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Latest & greatest articles for stroke
The Trip Database is a leading resource to help health professionals find trustworthy answers to their clinical questions. Users can access the latest research evidence and guidance to answer their clinical questions. We have a large collection of systematic reviews, clinical guidelines, regulatory guidance, clinical trials and many other forms of evidence. If you wanted the latest trusted evidence on stroke or other clinical topics then use Trip today.
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Pre-screening of sleep-disordered breathing after stroke: A systematic review. Sleep-Disordered Breathing (SDB) is frequent in stroke patients. Polysomnography (PSG) and cardiorespiratory polygraphy are used to confirm SDB, but the need for PSG exceeds the available resources for systematic testing. Therefore, a simple and robust pre-screening instrument is necessary to identify the patients with an urgent need for a targeted PSG. The aim of this systematic review was to identify and evaluate (...) the available methods to pre-screen stroke patients possibly suffering from SDB.Eleven studies out of 3,561 studies met the inclusion criteria. The selected studies assessed the efficiency of seven instruments based on the data acquired clinically or by inquiries (Berlin Questionnaire, Epworth Sleepiness Scale, SOS, Modified Sleep Apnea Scale of the Sleep Disorders Questionnaire, STOP-BANG, Four-variable Screening Tool and Multivariate Apnea Index) and three physiological measures (capnography, nocturia
population-based stroke incidence studies (1996-2014), forming part of INSTRUCT (International Stroke Outcomes Study). Information on sociodemographics, stroke-related clinical factors, comorbidities, and pre-stroke function were obtained. Within each study, relative risk regression using log-binominal modeling was used to estimate the female:male relative risk ( RR ) of more severe stroke (National Institutes of Health Stroke Scale>7) stratified by stroke type (ischemicstroke and intracerebral (...) hemorrhage). Study-specific unadjusted and adjusted RR s, controlling for confounding variables, were pooled using random-effects meta-analysis. National Institutes of Health Stroke Scale data were recorded in 5326 (96%) of 5570 cases with ischemicstroke and 773 (90%) of 855 participants with intracerebral hemorrhage. The pooled unadjusted female:male RR for severe ischemicstroke was 1.35 (95% CI 1.24-1.46). The sex difference in severity was attenuated after adjustment for age, pre-stroke dependency
of stroke, especially ischemicinfarction. (...) Association between red cell distribution width level and risk of stroke: A systematic review and meta-analysis of prospective studies. Red cell distribution width level may have relations with the incidence and prognosis of cerebrovascular diseases. Recent researches have reported that red cell distribution width level was linked to the occurrence of stroke. However, the predicted effect of red cell distribution width in stroke is still disputed. We sought to assess the relationship between
Association Between Atrial Fibrillation and Cognitive Impairment in Individuals With Prior Stroke: A Meta-Analysis and Meta-Regression Analysis. Background and Purpose- Atrial fibrillation (AF) is the most common chronic arrhythmia. Dementia and cognitive impairment (CI) are major burdens to public health. The prevalence of all 3 entities is projected to increase due to population aging. Previous reports have linked AF with a higher risk of CI and dementia in patients without prior stroke (...) . Stroke is known to increase the risk for dementia and CI. It is unclear if AF in patients with history of stroke can further increase the risk for dementia or CI. Our purpose was to evaluate the impact of AF on risk for dementia or CI among patients with history of stroke. Methods- Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines were followed. Pubmed, Scopus, and Cochrane central were searched. The outcomes of interest were dementia, CI, and the composite end point
