Nearly half of patients with hemorrhagic stroke experience headache

 So, you described something and incompetently provided NO EXACT NEXT STEPS TO SOLVE THE PROBLEM! In the business world that would be grounds for immediate firing. Aren't you glad you're in the absolutely incompetent stroke medical world?

Nearly half of patients with hemorrhagic stroke experience headache

Key takeaways:

• The systematic review included 24 studies and 4,688 adults with hemorrhagic stroke.
• There were no significant associations between headache and diabetes mellitus, hypertension, alcoholism or previous headache.

Nearly half of all patients with hemorrhagic stroke also experience headache across its acute and chronic phases that could contribute to long-term morbidity, according to a review published in Headache.

Yet the prevalence of headache varied substantially across populations and clinical settings, Bradley Ong, MD, adult neurology resident at Neurological Institute, Cleveland Clinic, and colleagues wrote.

Data derived from Ong B, et al. Headache. 2025; doi:10.1111/head.70008.

“In clinical practice, headaches after hemorrhagic stroke came up quite often in our clinical practice, but they were rarely addressed,” Ong told Healio.

Most treatment after stroke focuses on motor recovery and preventing its recurrence, he said, with headache treated as an incidental or transient symptom.

Bradley Ong

“When we looked at the literature, there was no clear, consolidated picture of how common these headaches are or how long they last,” Ong said. “That gap is what motivated this study.”

Ong and colleagues conducted a systematic review and meta-analysis that included 24 peer-reviewed, observational studies from Medline, Embase and CENTRAL with 4,688 adults (mean age, 56.9 years; weighted mean, 58.2% women) with hemorrhagic stroke.

“The most striking finding was how common headaches are,” Ong said. “Nearly half of patients with hemorrhagic stroke experience headache, and more than one-third go on to have persistent headaches months or years later.”

Overall, 46.1% (95% CI, 36.3% to 56.1%) of these patients experienced headache after their stroke. Eleven studies (n = 2,481) found that 55.9% of patients (95% CI, 41.1% to 70.1%) experienced acute headache. Thirteen studies (n = 2,207) found that 36.7% of patients (95% CI, 25.6% to 48.5%) had persistent headache.

“This challenges the assumption that headache is mainly an ‘acute’ symptom, especially in hemorrhagic stroke,” Ong said.

Specific prevalences of headache included 58.3% (95% CI, 44.4% to 71.6%) for those with subarachnoid hemorrhage (SAH) and 36.1% (95% CI, 26.7% to 46%) for those with intracerebral hemorrhage (ICH).

Prevalence of severe headaches included 42.7% (95% CI, 15.8% to 72.1%) among those whose headaches were acute/subacute and 14.3% (95% CI, 10.4% to 18.7%) among those whose headaches were persistent.

With an overall I2 of 96.7%, the researchers said their findings indicated substantial heterogeneity in these pooled prevalence estimates, with no statistically significant differences based on study design, population, geography, Human Developmental Index or risk for bias.

Further, Ong and colleagues said there were no significant associations between risk for headache and female sex, nor were there any significant associations with history of diabetes mellitus, hypertension, alcoholism or previous headache.

“Another important finding was that headache at stroke onset strongly predicted chronic headache, which gives us an early clinical signal we can actually act on,” Ong said.

The odds ratio for post-stroke headache among patients with headache at stroke onset was 1.7 (OR = 1.7; 95% CI, 1.4-2.05). Also, the odds ratio for post-stroke headache among patients with lobar ICH was 1.93 (95% CI, 1.08-3.44).

There were no significant associations between headache risk and cortical ICH or delayed cerebral ischemia. Also, there were no significant associations between headache risk and the presence of an anterior circulation aneurysm among patients with SAH.

Patients with atrial fibrillation had less risk for headache (OR = 0.59; 95% CI, 0.37-0.95), which the researchers attributed to differences in stroke severity and symptom reporting and not to any direct protective effect.

Noting that the prevalence of headache among patients with hemorrhagic stroke exceeds the prevalence of other primary headache disorders among the general population, with substantial variations by population and clinical settings, the researchers called these headaches “common” as well as “persistent and disabling.”

Ong said that clinicians can use these findings to improve outcomes for patients with stroke.

“Clinicians should ask about headache routinely, both in the hospital and during follow-up. Headache should be treated as a meaningful post-stroke complication,” he said.

“Patients who report headache early may benefit from closer monitoring and earlier referral to headache care,” he continued. “Even simple steps like education and avoiding unnecessary opioid exposure can improve quality of life.

