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  1. Article ; Online: Hypercoagulability State in Predicting Severe Functional Outcome in Patients with Acute Ischemic Stroke: Cause, Consequence, or Both?

    Paciaroni, Maurizio

    Thrombosis and haemostasis

    2023  Volume 123, Issue 12, Page(s) 1187–1189

    MeSH term(s) Humans ; Ischemic Stroke/diagnosis ; Ischemic Stroke/etiology ; Stroke/etiology ; Thrombophilia/complications ; Brain Ischemia
    Language English
    Publishing date 2023-07-10
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 518294-3
    ISSN 2567-689X ; 0340-6245
    ISSN (online) 2567-689X
    ISSN 0340-6245
    DOI 10.1055/s-0043-1771029
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Endovascular therapy for basilar occlusion: Is there robust evidence?

    Paciaroni, Maurizio

    European journal of internal medicine

    2023  Volume 110, Page(s) 19–20

    MeSH term(s) Humans ; Treatment Outcome ; Vascular Diseases ; Endovascular Procedures
    Language English
    Publishing date 2023-02-06
    Publishing country Netherlands
    Document type Journal Article ; Comment
    ZDB-ID 1038679-8
    ISSN 1879-0828 ; 0953-6205
    ISSN (online) 1879-0828
    ISSN 0953-6205
    DOI 10.1016/j.ejim.2023.01.027
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  3. Article: Hypercoagulability State in Predicting Severe Functional Outcome in Patients with Acute Ischemic Stroke: Cause, Consequence, or Both?

    Paciaroni, Maurizio

    Thrombosis and Haemostasis

    2023  Volume 123, Issue 12, Page(s) 1187–1189

    Language English
    Publishing date 2023-07-10
    Publisher Georg Thieme Verlag KG
    Publishing place Stuttgart ; New York
    Document type Article
    ZDB-ID 518294-3
    ISSN 2567-689X ; 0340-6245
    ISSN (online) 2567-689X
    ISSN 0340-6245
    DOI 10.1055/s-0043-1771029
    Database Thieme publisher's database

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  4. Article ; Online: Comparative study of venous thromboembolic prophylaxis strategies in hemorrhagic stroke: A systematic review and network meta-analysis.

    Maraziti, Giorgio / Mosconi, Maria Giulia / Paciaroni, Maurizio

    International journal of stroke : official journal of the International Stroke Society

    2024  , Page(s) 17474930241248542

    Abstract: Background: Venous thromboembolic events, including deep vein thrombosis (DVT) and pulmonary embolism (PE), are frequent complications in patients with intracerebral hemorrhage (ICH). Various prophylactic strategies have been employed to mitigate this ... ...

    Abstract Background: Venous thromboembolic events, including deep vein thrombosis (DVT) and pulmonary embolism (PE), are frequent complications in patients with intracerebral hemorrhage (ICH). Various prophylactic strategies have been employed to mitigate this risk, such as heparin, intermittent pneumatic compression (IPC), and graduated compression stockings (GCS). The optimal thromboembolic prophylaxis approach remains uncertain due to the lack of randomized controlled trials (RCTs) comparing all interventions.
    Aims: We conducted a network meta-analysis and meta-analysis to systematically review and synthesize evidence from RCTs and non-randomized studies on the efficacy and safety of thromboembolic prophylaxis strategies in hospitalized ICH patients.
    Summary of findings: Our study followed a registered protocol (PROSPERO CRD42023489217) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines incorporating the extension for network meta-analyses. Search for eligible studies was performed up to December 2023. We considered the occurrence of DVT, PE, hematoma expansion (HE), and all-cause mortality as outcome measures. A total of 16 studies, including 7 RCTs and 9 non-randomized studies, were included in the analysis. Network meta-analysis revealed that IPC demonstrated the highest efficacy in reducing DVT incidence (odds ratios (OR) 0.30, 95% confidence interval (CI) 0.08-1.16), particularly considering only RCTs (OR 0.33, 95% CI 0.16-0.67). GCS showed the highest safety profile for HE (OR 0.67, 95% CI 0.14-3.13), but without efficacy. Chemoprophylaxis did not reduce the risk of PE events (OR 1.10, 95% CI 0.17-7.19) with a higher occurrence of HE (OR 1.33, 95% CI 0.60-2.96), but the differences were not significant.
    Conclusion: Our study supports the use of IPC as the primary thromboembolic prophylaxis measure in ICH patients. Further research, including head-to-head RCTs, is needed to strengthen the evidence base and optimize clinical decision-making for thromboembolic prophylaxis in this vulnerable patient population.
    Language English
    Publishing date 2024-04-24
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2303728-3
    ISSN 1747-4949 ; 1747-4930
    ISSN (online) 1747-4949
    ISSN 1747-4930
    DOI 10.1177/17474930241248542
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Treatments in Ischemic Stroke: Current and Future.

    Mosconi, Maria Giulia / Paciaroni, Maurizio

    European neurology

    2022  Volume 85, Issue 5, Page(s) 349–366

    Abstract: Background and aim: Despite progress made over the last 30 years, stroke is still a leading cause of disability and mortality; likewise, its burden is expected to increase over the next decades, due to population growth and aging. The development of ... ...

