342 results on '"Polymeris, Alexandros A'
Search Results
2. Relationship between electronically monitored adherence to direct oral anticoagulants and ischemic or hemorrhagic events after an initial ischemic stroke-A case control study.
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Katharina Rekk, Isabelle Arnet, Fine Dietrich, Alexandros A Polymeris, Philippe A Lyrer, Stefan T Engelter, Sabine Schaedelin, and Samuel S Allemann
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Medicine ,Science - Abstract
BackgroundPatients with atrial fibrillation (AF) have a high risk for recurrent clinical events after an ischemic stroke. Direct oral anticoagulants (DOAC) are prescribed for secondary prevention. Adherence to DOAC is crucial mainly because of their short elimination half-life. Non-adherence to DOAC can negatively impact patients' outcomes. The relationship between (non-)adherence and recurrent clinical events is unknown in AF patients after initial stroke. We investigated adherence to DOAC in stroke survivors with AF who were included in the MAAESTRO study at the University Hospital Basel, Switzerland, between 2008 and 2022.MethodsThis study is a secondary analysis of data from MAAESTRO with a matched nested case-control design and 1:2 ratio. DOAC intake was measured with a small electronic device (Time4MedTM). We defined two arbitrary intervals of 17 days and 95 days as the longest time spans with electronic monitoring data per patient to maximize the number of participants with adequate amount of observation time available for analysis. Taking and timing adherence were calculated retrospectively i.e., prior to the recurrent event for cases. Trendline analysis of adherence over 95 days was calculated. Linear regression analysis was performed after adjusting for the co-variables age and daily pill burden. Sensitivity analysis was performed with controls for intervals in the reverse direction (prospectively).ResultsWe analyzed 11 cases and 22 matched controls (mean age: 75.9 ± 9.2 years vs. 73.1 ± 8.4 years; n.s.) with similar stroke characteristics (NIHSS, mRS, MoCA) and 36.4% women in each group. Mean adherence values were high and similar between cases and controls (95 days taking: 87.0 ± 18.9% (cases) vs. 90.8 ± 9.8% (controls), n.s.; similar values for timing adherence). Six hemorrhagic and five ischemic events had occurred. Compared to controls, a significantly higher 95 days taking adherence was observed for hemorrhagic events (96.0 ± 5.0% (cases) vs. 88.1 ± 11.5% (controls); pConclusionBecause recurrent ischemic events after an AF-related stroke were associated with low adherence to DOAC 96%.Trial registrationClinicalTrials.gov NCT03344146.
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- 2024
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3. Biomarker, Imaging, and Clinical Factors Associated With Overt and Covert Stroke in Patients With Atrial Fibrillation
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De Marchis, Gian Marco, Krisai, Philipp, Werlen, Laura, Sinnecker, Tim, Aeschbacher, Stefanie, Dittrich, Tolga D., Polymeris, Alexandros A., Coslovksy, Michael, Blum, Manuel R., Rodondi, Nicolas, Reichlin, Tobias, Moschovitis, Giorgio, Wuerfel, Jens, Lyrer, Philippe A., Fischer, Urs, Conen, David, Kastner, Peter, Ziegler, André, Osswald, Stefan, Kühne, Michael, and Bonati, Leo H.
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- 2023
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4. Thrombolysis in stroke patients with elevated inflammatory markers
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Altersberger, Valerian L., Enz, Lukas S., Sibolt, Gerli, Hametner, Christian, Nannoni, Stefania, Heldner, Mirjam R., Stolp, Jeffrey, Jovanovic, Dejana R., Zini, Andrea, Pezzini, Alessandro, Wegener, Susanne, Cereda, Carlo W., Ntaios, George, Räty, Silja, Gumbinger, Christoph, Heyse, Miriam, Polymeris, Alexandros A., Zietz, Annaelle, Schaufelbuehl, Anna, Strambo, Davide, Padlina, Giovanna, Slavova, Nedelina, Tiainen, Marjaana, Valkonen, Kati, Velzen, Twan J. van, Bigliardi, Guido, Stanarcevic, Predrag, Magoni, Mauro, Luft, Andreas, Bejot, Yannick, Vandelli, Laura, Padjen, Visnja, Nederkoorn, Paul J., Arnold, Marcel, Michel, Patrik, Ringleb, Peter A., Curtze, Sami, Engelter, Stefan T., and Gensicke, Henrik
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- 2022
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5. Tranexamic Acid for Intracerebral Hemorrhage in Patients on Non-Vitamin K Antagonist Oral Anticoagulants (TICH-NOAC): A Multicenter, Randomized, Placebo-Controlled, Phase 2 Trial
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Polymeris, Alexandros A., Karwacki, Grzegorz M., Siepen, Bernhard M., Schaedelin, Sabine, Tsakiris, Dimitrios A., Stippich, Christoph, Guzman, Raphael, Nickel, Christian H., Sprigg, Nikola, Kägi, Georg, Vehoff, Jochen, Barinka, Filip, Thilemann, Sebastian, Maurer, Marina, Wagner, Benjamin, Traenka, Christopher, Gensicke, Henrik, De Marchis, Gian Marco, Bonati, Leo H., Fischer, Urs, Z’Graggen, Werner J., Nedeltchev, Krassen, Wegener, Susanne, Baumgartner, Philipp, Engelter, Stefan T., Seiffge, David J., Peters, Nils, Lyrer, Philippe A., Clarke, Sandra, Falcao, Martina, Avramiotis, Nikolaos S, Dittrich, Tolga, Fisch, Urs, Fladt, Joachim, Hert, Lisa, Schneider, Iris, Wiegert, Martina, Zietz, Annaelle, Beyeler, Morin, Goeldlin, Martina, Kormann, Marianne, Maamari, Basel, McEvoy, Liselotte, Meinel, Thomas R, Müller, Madlaina, Vynckier, Jan, Ardila, Elena, Feuerstein, Ingrid, Gantenbein, Claudine, Müller, Anna, Seljmani, Vjosa, Wagner, Benedikt, Anders, Bettina, Backhaus, Roland, Paliantonis, Asterios, Taheri, Shadi, Thumm, Dennis, van Duinen, Jannie, and Von Bieberstein, Lita
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- 2023
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6. Aspirin versus anticoagulation in cervical artery dissection (TREAT-CAD): an open-label, randomised, non-inferiority trial
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Kahles, Timo, Nedeltchev, Krassen, Altersberger, Valerian, Bonati, Leo H, Brehm, Alex, Bruni, Nicole, De Marchis, Gian Marco, Engelter, Stefan T, Fabbro, Thomas, Fisch, Urs, Fladt, Joachim, Gensicke, Henrik, Hert, Lisa, Lyrer, Philippe A, Maurer, Marina, Peters, Nils, Polymeris, Alexandros, Psychogios, Marios-Nikos, Schaedelin, Sabine, Stippich, Christoph, Thilemann, Sebastian, Traenka, Christopher, Wagner, Benjamin, Arnold, Marcel, Fischer, Urs, Goeggel Simonetti, Barbara, Gralla, Jan, Heldner, Mirjam, Jung, Simon, Leib, Stephen L, Seiffge, David J, Mueller, Hubertus, Sveikata, Lukas, Sztajzel, Roman, Correia, Pamela, Eskandari, Ashraf, Meyer, Ivo, Michel, Patrik, Nannoni, Stefania, Remillard, Suzette, Sirimarco, Gaia, Zachariadis, Alexandros, Kaegi, Georg, Mueller, Anna, Vehoff, Jochen, Hamann, Janne, Luft, Andreas R, Steiner, Levke, Wegener, Susanne, Erdur, Hebun J, Nolte, Christian H, von Rennenberg, Regina, Scheitz, Jan F, Feil, Katharina, Kellert, Lars, Christensen, Hanne, Rosenbaum, Sverre, Schaedelin, Sabine A, Simonetti, Barbara Goeggel, Kägi, Georg, Seiffge, David, Polymeris, Alexandros A, and Lyrer, Philippe
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- 2021
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7. Etiology, 3-Month Functional Outcome and Recurrent Events in Non-Traumatic Intracerebral Hemorrhage
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Martina B. Goeldlin, Achim Mueller, Bernhard M. Siepen, Madlaine Mueller, Davide Strambo, Patrik Michel, Michael Schaerer, Carlo W. Cereda, Giovanni Bianco, Florian Lindheimer, Christian Berger, Friedrich Medlin, Roland Backhaus, Nils Peters, Susanne Renaud, Loraine Fisch, Julien Niederhaeuser, Emmanuel Carrera, Elisabeth Dirren, Christophe Bonvin, Rolf Sturzenegger, Timo Kahles, Krassen Nedeltchev, Georg Kaegi, Jochen Vehoff, Biljana Rodic, Manuel Bolognese, Ludwig Schelosky, Stephan Salmen, Marie-Luise Mono, Alexandros A. Polymeris, Stefan T. Engelter, Philippe Lyrer, Susanne Wegener, Andreas R. Luft, Werner Z’Graggen, David Bervini, Bastian Volbers, Tomas Dobrocky, Johannes Kaesmacher, Pasquale Mordasini, Thomas R. Meinel, Marcel Arnold, Javier Fandino, Leo H. Bonati, Urs Fischer, and David J. Seiffge
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cerebral hemorrhage ,etiology ,ischemic stroke ,outcome ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background and Purpose Knowledge about different etiologies of non-traumatic intracerebral hemorrhage (ICH) and their outcomes is scarce. Methods We assessed prevalence of pre-specified ICH etiologies and their association with outcomes in consecutive ICH patients enrolled in the prospective Swiss Stroke Registry (2014 to 2019). Results We included 2,650 patients (mean±standard deviation age 72±14 years, 46.5% female, median National Institutes of Health Stroke Scale 8 [interquartile range, 3 to 15]). Etiology was as follows: hypertension, 1,238 (46.7%); unknown, 566 (21.4%); antithrombotic therapy, 227 (8.6%); cerebral amyloid angiopathy (CAA), 217 (8.2%); macrovascular cause, 128 (4.8%); other determined etiology, 274 patients (10.3%). At 3 months, 880 patients (33.2%) were functionally independent and 664 had died (25.1%). ICH due to hypertension had a higher odds of functional independence (adjusted odds ratio [aOR], 1.33; 95% confidence interval [CI], 1.00 to 1.77; P=0.05) and lower mortality (aOR, 0.64; 95% CI, 0.47 to 0.86; P=0.003). ICH due to antithrombotic therapy had higher mortality (aOR, 1.62; 95% CI, 1.01 to 2.61; P=0.045). Within 3 months, 4.2% of patients had cerebrovascular events. The rate of ischemic stroke was higher than that of recurrent ICH in all etiologies but CAA and unknown etiology. CAA had high odds of recurrent ICH (aOR, 3.38; 95% CI, 1.48 to 7.69; P=0.004) while the odds was lower in ICH due to hypertension (aOR, 0.42; 95% CI, 0.19 to 0.93; P=0.031). Conclusions Although hypertension is the leading etiology of ICH, other etiologies are frequent. One-third of ICH patients are functionally independent at 3 months. Except for patients with presumed CAA, the risk of ischemic stroke within 3 months of ICH was higher than the risk of recurrent hemorrhage.
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- 2022
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8. Mechanical Thrombectomy Versus Best Medical Treatment in the Late Time Window in Non-DEFUSE-Non-DAWN Patients: A Multicenter Cohort Study
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Dittrich, Tolga D., Sporns, Peter B., Kriemler, Lilian F., Rudin, Salome, Nguyen, Anh, Zietz, Annaelle, Polymeris, Alexandros A., Tränka, Christopher, Thilemann, Sebastian, Wagner, Benjamin, Altersberger, Valerian L., Piot, Ines, Barinka, Filip, Müller, Susanne, Hänsel, Martin, Gensicke, Henrik, Engelter, Stefan T., Lyrer, Philippe A., Sutter, Raoul, Nickel, Christian H., Katan, Mira, Peters, Nils, Kulcsár, Zsolt, Karwacki, Grzegorz M., Pileggi, Marco, Cereda, Carlo, Wegener, Susanne, Bonati, Leo H., Fischer, Urs, Psychogios, Marios, and De Marchis, Gian Marco
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- 2023
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9. Impact of the COVID-19 lockdown on the adherence of stroke patients to direct oral anticoagulants: a secondary analysis from the MAAESTRO study
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Dietrich, Fine, Polymeris, Alexandros A., Verbeek, Melina, Engelter, Stefan T., Hersberger, Kurt E., Schaedelin, Sabine, Arnet, Isabelle, and Lyrer, Philippe A.
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- 2022
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10. Statin Therapy in Ischemic Stroke Patients with Atrial Fibrillation: Efficacy and Safety Outcomes
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Marvardi, Michele, primary, Ferrante, Mario, additional, Paciaroni, Maurizio, additional, Abdul-Rahim, Azmil H, additional, Tsivgoulis, Georgios, additional, Seiffge, David J, additional, Engelter, Stefan T, additional, Lyrer, Philippe A., additional, Polymeris, Alexandros A, additional, Dittrich, Tolga D, additional, Cancelloni, Virginia, additional, Zietz, Annaelle, additional, De Marchis, Gian Marco, additional, Putaala, Jukka, additional, Strbian, Daniel, additional, Tomppo, Liisa, additional, Michel, Patrik, additional, Strambo, Davide, additional, Salerno, Alexander, additional, Vanacker, Peter, additional, Zuurbier, Susanna M., additional, Yperzeele, Laetitia, additional, Loos, Caroline MJ, additional, Cappellari, Manuel, additional, Emiliani, Andrea, additional, Zedde, Marialuisa, additional, Becattini, Cecilia, additional, Pascarella, Rosario, additional, Dawson, Jesse, additional, Cronshaw, Robert, additional, Schirinzi, Erika, additional, Del Sette, Massimo, additional, Stretz, Christoph, additional, Kala, Narendra Sharma, additional, Schomer, Ashley, additional, Mac Grory, Brian, additional, Jayaraman, Mahesh V, additional, Yaghi, Shadi, additional, Furie, Karen L., additional, Masotti, Luca, additional, Grifoni, Elisa, additional, Toni, Danilo, additional, Risitano, Angela, additional, Falcou, Anne A, additional, Petraglia, Luca, additional, Lotti, Enrico Maria, additional, Pavolucci, Lucia, additional, Lochner, Piergiorgio, additional, Silvestrelli, Giorgio, additional, Ciccone, Alfonso, additional, Alberti, Andrea, additional, Venti, Michele, additional, Leone De Magistris, Ilaria, additional, Mosconi, Maria Giulia, additional, Giustozzi, Michela, additional, Kargiotis, Odysseas, additional, Rocco, Alessandro, additional, Diomedi, Marina, additional, Marcheselli, Simona, additional, Antonenko, Kateryna, additional, Rota, Eugenia, additional, Tassinari, Tiziana, additional, Saia, Valentina, additional, Palmerini, Francesco, additional, Aridon, Paolo, additional, Arnao, Valentina, additional, Monaco, Serena, additional, Cottone, Salvatore, additional, Baldi, Antonio, additional, D'Amore, Cataldo, additional, Ageno, Walter, additional, Pegoraro, Samuela, additional, Ntaios, George, additional, Adamou, Anastasia, additional, Sagris, Dimitrios, additional, Giannopoulos, Sotirios, additional, Kosmidou, Maria, additional, Ntais, Evangelos, additional, Romoli, Michele, additional, Pantoni, Leonardo, additional, Rosa, Silvia, additional, Bertora, Pierluigi, additional, Chiti, Alberto, additional, Canavero, Isabella, additional, Saggese, Carlo Emanuele, additional, Plocco, Maurizio, additional, Giorli, Elisa, additional, Palaiodimou, Lina, additional, Bakola, Eleni, additional, Bandini, Fabio, additional, Gasparro, Antonio, additional, Terruso, Valeria, additional, Mannino, Marina, additional, Pezzini, Alessandro, additional, Ornello, Raffaele, additional, Sacco, Simona, additional, Popovic, Nemanja, additional, Scoditti, Umberto, additional, Genovese, Antonio, additional, Flomin, Yuriy, additional, Mancuso, Michelangelo, additional, D'agliano, Roberto, additional, Baldini, Marco, additional, Ulivi, Leonardo, additional, Giannini, Nicola, additional, Vadikolias, Konstantinos, additional, Liantinioti, Chrysoula, additional, Chondrogianni, Maria, additional, Halvatsiotis, Panagiotis, additional, Karagkiozi, Efstathia, additional, Athanasakis, George, additional, Makaritsis, Konstantinos, additional, lanari, alessia, additional, Tatlisumak, Turgut, additional, Acciarresi, Monica, additional, Lorenzini, Gianni, additional, Tassi, Rossana, additional, Guideri, Francesca, additional, Acampa, Maurizio, additional, Martini, Giuseppe, additional, Sohn, Sung-Il, additional, Mumoli, Nicola, additional, Cararra, Davide, additional, Maccarrone, Miriam, additional, Galati, Franco, additional, Gourbali, Vanessa, additional, Orlandi, Giovanni, additional, Giuntini, Martina, additional, Corea, Francesco, additional, Bellesini, Marta, additional, Karapanayiotides, Theodore, additional, Csiba, Laszlo, additional, Szabo, Lilla, additional, Imberti, Davide, additional, Pieroni, Alessio, additional, Barlinn, Kristian, additional, Pallesen, Lars-Peder, additional, Barlinn, Jessica, additional, Doronin, Boris, additional, Volodina, Vera Alexandrovna, additional, Agnelli, Giancarlo, additional, Deleu, Dirk, additional, Bonetti, Bruno, additional, Gentile, Luana, additional, Reale, Giuseppe, additional, Caliandro, Pietro, additional, Morotti, Andrea, additional, Vannucchi, Vieri, additional, Padroni, Marina, additional, Letteri, Federica, additional, Magoni, Mauro, additional, Tiseo, Cindy, additional, Rigatelli, Alberto, additional, Zauli, Aurelia, additional, Bossi, Francesco, additional, and Caso, Valeria, additional
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- 2024
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11. Impact of type of oral anticoagulants in patients with cerebral microbleeds after atrial fibrillation-related ischemic stroke or TIA: Results of the NOACISP-LONGTERM registry
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Benjamin Wagner, Lisa Hert, Alexandros A. Polymeris, Sabine Schaedelin, Johanna M. Lieb, David J. Seiffge, Christopher Traenka, Sebastian Thilemann, Joachim Fladt, Valerian L. Altersberger, Annaelle Zietz, Tolga D. Dittrich, Urs Fisch, Henrik Gensicke, Gian Marco De Marchis, Leo H. Bonati, Philippe A. Lyrer, Stefan T. Engelter, and Nils Peters
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stroke ,atrial fibrillation ,anticoagulation ,direct-acting oral anticoagulant ,cerebral microbleeds ,small vessel disease ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
BackgroundCerebral microbleeds (CMBs) may have a differential impact on clinical outcome in stroke patients with atrial fibrillation (AF) treated with different types of oral anticoagulation (OAC).MethodsObservational single-center study on AF-stroke-patients treated with OAC. Magnetic-resonance-imaging was performed to assess CMBs. Outcome measures consisted of recurrent ischemic stroke (IS), intracranial hemorrhage (ICH), death, and their combined analysis. Functional disability was assessed by mRS. Using adjusted logistic regression and Cox proportional-hazards models, we assessed the association of the presence of CMBs and OAC type (vitamin K antagonists [VKAs] vs. direct oral anticoagulants [DOACs]) with clinical outcome.ResultsOf 310 AF-stroke patients treated with OAC [DOACs: n = 234 (75%); VKAs: n = 76 (25%)], CMBs were present in 86 (28%) patients; of these, 66 (77%) received DOACs. In both groups, CMBs were associated with an increased risk for the composite outcome: VKAs: HR 3.654 [1.614; 8.277]; p = 0.002; DOACs: HR 2.230 [1.233; 4.034]; p = 0.008. Patients with CMBs had ~50% higher absolute rates of the composite outcome compared to the overall cohort, with a comparable ratio between treatment groups [VKAs 13/20(65%) vs. DOACs 19/66(29%); p < 0.01]. The VKA-group had a 2-fold higher IS [VKAs:4 (20%) vs. DOACs:6 (9%); p = 0.35] and a 10-fold higher ICH rate [VKAs: 3 (15%) vs. DOACs: 1 (1.5%); p = 0.038]. No significant interaction was observed between type of OAC and presence of CMBs. DOAC-patients showed a significantly better functional outcome (OR 0.40 [0.17; 0.94]; p = 0.04).ConclusionsIn AF-stroke patients treated with OAC, the presence of CMBs was associated with an unfavorable composite outcome for both VKAs and DOACs, with a higher risk for recurrent IS than for ICH. Strokes were numerically higher under VKAs and increased in the presence of CMBs.Clinical trial registrationhttp://www.clinicaltrials.gov, Unique identifier: NCT03826927.
