Aspirin for secondary prevention after stroke of unknown etiology in resource-limited settings

Berkowitz, Aaron L.; Westover, M. Brandon; Bianchi, Matt T.; Chou, Sherry

doi:10.1212/wnl.0000000000000779

Cited by 9 publications

(7 citation statements)

References 30 publications

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“…Long‐term oral consumption of HCQ is clinically administered to control inflammation in autoimmune disease such as rheumatoid arthritis . Low‐dose ASA, commonly used to decrease risk of heart disease and it decreases inflammation through decreasing the production of prostaglandins and thromboxane A2 , however, its action on T cell IA is unknown.…”

Section: Discussionmentioning

confidence: 99%

Using safe, affordable and accessible non‐steroidal anti‐inflammatory drugs to reduce the number of HIV target cells in the blood and at the female genital tract

et al. 2018

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IntroductionAt its basic level, HIV infection requires a replication‐competent virus and a susceptible target cell. Elevated levels of vaginal inflammation has been associated with the increased risk of HIV infection as it brings highly activated HIV target cells (CCR5+CD4+ T cells; CCR5+CD4+CD161+ Th17 T cells) to the female genital tract (FGT) where they interact with HIV. Decreased HIV risk has been associated with a phenotype of decreased immune activation, called immune quiescence, described among Kenyan female sex workers who were intensely exposed to HIV yet remain uninfected. Current prevention approaches focus on limiting viral access. We took the novel HIV prevention approach of trying to limit the number of HIV target cells in the genital tract by reducing inflammation using safe, affordable and globally accessible anti‐inflammatory drugs.MethodsWe hypothesized that the daily administration of low doses of acetylsalicylic acid (ASA 81 mg) or hydroxychloroquine (HCQ 200 mg) would reduce inflammation thereby decreasing HIV target cells at the FGT. Low‐risk HIV seronegative women from Nairobi, Kenya were randomized for six weeks therapy of ASA (n = 37) or HCQ (n = 39) and tested to determine the impact on their systemic and mucosal immune environment.ResultsThe results showed that HCQ use was associated with a significant reduction in the proportion of systemic T cells that were CCR5+CD4+ (p = 0.01) and Th17 (p = 0.01). In the ASA arm, there was a 35% and 28% decrease in the proportion of genital T cells that were CD4+CCR5+ (p = 0.017) and Th17 (p = 0.04) respectively. Proteomic analyses of the cervical lavage showed ASA use was associated with significantly reduced amount of proteins involved in the inflammatory response and cell recruitment at the mucosa, although none of the individual proteins passed multiple comparison correction. These changes were more apparent in women with Lactobacillus dominant microbiomes.ConclusionTogether, these data indicate that taking low‐dose ASA daily was associated with significant reduction in HIV target cells at the FGT. This study provides proof‐of‐concept for a novel HIV‐prevention approach that reducing inflammation using safe, affordable and globally accessible non‐steroidal anti‐inflammatory agents is associated with significant reduction in the proportion of HIV‐target cells at the FGT.

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Section: Discussionmentioning

confidence: 99%

Using safe, affordable and accessible non‐steroidal anti‐inflammatory drugs to reduce the number of HIV target cells in the blood and at the female genital tract

et al. 2018

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“…The presence of headache, vomiting, severe hypertension, neck stiffness, and coma are suggestive of hemorrhagic stroke. When these symptoms and findings are absent, it should be beneficial to initiate acetylsalicylic acid for secondary prevention after stroke with unknown etiology [ 34 ]. However, antithrombotic treatments such as thrombolysis and anticoagulation cannot be administrated without brain imaging.…”

