Direct oral anticoagulants for secondary stroke prevention in patients over 80  years of age: the role of geriatric functional status

AbstractPrescribing anticoagulation therapy in very old ( ≥ 80-years) patients with atrial fibrillation (AF) is an emerging clinical issue, but current knowledge and recommendations are insufficient. We aimed to determine the efficacy and safety of direct oral anticoagulants (DOACs) in secondary stroke prevention in very old patients and to explore the related geriatric functional status of these patients. Three hundred fifty-three consecutive ≥ 80-year-old patients treated for transient ischemic attack (TIA) or ischemic stroke (IS) at the neurological clinic at UMC Ljubljana, who were prescribed DOACs for AF between December 2012 and May 2 020, were included. Data regarding recurrent TIA/IS, major bleeds, intracranial hemorrhage (ICH) and death were collected. Data were descriptively compared with data from RCTs- including younger patients. Patients prescribed DOACs between January 2018 and May 2020 were contacted in December 2020, an d their functional status was assessed using the Barthel index (BI). The efficacy of secondary stroke prevention with DOACs was comparable to RCTs for significantly younger patients. Major bleeds occurred more often, but most incidences were gastrointestinal, and the rate of ICH was comparable. Impo rtantly, most patients were highly independent determined by BI. Overall, our real world results suggest that DOACs are as effective at preventing IS in secondary prevention in very old patients than in younger patients an...
Source: Journal of Thrombosis and Thrombolysis - Category: Hematology Source Type: research

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CONCLUSION: This long-term follow-up study shows that percutaneous closure of LAA is a safe and technically feasible procedure with satisfactory outcomes in Asia. The procedure success rate, efficacy and adverse event were similar to those reported in the Caucasian populations.PMID:34799213 | DOI:10.1016/j.jfma.2021.10.010
Source: J Formos Med Assoc - Category: General Medicine Authors: Source Type: research
Evid Based Complement Alternat Med. 2021 Oct 21;2021:2468052. doi: 10.1155/2021/2468052. eCollection 2021.ABSTRACTOBJECTIVE: To evaluate the value of the Alberta stroke project early CT score (ASPECTS), DRAGON score, SEDAN score, and HAT score in predicting hemorrhagic transformation (HT) after intravenous thrombolysis in patients with acute ischemic stroke (AIS).METHODS: The clinical data of 248 AIS patients treated with intravenous thrombolysis in our hospital from December 2017 to December 2019 were analyzed. According to the prognosis, all patients were divided into the non-HT group (n = 200) and the HT group (n = 48)....
Source: Evidence-based Complementary and Alternative Medicine - Category: Complementary Medicine Authors: Source Type: research
In this study, a total of 156 patients with NVAF who received NOAC anticoagulation therapy in our hospital from January 2018 to January 2019 were retrospectively analyzed. The results showed that education background, place of residence, number of complications, CHA2DS2-VASc score, and HAS-BLED score were independent influencing factors for NOACS compliance of NVAF patients. Also, the Pearson correlation analysis showed that there was a negative correlation (r = -0.465, P
Source: Evidence-based Complementary and Alternative Medicine - Category: Complementary Medicine Authors: Source Type: research
CONCLUSION: Chinese patients with AF and coronary stenting had high mortality and incidence of MACCE. We compiled separate predictive models for all-cause death, IS/STE, MACCE, and major bleeding.PMID:34353224 | DOI:10.1080/00015385.2021.1950367
Source: Acta Cardiologica - Category: Cardiology Authors: Source Type: research
Barton et al's1 article studies cardiovascular risk in a cohort of individuals with a spinal cord injury (SCI). As the authors noted, the Framingham Risk Score (FRS) was derived to identify risk factors for cardiovascular disease. It is important to note, however, that the outcome measure for this risk score is defined as a “composite of coronary heart disease (coronary death, myocardial infarction, coronary insufficiency, and angina), cerebrovascular events (including ischemic stroke, hemorrhagic stoke, and transient ischemic attack), peripheral artery disease (intermittent claudication), and heart failure.”2 ...
Source: Archives of Physical Medicine and Rehabilitation - Category: Rehabilitation Authors: Tags: Letter to the Editor Source Type: research
Stroke is a common cause of mortality and serious long-term disability worldwide. In the acute setting, current American Heart Association/American Stroke Association guidelines do not recommend routine anticoagulation for the management of acute ischemic strokes. However, short-term use of unfractionated heparin (UFH) in select subpopulations has demonstrated improved outcomes. While tools such as CHADSVASC and HASBLED scores are useful in stratifying risk of long-term anticoagulation in patients with nonvalvular atrial fibrillation and additional risk factors, the carefully selected patient populations for the design of ...
Source: Case Reports in Neurology - Category: Neurology Source Type: research
AbstractBackgroundAtrial fibrillation (AF) is relatively common among nursing home residents, and decisions regarding anticoagulant therapy in this setting may be complicated by resident frailty and other factors.ObjectivesThe aim of this study was to examine trends and correlates of oral anticoagulant use among newly admitted nursing home residents with AF following the approval of direct-acting oral anticoagulants (DOACs).MethodsWe conducted a retrospective cohort study of all adults aged>  65 years with AF who were newly admitted to nursing homes in Ontario, Canada, between 2011 and 2018 (N  =  36,46...
Source: Drugs and Aging - Category: Geriatrics Source Type: research
Semin Neurol DOI: 10.1055/s-0041-1726332Atrial fibrillation (AF) is an important risk factor for ischemic stroke resulting in a fivefold increased stroke risk and a twofold increased mortality. Our understanding of stroke mechanisms in AF has evolved since the concept of atrial cardiopathy was introduced as an underlying pathological change, with both AF and thromboembolism being common manifestations and outcomes. Despite the strong association with stroke, there is no evidence that screening for AF in asymptomatic patients improves clinical outcomes; however, there is strong evidence that patients with embolic stroke of ...
Source: Seminars in Neurology - Category: Neurology Authors: Tags: Review Article Source Type: research
AbstractThe present study aimed to determine the associations between insomnia and cardiovascular diseases (CVDs) using Mendelian randomisation (MR) analysis. As instrumental variables, we used 208 independent single-nucleotide polymorphisms associated with insomnia at the genome-wide significance threshold in a meta-analysis of genome-wide association studies in the UK Biobank and 23andMe including a total of 397  959 self-reported insomnia cases and 933 057 non-cases. Summary-level data for nine CVDs were obtained from the UK Biobank including 367 586 individuals of European ancestry. After correction for ...
Source: European Journal of Epidemiology - Category: Epidemiology Source Type: research
In conclusion, further investigations are necessary to clarify the specific conditions where the risk of serious bleeding events in East Asian patients differ substantially compared to the global. In addition, further understanding of the mechanisms causing the different bleeding response in specific conditions in East Asian is awaited.
Source: Internal and Emergency Medicine - Category: Emergency Medicine Source Type: research
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