Terapia de alta intensidad con Atorvastatina de 40 miligramos para prevención secundaria en pacientes diagnosticados con ACV isquémico en la Clínica Misericordia Internacional de Barranquilla, enero – agosto 2021

INTRODUCCIÓN: El accidente cerebrovascular (ACV) se define como un déficit neurológico atribuido a una lesión focal aguda del sistema nervioso central por una causa vascular. Se estima que hay 9,6 millones de ACV isquémicos a nivel mundial cada a–o, con una incidencia creciente en países de bajos y...

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Autores:: Crespo Vizcaíno, Estiven de Jesús
Carlos José, Brito Jácome

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Fecha de publicación:: 2022

Institución:: Universidad Libre

Repositorio:: RIU - Repositorio Institucional UniLibre

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dc.title.spa.fl_str_mv	Terapia de alta intensidad con Atorvastatina de 40 miligramos para prevención secundaria en pacientes diagnosticados con ACV isquémico en la Clínica Misericordia Internacional de Barranquilla, enero – agosto 2021
title	Terapia de alta intensidad con Atorvastatina de 40 miligramos para prevención secundaria en pacientes diagnosticados con ACV isquémico en la Clínica Misericordia Internacional de Barranquilla, enero – agosto 2021
spellingShingle	Terapia de alta intensidad con Atorvastatina de 40 miligramos para prevención secundaria en pacientes diagnosticados con ACV isquémico en la Clínica Misericordia Internacional de Barranquilla, enero – agosto 2021 Accidente cerebrovascular Prevención secundaria Factores de riesgo Efectividad Atorvastatina Recurrencia Stroke Secondary prevention Risk factors Recurrence Effectiveness Atorvastatin Accidente cerebrovascular Atorvastatina Prevención secundaria
title_short	Terapia de alta intensidad con Atorvastatina de 40 miligramos para prevención secundaria en pacientes diagnosticados con ACV isquémico en la Clínica Misericordia Internacional de Barranquilla, enero – agosto 2021
title_full	Terapia de alta intensidad con Atorvastatina de 40 miligramos para prevención secundaria en pacientes diagnosticados con ACV isquémico en la Clínica Misericordia Internacional de Barranquilla, enero – agosto 2021
title_fullStr	Terapia de alta intensidad con Atorvastatina de 40 miligramos para prevención secundaria en pacientes diagnosticados con ACV isquémico en la Clínica Misericordia Internacional de Barranquilla, enero – agosto 2021
title_full_unstemmed	Terapia de alta intensidad con Atorvastatina de 40 miligramos para prevención secundaria en pacientes diagnosticados con ACV isquémico en la Clínica Misericordia Internacional de Barranquilla, enero – agosto 2021
title_sort	Terapia de alta intensidad con Atorvastatina de 40 miligramos para prevención secundaria en pacientes diagnosticados con ACV isquémico en la Clínica Misericordia Internacional de Barranquilla, enero – agosto 2021
dc.creator.fl_str_mv	Crespo Vizcaíno, Estiven de Jesús Carlos José, Brito Jácome
dc.contributor.advisor.none.fl_str_mv	Vargas Manotas, José Enrique Navarro Baene, Gina
dc.contributor.author.none.fl_str_mv	Crespo Vizcaíno, Estiven de Jesús Carlos José, Brito Jácome
dc.subject.spa.fl_str_mv	Accidente cerebrovascular Prevención secundaria Factores de riesgo Efectividad Atorvastatina Recurrencia
topic	Accidente cerebrovascular Prevención secundaria Factores de riesgo Efectividad Atorvastatina Recurrencia Stroke Secondary prevention Risk factors Recurrence Effectiveness Atorvastatin Accidente cerebrovascular Atorvastatina Prevención secundaria
dc.subject.subjectenglish.spa.fl_str_mv	Stroke Secondary prevention Risk factors Recurrence Effectiveness Atorvastatin
dc.subject.lemb.spa.fl_str_mv	Accidente cerebrovascular Atorvastatina Prevención secundaria
description	INTRODUCCIÓN: El accidente cerebrovascular (ACV) se define como un déficit neurológico atribuido a una lesión focal aguda del sistema nervioso central por una causa vascular. Se estima que hay 9,6 millones de ACV isquémicos a nivel mundial cada a–o, con una incidencia creciente en países de bajos y medianos ingresos. La terapia de alta intensidad con estatinas ha probado beneficio en prevención—n secundaria usando dosis de 80 mg de atorvastatina. OBJETIVO: Se pretende determinar el probable beneficio de dosis de 40 mg de atorvastatina manteniendo los beneficios cardiovasculares. METODOLOGÍA: Este es un estudio descriptivo, longitudinal y retrospectivo, se evaluaron 48 pacientes mayores de 18 a–os diagnosticados con ACV quienes recib’an atorvastatina en dosis de 40 mg diarios como prevención secundaria. Se caracterizaron sociodemográfica y clínicamente y se evalúa tasa de recurrencia en un periodo menor y mayor de 180 días. RESULTADOS: Tras la ingesta de atorvastatina de 40 mg, la muestra estudiada presenta una tasa de recurrencia de ACV de s—lo 12,5%, la mayoría presenta recurrencia luego de 180 días de seguimiento (50%), principalmente en pacientes con hipertensión arterial (88,3%), tabaquismo (77,1%) y sedentarismo (47,9%). CONCLUSIONES: Se determina el probable beneficio de atorvastatina de 40 mg en prevención secundaria de pacientes diagnosticados con ACV isquémico, a pesar de las limitaciones presentadas se observa una tendencia de baja recurrencia de ACV. Los resultados obtenidos dan pie al desarrollo de producción investigativa para comprobar la efectividad de la dosis de 40 mg de atorvastatina y demás consideraciones.
