Intracerebral hemorrhage under platelet inhibition and oral anticoagulation in patients with cerebral amyloid angiopathy

Nervenarzt. 2021 Oct 15. doi: 10.1007/s00115-021-01206-w. Online ahead of print.ABSTRACTOral anticoagulation in patients with cerebral amyloid angiopathy is a therapeutic challenge. The association of cerebral amyloid angiopathy with intracerebral hemorrhage, a high mortality of intracerebral hemorrhage especially under oral anticoagulation and the high risk of recurrent bleeding require a multidisciplinary approach and a thorough risk-benefit analysis. Vitamin K antagonists increase the risk of intracerebral bleeding and the accompanying mortality by 60% and should be avoided if possible or reserved for special clinical situations (e.g. mechanical aortic valve replacement). Treatment with novel oral anticoagulants and antiplatelet drugs also increases the risk of cerebral bleeding and therefore needs a thorough risk-benefit evaluation. An interventional left atrial appendage closure is a promising therapeutic option especially in patients with an absolute arrythmia with atrial fibrillation. Furthermore, other clinical implications in patients with cerebral amyloid angiopathy are the subject of this review of the literature, such as special characteristics after acute ischemic stroke and the necessary secondary prophylaxis, with previous intracerebral hemorrhage and in patients with cognitive deficits.PMID:34652485 | DOI:10.1007/s00115-021-01206-w
Source: Der Nervenarzt - Category: Neurology Authors: Source Type: research

Related Links:

We report our single-center experience with percutaneous left atrial appendage closure (LAAC) in patients with non-valvular atrial fibrillation (NVAF) and primary hemostasis disorders (HD).MethodsConsecutive patients with primary HD who underwent a percutaneous LAAC were included. Baseline characteristics, procedural data, and clinical outcomes were prospectively collected and compared with the overall LAAC cohort without HD.ResultsSince 2013, among 229 LAAC, 17 patients (7%) had a primary HD: thrombocytopenia (n = 5), myelodysplastic syndrome (n = 6), von Willebrand syndrome (n = ...
Source: Journal of Interventional Cardiac Electrophysiology - Category: Cardiology Source Type: research
Background: Hemorrhagic transformation (HT) after reperfusion therapy for acute ischemic stroke (AIS) has been well studied; however, there is scarce research focusing on spontaneous HT (sHT). Spontaneous HT is no less important with a relatively high incidence and could be associated with neurological worsening. We aimed to develop and validate a simple and practical model to predict sHT after AIS (SHAIS) and compared the predictive value of the SHAIS score against the models of post-Reperfusion HT for sHT.Methods: Patients with AIS admitted within 24 h of onset were prospectively screened to develop and validate the SHAI...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
Any screening program in the community, while providing useful and previously unknown information, has the potential of uncovering findings of uncertain interpretation, especially regarding their impact on clinical outcomes, and therefore the justification of extending the screening to larger cohorts with substantial health care costs. As Shang and colleagues [1] remind us, the STROKESTOP study [2] detected a modest benefit from screening for atrial fibrillation (AF) on the primary combined endpoint of ischaemic or haemorrhagic stroke, systemic embolism, bleeding leading to hospitalisation and all-cause death (1.1% absolut...
Source: International Journal of Cardiology - Category: Cardiology Authors: Tags: Letter to the Editor Source Type: research
by Jiaxi Zhao, Hao Wang, Xue Li, Yang Hu, Vincent K. C. Yan, Carlos K. H. Wong, Yutao Guo, Marco K. H. Cheung, Gregory Y. H. Lip, Chung-Wah Siu, Hung-Fat Tse, Esther W. Chan BackgroundAdherence to oral anticoagulant therapy in patients with atrial fibrillation (AF) in China is low. Patient preference, one of the main reasons for discontinuation of oral anticoagulant therapy, is an unfamiliar concept in China. Methods and findingsA discrete choice experiment (DCE) was conducted to quantify patient preference on 7 attributes of oral anticoagulant therapy: antidote (yes/no), food –drug interaction (yes/no), frequency of...
Source: PLoS Medicine - Category: Internal Medicine Authors: Source Type: research
CONCLUSION: Our findings suggest that increased overall OAC use has a positive clinical benefit on the annual number of ischemic stroke events and deaths avoided in the Medicare population, while maintaining a modest increase in the overall BI to the Medicare system.PMID:34415229 | DOI:10.1080/13696998.2021.1970954
Source: Journal of Medical Economics - Category: Health Management 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
More News: Atrial Fibrillation | Bleeding | Heart Valve Surgery | Hemorrhagic Stroke | Ischemic Stroke | Neurology | Stroke | Vitamin K | Vitamins