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  • 1.
    Asberg, Signild
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Henriksson, Karin M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Terént, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Farahmand, B.
    Statin therapy and the risk of death and recurrent intracerebral hemorrhage2015In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 10, p. 43-43Article in journal (Other academic)
  • 2. Asplund, Kjell
    et al.
    Åsberg, Kerstin Hulter
    Appelros, Peter
    Bjarne, Daniela
    Eriksson, Marie
    Johansson, Åsa
    Jonsson, Fredrik
    Norrving, Bo
    Stegmayr, Birgitta
    Terént, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Wallin, Sari
    Wester, Per-Olov
    The Riks-Stroke story: building a sustainable national register for quality assessment of stroke care2011In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 6, no 2, p. 99-108Article in journal (Refereed)
    Abstract [en]

    Background

    Riks-Stroke, the Swedish Stroke Register, is the world's longest-running national stroke quality register (established in 1994) and includes all 76 hospitals in Sweden admitting acute stroke patients. The development and maintenance of this sustainable national register is described.

    Methods

    Riks-Stroke includes information on the quality of care during the acute phase, rehabilitation and secondary prevention of stroke, as well as data on community support. Riks-Stroke is unique among stroke quality registers in that patients are followed during the first year after stroke. The data collected describe processes, and medical and patient-reported outcome measurements. The register embraces most of the dimensions of health-care quality (evidence-based, safe, provided in time, distributed fairly and patient oriented).

    Result

    Annually, approximately 25 000 patients are included. In 2009, approximately 320 000 patients had been accumulated (mean age 76-years). The register is estimated to cover 82% of all stroke patients treated in Swedish hospitals. Among critical issues when building a national stroke quality register, the delicate balance between simplicity and comprehensiveness is emphasised. Future developments include direct transfer of data from digital medical records to Riks-Stroke and comprehensive strategies to use the information collected to rapidly implement new evidence-based techniques and to eliminate outdated methods in stroke care.

    Conclusions

    It is possible to establish a sustainable quality register for stroke at the national level covering all hospitals admitting acute stroke patients. Riks-Stroke is fulfilling its main goals to support continuous quality improvement of Swedish stroke services and serve as an instrument for following up national stroke guidelines.

  • 3.
    Carlsson, Axel C
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology. Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med & Primary Care, Huddinge, Sweden.
    Li, Xinjun
    Lund Univ, Ctr Primary Hlth Care Res, Malmo, Sweden..
    Holzmann, Martin J.
    Karolinska Univ Hosp, Dept Emergency Med, Stockholm, Sweden.;Karolinska Inst, Dept Internal Med, Stockholm, Sweden..
    Ärnlov, Johan
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med & Primary Care, Huddinge, Sweden.;Dalarna Univ, Sch Hlth & Social Studies, Falun, Sweden..
    Wändell, Per
    Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med & Primary Care, Huddinge, Sweden..
    Gasevic, Danijela
    Univ Edinburgh, Usher Inst Populat Hlth Sci & Informat, Coll Med & Vet Med, Edinburgh, Midlothian, Scotland..
    Sundquist, Jan
    Lund Univ, Ctr Primary Hlth Care Res, Malmo, Sweden..
    Sundquist, Kristina
    Lund Univ, Ctr Primary Hlth Care Res, Malmo, Sweden..
    Neighborhood socioeconomic status at the age of 40 years and ischemic stroke before the age of 50 years: A nationwide cohort study from Sweden2017In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 12, no 8, p. 815-826Article in journal (Refereed)
    Abstract [en]

    Objective: We aimed to study the association between neighborhood socioeconomic status at the age of 40 years and risk of ischemic stroke before the age of 50 years.

    Methods: All individuals in Sweden were included if their 40th birthday occurred between 1998 and 2010. National registers were used to categorize neighborhood socioeconomic status into high, middle, and low and to retrieve information on incident ischemic strokes. Hazard ratios and their 95% confidence intervals were estimated.

