BackgroundAntithrombotic agents are the mainstay for prevention of stroke in patients with atrial fibrillation (AF) and/or rheumatic heart disease (RHD). However, the impact of antithrombotic agents on cerebral microbleeds (CMBs) and leukoaraiosis remains contro-versial.
ObjectiveWe aimed to explore this association in Chinese ischemic stroke patients with AF and/or RHD.
Patients and methods/material and methodsIschemic stroke patients with AF and/or RHD within 7 days of onset from two hospitals were enrolled. Clinical information, prior use of antiplatelets or anticoagulation, presence and location of CMBs and leukoaraiosis were recorded.
ResultsTotally, 160 patients (median age, 71 years) were included. CMBs were observed in 90 (56.3%) patients, of whom 37 were with strictly lobar CMBs and 53 were with deep/infratentorial CMBs. leukoaraiosis was observed in 107 (66.9%) patients. There was a significant difference in antiplatelet use between patients with and without CMBs (33.3 vs. 11.4%, P = 0.001), but not found for anticoagulants. Prior use of antiplatelets was independently associated with the presence of CMBs (OR 3.075, 95% CI 1.175-8.045, P = 0.022) and especially strictly lobar CMBs (OR 2.635, 95% CI 1.050-6.612, P = 0.039) in multivariate analysis. However, no significant association was found between any antithrombotic agent and leukoaraiosis.
ConclusionsCMBs and leukoaraiosis are common cerebral small vessel disease markers in ischemic stroke patients with AF and/or RHD. Prior antiplatelet use is independently associated with the presence of CMBs predominantly in the strictly lobar region.
Stroke is a leading cause of morbidity and mortality worldwide and there is a significant gap in the availability of standard of care in different regions especially in the rural areas. To assess the clinical profile and outcome of patients treated with iv rtPA at a rural tertiary care center. A prospective observational study of consecutive window period stroke patients treated with iv rtPA. Clinical, epidemiological, imaging parameters, outcome measures including baseline NIHSS, NIHSS at 1 hour, 24 hours, discharge and mRS [modified Rankin Score] at 1 and 3 months were entered in structured proforma. A total od 28 patients were thrombolysed with iv rtPA during the study period. Diabetes, Hypertension and smoking were the most common comorbidities. The mean arrival time in hospital was 151 minutes. The door to needle time was 68 minute. 22 had anterior circulation stroke and 6 with posterior circulation stroke. Mean NIHSS at arrival was 10.4. Mean NIHSS score at 24 hours was 10.1 and NIHSS at 7 days was 9.8. Major improvement as measured as a drop in NIHSS of 8 points was seen in 7 patients [25%]. The mean MRS at 1 month was 2.89 and at 3 months was 1.74. At 3 months follow up 10 out of 28 patients [35.7%] had major improvement characterized by mRS improvement of 3 from time of discharge or final mRS of 0 or 1. Thrombolysis with rtPA is safe and effective in rural setting.
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