Pub Date : 2025-02-01DOI: 10.1016/j.jstrokecerebrovasdis.2024.108187
Jie Yang , Yujian Liu , Yuanying Ma , Wei Zhang , Limei Han , Hao Feng , Meining Chen , Jianquan Zhong
Background
Cerebral small vessel disease (CSVD) is a common disease in the elderly, and its pathogenesis is still being explored. Glymphatic clearance function can be evaluated by diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) index. This study aims to investigate the changes in glymphatic clearance function in CSVD patients and its relationship with imaging markers and risk factors of CSVD.
Methods
The DTI-ALPS index of all participants was calculated. The DTI-ALPS index was compared between the patient group and healthy controls (HCs) group. Pearson correlation analysis was used to analyze the relation between the DTI-ALPS index and CSVD imaging markers, and to explore the effect of mean diffusivity (MD) as a covariate. Regression analysis was used to investigate the correlation between DTI-ALPS index and risk factors.
Results
The DTI-ALPS index in the bilateral hemispheres of CSVD patients was significantly lower than that in the HCs group (p < 0.001). The DTI-ALPS index in the bilateral hemisphere of CSVD patients was negatively correlated with the grade of EPVS in basal ganglia. There was a significant negative correlation between the left DTI-ALPS index and lacunas, the right DTI-ALPS index and DWMHs. After removing the covariate MD, there was no significant correlation between the DTI-ALPS index and CSVD imaging markers. The DTI-ALPS index was associated with gender, diabetes, drinking and smoking.
Conclusions
The CSVD patients have glymphatic clearance dysfunction, which may be related to the imaging features and CSVD risk factors. Meanwhile, it's recommended to consider removing MD as mixed signal.
{"title":"Association of glymphatic clearance function with imaging markers and risk factors of cerebral small vessel disease","authors":"Jie Yang , Yujian Liu , Yuanying Ma , Wei Zhang , Limei Han , Hao Feng , Meining Chen , Jianquan Zhong","doi":"10.1016/j.jstrokecerebrovasdis.2024.108187","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108187","url":null,"abstract":"<div><h3>Background</h3><div>Cerebral small vessel disease (CSVD) is a common disease in the elderly, and its pathogenesis is still being explored. Glymphatic clearance function can be evaluated by diffusion tensor imaging analysis along the perivascular space (DTI-ALPS) index. This study aims to investigate the changes in glymphatic clearance function in CSVD patients and its relationship with imaging markers and risk factors of CSVD.</div></div><div><h3>Methods</h3><div>The DTI-ALPS index of all participants was calculated. The DTI-ALPS index was compared between the patient group and healthy controls (HCs) group. Pearson correlation analysis was used to analyze the relation between the DTI-ALPS index and CSVD imaging markers, and to explore the effect of mean diffusivity (MD) as a covariate. Regression analysis was used to investigate the correlation between DTI-ALPS index and risk factors.</div></div><div><h3>Results</h3><div>The DTI-ALPS index in the bilateral hemispheres of CSVD patients was significantly lower than that in the HCs group (<em>p</em> < 0.001). The DTI-ALPS index in the bilateral hemisphere of CSVD patients was negatively correlated with the grade of EPVS in basal ganglia. There was a significant negative correlation between the left DTI-ALPS index and lacunas, the right DTI-ALPS index and DWMHs. After removing the covariate MD, there was no significant correlation between the DTI-ALPS index and CSVD imaging markers. The DTI-ALPS index was associated with gender, diabetes, drinking and smoking.</div></div><div><h3>Conclusions</h3><div>The CSVD patients have glymphatic clearance dysfunction, which may be related to the imaging features and CSVD risk factors. Meanwhile, it's recommended to consider removing MD as mixed signal.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108187"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To develop and internally validate a clinical prediction model that includes balance ability and nutritional indices for the motor-functional independence measure (M-FIM) at 90 days post-stroke stroke.
Materials and Methods
This retrospective, single-center study included 566 patients with stroke undergoing rehabilitation at our rehabilitation hospital. The primary outcome was the M-FIM score of >61 at 3 months post-strokes onset. Stepwise conditional forward selection was first used to identify predictors for the achievement of M-FIM>61 at 90 days post-stroke, from 25 potential predictors at admission. The selected predictors were dichotomized with cut-off values to establish scoring systems, resulting in the B-ADL model, which includes postural balance (B), albumin level, age, arm function (A), days since stroke onset (D), and level of activities of daily living (ADL) (L). For internal validation, we corrected the optimism of the area under the curve of receiver operating characteristic curve (AUROC) induced by overfitting the original data using the bootstrap validation method. Calibration capacity was assessed using a calibration plot.
Results
We developed a clinical model to predict the M-FIM at 90 days post-stroke onset. The AUROC of the B-ADL model was 0.92 (sensitivity, 93.7%; specificity, 89.7%). The B-ADL model showed high accuracy with an AUROC of 0.970 in the internal validation. The scoring system in the validation cohort had a cut-off value of 5.5/12 points to predict the achievement of M-FIM>61 (AUROC: 0.950; 95% CI 0.930–0.970).
Conclusions
The B-ADL model accurately predicted M-FIM >61 at 90 days post-stroke on the day of admission to the recovery rehabilitation ward. The B-ADL model is useful for optimizing rehabilitation programs and resource allocation, allowing for targeted interventions after stroke.