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- 2022
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12. Development of imaging-based risk scores for prediction of intracranial haemorrhage and ischaemic stroke in patients taking antithrombotic therapy after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies
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Harkness, Kirsty, Shaw, Louise, Sword, Jane, Mohd Nor, Azlisham, Sharma, Pankaj, Kelly, Deborah, Harrington, Frances, Randall, Marc, Smith, Matthew, Mahawish, Karim, Elmarim, Abduelbaset, Esisi, Bernard, Cullen, Claire, Nallasivam, Arumug, Price, Christopher, Barry, Adrian, Roffe, Christine, Coyle, John, Hassan, Ahamad, Birns, Jonathan, Cohen, David, Sekaran, Lakshmanan, Parry-Jones, Adrian, Parry, Anthea, Hargroves, David, Proschel, Harald, Datta, Prabel, Darawil, Khaled, Manoj, Aravindakshan, Burn, Mathew, Patterson, Chris, Giallombardo, Elio, Smyth, Nigel, Mansoor, Syed, Anwar, Ijaz, Marsh, Rachel, Ispoglou, Sissi, Chadha, Dinesh, Prabhakaran, Mathuri, Meenakishundaram, Sanjeevikumar, O'Connell, Janice, Scott, Jon, Krishnamurthy, Vinodh, Aghoram, Prasanna, McCormick, Michael, Sprigg, Nikola, O'Mahony, Paul, Cooper, Martin, Choy, Lillian, Wilkinson, Peter, Leach, Simon, Caine, Sarah, Burger, Ilse, Gunathilagan, Gunaratam, Guyler, Paul, Emsley, Hedley, Davis, Michelle, Manawadu, Dulka, Pasco, Kath, Mamun, Maam, Luder, Robert, Sajid, Mahmud, Okwera, James, Warburton, Elizabeth, Saastamoinen, Kari, England, Timothy, Putterill, Janet, Flossman, Enrico, Power, Michael, Dani, Krishna, Mangion, David, Suman, Appu, Corrigan, John, Lawrence, Enas, Vahidassr, Djamil, Shakeshaft, Clare, Brown, Martin, Charidimou, Andreas, Cohen, Hannah, Banerjee, Gargi, Houlden, Henry, White, Mark, Yousry, Tarek, Flossmann, Enrico, Muir, Keith, Gratz, Pascal, Mattle, Heinrich, Panos, Leonidas, Korczyn, Amos, Kliper, Efrat, Maeder, Philippe, Gass, Achim, Pachai, Chahin, Bracoub, Luc, Douste-Blazy, Marie-Yvonne, Fratacci, Marie Dominique, Vicaut, Eric, Sato, Shoichiro, Miwa, Kaori, Fujita, Kyohei, Ide, Toshihiro, Ma, Henry, Ly, John, Singhal, Shaloo, Chandra, Ronil, Slater, Lee-Anne, Soufan, Cathy, Moran, Christopher, Traenka, Christopher, Thilemann, Sebastian, Fladt, Joachim, Gensicke, Henrik, Bonati, Leo, Kim, Beom Joon, Han, Moon-Ku, Kang, Jihoon, Ko, Eunbin, Yang, Mi Hwa, Jang, Myung Suk, Murphy, Sean, Carty, Fiona, Akijian, Layan, Thornton, John, Schembri, Mark, Douven, Elles, Delgado-Mederos, Raquel, Marín, Rebeca, Camps-Renom, Pol, Guisado-Alonso, Daniel, Nuñez, Fidel, Medrano-Martorell, Santiago, Merino, Elisa, Iida, Kotaro, Ikeda, Syuhei, Irie, Hiroyuki, Demirelli, Derya Selcuk, Medanta, Jayesh Modi, Zerna, Charlotte, Hernández, Maria Valdés, Armitage, Paul, Heye, Anna, Muñoz-Maniega, Susana, Sakka, Eleni, Thrippleton, Michael, Dennis, Martin, Beigneux, Ysoline, Silva, Mauro, Venketasubramanian, Narayanaswamy, Ho, Shu Leung, Cheung, Raymond Tak Fai, Chan, Koon Ho, Teo, Kay Cheong, Hui, Edward, Kwan, Joseph Shiu Kwong, Chang, Richard, Tse, Man Yu, Hoi, Chu Peng, Chan, Chung Yan, Chan, Oi Ling, Cheung, Ryan Hoi Kit, Wong, Edmund Ka Ming, Leung, Kam Tat, Tsang, Suk Fung, Ip, Hing Lung, Ma, Sze Ho, Ma, Karen, Fong, Wing Chi, Li, Siu Hung, Li, Richard, Ng, Ping Wing, Wong, Kwok Kui, Liu, Wenyan, Wong, Lawrence, Ramos, Lino, De Schryver, Els, Jöbsis, Joost, van der Sande, Jaap, Brouwers, Paul, Roos, Yvo, Stam, Jan, Bakker, Stef, Verbiest, Henk, Schoonewille, Wouter, Linn, Cisca, Hertzberger, Leopold, van Gemert, Maarten, Berntsen, Paul, Van Dam-Nolen, Dianne, Kooi, M Eline, Van der Lugt, Aad, Koudstaal, Peter, Leff, Alexander, Ward, Nicholas, Nachev, Parashkev, Perry, Richard, Ozkan, Hatice, Mitchell, John, Best, Jonathan G, Ambler, Gareth, Wilson, Duncan, Lee, Keon-Joo, Lim, Jae-Sung, Shiozawa, Masayuki, Koga, Masatoshi, Li, Linxin, Lovelock, Caroline, Chabriat, Hugues, Hennerici, Michael, Wong, Yuen Kwun, Mak, Henry Ka Fung, Prats-Sanchez, Luis, Martínez-Domeño, Alejandro, Inamura, Shigeru, Yoshifuji, Kazuhisa, Arsava, Ethem Murat, Horstmann, Solveig, Purrucker, Jan, Lam, Bonnie Yin Ka, Wong, Adrian, Kim, Young Dae, Song, Tae-Jin, Lemmens, Robin, Eppinger, Sebastian, Gattringer, Thomas, Uysal, Ender, Tanriverdi, Zeynep, Bornstein, Natan M, Ben Assayag, Einor, Hallevi, Hen, Molad, Jeremy, Nishihara, Masashi, Tanaka, Jun, Coutts, Shelagh B, Polymeris, Alexandros, Wagner, Benjamin, Seiffge, David J, Lyrer, Philippe, Algra, Ale, Kappelle, L Jaap, Al-Shahi Salman, Rustam, Jäger, Hans R, Lip, Gregory Y H, Fischer, Urs, El-Koussy, Marwan, Mas, Jean-Louis, Legrand, Laurence, Karayiannis, Christopher, Phan, Thanh, Gunkel, Sarah, Christ, Nicolas, Abrigo, Jill, Leung, Thomas, Chu, Winnie, Chappell, Francesca, Makin, Stephen, Hayden, Derek, Williams, David J, Mess, Werner H, Nederkoorn, Paul J, Barbato, Carmen, Browning, Simone, Wiegertjes, Kim, Tuladhar, Anil M, Maaijwee, Noortje, Guevarra, Anne Cristine, Yatawara, Chathuri, Mendyk, Anne-Marie, Delmaire, Christine, Köhler, Sebastian, van Oostenbrugge, Robert, Zhou, Ying, Xu, Chao, Hilal, Saima, Gyanwali, Bibek, Chen, Christopher, Lou, Min, Staals, Julie, Bordet, Régis, Kandiah, Nagaendran, de Leeuw, Frank-Erik, Simister, Robert, Hendrikse, Jeroen, Kelly, Peter J, Wardlaw, Joanna, Soo, Yannie, Fluri, Felix, Srikanth, Velandai, Calvet, David, Jung, Simon, Kwa, Vincent I H, Engelter, Stefan T, Peters, Nils, Smith, Eric E, Hara, Hideo, Yakushiji, Yusuke, Orken, Dilek Necioglu, Fazekas, Franz, Thijs, Vincent, Heo, Ji Hoe, Mok, Vincent, Veltkamp, Roland, Ay, Hakan, Imaizumi, Toshio, Gomez-Anson, Beatriz, Lau, Kui Kai, Jouvent, Eric, Rothwell, Peter M, Toyoda, Kazunori, Bae, Hee-Joon, Marti-Fabregas, Joan, and Werring, David J
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- 2021
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13. Insights Into Direct Oral Anticoagulant Therapy Implementation of Stroke Survivors with Atrial Fibrillation in an Ambulatory Setting
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Albert, Valerie, Polymeris, Alexandros A., Dietrich, Fine, Engelter, Stefan T., Hersberger, Kurt E., Schaedelin, Sabine, Lyrer, Philippe A., and Arnet, Isabelle
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- 2021
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14. CADMUS
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Goeldlin, Martina B; https://orcid.org/0000-0001-5800-116X, Mueller, Madlaine; https://orcid.org/0000-0002-1142-9633, Siepen, Bernhard M; https://orcid.org/0000-0003-0240-4191, Zhang, Wenpeng; https://orcid.org/0000-0001-8748-3962, Ozkan, Hatice; https://orcid.org/0000-0003-1656-4559, Locatelli, Martina, Du, Yang; https://orcid.org/0000-0002-0805-6282, Valenzuela, Waldo; https://orcid.org/0000-0002-6629-3366, Radojewski, Piotr; https://orcid.org/0000-0002-1062-8622, Hakim, Arsany; https://orcid.org/0000-0001-9431-1069, Kaesmacher, Johannes; https://orcid.org/0000-0002-9177-2289, Meinel, Thomas R; https://orcid.org/0000-0002-0647-9273, Clénin, Leander; https://orcid.org/0000-0001-8993-0770, Branca, Mattia; https://orcid.org/0000-0002-8063-7882, Strambo, Davide; https://orcid.org/0000-0003-4429-2714, Fischer, Tim; https://orcid.org/0000-0002-1807-9146, Medlin, Friedrich; https://orcid.org/0000-0002-8477-899X, Peters, Nils; https://orcid.org/0000-0001-8451-7389, Carrera, Emmanuel; https://orcid.org/0000-0003-0045-5382, Lovblad, Karl-Olof; https://orcid.org/0000-0003-2768-9779, Karwacki, Grzegorz M; https://orcid.org/0000-0001-5963-6220, Cereda, Carlo W; https://orcid.org/0000-0002-6479-1476, Niederhauser, Julien; https://orcid.org/0000-0002-6543-7989, Mono, Marie-Luise, Mueller, Achim; https://orcid.org/0009-0009-4597-3440, Wegener, Susanne; https://orcid.org/0000-0003-4369-7023, Sartoretti, Sabine, Polymeris, Alexandros A; https://orcid.org/0000-0002-9475-2208, Altersberger, Valerian; https://orcid.org/0000-0002-0610-9328, Katan, Mira; https://orcid.org/0000-0002-9265-8066, et al, Goeldlin, Martina B; https://orcid.org/0000-0001-5800-116X, Mueller, Madlaine; https://orcid.org/0000-0002-1142-9633, Siepen, Bernhard M; https://orcid.org/0000-0003-0240-4191, Zhang, Wenpeng; https://orcid.org/0000-0001-8748-3962, Ozkan, Hatice; https://orcid.org/0000-0003-1656-4559, Locatelli, Martina, Du, Yang; https://orcid.org/0000-0002-0805-6282, Valenzuela, Waldo; https://orcid.org/0000-0002-6629-3366, Radojewski, Piotr; https://orcid.org/0000-0002-1062-8622, Hakim, Arsany; https://orcid.org/0000-0001-9431-1069, Kaesmacher, Johannes; https://orcid.org/0000-0002-9177-2289, Meinel, Thomas R; https://orcid.org/0000-0002-0647-9273, Clénin, Leander; https://orcid.org/0000-0001-8993-0770, Branca, Mattia; https://orcid.org/0000-0002-8063-7882, Strambo, Davide; https://orcid.org/0000-0003-4429-2714, Fischer, Tim; https://orcid.org/0000-0002-1807-9146, Medlin, Friedrich; https://orcid.org/0000-0002-8477-899X, Peters, Nils; https://orcid.org/0000-0001-8451-7389, Carrera, Emmanuel; https://orcid.org/0000-0003-0045-5382, Lovblad, Karl-Olof; https://orcid.org/0000-0003-2768-9779, Karwacki, Grzegorz M; https://orcid.org/0000-0001-5963-6220, Cereda, Carlo W; https://orcid.org/0000-0002-6479-1476, Niederhauser, Julien; https://orcid.org/0000-0002-6543-7989, Mono, Marie-Luise, Mueller, Achim; https://orcid.org/0009-0009-4597-3440, Wegener, Susanne; https://orcid.org/0000-0003-4369-7023, Sartoretti, Sabine, Polymeris, Alexandros A; https://orcid.org/0000-0002-9475-2208, Altersberger, Valerian; https://orcid.org/0000-0002-0610-9328, Katan, Mira; https://orcid.org/0000-0002-9265-8066, and et al
- Abstract
BACKGROUND AND OBJECTIVES Cerebral small vessel disease (SVD) is the major cause of intracerebral hemorrhage (ICH). There is no comprehensive, easily applicable classification of ICH subtypes according to the presumed underlying SVD using MRI. We developed an MRI-based classification for SVD-related ICH. METHODS We performed a retrospective study in the prospectively collected Swiss Stroke Registry (SSR, 2013-2019) and the Stroke InvestiGation in North And central London (SIGNAL) cohort. Patients with nontraumatic, SVD-related ICH and available MRI within 3 months were classified as Cerebral Amyloid angiopathy (CAA), Deep perforator arteriopathy (DPA), Mixed CAA-DPA, or Undetermined SVD using hemorrhagic and nonhemorrhagic MRI markers (CADMUS classification). The primary outcome was inter-rater reliability using Gwet's AC1. Secondary outcomes were recurrent ICH/ischemic stroke at 3 months according to the CADMUS phenotype. We performed Firth penalized logistic regressions and competing risk analyses. RESULTS The SSR cohort included 1,180 patients (median age [interquartile range] 73 [62-80] years, baseline NIH Stroke Scale 6 [2-12], 45.6% lobar hematoma, systolic blood pressure on admission 166 [145-185] mm Hg). The CADMUS phenotypes were as follows: mixed CAA-DPA (n = 751 patients, 63.6%), undetermined SVD (n = 203, 17.2%), CAA (n = 154, 13.1%), and DPA (n = 72, 6.3%), with a similar distribution in the SIGNAL cohort (n = 313). Inter-rater reliability was good (Gwet's AC1 for SSR/SIGNAL 0.69/0.74). During follow-up, 56 patients had 57 events (28 ICH, 29 ischemic strokes). Three-month event rates were comparable between the CADMUS phenotypes. DISCUSSION CADMUS, a novel MRI-based classification for SVD-associated ICH, is feasible and reproducible and may improve the classification of ICH subtypes in clinical practice and research.
