Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association
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J Stroke Cerebrovasc Dis · Nov 2012
Multicenter StudyPredictors of cerebral venous thrombosis and arterial ischemic stroke in young Asian women.
The management and outcome of cerebral venous thrombosis (CVT) may be different from that of arterial ischemic stroke (AIS). Clinically differentiating the 2 diseases on clinical grounds may be difficult. The main objective of this study was to identify predictors differentiating CVT from AIS in a large cohort of young Asian women, based on risk factors and investigations. ⋯ There was no difference in outcome between patients with obstetric and nonobstetric CVT. Our data indicate that in young Asian women, predictors of CVT differ from those for AIS. These findings could be useful in the early identification and diagnosis of patients with CVT.
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J Stroke Cerebrovasc Dis · Aug 2012
Randomized Controlled Trial Multicenter Study Comparative StudyStroke risk and efficacy of apixaban in atrial fibrillation patients with moderate chronic kidney disease.
Apixaban is superior to aspirin for the prevention of stroke in patients with atrial fibrillation. Apixaban is partially renally excreted and may accumulate in patients with renal impairment. ⋯ Stage III CKD was an independent predictor of stroke in atrial fibrillation patients taking aspirin. Among stage III CKD patients, apixaban significantly reduced stroke relative to aspirin without a significant increase in major hemorrhage.
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J Stroke Cerebrovasc Dis · Nov 2011
Multicenter Study Clinical TrialFactors predicting outcome in stroke patients treated with 0.6 mg/kg alteplase: evidence from the Japan Alteplase Clinical Trial (J-ACT).
The aim of the present study was to identify factors associated with functional outcome, mortality, and symptomatic intracranial hemorrhage (sICH) in patients from the Japan Alteplase Clinical Trial (J-ACT) data set with ischemic stroke treated with intravenous (IV) 0.6 mg/kg alteplase within 3 hours after onset. The patient sample comprised 103 patients from the J-ACT, a multicenter, single-dose, open-label cohort study conducted to verify the efficacy and safety of IV 0.6 mg/kg alteplase in treating acute hemispheric stroke. The effects of 21 patient baseline characteristics on a favorable outcome (as evaluated by modified Rankin scale [mRS] score of 0-1 after 3 months), death within 3 months, and incidence of sICH within 36 hours after the start of treatment were examined by univariate analysis and stepwise logistic regression analysis. ⋯ No factors significantly predicted sICH. Age and baseline NIHSS score were independent predictors for both favorable outcome and death. Although these factors are consistent with those found to be predictors in studies on IV 0.9 mg/kg alteplase, there were no factors predicting outcomes specific for IV 0.6 mg/kg alteplase.
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J Stroke Cerebrovasc Dis · Sep 2011
Multicenter StudyIs cognitive functioning 1 year poststroke related to quality of life domain?
Previous studies on the association between poststroke cognitive impairment and quality of life (QoL) have shown divergent results. In this study, we investigated the relationships between cognitive functioning and various QoL domains at 1 year poststroke. This was a cross-sectional study, examining 92 patients at 1 year poststroke. ⋯ Controlling for demographic factors and motor impairments resulted in negligible percentages of variance additionally explained by cognitive functioning. The percentages of explained variance were somewhat lower in the analyses with the separate cognitive domains and not significant for depression. Poor cognitive functioning was associated with reduced functional independence, social participation, depressive mood, and life satisfaction 1 year post; however, motor impairment was a stronger determinant of long-term QoL than cognitive functioning.
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J Stroke Cerebrovasc Dis · Sep 2011
Multicenter StudyFactors influencing cooperation among healthcare providers in a community-based stroke care system in Japan.
Community-based stroke care in Japan is currently provided in acute hospitals, convalescent rehabilitation units, general practices, sanatorium-type wards, nursing care facilities, and in-home/commuting care services. We conducted a nationwide survey to identify factors influencing cooperation among the various providers of community-based stroke care. We sent questionnaires to 11,178 facilities and assessed the independent variables of excellent and fair cooperation among the care providers. ⋯ The following independent variables were inversely associated with excellent or fair cooperation in the community: area with the higher population density among 3 groups divided by tertile threshold (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.41-0.69), facilities covered by long-term care insurance (OR, 0.27; 95% CI, 0.22-0.34), and insufficient communication with local government (OR, 0.19; 95% CI, 0.14-0.24). Positive independent variables of excellent or fair cooperation were the sharing of patient information in the community (OR, 2.53; 95% CI, 1.78-3.66), use of a scale for assessing activities of daily living (OR, 1.93; 95% CI, 1.42-2.63), appropriate utilization of care support managers (OR, 1.91; 95% CI, 1.43-2.55), and adequate comprehension of the long-term care insurance system (OR, 1.54; 95% CI, 1.24-1.92). Our findings suggest that improved communication between healthcare providers and local government, along with appropriate attention to the problems facing providers covered by long-term care insurance, may improve community-based stroke care in Japan.