Most treatments for acute ischemic stroke have focused on dissolving
or preventing clots. The TOAST investigators conducted a randomized controlled
trial to determine whether one of the low molecular weight heparinoids, which
cause less bleeding and thrombocytopenia than heparin, improves outcomes of
patients with acute ischemic stroke.
Warfarin substantially reduces the risk of stroke in patients with atrial
fibrillation but also increases the risk of hemorrhage. The Stroke Prevention
in Atrial Fibrillation (SPAF) investigators previously identified risk factors
for stroke among patients with atrial fibrillation. In this study, they use
their criteria to define a low-risk population and treat them with aspirin
to determine the risk of stroke during 2 years of follow-up.
How should physicians apply clinical trial results in daily practice?
Cautiously, Dr Wennberg and colleagues suggest. Compared with perioperative
mortality rates reported in the trials, perioperative mortality of nontrial
patients who were treated in trial hospitals was substantially higher than
mortality among trial patients, and mortality at nontrial hospitals was even
The risks of stroke and death from carotid endarterectomy in the community
differ from those reported in clinical trials. Dr Cebul and colleagues identify
factors associated with reduced risk of stroke and death, including having
surgery at a hospital at which a high volume of carotid endarterectomies is
Patients with symptoms and signs of acute stroke often delay seeking
medical attention. Dr Pancioli and colleagues provide information that may
help to explain why, documenting substantial gaps in public awareness of stroke
warning signs and risk factors. Of nearly 2000 adults surveyed, slightly more
than half could identify at least 1 common warning sign of stroke and only
two thirds could list at least 1 established stroke risk factor.
Accurate interpretation of cranial CT scans is essential for diagnosing
acute stroke and deciding whether to administer thrombolytic therapy. Dr Schriger
and colleagues asked a small sample of emergency physicians, neurologists,
and general radiologists to interpret CT scans regarding thrombolytic therapy.
Overall, nearly a quarter of decisions for thrombolytic therapy administration
were incorrect; intracranial hemorrhage was not identified in nearly one fifth
". . . time's corrugations have not annihilated beauty; their thick
encasement has only disguised it . . ." Ivan Albright, Self-portrait (No. 20), 1983, American.
Fifty Years of Framingham: An interview with Heart Study director William
P. Castelli, MD, and a retrospective look at research and clinical findings
from a unique half-century of data collection.
"Increasing pressures for cost control and the spread of managed care
throughout the country create an urgent, shared need for information on health
care quality among all health care stakeholders."
In this issue, we launch a new feature that will provide patient-friendly
information related to 1 or more articles in each week's JOURNAL. Physicians
are encouraged to make copies of these pages and share them with their patients.
This week's topic: stroke.
See Article and related editorial Article
This Week in JAMA. JAMA. 1998;279(16):1237. doi:10.1001/jama.279.16.1237