Incidence of Cardioembolic Stroke Including Paradoxical Brain Embolism in Patients with Acute Ischemic Stroke before and after the Great East Japan Earthquake

Abstract

Background: The incidence of heart disease or deep vein thrombosis (DVT) reportedly increased after the Great East Japan Earthquake. We hypothesized that the incidence of cardioembolic stroke (CES) including paradoxical brain embolism (PBE) among patients with acute stroke would increase after the earthquake due to cessation of antithrombotic therapy or the increase in heart disease and DVT associated with the evacuation. The aim of this study is to evaluate the changes in the prevalence of DVT and the incidence of CES including PBE in acute ischemic stroke before and after the earthquake. Methods: We retrospectively studied 1,044 consecutive ischemic stroke patients (73.1 ± 12.5 years old, male 61.5%) who were admitted to a comprehensive stroke center (from January 2010 through March 2012) located in the earthquake disaster area within 7 days after stroke onset. The prevalence of DVT and the incidence of CES including PBE were compared before and after the earthquake of 11 March 2011. Results: The median of the initial National Institutes of Health Stroke Scale (NIHSS) scores was 4 (interquartile range: 1-8). Two hundred and eighty-two patients (27.0% of those surveyed) were diagnosed with CES. After adjustment for sex, age, NIHSS score, and patient's residential address, the proportion of CES patients was significantly increased after the earthquake (odds ratio, OR 1.61, 95% confidence interval, 95% CI: 1.20-2.17). Eighty-nine patients (8.5% of those surveyed) had DVT. Compared with 2010 findings, the prevalence of DVT was significantly increased in the fourth quarter of 2011 and the first quarter of 2012 (OR 1.85, 95% CI: 1.05-3.24). Nineteen (1.8% of those surveyed) were diagnosed with PBE. The proportion of PBE patients was also significantly increased in the second half of 2011 (OR 3.69, 95% CI: 1.28-12.1). Conclusions: The incidence of CES was significantly increased after the earthquake, compared with the period before the earthquake. We encountered more PBE in the period from 3 to 9 months after the earthquake and found more DVT in the acute ischemic stroke patients in the period from 6 through 12 months after the earthquake. In these types of disasters, we have to ensure the distribution of drugs, including antithrombotics, and support the prevention of DVT in the refugees.

Increased prevalence of atrial fibrillation after the Great East Japan Earthquake: Results from the Fukushima Health Management Survey

“…In the three months following the Hanshin-Awaji Earthquake in 1995, the incidences of coronary heart disease and stroke events increased by 50% and 90%, respectively [4]. A recent observational study reported that a significant increase in the incidence of cardioembolic stroke occurred after the Great East Japan Earthquake, compared with the period before the earthquake [19]. Interestingly, the study found more cases of paradoxical brain embolism and deep vein thrombosis associated with evacuation in the period three to twelve months after the earthquake.…”

Increase in avoidable hospital admissions after the Great East Japan Earthquake

“…Other studies have shown the short-term influence of the Great East Japan Earthquake and tsunami disaster on increases in emergency department visits and hospital admissions due to cardiovascular disease,9 10 cerebrovascular disease,9 11 respiratory disease,9 12–14 infectious disease,15 gastrointestinal bleeding16 and others 9 17. However, it remains unknown whether the earthquake and tsunami disaster affected long-term health conditions of people in the affected areas.…”

Effects of socioeconomic factors on cardiovascular-related symptoms among residents in Fukushima after the Great East Japan Earthquake: a cross-sectional study using data from the Fukushima Health Management Survey

“…Further, an increase in the number of individuals with acute myocardial infarction, especially women, was particularly evident during the 4 weeks immediately following the disaster. 9 After the Great East Japan Earthquake, the incidence of reported cardioembolic stroke increased in the 3-9 months following the disaster, 10 as did the incidence of other cardiovascular diseases. [11][12][13][14] Our study contributes to the reported incidence of cardiovascular disease using self-report questionnaires rather than death certificates and by demonstrating that exacerbated cardiovascular symptoms occurred among evacuees after the disaster.…”

“…[2][3][4][5][6][7][8][9][10][11][12][13][14] A recent study reported a heterogeneous occurrence of cardiovascular events after the Great East Japan Earthquake, 2 while another study reported a significant increase in the incidence of cardioembolic stroke after the earthquake. 10 However, neither study examined the incidence of perceived cardiovascular disease symptoms after a disaster, nor did they focus on the effect of refugee socioeconomic status on health problems during the evacuation period. Yet these aspects should be considered because they are relevant for reviewing refugee health status, assessing the incidence of various diseases and providing health guidelines for refugees.…”