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- 2024
15. Andexanet alfa versus non-specific treatments for intracerebral hemorrhage in patients taking factor Xa inhibitors — Individual patient data analysis of ANNEXA-4 and TICH-NOAC.
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Siepen, Bernhard M, Polymeris, Alexandros, Shoamanesh, Ashkan, Connolly, Stuart, Steiner, Thorsten, Poli, Sven, Lemmens, Robin, Goeldlin, Martina B, Müller, Madlaine, Branca, Mattia, Rauch, Janis, Meinel, Thomas, Kaesmacher, Johannes, Z'Graggen, Werner, Arnold, Marcel, Fischer, Urs, Peters, Nils, Engelter, Stefan T, Lyrer, Philippe, and Seiffge, David
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CEREBRAL hemorrhage , *VENOUS thrombosis , *DATA analysis , *MYOCARDIAL infarction , *ISCHEMIC stroke - Abstract
Background: Data comparing the specific reversal agent andexanet alfa with non-specific treatments in patients with non-traumatic intracerebral hemorrhage (ICH) associated with factor-Xa inhibitor (FXaI) use are scarce. Aim: The study aimed to determine the association between the use of andexanet alfa compared with non-specific treatments with the rate of hematoma expansion and thromboembolic complications in patients with FXaI-associated ICH. Methods: We performed an individual patient data analysis combining two independent, prospective studies: ANNEXA-4 (180 patients receiving andexanet alfa, NCT02329327) and TICH-NOAC (63 patients receiving tranexamic acid or placebo ± prothrombin complex concentrate, NCT02866838). The primary efficacy outcome was hematoma expansion on follow-up imaging. The primary safety outcome was any thromboembolic complication (ischemic stroke, myocardial infarction, pulmonary embolism, or deep vein thrombosis) at 30 days. We used binary logistic regression models adjusted for baseline hematoma volume, age, calibrated anti-Xa activity, times from last intake of FXaI, and symptom onset to treatment, respectively. Results: Among 243 participants included, the median age was 80 (IQR 75–84) years, baseline hematoma volume was 9.1 (IQR 3.4–21) mL and anti-Xa activity 118 (IQR 78–222) ng/mL. Times from last FXaI intake and symptom onset to treatment were 11 (IQR 7–16) and 4.7 (IQR 3.0–7.6) h, respectively. Overall, 50 patients (22%) experienced hematoma expansion (ANNEXA-4: n=24 (14%); TICH-NOAC: n=26 (41%)). After adjusting for pre-specified confounders (baseline hematoma volume, age, calibrated anti-Xa activity, times from last intake of FXaI, and symptom onset to treatment, respectively), treatment with andexanet alfa was independently associated with decreased odds for hematoma expansion (aOR 0.33, 95% CI 0.13–0.80, p = 0.015). Overall, 26 patients (11%) had any thromboembolic complication within 30 days (ANNEXA-4: n=20 (11%); TICH-NOAC: n=6 (10%)). There was no association between any thromboembolic complication and treatment with andexanet alfa (aOR 0.70, 95% CI 0.16–3.12, p = 0.641). Conclusion: The use of andexanet alfa compared to any other non-specific treatment strategy was associated with decreased odds for hematoma expansion, without increased odds for thromboembolic complications. [ABSTRACT FROM AUTHOR]
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- 2024
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16. Renal Function and Body Mass Index Contribute to Serum Neurofilament Light Chain Levels in Elderly Patients With Atrial Fibrillation
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Alexandros A. Polymeris, Fabrice Helfenstein, Pascal Benkert, Stefanie Aeschbacher, David Leppert, Michael Coslovsky, Eline Willemse, Sabine Schaedelin, Manuel R. Blum, Nicolas Rodondi, Tobias Reichlin, Giorgio Moschovitis, Jens Wuerfel, Gian Marco De Marchis, Stefan T. Engelter, Philippe A. Lyrer, David Conen, Michael Kühne, Stefan Osswald, Leo H. Bonati, Jens Kuhle, and the Swiss-AF Investigators
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neurofilament light ,renal function ,glomerular filtration rate ,body mass index ,elderly ,atrial fibrillation ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
ObjectiveSerum neurofilament light chain (sNfL) is increasingly used as a neuroaxonal injury biomarker in the elderly. Besides age, little is known about how other physiological factors like renal function and body mass index (BMI) alter its levels. Here, we investigated the association of estimated glomerular filtration rate (eGFR) and BMI with sNfL in a large sample of elderly patients with atrial fibrillation (AF).MethodsThis is a cross-sectional analysis from the Swiss-AF Cohort (NCT02105844). We measured sNfL using an ultrasensitive single-molecule array assay. We calculated eGFR using the chronic kidney disease epidemiology collaboration (CKD-EPI) creatinine (eGFRcrea) and creatinine–cystatin C (eGFRcrea–cys) formulas, and BMI from weight and height measurements. We evaluated the role of eGFR and BMI as determinants of sNfL levels using multivariable linear regression and the adjusted R2 (R2adj).ResultsAmong 2,277 Swiss-AF participants (mean age 73.3 years), eGFRcrea showed an inverse curvilinear association with sNfL after adjustment for age and cardiovascular comorbidities. BMI also showed an independent, inverse linear association with sNfL. The R2adj of models with age, eGFRcrea, and BMI alone was 0.26, 0.35, and 0.02, respectively. A model with age and eGFRcrea combined explained 45% of the sNfL variance. Sensitivity analyses (i) further adjusting for vascular brain lesions (N = 1,402 participants with MRI) and (ii) using eGFRcrea–cys yielded consistent results.InterpretationIn an elderly AF cohort, both renal function and BMI were associated with sNfL, but only renal function explained a substantial proportion of the sNfL variance. This should be taken into account when using sNfL in elderly patients or patients with cardiovascular disease.
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- 2022
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17. Differences Between Anticoagulated Patients With Ischemic Stroke Versus Intracerebral Hemorrhage
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Fabian Schaub, Alexandros A. Polymeris, Sabine Schaedelin, Lisa Hert, Louisa Meya, Sebastian Thilemann, Christopher Traenka, Benjamin Wagner, David Seiffge, Henrik Gensicke, Gian Marco De Marchis, Leo Bonati, Stefan T. Engelter, Nils Peters, and Philippe Lyrer
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atherosclerosis ,intracerebral hemorrhage ,ischemic stroke ,oral anticoagulants ,small vessel disease ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Data on the relative contribution of clinical and neuroimaging risk factors to acute ischemic stroke (AIS) versus intracerebral hemorrhage (ICH) occurring on oral anticoagulant treatment are scarce. Methods and Results Cross‐sectional study was done on consecutive oral anticoagulant–treated patients presenting with AIS, transient ischemic attack (TIA), or ICH from the prospective observational NOACISP (Novel‐Oral‐Anticoagulants‐In‐Stroke‐Patients)‐Acute registry. We compared clinical and neuroimaging characteristics (small vessel disease markers and atherosclerosis) in ICH versus AIS/TIA (reference) using logistic regression. Among 734 patients presenting with stroke on oral anticoagulant treatment (404 [55%] direct oral anticoagulants, 330 [45%] vitamin K antagonists), 605 patients (82%) had AIS/TIA and 129 (18%) had ICH. Prior AIS/TIA, coronary artery disease, dyslipidemia, and worse renal function were associated with AIS/TIA (adjusted odds ratio [aOR] [95% CI] 0.51 [0.32–0.82], 0.48 [0.26–0.86], 0.55 [0.34–0.89], and 0.82 [0.75–0.90] per 10 mL/min). Prior ICH, older age, higher admission blood pressure, and statin treatment were associated with ICH (aOR [95% CI] 6.33 [2.87–14.04], 1.37 [1.04–1.81] per 10 years, 1.19 [1.10–1.29] per 10 mm Hg, and 1.81 [1.09–3.03]). Cerebral microbleeds and moderate‐to‐severe white matter hyperintensities contributed more to ICH (aOR [95% CI] 2.77 [1.34–6.18], and 2.62 [1.28–5.63]). Aortic arch, common and internal carotid artery atherosclerosis, and internal carotid artery stenosis ≥50% contributed more to AIS/TIA (aOR [95% CI] 0.54 [0.31–0.90], 0.29 [0.05–0.97], 0.48 [0.30–0.76], and 0.32 [0.13–0.67]). Conclusions In patients presenting with stroke on oral anticoagulant, AIS/TIA was 5 times more common than ICH. A high atherosclerotic burden (indicated by cardiovascular comorbidities and extracranial atherosclerosis) and prior AIS/TIA contributed more to AIS/TIA, while small vessel disease markers and prior ICH were stronger determinants for ICH. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02353585.
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- 2022
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18. Cerebral microbleeds and stroke risk after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies
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Harkness, Kirsty, Shaw, Louise, Sword, Jane, Mohd Nor, Azlisham, Sharma, Pankaj, Kelly, Deborah, Harrington, Frances, Randall, Marc, Smith, Matthew, Mahawish, Karim, Elmarim, Abduelbaset, Esisi, Bernard, Cullen, Claire, Nallasivam, Arumug, Price, Christopher, Barry, Adrian, Roffe, Christine, Coyle, John, Hassan, Ahamad, Birns, Jonathan, Cohen, David, Sekaran, Lakshmanan, Parry-Jones, Adrian, Parry, Anthea, Hargroves, David, Proschel, Harald, Datta, Prabel, Darawil, Khaled, Manoj, Aravindakshan, Burn, Mathew, Patterson, Chris, Giallombardo, Elio, Smyth, Nigel, Mansoor, Syed, Anwar, Ijaz, Marsh, Rachel, Ispoglou, Sissi, Chadha, Dinesh, Prabhakaran, Mathuri, Meenakishundaram, Sanjeevikumar, O'Connell, Janice, Scott, Jon, Krishnamurthy, Vinodh, Aghoram, Prasanna, McCormick, Michael, Sprigg, Nikola, O'Mahony, Paul, Cooper, Martin, Choy, Lillian, Wilkinson, Peter, Leach, Simon, Caine, Sarah, Burger, Ilse, Gunathilagan, Gunaratam, Guyler, Paul, Emsley, Hedley, Davis, Michelle, Manawadu, Dulka, Pasco, Kath, Mamun, Maam, Luder, Robert, Sajid, Mahmud, Okwera, James, Warburton, Elizabeth, Saastamoinen, Kari, England, Timothy, Putterill, Janet, Flossman, Enrico, Power, Michael, Dani, Krishna, Mangion, David, Suman, Appu, Corrigan, John, Lawrence, Enas, Vahidassr, Djamil, Shakeshaft, Clare, Brown, Martin, Charidimou, Andreas, Cohen, Hannah, Banerjee, Gargi, Houlden, Henry, White, Mark, Yousry, Tarek, Flossmann, Enrico, Muir, Keith, El-Koussy, Marwan, Gratz, Pascal, Molad, Jeremy, Korczyn, Amos, Kliper, Efrat, Maeder, Philippe, Gass, Achim, Pachai, Chahin, Bracoub, Luc, Douste-Blazy, Marie-Yvonne, Fratacci, Marie Dominique, Vicaut, Eric, Sato, Shoichiro, Miwa, Kaori, Fujita, Kyohei, Ide, Toshihiro, Ma, Henry, Ly, John, Singhal, Shahoo, Chandra, Ronil, Slater, Lee-Anne, Soufan, Cathy, Moran, Christopher, Traenka, Christopher, Thilemann, Sebastian, Fladt, Joachim, Gensicke, Henrik, Bonati, Leo, Kim, Beom Joon, Han, Moon-Ku, Kang, Jihoon, Ko, Eunbin, Yang, Mi Hwa, Jang, Myung Suk, Murphy, Sean, Carty, Fiona, Akijian, Layan, Thornton, John, Schembri, Mark, Douven, Elles, Delgado-Mederos;, Raquel, Marín, Rebeca, Camps-Renom, Pol, Guisado-Alonso, Daniel, Nuñez, Fidel, Medrano-Martorell, Santiago, Merino, Elisa, Iida, Kotaro, Ikeda, Syuhei, Nishihara, Masashi, Irie, Hiroyuki, Demirelli, Derya Selcuk, Medanta, Jayesh Modi, Zerna, Charlotte, Hernández, Maria Valdés, Armitage, Paul, Heye, Anna, Muñoz-Maniega, Susana, Sakka, Eleni, Thrippleton, Michael, Dennis, Martin, Beigneux, Ysoline, Silva, Mauro, Venketasubramanian, Narayanaswamy, Ho, Shu Leung, Cheung, Raymond Tak Fai, Chan, Koon Ho, Teo, Kay Cheong, Hui, Edward, Kwan, Joseph Shiu Kwong, Chang, Richard, Tse, Man Yu, Hoi, Chu Peng, Chan, Chung Yan, Chan, Oi Ling, Cheung, Ryan Hoi Kit, Wong, Edmund Ka Ming, Leung, Kam Tat, Tsang, Suk Fung, Ip, Hing Lung, Ma, Sze Ho, Ma, Karen, Fong, Wing Chi, Li, Siu Hung, Li, Richard, Ng, Ping Wing, Wong, Kwok Kui, Liu, Wenyan, Wong, Lawrence, Ramos, Lino, De Schryver, Els, Jöbsis, Joost, van der Sande, Jaap, Brouwers, Paul, Roos, Yvo, Stam, Jan, Bakker, Stef, Verbiest, Henk, Schoonewille, Wouter, Linn, Cisca, Hertzberger, Leopold, van Gemert, Maarten, Berntsen, Paul, Hendrikse, Jeroen, Nederkoorn, Paul, Mess, Werner, Koudstaal, Peter, Leff, Alexander, Ward, Nicholas, Nachev, Parashkev, Perry, Richard, Ozkan, Hatice, Mitchell, John, Wilson, Duncan, Ambler, Gareth, Lee, Keon-Joo, Lim, Jae-Sung, Shiozawa, Masayuki, Koga, Masatoshi, Li, Linxin, Lovelock, Caroline, Chabriat, Hugues, Hennerici, Michael, Wong, Yuen Kwun, Mak, Henry Ka Fung, Prats-Sánchez, Luis, Martínez-Domeño, Alejandro, Inamura, Shigeru, Yoshifuji, Kazuhisa, Arsava, Ethem Murat, Horstmann, Solveig, Purrucker, Jan, Lam, Bonnie Yin Ka, Wong, Adrian, Kim, Young Dae, Song, Tae-Jin, Schrooten, Maarten, Lemmens, Robin, Eppinger, Sebastian, Gattringer, Thomas, Uysal, Ender, Tanriverdi, Zeynep, Bornstein, Natan M, Assayag, Einor Ben, Hallevi, Hen, Tanaka, Jun, Hara, Hideo, Coutts, Shelagh B, Hert, Lisa, Polymeris, Alexandros, Seiffge, David J, Lyrer, Philippe, Algra, Ale, Kappelle, Jaap, Al-Shahi Salman, Rustam, Jäger, Hans R, Lip, Gregory Y H, Mattle, Heinrich P, Panos, Leonidas D, Mas, Jean-Louis, Legrand, Laurence, Karayiannis, Christopher, Phan, Thanh, Gunkel, Sarah, Christ, Nicolas, Abrigo, Jill, Leung, Thomas, Chu, Winnie, Chappell, Francesca, Makin, Stephen, Hayden, Derek, Williams, David J, Kooi, M Eline, van Dam-Nolen, Dianne H K, Barbato, Carmen, Browning, Simone, Wiegertjes, Kim, Tuladhar, Anil M, Maaijwee, Noortje, Guevarra, Christine, Yatawara, Chathuri, Mendyk, Anne-Marie, Delmaire, Christine, Köhler, Sebastian, van Oostenbrugge, Robert, Zhou, Ying, Xu, Chao, Hilal, Saima, Gyanwali, Bibek, Chen, Christopher, Lou, Min, Staals, Julie, Bordet, Régis, Kandiah, Nagaendran, de Leeuw, Frank-Erik, Simister, Robert, van der Lugt, Aad, Kelly, Peter J, Wardlaw, Joanna M, Soo, Yannie, Fluri, Felix, Srikanth, Velandai, Calvet, David, Jung, Simon, Kwa, Vincent I H, Engelter, Stefan T, Peters, Nils, Smith, Eric E, Yakushiji, Yusuke, Orken, Dilek Necioglu, Fazekas, Franz, Thijs, Vincent, Heo, Ji Hoe, Mok, Vincent, Veltkamp, Roland, Ay, Hakan, Imaizumi, Toshio, Gomez-Anson, Beatriz, Lau, Kui Kai, Jouvent, Eric, Rothwell, Peter M, Toyoda, Kazunori, Bae, Hee-Joon, Marti-Fabregas, Joan, and Werring, David J
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- 2019
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19. Relationship between electronically monitored adherence to direct oral anticoagulants and ischemic or hemorrhagic events after an initial ischemic stroke—A case control study.
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Rekk, Katharina, Arnet, Isabelle, Dietrich, Fine, Polymeris, Alexandros A., Lyrer, Philippe A., Engelter, Stefan T., Schaedelin, Sabine, and Allemann, Samuel S.
