uu.seUppsala University Publications
Change search
Link to record
Permanent link

Direct link
BETA
Terént, Andreas
Alternative names
Publications (10 of 68) Show all publications
Åsberg, S., Hijazi, Z., Norrving, B., Terént, A., Öhagen, P. & Oldgren, J. (2017). Timing of oral anticoagulant therapy in acute ischemic stroke with atrial fibrillation: study protocol for a registry-based randomised controlled trial. Trials, 18(1), Article ID 581.
Open this publication in new window or tab >>Timing of oral anticoagulant therapy in acute ischemic stroke with atrial fibrillation: study protocol for a registry-based randomised controlled trial
Show others...
2017 (English)In: Trials, ISSN 1745-6215, E-ISSN 1745-6215, Vol. 18, no 1, article id 581Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Oral anticoagulation therapy is recommended for the prevention of recurrent ischemic stroke in patients with atrial fibrillation (AF). Current guidelines do not provide evidence-based recommendations on optimal time-point to start anticoagulation therapy after an acute ischemic stroke. Non-vitamin K antagonist oral anticoagulants (NOACs) may offer advantages compared to warfarin because of faster and more predictable onset of action and potentially a lower risk of intracerebral haemorrhage also in the acute phase after an ischemic stroke. The TIMING study aims to establish the efficacy and safety of early vs delayed initiation of NOACs in patients with acute ischemic stroke and AF.

METHODS/DESIGN: The TIMING study is a national, investigator-led, registry-based, multicentre, open-label, randomised controlled study. The Swedish Stroke Register is used for enrolment, randomisation and follow-up of 3000 patients, who are randomised (1:1) within 72 h from ischemic stroke onset to either early (≤ 4 days) or delayed (≥ 5-10 days) start of NOAC therapy. The primary outcome is the composite of recurrent ischemic stroke, symptomatic intracerebral haemorrhage, or all-cause mortality within 90 days after randomisation. Secondary outcomes include: individual components of the primary outcome at 90 and 365 days; major haemorrhagic events; functional outcome by the modified Rankin Scale at 90 days; and health economics. In an optional biomarker sub-study, blood samples will be collected after randomisation from approximately half of the patients for central analysis of cardiovascular biomarkers after study completion. The study is funded by the Swedish Medical Research Council. Enrolment of patients started in April 2017.

CONCLUSION: The TIMING study addresses the ongoing clinical dilemma of when to start NOAC after an acute ischemic stroke in patients with AF. By the inclusion of a randomisation module within the Swedish Stroke Register, the advantages of a prospective randomised study design are combined with the strengths of a national clinical quality register in allowing simplified enrolment and follow-up of study patients. In addition, the register adds the possibility of directly assessing the external validity of the study findings.

TRIAL REGISTRATION: ClinicalTrials.gov, NCT02961348 . Registered on 8 November 2016.

Keywords
Acute ischemic stroke, Atrial fibrillation, Oral anticoagulation, Randomised clinical trial
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-342938 (URN)10.1186/s13063-017-2313-9 (DOI)000417073600004 ()29197413 (PubMedID)
Funder
Swedish Research Council, 2015-00881
Available from: 2018-02-23 Created: 2018-02-23 Last updated: 2018-03-02Bibliographically approved
Appelros, P., Farahmand, B., Terént, A. & Åsberg, S. (2017). To Treat or Not to Treat: Anticoagulants as Secondary Preventives to the Oldest Old With Atrial Fibrillation. Stroke, 48(6), 1617-1622
Open this publication in new window or tab >>To Treat or Not to Treat: Anticoagulants as Secondary Preventives to the Oldest Old With Atrial Fibrillation
2017 (English)In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 48, no 6, p. 1617-1622Article in journal (Refereed) Published
Abstract [en]

Background and Purpose-Anticoagulant treatment is effective for preventing recurrent ischemic strokes in patients who have atrial fibrillation. This benefit is paid by a small increase of hemorrhages. Anticoagulant-related hemorrhages seem to increase with age, but there are few studies showing whether the benefits of treatment persist in old age.

