Glasgow Theses Service http://theses.gla.ac.uk/ theses@gla.ac.uk Higgins, Peter (2014) Novel secondary preventative strategies in the management of ischaemic stroke and transient ischaemic attack. MD thesis http://theses.gla.ac.uk/5152/ Copyright and moral rights for this thesis are retained by the author A copy can be downloaded for personal non-commercial research or study, without prior permission or charge This thesis cannot be reproduced or quoted extensively from without first obtaining permission in writing from the Author The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the Author When referring to this work, full bibliographic details including the author, title, awarding institution and date of the thesis must be given ! ! ! ! ! ! ! "#$%&!'%(#)*+,-!.,%$%)/+/0$% !'/,+/%10%'!0)! /2%!3+)+1%3%)/!#4!0'(2+%30(!'/, #5%!+)*! /,+)'0%)/!0'(2+%30(!+//+(5! ! 6%/%,!70110)'!! 89:29;!9<(!=7#)'>;!8?:6!=@A>!! ! 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The incidence of stroke remains high in the UK 13 In England, stroke incidence was reported as 178 and 139, for males and females respectively, per 100,000 in 2007 17 There is regional variation within the UK, with higher incidence in Scotland at 208 and 159 cases per 100,000 18 Based on the incidence... 8, 9 Whilst age-‐specific incidence of stroke may have fallen, the elderly population has increased in size in recent years and is anticipated to continue to do so 10 As the incidence of stroke is highest in the elderly population, the absolute number of stroke hospital admissions has increased in recent years 11-‐13 ... witnessed a rise in stroke incidence in younger age groups In a combined analysis of the Greater Cincinnati & Northern Kentucky populations, the age at first stroke fell by two years between 1993-‐94 and 1999 – 2005 and events in the population aged under 55 years comprised almost one fifth of all cases in the latter time period... variation in stroke incidence was observed 20 years ago , with the highest 15 rates observed in the developed world Subsequently, the effects of globalisation have given rise to increased age-‐specific incidence of stroke in developing countries in recent decades, with approximately 70% of global stroke deaths now occuring in developing countries... of AF 51 2.5.3 Risk according to AF burden 52 2.6 Addressing the risk of recurrent stroke in patients with AF 54 2.7 The prevalence of AF in patients presenting with ischaemic stroke & TIA 57 2.8 The prevalence of paroxysmal AF in ischaemic stroke & TIA patients 58 xviii 2.9 The relevance of. .. recurrent events each year, comprising one quarter of all annual stokes 18, 19 Due to the simultaneous expansion of the elderly population, increasing incidence in younger age groups and in the developing world, the global burden of stroke is anticipated to rise in the coming decades By 2030, 7.8 million stroke- ‐attributable deaths are anticipated... thromboembolism and cardiac complications 27, 28 Accordingly, management of patients with acute stroke is based on attempting to limit the extent of initial neurological injury and providing supportive physiological monitoring and therapy to reduce the risk of complications 28 Management seamlessly proceeds to assessment for underlying... that is IHD: Ischaemic heart disease IL: Interleukin IMP: Inosine monophoshate IMS: Interventional Management of Stroke IRAS: Insulin Resistance Atherosclerosis Study ISRCTN: I nternational Standard Randomised Controlled Trial Number Register IST: International stroke trial IV: Intravenous KS: Karen Shields L: Litre LAA: Large artery atherosclerosis... embolism SEM: Standard error of the mean SIGN: Scottish Intercollegiate Guidelines Network SITS-‐ISTR: Safe Implementation of Treatments in Stroke International Stroke Thrombolysis Register SITS-‐MOST: Safe Implementation of Treatments in Stroke Monitoring Study SP: Standard practice SP-‐AM: Standard practice with additional monitoring SPARCL: Stroke Prevention... in 2005 and the number of disability-‐adjusted life years lost to stroke is expected increase from 50.8 million to 60.9 million 16 1.1.2 Mortality Stroke has risen to hold status as the 2nd leading single cause of adult mortality globally 3, reflecting high incidence in the developed world, increasing incidence . Glasgow Theses Service http://theses.gla.ac.uk/ theses@gla.ac.uk Higgins, Peter (2014) Novel secondary preventative strategies in the management of ischaemic stroke and transient ischaemic. medium without the formal permission of the Author When referring to this work, full bibliographic details including the author, title, awarding institution and date of the thesis must be. This thesis cannot be reproduced or quoted extensively from without first obtaining permission in writing from the Author The content must not be changed in any way or sold commercially in