Neutrophil-to-lymphocyte ratio predicts hemorrhagic transformation in ischemicstroke: A meta-analysis. The neutrophil-to-lymphocyte ratio (NLR) has been shown to be a marker associated with inflammation and is independently associated with the adverse clinical outcomes of symptomatic intracranial hemorrhage, cancer, and cardiovascular disease. Hemorrhagic transformation (HT) is a serious complication of ischemiccerebralinfarction and can be intensified by therapeutic interventions for acute (...) ischemicstroke (AIS). The purpose of our research was to explore the predictive effect of NLR for HT in patients with AIS and to determine the best predictive value.PubMed, Web of Science, EMBASE, MEDLINE, Cochrane, and Google Scholar were searched. The primary endpoint was HT, and subgroup analysis was performed. Review Manager software version 5.3 was used to statistically analyze the outcomes.A total of seven studies including 3,726 patients met the inclusion criteria. The pooled odds ratio
in the colchicine group compared with placebo arm (OR, .33; 95%CI, .15-.70; 6 studies evaluated). We did not find a significant reduction in the incidence of myocardial infarction, cardiovascular mortality or all-cause mortality.Our data suggest that in a population with high cardiovascular risk, the use of colchicine results in significant reduction on stroke risk. Colchicine is an accessible drug that could be successfully utilized for the prevention of atherosclerotic cerebrovascular disease (...) Role of Colchicine in Stroke Prevention: An Updated Meta-Analysis. Colchicine is a microtubule inhibitor with anti-inflammatory properties. As the body and quality of evidence regarding the efficacy of colchicine for cardiovascular prevention is controversial, the aims of this study was to evaluate the effect of colchicine therapy on vascular events.A meta-analysis was performed of randomized controlled clinical trials of colchicine on high cardiovascular risk populations, reporting data from
Migraine, low-dose combined hormonal contraceptives, and ischemicstroke in young women: a systematic review and suggestions for future research. Introduction: Migraine and combined hormonal contraceptives (CHCs) increase the risk of ischemicstroke in young women; however, the contribution of low-dose (<50 μg ethinylestradiol) CHCs to the risk of ischemicstroke in young women with migraine is not well defined.Areas covered: The authors performed a systematic review of observational studies (...) indexed in PubMed and Scopus from inception to 22 May 2019, reporting the effect sizes of ischemicstroke in women with migraine using low-dose CHCs compared with those without migraine not using CHCs. All the four included case-control studies, including a total of 12,256 women, reported increased odds of ischemicstroke in women with migraine and low-dose CHC use compared with those without migraine not using CHCs. A meta-analysis was not feasible due to significant heterogeneity.Expert opinion
= 1.68, 1.33-2.14; p < 0.001).Even after extensive adjustment for hypertension, proteinuria is strongly and independently associated with incident stroke risk, possibly indicating a shared renal and cerebral susceptibility to vascular injury that is not fully explained by traditional vascular risk factors. (...) Proteinuria as an independent predictor of stroke: Systematic review and meta-analysis. Proteinuria has emerged as an important vascular risk factor for adverse cardiovascular events including stroke. Hypertension has been proposed as the principal confounder of this relationship but its role has not been systematically examined.We aimed to determine if proteinuria remains an independent predictor of stroke after more complete adjustment for blood pressure.We performed a systematic review
Effectiveness of Hydrotherapy on Balance and Paretic Knee Strength in Patients With Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. The aim of the study was to compare the effects of hydrotherapy and land-based conventional therapy on postural balance and knee strength in stroke patients.A comprehensive search was done via databases (PubMed, EMBASE, and Web of Science) until April 12, 2019, to select randomized controlled trials. The methodological quality (...) was assessed by the PEDro scale. Berg Balance Scale was pooled as the primary outcome and Forward Reach Test, Timed Up and Go test, and paretic knee flexor and knee extensor torque as secondary outcomes.Eleven articles were included. Pooled results showed that hydrotherapy was more beneficial in stroke patients on Berg Balance Scale (mean difference = 1.60, 95% confidence interval = 1.00 to 2.19), Forward Reach Test (mean difference = 1.78, 95% confidence interval = 0.73 to 2.83), Timed Up and Go test
