Comparative study of venous thromboembolic prophylaxis strategies in hemorrhagic stroke: A systematic review and network meta-analysis

出血卒中静脉血栓栓塞预防策略的比较研究: 系统综述和网络meta分析

Venous thromboembolic events, including deep vein thrombosis (DVT) and pulmonary embolism (PE), are frequent complications in patients with intracerebral hemorrhage (ICH). Various prophylactic strategies have been employed to mitigate this risk, such as heparin, intermittent pneumatic compression (IPC), and graduated compression stockings (GCS). The optimal thromboembolic prophylaxis approach remains uncertain due to the lack of randomized controlled trials (RCTs) comparing all interventions.We conducted a network meta-analysis and meta-analysis to systematically review and synthesize evidence from RCTs and non-randomized studies on the efficacy and safety of thromboembolic prophylaxis strategies in hospitalized ICH patients. Our study supports the use of IPC as the primary thromboembolic prophylaxis measure in ICH patients. Further research, including head-to-head RCTs, is needed to strengthen the evidence base and optimize clinical decision-making for thromboembolic prophylaxis in this vulnerable patient population.

静脉血栓栓塞事件，包括深静脉血栓形成 (DVT) 和肺栓塞 (PE)，是脑出血 (ICH) 患者的常见并发症。已经采用了各种预防策略来减轻这种风险，例如肝素，间歇性气动压缩 (IPC) 和渐变压缩长袜 (GCS)。由于缺乏比较所有干预措施的随机对照试验 (RCTs)，最佳的血栓栓塞预防方法仍然不确定。我们进行了网络荟萃分析和荟萃分析，以系统地回顾和综合来自RCTs和非随机研究的证据，这些证据涉及住院ICH患者血栓栓塞预防策略的有效性和安全性。我们的研究支持使用IPC作为ICH患者的主要血栓栓塞预防措施。需要进一步的研究，包括头对头rct，以加强证据基础并优化该脆弱患者人群中血栓栓塞预防的临床决策。

REF: Maraziti G, Mosconi MG, Paciaroni M. Comparative study of venous thromboembolic prophylaxis strategies in hemorrhagic stroke: A systematic review and network meta-analysis. Int J Stroke. 2024;19(9):973-980. doi:10.1177/17474930241248542 PMID: 38591740

Quality of life and quality-adjusted life years after stroke in Sierra Leone

塞拉利昂卒中后的生活质量和质量调整生命年

Stroke is a leading cause of mortality and negatively affects health-related quality of life (HRQoL). HRQoL after stroke is understudied in Africa and there are no reports of quality-adjusted life years after stroke (QALYs) in African countries. We determined the impact of stroke on HRQoL after stroke in Sierra Leone. We calculated QALYs at 1 year post-stroke and determined sociodemographic and clinical variables associated with HRQoL and QALYs in this population. We generated QALYs after stroke for the first time in an African country. QALYs were significantly lower than studies from outside Africa, partially explained by the high mortality rate in our cohort. Further research is needed to develop appropriate value sets for West African countries and to examine QALYs lost due to stroke over longer time periods.

卒中是导致死亡的主要原因，并对健康相关生活质量 (HRQoL) 产生负面影响。在非洲，卒中后的HRQoL研究不足，在非洲国家，没有关于卒中后质量调整生命年 (QALYs) 的报告。我们确定了塞拉利昂卒中后卒中对HRQoL的影响。我们计算了卒中后1年的QALYs，并确定了该人群中与HRQoL和QALYs相关的社会人口统计学和临床变量。我们在非洲国家首次卒中后生成了qaly。Qaly明显低于非洲以外的研究，部分原因是我们队列中的高死亡率。需要进一步研究，为西非国家开发适当的价值集，并检查由于较长时期的卒中而损失的qaly。

REF: Youkee D, Deen GF, Sackley C, Lisk DR, Marshall I, Soley-Bori M. Quality of life and quality-adjusted life years after stroke in Sierra Leone. Int J Stroke. 2024;19(9):981-988. doi:10.1177/17474930241249589 PMID: 38651761

Prevalence and prognostic impact of stroke in a national cohort of infective endocarditis

卒中在感染性心内膜炎全国队列中的患病率和预后影响

Stroke is a common complication of infective endocarditis (IE). Our aim was to describe the prevalence and prognostic impact of stroke in a national cohort of IE. Consecutive inclusion at 46 Spanish hospitals between 2008 and 2021. One-fifth of patients with IE have concomitant stroke. Stroke is associated with mortality.

