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  • Ovid Technologies (Wolters Kluwer Health)  (43)
  • 1
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    Online Resource
    Randomized, Multicenter Trial of ARTSS-2 (Argatroban With Recombinant Tissue Plasminogen Activator for Acute Stroke)
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Stroke Vol. 48, No. 6 ( 2017-06), p. 1608-1616
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. 6 ( 2017-06), p. 1608-1616
    Abstract: We conducted a randomized exploratory study to assess safety and the probability of a favorable outcome with adjunctive argatroban, a direct thrombin-inhibitor, administered to recombinant tissue-type plasminogen activator (r-tPA)–treated ischemic stroke patients. Methods— Patients treated with standard-dose r-tPA, not receiving endovascular therapy, were randomized to receive no argatroban or argatroban (100 μg/kg bolus) followed by infusion of either 1 (low dose) or 3 μg/kg per minute (high dose) for 48 hours. Safety was incidence of symptomatic intracerebral hemorrhage. Probability of clinical benefit (modified Rankin Scale score 0–1 at 90 days) was estimated using a conservative Bayesian Poisson model (neutral prior probability centered at relative risk, 1.0 and 95% prior intervals, 0.33–3.0). Results— Ninety patients were randomized: 29 to r-tPA alone, 30 to r-tPA+low-dose argatroban, and 31 to r-tPA+high-dose argatroban. Rates of symptomatic intracerebral hemorrhage were similar among control, low-dose, and high-dose arms: 3/29 (10%), 4/30 (13%), and 2/31 (7%), respectively. At 90 days, 6 (21%) r-tPA alone, 9 (30%) low-dose, and 10 (32%) high-dose patients were with modified Rankin Scale score 0 to 1. The relative risks (95% credible interval) for modified Rankin Scale score 0 to 1 with low, high, and either low or high dose argatroban were 1.17 (0.57–2.37), 1.27 (0.63–2.53), and 1.34 (0.68–2.76), respectively. The probability that adjunctive argatroban was superior to r-tPA alone was 67%, 74%, and 79% for low, high, and low or high dose, respectively. Conclusions— In patients treated with r-tPA, adjunctive argatroban was not associated with increased risk of symptomatic intracerebral hemorrhage and provides evidence that a definitive effectiveness trial is indicated. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique Identifier: NCT01464788.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.117.016720
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 1467823-8
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  • 2
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    Cannabis Use and Outcomes in Patients With Aneurysmal Subarachnoid Hemorrhage
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. 5 ( 2016-05), p. 1371-1373
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. 5 ( 2016-05), p. 1371-1373
    Abstract: The incidence of cannabis use in patients with aneurysmal subarachnoid hemorrhage (aSAH) and its impact on morbidity, mortality, and outcomes are unknown. Our objective was to evaluate the relationship between cannabis use and outcomes in patients with aSAH. Methods— Records of consecutive patients admitted with aSAH between 2010 and 2015 were reviewed. Clinical features and outcomes of aSAH patients with negative urine drug screen and cannabinoids-positive (CB+) were compared. Regression analyses were used to assess for associations. Results— The study group consisted of 108 patients; 25.9% with CB+. Delayed cerebral ischemia was diagnosed in 50% of CB+ and 23.8% of urine drug screen negative patients ( P =0.01). CB+ was independently associated with development of delayed cerebral ischemia (odds ratio, 2.68; 95% confidence interval, 1.03–6.99; P =0.01). A significantly higher number of CB+ than urine drug screen negative patients had poor outcome (35.7% versus 13.8%; P =0.01). In univariate analysis, CB+ was associated with the composite end point of hospital mortality/severe disability (odds ratio, 2.93; 95% confidence interval, 1.07–8.01; P =0.04). However, after adjusting for other predictors, this effect was no longer significant. Conclusions— We offer preliminary data that CB+ is independently associated with delayed cerebral ischemia and possibly poor outcome in patients with aSAH. Our findings add to the growing evidence on the association of cannabis with cerebrovascular risk.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.116.013099
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 1467823-8
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  • 3
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    Abnormal Intraprosthetic Regurgitation After Tricuspid Valve Replacement With a Mechanical Prosthesis
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Anesthesia & Analgesia Vol. 124, No. 6 ( 2017-06), p. 1786-1788
    Details
    In: Anesthesia & Analgesia, Ovid Technologies (Wolters Kluwer Health), Vol. 124, No. 6 ( 2017-06), p. 1786-1788
    Type of Medium: Online Resource
    ISSN: 0003-2999
    URL: Article