目的：建立并内部验证一个包括平衡能力和营养指标的脑卒中后90天运动功能独立性测量（M-FIM）的临床预测模型。材料和方法：本回顾性、单中心研究纳入566例在我院接受康复治疗的脑卒中患者。主要终点为脑卒中后3个月M-FIM评分bbbb61。逐步条件前向选择首先用于从入院时的25个潜在预测因子中确定中风后90天达到M-FIM bbbb61的预测因子。将选择的预测因子用截断值进行二分类，建立评分系统，得到B-ADL模型，该模型包括姿势平衡(B)、白蛋白水平、年龄、手臂功能(A)、中风发病天数(D)和日常生活活动水平（ADL） (L)。为了进行内部验证，我们使用bootstrap验证方法修正了因原始数据过拟合而导致的受试者工作特征曲线（AUROC）曲线下面积的乐观性。使用校准图评估校准能力。结果：我们建立了一个临床模型来预测中风发作后90天的M-FIM。B-ADL模型的AUROC为0.92(敏感性为93.7%；特异性,89.7%)。在内部验证中，B-ADL模型具有较高的准确度，AUROC为0.970。验证队列的评分系统预测M-FIM实现的截断值为5.5/12分(AUROC: 0.950；95% ci 0.930-0.970)。结论：B-ADL模型准确预测脑卒中后90天的M-FIM bbb61。B-ADL模型有助于优化康复计划和资源分配，允许中风后的针对性干预。
{"title":"Development and validation of clinical prediction model for functional independence measure following stroke rehabilitation","authors":"Shinya Fukuda PT , Norio Yamamoto MD, PhD , Yosuke Tomita PT , Takeshi Matsumoto PT , Tomoya Shinohara OT , Tatsuro Ohno PT , Hitoshi Fukuda MD, PhD , Tetsuya Ueba PhD, MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108185","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108185","url":null,"abstract":"<div><h3>Objectives</h3><div>To develop and internally validate a clinical prediction model that includes balance ability and nutritional indices for the motor-functional independence measure (M-FIM) at 90 days post-stroke stroke.</div></div><div><h3>Materials and Methods</h3><div>This retrospective, single-center study included 566 patients with stroke undergoing rehabilitation at our rehabilitation hospital. The primary outcome was the M-FIM score of >61 at 3 months post-strokes onset. Stepwise conditional forward selection was first used to identify predictors for the achievement of M-FIM>61 at 90 days post-stroke, from 25 potential predictors at admission. The selected predictors were dichotomized with cut-off values to establish scoring systems, resulting in the B-ADL model, which includes postural balance (B), albumin level, age, arm function (A), days since stroke onset (D), and level of activities of daily living (ADL) (L). For internal validation, we corrected the optimism of the area under the curve of receiver operating characteristic curve (AUROC) induced by overfitting the original data using the bootstrap validation method. Calibration capacity was assessed using a calibration plot.</div></div><div><h3>Results</h3><div>We developed a clinical model to predict the M-FIM at 90 days post-stroke onset. The AUROC of the B-ADL model was 0.92 (sensitivity, 93.7%; specificity, 89.7%). The B-ADL model showed high accuracy with an AUROC of 0.970 in the internal validation. The scoring system in the validation cohort had a cut-off value of 5.5/12 points to predict the achievement of M-FIM>61 (AUROC: 0.950; 95% CI 0.930–0.970).</div></div><div><h3>Conclusions</h3><div>The B-ADL model accurately predicted M-FIM >61 at 90 days post-stroke on the day of admission to the recovery rehabilitation ward. The B-ADL model is useful for optimizing rehabilitation programs and resource allocation, allowing for targeted interventions after stroke.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108185"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ferroptosis is involved in the development and exacerbation of cerebral ischemia-reperfusion injury (CIRI), and its inhibition can alleviate CIRI. Tetramethylpyrazine (TMP) is used for the treatment of ischemic stroke. However, the mechanism by which TMP regulates ferroptosis in CIRI is yet to be explored. This study demonstrated the effects of TMP on ferroptosis and CIRI, including the roles of the adenosine 5′-monophosphate-activated protein kinase (AMPK)/nuclear factor erythroid-2-related factor 2 (Nrf2) signaling pathway.
Materials and methods
A Sprague–Dawley rat middle cerebral artery occlusion/reperfusion (MCAO/R) model was generated. The extent of neuronal injury was measured using 2,3,5-triphenyl tetrazolium chloride staining and Garcia neurological scoring and behavior was evaluated using open-field tests. Ferroptosis-related indexes were examined and ferroptosis-related proteins were detected using western blotting. The binding modes of TMP and AMPK were evaluated using molecular docking and molecular dynamics simulations.
Results
MCAO/R rats showed a reduced cerebral infarct area and improved neurological function after TMP intervention. TMP reduced levels of Fe2+, 4-hydroxynonenal, malonaldehyde, and acyl-coenzyme synthetase long-chain family member 4 and increased levels of glutathione and glutathione peroxidase 4. Increased AMPK phosphorylation and Nrf2 expression were also detected. TMP bound tightly to the AMPKα subunit in silico, and the LEU157, VAL41, LEU33, VAL107, and TYR106 residues were important for binding.
Conclusions
Our results indicate that TMP can alleviate CIRI by inhibiting ferroptosis via the activation of the AMPK/Nrf2 pathway, providing a theoretical basis for the clinical use of TMP in treating CIRI.
{"title":"Tetramethylpyrazine attenuates cerebral ischemia-reperfusion injury by inhibiting ferroptosis via the AMPK / Nrf2 pathways","authors":"Ke-xin Zhong , Qi Zeng , Hao Tang , Biao Tang Ph.D. (Professor) , Hao Wang","doi":"10.1016/j.jstrokecerebrovasdis.2024.108196","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108196","url":null,"abstract":"<div><h3>Objectives</h3><div>Ferroptosis is involved in the development and exacerbation of cerebral ischemia-reperfusion injury (CIRI), and its inhibition can alleviate CIRI. Tetramethylpyrazine (TMP) is used for the treatment of ischemic stroke. However, the mechanism by which TMP regulates ferroptosis in CIRI is yet to be explored. This study demonstrated the effects of TMP on ferroptosis and CIRI, including the roles of the adenosine 5′-monophosphate-activated protein kinase (AMPK)/nuclear factor erythroid-2-related factor 2 (Nrf2) signaling pathway.</div></div><div><h3>Materials and methods</h3><div>A Sprague–Dawley rat middle cerebral artery occlusion/reperfusion (MCAO/R) model was generated. The extent of neuronal injury was measured using 2,3,5-triphenyl tetrazolium chloride staining and Garcia neurological scoring and behavior was evaluated using open-field tests. Ferroptosis-related indexes were examined and ferroptosis-related proteins were detected using western blotting. The binding modes of TMP and AMPK were evaluated using molecular docking and molecular dynamics simulations.</div></div><div><h3>Results</h3><div>MCAO/R rats showed a reduced cerebral infarct area and improved neurological function after TMP intervention. TMP reduced levels of Fe<sup>2+</sup>, 4-hydroxynonenal, malonaldehyde, and acyl-coenzyme synthetase long-chain family member 4 and increased levels of glutathione and glutathione peroxidase 4. Increased AMPK phosphorylation and Nrf2 expression were also detected. TMP bound tightly to the AMPKα subunit in silico, and the LEU157, VAL41, LEU33, VAL107, and TYR106 residues were important for binding.</div></div><div><h3>Conclusions</h3><div>Our results indicate that TMP can alleviate CIRI by inhibiting ferroptosis via the activation of the AMPK/Nrf2 pathway, providing a theoretical basis for the clinical use of TMP in treating CIRI.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108196"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jstrokecerebrovasdis.2024.108201
Yue Li , Huiqiong Xu , Ting Zhang , Xianying Lu , Xuemei Xie , Jing Gao
Objective
Systematic evaluation of factors influencing social isolation in stroke patients for further intervention studies.
