Stroke Research Today is a free monthly online journal that collates and summarizes the latest research about Stroke, including details on treatment, recovery, rehabilitation, signs, symptoms.

Physical methods for preventing deep vein thrombosis in stroke.

Naccarato M, Chiodo Grandi F, Dennis M, Sandercock PA

U.C.O. Clinica Neurologica, University of Trieste, Ospedale di Cattinara, Trieste, Italy, 34100.

BACKGROUND: Deep vein thrombosis (DVT) and resulting pulmonary embolism (PE) are important complications of stroke. Physical methods to reduce the risk of DVT and PE, such as graduated compression stockings (GCS) or intermittent pneumatic compression (IPC) applied to the legs, do not appear to be associated with any bleeding risk and reduce the risk of DVT in some categories of surgical patients. We sought to assess their effects in stroke patients. OBJECTIVES: To assess the effectiveness and safety of physical methods of reducing the risk of DVT, fatal or non-fatal PE and death in patients with recent stroke. SEARCH STRATEGY: We searched the Cochrane Stroke Group Trials Register (last searched November 2009), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 4, 2009), MEDLINE (1966 to November 2009), EMBASE (1980 to November 2009), CINAHL (1982 to November 2009) and The British Nursing Index (1985 to November 2009). We screened reference lists of all relevant papers, searched ongoing trials registers (November 2009) and contacted experts in the field. SELECTION CRITERIA: Unconfounded randomised controlled trials comparing physical methods for reducing the risk of DVT with control and in which prophylaxis was started within seven days of the onset of stroke. DATA COLLECTION AND ANALYSIS: Two review authors searched for trials and extracted data. MAIN RESULTS: We identified two trials of GCS that included 2615 patients and two small studies of IPC that included 177 patients. Overall, physical methods were not associated with a significant reduction in DVTs during the treatment period (odds ratio (OR) 0.85, 95% confidence interval (CI) 0.70 to 1.04) or deaths (OR 1.12, 95% CI 0.87 to 1.45). Use of GCS was not associated with any significant reduction in risk of DVT (OR 0.88, 95% CI 0.72 to 1.08) or death (OR 1.13, 95% CI 0.87 to 1.47) at the end of follow up. IPC was associated with a non-significant trend towards a lower risk of DVTs (OR 0.45, 95% CI 0.19 to 1.10) with no evidence of an effect on deaths (OR 1.04, 95% CI 0.37 to 2.89). AUTHORS' CONCLUSIONS: Evidence from randomised trials does not support the routine use of GCS to reduce the risk of DVT after acute stroke. There is insufficient evidence to support the routine use of IPC to reduce the risk of DVT in acute stroke and further larger randomised studies of IPC are needed to reliably assess the balance of risks and benefits of this intervention.

Published 5 August 2010 in Cochrane Database Syst Rev, 8: CD001922.
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Articles on Stroke published 5 August 2010:

Three-dimensional movement analysis of handwriting in subjects with mild hemiparesis.   Arch Phys Med Rehabil, 91(8): 1210-7.

OBJECTIVE: To investigate the effects of hemiparesis on handwriting using a 3-dimensional movement analyzer. DESIGN: Comparative case study. SETTING: Ambulatory care clinic. PARTICIPANTS: Right-handed patients (n=25; mean age +/- SD, 62.3+/-10y) with mild right hemiparesis secondary to subcortical stroke, and age-matched (n=10; 65.6+/-13y) and age-unmatched (n=15; 32.4+/-10y) control subjects. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Time required to write a Japanese character of 2 ... [Abstract] [Full-text]

Articles on Stroke published 2 August 2010:

HDL cholesterol and residual risk of first cardiovascular events after treatment with potent statin therapy: an analysis from the JUPITER trial.   Lancet, 376(9738): 333-9.

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Articles on Stroke published 30 July 2010:

The science of stroke: mechanisms in search of treatments.   Neuron, 67(2): 181-98.

This review focuses on mechanisms and emerging concepts that drive the science of stroke in a therapeutic direction. Once considered exclusively a disorder of blood vessels, growing evidence has led to the realization that the biological processes underlying stroke are driven by the interaction of neurons, glia, vascular cells, and matrix components, which actively participate in mechanisms of tissue injury and repair. As new targets are identified, new opportunities emerge that build on an ... [Abstract] [Full-text]

Articles on Stroke published 28 July 2010:

Risk of acute myocardial infarction, stroke, heart failure, and death in elderly Medicare patients treated with rosiglitazone or pioglitazone.   JAMA, 304(4): 411-8.

CONTEXT: Studies have suggested that the use of rosiglitazone may be associated with an increased risk of serious cardiovascular events compared with other treatments for type 2 diabetes. OBJECTIVE: To determine if the risk of serious cardiovascular harm is increased by rosiglitazone compared with pioglitazone, the other thiazolidinedione marketed in the United States. DESIGN, SETTING, AND PATIENTS: Nationwide, observational, retrospective, inception cohort of 227,571 Medicare beneficiaries ... [Abstract] [Full-text]

Articles on Stroke published 27 July 2010:

Keeping memory clear and stable--the contribution of human basal ganglia and prefrontal cortex to working memory.   J Neurosci, 30(29): 9788-92.

Successful remembering involves both hindering irrelevant information from entering working memory (WM) and actively maintaining relevant information online. Using a voxelwise lesion-behavior brain mapping approach in stroke patients, we observed that lesions of the left basal ganglia render WM susceptible to irrelevant information. Lesions of the right prefrontal cortex on the other hand make it difficult to keep more than a few items in WM. These findings support basal ganglia-prefrontal ... [Abstract] [Full-text]

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