    DOI: 10.1213/ANE.0000000000001878
    RVK:
    XA 22250
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 2018275-2
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  • 4
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    Long-term Outcomes Following Primary Closure of Common Bile Duct Following Laparoscopic Common Bile Duct (CBD) Exploration: Experience of 355 Cases at a Tertiary Care Center
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Surgical Laparoscopy, Endoscopy & Percutaneous Techniques Vol. 30, No. 6 ( 2020-12), p. 504-507
    Details
    In: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques, Ovid Technologies (Wolters Kluwer Health), Vol. 30, No. 6 ( 2020-12), p. 504-507
    Abstract: Primary closure of common bile duct (CBD) after laparoscopic common bile duct exploration (LCBDE) is now becoming the preferred technique for closure of choledochotomy. Primary CBD closure not only circumvents the disadvantages of an external biliary drainage but also adds to the advantage of LCBDE. Here, we describe our experience of primary CBD closure following 355 cases of LCBDE in a single surgical unit at a tertiary care hospital. Materials and Methods: All patients undergoing LCBDE in a single surgical unit were included in the study. Preoperative and intraoperative parameters including the technique of CBD closure were recorded prospectively. The postoperative recovery, complications, hospital stay, antibiotic usage, and postoperative intervention, if any, were also recorded. Results: Three hundred fifty-five LCBDEs were performed from April 2007 to December 2018, and 143 were post-endoscopic retrograde cholangiopancreatography failures. The overall success rate was 91.8%. The mean operative time was 98±26.8 minutes (range, 70 to 250 min). Transient bile leak was seen in 10% of patients and retained stones in 3 patients. Two patients required re-exploration and 2 patients died in the postoperative period. Follow-up ranged from 6 months to 10 years, with a median follow-up of 72 months. No long-term complications such as CBD stricture or recurrent stones were noted. Conclusions: Primary closure of CBD after LCBDE is safe and associated with minimal complications and no long-term problems. The routine use of primary CBD closure after LCBDE is recommended based on our experience.
    Type of Medium: Online Resource
    ISSN: 1530-4515
    URL: Article
    DOI: 10.1097/SLE.0000000000000830
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 2045171-4
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  • 5
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    Diagnostic yield of brain MRI in patients presenting with spontaneous intracerebral hemorrhage (P2.268)
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Neurology Vol. 88, No. 16_supplement ( 2017-04-18)
    Details
    In: Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 88, No. 16_supplement ( 2017-04-18)
    Type of Medium: Online Resource
    ISSN: 0028-3878 , 1526-632X
    URL: Article
    DOI: 10.1212/WNL.88.16_supplement.P2.268
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
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  • 6
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    Abstract TP31: Safety and Feasibility of Argatroban, Tissue Plasminogen Activator and Intra-arterial Therapy in Stroke (artss-ia Study)
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Stroke Vol. 48, No. suppl_1 ( 2017-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. suppl_1 ( 2017-02)
    Abstract: Background and Objectives: A randomized trial of IV-tPA + thrombin-inhibition with argatroban in non-endovascular stroke patients ( ARTSS-2 ) recently demonstrated safety and signal of efficacy compared to tPA alone. The current study, ARTSS-IA, intended to study the safety and feasibility among concurrent IV-tPA, high-dose argatroban and endovascular therapy (ET) in large vessel occlusion. Methods: Eligible patients received IV-tPA (0.9mg/kg) and had CT-angiogram-proven intracranial large vessel occlusions requiring 〈 6-hours ET. During IV-tPA, a 100 μg/kg argatroban bolus was followed by 12-hour infusion to target an aPTT 2.25 times baseline. Feasibility, defined as ability to combine treatments without ET delays, was compared to data from consecutive tPA+ET treatments. Safety was incidence of symptomatic intracerebral hemorrhage (sICH). Results: Between 6/15 and 5/16, all pre-planned 10 patients were enrolled: median age=68.5 (IQR 12-24; range 52-92), median NIHSS=19.5 (range 6-25) and 70% male. Occlusions were proximal MCA (n=6), terminal ICA (n=1) and proximal PCA (n=1). All patients began argatroban before ET and completed 12-hour infusions. Study patients experienced trivial or no time delays in metrics (i.e., imaging to groin-puncture, groin-to-clot, etc) compared to non-ARTSS-IA patients during the same time (figure). Embolectomy with stentreivers were performed in all but 1 patient, a proximal PCA occlusion deemed too hazardous for device passage. All the remaining 9 patients achieved excellent angiographic reperfusion (TICI ≥2b); with 7 achieving complete reperfusion (TICI=3). There were no sICH, systemic hemorrhages, or ET complications. 24 hour NIHSS scores were markedly lower (median=7, IQR 2-16, range 1-21). At 90-days, 6 (60%) patients were functionally independent (mRS=0-2) and none died. Conclusion: In patients treated with IV tPA and ET, adjunctive argatroban appears safe and high rates of reperfusion warrant further study.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.48.suppl_1.tp31
