Oral Anticoagulation and Risk of Symptomatic Hemorrhagic Transformation in Stroke Patients Treated With Mechanical Thrombectomy: Data From the Nordictus Registry

Introduction: We aimed to evaluate if prior oral anticoagulation (OAC) and its type determines a greater risk of symptomatic hemorrhagic transformation in patients with acute ischemic stroke (AIS) subjected to mechanical thrombectomy. Materials and Methods: Consecutive patients with AIS included in the prospective reperfusion registry NORDICTUS, a network of tertiary stroke centers in Northern Spain, from January 2017 to December 2019 were included. Prior use of oral anticoagulants, baseline variables, and international normalized ratio (INR) on admission were recorded. Symptomatic intracranial hemorrhage (sICH) was the primary outcome measure. Secondary outcome was the relation between INR and sICH, and we evaluated mortality and functional outcome at 3 months by modified Rankin scale. We compared patients with and without previous OAC and also considered the type of oral anticoagulants. Results: About 1.455 AIS patients were included, of whom 274 (19%) were on OAC, 193 (70%) on vitamin K antagonists (VKA), and 81 (30%) on direct oral anticoagulants (DOACs). Anticoagulated patients were older and had more comorbidities. Eighty-one (5.6%) developed sICH, which was more frequent in the VKA group, but not in DOAC group. OAC with VKA emerged as a predictor of sICH in a multivariate regression model (OR, 1.89 [95% CI, 1.01–3.51], p = 0.04) and was not related to INR level on admission. Prior VKA use was not associated with worse outcome in the multivariate regression model nor with mortality at 3 months. Conclusions: OAC with VKA, but not with DOACs, was an independent predictor of sICH after mechanical thrombectomy. This excess risk was associated neither with INR value by the time thrombectomy was performed, nor with a worse functional outcome or mortality at 3 months

Estudio epidemiológico de la esclerosis múltiple en La Rioja

Resumen: Introducción La esclerosis múltiple (EM) es una enfermedad desmielinizante que causa gran discapacidad en jóvenes. Se han realizado múltiples estudios epidemiológicos en los que se ha constatado una prevalencia variable. El objetivo de este estudio era analizar la prevalencia de esta enfermedad en La Rioja (España) con variables como la edad, el sexo, la forma evolutiva, la clínica de inicio de la enfermedad, la EDSS y el número de brotes, el tratamiento modificador de la enfermedad y los motivos de su retirada, el cáncer y los antecedentes familiares, y la incidencia y la mortalidad. Métodos: Analizar los pacientes diagnosticados de EM según los criterios de McDonald 2005 o Poser, residentes en La Rioja, durante 10 años (2001-2011), recogidos a través del registro hospitalario, la Asociación de Esclerosis Múltiple y los registros personales de los neurólogos. Resultados: En La Rioja, existe una prevalencia de EM de 65 pacientes/100.000 habitantes y una incidencia de 3,5 casos/100.000 habitantes-año. El 67,6% de los pacientes presentan una EM remitente-recurrente. La edad media de inicio es 20-29 años (desde los 12 hasta los 70). La puntuación EDDS es mayoritariamente ≤ 2. Las EM sin tratamiento suponen el 47,6% y el tratamiento más usado son los interferones. Hallamos 4 tumores hematológicos y 7 familias con varios afectados por EM. Conclusiones: La prevalencia y la incidencia son similares a las halladas en el resto de España. La edad media de inicio de la forma primaria progresiva es ligeramente mayor que en otras publicaciones (40-49 años). En familias con varios miembros afectados, la EM podría tener un curso más agresivo. La discapacidad de estos pacientes sigue siendo muy elevada. Son necesarios más estudios epidemiológicos con métodos variables de recogida de datos para afianzar los hallazgos obtenidos en diferentes provincias acerca de la prevalencia. Abstract: Introduction: Multiple sclerosis is a demyelinating disease that causes severe disability in younger patients. Many epidemiology studies have confirmed a variable prevalence. The objective of this study was to analyse the prevalence of this disease in La Rioja (Spain), using such variables as age and sex; type of progression, initial form of the disease, EDSS and number of relapses; disease-modifying treatment and reasons for treatment withdrawal; personal and family history of cancer; and incidence and mortality. Methods: Analysis of patients in La Rioja diagnosed with MS (according to Poser criteria or the 2005 McDonald criteria) during a 10-year period (2001-2011). Data were collected from hospital records, multiple sclerosis associations, and personal records kept by neurologists. Results: The MS prevalence rate in La Rioja is 65 patients/100 000 inhabitants with an incidence rate of 3.5 cases/100 000 residents per year. Relapsing-remitting MS is present in 67.6% of the patient total. Mean age of onset is 20-29 years (range, 12 to 70). Most EDSS scores were mostly ≤ 2. Untreated MS cases account for 47.6% of the total and the most commonly used therapy is interferon. We detected 4 haematological tumours and 7 families with multiple members affected by MS. Conclusions: Prevalence and incidence are similar to those found in other regions Spain. The average age at onset age for primary progressive MS is slightly higher than in other papers (40-49 years). In families with multiple patients, MS may be more aggressive. Disability in these patients remains very severe. We require more epidemiology studies with a variety of data gathering methods to support findings for prevalence obtained in different provinces. Palabras clave: Prevalencia, Epidemiología, Esclerosis múltiple, España, Incidencia, La Rioja, Keywords: Prevalence, Epidemiology, Multiple sclerosis, Spain, Incidence, La Rioj

