Journal of Stroke & Cerebrovascular Diseases最新文献

{"title":"Letter to the Editor Regarding \"Investigating the role of gut microbiota in hemorrhagic stroke: Evidence from causal analysis\".","authors":"Rizwan Ahmad, Saad Khan, Ayesha Khan, Faraz Arshad, Fatima Naveed","doi":"10.1016/j.jstrokecerebrovasdis.2024.108184","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108184","url":null,"abstract":"","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108184"},"PeriodicalIF":2.0,"publicationDate":"2024-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The stroke meta-metric, Defect-Free Care, was maintained year-over-year within the Florida stroke registry during the COVID-19 pandemic.","authors":"David Z Rose, Lili Zhou, Karlon H Johnson, Charles Schutt, Daniel M Reyes de Jesus, Hannah Gardener, Carolina M Gutierrez, Dianne Foster, Angus Jameson, Sebastian Koch, Hao Ying, Ayham Alkhachroum, Jose G Romano, Tatjana Rundek, Negar Asdaghi","doi":"10.1016/j.jstrokecerebrovasdis.2024.108179","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108179","url":null,"abstract":"<p><strong>Background: </strong>Resource allocation for stroke care was impacted worldwide by the Coronavirus 2019 (COVID19) pandemic. Regionally, worsened stroke outcomes varied, however comparative year-over-year in-hospital performance metrics from the pandemic are unreported. Therefore, within the large Florida Stroke Registry (FSR), we assessed the pandemic's effects upon the American Heart Association (AHA) Get With The Guidelines (GWTG) ischemic stroke metrics and the meta-metric, Defect-Free Care (DFC).</p><p><strong>Methods: </strong>From March 2017 to February 2021, FSR collected 146,593 patients with a diagnosis of ischemic stroke or TIA (31,940 between 2017-2018; 35,086 between 2018-2019; 39,722 between 2019-2020; 39,845 between 2020-2021). FSR evaluated DFC, intravenous thrombolytic (IVT) use, endovascular therapy (EVT) use, and Door-To-Needle (DTN), Door-To-Computed Tomography (DTCT), and Door-To-Puncture (DTP) times.</p><p><strong>Results: </strong>Pre-pandemic versus pandemic stroke patients' demographics were similar (49.0 % vs. 48.6 % female, age 70.7±14.3 vs. 70.5±14.1 years, 64.0 % vs. 65.3 % white, 18.6 % vs. 18.8 % black, 17.4 % vs. 16.0 % Hispanic). Pandemic strokes, versus the immediate year pre-pandemic, were significantly more severe (median NIHSS 4 [IQR 8] vs. 3 [7]), utilized emergency medical services more (59.2 % vs. 57.6 %) and were more likely to receive EVT (8.0 % vs. 7.0 %). IVT use, and DTCT and DTP times were unchanged. The meta-metric DFC improved year-over-year, albeit slower during the pandemic [2017/18-2018/19: 70.7 % to 74.9 % (+4.2 %); 2018/19-2019/20: 74.9 % to 82.1 % (+7.2 %); 2019/20-2020/21: 82.1 % to 85.2 % (+3.1 %)].</p><p><strong>Conclusions: </strong>Despite pandemic challenges, the stroke meta-metric DFC improved, albeit more slowly than pre-pandemic years. In this large statewide registry, pandemic patients received EVT more, potentially due to more severe stroke presentations. Stroke care infrastructure preparedness for future pandemics is warranted.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108179"},"PeriodicalIF":2.0,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796555","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relevance of peripheral inflammation indexes in different collateral circulation for intracranial hemorrhage in acute anterior circulation ischemic stroke patients undergoing endovascular treatment.","authors":"Jinrui Li, Kailin Cheng, Jianxia Ke, Jintao Li, Jia Wen, Junting Chen, Xue Jia, Xiaoli Fu, Kefeng Lv, Zhu Shi","doi":"10.1016/j.jstrokecerebrovasdis.2024.108175","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108175","url":null,"abstract":"<p><strong>Background: </strong>Asymptomatic intracranial hemorrhage (aICH) is common after endovascular thrombectomy (EVT). Collateral circulation could modify the association between aICH with functional outcome and we aimed to investigate the impact of systemic inflammation index on 3-month outcome under different collateral circulation.</p><p><strong>Method: </strong>Consecutive patients undertaken EVT were enrolled and classified into non-intracranial hemorrhage (non-ICH), aICH and symptomatic intracranial hemorrhage (sICH) groups according to the neurological status and National Institutes of Health Stroke Scale (NIHSS) changes within 72 hours after EVT. Preoperative collateral status was scored using the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN/SIR) scale. Clinical data were collected and analyzed according to the stratification of collateral stratification. Multivariate regression models were constructed to evaluate the influence of systemic inflammation indexes and collateral status on functional outcome.