Looking ahead, the researchers called for studies with standardized diagnostic criteria, clearly defined populations and detailed headache characteristics into protective therapies and secondary prevention strategies.

“The next step is prospective, longitudinal studies using standardized headache definitions and patient-reported outcomes,” Ong said.

“We also need clinical trials focused specifically on post-stroke headache treatment, rather than extrapolating from primary headache disorders,” he added. “Ultimately, the goal is to integrate headache care into routine stroke recovery.”

For more information:

Bradley Ong, MD, can be reached at ongb@ccf.org.

New initiative aims to improve surgical care for hemorrhagic stroke

This is the whole problem in stroke enumerated in one word; 'care'; NOT RECOVERY!

If your hospital is touting 'care' it means they are a failure because they are delivering 'care'; NOT RECOVERY! I would never go to a failed hospital!

YOU have to get involved and change this failure mindset of 'care' to 100% RECOVERY! Survivors want RECOVERY, NOT 'CARE'!

I see nothing here that states going for 100% recovery! You need to create EXACT PROTOCOLS FOR THAT!

ASK SURVIVORS WHAT THEY WANT, THEY'LL NEVER RESPOND 'CARE'! This tyranny of low expectations has to be completely rooted out of any stroke conversation! I wouldn't go there because of such incompetency as not having 100% recovery protocols!

RECOVERY IS THE ONLY GOAL IN STROKE! 

GET THERE!'

New initiative aims to improve surgical care for hemorrhagic stroke

Hemorrhagic strokes account for just 13% of the nearly 800,000 strokes that occur in the U.S. each year, yet they are responsible for more than 40% of all stroke-related deaths. These devastating brain bleeds have long lacked standardized surgical treatment protocols, limiting patient recovery options.

In response, the American Heart Association, devoted to changing the future of health for all, is launching a new nationwide initiative to accelerate the adoption of effective surgical approaches, including minimally invasive techniques, to improve outcomes for people affected by intracerebral hemorrhage (ICH).

The Hemorrhagic Stroke Surgical Quality Improvement Initiative, supported financially by Stryker, will identify and amplify national models of effective ICH care(NOT RECOVERY!), including the use of minimally invasive parafascicular surgery (MIPS). MIPS is a minimally invasive procedure that uses a tubular retractor to navigate through the brain's natural folds, along with a powered instrument designed to remove clots and help prevent damage. Research has shown that when performed within 24 hours of a brain bleed, MIPS may lead to better recovery outcomes at six months compared to standard treatments.

The ability to share data and accelerate learning is critical to improving stroke care(NOT RECOVERY!). Through this initiative, we hope to reduce the devastating outcomes associated with hemorrhagic stroke by improving access to surgical interventions proven to improve patient recovery."

Kevin Sheth, M.D., FAHA, American Heart Association volunteer, chair of the Association's ICH Science Advisory Group and director of the Yale Center for Brain & Mind Health

Fifteen hospitals across the U.S. will participate in a learning collaborative, using data from the Association's Get With The Guidelines® - Stroke registry, which tracks approximately three-quarters of the nation's stroke hospitalizations. These selected sites will analyze ICH care(NOT RECOVERY!) data and clinical workflows to identify successful models that could be scaled nationally:

• Aurora St. Luke's Medical Center in Milwaukee
• Cleveland Clinic in Cleveland
• DMC Detroit Receiving Hospital in Detroit
• Eden Medical Center in Castro Valley, California
• Hackensack Meridian Health Jersey Shore University Medical Center in Neptune, New Jersey
• Indiana University Health Methodist Hospital in Indianapolis
• Massachusetts General Hospital in Boston
• Memorial Hermann-Texas Medical Center in Houston
• Montefiore Medical Center-Moses Campus in Bronx, New York
• Penn State Health Milton S. Hershey Medical Center in Hershey, Pennsylvania
• SSM Health Saint Louis University Hospital in St. Louis
• The University of Kansas Health System in Kansas City, Kansas
• UCI Medical Center in Orange, California
• University Medical Center of El Paso in El Paso, Texas
• Yale-New Haven Hospital in New Haven, Connecticut

Criteria for site selection included demonstrated leadership in MIPS, infrastructure readiness and interest in expanding ICH surgical options.

Source:

American Heart Association

U−shaped association between the glycemic variability and prognosis in hemorrhagic stroke patients: a retrospective cohort study from the MIMIC-IV database

 Useless, describes a problem; provides NO solution!

