Background: Patients with ischemic stroke and underlying Atrial Fibrillation (AF) have a high risk of recurrent embolic events. New Oral Anticoagulant (NOAC) is highly effective and reduces the risk of recurrence in AF-associated Ischemic Stroke (AFAIS). Objectives: This study aimed to determine the prescription pattern of NOAC and its determinant factors in patients with non-valvular AFAIS. Materials & Methods: This research was a cross-sectional descriptive study and the participants were referred to an academic hospital in the north of Iran from 2017 to 2018. The study variables included demographic variables such as the use of new anticoagulants, age, sex, place of residence, income level, education, the history of stroke and myocardial Infarction (MI), medication, and stroke severity based on The National Institutes of Health Stroke Scale criteria. The patient’s functional status based on the modified Rankin Scale (mRS) was extracted from the patients’ medical records. The data analysis was conducted by SPSS V. 19, using the Chi-square test and t-test, as well as the logistic regression model. Results: In this study, 363 patients with ischemic stroke with the origin of non-valvular AF and the mean age of 67.87 years were studied. Of them, 191 (52.6%) patients were women, and 30.6% were prescribed rivaroxaban at the time of discharge. The results showed that women were more likely to use rivaroxaban than men (P=0.001, OR=0.422). The history of stroke (P=0.004, OR=2.17) and the stroke severity (P=0.05, OR=2.19) was associated with an increase in NOAC prescription. Conclusion: The results of this study showed that the administration of NOAC in this population was low and associated with gender and the severity and the history of stroke.
Background: Intravenous (IV) recombinant tissue Plasminogen Activator (rtPA) (IV-rtPA) is the only FDA-approved pharmacological therapy for treatment in acute ischemic stroke and the administration of IV-rtPA is crucially time-dependent. Objectives: This study aimed to evaluate symptom-to-needle time and factors associated with the prehospital delay in patients with acute ischemic stroke referred to Poursina Hospital, a referral hospital in the north of Iran. Materials & Methods: In this cross-sectional study, all patients with acute stroke referred to Poursina Hospital from June to December 2016 were evaluated. The study data were extracted from the patients’ records. SPSS v. 21 was used to analyze the obtained data. The independent samples t-test and the Chi-square test were used to explore the appropriate relation of variables. Results: A total of 322 patients were included. Their mean age was 74.4 years and 55.6% were male. According to findings, only 74 patients (22.98%) were transferred to the hospital via Emergency Medical Service (EMS), most of them (64.86%) arrived at the right time. There is a significant relationship between EMS transfer use and arriving at the hospital at the right time. Overall, 13.9% of patients received IV rtPA, and 75.5% of the patients received rtPA in less than 60 minutes. Among the patients arrived in the golden time, the average times to treatment were as follows: onset-to-door (OTD), 105 min; door-to-admission, 3 min; admission-to-doctor, 7 min; doctor-to-Computed Tomography (CT), 15 min; CT-to-treatment, 26 min; symptom to needle time, 152 min; and door-to-needle time (DNT), 49 min. Conclusion: According to this study, although the two-third of eligible patients were transferred to the hospital at the right time, the rate of using EMS for patient transportation is low.
Background: Stroke is one of the common causes of disability and death in the world. Furthermore, diabetes mellitus is among the main risk factors for cerebrovascular events. However, a high percentage of individuals with diabetes mellitus are unaware of their disease. Objectives: To determine the frequency of Undiagnosed Diabetes mellitus (UD) in patients with stroke. Materials & Methods: In a descriptive cross-sectional study, all patients with stroke hospitalized in neurology ward of an academic hospital in the north of Iran were included in the study in 2016. A questionnaire was used to collect data including all demographic, laboratory and clinical factors such as high blood pressure, hypercholesterolemia and stroke type. Finally, the data were analyzed using Chi square, Fisher’s exact test and multinomial binary logistic regression in SPSS V. 21. Results: Most samples were male (53.8%) with a mean age of 69.2±10.1 years. The percentage of the UD was 21.7% based on level of HbA1c. The highest percentage of UD was observed in Subarachnoid Hemorrhage(SAH) (66.7%). The frequency of UD in patients with family history of diabetes mellitus (16.7%) was lower than that in patients without that history (27.7%). There was a significant relationship between UD and cholesterol and triglyceride levels and, in general, dyslipidemia (P<0.05). Conclusion: In this study, a large percentage of patients with stroke suffered UD. Therefore, it is recommended that extensive screening be conducted for diabetes mellitus in the community in order to prevent stroke.
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