset were identified using the 8 CSC SPOTRIAS (Specialized Programs of Translational Research in Acute Stroke) database. Patients who received intra-arterial therapy or who were enrolled in a nonobservational clinical trial were excluded. All patients meeting the inclusion criteria were then divided into two groups: weekday admissions or weekend admissions. Weekend admission was defined as Friday 17:01 to Monday 08:59. The remainder were classified as weekday admissions. Multivariate logistic regression was used, adjusting for age, stroke severity on admission [according to the National Institutes of Health Stroke Scale (NIHSS)] and admission glucose, in order to compare the outcomes of the weekend versus the weekday groups. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Eight thousand five hundred and eighty-one subjects from the combined SPOTRIAS database were screened from 2002 to 2009; 2,090 (24.4%) of these met the inclusion criteria. There was no significant difference in tissue plasminogen activator treatment rates between the weekday and weekend groups (58.5 vs. 60.4%, p = 0.397). Weekend admission was not a significant independent predictor of inhospital mortality (8.4 vs. 9.9%, p = 0.056), length of stay (4 vs. 5 days, p = 0.442), favorable discharge disposition (38.0 vs. 42.2%, p = 0.122), favorable functional outcome at discharge (41.6 vs. 43.4%, p = 0.805), favorable 90-day functional outcome (54.2 vs. 46.9%, p = 0.301), or 90-day mortality (18.2 vs. 19.8%, p = 0.680) when adjusting for age, NIHSS and admission glucose. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 In this large cohort of ischemic stroke patients treated at CSCs, we did not observe the ‘weekend effect.’ This may be due to access to stroke specialists 24 h a day on 365 days a year, nurses with stroke experience and the organized system for delivering care that is available at CSCs. These results suggest that EMS protocol should be reexamined regarding the preferential delivery of weekend stroke victims to hospitals that provide all levels of reperfusion therapy. This further highlights the importance of organized stroke care.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000345077
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2012
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  • 7
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    Abstract 132: In-hospital Versus Out-of-hospital Code Stroke: Iv Tpa Rate And Clinical Outcomes.
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  Stroke Vol. 43, No. suppl_1 ( 2012-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 43, No. suppl_1 ( 2012-02)
    Abstract: Background: Patients with Code Stroke alert in the hospital may have different risk factors, demographics and differential diagnoses than patients who are admitted with Code Stroke Alert to the ED. Hospitals and health care systems use considerable resources to provide 24/7 acute stroke care access to in-hospital Code Stroke alerts. Most of the utility analyses are based on data from out-of-hospital stroke. We analyzed the frequency of IV tPA use and the likelihood of home discharge in patients with Code Stroke alert in the hospital versus out-of-hospital. Methods: All adult patients with Code Stroke alerts in the UCSD SPOTRIAS Database from 2004 to 2011, excluding patients transferred from acute care facilities; grouped into 1: out-of-hospital Code Stroke alerts (EMS or ED) and 2: in-hospital (all inpatient units) and analyzed by baseline demographics; time to treatment decision; frequency of IV tPA use; diagnosis (Acute Ischemic Stroke, SAH, ICH, TIA, mimic, unknown); discharge disposition (home versus other), 90 day modified Rankin Scale (mRS) and adjusted for multiple co-variables. Results: We identified 2,699 Code Stroke alerts; 2,498 in group 1 and 201 in group 2. Patients in group 2 were younger (63.6±15.5 vs 66.8±16.8 years of age, p=0.005), more likely to have diabetes (27.9 vs 21.3%, p=0.03), had higher baseline NIHSS (11.6±11.6 vs 9.0±10.0, 0.007) and likelihood to have a pre-stroke mRS 〉 1 (35.8 vs 27.4%, p=0.01); had fewer acute ischemic strokes (38.8 vs 46.6%), but more stroke mimics (39.8 vs 29.5%), p=0.01,had shorter time from stroke onset to treatment decision (202.2±282.3 vs 275.2±423.1 min, p 〈 0.0001) and were less likely to receive IV tPA (10.0 vs 16.0%, p=0.03). The time from onset to IV tPA treatment in Group 2 was 162.9±69.8 min; vs 150.1±106.0, p=0.07. Multivariable logistic regression analysis adjusting for age, history of diabetes and admission NIHSS show that the rates of being discharge home (OR=0.83, 95%CI = 0.59, 1.17, p=0.29) and having a 90-day mRS of 0-1 (OR-1.35, 95% CI = 0.64, 2.86), p=0.44) are similar in the two groups. Conclusion: In-hospital are less likely to lead to IV tPA treatment than out-of-hospital Code Stroke alerts. Patient outcome based on discharge disposition and 90-day mRS is not significantly different from out-of-hospital Code Stroke.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.43.suppl_1.A132
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
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  • 8
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    Abstract 2703: In-hospital Versus Out-of-hospital Stroke Treated With Iv Tpa And 3 Month Outcomes.
