RESUMO
INTRODUCTION: The best therapeutic strategy for patients with mechanical heart valves (MHVs) having acute ischemic stroke during treatment with vitamin K antagonists (VKAs) remain unclear. Being so, we compared the outcomes for: (i) full dose heparin along with VKA (bridging therapy group) and (ii) restarting VKA without heparin (nonbridging group). PATIENTS AND METHODS: For this multicenter observational cohort study, data on consecutive acute ischemic stroke patients with MHV was retrospectively collected from prospective registries. Propensity score matching (PSM) was adopted to adjust for any treatment allocation confounders. The primary outcome was the composite of stroke, systemic embolism, symptomatic cerebral bleeding, and major extracerebral bleeding at 90 days. RESULTS: Overall, 255 out of 603 patients (41.3%) received bridging therapy: 36 (14.1%) had combined outcome, compared with 28 (8.0%) in the nonbridging group (adjusted OR 1.83; 95% CI 1.05-3.18; p = 0.03). Within the bridging group, 13 patients (5.1%) compared to 12 (3.4%) in the nonbridging group had an ischemic outcome (adjusted OR 1.71; 95% CI 0.84-3.47; p = 0.2); major bleedings were recorded in 23 (9.0%) in the bridging group and 16 (4.6%) in the nonbridging group (adjusted OR 1.88; 95% CI 0.95-3.73; p = 0.07). After PSM, 36 (14.2%) of the 254 bridging patients had combined outcome, compared with 23 (9.1%) of 254 patients in the nonbridging group (OR 1.66; 95% CI 0.95-2.85; p = 0.07). CONCLUSION: Acute ischemic stroke patients with MHV undergoing bridging therapy had a marginally higher risk of ischemic or hemorrhagic events, compared to nonbridging patients.
Assuntos
Fibrilação Atrial , AVC Isquêmico , Humanos , Heparina/efeitos adversos , AVC Isquêmico/tratamento farmacológico , Estudos Retrospectivos , Estudos Prospectivos , Fibrilação Atrial/induzido quimicamente , Anticoagulantes/efeitos adversos , Hemorragia/induzido quimicamente , Valvas CardíacasRESUMO
BACKGROUND: Migraine is a highly prevalent and disabling disease which is substantially underdiagnosed in primary care. Recently, the ID Migraine, a self-administered questionnaire, consisting of only 3 items, was shown to be a valid and reliable screening instrument for migraine in primary care in the United States. OBJECTIVE: The aim of the present study was to validate an Italian version of the "ID Migraine" questionnaire. METHODS: Two hundred and twenty-two consecutive headache patients referring to 8 headache centers in Sicily (Italy) completed an Italian version of the ID Migraine. The responses to the questionnaire were compared with the diagnosis of headache made by a headache specialist blind to the result of the questionnaire. Sensitivity, specificity, positive and negative predictive values for migraine were calculated. RESULTS: The statistical analysis of 222 patients examined showed a very good performance of the ID Migraine with high sensitivity: 0.95 (95% CI, 0.91 to 0.98), specificity: 0.72 (95% CI, 0.62 to 0.82), and positive predictive value: 0.88 (95% CI, 0.82 to 0.93). ID Migraine showed also a very good accuracy level: 0.87 (95% CI, 0.83 to 0.92). CONCLUSION: This validation study showed "ID Migraine" as a valid tool for migraine screening also in Italian patients referring to headache centers. If confirmed in a primary care setting, these results establish the "ID Migraine" as a valid screening instrument for migraine in Italian population.
Assuntos
Programas de Rastreamento/normas , Transtornos de Enxaqueca/diagnóstico , Inquéritos e Questionários/normas , Adolescente , Adulto , Feminino , Humanos , Itália , Masculino , Programas de Rastreamento/métodos , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
Migraine is a highly prevalent and disabling disease that is substantially undiagnosed in primary care. Recently, the ID Migraine, a self-administered questionnaire, was shown to be a valid and reliable screener for migraine in primary care in the USA. To validate an Italian version of the ID Migraine, we planned a multicentric study, evaluating at least 220 patients affected by various form of headache. The responses to the questionnaire were compared with the diagnosis of headache made by a headache specialist blind to the result of the questionnaire. Sensitivity, specificity, and positive and negative predictive values for migraine were calculated. The statistical analysis on 140 patients now examined showed a very good performance of the ID Migraine with high sensitivity: 0.94 (95% CI: 0.89-0.95), specificity: 0.70 (95% CI: 0.54-0.86) and positive predictive value: 0.89 (0.82-0.95). If confirmed, these results would establish ID Migraine as a valid screening instrument for migraine in Italian headache patients and warrant further investigation in primary care to assess the validity of this ID screener in Italian population.
