scholarly journals Sodium Valproate, a Histone Deacetylase Inhibitor, Is Associated With Reduced Stroke Risk After Previous Ischemic Stroke or Transient Ischemic Attack

Stroke ◽  
2018 ◽  
Vol 49 (1) ◽  
pp. 54-61 ◽  
Author(s):  
Rebecca L. Brookes ◽  
Siobhan Crichton ◽  
Charles D.A. Wolfe ◽  
Qilong Yi ◽  
Linxin Li ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Histone Deacetylase ◽  
Sodium Valproate ◽  
Transient Ischemic Attack ◽  
Histone Deacetylase Inhibitor ◽  
Stroke Risk ◽  
Deacetylase Inhibitor ◽  
Ischemic Attack

Risk of Ischemic Stroke and Transient Ischemic Attack Is Increased up to 90 Days after Non-Carotid and Non-Cardiac Surgery

2017 ◽  
Vol 43 (5-6) ◽  
pp. 242-249 ◽  
Author(s):  
Armin J. Grau ◽  
Martin Eicke ◽  
Christoph Burmeister ◽  
Roland Hardt ◽  
Eberhard Schmitt ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Rate Ratio ◽  
Stroke Risk ◽  
Care Quality ◽  
Stroke Severity ◽  
Carotid Surgery ◽  
Perioperative Stroke ◽  
Stroke Etiology ◽  
Ischemic Attack

Background: The risk of stroke after cardiac and carotid surgery is well established. In contrast, stroke risk in association with non-cardiac and non-carotid surgery and its time course are insufficiently known. We investigated the prevalence of recent and planned surgery among patients with stroke and transient ischemic attack (TIA), time dependency of stroke risk, stroke etiology, and interruption of antithrombotic medication in association with surgery. Methods: Data on type and date of surgery and similar interventions within the last year or planned for the next 2 weeks were anonymously collected together with demographic data, vascular risk factors, stroke severity, handicap before stroke and stroke etiology within a state-wide, mandatory, hospital-based acute stroke care quality monitoring project (Rhineland-Palatinate, Germany) for 1 year (2010). Results: Non-carotid and non-cardiothoracic surgery was reported as performed within 1 year before the index event or as planned for the next 2 weeks thereafter in 532 out of 12,120 patients with ischemic stroke/TIA (4.4%). Compared to 91-365 days before stroke/TIA as reference period, risk of cerebral ischemia (per day analysis) was increased for surgery within 61-90 days before ischemia (rate ratio 2.0, 95% CI 1.5-2.8) and continuously increased along shorter intervals between stroke and surgery (31-60 days: rate ratio 3.6, 95% CI 2.9-4.5; 15-30 days: rate ratio 8.2, 95% CI 6.7-10.1; 8-14 days: rate ratio 13.2, 95% CI 10.3-16.8; 4-7 days: rate ratio 16.5, 95% CI 12.2-22.1) peaking at an interval of 1-3 days before ischemia (rate ratio 34.0, 95% CI 26.9-42.8). On the day of surgery, rate ratio was 14.8 (95% CI 7.8-27.9) and for planned surgery it was 2.7 (95% CI 1.8-4.0). Results were similar for first-ever and for recurrent ischemic stroke. Perioperative stroke/TIA was positively associated with atrial fibrillation and cardioembolic stroke etiology, higher mortality, more severe neurological deficits at discharge, and longer hospital stay; and it was inversely associated with microangiopathic etiology and discharge at home. In 34.5% of patients with recent/planned surgery, prior antithrombotic or anticoagulant medication had been interrupted. Conclusions: Recent or planned surgery imposes a considerable short-term stroke risk particularly by cardioembolism with cessation of medication as an important contributor. Stroke after surgery is associated with poor outcome and high mortality. Better strategies to reduce the burden of perioperative stroke are urgently required.

scholarly journals Perception of Recurrent Stroke Risk among Black, White and Hispanic Ischemic Stroke and Transient Ischemic Attack Survivors: The SWIFT Study

2011 ◽  
Vol 37 (2) ◽  
pp. 83-87 ◽  
Author(s):  
Bernadette Boden-Albala ◽  
Heather Carman ◽  
Megan Moran ◽  
Margaret Doyle ◽  
Myunghee C. Paik
Keyword(s):  
Ischemic Stroke ◽  
Transient Ischemic Attack ◽  
Stroke Risk ◽  
Recurrent Stroke ◽  
Ischemic Attack

scholarly journals Redefinition of Transient Ischemic Attack Improves Prognosis of Transient Ischemic Attack and Ischemic Stroke

Stroke ◽  
2011 ◽  
Vol 42 (12) ◽  
pp. 3612-3613 ◽  
Author(s):  
Michael T. Mullen ◽  
Brett L. Cucchiara
Keyword(s):  
Magnetic Resonance Imaging ◽  
Sensitivity Analysis ◽  
Ischemic Stroke ◽  
Magnetic Resonance ◽  
Transient Ischemic Attack ◽  
Stroke Risk ◽  
Resonance Imaging ◽  
Acute Infarction ◽  
Ischemic Attack ◽  
The Impact

