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Dive into the research topics where Lisa Hert is active.

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Featured researches published by Lisa Hert.


Circulation | 2015

Recanalization therapies in acute ischemic stroke patients: impact of prior treatment with novel oral anticoagulants on bleeding complications and outcome

David J. Seiffge; Robbert-JanVan Hooff; Christian H. Nolte; Yannick Béjot; Guillaume Turc; Benno Ikenberg; Eivind Berge; Malte Persike; Nelly Dequatre-Ponchelle; Daniel Strbian; Waltraud Pfeilschifter; Andrea Zini; Arnstein Tveiten; Halvor Naess; Patrik Michel; Roman Sztajzel; Andreas R. Luft; Henrik Gensicke; Christopher Traenka; Lisa Hert; Jan F. Scheitz; Gian Marco De Marchis; Leo H. Bonati; Nils Peters; Andreas Charidimou; David J. Werring; Frederick Palm; Matthias Reinhard; Wolf-Dirk Niesen; Takehiko Nagao

Background— We explored the safety of intravenous thrombolysis (IVT) or intra-arterial treatment (IAT) in patients with ischemic stroke on non-vitamin K antagonist oral anticoagulants (NOACs, last intake <48 hours) in comparison with patients (1) taking vitamin K antagonists (VKAs) or (2) without previous anticoagulation (no-OAC). Methods and Results— This is a multicenter cohort pilot study. Primary outcome measures were (1) occurrence of intracranial hemorrhage (ICH) in 3 categories: any ICH (ICHany), symptomatic ICH according to the criteria of the European Cooperative Acute Stroke Study II (ECASS-II) (sICHECASS-II) and the National Institute of Neurological Disorders and Stroke (NINDS) thrombolysis trial (sICHNINDS); and (2) death (at 3 months). Cohorts were compared by using propensity score matching. Our NOAC cohort comprised 78 patients treated with IVT/IAT and the comparison groups of 441 VKA patients and 8938 no-OAC patients. The median time from last NOAC intake to IVT/IAT was 13 hours (interquartile range, 8–22 hours). In VKA patients, median pre-IVT/IAT international normalized ratio was 1.3 (interquartile range, 1.1–1.6). ICHany was observed in 18.4% NOAC patients versus 26.8% in VKA patients and 17.4% in no-OAC patients. sICHECASS-II and sICHNINDS occurred in 2.6%/3.9% NOAC patients, in comparison with 6.5%/9.3% of VKA patients and 5.0%/7.2% of no-OAC patients, respectively. At 3 months, 23.0% of NOAC patients in comparison with 26.9% of VKA patients and 13.9% of no-OAC patients had died. Propensity score matching revealed no statistically significant differences. Conclusions— IVT/IAT in selected patients with ischemic stroke under NOAC treatment has a safety profile similar to both IVT/IAT in patients on subtherapeutic VKA treatment or in those without previous anticoagulation. However, further prospective studies are needed, including the impact of specific coagulation tests.


Circulation | 2015

Recanalization Therapies in Acute Ischemic Stroke Patients: Impact of Prior Treatment with Novel Oral Anticoagulants on Bleeding Complications and Outcome - A Pilot Study

David J. Seiffge; Robbert-Jan Van Hooff; Christian H. Nolte; Yannick Béjot; Guillaume Turc; Benno Ikenberg; Eivind Berge; Malte Persike; Nelly Dequatre-Ponchelle; Daniel Strbian; Waltraud Pfeilschifter; Andrea Zini; Arnstein Tveiten; Halvor Naess; Patrik Michel; Roman Sztajzel; Andreas R. Luft; Henrik Gensicke; Christopher Traenka; Lisa Hert; Jan F. Scheitz; GianMarco De Marchis; Leo H. Bonati; Nils Peters; Andreas Charidimou; David J. Werring; Frederick Palm; Matthias Reinhard; Wolf-Dirk Niesen; Takehiko Nagao

