Novel diagnostic and monitoring tools in stroke : an individualized patient-centered precision medicine approach

Show simple item record De Villiers, Sulette Swanepoel, A.C. (Albe Carina) Bester, Janette Pretorius, Etheresia 2016-07-13T08:54:14Z 2016-07-13T08:54:14Z 2016
dc.description.abstract Central to the pathogenesis of ischaemic stroke are the normally protective processes of platelet adhesion and activation. Experimental evidence has shown that the ligand-receptor interactions in ischaemic stroke represent a thrombo-inflammatory cascade, which presents research opportunities into new treatment. However, as anti-platelet drugs have the potential to cause severe side effects in ischaemic stroke patients (as well as other vascular disease patients), it is important to carefully monitor the risk of bleeding and risk of thrombus in patients receiving treatment. Because thrombo-embolic ischaemic stroke is a major health issue, we suggest that the answer to adequate treatment is based on an individualized patient-centered approach, inline with the latest NIH precision medicine approach. A combination of viscoelastic methodologies may be used in a personalized patient-centered regime, including thromboelastography (TEG®) and the lesser used scanning electron microscopy approach (SEM). Thromboelastography provides a dynamic measure of clot formation, strength, and lysis, whereas SEM is a visual structural tool to study patient fibrin structure in great detail. Therefore, we consider the evidence for TEG® and SEM as unique means to confirm stroke diagnosis, screen at-risk patients, and monitor treatment efficacy. Here we argue that the current approach to stroke treatment needs to be restructured and new innovative thought patterns need to be applied, as even approved therapies require close patient monitoring to determine efficacy, match treatment regimens to each patient's individual needs, and assess the risk of dangerous adverse effects. TEG® and SEM have the potential to be a useful tool and could potentially alter the clinical approach to managing ischaemic stroke. As envisaged in the NIH precision medicine approach, this will involve a number of role players and innovative new research ideas, with benefits that will ultimately only be realized in a few years. Therefore, with this ultimate goal in mind, we suggest that an individualized patient-orientated approach is now available and therefore already within our ability to use. en_ZA
dc.description.department Physiology en_ZA
dc.description.librarian am2016 en_ZA
dc.description.sponsorship NRF and MRC of South Africa : E Pretorius en_ZA
dc.description.uri en_ZA
dc.identifier.citation De Villiers, S, Swanepoel, A, Bester, J & Pretorius, E 2016, 'Novel diagnostic and monitoring tools in stroke : an individualized patient-centered precision medicine approach', Journal of Atherosclerosis and Thrombosis, vol. 23, no. 5, pp. 493-504. en_ZA
dc.identifier.issn 1340-3478 (print)
dc.identifier.issn 1880-3873 (online)
dc.language.iso en en_ZA
dc.publisher Japan Atherosclerosis Society en_ZA
dc.rights Japan Atherosclerosis Society en_ZA
dc.subject Ischaemic stroke en_ZA
dc.subject Coagulation en_ZA
dc.subject Treatment monitoring en_ZA
dc.subject Scanning electron microscopy (SEM) en_ZA
dc.subject Thromboelastography (TEG®) en_ZA
dc.title Novel diagnostic and monitoring tools in stroke : an individualized patient-centered precision medicine approach en_ZA
dc.type Article en_ZA

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