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ATRIAL fibrillation ,ISCHEMIC stroke ,ORAL medication ,ELECTRONIC surveillance ,STROKE patients ,STROKE - Abstract
Background: Patients with atrial fibrillation (AF) have a high risk for recurrent clinical events after an ischemic stroke. Direct oral anticoagulants (DOAC) are prescribed for secondary prevention. Adherence to DOAC is crucial mainly because of their short elimination half-life. Non-adherence to DOAC can negatively impact patients' outcomes. The relationship between (non-)adherence and recurrent clinical events is unknown in AF patients after initial stroke. We investigated adherence to DOAC in stroke survivors with AF who were included in the MAAESTRO study at the University Hospital Basel, Switzerland, between 2008 and 2022. Methods: This study is a secondary analysis of data from MAAESTRO with a matched nested case-control design and 1:2 ratio. DOAC intake was measured with a small electronic device (Time4Med
TM ). We defined two arbitrary intervals of 17 days and 95 days as the longest time spans with electronic monitoring data per patient to maximize the number of participants with adequate amount of observation time available for analysis. Taking and timing adherence were calculated retrospectively i.e., prior to the recurrent event for cases. Trendline analysis of adherence over 95 days was calculated. Linear regression analysis was performed after adjusting for the co-variables age and daily pill burden. Sensitivity analysis was performed with controls for intervals in the reverse direction (prospectively). Results: We analyzed 11 cases and 22 matched controls (mean age: 75.9 ± 9.2 years vs. 73.1 ± 8.4 years; n.s.) with similar stroke characteristics (NIHSS, mRS, MoCA) and 36.4% women in each group. Mean adherence values were high and similar between cases and controls (95 days taking: 87.0 ± 18.9% (cases) vs. 90.8 ± 9.8% (controls), n.s.; similar values for timing adherence). Six hemorrhagic and five ischemic events had occurred. Compared to controls, a significantly higher 95 days taking adherence was observed for hemorrhagic events (96.0 ± 5.0% (cases) vs. 88.1 ± 11.5% (controls); p<0.01) and a significantly lower 95 days taking adherence was observed for ischemic events (75.7 ± 24.8% (cases) vs. 94.2 ± 6.2% (controls), p = 0.024). Values for timing adherence were similar. A non-significant downward linear trend of adherence was observed over 95 days independently of the clinical events. The sensitivity analysis showed that the direction of the interval had negligible impact on the 95 days adherence. Conclusion: Because recurrent ischemic events after an AF-related stroke were associated with low adherence to DOAC <76%, adherence enhancing interventions seem crucial in anticoagulated AF-patients. However, AF-patients with high adherence might benefit from a regular re-assessment of the bleeding risk as hemorrhagic complications were associated with adherence to DOAC >96%. Trial registration: ClinicalTrials.gov NCT03344146. [ABSTRACT FROM AUTHOR]- Published
- 2024
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20. Intake reminders are effective in enhancing adherence to direct oral anticoagulants in stroke patients: a randomised cross-over trial (MAAESTRO study)
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Dietrich, Fine, primary, Polymeris, Alexandros A., additional, Albert, Valerie, additional, Engelter, Stefan T., additional, Hersberger, Kurt E., additional, Schaedelin, Sabine, additional, Lyrer, Philippe A., additional, and Arnet, Isabelle, additional
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- 2023
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21. Mechanical Thrombectomy Versus Best Medical Treatment in the Late Time Window in Non-DEFUSE-Non-DAWN Patients: A Multicenter Cohort Study
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Tolga D. Dittrich, Peter B. Sporns, Lilian F. Kriemler, Salome Rudin, Anh Nguyen, Annaelle Zietz, Alexandros A. Polymeris, Christopher Tränka, Sebastian Thilemann, Benjamin Wagner, Valerian L. Altersberger, Ines Piot, Filip Barinka, Susanne Müller, Martin Hänsel, Henrik Gensicke, Stefan T. Engelter, Philippe A. Lyrer, Raoul Sutter, Christian H. Nickel, Mira Katan, Nils Peters, Zsolt Kulcsár, Grzegorz M. Karwacki, Marco Pileggi, Carlo Cereda, Susanne Wegener, Leo H. Bonati, Urs Fischer, Marios Psychogios, and Gian Marco De Marchis
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Advanced and Specialized Nursing ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine - Abstract
Background: We assessed the efficacy and safety of mechanical thrombectomy (MT) in adult stroke patients with anterior circulation large vessel occlusion presenting in the late time window not fulfilling the DEFUSE-3 (Thrombectomy for Stroke at 6 to 16 Hours With Selection by Perfusion Imaging trial) and DAWN (Thrombectomy 6 to 24 Hours After Stroke With a Mismatch Between Deficit and Infarct trial) inclusion criteria. Methods: Cohort study of adults with anterior circulation large vessel occlusion admitted between 6 and 24 hours after last-seen-well at 5 participating Swiss stroke centers between 2014 and 2021. Mismatch was assessed by computer tomography or magnetic resonance imaging perfusion with automated software (RAPID or OLEA). We excluded patients meeting DEFUSE-3 and DAWN inclusion criteria and compared those who underwent MT with those receiving best medical treatment alone by inverse probability of treatment weighting using the propensity score. The primary efficacy end point was a favorable functional outcome at 90 days, defined as a modified Rankin Scale score shift toward lower categories. The primary safety end point was symptomatic intracranial hemorrhage within 7 days of stroke onset; the secondary was all-cause mortality within 90 days. Results: Among 278 patients with anterior circulation large vessel occlusion presenting in the late time window, 190 (68%) did not meet the DEFUSE-3 and DAWN inclusion criteria and thus were included in the analyses. Of those, 102 (54%) received MT. In the inverse probability of treatment weighting analysis, patients in the MT group had higher odds of favorable outcomes compared with the best medical treatment alone group (modified Rankin Scale shift: acOR, 1.46 [1.02–2.10]; P =0.04) and lower odds of all-cause mortality within 90 days (aOR, 0.59 [0.37–0.93]; P =0.02). There were no significant differences in symptomatic intracranial hemorrhage (MT versus best medical treatment alone: 5% versus 2%, P =0.63). Conclusions: Two out of 3 patients with anterior circulation large vessel occlusion presenting in the late time window did not meet the DEFUSE-3 and DAWN inclusion criteria. In these patients, MT was associated with higher odds of favorable functional outcomes without increased rates of symptomatic intracranial hemorrhage. These findings support the enrollment of patients into ongoing randomized trials on MT in the late window with more permissive inclusion criteria.
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- 2023
22. Challenges of treatment adherence with direct oral anticoagulants in pandemic
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Dittrich, Tolga, Polymeris, Alexandros, and De Marchis, Gian Marco
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- 2021
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23. Stroke Risk and Antithrombotic Treatment During Follow-up of Patients With Ischemic Stroke and Cortical Superficial Siderosis
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Martí-Fàbregas, Joan, Camps-Renom, Pol, Best, Jonathan G, Ramos-Pachon, Anna, Guasch-Jiménez, Marina, Martinez-Domeño, Alejandro, Guisado-Alonso, Daniel, Gómez-Ansón, Beatriz M, Ambler, Gareth, Wilson, Duncan, Lee, Keon-Joo, Lim, Jae-Sung, Bae, Hee-Joon, Shiozawa, Masayuki, Koga, Masatoshi, Toyoda, Kazunori, Hennerici, Michael G, Chabriat, Hugues, Jouvent, Eric, Kwun Wong, Debbie Yuen, Mak, Henry, Lau, Kui Kai, Kim, Young Dae, Song, Tae-Jin, Heo, Ji-Hoe, Eppinger, Sebastian, Gattringer, Thomas, Uysal, Ender, Demirelli, Derya Selçuk, Bornstein, Natan, Ben Assayag, Einor, Hallevi, Hen, Molad, Jeremy A, Nishihara, Masashi, Tanaka, Jun, Hara, Hideo, Yakushiji, Yusuke, Coutts, Shelagh B, Smith, Eric, Polymeris, Alexandros A, Wagner, Benjamin, Seiffge, David, Lyrer, Philippe A, Peters, Nils, Engelter, Stefan T, Al-Shahi Salman, Rustam, Jäger, Hans Rudolf, Lip, Gregory Y H, Goeldlin, Martina, Panos, Leonidas, Karayiannis, Christopher Charles, Phan, Thanh G, Srikanth, Velandai K, Christ, Nicolas, Gunkel, Sarah, Fluri, Felix, Leung, Thomas W, Soo, Yannie O Y, Chu, Winnie, Abrigo, Jill, Barbato, Carmen, Browning, Simone, Simister, Robert, Mendyk, Anne-Marie, Bordet, Régis, Hilal, Saima, Gyanwali, Bibek, Chen, Christopher, Jung, Simon, Orken, Dilek Necioglu, Werring, David, and Prats-Sanchez, Luis
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HEMORRHAGE ,Neurology (clinical) ,610 Medizin und Gesundheit ,CEREBRAL AMYLOID ANGIOPATHY ,PREVALENCE ,Research Article - Abstract
Background and ObjectivesIn patients with ischemic stroke (IS) or transient ischemic attack (TIA) and cortical superficial siderosis (cSS), there are few data regarding the risk of future cerebrovascular events and also about the benefits and safety of antithrombotic drugs for secondary prevention. We investigated the associations of cSS and stroke risk in patients with recent IS or TIA.MethodsWe retrospectively analyzed the Microbleeds International Collaborative Network (MICON) database. We selected patients with IS or TIA from cohorts who had MRI-assessed cSS, available data on antithrombotic treatments, recurrent cerebrovascular events (intracranial hemorrhage [ICrH], IS, or any stroke [ICrH or IS]), and mortality. We calculated incidence rates (IRs) and performed univariable and multivariable Cox regression analyses.ResultsOf 12,669 patients (mean age 70.4 ± 12.3 years, 57.3% men), cSS was detected in 273 (2.2%) patients. During a mean follow-up of 24 ± 17 months, IS was more frequent than ICrH in both cSS (IR 57.1 vs 14.6 per 1,000 patient-years) and non-cSS (33.7 vs 6.3 per 1,000 patient-years) groups. Compared with the non-cSS group, cSS was associated with any stroke on multivariable analysis {IR 83 vs 42 per 1,000 patient-years, adjusted hazard ratio [HR] for cSS 1.62 (95% CI: 1.14–2.28;p= 0.006)}. This association was not significant in subgroups of patients treated with antiplatelet drugs (n = 6,554) or with anticoagulants (n = 4,044). Patients with cSS who were treated with both antiplatelet drugs and anticoagulants (n = 1,569) had a higher incidence of ICrH (IR 107.5 vs 4.9 per 1,000 patient-years, adjusted HR 13.26; 95% CI: 2.90–60.63;p= 0.001) and of any stroke (IR 198.8 vs 34.7 per 1,000 patient-years, adjusted HR 5.03; 95% CI: 2.03–12.44;p< 0.001) compared with the non-cSS group.DiscussionPatients with IS or TIA with cSS are at increased risk of stroke (ICrH or IS) during follow-up; the risk of IS exceeds that of ICrH for patients receiving antiplatelet or anticoagulant treatment alone, but the risk of ICrH exceeds that of IS in patients receiving both treatments. The findings suggest that either antiplatelet or anticoagulant treatment alone should not be avoided in patients with cSS, but combined antithrombotic therapy might be hazardous. Our findings need to be confirmed by randomized clinical trials.
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- 2022
24. Global Cortical Atrophy Is Associated with an Unfavorable Outcome in Stroke Patients on Oral Anticoagulation
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Marta Kubacka, Annaelle Zietz, Sabine Schaedelin, Alexandros A. Polymeris, Lisa Hert, Johanna Lieb, Benjamin Wagner, David Seiffge, Christopher Traenka, Valerian L. Altersberger, Tolga Dittrich, Joachim Fladt, Urs Fisch, Sebastian Thilemann, Gian Marco De Marchis, Henrik Gensicke, Leo H. Bonati, Philippe Lyrer, Stefan T. Engelter, and Nils Peters
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Neurology ,610 Medicine & health ,Neurology (clinical) ,610 Medizin und Gesundheit ,Cardiology and Cardiovascular Medicine - Abstract
Introduction: Measures of cerebral small vessel disease (cSVD), such as white matter hyperintensities (WMH) and cerebral microbleeds (CMB), are associated with an unfavorable clinical course in stroke patients on oral anticoagulation (OAC) for atrial fibrillation (AF). Here, we investigated whether similar findings can be observed for global cortical atrophy (GCA). Methods: Registry-based prospective observational study of 320 patients treated with OAC following AF stroke. Patients underwent magnetic resonance imaging (MRI) allowing assessment of GCA. Using the simplified visual Pasquier scale, the severity of GCA was categorized as follows: 0: no atrophy, 1: mild atrophy; 2: moderate atrophy, and 3: severe atrophy. Using adjusted logistic and Cox regression analysis, we investigated the association of GCA using a composite outcome measure, comprising: (i) recurrent acute ischemic stroke (IS); (ii) intracranial hemorrhage (ICH); and (iii) death. Results: In our time to event analysis after adjusting for potential confounders (i.e., WMH, CMB, age, sex, diabetes, arterial hypertension, coronary heart disease, hyperlipidemia, and antiplatelet use), GCA was associated with an increased risk for the composite outcome in all three degrees of atrophy (grade 1: aHR 3.95, 95% CI 1.34–11.63, p = 0.013; grade 2: aHR 3.89, 95% CI 1.23–12.30, p = 0.021; grade 3: aHR 4.16, 95% CI 1.17–14.84, p = 0.028). Conclusion: GCA was associated with our composite outcome also after adjusting for other cSVD markers (i.e., CMB, WMH) and age, indicating that GCA may potentially serve as a prognostic marker for stroke patients with atrial fibrillation on oral anticoagulation.
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- 2022
25. Anticoagulation in acute ischemic stroke patients with mechanical heart valves: To bridge or not with heparin. The ESTREM study
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Paciaroni, Maurizio, primary, Caso, Valeria, additional, Romoli, Michele, additional, Becattini, Cecilia, additional, Salerno, Alexander, additional, Rapillo, Costanza, additional, Simonnet, Fanny, additional, Strambo, Davide, additional, Canavero, Isabella, additional, Zedde, Marialuisa, additional, Pascarella, Rosario, additional, Sohn, Sung-Il, additional, Sacco, Simona, additional, Ornello, Raffaele, additional, Barlinn, Kristian, additional, Schoene, Daniela, additional, Rahmig, Jan, additional, Mosconi, Maria Giulia, additional, Leone De Magistris, Ilaria, additional, Alberti, Andrea, additional, Venti, Michele, additional, Silvestrelli, Giorgio, additional, Ciccone, Alfonso, additional, Padroni, Marina, additional, Laudisi, Michele, additional, Zini, Andrea, additional, Gentile, Luana, additional, Kargiotis, Odysseas, additional, Tsivgoulis, Georgios, additional, Tassi, Rossana, additional, Guideri, Francesca, additional, Acampa, Maurizio, additional, Masotti, Luca, additional, Grifoni, Elisa, additional, Rocco, Alessandro, additional, Diomedi, Marina, additional, Karapanayiotides, Theodore, additional, Engelter, Stefan T, additional, Polymeris, Alexandros A, additional, Zietz, Annaelle, additional, Bandini, Fabio, additional, Caliandro, Pietro, additional, Reale, Giuseppe, additional, Moci, Marco, additional, Zauli, Aurelia, additional, Cappellari, Manuel, additional, Emiliani, Andrea, additional, Gasparro, Antonio, additional, Terruso, Valeria, additional, Mannino, Marina, additional, Giorli, Elisa, additional, Toni, Danilo, additional, Andrighetti, Marco, additional, Falcou, Anne, additional, Palaiodimou, Lina, additional, Ntaios, George, additional, Sagris, Dimitrios, additional, Karagkiozi, Efstathia, additional, Adamou, Anastasia, additional, Halvatsiotis, Panagiotis, additional, Flomin, Yuriy, additional, Scoditti, Umberto, additional, Genovese, Antonio, additional, Popovic, Nemanja, additional, Pantoni, Leonardo, additional, Mele, Francesco, additional, Molitierno, Nicola, additional, Lochner, Piergiorgio, additional, Pezzini, Alessandro, additional, Del Sette, Massimo, additional, Sassos, Davide, additional, Giannopoulos, Sotirios, additional, Kosmidou, Maria, additional, Ntais, Evangelos, additional, Lotti, Enrico Maria, additional, Mastrangelo, Vincenzo, additional, Chiti, Alberto, additional, Naldi, Andrea, additional, Vanacker, Peter, additional, Ferrante, Mario, additional, Volodina, Vera, additional, Mancuso, Michelangelo, additional, Giannini, Nicola, additional, Baldini, Marco, additional, Vadikolias, Kostantinos, additional, Kitmeridou, Sofia, additional, Saggese, Carlo Emanuele, additional, Tassinari, Tiziana, additional, Saia, Valentina, additional, and Michel, Patrik, additional
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- 2023
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26. The impact of competing stroke etiologies in patients with atrial fibrillation
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Zietz, Annaelle, primary, Polymeris, Alexandros A, additional, Helfenstein, Fabrice, additional, Schaedelin, Sabine, additional, Hert, Lisa, additional, Wagner, Benjamin, additional, Seiffge, David J, additional, Traenka, Christopher, additional, Altersberger, Valerian L, additional, Dittrich, Tolga, additional, Kaufmann, Josefin, additional, Ravanelli, Flavia, additional, Fladt, Joachim, additional, Fisch, Urs, additional, Thilemann, Sebastian, additional, De Marchis, Gian Marco, additional, Gensicke, Henrik, additional, Bonati, Leo H, additional, Katan, Mira, additional, Fischer, Urs, additional, Lyrer, Philippe, additional, Engelter, Stefan T, additional, and Peters, Nils, additional
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- 2023
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27. Association of prestroke metformin use, stroke severity, and thrombolysis outcome
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Westphal, Laura P., Widmer, Roni, Held, Ulrike, Steigmiller, Klaus, Hametner, Christian, Ringleb, Peter, Curtze, Sami, Martinez-Majander, Nicolas, Tiainen, Marjaana, Nolte, Christian H., Scheitz, Jan F., Erdur, Hebun, Polymeris, Alexandros A., Traenka, Christopher, Eskandari, Ashraf, Michel, Patrik, Heldner, Mirjam R., Arnold, Marcel, Zini, Andrea, Vandelli, Laura, Coutinho, Jonathan M., Groot, Adrien E., Padjen, Visnja, Jovanovic, Dejana R., Bejot, Yannick, Brenière, Céline, Turc, Guillaume, Seners, Pierre, Pezzini, Alessandro, Magoni, Mauro, Leys, Didier, Gilliot, Sixtine, Scherrer, Michael J., Kägi, Georg, Luft, Andreas R., Gensicke, Henrik, Nederkoorn, Paul, Tatlisumak, Turgut, Engelter, Stefan T., and Wegener, Susanne
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- 2020
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28. Artery occlusion independently predicts unfavorable outcome in cervical artery dissection
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Traenka, Christopher, Grond-Ginsbach, Caspar, Goeggel Simonetti, Barbara, Metso, Tiina M., Debette, Stéphanie, Pezzini, Alessandro, Kloss, Manja, Majersik, Jennifer J., Southerland, Andrew M., Leys, Didier, Baumgartner, Ralf, Caso, Valeria, Béjot, Yannick, De Marchis, Gian Marco, Fischer, Urs, Polymeris, Alexandros, Sarikaya, Hakan, Thijs, Vincent, Worrall, Bradford B., Bersano, Anna, Brandt, Tobias, Gensicke, Henrik, Bonati, Leo H., Touzeé, Emmanuel, Martin, Juan J., Chabriat, Hugues, Tatlisumak, Turgut, Arnold, Marcel, Engelter, Stefan T., and Lyrer, Philippe
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- 2020
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29. The impact of competing stroke etiologies in patients with atrial fibrillation
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Zietz, Annaelle, Polymeris, Alexandros A, Helfenstein, Fabrice, Schaedelin, Sabine, Hert, Lisa, Wagner, Benjamin, Seiffge, David J, Traenka, Christopher, Altersberger, Valerian L, Dittrich, Tolga, Kaufmann, Josefin, Ravanelli, Flavia, Fladt, Joachim, Fisch, Urs, Thilemann, Sebastian, De Marchis, Gian Marco, Gensicke, Henrik, Bonati, Leo H, Katan, Mira, Fischer, Urs, Lyrer, Philippe, Engelter, Stefan T, and Peters, Nils
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610 Medicine & health - Abstract
BACKGROUND Data on the impact of competing stroke etiologies in stroke patients with atrial fibrillation (AF) are scarce. METHODS We used prospectively obtained data from an observational registry (Novel-Oral-Anticoagulants-in-Ischemic-Stroke-Patients-(NOACISP)-LONGTERM) of consecutive AF-stroke patients treated with oral anticoagulants. We compared the frequency of (i) the composite outcome of recurrent ischemic stroke (IS), intracerebral hemorrhage (ICH) or all-cause death as well as (ii) recurrent IS alone among AF-stroke patients with versus without competing stroke etiologies according to the TOAST classification. We performed cox proportional hazards regression modeling adjusted for potential confounders. Furthermore, the etiology of recurrent IS was assessed. RESULTS Among 907 patients (median age 81, 45.6% female), 184 patients (20.3%) had competing etiologies, while 723 (79.7%) had cardioembolism as the only plausible etiology. During 1587 patient-years of follow-up, patients with additional large-artery atherosclerosis had higher rates of the composite outcome (adjusted HR [95% CI] 1.64 [1.11, 2.40], p = 0.017) and recurrent IS (aHR 2.96 [1.65, 5.35 ], p