publishDate	2022
dc.date.accessioned.none.fl_str_mv	2022-12-05T20:45:30Z
dc.date.available.none.fl_str_mv	2022-12-05T20:45:30Z
dc.date.created.none.fl_str_mv	2022-06
dc.type.coar.fl_str_mv	http://purl.org/coar/resource_type/c_7a1f
dc.type.local.spa.fl_str_mv	Tesis de Especialización
dc.type.driver.spa.fl_str_mv	info:eu-repo/semantics/bachelorThesis
dc.identifier.uri.none.fl_str_mv	https://hdl.handle.net/10901/23841
url	https://hdl.handle.net/10901/23841
dc.relation.references.spa.fl_str_mv	Campbell B, Khatri P. Stroke. Lancet. 2020; 396: 129–42 Amruta N, Rahman A, Pinteaux E, Bix G. Neuroinflammation and fibrosis in stroke: The good, the bad and the ugly. Journal of Neuroimmunology. 2020; 346:577318 Pandian JD, Gall SL, Kate MP, et al. Prevention of stroke: a global perspective. Lancet. 2018; 392: 1269–78 GBD 2016 Stroke Collaborators. Global, regional, and national burden of stroke, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019; 18: 439-58 Amarenco P, Bogousslavsky J, Callahan A 3rd, et al. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med. 2006; 355: 549–59 Kazi D, Penko J, Bibbins-Domingo K. Statins for Primary Prevention of Cardiovascular Disease Review of Evidence and Recommendations for Clinical Practice. Med Clin N Am. 2017; 101:689–699 Thompson P, Panza G, Zaleski A, Taylor B. Statin-Associated Side Effects. J Am Coll Cardiol. 2016;67(20):2395-2410 Rojas-Fernandez C, Hudani Z, Bittner V. Statins and Cognitive Side Effects What Cardiologists Need to Know. Cardiol Clin. 2015;33: 245–256 Chowdhury R, Khan H, Heydon E, et al. Adherence to cardiovascular therapy: a meta-analysis of prevalence and clinical consequences. Eur Heart J 2013; 34:2940–8 Murphy S, Werring D. Stroke: causes and clinical features. Medicine. 2020;48(9): 561-566 Yanez N, Useche J, Bayona H, Porras A, Carrasquilla G. Analyses of Mortality and Prevalence of Cerebrovascular Disease in Colombia, South America (2014-2016): A Cross-Sectional and Ecological Study. J Stroke Cerebrovasc Dis. 2020;29(5):104699 Caprio F, Sorond F. Cerebrovascular Disease Primary and Secondary Stroke Prevention. Med Clin N Am. 2019;103: 295–308 Stone N, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J. Am. Coll. Cardiol. 2014; 63: 2889–2934 Cui C, Dong S, Chen N, Bao J, He L. Low-dose statin pretreatment improves function and prognosis of recurrent ischemic stroke patients. Ther Adv Neurol Disord. 2020; 13:1-11 O'Brien EC, Greiner MA, Xian Y, Fonarow GC, Olson DM, Schwamm LH, et al. Clinical Effectiveness of Statin Therapy After Ischemic Stroke: Primary Results From the Statin Therapeutic Area of the Patient-Centered Research Into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) Study. Circulation. 2015;132(15):1404-13 Amarenco P, Kim JS, Labreuche J, Charles H, Giroud M, Lee BC, et al. Treat Stroke to Target Investigators. Benefit of Targeting an LDL (Low-Density Lipoprotein) Cholesterol <70 mg/dL During 5 Years After Ischemic Stroke. Stroke. 2020;51(4):1231-1239 Yoshimura S, Uchida K, Daimon T, Takashima R, Kimura K, Morimoto T. Randomized Controlled Trial of Early Versus Delayed Statin Therapy in Patients with Acute Ischemic Stroke: ASSORT Trial (Administration of Statin on Acute Ischemic Stroke Patient). Stroke. 2017;48(11):3057-3063 Amarenco P, Bogousslavsky J, Callahan A, Goldstein L, Hennerici H, Rudolph A, et al. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med. 2006; 355:549-59 Choi KH, Seo WK, Park MS, Kim JT, Chung JW, Bang OY, et al. Effect of Statin Therapy on Outcomes of Patients with Acute Ischemic Stroke and Atrial Fibrillation. J Am Heart Assoc. 