Epidemiological study of multiple sclerosis in La Rioja

Introduction: Multiple sclerosis is a demyelinating disease that causes severe disability in younger patients. Many epidemiology studies have confirmed a variable prevalence. The objective of this study was to analyse the prevalence of this disease in La Rioja (Spain), using such variables as age and sex; type of progression, initial form of the disease, EDSS and number of relapses; disease-modifying treatment and reasons for treatment withdrawal; personal and family history of cancer; and incidence and mortality. Methods: Analysis of patients in La Rioja diagnosed with MS (according to Poser criteria or the 2005 McDonald criteria) during a 10-year period (2001-2011). Data were collected from hospital records, multiple sclerosis associations, and personal records kept by neurologists. Results: The MS prevalence rate in La Rioja is 65 patients/100 000 inhabitants with an incidence rate of 3.5 cases/100 000 residents per year. Relapsing-remitting MS is present in 67.6% of the patient total. Mean age of onset is 20-29 years (range 12-70). Most EDSS scores were mostly ≤2. Untreated MS cases account for 47.6% of the total, and the most commonly used therapy is interferon. We detected four haematological tumours and seven families with multiple members affected by MS. Conclusions: Prevalence and incidence are similar to those found in other regions of Spain. The average age at onset age for primary progressive MS is slightly higher than in other papers (40-49 years). In families with multiple patients, MS may be more aggressive. Disability in these patients remains very severe. We require more epidemiology studies with a variety of data gathering methods to support findings for prevalence obtained in different provinces. Resumen: Introducción: La esclerosis múltiple (EM) es una enfermedad desmielinizante que causa gran discapacidad en jóvenes. Se han realizado múltiples estudios epidemiológicos en los que se ha constatado una prevalencia variable. El objetivo de este estudio era analizar la prevalencia de esta enfermedad en La Rioja (España) con variables como la edad, el sexo, la forma evolutiva, la clínica de inicio de la enfermedad, la EDSS y el número de brotes, el tratamiento modificador de la enfermedad y los motivos de su retirada, el cáncer y los antecedentes familiares, y la incidencia y la mortalidad. Métodos: Analizar los pacientes diagnosticados de EM según los criterios de McDonald 2005 o Poser, residentes en La Rioja, durante 10 años (2001-2011), recogidos a través del registro hospitalario, la Asociación de Esclerosis Múltiple y los registros personales de los neurólogos. Resultados: En La Rioja, existe una prevalencia de EM de 65 pacientes/100.000 habitantes y una incidencia de 3,5 casos/100.000 habitantes-año. El 67,6% de los pacientes presentan una EM remitente-recurrente. La edad media de inicio es 20-29 años (desde los 12 hasta los 70). La puntuación EDDS es mayoritariamente ≤ 2. Las EM sin tratamiento suponen el 47,6% y el tratamiento más usado son los interferones. Hallamos 4 tumores hematológicos y 7 familias con varios afectados por EM. Conclusiones: La prevalencia y la incidencia son similares a las halladas en el resto de España. La edad media de inicio de la forma primaria progresiva es ligeramente mayor que en otras publicaciones (40-49 años). En familias con varios miembros afectados, la EM podría tener un curso más agresivo. La discapacidad de estos pacientes sigue siendo muy elevada. Son necesarios más estudios epidemiológicos con métodos variables de recogida de datos para afianzar los hallazgos obtenidos en diferentes provincias acerca de la prevalencia. Keywords: Prevalence, Epidemiology, Multiple sclerosis, Spain, Incidence, La Rioja, Palabras clave: Prevalencia, Epidemiología, Esclerosis múltiple, España, Incidencia, La Rioj

