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Acute ischemic stroke carries high morbidity and mortality. The advent of intravenous thrombolysis and endovascular reperfusion techniques have helped improve clinical outcomes for patients with large vessel acute ischemic stroke. The care of the post-endovascular stroke patient is complex and encompasses almost all aspects of medicine. Hemodynamics should be optimized post procedure to ensure adequate cerebral perfusion and strict hemodynamic parameters must be adhered to minimize reperfusion injury. Though no studies have specifically examined hemodynamic goals, our practice is to maintain a mean arterial pressure (MAP) > 70 and systolic blood pressure (SBP) < 140 for patients following successful recanalization. Early anti-thrombotic therapy is indicated in patients with stent placement. It remains less clear which patients may benefit from additional anticoagulation or therapy with IIb/IIIa inhibitors. Careful consideration must be paid to volume status to reduce risk of contrast nephropathy and maximize cerebral perfusion. Oral care and attention to dysphagia are key in preventing aspiration pneumonia. Glycemic control should be optimized to avoid excessive hyper and hypoglycemia. In the absence of data to guide treatment of anemia, our practice is to transfuse asymptomatic anemia when Hgb < 7 mg/dL, or if the patient is symptomatic or hemodynamically unstable. Neuro-protective strategies should be considered in the context of clinical trials until further studies are complete. At a minimum, fever should be treated aggressively. Young patients with good pre-morbid functional status who continue to have large volume infarcts may benefit from decompressive hemicraniectomy. When appropriate, aggressive and early mobilization is recommended to prepare patients for acute rehabilitation. Because randomized prospective data is lacking, patients should be encouraged to enroll in clinical trials to optimize care of this growing patient population.
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http://dx.doi.org/10.1007/s11940-012-0216-3 | DOI Listing |
Biomol Biomed
December 2024
Internal Medicine Clinic, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina.
The aim of the current research was to investigate the association between plasma endocan levels and metabolic control parameters, as well as to evaluate its predictive value for clinical complications in patients with type 2 diabetes mellitus (DMT2). A total of 100 DMT2 patients participated in this prospective observational study. Plasma endocan levels were significantly elevated in DMT2 patients with HbA1c > 7% (1.
View Article and Find Full Text PDFFront Public Health
December 2024
Department of Nursing, Harbin Medical University, Harbin, China.
Objective: This study investigates the factors influencing sedentary behavior in older adult Chinese stroke patients using decision trees and logistic regression models.
Methods: Convenience sampling method was employed to enroll 346 respondents aged ≥60 years with stroke from the Department of Neurology of three tertiary-level A hospitals in Heilongjiang province, based on the inclusion criteria. The Sedentary Behavior Questionnaire for Older Adults, the International Physical Activity Questionnaire Short Form (IPAQ-S), the Pittsburgh Sleep Quality Index (PSQI), the Self-Rating Depression Scale (SDS), and the Social Support Scale (SSRS) were used to assess sedentary behavior, physical activity level, sleep quality, depressive symptoms, and social support, respectively.
J Blood Med
December 2024
Department of Pharmacy, Kathmandu University, Dhulikhel, Nepal.
Purpose: Atrial fibrillation (AF) being a prevalent cardiovascular condition globally, has an increased risk of stroke and other complications. The effective management of AF often involves the use of oral anticoagulants (OACs) to prevent thromboembolic events. This study aimed to evaluate anticoagulation knowledge and medication adherence in AF patients on OACs at a tertiary care center in Nepal.
View Article and Find Full Text PDFTex Heart Inst J
December 2024
Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Background: Cardiogenic stroke is associated with substantial morbidity and mortality, necessitating a better understanding of its clinical characteristics for improved patient outcomes. This study aimed to identify clinical characteristics influencing short-term functional prognosis in patients with cardiogenic stroke.
Methods: The study prospectively enrolled 212 patients with cardiogenic stroke, collecting their clinical data and laboratory results.
EClinicalMedicine
January 2025
Department of Epidemiology, NHC Key Laboratory for Health Technology Assessment, Fudan University School of Public Health, 138 Yi Xue Yuan Road, Shanghai, 200032, China.
Background: Depression is a severe mental disorder commonly co-morbid with diabetes, but it remains to elucidate whether depression is associated with the risks of a wide range of vascular complications in people with type 2 diabetes mellitus (T2DM) and whether metabolic biomarkers may mediate this pathway.
Methods: We conducted this prospective analysis among the participants of the UK Biobank who were diagnosed with T2DM and free of vascular complications at baseline between March 13, 2006 and September 30, 2010. Major depressive disorder (MDD) was ascertained according to the hospital admission records and self-report of doctor-diagnosed conditions, while the presence of depressive symptoms was assessed using the Patient Health Questionnaire-2.
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