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Data from New VOYAGER PAD Analyses at ACC.22 Reinforce Benefit of XARELTO ® (rivaroxaban) Plus Aspirin in Patients with Peripheral Artery Disease (PAD) and Various Co-Morbid Conditions
RARITAN, N.J., April 1, 2022 – The Janssen Pharmaceutical Companies of Johnson & Johnson today announced data from new analyses from the Phase 3 VOYAGER PAD clinical trial reinforcing the benefit of the XARELTO® (rivaroxaban) vascular dose (2.5 mg twice daily plus aspirin 100 mg once daily) in reducing severe vascular events in patients with PAD after lower-extremity revascularization (LER), a procedure that restores blood flow to the legs. Data from the two analyses demonstrate the role that the XARELTO® vascular dose plays in PAD patients with and without chronic kidney disease (CKD) and in PAD patients with and ...
Source: Johnson and Johnson - April 1, 2022 Category: Pharmaceuticals Tags: Innovation Source Type: news

Prevalence of Guideline-Directed Medical Therapy for Cardiovascular Disease Among Baltimore City Adults in the Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS) Study
ConclusionsAmong an urban-dwelling population of adults, the use of secondary prevention of CVD was low, with lower aspirin and combination GDMT for Black participants with CAD. Efforts to improve GDMT use at the patient and provider levels may be needed to improve morbidity and mortality and reduce disparities in CVD.
Source: Journal of Racial and Ethnic Health Disparities - February 16, 2021 Category: International Medicine & Public Health Source Type: research

Medical Management for Secondary Stroke Prevention
This article reviews the evidence base and recommendations for medical management for secondary stroke prevention. RECENT FINDINGS Recent developments for secondary stroke prevention include evidence to support the use of short-term dual antiplatelet therapy after minor stroke and transient ischemic attack, direct oral anticoagulants for nonvalvular atrial fibrillation, reversal agents for direct oral anticoagulant–associated hemorrhage, and aspirin rather than presumptive anticoagulation with a direct oral anticoagulant for embolic stroke of undetermined source. SUMMARY Most strokes are preventable. The mainstays ...
Source: CONTINUUM: Lifelong Learning in Neurology - April 1, 2020 Category: Neurology Tags: REVIEW ARTICLES Source Type: research

Temporal Trends and Patient Characteristics Associated With Drug Utilisation After First-Ever Stroke: Insights From Chronic Disease Registry Data in Singapore.
CONCLUSION: This study reveals changes in prescription behaviour over time in a multiethnic Asian population with first-ever stroke. Patient characteristics including younger age, Malay ethnicity and certain comorbidities (i.e. hyperlipidaemia, atrial fibrillation) were associated with the combined use of all 3 guideline medications among ischaemic stroke patients. PMID: 32301477 [PubMed - in process]
Source: Ann Acad Med Singapo... - February 29, 2020 Category: General Medicine Authors: Yeo SH, Toh MPH, Lee SH, Seet RC, Wong LY, Yau WP Tags: Ann Acad Med Singapore Source Type: research

Prevention and Treatment of Acute Stroke in the Nonagenarians and Beyond: Medical and Ethical Issues
AbstractPurpose of reviewAs one of the fastest growing portions of the population, nonagenarians will constitute a significant percentage of the stroke patient population in the near future. Nonagenarians are nevertheless not specifically targeted by most clinical guidelines. In this review, we aimed to summarise the available evidence guiding stroke prevention and treatment in this age group.Recent findingsSeveral recent observational studies have shown that the benefits of anticoagulation for the oldest old patients with atrial fibrillation may outweigh the bleeding risk. A sub-analysis of the IST-3 trial has shown for t...
Source: Current Treatment Options in Neurology - May 7, 2019 Category: Neurology Source Type: research

Preventable Cases of Oral Anticoagulant-Induced Bleeding: Data From the Spontaneous Reporting System
Conclusion: Our findings describe the most reported risk factors for preventability of oral anticoagulant-induced bleedings. These factors may be useful for targeting interventions to improve pharmacovigilance activities in our regional territory and to reduce the burden of medication errors and inappropriate prescription. Introduction Oral anticoagulant therapy is widely used for the prevention of stroke and systemic embolism in patients with atrial fibrillation, or for the prevention and treatment of deep vein thrombosis and pulmonary embolism (Raj et al., 1994; Monaco et al., 2017). Oral anticoagulants can be di...
Source: Frontiers in Pharmacology - April 29, 2019 Category: Drugs & Pharmacology Source Type: research

Asymptomatic Carotid Stenosis Is Associated With Circadian and Other Variability in Embolus Detection
Conclusions: Embolism associated with asymptomatic carotid stenosis shows circadian variation with highest rates 4–6 h before midday. This corresponds with peak circadian incidence of stroke and other vascular complications. These and ASED Study results show that monitoring frequency, duration, and time of day are important in ES detection. Introduction Transcranial Doppler (TCD) detected microembolism in the ipsilateral middle cerebral artery (MCA) may help stratify the risk of stroke and other arterial disease complications in persons with advanced (≥60%) asymptomatic carotid stenosis. If so, this t...
Source: Frontiers in Neurology - April 15, 2019 Category: Neurology Source Type: research

