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Stroke Therapeutics in the Care of Older Persons

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Optimizing Pharmacotherapy in Older Patients

Part of the book series: Practical Issues in Geriatrics ((PIG))

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Abstract

Stroke is one of the main causes of long-term disability and death worldwide. With an ageing population and the incidence of stroke rising with age, therapeutics in stroke management has come into sharper focus in recent years. Recognition and early diagnosis can be challenging in older patients due to atypical presentations. Multimodality brain imaging is now widely accessible and has transformed hyperacute treatment of ischaemic stroke, which accounts for the majority of all strokes. Owing to the introduction of reperfusion therapy with thrombolysis and mechanical thrombectomy, reduction in morbidity and mortality has been seen in patients of all ages including the oldest old. Furthermore, anticoagulation in atrial fibrillation and revascularisation in atherosclerotic carotid disease have been associated with significant reductions in ischaemic stroke and transient ischaemic attacks. Optimisation of modifiable risk factors such as hypertension, hyperlipidaemia and diabetes is crucial for both haemorrhagic and ischaemic stroke prevention. Patient-centred and individualised stroke care delivered by an organised specialist multidisciplinary team remains the cornerstone of stroke management. Ongoing research continues in the arena of stroke therapeutics in the older person.

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References

  1. Truelsen T. The global burden of cerebrovascular disease: WHO. World Health Organisation. 2006; https://www.who.int/healthinfo/statistics/bod_cerebrovasculardiseasestroke.pdf

  2. WHO. The top 10 causes of death 2020. https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death.

  3. Shah R, Wilkins E, Nichols M, Kelly P, El-Sadi F, Wright FL, et al. Epidemiology report: trends in sex-specific cerebrovascular disease mortality in Europe based on WHO mortality data. Eur Heart J. 2019;40(9):755–64.

    PubMed  Google Scholar 

  4. Wafa HA, Wolfe CDA, Emmett E, Roth GA, Johnson CO, Wang Y. Burden of stroke in Europe: thirty-year projections of incidence, prevalence, deaths, and disability-adjusted life years. Stroke. 2020;51(8):2418–27.

    PubMed  PubMed Central  Google Scholar 

  5. Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, et al. Heart disease and stroke Statistics-2021 update: a report from the American Heart Association. Circulation. 2021;143(8):e254–743.

    PubMed  Google Scholar 

  6. Lindsay MP. Global stroke factsheet 2019. WSO, World Stroke Organisation; 2019.

    Google Scholar 

  7. Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJ, Culebras A, et al. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44(7):2064–89.

    PubMed  Google Scholar 

  8. Russo T, Felzani G, Marini C. Stroke in the very old: a systematic review of studies on incidence, outcome, and resource use. J Aging Res. 2011;2011:108785.

    PubMed  PubMed Central  Google Scholar 

  9. Navis A, Garcia-Santibanez R, Skliut M. Epidemiology and outcomes of ischemic stroke and transient ischemic attack in the adult and geriatric population. J Stroke Cerebrovasc Dis. 2019;28(1):84–9.

    PubMed  Google Scholar 

  10. Birnbaum LA, Rodriguez JS, Topel CH, Behrouz R, Misra V, Palacio S, et al. Older stroke patients with high stroke scores have delayed door-to-needle times. J Stroke Cerebrovasc Dis. 2016;25(11):2668–72.

    PubMed  Google Scholar 

  11. Easton JD, Saver JL, Albers GW, Alberts MJ, Chaturvedi S, Feldmann E, et al. Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists. Stroke. 2009;40(6):2276–93.

    PubMed  Google Scholar 

  12. Shahjouei S, Sadighi A, Chaudhary D, Li J, Abedi V, Holland N, et al. A 5-decade analysis of incidence trends of ischemic stroke after transient ischemic attack: a systematic review and meta-analysis. JAMA Neurol. 2021;78(1):77–87.

    PubMed  Google Scholar 

  13. Radu RA, Terecoasă EO, Băjenaru OA, Tiu C. Etiologic classification of ischemic stroke: where do we stand? Clin Neurol Neurosurg. 2017;159:93–106.