Methods
We searched for observational studies in 7 databases from inception to January 2024. Two researchers performed literature screening, quality assessment, and data extraction independently according to inclusion and exclusion criteria, and meta-analysis was performed using R4.3.1 software.
Results
A total of 10 studies with a total sample size of 4162 cases were included. Meta-analysis showed that social isolation in stroke patients was associated with economic status (β’=-0.21, 95%CI:0.39, -0.02; P=0.0261), degree of education (β’=-0.16, 95%CI:0.29, -0.03; P=0.0171), marital status (β’=0.13, 95%CI:0.04, 0.23; P=0.0069), social support (β’=-0.37, 95%CI;-0.50, -0.25; P<0.0001), stigma(β’=0.48, 95%CI:0.25, 0.72; P<0.0001), symptom burden (β’=0.25, 95%CI:0.18, 0.31; P<0.0001), course of disease (β’=0.23, 95%CI:0.08, 0.37; P=0.0021), combined chronic diseases (β’=0.14, 95%CI:0.04, 0.24; P=0.0057), and limb function (β’=0.33, 95%CI:0.23, 0.43; P<0.0001) were associated. Meta-regression and subgroup analyses showed that disease stage and sample source were sources of heterogeneity.
Conclusion
There are many factors influencing the social isolation of stroke patients, and healthcare professionals should take timely and targeted measures to prevent and intervene effectively, with a view to improving the social participation of stroke patients and reducing their social isolation.
{"title":"Factors associated with social isolation in stroke patients: a systematic review and meta-analysis","authors":"Yue Li , Huiqiong Xu , Ting Zhang , Xianying Lu , Xuemei Xie , Jing Gao","doi":"10.1016/j.jstrokecerebrovasdis.2024.108201","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108201","url":null,"abstract":"<div><h3>Objective</h3><div>Systematic evaluation of factors influencing social isolation in stroke patients for further intervention studies.</div></div><div><h3>Methods</h3><div>We searched for observational studies in 7 databases from inception to January 2024. Two researchers performed literature screening, quality assessment, and data extraction independently according to inclusion and exclusion criteria, and meta-analysis was performed using R4.3.1 software.</div></div><div><h3>Results</h3><div>A total of 10 studies with a total sample size of 4162 cases were included. Meta-analysis showed that social isolation in stroke patients was associated with economic status (<em>β’</em>=-0.21, <em>95%CI:</em>0.39, -0.02; <em>P</em>=0.0261), degree of education (<em>β’</em>=-0.16, 95%<em>CI</em>:0.29, -0.03; <em>P</em>=0.0171), marital status (<em>β’</em>=0.13, 95%<em>CI:</em>0.04, 0.23; <em>P</em>=0.0069), social support (<em>β’</em>=-0.37, 95%<em>CI</em>;-0.50, -0.25; <em>P</em><0.0001), stigma(<em>β’</em>=0.48, 95%<em>CI</em>:0.25, 0.72; <em>P</em><0.0001), symptom burden (<em>β’</em>=0.25, 95%<em>CI</em>:0.18, 0.31; <em>P</em><0.0001), course of disease (<em>β’</em>=0.23, 95%<em>CI</em>:0.08, 0.37; <em>P</em>=0.0021), combined chronic diseases (<em>β’</em>=0.14, 95%<em>CI</em>:0.04, 0.24; <em>P</em>=0.0057), and limb function (<em>β’</em>=0.33, 95%<em>CI</em>:0.23, 0.43; <em>P</em><0.0001) were associated. Meta-regression and subgroup analyses showed that disease stage and sample source were sources of heterogeneity.</div></div><div><h3>Conclusion</h3><div>There are many factors influencing the social isolation of stroke patients, and healthcare professionals should take timely and targeted measures to prevent and intervene effectively, with a view to improving the social participation of stroke patients and reducing their social isolation.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108201"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142840063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jstrokecerebrovasdis.2024.108167
Giovani Noll MD, MSc , Wyllians Vendramini Borelli MD, PhD , Gabriel Paulo Mantovani MD , Sheila Cristina Ouriques Martins MD, PhD , Luciano A. Sposato MD, MBA
Background
Stroke incidence remains a significant concern despite optimized prevention strategies. Colchicine shows potential for improving stroke prevention globally.
Aims
To summarize efficacy and safety estimates from systematic reviews and meta-analyses (SRMAs) of randomized controlled trials (RCTs) comparing colchicine to usual care or placebo for stroke prevention.
Methods
We conducted an overview of SRMAs according to the Preferred Reporting Items for Overviews of Reviews guidelines through a systematic search in Pubmed, Embase, and the Cochrane Library. Statistical analysis was performed using RevMan Web. Heterogeneity was assessed with I² statistics.
Results
Thirty-two studies were included. Colchicine significantly reduced stroke recurrence (RR 0.46; 95 % CI 0.41–0.52; p < 0.0001; I² = 0 %; OR 0.44, 95 % CI 0.36–0.55; p < 0.0001; I² = 0 %) but increased gastrointestinal adverse events (RR 1.54, 95 % CI 1.33–1.79; p < 0.0001; I² = 63 %; OR 1.60, 95 % CI 1.08–2.38; p = 0.0007; I² = 82 %). Most SRMAs (93.75 %) showed reduced stroke incidence (RR 0.26–0.54), while 65.22 % reported increased gastrointestinal events (RR 1.05–2.66). No significant differences were observed in mortality, infection or cancer rates. Overall quality was appraised as high in 28.12 %, moderate in 6.25 %, low in 40.06 %, and critically low in 25 % of SRMAs. Data were primarily derived from seven RCTs with low risk of bias.
