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  1. Article: Association Between Anemia and Clinical Outcome in Acute Ischemic Stroke Patients Treated With Endovascular Treatment.

    Ceulemans, Angelique / Pinckaers, Florentina M E / Postma, Alida A / van Zwam, Wim H / van Oostenbrugge, Robert J

    Journal of stroke

    2024  Volume 26, Issue 1, Page(s) 87–94

    Abstract: Background and purpose: Endovascular treatment (EVT) is the preferred treatment option in eligible acute ischemic stroke (AIS) patients with a large vessel occlusion of the anterior circulation. Several comorbidities have been identified that can affect ...

    Abstract Background and purpose: Endovascular treatment (EVT) is the preferred treatment option in eligible acute ischemic stroke (AIS) patients with a large vessel occlusion of the anterior circulation. Several comorbidities have been identified that can affect clinical outcomes. Various studies have investigated the association between anemia and clinical outcome and found conflicting.
    Results: . The aim is to investigate the association between pre-EVT anemia and clinical outcomes at different time points post-EVT, primarily focusing on the National Institutes of Health Stroke Scale (NIHSS) at 24-48 hours.
    Methods: We prospectively included 560 AIS patients who received EVT in the Maastricht University Medical Center+. Hemoglobin levels (Hb; g/dL) were determined on admission. Hb levels were also categorized into two groups: anemia (male: Hb ≤12.9 g/dL; female: Hb ≤11.9 g/dL) and no anemia. Multiple imputation was used to handle missing data. Multivariable regression was used to investigate the association between anemia or Hb levels and clinical outcomes.
    Results: Anemia was present in 26% of the patients. Multivariable regression did not show a significant association between anemia or Hb levels and NIHSS at 24-48 hours (adjusted β [aβ]anemia: 1.44, 95% confidence interval [CI]: -0.47 to 3.36; aβHb: -0.37, 95% CI: -0.88 to 0.13). However, multivariable regression showed significant associations with modified Rankin Scale (adjusted common odds ratio [acOR]anemia: 1.66, 95% CI: 1.12 to 2.48; acORHb: 0.83, 95% CI: 0.75 to 0.93) and poor functional outcome at 90 days (adjusted OR [aOR]anemia: 2.09, 95% CI: 1.21 to 3.63; aORHb: 0.80, 95% CI: 0.69 to 0.92).
    Conclusion: Anemia was not independently associated with early neurological deficit (NIHSS) post-AIS, suggesting it is more suitable as a general frailty marker.
    Language English
    Publishing date 2024-01-22
    Publishing country Korea (South)
    Document type Journal Article
    ZDB-ID 2814366-8
    ISSN 2287-6405 ; 2287-6391
    ISSN (online) 2287-6405
    ISSN 2287-6391
    DOI 10.5853/jos.2023.01669
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Current and potentially novel antithrombotic treatment in acute ischemic stroke.

    Ceulemans, Angelique / Spronk, Henri M H / Ten Cate, Hugo / van Zwam, Wim H / van Oostenbrugge, Robert J / Nagy, Magdolna

    Thrombosis research

    2024  Volume 236, Page(s) 74–84

    Abstract: Acute ischemic stroke (AIS) is the most common type of stroke and requires immediate reperfusion. Current acute reperfusion therapies comprise the administration of intravenous thrombolysis and/or endovascular thrombectomy. Although these acute ... ...

