Keeping prior anticoagulation treatment in the acute phase of ischaemic stroke: the REKOALA study.

INTRODUCTION: A consensus on the management of anticoagulated patients in the acute phase of ischaemic stroke has not yet been established. We aimed to evaluate clinical outcomes in such patients based on the continuation or discontinuation of anticoagulation. METHODS: Retrospective study of patients with acute ischaemic stroke and cardioembolic source receiving anticoagulant therapy is done. Patients were classified based on the continuation or discontinuation of anticoagulation at admission. Clinical outcomes, haemorrhagic and ischaemic events were assessed. Multivariate logistic regression analysis, propensity score matching (PSM) analysis and a sub-analysis of patients with severe ischaemic stroke at admission (NIHSS score ≥ 15) were performed. RESULTS: Anticoagulation was continued in 147 (78.8%) of 186 patients. Patients continuing anticoagulant had lower NIHSS (median 5 vs 18, p < 0.001). There were no differences in haemorrhagic or ischaemic events. In the multivariate analysis, good functional outcome at discharge was higher in the continuation group, OR (CI95%) 3.77 (1.2-11.2). PSM analysis adjusted for potential confounders such as NIHSS had higher rates of good functional outcomes at discharge (80% vs 36%, p = 0.004) and at 90 days (76% vs 44%, p = 0.042) in the continuation group. Patients with severe stroke in this group had lower 90-day mortality (34.6% vs 62.5%, p = 0.045) and higher rates of good clinical outcome at discharge (33.3% vs 8.3%, p = 0.032). No differences were observed in 90-day haemorrhagic or ischaemic events. CONCLUSION: Continuation of anticoagulation in patients with acute ischaemic stroke and cardioembolic source did not increase the risk of intracranial haemorrhage and may be associated with better functional outcomes.

Hallazgos neuropsicológicos en una muestra de pacientes con diagnóstico de glioma. CIMEQ (enero diciembre/2013) / Neuropsychological Findings in Patients with Glioma, CIMEQ 2013

Introducción. Entre el 50 y el 80 por ciento de los pacientes con diagnóstico de glioma presentan alteraciones cognitivas, lo cual empeora significativamente la calidad de vida del enfermo. Objetivo principal: Determinar la influencia del glioma en el rendimiento neuropsicológico. Material y método: La valoración neuropsicológica se realizó en el momento inicial de la enfermedad (previo a la cirugía) en pacientes atendidos en el hospital CIMEQ en el período de enero diciembre/2013 que cumplieron con los criterios de inclusión establecidos. La muestra incluyó a 27 pacientes. Se analizó la influencia de variables sociodemográficas (edad, género y escolaridad) y clínicas (hemisferio afectado e histología de la lesión) en el rendimiento neuropsicológico. Resultados: La distribución de acuerdo al género fue diferente (63 por ciento hombres y 37 por ciento mujeres) con una media de edad de 45 ± 15,3 años. Las lesiones localizadas en el lóbulo frontal (51 por ciento) fueron las más frecuentes y la distribución de acuerdo al hemisferio afectado fue similar. Se observaron alteraciones en la mayoría de las funciones neuropsicológicas en comparación con la población general y enlentecimiento en la velocidad en el procesamiento de la información. Los pacientes con lesiones derechas presentaron compromiso de las habilidades visuoconstructivas. Además, aquellos con glioma de bajo grado mostraron mejor rendimiento en tareas de atención y memoria respecto a los pacientes con gliomas de alto grado. Se identificó que la edad es una variable que influye en el rendimiento neuropsicológico, explicando las diferencias en cuanto a la velocidad del procesamiento de la información. Conclusiones: Se constató la existencia de afectación en múltiples dominios cognitivos en pacientes con glioma(AU)

Introduction: About 50 and 80 percent of patients with glioma presented cognitive alterations that significantly deteriorate his/her quality of life. Objective: To determine the influence of glioma on the neuropsychological achievement. Materials and Methods: The neuropsychological assessment in the upset of the disease and before surgery; on patients assisted at CIMEQ Hospital during the period January- December 2013. These patients fulfilled the criterions of inclusion. The sample included 27 patients. There were analyzed socialdemographic variables such as age, sex, and scholar level and clinical variables like affected hemisphere, and histology of the lesion on the neuropsychological achievement. Results: According to sex, the distribution was different (male 63 percent, female 37 percent) with an age percentage of 45=15, 3 years. The located lesions in the frontal lobule (51 percent) were the most frequent, meanwhile the distribution according the the affected hemisphere were similar. In comparison to the general population, alterations in the majority of the functions were, as well as, slowing on the information process speed observed. The patients with lesions located on the right hemisphere presented problems with the visuoconstructive abilities. The patients with low level of glioma showed better achievement in attention and memory tasks. Age was as a variable that affects the neuropsychological achievement identified, which explains the difference in relation to the information process speed. Conclusions: The existence of affectation was on multiple cognitive aspects on patients with glioma showed(AU)