title: Temporal Trends in Stroke Severity and Prior Antithrombotic Use Among Acute Ischemic Stroke Patients in Japan.
abstract: BACKGROUND
  Few existing stroke registries allow for evaluation of stroke severity, stroke subtype and antithrombotic usage prior to stroke onset over a given time period. The present study aimed to elucidate temporal trends in initial presenting stroke severity, stroke subtype and prior antithrombotic use over a 12-year period in a Japanese multicenter stroke registry.
  
  
  RESULTS
  We included 71,017 acute ischemic stroke patients (72±12 years old; 27,445 women) from the Japan Standard Stroke Registry Study (JSSRS) who were admitted to 94 hospitals between 2001 and 2012. The mean age of stroke onset increased gradually over time (P<0.001). Cardioembolic stroke patients (n=19,247) exhibited more severe NIHSS scores when compared with those with non-cardioembolic stroke (n=50,427). The proportion of cardioembolic stroke patients tended to increase over time, rising from 25.9% in 2001-2002 to 30.2% in 2011-2012 (P<0.001). Among the cardioembolic stroke patients, the frequency of prior anticoagulant use significantly increased from 15.6% in 2001-2002 to 24.8% in 2011-2012 (P<0.001). The frequency of prior antiplatelet use increased from 2001-2002 to 2007-2008 but decreased after 2007-2008. Among both cardioembolic and non-cardioembolic stroke patients, initial stroke severity at admission decreased over time, particularly after 2008.
  
  
  CONCLUSIONS
  In this Japanese study, the mean age of ischemic stroke onset increased, while the initial neurological severity at presentation decreased, over a 12-year period. (Circ J 2016; 80: 2033-2036).
authors.affiliation: Department of Clinical Neuroscience and Therapeutics, Hiroshima University Graduate School of Biomedical & Health Sciences.
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Nezu
authors.forename: Naohisa
authors.initials: N
authors.lastname: Hosomi
authors.forename: Gregory Yh
authors.initials: GY
authors.lastname: Lip
authors.forename: Shiro
authors.initials: S
authors.lastname: Aoki
authors.forename: Ryo
authors.initials: R
authors.lastname: Shimomura
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Maruyama
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Yagita
authors.forename: Masayasu
authors.initials: M
authors.lastname: Matsumoto
authors.forename: Shotai
authors.initials: S
authors.lastname: Kobayashi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008875:Middle Aged; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology / Q000503:physiopathology