    PubMed  Google Scholar 

  14. Bogousslavsky J, Van Melle G, Regli F. The Lausanne stroke registry: analysis of 1,000 consecutive patients with first stroke. Stroke. 1988;19(9):1083–92.

    CAS  PubMed  Google Scholar 

  15. Ferro JM. Cardioembolic stroke: an update. Lancet Neurol. 2003;2(3):177–88.

    PubMed  Google Scholar 

  16. Bamford J, Sandercock P, Dennis M, Burn J, Warlow C. Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet. 1991;337(8756):1521–6.

    CAS  PubMed  Google Scholar 

  17. Di Carlo A, Lamassa M, Pracucci G, Basile AM, Trefoloni G, Vanni P, et al. Stroke in the very old : clinical presentation and determinants of 3-month functional outcome: a European perspective. European BIOMED Study of Stroke Care Group. Stroke. 1999;30(11):2313–9.

    PubMed  Google Scholar 

  18. Jones WJ, Williams LS, Bruno A, Biller J. Hypertension and cerebrovascular disease. Semin Cerebrovasc Dis Stroke. 2003;3(3):144–54.

    Google Scholar 

  19. Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol. 2010;9(7):689–701.

    PubMed  Google Scholar 

  20. Allen CL, Bayraktutan U. Oxidative stress and its role in the pathogenesis of ischaemic stroke. Int J Stroke. 2009;4(6):461–70.

    CAS  PubMed  Google Scholar 

  21. Love S, Miners S, Palmer J, Chalmers K, Kehoe P. Insights into the pathogenesis and pathogenicity of cerebral amyloid angiopathy. Front Biosci (Landmark Ed). 2009;14:4778–92.

    CAS  PubMed  Google Scholar 

  22. Ntaios G, Hart RG. Embolic stroke. Circulation. 2017;136(25):2403–5.

    PubMed  Google Scholar 

  23. Dufouil C, Beiser A, McLure LA, Wolf PA, Tzourio C, Howard VJ, et al. Revised Framingham stroke risk profile to reflect temporal trends. Circulation. 2017;135(12):1145–59.

    PubMed  PubMed Central  Google Scholar 

  24. Avan A, Digaleh H, Di Napoli M, Stranges S, Behrouz R, Shojaeianbabaei G, et al. Socioeconomic status and stroke incidence, prevalence, mortality, and worldwide burden: an ecological analysis from the Global Burden of Disease Study 2017. BMC Med. 2019;17(1):191.

    PubMed  PubMed Central  Google Scholar 

  25. Soares-Miranda L, Siscovick DS, Psaty BM, Longstreth WT, Mozaffarian D. Physical activity and risk of coronary heart disease and stroke in older adults: the cardiovascular health study. Circulation. 2016;133(2):147–55.

    PubMed  Google Scholar 

  26. Singer J, Gustafson D, Cummings C, Egelko A, Mlabasati J, Conigliaro A, et al. Independent ischemic stroke risk factors in older Americans: a systematic review. Aging (Albany NY). 2019;11(10):3392–407.

    CAS  PubMed  Google Scholar 

  27. Ferrucci L, Guralnik JM, Pahor M, Harris T, Corti MC, Hyman BT, et al. Apolipoprotein E epsilon 2 allele and risk of stroke in the older population. Stroke. 1997;28(12):2410–6.

    CAS  PubMed  Google Scholar 

  28. Arbelaez JJ, Ariyo AA, Crum RM, Fried LP, Ford DE. Depressive symptoms, inflammation, and ischemic stroke in older adults: a prospective analysis in the cardiovascular health study. J Am Geriatr Soc. 2007;55(11):1825–30.

    PubMed  Google Scholar 

  29. Elkins JS, O'Meara ES, Longstreth WT, Carlson MC, Manolio TA, Johnston SC. Stroke risk factors and loss of high cognitive function. Neurology. 2004;63(5):793–9.

    CAS  PubMed  Google Scholar 

  30. Marshall IJ, Wang Y, Crichton S, McKevitt C, Rudd AG, Wolfe CD. The effects of socioeconomic status on stroke risk and outcomes. Lancet Neurol. 2015;14(12):1206–18.

