Restarting Oral Anticoagulation in Patients With Atrial Fibrillation After an Intracranial Hemorrhage

Atrial fibrillation is the most common sustained cardiac arrhythmia in the general population. In western countries with aging populations, atrial fibrillation poses a significant health concern, as it is associated with a high risk of thromboembolism, stroke, congestive heart failure, and myocardial infarction. Thrombi are generated in the left atrial appendage, and subsequent embolism into the cerebral circulation is a major cause of ischemic stroke. Therefore, patients have a lifetime risk of stroke, and those at high risk, defined as a CHA2DS2-VASc2 (congestive heart failure, hypertension, age>75 years, diabetes mellitus, stroke/transient ischemic attack/thromboembolism, vascular disease, age 65-74 yrs, sex category) ≥2, are usually placed on oral anticoagulants. Unfortunately, long-term anticoagulation poses bleeding risks, of which intracranial hemorrhage (ICH) is the most feared and deadly complication. In patients who survive an ICH, the question of oral anticoagulation resumption arises. It is a therapeutic dilemma in which clinicians must decide how to manage the risk of thromboembolism versus recurrent hemorrhage. Although there is a substantial amount of retrospective data on the topic of resumption of anticoagulation, there are, at this time, no randomized controlled trials addressing the issue. We therefore sought to address ICH risk and management, summarize high quality existing evidence on restarting oral anticoagulation, and suggest an approach to cli...
Source: Cardiology in Review - Category: Cardiology Tags: Review Articles Source Type: research

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Source: The Scientist - Category: Science Tags: News & Opinion Source Type: news
We describe the performance of the apnea test without disconnection from the mechanical ventilator in two patients. The first case involved an 8-year-old boy admitted with severe hypoxemia due to pneumonia. He presented with cardiorespiratory arrest, followed by unresponsive coma due to hypoxic-ischemic encephalopathy. Two clinical exams revealed the absence of brainstem reflexes, and transcranial Doppler ultrasound revealed brain circulatory arrest. Three attempts were made to perform the apnea test, which were interrupted by hypoxemia; therefore, the apnea test was performed without disconnection from the mechanical vent...
Source: Revista Brasileira de Terapia Intensiva - Category: Intensive Care Source Type: research
We describe the performance of the apnea test without disconnection from the mechanical ventilator in two patients. The first case involved an 8-year-old boy admitted with severe hypoxemia due to pneumonia. He presented with cardiorespiratory arrest, followed by unresponsive coma due to hypoxic-ischemic encephalopathy. Two clinical exams revealed the absence of brainstem reflexes, and transcranial Doppler ultrasound revealed brain circulatory arrest. Three attempts were made to perform the apnea test, which were interrupted by hypoxemia; therefore, the apnea test was performed without disconnection from the mechanical vent...
Source: Revista Brasileira de Terapia Intensiva - Category: Intensive Care Source Type: research
We describe the performance of the apnea test without disconnection from the mechanical ventilator in two patients. The first case involved an 8-year-old boy admitted with severe hypoxemia due to pneumonia. He presented with cardiorespiratory arrest, followed by unresponsive coma due to hypoxic-ischemic encephalopathy. Two clinical exams revealed the absence of brainstem reflexes, and transcranial Doppler ultrasound revealed brain circulatory arrest. Three attempts were made to perform the apnea test, which were interrupted by hypoxemia; therefore, the apnea test was performed without disconnection from the mechanical vent...
Source: Revista Brasileira de Terapia Intensiva - Category: Intensive Care Source Type: research
We describe the performance of the apnea test without disconnection from the mechanical ventilator in two patients. The first case involved an 8-year-old boy admitted with severe hypoxemia due to pneumonia. He presented with cardiorespiratory arrest, followed by unresponsive coma due to hypoxic-ischemic encephalopathy. Two clinical exams revealed the absence of brainstem reflexes, and transcranial Doppler ultrasound revealed brain circulatory arrest. Three attempts were made to perform the apnea test, which were interrupted by hypoxemia; therefore, the apnea test was performed without disconnection from the mechanical vent...
Source: Revista Brasileira de Terapia Intensiva - Category: Intensive Care Source Type: research
Authors: Jiang ZZ, He C, Wang DQ, Shen HL, Sun JL, Gan WN, Lu JY, Liu XT Abstract In December 2019, an outbreak of coronavirus infection emerged in Wuhan, Hubei Province of China, which is now named Coronavirus Disease 2019 (COVID-19). The outbreak spread rapidly within mainland China and globally. This paper reviews the different imaging modalities used in the diagnosis and treatment process of COVID-19, such as chest radiography, computerized tomography (CT) scan, ultrasound examination, and positron emission tomography (PET/CT) scan. A chest radiograph is not recommended as a first-line imaging modality for COVI...
Source: Medical Science Monitor - Category: Research Tags: Med Sci Monit Source Type: research
Conditions:   Amyotrophic Lateral Sclerosis;   Brainstem Stroke;   Muscular Dystrophies;   Parkinson's Disease and Parkinsonism;   Multiple System Atrophy;   Brain Tumor Adult;   Spinal Cord Injuries;   Locked-in Syndrome Interventions:   Behavioral: BCI-FIT multi-modal access;   Behavioral: BCI-FIT adaptive signal modeling;   Behavioral: BCI-FIT active querying;   Behavioral: BCI-FIT language modeling Sponsor:   Oregon H...
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
Conditions:   Stroke;   Subluxation, Glenohumeral Intervention:   Device: kinesiotape Sponsors:   Ankara Physical Medicine and Rehabilitation Education and Research Hospital;   Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey Completed
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
Conditions:   Post-polypectomy Bleeding;   Bowel Preparation;   Urgent Colonoscopy Intervention:   Behavioral: Bowel preparation Sponsor:   Ningbo No. 1 Hospital Completed
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
Condition:   Chronic Systolic Heart Failure Interventions:   Drug: Recombinant human Neuregulin for injection;   Drug: Placebo Sponsor:   Zensun Sci. & Tech. Co., Ltd. Not yet recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
More News: Arrhythmia | Atrial Fibrillation | Bleeding | Cardiac Arrhythmia | Cardiology | Congestive Heart Failure | Diabetes | Diabetes Mellitus | Endocrinology | Heart | Heart Attack | Heart Failure | Hemorrhagic Stroke | Hypertension | Ischemic Stroke | Stroke | Thrombosis