scholarly journals ABCD3-I and ABCD2 Scores in a TIA Population with Low Stroke Risk

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Fredrik Ildstad ◽  
Hanne Ellekjær ◽  
Torgeir Wethal ◽  
Stian Lydersen ◽  
Hild Fjærtoft ◽  
...  
Keyword(s):  
Stroke Risk ◽  
Risk Scores ◽  
Short Term ◽  
Clinical Trial Registration ◽  
Long Term Follow Up ◽  
Risk Patients ◽  
Abcd2 Score ◽  
Short Term Prediction

Objectives. We aimed to evaluate the ABCD3-I score and compare it with the ABCD2 score in short- (1 week) and long-term (3 months; 1 year) stroke risk prediction in our post-TIA stroke risk study, MIDNOR TIA. Materials and Methods. We performed a prospective, multicenter study in Central Norway from 2012 to 2015, enrolling 577 patients with TIA. In a subset of patients with complete data for both scores ( n = 305 ), we calculated the AUC statistics of the ABCD3-I score and compared this with the ABCD2 score. A telephone follow-up and registry data were used for assessing stroke occurrence. Results. Within 1 week, 3 months, and 1 year, 1.0% ( n = 3 ), 3.3% ( n = 10 ), and 5.2% ( n = 16 ) experienced a stroke, respectively. The AUCs for the ABCD3-I score were 0.72 (95% CI, 0.54 to 0.89) at 1 week, 0.66 (95% CI, 0.53 to 0.80) at 3 months, and 0.68 (0.95% CI, 0.56 to 0.79) at 1 year. The corresponding AUCs for the ABCD2 score were 0.55 (95% CI, 0.24 to 0.86), 0.55 (95% CI, 0.42 to 0.68), and 0.63 (95% CI, 0.50 to 0.76). Conclusions. The ABCD3-I score had limited value in a short-term prediction of subsequent stroke after TIA and did not reliably discriminate between low- and high-risk patients in a long-term follow-up. The ABCD2 score did not predict subsequent stroke accurately at any time point. Since there is a generally lower stroke risk after TIA during the last years, the benefit of these clinical risk scores and their role in TIA management seems limited. Clinical Trial Registration. This trial is registered with NCT02038725 (retrospectively registered, January 16, 2014).

scholarly journals ABCD2 and ABCD3-I scores in a TIA population with low stroke risk

2020 ◽  
Author(s):  
Fredrik Ildstad ◽  
Hanne Ellekjær ◽  
Torgeir Wethal ◽  
Stian Lydersen ◽  
Hild Fjærtoft ◽  
...  
Keyword(s):  
Stroke Risk ◽  
Risk Scores ◽  
Treatment Regimens ◽  
Clinical Risk ◽  
Long Term Follow Up ◽  
Abcd2 Score ◽  
Ischemic Attack ◽  
Short Term Prediction

Abstract Background Several clinical risk scores have been developed to predict stroke risk after transient ischemic attack (TIA). We aimed to evaluate the ABCD3-I score and compare it with the ABCD2 score in short and long-term stroke risk prediction in our post TIA stroke risk study, MIDNOR TIA. Methods We performed a prospective, multicenter study in Central Norway from October, 2012, to July, 2015, enrolling 577 patients with TIA. In a subset of patients (n=305) we calculated the AUC statistics of the ABCD3-I score and compared this with the ABCD2 score at 1 week, 3 months and 1 year. To assess stroke occurrences, data obtained by telephone follow-up and registry data from the Norwegian Stroke Register was used. Results Three hundred and five patients had complete data for both ABCD3-I and ABCD2 scores. Within 1 week, 3 months and 1 year, 1.0% (n=3), 3.3% (n=10) and 5.2% (n=16) experienced a stroke, respectively. The AUCs for the ABCD3-I score were 0.72 (95% CI, 0.54 to 0.89) at 1 week (compared with ABCD2 score p =0.019), 0.66 (95% CI, 0.53 to 0.80) at 3 months ( p =0.11), and 0.68 (0.95% CI, 0.56 to 0.79) at 1 year ( p =0.39). Conclusions The ABCD3-I score had limited value in short term prediction of subsequent stroke after TIA and did not reliably discriminate between low and high-risk patients in long-term follow-up. The ABCD2 score did not predict subsequent stroke accurately at any time point. Since modern treatment regimens and a decrease in risk factors in the population have contributed to a generally lower stroke risk after TIA during the last years, the benefit of these clinical risk scores and their role in TIA management seems limited.

