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Frank L Silver - One of the best experts on this subject based on the ideXlab platform.
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outcomes after acute ischemic stroke in patients with thrombocytopenia or thrombocytosis
Journal of the Neurological Sciences, 2016Co-Authors: Julio C Furlan, Jiming Fang, Frank L SilverAbstract:Abstract Introduction Thrombocytopenia may be associated with a greater risk of cerebral hemorrhage and thrombocytosis may be associated with a greater risk of cerebral thrombosis. There is a paucity of studies focused on the potential association between Blood Platelet Count (BPC) and outcomes after acute ischemic stroke (AIS). We hypothesized that abnormal BPC is associated with poorer outcomes after AIS. Methods This study included data from the Ontario Stroke Registry on consecutive patients with AIS admitted between July 2003 and March 2008. Patients were divided into groups as follows: low BPC ( 450,000/mm3). Primary outcome measures were the frequency of moderate/severe strokes on admission (Canadian Neurologic Scale: Results We included 9230 patients. Both low and high BPC were associated with higher 30-day mortality (p ≤ 0.0335) and 90-day mortality (p ≤ 0.048) following AIS. The Kaplan–Meier curves indicate that abnormal BPC is associated with greater mortality after AIS (p = 0.0002). Nonetheless, abnormal BPC was not associated with initial stroke severity (p ≥ 0.225), degree of disability (p ≥ 0.3761), or length of stay in the acute stroke care center (p ≥ 0.7818) after adjustment for major potential confounders. Conclusions Thrombocytopenia and thrombocytosis on the initial admission are associated with higher mortality after AIS. Abnormal BPC does not adversely affect the degree of initial impairment, disability at discharge, or length of stay in the acute care hospital after AIS.
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does abnormal Blood Platelet Count influence mortality impairment and disability after acute ischemic stroke p1 141
Neurology, 2014Co-Authors: Julio C Furlan, Jiming Fang, Frank L SilverAbstract:OBJECTIVE: We hypothesized that abnormal Blood Platelet Count is associated with worse outcomes after acute ischemic stroke. BACKGROUND: To date, a few prior studies comparing Blood Platelet Count and outcomes after acute stroke have shown conflicting results. DESIGN/METHODS: This retrospective case series included data from Phase 3 of the Registry of the Canadian Stroke Network on consecutive patients with ischemic stroke who were admitted to 11 stroke center in Ontario. We included all consecutive patients admitted to hospital with ischemic stroke between July/2003 and March/2008. We excluded patients with a final diagnosis of non stroke, patients taking antibiotics, anticonvulsants or iron supplement, patients with cancer, patients with history of gastro-intestinal or genitourinary bleeding, and pregnant patients. RESULTS: Abnormal Platelet ( 450,000 per microliter) Count is significantly associated with higher 30-day mortality (p=0.0103) and 90-day mortality (p=0.0189) following acute ischemic stroke after adjustment for major potential confounders in the multivariable logistic regression models. The Kaplan-Meier curves indicate that abnormal Platelet Count is associated with greater mortality after acute ischemic stroke (p=0.0002). The optimal thresholds are lower than 200,000 and\ higher than 400,000 per microliter. However, abnormal Platelet Count is not associated with degree of impairment (p=0.2524), degree of disability (p=0.684), risk of a Total Anterior Circulation Stroke (p=0.5825) or length of stay in the acute stroke care center (p=0.9541) after adjustment for major potential confounders. CONCLUSIONS: The results of our study indicate that thrombocytopenia and thrombocytosis on the initial admission is associated with higher mortality after an acute ischemic stroke. Nonetheless, abnormal Platelet Count does not adversely affect impairment, disability or length of stay in the acute care center after acute ischemic stroke. The large sample size of this prospectively collected database is an indicative that those results are robust and properly adjusted for major potential confounders. Study Supported by: Fellowships and Scholarships from University of Toronto. Disclosure: Dr. Fang has nothing to disclose. Dr. Silver has nothing to disclose.
Julio C Furlan - One of the best experts on this subject based on the ideXlab platform.