    Abstract Acute ischemic stroke (AIS) is the most common type of stroke and requires immediate reperfusion. Current acute reperfusion therapies comprise the administration of intravenous thrombolysis and/or endovascular thrombectomy. Although these acute reperfusion therapies are increasingly successful, optimized secondary antithrombotic treatment remains warranted, specifically to reduce the risk of major bleeding complications. In the development of AIS, coagulation and platelet activation play crucial roles by driving occlusive clot formation. Recent studies implicated that the intrinsic route of coagulation plays a more prominent role in this development, however, this is not fully understood yet. Next to the acute treatments, antithrombotic therapy, consisting of anticoagulants and/or antiplatelet therapy, is successfully used for primary and secondary prevention of AIS but at the cost of increased bleeding complications. Therefore, better understanding the interplay between the different pathways involved in the pathophysiology of AIS might provide new insights that could lead to novel treatment strategies. This narrative review focuses on the processes of platelet activation and coagulation in AIS, and the most common antithrombotic agents in primary and secondary prevention of AIS. Furthermore, we provide an overview of promising novel antithrombotic agents that could be used to improve in both acute treatment and stroke prevention.
    MeSH term(s) Humans ; Fibrinolytic Agents/therapeutic use ; Ischemic Stroke ; Brain Ischemia/complications ; Brain Ischemia/drug therapy ; Stroke/drug therapy ; Stroke/prevention & control ; Stroke/complications ; Anticoagulants ; Treatment Outcome
    Chemical Substances Fibrinolytic Agents ; Anticoagulants
    Language English
    Publishing date 2024-02-15
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 121852-9
    ISSN 1879-2472 ; 0049-3848
    ISSN (online) 1879-2472
    ISSN 0049-3848
    DOI 10.1016/j.thromres.2024.02.009
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 863: Show issues Location:
    Je nach Verfügbarkeit (siehe Angabe bei Bestand)
    bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular
    Jg. 1995 - 2021: Lesesall (1.OG)
    ab Jg. 2022: Lesesaal (EG)

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  3. Article ; Online: Optimal management of cardiac surgery patients using direct oral anticoagulants: recommendations for clinical practice.

    Heuts, Samuel / Ceulemans, Angelique / Kuiper, Gerhardus J A J M / Schreiber, Jan U / van Varik, Bernard J / Olie, Renske H / Ten Cate, Hugo / Maessen, Jos G / Milojevic, Milan / Maesen, Bart

    European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery

    2023  Volume 64, Issue 4

    Abstract: Objectives: Literature is scarce on the management of patients using direct oral anticoagulants (DOACs) undergoing elective, urgent and emergency surgery. Therefore, we summarize the current evidence and provide literature-based recommendations for the ... ...

    Abstract Objectives: Literature is scarce on the management of patients using direct oral anticoagulants (DOACs) undergoing elective, urgent and emergency surgery. Therefore, we summarize the current evidence and provide literature-based recommendations for the management of patients on DOACs in the perioperative phase.
    Methods: A general literature review was conducted on the pharmacology of DOACs and for recommendations on the management of cardiac surgical patients on DOACs. Additionally, we performed a systematic review for studies on the use of direct DOAC reversal agents in the emergency cardiac surgical setting.
    Results: When surgery is elective, the DOAC cessation strategy is relatively straightforward and should be adapted to the renal function. The same approach applies to urgent cases, but additional DOAC activity drug level monitoring tests may be useful. In emergency cases, idarucizumab can be safely administered to patients on dabigatran in any of the perioperative phases. However, andexanet alfa, which is not registered for perioperative use, should not be administered in the preoperative phase to reverse the effect of factor Xa inhibitors, as it may induce temporary heparin resistance. Finally, the administration of (activated) prothrombin complex concentrate may be considered in all patients on DOACs, and such concentrates are generally readily available.
    Conclusions: DOACs offer several advantages over vitamin K antagonists, but care must be taken in patients undergoing cardiac surgery. Although elective and urgent cases can be managed relatively straightforwardly, the management of emergency cases requires particular attention.
    MeSH term(s) Humans ; Administration, Oral ; Anticoagulants/therapeutic use ; Cardiac Surgical Procedures ; Dabigatran/therapeutic use ; Hemorrhage ; Heparin
    Chemical Substances Anticoagulants ; Dabigatran (I0VM4M70GC) ; Heparin (9005-49-6)
    Language English
    Publishing date 2023-10-09
    Publishing country Germany
    Document type Journal Article ; Review ; Systematic Review
    ZDB-ID 639293-3
    ISSN 1873-734X ; 1010-7940 ; 1567-4258
    ISSN (online) 1873-734X
    ISSN 1010-7940 ; 1567-4258
    DOI 10.1093/ejcts/ezad340
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    In stock of ZB MED Cologne/Königswinter

    Zs.A 2303: Show issues Location:
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  4. Article ; Online: Incidence, predictors and vascular sequelae of distal limb ischemia in minimally invasive cardiac surgery with femoral artery cannulation: an observational cohort study.