Long Term Follow-Up of Pediatric SCD Patients with Abnormal High Velocities on Transcranial Doppler: Monocenter Experience in Creteil, France.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1656-1656
Author(s):  
Francoise Bernaudin ◽  
Suzanne Verlhac ◽  
Lena COIC ◽  
Emmanuelle Lesprit ◽  
Pierre Brugieres ◽  
...  
Keyword(s):  
Stroke Risk ◽  
Color Doppler ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Vascular Abnormalities ◽  
Long Term Follow Up ◽  
Risk Patients ◽  
Selection Of

Abstract Abnormal high velocities are predictive of high stroke risk which can be significantly reduced by transfusion program (Adams and al). They are related to stenosis, severe anemia or tissue hypoxia. We hypothesized that high velocities observed in patients with normal MRA and normalized on transfusion program (TP), were anemia related and could be safely decreased with hydroxyurea (HU)-therapy. Patients and Methods: since 1992, 291 pediatric SCD patients (235 SS, 40 SC, 3 Sb0, 11 Sb+) were systematically explored once a year by TCD. The newborn screened cohort (n=149) had the first TCD exploration between 12 and 18 months age. TCD was performed with a real-time imaging unit, using a 2 MHz sector transducer with color Doppler capabilities. When abnormal high velocities (defined as mean maximum velocities > 200 cm/sec in MCA, ACA or ICA) were observed, TCD was controlled and the patient treated with TP and cerebral imaging (MRI/MRA) was performed within 3 months. In patients with severe stenosis, TP was pursued or transplantation performed. In patients with normal MRA and transfusion-normalized velocities, a progressive switch towards HU therapy was applied and TCD controlled once a trimester. Results: among the stroke-free patients (n=281), abn. high velocities were detected in 25 patients (all SS:11% of incidence in SS patients). In the newborn screened population, velocities became abnormal in 10 patients at the median age of 5.7 years (range 1.4 – 12.5 y). The first MRI/MRA (n=24/25) performed in the 3 months following the detection of high velocities showed MRI/silent infarcts in 9/24 (38%): only 1/11 among the newborn screened cohort had silent infarcts in contrast with 8/13 older patients secondary referred in our center. MRA detected severe vascular abnormalities in 10 and mild in 3 patients. Mean velocities (2.69 m/sec) were significantly higher (p=0.002) in the 7 patients with abn. MRI and MRA than in the 10 patients (2.11m/sec) who had normal MRI and MRA. One stroke occurred in a very young 1.6 y old girl just before the second TCD evaluation (first abn. TCD had been observed at 1.5 y) and before the beginning of the TP. Long-term outcome: no stroke was observed following the initiation of the TP. With a median follow-up of 4.4 years (0.5 to 11.4 y.), velocities remained abnormal in 11/25 patients: 7 of them had abnormal MRA and among the 4 patients with normal MRA at first exploration MRA became abnormal in 2 cases showing that abnormal TCD can precede the occurrence of cerebral vasculopathy. TP was maintained in 7 patients and safely stopped in 4 patients transplanted with genoidentical donor. Velocities normalization (defined as < 170 cm/sec) was observed in 13/25 patients in a median delay of 0.75 years (0.25 – 2.3 years). TP was stopped in 10 patients with normal MRA and therapy was switched towards HU in 7 patients with abstention in 3. However, abnormal TCD relapsed in 4 patients who were again placed on TP. Conclusion: abnormal high velocities concerned 11% of SS patients and were predictive of MRA and MRI lesions occurrence. TP was efficient to prevent the stroke risk and normalized velocities in about 50% of patients but relapses were observed in 4/7 patients following TP stop and HU switch. Only few patients with high velocities history did not develop cerebral vasculopathy. Also, early TCD allows a selection of very high risk patients justifying the research of suitable donors.