    Results: A total of 1,153,451 adults (women 48.9%) were followed for a mean of 5.5 years (SD 3.5 years), during which 1777 (0.30%) strokes among men and 1374 (0.24%) strokes among women were recorded. After adjustment for sex, marital status, education level, immigrant status, region of residence, and neighborhood services, there was a lower risk of stroke in residents from high-socioeconomic status neighborhoods (hazard ratio 0.87, 95% confidence interval 0.78-0.96), and an increased risk of stroke in adults from low-socioeconomic status neighborhoods (hazard ratio 1.16, 95% confidence interval 1.06-1.27), compared to their counterparts living in middle-socioeconomic status neighborhoods. After further adjustment for hospital diagnoses of hypertension, diabetes, heart failure, and atrial fibrillation prior to the age of 40, the higher risk in neighborhoods with low socioeconomic status was attenuated, but remained significant (hazard ratio 1.12, 95% confidence interval 1.02-1.23).

    Conclusions: In a nationwide study of individuals between 40 and 50 years, we found that the risk of ischemic stroke differed depending on neighborhood socioeconomic status, which calls for increased efforts to prevent cardiovascular diseases in low socioeconomic status neighborhoods.

  • 4.
    Eriksson, Gunilla
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Rehabilitation Medicine. Karolinska Inst, Div Occupat Therapy, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden.
    Hellman, Therese
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Nilsson, A. O.
    Karolinska Inst, Div Occupat Therapy, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden.
    Johansson, Ulla
    Karolinska Inst, Div Occupat Therapy, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden.
    Ekbladh, E.
    Linkoping Univ, Dept Social & Welf Studies, Linkoping, Sweden.
    Bernspang, B.
    Umea Univ, Dept Community Med & Rehabil, Umea, Sweden.
    The return to work process after stroke changes over time while participating in a newly designed person-centred rehabilitation programme2018In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 13, p. 31-31Article in journal (Other academic)
  • 5.
    Eriksson, Gunilla
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Rehabilitation Medicine. Karolinska Inst, Div Occupat Therapy, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden.
    Öst Nilsson, Annika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Karolinska Inst, Div Occupat Therapy, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden;Uppsala Univ Reg Gavleborg, Ctr Res & Dev, Gavle, Sweden.
    Asaba, E.
    Karolinska Inst, Div Occupat Therapy, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden.
    Johansson, Ulla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Karolinska Inst, Div Occupat Therapy, Dept Neurobiol Care Sci & Soc, Huddinge, Sweden.
    Hellman, Therese
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Occupational and Environmental Medicine.
    Being a co-worker or a manager of a colleague returning to work after stroke: a challenge facilitated by cooperation and flexibility2018In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 13, p. 31-31Article in journal (Other academic)
  • 6. Henriksson, Karin M.
    et al.
    Farahmand, Bahman
    Åsberg, Signild
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Edvardsson, Nils
    Terént, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Comparison of cardiovascular risk factors and survival in patients with ischemic or hemorrhagic stroke2012In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 7, no 4, p. 276-281Article in journal (Refereed)
    Abstract [en]

    Background: Differences in risk factor profiles between patients with ischemic and hemorrhagic stroke may have an impact on subsequent mortality.

    Aim: To explore cardiovascular disease risk factors, including the CHADS2 score, with survival after ischemic or hemorrhagic stroke.

    Methods: Between 2001 and 2005, 87 111 (83%) ischemic stroke, 12 497 (12%) hemorrhagic stroke, and 5435 (5%) patients with unspecified stroke were identified in the Swedish Stroke Register. Data on gender, age, and cardiovascular disease risk factors were linked to the Swedish Hospital Discharge and Cause of Death Registers. Adjusted odds and hazard ratios and 95% confidence interval were calculated using logistic and Cox proportional hazard regression models.

