Prevention and follow-up in thromboembolic ischemic stroke: Do we need to think out of the box?

Abstract

Stroke is one of the most debilitating thrombotic diseases, and world-wide it is estimated that by, 2030, 23 million people will be affected. Except for the impact on the individual families, the world economy is also affected adversely. Although the medical treatment and knowledge of stroke are both increasing and well-researched, we still do not see a decrease in stroke prevalence. Currently various diagnostic tests are employed to determine the specific type of ischemic stroke as classified by the TOAST criteria. However, these tests are done after the stroke has occurred and therefore only contribute to the unquestionably crucial aspect of treating that particular stroke patient, but it does not improve prevention of future events. Prevention strategies regarding first-time stroke need urgent attention given the alarming present and future incidence of stroke. Therefore, here we discuss the importance of stroke prevention and suggest a more inclusive, perhaps "new" comprehensive approach for pre-stroke screening. Ultrastructural tests, particularly scanning electron microscopy, provide an innovative and novel advance in preventative and individualized patient-centered precision medicine. This precise technique when used in combination with well-established methods, as well as viscoelastic methods like thromboelastography (TEG), as a screening tool to prevent stroke can ultimately alleviate the financial and economical burden of stroke and also improve quality of life. Although we appreciate the fact that this suggestion might be difficult to accept by clinicians, a bold new approach is needed to address this pandemic we call stroke.

Clinical relevance of hypercoagulability and possible hypofibrinolysis associated with estrone and estriol

“…We have called attention to the innovative and novel advances that morphological and viscoelastic analysis (particularly SEM and TEG) offer for individualized patient‐centred precision medicine as proposed by the NIH (Swanepoel and Pretorius, ). We therefore once more suggest the use of SEM and TEG for monitoring the wellbeing of female haematological health during pregnancy and menopause.…”

Vitamin D3 and Ischemic Stroke: A Narrative Review

“…Stroke is considered to be an acute cerebrovascular disease and includes ischemic stroke (about 85–90% of strokes) and hemorrhagic stroke, while the latter is further subdivided into intracerebral hemorrhage and subarachnoid hemorrhage. The current treatment of acute ischemic strokes is based on reperfusion therapies including intravenous administration of thrombolytic agents and endovascular therapy [ 3 , 4 ]. Ischemic stroke is one of the major causes of death and long-term severe disabilities worldwide.…”

“…According to the World Health Organization, 15 million people suffer from strokes worldwide each year [ 3 ]. Moreover, there are estimates that there will be 23 million first-case strokes and 7–8 million stroke deaths in 2030 [ 4 ]. Even worse, clinical observations showed that the SARS-CoV-2 pandemic engulfing the entire world in recent years brought about an increase in stroke incidences among COVID-19 patients [ 5 , 6 , 7 ].…”