U−shaped association between the glycemic variability and prognosis in hemorrhagic stroke patients: a retrospective cohort study from the MIMIC-IV database

Yuchen Liu^1†Houxin Fu^2†Yue Wang³Jingxuan Sun¹Rongting Zhang¹Yi Zhong¹Tianquan Yang¹Yong Han¹Yongjun Xiang¹Bin Yuan¹Ruxuan Zhou¹Min Chen¹Hangzhou Wang^1*

• ¹Department of Neurosurgery, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
• ²Department of Pediatric Hematology and Oncology, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
• ³Institute of Pediatric Research, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China

Background: Elevated glycemic variability (GV) is commonly observed in intensive care unit (ICU) patients and has been associated with clinical outcomes. However, the relationship between GV and prognosis in ICU patients with hemorrhagic stroke (HS) remains unclear. This study aims to investigate the association between GV and short- and long-term all-cause mortality.

Methods: Clinical data for hemorrhagic stroke (HS) patients were obtained from the MIMIC-IV 3.1 database. GV was quantified using the coefficient of variation (CV), calculated as the ratio of the standard deviation to the mean blood glucose level. The association between GV and clinical outcomes was analyzed using Cox proportional hazards regression models. Additionally, restricted cubic spline (RCS) curves were employed to examine the nonlinear relationship between GV and short- and long-term all-cause mortality.

Results: A total of 2,240 ICU patients with HS were included in this study. In fully adjusted models, RCS analyses revealed a U-shaped association between the CV and both short- and long-term all-cause mortality (P for nonlinearity < 0.001 for all outcomes). Two-piecewise Cox regression models were subsequently applied to identify CV thresholds. The thresholds for all-cause mortality in ICU, during hospitalization, and at 30, 90, and 180 days were determined to be 0.14, 0.16, 0.155, 0.14, and 0.14, respectively. These findings were consistent in sensitivity and subgroup analyses.

Conclusions: In HS patients, higher GV is associated with an increased risk of both short- and long-term all-cause mortality. Our findings suggest that stabilizing GV may improve the prognosis of HS patients.(Where the fuck is the protocol that does that? Your mentors and senior researchers need to be fired for incompetency?)

Background

Cerebrovascular disease (CVD) is the second leading cause of death worldwide, surpassed only by cardiovascular disease (1–3). Stroke, a major component of CVD, has been identified by the World Health Organization as the primary cause of long-term disability globally (4, 5). Although hemorrhagic stroke (HS) accounts for only 10–20% of all stroke cases, it is responsible for nearly half of all stroke-related deaths (6, 7). With an aging global population, the burden of stroke continues to rise, with HS patients in intensive care units (ICU) facing an elevated mortality risk (8). Consequently, identifying prognostic markers for predicting adverse outcomes in HS patients is essential. Historically, assessment tools such as the NIH Stroke Scale and the Canadian Neurological Scale have been widely utilized (9). Despite their utility, these scales are limited by their complexity, time requirements, and the need for specialized training.

Recently, glycemic variability (GV), a parameter of glycemic control, has emerged as a potential factor influencing the progression of cardiovascular and cerebrovascular conditions (10–13). GV reflects fluctuations in blood glucose levels relative to the mean and represents a key pattern of glycemic dysregulation observed in critically ill patients. Compared to persistent hyperglycemia, pronounced glycemic variability has been demonstrated to exacerbate endothelial dysfunction and trigger oxidative stress, potentially leading to more severe cerebrovascular damage (14–16). Moreover, both hyperglycemia and hypoglycemia were recognized as significant factors influencing stroke prognosis (16). Despite this, the impact of glycemic variability on HS patients has been understudied and remains a topic of debate in clinical practice (17, 18).

To address this gap, the present study examined the association between glycemic variability and short-term and long-term all-cause mortality in HS patients. The findings aimed to support clinicians in identifying high-risk individuals, facilitating closer monitoring and timely therapeutic interventions.

More at link.

Approved Cancer Drugs May Have Potential to Treat Hemorrhagic Stroke

 Are your stroke medical 'professionals' ensuring this research gets completed? NO? 

Do you prefer your doctor and hospital incompetence NOT KNOWING? OR NOT DOING?