Conclusions
Moderate-quality evidence supports colchicine's benefits and reasonable safety for preventing stroke among high-risk populations. However, stroke was not the primary endpoint in analyzed studies. RCTs directly assessing colchicine for stroke prevention are warranted.
背景：尽管有优化的预防策略，脑卒中的发病率仍然是一个值得关注的问题。秋水仙碱在全球范围内显示出改善中风预防的潜力。目的：从随机对照试验（rct）的系统评价和荟萃分析（SRMAs）中总结秋水仙碱与常规治疗或安慰剂预防脑卒中的疗效和安全性评估。方法：我们通过在Pubmed、Embase和Cochrane图书馆进行系统搜索，根据综述指南的首选报告项目对srma进行了综述。使用RevMan Web进行统计分析。采用I²统计量评估异质性。结果：纳入32项研究。秋水仙碱显著降低卒中复发率(RR 0.46；95% ci 0.41-0.52；P < 0.0001；我² = 0%;或0.44,95% ci 0.36-0.55；P < 0.0001；I² = 0%)，但胃肠道不良事件增加(RR 1.54, 95% CI 1.33-1.79；P < 0.0001；我² = 63%;或1.60,95% ci 1.08-2.38；p = 0.0007;我² = 82%)。大多数srma（93.75%）报告卒中发生率降低（RR 0.26-0.54）， 65.22%报告胃肠道事件增加（RR 1.05-2.66）。在死亡率、感染率和癌症发病率方面没有观察到显著差异。总体质量评价为高的占28.12%，中等的占6.25%，低的占40.06%，极低的占25%。数据主要来自7项低偏倚风险的随机对照试验。结论：中等质量的证据支持秋水仙碱在高危人群中预防卒中的益处和合理的安全性。然而，中风并不是分析研究的主要终点。直接评估秋水仙碱预防中风的随机对照试验是有根据的。
{"title":"Low-dose colchicine for stroke prevention: A systematic overview of systematic reviews and meta-analyses","authors":"Giovani Noll MD, MSc , Wyllians Vendramini Borelli MD, PhD , Gabriel Paulo Mantovani MD , Sheila Cristina Ouriques Martins MD, PhD , Luciano A. Sposato MD, MBA","doi":"10.1016/j.jstrokecerebrovasdis.2024.108167","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108167","url":null,"abstract":"<div><h3>Background</h3><div>Stroke incidence remains a significant concern despite optimized prevention strategies. Colchicine shows potential for improving stroke prevention globally.</div></div><div><h3>Aims</h3><div>To summarize efficacy and safety estimates from systematic reviews and meta-analyses (SRMAs) of randomized controlled trials (RCTs) comparing colchicine to usual care or placebo for stroke prevention.</div></div><div><h3>Methods</h3><div>We conducted an overview of SRMAs according to the Preferred Reporting Items for Overviews of Reviews guidelines through a systematic search in Pubmed, Embase, and the Cochrane Library. Statistical analysis was performed using RevMan Web. Heterogeneity was assessed with I² statistics.</div></div><div><h3>Results</h3><div>Thirty-two studies were included. Colchicine significantly reduced stroke recurrence (RR 0.46; 95 % CI 0.41–0.52; <em>p</em> < 0.0001; I² = 0 %; OR 0.44, 95 % CI 0.36–0.55; <em>p</em> < 0.0001; I² = 0 %) but increased gastrointestinal adverse events (RR 1.54, 95 % CI 1.33–1.79; <em>p</em> < 0.0001; I² = 63 %; OR 1.60, 95 % CI 1.08–2.38; <em>p</em> = 0.0007; I² = 82 %). Most SRMAs (93.75 %) showed reduced stroke incidence (RR 0.26–0.54), while 65.22 % reported increased gastrointestinal events (RR 1.05–2.66). No significant differences were observed in mortality, infection or cancer rates. Overall quality was appraised as high in 28.12 %, moderate in 6.25 %, low in 40.06 %, and critically low in 25 % of SRMAs. Data were primarily derived from seven RCTs with low risk of bias.</div></div><div><h3>Conclusions</h3><div>Moderate-quality evidence supports colchicine's benefits and reasonable safety for preventing stroke among high-risk populations. However, stroke was not the primary endpoint in analyzed studies. RCTs directly assessing colchicine for stroke prevention are warranted.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108167"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jstrokecerebrovasdis.2024.108206
Hong Li MD , Deyu Yang MD, PhD , Shudong Liu MD , Zhengbao Zhu MD, PhD , Mengyao Shi MD, PhD , Tan Xu MD, PhD , Jing Chen MD, MS , Yonghong Zhang MD, PhD , Jiang He MD, PhD , Chongke Zhong MD, PhD , Xiaoqing Bu MD, PhD
Background
It is unclear whether the extent of neuroaxonal damage, as measured by circulating levels of neurofilament light chain (NfL), would modify the effects of early antihypertensive therapy on cognitive performance following stroke. This study aimed to investigate the effects of early blood pressure reduction on the risk of post-stroke cognitive impairment (PSCI) among patients with different plasma NfL levels.
Methods
A total of 622 eligible patients from a pre-planned ancillary study of CATIS (China Antihypertensive Trial in Acute Ischemic Stroke) were included in this study. The electrochemiluminescence immunoassay technique was used to evaluate Plasma NfL levels at baseline, and the Mini-Mental State Examination (MMSE) in Chinese was used to assess cognition at the 3-month follow-up. An MMSE score of less than 27 was considered as PSCI.
Results
The effect of antihypertensive therapy on PSCI differed according to NfL levels at the 3-month follow-up. In the low NfL group, compared with the control group, antihypertensive treatment reduced the risk of PSCI [adjusted odds ratio (OR), 95 % confidence interval (CI): 0.50 (0.31-0.81)]. However, in the high NfL group, antihypertensive treatment increased the risk of PSCI compared with the control group [adjusted OR, 95 % CI: 1.93 (1.16-3.20)].
