Stroke Update: 3 Developments in the News

Dr Oh and colleagues studied 310 patients who had been taking aspirin for at least 7 days before they experienced an ischemic stroke. Aspirin resistance was checked within 24 hours of hospital admission. Nearly 28% of the patients were resistant to aspirin, and their strokes ranged from 3 to 11 on a stroke severity score, compared with scores of 1 to 6 among aspirin responders. Also, twice their brain area was affected compared with those who responded to aspirin. In patients at high risk for stroke with aspirin resistance, drugs with different anti-clotting mechanisms, such as clopidogrel, can be considered as alternatives to prevent another stroke or to decrease stroke severity, Dr Oh said. The researchers are scheduled to present the findings in April at the American Academy of Neurology’s 66th AAN Annual Meeting in Washington, DC.

One-third of Americans do not have access to a primary stroke center within 1 hour by ambulance, according to a new study. “Stroke is a time-critical disease. Each second after a stroke begins, brain cells die, so it is critically important that specialized stroke care be rapidly accessible to the population,” said study author Michael T. Mullen, MD, with the Perelman School of Medicine at the University of Pennsylvania in Philadelphia.

Dr Mullen and colleagues created models to estimate what proportion of the population would have access to a comprehensive stroke center within an hour under optimal circumstances. They found that converting up to 20 optimally located primary stroke centers per state into comprehensive stroke centers would result in less than two-thirds of the population living within a 1-hour drive and about one-fourth within a 1-hour flight of a center. Access to care in the models was lowest in the southeastern United States, often referred to as the “Stroke Belt.” The researchers published the results in the March 4, 2015, online issue of Neurology.http://www.neurology.org/content/early/2015/03/04/WNL.0000000000001390

A new mobile application to help first-time minority stroke patients become healthier is now under investigation in a clinical trial. Research shows that African Americans and Hispanics have their first stroke 10 to 13 years earlier than Caucasians and are more likely to have a second stroke. Also, they are more likely to be disabled 2 years after a stroke, said principal investigator Nneka Ifejika, MD, MPH, Associate Professor of Neurology and Director of Neurorehabilitation at the University of Texas Health Science Center in Houston.

The new physician-monitored app is designed to encourage minority patients with stroke to lose weight. The 2-year study will look at cholesterol, weight, vital signs, and inflammatory markers, as well as loneliness and depression, which can affect compliance. Patients will be randomized to usual care or the app and will receive dietary counseling. The usual-care group receives a food diary, and the app group receives an app called Lose It! that records food and exercise. An upgraded app program allows Dr Ifejika to see how the participants are doing and to send encouraging comments or reminders. Dr Ifejika presented the study at the Eighth Annual National Conference on Health Disparities in November 2014.

Take-Away Messages:
• Aspirin resistance may be a predictor of severe stroke and large stroke size in patients taking aspirin before having a stroke.
• A physician-monitored app may help first-time minority stroke patients lose weight.
• Many persons may not have rapid access to comprehensive stroke centers, even under optimal conditions.