Approved Cancer Drugs May Have Potential to Treat Hemorrhagic Stroke

tony Brook pathology researcher’s work supported by a $2.6 million NIH grant

STONY BROOK, NY, March 31, 2025 – There is currently no effective drug to treat a hemorrhagic stroke, when a ruptured blood vessel causes bleeding into the brain. Researcher Ke Jian Liu, PhD, however, believes that a drug treatment for hemorrhagic stroke may emerge by way of repurposing certain drugs that are already Food and Drug Administration (FDA) approved to treat cancer. His approach and experiments are supported by a five-year $2.6 million grant from the National Institute of Neurological Disorders and Stroke, a branch of the National Institutes of Health (NIH). The grant runs through November 2029.

According to the American Stroke Association, hemorrhagic strokes account for approximately 13 percent of stroke cases. One form of this type of stroke causes blood bleeds within the brain (intracerebral hemorrhage). Overall, stroke is a leading cause of disability to Americans and the fifth leading cause of death.

Ke Jian Liu, PhD, Professor of Pathology and research scientist
Credit: Jeanne Neville, Stony Brook Medicine

Liu’s research is based on his discovery of a novel mechanism related to processes of zinc in the blood and brain, which is affected by a class of cancer drugs called protein kinase inhibitors.

Despite extensive research, the mechanisms of intracerebral hemorrhage-induced brain damage are not well understood. This damage is thought to be mediated through red cell lysis and toxicity of released hemoglobin and its degradation products, heme and free iron. But therapeutic strategies on hemoglobin, heme, iron and other blood components in edema formation have fallen short. Liu’s lab uncovered that endogenously formed zinc protoporphyrin (ZnPP), a complex in red blood cells made up of the compound porphyrin and complexes of zinc, contributes to intracerebral hemorrhage-induced brain damage.

“We think that this discovery opens new avenues for drug therapeutic intervention to treat hemorrhagic stroke,” says Liu, Professor in the Department of Pathology in the Renaissance School of Medicine at Stony Brook University, and Associate Director of Basic Science in the Stony Brook University Cancer Center.

He and colleagues are targeting the formation of ZnPP in the brain. Their initial findings with a selected compound inhibitor that connects to ZnPP demonstrated that protein kinase inhibitors can reduce brain injury and improve neurological outcomes in animal models of hemorrhagic stroke.

“Essentially, we conduct experiments in models of hemorrhagic stroke to investigate the mechanisms underlying ZnPP generation and neurotoxicity,” says Liu.

He points out that the FDA-approved cancer drugs do not inhibit ZnPP, and that he and his team reached their hypothesis and conclusion through research taking several steps.

First, his lab discovered that ZnPP is generated during hemorrhagic stroke and that ZnPP is more neurotoxic than any other known compounds involved in stroke brain injury. Second, since ZnPP is known to be generated via an enzyme called ferrochelatase, Liu and colleagues tested and found that inhibiting ferrochelatase does decrease ZnPP generation and reduce brain injury following stroke. And third, they searched for clinically applicable ferrochelatase inhibitors. They centered on kinase inhibitors, which possess off-target effects on ferrochelatase not related to cancer treatments.

“We connected the dots and began testing some FDA-approved kinase inhibitors, which validated our speculation with ferrochelatase. So now we are exploring the potential of pharmacologically inhibiting ZnPP generation by investigating off-target ferrochelatase inhibition using these inhibitors,” explains Liu.

To date, the FDA has approved 82 small-molecule protein kinase inhibitors for treating a variety of cancers, including leukemia, lymphoma, and breast cancer. This provides many options for Liu and colleagues to test multiple kinase inhibitors in relation to inhibiting ferrochelatase and to compare the results.

Liu thinks that the research could potentially transform stroke researchers’ understanding of intracerebral hemorrhage-induced brain injury and ultimately provide a new treatment for hemorrhagic stroke.

He and fellow investigators believe that if the treatment approach continues to prove to be effective, safe, and improve outcomes after hemorrhagic stroke in their experimental models, proposals for human trials could progress quickly, given that drug toxicity studies would not be required because of the FDA-approved status that already exists with the inhibitors.

Optimal target blood pressure for the primary prevention of hemorrhagic stroke: a nationwide observational study

Well, WHERE IS THE PROTOCOL ON THIS LOCATED?

Optimal target blood pressure for the primary prevention of hemorrhagic stroke: a nationwide observational study

Hwan Seok Shim^‡ Jeong-Mee Park^†‡ Yong Jae Lee Young-Deok Kim Tackeun Kim Seung Pil Ban Jae Seung Bang O-Ki Kwon Chang Wan Oh Si Un Lee^*

• Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam-si, Republic of Korea

Background: There are few reports on the preventative value of intensive blood pressure (BP) management for stroke, especially hemorrhagic stroke (HS), after new criteria for hypertension (HTN) were announced by the American College of Cardiology/American Heart Association in 2017.