    Results: Hemorrhagic stroke patients were younger than ischemic stroke patients. All cardiovascular disease risk factors studied, alone or combined in the CHADS2 score, were associated with higher odds ratios for ischemic stroke vs. hemorrhagic stroke. Higher CHADS2 scores and all studied risk factors except hypertension were associated with higher odds ratio for death by ischemic stroke than hemorrhagic stroke. Ischemic stroke was associated with lower early mortality (within 30 days) vs. hemorrhagic stroke (hazard ratio = 0.28, confidence interval 0.27 to 0.29).

    Conclusions: Patients with hemorrhagic stroke had a higher risk of dying within the first 30 days after stroke, but the risk of death was similar in the two groups after one-month. Hypertension was the only cardiovascular disease risk factor associated with an increased mortality rate for hemorrhagic stroke as compared to ischemic stroke.

  • 7. Hornslien, Astrid G.
    et al.
    Sandset, Else C.
    Igland, Jannicke
    Terént, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Boysen, Gudrun
    Bath, Philip M. W.
    Murray, Gordon D.
    Berge, Eivind
    Effects of candesartan in acute stroke on vascular events during long-term follow-up: results from the Scandinavian Candesartan Acute Stroke Trial (SCAST)2015In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 10, no 6, p. 830-835Article in journal (Refereed)
    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.

  • 8.
    Hägg, Mary
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Hudiksvall Hosp, Speech & Swallowing Ctr, Dept Otorhinolaryngol, Hudiksvall, Sweden.
    Tibbling, L.
    Linkoping Univ, Dept Otorhinolaryngol, Linkoping, Sweden.
    Effect of IQoro® training on impaired postural control and oropharyngeal motor function in patients with dysphagia after stroke2018In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 13, p. 60-60Article in journal (Other academic)
  • 9.
    Johnston, S. Claiborne
    et al.
    Univ Texas Austin, Dell Med Sch, 1501 Red River, Austin, TX 78712 USA.
    Amarenco, Pierre
    Hop Xavier Bichat, Dept Neurol, Paris, France.
    Denison, Hans
    AstraZeneca, Global Med Dev, Gothenburg, Sweden.
    Evans, Scott R.
    George Washington Univ, Biostat Ctr, Washington, DC USA.
    Himmelmann, Anders
    AstraZeneca, Global Med Dev, Gothenburg, Sweden.
    James, Stefan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Knutsson, Mikael
    AstraZeneca, Global Med Dev, Gothenburg, Sweden.
    Ladenvall, Per
    AstraZeneca, Global Med Dev, Gothenburg, Sweden.
    Molina, Carlos A.
    Hosp Valle De Hebron, Stroke Unit, Barcelona, Spain.
    Wang, Yongjun
    Beijing Tiantan Hosp, Dept Neurol, Beijing, Peoples R China.
    The Acute Stroke or Transient Ischemic Attack Treated with Ticagrelor and Aspirin for Prevention of Stroke and Death (THALES) trial: Rationale and design2019In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 14, no 7, p. 745-751Article in journal (Refereed)
    Abstract [en]

    Rationale

    In patients with acute cerebral ischemia, the rate of stroke, myocardial infarction, or death during 90 days was reported to be non-significantly lower with ticagrelor compared with aspirin, with no increase in major hemorrhage. Dual antiplatelet therapy may be more effective in this setting.

    Aim

    To investigate whether ticagrelor combined with aspirin are superior to aspirin alone in preventing stroke or death in patients with non-severe, non-cardioembolic ischemic stroke or high-risk transient ischemic attack.

    Design

    The Acute Stroke or Transient Ischemic Attack Treated with Ticagrelor and Aspirin for Prevention of Stroke and Death (THALES) trial is a randomized, placebo-controlled, double-blind, event-driven study. Patients will be randomized within 24 h of onset of acute ischemic symptoms. THALES is expected to randomize 13,000 at ∼450 sites worldwide, to collect 764 primary outcome events. Study treatments are ticagrelor 180 mg loading dose on day 1, then 90 mg twice daily on days 2–30, or matching placebo. All patients will also receive open-label aspirin 300–325 mg on day 1, then 75–100 mg once daily on days 2–30.

