Pre Admission Antithrombotics are Associated with Improved Outcomes following Ischaemic Stroke: A Cohort from the Registry of the Canadian Stroke Network

Dowlatshahi, Dar; Hakim, Antoine M.; Fang, Jiming; Sharma, Mukul

doi:10.1111/j.1747-4949.2009.00331.x

Cited by 40 publications

(53 citation statements)

References 40 publications

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“…However, analyses of stroke registries and clinical trial data do not show reduced disability or mortality in alteplase-treated prestroke antiplatelet drug users compared with nonusers. 6,54,[447][448][449][450] A secondary analysis of the Combined Lysis of Thrombus in Brain Ischemia Using Transcranial Ultrasound and Systemic TPA (CLOTBUST) trial of patients with MCA occlusions found that recanalization rates were not different in prestroke aspirin users compared with nonusers. 181 Avoidance of antiplatelet drug use for 24 hours after alteplase was specified in the protocols of the 2 NINDS trials, the ECASS III trial, and the IST-3 trial.…”

Section: Concurrent Antiplatelet Medicationmentioning

confidence: 99%

Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke

Demaerschalk¹,

Kleindorfer²,

Adeoye³

et al. 2016

Stroke

585

237

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Purpose-To critically review and evaluate the science behind individual eligibility criteria (indication/inclusion and contraindications/exclusion criteria) for intravenous recombinant tissue-type plasminogen activator (alteplase) treatment in acute ischemic stroke. This will allow us to better inform stroke providers of quantitative and qualitative risks associated with alteplase administration under selected commonly and uncommonly encountered clinical circumstances and to identify future research priorities concerning these eligibility criteria, which could potentially expand the safe and judicious use of alteplase and improve outcomes after stroke. Methods-Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association Stroke Council's Scientific Statement Oversight Committee and the American Heart Association's Manuscript Oversight Committee. The writers used systematic literature reviews, references to published clinical and epidemiology studies, morbidity and mortality reports, clinical and public health guidelines, authoritative statements, personal files, and expert opinion to summarize existing evidence and to indicate gaps in current knowledge and, when appropriate, formulated recommendations using standard American Heart Association criteria. All members of the writing group had the opportunity to comment on and approved the final version of this document. The document underwent extensive American Heart Association internal peer review, Stroke The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that might be perceived as real or potential conflicts of interest.This statement was approved by the American Heart Association Science Advisory and Coordinating Committee on September 24, 2015, and the American Heart Association Executive Committee on October 5, 2015. A copy of the document is available at http://my.americanheart.org/statements by selecting either the "By Topic" link or the "By Publication Date" link. To purchase additional reprints, call 843-216-2533 or e-mail kelle.ramsay@ wolterskluwer.com.The online-only Data Supplement, which contains literature search strategies and Figures A, B, and C, is available with this article at http://circ. ahajournals.org/lookup/suppl/doi:10.1161/STR.0000000000000086/-/DC1.The American Heart Association requests that this document be cited as follows: Demaerschalk BM, Kleindorfer DO, Adeoye OM, Demchuk AM, Fugate JE, Grotta JC, Khalessi AA, Levy EI, Palesch YY, Prabhakaran S, Saposnik G, Saver JL, Smith EE; on behalf of the American Heart Association Stroke Council and Council on Epidemiology and Prevention. Scientific rational...

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Section: Concurrent Antiplatelet Medicationmentioning

confidence: 99%

Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke

Demaerschalk¹,

Kleindorfer²,

Adeoye³

et al. 2016

Stroke

585

237

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“…When analyzed as the outcome in logistic regression analysis, CNS was dichotomized into mild (CNS Ͼ7) or severe (CNS Յ7) based on prior studies. 17,18 Outcome at discharge was dichotomized as good (mRS 0 -3) or poor (mRS 4 -6) based on previously published studies. 17,18,21 We performed univariate analyses to explore potential associations between all covariates and primary outcomes using 2 test for categorical variables and 1-way analysis of variance for continuous variables.…”

Section: Methodsmentioning

confidence: 99%

“…17,18 Outcome at discharge was dichotomized as good (mRS 0 -3) or poor (mRS 4 -6) based on previously published studies. 17,18,21 We performed univariate analyses to explore potential associations between all covariates and primary outcomes using 2 test for categorical variables and 1-way analysis of variance for continuous variables. We then built separate multivariable logistic regression models for each primary outcome and included candidate variables from univariate testing with PՅ0.…”

Section: Methodsmentioning

confidence: 99%

Association of Statins and Statin Discontinuation With Poor Outcome and Survival After Intracerebral Hemorrhage

Dowlatshahi

Demchuk

Fang

et al. 2012

Stroke

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“…It recommended against starting antiplatelet (mono-or dual-therapy) or glycoprotein IIb/IIIa inhibitors in addition to IV-tPA in isolated AIS cases. Several studies have suggested increased risk of intracranial hemorrhage with the use of antiplatelet, especially dual antiplatelet therapy with IV-tPA, but have not shown to adversely influence clinical outcome (45)(46)(47)(48). The increased risk of intracranial hemorrhage with these antiplatelet is likely balanced by the beneficial effect of increased reperfusion or decreased risk of vessel re-occlusion, and these antiplatelets may not by themselves increase the risk of intracranial hemorrhage but makes one worse if it occurs (47).…”

Section: Management Of Simultaneous CCImentioning

confidence: 99%

Simultaneous acute cardio-cerebral infarction: is there a consensus for management?

et al. 2018

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Acute ischemic stroke (AIS) and acute myocardial infarction (AMI) are both life-threatening medical conditions with narrow therapeutic time-window that carry grave prognosis if not addressed promptly. The acute management of both condition is well documented in the literature, however the management of a simultaneous presentation of both AIS and AMI is unclear. A delayed intervention of one infarcted territory for the other may result in permanent irreversible morbidity or disability, and even death. In addition, the use of antiplatelet and anticoagulants that are inherently part of an AMI management may increase the risk for hemorrhagic conversion associated with intravenous thrombolysis used in AIS, and the use of a thrombolytic in AIS increases the risk of cardiac wall rupture in the setting of an AMI.Despite this ambiguity, there is no clear evidence-based guideline or clinical studies that have addressed the optimal management of this rare co-occurrence. This review paper examines the existing literature on the management of simultaneous acute cardio-cerebral infarction (CCI) and highlights the existing challenge to management.

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Pre Admission Antithrombotics are Associated with Improved Outcomes following Ischaemic Stroke: A Cohort from the Registry of the Canadian Stroke Network

Cited by 40 publications

References 40 publications

Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke

Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke

Association of Statins and Statin Discontinuation With Poor Outcome and Survival After Intracerebral Hemorrhage

Simultaneous acute cardio-cerebral infarction: is there a consensus for management?

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