2019;8(24): e013941 Amarenco P, Kim JS, Labreuche J, Charles H, Abtan J, Béjot Y, et al. A Comparison of Two LDL Cholesterol Targets after Ischemic Stroke. N Engl J Med. 2020;382(1):9-19 Parker BA, Capizzi JA, Grimaldi AS, Clarkson PM, Cole SM, Keadle J, et al. Effect of statins on skeletal muscle function. Circulation. 2013; 127(1):96– 103 Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJ, Culebras A, et al. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013; 44(7): 2064– 89 Adams HP, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in acute stroke treatment. Stroke. 1993; 24(1): 35-41 Chugh SS, Havmoeller R, Narayanan K, Singh D, Rienstra M, Benjamin E, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation. 2014; 129(8): 837–47 O’Donnell MJ, Chin SL, Rangarajan S, Xavier D, Liu L, Zhang H, et al. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. Lancet. 2016; 388(10046): 761-775 Arch AE, Weisman DC, Coca S, Nystrom KV, Wira CR, Schindler JL. Missed ischemic stroke diagnosis in the emergency department by emergency medicine and neurology services. Stroke. 2016; 47: 668–73 Hand PJ, Kwan J, Lindley RI, Dennis MS, Wardlaw JM. Distinguishing between stroke and mimic at the bedside: the Brain Attack Study. Stroke. 2006; 37: 769–75 Campbell B, Christensen S, Levi C, Desmond P, Donnan G, Davis S, et al. Comparison of computed tomography perfusion and magnetic resonance 65 imaging perfusion-diffusion mismatch in ischemic stroke. Stroke. 2012;43: 2648–53 Langhorne P, Kamachandra S. Organised inpatient (stroke unit) care for stroke: network meta-analysis. Cochrane Database Syst Rev. 2020; 4:1-116 The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995; 333: 1581–87 Emberson J, Lees KR, Lyden P, Blackwell L, Albers G, Bluhmki E, et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet. 2014; 384(9958): 1929–35 Noncommunicable Diseases Progress Monitor, 2017. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO Diener HC, Hankey GJ. Primary and Secondary Prevention of Ischemic Stroke and Cerebral Hemorrhage: JACC Focus Seminar. J Am Coll Cardiol. 2020;75(15):1804-1818 Collins R, Reith C, Emberson J, Armitage J, Baigent C, Blackwell L, et al. Interpretation of the evidence for the efficacy and safety of statin therapy. Lancet. 2016; 388(10059):2532–61 Stone N, Robinson J, Lichtenstein A, Merz C, Blum C, Eckel R, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol.2014; 63:2889–2934 Thompson P, Panza G, Zaleski A, Taylor B. Statin-Associated Side Effects. J Am Coll Cardiol. 2016;67(20):2395-2410 Adhyaru BB, Jacobson TA. Safety and efficacy of statin therapy. Nat Rev Cardiol. 2018;15(12):757-769 Rosenson R, Miller K, Bayliss M, Sanchez R, Baccara-Dinet M, Chibedi-DeRoche D, et al. The statin-associated muscle symptom clinical index (SAMSCI): revision for clinical use, content validation, and inter-rater reliability. Cardiovasc Drugs Ther. 2017;31(2): 179–186 Stroes E, Thompson P, Corsini A, Vladutiu G, Raal F, Ray K, et al. Statinassociated muscle symptoms: impact on statin therapy-European Atherosclerosis Society Consensus Panel Statement on Assessment, Aetiology and Management. Eur Heart J. 2015;36(17):1012–1022 Preiss D, Welsh P, Murphy S, Ho J, Waters D, DeMicco D, et al. Risk of incident diabetes with intensive-dose compared with moderate-dose statin therapy: a meta-analysis. JAMA. 2011;305(24): 2556–2564 Bays H, Cohen D, Chalasani N, Harrison S. The National Lipid Association’s Statin Safety Task Force. An assessment by the Statin Liver Safety Task Force: 2014 update. J Clin Lipidol. 2014; 8:47–57 Ott B, Daiello L, Dahabreh I, Springate B, Bixy K, Murali M, et al. Do statins impair cognition? A systematic review and meta-analysis of randomized controlled trials. J Gen Intern Med. 2015;30(3): 348–358 Easton JD, Saver JL, Albers GW, Alberts MJ, Chaturvedi S, Feldmann E, et al. Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease. The American Academy of Neurology affirms the value of this statement as an educational tool for neurologists. Stroke. 2009;40:2276- 2293
