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Latest & greatest articles for stroke
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Effect of Alteplase vs Aspirin on Functional Outcome for Patients With Acute Ischemic Stroke and Minor Nondisabling Neurologic Deficits: The PRISMS Randomized Clinical Trial. Importance: More than half of patients with acute ischemic stroke have minor neurologic deficits (National Institutes of Health Stroke Scale [NIHSS] score of 0-5) at presentation. Although prior major trials of alteplase included patients with low NIHSS scores, few without clearly disabling deficits were enrolled (...) . Objective: To evaluate the efficacy and safety of alteplase in patients with NIHSS scores of 0 to 5 whose deficits are not clearly disabling. Design, Setting, and Participants: The PRISMS trial was designed as a 948-patient, phase 3b, double-blind, double-placebo, multicenter randomized clinical trial of alteplase compared with aspirin for emergent stroke at 75 stroke hospital networks in the United States. Patients with acute ischemic stroke whose deficits were scored as 0 to 5 on the NIHSS and judged
Remote ischaemic conditioning for preventing and treating ischaemic stroke. BACKGROUND: Remote ischaemic conditioning (RIC) has been developed as a neuroprotective strategy to prevent and treat ischaemic stroke. It usually involves restricting blood flow to limbs and then releasing the ischaemic blood to promote a neuroprotective effect. Preclinical studies have suggested that RIC may have beneficial effects in ischaemic stroke patients and those at risk of ischaemic stroke. However, existing (...) evidence is insufficient to demonstrate the efficacy and safety of RIC in preventing and treating ischaemic stroke. OBJECTIVES: To assess the benefits and harms of RIC for preventing ischaemic stroke and for treating people with ischaemic stroke and those at risk for ischaemic stroke. SEARCH METHODS: We searched the Cochrane Stroke Group Trials Register (16 January 2018), the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 12) in the Cochrane Library (January 2018), MEDLINE Ovid
Very early mobilisation following a stroke is no better than usual care Signal - Very early mobilisation following a stroke is no better than usual care Dissemination Centre Discover Portal NIHR DC Discover Very early mobilisation following a stroke is no better than usual care Published on 22 April 2015 The AVERT trial found very early mobilisation - such as out-of-bed sitting, standing and walking - within 24 hours of stroke onset and at increased intensity, led to 4% fewer people with good (...) recovery than usual care. No differences were found in death rates, overall disability scores, or in the time to be able to walk. Most people in this study, even as part of usual care, started mobilising in less than 24 hours. Guidelines recommend early mobilisation when appropriate and this study may not prompt an immediate change in practice, but does provide clearer evidence that higher intensity early intervention may not be better than more slowly mobilising at around one day after a stroke. Share
Prevention of cardiovascular events in Asian patients with ischaemic stroke at high risk of cerebral haemorrhage (PICASSO): a multicentre, randomised controlled trial 29778364 2018 05 20 1474-4465 17 6 2018 Jun The Lancet. Neurology Lancet Neurol Prevention of cardiovascular events in Asian patients with ischaemic stroke at high risk of cerebral haemorrhage (PICASSO): a multicentre, randomised controlled trial. 509-518 S1474-4422(18)30128-5 10.1016/S1474-4422(18)30128-5 The optimal treatment (...) for patients with ischaemic stroke with a high risk of cerebral haemorrhage is unclear. We assessed the efficacy and safety of cilostazol versus aspirin, with and without probucol, in these patients. In this randomised, controlled, 2 × 2 factorial trial, we enrolled patients with ischaemic stroke with a history of or imaging findings of intracerebral haemorrhage or two or more microbleeds from 67 centres in three Asian countries. Patients were randomly assigned (1:1:1:1) to receive oral cilostazol (100 mg