卒中是感染性心内膜炎 (IE) 的常见并发症。我们的目的是描述卒中在全国IE队列中的患病率和预后影响。2008年至2021间连续入选46家西班牙医院。1/5的IE患者伴有卒中。卒中与死亡率有关。

REF: Álvarez-Zaballos S, Vázquez-Alen P, Muñoz P, et al. Prevalence and prognostic impact of stroke in a national cohort of infective endocarditis. Int J Stroke. 2024;19(9):989-998. doi:10.1177/17474930241255560 PMID: 38708722

Associated demographic factors for the recurrence and prognosis of stroke patients within a multiethnic Asian population

多民族亚洲人群中卒中患者复发和预后的相关人口统计学因素

There is a paucity of studies investigating the outcomes among Asian stroke patients. Identifying subgroups of stroke patients at risk of poorer outcomes could identify patients who would benefit from targeted interventions. Therefore, the aim of this study was to identify which ischemic stroke patients at high risk of recurrent events and mortality. This study found that older stroke patients are at risk of poorer outcomes. Within the young stroke population specifically, males were predisposed to recurrent stroke and AMI but were protected against all-cause and stroke-related deaths. Males were also at reduced risk of all-cause and stroke-related deaths in the older stroke population. In addition, Malay and Indian patients experience poorer outcomes after first stroke. Further optimization of risk factors targeting these high-priority populations are needed to achieve high-quality care.

缺乏调查亚洲卒中患者结局的研究。识别具有较差结局风险的卒中患者亚组可以识别将从针对性干预中受益的患者。因此，本研究的目的是确定哪些缺血性卒中患者复发事件和死亡的高风险。这项研究发现，老年卒中患者有预后较差的风险。特别是在年轻的卒中人群中，男性易患复发性卒中和AMI，但可以防止全因和卒中相关的死亡。在老年卒中人群中，男性全因死亡和卒中相关死亡的风险也降低了。此外，马来人和印度患者在首次卒中后的预后较差。需要进一步优化针对这些高优先级人群的风险因素，以实现高质量的护理。

REF: Lee KS, Siow I, Riandini T, Narasimhalu K, Tan KB, De Silva DA. Associated demographic factors for the recurrence and prognosis of stroke patients within a multiethnic Asian population. Int J Stroke. 2024;19(9):999-1009. doi:10.1177/17474930241257759 PMID: 38751129

Enhanced versus standard hydration in acute ischemic stroke: REVIVE—A randomized clinical trial

急性缺血性卒中的增强与标准水合作用: 复兴-一项随机临床试验

Early neurological deterioration (END) within 72 h of stroke onset is associated with poor prognosis. Optimizing hydration might reduce the risk of END. This study aimed to determine in acute ischemic stroke patients if enhanced hydration versus standard hydration reduced the incidence of major (primary) and minor (secondary) END, as well as whether it increased the incidence of early neurological improvement (secondary), at 72 h after admission. Overall, 487 participants were randomized (median age 67 years; 287 females). At 72 h, 7 (2.9%) in the enhanced hydration arm and 5 (2.0%) in the standard hydration developed major END (p = 0.54). The incidence of minor END and early neurological improvement did not differ between treatment arms. Enhanced hydration did not reduce END or improve short-term outcomes in acute ischemic stroke.

卒中发作72小时内早期神经功能恶化 (END) 与预后不良有关。优化水合作用可能会降低END的风险。本研究旨在确定在急性缺血性卒中患者中，在入院后72小时，增强水化与标准水化是否降低了主要 (原发性) 和次要 (继发性) 终点的发生率，以及是否增加了早期神经系统改善 (继发性) 的发生率。总体而言，487名参与者被随机分组 (中位年龄67岁; 287名女性)。在72 h，增强水合臂中的7 (2.9%) 和标准水合中的5 (2.0%) 发展为主要末端 (p = 0.54)。治疗组之间的轻微末端和早期神经系统改善的发生率没有差异。在急性缺血性卒中中，加强水化并不能降低终点或改善短期预后。

REF: Lin LC, Lee TH, Huang YC, et al. Enhanced versus standard hydration in acute ischemic stroke: REVIVE-A randomized clinical trial. Int J Stroke. 2024;19(9):1010-1019. doi:10.1177/17474930241259940 PMID: 38785314

Prevalence of right-to-left shunt in stroke patients with cancer

卒中癌症患者右向左分流的患病率

Cancer is associated with an increased risk of acute ischemic stroke (AIS) and venous thromboembolism. The role of a cardiac right-to-left shunt (RLS) as a surrogate parameter for paradoxical embolism in cancer-related strokes is uncertain. We sought to investigate the relationship between the presence of an RLS and cancer in AIS patients. RLS was diagnosed less frequently in AIS patients with cancer than in cancer-free patients, suggesting that arterial sources may play a larger role in cancer-related strokes than paradoxical venous embolization. Future studies are needed to validate these findings and evaluate potential therapeutic implications, such as the general indication, or lack thereof, for patent foramen ovale (PFO) closure in this patient population.