</p><p><strong>Results: </strong>Of 302 patients, 86 (28.5%) developed aICH with 36(11.9%) sICH. Compared to non-ICH patients, there was a significant trend towards higher proportion of poor collateral circulation in patients with aICH, sICH (47.8% vs. 67.2% vs. 94.4%, p <0.001). Spearman's correlation analysis revealed a significant negative correlation of peripheral neutrophil counts, NLR, and SIRI with collateral circulation score. Under poor collateral circulation, neutrophil counts showed a significant positive association with sICH (OR 1.20, 95%CI: 1.07-1.35, p=0.002), but not with aICH. Under good collateral circulation, the inflammation indexes did not show a significant correlation with either ICH.</p><p><strong>Conclusion: </strong>aICH patients with good collateral circulation have good functional outcome comparable to no-ICH patients. Under poor collateral circulation, elevated neutrophil counts may contribute to the conversion from aICH to sICH. Tailored anti-inflammatory therapy has potential to improve the efficacy and safety of EVT.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108175"},"PeriodicalIF":2.0,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic yield and therapeutic implications of vascular imaging in acute ischemic stroke: prospective and consecutive study of small vessel versus large vessel ischemia.","authors":"Roger E Kelley, Prabandh Buchhanolla, Amrita Pandey, Monika Thapa, Md Ismail Hossain, Mohammad Alfrad Nobel Bhuiyan","doi":"10.1016/j.jstrokecerebrovasdis.2024.108182","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108182","url":null,"abstract":"<p><strong>Introduction: </strong>To evaluate patients acute cerebral ischemia in order to assess for factors which may help to differentiate patients with small vessel involvement from those with large vessel involvement in an effort to determine diagnostic yield of vascular imaging.</p><p><strong>Material and method: </strong>We prospectively and consecutively evaluated all acute ischemic stroke patients at our medical center from May 16, 2021 to December 10, 2021. Distinction between small vessel and large vessel involvement was based upon clinical presentation, the results of brain imaging and either computed tomographic angiography, in the vast majority, or magnetic resonance angiography. Patient demographics and risk factors for stroke as well as therapeutic intervention was assessed.</p><p><strong>Conclusion and result: </strong>Of the 90 patients studied, 59 had large vessel ischemia (66%) with 26 (44%) having large vessel occlusion and one had symptomatic high-grade middle cerebral artery stenosis. Conversely, none of the 31 patients with small vessel presentation (34%) had large vessel occlusion or high-grade stenosis. In addition, 19 out of 59 (32%) large vessel patients compared to 2 of 31 (6%) of the small vessel patients had atrial fibrillation identified as a potential mechanism with a p-value of 0.01 by univariate analysis and 0.17 by multivariate analysis. The routine use of vascular imaging in acute ischemic stroke is of very low yield in small vessel presentation with the presence of potential cardiogenic emboli is also relatively low. Efforts at accelerated identification of a small vessel mechanism, to avoid unnecessary testing, should provide significant value from both a patient management and cost standpoint.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108182"},"PeriodicalIF":2.0,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stimulant use disorder and the likelihood of stroke: Analysis of a national database in the United States.","authors":"Akash Venkataramanan, Divya Nayar, Sama Almasri, Thirumalaivasan Dhasakeerthi, Sowmya Jayachandran, Suryansh Bajaj, Cheran Elangovan","doi":"10.1016/j.jstrokecerebrovasdis.2024.108178","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108178","url":null,"abstract":"<p><strong>Background: </strong>Stimulant use has been associated with an increased risk of stroke, though data on clinical characteristics and exact risk are limited. This retrospective case-control study examines stroke risk in individuals with stimulant use disorder using data from a national U.S.