Safety and feasibility of post-stroke care and exercise after minor ischemic stroke or transient ischemic attack: MotiveS & MoveIT

Background: Evidence about the use of dual antiplatelet therapy (DAPT) with aspirin and P2Y12 inhibitors in patients with acute minor ischemic stroke or transient ischemic attack (TIA) is emerging. The aim of our study was to provide an updated and comprehensive analysis about the risks and benefits of DAPT versus aspirin monotherapy in this setting. Methods: The PubMed, Embase, Cochrane Central Register of Controlled Trials, ClinicalTrials.gov databases, main international conference proceedings were searched for randomized controlled trials comparing DAPT versus aspirin monotherapy in patients with acute ischemic stroke or TIA not eligible for thrombolysis or thrombectomy presenting in the first 24 hours after the acute event. Data were pooled by meta-analysis using a random-effects model. The primary efficacy endpoint was ischemic stroke recurrence, and the primary safety outcome was major bleeding. Secondary endpoints were intracranial hemorrhage, hemorrhagic stroke, and all-cause death. Results: A total of 4 studies enrolling 21,459 patients were included. DAPT with clopidogrel was used in 3 studies, DAPT with ticagrelor in one study. DAPT duration was 21 days in one study, 1 month in one study, and 3 months in the remaining studies. DAPT was associated with a significant reduction in the risk of ischemic stroke recurrence (relative risk [RR], 0.74; 95% confidence interval [CI], 0.67-0.82, P<0.001, number needed to treat 50 [95% CI 40-72], while it was associated with a significantly higher risk of major bleeding (RR, 2.59; 95% CI 1.49-4.53, P=0.001, number needed to harm 330 [95% CI 149-1111]), of intracranial hemorrhage (RR 3.06, 95% CI 1.41-6.66, P=0.005), with a trend towards higher risk of hemorrhagic stroke (RR 1.83, 95% CI 0.83-4.05, P=0.14), and a slight tendency towards higher risk of all-cause death (RR 1.30, 95% CI 0.89-1.89, P=0.16). Conclusions: Among patients with acute minor ischemic stroke or TIA, DAPT, as compared with aspirin monotherapy, might offer better effectiveness in terms of ischemic stroke recurrence at the expense of a higher risk of major bleeding. The trade-off between ischemic benefits and bleeding risks should be assessed in tailoring the therapeutic strategies.

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Canadian Stroke Best Practice Recommendations for Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care, 6th Edition, Update 2018

International Journal of Stroke ◽

10.1177/1747493018786616 ◽

2018 ◽

Vol 13 (9) ◽

pp. 949-984 ◽

Cited By ~ 73

Author(s):

JM Boulanger ◽

MP Lindsay ◽

G Gubitz ◽

EE Smith ◽

G Stotts ◽

...

Keyword(s):

Emergency Department ◽

Ischemic Stroke ◽

Acute Stroke ◽

Transient Ischemic Attack ◽

Best Practice ◽

Stroke Care ◽

Stroke Management ◽

Practice Recommendations ◽

Prehospital Emergency ◽

Ischemic Attack

The 2018 update of the Canadian Stroke Best Practice Recommendations for Acute Stroke Management, 6th edition, is a comprehensive summary of current evidence-based recommendations, appropriate for use by healthcare providers and system planners caring for persons with very recent symptoms of acute stroke or transient ischemic attack. The recommendations are intended for use by a interdisciplinary team of clinicians across a wide range of settings and highlight key elements involved in prehospital and Emergency Department care, acute treatments for ischemic stroke, and acute inpatient care. The most notable changes included in this 6th edition are the renaming of the module and its integration of the formerly separate modules on prehospital and emergency care and acute inpatient stroke care. The new module, Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care is now a single, comprehensive module addressing the most important aspects of acute stroke care delivery. Other notable changes include the removal of two sections related to the emergency management of intracerebral hemorrhage and subarachnoid hemorrhage. These topics are covered in a new, dedicated module, to be released later this year. The most significant recommendation updates are for neuroimaging; the extension of the time window for endovascular thrombectomy treatment out to 24 h; considerations for treating a highly selected group of people with stroke of unknown time of onset; and recommendations for dual antiplatelet therapy for a limited duration after acute minor ischemic stroke and transient ischemic attack. This module also emphasizes the need for increased public and healthcare provider’s recognition of the signs of stroke and immediate actions to take; the important expanding role of paramedics and all emergency medical services personnel; arriving at a stroke-enabled Emergency Department without delay; and launching local healthcare institution code stroke protocols. Revisions have also been made to the recommendations for the triage and assessment of risk of recurrent stroke after transient ischemic attack/minor stroke and suggested urgency levels for investigations and initiation of management strategies. The goal of this updated guideline is to optimize stroke care across Canada, by reducing practice variations and reducing the gap between current knowledge and clinical practice.

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Abstract 137: Neighborhood Income and 30-day Readmissions for Stroke and Transient Ischemic Attack

Stroke ◽

10.1161/str.48.suppl_1.137 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Judith H Lichtman ◽

Erica C Leifheit-Limson ◽

Yun Wang ◽

Larry B Goldstein

Keyword(s):