    PubMed  Google Scholar 

  31. Muangpaisan W, Hinkle JL, Westwood M, Kennedy J, Buchan AM. Stroke in the very old: clinical presentations and outcomes. Age Ageing. 2008;37(4):473–5.

    PubMed  Google Scholar 

  32. Edlow JA, Selim MH. Atypical presentations of acute cerebrovascular syndromes. Lancet Neurol. 2011;10(6):550–60.

    PubMed  Google Scholar 

  33. Huff JS. Stroke mimics and chameleons. Emerg Med Clin North Am. 2002;20(3):583–95.

    PubMed  Google Scholar 

  34. Anathhanam S, Hassan A. Mimics and chameleons in stroke. Clin Med (Lond). 2017;17(2):156–60.

    PubMed  Google Scholar 

  35. Nor AM, Davis J, Sen B, Shipsey D, Louw SJ, Dyker AG, et al. The recognition of stroke in the emergency room (ROSIER) scale: development and validation of a stroke recognition instrument. Lancet Neurol. 2005;4(11):727–34.

    PubMed  Google Scholar 

  36. Saver JL. Time is brain—quantified. Stroke. 2006;37(1):263–6.

    PubMed  Google Scholar 

  37. Evans NR, Wall J, To B, Wallis SJ, Romero-Ortuno R, Warburton EA. Clinical frailty independently predicts early mortality after ischaemic stroke. Age Ageing. 2020;49(4):588–91.

    PubMed  Google Scholar 

  38. Smithard DG. Stroke in frail older people. Geriatrics (Basel). 2017;2(3)

    Google Scholar 

  39. Wallis SJ, Wall J, Biram RW, Romero-Ortuno R. Association of the clinical frailty scale with hospital outcomes. QJM. 2015;108(12):943–9.

    CAS  PubMed  Google Scholar 

  40. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–56.

    CAS  PubMed  Google Scholar 

  41. Mahoney FI, Barthel DW. Functional evaluation: the Barthel index. Md State Med J. 1965;14:61–5.

    CAS  PubMed  Google Scholar 

  42. Quinn TJ, Elliott E, Langhorne P. Cognitive and mood assessment tools for use in stroke. Stroke. 2018;49(2):483–90.

    PubMed  Google Scholar 

  43. McGovern A, Pendlebury ST, Mishra NK, Fan Y, Quinn TJ. Test accuracy of informant-based cognitive screening tests for diagnosis of dementia and multidomain cognitive impairment in stroke. Stroke. 2016;47(2):329–35.

    PubMed  Google Scholar 

  44. Burton L, Tyson SF. Screening for cognitive impairment after stroke: a systematic review of psychometric properties and clinical utility. J Rehabil Med. 2015;47(3):193–203.

    PubMed  Google Scholar 

  45. Langhorne P, Ramachandra S. Organised inpatient (stroke unit) care for stroke: network meta-analysis. Cochrane Database Syst Rev. 2020;4(4):Cd000197.

    PubMed  Google Scholar 

  46. Wardlaw JM, Murray V, Berge E, del Zoppo GJ. Thrombolysis for acute ischaemic stroke. Cochrane Database Syst Rev. 2014;2014(7):Cd000213.

    PubMed  PubMed Central  Google Scholar 

  47. Emberson J, Lees KR, Lyden P, Blackwell L, Albers G, Bluhmki E, et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet. 2014;384(9958):1929–35.

    CAS  PubMed  PubMed Central  Google Scholar 

  48. Wardlaw JM, Murray V, Berge E, del Zoppo G, Sandercock P, Lindley RL, et al. Recombinant tissue plasminogen activator for acute ischaemic stroke: an updated systematic review and meta-analysis. Lancet. 2012;379(9834):2364–72.

    CAS  PubMed  PubMed Central  Google Scholar 

  49. Sandercock P, Wardlaw JM, Lindley RI, Dennis M, Cohen G, Murray G, et al. The benefits and harms of intravenous thrombolysis with recombinant tissue plasminogen activator within 6 h of acute ischaemic stroke (the third international stroke trial [IST-3]): a randomised controlled trial. Lancet. 2012;379(9834):2352–63.