    Ceulemans, Angelique / Derwael, Ruben / Vandenbrande, Jeroen / Buyck, Katelijne / Gruyters, Ine / Van Tornout, Michiel / Murkin, John M / Starinieri, Pascal / Yilmaz, Alaaddin / Stessel, Björn

    Heart and vessels

    2023  Volume 38, Issue 7, Page(s) 964–974

    Abstract: Literature regarding monitoring and consequences of distal limb ischemia due to femoral artery cannulation for Minimally Invasive Cardiac Surgery (MICS) remains limited. The primary objective was to determine its incidence, defined as a ≥ 15% difference ... ...

    Abstract Literature regarding monitoring and consequences of distal limb ischemia due to femoral artery cannulation for Minimally Invasive Cardiac Surgery (MICS) remains limited. The primary objective was to determine its incidence, defined as a ≥ 15% difference in regional Oxygen Saturation (rSO
    MeSH term(s) Humans ; Adolescent ; Femoral Artery/surgery ; Prospective Studies ; Incidence ; Catheterization/adverse effects ; Ischemia/diagnosis ; Ischemia/epidemiology ; Ischemia/etiology ; Arterial Occlusive Diseases ; Cardiac Surgical Procedures/adverse effects ; Cardiac Surgical Procedures/methods ; Acute Kidney Injury ; Retrospective Studies
    Language English
    Publishing date 2023-02-01
    Publishing country Japan
    Document type Observational Study ; Journal Article
    ZDB-ID 89678-0
    ISSN 1615-2573 ; 0910-8327 ; 0935-736X
    ISSN (online) 1615-2573
    ISSN 0910-8327 ; 0935-736X
    DOI 10.1007/s00380-023-02241-0
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    In stock of ZB MED Cologne/Königswinter

    Zs.A 2049: Show issues Location:
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  5. Article ; Online: Endovascular treatment versus no endovascular treatment after 6-24 h in patients with ischaemic stroke and collateral flow on CT angiography (MR CLEAN-LATE) in the Netherlands: a multicentre, open-label, blinded-endpoint, randomised, controlled, phase 3 trial.

    Olthuis, Susanne G H / Pirson, F Anne V / Pinckaers, Florentina M E / Hinsenveld, Wouter H / Nieboer, Daan / Ceulemans, Angelique / Knapen, Robrecht R M M / Robbe, M M Quirien / Berkhemer, Olvert A / van Walderveen, Marianne A A / Lycklama À Nijeholt, Geert J / Uyttenboogaart, Maarten / Schonewille, Wouter J / van der Sluijs, P Matthijs / Wolff, Lennard / van Voorst, Henk / Postma, Alida A / Roosendaal, Stefan D / van der Hoorn, Anouk /
    Emmer, Bart J / Krietemeijer, Menno G M / van Doormaal, Pieter-Jan / Roozenbeek, Bob / Goldhoorn, Robert-Jan B / Staals, Julie / de Ridder, Inger R / van der Leij, Christiaan / Coutinho, Jonathan M / van der Worp, H Bart / Lo, Rob T H / Bokkers, Reinoud P H / van Dijk, Ewoud I / Boogaarts, Hieronymus D / Wermer, Marieke J H / van Es, Adriaan C G M / van Tuijl, Julia H / Kortman, Hans G J / Gons, Rob A R / Yo, Lonneke S F / Vos, Jan-Albert / de Laat, Karlijn F / van Dijk, Lukas C / van den Wijngaard, Ido R / Hofmeijer, Jeannette / Martens, Jasper M / Brouwers, Paul J A M / Bulut, Tomas / Remmers, Michel J M / de Jong, Thijs E A M / den Hertog, Heleen M / van Hasselt, Boudewijn A A M / Rozeman, Anouk D / Elgersma, Otto E H / van der Veen, Bas / Sudiono, Davy R / Lingsma, Hester F / Roos, Yvo B W E M / Majoie, Charles B L M / van der Lugt, Aad / Dippel, Diederik W J / van Zwam, Wim H / van Oostenbrugge, Robert J

    Lancet (London, England)

    2023  Volume 401, Issue 10385, Page(s) 1371–1380

    Abstract: Background: Endovascular treatment for anterior circulation ischaemic stroke is effective and safe within a 6 h window. MR CLEAN-LATE aimed to assess efficacy and safety of endovascular treatment for patients treated in the late window (6-24 h from ... ...

