Ischemic stroke incidence

However, several important studies have shown that intravenous thrombolysis may be beneficial more than 3 hours after stroke onset, provided that only patients with a significant diffusion-perfusion mismatch are treated. In one such smdy, Ribo et al. found that patients with a significant diffusion-perfusion mismatch could be treated safely and effectively in the 3-6-hour time period. In phase II of the desmo-teplase in acute stroke (DIAS) trial, patients with diffusion-perfusion mismatch were treated with desmoteplase up to 9 hours after stroke onset, and showed better outcomes than patients given placebo, with only a minimal incidence of symptomatic hemorrhage. Similar success was achieved in the same time window by the dose escalation study of desmoteplase in acute ischemic stroke (DEDAS). ... 

In rodent stroke models, statin pretreatment has been shown to reduce infarct volumes and improve outcomes. Similarly, several clinical studies have shown that prior statin use reduced the severity of acute ischemic stroke and myocardial infarction. Recent studies indicate that beneftt can be achieved even when treatment is initiated after the onset of symptoms. In rodents, atorvastatin and simvastatin have been shown to reduce the growth of ischemic lesions, enhance functional outcome, and induce brain plasticity when administered after stroke onset. A retrospective analysis of the population-based Northern Manhattan Stroke Study (NOMASS) showed that patients using lipid-lowering agents at the time of ischemic stroke have a lower incidence of in-hospital stroke progression and reduced 90-day mortality rates. Retrospective analysis of data of the phase III citicoline trial showed... 

Lovett JK, Coull AJ, Rothwell PM. Early risk of recurrence by subtype of ischemic stroke in population-based incidence studies. Neurology 2004 62 569-573. 

One meta-analysis examined the safety and efficacy of LMWH and heparinoids in 11 randomized trials of 3048 patients with acute ischemic stroke. It reported a reduction in the incidence of deep venous thrombosis (DVT) (odds ratio (OR) 0.27,... 

The REACH system in southern Georgia (United States) and the TEMPiS system in Germany reported decreased latency to rt-PA delivery on a larger scale. REACH system investigators reported 194 acute stroke consultations dehvered via telemedicine. The time from symptom onset to rt-PA delivery decreased from 143 minutes in the first 10 patients treated to 111 minutes in last 20 patients of 30 patients treated with rt-PA, 23% were treated in 90 minutes or less and 60% were treated within 2 hours without any incidence of post-treatment symptomatic intracerebral hemorrhage. In 2004, the second year of the TEMPiS system, 115 patients in telemedicine-networked community hospitals and 110 patients in stroke centers received rt-PA for acute ischemic stroke or TIA. Patients treated at networked community... 

Streptokinase is not indicated for use in acute ischemic stroke treatment. Three large randomized controlled trials evaluating streptokinase were stopped early due to a high incidence of hemorrhage in the streptokinase-treated patients.14-16 At the present time, there is no indication for the use of streptokinase or thrombolytics other than alteplase in the acute treatment of ischemic stroke. 

Early detection of ischemic stroke can be done with the use of transcranial Doppler ultrasonography. In the Stroke Prevention Trial in Sickle Cell Anemia (STOP) study, screening with this method followed by transfusion significantly reduced the incidence of stroke.29 Screening is recommended in all patients over 2 years of age. 

One clinical trial showed that the combination of an ACE inhibitor and thiazide diuretic reduces the incidence of recurrent stroke in patients with a history of ischemic stroke or transient ischemic attacks. 

Pharmacologic techniques counteract the propensity for thrombosis formation by dampening the coagulation cascade. Appropriately selected therapy can dramatically reduce the incidence of VTE after hip or knee replacement, general surgery, myocardial infarction, and ischemic stroke. 

The sahcylates are useful in the treatment of minor musculoskeletal disorders such as bursitis, synovitis, tendinitis, myositis, and myalgia. They may also be used to relieve fever and headache. They can be used in the treatment of inflammatory disease, such as acute rheumatic fever, rheumatoid arthritis, osteoarthritis, and certain rheumatoid variants, such as ankylosing spondylitis, Reiter s syndrome, and psoriatic arthritis. However, other NS AIDS are usually favored for the treatment of these chronic conditions because of their lower incidence of GI side effects. Aspirin is used in the treatment and prophylaxis of myocardial infarction and ischemic stroke. 

