Timing of anticoagulation after recent ischaemic stroke in patients with atrial fibrillation

Publication date: Available online 8 November 2018Source: The Lancet NeurologyAuthor(s): David J Seiffge, David J Werring, Maurizio Paciaroni, Jesse Dawson, Steven Warach, Truman J Milling, Stefan T Engelter, Urs Fischer, Bo NorrvingSummaryBackgroundAbout 13–26% of all acute ischaemic strokes are related to non-valvular atrial fibrillation, the most common cardiac arrhythmia globally. Deciding when to initiate oral anticoagulation in patients with non-valvular atrial fibrillation is a longstanding, common, and unresolved clinical challenge. Although the risk of early recurrent ischaemic stroke is high in this population, early oral anticoagulation is suspected to increase the risk of potentially harmful intracranial haemorrhage, including haemorrhagic transformation of the infarct. This assumption, and current treatment guidelines, are based on historical, mostly observational data from patients with ischaemic stroke and atrial fibrillation treated with heparins, heparinoids, or vitamin K antagonists (VKAs) to prevent recurrent ischaemic stroke. Randomised controlled trials have subsequently shown that direct oral anticoagulants (DOACs; ie, apixaban, dabigatran, edoxaban, and rivaroxaban) are at least as effective as VKAs in primary and secondary prevention of atrial fibrillation-related ischaemic stroke, with around half the risk of intracranial haemorrhage. However, none of these DOAC trials included patients who had experienced ischaemic stroke recently (within the f...
Source: The Lancet Neurology - Category: Neurology Source Type: research

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Publication date: Available online 21 September 2019Source: Materials Today: ProceedingsAuthor(s): Nagendra Kumar Maurya, Manish Maurya, Ashish Kumar Srivastava, Shashi Prakash Dwivedi, Abdhesh kumar, Sandeep ChauhanAbstractThis experimental investigation deals with the effect of SiC content on aluminium alloy Al 6061. Composites were fabricated with varied (0, 1, 2, 3 and 5) weight percent of SiC content via stir casting method. Scanning electronic microscope test had confirmed the uniform distribution of reinforced particles. It was seen that the density of Al 6061/SiC composite was improved with the reinforcement of SiC...
Source: Materials Today: Proceedings - Category: Materials Science Source Type: research
Publication date: Available online 21 September 2019Source: The Annals of Thoracic SurgeryAuthor(s): Chien-Hung Chiu, Peng Zhang, Andrew C. Chang, Brian A. Derstine, Brian E. Ross, Binu Enchakalody, Nidhi V. Shah, Stewart C. Wang, Yin-Kai Chao, Jules LinAbstractBackgroundIn patients undergoing neoadjuvant chemoradiotherapy (nCRT) followed by surgery for locally advanced esophageal squamous cell carcinoma (ESCC), patients with a pathological complete response (pCR) have the greatest benefit. The purpose of this study was to identify morphomic factors obtained from pre-treatment computed tomography scans associated with a pa...
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
ConclusionsThe frequency of nAF in our patients was 6.0%. Insular damage was a risk factor for nAF and an independent predictor of death at 3 months.
Source: European Journal of Neurology - Category: Neurology Authors: Tags: Original Article Source Type: research
ConclusionThe frequency of nAF in our patients was 6.0%. Insular damage was a risk factor for nAF and an independent predictor of death at 3 months.This article is protected by copyright. All rights reserved.
Source: European Journal of Neurology - Category: Neurology Authors: Tags: Original Article Source Type: research
CONCLUSIONS: Moderate-quality evidence suggests that the LAAC device is as effective as novel oral anticoagulants in preventing stroke in people with nonvalvular atrial fibrillation. However, our results indicate that the LAAC device is cost-effective only in patients with contraindications to oral anticoagulants. People with nonvalvular atrial fibrillation with whom we spoke reported positive support for the LAAC device. PMID: 28744335 [PubMed - in process]
Source: Ontario Health Technology Assessment Series - Category: General Medicine Tags: Ont Health Technol Assess Ser Source Type: research
Conclusions: In a selected cohort of patients with stroke, the in-field recordings of the ECG detected a relevant rate of cardiac arrhythmia. The results can add to the in-hospital evaluation and should be considered in prehospital care of acute stroke.
Source: Neurology - Category: Neurology Authors: Tags: All Cerebrovascular disease/Stroke, Cardiac, Critical care ARTICLE Source Type: research
This study found that though it is often associated with coronary artery disease (CAD), it can also occur in those without significant CAD. It was not specifically associated with disease of right coronary artery disease. This cardioinhibitory response may be a manifestation of the Bezold-Jarisch reflex. Bezold-Jarisch reflex inhibits sympathetic activity (sympathetic withdrawal) and increases parasympathetic activity, resulting in bradycardia, which may be associated with vasodilatation, nausea and hypotension. Bezold-Jarisch has been described in the setting of inferior wall infarction and coronary angiography. Origin...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Cardiology MCQ Cardiology X-ray Featured Source Type: blogs
Authors: Manea MM, Comsa M, Minca A, Dragos D, Popa C Abstract UNLABELLED: There has been a large confirmation over the last decades that stroke may produce cardiac changes (echocardiographic, electrocardiographic, enzymatic). In ischemic stroke, systolic dysfunction is associated with a high risk of mortality during hospitalization. A recent study demonstrated that cardiac diastolic dysfunction could also accompany acute stroke besides the systolic dysfunction already pointed out by previous studies, being a predictive marker of acute cerebrovascular events. Increased sympathetic activity is contributory, inducing...
Source: Journal of Medicine and Life - Category: Journals (General) Tags: J Med Life Source Type: research
Abstract Evidence-based therapeutic options for stroke continue to emerge based on results from well-designed clinical studies. Ischemic stroke far exceeds hemorrhagic stroke in terms of prevalence and incidence, both in the USA and worldwide. The public health effect of reducing death and disability related to ischemic stroke justifies the resources that have been invested in identifying safe and effective treatments. The emergence of novel oral anticoagulants for ischemic stroke prevention in atrial fibrillation has introduced complexity to clinical decision making for patients with this common cardiac arrhythm...
Source: Current Cardiology Reports - Category: Cardiology Source Type: research
Conclusions: Many unnecessary tests are obtained to evaluate syncope. Selecting tests based on history and examination and prioritizing less expensive and higher yield tests would ensure a more informed and cost-effective approach to evaluating older patients with syncope._____________________________________________________________________________4)    Reed MJ.  The ROSE (Risk Stratification of syncope in the emergency department) Study.  J Am Coll Cardiol, 2010; 55:713-721, doi:10.1016/j.jacc.2009.09.049  Objectives: The aim of this study was to develop and validate a clinical deci...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
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