Sökning: WFRF:(Lindgren Arne G.) >
Characteristics of ...
Characteristics of Recurrent Ischemic Stroke after Embolic Stroke of Undetermined Source: Secondary Analysis of a Randomized Clinical Trial
-
- Veltkamp, R. (författare)
- Imperial College London,Alfried Krupp Krankenhaus
-
- Lindgren, Arne (författare)
- Lund University,Lunds universitet,Klinisk strokeforskning,Forskargrupper vid Lunds universitet,Clinical Stroke Research Group,Lund University Research Groups,Skåne University Hospital
-
- Korompoki, E. (författare)
- Imperial College London,National and Kapodistrian University of Athens
-
visa fler...
-
- Sharma, M. (författare)
- Population Health Research Institute, Ontario,McMaster University
-
- Kasner, S. E. (författare)
- University of Pennsylvania
-
- Toni, D. S. (författare)
- Sapienza University of Rome
-
- Ameriso, S. F. (författare)
- Fundacion Para La Lucha Contra Las Enfermedades Neurologicas de La Infancia (FLENI)
-
- Mundl, H. (författare)
- Bayer Pharma AG
-
- Tatlisumak, Turgut (författare)
- University 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
-
- Hankey, G. J. (författare)
- University of Western Australia, Perth
-
Lindgren, A. (författare)
-
- Berkowitz, S. D. (författare)
- Bayer Corporation, USA
-
- Arauz, A. (författare)
- Instituto Nacional de Neurología y Neurocirugía
-
- Ozturk, S. (författare)
- Selcuk University
-
- Muir, K. W. (författare)
- Queen Elizabeth University Hospital,University of Glasgow
-
- Chamorro, Á (författare)
- University of Barcelona
-
- Perera, K. (författare)
- McMaster University,Population Health Research Institute, Ontario
-
- Shuaib, A. (författare)
- University of Alberta
-
- Rudilosso, S. (författare)
- University of Barcelona
-
- Shoamanesh, A. (författare)
- McMaster University,Population Health Research Institute, Ontario
-
- Connolly, S. J. (författare)
- McMaster University,Population Health Research Institute, Ontario
-
- Hart, R. G. (författare)
- McMaster University,Population Health Research Institute, Ontario
-
visa färre...
-
(creator_code:org_t)
- American Medical Association (AMA), 2020
- 2020
- Engelska.
-
Ingår i: JAMA Neurology. - : American Medical Association (AMA). - 2168-6149. ; 77:10, s. 1233-1240
- Relaterad länk:
-
https://iris.uniroma...
-
visa fler...
-
http://dx.doi.org/10...
-
https://gup.ub.gu.se...
-
https://doi.org/10.1...
-
https://lup.lub.lu.s...
-
visa färre...
Abstract
Ämnesord
Stäng
- 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
- MEDICIN OCH HÄLSOVETENSKAP -- Medicinska och farmaceutiska grundvetenskaper -- Neurovetenskaper (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Basic Medicine -- Neurosciences (hsv//eng)
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Neurologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Neurology (hsv//eng)
Publikations- och innehållstyp
- ref (ämneskategori)
- art (ämneskategori)
Hitta via bibliotek
Till lärosätets databas
- Av författaren/redakt...
-
Veltkamp, R.
-
Lindgren, Arne
-
Korompoki, E.
-
Sharma, M.
-
Kasner, S. E.
-
Toni, D. S.
-
visa fler...
-
Ameriso, S. F.
-
Mundl, H.
-
Tatlisumak, Turg ...
-
Hankey, G. J.
-
Lindgren, A.
-
Berkowitz, S. D.
-
Arauz, A.
-
Ozturk, S.
-
Muir, K. W.
-
Chamorro, Á
-
Perera, K.
-
Shuaib, A.
-
Rudilosso, S.
-
Shoamanesh, A.
-
Connolly, S. J.
-
Hart, R. G.
-
visa färre...
- Om ämnet
-
- MEDICIN OCH HÄLSOVETENSKAP
-
MEDICIN OCH HÄLS ...
-
och Medicinska och f ...
-
och Neurovetenskaper
-
- MEDICIN OCH HÄLSOVETENSKAP
-
MEDICIN OCH HÄLS ...
-
och Klinisk medicin
-
och Neurologi
- Artiklar i publikationen
-
JAMA Neurology
- Av lärosätet
-
Göteborgs universitet
-
Lunds universitet