Methods-For this observational study, 4 different registers were used, among them Riksstroke, the Swedish Stroke Register. Patients who have had a recent ischemic stroke, were 80 to 100 years of age, and had atrial fibrillation, were included from 2006 through 2013. The patients were stratified into 3 age groups: 80 to 84, 85 to 89, and ?90 years of age. Information on stroke severity, risk factors, drugs, and comorbidities was gathered from the registers. The patients were followed with respect to ischemic or hemorrhagic stroke, other hemorrhages, or death.

Results-Of all 23 356 patients with atrial fibrillation, 6361 (27%) used anticoagulants after an ischemic stroke. Anticoagulant treatment was associated with less recurrent ischemic stroke in all age groups. Hemorrhages increased most in the >= 90-year age group, but this did not offset the overall beneficial effect of the anticoagulant. Apart from age, no other cardiovascular risk factor or comorbidity was identified that influenced the risk of anticoagulant-associated hemorrhage. Drugs other than anticoagulants did not influence the incidence of major hemorrhage.

Conclusions-Given the patient characteristics in this study, there is room for more patients to be treated with anticoagulants, without hemorrhages to prevail. In nonagenarians, hemorrhages increased somewhat more, but this did not affect the overall outcome in this age stratum.

Place, publisher, year, edition, pages
LIPPINCOTT WILLIAMS & WILKINS, 2017
Keywords
aged, 80 and over, anticoagulants, atrial fibrillation, comorbidity, stroke
National Category
Neurology Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-327140 (URN)10.1161/STROKEAHA.117.016902 (DOI)000401819300042 ()28487335 (PubMedID)
Available from: 2017-08-17 Created: 2017-08-17 Last updated: 2017-08-17Bibliographically approved
Friberg, L., Skeppholm, M. & Terént, A. (2015). Benefit of Anticoagulation Unlikely in Patients With Atrial Fibrillation and a CHA(2)DS(2)-VASc Score of 1. Journal of the American College of Cardiology, 65(3), 225-232
Open this publication in new window or tab >>Benefit of Anticoagulation Unlikely in Patients With Atrial Fibrillation and a CHA(2)DS(2)-VASc Score of 1
2015 (English)In: Journal of the American College of Cardiology, ISSN 0735-1097, E-ISSN 1558-3597, Vol. 65, no 3, p. 225-232Article in journal (Refereed) Published
Abstract [en]

BACKGROUND Patients with atrial fibrillation (AF) and >= 1 point on the stroke risk scheme CHA(2)DS(2)-VASc (congestive heart failure, hypertension, age >= 75 years, diabetes mellitus, stroke/transient ischemic attack, vascular disease, age 65-74 years, sex category) are considered at increased risk for future stroke, but the risk associated with a score of 1 differs markedly between studies. OBJECTIVES The goal of this study was to assess AF-related stroke risk among patients with a score of 1 on the CHA(2)DS(2)-VASc. METHODS We conducted this retrospective study of 140,420 patients with AF in Swedish nationwide health registries on the basis of varying definitions of "stroke events." RESULTS Using a wide "stroke" diagnosis (including hospital discharge diagnoses of ischemic stroke as well as unspecified stroke, transient ischemic attack, and pulmonary embolism) yielded a 44% higher annual risk than if only ischemic strokes were counted. Including stroke events in conjunction with the index hospitalization for AF doubled the long-term risk beyond the first 4 weeks. For women, annual stroke rates varied between 0.1% and 0.2% depending on which event definition was used; for men, the corresponding rates were 0.5% and 0.7%. CONCLUSIONS The risk of ischemic stroke in patients with AF and a CHA(2)DS(2)-VASc score of 1 seems to be lower than previously reported. (C) 2015 by the American College of Cardiology Foundation.

