Sunday, February 05, 2023

Dual blood thinners under prescribed after minor or warning stroke, especially in women

American Stroke Association International Stroke Conference 2023, Abstract 43

Reports and Proceedings

AMERICAN HEART ASSOCIATION

Research Highlights:

  • In a recent study, less than half of the people were prescribed dual blood-thinning therapy, despite evidence that starting two anti-platelet blood thinning medications, such as aspirin or clopidogrel, may reduce the short-term risk of recurrent stroke after a minor stroke or a transient ischemic attack (TIA) - also known as a warning stroke.

  • In the analysis of medications prescribed to nearly 3,000 stroke survivors at discharge from stroke centers in Maryland, only 40% of patients were prescribed dual anti-platelet therapy, and women were significantly less likely to be prescribed two anti-platelet medications compared to men. This gender gap in treatment echoes under-treatment of women in other aspects of cardiovascular disease care.

  • Increasing the use of dual anti-platelet therapy, particularly in women, may lead to a lower rate of stroke recurrence after a minor stroke or TIA.

DALLAS, Feb. 2, 2023 — Despite evidence that starting two blood-thinning medications shortly after a minor stroke or a warning stroke (transient ischemic attack - TIA) may prevent a second – possibly more serious – clot-caused stroke within a few months, the treatment regimen is underused especially among women, according to preliminary research to be presented at the American Stroke Association’s International Stroke Conference 2023. The meeting, to be held in person in Dallas and virtually Feb. 8-10, 2023, is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

Blood thinners, such as aspirin and clopidogrel, prevent platelets from sticking together and forming blood clots. Prescribing two anti-platelet medications at the same time is known as dual antiplatelet therapy (DAPT). In recent trials, DAPT has been shown to reduce the short-term risk of another stroke in people with a recent minor stroke (mild, non-disabling symptoms) or with a TIA. As with most strokes, a TIA is caused by a clot temporarily blocking blood flow to the brain, however, TIA symptoms usually only last a few minutes and result in no permanent brain injury or physical disability.

“All stroke survivors, regardless of sex, should receive optimal proven medications for stroke prevention including DAPT when medically appropriate,” said Jonathan Solomonow, M.D., lead author of the study and chief resident in neurology at the University of Maryland Medical Center in Baltimore.

To gauge how often DAPT was being prescribed when people with a minor stroke or TIA were discharged, the researchers reviewed the electronic health records of 2,953 adults admitted to one of the hospitals of the University of Maryland Stroke Clinical Network. The Maryland network includes nine stroke centers located in urban, suburban and rural hospitals serving a diverse population. All were treated for minor stroke or TIA between 2018 and 2021. None were taking blood thinning medication such as warfarin or apixaban before the stroke or TIA. The participants were average age 67 years; 42% were age 70 or older; 48% women, 37% Black adults and 60% white adults.

The analysis found:

  • DAPT was underutilized across all hospitals reviewed, prescribed to just 40% of the overall patients.
  • Men were more likely than women (43% vs. 37%, respectively) to be prescribed DAPT.
  • The percentage of patients receiving DAPT did not differ significantly by race, age or whether the person was treated at a stroke center that delivers specialized stroke care.

“There are an increasing number of options available to prevent and reduce the risk of a recurrent stroke, including high blood pressure medications, statins to control cholesterol and dual blood thinners. Patients and their family members should inquire about the use of DAPT after a stroke or TIA to consider if DAPT may be beneficial,” Solomonow said.

The gender gap noted in the study could not be explained by differences in insurance coverage or in anticipated side effects of the medications, Solomonow added.

“The gender gap was not entirely surprising because there is extensive literature indicating that women with cardiovascular disease tend to be undertreated. For example, some studies show that women with heart disease or stroke are not prescribed  statins as frequently as men. In addition, women with atrial fibrillation receive ablation less often than men,” Solomonow said. “Further research is needed to examine whether women are less likely to receive other proven therapies, such as statins for stroke prevention and anti-coagulation for atrial fibrillation.”

The study analyzed data from a single health system in Maryland, so the findings need to be confirmed in other settings including hospitals that are not certified stroke centers.

“Identifying systemic inequities is essential to improving patient care across all demographics. It would be useful for other centers to explore whether sex differences are present in other parts of the U.S. or health care systems in other countries,” Solomonow said.

Co-authors are Jamie R. Marks, Ph.D.; Karen L. Yarbrough, C.R.N.P.; Prachi Mehndiratta, M.B.B.S.; and Seemant Chaturvedi, M.D. Authors’ disclosures are listed in the abstract.

The study was funded by the department of neurology at the University of Maryland.

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available here.

Additional Resources:


Smartphone app may help identify stroke

symptoms as they occur


American Stroke Association International Stroke Conference 2023, Abstract WMP120

Reports and Proceedings

AMERICAN HEART ASSOCIATION

Research Highlights:

  • A new smartphone application called FAST.AI may recognize common stroke symptoms as they are happening.
  • Preliminary research suggests the app might be as accurate at diagnosing stroke as a neurologist.
  • Early recognition of stroke symptoms may result in more timely treatment, which may minimize the long-term effects of a stroke and improve chances for a full recovery.

DALLAS, Feb. 2, 2023 — A new smartphone application called FAST.AI may help people who are having a stroke or their family and caregivers recognize common stroke symptoms in real time, prompting them to quickly call 9-1-1, according to preliminary research to be presented at the American Stroke Association’s International Stroke Conference 2023. The meeting, to be held in person in Dallas and virtually Feb. 8-10, 2023, is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.