    Study outcomes

    The primary efficacy outcome is time to the composite endpoint of stroke or death through 30-day follow-up. The primary safety outcome is time to first severe bleeding event.

    Discussion

    The THALES trial will provide important information about the benefits and risks of dual antiplatelet therapy with ticagrelor and aspirin in patients with acute cerebral ischemia in a global setting (funding: AstraZeneca)

  • 10. Langhammer, B.
    et al.
    Lindmark, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Can balance, sitting, standing static or dynamic balance in persons with acute stroke be a predictor for hand/arm function 1 and 3 years poststroke?2014In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 9, no SI, p. 231-231Article in journal (Other academic)
  • 11. Langhammer, B.
    et al.
    Stanghelle, J. K.
    Lindmark, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Physiotherapy.
    Walking ability, independence and health-related quality of life2015In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 10, no S2, p. 176-176Article in journal (Other academic)
  • 12. Mead, Gillian E
    et al.
    Legg, Lynn
    Tilney, Russel
    Hsieh, Cheng Fang
    Wu, Simiao
    Lundström, E
    Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Automatic control. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Landtblom: Neurology.
    Rudberg, Ann Sofie
    Kutlubaev, Mansur
    Dennis, Martin S
    Soleimani, Babak
    Barugh, Amanda
    Hackett, Maree L
    Hankey, Graeme J
    Fluoxetine for stroke recovery: Meta-analysis of randomized controlled trials.2019In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, article id 1747493019879655Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To determine whether fluoxetine, at any dose, given within the first year after stroke to patients who did not have to have mood disorders at randomization reduced disability, dependency, neurological deficits and fatigue; improved motor function, mood, and cognition at the end of treatment and follow-up, with the same number or fewer adverse effects.

    METHODS: Searches (from 2012) in July 2018 included databases, trials registers, reference lists, and contact with experts. Co-primary outcomes were dependence and disability. Dichotomous data were synthesized using risk ratios (RR) and continuous data using standardized mean differences (SMD). Quality was appraised using Cochrane risk of bias methods. Sensitivity analyses explored influence of study quality.

    RESULTS: The searches identified 3414 references of which 499 full texts were assessed for eligibility. Six new completed RCTs (n = 3710) were eligible, and were added to the seven trials identified in a 2012 Cochrane review (total: 13 trials, n = 4145). There was no difference in the proportion independent (3 trials, n = 3249, 36.6% fluoxetine vs. 36.7% control; RR 1.00, 95% confidence interval 0.91 to 1.09, p = 0.99, I2 = 78%) nor in disability (7 trials n = 3404, SMD 0.05, -0.02 to 0.12 p = 0.15, I2 = 81%) at end of treatment. Fluoxetine was associated with better neurological scores and less depression. Among the four (n = 3283) high-quality RCTs, the only difference between groups was lower depression scores with fluoxetine.

    CONCLUSION: This class I evidence demonstrates that fluoxetine does not reduce disability and dependency after stroke but improves depression.