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outcomes after acute ischemic stroke in patients with thrombocytopenia or thrombocytosis
Journal of the Neurological Sciences, 2016Co-Authors: Julio C Furlan, Jiming Fang, Frank L SilverAbstract:Abstract Introduction Thrombocytopenia may be associated with a greater risk of cerebral hemorrhage and thrombocytosis may be associated with a greater risk of cerebral thrombosis. There is a paucity of studies focused on the potential association between Blood Platelet Count (BPC) and outcomes after acute ischemic stroke (AIS). We hypothesized that abnormal BPC is associated with poorer outcomes after AIS. Methods This study included data from the Ontario Stroke Registry on consecutive patients with AIS admitted between July 2003 and March 2008. Patients were divided into groups as follows: low BPC ( 450,000/mm3). Primary outcome measures were the frequency of moderate/severe strokes on admission (Canadian Neurologic Scale: Results We included 9230 patients. Both low and high BPC were associated with higher 30-day mortality (p ≤ 0.0335) and 90-day mortality (p ≤ 0.048) following AIS. The Kaplan–Meier curves indicate that abnormal BPC is associated with greater mortality after AIS (p = 0.0002). Nonetheless, abnormal BPC was not associated with initial stroke severity (p ≥ 0.225), degree of disability (p ≥ 0.3761), or length of stay in the acute stroke care center (p ≥ 0.7818) after adjustment for major potential confounders. Conclusions Thrombocytopenia and thrombocytosis on the initial admission are associated with higher mortality after AIS. Abnormal BPC does not adversely affect the degree of initial impairment, disability at discharge, or length of stay in the acute care hospital after AIS.
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does abnormal Blood Platelet Count influence mortality impairment and disability after acute ischemic stroke p1 141
Neurology, 2014Co-Authors: Julio C Furlan, Jiming Fang, Frank L SilverAbstract:OBJECTIVE: We hypothesized that abnormal Blood Platelet Count is associated with worse outcomes after acute ischemic stroke. BACKGROUND: To date, a few prior studies comparing Blood Platelet Count and outcomes after acute stroke have shown conflicting results. DESIGN/METHODS: This retrospective case series included data from Phase 3 of the Registry of the Canadian Stroke Network on consecutive patients with ischemic stroke who were admitted to 11 stroke center in Ontario. We included all consecutive patients admitted to hospital with ischemic stroke between July/2003 and March/2008. We excluded patients with a final diagnosis of non stroke, patients taking antibiotics, anticonvulsants or iron supplement, patients with cancer, patients with history of gastro-intestinal or genitourinary bleeding, and pregnant patients. RESULTS: Abnormal Platelet ( 450,000 per microliter) Count is significantly associated with higher 30-day mortality (p=0.0103) and 90-day mortality (p=0.0189) following acute ischemic stroke after adjustment for major potential confounders in the multivariable logistic regression models. The Kaplan-Meier curves indicate that abnormal Platelet Count is associated with greater mortality after acute ischemic stroke (p=0.0002). The optimal thresholds are lower than 200,000 and\ higher than 400,000 per microliter. However, abnormal Platelet Count is not associated with degree of impairment (p=0.2524), degree of disability (p=0.684), risk of a Total Anterior Circulation Stroke (p=0.5825) or length of stay in the acute stroke care center (p=0.9541) after adjustment for major potential confounders. CONCLUSIONS: The results of our study indicate that thrombocytopenia and thrombocytosis on the initial admission is associated with higher mortality after an acute ischemic stroke. Nonetheless, abnormal Platelet Count does not adversely affect impairment, disability or length of stay in the acute care center after acute ischemic stroke. The large sample size of this prospectively collected database is an indicative that those results are robust and properly adjusted for major potential confounders. Study Supported by: Fellowships and Scholarships from University of Toronto. Disclosure: Dr. Fang has nothing to disclose. Dr. Silver has nothing to disclose.
Jan Balldin - One of the best experts on this subject based on the ideXlab platform.
