A Prototype Worldwide Survey of Diagnostic and Treatment Modalities for Stroke

Aiyagari, Venkatesh; Pandey, Dilip K.; Testai, Fernando D.; Grysiewicz, Rebbeca; Tsiskaridze, Alexander; Sacks, Claudio; Ogun, Y; Ogunrin, Olubunmi; Uthman, Basim M.; Lindsay, Patrice; Gorelick, Philip B.

doi:10.1016/j.jstrokecerebrovasdis.2014.08.002

Cited by 6 publications

(5 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Second, our results may be affected by non-responder bias. While our response rates are similar to those typically observed in similar international stroke surveys [ 20 , 21 ], selection bias cannot be ruled out. Nonetheless, our cross-sectional survey captured a representative sample of practicing neurosurgeons, stroke neurologists and thrombosis experts worldwide facing ICH in patients with non-valvular AF, and obtained diverse distribution of responses in countries, years in practice, and number of anticoagulant-associated ICH cases per year.…”

Section: Discussionsupporting

confidence: 81%

Oral anticoagulant re-initiation following intracerebral hemorrhage in non-valvular atrial fibrillation: Global survey of the practices of neurologists, neurosurgeons and thrombosis experts

Shoamanesh

Schulman

et al. 2018

PLoS ONE

View full text Add to dashboard Cite

BackgroundWhile oral anticoagulants (OACs) are highly effective for ischemic stroke prevention in atrial fibrillation, intracerebral hemorrhage (ICH) remains the most feared complication of OAC. Clinical controversy remains regarding OAC resumption and its timing for ICH survivors with atrial fibrillation because the balance between risks and benefits has not been investigated in randomized trials.Aims/HypothesisTo survey the practice of stroke neurologists, thrombosis experts and neurosurgeons on OAC re-initiation following OAC-associated ICH.MethodsAn online survey was distributed to members of the International Society for Thrombosis and Haemostasis, Canadian Stroke Consortium, NAVIGATE-ESUS trial investigators (Clinicatrials.gov identifier NCT02313909) and American Association of Neurological Surgeons. Demographic factors and 11 clinical scenarios were included.ResultsTwo hundred twenty-eight participants from 38 countries completed the survey. Majority of participants were affiliated with academic centers, and >20% managed more than 15 OAC-associated ICH patients/year. Proportion of respondents suggesting OAC anticoagulant resumption varied from 30% (for cerebral amyloid angiopathy) to 98% (for traumatic ICH). Within this group, there was wide distribution in response for timing of resumption: 21.4% preferred to re-start OACs after 1–3 weeks of incident ICH, while 25.3% opted to start after 1–3 months. Neurosurgery respondents preferred earlier OAC resumption compared to stroke neurologists or thrombosis experts in 5 scenarios (p<0.05 by Kendall’s tau).ConclusionsWide variations in current practice exist among management of OAC-associated ICH, with decisions influenced by patient- and provider-related factors. As these variations likely reflect the lack of high quality evidence, randomized trials are direly needed in this population.

show abstract

Section: Discussionsupporting

confidence: 81%

Oral anticoagulant re-initiation following intracerebral hemorrhage in non-valvular atrial fibrillation: Global survey of the practices of neurologists, neurosurgeons and thrombosis experts

Shoamanesh

Schulman

et al. 2018

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…17 In a recent Web-survey, no neurologists in Indonesia or Kazakhstan and only one-ninth of those in Bangladesh replied that most of their patients with stroke could undergo thrombolysis. 18 Thus, the spread of this standard therapy across the whole of Asia is an urgent problem.…”

Section: Current Status and Prospects Of Intravenousmentioning

confidence: 99%

Acute Reperfusion Therapy and Stroke Care in Asia After Successful Endovascular Trials

Toyoda

Koga

Hayakawa

et al. 2015

Stroke

View full text Add to dashboard Cite

Abstract-The current status of and prospects for acute stroke care in Asia in the situation where both intravenous thrombolysis and endovascular therapies have been recognized as established strategies for acute stroke are reviewed. Of 15 million people annually having stroke worldwide, ≈9 million are Asians. The burdens of both ischemic and hemorrhagic strokes are severe in Asia. The unique features of stroke in Asia include susceptibility to intracranial atherosclerosis, high prevalence of intracerebral hemorrhage, effects of dietary and lifestyle habits, and several disorders with genetic causes. These features affect acute stroke care, such as the dosage of alteplase for thrombolysis and consideration of bleeding complications during antithrombotic therapy. Acute endovascular thrombectomy, as well as intravenous thrombolysis, is relatively prevalent in East Asia, but most of the other Asian countries need to develop their human resources and fundamental medical infrastructure for stroke care. A limitation of endovascular therapy in East Asia is the high prevalence of intracranial atherosclerosis that can cause recanalization failure and require additional angioplasty or permanent stent insertion although intracranial stenting is not an established strategy. Multinational collaboration on stroke research among Asian countries is infrequent. Asians should collaborate to perform their own thrombolytic and endovascular trials and seek the optimal strategy for stroke care specific

show abstract

“…In a recent systematic review, it is evident that much effort was put in by these countries to improve stroke infrastructure in the past decade, in part contributing to the improved IVT service provision in the present study compared with a prior survey in 2012. 16,17 In the longer term, charitable access to EVT devices and IVT medications for low- and middle-income countries may be the solution.…”

Section: Discussionmentioning

confidence: 99%

Overview of endovascular thrombectomy accessibility gap for acute ischemic stroke in Asia: A multi-national survey

Tsang

Yang

Orrù

et al. 2019

International Journal of Stroke

View full text Add to dashboard Cite

Endovascular thrombectomy revolutionized the treatment of acute ischemic stroke. Nevertheless, access to endovascular thrombectomy is limited in many parts of the world. Asia holds 60% of the world’s population and its countries carry some of the highest stroke disease burden. To understand the availability of endovascular thrombectomy and intravenous thrombolysis in this region, we interviewed stroke neurologists and neuro-interventionists of 19 Asian countries, and found a large disparity in access to endovascular thrombectomy and intravenous thrombolysis between high- and low-income countries. Lack of neuro-interventionists, comprehensive stroke units, stroke triage systems and high treatment cost are the major obstacles to wider accessibility of endovascular thrombectomy, especially among developing countries. The potential solutions to provide equitable access to stroke revascularization therapy are discussed.

show abstract

A Prototype Worldwide Survey of Diagnostic and Treatment Modalities for Stroke

Cited by 6 publications

References 21 publications

Oral anticoagulant re-initiation following intracerebral hemorrhage in non-valvular atrial fibrillation: Global survey of the practices of neurologists, neurosurgeons and thrombosis experts

Oral anticoagulant re-initiation following intracerebral hemorrhage in non-valvular atrial fibrillation: Global survey of the practices of neurologists, neurosurgeons and thrombosis experts

Acute Reperfusion Therapy and Stroke Care in Asia After Successful Endovascular Trials

Overview of endovascular thrombectomy accessibility gap for acute ischemic stroke in Asia: A multi-national survey

Contact Info

Product

Resources

About