Deans' stroke musings: Impact of D-dimer levels for short-term or long-term outcomes in cryptogenic stroke patients

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 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:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. 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 lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Saturday, January 27, 2018

Impact of D-dimer levels for short-term or long-term outcomes in cryptogenic stroke patients

I see nothing here that suggests that they have done anything to find out what might reduce these levels and what good that might do.
https://www.mdlinx.com/internal-medicine/medical-news-article/2018/01/26/d-dimer-levels-cryptogenic-stroke-patients/7501504/?

Journal of Neurology — | January 26, 2018

Nezu T, et al. - The present study was planned to investigate the associations between plasma D-dimer levels at admission, clinical characteristics and mortality at discharge in cryptogenic stroke patients. In addition, researchers assessed if D-dimer levels could predict long-term outcomes in those patients, including those with and without right-to-left shunt (RLS). In cryptogenic stroke patients, an association of increased D-dimer levels at admission with mortality at discharge was observed. High D-dimer levels were also found to have a correlation with long-term outcomes in cryptogenic stroke patients with RLS.

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Methods

Researchers consecutively enrolled and retrospectively analyzed acute cryptogenic stroke patients (n = 295, 72 ± 13 years old).
The cryptogenic stroke was defined as an undetermined etiology according to the Trial of Org 10172 in Acute Stroke Treatment criteria.
Evaluation of plasma D-dimer levels at admission was performed.
Using saline contrast-transcranial Doppler ultrasonography or contrast-transesophageal echography, they performed assessments for RLS.
Follow-up for up to 3 years after stroke onset was performed of the survivors (at discharge).

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Results

Seventeen patients of the total enrolled cohort died at discharge.
With initial National Institutes of Health Stroke Scale (NIHSS) score, D-dimer levels were correlated (r = 0.391, P < 0.001); these levels were associated with mortality at discharge [odds ratio 1.04; 95% confidence interval (CI) 1.00–1.08, P = 0.049] after adjusting for age, sex and initial NIHSS score.
Researchers evaluated 266 patients to assess RLS during hospitalization among the 278 survivors at discharge; 62 patients (23.3%) exhibited RLS.
The patients were divided into a low D-dimer group (n = 136, < median) and a high D-dimer group (n = 130, ≥ median) in accordance to the median plasma D-dimer levels at admission (0.7 μg/ml).
Compared to the patients in the low D-dimer group, patients in the high D-dimer group were older, more frequently female, had a lower BMI, had a higher prevalence of cancer and had greater initial neurological severity.
Recurrent stroke developed in 31 patients and death of 33 patients was reported during the follow-up period (median, 1,093 days).
An independent association of high D-dimer levels at admission was observed with recurrent stroke and all-cause mortality [hazard ratio (HR) 3.76; 95% CI 1.21–14.1, P = 0.021) in patients with RLS, but not in those without RLS (HR 1.35; 95% CI 0.74–2.50, P = 0.335).