Early Versus Delayed Stroke After Cardiac Surgery: A Systematic Review and Meta-Analysis. Background Although it is traditionally regarded as a single entity, perioperative stroke comprises 2 separate phenomena (early/intraoperative and delayed/postoperative stroke). We aimed to systematically evaluate incidence, risk factors, and clinical outcome of early and delayed stroke after cardiac surgery. Methods and Results A systematic review ( MEDLINE , EMBASE , Cochrane Library) was performed (...) to identify all articles reporting early (on awakening from anesthesia) and delayed (after normal awakening from anesthesia) stroke after cardiac surgery. End points were pooled event rates of stroke and operative mortality and incident rate of late mortality. Thirty-six articles were included (174 969 patients). The pooled event rate for early stroke was 0.98% (95% CI 0.79% to 1.23%) and was 0.93% for delayed stoke (95% CI 0.77% to 1.11%; P=0.68). The pooled event rate of operative mortality was 28.8
Meta-analysis of the Smoker's Paradox in Acute IschemicStroke Patients Receiving Intravenous Thrombolysis or Endovascular Treatment. The existence of the smoker's paradox is controversial and potential mechanisms have not been explained. We aimed to explore the association between cigarette smoking and functional outcome at 3 months in patients with acute ischemicstroke who were treated with intravenous thrombolysis (IVT) or endovascular treatment (EVT).This meta-analysis was conducted (...) between smoking and good functional outcome following IVT lost statistical significance (OR 1.14 [95% CI: 0.81-1.59]).Our meta-analysis suggested that smoking was not associated with good functional outcome (mRS ≤ 2) at 3 months in patients with acute ischemicstroke who were treated with intravenous thrombolysis.The existence of the smoker's paradox is controversial. A previous letter by Plas et al. published in 2013 reported a positive result for the association between smoking and good functional
Aspirin for primary prevention of stroke in individuals without cardiovascular disease-A meta-analysis. The benefits of aspirin for primary prevention of stroke are uncertain.We performed a cumulative meta-analysis of trials investigating aspirin for primary prevention of cardiovascular disease with a focus on stroke. We assessed the effects of aspirin on non-fatal stroke, hemorrhagic stroke, non-fatal myocardial infarction, all-cause mortality, cardiovascular mortality, major gastrointestinal (...) bleeding, and an analysis of net clinical effect, in populations without a history of clinical or subclinical cardiovascular disease.Among 11 trials (157,054 participants), aspirin was not associated with a statistically significant reduction in non-fatal stroke (odds ratio, 0.94; 95% CI, 0.85 to 1.04) but was associated with an increased risk of hemorrhagic stroke (odds ratio, 1.29; 95% CI, 1.06 to 1.56). Aspirin was not associated with a statistically significant reduction in all-cause mortality
Association between K469E polymorphism of ICAM-1 gene and susceptibility of ischemicstroke: An updated meta-analysis. The intercellular adhesion molecule-1 (ICAM-1)/leukocyte function associated antigen-1 (LFA-1) adhesion system regulates leukocyte interactions, migration, and adhesion, and appears to play an important role in atherosclerosis and thrombosis. Therefore, single nucleotide polymorphisms (SNPs) of the ICAM-1 gene may strongly influence the expression and biological activity (...) of ICAM-1 and play a potentially important role in the pathogenesis of ischemicstroke. In the current meta-analysis, we investigated the relationship between the ICAM-1 gene K469E SNP and the risk of ischemic stroke.Two investigators independently searched PubMed, Web of Science, Google Scholar, WANFANG, China National Knowledge Infrastructure (CNKI) and J-STAGE for studies published from January 2000 to February 2019 without language restriction. The association of K469E polymorphism and ischemic
. We performed a random-effects meta-analysis using mean difference. Nine studies with a total of 3773 ischemicstroke patients were included into the meta-analysis. Our results showed that patients with ischemicstroke had significantly higher serum cystatin C concentrations compared with the participants without ischemicstroke (pooled mean difference, 0.11; 95% confidence interval (CI), 0.00-0.22; P = 0.04), in particular acute ischemicstroke and subclinical cerebralinfarction (mean difference (...) , 0.23; 95% CI, 0.11-0.36; P = 0.0003 and mean difference, 0.07; 95% CI, 0.05-0.09; P < 0.00001, respectively). Cystatin C was associated with ischemicstroke, and it could be considered a predictor for the risk of ischemicstroke, especially in acute ischemicstroke and subclinical cerebralinfarction.