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 1467823-8
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  • 7
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    Abstract WP307: Lone Star Stroke Consortium TeleStroke Registry (LESTER)
    Ovid Technologies (Wolters Kluwer Health) ; 2017
    In:  Stroke Vol. 48, No. suppl_1 ( 2017-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 48, No. suppl_1 ( 2017-02)
    Abstract: Background: The Lone Star Stroke Consortium TeleStroke Registry (LESTER) currently consisting of 3 academic hub centers and 25 partner spokes is a statewide initiative organized by UTHealth to understand practice patterns of acute stroke management via telemedicine (TM) in Texas, a state with one of the largest rural populations in the US. Methods: All presumed stroke patients for whom a TM consultation has been obtained in the network are entered into a web-based, HIPAA-compliant database from 9/2013 to 3/2016. 90-day mRS and disposition are obtained by a standard phone interview. Results: A total of 3390 TM consults were performed: 57.3% acute ischemic stroke (AIS); 8.6% TIA; 1.4% ICH; 32.3% non-stroke related diagnoses (Table). Half of the cases were 〈 65 years of age. Overall 38.3% of AIS cases received tPA and 12.5% of all cases were transferred to a hub. tPA rates varied from 19% to 50% and transfer rates varied from 0% to 37.5% among spokes with at least 10 AIS consults. Conclusions: In this statewide registry of telestroke organized by academic health centers, TM leads to substantially high rates of tPA administration for AIS cases compared with national treatment rates in the US. TM provided by academic centers also leads to low rates of transfer from spoke hospitals, suggesting improvement in allocation of healthcare resources.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.48.suppl_1.wp307
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2017
    detail.hit.zdb_id: 1467823-8
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  • 8
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    Abstract 92: Delirium In-hospital Leads To Poor Short And Long-term Outcomes Among Treated And Non-treated Patients With Acute Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Stroke Vol. 53, No. Suppl_1 ( 2022-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 53, No. Suppl_1 ( 2022-02)
    Abstract: Background: Delirium in-hospital (DIH) is common among the critically ill. However, DIH incidence and outcomes are not well characterized among ischemic stroke (IS) patients, particularly those treated with intravenous tissue plasminogen activator (tPA) and / or mechanical thrombectomy (MT). Methods: Utilizing data from a healthcare system with standardized delirium screening protocols, DIH was determined by a positive 4AT / CAM-ICU screen or diagnosis codes. IS patients with tPA or MT were flagged and a subset with available 90-day modified Rankin Scale (mRS) were analyzed for shifts in mRS scores associated with DIH, via ordinal logistic regression models adjusted for age, stroke severity, tPA or MT, Charlson Comorbidity Index [CCI], prior stroke and sepsis / infections. Common odds ratios (OR) and 95% confidence intervals (CI) are reported. Results: Between May 2016 and June 2021, IS was the primary discharge diagnosis in 12,415 encounters (10,878 unique patients). DIH was documented in 41.6% of IS encounters, compared to 20.0% of non-IS encounters. Stroke-DIH patients (vs no-DIH Stroke) were older (median: 75 vs 65 years), more frequently female (53.3% vs 48.7%), with higher comorbidity burden (median CCI: 7 vs 5), longer hospital stays (median: 6 vs 3 days), higher in-hospital mortality (3.1% vs 0.5%), and fewer home discharges (36.2% vs 75.2%). Among a sub-cohort of 2,785 IS patients with 90-day mRS, fully adjusted model indicated lower mRS (OR, CI: 0.48, 0.41-0.57) for those with tPA or MT, and worse outcomes for DIH patients (OR, CI: 2.70, 2.26-3.23). Among 948 treated IS patients, DIH remained a significant risk for worse outcomes (OR, CI: 2.54, 1.89-3.43). Conclusion: Delirium was twice as common in IS patients and was a negative prognostic indicator of short and long-term outcomes among non-treated and treated IS patients. Active screening and management of DIH is critically important to improve stroke outcomes.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.53.suppl_1.92
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 1467823-8
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  • 9
