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The challenge of coprescription of antiplatelet therapy and oral anticoagulants
The coexistence of symptomatic carotid artery stenosis and nonvalvular atrial fibrillation (NVAF) in the recently reported 85year old man [1] bears out the findings of the study which documented a 24.3% prevalence of high-grade (50% or more) carotid artery stenosis among 103 consecutive NVAF patients (mean age 69) who presented with stroke [2]. Among these patients with high-grade stenosis 66.7% had stenosis ipsilateral to the cerebral infarct [2]. Given the fact that patients with symptomatic carotid artery stenosis are at high risk of stroke recurrence and/or worsening neurological disability during the first 14days foll...
Source: The American Journal of Emergency Medicine - May 22, 2017 Category: Emergency Medicine Authors: Oscar M.P. Jolobe Source Type: research

Comparison of dual antiplatelet therapy versus oral anticoagulation following transcatheter aortic valve replacement: A retrospective single-center registry analysis.
CONCLUSIONS: OAC after TAVR seems to reduce the risk of clinical valve thrombosis without a statistically significant increase in bleeding complications. PMID: 28497845 [PubMed - as supplied by publisher]
Source: Cardiology Journal - May 12, 2017 Category: Cardiology Authors: Holy EW, Kebernik J, Allali A, El-Mawardy M, Richardt G, Abdel-Wahab M Tags: Cardiol J Source Type: research

Predictors of Direct Oral Anticoagulants Utilization for Thromboembolism Prevention in Atrial Fibrillation.
CONCLUSION: To the best of our knowledge, this is the first observational study finding that concomitant use of clopidogrel reduced the likelihood of DOAC utilization while prescription by a neurologist increased the probability of receiving a DOAC over warfarin in patients with AF.This article is open to POST-PUBLICATION REVIEW. Registered readers (see "For Readers") may comment by clicking on ABSTRACT on the issue's contents page. PMID: 28459661 [PubMed - in process]
Source: Journal of Pharmacy and Pharmaceutical Sciences - May 2, 2017 Category: Drugs & Pharmacology Tags: J Pharm Pharm Sci Source Type: research

Evaluation of Antithrombotic Bridging Methods in Acute Ischemic Stroke Patients with Atrial Fibrillation (P6.281)
Conclusions:Preliminary data supports against bridging with parenteral anticoagulation in acute ischemic stroke and AF, with a higher incidence of complications observed overall. Higher incidence of extracranial complications observed with bridging anticoagulation and higher incidence of intracranial complications observed from bridging antiplatelet therapy. This finding may be related to the limited number of patients included. A future goal for this project will be to expand the number of charts reviewed to strengthen the validity of these results.Disclosure: Dr. Swafford has nothing to disclose. Dr. Lee has nothing to disclose.
Source: Neurology - April 17, 2017 Category: Neurology Authors: Swafford, K., Lee, J. Tags: Prevention of Cerebrovascular Disease Source Type: research

Rates of Adverse Events in the Very Old: A Community Anticoagulation Clinic Study (P6.291)
Conclusions:The very old still achieve minimum TTR to experience anticoagulation benefits. Patients older than 95 are at appreciably increased risk of hemorrhage, while ischemic events were overrepresented in ages 90–95. Future work aims to determine risk factors for thrombotic and hemorrhagic events in the very old.Disclosure: Dr. Stanley has nothing to disclose. Dr. Knight has nothing to disclose. Dr. Stein has nothing to disclose.
Source: Neurology - April 17, 2017 Category: Neurology Authors: Stanley, M., Knight, C., Stein, R. Tags: Prevention of Cerebrovascular Disease Source Type: research

Ticagrelor, but not clopidogrel active metabolite, displays antithrombotic properties in the left atrial endocardium
Conclusion</div>Ticagrelor, but not CAM, reduces expression and activity of TF and PAI-1 in LAA endocardial cells isolated from patients with AF, indicating possible local antithrombotic effects. Such pleiotropic properties of ticagrelor may contribute to a reduction in thromboembolic complications in patients with AF.</span>
Source: European Heart Journal - January 8, 2017 Category: Cardiology Source Type: research

Quality of Care Provided by Board-Certified Versus Non-Board-Certified Psychiatrists and Neurologists
Conclusions: The authors demonstrated the feasibility of linking physician information with patient records to construct quality measures from electronic claims data, but there may be only minimal differences in the quality of care between BC and nBC psychiatrists and neurologists, or there may be a difference that could not be measured with the quality measures used.
Source: Academic Medicine - December 29, 2016 Category: Universities & Medical Training Tags: Research Reports Source Type: research

