A transient ischaemic attack clinic with round-the-clock access (SOS-TIA): feasibility and effects

Lavallée, Philippa C.; Meseguer, Elena; Abboud, Halim; Cabrejo, Lucie; Olivot, Jean‐Marc; Simon, Olivier; Mazighi, Mikaël; Nifle, Chantal; Niclot, Philippe; Lapergue, Bertrand; Klein, Isabelle; Brochet, Éric; Steg, Philippe Gabriel; Lesèche, Guy; Labreuche, Julien; Touboul, Pierre‐Jean; Amarenco, Pierre

doi:10.1016/s1474-4422(07)70248-x

Cited by 609 publications

(572 citation statements)

References 16 publications

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“…9,10 The rapid initiation of antiplatelet agents and early assessment in a dedicated stroke prevention clinic can cut this risk dramatically, and both interventions were used in our cohort, 14,21,22 as evidenced by a relatively low overall rate of stroke. Despite these interventions, patients with isolated aphasia in this study had double the rate of stroke at all time points assessed and a 7.3% rate of stroke at 90 days.…”

Section: Discussionmentioning

confidence: 99%

Isolated transient aphasia at emergency presentation is associated with a high rate of cardioembolic embolism

Wasserman

Perry

Dowlatshahi

et al. 2015

CJEM

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Objective: A cardiac source is often implicated in strokes where the deficit includes aphasia. However, less is known about the etiology of isolated aphasia during transient ischemic attack (TIA). Our objective was to determine whether patients with isolated aphasia are likely to have a cardioembolic etiology for their TIA. Methods: We prospectively studied a cohort of TIA patients in eight tertiary-care emergency departments. Patients with isolated aphasia were identified by the treating physician at the time of emergency department presentation. Patients with dysarthria (i.e., a phonation disturbance) were not included. Potential cardiac sources for embolism were defined as atrial fibrillation on history, electrocardiogram, Holter monitor, atrial fibrillation on echocardiography, or thrombus on echocardiography. Results: Of the 2,360 TIA patients identified, 1,155 had neurological deficits at the time of the emergency physician assessment and were included in this analysis, and 41 had isolated aphasia as their only neurological deficit. Patients with isolated aphasia were older (73.9 ± 10.0 v. 67.2 ± 14.5 years; p = 0.003), more likely to have a history of heart failure (9.8% v. 2.6%; p = 0.027), and were twice as likely to have any cardiac source of embolism (22.0% v. 10.6%; p = 0.037). Conclusions: Isolated aphasia is associated with a high rate of cardioembolic sources of embolism after TIA. Emergency patients with isolated aphasia diagnosed with a TIA warrant a rapid and thorough assessment for a cardioembolic source. RÉSUMÉObjectif: L'origine cardiaque est souvent incriminée dans les accidents vasculaires cérébraux dans lesquels le déficit neurologique comprend de l'aphasie. Cependant, on connaît peu de choses sur la cause de l'aphasie isolée durant les accidents ischémiques transitoires (AIT). L'étude visait donc à déterminer si les patients atteints d'aphasie isolée étaient plus susceptibles de subir un AIT d'origine cardioembolique. Méthode: Il s'agit d'une étude prospective de cohortes, composées de patients qui ont subi un AIT et qui ont été examinés dans 8 services d'urgence (SU) de soins tertiaires. Ceux qui présentai-ent des signes d'aphasie isolée étaient reconnus par le médecin traitant au moment de la consultation au SU. Les malades souffrant de dysarthrie (c'est-à-dire de troubles de la phonation) ont été écartés. Les sources possibles d'embolie d'origine cardiaque comprenaient la mention d'antécédents de fibrillation auriculaire (FA) à l'anamnèse; la présence de FA à l'électrocardio-graphie, à l'enregistrement de Holter ou à l'échocardiographie; ou encore la présence de thrombus à l'échocardiographie. Résultats: Sur 2360 patients qui avaient subi un AIT, 1155 présentaient un déficit neurologique au moment de l'évalua-tion par l'urgentologue et ont été sélectionnés aux fins de l'analyse; parmi ceux-ci, 41 avaient comme seul déficit neurologique de l'aphasie isolée. Les patients atteints d'aphasie isolée étaient plus âgés que ceux qui étaient épargnés (73,9 ± 10,0 contre [c.] 67,2 ± 14,...