Background— We explored the safety of intravenous thrombolysis (IVT) or intra-arterial treatment (IAT) in patients with ischemic stroke on non-vitamin K antagonist oral anticoagulants (NOACs, last intake <48 hours) in comparison with patients (1) taking vitamin K antagonists (VKAs) or (2) without previous anticoagulation (no-OAC). Methods and Results— This is a multicenter cohort pilot study. Primary outcome measures were (1) occurrence of intracranial hemorrhage (ICH) in 3 categories: any ICH (ICHany), symptomatic ICH according to the criteria of the European Cooperative Acute Stroke Study II (ECASS-II) (sICHECASS-II) and the National Institute of Neurological Disorders and Stroke (NINDS) thrombolysis trial (sICHNINDS); and (2) death (at 3 months). Cohorts were compared by using propensity score matching. Our NOAC cohort comprised 78 patients treated with IVT/IAT and the comparison groups of 441 VKA patients and 8938 no-OAC patients. The median time from last NOAC intake to IVT/IAT was 13 hours (interquartile range, 8–22 hours). In VKA patients, median pre-IVT/IAT international normalized ratio was 1.3 (interquartile range, 1.1–1.6). ICHany was observed in 18.4% NOAC patients versus 26.8% in VKA patients and 17.4% in no-OAC patients. sICHECASS-II and sICHNINDS occurred in 2.6%/3.9% NOAC patients, in comparison with 6.5%/9.3% of VKA patients and 5.0%/7.2% of no-OAC patients, respectively. At 3 months, 23.0% of NOAC patients in comparison with 26.9% of VKA patients and 13.9% of no-OAC patients had died. Propensity score matching revealed no statistically significant differences. Conclusions— IVT/IAT in selected patients with ischemic stroke under NOAC treatment has a safety profile similar to both IVT/IAT in patients on subtherapeutic VKA treatment or in those without previous anticoagulation. However, further prospective studies are needed, including the impact of specific coagulation tests.


Neurology | 2016

Early start of DOAC after ischemic stroke: Risk of intracranial hemorrhage and recurrent events

David J. Seiffge; Christopher Traenka; Alexandros Polymeris; Lisa Hert; Nils Peters; Philippe Lyrer; Stefan T. Engelter; Leo H. Bonati; Gian Marco De Marchis

Objective: In patients with recent acute ischemic stroke (AIS) and atrial fibrillation, we assessed the starting time of direct, non–vitamin K antagonist oral anticoagulants (DOACs) for secondary prevention, the rate of intracranial hemorrhage (ICH), and recurrent ischemic events during follow-up. Methods: We included consecutive patients with nonvalvular atrial fibrillation admitted to our hospital for AIS or TIA (index event) who received secondary prophylaxis with DOAC or vitamin K antagonists (VKAs). Follow-up was at least 3 months. In the primary analysis, we compared rates of ICH and recurrent ischemic events (AIS or TIA) between patients with early (≤7 days since event; DOACearly) and those with late (>7 days, DOAClate) start of DOAC. Results: Two hundred four patients were included (median age 79 years, 89% AIS) and total follow-up time was 78.25 patient-years. One hundred fifty-five patients received DOAC with a median delay of 5 days after the index event (interquartile range 3–11) and 49 received VKA. DOAC was started early in 100 patients (65%). We observed one ICH (1.3%/y) and 6 recurrent AIS (7.7%/y). The ICH occurred in a patient taking VKA. No significant difference in the rate of recurrent AIS between DOACearly (5.1%/y) and DOAClate (9.3%/y, p = 0.53) was observed. Conclusions: Even if DOACs are often started early after an index event, the risk of ICH appears to be low. Among all patients receiving anticoagulation, the rate of recurrent events was 6 times higher than the rate of ICH.


