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Search All Research Studies
Topics
- Adverse Drug Events (ADE) (2)
- Adverse Events (2)
- Blood Clots (1)
- Blood Thinners (1)
- Cardiovascular Conditions (2)
- Caregiving (1)
- Decision Making (1)
- Diagnostic Safety and Quality (1)
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- (-) Patient Safety (5)
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 5 of 5 Research Studies DisplayedMarcaccio CL, Patel PB, Rastogi V
Efficacy and safety of single versus dual antiplatelet therapy in carotid artery stenting.
This study’s objective was to examine the efficacy and safety of preoperative single antiplatelet therapy (AP) therapy vs double antiplatelet therapy (DAPT) in patients who had undergone transfemoral CAS (tfCAS) or transcarotid artery revascularization (TCAR). The authors identified all patients who had undergone tfCAS or TCAR in the Vascular Quality Initiative database from 2016 to 2021. A total of 18,570 tfCAS patients were included, of which 70% had received DAPT, 5.6% no AP therapy, 10% ASA only, 8.0% ASA + AP loading dose, 4.6% P2Y12 inhibitor (P2Yi) only, and 2.9% P2Yi + AP loading dose. After adjustment, compared with DAPT, the incidence of stroke/death was higher with no AP therapy, ASA only, and ASA + AP loading dose, but was similar with P2Yi only, and P2Yi + AP loading dose. No differences were found in the incidence of bleeding rates between the treatment groups after tfCAS or TCAR. These findings support the current guidelines recommending DAPT before CAS but also suggest that P2Yi monotherapy might confer thromboembolic benefits similar to those with DAPT.
AHRQ-funded; HS027285.
Citation: Marcaccio CL, Patel PB, Rastogi V .
Efficacy and safety of single versus dual antiplatelet therapy in carotid artery stenting.
J Vasc Surg 2023 May; 77(5):1434-46.e11. doi: 10.1016/j.jvs.2022.12.034..
Keywords: Blood Thinners, Medication, Medication: Safety, Cardiovascular Conditions, Stroke, Adverse Drug Events (ADE), Adverse Events, Patient Safety
Marcaccio CL, Patel PB, Liang P
Efficacy and safety of perioperative dual antiplatelet therapy with ticagrelor versus clopidogrel in carotid artery stenting.
This study’s objective was to compare the efficacy and safety of perioperative dual antiplatelet therapy with aspirin/ticagrelor vs aspirin/clopidogrel in patients undergoing transfemoral carotid artery stenting (tfCAS) or transcarotid artery revascularization (TCAR). The authors identified all patients who underwent tfCAS or TCAR in the Vascular Quality Initiative registry from January 2016 to March 2021. They stratified patients by procedure and assessed outcomes using 1:3 propensity score-matched cohorts of patients who received perioperative aspirin/ticagrelor vs aspirin/clopidogrel. Among the cohort of 17,731 tfCAS patients, 593 (3.3%) received aspirin/ticagrelor and 11,404 (64%) received aspirin/clopidogrel. For the 2065 matched patients, no significant differences were found in the composite endpoint of stroke/death (aspirin/ticagrelor, 4.1%; vs aspirin/clopidogrel, 2.6%) or in the individual endpoints of stroke (2.9% vs 1.8%) or death (1.7% vs 1.1%). However, aspirin/ticagrelor was associated with a higher risk of bleeding (5.8% vs 2.8%). In a subgroup analysis of 297 tfCAS patients (14%) who received intraoperative protamine, no differences remained in stroke/death (1.5% vs 3.9%), and there was no longer a difference in bleeding (3.0% vs 2.6%). Among 17,946 TCAR patients, 453 (2.5%) received aspirin/ticagrelor and 13,696 (76%) received aspirin/clopidogrel. With the 1618 matched patients, no differences were found in stroke/death (0.7% vs 1.4%), stroke (0.2% vs 1.2%), death (0.5% vs 0.2%), or bleeding (1.2% vs 1.6%). For the 1429 TCAR patients (88%) who received protamine, no differences were found in stroke/death (0.8% vs 1.2%) or bleeding (0.6% vs 1.4%).
AHRQ-funded; HS027285.
Citation: Marcaccio CL, Patel PB, Liang P .
Efficacy and safety of perioperative dual antiplatelet therapy with ticagrelor versus clopidogrel in carotid artery stenting.
J Vasc Surg 2022 Apr; 75(4):1293-303.e8. doi: 10.1016/j.jvs.2021.09.045..
Keywords: Cardiovascular Conditions, Medication, Stroke, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Surgery
Krishnan S, Pappadis MR, Weller SC
Patient-centered mobility outcome preferences according to individuals with stroke and caregivers: a qualitative analysis.
This study explored the mobility-related preferences among stroke survivors and caregivers following post-acute rehabilitation at inpatient or skilled nursing facilities. Frequently mentioned outcome preferences by survivors were ability to walk (88 percent), move, and balance. They also wanted to acquire assistive devices to move independently. Caregivers were concerned with the survivor's safety and wanted them to drive (53 percent), prevent falls, have home accommodations, and transfer independently.
AHRQ-funded; HS022134; HS024711.
Citation: Krishnan S, Pappadis MR, Weller SC .
Patient-centered mobility outcome preferences according to individuals with stroke and caregivers: a qualitative analysis.
Disabil Rehabil 2018 Jun;40(12):1401-09. doi: 10.1080/09638288.2017.1297855.
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Keywords: Caregiving, Patient-Centered Outcomes Research, Patient Safety, Rehabilitation, Stroke
Newman-Toker DE, Moy E, Valente E
AHRQ Author: Moy E
Missed diagnosis of stroke in the emergency department: a cross-sectional analysis of a large population-based sample.
The authors sought to estimate the frequency of missed stroke and examine associations with patient, emergency department (ED), and hospital characteristics. They estimated 15,000-165,000 misdiagnosed cerebrovascular events annually in US EDs, disproportionately presenting with headache or dizziness. They recommended that physicians evaluating these symptoms be particularly attuned to the possibility of stroke in younger, female, and non-White patients.
AHRQ-authored; AHRQ-funded; HS019252.
Citation: Newman-Toker DE, Moy E, Valente E .
Missed diagnosis of stroke in the emergency department: a cross-sectional analysis of a large population-based sample.
Diagnosis 2014 Jun;1(2):155-66. doi: 10.1515/dx-2013-0038.
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Keywords: Diagnostic Safety and Quality, Emergency Department, Healthcare Cost and Utilization Project (HCUP), Patient Safety, Stroke
Radecki RP
Letter by Radecki regarding article, "safety of thrombolysis in stroke mimics: results from a multicenter cohort study".
In this letter commenting on an article on the treatment of stroke mimics, the author asserts that the difficult question of the acceptable rate of misdiagnosis remains. He suggests that patients undergoing thrombolytic therapy for acute ischemic stroke have confirmatory testing such as an MRI with diffusion-weighted sequences and that the incidence of neuroimaging negative events be reported.
AHRQ-funded; HS017586
Citation: Radecki RP .
Letter by Radecki regarding article, "safety of thrombolysis in stroke mimics: results from a multicenter cohort study".
Stroke. 2013 Sep;44(9):e105. doi: 10.1161/STROKEAHA.113.002040..
Keywords: Stroke, Decision Making, Patient Safety, Blood Clots