Comment on the article "Symptomatic carotid near-occlusion causes a high risk of recurrent ipsilateral ischemic stroke" by Gu et al.

We read with great interest the recent article “Symptomatic carotid near-occlusion causes a high risk of recurrent ipsilateral ischemic stroke” by Gu et al. [1]. The authors present a single-centre retrospective study in which they describe a preoperative or 90-day ipsilateral ischemic stroke risk that reaches 22% in patients with carotid near-occlusion (CNO) without full collapse and 30% for CNO with full collapse. The risk for CNO exceeds even that observed for “conventional” ≥ 50% carotid stenosis. These results are striking and, if confirmed, could lead to a significant change in the management of patients with symptomatic carotid near-occlusion [2]

Oral Anticoagulation and Risk of Symptomatic Hemorrhagic Transformation in Stroke Patients Treated With Mechanical Thrombectomy: Data From the Nordictus Registry

Introduction: We aimed to evaluate if prior oral anticoagulation (OAC) and its type determines a greater risk of symptomatic hemorrhagic transformation in patients with acute ischemic stroke (AIS) subjected to mechanical thrombectomy. Materials and Methods: Consecutive patients with AIS included in the prospective reperfusion registry NORDICTUS, a network of tertiary stroke centers in Northern Spain, from January 2017 to December 2019 were included. Prior use of oral anticoagulants, baseline variables, and international normalized ratio (INR) on admission were recorded. Symptomatic intracranial hemorrhage (sICH) was the primary outcome measure. Secondary outcome was the relation between INR and sICH, and we evaluated mortality and functional outcome at 3 months by modified Rankin scale. We compared patients with and without previous OAC and also considered the type of oral anticoagulants. Results: About 1.455 AIS patients were included, of whom 274 (19%) were on OAC, 193 (70%) on vitamin K antagonists (VKA), and 81 (30%) on direct oral anticoagulants (DOACs). Anticoagulated patients were older and had more comorbidities. Eighty-one (5.6%) developed sICH, which was more frequent in the VKA group, but not in DOAC group. OAC with VKA emerged as a predictor of sICH in a multivariate regression model (OR, 1.89 [95% CI, 1.01-3.51], p = 0.04) and was not related to INR level on admission. Prior VKA use was not associated with worse outcome in the multivariate regression model nor with mortality at 3 months. Conclusions: OAC with VKA, but not with DOACs, was an independent predictor of sICH after mechanical thrombectomy. This excess risk was associated neither with INR value by the time thrombectomy was performed, nor with a worse functional outcome or mortality at 3 months

Mapa epidemiológico transversal de las ataxias y paraparesias espásticas hereditarias en España