Journal of stroke | 2017

Intravenous Thrombolysis in Patients with Stroke Taking Rivaroxaban Using Drug Specific Plasma Levels: Experience with a Standard Operation Procedure in Clinical Practice

David J. Seiffge; Christopher Traenka; Alexandros Polymeris; Sebastian Thilemann; Benjamin Wagner; Lisa Hert; Mandy D. Müller; Henrik Gensicke; Nils Peters; Christian H. Nickel; Christoph Stippich; Raoul Sutter; Stephan Marsch; Urs Fisch; Raphael Guzman; Gian Marco De Marchis; Philippe Lyrer; Leo H. Bonati; Dimitrios Tsakiris; Stefan T. Engelter

Background and Purpose Standard operating procedures (SOP) incorporating plasma levels of rivaroxaban might be helpful in selecting patients with acute ischemic stroke taking rivaroxaban suitable for IVthrombolysis (IVT) or endovascular treatment (EVT). Methods This was a single-center explorative analysis using data from the Novel-Oral-Anticoagulants-in-Stroke-Patients-registry (clinicaltrials.gov:NCT02353585) including acute stroke patients taking rivaroxaban (September 2012 to November 2016). The SOP included recommendation, consideration, and avoidance of IVT if rivaroxaban plasma levels were <20 ng/mL, 20‒100 ng/mL, and >100 ng/mL, respectively, measured with a calibrated anti-factor Xa assay. Patients with intracranial artery occlusion were recommended IVT+EVT or EVT alone if plasma levels were ≤100 ng/mL or >100 ng/mL, respectively. We evaluated the frequency of IVT/EVT, door-to-needle-time (DNT), and symptomatic intracranial or major extracranial hemorrhage. Results Among 114 acute stroke patients taking rivaroxaban, 68 were otherwise eligible for IVT/EVT of whom 63 had plasma levels measured (median age 81 years, median baseline National Institutes of Health Stroke Scale 6). Median rivaroxaban plasma level was 96 ng/mL (inter quartile range [IQR] 18‒259 ng/mL) and time since last intake 11 hours (IQR 4.5‒18.5 hours). Twenty-two patients (35%) received IVT/EVT (IVT n=15, IVT+EVT n=3, EVT n=4) based on SOP. Median DNT was 37 (IQR 30‒60) minutes. None of the 31 patients with plasma levels >100 ng/mL received IVT. Among 14 patients with plasma levels ≤100 ng/mL, the main reason to withhold IVT was minor stroke (n=10). No symptomatic intracranial or major extracranial bleeding occurred after treatment. Conclusions Determination of rivaroxaban plasma levels enabled IVT or EVT in one-third of patients taking rivaroxaban who would otherwise be ineligible for acute treatment. The absence of major bleeding in our pilot series justifies future studies of this approach.


European Journal of Neurology | 2018

Serum neurofilament light chain in patients with acute cerebrovascular events

G M De Marchis; Mira Katan; C. Barro; Joachim Fladt; Christopher Traenka; David J. Seiffge; Lisa Hert; Henrik Gensicke; G. Disanto; Raoul Sutter; Nils Peters; Hakan Sarikaya; Barbara Goeggel-Simonetti; Marwan El-Koussy; Stefan T. Engelter; P. A. Lyrer; Mirjam Christ-Crain; Marcel Arnold; Jens Kuhle; Leo H. Bonati

Serum neurofilaments are markers of axonal injury. We addressed their diagnostic and prognostic role in acute ischemic stroke (AIS) and transient ischemic attack (TIA).


European Neurology | 2016

Frequency and Determinants of Adherence to Oral Anticoagulants in Stroke Patients with Atrial Fibrillation in Clinical Practice

Alexandros Polymeris; Christopher Traenka; Lisa Hert; David J. Seiffge; Nils Peters; Gian Marco De Marchis; Leo H. Bonati; Philippe Lyrer; Stefan T. Engelter

