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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Acetylsalicylic acid (ASA; Aspirin) has a neuroprotective potential by its anti-excitotoxic and anti-inflammatory effects. A temporary middle cerebral artery occlusion (tMCAO) model was used in 80 Wistar rats to evaluate whether a high dose of Aspirin (40 mg/kg) applied with different initiation time points after stroke onset (30 min, 3 h, 6 h, 12 h, 20 rats for each time group) and followed by repeated administration (1, 2 and 3 days) is neuroprotective. Neurological score and brain infarct volume were analyzed and indicated that postischemic therapy initiation at 30 min and as late as 6 h led to better neurological recovery (6 h, p=0.0046) and significant smaller infarct size (6 h, 57+/-9 mm(3), n=10, p=0.0043) compared to the saline control group (110+/-13 mm(3), n=10). Thus, there may be a relatively wide time window for acute stroke therapy with high dose Aspirin.
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PMID:Neuroprotection by early and delayed treatment of acute stroke with high dose aspirin. 1799 48

Acetylsalicylic acid (aspirin; ASA) is widely used as an analgesic/antipyretic drug. ASA exhibits a wide range of biological effects, including preventative effects against heart attack, stroke, and the development of some types of cancer. However, the effects of ASA on melanogenesis are not well known. Therefore, we investigated the effect of ASA on melanin production using B16 murine melanoma cells and demonstrated a new biological effect of ASA. In the presence of alpha-melanocyte stimulating hormone (alpha-MSH), B16 melanoma cells are stimulated to enhance melanin synthesis. ASA (2 mM) inhibited alpha-MSH-enhanced melanin synthesis in melanoma more strongly than other well-known anti-melanogenic agents such as arbutin (2 mM) and kojic acid (200 microM). Interestingly, ASA did not inhibit the catalytic activity of mushroom tyrosinase (concentration range 0.5-4.0 mM). To clarify the target of ASA action in melanogenesis, we performed Western blotting for tyrosinase, which is a key melanogenic enzyme. ASA inhibited tyrosinase expression in a dose-dependent manner. Therefore, the depigmenting effect of ASA might be due to inhibition of tyrosinase expression or enhancement of tyrosinase degradation. This study suggests that ASA is a candidate anti-melanogenic agent and it might be effective in hyperpigmentation disorders.
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PMID:Down-regulation of tyrosinase expression by acetylsalicylic acid in murine B16 melanoma. 1817 38

Patients with recent ischemic stroke or transient ischemic attack (TIA) face a high risk of recurrent stroke as well as an increased risk of myocardial infarction and sudden cardiac death. In the absence of a clearly established indication for long-term anticoagulation, such as atrial fibrillation, antiplatelet agents are the antithrombotic drugs of choice for preventing recurrent vascular events. For many years, aspirin (ASA) has been the first-line therapy for patients at high risk of vascular ischemic events. Two large clinical trials have established the superiority of the combination of ASA and extended-release dipyridamole (ASA/ERDP) over ASA alone in patients with recent noncardioembolic ischemic stroke or TIA. Clopidogrel, another antiplatelet agent, is a reasonable alternative to ASA, but its superiority to ASA in patients with a history of stroke has not been as clearly established. The combination of ASA and clopidogrel, which is effective in patients with acute coronary syndrome, has not been shown to be either effective or safe, compared with either agent alone, in stroke patients, although there may be some benefit to this combination in patients with acute TIA. The results from a large randomized trial comparing ASA/ERDP with clopidogrel, anticipated soon, will further assist clinicians in choosing among available antiplatelet agents.
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PMID:Antiplatelet agents for secondary prevention of stroke. 1858 11