    PubMed  Google Scholar 

  50. Kongbunkiat K, Wilson D, Kasemsap N, Tiamkao S, Jichi F, Palumbo V, et al. Leukoaraiosis, intracerebral hemorrhage, and functional outcome after acute stroke thrombolysis. Neurology. 2017;88(7):638–45.

    PubMed  PubMed Central  Google Scholar 

  51. Bhatnagar P, Sinha D, Parker RA, Guyler P, O'Brien A. Intravenous thrombolysis in acute ischaemic stroke: a systematic review and meta-analysis to aid decision making in patients over 80 years of age. J Neurol Neurosurg Psychiatry. 2011;82(7):712–7.

    PubMed  Google Scholar 

  52. Thomalla G, Boutitie F, Ma H, Koga M, Ringleb P, Schwamm LH, et al. Intravenous alteplase for stroke with unknown time of onset guided by advanced imaging: systematic review and meta-analysis of individual patient data. Lancet. 2020;396(10,262):1574–84.

    CAS  PubMed  PubMed Central  Google Scholar 

  53. Goyal M, Menon BK, van Zwam WH, Dippel DW, Mitchell PJ, Demchuk AM, et al. Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials. Lancet. 2016;387(10,029):1723–31.

    PubMed  Google Scholar 

  54. Zhao W, Ma P, Zhang P, Yue X. Mechanical thrombectomy for acute ischemic stroke in octogenarians: a systematic review and meta-analysis. Front Neurol. 2019;10:1355.

    PubMed  Google Scholar 

  55. Hilditch CA, Nicholson P, Murad MH, Rabinstein A, Schaafsma J, Pikula A, et al. Endovascular management of acute stroke in the elderly: a systematic review and meta-analysis. AJNR Am J Neuroradiol. 2018;39(5):887–91.

    CAS  PubMed  PubMed Central  Google Scholar 

  56. Arora R, Salamon E, Katz JM, Cox M, Saver JL, Bhatt DL, et al. Use and outcomes of intravenous thrombolysis for acute ischemic stroke in patients ≥90 years of age. Stroke. 2016;47(9):2347–54.

    CAS  PubMed  Google Scholar 

  57. Parry-Jones AR, Paley L, Bray BD, Hoffman AM, James M, Cloud GC, et al. Care-limiting decisions in acute stroke and association with survival: analyses of UK national quality register data. Int J Stroke. 2016;11(3):321–31.

    PubMed  Google Scholar 

  58. Morgenstern LB, Zahuranec DB, Sánchez BN, Becker KJ, Geraghty M, Hughes R, et al. Full medical support for intracerebral hemorrhage. Neurology. 2015;84(17):1739–44.

    PubMed  PubMed Central  Google Scholar 

  59. Rodriguez-Luna D, Piñeiro S, Rubiera M, Ribo M, Coscojuela P, Pagola J, et al. Impact of blood pressure changes and course on hematoma growth in acute intracerebral hemorrhage. Eur J Neurol. 2013;20(9):1277–83.

    CAS  PubMed  Google Scholar 

  60. Anderson CS, Heeley E, Huang Y, Wang J, Stapf C, Delcourt C, et al. Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med. 2013;368(25):2355–65.

    CAS  PubMed  Google Scholar 

  61. Lattanzi S, Cagnetti C, Provinciali L, Silvestrini M. How should we lower blood pressure after cerebral hemorrhage? A systematic review and meta-analysis. Cerebrovasc Dis. 2017;43(5–6):207–13.

    PubMed  Google Scholar 

  62. Al-Shahi Salman R, Frantzias J, Lee RJ, Lyden PD, Battey TWK, Ayres AM, et al. Absolute risk and predictors of the growth of acute spontaneous intracerebral haemorrhage: a systematic review and meta-analysis of individual patient data. Lancet Neurol. 2018;17(10):885–94.

    PubMed  PubMed Central  Google Scholar 

  63. Seiffge DJ, Goeldlin MB, Tatlisumak T, Lyrer P, Fischer U, Engelter ST, et al. Meta-analysis of haematoma volume, haematoma expansion and mortality in intracerebral haemorrhage associated with oral anticoagulant use. J Neurol. 2019;266(12):3126–35.