Keywords
epidemiology, oral anticoagulation, stroke
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-245359 (URN)10.1016/j.jacc.2014.10.052 (DOI)000348046200001 ()25614418 (PubMedID)
Available from: 2015-02-27 Created: 2015-02-26 Last updated: 2017-12-04Bibliographically approved
Hornslien, A. G., Sandset, E. C., Igland, J., Terént, A., Boysen, G., Bath, P. M. W., . . . Berge, E. (2015). Effects of candesartan in acute stroke on vascular events during long-term follow-up: results from the Scandinavian Candesartan Acute Stroke Trial (SCAST). International Journal of Stroke, 10(6), 830-835
Open this publication in new window or tab >>Effects of candesartan in acute stroke on vascular events during long-term follow-up: results from the Scandinavian Candesartan Acute Stroke Trial (SCAST)
Show others...
2015 (English)In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 10, no 6, p. 830-835Article in journal (Refereed) Published
Abstract [en]

BackgroundRandomized-controlled trials have shown no beneficial short-term effects of blood pressure lowering treatment in the acute phase of stroke. AimWe aimed to see whether blood pressure lowering treatment with candesartan in the acute phase can lead to benefits that become apparent over a longer period of follow-up. MethodsThe Scandinavian Candesartan Acute Stoke Trial was a randomized- and placebo-controlled trial of candesartan in 2,029 patients with acute stroke and systolic blood pressure140mmHg. Trial treatment was given for seven-days, and the primary follow-up period was six-months. We have used the national patient registries and the cause of death registries in the Scandinavian countries to collect data on vascular events and deaths up to three-years from randomization. The primary end-point was the composite of stroke, myocardial infarction, or vascular death, and we used Cox proportional hazards regression model for analysis. ResultsLong-term data were available for 1,256 of the 1,286 patients (98%) from Scandinavia. The risk of the primary composite end-point did not differ significantly between the groups (candesartan 178/632 events, placebo 203/624 events, hazard ratio=087, 95% confidence interval 071-107). There were also no statistically significant differences for the secondary end-points stroke and all-cause death, or in any of the pre-specified subgroups. ConclusionsTreatment with candesartan in the acute phase of stroke was not associated with clear long-term clinical benefits. This result supports the conclusion from trials with short-term follow-up, that blood pressure lowering treatment with candesartan should not be given routinely to patients with acute stroke and raised blood pressure.

Keywords
acute stroke therapy, hypertension, blood pressure, candesartan, long-term results
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-260818 (URN)10.1111/ijs.12477 (DOI)000358451500019 ()25808741 (PubMedID)
Funder
AstraZeneca
Available from: 2015-08-27 Created: 2015-08-25 Last updated: 2017-12-04Bibliographically approved
Asberg, S., Henriksson, K. M., Terént, A. & Farahmand, B. (2015). Statin therapy and the risk of death and recurrent intracerebral hemorrhage. International Journal of Stroke, 10, 43-43
Open this publication in new window or tab >>Statin therapy and the risk of death and recurrent intracerebral hemorrhage
2015 (English)In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 10, p. 43-43Article in journal, Meeting abstract (Other academic) Published
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-262147 (URN)000359304000099 ()
Available from: 2015-09-09 Created: 2015-09-09 Last updated: 2017-12-04Bibliographically approved
Appelros, P. & Terént, A. (2015). Thrombolysis in acute stroke [Letter to the editor]. The Lancet, 385(9976), 1394-1394
Open this publication in new window or tab >>Thrombolysis in acute stroke
2015 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 385, no 9976, p. 1394-1394Article in journal, Letter (Refereed) Published
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-252514 (URN)000352719800021 ()25890417 (PubMedID)
Available from: 2015-05-08 Created: 2015-05-07 Last updated: 2017-12-04Bibliographically approved
Terént, A., Åsberg, S. & Hijazi, Z. (2014). Antikoagulation vid akut stroke med förmaksflimmer Fem frågor bör besvaras innan behandlingen kan anses vara evidensbaserad: [Anticoagulation in acute stroke with atrial fibrillation. Five questions should be answered before the treatment can be considered evidence-based].. Läkartidningen, 111(20), 872-874, Article ID CRZR.
Open this publication in new window or tab >>Antikoagulation vid akut stroke med förmaksflimmer Fem frågor bör besvaras innan behandlingen kan anses vara evidensbaserad: [Anticoagulation in acute stroke with atrial fibrillation. Five questions should be answered before the treatment can be considered evidence-based].
2014 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 111, no 20, p. 872-874, article id CRZRArticle in journal (Refereed) Published
Abstract [sv]

Flera frågor finns kring användningen av orala antikoagulantia vid akut ischemisk stroke med förmaksflimmer. 

