Pulmonary embolism in patients after central nervous system haemorrhage — is it possible to optimise antithrombotic therapy?

Przedstawiono opisy 2 chorych, którzy po krwawieniu do ośrodkowego układu nerwowego doznali zatorowości płucnej, oraz trudności terapeutyczne związane z wyborem bezpiecznego leczenia przeciwkrzepliwego w ostrej zatorowości płucnej.We here present descriptions of two patients who after bleeding to the central nervous system sustained pulmonary embolisms, and we discuss the therapeutic difficulties connected with the choice of safe antithrombotic treatment in acute pulmonary embolism

Atrial fibrillation in patients with ischaemic stroke: clinical characteristics and in-hospital outcomes. A pilot study

Introduction Thromboembolic complications are the most serious consequences of atrial fibrillation (MP). Atrial fibrillation significantly worsens prognosis in patients with ischemic stroke. The aim of the study was to evaluate the prevalence of MP in hospitalized patients due to ischemic stroke, the assessment of the incidence of co-morbidities and the evaluation of in-hospital prognosis in the study group.Methodology The retrospective study enrolled 2000 patients with cerebral stroke hospitalized in the years 2013-2014. The ischemic stroke was diagnosed on the basis of the patient's clinical picture and head imaging (TK or MRI head).Results In the whole study group (n = 2000), 579 patients (28.5%) had MP, MP (+), and 456 patients (78.8%) had arrhythmia prior to admission. The hospital, and 123 (21.2%) patients were first detected MP. The mean age of patients in the MP (+) group was 78.6 years, and in the MP group (-) 71.6 years. Carotid artery ultrasonography was performed in 1805 patients with ischemic stroke. This study demonstrated critical vasoconstriction (> 70%) in 232 patients (16.3%) in the MP (+) group and in 69 (11.9%) patients in the MP (-) group. Significant neurological deficit (> 10 points) at hospital admission was observed in 485 patients (34.2%) in the MP group (-) and 196 patients (33.85%) in the MP (+) group. At discharge from the hospital, 224 (15.7%) without MP had a significant neurological deficit or functional impairment, and in the MP (+) group it was 226 (39.03%). 229 patients (16.1%) without MP and 22 subjects (15.5%) with MP died during hospitalization.Conclusions Atrial fibrillation was often found in arrhythmia in patients with ischemic stroke. Patients with stroke and MP were older than patients with stroke and sinus rhythm. Critical stenosis of the carotid arteries was found in a higher proportion of patients with arrhythmia than sinus rhythm.331/5000Deterioration of the neurological deficit during hospitalization was reported in a higher proportion of patients with MP than without arrhythmias. In-hospital mortality in stroke patients was similar in patients with MP and in patients with sinus rhythm.Introduction. Thromboembolic complications are the most severe consequences of atrial fibrillation (AF). AF is associated with significantly worse outcomes in patients with ischaemic stroke. The aim of the study was to evaluate the prevalence of AF, concomitant conditions, and in-hospital outcomes in patients hospitalized due to ischaemic stroke. Material and methods. Our retrospective study included 2000 patients hospitalized due to ischaemic stroke in 2013–2014. The diagnosis of ischaemic stroke was based on clinical presentations and brain imaging studies (head CT or MRI). Results. Overall, AF was present in 579 of 2000 patients (28.5%) [AF(+) group]. In 456 of these patients (78.8%), this arrhythmia was diagnosed previously, and in 123 (21.2%) patients AF was newly detected on admission. The mean patient age was 78.6 years in the AF(+) group and 71.6 years in the AF(–) group. Carotid ultrasound was performed in 1,805 patients with ischaemic stroke and showed a critical carotid artery stenosis (> 70%) in 232 patients (16.3%) in the AF(+) group and in 69 (11.9%) patients in the AF(–) group. Major neurological deficit (NIHSS score > 10) on admission was found in 485 patients (34.2%) in the AF(–) group and in 196 patients (33.85%) in the AF(+) group. At discharge, persistence of a major neurological deficit or worsening of the functional status was noted in 224 patients (15.7%) without AF and in 226 (39.03%) patients with AF. Two hundred twenty-nine patients (16.1%) without AF and 90 patients (15.5%) with AF died during hospitalization. Conclusions. Atrial fibrillation was common arrhythmia in patients with ischaemic stroke. Patients with stroke and AF were older than patients with stroke and sinus rhythm. Critical carotid artery stenosis was more common in patients with AF compared to those without AF, as was worsening of the neurological deficit during hospitalization, In-hospital mortality was similar in stroke patients with AF or sinus rhythm

Zatorowość płucna u chorych po krwawieniu do ośrodkowego układu nerwowego — czy optymalizacja leczenia przeciwkrzepliwego jest możliwa?

We here present descriptions of two patients who after bleeding to the central nervous system sustained pulmonaryembolisms, and we discuss the therapeutic difficulties connected with the choice of safe antithrombotic treatment inacute pulmonary embolism.Przedstawiono opisy 2 chorych, którzy po krwawieniu do ośrodkowego układu nerwowego doznali zatorowości płucnej, oraz trudności terapeutyczne związane z wyborem bezpiecznego leczenia przeciwkrzepliwego w ostrej zatorowości płucnej

Long-Term Outcomes after Stroke in Patients with Atrial Fibrillation: A Single Center Study

Atrial fibrillation (AF) is known to be a significant risk factor for poor prognosis after stroke. In this study, we compared differences in long-term outcomes after ischemic stroke among patients with AF and sinus rhythm (SR). We identified patients admitted to the reference Neurology Center between 1 January 2013 and 30 April 2015, inclusive, with acute ischemic stroke. Of the 1959 surviving patients, 892 were enrolled and followed for five years or until death. We analyzed the risk of stroke recurrence and death between patients with AF and SR at 1, 3, and 5 years after stroke. The rates of death and stroke recurrence were estimated using Kaplan–Meier analysis and multivariate Cox regression. During follow-up, 17.8% of patients died and 14.6% had recurrent stroke. The mortality in the AF group increased relative to the SR group with subsequent years. The risk of death was statistically higher in the AF than SR group at 1 year after stroke (13.5 vs. 7%, p = 0.004). After adjusting for age, stroke severity, and comorbidities, there was also no significant effect of AF on mortality in the first year after stroke (OR = 1.59, p = 0.247). There were no significant differences between the groups in stroke recurrence during follow-up. The results of our study showed that post-stroke patients with AF have a more severe prognosis, although AF itself does not have an independent negative effect on long-term outcomes after stroke. Long-term survival after stroke in patients with AF was strongly associated with age, stroke severity, and heart failure. The impact of other factors on prognosis after stroke in patients with AF should be considered