Anticoagulation in addition to dual antiplatelet therapy has no impact on long-term follow-up after endovascular treatment of (sub)acute lower limb ischemia

VASA ◽  
2019 ◽  
Vol 48 (4) ◽  
pp. 321-329
Author(s):  
Mariya Kronlage ◽  
Erwin Blessing ◽  
Oliver J. Müller ◽  
Britta Heilmeier ◽  
Hugo A. Katus ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Antiplatelet Therapy ◽  
Dual Antiplatelet Therapy ◽  
Limb Ischemia ◽  
Bleeding Complications ◽  
Severe Bleeding ◽  
Short Term ◽  
Long Term Follow Up

Summary. Background: To assess the impact of short- vs. long-term anticoagulation in addition to standard dual antiplatelet therapy (DAPT) upon endovascular treatment of (sub)acute thrombembolic occlusions of the lower extremity. Patient and methods: Retrospective analysis was conducted on 202 patients with a thrombembolic occlusion of lower extremities, followed by crirical limb ischemia that received endovascular treatment including thrombolysis, mechanical thrombectomy, or a combination of both between 2006 and 2015 at a single center. Following antithrombotic regimes were compared: 1) dual antiplatelet therapy, DAPT for 4 weeks (aspirin 100 mg/d and clopidogrel 75 mg/d) upon intervention, followed by a lifelong single antiplatelet therapy; 2) DAPT plus short term anticoagulation for 4 weeks, followed by a lifelong single antiplatelet therapy; 3) DAPT plus long term anticoagulation for > 4 weeks, followed by a lifelong anticoagulation. Results: Endovascular treatment was associated with high immediate revascularization (> 98 %), as well as overall and amputation-free survival rates (> 85 %), independent from the chosen anticoagulation regime in a two-year follow up, p > 0.05. Anticoagulation in addition to standard antiplatelet therapy had no significant effect on patency or freedom from target lesion revascularization (TLR) 24 months upon index procedure for both thrombotic and embolic occlusions. Severe bleeding complications occurred more often in the long-term anticoagulation group (9.3 % vs. 5.6 % (short-term group) and 6.5 % (DAPT group), p > 0.05). Conclusions: Our observational study demonstrates that the choice of an antithrombotic regime had no impact on the long-term follow-up after endovascular treatment of acute thrombembolic limb ischemia whereas prolonged anticoagulation was associated with a nominal increase in severe bleeding complications.

Exercise interventions in lateral elbow tendinopathy have better outcomes than passive interventions, but the effects are small: a systematic review and meta-analysis of 2123 subjects in 30 trials

2020 ◽  
pp. bjsports-2020-102525
Author(s):  
Stefanos Karanasios ◽  
Vasileios Korakakis ◽  
Rod Whiteley ◽  
Ioannis Vasilogeorgis ◽  
Sarah Woodbridge ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Short Term ◽  
Lateral Elbow ◽  
Long Term Follow Up ◽  
Wait And See ◽  
Lateral Elbow Tendinopathy

ObjectiveTo evaluate the effectiveness of exercise compared with other conservative interventions in the management of lateral elbow tendinopathy (LET) on pain and function.DesignSystematic review and meta-analysis.MethodsWe used the Cochrane risk-of-bias tool 2 for randomised controlled trials (RCTs) to assess risk of bias and the Grading of Recommendations Assessment, Development and Evaluation methodology to grade the certainty of evidence. Self-perceived improvement, pain intensity, pain-free grip strength (PFGS) and elbow disability were used as primary outcome measures.Eligibility criteriaRCTs assessing the effectiveness of exercise alone or as an additive intervention compared with passive interventions, wait-and-see or injections in patients with LET.Results30 RCTs (2123 participants, 5 comparator interventions) were identified. Exercise outperformed (low certainty) corticosteroid injections in all outcomes at all time points except short-term pain reduction. Clinically significant differences were found in PFGS at short-term (mean difference (MD): 12.15, (95% CI) 1.69 to 22.6), mid-term (MD: 22.45, 95% CI 3.63 to 41.3) and long-term follow-up (MD: 18, 95% CI 11.17 to 24.84). Statistically significant differences (very low certainty) for exercise compared with wait-and-see were found only in self-perceived improvement at short-term, pain reduction and elbow disability at short-term and long-term follow-up. Substantial heterogeneity in descriptions of equipment, load, duration and frequency of exercise programmes were evident.ConclusionsLow and very low certainty evidence suggests exercise is effective compared with passive interventions with or without invasive treatment in LET, but the effect is small.PROSPERO registration numberCRD42018082703.