Conclusions
Antihypertensive therapy in the acute phase reduced the risk of PSCI in patients with low plasma NfL levels, but increased the risk in patients with high NfL levels.
{"title":"Effects of early antihypertensive treatment on cognitive function in patients with acute ischemic stroke with different neurofilament light chain levels","authors":"Hong Li MD , Deyu Yang MD, PhD , Shudong Liu MD , Zhengbao Zhu MD, PhD , Mengyao Shi MD, PhD , Tan Xu MD, PhD , Jing Chen MD, MS , Yonghong Zhang MD, PhD , Jiang He MD, PhD , Chongke Zhong MD, PhD , Xiaoqing Bu MD, PhD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108206","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108206","url":null,"abstract":"<div><h3>Background</h3><div>It is unclear whether the extent of neuroaxonal damage, as measured by circulating levels of neurofilament light chain (NfL), would modify the effects of early antihypertensive therapy on cognitive performance following stroke. This study aimed to investigate the effects of early blood pressure reduction on the risk of post-stroke cognitive impairment (PSCI) among patients with different plasma NfL levels.</div></div><div><h3>Methods</h3><div>A total of 622 eligible patients from a pre-planned ancillary study of CATIS (China Antihypertensive Trial in Acute Ischemic Stroke) were included in this study. The electrochemiluminescence immunoassay technique was used to evaluate Plasma NfL levels at baseline, and the Mini-Mental State Examination (MMSE) in Chinese was used to assess cognition at the 3-month follow-up. An MMSE score of less than 27 was considered as PSCI.</div></div><div><h3>Results</h3><div>The effect of antihypertensive therapy on PSCI differed according to NfL levels at the 3-month follow-up. In the low NfL group, compared with the control group, antihypertensive treatment reduced the risk of PSCI [adjusted odds ratio (OR), 95 % confidence interval (CI): 0.50 (0.31-0.81)]. However, in the high NfL group, antihypertensive treatment increased the risk of PSCI compared with the control group [adjusted OR, 95 % CI: 1.93 (1.16-3.20)].</div></div><div><h3>Conclusions</h3><div>Antihypertensive therapy in the acute phase reduced the risk of PSCI in patients with low plasma NfL levels, but increased the risk in patients with high NfL levels.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108206"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142873475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jstrokecerebrovasdis.2024.108175
Jinrui Li MD , Kailin Cheng MD , Jianxia Ke MD , Jintao Li MD , Jia Wen MD , Junting Chen MD , Xue Jia , Xiaoli Fu MD , Kefeng Lv MD , Zhu Shi MDPhD
Background
Asymptomatic intracranial hemorrhage (aICH) is common after endovascular thrombectomy (EVT). Collateral circulation could modify the association between aICH with functional outcome and we aimed to investigate the impact of systemic inflammation index on 3-month outcome under different collateral circulation.
Method
Consecutive patients undertaken EVT were enrolled and classified into non-intracranial hemorrhage (non-ICH), aICH and symptomatic intracranial hemorrhage (sICH) groups according to the neurological status and National Institutes of Health Stroke Scale (NIHSS) changes within 72 hours after EVT. Preoperative collateral status was scored using the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) scale. Clinical data were collected and analyzed according to the stratification of collateral stratification. Multivariate regression models were constructed to evaluate the influence of systemic inflammation indexes and collateral status on functional outcome.
Results
Of 302 patients, 86 (28.5%) developed aICH with 36(11.9%) sICH. Compared to non-ICH patients, there was a significant trend towards higher proportion of poor collateral circulation in patients with aICH, sICH (47.8% vs. 67.2% vs. 94.4%, p <0.001). Spearman's correlation analysis revealed a significant negative correlation of peripheral neutrophil counts, NLR, and SIRI with collateral circulation score. Under poor collateral circulation, neutrophil counts showed a significant positive association with sICH (OR 1.20, 95%CI: 1.07-1.35, p=0.002), but not with aICH. Under good collateral circulation, the inflammation indexes did not show a significant correlation with either ICH.
Conclusion
aICH patients with good collateral circulation have good functional outcome comparable to no-ICH patients. Under poor collateral circulation, elevated neutrophil counts may contribute to the conversion from aICH to sICH. Tailored anti-inflammatory therapy has potential to improve the efficacy and safety of EVT.
背景：无症状性颅内出血（aICH）在血管内血栓切除术（EVT）后很常见。侧支循环可改变无症状颅内出血与功能预后之间的关系，我们旨在研究不同侧支循环下全身炎症指数对3个月预后的影响：方法：我们纳入了接受EVT的连续患者，并根据EVT术后72小时内的神经功能状态和美国国立卫生研究院卒中量表（NIHSS）的变化将其分为非颅内出血组（non-intranial hemorrhage，NICH）、aICH组和症状性颅内出血组（symptomatic intracranial hemorrhage，sICH）。术前侧支状态采用美国介入和治疗神经放射学会/介入放射学会（ASITN/SIR）量表评分。根据侧支分层收集和分析临床数据。建立了多变量回归模型，以评估全身炎症指数和侧支状态对功能预后的影响：302名患者中，86人（28.5%）发生了aICH，36人（11.9%）发生了sICH。与非 ICH 患者相比，aICH 和 sICH 患者侧支循环不良的比例呈显著上升趋势（47.8% vs. 67.2% vs. 94.4%，p 结论：侧支循环良好的 aICH 患者与非 ICH 患者相比，功能预后良好。在侧支循环不良的情况下，中性粒细胞计数升高可能会导致 aICH 转为 sICH。量身定制的抗炎疗法有可能提高 EVT 的疗效和安全性。
{"title":"Relevance of peripheral inflammation indexes in different collateral circulation for intracranial hemorrhage in acute anterior circulation ischemic stroke patients undergoing endovascular treatment","authors":"Jinrui Li MD , Kailin Cheng MD , Jianxia Ke MD , Jintao Li MD , Jia Wen MD , Junting Chen MD , Xue Jia , Xiaoli Fu MD , Kefeng Lv MD , Zhu Shi MDPhD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108175","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108175","url":null,"abstract":"<div><h3>Background</h3><div>Asymptomatic intracranial hemorrhage (aICH) is common after endovascular thrombectomy (EVT). Collateral circulation could modify the association between aICH with functional outcome and we aimed to investigate the impact of systemic inflammation index on 3-month outcome under different collateral circulation.</div></div><div><h3>Method</h3><div>Consecutive patients undertaken EVT were enrolled and classified into non-intracranial hemorrhage (non-ICH), aICH and symptomatic intracranial hemorrhage (sICH) groups according to the neurological status and National Institutes of Health Stroke Scale (NIHSS) changes within 72 hours after EVT. Preoperative collateral status was scored using the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) scale. Clinical data were collected and analyzed according to the stratification of collateral stratification. Multivariate regression models were constructed to evaluate the influence of systemic inflammation indexes and collateral status on functional outcome.