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spelling	Vargas Manotas, José EnriqueNavarro Baene, GinaCrespo Vizcaíno, Estiven de JesúsCarlos José, Brito JácomeBarranquilla2022-12-05T20:45:30Z2022-12-05T20:45:30Z2022-06https://hdl.handle.net/10901/23841INTRODUCCIÓN: El accidente cerebrovascular (ACV) se define como un déficit neurológico atribuido a una lesión focal aguda del sistema nervioso central por una causa vascular. Se estima que hay 9,6 millones de ACV isquémicos a nivel mundial cada a–o, con una incidencia creciente en países de bajos y medianos ingresos. La terapia de alta intensidad con estatinas ha probado beneficio en prevención—n secundaria usando dosis de 80 mg de atorvastatina. OBJETIVO: Se pretende determinar el probable beneficio de dosis de 40 mg de atorvastatina manteniendo los beneficios cardiovasculares. METODOLOGÍA: Este es un estudio descriptivo, longitudinal y retrospectivo, se evaluaron 48 pacientes mayores de 18 a–os diagnosticados con ACV quienes recib’an atorvastatina en dosis de 40 mg diarios como prevención secundaria. Se caracterizaron sociodemográfica y clínicamente y se evalúa tasa de recurrencia en un periodo menor y mayor de 180 días. RESULTADOS: Tras la ingesta de atorvastatina de 40 mg, la muestra estudiada presenta una tasa de recurrencia de ACV de s—lo 12,5%, la mayoría presenta recurrencia luego de 180 días de seguimiento (50%), principalmente en pacientes con hipertensión arterial (88,3%), tabaquismo (77,1%) y sedentarismo (47,9%). CONCLUSIONES: Se determina el probable beneficio de atorvastatina de 40 mg en prevención secundaria de pacientes diagnosticados con ACV isquémico, a pesar de las limitaciones presentadas se observa una tendencia de baja recurrencia de ACV. Los resultados obtenidos dan pie al desarrollo de producción investigativa para comprobar la efectividad de la dosis de 40 mg de atorvastatina y demás consideraciones.Universidad Libre Seccional Barranquilla -- Facultad de Ciencias de la Salud -- Especialización en Medicina InternaBACKGROUND: Stroke is defined as a neurological deficit attributed to an acute focal lesion of central nervous system due to a vascular cause. There are an estimated 9.6 million ischemic strokes worldwide each year, with an increasing incidence in low and middle-income countries. High-intensity statin therapy has proven beneficial in secondary prevention using 80 mg doses of atorvastatin. OBJECTIVE: It is intended to determine probable benefit of 40 mg dose of atorvastatin; maintaining cardiovascular benefits. MATERIALS AND METHODS: This is a descriptive, longitudinal and retrospective study. 48 patients older than 18 years diagnosed with isquemic stroke who received atorvastatin in doses of 40 mg daily as secondary prevention were evaluated. They were characterized in terms of sociodemographic and clinical features and recurrence rate was evaluated in a period of less than and greater than 180 days. RESULTS: After the intake of atorvastatin 40 mg, studied sample presented a recurrence rate of stroke of only 12.5%, majority presented recurrence after 180 days of follow-up (50%), mainly in patients with arterial hypertension (88.3%), smoking (77.1%) and sedentary lifestyle (47.9%). CONCLUSIONS: The probable benefit of atorvastatin 40 mg in secondary prevention of patients diagnosed with ischemic stroke was determined, despite the limitations presented, a trend of low stroke recurrence was observed. The results obtained give rise to the development of investigation to prove the effectiveness of 40 mg dose of atorvastatin and other