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Compared with typical TIA episodes, patients with atypical TIA episodes have a higher risk of early and long-term stroke.
After taking into account patients with atypical symptoms, TIA diagnosis will increase by about 50%.
Transient ischemic attack (TIA), also known as "minor stroke", about 25% of strokes are caused by TIA.
The early risk of stroke after the onset of TIA is very high, so it often requires meticulous examination and intensive treatment.
In order to reduce the risk of early recurrent stroke, TIA often requires the simultaneous use of aspirin and clopidogrel two antiplatelet drugs, referred to as double antibodies.
The onset of TIA is generally without aura, and there is a transient neurological location sign, but there is no evidence of responsible lesions.
Because patients often recover completely within 24 hours without sequelae, TIA is commonly known as "small stroke".
However, previous studies have concluded that TIA patients have a high risk of early stroke.
Not only does the incidence of cerebral infarction increase (10%-20%) within 90 days of the onset of TIA, the risk of myocardial infarction and sudden death also increases.
90 days is regarded as the "high-risk period" of cerebral infarction risk.
Earlier, the research published on JAMA concluded that the risk of stroke after TIA was significantly increased, with 30.
8%, 39%, and 48.
5% of strokes occurring 30 days, 90 days, and more than 1 year after TIA, respectively.
Among them, the median time to stroke was 1.
6 years.
Therefore, the monitoring time for stroke in such patients should be extended to 90 days later.
In addition, because many TIA patients may not be able to observe the manifestations of acute ischemia during imaging examinations, diagnosis based on symptoms is still common in clinical practice.
However, there is still a lack of consensus on "atypical" symptoms, related diagnosis is challenging, and a large number of patients may not receive standardized treatment.
To this end, experts from the University of Oxford Vascular Research Team evaluated whether TIA patients with atypical symptoms and TIA patients with typical symptoms have similar follow-up stroke risks and long-term risks, and found that some atypical symptoms that have not yet reached a diagnosis consensus are the same.
It is worthy of attention, so as not to miss follow-up treatment and prevention.
The results are published in the latest Lancet magazine.
Researchers prospectively investigated all strokes and sudden transient neurological symptoms in 92,728 people from Oxfordshire, England.
According to the secondary prevention guidelines, patients who were classified as mild ischemic stroke (NIHSS<5), classic TIA, or atypical TIA at baseline were treated.
Face-to-face follow-up was used to determine the risk of stroke (7-day, 90-day, and 10-year risk) and the risk of all major vascular events, and compared with the expected risk of the basic research population.
Between April 1, 2002 and March 31, 2018, 2878 patients were identified as having mild ischemic stroke (n=1287), typical TIA (n=1021), or atypical TIA attack (n=570) .
After a median follow-up time of 5.
2 years, a total of 577 first recurring strokes occurred.
In general, the risk of stroke 90 days after the onset of atypical TIA is similar to that of typical TIA (10.
6% vs 11.
6) and higher than the risk of stroke after transient amaurosis (4.
3%).
However, patients with atypical TIA are less likely to seek medical help than patients with a typical TIA (59% vs 75%), and they are more likely to have a stroke before seeking treatment (8% vs 5%), and the risk is the same as that of patients with a typical TIA.
1.
77 times.
After excluding such recurrent strokes, the risk of stroke (2.
9%) in patients with atypical TIA within 7 days after presentation was also 203 times higher than that of ordinary people; for patients with atypical TIA who presented on the same day, the risk of stroke within 7 days after presentation ( 5.
9%) is 300 times that of ordinary people.
In addition, the 10-year risk of major vascular events in patients with typical and atypical TIA was similar (27.
1% vs 30.
9%). The baseline prevalence of atrial fibrillation, patent foramen ovale, and arterial stenosis was also similar in patients with typical and atypical TIA.
However, patients with atypical TIA have an increased risk of circulatory stenosis by 121%.
Therefore, compared with typical TIA attacks, patients with atypical TIA attacks have a higher risk of early and long-term stroke.
After taking into account patients with atypical symptoms, TIA diagnosis will increase by about 50%.
Reference: Diagnosis of non-consensus transient ischaemic attacks with focal, negative, and non-progressive symptoms: population-based validation by investigation and prognosis.
DOI:https://doi.
org/10.
