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Cardiovascular and Metabolic Conditions - Ischemic Stroke Prevention and Treatment

Kaiser Permanente stroke prevention and treatment studies include:

ATRIA Study and ATRIA-CKD Study

The NIH-sponsored AnTicoagulation and Risk factors In Atrial Fibrillation (ATRIA) and ATRIA-Cardiovascular Research Network (ATRIA-CVRN) studies have provided key insights into risk factors for atrial fibrillation-related stroke from very large, ethnically diverse populations. These studies have generated a more accurate ATRIA stroke risk score that can be used for patient decision-making on oral drugs for stroke prevention.

The NHLBI-sponsored ATRIA-Chronic Kidney Disease (ATRIA CKD) cohort study involves a collaboration between Kaiser Permanente Northern and Southern California in about 180,000 members with atrial fibrillation. These studies are investigating whether stroke prevention and other treatment-related outcomes vary across the spectrum of kidney function.

Kaiser Permanente Stroke EXPRESS program

The internationally recognized Kaiser Permanente Northern California Stroke EXPRESS (EXpediting the Process of Evaluating and Stopping Stroke) program has led to higher use of IV thrombolytic therapy, shorter door-to-needle times, no increase in symptomatic intracranial hemorrhage rate, shorter length of hospital stay, and lower inpatient mortality. Research on the program has also shown that most stroke patients could seemingly be treated at a primary stroke center.


Kaiser Permanente Northern California was a leading site for the pivotal ROCKET-AF double-blinded, placebo-controlled trial which compared the effectiveness and safety of rivaroxaban, an oral factor Xa inhibitor, with dose-adjusted warfarin in 14,264 patients with atrial fibrillation (AF). This study found that rivaroxaban was noninferior to warfarin in preventing ischemic stroke, with a similar risk of major bleeding overall and a lower risk of intracranial hemorrhage and fatal bleeding.

Shake, Rattle & Roll Study

Shake Rattle & Roll was funded by the National Institute of Neurological Disorders and Stroke as a cluster-randomized controlled pragmatic trial. Conducted at Kaiser Permanente Northern California’s urban medical centers, it aimed to improve hypertension control in blacks and to reduce disparities in hypertension control by helping people “shake” the salt habit, having pharmacists “rattle” the intensity of the hypertension pharmacotherapy protocol, and “roll” out the best strategies for controlling blood pressure. It is the only trial that has shown that a lifestyle coaching intervention can bring about changes that lead to better blood pressure control long after the intervention has ended.

Kaiser Permanente Stroke Trials Network

The primary goal of the NINDS Stroke Trials Network is to maximize efficiencies to develop, promote, and conduct high-quality, multi-site clinical trials focused on key interventions in stroke prevention, treatment, and recovery with the objective to have a balanced portfolio between all three approaches. The aims of the Northern California Regional Coordinating Stroke Center are to: become a resource to any network PI to plan, initiate and complete a clinical trial in the neurosciences (this will be a joint effort between UCSF and selected medical centers within KPNC); and provide training opportunities to medical students, residents, fellows, and faculty within the network to plan and conduct clinical trials.

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