    CAS  PubMed  PubMed Central  Google Scholar 

  64. Tsivgoulis G, Wilson D, Katsanos AH, Sargento-Freitas J, Marques-Matos C, Azevedo E, et al. Neuroimaging and clinical outcomes of oral anticoagulant-associated intracerebral hemorrhage. Ann Neurol. 2018;84(5):694–704.

    CAS  PubMed  Google Scholar 

  65. Christensen H, Cordonnier C, Kõrv J, Lal A, Ovesen C, Purrucker JC, et al. European stroke organisation guideline on reversal of oral anticoagulants in acute intracerebral haemorrhage. Eur Stroke J. 2019;4(4):294–306.

    PubMed  PubMed Central  Google Scholar 

  66. Mendelow AD, Gregson BA, Fernandes HM, Murray GD, Teasdale GM, Hope DT, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the International Surgical Trial in Intracerebral Haemorrhage (STICH): a randomised trial. Lancet. 2005;365(9457):387–97.

    PubMed  Google Scholar 

  67. Hanley DF, Thompson RE, Rosenblum M, Yenokyan G, Lane K, McBee N, et al. Efficacy and safety of minimally invasive surgery with thrombolysis in intracerebral haemorrhage evacuation (MISTIE III): a randomised, controlled, open-label, blinded endpoint phase 3 trial. Lancet. 2019;393(10175):1021–32.

    PubMed  PubMed Central  Google Scholar 

  68. Sondag L, Schreuder F, Boogaarts HD, Rovers MM, Vandertop WP, Dammers R, et al. Neurosurgical intervention for supratentorial intracerebral Hemorrhage. Ann Neurol. 2020;88(2):239–50.

    PubMed  PubMed Central  Google Scholar 

  69. Fonseca AC, Merwick Á, Dennis M, Ferrari J, Ferro JM, Kelly P, et al. European Stroke Organisation (ESO) guidelines on management of transient ischaemic attack. Eur Stroke J. 2021;6(2):V

    Google Scholar 

  70. Prabhakaran S, Silver AJ, Warrior L, McClenathan B, Lee VH. Misdiagnosis of transient ischemic attacks in the emergency room. Cerebrovasc Dis. 2008;26(6):630–5.

    PubMed  Google Scholar 

  71. Rothwell PM, Giles MF, Chandratheva A, Marquardt L, Geraghty O, Redgrave JN, et al. Effect of urgent treatment of transient ischaemic attack and minor stroke on early recurrent stroke (EXPRESS study): a prospective population-based sequential comparison. Lancet. 2007;370(9596):1432–42.

    PubMed  Google Scholar 

  72. Kaplan RC, Tirschwell DL, Longstreth WT Jr, Manolio TA, Heckbert SR, Lefkowitz D, et al. Vascular events, mortality, and preventive therapy following ischemic stroke in the elderly. Neurology. 2005;65(6):835–42.

    CAS  PubMed  Google Scholar 

  73. Rothwell PM, Algra A, Amarenco P. Medical treatment in acute and long-term secondary prevention after transient ischaemic attack and ischaemic stroke. Lancet. 2011;377(9778):1681–92.

    PubMed  Google Scholar 

  74. Rothwell PM, Algra A, Chen Z, Diener HC, Norrving B, Mehta Z. Effects of aspirin on risk and severity of early recurrent stroke after transient ischaemic attack and ischaemic stroke: time-course analysis of randomised trials. Lancet. 2016;388(10,042):365–75.

    CAS  PubMed  PubMed Central  Google Scholar 

  75. CAPRIE Steering Committee. A randomised, blinded, trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet. 1996;348(9038):1329–39.

    Google Scholar 

  76. Bhatia K, Jain V, Aggarwal D, Vaduganathan M, Arora S, Hussain Z, et al. Dual antiplatelet therapy versus aspirin in patients with stroke or transient ischemic attack: meta-analysis of randomized controlled trials. Stroke. 2021;52(6):e217–e23.

    CAS  PubMed  Google Scholar 

  77. Zhang H, Thijs L, Staessen JA. Blood pressure lowering for primary and secondary prevention of stroke. Hypertension. 2006;48(2):187–95.