    Abstract Background: Endovascular treatment for anterior circulation ischaemic stroke is effective and safe within a 6 h window. MR CLEAN-LATE aimed to assess efficacy and safety of endovascular treatment for patients treated in the late window (6-24 h from symptom onset or last seen well) selected on the basis of the presence of collateral flow on CT angiography (CTA).
    Methods: MR CLEAN-LATE was a multicentre, open-label, blinded-endpoint, randomised, controlled, phase 3 trial done in 18 stroke intervention centres in the Netherlands. Patients aged 18 years or older with ischaemic stroke, presenting in the late window with an anterior circulation large-vessel occlusion and collateral flow on CTA, and a neurological deficit score of at least 2 on the National Institutes of Health Stroke Scale were included. Patients who were eligible for late-window endovascular treatment were treated according to national guidelines (based on clinical and perfusion imaging criteria derived from the DAWN and DEFUSE-3 trials) and excluded from MR CLEAN-LATE enrolment. Patients were randomly assigned (1:1) to receive endovascular treatment or no endovascular treatment (control), in addition to best medical treatment. Randomisation was web based, with block sizes ranging from eight to 20, and stratified by centre. The primary outcome was the modified Rankin Scale (mRS) score at 90 days after randomisation. Safety outcomes included all-cause mortality at 90 days after randomisation and symptomatic intracranial haemorrhage. All randomly assigned patients who provided deferred consent or died before consent could be obtained comprised the modified intention-to-treat population, in which the primary and safety outcomes were assessed. Analyses were adjusted for predefined confounders. Treatment effect was estimated with ordinal logistic regression and reported as an adjusted common odds ratio (OR) with a 95% CI. This trial was registered with the ISRCTN, ISRCTN19922220.
    Findings: Between Feb 2, 2018, and Jan 27, 2022, 535 patients were randomly assigned, and 502 (94%) patients provided deferred consent or died before consent was obtained (255 in the endovascular treatment group and 247 in the control group; 261 [52%] females). The median mRS score at 90 days was lower in the endovascular treatment group than in the control group (3 [IQR 2-5] vs 4 [2-6]), and we observed a shift towards better outcomes on the mRS for the endovascular treatment group (adjusted common OR 1·67 [95% CI 1·20-2·32]). All-cause mortality did not differ significantly between groups (62 [24%] of 255 patients vs 74 [30%] of 247 patients; adjusted OR 0·72 [95% CI 0·44-1·18]). Symptomatic intracranial haemorrhage occurred more often in the endovascular treatment group than in the control group (17 [7%] vs four [2%]; adjusted OR 4·59 [95% CI 1·49-14·10]).
    Interpretation: In this study, endovascular treatment was efficacious and safe for patients with ischaemic stroke caused by an anterior circulation large-vessel occlusion who presented 6-24 h from onset or last seen well, and who were selected on the basis of the presence of collateral flow on CTA. Selection of patients for endovascular treatment in the late window could be primarily based on the presence of collateral flow.
    Funding: Collaboration for New Treatments of Acute Stroke consortium, Dutch Heart Foundation, Stryker, Medtronic, Cerenovus, Top Sector Life Sciences & Health, and the Netherlands Brain Foundation.
    MeSH term(s) Female ; Humans ; Male ; Stroke/therapy ; Stroke/drug therapy ; Brain Ischemia/diagnostic imaging ; Brain Ischemia/surgery ; Computed Tomography Angiography ; Netherlands ; Intracranial Hemorrhages/etiology ; Ischemic Stroke/complications ; Treatment Outcome
    Language English
    Publishing date 2023-03-29
    Publishing country England
    Document type Randomized Controlled Trial ; Multicenter Study ; Clinical Trial, Phase III ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 3306-6
    ISSN 1474-547X ; 0023-7507 ; 0140-6736
    ISSN (online) 1474-547X
    ISSN 0023-7507 ; 0140-6736
    DOI 10.1016/S0140-6736(23)00575-5
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