Background: Vitamin K antagonists (VKAs) and non-VKA oral anticoagulants (NOACs) are beneficial in patients with stroke and atrial fibrillation (AF). However, little is known about frequency and determinants of adherence to NOACs/VKAs in clinical practice. Methods: This is a single-center explorative study from the Novel Oral Anticoagulants in Stroke Patients (NOACISP)-LONGTERM registry. We included consecutive AF-stroke patients treated with NOACs/VKAs and followed up for 3-24 months. Adherence was assessed at follow-up using structured interviews and quantified as the proportion of prescribed doses taken (PDT). Outcome measures were (i) full adherence, (ii) ≥95% adherence and (iii) ≥80% adherence (i.e., PDT 100/≥95/≥80%). To explore determinants of full adherence, we compared characteristics of fully and non-fully adherent patients. Results: A total of 218 of 251 (86.9%) patients (48% female, mean age 77.9 ± 9.1 years, 78% NOACs; 22% VKAs) were eligible for analysis with a median follow-up of 12 months: fully adherent were 78.4% patients (NOACs 77.1%, VKAs 83.3%, p = 0.35), ≥95% adherent were 95.4% and ≥80% adherent were 97.2%. Fully adherent patients took more pills daily (median (interquartile range) 7 (5-10) vs. 6 (4-8), p = 0.039), had more often previous antithrombotic treatment (70.8 vs. 53.2%, p = 0.023), caregiver-assisted medication administration (54.2 vs. 19.1%, p < 0.001) and functional dependency (32.8 vs. 15%, p = 0.011) than non-fully adherent patients. Conclusions: Full adherence was frequent. Patients naïve to antithrombotics, taking few pills, which they self-administer, were at the highest risk of non-adherence and may benefit most from adherence-enhancing interventions.


Circulation | 2015

Recanalization Therapies in Acute Ischemic Stroke PatientsCLINICAL PERSPECTIVES

David J. Seiffge; Robbert-JanVan Hooff; Christian H. Nolte; Yannick Béjot; Guillaume Turc; Benno Ikenberg; Eivind Berge; Malte Persike; Nelly Dequatre-Ponchelle; Daniel Strbian; Waltraud Pfeilschifter; Andrea Zini; Arnstein Tveiten; Halvor Naess; Patrik Michel; Roman Sztajzel; Andreas R. Luft; Henrik Gensicke; Christopher Traenka; Lisa Hert; Jan F. Scheitz; Gian Marco De Marchis; Leo H. Bonati; Nils Peters; Andreas Charidimou; David J. Werring; Frederick Palm; Matthias Reinhard; Wolf-Dirk Niesen; Takehiko Nagao

Background— We explored the safety of intravenous thrombolysis (IVT) or intra-arterial treatment (IAT) in patients with ischemic stroke on non-vitamin K antagonist oral anticoagulants (NOACs, last intake <48 hours) in comparison with patients (1) taking vitamin K antagonists (VKAs) or (2) without previous anticoagulation (no-OAC). Methods and Results— This is a multicenter cohort pilot study. Primary outcome measures were (1) occurrence of intracranial hemorrhage (ICH) in 3 categories: any ICH (ICHany), symptomatic ICH according to the criteria of the European Cooperative Acute Stroke Study II (ECASS-II) (sICHECASS-II) and the National Institute of Neurological Disorders and Stroke (NINDS) thrombolysis trial (sICHNINDS); and (2) death (at 3 months). Cohorts were compared by using propensity score matching. Our NOAC cohort comprised 78 patients treated with IVT/IAT and the comparison groups of 441 VKA patients and 8938 no-OAC patients. The median time from last NOAC intake to IVT/IAT was 13 hours (interquartile range, 8–22 hours). In VKA patients, median pre-IVT/IAT international normalized ratio was 1.3 (interquartile range, 1.1–1.6). ICHany was observed in 18.4% NOAC patients versus 26.8% in VKA patients and 17.4% in no-OAC patients. sICHECASS-II and sICHNINDS occurred in 2.6%/3.9% NOAC patients, in comparison with 6.5%/9.3% of VKA patients and 5.0%/7.2% of no-OAC patients, respectively. At 3 months, 23.0% of NOAC patients in comparison with 26.9% of VKA patients and 13.9% of no-OAC patients had died. Propensity score matching revealed no statistically significant differences. Conclusions— IVT/IAT in selected patients with ischemic stroke under NOAC treatment has a safety profile similar to both IVT/IAT in patients on subtherapeutic VKA treatment or in those without previous anticoagulation. However, further prospective studies are needed, including the impact of specific coagulation tests.