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Section: Discussionmentioning

confidence: 99%

Isolated transient aphasia at emergency presentation is associated with a high rate of cardioembolic embolism

Wasserman

Perry

Dowlatshahi

et al. 2015

CJEM

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“…TIA is difficult to validate and may be used as diagnosis for diffuse symptoms or dizziness 20. A sensitivity analysis was conducted to include TIA in the stroke definition.…”

Section: Methodsmentioning

confidence: 99%

Effect of Adherence to Oral Anticoagulants on Risk of Stroke and Major Bleeding Among Patients With Atrial Fibrillation

Yao

Abraham

Alexander

et al. 2016

JAHA

371

329

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BackgroundIn comparison to warfarin, non–vitamin K antagonist oral anticoagulants (NOACs) have the advantages of ease of dosing, fewer drug interactions, and lack of need for ongoing monitoring. We sought to evaluate whether these advantages translate to improved adherence and whether adherence is associated with improved outcomes in patients with atrial fibrillation.Methods and ResultsWe performed a retrospective cohort analysis by using a large US commercial insurance database to identify 64 661 patients with atrial fibrillation who initiated warfarin, dabigatran, rivaroxaban, or apixaban treatment between November 1, 2010, and December 31, 2014. During a median of 1.1 y of follow‐up, 47.5% of NOAC patients had a proportion of days covered of ≥80%, compared with 40.2% in warfarin patients (P<0.001). Patients with CHA 2 DS 2‐VASc (risk based on the presence of congestive heart failure, hypertension age 65–74 y, age ≥75 y, diabetes mellitus, prior stroke or transient ischemic attack, vascular disease, sex category) score ≥4 were at increased risk of stroke when they were not taking anticoagulation ≥1 month versus <1 week (1–3 months: hazard ratio [HR] 1.96, 3–6 months: HR 2.64, ≥6 months: HR 3.66; all P<0.001). Patients with CHA 2 DS 2‐VASc score 2 or 3 were at increased risk of stroke when they were not taking anticoagulation ≥6 months (HR 2.73, P<0.001). In these patients with CHA 2 DS 2‐VASc score ≥2, nonadherence was not associated with intracranial hemorrhage. Among patients with CHA 2 DS 2‐VASc score 0 or 1, time not taking anticoagulation was not associated with stroke, but not taking anticoagulation ≥3 months was associated with a significant reduction of bleeding.ConclusionsAdherence to anticoagulation is poor in practice and may be modestly improved with NOACs. Adherence to therapy appears to be most important in patients with CHA 2 DS 2‐VASc score ≥2, whereas the benefits of anticoagulation may not outweigh the harms in patients with CHA 2 DS 2‐VASc score 0 or 1.

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“…The original ABCD score is one of the most famous applicable risk scores [7]. In 2007, Purroy et al [5] suggested a new risk score called ABCD2, then in 2010, Lavallée et al [6] suggested two new risk scores to predict stroke occurrence earlier in time after a patient suffers from TIA. The two new risk scores are named ABCD3 and ABCD3-1.…”

Section: Definition and Motivationmentioning

confidence: 99%

Stroke Prediction Context-Aware Health Care System

Mcheick

Nasser

Dbouk

et al. 2016

2016 IEEE First International Conference on Connected Health: Applications, Systems and Engineering Technologies (CHASE)

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Abstract-This paper proposes a prediction framework based on ontology and Bayesian Belief Networks BBN to support a medical teams in every daily. We propose a Stroke Prediction System (SPS), a new software component to handle the uncertainty of having a stroke disease by determining the risk score level. This is composed of four layers: acquisition of data, aggregation, reasoning and application. SPS senses, collects, and analyzes data of a patient, then uses wearable sensors and the mobile application to interact with the patient and staffs. When the risk reaches critical limits, SPS notifies all concerned parties; the patient, the doctor, and the emergency department. The patient profile is also updated to reflect this urgent intervention requirement. A Bayesian model is designed and implemented using the Netica tool to prove its efficiency i) by handling patient context remotely and verifying its changes locally and ii) on predicting missing probabilities and calculate the probability of high risk level for emergency cases. The SPS system improves the accuracy of decision making and uses a new ontology of stroke disease inspired from our Parkinson ontology already developed.

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A transient ischaemic attack clinic with round-the-clock access (SOS-TIA): feasibility and effects

Cited by 609 publications

References 16 publications

Isolated transient aphasia at emergency presentation is associated with a high rate of cardioembolic embolism

Isolated transient aphasia at emergency presentation is associated with a high rate of cardioembolic embolism

Effect of Adherence to Oral Anticoagulants on Risk of Stroke and Major Bleeding Among Patients With Atrial Fibrillation

Stroke Prediction Context-Aware Health Care System

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