Early Secondary Prevention in Transient Ischemic Attack (TIA) and Minor Stroke

AbstractPurpose of ReviewThe purpose of this study was to review recent literature on the early secondary prevention in transient ischemic attack (TIA) and minor stroke.Recent FindingsThe result of Clopidogrel in High-Risk Patients with Acute Nondisabling Cerebrovascular Events and the secondary analysis of Platelet-Oriented Inhibition in New TIA and Minor Ischemic Stroke (POINT) have shown that treatment with clopidogrel and aspirin for 21  days reduced the risk of recurrent stroke with no significant increase in bleeding risk. Triple antiplatelet therapy with aspirin, clopidogrel, and dipyridamole resulted in a significant increase in major (including fatal) bleeding with no significant reduction in the recurrent stroke or TIA.SummaryThe early treatment of patients with TIA or minor stroke with clopidogrel and aspirin for 21  days was effective in reducing the risk of recurrent stroke with no significant increase in bleeding risk. Most stroke guidelines have been updated to reflect this recommendation.
Source: Current Neurology and Neuroscience Reports - Category: Neuroscience Source Type: research

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CONCLUSIONS: In 2014, there were 28,212,820 (2.02% AIS and 5.50% LDs) hospitalizations. LDs patients had higher prevalence and odds of having AIS compared with non-LDs. Between 2003-2014, of the total 4,224,924 AIS hospitalizations, 451,645 (10.69%) had LDs. Patients with LDs had lower percentages and odds of mortality, risk of death, major/extreme disability, discharge to nursing facility, and complications including epilepsy, stroke-associated pneumonia, GI-bleeding and hemorrhagic-transformation compared to non-LDs. Although LDs are risk factors for AIS, concurrent LDs in AIS is not only associated with lower mortality ...
Source: Medicina (Kaunas) - Category: Universities & Medical Training Authors: Tags: Medicina (Kaunas) Source Type: research
Conclusions Our findings suggest that rt-PA patients have the highest risk of post rt-PA sICH within the first 24 hours after treatment. This supports monitoring of rt-PA-treated patients in specialized settings such as neuro-intensive care units or stroke units. Our findings suggest that the probability of sICH is low 36 hours post rt-PA. Future larger studies are warranted to identify the patterns of bleeding after rt-PA administration.
Source: Neurology Clinical Practice - Category: Neurology Authors: Tags: All Cerebrovascular disease/Stroke, Intracerebral hemorrhage Research Source Type: research
Publication date: Available online 8 August 2019Source: Canadian Journal of CardiologyAuthor(s): Leszek Drabik, Małgorzata Konieczyńska, Anetta UndasAbstractBackgroundFormation of dense fibrin clots has been reported in both atrial fibrillation (AF) and ischemic stroke. We have previously demonstrated that such clot properties can predict thromboembolism and major bleeding in AF patients treated with vitamin K antagonists (VKA). In this longitudinal cohort study, we evaluated whether impaired fibrinolysis is associated with clinical outcomes in AF.MethodsIn 236 patients with AF receiving with vitamin K antagonists (VKA),...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research
AbstractAtrial fibrillation (AF) is the most common arrhythmia in clinical practice and its prevalence increases with age. Few data are available about the clinical performance of direct oral anticoagulant (DOACs) in patients aged  ≥ 80 years with AF. The aim of our propensity score matched cohort study was to compare the safety and efficacy of DOACs versus well-controlled VKA therapy among octogenarians with AF in real life setting. Data for this study were sourced from the multicenter prospectively maintained Atrial Fibrillation Research Database (NCT03760874), which includes all AF patients followe...
Source: Journal of Thrombosis and Thrombolysis - Category: Hematology Source Type: research
Purpose of review Activated protein C (APC) is a homeostatic coagulation protease with anticoagulant and cytoprotective activities. Focusing on APC's effects in the brain, this review discusses three different scenarios that illustrate how APC functions are intimately affecting the physiology and pathophysiology of the brain. Recent findings Cytoprotective APC therapy holds promise for the treatment of ischemic stroke, and a recently completed trial suggested that cytoprotective-selective 3K3A-APC reduced bleeding in ischemic stroke patients. In contrast, APC's anticoagulant activity contributes to brain bleeding as s...
Source: Current Opinion in Hematology - Category: Hematology Tags: HEMOSTASIS AND THROMBOSIS: Edited by Alvin H. Schmaier Source Type: research
ConclusionIn our study, we have shown that the administration of Idarucizumab is a rare intervention and restricted to patients with severe bleeding complications or ischemic stroke. The clinical outcome of patients who received Idarucizumab in emergency situations was poor.
Source: Journal of Neurology - Category: Neurology Source Type: research
Authors: Wu Y, Song Y, Pan Y, Gong Y, Zhou Y Abstract The study aimed to compare the efficacy and safety outcome associated with a short and a prolonged duration of thienopyridine therapy in patients with chronic kidney disease (CKD) after coronary stenting. We systematically searched PubMed, EMBASE and the Cochrane Library from their inception to 1 January 2019 for studies comparing short and prolonged thienopyridine therapy in patients with CKD. Ischemic and bleeding events were considered as the clinical endpoints in this analysis. Odds Ratios (OR) with 95% confidence intervals (CIs) were used as estimates of ef...
Source: Platelets - Category: Hematology Tags: Platelets Source Type: research
CONCLUSIONS: Although a big step forward that will benefit many patients has been taken with recent trials, many questions remain unanswered. Pending results from further studies, decision-making regarding management of patients with PFO-associated ischaemic stroke should be based on a close coordination between neurologists/stroke specialists and cardiologists. PMID: 31378692 [PubMed - as supplied by publisher]
Source: Archives of Cardiovascular Diseases - Category: Cardiology Authors: Tags: Arch Cardiovasc Dis Source Type: research
Oral anticoagulant prescribing in elderly patients above and below age 80 with atrial fibrillation
. Int J Clin Pharmacol Ther. 2019 Jul 26;: Authors: Xie K, Shen J, Xiong N, Li J, Ni H, Yuan F, Zhang J, Chen H, Gao W, Jiang X, Luo X Abstract BACKGROUND: Oral anticoagulation is efficient to prevent ischemic stroke in atrial fibrillation (AF), but in very old patients, physicians always remain cautious to use anticoagulants concerning the bleeding risk. This research aims to investigate the current situation of oral anticoagulation therapy in very old (≥ 80 years) AF patients. MATERIALS AND MET...
Source: International Journal of Clinical Pharmacology and Therapeutics - Category: Drugs & Pharmacology Tags: Int J Clin Pharmacol Ther Source Type: research
Authors: Shlofmitz E, Shlofmitz R, Lee MS Abstract The number of patients undergoing percutaneous coronary intervention (PCI) who mandate additional oral anticoagulant therapy has been increasing. Dual antiplatelet therapy (DAPT) is associated with reduced ischemic events including stent thrombosis, myocardial infarction and stroke following PCI. However, the tradeoff is an increased risk for bleeding while on DAPT. The addition of a novel oral anticoagulant (NOAC) further increases the likelihood of bleeding while on antiplatelet therapy. Thus, the overall risks and benefits for each patient undergoing PCI on NOAC...
Source: Korean Circulation Journal - Category: Cardiology Tags: Korean Circ J Source Type: research
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