    Abstract Background and aim: Despite progress made over the last 30 years, stroke is still a leading cause of disability and mortality; likewise, its burden is expected to increase over the next decades, due to population growth and aging. The development of drugs with better safety-efficacy profiles as well as strategies able to improve ischemic stroke management from the pre-hospital setting is needed.
    Summary: The pathophysiology of ischemic stroke involves multiple pathways resulting in cerebral artery obstruction and brain tissue ischemia. To date, the only approved drug for acute ischemic stroke is intravenous thrombolytic alteplase. Intravenous thrombolysis (IVT) can be administered alone or in combination with endovascular treatment (EVT) with mechanical thrombectomy, in case of large vessel occlusion and generally within 6 h from symptoms onset. The risk of potential bleeding complications, especially symptomatic intracerebral hemorrhage, is one of the reasons for the reluctance to administer IVT. Tenecteplase is a promising alternative fibrinolytic agent, having a better safety profile than alteplase. Moreover, recent evidences have allowed an extension of the IVT ± EVT time window for patients with unknown onset time and for those with a known onset time thanks to the new "tissue-window" approach guided by advanced neuroimaging techniques, which also helps in collateral circulation estimation. Regarding primary-secondary prevention, researchers are focused on improving the efficacy of antithrombotic drugs with a "hemostasis-sparing" approach. Neuroprotective agents are also under development, particularly stem cells. The COVID-19 pandemic has critically stressed global healthcare systems, with collateral damage resulting in access delivery of only emergency care, such as ischemic stroke. Regarding telemedicine, it has had a minor role in acute stroke management, and with the onset of COVID-19, this role will most likely be adopted to increase access and delivery in stroke assessment, but also in the follow-up.
    MeSH term(s) Brain Ischemia/complications ; Brain Ischemia/drug therapy ; COVID-19/complications ; Endovascular Procedures/methods ; Fibrinolytic Agents/therapeutic use ; Humans ; Ischemic Stroke ; Neuroprotective Agents/therapeutic use ; Pandemics ; Stroke/diagnosis ; Stroke/drug therapy ; Tenecteplase/therapeutic use ; Thrombectomy/methods ; Thrombolytic Therapy ; Tissue Plasminogen Activator/therapeutic use ; Treatment Outcome
    Chemical Substances Fibrinolytic Agents ; Neuroprotective Agents ; Tissue Plasminogen Activator (EC 3.4.21.68) ; Tenecteplase (WGD229O42W)
    Language English
    Publishing date 2022-08-02
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 209426-5
    ISSN 1421-9913 ; 0014-3022
    ISSN (online) 1421-9913
    ISSN 0014-3022
    DOI 10.1159/000525822
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 575: Show issues Location:
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  6. Article ; Online: Systemic thrombolysis in patients with acute stroke and active cancer: a systematic review and meta-analysis.

    Mosconi, Maria Giulia / Capponi, Andrea / Paciaroni, Maurizio

    Internal and emergency medicine

    2023  Volume 18, Issue 6, Page(s) 1843–1850

    Abstract: Cancer patients frequently have concomitant cerebrovascular diseases, which significantly worsen their prognosis. Prospective studies validating intravenous thrombolysis (IVT) safety profile in patients with acute ischemic stroke and active cancer are ... ...

    Abstract Cancer patients frequently have concomitant cerebrovascular diseases, which significantly worsen their prognosis. Prospective studies validating intravenous thrombolysis (IVT) safety profile in patients with acute ischemic stroke and active cancer are still lacking. Therefore, we aimed to evaluate IVT's efficacy and safety profile in acute ischemic stroke patients with comorbid active cancer. We included in a meta-analysis all relevant published studies, including patients with acute ischemic stroke with or without active cancer and receiving IVT, according to recommendations for IVT treatment for acute ischemic stroke. The primary outcomes were: any intracerebral hemorrhage, all-cause mortality, and good functional outcome reported as modified Rankin Scale (mRS) ≤ 2 at the end of the scheduled follow-up period. We included 11 studies in the meta-analysis. IVT was not associated with a significant increase in the incidence of intracerebral hemorrhage (OR 1.35; 95% CI 0.85-2.14; I
    MeSH term(s) Humans ; Fibrinolytic Agents/therapeutic use ; Thrombolytic Therapy ; Ischemic Stroke/complications ; Brain Ischemia ; Prospective Studies ; Treatment Outcome ; Stroke/epidemiology ; Cerebral Hemorrhage/complications ; Neoplasms/complications ; Neoplasms/drug therapy
    Chemical Substances Fibrinolytic Agents
    Language English
    Publishing date 2023-06-19
    Publishing country Italy
    Document type Meta-Analysis ; Systematic Review ; Journal Article ; Review
    ZDB-ID 2454173-4
    ISSN 1970-9366 ; 1828-0447
    ISSN (online) 1970-9366
    ISSN 1828-0447
    DOI 10.1007/s11739-023-03312-w
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  7. Article ; Online: Ischemic stroke while on NOAC therapy in patients with atrial fibrillation: suggested treatment strategies.

