The Riga East University Hospital Stroke Registry—An Analysis of 4915 Consecutive Patients with Acute Stroke

Karelis, Guntis; Micule, Madara; Klavina, Evija; Haritoncenko, Iveta; Kikule, Ilga; Tilgale, Biruta; Poļaka, Inese

doi:10.3390/medicina57060632

Cited by 7 publications

(8 citation statements)

References 28 publications

(48 reference statements)

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“…This data is similar to the latest studies, showing the increase in cardioembolic strokes worldwide [ 14 , 15 ]. A similar increase in the incidence of cardioembolic ischemic stroke was reported in another Latvian Stroke Unit [ 16 ]. Our study consisted of the systematically collected data, as well as multiple follow-ups conducted via telephone, of 654 patients who were treated at our hospital’s Stroke Unit in the year 2017.…”

Section: Discussionsupporting

confidence: 81%

“…In the DOAC group, only 12.9% died within 4 years. This might be because a meta-analysis of DOACs determined non-inferiority for the prevention of ischemic stroke and superiority for the rates of hemorrhagic stroke [ 15 , 16 ]. In the atherothrombotic stroke group, a satisfactory functional outcome was obtained for only 35.3% of patients.…”

Section: Discussionmentioning

confidence: 99%

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Impact of Anticoagulants in Reducing Mortality and Disability in Cardioembolic Stroke Patients

et al. 2022

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Background and Objectives: Stroke is currently the second most common cause of death and disability-adjusted life years worldwide. Previous studies have determined that cardioembolic stroke is associated with higher mortality. Our aim is to compare the long-term outcome and mortality of atherothrombotic, cardioembolic stroke patients and patients taking direct oral anticoagulants (DOACs), and to demonstrate that adequate treatment with DOACs is associated with better results. Materials and Methods: In our retrospective study, we collected the data of ischemic stroke patients who were treated at P. Stradins Clinical University Hospital, Riga, Latvia, Stroke Unit, in the year 2017. In the present study, we analyzed this information to assess the patients’ demographic and clinical data, vascular risk factors, functional and neurological evaluation results, and the use of anticoagulant therapy. Stroke survivors were followed-up via telephone at 30/90/180/365 days and 4 years after being discharged from the hospital. The Latvian version of the National Institutes of Health Stroke Scale (NIHSS-LV) was used to evaluate patients’ neurological outcomes at discharge, and patients’ functional outcomes were evaluated using the modified Rankin scale (mRS). The collected data of the patients were separated into three groups according to the stroke subtype and use of direct oral anticoagulants. Results: A total of 654 ischemic stroke patients were admitted to the hospital in the year 2017. Of all the strokes included in the study, 262 presented an atherothrombotic etiology and 392 presented a cardioembolic etiology. The median age of the patients in the study was 76 years (IQR: 67–83). The median age of patients in the atherothrombotic stroke group was 71 years (IQR = 64–79), in the cardioembolic stroke group it was 79 (IQR = 72–84), and in the DOAC group it was 75 years (IQR = 69–82), respectively. At the period of four years, of all the atherothrombotic stroke survivors 14 (10.5%) had a severe disability, and 64 (48.1%) did not survive. However, 12 (4.1%) of the cardioembolic stroke survivors were severely disabled and 37 (12.5%) had died. In the group of patients taking DOACs 6 (4.5%) had a severe disability and 17 (12.9%) did not survive. In all the patient groups, the leading cause of death was due to severe disability (22%), followed by recurrent cardioembolic events (8%). Conclusions: Previous studies until now have concluded that cardioembolic stroke is associated with higher mortality and an unfavorable functional outcome. In our study, the cardioembolic stroke group and the DOAC group had a statistically significant higher percentage of patients with congestive heart failure and older age, but their long-term mortality was lower and they achieved independence more often than the atherothrombotic stroke patients. The proper use of anticoagulants shows great improvement in long-term survival rate and functional outcome.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Impact of Anticoagulants in Reducing Mortality and Disability in Cardioembolic Stroke Patients

et al. 2022

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“…In our study, the median door-to-needle time was 51 min (IQR = 43–133) which is longer compared to a study of the single-centre stroke registry data of 4915 consecutive acute stroke patients who had received intravenous thrombolysis and in which the median (IQR) door-to-needle time was 42 min (32–57 min) [ 15 ]. This time deviation is most likely due to the variation in the idarucizumab administration method (two intravenous boluses of 2.5 g within 15 min vs. a single 5 g bolus).…”

