Dimitrios Athanasiadis

Dabigatran etexilate for secondary stroke prevention: the first year experience from a multicenter short-term registry

Background: There are growing concerns for the side effects of dabigatran etexilate (dabigatran), including higher incidence of dyspepsia and gastrointestinal bleeding. We conducted a multicenter early implementation study to prospectively evaluate the safety, efficacy and adherence to dabigatran for secondary stroke prevention. Methods: Consecutive atrial fibrillation (AF) patients with ischemic stroke (IS) or transient ischemic attack (TIA) received dabigatran for secondary stroke prevention during their hospital stay according to American Heart Association recommendations at five tertiary care stroke centers. The study population was prospectively followed and outcomes were documented. The primary and secondary safety outcomes were major hemorrhage and all other bleeding events respectively defined according to RE-LY trial methodology. Results: A total of 78 AF patients (mean age 71 ± 9years; 54% men; 81% IS, 19% TIA; median CHADS2 (Congestive heart failure, Hypertension, diabetes mellitus, age >75 years, prior stroke or TIA); range 2–5) score 4 were treated with dabigatran [(110mg bid (74%); 150mg bid (26%)]. During a mean follow-up period of 7 ± 5 months (range 1–18) we documented no cases of IS, TIA, intracranial hemorrhage, systemic embolism or myocardial infarction in AF patients treated with dabigatran. There were two (2.6%) major bleeding events (lower gastrointestinal bleeding) and two (2.6%) minor bleedings [hematuria (n = 1) and rectal bleeding (n = 1)]. Dabigatran was discontinued in 26% of the study population with high cost being the most common reason for discontinuation (50%). Discussion: Our pilot data indicate that dabigatran appears to be safe for secondary stroke prevention during the first year of implementation of this therapy. However, high cost may limit the long-term treatment of AF patients with dabigatran, leading to early discontinuation.

The role of remote ischemic preconditioning in the treatment of atherosclerotic diseases

Remote ischemic preconditioning (RIPC) is the application of a transient and brief ischemic stimulus to a distant site from the organ or tissue that is afterward exposed to injury ischemia, and has been found to reduce ischemia–reperfusion injury (IRI) in various animal models. RIPC appears to offer two distinct phases of endothelial IRI protection, which are presumably mediated through neuronal and humoral pathways.

Intravenous thrombolysis for acute ischemic stroke occurring during hospitalization for transient ischemic attack

Background There are limited data regarding the use of intravenous thrombolysis in patients who experienced acute ischemic symptoms during their hospitalization for prior transient ischemic attack. Aim We sought to prospectively evaluate the safety and efficacy of intravenous thrombolysis for the treatment of acute ischemic stroke occurring during hospitalization for transient ischemic attack in an international, multicenter study. Methods Consecutive patients with acute ischemic stroke that occurred during hospitalization for prior transient ischemic attack were treated with intravenous thrombolysis in five tertiary-care stroke centers. Early arterial recanalization was determined by transcranial Doppler at the end of recombinant tissue plasminogen activator infusion using previously validated criteria. Symptomatic intracranial hemorrhage complicating intravenous thrombolysis was evaluated using the National Institute of Neurological Disorders and Stroke Recombinant Tissue Plasminogen Activator Stroke Study definition. Functional independence at three-months was defined as Modified Rankin Scale score of 0–2. Results Systemic recombinant tissue plasminogen activator infusion (median onset-to-treatment time 70 mins, interquartile range 50–150) was given in 25 consecutive patients (mean age 66 ± 10 years) who developed acute ischemic stroke symptoms (median National Institutes of Health Stroke Scale score 10 points; interquartile range 8–14) during hospitalization for prior transient ischemic attack (median ABCD2 score 5 points; median time-to-symptom recurrence 24 h, interquartile range 24–48). No symptomatic intracranial hemorrhage (0%; 95% confidence interval 0–12%) was documented. Early complete recanalization occurred in 64% of patients (95% confidence interval 44–80%), and 84% (95% confidence interval 65–94%) achieved three-month functional independence. The rate of three-month functional independence was higher in patients treated with intravenous tissue plasminogen activator within 90 mins from symptom onset compared with those with onset-to-treatment time>90 mins (81% vs. 33%; P = 0·031). Conclusions Intravenous thrombolysis for symptoms of acute ischemic stroke occurring after hospitalization for transient ischemic attack appears to be safe. These pilot data support resetting the clock if new symptoms recur shortly after transient ischemic attack.

Erratum to: Racial disparities in early mortality in 1,134 young patients with acute stroke

Georgios Tsivgoulis • Jukka Putaala • Vijay K. Sharma • Clotilde Balucani • Sheryl Martin-Schild • Sotirios Giannopoulos • Lokesh Batala • Christos Krogias • Paola Palazzo • Reza Bavarsad Shahripour • Chrysa Arvaniti • Kristian Barlinn • Daniel Strbian • Elena Haapaniemi • Maria Flamouridou • Konstantinos Vadikolias • Ioannis Heliopoulos • Konstantinos Voumvourakis • Nikos Triantafyllou • Mahmoud Reza Azarpazhooh • Dimitrios Athanasiadis • Maria Kosmidou • Aristeidis H. Katsanos • Spyros N. Vasdekis • Leonidas Stefanis • Elefterios Stamboulis • Charitomeni Piperidou • Turgut Tatlisumak • Andrei V. Alexandrov