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  • 1
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    Online Resource
    Blood Pressure Level and Variability During Long-Term Prasugrel or Clopidogrel Medication After Stroke : PRASTRO-I
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Stroke Vol. 52, No. 4 ( 2021-04), p. 1234-1243
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 52, No. 4 ( 2021-04), p. 1234-1243
    Abstract: High blood pressure increases bleeding risk during treatment with antithrombotic medication. The association between blood pressure levels and the risk of recurrent stroke during long-term secondary stroke prevention with thienopyridines (particularly prasugrel) has not been well studied. Methods: This was a post hoc analysis of the randomized, double-blind, multicenter PRASTRO-I trial (Comparison of Prasugrel and Clopidogrel in Japanese Patients With Ischemic Stroke-I). Patients with noncardioembolic stroke were randomly assigned (1:1) to receive prasugrel 3.75 mg/day or clopidogrel 75 mg/day for 96 to 104 weeks. Risks of any ischemic or hemorrhagic stroke, combined ischemic events, and combined bleeding events were determined based on the mean level and visit-to-visit variability, including successive variation, of systolic blood pressure (SBP) throughout the observational period. These risks were also compared between quartiles of mean SBP level and successive variation of SBP. Results: A total of 3747 patients (age 62.1±8.5 years, 797 women), with a median average SBP level during the observational period of 132.5 mm Hg, were studied. All the risks of any stroke (146 events; hazard ratio, 1.318 [95% CI, 1.094–1.583] per 10-mm Hg increase), ischemic stroke (133 events, 1.219 [1.010–1.466] ), hemorrhagic stroke (13 events, 3.247 [1.660–6.296]), ischemic events (142 events, 1.219 [1.020–1.466] ), and bleeding events (47 events, 1.629 [1.172–2.261]) correlated with increasing mean SBP overall. Similarly, an increased risk of these events correlated with increasing successive variation of SBP (hazard ratio, 3.078 [95% CI, 2.220–4.225] per 10-mm Hg increase; 3.051 [2.179–4.262]; 3.276 [1.172–9.092] ; 2.865 [2.042–4.011]; 2.764 [1.524–5.016] , respectively). Event rates did not differ between the clopidogrel and prasugrel groups within each quartile of SBP or successive variation of SBP. Conclusions: Both high mean SBP level and high visit-to-visit variability in SBP were significantly associated with the risk of recurrent stroke during long-term medication with either prasugrel or clopidogrel after stroke. Control of hypertension would be important regardless of the type of antiplatelet drugs. Registration: URL: https://www.clinicaltrials.jp ; Unique identifier: JapicCTI-111582.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.120.032824
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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  • 2
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    Significance of Nonfocal Symptoms in Patients With Transient Ischemic Attack : The PROMISE-TIA Study
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  Stroke Vol. 49, No. 8 ( 2018-08), p. 1893-1898
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 49, No. 8 ( 2018-08), p. 1893-1898
    Abstract: Patients with transient ischemic attack (TIA) occasionally show nonfocal symptoms, such as unconsciousness, amnesia, and unsteadiness. The purpose of this study was to clarify the characteristics and prognosis of patients with TIA with nonfocal symptoms, using data from the PROMISE-TIA (Prospective Multicenter Registry to Identify Subsequent Cardiovascular Events After Transient Ischemic Attack). Methods— Patients with TIA within 7 days of onset were consecutively enrolled in the Japanese nationwide registry. Factors associated with nonfocal symptoms and 1-year risks of ischemic stroke and coronary artery diseases were assessed in multivariate-adjusted models. Results— We studied 1362 patients with TIA (879 men; mean age, 69±12 years), including 219 (16%) with nonfocal symptoms. Patients with TIA with nonfocal symptoms were more likely to show acute ischemic lesions in the posterior circulation on diffusion-weighted imaging (multivariate-adjusted odds ratio, 3.07; 95% confidence interval, 1.57–5.82) and arterial stenosis or occlusion in the posterior circulation on vascular examination (odds ratio, 1.94; 95% confidence interval, 1.19–3.09) than those without nonfocal symptoms. Although 1-year risk of ischemic stroke did not differ significantly between groups (adjusted hazard ratio, 0.79; 95% confidence interval, 0.42–1.37), risk of coronary artery disease was higher in patients with TIA with nonfocal symptoms (hazard ratio, 3.37; 95% confidence interval, 1.14–9.03). Conclusions— Both acute ischemic lesions and arterial stenosis and occlusion in the posterior circulation were more frequently observed in patients with TIA with nonfocal symptoms.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.118.022009
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
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  • 3
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    Factors Associated With Onset-to-Door Time in Patients With Transient Ischemic Attack Admitted to Stroke Centers
    Ovid Technologies (Wolters Kluwer Health) ; 2014
    In:  Stroke Vol. 45, No. 2 ( 2014-02), p. 611-613
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 45, No. 2 ( 2014-02), p. 611-613
