Risk of Subsequent Stroke Among Patients Receiving Outpatient vs Inpatient Care for Transient Ischemic Attack

Shahjouei, Shima; Jiang, Li; Koza, Eric; Abedi, Vida; Sadr, Alireza Vafaei; Chen, Qiushi; Mowla, Ashkan; Griffin, Paul C.; Ranta, Annemarei; Zand, Ramin

doi:10.1001/jamanetworkopen.2021.36644

Cited by 13 publications

(9 citation statements)

References 125 publications

(821 reference statements)

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“…However, further studies to ascertain the impact of various ASA doses on ASA responsiveness are needed. Furthermore, this study is different from Cox et al (or indeed Frelinger or Mree et al) [ 41 , 43 , 46 ] as it was conducted in patients with acute stroke or TIA rather than healthy volunteers or patients with stable CAD, as there is a considerable risk of stroke recurrence among admitted patients in initial period [ 47 ].…”

Section: Discussionmentioning

confidence: 91%

The impact of enteric coating of aspirin on aspirin responsiveness in patients with suspected or newly diagnosed ischemic stroke: prospective cohort study: results from the (ECASIS) study

Elshafei

Imam

Alsaud

et al. 2022

Eur J Clin Pharmacol

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Background and purpose Uncertainty remains regarding the impact of enteric-coated aspirin (EC-ASA) on secondary prevention of ischemic stroke compared to plain aspirin (P-ASA). Hence, this study was designed to investigate the effect of EC formulation on ASA response via evaluating thromboxane B2 (TXB2) levels in patients with suspected or newly diagnosed stroke. Methods A prospective cohort study on suspected or newly diagnosed ischemic stroke patients who are aspirin-naive was conducted. Patients were received either EC aspirin or plain aspirin for at least 3 days. The primary outcome was the proportion of aspirin non-responsiveness between two groups (level of residual serum TXB2 associated with elevated thrombotic risk (< 99.0% inhibition or TXB2 > 3.1 ng/ml) within 72 h after three daily aspirin doses, while secondary outcomes were the incidence of early gastrointestinal tract (GIT) bleeding with the various aspirin preparations. (Trial registration: Clinicaltrials.gov NCT04330872 registered on 02 April 2020). Results Of 42 patients, ischemic strokes were confirmed in both P-ASA (81%) and EC-ASA (67%) arms. ASA non-responsiveness showed no significant difference between the two formulations (P-ASA vs. EC-ASA; 28.6% vs 23.8%; P = 0.726). Univariate and multivariate logistic regression analysis showed that patients treated with EC-ASA were more likely to have a lower rate of non-responders compared to P-ASA (unadjusted OR 0.78; 95% CI 0.20, 3.11); with the risk highest in type 2 diabetic patients with HBA1c > 6.5% (adjusted OR 6; 95% CI 1.02, 35.27; P = 0.047). No incidence of GIT bleeding observed throughout the study. Conclusion A significant proportion of ASA non-responsiveness was recorded regardless of ASA formulation administered. The increased risk of ASA non-responsiveness in diabetic patients needs further exploration by larger prospective studies.

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Section: Discussionmentioning

confidence: 91%

The impact of enteric coating of aspirin on aspirin responsiveness in patients with suspected or newly diagnosed ischemic stroke: prospective cohort study: results from the (ECASIS) study

Elshafei

Imam

Alsaud

et al. 2022

Eur J Clin Pharmacol

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“…The origins of heterogeneity were further examined by subgroup analyses. Publication biases were determined by using Begg’s and Egger’s tests ( 30 , 31 ). p > 0.05 indicated no publication bias, while p < 0.05 was judged to be a statistical publication bias.…”

Section: Methodsmentioning

confidence: 99%

The positive relationship between androgen receptor splice variant-7 expression and the risk of castration-resistant prostate cancer: A cumulative analysis

Zhao

Liao²,

Zhang³

et al. 2023

Front. Oncol.

