Neurología Vascular

Rationale, design and baseline characteristics of participants in the OCEANIC-STROKE trial of FXIa inhibition for secondary stroke prevention

2026-05-27T17:38:06Z

Rationale, design and baseline characteristics of participants in the OCEANIC-STROKE trial of FXIa inhibition for secondary stroke prevention Sharma, Mukul; Dong, Qiang; Hirano, Teruyuki; Kasner, Scott E.; Saver, Jeffrey; Masjuan, Jaime; Demchuk, Andrew M.; Cordonnier, Charlotte; Bereczki, Daniel; Tsivgoulis, Georgios; Veltkamp, Roland; Staikov, Ivan; Bae, Hee-Joon; Campbell, Bruce C. V.; Zini, Andrea; Lee, I-Hui; Ameriso, Sebastián Francisco; Kovar, Martin; Mikulik, Robert; Lemmens, Robin Introduction: Genetic deficiency of factor XI is associated with a reduced risk of ischemic stroke. Asundexian is a direct inhibitor of activated factor XIa (FXIa) with a low risk of bleeding in early trials. We seek to determine its efficacy and safety combined with antiplatelet therapy for prevention of ischemic stroke. Patients and methods: Oral faCtor Eleven A iNhibitor asundexian as novel antithrombotiC (OCEANIC-STROKE) is a placebo-controlled, double-blind, event-driven randomised trial including participants with stroke (NIHSS ≤ 15) or high-risk TIA (ABCD2 6 or 7) within 72 h of onset. Participants had at least one of the following: atherosclerosis of extra- or intracranial vessels, a medical history of atherosclerosis or an imaged acute non-lacunar infarct. We excluded sources of stroke requiring anticoagulation and active non-trivial bleeding other than hemorrhagic infarction (HI 1 or 2). Participants received asundexian 50 mg daily or placebo stratified by planned concurrent antiplatelet therapy (single vs dual). The primary endpoint is time to ischemic stroke. We present baseline characteristics as of 5 June 2025. Results: Between January 2023 and February 2025, we randomised 12,327 participants. Participants were 67% male with a mean (SD) age of 68 (11) years. Ischemic stroke was the index event for 95% of whom 27.4% had thrombolysis and/or mechanical thrombectomy. By TOAST classification, 43% of index strokes were LAA, 22% small vessel disease, 30% undetermined and 2% cardioembolic. Dual antiplatelets were planned in 63% as standard initial treatment. Trial completion is anticipated in October 2025. Conclusion: OCEANIC-STROKE will be the first completed trial of FXIa inhibition for prevention of stroke after non-cardioembolic stroke or TIA.

SmartRehab: Enhancing Stroke Recovery through Automated Telerehabilitation (P7-14.011)

2026-02-12T14:56:28Z

SmartRehab: Enhancing Stroke Recovery through Automated Telerehabilitation (P7-14.011) Velez, Faddi Saleh; Yeung, Elton; Bonin Pinto, Camila; Ling, Tsei Mei; Alet, Matías Javier; Carbonera, Leonardo; Ciopleias, Bogdan; khan, Abdul; Law, Zhe Kang; Lotlikar, Radhika; Liu, Roxanna; So, Adrian; Chan, Yin; Poon, Gloria; Boada Robayo, Laura; Rudyk, Demian; Kiper, Pawel; Yabluchanskiy, Andriy; Savitz, Sean; Luo, Louis Objective: We tested the SmartRehab efficacy, usability, and feasibility for stroke rehabilitation across seven countries. Background: Stroke is a major cause of disability worldwide. Timely and personalized rehabilitation is critical for recovery, yet current methods are limited by medical shortages, overwhelmed healthcare systems, and insurance constraints. Telerehabilitation has emerged as a promising solution to address these gaps. The SmartRehab app, developed to tackle these issues, uses an Artificial Intelligence powered, computer vision-based pose estimation algorithm to track patient movements, providing precise performance assessment, immediate feedback, and tailored adjustments. The app operates autonomously, allowing patients to complete sessions without a physical therapist (PT) being present, while a single PT can remotely track progress and monitor dozens of patients offline at their convenience. Design/Methods: This ongoing prospective single-arm international multicenter study spans four continents, testing SmartRehab's feasibility and efficacy for post-stroke motor disability. Participants enrolled receive a 4-week automated telerehabilitation program, prescribed by PTs using the SmartRehab platform. Motor improvements are assessed with the Fugl-Meyer Assessment (FMA) for upper and lower extremities. Usability and satisfaction are measured using the Telehealth Usability Questionnaire (TUQ). Results: This ongoing multicenter study has enrolled 30 subjects to date, with 15 stroke survivors completing telerehabilitation (mean age 57.6±16.97; 75% male). Preliminary analysis of patients with complete FMA (n=11) revealed a statistically significant improvement in upper extremity motor function (mean change [Baseline-Follow-up: −10.8±6.8; p<0.001]) and a trend toward improvement in lower extremities (mean change: −4.571±4.9; p=0.052). Usability feedback showed high ratings on TUQ (1-poor,7-great, mean 5.87±1.1). Therapists reported high satisfaction, ease of use, and benefits for patients, while adherence rates varied across countries (19%–95%, average 48%), with lower compliance linked to technology challenges Conclusions: SmartRehab is a feasible and effective telerehabilitation platform for stroke recovery, with high user satisfaction. Significant motor function improvements were observed. Addressing technological barriers may enhance adherence and outcome