Management of acute ischemic stroke in adults, and acute massive pulmonary embolism, for improving neurological recovery, and reducing the incidence of disability... 

More than 50% of patients with cerebral embolism have atrial fibrillation. In the majority of these patients, the underlying cardiac disease is nonvalvular. The risk of ischemic stroke and atrial fibrillation increases with age, reaching a cumulative risk of 35% during a patient s lifetime. Combined results from several randomized trials show that warfarin reduces the risk of stroke in patients with nonrheumatic atrial fibrillation by 68% (to 1.4% per year), with an excess incidence of major hemorrhage (including intracranial) of only 0.3% per year. 

Fig. 1.4. The proportions of first-ever-in-a-lifetime strokes caused by ischemic stroke (IS), primary intracerebral hemorrhage (RICH), subarachnoid hemorrhage (SAH) and of undetermined cause (UND) in "ideal" incidence studies. Numbers indicate the percentage estimates (Sudlow and Warlow 1997).

Annals of Epidemiology 3 524-528 Lemesle M, Milan G, Faivre J et al. (1999). Incidence trends of ischemic stroke and transient ischemic attacks in a well-defined French population from 1985 through 1994. Stroke 30 371-377... 

Tunstall-Pedoe H, Kuulasmaa K, Amouyel P et al. (1994). Myocardial infarction and coronary deaths in the World Health Organization MONICA Project. Registration procedures, event rates and case-fatality rates in 38 populations from 21 countries in four continents. Circulation 90 583-612 Wald NJ, Law MR (2003). A strategy to reduce cardiovascular disease by more than 80%. British Medical Journal 326 1419 White H, Boden-Albala B, Wang C et al. (2005). Ischemic stroke subtype incidence among whites, blacks and Hispanics the Northern Manhattan Study. Circulation 111 1327-1331 Wityk RJ, Pessin MS, Kaplan RF et al. (1994). Serial assessment of acute stroke using the NIH Stroke Scale. Stroke 25 362-365. 

Wolfe CDA (2000). The impact of stroke. British Medical Bulletin 56 275-286 Wohe CD, Corbin DO, Smeeton NC et al. (2006a). Estimation of the risk of stroke in black populations in Barbados and South London. Stroke 37 1986-1990 Wohe CD, Corbin DO, Smeeton NC et al. (2006b). Poststroke survival for black-Caribbean populations in Barbados and South London. Stroke 37 1991-1996 Woo D, Gehel J, Miller R et al. (1999). Incidence rates of first-ever ischemic stroke subtypes among blacks a population-based study. Stroke 30 2517-2522... 

Age is the strongest risk factor for ischemic stroke of all subtypes and for primary intracerebral hemorrhage, but it is less important for subarachnoid hemorrhage (Bamford et al. 1990 Rothwell et al. 2005). Overall stroke incidence at age 75-84 is approximately 25 times higher than at age 45-54 (see Fig. 1.2). 

Schulz UG, Flossman E, Rothwell PM (2004). Heritability of ischemic stroke in relation to age, vascular risk factors and subtypes of incident stroke in population-based studies. Stroke 35 819-824... 

Incidence and prevention of ischemic stroke following myocardial infarction review of current literature. Cerebrovascular Diseases 22 331-339... 

White H, Boden-Albala B, Wang C et al. (2005). Ischemic stroke suhtype incidence among whites, blacks and Hispanics the Northern Manhattan Study. Circulation 111 1327-1331... 

The risks of stroke, other acute vascular events and death after stroke have been studied in six population-based cohorts over a follow-up period of five or more years (Scmidt et aL 1988 Burn et al. 1994 Hankey et al. 2000 Petty et al. 2000 Brpnnum-Hansen et al. 2001 Hartmann et al. 2001). Two of these studies included ischemic stroke only (Petty et al. 2000 Hartmann et al. 2001) and the remaining four included both ischemic and hemorrhagic stroke. One study included incident and recurrent events (Br0nnum-Hansen et al. 2001) and the remaining five included incident stroke only. The risks of death at five years varied between 41% and 72%, while the proportion of deaths caused by acute coronary disease and stroke (either inception event or recurrent stroke) were similar. As in the TIA outcome... 

Wilson PV, Ammar AD (2005). The incidence of ischemic stroke versus intracerebral hemorrhage after carotid endarterectomy a review of 2452 cases. Annals of Vascular Surgery 19 1-4... 

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