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Early Initiation of Anticoagulation with Direct Oral Anticoagulants in Patients after Transient Ischemic Attack or Ischemic Stroke
Direct oral anticoagulants (DOACs) are increasingly used for secondary prevention of cardioembolic stroke. While DOACs are associated with a long-term reduced risk of intracranial hemorrhage compared to vitamin K antagonists, pivotal trials avoided the very early period after stroke and few data exist on early initiation of DOAC therapy post stroke.
Source: Journal of Stroke and Cerebrovascular Diseases - July 18, 2016 Category: Neurology Authors: Kosmas Macha, Bastian Volbers, Tobias Bobinger, Natalia Kurka, Lorenz Breuer, Hagen B. Huttner, Stefan Schwab, Martin Köhrmann Source Type: research

Safety of Recanalization Therapy in Patients with Acute Ischemic Stroke Under Anticoagulation: A Systematic Review and Meta-Analysis
Intravenous thrombolysis treatment (IVT) and endovascular therapy (EVT) have been proved as fist-line beneficial option for eligible patients who have acute ischemic stroke (AIS) with major safety concern of symptomatic intracranial hemorrhage (sICH). Unfortunately, the emergency management of patients with AIS taking vitamin K antagonists and with international normalized ratio  higher than 1.7 or taking new oral anticoagulants (NOACs) represents a great challenge. We aim to comprehensively determine the safety of EVT in patients under prior-stroke anticoagulants and IVT in patients under NOAC use.
Source: Journal of Stroke and Cerebrovascular Diseases - July 15, 2018 Category: Neurology Authors: Mingsu Liu, Yang Zheng, Guangqin Li Tags: Review Article Source Type: research

Protocol for Cerebral Microbleeds During the Non–Vitamin K Antagonist Oral Anticoagulants or Warfarin Therapy in Stroke Patients With Nonvalvular Atrial Fibrillation (CMB-NOW) Study: Multisite Pilot Trial
Anticoagulants are widely used to prevent recurrence of ischemic stroke in patients with nonvalvular atrial fibrillation, but in some patients, they also cause bleeding, particularly intracranial hemorrhage. One of the independent predictors of intracerebral hemorrhage is the presence of cerebral microbleeds (CMBs); a high incidence of intracerebral hemorrhage is reported in warfarin-treated patients with multiple CMBs. Longitudinal study suggested that the presence of CMBs at baseline is a predictor of new CMBs in warfarin-treated patients.
Source: Journal of Stroke and Cerebrovascular Diseases - July 4, 2015 Category: Neurology Authors: Shunya Takizawa, Fumiaki Tanaka, Kazutoshi Nishiyama, Yasuhiro Hasegawa, Eiichiro Nagata, Atsushi Mizuma, Sachiko Yutani, Taira Nakayama, Hiroyuki Kobayashi, Noriharu Yanagimachi, Takashi Okazaki, Kazuo Kitagawa, CMB-NOW Study Investigators Source Type: research

Vitamin K Antagonist–associated Intracerebral Hemorrhage: Lessons from a Devastating Disease in the Dawn of the New Oral Anticoagulants
Conclusions: VKA-associated ICH presents in a particularly vulnerable population and has a poor prognosis that may be reliably predicted by several clinicoradiologic features.
Source: Journal of Stroke and Cerebrovascular Diseases - August 19, 2013 Category: Neurology Authors: Marta Suárez-Pinilla, Ángeles Fernández-Rodríguez, Lorena Benavente-Fernández, Sergio Calleja-Puerta Tags: Original Articles Source Type: research

