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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Cerebrovascular diseases · Jan 2009
Multicenter StudyStroke in the very elderly: hospital care, case fatality and disposition.
The worldwide growing number of older people represents a new phenomenon. Considering that the prevalence of stroke increases with age and higher life expectancy, the prevalence of stroke will likely rise in the next decade. However, limited information is available about the burden of stroke in individuals over 90. ⋯ In our study, stroke patients over 90 had higher risk-adjusted mortality, longer hospitalization, and were less likely to be discharged to their original place of residence. In view of these findings, strategies need to be implemented to facilitate equal access to specialized stroke care for the elderly.
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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.
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Cerebrovascular diseases · Jan 2009
ReviewRelevance of neuroimaging in the evaluation of cerebral ischemia.
The rapid development of neuroimaging techniques has provided us with a wide range of tools for the assessment of patients who may have experienced cerebrovascular events. Each of these technologies provides specific and potentially informative insights. For clinical practice, however, we always have to tailor our diagnostic approach according to a maximum benefit/minimal burden and cost ratio. ⋯ For patients in the postacute phase of acute ischemic stroke, neuroimaging should contribute a maximum of information to the clarification of stroke etiology to allow for specific secondary prevention. Patients with transient ischemic attacks appear to represent yet another distinct group of patients who can benefit greatly from a rapid and comprehensive neuroimaging evaluation, as this allows identification of individuals at a specifically high risk for a subsequent stroke. Using these categories, the relevance of respective neuroimaging tools can be substantiated by a large body of evidence.
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Cerebrovascular diseases · Jan 2009
ReviewOld and new anticoagulant agents for the prevention and treatment of patients with ischemic stroke.
Vitamin K antagonists are the only oral anticoagulants available and are considered as well-established treatment to prevent a first stroke or a recurrent stroke in patients with atrial fibrillation. The difficulties in the routine management of these patients cause an underuse of vitamin K antagonists. For long-term use, there is a need for safer and more effective oral anticoagulants that do not require routine monitoring of coagulation. ⋯ Direct thrombin inhibitors include ximelagatran and dabigatran etexilate. Although ximelagatran was withdrawn early because of liver toxicity, it provided convincing evidence that new oral anticoagulants have the potential to replace warfarin. However, even if these new drugs prove superior to dose-adjusted warfarin, their benefits must be substantial (retaining high efficacy with added safety and convenience) to offset their increased cost.