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- 2023
30. Transient focal neurologic deficits upon hematopoietic stem cell transplantation: just a coincidence?
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Polymeris, Alexandros A., Stehle, Gregor T., Medinger, Michael, and De Marchis, Gian Marco
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- 2019
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31. Intravenous Thrombolysis in Patients with Stroke Taking Rivaroxaban Using Drug Specific Plasma Levels: Experience with a Standard Operation Procedure in Clinical Practice
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David J. Seiffge, Christopher Traenka, Alexandros A. Polymeris, Sebastian Thilemann, Benjamin Wagner, Lisa Hert, Mandy D. Müller, Henrik Gensicke, Nils Peters, Christian H. Nickel, Christoph Stippich, Raoul Sutter, Stephan Marsch, Urs Fisch, Raphael Guzman, Gian Marco De Marchis, Philippe A. Lyrer, Leo H. Bonati, Dimitrios A. Tsakiris, and Stefan T. Engelter
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rivaroxaban ,stroke ,plasma levels ,thrombolysis ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background and Purpose Standard operating procedures (SOP) incorporating plasma levels of rivaroxaban might be helpful in selecting patients with acute ischemic stroke taking rivaroxaban suitable for IVthrombolysis (IVT) or endovascular treatment (EVT). Methods This was a single-center explorative analysis using data from the Novel-Oral-Anticoagulants-in-Stroke-Patients-registry (clinicaltrials.gov:NCT02353585) including acute stroke patients taking rivaroxaban (September 2012 to November 2016). The SOP included recommendation, consideration, and avoidance of IVT if rivaroxaban plasma levels were 100 ng/mL, respectively, measured with a calibrated anti-factor Xa assay. Patients with intracranial artery occlusion were recommended IVT+EVT or EVT alone if plasma levels were ≤100 ng/mL or >100 ng/mL, respectively. We evaluated the frequency of IVT/EVT, door-to-needle-time (DNT), and symptomatic intracranial or major extracranial hemorrhage. Results Among 114 acute stroke patients taking rivaroxaban, 68 were otherwise eligible for IVT/EVT of whom 63 had plasma levels measured (median age 81 years, median baseline National Institutes of Health Stroke Scale 6). Median rivaroxaban plasma level was 96 ng/mL (inter quartile range [IQR] 18‒259 ng/mL) and time since last intake 11 hours (IQR 4.5‒18.5 hours). Twenty-two patients (35%) received IVT/EVT (IVT n=15, IVT+EVT n=3, EVT n=4) based on SOP. Median DNT was 37 (IQR 30‒60) minutes. None of the 31 patients with plasma levels >100 ng/mL received IVT. Among 14 patients with plasma levels ≤100 ng/mL, the main reason to withhold IVT was minor stroke (n=10). No symptomatic intracranial or major extracranial bleeding occurred after treatment. Conclusions Determination of rivaroxaban plasma levels enabled IVT or EVT in one-third of patients taking rivaroxaban who would otherwise be ineligible for acute treatment. The absence of major bleeding in our pilot series justifies future studies of this approach.
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- 2017
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32. Practical '1-2-3-4-Day' Rule for Starting Direct Oral Anticoagulants After Ischemic Stroke With Atrial Fibrillation: Combined Hospital-Based Cohort Study
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Shunsuke Kimura, Kazunori Toyoda, Sohei Yoshimura, Kazuo Minematsu, Masahiro Yasaka, Maurizio Paciaroni, David J. Werring, Hiroshi Yamagami, Takehiko Nagao, Shinichi Yoshimura, Alexandros Polymeris, Annaelle Zietz, Stefan T. Engelter, Bernd Kallmünzer, Manuel Cappellari, Tetsuya Chiba, Takeshi Yoshimoto, Masayuki Shiozawa, Takanari Kitazono, Masatoshi Koga, Kenichi Todo, Kazumi Kimura, Yoshiki Yagita, Eisuke Furui, Ryo Itabashi, Tadashi Terasaki, Yoshiaki Shiokawa, Teruyuki Hirano, Kenji Kamiyama, Jyoji Nakagawara, Shunya Takizawa, Kazunari Homma, Satoshi Okuda, Yasushi Okada, Keisuke Tokunaga, Tomoaki Kameda, Kazuomi Kario, Yoshinari Nagakane, Yasuhiro Hasegawa, Hisanao Akiyama, Satoshi Shibuya, Hiroshi Mochizuki, Yasuhiro Ito, Takahiro Nakashima, Hideki Matsuoka, Kazuhiro Takamatsu, Kazutoshi Nishiyama, Shoichiro Sato, Shoji Arihiro, Manabu Inoue, Masahito Takagi, Kanta Tanaka, Kazuyuki Nagatsuka, Takenori Yamaguchi, Yoichiro Hashimoto, Kiyohiro Houkin, Kazuo Kitagawa, Masayasu Matsumoto, Norio Tanahashi, Yasuo Terayama, Shinichiro Uchiyama, Etsuro Mori, Yutaka Furukawa, Takeshi Kimura, Yoshiaki Kumon, Ken Nagata, Shigeru Nogawa, Tomohiro Sakamoto, Toshinori Hirai, Kohsuke Kudo, Makoto Sasaki, Shotai Kobayashi, Toshimitsu Hamasaki, Michela Giustozzi, Monica Acciarresi, Giancarlo Agnelli, Valeria Caso, Fabio Bandini, Georgios Tsivgoulis, Shadi Yaghi, Karen L. Furie, Prasanna Tadi, Cecilia Becattini, Marialuisa Zedde, Azmil H Abdul-Rahim, Kennedy R Lees, Andrea Alberti, Michele Venti, Cataldo D’Amore, Maria Giulia Mosconi, Ludovica Anna Cimini, Paolo Bovi, Monica Carletti, Alberto Rigatelli, Jukka Putaala, Liisa Tomppo, Turgut Tatlisumak, Simona Marcheselli, Alessandro Pezzini, Loris Poli, Alessandro Padovani, Vieri Vannucchi, Sung-Il Sohn, Gianni Lorenzini, Rossana Tassi, Francesca Guideri, Maurizio Acampa, Giuseppe Martini, George Ntaios, George Athanasakis, Konstantinos Makaritsis, Efstathia Karagkiozi, Konstantinos Vadikolias, Chrissoula Liantinioti, Maria Chondrogianni, Nicola Mumoli, Franco Galati, Simona Sacco, Cindy Tiseo, Francesco Corea, Walter Ageno, Marta Bellesini, Giovanna Colombo, Giorgio Silvestrelli, Alfonso Ciccone, Alessia Lanari, Umberto Scoditti, Licia Denti, Michelangelo Mancuso, Miriam Maccarrone, Leonardo Ulivi, Giovanni Orlandi, Nicola Giannini, Tiziana Tassinari, Maria Luisa De Lodovici, Christina Rueckert, Antonio Baldi, Danilo Toni, Federica Letteri, Martina Giuntini, Enrico Maria Lotti, Yuriy Flomin, Alessio Pieroni, Odysseas Kargiotis, Theodore Karapanayiotides, Serena Monaco, Mario Maimone Baronello, Laszló Csiba, Lilla Szabó, Alberto Chiti, Elisa Giorli, Massimo Del Sette, Davide Imberti, Dorjan Zabzuni, Boris Doronin, Vera Volodina, Patrik Michel, Peter Vanacker, Kristian Barlinn, Lars-Peder Pallesen, Jessica Barlinn, Dirk Deleu, Gayane Melikyan, Faisal Ibrahim, Naveed Akhtar, Vanessa Gourbali, Luca Masotti, Adrian Parry-Jones, Chris Patterson, Christopher Price, Abduelbaset Elmarimi, Anthea Parry, Arumug Nallasivam, Azlisham Mohd Nor, Bernard Esis, David Bruce, Christine Roffe, Clare Holmes, David Cohen, David Hargroves, David Mangion, Dinesh Chadha, Djamil Vahidassr, Dulka Manawadu, Elio Giallombardo, Elizabeth Warburton, Enrico Flossman, Gunaratam Gunathilagan, Harald Proschel, Hedley Emsley, Ijaz Anwar, James Okwera, Janet Putterill, Janice O’Connell, John Bamford, John Corrigan, Jon Scott, Jonathan Birns, Karen Kee, Kari Saastamoinen, Kath Pasco, Krishna Dani, Lakshmanan Sekaran, Lillian Choy, Liz Iveson, Maam Mamun, Mahmud Sajid, Martin Cooper, Matthew Burn, Matthew Smith, Michael Power, Michelle Davis, Nigel Smyth, Roland Veltkamp, Pankaj Sharma, Paul Guyler, Paul O’Mahony, Peter Wilkinson, Prabel Datta, Prasanna Aghoram, Rachel Marsh, Robert Luder, Sanjeevikumar Meenakishundaram, Santhosh Subramonian, Simon Leach, Sissi Ispoglou, Sreeman Andole, Timothy England, Aravindakshan Manoj, Frances Harrington, Habib Rehman, Jane Sword, Julie Staals, Karim Mahawish, Kirsty Harkness, Louise Shaw, Michael McCormich, Nikola Sprigg, Syed Mansoor, Vinodh Krishnamurthy, Philippe A Lyrer, Leo H Bonati, David J Seiffge, Christopher Traenka, Nils Peters, Gian Marco De Marchis, Sebastian Thilemann, Nikolaos S Avramiotis, Henrik Gensicke, Lisa Hert, Benjamin Wagner, Fabian Schaub, Louisa Meya, Joachim Fladt, Tolga Dittrich, Urs Fisch, Bruno Bonetti, Giampaolo Tomelleri, Nicola Micheletti, Cecilia Zivelonghi, Andrea Emiliani, Kosmas Macha, Gabriela Siedler, Svenja Stoll, Ruihao Wang, Bastian Volbers, Stefan Schwab, David Haupenthal, and Luise Gaßmann
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Advanced and Specialized Nursing ,acute ischemic stroke ,Time Factors ,Administration, Oral ,Anticoagulants ,Hemorrhage ,cardioembolism ,Hospitals ,United States ,Brain Ischemia ,anticoagulation ,atrial fibrillation ,stroke prevention ,Cohort Studies ,Stroke ,Treatment Outcome ,Ischemic Attack, Transient ,Atrial Fibrillation ,Humans ,Prospective Studies ,Neurology (clinical) ,Cardiology and Cardiovascular Medicine ,Ischemic Stroke - Abstract
Background: The “1-3-6-12-day rule” for starting direct oral anticoagulants (DOACs) in patients with nonvalvular atrial fibrillation after acute ischemic stroke or transient ischemic attack recommends timings that may be later than used in clinical practice. We investigated more practical optimal timing of DOAC initiation according to stroke severity. Methods: The combined data of prospective registries in Japan, Stroke Acute Management with Urgent Risk-factor Assessment and Improvement-nonvalvular atrial fibrillation (September 2011 to March 2014) and RELAXED (February 2014 to April 2016) were used. Patients were divided into transient ischemic attack and 3 stroke subgroups by the National Institutes of Health Stroke Scale score: mild (0–7), moderate (8–15), and severe (≥16). The early treatment group was defined as patients starting DOACs earlier than the median initiation day in each subgroup. Outcomes included a composite of recurrent stroke or systemic embolism, ischemic stroke, and severe bleeding within 90 days. Six European prospective registries were used for validation. Results: In the 1797 derivation cohort patients, DOACs were started at median 2 days after transient ischemic attack and 3, 4, and 5 days after mild, moderate, and severe strokes, respectively. Stroke or systemic embolism was less common in Early Group (n=785)—initiating DOACS within 1, 2, 3, and 4 days, respectively—than Late Group (n=1012) (1.9% versus 3.9%; adjusted hazard ratio, 0.50 [95% CI, 0.27–0.89]), as was ischemic stroke (1.7% versus 3.2%, 0.54 [0.27–0.999]). Major bleeding was similarly common in the 2 groups (0.8% versus 1.0%). On validation, both ischemic stroke (2.4% versus 2.2%) and intracranial hemorrhage (0.2% versus 0.6%) were similarly common in Early (n=547) and Late (n=1483) Groups defined using derivation data. Conclusions: In Japanese and European populations, early DOAC initiation within 1, 2, 3, or 4 days according to stroke severity seemed to be feasible to decrease the risk of recurrent stroke or systemic embolism and no increase in major bleeding. These findings support ongoing randomized trials to better establish the optimal timing of DOAC initiation.
