Stroke; a journal of cerebral circulation
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Review Meta Analysis
Delirium in acute stroke: a systematic review and meta-analysis.
Delirium is common in the early stage after hospitalization for an acute stroke. We conducted a systematic review and meta-analysis to evaluate the outcomes of acute stroke patients with delirium. ⋯ Stroke patients with development of delirium have unfavorable outcomes, particularly higher mortality, longer hospitalizations, and a greater degree of dependence after discharge. Early recognition and prevention of delirium may improve outcomes in stroke patients.
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Review Meta Analysis
Patent foramen ovale closure and medical treatments for secondary stroke prevention: a systematic review of observational and randomized evidence.
Patients discovered to have a patent foramen ovale in the setting of a cryptogenic stroke may be treated with percutaneous closure, antiplatelet therapy, or anticoagulants. A recent randomized trial (CLOSURE I) did not detect any benefit of closure over medical treatment alone; the optimal medical therapy is also unknown. We synthesized the available evidence on secondary stroke prevention in patients with patent foramen ovale and cryptogenic stroke. ⋯ Although further randomized trial data are needed to precisely determine the effects of closure on stroke recurrence, the results of CLOSURE I challenge the credibility of a substantial body of observational evidence strongly favoring mechanical closure over medical therapy.
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Meta Analysis
Renin-Angiotensin system modulators modestly reduce vascular risk in persons with prior stroke.
Although the efficacy of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in reducing future vascular events for patients with coronary heart disease is established, less is known about the precise benefit of these agents among patients with stroke. We evaluated whether use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers reduces future vascular events in persons with prior stroke. ⋯ Treatment with an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker has a clear but rather modest effect on reducing vascular risk in persons with prior stroke.
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Meta Analysis Comparative Study
Intraventricular fibrinolysis versus external ventricular drainage alone in intraventricular hemorrhage: a meta-analysis.
The purpose of this study was to analyze the effect of intraventricular fibrinolysis (IVF) compared with external ventricular drainage alone on mortality and functional outcome in the management of intraventricular hemorrhage secondary to spontaneous supratentorial intracerebral hemorrhage. ⋯ The combination of IVF and external ventricular drainage in the management of severe intraventricular hemorrhage secondary to small intracerebral hemorrhage in young patients was associated with better survival and functional outcome results. Urokinase and recombinant tissue-type plasminogen activator could not have the same therapeutic effects. Well-designed randomized trials with special considerations to the fibrinolytic agents are needed.
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Meta Analysis Comparative Study
Low body temperature does not compromise the treatment effect of alteplase.
Hypothermia is neuroprotective in ischemic stroke models. The influence of baseline body temperature on outcomes after thrombolytic therapy is unclear. We examined outcomes after alteplase treatment across baseline body temperature for patients with ischemic stroke in data held within the Virtual International Stroke Trials Archive (VISTA; 1998 to 2007). ⋯ There is no evidence of influence of body temperature on alteplase treatment response. These results are reassuring that low temperatures across a physiological range do not compromise therapeutic effect of alteplase.