Section: Discussionmentioning

confidence: 54%

Idarucizumab in Dabigatran-Treated Patients with Acute Ischemic Stroke Receiving Thrombolytic Therapy

et al. 2022

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Background and Objectives: Thrombolytic therapy with recombinant tissue-type plasminogen activator (rt-PA) is used to treat acute ischemic stroke. Dabigatran is a reversible thrombin inhibitor approved for stroke prevention in patients with nonvalvular atrial fibrillation. In such cases, thrombolytic therapy can be administered to certain patients after idarucizumab treatment. We evaluated the effectiveness of idarucizumab in dabigatran-treated patients receiving rt-PA. Materials and Methods: We included the data of nine idarucizumab-treated patients from the Riga East University Hospital Stroke Registry from 2018 to 2022 in our retrospective medical records analysis. We used the National Institutes of Health Stroke Scale (LV-NIHSS) score and modified Rankin scale (mRS) on admission and discharge to evaluate neurological deficit and functional outcomes. Results: We analyzed the data of nine patients (seven males and two females) with a mean age of 75.67 ± 8.59 years. The median door-to-needle time for all patients, including those who received idarucizumab before rt-PA, was 51 min (IQR = 43–133); the median LV-NIHSS score was 9 (IQR = 6.0–16.0) on admission and 4 (IQR = 2.5–4.0) at discharge; and the intrahospital mortality rate was 11.1% due to intracranial hemorrhage as a complication of rt-PA. Conclusions: Our study shows that idarucizumab as an antidote of dabigatran appears to be effective and safe in patients with acute ischemic stroke. Furthermore, the administration of idarucizumab slightly prolongs the door-to-needle time; however, the majority of cases showed clinical improvement after receiving therapy. Further randomized controlled trials should be performed to evaluate the safety and effectiveness of idarucizumab for acute ischemic stroke treatment.

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“…The prevalence of AF among AIS patients varies between countries and was found to be as high as 31-38% in a population-based registry in Greece [31,32], and up to 48.6% in two separate hospital-based registries in neighboring Latvia [22,24]. The high prevalence of AF found in our investigated AIS patient population could indicate a regional trend, as other cardiovascular risk factors are largely similar within the Baltic States [32].…”

Section: Discussionmentioning

confidence: 89%

“…Moreover, in Lithuania the expected increase in age-adjusted stroke incidence and prevalence rates is the highest, and the expected decrease in stroke mortality is the lowest among all European Union countries [21]. However, data regarding the proportion of AIS cases associated with AF is lacking, although studies from the other two Baltic States indicate some of the highest AF prevalence among AIS patients globally, reaching up to a striking 48.6% [22][23][24].…”

Section: Introductionmentioning

confidence: 99%

High Prevalence of Atrial Fibrillation in a Lithuanian Stroke Patient Cohort

et al. 2022

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Background and Objectives: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with a five-fold increased risk for acute ischemic stroke (AIS). We aimed to estimate the prevalence of AF in a Lithuanian cohort of stroke patients, and its impact on patients regarding case fatality, functional outcome, and health-related quality of life (HRQoL) at 90 days. Materials and Methods: A single-center prospective study was carried out for four non-consecutive months between December 2018 and July 2019 in one of the two comprehensive stroke centers in Eastern Lithuania. A telephone-based follow-up was conveyed at 90 days using the modified Rankin Scale (mRS) and EuroQoL five-dimensional three-level descriptive system (EQ-5D-3L) with a self-rated visual analog scale (EQ-VAS). One-year case fatality was investigated. Results: We included 238 AIS patients with a mean age of 71.4 ± 11.9 years of whom 45.0% were female. A striking 97 (40.8%) AIS patients had a concomitant AF, in 68 (70.1%) of whom the AF was pre-existing. The AIS patients with AF were at a significantly higher risk for a large vessel occlusion (LVO; odds ratio 2.72 [95% CI 1.38–5.49], p = 0.004), and had a more severe neurological impairment at presentation (median NIHSS score (interquartile range): 9 (6–16) vs. 6 (3–9), p < 0.001). The LVO status was only detected in those who had received computed tomography angiography. Fifty-five (80.9%) patients with pre-existing AF received insufficient anticoagulation at stroke onset. All patients received a 12-lead ECG, however, in-hospital 24-h Holter monitoring was only performed in 3.4% of AIS patients without pre-existing AF. Although multivariate analyses found no statistically significant difference in one-year stroke patient survival and favorable functional status (mRS 0–2) at 90 days, when adjusted for age, gender, reperfusion treatment, baseline functional status, and baseline NIHSS, stroke patients with AF had a significantly poorer self-perceived HRQoL, indicated by a lower EQ-VAS score (regression coefficient ± standard error: β = −11.776 ± 4.850, p = 0.017). Conclusions: In our single-center prospective observational study in Lithuania, we found that 40.8% of AIS patients had a concomitant AF, were at a higher risk for an LVO, and had a significantly poorer self-perceived HRQoL at 90 days. Despite the high AF prevalence, diagnostic tools for subclinical AF were greatly underutilized.

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The Riga East University Hospital Stroke Registry—An Analysis of 4915 Consecutive Patients with Acute Stroke

Cited by 7 publications

References 28 publications

Impact of Anticoagulants in Reducing Mortality and Disability in Cardioembolic Stroke Patients

Impact of Anticoagulants in Reducing Mortality and Disability in Cardioembolic Stroke Patients

Idarucizumab in Dabigatran-Treated Patients with Acute Ischemic Stroke Receiving Thrombolytic Therapy

High Prevalence of Atrial Fibrillation in a Lithuanian Stroke Patient Cohort

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