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- 2022
33. Tranexamic Acid for Intracerebral Hemorrhage in Patients on Non-Vitamin K Antagonist Oral Anticoagulants (TICH-NOAC): A Multicenter, Randomized, Placebo-Controlled, Phase 2 Trial
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Polymeris, Alexandros A; https://orcid.org/0000-0002-9475-2208, Karwacki, Grzegorz M; https://orcid.org/0000-0001-5963-6220, Siepen, Bernhard M; https://orcid.org/0000-0003-0240-4191, Schaedelin, Sabine, Tsakiris, Dimitrios A; https://orcid.org/0009-0009-3135-4630, Stippich, Christoph, Guzman, Raphael, Nickel, Christian H; https://orcid.org/0000-0001-6619-9284, Sprigg, Nikola; https://orcid.org/0000-0002-5871-8168, Kägi, Georg; https://orcid.org/0000-0001-7749-8060, Vehoff, Jochen; https://orcid.org/0000-0001-9531-8262, Barinka, Filip; https://orcid.org/0000-0002-5823-0656, Thilemann, Sebastian; https://orcid.org/0000-0002-2735-0794, Maurer, Marina, Wagner, Benjamin; https://orcid.org/0000-0001-9330-1790, Traenka, Christopher; https://orcid.org/0000-0002-7600-1005, Gensicke, Henrik; https://orcid.org/0000-0002-0949-2422, De Marchis, Gian Marco; https://orcid.org/0000-0002-0342-9780, Bonati, Leo H; https://orcid.org/0000-0003-1163-8133, Fischer, Urs; https://orcid.org/0000-0003-0521-4051, Z'Graggen, Werner J; https://orcid.org/0000-0002-5684-4419, Nedeltchev, Krassen, Wegener, Susanne; https://orcid.org/0000-0003-4369-7023, Baumgartner, Philipp; https://orcid.org/0000-0003-1525-2019, Engelter, Stefan T; https://orcid.org/0000-0003-3855-6234, Seiffge, David J; https://orcid.org/0000-0003-3890-3849, Peters, Nils; https://orcid.org/0000-0001-8451-7389, Lyrer, Philippe A; https://orcid.org/0000-0002-1435-1114, TICH-NOAC Investigators, Polymeris, Alexandros A; https://orcid.org/0000-0002-9475-2208, Karwacki, Grzegorz M; https://orcid.org/0000-0001-5963-6220, Siepen, Bernhard M; https://orcid.org/0000-0003-0240-4191, Schaedelin, Sabine, Tsakiris, Dimitrios A; https://orcid.org/0009-0009-3135-4630, Stippich, Christoph, Guzman, Raphael, Nickel, Christian H; https://orcid.org/0000-0001-6619-9284, Sprigg, Nikola; https://orcid.org/0000-0002-5871-8168, Kägi, Georg; https://orcid.org/0000-0001-7749-8060, Vehoff, Jochen; https://orcid.org/0000-0001-9531-8262, Barinka, Filip; https://orcid.org/0000-0002-5823-0656, Thilemann, Sebastian; https://orcid.org/0000-0002-2735-0794, Maurer, Marina, Wagner, Benjamin; https://orcid.org/0000-0001-9330-1790, Traenka, Christopher; https://orcid.org/0000-0002-7600-1005, Gensicke, Henrik; https://orcid.org/0000-0002-0949-2422, De Marchis, Gian Marco; https://orcid.org/0000-0002-0342-9780, Bonati, Leo H; https://orcid.org/0000-0003-1163-8133, Fischer, Urs; https://orcid.org/0000-0003-0521-4051, Z'Graggen, Werner J; https://orcid.org/0000-0002-5684-4419, Nedeltchev, Krassen, Wegener, Susanne; https://orcid.org/0000-0003-4369-7023, Baumgartner, Philipp; https://orcid.org/0000-0003-1525-2019, Engelter, Stefan T; https://orcid.org/0000-0003-3855-6234, Seiffge, David J; https://orcid.org/0000-0003-3890-3849, Peters, Nils; https://orcid.org/0000-0001-8451-7389, Lyrer, Philippe A; https://orcid.org/0000-0002-1435-1114, and TICH-NOAC Investigators
- Abstract
BACKGROUND: Evidence-based hemostatic treatment for intracerebral hemorrhage (ICH) associated with non-vitamin K antagonist oral anticoagulants (NOACs) is lacking. Tranexamic acid (TXA) is an antifibrinolytic drug potentially limiting hematoma expansion. We aimed to assess the efficacy and safety of TXA in NOAC-ICH. METHODS: We performed a double-blind, randomized, placebo-controlled trial at 6 Swiss stroke centers. Patients with NOAC-ICH within 12 hours of symptom onset and 48 hours of last NOAC intake were randomized (1:1) to receive either intravenous TXA (1 g over 10 minutes followed by 1 g over 8 hours) or matching placebo in addition to standard medical care via a centralized Web-based procedure with minimization on key prognostic factors. All participants and investigators were masked to treatment allocation. Primary outcome was hematoma expansion, defined as ≥33% relative or ≥6 mL absolute volume increase at 24 hours and analyzed using logistic regression adjusted for baseline hematoma volume on an intention-to-treat basis. RESULTS: Between December 12, 2016, and September 30, 2021, we randomized 63 patients (median age, 82 years [interquartile range, 76-86]; 40% women; median hematoma volume, 11.5 [4.8-27.4] mL) of the 109 intended sample size before premature trial discontinuation due to exhausted funding. The primary outcome did not differ between TXA (n=32) and placebo (n=31) arms (12 [38%] versus 14 [45%]; adjusted odds ratio, 0.63 [95% CI, 0.22-1.82]; P=0.40). There was a signal for interaction with onset-to-treatment time (P$_{interaction}$=0.024), favoring TXA when administered within 6 hours of symptom onset. Between the TXA and placebo arms, the proportion of participants who died (15 [47%] versus 13 [42%]; adjusted odds ratio, 1.07 [0.37-3.04]; P=0.91) or had major thromboembolic complications within 90 days (4 [13%] versus 2 [6%]; odds ratio, 1.86 [0.37-9.50]; P=0.45) did not differ. All thromboembolic events occurred at least 2 weeks after study
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- 2023
34. Mechanical Thrombectomy Versus Best Medical Treatment in the Late Time Window in Non-DEFUSE-Non-DAWN Patients: A Multicenter Cohort Study
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Dittrich, Tolga D; https://orcid.org/0000-0002-9987-3631, Sporns, Peter B; https://orcid.org/0000-0002-3028-0539, Kriemler, Lilian F, Rudin, Salome, Nguyen, Anh; https://orcid.org/0000-0002-9343-8276, Zietz, Annaelle; https://orcid.org/0000-0002-4362-2497, Polymeris, Alexandros A; https://orcid.org/0000-0002-9475-2208, Tränka, Christopher, Thilemann, Sebastian; https://orcid.org/0000-0002-2735-0794, Wagner, Benjamin; https://orcid.org/0000-0001-9330-1790, Altersberger, Valerian L; https://orcid.org/0000-0002-0610-9328, Piot, Ines; https://orcid.org/0000-0001-8502-7453, Barinka, Filip; https://orcid.org/0000-0002-5823-0656, Müller, Susanne; https://orcid.org/0000-0002-5638-722X, Hänsel, Martin; https://orcid.org/0000-0001-9300-1130, Gensicke, Henrik; https://orcid.org/0000-0002-0949-2422, Engelter, Stefan T; https://orcid.org/0000-0003-3855-6234, Lyrer, Philippe A; https://orcid.org/0000-0002-1435-1114, Sutter, Raoul; https://orcid.org/0000-0002-6575-356X, Nickel, Christian H, Katan, Mira; https://orcid.org/0000-0002-9265-8066, Peters, Nils, Kulcsár, Zsolt; https://orcid.org/0000-0002-6805-5150, Karwacki, Grzegorz M; https://orcid.org/0000-0001-5963-6220, Pileggi, Marco; https://orcid.org/0000-0002-7691-8999, Cereda, Carlo; https://orcid.org/0000-0002-6479-1476, Wegener, Susanne; https://orcid.org/0000-0003-4369-7023, Bonati, Leo H; https://orcid.org/0000-0003-1163-8133, Fischer, Urs; https://orcid.org/0000-0003-0521-4051, Psychogios, Marios; https://orcid.org/0000-0002-0016-414X, et al, Dittrich, Tolga D; https://orcid.org/0000-0002-9987-3631, Sporns, Peter B; https://orcid.org/0000-0002-3028-0539, Kriemler, Lilian F, Rudin, Salome, Nguyen, Anh; https://orcid.org/0000-0002-9343-8276, Zietz, Annaelle; https://orcid.org/0000-0002-4362-2497, Polymeris, Alexandros A; https://orcid.org/0000-0002-9475-2208, Tränka, Christopher, Thilemann, Sebastian; https://orcid.org/0000-0002-2735-0794, Wagner, Benjamin; https://orcid.org/0000-0001-9330-1790, Altersberger, Valerian L; https://orcid.org/0000-0002-0610-9328, Piot, Ines; https://orcid.org/0000-0001-8502-7453, Barinka, Filip; https://orcid.org/0000-0002-5823-0656, Müller, Susanne; https://orcid.org/0000-0002-5638-722X, Hänsel, Martin; https://orcid.org/0000-0001-9300-1130, Gensicke, Henrik; https://orcid.org/0000-0002-0949-2422, Engelter, Stefan T; https://orcid.org/0000-0003-3855-6234, Lyrer, Philippe A; https://orcid.org/0000-0002-1435-1114, Sutter, Raoul; https://orcid.org/0000-0002-6575-356X, Nickel, Christian H, Katan, Mira; https://orcid.org/0000-0002-9265-8066, Peters, Nils, Kulcsár, Zsolt; https://orcid.org/0000-0002-6805-5150, Karwacki, Grzegorz M; https://orcid.org/0000-0001-5963-6220, Pileggi, Marco; https://orcid.org/0000-0002-7691-8999, Cereda, Carlo; https://orcid.org/0000-0002-6479-1476, Wegener, Susanne; https://orcid.org/0000-0003-4369-7023, Bonati, Leo H; https://orcid.org/0000-0003-1163-8133, Fischer, Urs; https://orcid.org/0000-0003-0521-4051, Psychogios, Marios; https://orcid.org/0000-0002-0016-414X, and et al
- Abstract
Background: We assessed the efficacy and safety of mechanical thrombectomy (MT) in adult stroke patients with anterior circulation large vessel occlusion presenting in the late time window not fulfilling the DEFUSE-3 (Thrombectomy for Stroke at 6 to 16 Hours With Selection by Perfusion Imaging trial) and DAWN (Thrombectomy 6 to 24 Hours After Stroke With a Mismatch Between Deficit and Infarct trial) inclusion criteria. Methods: Cohort study of adults with anterior circulation large vessel occlusion admitted between 6 and 24 hours after last-seen-well at 5 participating Swiss stroke centers between 2014 and 2021. Mismatch was assessed by computer tomography or magnetic resonance imaging perfusion with automated software (RAPID or OLEA). We excluded patients meeting DEFUSE-3 and DAWN inclusion criteria and compared those who underwent MT with those receiving best medical treatment alone by inverse probability of treatment weighting using the propensity score. The primary efficacy end point was a favorable functional outcome at 90 days, defined as a modified Rankin Scale score shift toward lower categories. The primary safety end point was symptomatic intracranial hemorrhage within 7 days of stroke onset; the secondary was all-cause mortality within 90 days. Results: Among 278 patients with anterior circulation large vessel occlusion presenting in the late time window, 190 (68%) did not meet the DEFUSE-3 and DAWN inclusion criteria and thus were included in the analyses. Of those, 102 (54%) received MT. In the inverse probability of treatment weighting analysis, patients in the MT group had higher odds of favorable outcomes compared with the best medical treatment alone group (modified Rankin Scale shift: acOR, 1.46 [1.02–2.10]; P=0.04) and lower odds of all-cause mortality within 90 days (aOR, 0.59 [0.37–0.93]; P=0.02). There were no significant differences in symptomatic intracranial hemorrhage (MT versus best medical treatment alone: 5% versus 2%, P=0.63). Conclusio
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- 2023
35. Reasons for Prehospital Delay in Acute Ischemic Stroke
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Joachim Fladt, Nicole Meier, Sebastian Thilemann, Alexandros Polymeris, Christopher Traenka, David J. Seiffge, Raoul Sutter, Nils Peters, Henrik Gensicke, Benjamin Flückiger, Kees de Hoogh, Nino Künzli, Bettina Bringolf‐Isler, Leo H. Bonati, Stefan T. Engelter, Philippe A. Lyrer, and Gian Marco De Marchis
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magnetic resonance imaging ,prehospital delay ,stroke, ischemic ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Prehospital delay reduces the proportion of patients with stroke treated with recanalization therapies. We aimed to identify novel and modifiable risk factors for prehospital delay. Methods and Results We included patients with an ischemic stroke confirmed by diffusion‐weighted magnetic resonance imaging, symptom onset within 24 hours and hospitalized in the Stroke Center of the University Hospital Basel, Switzerland. Trained study nurses interviewed patients and proxies along a standardized questionnaire. Prehospital delay was defined as >4.5 hours between stroke onset—or time point of wake‐up—and admission. Overall, 336 patients were enrolled. Prehospital delay was observed in 140 patients (42%). The first healthcare professionals to be alarmed were family doctors for 29% of patients (97/336), and a quarter of these patients had a baseline National Institute of Health Stroke Scale score of 4 or higher. The main modifiable risk factor for prehospital delay was a face‐to‐face visit to the family doctor (adjusted odds ratio, 4.19; 95% CI, 1.85–9.46). Despite transport by emergency medical services being associated with less prehospital delay (adjusted odds ratio, 0.41; 95% CI, 0.24–0.71), a minority of patients (39%) who first called their family doctor were transported by emergency medical services to the hospital. The second risk factor was lack of awareness of stroke symptoms (adjusted odds ratio, 4.14; 95% CI, 2.36–7.24). Conclusions Almost 1 in 3 patients with a diffusion‐weighted magnetic resonance imaging–confirmed ischemic stroke first called the family doctor practice. Face‐to‐face visits to the family doctor quadrupled the odds of prehospital delay. Efforts to reduce prehospital delay should address family doctors and their staffs as important partners in the prehospital pathway. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02798770.
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- 2019
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36. Protocol for MAAESTRO: Electronic Monitoring and Improvement of Adherence to Direct Oral Anticoagulant Treatment—A Randomized Crossover Study of an Educational and Reminder-Based Intervention in Ischemic STROke Patients Under Polypharmacy
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Alexandros A. Polymeris, Valerie Albert, Kurt E. Hersberger, Stefan T. Engelter, Sabine Schaedelin, Isabelle Arnet, and Philippe A. Lyrer
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ischemic stroke ,direct oral anticoagulants ,adherence ,electronic monitoring ,adherence-improving intervention ,polypharmacy ,Neurology. Diseases of the nervous system ,RC346-429 - Abstract
Background: Non-adherence to direct oral anticoagulants (DOACs) remains a matter of concern, especially for patients with a recent stroke. However, data on electronically monitored adherence and adherence-improving interventions are scarce.Aims: We aim to use electronic monitoring in DOAC-treated stroke patients to (i) evaluate the effect of an educational, reminder-based adherence-improving intervention, (ii) investigate predictors of non-adherence, (iii) identify reliable self-report measures of adherence, and (iv) explore the association of non-adherence with clinical outcomes.Methods: Single-center, randomized, crossover, open-label study. Adherence to DOACs of polymedicated patients self-administering their medication will be monitored electronically throughout the 12-month-long study following hospitalization for ischemic stroke. After a 6-month observational phase, patients will receive pharmaceutical counseling with feedback on their intake history and be given a multi-compartment pillbox for the subsequent 6-month interventional phase. The pillbox will provide intake reminders either during the first or the last three interventional-phase months. Patients will be randomly allocated to reminders-first or reminders-last.Study outcomes: Primary: non-optimal timing adherence; Secondary: non-optimal taking adherence; timing adherence; taking adherence; self-reported adherence; clinical outcomes including ischemic and hemorrhagic events; patient-reported device usability and satisfaction.Sample size estimates: A sample of 130 patients provides 90% power to show a 20% improvement of the primary adherence outcome with intake reminders.Discussion: MAAESTRO will investigate various aspects of non-adherence and evaluate the effect of an adherence-improving intervention in DOAC-treated patients with a recent stroke using electronic monitoring.Clinical Trial Registration: ClinicalTrials.gov identifier: NCT03344146, Swiss National Clinical Trials Portal SNCTP000002410
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- 2018
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37. Atrial Fibrillation Detected before or after Stroke:Role of Anticoagulation
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Lyrer, Flurina, Zietz, Annaelle, Seiffge, David J., Koga, Masatoshi, Volbers, Bastian, Wilson, Duncan, Bonetti, Bruno, Schaedelin, Sabine, Gensicke, Henrik, Yoshimura, Sohei, Macha, Kosmas, Ambler, Gareth, Thilemann, Sebastian, Dittrich, Tolga, Inoue, Manabu, Miwa, Kaori, Wang, Ruihao, Siedler, Gabriela, Biburger, Luise, Brown, Martin M., Jäger, Rolf H., Muir, Keith, Traenka, Christopher, Tanaka, Kanta, Shiozawa, Masayuki, Bonati, Leo H., Peters, Nils, Lip, Gregory Y. H., Lyrer, Philippe A., Cappellari, Manuel, Toyoda, Kazunori, Kallmünzer, Bernd, Schwab, Stefan, Werring, David J., Engelter, Stefan T., De Marchis, Gian Marco, and Polymeris, Alexandros A.
- Abstract
Background: Atrial fibrillation (AF) known before ischemic stroke (KAF) has been postulated to be an independent category with a recurrence risk higher than that of AF detected after stroke (AFDAS). However, it is unknown whether this risk difference is confounded by pre-existing anticoagulation, which is most common in KAF and also indicates a high ischemic stroke recurrence risk.Methods: Individual patient data analysis from 5 prospective cohorts of anticoagulated patients following AF-associated ischemic stroke. We compared the primary (ischemic stroke recurrence) and secondary outcome (all-cause death) among patients with AFDAS versus KAF and among anticoagulation-naïve versus previously anticoagulated patients using multivariable Cox, Fine-Gray models, and goodness-of-fit statistics to investigate the relative independent prognostic importance of AF-category and pre-existing anticoagulation.Results: Of 4,357 patients, 1,889 (43%) had AFDAS and 2,468 (57%) had KAF, while 3,105 (71%) were anticoagulation-naïve before stroke and 1,252 (29%) were previously anticoagulated. During 6,071 patient-years of follow-up, we observed 244 recurrent strokes and 661 deaths. Only pre-existing anticoagulation (but not KAF) was independently associated with a higher hazard for stroke recurrence in both Cox and Fine-Gray models. Models incorporating pre-existing anticoagulation showed better fit than those with AF category; adding AF-category did not result in better model fit. Neither pre-existing anticoagulation nor KAF were independently associated with death.Conclusion: Our findings challenge the notion that KAF and AFDAS are clinically relevant and distinct prognostic entities. Instead of attributing an independently high stroke recurrence risk to KAF, future research should focus on the causes of stroke despite anticoagulation to develop improved preventive treatments. ANN NEUROL 2023. Background: Atrial fibrillation (AF) known before ischemic stroke (KAF) has been postulated to be an independent category with a recurrence risk higher than that of AF detected after stroke (AFDAS). However, it is unknown whether this risk difference is confounded by pre-existing anticoagulation, which is most common in KAF and also indicates a high ischemic stroke recurrence risk.Methods: Individual patient data analysis from 5 prospective cohorts of anticoagulated patients following AF-associated ischemic stroke. We compared the primary (ischemic stroke recurrence) and secondary outcome (all-cause death) among patients with AFDAS versus KAF and among anticoagulation-naïve versus previously anticoagulated patients using multivariable Cox, Fine-Gray models, and goodness-of-fit statistics to investigate the relative independent prognostic importance of AF-category and pre-existing anticoagulation.Results: Of 4,357 patients, 1,889 (43%) had AFDAS and 2,468 (57%) had KAF, while 3,105 (71%) were anticoagulation-naïve before stroke and 1,252 (29%) were previously anticoagulated. During 6,071 patient-years of follow-up, we observed 244 recurrent strokes and 661 deaths. Only pre-existing anticoagulation (but not KAF) was independently associated with a higher hazard for stroke recurrence in both Cox and Fine-Gray models. Models incorporating pre-existing anticoagulation showed better fit than those with AF category; adding AF-category did not result in better model fit. Neither pre-existing anticoagulation nor KAF were independently associated with death.Conclusion: Our findings challenge the notion that KAF and AFDAS are clinically relevant and distinct prognostic entities. Instead of attributing an independently high stroke recurrence risk to KAF, future research should focus on the causes of stroke despite anticoagulation to develop improved preventive treatments. ANN NEUROL 2023.
