Pregnancy and Stroke – and the other way around

Mar 6, 2020

First published by ESO | 6.3.2020

Author: Dr Nicolas Martinez-Majander, Department of Neurology, Helsinki University Hospital, Finland

Incidence of young-onset ischemic stroke is currently about 13/100 000 per year in high-income countries and has been increasing since 1980s. In young patients, stroke affects social life, family, and working ability for years after the event. In addition to well-known risk factors, such as diabetes mellitus, hypertension, and hypercholesterolemia, young patients also have unconventional, age-specific risk factors such as pregnancy and puerperium. However, there are still many unanswered questions in terms of risk factors for stroke in the young, and so far study results have been inconsistent.

Ischemic stroke during and after pregnancy

Both pregnancy and puerperium are associated with an increased risk of all stroke subtypes. In a single-center Canadian study, most ischemic strokes occurred during the third trimester, around delivery, or during postnatal period with an incidence of 18 strokes per 100.000 deliveries.(1) Furthermore, of all thromboembolisms during pregnancy, stroke contributed to 12% of them.(2) Up to 25% of ischemic strokes during pregnancy can be associated with eclampsia.(3)Other risk factors for ischemic stroke during pregnancy include e.g. hypertension, diabetes, age over 35 years, black ethnicity, migraine headaches, thrombophilia, smoking, alcohol, and other substance abuse.(4) Kittner et al. also showed that the relative risk of ischemic stroke was up to 8.7 (95% CI, 4.6-16.7) during puerperium.3

The choice of secondary prevention depends mostly on the stroke etiology and gestational age. Aspirin in low daily doses is usually the drug of choice especially during the second and third trimester, but there are inconsistent results regarding its teratogenic effects during the first trimester.5 If anticoagulation is indicated, e.g. in high-risk source of cardioembolism, then low-molecular-weight heparin would be recommended instead of novel anticoagulants or warfarin which crosses placenta and is found to be potentially teratogenic. A few case reports and retrospective studies have shown that in acute treatment, intravenous thrombolysis (rtPA) might be safe during pregnancy, but since these women were excluded from all the randomized clinical trials, pregnancy is still a formal contraindication of rtPA. The same applies to mechanical thrombectomy and treatment decisions should be made on an individual basis for each patient.

You can read the full article and references here.

Illustration: Image by ekseaborn0 from Pixabay

PRECIOUS trial: Looking for ways to improve the recovery of stroke patients aged 66 years or older

Mar 5, 2020

Every year, around 1.3 million Europeans have a stroke. Twenty to 35% of the patients die in the first month after stroke, and around one third remain dependent on the help of others. The annual costs for stroke care in Europe are estimated at € 64.1 billion. Mainly in the first days after stroke onset, patients are at risk of complications, such as infections and fever. These complications are strongly and independently associated with a higher risk of death or dependency. This week, we bring you an interview with  Jeroen de Jonge, Neurology Resident, UMC Utrecht, a trial manager of PRECIOUS, a trial that is looking for ways to improve the recovery of stroke patients aged 66 years or older.

SAFE: If you were to explain the project’s aim to a person without any medical background, what would you say?

The PRECIOUS trial stands for ‘PREvention of Complications to Improve OUtcome in elderly patients with acute Stroke’. This medical trial is an EU-funded Horizon 2020 collaborative research project dedicated to look for ways to improve the recovery of stroke patients aged 66 years or older. After a stroke, patients can have complications, such as fever or a pneumonia. Patients who have a complication after stroke, usually recovery worse than patients without a complication. Normally, the complications are treated when symptoms become obvious. Fever is treated with paracetamol, nausea and vomiting with metoclopramide, and infections are treated with antibiotics. In this trial, we give the treatments before symptoms occur, to test if we can prevent the complications and thereby improve recovery.

SAFE: What types of partner do you need to carry out a project like this?

The setting-up, conduct and management of a trial like PRECIOUS involves many different partners and organizations. PRECIOUS is carried out in about 80 hospitals in 9 European countries. Before starting medical research with patients, it has to be approved by regulatory authorities, which assess if your trial is useful, safe, ethical and feasible. In every participating hospital, there is a dedicated doctor who helps with setting-up the trial. However, sometimes the rules and regulations are so complex, that a specialized research organization is involved to help this process.

