Acute stroke, hematocrit, and blood pressure.

LaRue, Linda; Alter, Milton; Lai, Sue Min; Friday, Gary; Sobel, Eugene; Levitt, Larry; McCoy, Robert L.; Isack, T.

doi:10.1161/01.str.18.3.565

Cited by 19 publications

(12 citation statements)

References 11 publications

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“…In the anemic group, five patients died from the first ischemic stroke and one from recurrent stroke. Other causes of death were cardiovascular diseases (3), acute respiratory failure (4), septic shock (5), gastrointestinal bleeding (1) and malignant tumor (2). In the control group, 11 patients died from the first ischemic stroke, one from recurrent ischemic stroke and three from intracerebral hemorrhage.…”

Section: Resultsmentioning

confidence: 99%

“…1 Most previous studies focused on the impact of a high hematocrit value because of its contribution to cerebrovascular blood viscosity and its potential role in cerebral atherogenesis. 2,3 The few studies investigating a low hematocrit value as a risk factor for ischemic stroke have produced conflicting findings. [4][5][6] Anemia as an independent risk factor has mainly been described in children.…”

Section: Introductionmentioning

confidence: 99%

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The influence of anemia on clinical presentation and outcome of patients with first-ever atherosclerosis-related ischemic stroke

Huang

Chen

Lee

et al. 2009

Journal of Clinical Neuroscience

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The influence of anemia on clinical presentation and outcome of patients with first-ever atherosclerosis-related ischemic stroke

Huang

Chen

Lee

et al. 2009

Journal of Clinical Neuroscience

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“…A recent hospital-based study found that 7.5% of stroke admissions were lacunar. 8 Large lesions may produce coma, which precludes evaluation by standardized scales usually included in a stroke clinical trial. Moreover, prognosis for survival in comatose patients is poor.…”

Section: Discussionmentioning

confidence: 99%

Acute stroke therapy trials: problems in patient accrual.

LaRue

Alter

Traven

et al. 1988

Stroke

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Hospital participated in a multicenter acute stroke trial but enrolled only one patient out of 192 screened over 2 years; other centers had similar difficulty in patient recruitment. We analyzed our screening data to determine which enrollment criteria created difficulties in recruitment and whether the problem was attributable to any single criterion or to combinations of criteria. Six individual criteria were frequent causes for exclusion; however, >80% of the patients were excluded for multiple reasons. Consequently, modifying or eliminating any single criterion did not appreciably increase patient accrual. Only 17 of 210 possible pairs of criteria occurred with statistically significant frequency (/><0.05), and these were most likely random associations. Therefore, only by minimizing the number and stringency of enrollment criteria will patient accrual be at a level that allows the study to be completed in a timely manner with a fiscally reasonable number of centers. T he efficacy of new therapies for acute stroke can be assessed formally only by controlled clinical trials. However, one difficulty in conducting such trials has been patient accrual. For example, the recent Scandinavian multicenter hemodilution trial enrolled only 32% of 604 patients screened.1 Other stroke studies have experienced even greater difficulties. After 980 patients were screened for a study of naftidrofuryl in acute cerebral infarction, only 100 (10.2%) met the enrollment criteria and were actually included in the study. 2Another recent 4-year trial of intravenous heparin for acute partial stable thrombotic stroke enrolled only 7.4% of the screened patients. 3Patient accrual was difficult in these studies in part because restrictive enrollment criteria have been devised to provide as homogeneous a population of stroke patients as possible. This is a reasonable approach since a given therapy may be targeted toward modifying only a specific aspect of stroke pathophysiology. While such homogeneity simplifies interpretation of results and increases the chance of detecting any beneficial effect of the new From the

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“…Inconsistent findings have been reported previously. In an analysis of 2077 people who had experienced a stroke, 23 high mean Hct predicted lacunar stroke in people with an SBP Ͼ150 mm Hg. However, in the Framingham Heart Study participants, women in the age group of 65 to 94 years showed an approximately U-shaped relationship between Hct quartiles and stroke mortality.…”

Section: Discussionmentioning

confidence: 99%

Hematocrit Predicts Long-Term Mortality in a Nonlinear and Sex-Specific Manner in Hypertensive Adults

et al. 2012

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Hematocrit has been inconsistently reported to be a risk marker of cardiovascular morbidity and mortality. The Glasgow Blood Pressure Clinic Study cohort included 10951 hypertensive patients, who had hematocrit measured at their initial clinic visit and followed for ≤35 years. Cox proportional hazards models were used to estimate hazard ratios for all-cause, cardiovascular, ischemic heart disease, stroke, and noncardiovascular mortality. There were 3484 deaths over a follow-up period of 173245 person-years. Hematocrit was higher in men (median, 0.44; interquartile range, 0.42–0.47) than in women (median, 0.41; interquartile range, 0.38–0.43). The lowest risk for all-cause mortality was seen in quartile 2 for men (range, 0.421–0.440) and women (range, 0.381–0.400). Compared with quartile 2, the adjusted hazard ratios for quartiles 1, 3, and 4 were, respectively, 1.11 (range, 0.97–1.28), 1.19 (range, 1.04–1.37), and 1.22 (range, 1.06–1.39) in men and 1.17 (range, 1.01–1.36), 0.97 (range, 0.83–1.13), and 1.19 (range, 1.04–1.37) in women. Men showed a J-shaped pattern for cardiovascular mortality and a linear pattern for noncardiovascular mortality in cause-specific analysis, whereas in women a U-shaped pattern was observed for noncardiovascular mortality only. Higher baseline hematocrit was associated with higher on-treatment blood pressure during follow-up. Baseline hematocrit did not affect the time to reach target blood pressure. The increased risk of death attributed to higher hematocrit was seen in men and women irrespective of their achievement of target blood pressure, indicating that the risk is independent of the effect of hematocrit on blood pressure. Hypertensive patients with hematocrit levels outside of the sex-specific reference ranges identified in this study should be targeted for more aggressive blood pressure and cardiovascular risk reduction treatment.

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Acute stroke, hematocrit, and blood pressure.

Cited by 19 publications

References 11 publications

The influence of anemia on clinical presentation and outcome of patients with first-ever atherosclerosis-related ischemic stroke

The influence of anemia on clinical presentation and outcome of patients with first-ever atherosclerosis-related ischemic stroke

Acute stroke therapy trials: problems in patient accrual.

Hematocrit Predicts Long-Term Mortality in a Nonlinear and Sex-Specific Manner in Hypertensive Adults

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