Aims: This study aimed to identify the optimal BP for the primary prevention of HS in a healthy population aged between 20 and 65 years.

Methods: We conducted a 10-year observational study on the risk of HS, subclassified as intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) according to BP categories (e.g., low normal BP, high normal BP, elevated BP, stage 1 HTN, and stage 2 HTN) using the National Health Insurance Service Database.

Results: Out of 8,327,751 participants who underwent a health checkup in 2008, 949,550 were included in this study and observed from 2009 to 2018. The risk of ICH was significantly increased in men with stage 2 HTN {adjusted hazard ratio [aHR] 2.002 [95% confidence interval (CI) 1.203–3.332]} and in women with stage 1 HTN [aHR 2.021 (95% CI, 1.251–3.263)]. The risk of SAH was significantly increased in both men [aHR 1.637 (95% CI, 1.066–2.514)] and women [aHR 4.217 (95% CI, 2.648–6.715)] with stage 1 HTN. Additionally, the risk of HS was significantly increased in men with stage 2 HTN [aHR 3.034 (95% CI, 2.161–4.260)] and in women with stage 1 HTN [aHR 2.976 (95% CI, 2.222–3.986)].

Conclusion: To prevent primary HS, including ICH and SAH, BP management is recommended for adults under the age of 65 years with stage 1 HTN.

Introduction

The incidence and diagnosis rates of cerebrovascular diseases related to stroke are increasing as the population ages and diagnostic technology is developed (1–3). Accordingly, the demand for research on the primary or secondary prevention of stroke is also increasing. Among the modifiable risk factors for stroke, hypertension (HTN) is an important common factor in several studies (4). In 2017, the American College of Cardiology/American Heart Association (ACC/AHA) released an updated guideline with new criteria for HTN, defining stage 1 HTN as a systolic blood pressure (BP) of 130–139 mm Hg or a diastolic BP as 80–89 mm Hg (5).

However, although several studies have reported new diagnostic criteria for HTN that lower the incidence of various cardiovascular events (CVEs) (6–8), there are few helpful reports on the prevention of stroke. Some studies reported that intensive BP control prevents secondary stroke (3, 9, 10), but few studies reported a significant correlation with primary stroke prevention (8). Studies reporting that intensive BP control helps prevent primary stroke have limitations in that they include only patients with specific diseases, such as diabetes, or subgroup analysis, such as for hemorrhagic or ischemic stroke, was not conducted (9).

Therefore, we conducted a large-scale observational study on the risk of hemorrhagic stroke (HS), subclassified as subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH) according to BP based on the new diagnostic criteria for HTN in a healthy population using a nationwide cohort.

More at link.

Antisecretory Factor May Reduce ICP in Severe TBI—A Case Series

Would this work in hemorrhagic stroke? Reduce the pressure?  WHOM is your doctor and stroke hospital contacting to get that answered? Or will incompetence occur again by DOING NOTHING?

Antisecretory Factor May Reduce ICP in Severe TBI—A Case Series

David Cederberg^1*, Hans-Arne Hansson², Edward Visse¹ and Peter Siesjö¹

• ¹Department of Neurosurgery, Skane University Hospital, Lund, Sweden
• ²Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden

Traumatic brain injury (TBI) constitutes a global epidemic. Overall outcome is poor, with mortality ranging from 10 to 70% and significant long-term morbidity. Several experimental reports have claimed effect on traumatic edema, but all clinical trials have failed. Antisecretory factor, an endogenous protein, is commercially available as Salovum^®, which is classified as a medical food by the European Union and has been proven effective in experimental trauma models. It has, however, previously not been tested in humans with severe TBI. We hereby report a case series of five adult patients with severe TBI, treated with Salovum. The objective of the intervention was to evaluate safety and, if possible, its effect on intracranial pressure and outcome. Patients received 1 g Salovum per kilo of body weight divided into six doses per 24 h. Each dose was administered through the nasogastric tube. Patients were scheduled for 5 days of treatment with Salovum. Intracranial pressure was controlled in all patients. In three of five patients, intracranial pressure could be controlled with Salovum and deep sedation (no barbiturates), except during periods of gastroparesis. Five of five patients had a favorable short-term outcome, and four of five patients had a favorable long-term outcome. No toxicity was observed. We conclude that at least three of the five treated patients experienced an effect of Salovum with signs of reduction of intracranial pressure and signs of clinical benefit. In order to validate the potential of antisecretory factor in TBI, a prospective, randomized, double-blind, placebo-controlled trial with Salovum has been initiated. Primary outcome for the trial is 30-day mortality; secondary outcomes are treatment intensity level, intracranial pressure, and number of days at the neurointensive care unit.