During the course of the trial, several partners are involved, each with a specific task. For example, there is a safety team that collects information about potential side effects of the drugs, to keep an eye on the safety of the treatments. A different team designs an electronic data system, which is a safe online platform where local investigators can fill in patient data. Also, there is a team that visits the hospitals periodically, to monitor if the trial is being performed according to the rules. Also, at the end of the trial, a lot of information is gathered, and we need a statistical team to process all the information to determine if the treatments are effective. However, these are just a few examples, and you need a lot of partners to carry out such as project.

SAFE: Can you briefly describe your role in the project?

My role as a trial manager is to oversee all processes related to PRECIOUS on a day-to-day basis. The work is very broad and consists, for example, the general management of the trial, support with obtaining regulatory approvals, setting-up participating hospitals, including patients into the trial, and answering questions of local investigators about patient recruitment, data collection or follow-up of patients.

SAFE: What (if any) are the difficulties with carrying out the work?

Obtaining regulatory approvals in different countries and hospitals requires a lot of paperwork and bureaucratic tasks. This process takes a lot of time. Off course, it is very important that research is assessed very carefully before it can start, but sometimes specific aspects of the research are being assessed multiple times. It takes a lot of time before the research can actually start, and that is sometimes challenging.

SAFE: What personally attracted you to be in this project?

Stroke is the world’s second largest cause of death and the third cause of long-term disability.

Many patients suffer from a stroke on a daily basis. However, there are still limited treatment options available. Because of medical research, there has been considerable progress in the treatment of stroke and new effective treatment options have become available in the past decade. The possibility support research that looks for new ways to treat stroke is what personally attracts me in this project.

SAFE: When this project ends, what do you expect to change, i.e. how it will reflect on stroke treatment?

We hope to find a simple, safe and effective treatment strategy for patients who have had a stroke, which can prevent the development of complications and improve recovery after stroke.

PRECIOUS has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 634809.

President of Slovakian Stroke Support Organisation nominated for Slovak Woman of the Year

Feb 27, 2020

Slovak weekly magazine in cooperation with RTVS -Slovak national TV and Radio and with the Slovak National Theater presented the nominees of the twelfth year of the SLOVENKA OF THE YEAR.

JUDr. Alžbeta Husarovič, MHA, MPH is one of this year’s laureates for the Slovakian Women of the Year. She is the President of the civic association Porážka.sk, which is dedicated to raising stroke awareness and helping patients and their families with information about physiotherapy, speech therapy, psychology, social assistance. The aim of this organisation is to improve patients’ quality of life and lead them to self-sufficiency.

“I was very pleased and amazed when I became the Nominee for the Slovak Woman of the year 2020. I didn’t think that somebody is even noticing me for what I am doing. And I am doing this activity with love” said Alžbeta, adding: “This event Slovak Woman is a competition but I don’t consider it so. For me, it is a opportunity for woman to show others what the can do!”

The Official Press Release “Slovakia 2020”

We have no idea yet of which successful Slovak woman will be awarded in the following categories: Business and Management, Arts and Culture, Media and Communication, Science and Research, Education, Support for Young Talents, Healthcare, Sport and Charity, since all laureates are inspirational ladies, who will be introduced to you over the next few weeks.

In addition, this year the nomination committee will award the title of Absolute Slovak Woman of the Year and the Special Lifetime Achievement Award for Slovakia. We will come to learn the winning names during the gala evening in the historical building of the Slovak National Theater and live broadcast of RTVS – Slovak National TV and Radio on May 31, 2020.

Throwback

Historically, the first Slovak Woman of the year in 2009 became the head physician of the 2nd Pediatric Clinic of the Faculty of Medicine and the Pediatric University Hospital with the Policlinic in Bratislava MUDr. Anna Hlavatá, and so far the last – Slovak of the year 2019 – is Andrea Gontkovičová.

Voting from today at www.slovenkaroka.sk

Starting today, it is possible to vote for individual nominees at www.slovenkaroka.sk and from next week also in the weekly Magazine Slovenka. Vote for your favorite and win an exclusive 8-day vacation stay for 2 people at Labranda Coral Beach 4 * with all inclusive in attractive Gambia from CK Hydrotour.

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Image credits: Porazka.sk