Section: Discussionmentioning

confidence: 99%

Stroke in a resource-constrained hospital in Madagascar

et al. 2017

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BackgroundStroke is reported as the most frequent cause of in-hospital death in Madagascar. However, no descriptive data on hospitalized stroke patients in the country have been published. In the present study, we sought to investigate the feasibility of collecting data on stroke patients in a resource-constrained hospital in Madagascar. We also aimed to characterize patients hospitalized with stroke.MethodsWe registered socio-demographics, clinical characteristics, and early outcomes of patients admitted for stroke between 23 September 2014 and 3 December 2014. We used several validated scales for the evaluation. Stroke severity was measured by the National Institutes of Health Stroke Scale (NIHSS), disability by the modified Rankin Scale (mRS), and function by the Barthel Index (BI).ResultsWe studied 30 patients. Sixteen were males. The median age was 62.5 years (IQR 58–67). The NIHSS and mRS were completed for all of the patients, and BI was used for the survivors. Three patients received a computed tomography (CT) brain scan. The access to laboratory investigations was limited. Electrocardiographs (ECGs) were not performed. The median NIHSS score was 16.5 (IQR 10–35). The in-hospital stroke mortality was 30%. At discharge, the median mRS score was 5 (IQR 4–6), and the median BI score was 45 (IQR 0–72.5).ConclusionsAlthough the access to brain imaging and supporting investigations was deficient, this small-scale study suggests that it is feasible to collect essential data on stroke patients in a resource-constrained hospital in Madagascar. Such data should be useful for improving stroke services and planning further research. The hospitalized stroke patients had severe symptoms. The in-hospital stroke mortality was high. At discharge, the disability category was high, and functional status low.

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“…PVSs are defined as fluid-filled spaces that follow the typical course of a vessel as it travels through gray or white matter[33]. PVSs also act as pre-lymphatic drainage system for the removal of substances.…”

Section: Discussionmentioning

confidence: 99%

High-degree centrum semiovale-perivascular spaces are associated with development of subdural fluid in mild traumatic brain injury

Koo

Kang

et al. 2019

PLoS ONE

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Background Severe centrum semiovale perivascular spaces (CSO-PVSs) are associated with the onset of brain atrophy and dementia. This study explored the relationship between severity of CSO-PVS and development of subdural fluid (SDF) in patients with mild traumatic brain injury (TBI), with the aim of investigating independent radiological risk factors for development of SDF. Methods The study cohort comprised 222 patients with a mean age of 51 years (64.0% men) who presented with mild TBI from January 2013 to November 2016. In this study, mild TBI was defined as a Glasgow Coma Scale (GCS) of ≥ 13, Post-Traumatic Amnesia (PTA) of <1 day, and Loss of Consciousness (LOC) of <30 minutes. The severity of CSO-PVS was categorized as low or high-degree. Results Among the 222 enrolled patients, 38 (17.1%) and 90 (40.5%) had high-degree PVS in the basal ganglia (BG) and centrum semiovale, respectively. Compared with patients who did not develop SDF, the mean age of patients who developed SDF was significantly higher (47.41 years versus 60.33 years, P < 0.0001). The incidence of de novo SDF was significantly higher in men than in women (77.8% versus 59.5%, P = 0.0151). Patients who showed SDF on brain computed tomography at admission more frequently developed de novo SDF (68.5% versus 38.1%, P < 0.0001). In multivariate logistic regression analysis of risk factors, high-degree CSO-PVS, male sex, initial SDF on admission, and old age were independently associated with development of de novo SDF after mild TBI. In Cox proportional hazards models of risk factors for SDF-development free survival rate, high-degree CSO-PVS, old age, and initial subdural hemorrhage showed statistically significant differences. Conclusions Our study might help neurosurgeons determine the frequency of brain CT or the duration of follow-up for patients who present with mild TBI with high-degree CSO-PVS.

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Aspirin for secondary prevention after stroke of unknown etiology in resource-limited settings

Cited by 9 publications

References 30 publications

Using safe, affordable and accessible non‐steroidal anti‐inflammatory drugs to reduce the number of HIV target cells in the blood and at the female genital tract

Using safe, affordable and accessible non‐steroidal anti‐inflammatory drugs to reduce the number of HIV target cells in the blood and at the female genital tract

Stroke in a resource-constrained hospital in Madagascar

High-degree centrum semiovale-perivascular spaces are associated with development of subdural fluid in mild traumatic brain injury

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