Introduction

Traumatic brain injury (TBI) constitutes a global burden despite the fact that mortality and morbidity have been reduced in several countries during the last decades (1, 2). Advances in neurointensive care, cerebral monitoring, and neuroradiology have improved outcome for patients with severe TBI, but the results globally are still poor with a mortality ranging from 10 to 70% and significant long-term morbidity (3).

Traumatic brain injury encompasses several pathogenic mechanisms as primary mechanical injury and hemorrhage followed by secondary events such as vasospasm, inflammation, excitotoxic cell damage, and energy deprivation but also long-term progressive brain tissue degeneration. One common denominator in TBI is cerebral edema, which may cause raised intracranial pressure (ICP) and is a major factor responsible for mortality and morbidity in TBI (4). The pathophysiologic mechanisms of cerebral edema are, however, only partially known (5).

Although several experimental reports have claimed effect on traumatic cerebral edema, all clinical trials have failed (6).

Antisecretory factor (AF) is a 41-kDa endogenous protein proposed to possess both antisecretory and anti-inflammatory effects (7). The exact mechanism of AF is unknown, but it has been proposed to act by modulation of proteasomes, complement, and myeloid cells (8–10). A recent report shows that AF inhibits the NKCC1 ion pump; the latter also has been implicated in the evolution of edema in TBI (11, 12).

Salovum^® is an egg yolk powder enriched for AF and classified as food for specific medical purposes in the EU. Salovum has been used in clinical trials for gastroenteritis and Ménière inflammatory bowel disease, and no toxicity has been reported [Lantmännen Functional Foods AB Besöksadress: S:t Göransgatan 160, Stockholm, Sweden, (13)].

The functional part of AF has been synthesized within a 16-amino-acid peptide, AF16. AF16 and AF have shown effects against cerebral edema and increased ICP in models of herpes encephalitis and TBI (14, 15).

We hereby report the first five patients with severe TBI, treated with the AF-enriched dietary supplement Salovum with the aim to assess ICP control and clinical outcome.

More at link. 

A Tale of Two Strokes: Hemorrhagic Cases Getting Left Behind

But have you identified EXACTLY why they died? They didn't die from stroke, they died from a type of brain damage. If you don't know where and when you will never solve Hemorrhagic strokes.

Have you worked on solving these hemorrhage cascade of death problems?

• hemorrhage cascade of death (9 posts)

 

 

A Tale of Two Strokes: Hemorrhagic Cases Getting Left Behind

— "We've tried surgery, we've tried medications" -- and not much to show for it

by Crystal Phend, Senior Editor, MedPage Today February 21, 2020

LOS ANGELES -- Improvements over the past decades in ischemic stroke mortality haven't been mirrored by even a budge in hemorrhagic stroke prognosis, a population-based study from the Netherlands showed.
In the Rotterdam Study, ischemic stroke mortality rates dropped starting around 1998 for a relative 29% reduction from 1991-1998 to 2008-2015 (29 vs 11 per 100 person-years, P<0.01).
Hemorrhagic stroke mortality rates, though, stayed steady (30 vs 25 per 100 person-years, P=0.93), Reem Waziry, MD, PhD, of Harvard T.H. Chan School of Public Health in Boston, reported here at the International Stroke Conference and online in Stroke.
"It makes sense, given the amazing advances we've had in the treatment of ischemic stroke with tPA now 25 years old and endovascular therapy now 5 years old," even though most of these therapies have been aimed at reducing disability rather than mortality, commented Ralph Sacco, MD, chairman of neurology at the University of Miami and past president of the American Heart Association.
"We've had many more failures for hemorrhagic stroke," Sacco told MedPage Today. "We don't have any major breakthroughs. We've tried surgery, we've tried medications, and we have not been as successful in altering the course for hemorrhagic stroke."
There have been some positive developments in hemorrhagic stroke recently, with the STICH trial showing improved mortality with early surgical hematoma evacuation but the MISTIE III trial missing significance for a similar approach with minimally invasive surgery plus thrombolysis.
"Although, these interventions show promise in selected samples of patients in the setting of clinical trials, these advances are not yet reflected in the setting of the general population," Waziry's group wrote in the Stroke paper.
The study assessed time trends in survival after first-ever strokes among the 14,926 participants in the long-running prospective study of middle-age and older adults getting follow-up exams every 3 to 4 years. After excluding those with a past history of stroke or an unspecified stroke diagnosis during the study period, there were 162 first-ever hemorrhagic and 988 ischemic strokes recorded from 1991 through 2015.
Limitations included low power for subgroup analyses, exclusion of unspecified strokes, and a population of mainly elderly stroke survivors.