Dynamic Changes of CHA2DS2-VASc Score and the Risk of Ischaemic Stroke in Asian Patients with Atrial Fibrillation: A Nationwide Cohort Study 29723875 2018 07 02 2567-689X 118 7 2018 Jul Thrombosis and haemostasis Thromb. Haemost. Dynamic Changes of CHA2DS2-VASc Score and the Risk of Ischaemic Stroke in Asian Patients with Atrial Fibrillation: A Nationwide Cohort Study. 1296-1304 10.1055/s-0038-1651482 Stroke risk in atrial fibrillation (AF) is often assessed at initial presentation, and risk (...) stratification performed as a 'one off'. In validation studies of risk prediction, baseline values are often used to 'predict' events that occur many years later. Many clinical variables have 'dynamic' changes over time, as the patient is followed up. These dynamic changes in risk factors may increase the CHA 2 DS 2 -VASc score, stroke risk category and absolute ischaemic stroke rate. This article evaluates the 'dynamic' changes of CHA 2 DS 2 -VASc variables and its effect on prediction of stroke risk. From
Network meta-analysis of patent foramen ovale management strategies in cryptogenic stroke 29875222 2018 07 03 1526-632X 91 1 2018 Jul 03 Neurology Neurology Network meta-analysis of patent foramen ovale management strategies in cryptogenic stroke. e1-e7 10.1212/WNL.0000000000005736 To compare the outcomes of patent foramen ovale (PFO) closure vs antiplatelet agent (APA) vs oral anticoagulation therapy (OAT) for secondary prevention of stroke in patients with cryptogenic stroke, using direct (...) and indirect evidence from existing randomized data. Relevant randomized controlled trials were identified by a systematic review. The efficacy outcome was stroke recurrence, and safety outcomes were atrial fibrillation and bleeding complications at the end of follow-up. Bayesian network meta-analysis was performed to calculate risk estimates and the rank probabilities using APA therapy as the reference. In a network meta-analysis of 6 randomized controlled trials consisting of 3,497 patients (1,732 PFO
Effects of mirror therapy on walking ability, balance and lower limb motor recovery after stroke: a systematic review and meta-analysis of randomized controlled trials 29644880 2018 04 12 1477-0873 2018 Apr 01 Clinical rehabilitation Clin Rehabil Effects of mirror therapy on walking ability, balance and lower limb motor recovery after stroke: a systematic review and meta-analysis of randomized controlled trials. 269215518766642 10.1177/0269215518766642 To investigate the effects of mirror (...) therapy on walking ability, balance and lower limb motor recovery in patients with stroke. MEDLINE, EMBASE, Web of Science, CENTRAL, PEDro Database, CNKI, VIP, Wan Fang, ClinicalTrials.gov, Current controlled trials and Open Grey were searched for randomized controlled trials that investigated the effects of mirror therapy on lower limb function through January 2018. The primary outcomes included were walking speed, mobility and balance function. Secondary outcomes included lower limb motor recovery
The efficacy comparison of citalopram, fluoxetine, and placebo on motor recovery after ischemic stroke: a double-blind placebo-controlled randomized controlled trial 29783900 2018 05 22 1477-0873 2018 May 01 Clinical rehabilitation Clin Rehabil The efficacy comparison of citalopram, fluoxetine, and placebo on motor recovery after ischemic stroke: a double-blind placebo-controlled randomized controlled trial. 269215518777791 10.1177/0269215518777791 The present study aimed to assess (...) the effectiveness of oral citalopram, compared with fluoxetine and a placebo, in patients with post-stroke motor disabilities. A randomized double-blind placebo-controlled clinical trial was conducted between January 2015 and January 2016. The neurology department of a university-affiliated urban hospital in Tehran, Iran. Ninety adult patients with acute ischemic stroke, hemiplegia, or hemiparesis and a Fugl-Meyer Motor Scale score of below 55 were included. Participants were randomly allocated to one of three
