Intravenous thrombolytic therapy and endovascular thrombectomy are the mainstay of treatment for patients with acute ischemic stroke. Although not evidence-based, treatment is often withheld due to safety concerns in patients with a perceived increased risk of bleeding complications. We investigate the safety of off-label/off-guideline reperfusion therapy in ischemic stroke. This line of research fills crucial evidence gaps in acute stroke care and paves the way for more personalized approaches to stroke reperfusion therapy.
Key Publications
Xian Y, Liang L, Smith EE, Schwamm LH, Reeves MJ, Olson DM, Hernandez AF, Fonarow GC, Peterson ED. Risks of intracranial hemorrhage among patients with acute ischemic stroke receiving warfarin and treated with intravenous tissue plasminogen activator. JAMA.
Xian Y, Federspiel JJ, Grau-Sepulveda M, Hernandez AF, Schwamm LH, Bhatt DL, Smith EE, Reeves MJ, Thomas L, Webb L, Bettger JP, Laskowitz DT, Fonarow GC, Peterson ED. Risks and Benefits Associated With Prestroke Antiplatelet Therapy Among Patients With Acute Ischemic Stroke Treated With Intravenous Tissue Plasminogen Activator. JAMA Neurol.
Kam W, Holmes DN, Hernandez AF, Saver JL, Fonarow GC, Smith EE, Bhatt DL, Schwamm LH, Reeves MJ, Matsouaka RA, Khan YM, Unverdorben M, Birmingham MC, Lyden PD, Asimos AW, Altschul D, Schoonover TL, Jumaa MA, Nomura JT, Suri MFK, Moore SA, Lafranchise EF, Olson D, Peterson ED, Xian Y. Association of Recent Use of Non-Vitamin K Antagonist Oral Anticoagulants With Intracranial Hemorrhage Among Patients With Acute Ischemic Stroke Treated With Alteplase. JAMA.
Mac Grory B, Holmes DN, Matsouaka RA, Shah S, Chang CWJ, Rison R, Jindal J, Holmstedt C, Logan WR, Corral C, Mackey JS, Gee JR, Bonovich D, Walker J, Gropen T, Benesch C, Dissin J, Pandey H, Wang D, Unverdorben M, Hernandez AF, Reeves M, Smith EE, Schwamm LH, Bhatt DL, Saver JL, Fonarow GC, Peterson ED, Xian Y. Recent Vitamin K Antagonist Use and Intracranial Hemorrhage After Endovascular Thrombectomy for Acute Ischemic Stroke. JAMA
Atrial fibrillation (AF) is a major risk factor for stroke, responsible for at least 15% or over 70,000 ischemic strokes per year in the United States. Oral anticoagulants, including warfarin and direct oral anticoagulants (DOACs), are crucial for stroke prevention in patients with atrial fibrillation. We aim to develop evidence-based strategies to improve anticoagulant therapy in ischemic stroke patients with AF.
Key Publications
Xian Y, Wu J, O'Brien EC, Fonarow GC, Olson DM, Schwamm LH, Bhatt DL, Smith EE, Suter RE, Hannah D, Lindholm B, Maisch L, Greiner MA, Lytle BL, Pencina MJ, Peterson ED, Hernandez AF. Real-world effectiveness of warfarin among ischemic stroke patients with atrial fibrillation: observational analysis from Patient-Centered Research into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) study. BMJ.
Xian Y, O'Brien EC, Liang L, Xu H, Schwamm LH, Fonarow GC, Bhatt DL, Smith EE, Olson DM, Maisch L, Hannah D, Lindholm B, Lytle BL, Pencina MJ, Hernandez AF, Peterson ED. Association of Preceding Antithrombotic Treatment With Acute Ischemic Stroke Severity and In-Hospital Outcomes Among Patients With Atrial Fibrillation. JAMA.
