Stroke Care and Application of Thrombolysis in Ibero-America: Report From the SITS-SIECV Ibero-American Stroke Register

Background and Purpose: Standardized registries may provide valuable data to further improve stroke care. Our aim was to obtain updated information about characteristics of stroke patients and management of stroke across the Ibero-American countries, using a common in-hospital registry (Safe Implementation of Treatments in Stroke­Sociedad Iberoamericana de Enfermedades Cerebrovasculares) as a basis for further quality improvement. Methods: Data for this study were entered into the Safe Implementation of Treatments in Stroke registry from September 2009 to December 2013 by 58 centers in 14 countries. Data included demographics, risk factors, onset-to-door time, National Institutes of Health Stroke Scale score, stroke subtype, ischemic stroke etiology, treatments, 3-month mortality, and modified Rankin Scale score. Time to treatment was also recorded for patients treated with thrombolysis. Results: Five thousand four hundred one patients were registered; median age, 65 years; 46% women; 3915 (72.5%) ischemic strokes; 686 (13.7%) hemorrhagic strokes; 213 (4.3%) subarachnoid hemorrhages; 414 (8.3%) transient ischemic attacks; and 31 (0.6%) cerebral vein thrombosis. The most prevalent risk factors were hypertension (71.3%), dyslipidemia (35.2%), and diabetes mellitus (23.6%). Atrial fibrillation was present in 15.1%. Three hundred one ischemic strokes were treated with intravenous thrombolysis (IVT; 7.7%). Patients undergoing IVT were more severely affected (median baseline National Institutes of Health Stroke Scale score, 11 versus 6). The rate of symptomatic intracerebral hemorrhages after IVT was 5.7%. At 3 months, 60.3% of IVT-treated patients and 59.1% of untreated patients were independent (modified Rankin Scale score, 0­2). Mortality was 11.4% in treated and 12.8% in untreated patients. Conclusions: Safe Implementation of Treatments in Stroke­Sociedad Iberoamericana de Enfermedades Cerebrovasculares is the largest registry of a general stroke population and the first study to evaluate the level of IVT use in Ibero-America. It provides valuable information that may help to improve the quality of stroke care in the Ibero-American region.

Outcome after intravenous thrombolysis in patients with acute lacunar stroke: An observational study based on SITS international registry and a meta-analysis.

BACKGROUND: Intravenous thrombolysis (IVT) for lacunar stroke (LS) is debated, as the underlying pathophysiological mechanism may not be thrombogenic. AIMS: To investigate outcomes after IVT in LS in the SITS International Stroke Thrombolysis Register and perform a meta-analysis. METHODS: LS was identified by both baseline NIHSS-subscores and discharge ICD-10 codes, and contrasted by IVT to non-IVT treated. IVT patients were predominantly from Europe, non-IVT patients predominantly from South America and Asia. Outcome measurements were functional independence (modified Rankin Scale [mRS] score ≤2), excellent outcome (mRS ≤ 1), and mortality at three months. Matched-control comparisons of symptomatic intracerebral hemorrhage (SICH) between IVT-treated LS and IVT-treated non-LS patients were performed. Additionally, we performed a meta-analysis. RESULTS: Median age for IVT-treated LS patients (n = 4610) was 66 years vs. 64 years and NIHSS score was 6 vs. 3, compared to non-IVT-treated LS (n = 1221). Univariate outcomes did not differ; however, IVT-treated LS patients had higher adjusted odds ratios (aOR) for functional independence (aOR = 1.65, 95% CI = 1.28-2.13) but similar mortality at three months (aOR = 0.57, 0.29-1.13) than non-IVT-LS. Propensity-score matched analysis showed that IVT-treated LS patients had a 7.1% higher chance of functional independency than non-IVT LS patients (p < 0.001). IVT-treated LS patients had lower odds for SICH (aOR = 0.33, 0.19-0.58 per SITS, aOR = 0.40, 0.27-0.57 per ECASS-2) than matched non-LS controls, which was mirrored in the meta-analysis. CONCLUSIONS: Our adjusted results show that IVT treatment in LS patients was associated with better functional outcome than non-IVT-treated LS and less SICH than IVT-treated non-LS patients.

Guía de práctica clínica para terapia antitrombótica y trombolítica 2005 / Clinical practice guidelines for antithrombotic and thrombolytic therapy 2005

La enfermedad tromboembólica es un área de creciente interés; un diagnóstico y tratamiento adecuados son imprescindibles para la buena práctica médica, por lo cual requiere certeza en la toma de decisiones. Motivados por la diversidad de opciones del arsenal terapéutico, se decidió actualizar las pautas venezolanas de terapia antitrombótica y trombolítica, a través de la guía 2005. Metodología para el Desarrollo de las Guías de Práctica -Clínica Basadas en Evidencia.

Enfermedad Cerebrovascular: registro de datos del Servicio d Neurología Hospital Universitario de Caracas / Cerebral and vascular diseases: register of dates of Neurology Service

Se reportan los datos obtenidos del estudio de 572 pacientes con Enfermedad Cerebrovascular ingresados al Servicio de Neurología del Hospital Universitario de Caracas entre 1981 y 1984 siguiendo un protocolo ad-hoc. Un total de 321(56,1 por ciento) fueron diagnósticados como trombóticos, 74 (12,9 por ciento) como cardioembólicos, 85(14,9 por ciento) como hemorragias intraparenquimatosas y 92 (16,1 por ciento) como hemorragia subaracnoidea primaria. Los principales factores de riesgo fueron: Hipertensión Arterial: 57,3 por ciento, Cardiopatía Embolígena: 12,9 por ciento y Diabetes Mellitus: 19,3 por ciento. La mortalidad hospitalaria fue determinada en un subgrupo de 139 pacientes, siendo los resultados: Mortalidad General: 16,5 por ciento; Trombóticos: 10,9 por ciento; Embólicos: 21,4 por ceinto; Hemorragia Intraparenquimatosa: 26,3 por ciento y Hemorragia Subaracnoidea: 10,3 por ciento

Anticoagulación en enfermedad cerebrovascular / Anticoagulation in cerebro-vascular disease

Presentamos la experiencia del servicio de neurología delH.U.C. en el uso de anticoagulantes en el tratamiento de 83 pacientes con accidentes cerebro vascular isquémico de probable origen cardioembólico. De estos pacientes el 54,2