Introduction: Ataxia and hereditary spastic paraplegia are rare neurodegenerative syndromes. We aimed to determine the prevalence of these disorders in Spain in 2019. Patients and methods: We conducted a cross-sectional, multicentre, retrospective, descriptive study of patients with ataxia and hereditary spastic paraplegia in Spain between March 2018 and December 2019. Results: We gathered data from a total of 1933 patients from 11 autonomous communities, provided by 47 neurologists or geneticists. Mean (SD) age in our sample was 53.64 (20.51) years; 938 patients were men (48.5%) and 995 were women (51.5%). The genetic defect was unidentified in 920 patients (47.6%). A total of 1371 patients (70.9%) had ataxia and 562 (29.1%) had hereditary spastic paraplegia. Prevalence rates for ataxia and hereditary spastic paraplegia were estimated at 5.48 and 2.24 cases per 100 000 population, respectively. The most frequent type of dominant ataxia in our sample was SCA3, and the most frequent recessive ataxia was Friedreich ataxia. The most frequent type of dominant hereditary spastic paraplegia in our sample was SPG4, and the most frequent recessive type was SPG7. Conclusions: In our sample, the estimated prevalence of ataxia and hereditary spastic paraplegia was 7.73 cases per 100 000 population. This rate is similar to those reported for other countries. Genetic diagnosis was not available in 47.6% of cases. Despite these limitations, our study provides useful data for estimating the necessary healthcare resources for these patients, raising awareness of these diseases, determining the most frequent causal mutations for local screening programmes, and promoting the development of clinical trials. (c) 2021 Sociedad Espanola de Neurologia. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/ 4.0/)

Mapa epidemiológico transversal de las ataxias y paraparesias espásticas hereditarias en España

Resume: Introducción: Las ataxias (AT) y paraparesias espásticas hereditarias (PEH) son síndromes neurodegenerativos raros. Nos proponemos conocer la prevalencia de las AT y PEH en España en 2019. Pacientes y métodos: Estudio transversal, multicéntrico, descriptivo y retrospectivo de los pacientes con AT y PEH, desde marzo de 2018 a diciembre de 2019 en toda España. Resultados: Se obtuvo información de 1933 pacientes procedentes de 11 Comunidades Autónomas, de 47 neurólogos o genetistas. Edad media: 53,64 años ± 20,51 desviación estándar (DE); 938 varones (48,5%), 995 mujeres (51,5%). En 920 pacientes (47,6%) no se conoce el defecto genético. Por patologías, 1.371 pacientes (70,9%) diagnosticados de AT, 562 diagnosticados de PEH (29,1%). La prevalencia estimada de AT es 5,48/100.000 habitantes, y la de PEH es 2,24 casos/100.000 habitantes. La AT dominante más frecuente es la SCA3. La AT recesiva más frecuente es la ataxia de Friedreich (FRDA). La PEH dominante más frecuente es la SPG4, y la PEH recesiva más frecuente es la SPG7. Conclusiones: La prevalencia estimada de AT y PEH en nuestra serie es de 7,73 casos/100.000 habitantes. Estas frecuencias son similares a las del resto del mundo. En el 47,6% no se ha conseguido un diagnóstico genético. A pesar de las limitaciones, este estudio puede contribuir a estimar los recursos, visibilizar estas enfermedades, detectar las mutaciones más frecuentes para hacer los screenings por comunidades, y favorecer los ensayos clínicos. Abstract: Introduction: Ataxia and hereditary spastic paraplegia are rare neurodegenerative syndromes. We aimed to determine the prevalence of these disorders in Spain in 2019. Patients and methods: We conducted a cross-sectional, multicentre, retrospective, descriptive study of patients with ataxia and hereditary spastic paraplegia in Spain between March 2018 and December 2019. Results: We gathered data from a total of 1933 patients from 11 autonomous communities, provided by 47 neurologists or geneticists. Mean (SD) age in our sample was 53.64 (20.51) years; 938 patients were men (48.5%) and 995 were women (51.5%). The genetic defect was unidentified in 920 patients (47.6%). A total of 1371 patients (70.9%) had ataxia and 562 (29.1%) had hereditary spastic paraplegia. Prevalence rates for ataxia and hereditary spastic paraplegia were estimated at 5.48 and 2.24 cases per 100 000 population, respectively. The most frequent type of dominant ataxia in our sample was SCA3, and the most frequent recessive ataxia was Friedreich ataxia. The most frequent type of dominant hereditary spastic paraplegia in our sample was SPG4, and the most frequent recessive type was SPG7. Conclusions: In our sample, the estimated prevalence of ataxia and hereditary spastic paraplegia was 7.73 cases per 100 000 population. This rate is similar to those reported for other countries. Genetic diagnosis was not available in 47.6% of cases. Despite these limitations, our study provides useful data for estimating the necessary healthcare resources for these patients, raising awareness of these diseases, determining the most frequent causal mutations for local screening programmes, and promoting the development of clinical trials