</div></div><div><h3>Results</h3><div>Of 302 patients, 86 (28.5%) developed aICH with 36(11.9%) sICH. Compared to non-ICH patients, there was a significant trend towards higher proportion of poor collateral circulation in patients with aICH, sICH (47.8% vs. 67.2% vs. 94.4%, p <0.001). Spearman's correlation analysis revealed a significant negative correlation of peripheral neutrophil counts, NLR, and SIRI with collateral circulation score. Under poor collateral circulation, neutrophil counts showed a significant positive association with sICH (OR 1.20, 95%CI: 1.07-1.35, p=0.002), but not with aICH. Under good collateral circulation, the inflammation indexes did not show a significant correlation with either ICH.</div></div><div><h3>Conclusion</h3><div>aICH patients with good collateral circulation have good functional outcome comparable to no-ICH patients. Under poor collateral circulation, elevated neutrophil counts may contribute to the conversion from aICH to sICH. Tailored anti-inflammatory therapy has potential to improve the efficacy and safety of EVT.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108175"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Non-verbal Screening Test for Aphasia and Dysarthria scores correlate with post-stroke cognitive function; however, their correlations with activities of daily living dependency and home discharge (cognitive function-associated outcomes) remain unclear. We investigated the correlation of these scores with activities of daily living dependency and home discharge outcomes.
Materials and Methods
Disability levels and functional outcomes of 278 inpatients with brain injury (age: 72.8 ± 13.0 years) were evaluated using the modified Rankin Scale. Patients were grouped according to activities of daily living dependency (independent [n = 96; modified Rankin Scale score≤2]) and non-home discharge (n = 126) status. Factors predicting home discharge were analyzed using univariate and multivariate logistic regression analyses.
Results
Cognitive impairment was more prevalent in the activities of daily living-dependent group than in the independent group (odds ratio: 6.34 [95 % confidence interval: 3.57–11.52]; p < 0.001) and in the non-home discharge than in the home discharge group (2.78 [1.65–4.73]; p < 0.001). Non-verbal test scores correlated moderately with activities of daily living independence and home discharge. Age, modified Rankin Scale score, cognitive impairment, and the Screening Test for Aphasia and Dysarthria scores were significantly associated with home discharge in univariate analyses. Only modified Rankin Scale and non-verbal test scores were significantly associated with home discharge in multivariate analysis (p < 0.001).
Conclusions
Non-verbal test scores were significantly associated with activities of daily living independence and home discharge in patients with stroke. The non-verbal test, being less influenced by communicative disorders, offers a novel tool for estimating cognitive function.
{"title":"Associations between non-verbal cognitive assessment and stroke recovery via screening test for aphasia and dysarthria","authors":"Kentaro Araki PhD, SLT, Yoshiyuki Hirano PhD, Kohei Kurita MS, Eiji Shimizu PhD, MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108217","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108217","url":null,"abstract":"<div><h3>Objective</h3><div>Non-verbal Screening Test for Aphasia and Dysarthria scores correlate with post-stroke cognitive function; however, their correlations with activities of daily living dependency and home discharge (cognitive function-associated outcomes) remain unclear. We investigated the correlation of these scores with activities of daily living dependency and home discharge outcomes.</div></div><div><h3>Materials and Methods</h3><div>Disability levels and functional outcomes of 278 inpatients with brain injury (age: 72.8 ± 13.0 years) were evaluated using the modified Rankin Scale. Patients were grouped according to activities of daily living dependency (independent [<em>n</em> = 96; modified Rankin Scale score≤2]) and non-home discharge (<em>n</em> = 126) status. Factors predicting home discharge were analyzed using univariate and multivariate logistic regression analyses.</div></div><div><h3>Results</h3><div>Cognitive impairment was more prevalent in the activities of daily living-dependent group than in the independent group (odds ratio: 6.34 [95 % confidence interval: 3.57–11.52]; <em>p</em> < 0.001) and in the non-home discharge than in the home discharge group (2.78 [1.65–4.73]; <em>p</em> < 0.001). Non-verbal test scores correlated moderately with activities of daily living independence and home discharge. Age, modified Rankin Scale score, cognitive impairment, and the Screening Test for Aphasia and Dysarthria scores were significantly associated with home discharge in univariate analyses. Only modified Rankin Scale and non-verbal test scores were significantly associated with home discharge in multivariate analysis (<em>p</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>Non-verbal test scores were significantly associated with activities of daily living independence and home discharge in patients with stroke. The non-verbal test, being less influenced by communicative disorders, offers a novel tool for estimating cognitive function.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108217"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jstrokecerebrovasdis.2024.108158
Ahmed A. Ibrahim , Yehya Khlidj , Ahmed Mazen Amin , Mohamed Saad Rakab , AlMothana Manasrah , Abdelrahman Mahmoud , Muhammad Imran , Ahmed Gaber Emara , Mohamed Abuelazm
Background
High blood pressure (BP) is common in acute stroke and a predictor of poor outcomes. Treatment of acute stroke, before a distinction can be made between ischemic and hemorrhagic types, is challenging. We aimed to assess whether patients with presumed acute stroke benefit from pre-hospital BP lowering.
Methods
We conducted a comprehensive systematic review and meta-analysis of randomized controlled trials from PubMed, Web of Science, Scopus, and Cochrane searches until June 2024. Dichotomous data were pooled using risk ratio (RR), and continuous data were pooled using mean difference (MD), both with a 95% confidence interval (CI), using (R version 4.3). PROSPERO ID: CRD42024560200.