Risk of Ischemic Stroke After Perioperative Atrial Fibrillation in Total Knee and Hip Arthroplasty Patients 29793849 2018 05 25 1532-8406 2018 Apr 16 The Journal of arthroplasty J Arthroplasty Risk of Ischemic Stroke After Perioperative Atrial Fibrillation in Total Knee and Hip Arthroplasty Patients. S0883-5403(18)30358-9 10.1016/j.arth.2018.04.009 To determine if new-onset perioperative atrial fibrillation during arthroplasty represents a benign response to intraoperative cardiac stress (...) or is a risk factor for stroke, we evaluated the subsequent risk of ischemic stroke in patients with new-onset atrial fibrillation occurring during primary total knee arthroplasty (TKA) and total hip arthroplasty (THA). Discharge data of all adult patients undergoing primary TKA or THA from 1997 to 2013 were queried via the New York Statewide Planning and Research Cooperative System database to find patients with new-onset perioperative atrial fibrillation. These patients were then followed up over time
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Functional strength training versus movement performance therapy for upper limb motor recovery early after stroke: a RCT Functional strength training versus movement performance therapy for upper limb motor recovery early after stroke: a RCT Journals Library An error occurred retrieving content to display, please try again. >> >> >> Page Not Found Page not found (404) Sorry - the page you requested could not be found. Please choose a page from the navigation or try a website search above
Effect of a Multifaceted Quality Improvement Intervention on Hospital Personnel Adherence to Performance Measures in Patients With Acute Ischemic Stroke in China: A Randomized Clinical Trial. Importance: In China and other parts of the world, hospital personnel adherence to evidence-based stroke care is limited. Objective: To determine whether a multifaceted quality improvement intervention can improve hospital personnel adherence to evidence-based performance measures in patients with acute (...) ischemic stroke (AIS) in China. Design, Setting, and Participants: A multicenter, cluster-randomized clinical trial among 40 public hospitals in China that enrolled 4800 patients hospitalized with AIS from August 10, 2014, through June 20, 2015, with 12-month follow-up through July 30, 2016. Interventions: Twenty hospitals received a multifaceted quality improvement intervention (intervention group; 2400 patients), including a clinical pathway, care protocols, quality coordinator oversight
Dual versus mono antiplatelet therapy for acute non-cardioembolic ischaemic stroke or transient ischaemic attack: a systematic review and meta-analysis 30022798 2018 11 14 2059-8696 3 2 2018 Jun Stroke and vascular neurology Stroke Vasc Neurol Dual versus mono antiplatelet therapy for acute non-cardioembolic ischaemic stroke or transient ischaemic attack: a systematic review and meta-analysis. 107-116 10.1136/svn-2018-000168 Recent years have seen new evidence on the efficacy and safety of dual (...) antiplatelet therapy for secondary stroke prevention. We updated a meta-analysis of randomised controlled trials evaluating dual antiplatelet versus monotherapy for patients with acute non-cardioembolic ischaemic stroke (IS) or transient ischaemic attack (TIA). We searched PubMed and identified randomised controlled trials evaluating dual antiplatelet versus monotherapy for acute non-cardioembolic IS or TIA within 3 days of ictus up to May 2018. Risk ratio (RR) with 95% CI were calculated using random
Patent foramen ovale and cryptogenic stroke: diagnosis and updates in secondary stroke prevention 30022802 2018 11 14 2059-8696 3 2 2018 Jun Stroke and vascular neurology Stroke Vasc Neurol Patent foramen ovale and cryptogenic stroke: diagnosis and updates in secondary stroke prevention. 84-91 10.1136/svn-2018-000173 The patent foramen ovale (PFO), given its high prevalence in the general population and especially in patients with cryptogenic stroke, has long generated investigation and debate (...) on its propensity for stroke by paradoxical embolism and its management for stroke prevention. The pendulum has swung for percutaneous PFO closure for secondary stroke prevention in cryptogenic stroke. Based on a review of current evidence, the benefit from PFO closure relies on careful patient selection: those under the age of 60 years with few to no vascular risk factors and embolic-appearing stroke deemed cryptogenic after thorough evaluation. As these data look towards influencing guideline