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- 2023
38. Causes and Risk Factors of Cerebral Ischemic Events in Patients With Atrial Fibrillation Treated With Non–Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention: The RENo Study
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Paciaroni, Maurizio, Agnelli, Giancarlo, Caso, Valeria, Silvestrelli, Giorgio, Seiffge, David Julian, Engelter, Stefan, De Marchis, Gian Marco, Polymeris, Alexandros, Zedde, Maria Luisa, Yaghi, Shadi, Michel, Patrik, Eskandari, Ashraf, Antonenko, Kateryna, Sohn, Sung-Il, Cappellari, Manuel, Tassinari, Tiziana, Tassi, Rossana, Masotti, Luca, Katsanos, Aristeidis H., Giannopoulos, Sotirios, Acciarresi, Monica, Alberti, Andrea, Venti, Michele, Mosconi, Maria Giulia, Vedovati, Maria Cristina, Pierini, Patrizia, Giustozzi, Michela, Lotti, Enrico Maria, Ntaios, George, Kargiotis, Odysseas, Monaco, Serena, Lochner, Piergiorgio, Bandini, Fabio, Liantinioti, Chrysoula, Palaiodimou, Lina, Abdul-Rahim, Azmil H., Lees, Kennedy, Mancuso, Michelangelo, Pantoni, Leonardo, Rosa, Silvia, Bertora, Pierluigi, Galliazzo, Silvia, Ageno, Walter, Toso, Elisabetta, Angelini, Filippo, Chiti, Alberto, Orlandi, Giovanni, Denti, Licia, Flomin, Yuriy, Marcheselli, Simona, Mumoli, Nicola, Rimoldi, Alexandra, Verrengia, Elena, Schirinzi, Erika, Del Sette, Massimo, Papamichalis, Panagiotis, Komnos, Apostolos, Popovic, Nemanja, Zarkov, Marija, Rocco, Alessandro, Diomedi, Marina, Giorli, Elisa, Ciccone, Alfonso, Mac Grory, Brian C., Furie, Karen L., Bonetti, Bruno, Saia, Valentina, Guideri, Francesca, Acampa, Maurizio, Martini, Giuseppe, Grifoni, Elisa, Padroni, Marina, Karagkiozi, Efstathia, Perlepe, Kalliopi, Makaritsis, Konstantinos, Mannino, Marina, Maccarrone, Miriam, Ulivi, Leonardo, Giannini, Nicola, Ferrari, Elena, Pezzini, Alessandro, Doronin, Boris, Volodina, Vera, Baldi, Antonio, D’Amore, Cataldo, Deleu, Dirk, Corea, Francesco, Putaala, Jukka, Santalucia, Paola, Nardi, Katiuscia, Risitano, Angela, Toni, Danilo, and Tsivgoulis, Georgios
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- 2019
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39. Recurrent Ischemic Stroke and Bleeding in Patients With Atrial Fibrillation Who Suffered an Acute Stroke While on Treatment With Nonvitamin K Antagonist Oral Anticoagulants: The RENO-EXTEND Study
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Maurizio Paciaroni, Valeria Caso, Giancarlo Agnelli, Maria Giulia Mosconi, Michela Giustozzi, David Julian Seiffge, Stefan T. Engelter, Philippe Lyrer, Alexandros A. Polymeris, Lilian Kriemler, Annaelle Zietz, Jukka Putaala, Daniel Strbian, Liisa Tomppo, Patrik Michel, Davide Strambo, Alexander Salerno, Suzette Remillard, Manuela Buehrer, Odessa Bavaud, Peter Vanacker, Susanna Zuurbier, Laetitia Yperzeele, Caroline M.J. Loos, Manuel Cappellari, Andrea Emiliani, Marialuisa Zedde, Azmil Abdul-Rahim, Jesse Dawson, Robert Cronshaw, Erika Schirinzi, Massimo Del Sette, Christoph Stretz, Narendra Kala, Michael Reznik, Ashley Schomer, Brian Mac Grory, Mahesh Jayaraman, Ryan McTaggart, Shadi Yaghi, Karen L. Furie, Luca Masotti, Elisa Grifoni, Danilo Toni, Angela Risitano, Anne Falcou, Luca Petraglia, Enrico Maria Lotti, Marina Padroni, Lucia Pavolucci, Piergiorgio Lochner, Giorgio Silvestrelli, Alfonso Ciccone, Andrea Alberti, Michele Venti, Laura Traballi, Chiara Urbini, Odysseas Kargiotis, Alessandro Rocco, Marina Diomedi, Simona Marcheselli, Pietro Caliandro, Aurelia Zauli, Giuseppe Reale, Kateryna Antonenko, Eugenia Rota, Tiziana Tassinari, Valentina Saia, Francesco Palmerini, Paolo Aridon, Valentina Arnao, Serena Monaco, Salvatore Cottone, Antonio Baldi, Cataldo D’Amore, Walter Ageno, Samuela Pegoraro, George Ntaios, Dimitrios Sagris, Sotirios Giannopoulos, Maria Kosmidou, Evangelos Ntais, Michele Romoli, Leonardo Pantoni, Silvia Rosa, Pierluigi Bertora, Alberto Chiti, Isabella Canavero, Carlo Emanuele Saggese, Maurizio Plocco, Elisa Giorli, Lina Palaiodimou, Eleni Bakola, Georgios Tsivgoulis, Fabio Bandini, Antonio Gasparro, Valeria Terruso, Marina Mannino, Alessandro Pezzini, Raffaele Ornello, Simona Sacco, Nemanja Popovic, Umberto Scoditti, Antonio Genovese, Licia Denti, Yuriy Flomin, Michelangelo Mancuso, Elena Ferrari, Maria Chiara Caselli, Leonardo Ulivi, Nicola Giannini, Gian Marco De Marchis, Paciaroni, Maurizio, Caso, Valeria, Agnelli, Giancarlo, Mosconi, Maria Giulia, Giustozzi, Michela, Seiffge, David Julian, Engelter, Stefan T, Lyrer, Philippe, Polymeris, Alexandros A, Kriemler, Lilian, Zietz, Annaelle, Putaala, Jukka, Strbian, Daniel, Tomppo, Liisa, Michel, Patrik, Strambo, Davide, Salerno, Alexander, Remillard, Suzette, Buehrer, Manuela, Bavaud, Odessa, Vanacker, Peter, Zuurbier, Susanna, Yperzeele, Laetitia, Loos, Caroline M J, Cappellari, Manuel, Emiliani, Andrea, Zedde, Marialuisa, Abdul-Rahim, Azmil, Dawson, Jesse, Cronshaw, Robert, Schirinzi, Erika, Del Sette, Massimo, Stretz, Christoph, Kala, Narendra, Reznik, Michael, Schomer, Ashley, Grory, Brian Mac, Jayaraman, Mahesh, McTaggart, Ryan, Yaghi, Shadi, Furie, Karen L, Masotti, Luca, Grifoni, Elisa, Toni, Danilo, Risitano, Angela, Falcou, Anne, Petraglia, Luca, Lotti, Enrico Maria, Padroni, Marina, Pavolucci, Lucia, Lochner, Piergiorgio, Silvestrelli, Giorgio, Ciccone, Alfonso, Alberti, Andrea, Venti, Michele, Traballi, Laura, Urbini, Chiara, Kargiotis, Odyssea, Rocco, Alessandro, Diomedi, Marina, Marcheselli, Simona, Caliandro, Pietro, Zauli, Aurelia, Reale, Giuseppe, Antonenko, Kateryna, Rota, Eugenia, Tassinari, Tiziana, Saia, Valentina, Palmerini, Francesco, Aridon, Paolo, Arnao, Valentina, Monaco, Serena, Cottone, Salvatore, Baldi, Antonio, D'Amore, Cataldo, Ageno, Walter, Pegoraro, Samuela, Ntaios, George, Sagris, Dimitrio, Giannopoulos, Sotirio, Kosmidou, Maria, Ntais, Evangelo, Romoli, Michele, Pantoni, Leonardo, Rosa, Silvia, Bertora, Pierluigi, Chiti, Alberto, Canavero, Isabella, Saggese, Carlo Emanuele, Plocco, Maurizio, Giorli, Elisa, Palaiodimou, Lina, Bakola, Eleni, Tsivgoulis, Georgio, Bandini, Fabio, Gasparro, Antonio, Terruso, Valeria, Mannino, Marina, Pezzini, Alessandro, Ornello, Raffaele, Sacco, Simona, Popovic, Nemanja, Scoditti, Umberto, Genovese, Antonio, Denti, Licia, Flomin, Yuriy, Mancuso, Michelangelo, Ferrari, Elena, Caselli, Maria Chiara, Ulivi, Leonardo, Giannini, Nicola, De Marchis, Gian Marco, and Neurology
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Oral ,Advanced and Specialized Nursing ,hypertension ,recurrence ,anticoagulant ,Administration, Oral ,Anticoagulants ,Hemorrhage ,Settore MED/26 ,Brain Ischemia ,Stroke ,Risk Factors ,Administration ,Atrial Fibrillation ,Humans ,Settore MED/26 - Neurologia ,Human medicine ,Neurology (clinical) ,Prospective Studies ,Cardiology and Cardiovascular Medicine ,atrial fibrillation ,ischemic stroke ,Ischemic Stroke - Abstract
Background: In patients with atrial fibrillation who suffered an ischemic stroke while on treatment with nonvitamin K antagonist oral anticoagulants, rates and determinants of recurrent ischemic events and major bleedings remain uncertain. Methods: This prospective multicenter observational study aimed to estimate the rates of ischemic and bleeding events and their determinants in the follow-up of consecutive patients with atrial fibrillation who suffered an acute cerebrovascular ischemic event while on nonvitamin K antagonist oral anticoagulant treatment. Afterwards, we compared the estimated risks of ischemic and bleeding events between the patients in whom anticoagulant therapy was changed to those who continued the original treatment. Results: After a mean follow-up time of 15.0±10.9 months, 192 out of 1240 patients (15.5%) had 207 ischemic or bleeding events corresponding to an annual rate of 13.4%. Among the events, 111 were ischemic strokes, 15 systemic embolisms, 24 intracranial bleedings, and 57 major extracranial bleedings. Predictive factors of recurrent ischemic events (strokes and systemic embolisms) included CHA 2 DS 2 -VASc score after the index event (odds ratio [OR], 1.2 [95% CI, 1.0–1.3] for each point increase; P =0.05) and hypertension (OR, 2.3 [95% CI, 1.0–5.1]; P =0.04). Predictive factors of bleeding events (intracranial and major extracranial bleedings) included age (OR, 1.1 [95% CI, 1.0–1.2] for each year increase; P =0.002), history of major bleeding (OR, 6.9 [95% CI, 3.4–14.2]; P =0.0001) and the concomitant administration of an antiplatelet agent (OR, 2.8 [95% CI, 1.4–5.5]; P =0.003). Rates of ischemic and bleeding events were no different in patients who changed or not changed the original nonvitamin K antagonist oral anticoagulants treatment (OR, 1.2 [95% CI, 0.8–1.7]). Conclusions: Patients suffering a stroke despite being on nonvitamin K antagonist oral anticoagulant therapy are at high risk of recurrent ischemic stroke and bleeding. In these patients, further research is needed to improve secondary prevention by investigating the mechanisms of recurrent ischemic stroke and bleeding.
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- 2022
40. Global Cortical Atrophy Is Associated with an Unfavorable Outcome in Stroke Patients on Oral Anticoagulation.
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Kubacka, Marta, Zietz, Annaelle, Schaedelin, Sabine, Polymeris, Alexandros A., Hert, Lisa, Lieb, Johanna, Wagner, Benjamin, Seiffge, David, Traenka, Christopher, Altersberger, Valerian L., Dittrich, Tolga, Fladt, Joachim, Fisch, Urs, Thilemann, Sebastian, De Marchis, Gian Marco, Gensicke, Henrik, Bonati, Leo H., Lyrer, Philippe, Engelter, Stefan T., and Peters, Nils
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CEREBRAL atrophy ,CEREBRAL small vessel diseases ,STROKE patients ,ISCHEMIC stroke ,CORONARY disease - Abstract
Introduction: Measures of cerebral small vessel disease (cSVD), such as white matter hyperintensities (WMH) and cerebral microbleeds (CMB), are associated with an unfavorable clinical course in stroke patients on oral anticoagulation (OAC) for atrial fibrillation (AF). Here, we investigated whether similar findings can be observed for global cortical atrophy (GCA). Methods: Registry-based prospective observational study of 320 patients treated with OAC following AF stroke. Patients underwent magnetic resonance imaging (MRI) allowing assessment of GCA. Using the simplified visual Pasquier scale, the severity of GCA was categorized as follows: 0: no atrophy, 1: mild atrophy; 2: moderate atrophy, and 3: severe atrophy. Using adjusted logistic and Cox regression analysis, we investigated the association of GCA using a composite outcome measure, comprising: (i) recurrent acute ischemic stroke (IS); (ii) intracranial hemorrhage (ICH); and (iii) death. Results: In our time to event analysis after adjusting for potential confounders (i.e., WMH, CMB, age, sex, diabetes, arterial hypertension, coronary heart disease, hyperlipidemia, and antiplatelet use), GCA was associated with an increased risk for the composite outcome in all three degrees of atrophy (grade 1: aHR 3.95, 95% CI 1.34–11.63, p = 0.013; grade 2: aHR 3.89, 95% CI 1.23–12.30, p = 0.021; grade 3: aHR 4.16, 95% CI 1.17–14.84, p = 0.028). Conclusion: GCA was associated with our composite outcome also after adjusting for other cSVD markers (i.e., CMB, WMH) and age, indicating that GCA may potentially serve as a prognostic marker for stroke patients with atrial fibrillation on oral anticoagulation. [ABSTRACT FROM AUTHOR]
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- 2023
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41. Risk of recurrent stroke in patients with atrial fibrillation treated with oral anticoagulants alone or in combination with anti-platelet therapy.