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    Abstract P2: Results of a Prospective Observational Cohort Study of Tenecteplase as Standard of Care Stroke Thrombolytic
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Stroke Vol. 52, No. Suppl_1 ( 2021-03)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 52, No. Suppl_1 ( 2021-03)
    Abstract: Background: Our 10-hospital network (2 CSCs, 2PSCs, 6 non-SCs) switched our standard stroke thrombolytic from alteplase (ALT) to tenecteplase (TNK; 0.25 mg/kg) in September 2019. Methods: We designed a two-year prospective cohort analysis of key processes and clinical outcomes for TNK-treated patients with planned quarterly assessments of feasibility and safety. The TNK cohort is compared to the retrospective historical cohort of all unique patients at these hospitals treated with ALT during the prior 2-year period (n=354). Analysis were taken from a local REDcap registry that recorded data fields required for Stroke Center certification and submission to Get-With-The Guidelines (GWTG). Interim results through three quarters ending June 30, 2020. Results: 151 patients were treated with TNK. The samples TNK v ALT were well matched on age (median, IQR) 66.0 (55.0, 76.0) v 67.0 (55.0, 78.8) and NIHSS at admission (median, IQR), 8 (4, 13) v 8 (4, 15). Symptomatic ICH (ECASS 3 definition) occurred in 2.0% of TNK and 2.3% of ALT treated patients; all but one symptomatic ICH occurred in patients treated with both thrombolytic and endovascular therapies. All cause in-hospital mortality was 3.3% and 6.8%, respectively. No differences were observed in early outcomes of discharge to home (52%, 53%) or independent ambulation (46%, 45%). Day 90 Rankin Score (last observation carried forward for missing values) was available only for TNK: mRS 0-1 in 46.4% (95%CI 38.6%-54.3%), 0-2 in 55.6% (95%CI 47.7%-63.3%). A significantly greater proportion of patients were treated with the lytic within 45 minutes of hospital arrival after the switch to TNK using Get-With-The-Guidelines DTN time criteria (Table), most notably at the primary stroke centers. Conclusions: To date, the transition to TNK was associated with reductions in DTN times and in Drip-and-Ship transfer times (see related abstract). No differences were seen on early indices of safety or efficacy.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.52.suppl_1.P2
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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  • 10
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    Abstract 33: Stroke Severity Mediates The Association Between Socioeconomic Disadvantage And Poor Outcomes Among Patients With Acute Ischemic Stroke
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Stroke Vol. 53, No. Suppl_1 ( 2022-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 53, No. Suppl_1 ( 2022-02)
    Abstract: Background: Impact of socioeconomic disadvantage on outcomes among acute ischemic stroke (AIS) patients has not been well characterized. Methods: Clinical data on AIS patients were extracted from electronic medical records and 90-day modified Rankin Scale (mRS) scores were collected as a part of prospective stroke registry. Exact patient addresses were geocoded, and state-level Area Deprivation Index (ADI) ranks were categorized as low, medium, high. Patients with a 90-day mRS score ≥ 4 were categorized as severe disability or death (SDD). Logistic regression models (adjusted for treatment with intravenous tissue plasminogen activator or mechanical thrombectomy, age, sex, race/ethnicity, insurance, prior stroke, vascular risk factors) were fitted to compute odds ratios (OR) and 95% confidence intervals (CI) for total effect of high ADI on SDD. Structural equation modeling was used to assess mediation effects of stroke severity as measured by National Institutes of Health Stroke Scale (NIHSS). Results: Between May 2016 and Apr 2021, a total of 2,900 AIS patients (mean age: 68.5 years; 50.1% male; 28.4% non-Hispanic Black; 12.9% Hispanic) with complete outcomes data were included. In an adjusted model, high ADI was significantly associated with SDD (OR, CI: 1.14, 1.02-1.28). In the mediation analysis, patients in higher ADI neighborhoods had a 28% increased likelihood of having higher NIHSS (OR: 1.28, CI: 1.15-1.44). Likewise, higher NIHSS was associated with SDD (OR: 7.10, CI: 5.96-8.51). The effect of neighborhood disadvantage on SDD was fully mediated by NIHSS (average causal mediation effect of ADI on SDD: P=0.002), with 77% of the total effect pathway mediated through NIHSS. The proportions of 90-day mRS by ADI categories are reported (Figure). Conclusion: Neighborhood disadvantage leads to poor stroke outcomes mediated via stroke severity. Tracking social determinants of health may identify opportunities for reducing stroke related disability.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.53.suppl_1.33
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 1467823-8
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