Patients who suffer ischemic stroke or transient ischemic attack (TIA) are at increased risk for subsequent cerebrovascular events. Secondary prevention is essential to reduce risks of recurrence and should include lifestyle modification to improve cardiovascular health, along with strict control of blood pressure, glucose, and lipids. Recurrent stroke in ischemic stroke patients is likely to be the same subtype as the initial stroke, and treatment should be unique to the stroke subtype and patient risk factors. This article presents an overview of the recommendations for the secondary prevention of ischemic stroke or TIA and a review of the evidence supporting the role of antiplatelet therapy in managing the risk of recurrent noncardioembolic stroke. Although anticoagulants are recommended preventive treatment for cardioembolic stroke, they can increase the patient's risk of bleeding complications and are not recommended for all subtypes of ischemic stroke. The American Heart Association/American Stroke Association guidelines recommend 3 antiplatelet regimens for the secondary prevention of noncardioembolic ischemic stroke: aspirin (ASA), clopidogrel, and combined ASA + extended-release (ER) dipyridamole (DP). ASA + ER-DP is recommended over ASA alone. Several studies have established the effectiveness of these 3 antiplatelet regimens as first-line options in the secondary prevention of noncardioembolic ischemic stroke. Clopidogrel monotherapy is a reasonable alternative for patients who cannot tolerate ASA. ASA + ER-DP has been shown to be more effective than ASA alone and does not increase the risk of bleeding. Effective secondary prevention must also address modifiable risk factors, such as obesity, smoking, and excessive alcohol consumption.
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PMID:Therapeutic interventions for prevention of recurrent ischemic stroke. 1861 Nov 3

Stroke is the third leading cause of death in the United States and among the most costly diseases. Most strokes are categorized as ischemic, and 10% to 15% are preceded by a transient ischemic attack (TIA). Stroke survivors suffer levels of disability and handicap that range from mild to very severe, and they rarely make a complete recovery. Initial stroke patients are at considerable risk for recurrent stroke, which can compound a patient's impairment and associated costs. This article discusses the burden of stroke on patients and caregivers, the risk of stroke recurrence, and the pharmacoeconomics of antiplatelet therapy. Studies show that effective secondary prevention such as antiplatelet therapy can improve clinical outcomes in patients who have experienced TIA or prior stroke. Recently updated guidelines for secondary stroke prevention from the American Heart Association/American Stroke Association recommend administering antiplatelet agents rather than anticoagulants for patients who experienced an ischemic noncardioembolic stroke or TIA to reduce the risk of stroke or other cardiovascular events. The guidelines state that aspirin (ASA), ASA + extended-release dipyridamole (DP), and clopidogrel are acceptable initial treatment options for these patients. A recent pharmacoeconomic analysis of all 3 therapies concluded that ASA and ASA + DP offer cost-effective secondary prevention for patients who have suffered a mild initial stroke. Understanding the role of antiplatelet therapy in secondary prevention can help the managed care community optimize clinical and economic outcomes, thereby reducing the overall burden of cerebrovascular disease.
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PMID:Managed care considerations. 1861 Nov 4

A single pill containing a statin, thiazide diuretic, beta-blocker, angiotensin receptor antagonist, folate and ASA has been proposed for all people over age 55, with the aim of reducing cardiovascular disease by 80%. Unfortunately, there are insurmountable problems with choosing appropriate constituents of any such single remedy. Adverse effects, drug interactions, inter-individual variation in drug metabolism, and underlying causes of hypertension that differ between patients require individualized therapy. A single pill that will succeed in all patients is not only practically, but conceptually, an inappropriate approach for the prevention of cardiovascular disease.
Int J Stroke 2008 May
PMID:Polypill: for Pollyanna. 1870 2

The authors set themselves a task of assessing systemic hemodynamic parameters under combined general anesthesia on the basis of a thoracic epidural block (TEB) versus combined general anesthesia during thoracoabdominal interventions. Thirty patients were examined. Their physical status was in ASA Class II-IV. The preoperative examination was as follows: electrocardiography (ECG) (at rest), ECG (during exercise), and 24-hour ECG monitoring. Hemodynamic parameters, such as systolic blood pressure (BP), diastolic BP, mean BP, and heart rate), were intraoperatively measured by invasive and noninvasive techniques. By using the measurements of cardiac output (extrasternal Doppler study), the authors calculated cardiac index, specific peripheral vascular resistance (SPVS), and stroke index (SI). They made 24-hour ECG monitoring intra- and postoperatively (on days 1 and 5, respectively). The findings suggest that inclusion of TEB in a complex of anesthetic maintenance of thoracoabdominal operations along with combined or total intravenous anesthesia shows better hemodynamic changes, as indicated by a 31% increase in SI and a 32.6% decrease in double product with the stable values of mean BP and heart rate, which was not noted in the control group. The dose of narcotic analgesics was decreased by 2.6 times.
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PMID:[Central hemodynamics under conditions of combined anesthesia on the basis of a thoracic epidural block]. 1910 37