    De Magistris, Ilaria Leone / Paciaroni, Maurizio

    Internal and emergency medicine

    2023  Volume 18, Issue 4, Page(s) 963–967

    MeSH term(s) Humans ; Atrial Fibrillation/complications ; Atrial Fibrillation/drug therapy ; Anticoagulants/therapeutic use ; Ischemic Stroke/drug therapy ; Stroke ; Warfarin/therapeutic use ; Administration, Oral ; Treatment Outcome
    Chemical Substances Anticoagulants ; Warfarin (5Q7ZVV76EI)
    Language English
    Publishing date 2023-05-03
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2454173-4
    ISSN 1970-9366 ; 1828-0447
    ISSN (online) 1970-9366
    ISSN 1828-0447
    DOI 10.1007/s11739-023-03266-z
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  8. Article ; Online: Investigational drugs for ischemic stroke: what's in the clinical development pipeline for acute phase and prevention?

    Mosconi, Maria Giulia / Paciaroni, Maurizio / Ageno, Walter

    Expert opinion on investigational drugs

    2022  Volume 31, Issue 7, Page(s) 645–667

    Abstract: Introduction: Stroke is a leading cause of disability and mortality and its burden expected to increase. The only approved drug for acute ischemic stroke (IS) is the intravenous thrombolytic alteplase. The risk of bleeding complications is one of the ... ...

    Abstract Introduction: Stroke is a leading cause of disability and mortality and its burden expected to increase. The only approved drug for acute ischemic stroke (IS) is the intravenous thrombolytic alteplase. The risk of bleeding complications is one of the reasons for the undertreatment of eligible patients. Numerous drugs are currently being developed to improve safety-efficacy.
    Areas covered: We reviewed literature from 1 January 2000, to 15 January 2022 for the development and testing of novel drugs with the aim of targeting treatment at prevention of ischemic stroke: PubMed, MEDLINE, Google Scholar, and ClinicalTrial.gov.
    Expert opinion: The pathophysiology of IS involves multiple pathways causing cerebral artery obstruction and brain tissue ischemia. Data suggest that tenecteplase is a promising fibrinolytic agent with a superior efficacy-safety profile, compared to alteplase. Current guidelines consider a short-term cycle of mannitol or hypertonic saline to be advisable in patients with space-occupying hemispheric infarction. Regarding primary and secondary prevention, research is primarily focused on identifying mechanisms to improve the safety-efficacy profile using a 'hemostasis-sparing' approach. Further evaluation on those agents that have shown promise for their risk/benefit profiles, would benefit greatly a neurologist's capacity to successfully prevent and treat IS patients.
    MeSH term(s) Brain Ischemia/drug therapy ; Brain Ischemia/prevention & control ; Drugs, Investigational/adverse effects ; Fibrinolytic Agents/adverse effects ; Humans ; Ischemic Stroke ; Stroke/drug therapy ; Stroke/etiology ; Stroke/prevention & control ; Tenecteplase/therapeutic use ; Tissue Plasminogen Activator/adverse effects ; Treatment Outcome
    Chemical Substances Drugs, Investigational ; Fibrinolytic Agents ; Tissue Plasminogen Activator (EC 3.4.21.68) ; Tenecteplase (WGD229O42W)
    Language English
    Publishing date 2022-05-13
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 1182884-5
    ISSN 1744-7658 ; 0967-8298 ; 1354-3784
    ISSN (online) 1744-7658
    ISSN 0967-8298 ; 1354-3784
    DOI 10.1080/13543784.2022.2072725
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  9. Article ; Online: The possible clinical impact of a threshold left atrial diameter associated with new AF in ESUS patients.

    Giustozzi, Michela / Paciaroni, Maurizio

    European journal of internal medicine

    2020  Volume 75, Page(s) 19–20

    MeSH term(s) Atrial Fibrillation/diagnostic imaging ; Heart Atria/diagnostic imaging ; Humans ; Stroke
    Language English
    Publishing date 2020-03-17
    Publishing country Netherlands
    Document type Journal Article ; Comment
    ZDB-ID 1038679-8
    ISSN 1879-0828 ; 0953-6205
    ISSN (online) 1879-0828
    ISSN 0953-6205
    DOI 10.1016/j.ejim.2020.03.010
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  10. Article ; Online: Italian guidelines on thrombolysis indications in ischemic stroke have been revised after the IST-3 trial and Cochrane review.

    Paciaroni, Maurizio

    Internal and emergency medicine

    2014  Volume 9, Issue 7, Page(s) 823–824

    MeSH term(s) Humans ; Practice Guidelines as Topic ; Review Literature as Topic ; Stroke/drug therapy ; Thrombolytic Therapy
    Language English
    Publishing date 2014-07-23
    Publishing country Italy
    Document type Letter ; Comment
    ZDB-ID 2454173-4
    ISSN 1970-9366 ; 1828-0447
    ISSN (online) 1970-9366
    ISSN 1828-0447
    DOI 10.1007/s11739-014-1109-0
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