</p><p><strong>Database: </strong></p><p><strong>Methods: </strong>Data was obtained from the 2019 National Readmission Database (NRD) using ICD-10 codes to identify relevant diagnoses. A multivariate logistic regression analyzed the impact of stimulant use disorder on stroke admission odds, adjusting for alcohol use disorder, tobacco use, diabetes, hypertension, dyslipidemia, age, insurance status, and median income. Outcomes like total hospitalization charge, length of stay, and in-hospital mortality were assessed with multivariate regression. Gender-specific analyses were also conducted. Statistical significance was set at p < 0.05.</p><p><strong>Results: </strong>A total of 4,821 adults with stimulant use disorder and stroke were compared to 542,618 stroke patients without stimulant use disorder. Patients with stimulant use disorder (PWSU) had significantly higher odds of hemorrhagic and ischemic stroke admissions, especially hemorrhagic strokes in women. PWSU with hemorrhagic strokes also had higher odds of in-hospital mortality.</p><p><strong>Conclusions: </strong>Stimulant use disorder is associated with higher odds of admission for stroke, especially in women with an overall elevated mortality from hemorrhagic strokes. These findings underscore the need for further research and emphasize the importance of stroke prevention and treatment in individuals with stimulant use disorder.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108178"},"PeriodicalIF":2.0,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differential outcomes and treatment in non-traumatic carotid versus vertebral cervical artery dissection: A national inpatient sample study.","authors":"Elizabeth Lee, Liqi Shu, Setareh Salehi Omran, Eric D Goldstein, Nils Henninger, Thanh N Nguyen, James E Siegler, Lukas Strelecky, Farhan Khan, Christoph Stretz, Karen L Furie, Shadi Yaghi","doi":"10.1016/j.jstrokecerebrovasdis.2024.108170","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108170","url":null,"abstract":"<p><strong>Introduction: </strong>Cervical artery dissection (CAD) involves the carotid or vertebral artery. However, limited studies have compared their clinical features and outcomes.</p><p><strong>Methods: </strong>We examined non-traumatic CAD patients from the National Inpatient Sample (2005-2019). Those diagnosed with both carotid and vertebral artery dissections were excluded. The evaluation included patient demographics, comorbidities, and treatment. Differences between carotid and vertebral dissections were assessed using survey-weighted stepwise backward logistic regression, followed by adjusted multivariable regressions for the primary outcomes of in-hospital mortality and routine discharge (to home or self-care).</p><p><strong>Results: </strong>From 2005 to 2019, we included 123,224 non-traumatic CAD admissions without concurrent vertebral and carotid dissections. There were more carotid dissections than vertebral dissections (67,533 vs. 55,691). Compared to vertebral dissection, carotid dissection was associated with older age (54 [44-66] years vs. 49 [37-62] years, P<0.001), Black race (12.6% vs. 8.8%, P<0.001), White race (73.5% vs. 72.0%, P = 0.024), atrial fibrillation (10.8% vs. 6.3%, P<0.001), aortic dissection (7.7% vs. 0.3%, P<0.001), and fewer concurrent acute ischemic strokes (AIS) (47.8% vs. 56.7%, P<0.001).Within the concurrent AIS group, carotid CAD patients exhibited higher NIHSS (8 [2-17] vs. 2 [0-5], P<0.001), an increased utilization of intravenous thrombolysis (6.7% vs. 2.7% P<0.001), endovascular therapy (13.3% vs. 3.3%, P<0.001), and angioplasties (9.8% vs. 0.3%, P<0.001). Overall, carotid CAD was associated with more inpatient deaths (aOR 1.30, 95% CI 1.04-1.62, P=0.023) and less routine discharges (aOR 0.88, 95% CI 0.79-0.97, P=0.014) than vertebral CAD.</p><p><strong>Conclusion: </strong>Our study underscores distinct comorbidity profiles and treatment patterns between non-traumatic carotid dissection and vertebral dissection groups. These findings advocate for tailored treatment strategies based on dissection type to optimize patient outcomes.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108170"},"PeriodicalIF":2.0,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute stroke care coordination in the United States: Variation in state laws for Emergency Medical Services and hospitals.","authors":"Zhiqiu Ye, Siobhan Gilchrist, Nina Omeaku, Sharada Shantharam, Matthew Ritchey, Sallyann M Coleman King, Laurence Sperling, Jane L Holl","doi":"10.1016/j.jstrokecerebrovasdis.2024.108174","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108174","url":null,"abstract":"<p><strong>Background: </strong>Lack of care coordination between Emergency Medical Services (EMS) and hospitals contributes to delay of acute stroke (AS) treatment. In the United States, states have adopted laws to improve the quality of EMS and hospital care; the degree to which these laws create regulatory incentives to promote care coordination between them is less well known. We examined state variation in attributes of laws that may influence AS care coordination between EMS and hospitals.