Disclosures

The researchers and Sacco disclosed no relevant relationships with industry.

Primary Source

Stroke

Source Reference: Waziry R, et al "Time Trends in Survival Following First Hemorrhagic or Ischemic Stroke Between 1991 and 2015 in the Rotterdam Study" Stroke 2020; DOI: 10.1161/STROKEAHA.119.027198.

Black, Hispanic people may have greater risk of second hemorrhagic stroke than whites

Then you didn't look hard enough.  Genetically Speaking, Race Doesn't Exist In Humans.

Black, Hispanic people may have greater risk of second hemorrhagic stroke than whites

Black and Hispanic people may be more likely to have another intracerebral hemorrhage or a stroke caused by bleeding in the brain, than white people, according to a study published in the June 6, 2018, online issue of Neurology^®, the medical journal of the American Academy of Neurology.

Hemorrhagic stroke makes up only 10 to 15 percent of all strokes, but it is the deadliest and most disabling type of stroke. Once people have had a first stroke of this kind, they are at high risk of having another one, which is often fatal.

"Previous studies have shown that black and Hispanic people are at greater risk of having a first bleeding stroke, but studies have not looked at ethnic and racial differences in recurrent intracerebral hemorrhage," said study author Alessandro Biffi, MD, of Massachusetts General Hospital in Boston and a member of the American Academy of Neurology. "Since controlling high blood pressure is the main method of preventing second strokes and we know that there are racial and ethnic differences in the prevalence of high blood pressure and its severity, we really wanted to investigate these differences."

For the study, researchers combined results from two studies of people who had an intracerebral hemorrhage, for a total of 2,291 people. Of those 1,121 were white, 529 black, 605 Hispanic and 36 of other race/ethnicity. The participants' blood pressure readings were taken at the start of the study and at least once every six months after that. A total of 41 participants had previously had an intracerebral hemorrhage before the one involved in this study.

The 1,532 people in one study were followed for a year after the stroke and during that time 23 people had another stroke, for a recurrence rate of 1.5 percent. The 759 people in the second study were followed for an average of about four years. During that time 75 people had another stroke, for a recurrence rate of 3.9 percent.

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Combining both studies, there were 26 second strokes among the 1,121 white people, or 1.7 percent, compared to 35 second strokes among the 529 black people, or 6.6 percent, and 37 among the 605 Hispanic people, or 6.1 percent. The researchers found that black people were more than twice as likely as white people to have another stroke and Hispanic people were about 70 percent more likely than whites to do so.

The average systolic blood pressure was higher for black and Hispanic people than for whites, with an average of 149 mmHg for black people, 146 mmHg for Hispanic people and 141 mmHg for white people. Systolic blood pressure of less than 120 mmHg is considered normal; pressure of 140 mmHg or more is considered high.

Once researchers adjusted the results for the blood pressure differences, they found that black people were still nearly twice as likely to have another stroke as white people and Hispanic people were about 50 percent more likely to have another stroke.

"The differences in blood pressure among these groups do not fully account for the differences in the risk of having another stroke," Biffi said. "More research is needed to determine the factors behind this disparity."

Limitations of the study include that the number of recurrent strokes was limited and that the study captured only long-term blood pressure changes, not day-to-day variations.​

Source:

https://www.aan.com/PressRoom/Home/PressRelease/1653

Drug to treat bleeding may benefit some stroke patients, study finds

How many decades will it take before your hospital implements this? Or works with researchers to further test it out?  Incompetency in action if not done within a year.
https://medicalxpress.com/print445672790.html
May 16, 2018 in Medicine & Health / Cardiology

Patients with stroke caused by bleeding on the brain (intracerebral haemorrhage) may benefit from receiving a drug currently used to treat blood loss from major trauma and bleeding after childbirth, an international trial has revealed.

The study, led by experts at The University of Nottingham and funded by the National Institute for Health Research (NIHR) Health Technology Assessment Programme, found that giving tranexamic acid (TXA) to people who had experienced intracerebral haemorrhage reduced the number of deaths in the early days following the stroke.