considerations.PDFhttp://creativecommons.org/licenses/by-nc-nd/2.5/co/Atribución-NoComercial-SinDerivadas 2.5 Colombiahttp://purl.org/coar/access_right/c_abf2Accidente cerebrovascularPrevención secundariaFactores de riesgoEfectividadAtorvastatinaRecurrenciaStrokeSecondary preventionRisk factorsRecurrenceEffectivenessAtorvastatinAccidente cerebrovascularAtorvastatinaPrevención secundariaTerapia de alta intensidad con Atorvastatina de 40 miligramos para prevención secundaria en pacientes diagnosticados con ACV isquémico en la Clínica Misericordia Internacional de Barranquilla, enero – agosto 2021Tesis de Especializacióninfo:eu-repo/semantics/bachelorThesishttp://purl.org/coar/resource_type/c_7a1fCampbell B, Khatri P. Stroke. Lancet. 2020; 396: 129–42Amruta N, Rahman A, Pinteaux E, Bix G. Neuroinflammation and fibrosis in stroke: The good, the bad and the ugly. Journal of Neuroimmunology. 2020; 346:577318Pandian JD, Gall SL, Kate MP, et al. Prevention of stroke: a global perspective. Lancet. 2018; 392: 1269–78GBD 2016 Stroke Collaborators. Global, regional, and national burden of stroke, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019; 18: 439-58Amarenco P, Bogousslavsky J, Callahan A 3rd, et al. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med. 2006; 355: 549–59Kazi D, Penko J, Bibbins-Domingo K. Statins for Primary Prevention of Cardiovascular Disease Review of Evidence and Recommendations for Clinical Practice. Med Clin N Am. 2017; 101:689–699Thompson P, Panza G, Zaleski A, Taylor B. Statin-Associated Side Effects. J Am Coll Cardiol. 2016;67(20):2395-2410Rojas-Fernandez C, Hudani Z, Bittner V. Statins and Cognitive Side Effects What Cardiologists Need to Know. Cardiol Clin. 2015;33: 245–256Chowdhury R, Khan H, Heydon E, et al. Adherence to cardiovascular therapy: a meta-analysis of prevalence and clinical consequences. Eur Heart J 2013; 34:2940–8Murphy S, Werring D. Stroke: causes and clinical features. Medicine. 2020;48(9): 561-566Yanez N, Useche J, Bayona H, Porras A, Carrasquilla G. Analyses of Mortality and Prevalence of Cerebrovascular Disease in Colombia, South America (2014-2016): A Cross-Sectional and Ecological Study. J Stroke Cerebrovasc Dis. 2020;29(5):104699Caprio F, Sorond F. Cerebrovascular Disease Primary and Secondary Stroke Prevention. Med Clin N Am. 2019;103: 295–308Stone N, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J. Am. Coll. Cardiol. 2014; 63: 2889–2934Cui C, Dong S, Chen N, Bao J, He L. Low-dose statin pretreatment improves function and prognosis of recurrent ischemic stroke patients. Ther Adv Neurol Disord. 2020; 13:1-11O'Brien EC, Greiner MA, Xian Y, Fonarow GC, Olson DM, Schwamm LH, et al. Clinical Effectiveness of Statin Therapy After Ischemic Stroke: Primary Results From the Statin Therapeutic Area of the Patient-Centered Research Into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) Study. Circulation. 2015;132(15):1404-13Amarenco P, Kim JS, Labreuche J, Charles H, Giroud M, Lee BC, et al. Treat Stroke to Target Investigators. Benefit of Targeting an LDL (Low-Density Lipoprotein) Cholesterol <70 mg/dL During 5 Years After Ischemic Stroke. Stroke. 2020;51(4):1231-1239Yoshimura S, Uchida K, Daimon T, Takashima R, Kimura K, Morimoto T. Randomized Controlled Trial of Early Versus Delayed Statin Therapy in Patients with Acute Ischemic Stroke: ASSORT Trial (Administration of Statin on Acute Ischemic Stroke Patient). Stroke. 2017;48(11):3057-3063Amarenco P, Bogousslavsky J, Callahan A, Goldstein L, Hennerici H, Rudolph A, et al. High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med. 2006; 355:549-59Choi KH, Seo WK, Park MS, Kim JT, Chung JW, Bang OY, et al. Effect of Statin Therapy on Outcomes of Patients with Acute Ischemic Stroke and Atrial Fibrillation. J Am Heart Assoc. 