SwePub
Sök i LIBRIS databas

  Utökad sökning

onr:"swepub:oai:gup.ub.gu.se/297529"
 

Sökning: onr:"swepub:oai:gup.ub.gu.se/297529" > Characteristics of ...

  • Veltkamp, R.Alfried Krupp Krankenhaus,Imperial College London (författare)

Characteristics of Recurrent Ischemic Stroke after Embolic Stroke of Undetermined Source: Secondary Analysis of a Randomized Clinical Trial

  • Artikel/kapitelEngelska2020

Förlag, utgivningsår, omfång ...

  • American Medical Association (AMA),2020

Nummerbeteckningar

  • LIBRIS-ID:oai:gup.ub.gu.se/297529
  • https://gup.ub.gu.se/publication/297529URI
  • https://doi.org/10.1001/jamaneurol.2020.1995DOI
  • https://lup.lub.lu.se/record/b4fdab37-548b-4bcf-b42a-24e1049e6edaURI

Kompletterande språkuppgifter

  • Språk:engelska

Ingår i deldatabas

Klassifikation

  • Ämneskategori:ref swepub-contenttype
  • Ämneskategori:art swepub-publicationtype

Anmärkningar

  • Importance: The concept of embolic stroke of undetermined source (ESUS) unifies a subgroup of cryptogenic strokes based on neuroimaging, a defined minimum set of diagnostic tests, and exclusion of certain causes. Despite an annual stroke recurrence rate of 5%, little is known about the etiology underlying recurrent stroke after ESUS. Objective: To identify the stroke subtype of recurrent ischemic strokes after ESUS, to explore the interaction with treatment assignment in each category, and to examine the consistency of cerebral location of qualifying ESUS and recurrent ischemic stroke. Design, Setting, and Participants: The NAVIGATE-ESUS trial was a randomized clinical trial conducted from December 23, 2014, to October 5, 2017. The trial compared the efficacy and safety of rivaroxaban and aspirin in patients with recent ESUS (n = 7213). Ischemic stroke was validated in 309 of the 7213 patients by adjudicators blinded to treatment assignment and classified by local investigators into the categories ESUS or non-ESUS (ie, cardioembolic, atherosclerotic, lacunar, other determined cause, or insufficient testing). Five patients with recurrent strokes that could not be defined as ischemic or hemorrhagic in absence of neuroimaging or autopsy were excluded. Data for this secondary post hoc analysis were analyzed from March to June 2019. Interventions: Patients were randomly assigned to receive rivaroxaban, 15 mg/d, or aspirin, 100 mg/d. Main Outcomes and Measures: Association of recurrent ESUS with stroke characteristics. Results: A total of 309 patients (205 men [66%]; mean [SD] age, 68 [10] years) had ischemic stroke identified during the median follow-up of 11 (interquartile range [IQR], 12) months (annualized rate, 4.6%). Diagnostic testing was insufficient for etiological classification in 39 patients (13%). Of 270 classifiable ischemic strokes, 156 (58%) were ESUS and 114 (42%) were non-ESUS (37 [32%] cardioembolic, 26 [23%] atherosclerotic, 35 [31%] lacunar, and 16 [14%] other determined cause). Atrial fibrillation was found in 27 patients (9%) with recurrent ischemic stroke and was associated with higher morbidity (median change in modified Rankin scale score 2 [IQR, 3] vs 0 (IQR, 1]) and mortality (15% vs 1%) than other causes. Risk of recurrence did not differ significantly by subtype between treatment groups. For both the qualifying and recurrent strokes, location of infarct was more often in the left (46% and 54%, respectively) than right hemisphere (40% and 37%, respectively) or brainstem or cerebellum (14% and 9%, respectively). Conclusions and Relevance: In this secondary analysis of randomized clinical trial data, most recurrent strokes after ESUS were embolic and of undetermined source. Recurrences associated with atrial fibrillation were a minority but were more often disabling and fatal. More extensive investigation to identify the embolic source is important toward an effective antithrombotic strategy. Trial Registration: ClinicalTrials.gov Identifier: NCT02313909.. © 2020 American Medical Association. All rights reserved.

Ämnesord och genrebeteckningar

Biuppslag (personer, institutioner, konferenser, titlar ...)

  • Lindgren, ArneLund University,Lunds universitet,Klinisk strokeforskning,Forskargrupper vid Lunds universitet,Clinical Stroke Research Group,Lund University Research Groups,Skåne University Hospital(Swepub:lu)neur-ali (författare)
  • Korompoki, E.Imperial College London,National and Kapodistrian University of Athens (författare)
  • Sharma, M.McMaster University,Population Health Research Institute, Ontario (författare)
  • Kasner, S. E.University of Pennsylvania (författare)
  • Toni, D. S.Sapienza University of Rome (författare)
  • Ameriso, S. F.Fundacion Para La Lucha Contra Las Enfermedades Neurologicas de La Infancia (FLENI) (författare)
  • Mundl, H.Bayer Pharma AG (författare)
  • Tatlisumak, TurgutUniversity of Gothenburg,Gothenburg University,Göteborgs universitet,Institutionen för neurovetenskap och fysiologi, sektionen för klinisk neurovetenskap,Institute of Neuroscience and Physiology, Department of Clinical Neuroscience,Sahlgrenska University Hospital(Swepub:gu)xtatlt (författare)
  • Hankey, G. J.University of Western Australia, Perth (författare)
  • Lindgren, A. (författare)
  • Berkowitz, S. D.Bayer Corporation, USA (författare)
  • Arauz, A.Instituto Nacional de Neurología y Neurocirugía (författare)
  • Ozturk, S.Selcuk University (författare)
  • Muir, K. W.Queen Elizabeth University Hospital,University of Glasgow (författare)
  • Chamorro, ÁUniversity of Barcelona (författare)
  • Perera, K.McMaster University,Population Health Research Institute, Ontario (författare)
  • Shuaib, A.University of Alberta (författare)
  • Rudilosso, S.University of Barcelona (författare)
  • Shoamanesh, A.McMaster University,Population Health Research Institute, Ontario (författare)
  • Connolly, S. J.Population Health Research Institute, Ontario,McMaster University (författare)
  • Hart, R. G.McMaster University,Population Health Research Institute, Ontario (författare)
  • Alfried Krupp KrankenhausImperial College London (creator_code:org_t)

Sammanhörande titlar

  • Ingår i:JAMA Neurology: American Medical Association (AMA)77:10, s. 1233-12402168-6149

Internetlänk

Hitta via bibliotek

Till lärosätets databas

Kungliga biblioteket hanterar dina personuppgifter i enlighet med EU:s dataskyddsförordning (2018), GDPR. Läs mer om hur det funkar här.
Så här hanterar KB dina uppgifter vid användning av denna tjänst.

 
pil uppåt Stäng

Kopiera och spara länken för att återkomma till aktuell vy