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Warfarin may reduce risk of ischemic stroke by preventing atrial fibrillation for patients with heart failure and sinus rhythm
As compared with the general population, patients with reduced ejection fraction who are in sinus rhythm are observed with a higher risk for ischemic stroke. This relationship is caused by left ventricular stasis, a systemic hypercoagulable state, and endocardial dysfunction in a situation of impaired left ventricular systolic function . Therefore, the issue whether antithrombotic agents especially aspirin or warfarin could successfully prevent stroke for patients with heart failure and sinus rhythm has been tested in a series of clinical trials. The former two trials (the Warfarin/Aspirin Study in Heart Failure (WASH) tri...
Source: International Journal of Cardiology - July 16, 2012 Category: Cardiology Authors: Gen-Min Lin, Yi-Hwei Li, Lamin .E.S. Jaiteh, Chih-Lu Han Tags: Letters to the Editor Source Type: research

Simultaneous onset of myocardial infarction and ischemic stroke in a patient with atrial fibrillation: Multiple territory injury revealed on angiography and magnetic resonance
An 84-year-old man with a history of hypertension and paroxysmal atrial fibrillation (AF) who received no anticoagulant drugs experienced acute chest pain and transient loss of consciousness. He was transferred to our emergency room. His initial electrocardiogram showed sinus rhythm with ST-segment elevation in the I, aVL, and V1–V6 leads. His blood pressure was 158/92mmHg and his pulse was regular at 70beats per minute. A chest radiograph showed increased heart size and pulmonary vascular congestion. His troponin T level was elevated (more than 0.1ng/mL). He was diagnosed with ST-elevation myocardial infarction (MI) and...
Source: International Journal of Cardiology - February 4, 2014 Category: Cardiology Authors: Osamu Hashimoto, Kozo Sato, Yohei Numasawa, Joji Hosokawa, Masahiro Endo Tags: Online Letters to the Editor Source Type: research

Beyond age, the need for useful parameters to identify heart failure patients in sinus rhythm that can benefit from oral anticoagulation
It is still unclear whether oral anticoagulant or aspirin therapy is superior for patients with heart failure (HF) who are in sinus rhythm. The subanalyses of the warfarin vs. aspirin in Reduced Cardiac Ejection Fraction (WARCEF) trial, that have been recently published , were aimed to identify subgroups of patients with reduced left ventricular ejection fraction (LVEF≤35%) in sinus rhythm that may benefit from warfarin or aspirin. They showed that patients under 60years have an improved outcome with warfarin over aspirin concerning the composite outcome of ischemic stroke, intracerebral hemorrhage and overall death, wha...
Source: International Journal of Cardiology - January 23, 2014 Category: Cardiology Authors: Enrico Ammirati, Dacia Dalla Libera, Maria Frigerio Tags: Online Letters to the Editor Source Type: research

The C of CHADS: Historical Perspective and Clinical Applications for Anticoagulation in patients with Non Valvular Atrial Fibrillation and Congestive Heart Failure
The risk stratification of patients with coexisting non valvular atrial fibrillation and congestive heart failure, is often a clinical challenge, as the definitions of congestive heart failure in the popular CHADS2 and CHA2DS2VASc scoring systems, and amongst major clinical trials on Warfarin and Novel Oral Anticoagulants (NOAC) have heterogeneity. Available evidence reveals that any heart failure and/or left ventricular systolic dysfunction is associated with higher rates of stroke/systemic embolism and bleeding in patients with non valvular atrial fibrillation compared to patients without heart failure and normal left ventricular function.
Source: International Journal of Cardiology - September 16, 2016 Category: Cardiology Authors: Y Chugh, RT Faillace Tags: Editorial Source Type: research