Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:http://oc1dean.blogspot.com/2010/11/my-background-story_8.html

Sunday, April 29, 2018

Delay SAVR After Stroke, Study Suggests

Be careful out there even if your doctor isn't. 
https://www.medpagetoday.com/cardiology/strokes/72536?
Aortic valve replacement within 3 months associated with big risk
  • by Contributing Writer, MedPage Today
The months immediately following a stroke are a particularly risky time for a patient to get surgical aortic valve replacement (SAVR), according to a Danish registry study.
SAVR within 3 months of surviving a stroke was associated with a substantially higher risk of combined non-fatal MI, non-fatal ischemic stroke, and cardiovascular death by 30 days (23.3% versus 5.7% for SAVR recipients who had no history of stroke, adjusted OR 4.57, 95% CI 3.24-6.44), according to the report published online in JAMA Cardiology.

Ischemic strokes drove a large part of the increased risk (18.3% versus 1.2%, adjusted OR 14.69, 95% CI 9.69-22.27). On the other hand, all-cause mortality was not significantly more likely with early post-stroke SAVR (6.8% versus 3.6%, adjusted OR 1.45, 95% CI 0.83-2.54), reported researchers led by Charlotte Andreasen, MD, of Copenhagen University Hospital Herlev and Centofte.
The longer patients waited to get SAVR after a stroke, the lower their risk appeared to be.
"The splines of the subgroup with prior stroke supports that the risk of recurrent stroke declines with time and reaches a nadir after approximately 4 months. Thus, data suggest that postponement of SAVR for at least 3 to 4 months after a stroke, if possible, may reduce the risk of recurrent stroke during surgery," the authors suggested.
Even so, prior stroke at any time was still associated with elevated risk for major adverse events and ischemic strokes at 30 days.
"Previous stroke is a major risk factor of recurrent ischemic stroke and MACE in patients undergoing SAVR, especially if time elapsed between previous stroke and surgery is less than 3 months," Andreasen's group concluded.

Of all the adults who got SAVR in 1996-2014 and were included in Danish administrative registries (n=14,030), only 616 had had a prior stroke and were included in the study. Exclusion criteria included simultaneous mitral, tricuspid, or pulmonary valve surgery and patients with endocarditis within 1 year preceding surgery.
Such a small sample size made some estimates uncertain, the investigators acknowledged, adding that their observational study should be deemed hypothesis-generating only, as patients getting surgery within 3 months of a stroke might be critically ill to begin with.
"In addition, misclassification of outcome events is a serious concern. If patients with a prior stroke were mistakenly assigned an acute stroke diagnosis code based on their prior event or owing to recrudescence of symptoms in the perioperative period, misclassification bias could lead to an overestimation of the stroke rate in these patients," added Michael Mullen, MD, and Steven Messé, MD, both of University of Pennsylvania in Philadelphia.
In an accompanying editorial, Mullen and Messé also suggested that patients with a prior stroke could have been monitored more carefully for signs and symptoms of stroke. "This could result in differential ascertainment of outcome events between groups and bias the results," they wrote.
"Nonetheless, this study provides important information on an understudied topic," they added. A prospective, randomized trial addressing the timing of SAVR after stroke does not and probably will never exist, they said, considering how many patients were screened to get 616 patients in the present study.
"Although this is an area that requires additional study, for now, it seems reasonable to avoid aortic valve surgery or any surgery within the first 3 months after a stroke unless the procedure is urgent or emergent and waiting would be harmful. The old saw that patience is a virtue certainly seems to hold for cardiac surgery after a stroke," according to the editorialists.
The study was supported by a grant from the Danish Heart Foundation and the Gerda & Hans Hansens Fund.
Andreasen and Mullen disclosed no relevant conflicts of interest.
Messé reported receiving consulting fees from Claret Medical, personal fees from Yale Cardiovascular Research Group and Claret Medical, and grants from the NIH.
Several study co-authors declared ties to industry.
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