Transient Ischemic Attack ◽

Stroke Care ◽

Stroke Incidence ◽

Logistic Regression Models ◽

Post Stroke ◽

Explanatory Factors ◽

Nationally Representative ◽

Ischemic Attack ◽

The Relationship ◽

Income Quartile

Background: Residence in a socioeconomically challenged neighborhood is associated with increased stroke incidence and shorter post-stroke survival. Little is known about the relationship between socioeconomic status and 30-day post-stroke readmissions. We used a nationally representative readmission database that includes both insured and uninsured patients to determine whether there is a relationship between community-level income and 30-day readmissions after stroke and transient ischemic attack (TIA). Methods: Hospitalizations were identified in the 2013 Nationwide Readmissions Database for patients aged ≥18y with subarachnoid hemorrhage (SAH; ICD-9 430), intracerebral hemorrhage (ICH; ICD-9 431), ischemic stroke (IS; ICD-9 433, 434, 436), and TIA (ICD-9 435). We used mixed logistic regression models with hospital-specific random effects to assess the relationship between community income level (measured according to the median household income quartile for a patient’s ZIP code) and 30-day readmissions. Models were stratified by age and adjusted for demographic and clinical characteristics. Results: There were 7,061 hospitalizations for SAH, 17,325 for ICH, 212,306 for IS, and 67,606 for TIA. In unadjusted analyses, 30-day readmission rates decreased with increasing income quartile for younger patients hospitalized with IS and SAH (figure). In adjusted analyses, this association persisted only among those with IS aged 18-44y for whom each quartile increase in income was associated with a 7% decrease in 30-day readmission (figure). There were no significant associations between income and 30-day readmission for SAH, ICH, and TIA. Conclusions: Overall, community income was not associated with readmission for hemorrhagic stroke and TIA, but higher income was associated with lower 30-day readmission for younger IS patients. Possible explanatory factors such as better access to post-stroke care warrant further research for this subgroup.

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Corneal nerve and endothelial cell damage in patients with transient ischemic attack and minor ischemic stroke

PLoS ONE ◽

10.1371/journal.pone.0213319 ◽

2019 ◽

Vol 14 (3) ◽

pp. e0213319 ◽

Cited By ~ 4

Author(s):

Hoda Gad ◽

Adnan Khan ◽

Naveed Akhtar ◽

Saadat Kamran ◽

Ahmed El-Sotouhy ◽

...

Keyword(s):

Ischemic Stroke ◽

Endothelial Cell ◽

Transient Ischemic Attack ◽

Cell Damage ◽

Endothelial Cell Damage ◽

Minor Ischemic Stroke ◽

Corneal Nerve ◽

Ischemic Attack

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PCV90 RISK FACTORS, USE OF HEALTH CARE RESOURCES, AND MORTALITY IN PATIENTS WITH MINOR ISCHEMIC STROKE OR HIGH-RISK TRANSIENT ISCHEMIC ATTACK

Value in Health ◽

10.1016/j.jval.2019.09.814 ◽

2019 ◽

Vol 22 ◽

pp. S558

Author(s):

O. Fasth ◽

P. Appelros ◽

B. Farahmand ◽

J. Hedberg ◽

P. Ladenvall ◽

...

Keyword(s):

Risk Factors ◽

Health Care ◽

Ischemic Stroke ◽

High Risk ◽

Transient Ischemic Attack ◽

Health Care Resources ◽

Minor Ischemic Stroke ◽

Ischemic Attack ◽

Use Of Health Care

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Diagnostic Usefulness of the ABCD 2 Score to Distinguish Transient Ischemic Attack and Minor Ischemic Stroke From Noncerebrovascular Events

Stroke ◽

10.1161/strokeaha.109.557074 ◽

2009 ◽

Vol 40 (11) ◽

pp. 3449-3454 ◽

Cited By ~ 61

Author(s):

Orla C. Sheehan ◽

Aine Merwick ◽

Lisa A. Kelly ◽

Niamh Hannon ◽

Michael Marnane ◽

...

Keyword(s):

Ischemic Stroke ◽

Transient Ischemic Attack ◽

Minor Ischemic Stroke ◽

Diagnostic Usefulness ◽

Ischemic Attack

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Risk factors for cervical atherosclerosis in patients with transient ischemic attack or minor ischemic stroke.

Stroke ◽

10.1161/01.str.24.7.970 ◽

1993 ◽

Vol 24 (7) ◽

pp. 970-975 ◽

Cited By ~ 25

Author(s):

H Palomäki ◽

M Kaste ◽

R Raininko ◽

O Salonen ◽

S Juvela ◽

...

Keyword(s):

Risk Factors ◽

Ischemic Stroke ◽

Transient Ischemic Attack ◽

Minor Ischemic Stroke ◽

Ischemic Attack

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Antiplatelet therapy in stroke prevention after non-cardioembolic transient ischemic attack

Neurology neuropsychiatry Psychosomatics ◽

10.14412/2074-2711-2021-5-14-19 ◽

2021 ◽

Vol 13 (5) ◽

pp. 14-19

Author(s):

A. V. Fonyakin ◽

L. A. Geraskina ◽

M. Yu. Maksimova

Keyword(s):

Ischemic Stroke ◽

Antiplatelet Therapy ◽

Transient Ischemic Attack ◽

Antiplatelet Agents ◽

Basic Principles ◽

Advantages And Disadvantages ◽

Minor Ischemic Stroke ◽

New Ideas ◽

Ischemic Attack

The review shows modern concepts on the role of antiplatelet therapy in the secondary prevention of cardiovascular diseases in patients after non-cardioembolic ischemic stroke or transient ischemic attack (TIA). We present an analytical characteristic of all antiplatelet agents that have been studied in randomized controlled trials worldwide. We demonstrate the advantages and disadvantages of each agent in monotherapy and in combination. New ideas about the rationality of the use of combined antiplatelet therapy with clopidogrel and acetylsalicylic acid in the first 24 hours and no more than 90 days in patients with minor ischemic stroke or TIA are discussed. The efficacy and safety of new antiplatelet agents are analyzed. The basic principles of choosing antiplatelet agents in patients after ischemic noncardioembolic stroke/TIA are outlined.

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