Background and Purpose— The recent redefinition of transient ischemic attack (TIA) reclassifies patients with acute infarction on magnetic resonance imaging as ischemic stroke. Redefinition will improve the prognosis of both TIA and ischemic stroke, an epidemiological paradox known as the Will Rogers phenomenon. We sought to quantify the impact of this phenomenon. Methods— Incidence of TIA, risk of death/disability after stroke, rate of acute infarction on magnetic resonance imaging after TIA, and 90-day stroke risk after TIA with and without infarction on magnetic resonance imaging were determined based on published data. The impact on poststroke disability in the redefined cohort of patients with ischemic stroke was computed. A sensitivity analysis was performed to account for uncertainty in input variables. Results— Using the new TIA definition, the 90-day risk of stroke following TIA is 1%. In the United States, redefinition will increase annual ischemic stroke incidence from 691 650 to 747 755 and result in a 3.4% absolute reduction in poststroke disability. In a sensitivity analysis, this risk reduction varies from 1.5 to 6.5%, and is most dependent on the incidence of TIA. Conclusions— Redefinition of TIA reduces stroke risk after TIA to approximately 1% at 90 days, and reduces the rate of poststroke disability by approximately 3.4%.

scholarly journals Impaired Glucose Tolerance Increases Stroke Risk in Nondiabetic Patients With Transient Ischemic Attack or Minor Ischemic Stroke

Stroke ◽  
2006 ◽  
Vol 37 (6) ◽  
pp. 1413-1417 ◽  
Author(s):  
Sarah E. Vermeer ◽  
Willemijn Sandee ◽  
Ale Algra ◽  
Peter J. Koudstaal ◽  
L. Jaap Kappelle ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Glucose Tolerance ◽  
Impaired Glucose Tolerance ◽  
Transient Ischemic Attack ◽  
Stroke Risk ◽  
Minor Ischemic Stroke ◽  
Ischemic Attack

scholarly journals Carotid Stenosis and Recurrent Ischemic Stroke

Stroke ◽  
2021 ◽  
Author(s):  
Shadi Yaghi ◽  
Adam de Havenon ◽  
Sara Rostanski ◽  
Alexandra Kvernland ◽  
Brian Mac Grory ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
High Risk ◽  
Carotid Stenosis ◽  
Transient Ischemic Attack ◽  
Stroke Risk ◽  
Hazard Ratio ◽  
Minor Ischemic Stroke ◽  
Increased Risk ◽  
Ischemic Stroke Risk ◽  
Ischemic Attack

Background and Purpose: Randomized trials demonstrated the benefit of dual antiplatelet therapy in patients with minor ischemic stroke or high-risk transient ischemic attack. We sought to determine whether the presence of carotid stenosis was associated with increased risk of ischemic stroke and whether the addition of clopidogrel to aspirin was associated with more benefit in patients with versus without carotid stenosis. Methods: This is a post-hoc analysis of the POINT trial (Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke) that randomized patients with minor ischemic stroke or high-risk transient ischemic attack within 12 hours from last known normal to receive either clopidogrel plus aspirin or aspirin alone. The primary predictor was the presence of ≥50% stenosis in either cervical internal carotid artery. The primary outcome was ischemic stroke. We built Cox regression models to determine the association between carotid stenosis and ischemic stroke and whether the effect of clopidogrel was modified by ≥50% carotid stenosis. Results: Among 4881 patients enrolled POINT, 3941 patients met the inclusion criteria. In adjusted models, ≥50% carotid stenosis was associated with ischemic stroke risk (hazard ratio, 2.45 [95% CI, 1.68–3.57], P <0.001). The effect of clopidogrel (versus placebo) on ischemic stroke risk was not significantly different in patients with <50% carotid stenosis (adjusted hazard ratio, 0.68 [95% CI, 0.50–0.93], P =0.014) versus those with ≥50% carotid stenosis (adjusted hazard ratio, 0.88 [95% CI, 0.45–1.72], P =0.703), P value for interaction=0.573. Conclusions: The presence of carotid stenosis was associated with increased risk of ischemic stroke during follow-up. The effect of added clopidogrel was not significantly different in patients with versus without carotid stenosis. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03354429.

scholarly journals Sex-Dependent Effects of the Histone Deacetylase Inhibitor, Sodium Valproate, on Reversal Learning After Developmental Arsenic Exposure

2018 ◽  
Vol 9 ◽  
Author(s):  
Christina R. Steadman Tyler ◽  
Jane J. W. Smoake ◽  
Elizabeth R. Solomon ◽  
Estrella Villicana ◽  
Kevin K. Caldwell ◽  
...  
Keyword(s):  
Histone Deacetylase ◽  
Sodium Valproate ◽  
Reversal Learning ◽  
Histone Deacetylase Inhibitor ◽  
Arsenic Exposure ◽  
Deacetylase Inhibitor
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