novel secondary preventative strategies in the management of ischaemic stroke and transient ischaemic attack

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novel secondary preventative strategies in the management of ischaemic stroke and transient ischaemic attack

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Glasgow Theses Service http://theses.gla.ac.uk/ theses@gla.ac.uk Higgins, Peter (2014) Novel secondary preventative strategies in the management of ischaemic stroke and transient ischaemic attack. MD thesis http://theses.gla.ac.uk/5152/ Copyright and moral rights for this thesis are retained by the author A copy can be downloaded for personal non-commercial research or study, without prior permission or charge This thesis cannot be reproduced or quoted extensively from without first obtaining permission in writing from the Author The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the Author When referring to this work, full bibliographic details including the author, title, awarding institution and date of the thesis must be given ! ! ! ! ! ! ! "#$%&!'%(#)*+,-!.,%$%)/+/0$% !'/,+/%10%'!0)! /2%!3+)+1%3%)/!#4!0'(2+%30(!'/, #5%!+)*! /,+)'0%)/!0'(2+%30(!+//+(5! ! 6%/%,!70110)'!! 89:29;!9<(!=7#)'>;!8?:6!=@A>!! ! 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[...]...   The   incidence   of   stroke   remains   high   in   the   UK   13     In   England,   stroke   incidence   was   reported   as  178 and  139,  for  males and  females  respectively,  per  100,000 in  2007  17    There  is  regional   variation   within   the   UK,   with   higher   incidence   in   Scotland   at   208   and   159   cases   per             100,000  18     Based  on the  incidence...  8, 9     Whilst  age-­‐specific  incidence of stroke  may  have  fallen, the  elderly  population  has  increased   in  size in  recent  years and  is  anticipated  to  continue  to  do  so  10    As the  incidence of stroke  is   highest   in   the   elderly   population,   the   absolute   number   of   stroke   hospital   admissions   has   increased in  recent  years  11-­‐13      ... witnessed   a   rise   in   stroke   incidence   in   younger   age   groups     In   a   combined  analysis of the  Greater  Cincinnati  &  Northern  Kentucky  populations, the  age  at  first   stroke  fell  by  two  years  between  1993-­‐94 and  1999  –  2005 and  events in the  population  aged   under  55  years  comprised  almost  one  fifth of  all  cases in the  latter  time  period... variation   in   stroke   incidence   was   observed   20   years   ago   ,   with   the   highest   15 rates  observed in the  developed  world    Subsequently, the  effects of  globalisation  have  given   rise  to  increased  age-­‐specific  incidence of stroke in  developing  countries in  recent  decades,   with  approximately  70% of  global stroke  deaths  now  occuring in  developing  countries... of  AF    51   2.5.3  Risk  according  to  AF  burden    52   2.6  Addressing the  risk of  recurrent stroke in  patients  with  AF    54   2.7 The  prevalence of  AF in  patients  presenting  with ischaemic stroke  &  TIA    57   2.8 The  prevalence of  paroxysmal  AF in ischaemic stroke  &  TIA  patients    58     xviii   2.9 The  relevance of. .. recurrent   events   each   year,   comprising   one   quarter of  all  annual  stokes  18, 19     Due  to the  simultaneous  expansion of the  elderly  population,  increasing  incidence in  younger   age  groups and in the  developing  world, the  global  burden of stroke  is  anticipated  to  rise in   the  coming  decades    By  2030,  7.8  million stroke- ­‐attributable  deaths  are  anticipated...  thromboembolism and  cardiac  complications  27, 28       Accordingly, management of  patients  with  acute stroke  is  based  on  attempting  to  limit the   extent   of   initial   neurological   injury   and   providing   supportive   physiological   monitoring   and   therapy   to   reduce   the   risk   of   complications   28     Management   seamlessly   proceeds   to   assessment  for  underlying...  that  is   IHD: Ischaemic  heart  disease   IL:  Interleukin   IMP:  Inosine  monophoshate   IMS:  Interventional Management of Stroke   IRAS:  Insulin  Resistance  Atherosclerosis  Study   ISRCTN:  I nternational  Standard  Randomised  Controlled  Trial  Number  Register   IST:  International stroke  trial   IV:  Intravenous   KS:  Karen  Shields   L:  Litre   LAA:  Large  artery  atherosclerosis...  embolism   SEM:  Standard  error of the  mean   SIGN:  Scottish  Intercollegiate  Guidelines  Network   SITS-­‐ISTR:  Safe  Implementation of  Treatments in Stroke  International Stroke  Thrombolysis  Register   SITS-­‐MOST:  Safe  Implementation of  Treatments in Stroke  Monitoring  Study   SP:  Standard  practice   SP-­‐AM:  Standard  practice  with  additional  monitoring   SPARCL: Stroke  Prevention...   in   2005   and   the   number   of   disability-­‐adjusted   life   years   lost   to   stroke  is  expected  increase  from  50.8  million  to  60.9  million  16         1.1.2 Mortality   Stroke   has   risen   to   hold   status   as   the   2nd   leading   single   cause   of   adult   mortality   globally   3,   reflecting   high   incidence   in   the   developed   world,   increasing   incidence . Glasgow Theses Service http://theses.gla.ac.uk/ theses@gla.ac.uk Higgins, Peter (2014) Novel secondary preventative strategies in the management of ischaemic stroke and transient ischaemic. medium without the formal permission of the Author When referring to this work, full bibliographic details including the author, title, awarding institution and date of the thesis must be. This thesis cannot be reproduced or quoted extensively from without first obtaining permission in writing from the Author The content must not be changed in any way or sold commercially in

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