Results
Our analysis included five RCTs encompassing 3,933 patients. There was no difference between early BP control and usual care regarding National Institutes of Health Stroke Scale (NIHSS) after 24 hours (MD: 0.65 with 95% CI [0.01, 1.29], P = 0.05), excellent neurological recovery (Modified Rankin Score (mRS) 0–1) (RR: 1.00 with 95% CI [0.91, 1.11], P= 0.98), functional independence (mRS 0–2) (RR: 1.04 with 95% CI [0.96, 1.13], P= 0.30), and independent Ambulation (mRS 0–3) (RR: 1.01 with 95% CI [0.95, 1.06], P= 0.84). Also, there was no difference between both groups in poor neurological recovery (mRS 4–6) (RR: 0.98 with 95% CI [0.91, 1.07], P= 0.68), all-cause mortality (RR: 1.02 with 95% CI [0.90, 1.15], P= 0.79), and any serious adverse events (RR: 1.04 with 95% CI [0.95, 1.15], P= 0.40). However, early BP control significantly increased the incidence of hypotension (RR: 2.24 with 95% CI [1.14, 4.38], P= 0.02) and headache (RR: 1.51 with 95% CI [1.01, 2.26], P= 0.04).
Conclusion
In patients with presumed hyperacute stroke and elevated blood pressure, the rapid initiation of blood pressure reduction in the ambulance very early after symptom onset had no significant benefit regarding functional outcomes in patients with undifferentiated stroke but with an increased incidence of hypotension and headaches.
背景：高血压（BP）在急性卒中中很常见，是预后不良的预测因子。在区分出血性和缺血性中风之前，急性中风的治疗是具有挑战性的。我们的目的是评估急性卒中患者是否从院前降压中获益。方法：我们对PubMed、Web of Science、Scopus和Cochrane搜索到2024年6月的随机对照试验进行了全面的系统评价和荟萃分析。二分类数据采用风险比（RR）合并，连续数据采用均值差（MD）合并，均为95%置信区间（CI），采用（R版本4.3）。普洛斯彼罗id: CRD42024560200。结果：我们的分析包括5项随机对照试验，共3933例患者。在24小时后美国国立卫生研究院卒中量表（NIHSS） （MD: 0.65, 95% CI [0.01, 1.29], P = 0.05）、良好的神经恢复（修正Rankin评分（mRS） 0-1） （RR: 1.00, 95% CI [0.91, 1.11]， P= 0.98）、功能独立性（mRS 0-2） （RR: 1.04, 95% CI [0.96, 1.13]， P= 0.30）和独立行走（mRS 0-3） （RR: 1.01, 95% CI [0.95, 1.06]， P= 0.84）方面，早期血压控制与常规护理之间无差异。此外，两组在神经恢复不良（mRS 4-6） （RR: 0.98, 95% CI [0.91, 1.07]， P= 0.68）、全因死亡率（RR: 1.02, 95% CI [0.90, 1.15]， P= 0.79）和任何严重不良事件（RR: 1.04, 95% CI [0.95, 1.15]， P= 0.40）方面均无差异。然而，早期血压控制显著增加了低血压（RR: 2.24, 95% CI [1.14, 4.38]， P= 0.02）和头痛（RR: 1.51, 95% CI [1.01, 2.26]， P= 0.04）的发生率。结论：在假定为超急性卒中和血压升高的患者中，在症状出现后很早就在救护车上快速开始降压对未分化卒中患者的功能结局没有显著益处，但会增加低血压和头痛的发生率。
{"title":"Pre-hospital blood pressure lowering in presumed hyperacute stroke: A systematic review and meta-analysis of randomized controlled trials","authors":"Ahmed A. Ibrahim , Yehya Khlidj , Ahmed Mazen Amin , Mohamed Saad Rakab , AlMothana Manasrah , Abdelrahman Mahmoud , Muhammad Imran , Ahmed Gaber Emara , Mohamed Abuelazm","doi":"10.1016/j.jstrokecerebrovasdis.2024.108158","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108158","url":null,"abstract":"<div><h3>Background</h3><div>High blood pressure (BP) is common in acute stroke and a predictor of poor outcomes. Treatment of acute stroke, before a distinction can be made between ischemic and hemorrhagic types, is challenging. We aimed to assess whether patients with presumed acute stroke benefit from pre-hospital BP lowering.</div></div><div><h3>Methods</h3><div>We conducted a comprehensive systematic review and meta-analysis of randomized controlled trials from PubMed, Web of Science, Scopus, and Cochrane searches until June 2024. Dichotomous data were pooled using risk ratio (RR), and continuous data were pooled using mean difference (MD), both with a 95% confidence interval (CI), using (R version 4.3). PROSPERO ID: CRD42024560200.</div></div><div><h3>Results</h3><div>Our analysis included five RCTs encompassing 3,933 patients. There was no difference between early BP control and usual care regarding National Institutes of Health Stroke Scale (NIHSS) after 24 hours (MD: 0.65 with 95% CI [0.01, 1.29], P = 0.05), excellent neurological recovery (Modified Rankin Score (mRS) 0–1) (RR: 1.00 with 95% CI [0.91, 1.11], P= 0.98), functional independence (mRS 0–2) (RR: 1.04 with 95% CI [0.96, 1.13], P= 0.30), and independent Ambulation (mRS 0–3) (RR: 1.01 with 95% CI [0.95, 1.06], P= 0.84). Also, there was no difference between both groups in poor neurological recovery (mRS 4–6) (RR: 0.98 with 95% CI [0.91, 1.07], P= 0.68), all-cause mortality (RR: 1.02 with 95% CI [0.90, 1.15], P= 0.79), and any serious adverse events (RR: 1.04 with 95% CI [0.95, 1.15], P= 0.40). However, early BP control significantly increased the incidence of hypotension (RR: 2.24 with 95% CI [1.14, 4.38], P= 0.02) and headache (RR: 1.51 with 95% CI [1.01, 2.26], P= 0.04).</div></div><div><h3>Conclusion</h3><div>In patients with presumed hyperacute stroke and elevated blood pressure, the rapid initiation of blood pressure reduction in the ambulance very early after symptom onset had no significant benefit regarding functional outcomes in patients with undifferentiated stroke but with an increased incidence of hypotension and headaches.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108158"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.jstrokecerebrovasdis.2024.108173
Lazzaro di Biase MD, Ph.D , Adriano Bonura MD , Pasquale Maria Pecoraro MD , Vincenzo Di Lazzaro MD
Background
Direct Oral Anticoagulants (DOACs) have revolutionized the management of thrombotic conditions, providing more predictable and manageable anticoagulation compared to traditional vitamin K antagonists. Despite their success, major bleeding events remain a significant concern. This study aims to assess and compare the haemorrhagic risks associated with various DOACs using data from the FDA's Adverse Event Reporting System (FAERS).