    Abstract: The aim of this study was to elucidate the factors associated with the time from symptom onset to arrival at a stroke center (onset-to-door time [ODT]) in patients with classically defined transient ischemic attack using data from a multicenter, retrospective study. Methods— The subjects were patients with transient ischemic attack admitted to 13 stroke centers in Japan within 7 days of onset between 2008 and 2009. A total of 464 patients registered (292 men, 68.5±13.2 years old), and 421 of them (268 men, 68.8±13.1 years old) were included in the analyses. ODT was classified into the following 5 categories: 〈 3 hours, 3 to 6 hours, 7 to 12 hours, 13 to 24 hours, and 〉 24 hours. Results— There were 233 patients (55.3%) who visited a stroke center within 3 hours of symptom onset. Multiple ordinal logistic regression analysis revealed that motor weakness, speech disturbance, and duration of symptoms 〉 10 minutes were independently associated with a short ODT. Furthermore, a history of transient ischemic attack and hypertension and a referral from another medical facility were independently associated with a long ODT. Patients with a higher ABCD 2 score were likely to arrive at a stroke center more quickly. Conclusions— We identified several factors that were positively and negatively associated with the ODT in patients with transient ischemic attack.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.113.003367
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2014
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  • 4
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    Online Resource
    Abstract WP423: Final Results of Cilostazol-Aspirin Therapy Against Recurrent Stroke with Intracranial Artery Stenosis (CATHARSIS)
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Stroke Vol. 44, No. suppl_1 ( 2013-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. suppl_1 ( 2013-02)
    Abstract: Background: The Cilostazol-Aspirin Against Recurrent Stroke with Intracranial Artery Stenosis (CATHARSIS) (Clinicaltrials.gov identifier: NCT 00333164) was a randomized controlled trial to compare cilostazol plus aspirin with aspirin alone in patients with symptomatic intracranial artery stenosis (IAS). We presented final results of CATHARSIS. Methods: Subjects were patients at age of 45-85 years with ischemic stroke after two weeks to six months from onset and 〉 50% stenosis in responsible intracranial arteries on MRA. They were randomly allocated either group of cilostazol 200 mg/day plus aspirin 100 mg/day (CA group) or aspirin 100 mg/day alone (A group), who were followed up for two years. Primary endpoint was progression of IAS after two years. Secondary endopoints included ischemic stroke, all strokes, all vascular events (ischemic stroke, MI, and other vascular events) and new silent brain infarcts. Results: A total of 165 patients (109 males, average 68 years) were randomized. Male (77.1% vs 53.8%), hypertension (83.1% vs 68.8%), and diabetes (48.2% vs 25.0%) were more frequent in CA than A group. There was no difference in the progression of IAS between both groups (9.6% [95 CI 3.9-18.8%] in CA group and 7.6% [95% CI 3.8-13.2%] in A group, p = 0.5326). Stroke recurrence occurred in 2.4%/year in CA group (ischemic 4, hemorrhagic 0) and 5.5%/year in A group (ischemic 6, hemorrhagic 2). Rate of stroke recurrence tended to be lower in CA than C group (adjusted HR 0.439, 95% CI 0.112-1.497, p = 0.191). Rate of vascular events also tended to be lower in CA than A group (adjusted HR 0.390, 95% CI 0.118-1.136, p = 0.085). New silent brain infarcts were observed in 4.8% in CA group and 10.0% in A group at two years (p = 0.2445). Conclusion: Rates of IAS progression and recurrent stroke were unexpectedly low in both treatment groups, which could be due to excellent medical management and have reduced statistical power. There was no difference in the progression of IAS between two groups. Rates of stroke recurrence, vascular events, and new silent brain infarcts tended to be lower in CA than A group.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.44.suppl_1.AWP423
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
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  • 5
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    Practical “1-2-3-4-Day” Rule for Starting Direct Oral Anticoagulants After Ischemic Stroke With Atrial Fibrillation: Combined Hospital-Based Cohort Study
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Stroke Vol. 53, No. 5 ( 2022-05), p. 1540-1549
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 53, No. 5 ( 2022-05), p. 1540-1549
    Abstract: The “1-3-6-12-day rule” for starting direct oral anticoagulants (DOACs) in patients with nonvalvular atrial fibrillation after acute ischemic stroke or transient ischemic attack recommends timings that may be later than used in clinical practice. We investigated more practical optimal timing of DOAC initiation according to stroke severity. Methods: The combined data of prospective registries in Japan, Stroke Acute Management with Urgent Risk-factor Assessment and Improvement-nonvalvular atrial fibrillation (September 2011 to March 2014) and RELAXED (February 2014 to April 2016) were used. Patients were divided into transient ischemic attack and 3 stroke subgroups by the National Institutes of Health Stroke Scale score: mild (0–7), moderate (8–15), and severe (≥16). The early treatment group was defined as patients starting DOACs earlier than the median initiation day in each subgroup. Outcomes included a composite of recurrent stroke or systemic embolism, ischemic stroke, and severe bleeding within 90 days. Six European prospective registries were used for validation. Results: In the 1797 derivation cohort patients, DOACs were started at median 2 days after transient ischemic attack and 3, 4, and 5 days after mild, moderate, and severe