Computational Image Analysis of Nonenhanced Computed Tomography for Acute IschaemicStroke: A Systematic Review. Noncontrast enhanced computed tomography (NCCT) remains the most common method for brain imaging patients who present acutely with ischaemicstroke. Computational methods may improve NCCT analysis in this context. We systematically reviewed current research.We searched 7 medical and computer engineering databases for studies testing computational methods for analysing NCCT in acute (...) ischaemicstroke. Two independent reviewers extracted the following data; computational method, imaging features investigated, test dataset, ground truth comparison, and performance. We critically evaluated studies for risk of bias and applicability using the Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2).From 11,235 nonduplicated articles, we full-text reviewed 200 and selected 68 for inclusion. We identified three dominant study types testing a large range of computational methods
The Short-term and Long-term Safety and Efficacy of Treatment of Acute IschemicStroke with Low Molecular Weight Heparin: A Meta-analysis of 19 randomized controlled trials. Currently, it remains controversial about the guidelines for the application of low molecular weight heparin (LMWH) in patients with acute ischemicstroke (AIS). Therefore, this meta-analysis was carried out aiming to systematically investigate the short-term and long-term safety and efficacy of LMWH in AIS patients.Three (...) electronic databases, including Pubmed, Embase database, and Cochrane library, were comprehensively retrieved by two investigators independently. Finally, a total of 19 randomized controlled trials (RCTs) were enrolled for analysis. The safety endpoints in this study included all-cause mortality, risk of bleeding (major, minor or cerebral hemorrhage), and the efficacy endpoints were the prevention of deep vein thrombosis (DVT)and recurrent stroke.The application of LMWH led to a decreased risk of DVT
Synergistic Effect of Combined Mirror Therapy on Upper Extremity in Patients With Stroke: A Systematic Review and Meta-Analysis. Background: There is an increasing trend for researchers to combine mirror therapy with another rehabilitation therapy when treating the upper extremity of patients with stroke. Objective: To evaluate the synergistic effect of combined mirror therapy (MT) on the upper extremity in patients with stroke and to judge efficacies of four combined mirror therapy subgroups (...) performed using the Cochrane Handbook criteria in order to accurately review interventions. The primary outcomes were measured by the Fugl-Meyer Assessment-upper extremity (FMA-UE). Results: Ten trials, with a total of 444 patients whose upper limb functions were damaged after stroke, were included in the meta-analysis. Compared with the control group, a remarkable effect of combined mirror therapy [all: weight mean difference in random effects model (WMD): 8.07, 95% confidence interval (CI) 5.87, 10.26
Etiologic Workup in Cases of Cryptogenic Stroke: A Systematic Review of International Clinical Practice Guidelines. Background and Purpose- Identifying the etiology of acute ischemicstroke is essential for effective secondary prevention. However, in at least one third of ischemicstrokes, existing investigative protocols fail to determine the underlying cause. Establishing etiology is complicated by variation in clinical practice, often reflecting preferences of treating clinicians (...) and variable availability of investigative techniques. In this review, we systematically assess the extent to which there exists consensus, disagreement, and gaps in clinical practice recommendations on etiologic workup in acute ischemicstroke. Methods- We identified clinical practice guidelines/consensus statements through searches of 4 electronic databases and hand-searching of websites/reference lists. Two reviewers independently assessed reports for eligibility. We extracted data on report
Efficacy and Safety of Thrombolytic Therapy for Stroke with Unknown Time of Onset: A Meta-Analysis of Observational Studies. Recombinant tissue plasminogen activator (rt-PA) is one of the most effective therapies available for patients with known-onset stroke (KOS). Whether rt-PA treatment would improve functional outcomes in patients with stroke with unknown time of onset (UTOS) is undetermined, we aimed to systematically assess the efficacy and safety of thrombolysis for UTOS patients (...) with 2581 patients meeting the inclusion criteria were included in the meta-analysis. All the patients had an ischemic lesion that was assessed by imaging including computed tomography or magnetic resonance imaging. Among these studies, 6 compared the thrombolytic efficacy in thrombolyzed UTOS patients with that in nonthrombolyzed UTOS patients (mRS 0-2: odds ratio [OR] =1.76, 95% confidence interval [CI] 1.11-2.81, P = .02), and 8 studies compared thrombolyzed UTOS patients with thrombolyzed KOS