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Background

The SOCRATES study compares ticagrelor versus aspirin for the prevention of major vascular events in patients with acute ischemic stroke or transient ischemic attack [1,2].

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SOCRATES (Acute Stroke Or Transient IsChaemic Attack TReated with Aspirin or Ticagrelor and Patient OutcomES) is a global clinical trial involving 9,600 patients who have experienced an acute ischemic stroke or transient ischemic attack (TIA). Annually, 15 million people worldwide suffer a stroke of this type. Ischemic strokes occur as a result of an obstruction of a vessel supplying blood to the brain. A TIA is secondary to a temporary insufficient blood supply to parts of the brain and is often considered a warning sign that a stroke may follow.

SOCRATES is a randomized, parallel group study evaluating the efficacy of ticagrelor compared to aspirin in reducing major vascular events (composite of all-cause mortality, myocardial infarction [MI], and stroke) in patients with acute ischemic stroke (NIHSS ≤ 5) and TIA.

Also announced today is the initiation of THEMIS (Effect of Ticagrelor on Health Outcomes in DiabEtes Mellitus Patients Intervention Study), a global clinical trial involving 17,000 patients with Type 2 diabetes at high risk of cardiovascular (CV) events. Of the 340 million people who suffer from the disease, 90 percent have type 2 diabetes and 50 percent of whom die from CV disease.

“A major goal of treating patients with diabetes is to reduce their cardiovascular risk,” said THEMIS study co-chair Deepak L. Bhatt, MD, MPH, Professor of Medicine at Harvard Medical School and Senior Physician at Brigham and Women’s Hospital.

“THEMIS will allow us to test a bold new strategy in the care of patients with diabetes who are at high risk of myocardial infarction, stroke, and cardiovascular death,” stated THEMIS study co-chair Ph. Gabriel Steg, MD, Professor of Medicine at Université Paris-Diderot and Director of the Coronary Care Unit at Hôpital Bichat.

THEMIS is an event-driven, randomized, parallel group study evaluating the efficacy of long-term treatment with ticagrelor versus placebo for the prevention of major CV events – the composite of CV death, MI or stroke – in patients with Type 2 diabetes without a history of previous MI or stroke but with documented coronary atherosclerosis.

SOCRATES and THEMIS will be monitored by Independent Data Monitoring Committees who will review the safety and efficacy of treatments in these trials. The trials will be conducted in accordance with Good Clinical Practice. Both studies will be posted on clinicaltrials.gov in the near future.

AstraZeneca is currently collaborating with over 4,000 clinical investigators in more than 30 countries as part of the PARTHENON program, and has established partnerships with a number of pre-eminent research institutions. Other studies in the PARTHENON program include PEGASUS, studying BRILINTA for secondary prevention in patients with previous myocardial infarction, and EUCLID studying patients with Peripheral Artery Disease.

PARTHENON will provide an unparalleled dataset to build scientific understanding of BRILINTA in a broad a range of atherothrombotic conditions. AstraZeneca has approved more than 100 investigator sponsored studies, which will be starting during the coming year.

BRILINTA is currently not approved for the treatment of patients with ischemic stroke, TIA, peripheral artery disease, or for secondary prevention in patients with a history of previous myocardial infarction.

BRILINTA Indications

BRILINTA is indicated to reduce the rate of thrombotic cardiovascular (CV) events in patients with ACS (unstable angina [UA], non–ST-elevation myocardial infarction [NSTEMI], or ST-elevation myocardial infarction [STEMI]). In PLATO, BRILINTA has been shown to reduce the rate of a combined end point of CV death, myocardial infarction (MI), or stroke compared to clopidogrel. In PLATO, the difference between treatments was driven by CV death and MI with no difference in stroke. In patients treated with an artery-opening procedure known as percutaneous coronary intervention (PCI), BRILINTA reduces the rate of stent thrombosis.

BRILINTA has been studied in ACS in combination with aspirin. Maintenance doses of aspirin above 100 mg decreased the effectiveness of BRILINTA. Avoid maintenance doses of aspirin above 100 mg daily.

References

1.Giacalone G, Abbas MA, Corea F. Prevention strategies for cardioembolic stroke: present and future perspectives. Open Neurol J. 2010; 4:56-63. doi: 10.2174/1874205X01004020056.

2.Silvestrelli G, Corea F, Micheli S, Lanari A. Clinical pharmacology and vascular risk.Open Neurol J. 2010;4:64-72. doi: 10.2174/1874205X01004020064.

Neurology meeting in Perugia under the patronage of the Società Italiana di Neurologia. Hosted by the Neurolgy Department University of Perugia, Paolo Calabresi, Aroldo Rossi, Lucilla Parnetti, Nicola Tambasco.
First ever as far as i know. I can remember in 1996 a joint tosco-umbro meeting at palazzo Murena.