Hur stor är risken för ny embolisering vid senarelagd behandling? Epidemiologiska data saknas.

Hur stor är risken för blödning vid akut insatt behandling? Betydelsen av hemorragisk omvandling av hjärninfarkten är oklar.

Vilken nytta har vi av prognos­tiska modeller? Dessa modeller är inte baserade på studier av patienter med akut stroke.

Vilken roll spelar högre ålder? Risken för blödning ökar med ökande ålder, särskilt efter 75 år.

National Category
Neurology Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-304100 (URN)24908802 (PubMedID)
Available from: 2016-10-02 Created: 2016-10-02 Last updated: 2017-06-12Bibliographically approved
Friberg, L., Rosenqvist, M., Lindgren, A., Terént, A., Norrving, B. & Asplund, K. (2014). High Prevalence of Atrial Fibrillation Among Patients With Ischemic Stroke. Stroke, 45(9), 2599-+
Open this publication in new window or tab >>High Prevalence of Atrial Fibrillation Among Patients With Ischemic Stroke
Show others...
2014 (English)In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 45, no 9, p. 2599-+Article in journal (Refereed) Published
Abstract [en]

Background and Purpose-Atrial fibrillation (AF) is a common cause of devastating but potentially preventable stroke. Estimates of the prevalence of AF among patients with stroke vary considerably because of difficulties in detection of intermittent, silent AF. Better recognition of AF in this patient group may help to identify and offer protection to individuals at risk. Our aim was to determine the nationwide prevalence of AF among patients with ischemic stroke, as well as their use of oral anticoagulation. Methods-Cross-sectional study of unselected patients in cross-linked nationwide Swedish health registers. All 94 083 patients with a diagnosis of ischemic stroke in the nationwide stroke register Riks-Stroke between 2005 and 2010 were studied. Information about previously diagnosed AF, and comorbidity, was obtained from the nationwide Patient Register and cross-referenced with the national Drug Register containing data on all dispensed pharmacological prescriptions in Sweden. Results-Combination of data from Riks-Stroke and from the Patient Register showed that 31 428 (33.4%) patients with ischemic stroke had previously known, or newly diagnosed, AF. Of those, only 16.2% had received warfarin in a pharmacy within 6 months before stroke onset. After hospital discharge, only 35.0% of the survivors received warfarin within the first 3 months after discharge. The likelihood for underlying AF was strongly correlated to the CHA(2)DS(2)-VASC score, which is a point based scheme for assessment of stroke risk in AF but which also predicts likelihood of AF. In this scheme points are given for age, previous stroke or transient ischemic attack, hypertension, heart failure, diabetes, vascular disease and female sex. Conclusions-Access to nationwide register data shows that AF is more common among patients with ischemic stroke than those previously reported. Few patients with stroke and AF had anticoagulant treatment before the event, and few got it after the event. CHA(2)DS(2)-VASc could be a useful monitoring tool to intensify efforts to diagnose AF among patients with cryptogenic stroke.

Keywords
atrial fibrillation, stroke
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:uu:diva-234197 (URN)10.1161/STROKEAHA.114.006070 (DOI)000341491500029 ()
Available from: 2014-10-28 Created: 2014-10-15 Last updated: 2017-12-05Bibliographically approved
Appelros, P., Jonsson, F., Åsberg, S., Asplund, K., Glader, E.-L., Asberg, K. H., . . . Terént, A. (2014). Trends in Stroke Treatment and Outcome between 1995 and 2010: Observations from Riks-Stroke, the Swedish Stroke Register. Cerebrovascular Diseases, 37(1), 22-29
Open this publication in new window or tab >>Trends in Stroke Treatment and Outcome between 1995 and 2010: Observations from Riks-Stroke, the Swedish Stroke Register
Show others...
2014 (English)In: Cerebrovascular Diseases, ISSN 1015-9770, E-ISSN 1421-9786, Vol. 37, no 1, p. 22-29Article in journal (Refereed) Published
Abstract [en]