Incidence, Mortality, and Risk Factors for Oral Anticoagulant–associated Intracranial Hemorrhage in Patients with Atrial Fibrillation
Warfarin, a vitamin K epoxide reductase inhibitor, is the oral anticoagulant most commonly used to reduce the risk of stroke in patients with atrial fibrillation (AF). Warfarin has proved to be efficacious for this purpose in multiple clinical trials. However, warfarin use is laborious and associated with an increased risk of intracranial hemorrhage (ICH). Various factors increase the risk of warfarin-related ICH, including older age, intensity of anticoagulation, hypertension, and history of cerebrovascular disease.
Source: Journal of Stroke and Cerebrovascular Diseases - October 29, 2014 Category: Neurology Authors: Rebbeca Grysiewicz, Philip B. Gorelick Tags: Review Article Source Type: research

Pharmacological Difference Between Platelet Aggregations in Cardioembolic Stroke Patients with Direct Oral Anticoagulants: A Pilot Study
Major hemorrhagic complication incidence in patients with arterial fibrillation (AF), and treated with direct oral anticoagulants (DOACs), is lower than in vitamin K antagonist-treated patients.1 –5 Additionally, among DOACs, the direct oral thrombin inhibitor (dabigatran) and direct oral factor Xa (FXa) inhibitors (apixaban and rivaroxaban) seem to affect the coagulation system differently, which could provide distinct clinical outcomes.6,7 The results from the US6 and Denmark8 cohort stu dies suggest there is a minute, but notable difference in major bleeding complication incidence between dabigatran and FXa inhibitors.
Source: Journal of Stroke and Cerebrovascular Diseases - May 3, 2022 Category: Neurology Authors: Masahito Nakazaki, Shinichi Oka, Hirotoshi Magota, Ryo Kiyose, Rie Onodera, Ryo Ukai, Yuko Kataoka-Sasaki, Masanori Sasaki, Osamu Honmou Source Type: research

Intracerebral Hemorrhagic Expansion Occurs in Patients Using Non –Vitamin K Antagonist Oral Anticoagulants Comparable with Patients Using Warfarin
Non –vitamin K antagonist oral anticoagulant (NOAC) use has significantly reduced intracerebral hemorrhagic (ICH) risk compared with standard anticoagulant treatment. Hematoma expansion (HE) is a known predictor of mortality in warfarin-associated ICH. Little is known about HE in patients using NOACs.
Source: Journal of Stroke and Cerebrovascular Diseases - June 21, 2017 Category: Neurology Authors: Kara R. Melmed, Patrick Lyden, Norman Gellada, Asma Moheet Source Type: research

Cryptogenic Intracranial Hemorrhagic Strokes Associated with Hypervitaminosis E and Acutely Elevated α-Tocopherol Levels
Objectives: Up to 41% of intracerebral hemorrhages (ICH) are considered cryptogenic despite a thorough investigation to determine etiology. Certain over-the-counter supplements may increase proclivity to bleeding, and we hypothesize that specifically vitamin E may have an association with ICH and acutely elevated serum levels of α-tocopherol. Our aim is to report 3 cases of recently admitted patients with hypervitaminosis E and otherwise cryptogenic ICH. Methods: At our institution between January and December 2018, 179 patients were admitted with ICH with 73 imputed to be “cryptogenic” (without clear etiology as per ...
Source: Journal of Stroke and Cerebrovascular Diseases - March 5, 2020 Category: Neurology Authors: Nicole K. Le, Tigran Kesayan, Jane Y. Chang, David Z. Rose Source Type: research

The impact of the approval of prothrombin complex concentrates for vitamin K antagonist-related intracerebral hemorrhage: A retrospective study
This study aimed to determine the impact of the approval of prothrombin complex concentrates on the treatment of vitamin K antagonist-related intracerebral hemorrhage.
Source: Journal of Stroke and Cerebrovascular Diseases - October 27, 2022 Category: Neurology Authors: Sadayoshi Watanabe, Shoji Matsumoto, Ichiro Nakahara, Jun Morioka, Akiko Hasebe, Jun Tanabe, Kenichiro Suyama, Takuma Ishihara, Tsuyoshi Ohta, Taketo Hatano, Izumi Nagata, Yuichi Hirose Source Type: research