According to the American Heart Association, stroke is the No. 5 cause of death and a leading cause of disability in the U.S. About 85% of all strokes in the U.S. are ischemic strokes, which are caused by a blood clot in a blood vessel that blocks the flow of blood to the brain.

FAST.AI is a fully automated smartphone application for detection of severe stroke using machine learning algorithms to recognize facial asymmetry (drooping of the muscles in the face), arm weakness and speech changes – all common stroke symptoms. This study is ongoing, and the mobile application is still in development and not available to the public.

The smartphone application uses a facial video of the patient to examine 68 facial landmark points; sensors that measure arm movement and orientation; and voice recordings detect speech changes. Information from each test was sent to a database server for analysis.

Researchers validated FAST.AI’s performance by testing nearly 270 patients with a diagnosis of acute stroke (41% women; average age of 71 years) within 72 hours of hospital admission at four major metropolitan stroke centers in Bulgaria (St. Anna University Hospital in Sofia; University Hospital Haskovo in Haskovo; University Hospital Pulmed in Plovdiv; and University Hospital “Prof. Dr. Stoyan Kirkovich” in Stara Zagora) from July 2021 to July 2022. Neurologists who examined the patients tested the app then compared the FAST.AI results with their clinical impressions.

The analysis found:

  • The smart phone app accurately detected stroke-associated facial asymmetry in nearly 100% of patients.
  • The app accurately detected arm weakness in more than two-thirds of the cases.
  • And while the slurred speech module remains to be fully validated and tested, preliminary analyses confirmed that it may be able to reliably detect slurred speech, according to the researchers.

Clot-busting medication should be administered within three hours (up to four-and-a-half hours in certain eligible patients) after symptoms begin. And the faster the treatment is administered, the more likely for a better recovery: on average, 1.9 million brain cells die every minute that a stroke goes untreated, according to the American Stroke Association, a division of the American Heart Association. Previous research has found that stroke patients who are treated within 90 minutes of their first symptoms were almost three times more likely to recover with little or no disability in comparison to those who received treatment more than 90 minutes after symptoms begin.

“Many stroke patients don’t make it to the hospital in time for clot-busting treatment, which is one reason why it is vital to recognize stroke symptoms and call 9-1-1 right away,” said study author Radoslav I. Raychev, M.D., FAHA, a clinical professor of neurology and a vascular neurologist at the University of California, Los Angeles. “These early results confirm the app reliably identified acute stroke symptoms as accurately as a neurologist, and they will help to improve the app’s accuracy in detecting signs and symptoms of stroke.”

A limitation of the study is that neurologists (not the individuals, family members or caregivers) conducted the screenings and taught patients how to use the application.

American Stroke Association volunteer expert and EPI and Stroke Council member Daniel T. Lackland, Dr.P.H., FAHA, professor and director of the Division of Translational Neurosciences and Population Studies in the department of neurology at the Medical University of South Carolina in Charleston, South Carolina, applauded the research as a promising tool to address a major health challenge – how to prompt individuals with stroke symptoms to seek care in a short window of opportunity.

“This abstract describes a validated approach for an easy assessment of signs of a stroke and the prompt to seek care. The app may help individuals assess the signs of a stroke without the need to recall the warning signs, ” said Lackland, who was not involved in the study.

Co-authors are Jeffrey L. Saver, M.D., FAHA; David S. Liebeskind, M.D., FAHA; Svetlin Penkov, Ph.D.; Daniel Angelov, Ph.D.; Krasimir Stoev; Todor Todorov; Teodora Sakelarova, M.D.; Dobrinka Kalpachka, M.D.; Hristiana Pelyova, M.D.; Rostislava Ruseva, M.D.; Svetlana Velcheva, M.D.; Emanuela Kostadinova, M.D.; Denislav Dimov, M.D.; Kolarova Anna, M.D.; Teodora Manolova, M.D.; Filip Alexiev, M.D., Ph.D.; and Ivan Milanov, M.D., Ph.D.  Authors’ disclosures are listed in the abstract.

The app is owned by Neuronics Medical, of which Raychev is a co-founder. Boehringer Ingelheim funded the study through a research grant with no app ownership. The Bulgarian Society of Neurology helped with study organization. Study senior author, Ivan Milanov is president of the Bulgarian Society of Neurology.

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available here.

Additional Resources:

The American Stroke Association’s International Stroke Conference (ISC) is the world’s premier meeting dedicated to the science and treatment of cerebrovascular disease. ISC 2023 will be held in person in Dallas and virtually, Feb. 8-10, 2023. The three-day conference will feature more than a thousand compelling presentations in categories that emphasize basic, clinical and translational sciences as research evolves toward a better understanding of stroke pathophysiology with the goal of developing more effective therapies. Engage in the International Stroke Conference on social media via #ISC23.

About the American Stroke Association

The American Stroke Association is devoted to saving people from stroke — the No. 2 cause of death in the world and a leading cause of serious disability. We team with millions of volunteers to fund innovative research, fight for stronger public health policies and provide lifesaving tools and information to prevent and treat stroke. The Dallas-based association officially launched in 1998 as a division of the American Heart Association. To learn more or to get involved, call 1-888-4STROKE or visit stroke.org. Follow us on Facebook, Twitter.

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