Background: Continuous changes in stroke treatment and care, as well as changes in stroke characteristics, may alter stroke outcome over time. The aim of this paper is to describe time trends for treatment and outcome data, and to discuss if any such changes could be attributed to quality changes in stroke care. Methods: Data from Riks-Stroke, the Swedish stroke register, were analyzed for the time period of 1995 through 2010. The total number of patients included was 320,181. The following parameters were included: use of computed tomography (CT), stroke unit care, thrombolysis, medication before and after the stroke, length of stay in hospital, and discharge destination. Three months after stroke, data regarding walking, toileting and dressing ability, as well social situation, were gathered. Survival status after 7, 27 and 90 days was registered. Results: In 1995, 53.9% of stroke patients were treated in stroke units. In 2010 this proportion had increased to 87.5%. Fewer patients were discharged to geriatric or rehabilitation departments in later years (23.6% in 2001 compared with 13.4% in 2010), but more were discharged directly home (44.2 vs. 52.4%) or home with home rehabilitation (0 vs. 10.7%). The need for home help service increased from 18.2% in 1995 to 22.1% in 2010. Regarding prevention, more patients were on warfarin, antihypertensives and statins both before and after the stroke. The functional outcome measures after 3 months did improve from 2001 to 2010. In 2001, 83.8% of patients were walking independently, while 85.6% were independent in 2010. For toileting, independence increased from 81.2 to 84.1%, and for dressing from 78.0 to 80.4%. Case fatality (CF) rates after 3 months increased from 18.7% (2001) to 20.0% (2010). This trend is driven by patients with severe strokes. Conclusions: Stroke outcomes may change over a relatively short time period. In some ways, the quality of care has improved. More stroke patients have CT, more patients are treated in stroke units and more have secondary prevention. Patients with milder strokes may have benefited more from these measures than patients with severe strokes. Increased CF rates for patients with severe stroke may be caused by shorter hospital stays, shorter in-hospital rehabilitation periods and lack of suitable care after discharge from hospital.

Keywords
Quality improvement, Stroke registries, Stroke risk factors, Time trends
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-220308 (URN)10.1159/000356346 (DOI)000330857800004 ()
Available from: 2014-03-17 Created: 2014-03-12 Last updated: 2017-12-05Bibliographically approved
Åsberg, S., Eriksson, M., Henriksson, K. M. & Terént, A. (2014). Warfarin-Associated Intracerebral Hemorrhage After Ischemic Stroke. Stroke, 45(7), 2118-2120
Open this publication in new window or tab >>Warfarin-Associated Intracerebral Hemorrhage After Ischemic Stroke
2014 (English)In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 45, no 7, p. 2118-2120Article in journal (Refereed) Published
Abstract [en]

Background and Purpose-The aim was to investigate the risk of intracerebral hemorrhage (ICH) in patients with ischemic stroke taking warfarin and whether this risk changed over time. Methods-Between 2001 and 2008, the Swedish Stroke Register registered 12 790 patients with ischemic stroke discharged on warfarin. The patients was studied in two 4-year periods (inclusion 2001-2004: follow-up until 2005 and inclusion 2005-2008: follow-up until 2009) for which rates of subsequent ICH were calculated. Adjusted hazard ratios, comparing the second period with the first period, were estimated in Cox regression models. Results-Of 6039 patients, 58 patients (1.0%) in the first period and 69 of 6751 patients (1.0%) in the second period had subsequent ICH. Annual rates of ICH ranged from 0.37% in the first period to 0.39% in the second period (adjusted hazard ratio, 1.04; 95% confidence interval, 0.73-1.48). Conclusions-In this nationwide study, the risk of warfarin-associated ICH among ischemic stroke patients was low and did not change during the 2000s.

Keywords
anticoagulants, stroke
National Category
Clinical Medicine
Identifiers
urn:nbn:se:uu:diva-229441 (URN)10.1161/STROKEAHA.114.005729 (DOI)000338129400045 ()
Available from: 2014-08-08 Created: 2014-08-07 Last updated: 2017-12-05Bibliographically approved
Organisations

Search in DiVA

Show all publications