癌症与急性缺血性卒中 (AIS) 和静脉血栓栓塞的风险增加有关。心脏右向左分流 (RLS) 作为癌症相关卒中反常栓塞的替代参数的作用尚不确定。我们试图调查AIS患者中RLS的存在与癌症之间的关系。与无癌症患者相比，AIS患者中RLS的诊断频率较低，这表明动脉来源在癌症相关的中风中可能比矛盾的静脉栓塞发挥更大的作用。需要进一步的研究来验证这些发现并评估潜在的治疗意义，例如该患者群体中卵圆孔未闭 (PFO) 闭合的一般适应症或缺乏适应症。

REF: Steinauer F, Bücke P, Buffle E, et al. Prevalence of right-to-left shunt in stroke patients with cancer. Int J Stroke. 2024;19(9):1020-1027. doi:10.1177/17474930241260589 PMID: 38816936

Temporal trends of sex differences in acute reperfusion therapy and early outcomes of acute ischemic stroke in South Korea: 10-year analysis of the nationwide stroke registry

韩国急性再灌注治疗的性别差异的时间趋势和急性缺血性卒中的早期结果: 全国卒中登记的10年分析

Sex differences in stroke outcomes are notable, with women experiencing higher incidence rates, greater disability-adjusted life years, and poorer recovery compared to men, even after adjusting for age and comorbidities. Despite the disproportionate burden in women, studies have reported that women are less likely to receive appropriate stroke treatment than men. This study investigated temporal trends of sex differences in acute reperfusion therapy and early outcomes in patients with acute ischemic stroke over 10 years in South Korea.Women have received acute reperfusion therapy at similar or lower rates than men and experienced poorer outcomes, despite having more stroke risk factors and often more severe strokes.

卒中结局的性别差异是显著的，即使在调整了年龄和合并症之后，与男性相比，女性的发病率更高，残疾调整寿命更长，恢复较差。尽管女性的负担不成比例，但研究报告说，与男性相比，女性接受适当卒中治疗的可能性较小。这项研究调查了韩国10年以上急性缺血性卒中患者的急性再灌注治疗和早期结局的性别差异的时间趋势。尽管有更卒中的危险因素和更严重的中风，但女性接受急性再灌注治疗的比率与男性相似或更低，并且经历了更差的结局。

REF: Chung D, Lee JS, Oh MS, et al. Temporal trends of sex differences in acute reperfusion therapy and early outcomes of acute ischemic stroke in South Korea: 10-year analysis of the nationwide stroke registry. Int J Stroke. 2024;19(9):1028-1037. doi:10.1177/17474930241261877 PMID: 38836445

Modification effects of immigration status and comorbidities on associations of heat and heatwave with stroke morbidity

移民身份和合并症对热和热浪与卒中发病率关联的修正作用

Heat and heatwave have been associated with stroke morbidity, but it is still unclear whether immigrants from different geographic regions and patients with comorbidity are more vulnerable to heat and heatwave. Heat and heatwave are associated with an increased risk of first-ever stroke morbidity among immigrants and those with comorbid hypertension, dyslipidemia, or diabetes, with the effects primarily due to non-native individuals.

热量和热浪与卒中发病率有关，但目前尚不清楚来自不同地理区域的移民和患有合并症的患者是否更容易受到热量和热浪的影响。高温和热浪与移民以及合并高血压，血脂异常或糖尿病的人首次卒中发病率的风险增加有关，其影响主要是由于非本地人。

REF: Yang C, Li Y, Huang C, Hou Y, Chu D, Bao J. Modification effects of immigration status and comorbidities on associations of heat and heatwave with stroke morbidity. Int J Stroke. 2024;19(9):1038-1045. doi:10.1177/17474930241263725 PMID: 38863348

Relationship between carotid web morphology on CT angiography and stroke: A pooled multicenter analysis

颈动脉网形态CT血管成像与卒中关系的多中心分析

The Carotid web (CaW) is a cause of stroke, particularly in younger individuals. However, the frequency and the radiological features of the web's morphology associated with stroke risk are uncertain. We determined the CaW radiological features on computed tomography (CT) angiography associated with ipsilateral stroke. Data from six studies of patients with acute ischemic stroke were pooled. Radiological assessment of CaW morphology may determine its potential causal role in ischemic stroke etiology. Symptomatic CaWs tend to be longer, larger, and oriented at more acute angles relative to the carotid wall as compared to asymptomatic CaWs.

颈动脉网 (CaW) 是卒中的原因，特别是在年轻人中。但是，与卒中风险相关的网络形态的频率和放射学特征尚不确定。我们确定了与同侧卒中相关的计算机断层扫描 (CT) 血管造影的CaW放射学特征。汇总了6项急性缺血性卒中患者研究的数据。CaW形态的放射学评估可能确定其在缺血性卒中病因中的潜在因果作用。与无症状的CaWs相比，有症状的CaWs倾向于更长，更大，并且相对于颈动脉壁成更尖锐的角度。

REF: Bala F, Alhabli I, Singh N, et al. Relationship between carotid web morphology on CT angiography and stroke: A pooled multicenter analysis. Int J Stroke. 2024;19(9):1046-1052. doi:10.1177/17474930241264141 PMID: 38877750