Methods
A retrospective disproportionality analysis of the FAERS database was conducted, covering the period from January 1, 2015, to December 31, 2023. The study focused on adverse bleeding events reported for DOACs. The Proportional Reporting Ratio (PRR) was calculated for each DOAC to identify disproportionate reporting of haemorrhagic events. Major haemorrhagic events were classified as those leading to hospitalization. The analysis also utilized the Medicare Part D dataset to estimate the usage of specific DOACs from 2015 to 2021.
Results
A total of 353,188 haemorrhagic events were identified, with 17,236 (4.9%) attributed to DOACs. The PRR for major haemorrhagic events was highest for Edoxaban at 14.1 (95% CI 13.93-14.85), followed by Dabigatran at 4.0 (95% CI 3.81-4.20), Apixaban at 3.53 (95% CI 3.47-3.61), and Rivaroxaban at 2.11 (95% CI 2.05-2.18). Edoxaban also had the highest PRR for cerebral haemorrhages. Medicare data indicated that Apixaban was the most commonly used DOAC (58.3%), followed by Rivaroxaban (34.5%).
Conclusions
Edoxaban shows a significantly higher risk of major and cerebral haemorrhages compared to other DOACs, while Rivaroxaban demonstrates a lower overall risk of haemorrhage. These findings emphasize the need for careful consideration of bleeding risks in DOAC therapy. Continuous post-marketing surveillance is crucial for understanding the safety profiles of DOACs in real-world clinical settings, aiding clinicians and patients in making informed decisions about anticoagulant therapy.
背景：与传统的维生素K拮抗剂相比，直接口服抗凝剂（DOACs）已经彻底改变了血栓形成条件的管理，提供了更可预测和可管理的抗凝。尽管取得了成功，但重大出血事件仍然令人担忧。本研究旨在利用FDA不良事件报告系统（FAERS）的数据，评估和比较与各种doac相关的出血风险。方法：对FAERS数据库2015年1月1日至2023年12月31日的数据进行回顾性歧化分析。该研究的重点是DOACs报告的不良出血事件。计算每个DOAC的比例报告比（PRR），以确定不成比例的出血事件报告。大出血事件被归类为导致住院的事件。该分析还利用医疗保险D部分数据集来估计2015年至2021年特定doac的使用情况。结果：共发现353188例出血事件，其中17236例（4.9%）归因于doac。主要出血事件的PRR最高的是依多沙班，为14.1 (95% CI 13.93-14.85)，其次是达比加群4.0 (95% CI 3.81-4.20)，阿哌沙班3.53 (95% CI 3.47-3.61)，利伐沙班2.11 （95% CI 2.05-2.18）。依多沙班治疗脑出血的PRR也最高。医疗数据显示，阿哌沙班是最常用的DOAC(58.3%)，其次是利伐沙班（34.5%）。结论：与其他doac相比，依多沙班显示出明显更高的大出血和脑出血风险，而利伐沙班显示出较低的总体出血风险。这些发现强调在DOAC治疗中需要仔细考虑出血风险。持续的上市后监测对于了解doac在实际临床环境中的安全性至关重要，有助于临床医生和患者对抗凝治疗做出明智的决定。
{"title":"Real-world safety profile of direct oral anticoagulants (DOACs): Disproportionality analysis of major bleeding events","authors":"Lazzaro di Biase MD, Ph.D , Adriano Bonura MD , Pasquale Maria Pecoraro MD , Vincenzo Di Lazzaro MD","doi":"10.1016/j.jstrokecerebrovasdis.2024.108173","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108173","url":null,"abstract":"<div><h3>Background</h3><div>Direct Oral Anticoagulants (DOACs) have revolutionized the management of thrombotic conditions, providing more predictable and manageable anticoagulation compared to traditional vitamin K antagonists. Despite their success, major bleeding events remain a significant concern. This study aims to assess and compare the haemorrhagic risks associated with various DOACs using data from the FDA's Adverse Event Reporting System (FAERS).</div></div><div><h3>Methods</h3><div>A retrospective disproportionality analysis of the FAERS database was conducted, covering the period from January 1, 2015, to December 31, 2023. The study focused on adverse bleeding events reported for DOACs. The Proportional Reporting Ratio (PRR) was calculated for each DOAC to identify disproportionate reporting of haemorrhagic events. Major haemorrhagic events were classified as those leading to hospitalization. The analysis also utilized the Medicare Part D dataset to estimate the usage of specific DOACs from 2015 to 2021.</div></div><div><h3>Results</h3><div>A total of 353,188 haemorrhagic events were identified, with 17,236 (4.9%) attributed to DOACs. The PRR for major haemorrhagic events was highest for Edoxaban at 14.1 (95% CI 13.93-14.85), followed by Dabigatran at 4.0 (95% CI 3.81-4.20), Apixaban at 3.53 (95% CI 3.47-3.61), and Rivaroxaban at 2.11 (95% CI 2.05-2.18). Edoxaban also had the highest PRR for cerebral haemorrhages. Medicare data indicated that Apixaban was the most commonly used DOAC (58.3%), followed by Rivaroxaban (34.5%).</div></div><div><h3>Conclusions</h3><div>Edoxaban shows a significantly higher risk of major and cerebral haemorrhages compared to other DOACs, while Rivaroxaban demonstrates a lower overall risk of haemorrhage. These findings emphasize the need for careful consideration of bleeding risks in DOAC therapy. Continuous post-marketing surveillance is crucial for understanding the safety profiles of DOACs in real-world clinical settings, aiding clinicians and patients in making informed decisions about anticoagulant therapy.</div></div>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":"34 2","pages":"Article 108173"},"PeriodicalIF":2.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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