Latin America Multidisciplinary Consensus Panel on Management of Severe Bleeding in the Anticoagulated Patient

2026-02-04T17:08:16Z

Latin America Multidisciplinary Consensus Panel on Management of Severe Bleeding in the Anticoagulated Patient Pontes-Neto, Octávio M.; Noble-Lugo, Alejandra; Montenegro Arenas, Ana Cristina; de Campos Guerra, Joao Carlos; Ceresetto, Jose Manuel; Rosales, Julieta Soledad; Colunga-Lozano, Luis Enrique; Meillon-Garcia, Luis Antonio; Vargas Tellez, Luis Eduardo; Dos Reis Rodrigues, Roseny; Gibler, W. Brian; Kreitzer, Natalie P. Background: Bleeding is the most important complication associated with anticoagulants. Patients experiencing bleeding while on an anticoagulation require proper risk stratification, which involves careful assessment of multiple factors, including hemodynamic stability, the origin of bleeding, and the extent of blood loss. Over the last several decades, important advances have been made in the field of anticoagulant therapy and reversal. Objectives: This manuscript provides a review of anticoagulant related hemorrhages, with particular emphasis on topics most relevant to Latin America. It offers an updated assessment of evidence-based strategies for managing major bleeding related to anticoagulation. We will also explore what happens to patients in real-life situations, where there are not specific reversal agents available. Discussion: While minor bleeding can usually be managed simply by discontinuing the anticoagulant, major bleeding is a medical emergency that may threaten life and require the administration of blood products and the utilization of specific antidotes. Fresh frozen plasma (FFP) or prothrombin complex concentrates (PCCs) can be administrated for major bleeding incidents linked to warfarin. Protamine sulfate is administrated for unfractionated heparin and partially for low-molecular-weight heparin (LMWH). Idarucizumab is the reversal agent for dabigatran, while andexanet alfa is approved for the reversal of oral factor Xa inhibitors. Conclusions: This review highlights the significance of appropriate risk stratification and management strategies for bleeding complications associated with anticoagulants. The manuscript emphasizes the need for adaptable management strategies in regions like Latin America, where resource limitations may impact the availability of specific reversal agents.

Initial Experience of Transarterial Embolization for Shoulder Musculoskeletal Pain Using an Ethiodized Oil-Based Emulsion: A Multicenter Study

2025-11-26T17:04:21Z

Initial Experience of Transarterial Embolization for Shoulder Musculoskeletal Pain Using an Ethiodized Oil-Based Emulsion: A Multicenter Study Sapoval, Marc; Stacoffe, Nicolas; Bertoni, Hernán Gabriel; Déan, Carole; Ghelfi, Julien; Jehanno, Pascal; Gremen, Emeric; Boeken, Tom Purpose: The study reports the initial experience in transarterial embolization (TAE) using an ethiodized oil-based emulsion for patients with refractory shoulder pain, focusing on safety, pain reduction, and functional improvement. Methods: This is a retrospective, multicenter study including 23 patients treated with TAE using an ethiodized oil-based emulsion between April 2021 and May 2024. Clinical outcomes were assessed using visual analog scale (VAS) scores for pain (0-100 mm) and QuickDASH (0-100) scores (Disability of the Arm, Shoulder and Hand) for functionality. Adverse events were recorded and classified. Results: The primary etiology of shoulder pain was adhesive capsulitis (61%), followed by bursitis (39%). Median follow-up was 87 days (range: 27-1088 days). Mean VAS score decreased from 65 mm (± 22) at rest, and 82 mm (± 13) during mobilization to 30 mm (± 27) at rest, and 36 mm (± 24) during mobilization at the last follow-up (p < 0.05). Mean QuickDASH score improved from 67 (± 17) pre-procedure to 43 (± 25) post-procedure (p < 0.05). No major complications occurred, and minor adverse events included one radial artery thrombosis (4%) and one puncture site hematoma (4%). Conclusion: TAE of the shoulder using an ethiodized oil-based emulsion is safe and effective, warranting further investigation in larger studies.