    CAS  PubMed  Google Scholar 

  78. Appleton JP, Sprigg N, Bath PM. Blood pressure management in acute stroke. Stroke Vasc Neurol. 2016;1(2):72–82.

    PubMed  PubMed Central  Google Scholar 

  79. National Institute for Health and Care Excellence (NICE). Stroke and transient ischaemic attack in over 16s: diagnosis and initial management. NICE guideline [NG128]; 2019.

    Google Scholar 

  80. Turnbull F, Neal B, Ninomiya T, Algert C, Arima H, Barzi F, et al. Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults: meta-analysis of randomised trials. BMJ. 2008;336(7653):1121–3.

    CAS  PubMed  Google Scholar 

  81. Beckett NS, Peters R, Fletcher AE, Staessen JA, Liu L, Dumitrascu D, et al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med. 2008;358(18):1887–98.

    CAS  PubMed  Google Scholar 

  82. Aronow WS. Managing hyperlipidaemia in the elderly: special considerations for a population at high risk. Drugs Aging. 2006;23(3):181–9.

    CAS  PubMed  Google Scholar 

  83. Amarenco P, Kim JS, Labreuche J, Charles H, Abtan J, Béjot Y, et al. A comparison of two LDL cholesterol targets after ischemic stroke. N Engl J Med. 2020;382(1):9.

    CAS  PubMed  Google Scholar 

  84. Amarenco P, Labreuche J, Lavallée P, Touboul PJ. Statins in stroke prevention and carotid atherosclerosis: systematic review and up-to-date meta-analysis. Stroke. 2004;35(12):2902–9.

    CAS  PubMed  Google Scholar 

  85. Deedwania P, Stone PH, Bairey Merz CN, Cosin-Aguilar J, Koylan N, Luo D, et al. Effects of intensive versus moderate lipid-lowering therapy on myocardial ischemia in older patients with coronary heart disease: results of the Study Assessing Goals in the Elderly (SAGE). Circulation. 2007;115(6):700–7.

    CAS  PubMed  Google Scholar 

  86. Shepherd J, Blauw GJ, Murphy MB, Bollen EL, Buckley BM, Cobbe SM, et al. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet. 2002;360(9346):1623–30.

    CAS  PubMed  Google Scholar 

  87. Tun NN, Arunagirinathan G, Munshi SK, Pappachan JM. Diabetes mellitus and stroke: a clinical update. (1948–9358 (Print)).

    Google Scholar 

  88. Shou J, Zhou L, Zhu S, Zhang X. Diabetes is an independent risk factor for stroke recurrence in stroke patients: a meta-analysis. J Stroke Cerebrovasc Dis. 2015;24(9):1961–8.

    PubMed  Google Scholar 

  89. Turnbull FM, Abraira C, Anderson RJ, Byington RP, Chalmers JP, Duckworth WC, et al. Intensive glucose control and macrovascular outcomes in type 2 diabetes. Diabetologia. 2009;52(11):2288–98.

    CAS  PubMed  Google Scholar 

  90. National Institute for Health and Care Excellence (NICE). Type 2 diabetes in adults: management. NICE guideline [NG28]; 2015.

    Google Scholar 

  91. Friberg L, Rosenqvist M, Lindgren A, Terént A, Norrving B, Asplund K. High prevalence of atrial fibrillation among patients with ischemic stroke. Stroke. 2014;45(9):2599–605.

    CAS  PubMed  Google Scholar 

  92. National Institute for Health and Care Excellence (NICE). Atrial fibrillation: diagnosis and management. NICE guidelines [NG196]; 2021.

    Google Scholar 

  93. Mant J, Hobbs FD, Fletcher K, Roalfe A, Fitzmaurice D, Lip GY, et al. Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial. Lancet. 2007;370(9586):493–503.

    CAS  PubMed  Google Scholar 

  94. Björck F, Renlund H, Lip GY, Wester P, Svensson PJ, Själander A. Outcomes in a warfarin-treated population with atrial fibrillation. JAMA Cardiol. 2016;1(2):172–80.

    PubMed  Google Scholar 

  95. Ruff CT, Giugliano RP, Braunwald E, Hoffman EB, Deenadayalu N, Ezekowitz MD, et al. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet. 2014;383(9921):955–62.