Xian Y, Xu H, O'Brien EC, Shah S, Thomas L, Pencina MJ, Fonarow GC, Olson DM, Schwamm LH, Bhatt DL, Smith EE, Hannah D, Maisch L, Lytle BL, Peterson ED, Hernandez AF. Clinical Effectiveness of Direct Oral Anticoagulants vs Warfarin in Older Patients With Atrial Fibrillation and Ischemic Stroke: Findings From the Patient-Centered Research Into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) Study. JAMA Neurol.
The current U.S. and European guidelines recommend antiplatelet therapy such as aspirin, clopidogrel, or dual antiplatelet therapy to reduce the risk of recurrent ischemic events in patients with noncardioembolic ischemic stroke. However, selection of antiplatelet agents can be a difficult decision to make for older patients. Not only older individuals are at increased risk for recurrent strokes, they also face risk for bleeding complications. While it is known that drug selection should be individualized, it remains unknown how to tailor antiplatelet therapy according to patient unique characteristics, preferences, needs, and values.
Key Publications
Xian Y, Xu H, Smith EE, Fonarow GC, Bhatt DL, Schwamm LH, Peterson ED. Evaluation of Evidence-Based Dual Antiplatelet Therapy for Secondary Prevention in US Patients With Acute Ischemic Stroke. JAMA Intern Med.
Xian Y, Xu H, Matsouaka R, Laskowitz DT, Maisch L, Hannah D, Smith EE, Fonarow GC, Bhatt DL, Schwamm LH, Mac Grory B, Feng W, Fosbøl EL, Peterson ED, Johnson M. Analysis of Prescriptions for Dual Antiplatelet Therapy After Acute Ischemic Stroke. JAMA Netw Open.
Lusk JB, Xu H, Peterson ED, Bhatt DL, Fonarow GC, Smith EE, Matsouaka R, Schwamm LH, Xian Y. Antithrombotic Therapy for Stroke Prevention in Patients With Ischemic Stroke With Aspirin Treatment Failure. Stroke.
Stroke is the fifth-leading cause of death and a leading cause of long-term disability in the United States, impacting not only individual patients but also their families and communities at large. We aim to improve stroke care quality and outcomes through data-driven, evidence-based interventions.
Key Publications
Xian Y, Holloway RG, Chan PS, Noyes K, Shah MN, Ting HH, Chappel AR, Peterson ED, Friedman B. Association between stroke center hospitalization for acute ischemic stroke and mortality. JAMA.
Xian Y, Smith EE, Zhao X, Peterson ED, Olson DM, Hernandez AF, Bhatt DL, Saver JL, Schwamm LH, Fonarow GC. Strategies used by hospitals to improve speed of tissue-type plasminogen activator treatment in acute ischemic stroke. Stroke.
Xian Y, Xu H, Lytle B, Blevins J, Peterson ED, Hernandez AF, Smith EE, Saver JL, Messé SR, Paulsen M, Suter RE, Reeves MJ, Jauch EC, Schwamm LH, Fonarow GC. Use of Strategies to Improve Door-to-Needle Times With Tissue-Type Plasminogen Activator in Acute Ischemic Stroke in Clinical Practice: Findings from Target: Stroke. Circ Cardiovasc Qual Outcomes.
Xian Y, Xu H, Smith EE, Saver JL, Reeves MJ, Bhatt DL, Hernandez AF, Peterson ED, Schwamm LH, Fonarow GC. Achieving More Rapid Door-to-Needle Times and Improved Outcomes in Acute Ischemic Stroke in a Nationwide Quality Improvement Intervention. Stroke.
Xian Y, Li S, Jiang T, Beon CD, Poudel R, Thomas K, Reeves MJ, Smith EE, Saver JL, Sheth KN, Messé SR, Schwamm LH, Fonarow GC. Twenty Years of Sustained Improvement in Quality of Care and Outcomes for Patients Hospitalized With Stroke or Transient Ischemic Attack: Data From The Get With The Guidelines-Stroke Program. Stroke.