1016/S0140-6736(20)31961 -9
After taking into account patients with atypical symptoms, TIA diagnosis will increase by about 50%.
Transient ischemic attack (TIA), also known as "minor stroke", about 25% of strokes are caused by TIA.
The early risk of stroke after the onset of TIA is very high, so it often requires meticulous examination and intensive treatment.
In order to reduce the risk of early recurrent stroke, TIA often requires the simultaneous use of aspirin and clopidogrel two antiplatelet drugs, referred to as double antibodies.
The onset of TIA is generally without aura, and there is a transient neurological location sign, but there is no evidence of responsible lesions.
Because patients often recover completely within 24 hours without sequelae, TIA is commonly known as "small stroke".
However, previous studies have concluded that TIA patients have a high risk of early stroke.
Not only does the incidence of cerebral infarction increase (10%-20%) within 90 days of the onset of TIA, the risk of myocardial infarction and sudden death also increases.
90 days is regarded as the "high-risk period" of cerebral infarction risk.
Earlier, the research published on JAMA concluded that the risk of stroke after TIA was significantly increased, with 30.
8%, 39%, and 48.
5% of strokes occurring 30 days, 90 days, and more than 1 year after TIA, respectively.
Among them, the median time to stroke was 1.
6 years.
Therefore, the monitoring time for stroke in such patients should be extended to 90 days later.
In addition, because many TIA patients may not be able to observe the manifestations of acute ischemia during imaging examinations, diagnosis based on symptoms is still common in clinical practice.
However, there is still a lack of consensus on "atypical" symptoms, related diagnosis is challenging, and a large number of patients may not receive standardized treatment.
To this end, experts from the University of Oxford Vascular Research Team evaluated whether TIA patients with atypical symptoms and TIA patients with typical symptoms have similar follow-up stroke risks and long-term risks, and found that some atypical symptoms that have not yet reached a diagnosis consensus are the same.
It is worthy of attention, so as not to miss follow-up treatment and prevention.
The results are published in the latest Lancet magazine.
Researchers prospectively investigated all strokes and sudden transient neurological symptoms in 92,728 people from Oxfordshire, England.
According to the secondary prevention guidelines, patients who were classified as mild ischemic stroke (NIHSS<5), classic TIA, or atypical TIA at baseline were treated.
Face-to-face follow-up was used to determine the risk of stroke (7-day, 90-day, and 10-year risk) and the risk of all major vascular events, and compared with the expected risk of the basic research population.
Between April 1, 2002 and March 31, 2018, 2878 patients were identified as having mild ischemic stroke (n=1287), typical TIA (n=1021), or atypical TIA attack (n=570) .
After a median follow-up time of 5.
2 years, a total of 577 first recurring strokes occurred.
In general, the risk of stroke 90 days after the onset of atypical TIA is similar to that of typical TIA (10.
6% vs 11.
6) and higher than the risk of stroke after transient amaurosis (4.
3%).
However, patients with atypical TIA are less likely to seek medical help than patients with a typical TIA (59% vs 75%), and they are more likely to have a stroke before seeking treatment (8% vs 5%), and the risk is the same as that of patients with a typical TIA.
1.
77 times.
After excluding such recurrent strokes, the risk of stroke (2.
9%) in patients with atypical TIA within 7 days after presentation was also 203 times higher than that of ordinary people; for patients with atypical TIA who presented on the same day, the risk of stroke within 7 days after presentation ( 5.
9%) is 300 times that of ordinary people.
In addition, the 10-year risk of major vascular events in patients with typical and atypical TIA was similar (27.
1% vs 30.
9%). The baseline prevalence of atrial fibrillation, patent foramen ovale, and arterial stenosis was also similar in patients with typical and atypical TIA.
However, patients with atypical TIA have an increased risk of circulatory stenosis by 121%.
Therefore, compared with typical TIA attacks, patients with atypical TIA attacks have a higher risk of early and long-term stroke.
After taking into account patients with atypical symptoms, TIA diagnosis will increase by about 50%.
Reference: Diagnosis of non-consensus transient ischaemic attacks with focal, negative, and non-progressive symptoms: population-based validation by investigation and prognosis.
DOI:https://doi.
org/10.
1016/S0140-6736(20)31961 -9