Stenosis Length and Degree Interact With the Risk of Cerebrovascular Events Related to Internal Carotid Artery Stenosis
Conclusion: We found a statistically insignificant tendency for the ultrasound-measured length of sICAS<70% to be longer than that of sICAS≥70%. Moreover, the ultrasound-measured length of sICAS<90% was significantly longer than that of sICAS 90%. Among patients with sICAS≥70%, the degree and length of stenosis were inversely correlated. Larger studies are needed before a clinical implication can be drawn from these results. Introduction Internal carotid artery stenosis (ICAS) causes around one-fifth of ischemic cerebrovascular stroke and has the highest risk of early stroke recurrence...
Source: Frontiers in Neurology - April 8, 2019 Category: Neurology Source Type: research

Opportunities for intervention: stroke treatments, disability and mortality in urban Tanzania
ConclusionsThe 90-day mortality of stroke presenting at MNH is 50%, much higher than in higher income settings. Although severe stroke presentations are a major factor, efforts to improve the quality of care and prevent complications of stroke are urgently needed. Acute stroke interventions with low number needed to treat represent challenging long-term goals.
Source: International Journal for Quality in Health Care - August 28, 2018 Category: International Medicine & Public Health Source Type: research

A Diagnostic Approach to Stroke in Young Adults
Opinion statementOptimal diagnosis and management of stroke in young adults benefit from a multidisciplinary team, including a vascular neurology specialist. In addition to the “standard” vascular risk factors including smoking, hypertension, diabetes, and hyperlipidemia, one needs to consider alternative etiologies including substance abuse, carotid/vertebral artery dissections, and rare genetic conditions among others. Once a young patient is determined to have had a stroke, the next question a clinician should ask iswhy did this patient have a stroke? A “heart to head” diagnostic approach is recommended. A thoro...
Source: Current Treatment Options in Cardiovascular Medicine - September 25, 2017 Category: Cardiology Source Type: research

A Case of Transient Global Amnesia: A Review and How It May Shed Further Insight into the Neurobiology of Delusions
Conclusion In closing, our patient’s episode of TGA combined with her emotional and perceptual response lends credence to the proposal of a “fear/paranoia” circuit in the genesis of paranoid delusions—a circuit incorporating amygdala, frontal, and parietal cortices. Here, neutral or irrelevant stimuli, thoughts, and percepts come to engender fear and anxiety, while dysfunction in frontoparietal circuitry engenders inappropriate social predictions and maladaptive inferences about the intentions of others.[54] Hippocampus relays information about contextual information based on past experiences and the current situat...
Source: Innovations in Clinical Neuroscience - April 1, 2016 Category: Neuroscience Authors: ICN Online Editor Tags: Anxiety Disorders Behavioral and Cognitive Neurology Case Report Cognition Current Issue Dementia Medical Issues Neurologic Systems and Symptoms Psychiatry Schizophrenia delusions hippocampus neurobiology Transient global amnesia Source Type: research

Stroke subtypes and interventional studies for transient ischemic attack.
Authors: Lavallée P, Amarenco P Abstract Transient ischemic attack (TIA) is the most important risk factor for ischemic stroke. The risk is the highest in the first hours after symptom onset, and treatment must be initiated in emergency. In the acute phase, antithrombotic agent is probably the most important treatment, but it is not excluded that lipid-lowering agents and/or antihypertensive drugs are also important. For current guidelines, monotherapy of antiplatelet agent remains the gold standard in emergency. However, most recent data and meta-analysis support a combination therapy of clopidogrel and aspirin. ...
Source: Frontiers of Neurology and Neuroscience - December 2, 2015 Category: Neuroscience Tags: Front Neurol Neurosci Source Type: research

A high burden of ischemic stroke in regions of Eastern/Central Europe is largely due to modifiable risk factors.
Abstract Incidence and mortality of ischemic stroke in Croatia is significantly higher than in many other developed European countries. Here, we aimed to evaluate underlying conditions of this unacceptably high ischemic stroke burden. An observational prospective cohort study of ) first-ever ischemic stroke patients identified in a population-based incidence study (N=751) (study 1, S1) and a concurrent case-control trial (215 patients, 125 controls, S2) were conducted in the country of Varazdin from 2007-2010. Atrial fibrillation (AF) was common (36.1% in S1, 40.9% in S2) and mostly (>50%) unrecognized before t...
Source: Current Neurovascular Research - July 30, 2015 Category: Neurology Authors: Pikija S, Trkulja V, Malojcic B, Mutzenbach JS, Sellner J Tags: Curr Neurovasc Res Source Type: research

Incidence, Trends, and Predictors of Ischemic Stroke 1 Year After an Acute Myocardial Infarction Clinical Sciences
Conclusions— The risk of ischemic stroke within a year after myocardial infarction is substantial but has clearly been reduced during the studied time period. The major predictive factors found to correlate well with previous investigations. Reperfusion treatment, thrombocyte aggregation inhibition, and lipid lowering are the main contributors to the observed risk reduction.
Source: Stroke - October 27, 2014 Category: Neurology Authors: Ulvenstam, A., Kajermo, U., Modica, A., Jernberg, T., Soderstrom, L., Mooe, T. Tags: Platelet function inhibitors, Acute myocardial infarction, Acute Cerebral Infarction, Platelets Clinical Sciences Source Type: research

GPs to review aspirin use in atrial fibrillation patients
NICE calls for increased uptake of anticoagulantsRelated items from OnMedicaAlteplase use linked to reduction in disability after strokeGPs should screen over 65s for atrial fibrillationAtrial fibrillation raises risk of cognitive problems Statin use after stroke not linked to bleedsNew guidance to prevent strokes
Source: OnMedica Latest News - June 19, 2014 Category: UK Health Source Type: news

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