It also found that both the amount of bleeding in the brain and number of associated serious complications were lower in the patients who had received the TXA treatment.

However, the trial found no difference in the number of people who were left disabled or had died at three months after their stroke (the study's primary outcome). The researchers believe further study is needed on larger groups of patients to enable them to fully understand the potential benefits.

The research is published in the medical journal The Lancet and was presented at the 4th European Stroke Conference in Gothenburg, Sweden on 16th May.

Nikola Sprigg, Professor of Stroke Medicine at the Stroke Trials Unit in the University's Division of Clinical Neuroscience, led the trial. She said: "Tranexamic acid is cheap—costing less than £15 per patient—and widely available so has the potential for reducing death and disability across the world."

"While we failed to show significant benefits three months after stroke, the reduction in early deaths, amount of bleeding on the brain and serious complications are signs that this drug may be of benefit in the future. More trials are needed, particularly focusing on giving treatment as soon as possible after the start of bleeding in this emergency condition.

"TICH-2 cements the position of the NIHR and the UK as key players in the world of stroke research. A study of this scale would simply not have been possible without support of the NIHR infrastructure. Alongside the large stroke centres, the contribution made by the network of smaller sites across the UK has been crucial to the success of TICH-2."

Around 150,000 people in the UK suffer a stroke every year—the majority of these are ischaemic strokes caused by a blocked blood vessel on the brain which can be treated very successfully in many cases with the use of clot-busting drugs (thrombolysis) administered within 4.5 hours of the stroke.

However, 15 per cent of all strokes—affecting around 22,000 people every year—are caused by haemorrhagic stroke when a blood vessel in the brain bursts, leading to permanent damage. While all people with acute stroke benefit from treatment on a stroke unit, there is currently no specific treatment for haemorrhagic stroke and unfortunately many people affected will die within a few days. Those who do survive are often left with debilitating disabilities including paralysis and an inability to speak.

A previous small pilot study by The University of Nottingham and funded by both the university and the charity the Stroke Association, concluded that a larger study was needed to accurately assess the effectiveness of the drug tranexamic acid. The drug was chosen for the study after previous research showed that it was successful in stopping bleeding in people involved in road traffic accidents.

For the latest trial, people who were diagnosed as having had bleeding on the brain—confirmed by CT scan—were offered the chance to take part in the study. Where the person was too ill to decide, permission was asked of their family or close friends. Where no family were available a doctor unconnected with the study decided if the patient should take part.

The five-year TICH-2 trial recruited more than 2,000 patients from 124 hospitals in 12 countries between 2013 and 2017. They were randomly sorted into two patient groups—one received TXA within eight hours of their stroke and another was given a saline placebo. In the UK, more than 80 hospitals took part in the study with support from the NIHR clinical research network.

CT scans of the patients' brains were performed 24 hours after their stroke and their progress was monitored and measured at day two and day seven after their stroke. The final follow up was performed at 90 days.

The study revealed that TXA did not improve the outcome for patients after 90 days as there was no significant difference in the number of patients who had subsequently died or had been left with disabilities between the TXA and placebo groups at three months.

However, in the TXA group there were fewer deaths by day seven following the stroke and, at day two, fewer people on TXA experienced a worsening of the bleed on their brain and had smaller amounts of blood in the brain compared to their control group counterparts. Also, the number of patients who experienced associated serious complications (such as pneumonia and brain swelling) were lower in the patients who had received the TXA treatment compared to those who had control.

The trial also found evidence that TXA might be more effective in patients with lower blood pressure as those with blood pressure lower than 170 mmHg had a more favourable outcome that those with 170mmHg and above. Other studies have confirmed that the sooner TXA is given, the more effective it is, and ideally it needs to be given within less than 3 hours of bleeding onset. In this study only one third of patients were given treatment within 3 hours of stroke onset.

As a result, the researchers have highlighted the need for further studies to find out whether giving an earlier dose of TXA might be beneficial for patients.

More information: Nikola Sprigg et al, Tranexamic acid for hyperacute primary IntraCerebral Haemorrhage (TICH-2): an international randomised, placebo-controlled, phase 3 superiority trial, The Lancet (2018). DOI: 10.1016/S0140-6736(18)31033-X

Provided by University of Nottingham

"Drug to treat bleeding may benefit some stroke patients, study finds" May 16, 2018 https://medicalxpress.com/news/2018-05-drug-benefit-patients.html