</p><p><strong>Materials and methods: </strong>We selected ten law \"dyads\" across seven domains of EMS and hospital AS care informed by published risk assessments of critical steps for improved door-to-needle time and door-in-door-out time. We assessed concordance in prescriptiveness (degree to which levels were similar) and in adoption (degree to which laws were adopted concurrently) of the laws in effect between January 2002 and January 2018 in the United States.</p><p><strong>Results: </strong>The proportion of states with prescriptiveness concordance ranged from 47 % (e.g., inter-facility transfer agreements, comprehensive, primary stroke center certification) to 75 % (e.g., Continuous Quality Improvement (CQI) for EMS and hospitals). Adoption concordance ranged from 31 % (e.g., inter-facility transfer agreements, Acute Stroke Ready Hospital certification) to 86 % (e.g., CQI for EMS and hospitals). Laws for EMS triage were less prescriptive than laws for stroke center certification in 22 %-35 % of states adopting both laws, depending on stroke center type.</p><p><strong>Conclusions: </strong>Subsequent policy implementation and impact studies may benefit from assessing concordance and prescriptiveness in policy intervention adoption, particularly as a foundation for evaluating delays in AS treatment due to inefficient care coordination.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108174"},"PeriodicalIF":2.0,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Topography of ischemic strokes in cancer-associated non-bacterial thrombotic endocarditis: A single-institution descriptive case series.","authors":"Carlee I Oakley, Ewa M Wysokinska, Alicja Kaminska, Marwa A Mohammed, Patryk Patrzalek, Damon Houghton, David Hodge, Waleed Brinjikji, James P Klaas, Waldemar E Wysokinski","doi":"10.1016/j.jstrokecerebrovasdis.2024.108171","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108171","url":null,"abstract":"<p><strong>Background: </strong>Very limited data indicate that patients with stroke from cancer-associated NBTE (Ca-NBTE) exhibit a characteristic pattern of widely distributed ischemic lesions of varying sizes.</p><p><strong>Methods: </strong>An electronic search of Mayo Clinic records (03/31/2002-06/30/2022) with ensuing manual review of brain magnetic resonance imaging (MRI) was performed to identify topographic characteristics of stroke from Ca-NBTE.</p><p><strong>Results: </strong>In 112 patients with Ca-NBTE, 92 (82.1 %) had a stroke and 84 (76.5 %) had an MRI available for analysis (mean age 62.7±9.2, 57 women). 64 (76.2 %) patients had ischemic strokes in both cerebral hemispheres, 10 (11.9 %) had isolated left hemispheric infarcts, and 7 (8.3 %) had isolated right hemispheric infarcts. Strokes involving both the anterior and posterior circulation were seen in 66 (78.6 %) patients. Disseminated small, medium, and large ischemic strokes (Type IV) were seen in 57 (67.8 %), multiple punctate disseminated strokes (Type III) in 14 (16.7 %), multiple strokes in a single vascular territory (Type II) in 7 (8.3 %), and a single ischemic stroke (Type I) in 6 (7.1 %) patients. Strokes were most commonly observed in the middle cerebral artery territories - on the right in 65 (77.4 %) and on the left in 68 (81.0 %) patients. Strokes within the right posterior cerebral artery territory were observed in 54 (64.3 %) and the left posterior cerebral artery territory in 54 (64.3 %) patients. 46 (54.8 %) patients had strokes in the right cerebellum and 50 (59.5 %) had strokes in the left cerebellum. Only 5 patients had strokes in the right brainstem and 3 in the left brainstem.</p><p><strong>Discussion: </strong>Ca-NBTE is most commonly associated with multifocal bihemispheric ischemic strokes of varying sizes involving both the anterior and posterior circulation, but solitary infarcts or infarcts confined to a single vascular territory can also be seen.