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BackgroundAt present, androgen deprivation therapy (ADT) is still the standard regimen for patients with metastatic and locally advanced prostate cancer (PCa). The level of androgen receptor splice variant-7 (AR-V7) in men with castration-resistant prostate cancer (CRPC) has been reported to be elevated compared with that in patients diagnosed with hormone-sensitive prostate cancer (HSPC).AimHerein, we performed a systematic review and cumulative analysis to evaluate whether the expression of AR-V7 was significantly higher in patients with CRPC than in HSPC patients.MethodsThe commonly used databases were searched to identify the potential studies reporting the level of AR-V7 in CRPC and HSPC patients. The association between CRPC and the positive expression of AR-V7 was pooled by using the relative risk (RR) with the corresponding 95% confidence intervals (CIs) under a random-effects model. For detecting the potential bias and the heterogeneity of the included studies, sensitivity analysis and subgroup analysis were performed. Publication bias was assessed Egger’s and Begg’s tests. This study was registered on PROSPERO (ID: CRD42022297014).ResultsThis cumulative analysis included 672 participants from seven clinical trials. The study group contained 354 CRPC patients, while the other group contained 318 HSPC patients. Pooled results from the seven eligible studies showed that the expression of positive AR-V7 was significantly higher in men with CRPC compared to those with HSPC (RR = 7.55, 95% CI: 4.61–12.35, p < 0.001). In the sensitivity analysis, the combined RRs did not change substantially, ranging from 6.85 (95% CI: 4.16–11.27, p < 0.001) to 9.84 (95% CI: 5.13–18.87, p < 0.001). In the subgroup analysis, a stronger association was detected in RNA in situ hybridization (RISH) measurement in American patients, and those studies were published before 2011 (all p < 0.001). There was no significant publication bias identified in our study.ConclusionEvidence from the seven eligible studies demonstrated that patients with CRPC had a significantly elevated positive expression of AR-V7. More investigations are still warranted to clarify the association between CRPC and AR-V7 testing.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42022297014.

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“…As mentioned above, studies attempted to deploy strategies to maximize the efficiency of referral systems and minimize waiting periods and loss of follow-up. However, our prior meta-analysis [ 9 ] demonstrated a no-show rate of 36% among referred patients with suspected TIA or minor stroke but a minimal risk of complications while waiting for an outpatient visit. Choice of appropriate brain imaging and cardiac workups, administration of first-line medications, such as aspirin, deciding whether and when a neurologist should be involved in diagnosis, and the potential roles of nurse practitioners are other challenges in defining the optimal referral system for outpatient management of patients with TIA [ 31 , 38 , 39 ].…”

Section: Challenges Of Outpatient Tia Management and Possible Solutionsmentioning

confidence: 99%

Transient Ischemic Attack Outpatient Clinic: Past Journey and Future Adventure

Shahjouei

Seyedmirzaei

Abedi

et al. 2023

JCM

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A transient ischemic attack (TIA), a constellation of temporary neurological symptoms, precedes stroke in one-fifth of patients. Thus far, many clinical models have been introduced to optimize the quality, time to treatment, and cost of acute TIA care, either in an inpatient or outpatient setting. In this article, we aim to review the characteristics and outcomes of outpatient TIA clinics across the globe. In addition, we discussed the main challenges for outpatient management of TIA, including triage and diagnosis, and the system dynamics of the clinics. We further reviewed the potential developments in TIA care, such as telemedicine, predictive analytics, personalized medicine, and advanced imaging.

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Risk of Subsequent Stroke Among Patients Receiving Outpatient vs Inpatient Care for Transient Ischemic Attack

Cited by 13 publications

References 125 publications

The impact of enteric coating of aspirin on aspirin responsiveness in patients with suspected or newly diagnosed ischemic stroke: prospective cohort study: results from the (ECASIS) study

The impact of enteric coating of aspirin on aspirin responsiveness in patients with suspected or newly diagnosed ischemic stroke: prospective cohort study: results from the (ECASIS) study

The positive relationship between androgen receptor splice variant-7 expression and the risk of castration-resistant prostate cancer: A cumulative analysis

Transient Ischemic Attack Outpatient Clinic: Past Journey and Future Adventure

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