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After a decade of preparation….

At the EFNS/ENS Joint Congress of European Neurology in Istanbul, June 2014, one strong unified European neurological society, the

EUROPEAN ACADEMY OF NEUROLOGY

will be founded.

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THE ASSEMBLY OF DELEGATES will be the democratic heart of the EAN: 45 national delegates representing the 45 member nations of the EAN and an equal number of delegates representing the currently 900 individual members.

THE EAN BOARD – 7 elected and two appointed officers: President, Vice President, Secretary General, Treasurer, Chairpersons of the Scientific and Liaison Committees and one Member at Large; Congress Programme and Education Committees chairpersons.

THE EAN HEAD OFFICE will be in Vienna, Austria with two branch offices in Brussels, Belgium and Basel, Switzerland.

THE EUROPEAN JOURNAL OF NEUROLOGY will be the official publication of the EAN.

THE FIRST EAN CONGRESS will be held in Berlin, Germany in June 2015.

 

 

 

 

 

An excellent overview on current stroke syndromes, including problematic clinical pictures various editors (Bogousslavsky, Agnelli, Caso and Paciaroni) .
In the Frontiers of Neurology and Neurosciences by Karger out this month.

Since Stroke is the most common neurologic disease and the leading cause of adult disability in Western countries. The initial diagnosis of stroke is clinical and needs to be done as rapidly as possible to guarantee optimal medical and interventional therapy. The emergency stroke management depends heavily upon stroke scores to quantify the damage and to speed up the diagnosis process. Unfortunately, several important stroke syndromes are not taken into consideration in these currently used stroke scores and therefore tend to be overlooked and not treated. Compiled by leading international experts, this book provides an excellent overview on current stroke syndromes, including particularly problematic clinical pictures. Thus, together with stroke scores, the publication will lead to more thorough assessments in emergency settings.

“…..This book is indispensable for neurologists, neurosurgeons, neuroradiologists and physicians involved in the care of stroke patients…..”

In the Jan issue of Neuroepidemiology statements and commentaries regarding epidemiological confounders found in Arab countries.

GermanyBayer has announced preliminary results of the ROCKET AF study, showed how thet the new oral factor Xa inhibitor rivaroxaban (Xarelto (R) ) met its primary efficacy end point of noninferiority to dose-adjusted warfarin on all-cause stroke and non-CNS embolism. The rates of the composite of major and nonmajor clinically relevant bleeding were comparable (the primary safety end point). The overall feeling in the field is not completely satisfactory, but is better to wait the full paper.

Stroke Track is an Acute Stroke Checklist developed at Michigan University as a training toolk for iPhone.

It nicely reports demo data of the lysis candidate, NIH measurement as well as rTPA dosage.  This free app available at iTunes store together with MediMath represent the most relevant iPhone tool available for stroke in the3 acute phase and recovery. Sill much may be improved to offer a better tailored panel of stroke tool for trainees as well as stroke doctors

Have a look to the last update on the SITS-ISTR. The paper on ‘Implementation of thrombolysis with alteplase 3-4.5 hours after an acute stroke: an updated analysis from ISTR’ by Niaz Ahmed et al is now published in the September issue of Lancet Neurology.

The Open Neurology Journal
Volume 4, 2010

HOT TOPIC: STROKE
A panel of international experts depicts from bench to bedside promising lines in stroke medicine and research

http://www.ncbi.nlm.nih.gov/pubmed/20721324

Editorial [Hot topic; Cerebrovascular Diseases: Perspectives for the Next Decade] pp.25-25 (1) Author: Francesco Corea

Animal Models of Ischemic Stroke. Part One: Modeling Risk Factors pp.26-33 (8) Authors: Marco Bacigaluppi, Giancarlo Comi, Dirk M. Hermann

Animal Models of Ischemic Stroke. Part Two: Modeling Cerebral ischemia pp.34-38 (5) Authors: Marco Bacigaluppi, Giancarlo Comi, Dirk M. Hermann

Autonomic Dysfunction and Risk Stratification Assessed from Heart Rate Pattern pp.39-49 (11) Authors: A. Gunther, O. W. Witte, D. Hoyer

Cervical Artery Dissection: Emerging Risk Factors pp.50-55 (6) Authors: S. Micheli, M. Paciaroni, F. Corea, G. Agnelli, M. Zampolini, V. Caso

Prevention Strategies for Cardioembolic Stroke: Present and Future Perspectives pp.56-63 (8) Authors: Giacomo Giacalone, Mohammed Abballa Abbas, Francesco Corea

Clinical Pharmacology and Vascular Risk pp.64-72 (9) Authors: G. Silvestrelli, F. Corea, S. Micheli, A. Lanari