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108171"},"PeriodicalIF":2.0,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge, attitude, and practice of stroke patients' family members towards stroke rehabilitation: A cross-sectional study.","authors":"Dongdong Li, Hui Guo, Yiwen Sun, Zhijun Zhang, Huilin Liu","doi":"10.1016/j.jstrokecerebrovasdis.2024.108177","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108177","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to explore the knowledge, attitude, and practice (KAP) among family members of stroke patients regarding stroke rehabilitation.</p><p><strong>Methods: </strong>A cross-sectional study was conducted on the family members of stroke patients at the China Rehabilitation Research Center from February 15 to May 2, 2024. This study collected demographic data and KAP scores through a self-designed questionnaire.</p><p><strong>Results: </strong>The study enrolled 517 family members, of which 344 (66.54%) were male. The mean scores for knowledge, attitude, and practice were 12.01 ± 5.46 (possible range: 0-20), 49.40 ± 4.96 (possible range: 11-55), and 41.93 ± 7.49 (possible range: 10-50), respectively. Correlation analyses demonstrated a significant positive relationship between knowledge and attitude (r = 0.501, P < 0.001), knowledge and practice (r = 0.471, P < 0.001), and attitude and practice (r = 0.441, P < 0.001). Structural Equation Modeling indicated that showed that knowledge directly affected attitude (β = 0.481, P = 0.004) and practice (β = 0.351, P = 0.009), and attitude directly affected practice (β = 0.244, P = 0.007). Additionally, knowledge indirectly affected practice through attitude (β = 0.117, P = 0.006).</p><p><strong>Conclusions: </strong>This study identified significant gaps in knowledge, despite generally positive attitudes and proactive practices among family members of stroke patients regarding stroke rehabilitation. This highlights the necessity for tailored educational programs for family members to address these knowledge gaps.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108177"},"PeriodicalIF":2.0,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-world safety profile of direct oral anticoagulants (DOACs): Disproportionality analysis of major bleeding events.","authors":"Lazzaro di Biase, Adriano Bonura, Pasquale Maria Pecoraro, Vincenzo Di Lazzaro","doi":"10.1016/j.jstrokecerebrovasdis.2024.108173","DOIUrl":"10.1016/j.jstrokecerebrovasdis.2024.108173","url":null,"abstract":"<p><strong>Background: </strong>Direct Oral Anticoagulants (DOACs) have revolutionized the management of thrombotic conditions, providing more predictable and manageable anticoagulation compared to traditional vitamin K antagonists. Despite their success, major bleeding events remain a significant concern. This study aims to assess and compare the haemorrhagic risks associated with various DOACs using data from the FDA's Adverse Event Reporting System (FAERS).</p><p><strong>Methods: </strong>A retrospective disproportionality analysis of the FAERS database was conducted, covering the period from January 1, 2015, to December 31, 2023. The study focused on adverse bleeding events reported for DOACs. The Proportional Reporting Ratio (PRR) was calculated for each DOAC to identify disproportionate reporting of haemorrhagic events. Major haemorrhagic events were classified as those leading to hospitalization. The analysis also utilized the Medicare Part D dataset to estimate the usage of specific DOACs from 2015 to 2021.</p><p><strong>Results: </strong>A total of 353,188 haemorrhagic events were identified, with 17,236 (4.9%) attributed to DOACs. The PRR for major haemorrhagic events was highest for Edoxaban at 14.1 (95% CI 13.93-14.85), followed by Dabigatran at 4.0 (95% CI 3.81-4.20), Apixaban at 3.53 (95% CI 3.47-3.61), and Rivaroxaban at 2.11 (95% CI 2.05-2.18). Edoxaban also had the highest PRR for cerebral haemorrhages. Medicare data indicated that Apixaban was the most commonly used DOAC (58.3%), followed by Rivaroxaban (34.5%).</p><p><strong>Conclusions: </strong>Edoxaban shows a significantly higher risk of major and cerebral haemorrhages compared to other DOACs, while Rivaroxaban demonstrates a lower overall risk of haemorrhage. These findings emphasize the need for careful consideration of bleeding risks in DOAC therapy. Continuous post-marketing surveillance is crucial for understanding the safety profiles of DOACs in real-world clinical settings, aiding clinicians and patients in making informed decisions about anticoagulant therapy.</p>","PeriodicalId":54368,"journal":{"name":"Journal of Stroke & Cerebrovascular Diseases","volume":" ","pages":"108173"},"PeriodicalIF":2.0,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142792845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}