  • 13.
    Oldgren, Jonas
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Friberg, L.
    Karolinska Inst, Dept Clin Sci, Danderyd Hosp, Stockholm, Sweden..
    Efficacy And Safety Of Non-Vitamin K Oral Anticoagulants (NOAC) Compared With Warfarin At Its Best In Patients With Atrial Fibrillation2016In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 11, no SUPP 3, p. 46-46Article in journal (Refereed)
  • 14. Pennlert, J.
    et al.
    Asplund, K.
    Carlberg, B.
    Wiklund, P. G.
    Wisten, A.
    Asberg, Signild
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Eriksson, M.
    Antithrombotic treatment following intracerebral hemorrhage in patients with and without atrial fibrillation. A nationwide study based on Riksstroke2015In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 10, p. 294-295Article in journal (Other academic)
  • 15. Willeit, P.
    et al.
    Thompson, S. G.
    Agewall, S.
    Bergstrom, G.
    Bickel, H.
    Catapano, A. L.
    Chien, K. L.
    de Groot, E.
    Empana, J. P.
    Etgen, T.
    Franco, O. H.
    Iglseder, B.
    Johnsen, S. H.
    Kavousi, M.
    Lind, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Liu, J.
    Mathiesen, E. B.
    Norata, G. D.
    Olsen, M. H.
    Papagianni, A.
    Poppert, H.
    Price, J. F.
    Sacco, R. L.
    Yanez, D. N.
    Zhao, D.
    Schminke, U.
    Buelbuel, A.
    Polak, J. F.
    Sitzer, M.
    Hofman, A.
    Grigore, L.
    Doerr, M.
    Su, T. C.
    Ducimetiere, P.
    Xie, W.
    Ronkainen, K.
    Kiechl, S.
    Rundek, T.
    Robertson, C.
    Fagerberg, B.
    Bokemark, L.
    Steinmetz, H.
    Ikram, M. A.
    Voelzke, H.
    Lin, H. J.
    Plichart, M.
    Tuomainen, T. P.
    Desvarieux, M.
    McLachlan, S.
    Schmidt, C.
    Kauhanen, J.
    Willeit, J.
    Lorenz, M. W.
    Sander, D.
    Inflammatory markers and extent and progression of early atherosclerosis: Pooled analysis of individual participant data from 20 prospective studies of the PROG-IMT collaboration2014In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 9, p. 27-27Article in journal (Other academic)
  • 16.
    Åsberg, Signild
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiovascular epidemiology.
    Eriksson, Marie
    Umea Univ, Dept Stat, USBE, S-90187 Umea, Sweden..
    Statin therapy and the risk of intracerebral haemorrhage: a nationwide observational study2015In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 10, p. 46-49Article in journal (Refereed)
    Abstract [en]

    BackgroundThe association between statin therapy and intracerebral haemorrhage is still unclear. The aim was to investigate whether prior use of statin was associated with risk of intracerebral haemorrhage. MethodsBetween 2006 and 2009, we identified 7696 cases of intracerebral haemorrhage that were first-ever strokes in the Swedish Stroke Register and 14670 stroke-free controls that were matched on age and gender in the Population Register. Drug therapy at the time of intracerebral haemorrhage was extracted from the Drug Prescription Register. The risk of intracerebral haemorrhage with statins was estimated by conditional logistic regression. ResultsIn cases and controls, the median age was 73 years and 53% were men. Intracerebral haemorrhage cases had higher prevalence of antithrombotic therapy, hypertension, and diabetes than controls. Statins were used by 1276 (166%) of the intracerebral haemorrhage cases and by 2552 (174%) of the controls. The crude odds ratios of intracerebral haemorrhage did not differ significantly between patients with and without statins, but after adjustment for antithrombotic therapy, hypertension, and diabetes, patients with statins had a decreased risk of intracerebral haemorrhage (odds ratio=068, 95% confidence interval, 063-074). The highest proportion (>20%) of antecedent statins was seen in the 70-84 age group, for both cases and controls. ConclusionsIn this matched case-controlled study, statin therapy was associated with a decreased risk of incident intracerebral haemorrhage. Future studies on risk of stroke with statin therapy after intracerebral haemorrhage are needed.

  • 17.
    Åsberg, Signild
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Eriksson, Marie
    Umeå University, Department of Statistics.
    Henriksson, Karin Maria
    Lund University, Department of Laboratory Medicine.
    Terént, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Reduced Risk of Death with Warfarin: Results of an Observational Nationwide Study of 20 442 Patients with Atrial Fibrillation and Ischemic Stroke2013In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 8, no 8, p. 689-695Article in journal (Refereed)
    Abstract [en]

    Background

    Warfarin is demonstrated to be superior in efficacy over antiplatelet agents (AP) for the prevention of stroke, but the relationship between warfarin and mortality is less clear. Our aim was to investigate this relationship in a large cohort of unselected patients with atrial fibrillation and ischemic stroke.

