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  • Επιστημονικές Δημοσιεύσεις Μελών ΠΘ (ΕΔΠΘ)
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Prediction of Early Recurrent Thromboembolic Event and Major Bleeding in Patients with Acute Stroke and Atrial Fibrillation by a Risk Stratification Schema: The ALESSA Score Study

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Autor
Paciaroni M., Agnelli G., Caso V., Tsivgoulis G., Furie K.L., Tadi P., Becattini C., Falocci N., Zedde M., Abdul-Rahim A.H., Lees K.R., Alberti A., Venti M., Acciarresi M., D'Amore C., Mosconi M.G., Cimini L.A., Procopio A., Bovi P., Carletti M., Rigatelli A., Cappellari M., Putaala J., Tomppo L., Tatlisumak T., Bandini F., Marcheselli S., Pezzini A., Poli L., Padovani A., Masotti L., Vannucchi V., Sohn S.-I., Lorenzini G., Tassi R., Guideri F., Acampa M., Martini G., Ntaios G., Karagkiozi E., Athanasakis G., Makaritsis K., Vadikolias K., Liantinioti C., Chondrogianni M., Mumoli N., Consoli D., Galati F., Sacco S., Carolei A., Tiseo C., Corea F., Ageno W., Bellesini M., Colombo G., Silvestrelli G., Ciccone A., Scoditti U., Denti L., Mancuso M., Maccarrone M., Orlandi G., Giannini N., Gialdini G., Tassinari T., De Lodovici M.L., Bono G., Rueckert C., Baldi A., D'Anna S., Toni D., Letteri F., Giuntini M., Lotti E.M., Flomin Y., Pieroni A., Kargiotis O., Karapanayiotides T., Monaco S., Baronello M.M., Csiba L., Szabó L., Chiti A., Giorli E., Del Sette M., Imberti D., Zabzuni D., Doronin B., Volodina V., Michel P., Vanacker P., Barlinn K., Pallesen L.-P., Kepplinger J., Bodechtel U., Gerber J., Deleu D., Melikyan G., Ibrahim F., Akhtar N., Gourbali V., Yaghi S.
Fecha
2017
Language
en
DOI
10.1161/STROKEAHA.116.015770
Materia
anticoagulant agent
anticoagulant agent
warfarin
aged
anticoagulant therapy
Article
atrial fibrillation
cardiovascular risk
cerebrovascular accident
computer assisted tomography
early diagnosis
early intervention
female
heart atrium enlargement
human
major clinical study
male
nuclear magnetic resonance
observational study
outcome assessment
priority journal
prospective study
recurrence risk
risk assessment
thromboembolism
transient ischemic attack
transthoracic echocardiography
atrial fibrillation
bleeding
chemically induced
complication
Ischemic Attack, Transient
procedures
recurrent disease
Stroke
thromboembolism
very elderly
Aged
Aged, 80 and over
Anticoagulants
Atrial Fibrillation
Female
Hemorrhage
Humans
Ischemic Attack, Transient
Male
Prospective Studies
Recurrence
Risk Assessment
Stroke
Thromboembolism
Warfarin
Lippincott Williams and Wilkins
Mostrar el registro completo del ítem
Resumen
Background and Purposes - This study was designed to derive and validate a score to predict early ischemic events and major bleedings after an acute ischemic stroke in patients with atrial fibrillation. Methods - The derivation cohort consisted of 854 patients with acute ischemic stroke and atrial fibrillation included in prospective series between January 2012 and March 2014. Older age (hazard ratio 1.06 for each additional year; 95% confidence interval, 1.00-1.11) and severe atrial enlargement (hazard ratio, 2.05; 95% confidence interval, 1.08-2.87) were predictors for ischemic outcome events (stroke, transient ischemic attack, and systemic embolism) at 90 days from acute stroke. Small lesions (≤1.5 cm) were inversely correlated with both major bleeding (hazard ratio, 0.39; P=0.03) and ischemic outcome events (hazard ratio, 0.55; 95% confidence interval, 0.30-1.00). We assigned to age ≥80 years 2 points and between 70 and 79 years 1 point; ischemic index lesion >1.5 cm, 1 point; severe atrial enlargement, 1 point (ALESSA score). A logistic regression with the receiver-operating characteristic graph procedure (C statistic) showed an area under the curve of 0.697 (0.632-0.763; P=0.0001) for ischemic outcome events and 0.585 (0.493-0.678; P=0.10) for major bleedings. Results - The validation cohort consisted of 994 patients included in prospective series between April 2014 and June 2016. Logistic regression with the receiver-operating characteristic graph procedure showed an area under the curve of 0.646 (0.529-0.763; P=0.009) for ischemic outcome events and 0.407 (0.275-0.540; P=0.14) for hemorrhagic outcome events. Conclusions - In acute stroke patients with atrial fibrillation, high ALESSA scores were associated with a high risk of ischemic events but not of major bleedings. © 2017 American Heart Association, Inc.
URI
http://hdl.handle.net/11615/77416
Colecciones
  • Δημοσιεύσεις σε περιοδικά, συνέδρια, κεφάλαια βιβλίων κλπ. [19735]

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