Exercise for stroke prevention 30191075 2018 11 14 2059-8696 3 2 2018 Jun Stroke and vascular neurology Stroke Vasc Neurol Exercise for stroke prevention. 59-68 10.1136/svn-2018-000155 We review evidence concerning exercise for stroke prevention. Plausible biological reasons suggest that exercise would be important in preventing stroke. While definitive randomised controlled trials evaluating the impact of physical activity (PA) and exercise on preventing stroke and mortality are lacking (...) , observational studies, small randomised controlled trials and meta-analyses have provided evidence that PA and exercise favourably modify stroke risk factors, including hypertension, dyslipidaemia, diabetes, sedentary lifestyle, obesity, excessive alcohol consumption and tobacco use. It is, therefore, important to understand the factors associated with poststroke PA/exercise and cardiorespiratory fitness. Positively associated factors include self-efficacy, social support and quality of patients
Peak exercise stroke volume effects on cognitive impairment in communityâ€dwelling people with preserved ejection fraction 29947095 2018 11 29 2055-5822 5 5 2018 10 ESC heart failure ESC Heart Fail Peak exercise stroke volume effects on cognitive impairment in community-dwelling people with preserved ejection fraction. 876-883 10.1002/ehf2.12311 The association of vascular dysfunction and amyloid beta deposition attracted attentions for its relationship with cognitive decline. Previous studies (...) equivalents (r = 0.244), usual walking speed (r = -0.200), and the Timed Up and Go test (r = -0.230). Multiple linear regression analysis showed peak VO 2 /HR was an independent determinant of MoCA-J score after adjusting for potential confounders (B = 0.424). After 6 months of exercise training with 64 subjects, we found that the per cent change of peak VO 2 /HR was related to the per cent change of MoCA-J score (r = 0.296). These results suggested that peak VO 2 /HR (an index of stroke volume at peak
Stenting for intracranial stenosis: potential future for the prevention of disabling or fatal stroke 30294469 2018 11 14 2059-8696 3 3 2018 Sep Stroke and vascular neurology Stroke Vasc Neurol Stenting for intracranial stenosis: potential future for the prevention of disabling or fatal stroke. 140-146 10.1136/svn-2018-000158 Intracranial stenosis is a common cause of ischaemic strokes, in particular, in the Asian, African and Hispanic populations. The randomised multicentre study Stenting (...) and Aggressive Medical Management for the Prevention of Recurrent stroke in Intracranial Stenosis (SAMMPRIS) showed 14.7% risk of stroke or death in the stenting group versus 5.8% in the medical group at 30 days, and 23% in the stenting group versus 15% in the medical group at a median follow-up of 32.4 months. The results demonstrated superiority of medical management over stenting and have almost put the intracranial stenting to rest in recent years. Of note, 16 patients (7.1%) in the stenting group had
B vitamins for stroke prevention 30022794 2018 11 14 2059-8696 3 2 2018 Jun Stroke and vascular neurology Stroke Vasc Neurol B vitamins for stroke prevention. 51-58 10.1136/svn-2018-000156 Supplementation with B vitamins (vitamin B 9 (folic acid), vitamin B 12 and vitamin B 6 ) lowers blood total homocysteine (tHcy) concentrations by about 25% and reduces the relative risk of stroke overall by about 10% (risk ratio (RR) 0.90, 95% CI 0.82 to 0.99) compared with placebo. Homocysteine-lowering (...) interventions have no significant effect on myocardial infarction, death from any cause or adverse outcomes. Factors that appear to modify the effect of B vitamins on stroke risk include low folic acid status, high tHcy, high cyanocobalamin dose in patients with impaired renal function and concurrent antiplatelet therapy. In regions with increasing levels or established policies of population folate supplementation, evidence from observational genetic epidemiological studies and randomised controlled