    Methods

    This observational study was based on patients who were discharged alive and registered in the Swedish Stroke Register in 2001 through 2005. Vital status was retrieved by linkage to the Swedish Cause of Death Register. We calculated a propensity score for the likelihood of warfarin prescription at discharge from hospital. The risk of death and 95% confidence intervals (CI) were estimated in Cox regression models.

    Results

    Out of the 20 442 patients with atrial fibrillation and ischemic stroke (mean age=79.5 years), 31% (n=6399) were prescribed warfarin. After adjustment for the propensity score, warfarin was associated with a reduced risk of death (0.67; 95% CI, 0.63-0.71). The crude rate (per 100 person-years) of fatal non-hemorrhagic stroke was lower in patients who received warfarin (1.60; 95% CI, 1.34-1.89) compared to those who received AP (6.83; 95% CI, 6.42-7.25). The rates (per 100 person-years) of fatal hemorrhagic stroke were 0.21 (95% CI, 0.12-0.32) and 0.43 (95% CI, 0.34-0.55) in patients prescribed warfarin and AP therapy, respectively.

    Conclusions

    In addition to its established benefit for stroke prevention, warfarin therapy in patients with atrial fibrillation and ischemic stroke was associated with a reduced risk of death, without an increased risk of fatal hemorrhagic stroke.

  • 18.
    Åsberg, Signild
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Henriksson, Karin M
    Lund University, Department of Laboratory Medicine.
    Farahmand, Bahman
    Karolinska Institutet, Institute of Enviromental Medicine.
    Terént, Andreas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Hemorrhages After Ischemic Stroke: Relation to Age and Previous Hemorrhages in a Nationwide Cohort of 58 868 Patients2013In: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 8, no 2, p. 80-86Article in journal (Refereed)
    Abstract [en]

    Background:

    In randomized controlled trials of secondary prevention after stroke, the risk of hemorrhage varies between 1% and 5% per year in patients with antithrombotic therapy, i.e. anticoagulants and antiplatelets.

    Aim:

    To explore the rate and the risk of hemorrhage after stroke in a nationwide cohort.

    Methods:

    We identified 58 868 first-ever ischemic stroke patients in the Swedish Stroke Register during 2001 to 2005 (=index stroke) and followed them by record linkage to the National Patient Register. Rates of hemorrhage and hazard ratios, for comparisons of rates between subgroups, were calculated.

    Results:

    Of the 58 586 ischemic stroke patients identified, 5527 (9.4%) had a history of hemorrhage. During follow-up (mean 2.0 years), 2876 patients endured a hemorrhage, giving an average hemorrhage rate of 2.6 (95% confidence interval 2.5-2.7) per 100 person-years. After index stroke, 11% of the patients were discharged with anticoagulants, and 79% with antiplatelets. Given the differences in baseline characteristics, the hemorrhage rates (per 100 person-years) were 2.5 (95% confidence interval 2.2-2.8), 2.4 (95% confidence interval 2.3-2.5), and 3.8 (95% confidence interval 3.5-4.2) in patients prescribed anticoagulants, antiplatelets, and no antithrombotics, respectively. There was an increased risk of hemorrhage in patients ≥75 years compared to those <75 years (hazard ratio = 1.61, 95% CI 1.49-1.73), and in patients with previous hemorrhages compared to those without (hazard ratio = 1.82, 95% confidence interval 1.64-2.02).

    Conclusions:

    When antithrombotics were used in large-scale clinical practice, the observed rates of hemorrhage were similar with anticoagulant therapy but increased with antiplatelet therapy, compared to rates reported in randomized controlled trials. Old age and previous hemorrhage were associated with an increased risk of hemorrhage after an ischemic stroke.

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