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

PRESTIGE-AF: Should patients with a brain bleed be given anticoagulant medication?

Feb 25, 2020

Stroke is one of the largest public health challenges around the world, and occur when the blood supply to the brain is interrupted, such as through a clot or a brain bleed. It is the most common cause of adult-acquired disability, the second leading cause of death globally and the second most frequent cause of dementia. In addition, its impact is expected to further increase in the coming decades due to the ageing population.

Dr Eleni Korompoki, MD, PhD, FESO, PRESTIGE AF researcher

We spoke with Dr Eleni Korompoki, MD, PhD, FESO, about a €6.9m worth EU funded research project, aimed at patients with atrial fibrillation (AF), a common heart condition which causes irregular and abnormally fast heartbeat, who have previously had a stroke caused by bleeding in the brain (termed intracerebral hemorrhage or ICH). The Prevention of Stroke in intracerebral hemorrhage survivor with Atrial Fibrillation (PRESTIGE-AF) brings together scientists and clinicians across Europe with the goal of reducing the risk of further stroke in this group of patients. Dr Korompoki is a Clinical Research Fellow in Stroke Medicine at Division of Brain Sciences, Imperial College London.

SAFE: If you were to explain the project’s aim to a person without any medical background, what would you say?
EK: We are conducting a research study to show whether or not patients who have had a brain hemorrhage should be given anticoagulant medication to prevent blood clots that can be caused by a heart arrhythmia called atrial fibrillation. Currently we do not know the best way to prevent strokes in these patients.

SAFE: What types of partner do you need to carry out a project like this?
EK: This project is covering many specialties, so we need to have partners with experts in stroke, cardiology, genetics, biomarkers, neuroimaging and predictive modelling to name just a few!

SAFE: Can you briefly describe your role in the project?
EK: I am part of the central clinical trial team who assist all of the (70!) hospitals who recruit to our clinical trial. I am available to provide medical support, answer questions about patient eligibility and review the safety reports (called adverse events) as we closely monitor all health complaints that patients have whilst they are in the study. Towards the end of the project I will be involved with data analysis and writing up the results of the trial.

SAFE: What (if any) are the difficulties with carrying out the work?
EK: Stroke is the leading cause of disability in Europe and strokes caused by bleeding tend to be more disabling. Therefore it can be a challenge to identify patients who are willing and able to take part in a study like this.

SAFE: What personally attracted you to be in this project?
EK: I have been involved in stroke research for more than 10 years, focusing on stroke prevention and heart-brain connection. As a physician and researcher, I strongly believe that prevention is the key element for well- being. PRESTIGE-AF is a prevention trial targeting an individualised approach and better quality of life after stroke. The trial will also address important aspects such as gender differences, and patients’ attitudes and preferences.

As part of PRESTIGE-AF consortium I have plenty opportunity to interact with internationally recognised experts of ten leading European academic institutions, to work together with a multidisciplinary team from different European countries gaining a lot of experience and improving my scientific skills.

SAFE: When this project ends, what do you expect to change, i.e. how it will reflect on stroke treatment?
EK: We expect to be able to provide evidence based treatment to patients who have had a brain hemorrhage and have atrial fibrillation, the most common cardiac arrhythmia. In addition we hope that we will be able to start using a more person centered approach with these patients using information learnt from looking at brain scans, blood tests, gender differences and psychological aspects.

PRESTIGE-AF has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No. 754517.

SAVE THE DATE – European Life After Stroke Forum, 19 November 2020, Barcelona, Spain

Feb 20, 2020

Life after stroke is a key priority within SAFE’s strategy. It is our pleasure to share with you the date of the first European Life After Stroke Forum – the 19 November 2020 in Barcelona, Spain.

This first European Life After Stroke Forum is driven by the need to implement the Stroke Action Plan for Europe and to create a network of stakeholders involved in professionally researching, advocating and providing evidence for improved life after stroke care.

SAVE THE DATE – EUROPEAN LIFE AFTER STROKE FORUM, 19 NOVEMBER 2020, BARCELONA, SPAIN

We hope we could get you to support the European Life After Stroke Forum by sharing this information with people you know.

When? 19 November 2020

Where? Hotel Catalonia Barcelona Plaza, Barcelona, Spain

Who can attend?  Organisations and individuals who operate in the life after stroke area and are research, policy, advocacy or support oriented.

How to register? The registration link will be available soon. Stay tuned!

Please put this date in your calendar and stay tuned for more information that will follow.

We hope to welcome you to Barcelona,

SAFE team

Turning the Tide: Stroke Ready Hospitals

Feb 20, 2020

Turning the Tide is a series of 26 mini-films from 24 countries, presenting the bold actions being carried out by communities and organisations to take on the world’s biggest killers – non-communicable diseases, like cancer, diabetes and lung disease – and bring better health for all.

Time is everything when dealing with stroke patients, but many hospitals are not “stroke ready”. Every 30 minutes a stroke patient who could have been saved, dies or is permanently disabled, because they were treated in the wrong hospital.

The Angels Initiative is building a global community of stroke centres and stroke-ready hospitals, working every day to improve the quality of treatment for every stroke patient. The story in this video would have been very different if it wasn’t for a joint effort of the Angels Community.

The man who can be seen in the video is one of the lucky ones. Both he and his wife are medics, so, when he collapsed from a stroke in his home in Sofia, Bulgaria, his wife instantly recognised what happened and knew that she had to act quickly. He was swiftly taken to the nearest stroke-ready hospital and was treated immediately by the responding doctors. Thanks to a swift reaction from their colleagues, medics who work in the stroke-ready hospital and to the timely received treatment, the man was able to recover. “I started to go shopping. I started driving. I started to feel like a normal human being again. These days I realise how blessed I was to have fully recovered to be with my family, my children and my grandchildren” he said.

Please watch the video and see how having stroke-ready hospitals helps #TurningTheTide.

The video was produced by the NCD Alliance and BBC StoryWorks

The Angels Initiative, launched by Boehringer Ingelheim in partnership with the European Stroke Organisation (ESO), and the World Stroke Organisation (WSO), the Stroke Alliance for Europe (SAFE) and others is set to improve acute stroke care, by increasing the number of patients treated in stroke ready hospitals and optimising the quality of treatment in all existing stroke centres. For more information about Angels Initiative, please visit www.angels-initiative.com

Image source: The video print screen

ESO-WSO 2020: A United Voice for Stroke

Feb 19, 2020

ESO-WSO 2020 congress is fast approaching. For the first time, two large congresses, the World Stroke Congress and the European Stroke Congress will merge into one, bringing together stroke researchers, medical experts, patient organisations, pharma industry, medical devices manufacturers and many others to Vienna, Austria between 12 – 15 May 2020.

The Stroke Alliance for Europe will have a stand at this big event, seizing opportunity for a direct communication with the congress delegates and promoting our flagship projects.

The ESO-WSO 2020 Key Dates

Late Breaking Abstract Submission: 24 February – 1 April 2020
Early Registration Deadline: 17 March 2020

A United Voice for Stroke

ESO-WSO 2020 will give people the opportunity to meet, discuss and learn from international speakers and peers. The Conference will be the biggest stroke conference to date!

If you wish to register and take advantage of the early bird rates that are available until 17 March 2020, visit eso-wso-conference.org for more information.