Oral antiplatelet and anticoagulant agents in the prevention and management of ischemic stroke.
Abstract Despite numerous advances over the last 50 years, stroke continues to be a leading cause of death and disability worldwide. The treatment and prevention of stroke has undergone extensive study, and significant advances in medical management have occurred within the past decade principally with the development of new classes of orally active anticoagulant drugs. Here we review these recent breakthroughs and the varying roles of anticoagulants and antiplatelet agents in the prevention and management of different ischemic stroke subtypes, as well as describe the benefits and ongoing challenges to incorporati...
Source: Current Pharmaceutical Design - December 20, 2016 Category: Drugs & Pharmacology Authors: Shrestha S, Coy S, Bekelis K Tags: Curr Pharm Des Source Type: research

Antiplatelet agents in hemodialysis.
In conclusion, since CRF patients are one of the groups at highest risk for atherosclerotic events, it could be reasonable to use aspirin in HD patients. However, the bleeding risk in HD patients needs to be strongly evaluated, especially before starting dual AA treatment. PMID: 27928736 [PubMed - as supplied by publisher]
Source: Journal of Nephrology - December 7, 2016 Category: Urology & Nephrology Authors: Migliori M, Cantaluppi V, Scatena A, Panichi V Tags: J Nephrol Source Type: research

Anticoagulation for stroke prevention in elderly patients with non-valvular atrial fibrillation: what are the obstacles?
Authors: Wong CW Abstract The elderly with atrial fibrillation are more prone to stroke. Oral anticoagulants such as warfarin are effective in the prevention of atrial fibrillation-associated stroke and systemic embolism. The CHADS2 or CHA2D2-VASc score and HAS-BLED score were developed to stratify stroke risk associated with atrial fibrillation and bleeding risk in a patient with atrial fibrillation, respectively, to facilitate the decision for and safe use of oral anticoagulant. Nonetheless, the decision for anticoagulation is not straightforward and the elderly with non-valvular atrial fibrillation are often pre...
Source: Hong Kong Medical Journal - December 7, 2016 Category: Journals (General) Tags: Hong Kong Med J Source Type: research

Trial design: Rivaroxaban for the prevention of major cardiovascular events after transcatheter aortic valve replacement: Rationale and design of the GALILEO study
Conclusions GALILEO will test the hypothesis that a rivaroxaban-based antithrombotic strategy reduces the risk of thromboembolic complications post-TAVR with an acceptable risk of bleeding compared with the currently recommended antiplatelet therapy–based strategy in subjects without need of chronic oral anticoagulation.
Source: American Heart Journal - November 25, 2016 Category: Cardiology Source Type: research

Acute hemifield room tilt illusion in cerebral ischaemia
We present 2 cases in the setting of acute vertebrobasilar territory ischaemia. Case 1: A 56-year old man was admitted with acute dyspnoea and new atrial fibrillation. On day two while lying in bed, he developed vomiting and suddenly perceived the curtain to his left was lying horizontal along the floor and felt he was sliding towards the left. MRI brain revealed acute multiterritory infarction (Figure 1). He was commenced on therapeutic anticoagulation and was well on follow-up. Case 2: A 47-year old man awoke with acute vertigo, vomiting and ataxia, exacerbated by head movement with dysarthria and diplopia. The worl...
Source: Journal of Neurology, Neurosurgery and Psychiatry - November 14, 2016 Category: Neurosurgery Authors: Kinsella, J., Lonergan, R., Killeen, R., McGuigan, C. Tags: Drugs: CNS (not psychiatric), Stroke, Ophthalmology, Ear, nose and throat/otolaryngology ABN Annual Meeting, 17-19 May 2016, The Brighton Centre, Brighton Source Type: research

Association between antithrombotic treatment and hemorrhagic stroke in patients with atrial fibrillation —a cohort study in primary care
ConclusionsIn this clinical setting, we found no evidence pointing to an increased risk of HS with antithrombotic treatment.
Source: European Journal of Clinical Pharmacology - November 7, 2016 Category: Drugs & Pharmacology Source Type: research

Trial design: Rivaroxaban for the prevention of major cardiovascular events post transcatheter aortic valve replacement: rationale and design of the GALILEO study
Conclusions GALILEO will test the hypothesis that a rivaroxaban-based antithrombotic strategy reduces the risk of thromboembolic complications post-TAVR with an acceptable risk of bleeding compared with the currently recommended antiplatelet therapy-based strategy in subjects without need of chronic oral anticoagulation.
Source: American Heart Journal - October 31, 2016 Category: Cardiology Source Type: research

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