2019;8(24): e013941Amarenco P, Kim JS, Labreuche J, Charles H, Abtan J, Béjot Y, et al. A Comparison of Two LDL Cholesterol Targets after Ischemic Stroke. N Engl J Med. 2020;382(1):9-19Parker BA, Capizzi JA, Grimaldi AS, Clarkson PM, Cole SM, Keadle J, et al. Effect of statins on skeletal muscle function. Circulation. 2013; 127(1):96– 103Sacco RL, Kasner SE, Broderick JP, Caplan LR, Connors JJ, Culebras A, et al. An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013; 44(7): 2064– 89Adams HP, Bendixen BH, Kappelle LJ, Biller J, Love BB, Gordon DL, et al. Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in acute stroke treatment. Stroke. 1993; 24(1): 35-41Chugh SS, Havmoeller R, Narayanan K, Singh D, Rienstra M, Benjamin E, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation. 2014; 129(8): 837–47O’Donnell MJ, Chin SL, Rangarajan S, Xavier D, Liu L, Zhang H, et al. Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study. Lancet. 2016; 388(10046): 761-775Arch AE, Weisman DC, Coca S, Nystrom KV, Wira CR, Schindler JL. Missed ischemic stroke diagnosis in the emergency department by emergency medicine and neurology services. Stroke. 2016; 47: 668–73Hand PJ, Kwan J, Lindley RI, Dennis MS, Wardlaw JM. Distinguishing between stroke and mimic at the bedside: the Brain Attack Study. Stroke. 2006; 37: 769–75Campbell B, Christensen S, Levi C, Desmond P, Donnan G, Davis S, et al. Comparison of computed tomography perfusion and magnetic resonance 65 imaging perfusion-diffusion mismatch in ischemic stroke. Stroke. 2012;43: 2648–53Langhorne P, Kamachandra S. Organised inpatient (stroke unit) care for stroke: network meta-analysis. Cochrane Database Syst Rev. 2020; 4:1-116The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995; 333: 1581–87Emberson J, Lees KR, Lyden P, Blackwell L, Albers G, Bluhmki E, et al. Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet. 2014; 384(9958): 1929–35Noncommunicable Diseases Progress Monitor, 2017. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGODiener HC, Hankey GJ. Primary and Secondary Prevention of Ischemic Stroke and Cerebral Hemorrhage: JACC Focus Seminar. J Am Coll Cardiol. 2020;75(15):1804-1818Collins R, Reith C, Emberson J, Armitage J, Baigent C, Blackwell L, et al. Interpretation of the evidence for the efficacy and safety of statin therapy. Lancet. 2016; 388(10059):2532–61Stone N, Robinson J, Lichtenstein A, Merz C, Blum C, Eckel R, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol.2014; 63:2889–2934Thompson P, Panza G, Zaleski A, Taylor B. Statin-Associated Side Effects. J Am Coll Cardiol. 2016;67(20):2395-2410Adhyaru BB, Jacobson TA. Safety and efficacy of statin therapy. 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Stroke. 2009;40:2276- 2293THUMBNAILCRESPO.pdf.jpgCRESPO.pdf.jpgIM Thumbnailimage/jpeg12160http://repository.unilibre.edu.co/bitstream/10901/23841/3/CRESPO.pdf.jpg4e449fe65acef4a231e29dd1bb777d32MD53LICENSElicense.txtlicense.txttext/plain; charset=utf-81748http://repository.unilibre.edu.co/bitstream/10901/23841/2/license.txt8a4605be74aa9ea9d79846c1fba20a33MD52ORIGINALCRESPO.pdfCRESPO.pdfapplication/pdf673041http://repository.unilibre.edu.co/bitstream/10901/23841/1/CRESPO.pdf3403dc23bdb3309469d7d3582eb4beb6MD5110901/23841oai:repository.unilibre.edu.co:10901/238412023-08-03 11:48:56.807Repositorio Institucional Unilibrerepositorio@unilibrebog.edu.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

Terapia de alta intensidad con Atorvastatina de 40 miligramos para prevención secundaria en pacientes diagnosticados con ACV isquémico en la Clínica Misericordia Internacional de Barranquilla, enero – agosto 2021

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