strokes, respectively. Stroke or systemic embolism was less common in Early Group (n=785)—initiating DOACS within 1, 2, 3, and 4 days, respectively—than Late Group (n=1012) (1.9% versus 3.9%; adjusted hazard ratio, 0.50 [95% CI, 0.27–0.89]), as was ischemic stroke (1.7% versus 3.2%, 0.54 [0.27–0.999] ). Major bleeding was similarly common in the 2 groups (0.8% versus 1.0%). On validation, both ischemic stroke (2.4% versus 2.2%) and intracranial hemorrhage (0.2% versus 0.6%) were similarly common in Early (n=547) and Late (n=1483) Groups defined using derivation data. Conclusions: In Japanese and European populations, early DOAC initiation within 1, 2, 3, or 4 days according to stroke severity seemed to be feasible to decrease the risk of recurrent stroke or systemic embolism and no increase in major bleeding. These findings support ongoing randomized trials to better establish the optimal timing of DOAC initiation.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.121.036695
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 6
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    Abstract TP231: Clinical Characteristics of TIA with Atrial Fibrillation
    Ovid Technologies (Wolters Kluwer Health) ; 2013
    In:  Stroke Vol. 44, No. suppl_1 ( 2013-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 44, No. suppl_1 ( 2013-02)
    Abstract: Objectives: Patients with transient ischemic attack (TIA) are at high risk of early stroke, indicating a need for urgent diagnostic workup and treatment. Atrial fibrillation (AF) is one of important causes for TIA. The purpose of this study was to investigate characteristics of TIA patients with AF, using data of a multicenter retrospective study. Methods: The subjects of this study were TIA patients admitted to 13 stroke centers within 7 days after onset between 2008 and 2009. The definition of TIA used in this study was that of clinical symptoms lasting less than 24 hours, regardless of imaging findings. We compared baseline characteristics and diffusion weighted-MRI (DWI) findings between patients with AF and those without AF. Results: A total of 464 patients (69 ± 13 years in age, 172 women) were enrolled. We diagnosed 79 patients (17%) as having AF. TIA patients with AF were older (74 ± 9 vs. 67 ± 14 years old, P = 0.0001) and more likely to have a longer length of hospital stay (15 ± 9 vs. 14 ± 20 days, P = 0.046) than those without AF. Of 464 TIA patients, 458 patients (99%) underwent head MRI. DWI lesion was detected in 96 (21%) patients. There was no difference of DWI positivity rate between patients with or without AF (28% vs. 20%, P = 0.10). Compared to patients without AF, patients with AF were more likely to have a single lesion on DWI (86% vs. 51%, P = 0.005). DWI lesion of ≥15 mm was found more frequently in TIA patients with AF than in those without AF (45% vs. 22%, P = 0.04). Conclusions: This study demonstrated that TIA patients with AF were older and had a longer length of hospital stay than those without AF. In addition, characteristics of DWI findings differed between TIA patient with AF and those without AF; TIA patients with AF were more likely to have a single lesion with a size of ≥15 mm.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.44.suppl_1.ATP231
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2013
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  • 7
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    Abstract 2867: Factors Relating To An Early Visit To A Stroke Center In Patients With Transient Ischemic Attack: Analyses Of Data From A Multicenter Retrospective Study
    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: Purpose: As transient ischemic attack (TIA) is a medical emergency associated with a high risk of early recurrent stoke, an immediate seeking medical attention is essential to reduce a risk of stroke after TIA. The purpose of this study was to investigate factors relating to an early visit to a stroke center in patients with TIA, using data of a multicenter retrospective study. Methods: The subjects of this study were TIA patients admitted to 13 stroke centers within 7 days after onset between 2008 and 2009. The diagnosis of TIA was made in this study if clinical symptoms lasted less than 24 hours, regardless of imaging findings. We compared baseline characteristics between patients visiting a stroke center within 3 hours of TIA onset (early visit, EV group) and those after the initial 3 hours (late visit, LV group), using Chi-square tests. Results: Four hundred sixty-four patients (292 men, mean age of 69 years) were registered. Of them, 240 patients (52%) belonged to the EV group and 220 (47%) used an ambulance. One hundred twenty-seven patients (27.4%) were referred from some other medical facility and 23 patients (5.0%) were from another department within the hospital. As compared to patients in the LV group, those in the EV group more commonly had motor symptoms (p 〈 0.0001) and consciousness disturbance (p = 0.0027), and were less commonly referred from some other medical facility (p 〈 0.0001) or from another department (p = 0.0057). Patients were less likely to have a past history of TIA in the EV group than in the LV group, but not significantly (p = 0.065). Conclusions: Almost half of TIA patients visited a stroke center within 3 hours after onset. Motor symptoms and consciousness disturbance were related to an early visit. Referrals from some other medical facility or department were associated with delay in a contact to stroke specialists.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.43.suppl_1.A2867
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2012
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