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Caliandro, Pietro, Cancelloni, Virginia, Marco, Moci, Reale, Giuseppe, Zauli, Aurelia, Agnelli, Giancarlo, Caso, Valeria, Becattini, Cecilia, Calabresi, Paolo, Giulia Mosconi, Maria, Giustozzi, Michela, Tsivgoulis, Georgios, Julian Seiffge, David, Engelter, Stefan T., Lyrer, Philippe, Polymeris, Alexandros A., Dittrich, Tolga, Zietz, Annaelle, Marco De Marchis, Gian, and Putaala, Jukka
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- 2023
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42. Apical pulmonary lesions suspected of malignancy visible on neck CT angiography performed for acute stroke: Prevalence, treatment, and clinical implications – the PLEURA study
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Dittrich, Tolga D, primary, Aujesky, Mara, additional, Rudin, Salome, additional, Zietz, Annaelle, additional, Wagner, Benjamin, additional, Polymeris, Alexandros, additional, Altersberger, Valerian L, additional, Sinnecker, Tim, additional, Gensicke, Henrik, additional, Engelter, Stefan T, additional, Lyrer, Philippe, additional, Hess, Viviane, additional, Sutter, Raoul, additional, Nickel, Christian H, additional, Bonati, Leo H, additional, Fischer, Urs, additional, Psychogios, Marios, additional, Katan, Mira, additional, and De Marchis, Gian Marco, additional
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- 2023
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43. Mechanical thrombectomy for large vessel occlusion between 6 and 24 h: outcome comparison of DEFUSE-3/DAWN eligible versus non-eligible patients
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Dittrich, Tolga D, primary, Sporns, Peter B, additional, Kriemler, Lilian F, additional, Rudin, Salome, additional, Nguyen, Anh, additional, Zietz, Annaelle, additional, Polymeris, Alexandros A, additional, Tränka, Christopher, additional, Thilemann, Sebastian, additional, Wagner, Benjamin, additional, Altersberger, Valerian L, additional, Piot, Ines, additional, Barinka, Filip, additional, Hänsel, Martin, additional, Gensicke, Henrik, additional, Engelter, Stefan T, additional, Lyrer, Philippe A, additional, Sutter, Raoul, additional, Nickel, Christian H, additional, Katan, Mira, additional, Peters, Nils, additional, Michels, Lars, additional, Kulcsár, Zsolt, additional, Karwacki, Grzegorz M, additional, Pileggi, Marco, additional, Cereda, Carlo, additional, Wegener, Susanne, additional, Bonati, Leo H, additional, Fischer, Urs, additional, Psychogios, Marios, additional, and De Marchis, Gian Marco, additional
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- 2022
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44. Global Cortical Atrophy Is Associated with an Unfavorable Outcome in Stroke Patients on Oral Anticoagulation
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Kubacka, Marta, primary, Zietz, Annaelle, additional, Schaedelin, Sabine, additional, Polymeris, Alexandros A., additional, Hert, Lisa, additional, Lieb, Johanna, additional, Wagner, Benjamin, additional, Seiffge, David, additional, Traenka, Christopher, additional, Altersberger, Valerian L., additional, Dittrich, Tolga, additional, Fladt, Joachim, additional, Fisch, Urs, additional, Thilemann, Sebastian, additional, De Marchis, Gian Marco, additional, Gensicke, Henrik, additional, Bonati, Leo H., additional, Lyrer, Philippe, additional, Engelter, Stefan T., additional, and Peters, Nils, additional
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- 2022
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45. sj-doc-2-eso-10.1177_23969873231151488 – Supplemental material for Apical pulmonary lesions suspected of malignancy visible on neck CT angiography performed for acute stroke: Prevalence, treatment, and clinical implications – the PLEURA study
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Dittrich, Tolga D, Aujesky, Mara, Rudin, Salome, Zietz, Annaelle, Wagner, Benjamin, Polymeris, Alexandros, Altersberger, Valerian L, Sinnecker, Tim, Gensicke, Henrik, Engelter, Stefan T, Lyrer, Philippe, Hess, Viviane, Sutter, Raoul, Nickel, Christian H, Bonati, Leo H, Fischer, Urs, Psychogios, Marios, Katan, Mira, and De Marchis, Gian Marco
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FOS: Clinical medicine ,Cardiology ,Medicine ,110904 Neurology and Neuromuscular Diseases - Abstract
Supplemental material, sj-doc-2-eso-10.1177_23969873231151488 for Apical pulmonary lesions suspected of malignancy visible on neck CT angiography performed for acute stroke: Prevalence, treatment, and clinical implications – the PLEURA study by Tolga D Dittrich, Mara Aujesky, Salome Rudin, Annaelle Zietz, Benjamin Wagner, Alexandros Polymeris, Valerian L Altersberger, Tim Sinnecker, Henrik Gensicke, Stefan T Engelter, Philippe Lyrer, Viviane Hess, Raoul Sutter, Christian H Nickel, Leo H Bonati, Urs Fischer, Marios Psychogios, Mira Katan and Gian Marco De Marchis in European Stroke Journal
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- 2023
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46. sj-docx-1-eso-10.1177_23969873231151488 – Supplemental material for Apical pulmonary lesions suspected of malignancy visible on neck CT angiography performed for acute stroke: Prevalence, treatment, and clinical implications – the PLEURA study
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Dittrich, Tolga D, Aujesky, Mara, Rudin, Salome, Zietz, Annaelle, Wagner, Benjamin, Polymeris, Alexandros, Altersberger, Valerian L, Sinnecker, Tim, Gensicke, Henrik, Engelter, Stefan T, Lyrer, Philippe, Hess, Viviane, Sutter, Raoul, Nickel, Christian H, Bonati, Leo H, Fischer, Urs, Psychogios, Marios, Katan, Mira, and De Marchis, Gian Marco
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FOS: Clinical medicine ,Cardiology ,Medicine ,110904 Neurology and Neuromuscular Diseases - Abstract
Supplemental material, sj-docx-1-eso-10.1177_23969873231151488 for Apical pulmonary lesions suspected of malignancy visible on neck CT angiography performed for acute stroke: Prevalence, treatment, and clinical implications – the PLEURA study by Tolga D Dittrich, Mara Aujesky, Salome Rudin, Annaelle Zietz, Benjamin Wagner, Alexandros Polymeris, Valerian L Altersberger, Tim Sinnecker, Henrik Gensicke, Stefan T Engelter, Philippe Lyrer, Viviane Hess, Raoul Sutter, Christian H Nickel, Leo H Bonati, Urs Fischer, Marios Psychogios, Mira Katan and Gian Marco De Marchis in European Stroke Journal
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- 2023
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47. Tranexamic Acid for Intracerebral Hemorrhage in Patients on Non-Vitamin K Antagonist Oral Anticoagulants (TICH-NOAC): A Multicenter, Randomized, Placebo-Controlled, Phase 2 Trial
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Polymeris, Alexandros A, Karwacki, Grzegorz M, Siepen, Bernhard M, Schaedelin, Sabine, Tsakiris, Dimitrios A, Stippich, Christoph, Guzman, Raphael, Nickel, Christian H, Sprigg, Nikola, Kägi, Georg, Vehoff, Jochen, Barinka, Filip, Thilemann, Sebastian, Maurer, Marina, Wagner, Benjamin, Traenka, Christopher, Gensicke, Henrik, De Marchis, Gian Marco, Bonati, Leo H, Fischer, Urs, Z'Graggen, Werner J, Nedeltchev, Krassen, Wegener, Susanne, Baumgartner, Philipp, Engelter, Stefan T, Seiffge, David J, Peters, Nils, and Lyrer, Philippe A
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610 Medicine & health - Abstract
BACKGROUND Evidence-based hemostatic treatment for intracerebral hemorrhage (ICH) associated with non-vitamin K antagonist oral anticoagulants (NOACs) is lacking. Tranexamic acid (TXA) is an antifibrinolytic drug potentially limiting hematoma expansion. We aimed to assess the efficacy and safety of TXA in NOAC-ICH. METHODS We performed a double-blind, randomized, placebo-controlled trial at 6 Swiss stroke centers. Patients with NOAC-ICH within 12 hours of symptom onset and 48 hours of last NOAC intake were randomized (1:1) to receive either intravenous TXA (1 g over 10 minutes followed by 1 g over 8 hours) or matching placebo in addition to standard medical care via a centralized Web-based procedure with minimization on key prognostic factors. All participants and investigators were masked to treatment allocation. Primary outcome was hematoma expansion, defined as ≥33% relative or ≥6 mL absolute volume increase at 24 hours and analyzed using logistic regression adjusted for baseline hematoma volume on an intention-to-treat basis. RESULTS Between December 12, 2016, and September 30, 2021, we randomized 63 patients (median age, 82 years [interquartile range, 76-86]; 40% women; median hematoma volume, 11.5 [4.8-27.4] mL) of the 109 intended sample size before premature trial discontinuation due to exhausted funding. The primary outcome did not differ between TXA (n=32) and placebo (n=31) arms (12 [38%] versus 14 [45%]; adjusted odds ratio, 0.63 [95% CI, 0.22-1.82]; P=0.40). There was a signal for interaction with onset-to-treatment time (Pinteraction=0.024), favoring TXA when administered within 6 hours of symptom onset. Between the TXA and placebo arms, the proportion of participants who died (15 [47%] versus 13 [42%]; adjusted odds ratio, 1.07 [0.37-3.04]; P=0.91) or had major thromboembolic complications within 90 days (4 [13%] versus 2 [6%]; odds ratio, 1.86 [0.37-9.50]; P=0.45) did not differ. All thromboembolic events occurred at least 2 weeks after study treatment, exclusively in participants not restarted on oral anticoagulation. CONCLUSIONS In a smaller-than-intended NOAC-ICH patient sample, we found no evidence that TXA prevents hematoma expansion, but there were no major safety concerns. Larger trials on hemostatic treatments targeting an early treatment window are needed for NOAC-ICH. REGISTRATION URL: https://clinicaltrials.gov; Unique identifier: NCT02866838.
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- 2023
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48. sj-docx-1-eso-10.1177_23969873231185220 – Supplemental material for The impact of competing stroke etiologies in patients with atrial fibrillation
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Zietz, Annaelle, Polymeris, Alexandros A, Helfenstein, Fabrice, Schaedelin, Sabine, Hert, Lisa, Wagner, Benjamin, Seiffge, David J, Traenka, Christopher, Altersberger, Valerian L, Dittrich, Tolga, Kaufmann, Josefin, Ravanelli, Flavia, Fladt, Joachim, Fisch, Urs, Thilemann, Sebastian, De Marchis, Gian Marco, Gensicke, Henrik, Bonati, Leo H, Katan, Mira, Fischer, Urs, Lyrer, Philippe, Engelter, Stefan T, and Peters, Nils
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Neurology and Neuromuscular Diseases ,FOS: Clinical medicine ,Cardiology ,Medicine - Abstract
Supplemental material, sj-docx-1-eso-10.1177_23969873231185220 for The impact of competing stroke etiologies in patients with atrial fibrillation by Annaelle Zietz, Alexandros A Polymeris, Fabrice Helfenstein, Sabine Schaedelin, Lisa Hert, Benjamin Wagner, David J Seiffge, Christopher Traenka, Valerian L Altersberger, Tolga Dittrich, Josefin Kaufmann, Flavia Ravanelli, Joachim Fladt, Urs Fisch, Sebastian Thilemann, Gian Marco De Marchis, Henrik Gensicke, Leo H Bonati, Mira Katan, Urs Fischer, Philippe Lyrer, Stefan T Engelter and Nils Peters in European Stroke Journal
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- 2023
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49. Impact of Cerebral Microbleeds in Stroke Patients with Atrial Fibrillation
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Soo, Yannie, Zietz, Annaelle, Yiu, Brian, Mok, Vincent C T, Polymeris, Alexandros A, Seiffge, David, Ambler, Gareth, Wilson, Duncan, Leung, Thomas Wai Hong, Tsang, Suk Fung, Chu, Winnie, Abrigo, Jill, Cheng, Cyrus, Lee, Keon-Joo, Lim, Jae-Sung, Shiozawa, Masayuki, Koga, Masatoshi, Chabriat, Hugues, Hennerici, Michael, Wong, Yuen Kwun, Mak, Henry, Collet, Roger, Inamura, Shigeru, Yoshifuji, Kazuhisa, Arsava, Ethem Murat, Horstmann, Solveig, Purrucker, Jan, Lam, Bonnie Y K, Wong, Adrian, Kim, Young Dae, Song, Tae-Jin, Lemmens, Robin, Eppinger, Sebastian, Gattringer, Thomas, Uysal, Ender, Demirelli, Derya Selçuk, Bornstein, Natan M, Assayag, Einor Ben, Hallevi, Hen, Molad, Jeremy, Nishihara, Masashi, Tanaka, Jun, Coutts, Shelagh B, Kappelle, L Jaap, Salman, Rustam Al-Shahi, Jager, Rolf, Lip, Gregory Y. H., Goeldlin, Martina B, Panos, Leonidas D, Mas, Jean-Louis, Legrand, Laurence, Karayiannis, Chris, Phan, Thanh, Bellut, Maximilian, Chappell, Francesca, Makin, Stephen, Hayden, Derek, Williams, David, van Dam-Nolen, Dianne H K, Nederkoorn, Paul J, Barbato, Carmen, Browning, Simone, Wiegertjes, Kim, Tuladhar, Anil Man, Mendyk, Anne-Marie, Köhler, Sebastian, van Oostenburgge, Robert, Zhou, Ying, Xu, Chao, Hilal, Saima, Gyanwali, Bibek, Chen, Christopher, Lou, Min, Staals, Julie, Bordet, Regis, Kandiah, Nagaendran, de Leeuw, Frank-Erik, Simister, Robert, Hendrikse, Jeroen, Wardlaw, Joanna, Kelly, Peter, Fluri, Felix, Srikanth, Velandai, Calvet, David, Jung, Simon, Kwa, Vincent I H, Smith, Eric E, Hara, Hideo, Yakushiji, Yusuke, Orken, Dilek Necioglu, Fazekas, Franz, Thijs, Vincent, Heo, Ji-Hoe, Veltkamp, Roland, Ay, Hakan, Imaizumi, Toshio, Lau, Kui Kai, Jouvent, Eric, Toyoda, Kazunori, Yoshimura, Sohei, Bae, Hee-Joon, Martí-Fàbregas, Joan, Prats-Sánchez, Luis, Lyrer, Philippe, Best, Jonathan, Werring, David, Engelter, Stefan T, Peters, Nils, Neurology, ACS - Atherosclerosis & ischemic syndromes, and ANS - Neurovascular Disorders
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All institutes and research themes of the Radboud University Medical Center ,Neurology ,Neurology (clinical) ,Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3] - Abstract
Objectives: Cerebral microbleeds are associated with the risks of ischemic stroke and intracranial hemorrhage, causing clinical dilemmas for antithrombotic treatment decisions. We aimed to evaluate the risks of intracranial hemorrhage and ischemic stroke associated with microbleeds in patients with atrial fibrillation treated with vitamin K antagonists, direct oral anticoagulants, antiplatelets, and combination therapy (i.e. concurrent oral anticoagulant and antiplatelet).Methods: We included patients with documented atrial fibrillation from the pooled individual patient data analysis by the Microbleeds International Collaborative Network. Risks of subsequent intracranial hemorrhage and ischemic stroke were compared between patients with and without microbleeds, stratified by antithrombotic use.Results: A total of 7,839 patients were included. The presence of microbleeds was associated with an increased relative risk of intracranial hemorrhage (adjusted hazard ratio [aHR] = 2.74, 95% confidence interval = 1.76-4.26) and ischemic stroke (aHR = 1.29, 95% confidence interval = 1.04-1.59). For the entire cohort, the absolute incidence of ischemic stroke was higher than intracranial hemorrhage regardless of microbleed burden. However, for the subgroup of patients taking combination of anticoagulant and antiplatelet therapy, the absolute risk of intracranial hemorrhage exceeded that of ischemic stroke in those with 2 to 4 microbleeds (25 vs 12 per 1,000 patient-years) and ≥ 11 microbleeds (94 vs 48 per 1,000 patient-years).Interpretation: Patients with atrial fibrillation and high burden of microbleeds receiving combination therapy have a tendency of higher rate of intracranial hemorrhage than ischemic stroke, with potential for net harm. Further studies are needed to help optimize stroke preventive strategies in this high-risk group. ANN NEUROL 2023. Objectives: Cerebral microbleeds are associated with the risks of ischemic stroke and intracranial hemorrhage, causing clinical dilemmas for antithrombotic treatment decisions. We aimed to evaluate the risks of intracranial hemorrhage and ischemic stroke associated with microbleeds in patients with atrial fibrillation treated with vitamin K antagonists, direct oral anticoagulants, antiplatelets, and combination therapy (i.e. concurrent oral anticoagulant and antiplatelet).Methods: We included patients with documented atrial fibrillation from the pooled individual patient data analysis by the Microbleeds International Collaborative Network. Risks of subsequent intracranial hemorrhage and ischemic stroke were compared between patients with and without microbleeds, stratified by antithrombotic use.Results: A total of 7,839 patients were included. The presence of microbleeds was associated with an increased relative risk of intracranial hemorrhage (adjusted hazard ratio [aHR] = 2.74, 95% confidence interval = 1.76-4.26) and ischemic stroke (aHR = 1.29, 95% confidence interval = 1.04-1.59). For the entire cohort, the absolute incidence of ischemic stroke was higher than intracranial hemorrhage regardless of microbleed burden. However, for the subgroup of patients taking combination of anticoagulant and antiplatelet therapy, the absolute risk of intracranial hemorrhage exceeded that of ischemic stroke in those with 2 to 4 microbleeds (25 vs 12 per 1,000 patient-years) and ≥ 11 microbleeds (94 vs 48 per 1,000 patient-years).Interpretation: Patients with atrial fibrillation and high burden of microbleeds receiving combination therapy have a tendency of higher rate of intracranial hemorrhage than ischemic stroke, with potential for net harm. Further studies are needed to help optimize stroke preventive strategies in this high-risk group. ANN NEUROL 2023.
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- 2023
50. Anticoagulation in acute ischemic stroke patients with mechanical heart valves: To bridge or not with heparin. The ESTREM study
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Paciaroni, Maurizio, Caso, Valeria, Romoli, Michele, Becattini, Cecilia, Salerno, Alexander, Rapillo, Costanza, Simonnet, Fanny, Strambo, Davide, Canavero, Isabella, Zedde, Marialuisa, Pascarella, Rosario, Sohn, Sung-Il, Sacco, Simona, Ornello, Raffaele, Barlinn, Kristian, Schoene, Daniela, Rahmig, Jan, Mosconi, Maria Giulia, Leone De Magistris, Ilaria, Alberti, Andrea, Venti, Michele, Silvestrelli, Giorgio, Ciccone, Alfonso, Padroni, Marina, Laudisi, Michele, Zini, Andrea, Gentile, Luana, Kargiotis, Odysseas, Tsivgoulis, Georgios, Tassi, Rossana, Guideri, Francesca, Acampa, Maurizio, Masotti, Luca, Grifoni, Elisa, Rocco, Alessandro, Diomedi, Marina, Karapanayiotides, Theodore, Engelter, Stefan T, Polymeris, Alexandros A, Zietz, Annaelle, Bandini, Fabio, Caliandro, Pietro, Reale, Giuseppe, Moci, Marco, Zauli, Aurelia, Cappellari, Manuel, Emiliani, Andrea, Gasparro, Antonio, Terruso, Valeria, Mannino, Marina, Giorli, Elisa, Toni, Danilo, Andrighetti, Marco, Falcou, Anne, Palaiodimou, Lina, Ntaios, George, Sagris, Dimitrios, Karagkiozi, Efstathia, Adamou, Anastasia, Halvatsiotis, Panagiotis, Flomin, Yuriy, Scoditti, Umberto, Genovese, Antonio, Popovic, Nemanja, Pantoni, Leonardo, Mele, Francesco, Molitierno, Nicola, Lochner, Piergiorgio, Pezzini, Alessandro, Del Sette, Massimo, Sassos, Davide, Giannopoulos, Sotirios, Kosmidou, Maria, Ntais, Evangelos, Lotti, Enrico Maria, Mastrangelo, Vincenzo, Chiti, Alberto, Naldi, Andrea, Vanacker, Peter, Ferrante, Mario, Volodina, Vera, Mancuso, Michelangelo, Giannini, Nicola, Baldini, Marco, Vadikolias, Kostantinos, Kitmeridou, Sofia, Saggese, Carlo Emanuele, Tassinari, Tiziana, Saia, Valentina, and Michel, Patrik
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Mechanical heart valve ,acute stroke ,oral anticoagulants ,prevention - Published
- 2023
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