We studied the effect of prophylactic aspirin (ASA) ingestion on platelet function in 463 patients with stroke, transient ischemic attack (TIA) or acute coronary disease (ACD), using the Platelet Function Analyzer-100 (PFA-100). We correlated ASA responsiveness with haplotypes of seven candidate genes, selected for their documented role in platelet function, namely, the genes for integrins alpha2beta1and alphaIIbbeta3 (ITGA2, ITGA2B, and ITGB3), platelet glycoproteins Ibalpha and VI (GPIBA and GP6), the purinergic receptor P2Y1 (P2RY1), and prostaglandin H synthase 1 (PTGS1 = COX1). Non-responsiveness to ASA was defined as the failure of prior ASA ingestion to prolong the PFA-100 closure time (CT) when blood was perfused through cartridges coated with collagen plus epinephrine (CEPI-CT). ASA non-responsiveness was observed in 114 of 463 patients (24.6 %), but was not associated with haplotypes of any of the seven candidate genes. There was also no association between any haplotypes and the CT when blood was perfused through cartridges coated with collagen plus ADP (CADP-CT). The ASA non-responsive cohort had significantly increased whole blood platelet counts (p = 0.03) and plasma von Willebrand Factor antigen levels (p < 0.001), which likely contributes to resistance to the inhibitory effects of ASA in the PFA-100.
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PMID:Lack of association between aspirin responsiveness and seven candidate gene haplotypes in patients with symptomatic vascular disease. 1913 98

In principle, only patients with an ASA (American Society of Anaesthesiologists)-score I or II qualify for an elective surgical procedure, such as an implantation treatment. Surgical risks are weighed against the potential benefits offered by oral implants. Counter-indications to implant rehabilitation include recent myocardial infarction and cerebrovascular accident, immunosuppression, active treatment of malignancy, drug abuse, as well as long-standing intravenous bisphosphonate use. In the case of patients with an endocarditis risk, and also in the case of patients with an orthopedic prosthesis, implants should be placed with some reluctance. If the decision is made for treatment, then consultation with the treating specialist is recommended. Beside absolute counter-indications, there are also conditions which compromise the success of an implant treatment, such as radiation of the jaw or long-term smoking. Concerning the effect which medical conditions have on the life-expectancy of the implant, little is known. There appear to be few existing factors which actually have a negative influence on the chance that an implant will survive.
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PMID:[Surgical dilemmas. Medical restrictions and risk factors]. 1914 31

Dental undertreatment is often seen in the older population. This is particularly true for the elderly living in nursing homes and geriatric hospitals. The progression of chronic diseases results in loss of their independence. They rely on daily support and care due to physical or mental impairment. The visit of a dentist in private praxis becomes difficult or impossible and is a logistic problem. These elderly patients are often not aware of oral and dental problems or these are not addressed. The geriatric hospital Bern, Ziegler, has integrated dental care in the concept of physical rehabilitation of geriatric patients. A total of 139 patients received dental treatment in the years 2005/2006. Their mean age was 83 years, but the segment with > 85 years of age amounted to 46%. The general health examinations reveald multiple and complex disorders. The ASA classification (American Society of Anesthesiologists, Physical Status Classification System) was applied and resulted in 15% = P2 (mild systemic disease, no functional limitation), 47% = P3 (severe systemic disease, definite functional limitations) and 38% = P4 (severe systemic disease, constant threat to life). Eighty-seven of the patients exhibited 3 or more chronic diseases with a prevalence of cardiovascular diseases, musculoskelettal disorders and dementia. Overall the differences between men and women were small, but broncho-pulmonary dieseases were significantly more frequent in women, while men were more often diagnosed with dementia and depression. Verbal communication was limited or not possible with 60% of the patients due to cognitive impairment or aphasia after a stroke. Although the objective treatment need is high, providing dentistry for frail and geriatric patients is characterized by risks due to poor general health conditions, difficulties in communication, limitations in feasibility and lack of adequate aftercare. In order to prevent the problem of undertreatment, elderly independently living people should undergo dental treatment regularly and in time. Training of nurses and doctors of geriatric hospitals in oral hygiene should improve the awareness. A multidisciplinary assessment of geriatric patients should include the oral and dental aspect if they enter the hospital.
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PMID:[Gerodontology consultation in geriatric facilities: general health status (I)]. 1922 1


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