    Ovid Technologies (Wolters Kluwer Health) ; 2012
    In:  Stroke Vol. 43, No. suppl_1 ( 2012-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 43, No. suppl_1 ( 2012-02)
    Abstract: Background: Most hospitals set up Code Stroke alert teams in the Emergency Departments. Expanding sufficient Code Stroke coverage to in-hospital areas requires additional resources, often through Neuro-hospitalist teams. Most data on outcomes after stroke are based on out-of-hospital stroke. We evaluated the outcomes of patients with stroke that occurs in the hospital versus out-of-hospital. Methods: We included all adult patients with Code Stroke alerts, diagnosis of acute ischemic stroke, who had 90-days post Code Stroke modified Rankin Scale from the UCSD SPOTRIAS database (2004 to 2011) and excluded patients transferred from acute care facilities. The patients were grouped into 1: out-of-hospital Code Stroke alerts (EMS or ED) and 2: in-hospital (all inpatient units) and analyzed by baseline demographics, time to treatment decision, frequency of IV tPA use, 90-day modified Rankin Scale (mRS) and adjusted for multiple co-variables. Symptomatic intracranial hemorrhage (SICH) was defined as ≥4 point increase in NIHSS and ICH that was deemed the cause of the clinical change. Results: We identified 590 Code Stroke alerts; 563 in group 1 and 27 in group 2. Baseline demographics were balanced, except group 2 patients younger (64.26±16 vs 70.2±15.5 years of age, p=0.0497) and were more likely to be Hispanic (29.6 vs 14.2%, p=0.047). IV tPA was given in 13/27 (48.2%) patients in Group 2 and 266/563 (47.3%) in Group 1 (NS). Anticoagulation was the reason for exclusion in 4/14 (28.6%) of patients in Group 2 vs 18/266 (6.5%) (p=0.017). The frequency of other diagnoses and reasons for exclusion were similar between groups. The time from stroke onset to tPA treatment in group 2 was 135.1±57.9 vs 151.4±121.2 min (NS). A 90-day mRS of 0 or 1 was achieved in 9/27 (33.3%) patients in Group 2 and 221/563 (39.3%) patients in Group 1 (NS); in tPA treated patients: Group 2 3/13 (23.1%), Group 1 83/266 (31.2%) (NS). SICH occurred in the tPA treated patients: Group 2 1/13 (7.7%); Group 1 9/266 (3.4%) (NS). Conclusion: We identified a relatively small group of ischemic stroke patients with in-hospital onset. In those patients, however, rates of tPA use and outcomes were similar to out-of-hospital stroke.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.43.suppl_1.A2703
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
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  • 9
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    (VISIION-S): Viz.ai Implementation of Stroke augmented Intelligence and communications platform to improve Indicators and Outcomes for a comprehensive stroke center and Network – Sustainability
    Elsevier BV ; 2023
    In:  Journal of Stroke and Cerebrovascular Diseases Vol. 32, No. 10 ( 2023-10), p. 107303-
    Details
    In: Journal of Stroke and Cerebrovascular Diseases, Elsevier BV, Vol. 32, No. 10 ( 2023-10), p. 107303-
    Type of Medium: Online Resource
    ISSN: 1052-3057
    URL: Article
    DOI: 10.1016/j.jstrokecerebrovasdis.2023.107303
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2023
    detail.hit.zdb_id: 2052957-0
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  • 10
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    The Impact of Atrial Fibrillation on the Outcome of Ischemic Stroke Treated With Thrombolysis or Endovascular Therapy
    Elmer Press, Inc. ; 2022
    In:  Journal of Neurology Research Vol. 12, No. 3 ( 2022-10), p. 121-127
    Details
    In: Journal of Neurology Research, Elmer Press, Inc., Vol. 12, No. 3 ( 2022-10), p. 121-127
    Type of Medium: Online Resource
    ISSN: 1923-2845 , 1923-2853
    URL: Article
    DOI: 10.14740/jnr738
    Language: English
    Publisher: Elmer Press, Inc.
    Publication Date: 2022
    detail.hit.zdb_id: 2662520-9
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