Cibenzoline for High-Frequency Ventricular Arrhythmias: A Short-Term Comparison With Quinidine and a Long-Term Follow-up

1987 ◽  
Vol 27 (4) ◽  
pp. 283-287 ◽  
Author(s):  
Prasad R. Palakurthy ◽  
Claudio Maldonado ◽  
Gurbachan Sohi ◽  
Nancy C. Flowers
Keyword(s):  
High Frequency ◽  
Ventricular Arrhythmias ◽  
Short Term ◽  
Long Term Follow Up

Early course and Long term follow-up after Automated Percutaneous Lumbar Discectomy and Short term follow-up after Nucleoplasty

2005 ◽  
Vol 12 (4) ◽  
pp. 344
Author(s):  
Young-Woo Kim ◽  
Ho-Guen Chang ◽  
Kyu-Nam Seo ◽  
Kee-Byung Lee ◽  
Hyung-Su Kim
Keyword(s):  
Lumbar Discectomy ◽  
Short Term ◽  
Early Course ◽  
Long Term Follow Up

scholarly journals Improvement of Back and Leg Pain after Lumbar Spinal Decompression without Fusion

2018 ◽  
Vol 80 (02) ◽  
pp. 081-087
Author(s):  
Nicola Bongartz ◽  
Christian Blume ◽  
Hans Clusmann ◽  
Christian Müller ◽  
Matthias Geiger
Keyword(s):  
Back Pain ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Leg Pain ◽  
Short Term ◽  
Clear Trend ◽  
Long Term Follow Up ◽  
Lumbar Spinal

Background To evaluate whether decompression in lumbar spinal stenosis without fusion leads to sufficient improvement of back pain and leg pain and whether re-decompression alone is sufficient for recurrent lumbar spinal stenosis for patients without signs of instability. Material and Methods A successive series of 102 patients with lumbar spinal stenosis (with and without previous lumbar surgery) were treated with decompression alone during a 3-year period. Data on pre- and postoperative back pain and leg pain (numerical rating scale [NRS] scale) were retrospectively collected from questionnaires with a return rate of 65% (n = 66). The complete cohort as well as patients with first-time surgery and re-decompression were analyzed separately. Patients were dichotomized to short-term follow-up (< 100 weeks) and long-term follow-up (> 100 weeks) postsurgery. Results Overall, both back pain (NRS 4.59 postoperative versus 7.89 preoperative; p < 0.0001) and leg pain (NRS 4.09 versus 6.75; p < 0.0001) improved postoperatively. The short-term follow-up subgroup (50%, n = 33) showed a significant reduction in back pain (NRS 4.0 versus 6.88; p < 0.0001) and leg pain (NRS 2.49 versus 6.91: p < 0.0001). Similar results could be observed for the long-term follow-up subgroup (50%, n = 33) with significantly less back pain (NRS 3.94 versus 7.0; p < 0.0001) and leg pain (visual analog scale 3.14 versus 5.39; p < 0.002) postoperatively. Patients with previous decompression surgery benefit significantly regarding back pain (NRS 4.82 versus 7.65; p < 0.0024), especially in the long-term follow-up subgroup (NRS 4.75 versus 7.67; p < 0.0148). There was also a clear trend in favor of leg pain in patients with previous surgery; however, it was not significant. Conclusions Decompression of lumbar spinal stenosis without fusion led to a significant and similar reduction of back pain and leg pain in a short-term and a long-term follow-up group. Patients without previous surgery benefited significantly better, whereas patients with previous decompression benefited regarding back pain, especially for long-term follow-up with a clear trend in favor of leg pain.

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