    CAS  PubMed  Google Scholar 

  96. Pugh D, Pugh J, Mead GE. Attitudes of physicians regarding anticoagulation for atrial fibrillation: a systematic review. Age Ageing. 2011;40(6):675–83.

    PubMed  Google Scholar 

  97. Petty GW, Brown RD Jr, Whisnant JP, Sicks JD, O'Fallon WM, Wiebers DO. Ischemic stroke subtypes: a population-based study of incidence and risk factors. Stroke. 1999;30(12):2513–6.

    CAS  PubMed  Google Scholar 

  98. MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70-99%) or with mild (0-29%) carotid stenosis. European Carotid Surgery Trialists’ Collaborative Group. Lancet. 1991;337(8752):1235–43.

    Google Scholar 

  99. Barnett HJM, Taylor DW, Haynes RB, Sackett DL, Peerless SJ, Ferguson GG, et al. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991;325(7):445–53.

    CAS  PubMed  Google Scholar 

  100. Rothwell PM, Eliasziw M, Gutnikov SA, Fox AJ, Taylor DW, Mayberg MR, et al. Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet. 2003;361(9352):107–16.

    CAS  PubMed  Google Scholar 

  101. Naylor AR, Sillesen H, Schroeder TV. Clinical and imaging features associated with an increased risk of early and late stroke in patients with symptomatic carotid disease. Eur J Vasc Endovasc Surg. 2015;49(5):513–23.

    CAS  PubMed  Google Scholar 

  102. Bonati LH, Lyrer P, Ederle J, Featherstone R, Brown MM. Percutaneous transluminal balloon angioplasty and stenting for carotid artery stenosis. Cochrane Database Syst Rev. 2012;(9):Cd000515.

    Google Scholar 

  103. Bonati LH, Kakkos S, Berkefeld J, de Borst GJ, Bulbulia R, Halliday A, et al. European Stroke Organisation guideline on endarterectomy and stenting for carotid artery stenosis. Eur Stroke J. 2021;6(2):I.

    PubMed  PubMed Central  Google Scholar 

  104. Langhorne P, Stott DJ, Robertson L, MacDonald J, Jones L, McAlpine C, et al. Medical complications after stroke: a multicenter study. Stroke. 2000;31(6):1223–9.

    CAS  PubMed  Google Scholar 

  105. Cruz-Flores S, Berge E, Whittle IR. Surgical decompression for cerebral oedema in acute ischaemic stroke. Cochrane Database Syst Rev. 2012;1:Cd003435.

    PubMed  Google Scholar 

  106. Zelano J, Holtkamp M, Agarwal N, Lattanzi S, Trinka E, Brigo F. How to diagnose and treat post-stroke seizures and epilepsy. Epileptic Disord. 2020;22(3):252–63.

    PubMed  Google Scholar 

  107. Dennis M, Sandercock P, Reid J, Graham C, Forbes J, Murray G. Effectiveness of intermittent pneumatic compression in reduction of risk of deep vein thrombosis in patients who have had a stroke (CLOTS 3): a multicentre randomised controlled trial. Lancet. 2013;382(9891):516–24.

    CAS  PubMed  Google Scholar 

  108. Wu S, Kutlubaev MA, Chun HY, Cowey E, Pollock A, Macleod MR, et al. Interventions for post-stroke fatigue. Cochrane Database Syst Rev. 2015;2015(7):Cd007030.

    PubMed  PubMed Central  Google Scholar 

  109. Pendlebury ST, Rothwell PM. Incidence and prevalence of dementia associated with transient ischaemic attack and stroke: analysis of the population-based Oxford Vascular Study. Lancet Neurol. 2019;18(3):248–58.

    PubMed  PubMed Central  Google Scholar 

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Bahk, A., Kirkham, F.A., Ng, Y.T., Rajkumar, C. (2023). Stroke Therapeutics in the Care of Older Persons. In: Cherubini, A., Mangoni, A.A., O’Mahony, D., Petrovic, M. (eds) Optimizing Pharmacotherapy in Older Patients. Practical Issues in Geriatrics. Springer, Cham. https://doi.org/10.1007/978-3-031-28061-0_24

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