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thrombocytopenia in early alcohol withdrawal is associated with development of delirium tremens or seizures
Alcohol and Alcoholism, 2009Co-Authors: Ulf Berggren, Claudia Fahlke, Kristina Berglund, Kaj Blennow, Henrik Zetterberg, Jan BalldinAbstract:Aims In several studies, possible risk factors/predictors for severe alcohol withdrawal syndrome (AWS), i.e. delirium tremens (DT) and/or seizures, have been investigated. We have recently observed that low Blood Platelet Count could be such a risk factor/predictor. We therefore investigated whether such an association could be found using a large number of alcohol-dependent individuals (n = 334). Methods This study is a retrospectively conducted cohort study based on data from female and male patients (>20 years of age), consecutively admitted to an alcohol treatment unit. The individuals had to fulfil the discharge diagnoses alcohol dependence and alcohol withdrawal syndrome according to DSM-IV. Results During the treatment period, 3% of the patients developed DT, 2% seizures and none had co-occurrence of both conditions. Among those with DT, a higher proportion had thrombocytopenia. Those with seizures had lower Blood Platelet Count and a higher proportion of them had thrombocytopenia. The sensitivity and specificity of thrombocytopenia for the development of DT during the treatment period was 70% and 69%, respectively. The positive predictive value (PPV) was 6% and the negative predictive value (NPV) was 99%. For the development of seizures, the figure for sensitivity was 75% and for specificity 69%. The figures for PPV and NPV were similar as those for the development of DT. Conclusions Thrombocytopenia is more frequent in patients who develop severe AWS (DT or seizures). The findings, including the high NPV of thrombocytopenia, must be interpreted with caution due to the small number of patients who developed AWS. Further studies replicating the present finding are therefore needed before the clinical usefulness can be considered.
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clinical aspects thrombocytopenia in early alcohol withdrawal is associated with development of delirium tremens or seizures
2009Co-Authors: Ulf Berggren, Claudia Fahlke, Kristina Berglund, Kaj Blennow, Henrik Zetterberg, Jan BalldinAbstract:Aims: In several studies, possible risk factors/predictors for severe alcohol withdrawal syndrome (AWS), i.e. delirium tremens (DT) and/or seizures, have been investigated. We have recently observed that low Blood Platelet Count could be such a risk factor/predictor. We therefore investigated whether such an association could be found using a large number of alcohol-dependent individuals (n = 334). Methods: This study is a retrospectively conducted cohort study based on data from female and male patients (>20 years of age), consecutively admitted to an alcohol treatment unit. The individuals had to fulfil the discharge diagnoses alcohol dependence and alcohol withdrawal syndrome according to DSM-IV.Results: During the treatment period, 3% of the patients developed DT, 2% seizures and none had co-occurrence of both conditions. Among those with DT, a higher proportion had thrombocytopenia. Those with seizures had lower Blood Platelet Count and a higher proportion of them had thrombocytopenia. The sensitivity and specificity of thrombocytopenia for the development of DT during the treatment period was 70% and 69%, respectively. The positive predictive value (PPV) was 6% and the negative predictive value (NPV) was 99%. For the development of seizures, the figure for sensitivity was 75% and for specificity 69%. The figures for PPV and NPV were similar as those for the development of DT. Conclusions: Thrombocytopenia is more frequent in patients who develop severe AWS (DT or seizures). The findings, including the high NPV of thrombocytopenia, must be interpreted with caution due to the small number of patients who developed AWS. Further studies replicating the present finding are therefore needed before the clinical usefulness can be considered.
Bahaeddine M Sibai - One of the best experts on this subject based on the ideXlab platform.
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risk factors for adverse maternal outcomes among women with hellp hemolysis elevated liver enzymes and low Platelet Count syndrome
American Journal of Obstetrics and Gynecology, 2000Co-Authors: Bassam Haddad, John R Barton, Jeffrey Livingston, Rabih Chahine, Bahaeddine M SibaiAbstract:Abstract Objective: This study was undertake to determine risk factors for adverse maternal outcomes among women with HELLP (hemolysis, elevated liver enzymes, and low Platelet Count) syndrome. Study Design: Maternal medical records of pregnancies complicated by HELLP syndrome managed between July 1, 1992, and April 30, 1999, were reviewed. Risk factors evaluated included maternal age, parity, race, previous preeclampsia, chronic hypertension, gestational age at diagnosis, mean arterial Blood pressure, nadir Blood Platelet Count ( t test, the χ 2 test, and logistic regression analysis. Results: A total of 183 women with HELLP syndrome were studied. Eclampsia was present in 6%, abruptio placentae was present in 10%, and disseminated intravascular coagulopathy was present in 8%. Forty-one women (22%) required transfusion of Blood products. Incidence of eclampsia significantly decreased with increasing gestational age, from 16% at ≤28 weeks' gestation to 3% at >32 weeks' gestation ( P P P P P P 150 U/L, and a peak serum lactate dehydrogenase level of >1400 U/L were not independent risk factors for adverse outcome. Conclusions: Among women with HELLP syndrome, African American race is a risk factor for eclampsia. Both acute renal failure and abruptio placentae are associated with disseminated intravascular coagulopathy. Laboratory parameters of HELLP syndrome are not independent risk factors for adverse maternal outcome. (Am J Obstet Gynecol 2000;183:444-8.)