Circulation | 2015

Recanalization Therapies in Acute Ischemic Stroke PatientsCLINICAL PERSPECTIVES: Impact of Prior Treatment With Novel Oral Anticoagulants on Bleeding Complications and Outcome

David J. Seiffge; Robbert-JanVan Hooff; Christian H. Nolte; Yannick Béjot; Guillaume Turc; Benno Ikenberg; Eivind Berge; Malte Persike; Nelly Dequatre-Ponchelle; Daniel Strbian; Waltraud Pfeilschifter; Andrea Zini; Arnstein Tveiten; Halvor Naess; Patrik Michel; Roman Sztajzel; Andreas R. Luft; Henrik Gensicke; Christopher Traenka; Lisa Hert; Jan F. Scheitz; Gian Marco De Marchis; Leo H. Bonati; Nils Peters; Andreas Charidimou; David J. Werring; Frederick Palm; Matthias Reinhard; Wolf-Dirk Niesen; Takehiko Nagao

Background— We explored the safety of intravenous thrombolysis (IVT) or intra-arterial treatment (IAT) in patients with ischemic stroke on non-vitamin K antagonist oral anticoagulants (NOACs, last intake <48 hours) in comparison with patients (1) taking vitamin K antagonists (VKAs) or (2) without previous anticoagulation (no-OAC). Methods and Results— This is a multicenter cohort pilot study. Primary outcome measures were (1) occurrence of intracranial hemorrhage (ICH) in 3 categories: any ICH (ICHany), symptomatic ICH according to the criteria of the European Cooperative Acute Stroke Study II (ECASS-II) (sICHECASS-II) and the National Institute of Neurological Disorders and Stroke (NINDS) thrombolysis trial (sICHNINDS); and (2) death (at 3 months). Cohorts were compared by using propensity score matching. Our NOAC cohort comprised 78 patients treated with IVT/IAT and the comparison groups of 441 VKA patients and 8938 no-OAC patients. The median time from last NOAC intake to IVT/IAT was 13 hours (interquartile range, 8–22 hours). In VKA patients, median pre-IVT/IAT international normalized ratio was 1.3 (interquartile range, 1.1–1.6). ICHany was observed in 18.4% NOAC patients versus 26.8% in VKA patients and 17.4% in no-OAC patients. sICHECASS-II and sICHNINDS occurred in 2.6%/3.9% NOAC patients, in comparison with 6.5%/9.3% of VKA patients and 5.0%/7.2% of no-OAC patients, respectively. At 3 months, 23.0% of NOAC patients in comparison with 26.9% of VKA patients and 13.9% of no-OAC patients had died. Propensity score matching revealed no statistically significant differences. Conclusions— IVT/IAT in selected patients with ischemic stroke under NOAC treatment has a safety profile similar to both IVT/IAT in patients on subtherapeutic VKA treatment or in those without previous anticoagulation. However, further prospective studies are needed, including the impact of specific coagulation tests.


Swiss Medical Forum ‒ Schweizerisches Medizin-Forum | 2014

Die neuen Antikoagulantien bei Hirnschlagpatienten

David J. Seiffge; Christopher Traenka; Lisa Hert; Henrik Gensicke; Nils Peters; Gian Marco De Marchis; Daniel Mayer; Alexander von Hessling; Dimitrios Tsakiris; Philippe Lyrer; S. T. Engelter; Leo H. Bonati

The Swiss Registry of New Anticoagulants in Stroke Patients (NOACISP): A national audit and prospective registry


Journal of Thrombosis and Thrombolysis | 2017

Feasibility of rapid measurement of Rivaroxaban plasma levels in patients with acute stroke

David J. Seiffge; Christopher Traenka; Alexandros Polymeris; Lisa Hert; Urs Fisch; Nils Peters; Gian Marco De Marchis; Raphael Guzman; Christian H. Nickel; P. A. Lyrer; Leo H. Bonati; Dimitrios Tsakiris; Stefan T. Engelter

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Christopher Traenka

Ottawa Hospital Research Institute

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