Cerebrovascular diseases
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Cerebrovascular diseases · Jan 2009
Multicenter StudyAntithrombotic therapy influences location, enlargement, and mortality from intracerebral hemorrhage. The Bleeding with Antithrombotic Therapy (BAT) Retrospective Study.
To determine whether the use of oral antithrombotic agents before the onset of intracerebral hemorrhage (ICH) affects hematoma features and early patient outcome. ⋯ Prior medication with antiplatelet agents, warfarin, or both was predictive of cerebellar hemorrhage, hematoma enlargement, and early death in Japanese ICH patients.
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The lack of physicians with specialty stroke training represents a significant challenge to the future of stroke. This deficit limits both quality stroke care and clinical research initiatives. ⋯ Greater diffusion and long-term sustainability of telestroke systems will be dependent upon improvements in patient and hospital reimbursement for acute stroke and telestroke care.
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Cerebrovascular diseases · Jan 2009
Comparative StudyGender differences in mortality after hospital admission for stroke.
Differences between men and women in stroke symptoms, management and disability have been reported to be unfavorable for women. Yet, studies into differences between men and women in survival after a stroke yielded inconsistent results. We investigated whether gender was associated with all-cause mortality after hospital admission for stroke. ⋯ Women have lower 28-day case-fatality and long-term mortality risks after an ischemic stroke and lower 1-year and 5-year mortality risks after an intracerebral hemorrhage compared to men, whereas no differences in mortality risks were found for subarachnoid hemorrhage.
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Cerebrovascular diseases · Jan 2009
Multicenter StudyUtilization of intravenous tissue plasminogen activator for ischemic stroke: are there sex differences?
We evaluated whether there were sex-related differences in the administration of intravenous tissue plasminogen activator (IV-tPA) to patients with acute ischemic stroke admitted to US academic medical centers. ⋯ Women admitted to academic hospitals receive IV-tPA as often as men; however, a substantial percentage of both women and men are not arriving within the 3-hour time window required for diagnostic assessment and administration of intravenous thrombolytic therapy. Additional efforts are needed to improve the rapid identification, evaluation and treatment of stroke patients.
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Cerebrovascular diseases · Jan 2009
ReviewGenetic association studies in ischaemic stroke: replication failure and prospects.
Although hundreds of genetic association studies of ischaemic stroke have been published, the failure to replicate associations has led to scepticism about their findings. Possible explanations for this failure are: (1) a false-positive association in the initial study; (2) a false-negative association in a replication study; (3) methodological differences (e.g. study populations or study designs). We review underlying causes for replication failure, such as small sample size, multiple testing and publication bias, and methods to deal with these problems. We also make suggestions about the design of genetic association studies in ischaemic stroke with regard to stroke subtype classification, candidate pathways, subgroups, intermediate phenotypes and potential clinical impact.