Jiming Fang - One of the best experts on this subject based on the ideXlab platform.
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outcomes after acute ischemic stroke in patients with thrombocytopenia or thrombocytosis
Journal of the Neurological Sciences, 2016Co-Authors: Julio C Furlan, Jiming Fang, Frank L SilverAbstract:Abstract Introduction Thrombocytopenia may be associated with a greater risk of cerebral hemorrhage and thrombocytosis may be associated with a greater risk of cerebral thrombosis. There is a paucity of studies focused on the potential association between Blood Platelet Count (BPC) and outcomes after acute ischemic stroke (AIS). We hypothesized that abnormal BPC is associated with poorer outcomes after AIS. Methods This study included data from the Ontario Stroke Registry on consecutive patients with AIS admitted between July 2003 and March 2008. Patients were divided into groups as follows: low BPC ( 450,000/mm3). Primary outcome measures were the frequency of moderate/severe strokes on admission (Canadian Neurologic Scale: Results We included 9230 patients. Both low and high BPC were associated with higher 30-day mortality (p ≤ 0.0335) and 90-day mortality (p ≤ 0.048) following AIS. The Kaplan–Meier curves indicate that abnormal BPC is associated with greater mortality after AIS (p = 0.0002). Nonetheless, abnormal BPC was not associated with initial stroke severity (p ≥ 0.225), degree of disability (p ≥ 0.3761), or length of stay in the acute stroke care center (p ≥ 0.7818) after adjustment for major potential confounders. Conclusions Thrombocytopenia and thrombocytosis on the initial admission are associated with higher mortality after AIS. Abnormal BPC does not adversely affect the degree of initial impairment, disability at discharge, or length of stay in the acute care hospital after AIS.
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does abnormal Blood Platelet Count influence mortality impairment and disability after acute ischemic stroke p1 141
Neurology, 2014Co-Authors: Julio C Furlan, Jiming Fang, Frank L SilverAbstract:OBJECTIVE: We hypothesized that abnormal Blood Platelet Count is associated with worse outcomes after acute ischemic stroke. BACKGROUND: To date, a few prior studies comparing Blood Platelet Count and outcomes after acute stroke have shown conflicting results. DESIGN/METHODS: This retrospective case series included data from Phase 3 of the Registry of the Canadian Stroke Network on consecutive patients with ischemic stroke who were admitted to 11 stroke center in Ontario. We included all consecutive patients admitted to hospital with ischemic stroke between July/2003 and March/2008. We excluded patients with a final diagnosis of non stroke, patients taking antibiotics, anticonvulsants or iron supplement, patients with cancer, patients with history of gastro-intestinal or genitourinary bleeding, and pregnant patients. RESULTS: Abnormal Platelet ( 450,000 per microliter) Count is significantly associated with higher 30-day mortality (p=0.0103) and 90-day mortality (p=0.0189) following acute ischemic stroke after adjustment for major potential confounders in the multivariable logistic regression models. The Kaplan-Meier curves indicate that abnormal Platelet Count is associated with greater mortality after acute ischemic stroke (p=0.0002). The optimal thresholds are lower than 200,000 and\ higher than 400,000 per microliter. However, abnormal Platelet Count is not associated with degree of impairment (p=0.2524), degree of disability (p=0.684), risk of a Total Anterior Circulation Stroke (p=0.5825) or length of stay in the acute stroke care center (p=0.9541) after adjustment for major potential confounders. CONCLUSIONS: The results of our study indicate that thrombocytopenia and thrombocytosis on the initial admission is associated with higher mortality after an acute ischemic stroke. Nonetheless, abnormal Platelet Count does not adversely affect impairment, disability or length of stay in the acute care center after acute ischemic stroke. The large sample size of this prospectively collected database is an indicative that those results are robust and properly adjusted for major potential confounders. Study Supported by: Fellowships and Scholarships from University of Toronto. Disclosure: Dr. Fang has nothing to disclose. Dr. Silver has nothing to disclose.