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Condition: Atrial Fibrillation
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Abstract 12: Accuracy and Validation of an Automated Electronic Medical Record Algorithm to Identify Patients with Atrial Fibrillation at Risk for Stroke Session Title: Concurrent I Session B: Oral Abstracts on Stroke Topics
Discussion: Automated methods can be used to identify patients with prevalent AF indicated for anticoagulation, but may suffer from misclassification of up to 12%. Misclassification is minimized by requiring a diagnosis of AF within the prior year and using a CHA2DS2-Vasc based algorithm. Despite differences in accuracy between definitions, system-wide anticoagulation rates assessed using these definitions were similar. The diagnosis codes validated in this study can be applied for internal quality improvement and observational studies, and might be adapted for use in nationwide quality reporting programs.
Source: Circulation: Cardiovascular Quality and Outcomes - June 2, 2014 Category: Cardiology Authors: Navar-Boggan, A. M., Rymer, J., Piccini, J. P., Shatila, W., Ring, L., Stafford, J., Al-Khatib, S. M., Peterson, E. Tags: Session Title: Concurrent I Session B: Oral Abstracts on Stroke Topics Source Type: research

Rationale and design of Triple AXEL: trial for early anticoagulation in acute ischemic stroke patients with nonvalvular atrial fibrillation
DiscussionThe results of this proof‐of‐concept trial will guide go/no‐go decision to a large phase 3 confirmatory trial.
Source: International Journal of Stroke - October 26, 2014 Category: Neurology Authors: Keun‐Sik Hong, Yun Jung Choi, Sun U. Kwon, Tags: Protocols Source Type: research

Prolonged cardiac monitoring after cryptogenic stroke superior to 24 h ECG in detection of occult paroxysmal atrial fibrillation
Commentary on: Gladstone DJ, Spring M, Dorian P, et al.. Atrial fibrillation in patients with cryptogenic stroke. N Eng J Med 2014;370:2467–77. Context Stroke remains a prevalent and devastating condition for many people across the world, it is a leading cause of disability and is associated with significant monetary and social losses, yet is considered to be a largely preventable disease. One-third of all strokes are considered cryptogenic after initial diagnostic evaluations. Cryptogenic stroke has been identified, only recently, as an important area of additional investigation. Part of the EMBRACE trial, Gladstone...
Source: Evidence-Based Medicine - November 19, 2014 Category: Internal Medicine Authors: Miller, D. J. Tags: EBM Diagnosis, Drugs: cardiovascular system, Stroke, Arrhythmias Source Type: research

Embolic Stroke of Undetermined Source (ESUS): A single center study from Argentina (P1.060)
CONCLUSIONS: Even with complete work-up, upon initial assessment more than one third of ischemic stroke patients met criteria for ESUS. After one year follow-up, it is possible to reclassify some of them, mostly as cardioembolic. More studies are needed to establish unidentified etiologies and the effect of longer follow-ups. Study Supported by:Disclosure: Dr. Pertierra has nothing to disclose. Dr. Hawkes has nothing to disclose. Dr. Farez has received personal compensation for activities with Merck Serono. Dr. Gomez-Scheneider has nothing to disclose. Dr. Pastor-Rueda has nothing to disclose. Dr. Calandri has nothing to d...
Source: Neurology - April 8, 2015 Category: Neurology Authors: Pertierra, L., Hawkes, M., Farez, M., Gomez-Scheneider, M., Pastor-Rueda, J., Calandri, I., Pujol-Lereis, V., Ameriso, S. Tags: Cerebrovascular Disease and Interventional Neurology: Atrial Fibrillation and Cardio-embolic Stroke Source Type: research

Are there Different Rates of Acute Stroke Risk Factors in the South Texas Mexican American population? (P7.146)
CONCLUSION: In the South Texas Mexican American AIS population, there is greater then a three-fold higher prevalence of hypertension, diabetes and CHF compared with Hispanics/Latinos in the US. AFIB and CHF are significant predictors of poor outcome in this unique population.Disclosure: Dr. Tekle has nothing to disclose. Dr. Hassan has nothing to disclose. Dr. Malik has nothing to disclose. Dr. Jones-Fullingim has nothing to disclose. Dr. Sanchez has nothing to disclose. Dr. Jani has nothing to disclose. Dr. Sanchez has nothing to disclose. Dr. Abantao has nothing to disclose. Dr. Qureshi has nothing to disclose.
Source: Neurology - April 8, 2015 Category: Neurology Authors: Tekle, W., Hassan, A., Malik, A., Jones-Fullingim, L., Sanchez, C., Jani, V., Sanchez, O., Abantao, E., Qureshi, A. Tags: Cerebrovascular Disease and Interventional Neurology: Race, Ethnicity, and Stroke Source Type: research

Stroke Risk Perception in Atrial Fibrillation Patients is not Associated with Clinical Stroke Risk
Clinical risk stratification models, such as the CHA2DS2-VASc, are used to assess stroke risk in atrial fibrillation (AF) patients. No study has yet investigated whether and to which extent these patients have a realistic perception of their personal stroke risk. The purpose of this study was to investigate and describe the association between AF patients' stroke risk perception and clinical stroke risk.
Source: Journal of Stroke and Cerebrovascular Diseases - September 11, 2015 Category: Neurology Authors: Anders Fournaise, Jane Skov, Else-Marie Bladbjerg, Anja Leppin Source Type: research

Effectiveness of Left Atrial Appendage Exclusion Procedures to Reduce the Risk of Stroke: A Systematic Review of the Evidence Original Articles
Conclusions— There is limited evidence that the Watchman device may be noninferior to long-term OAC in selected patients. Data on effectiveness of LAA exclusion devices is lacking in patients ineligible for long-term OAC. Percutaneous LAA devices are associated with high rates of procedure-related harms. Although surgical LAA exclusion during heart surgery does not seem to add incremental harm, there is insufficient evidence of benefit.
Source: Circulation: Cardiovascular Quality and Outcomes - July 18, 2016 Category: Cardiology Authors: Noelck, N., Papak, J., Freeman, M., Paynter, R., Low, A., Motuapuaka, M., Kondo, K., Kansagara, D. Tags: Atrial Fibrillation, Anticoagulants, Cardiovascular Surgery, Complications, Ischemic Stroke Original Articles Source Type: research

How long should we wait to start oral anticoagulation after cardioembolic stroke?
As a neurology resident many years ago, I carried in the pocket of my white coat a small notebook. I used this as a quick reference guide, recording the diagnostic and treatment recommendations of the neurology professors training me. I still have the book, and occasionally amuse myself by perusing the entry for acute stroke, satisfying in its pure simplicity: "If Afib present > start IV heparin; if no Afib > start aspirin." As is so often the case, clinical trial data soon enough proved this received wisdom wrong. In the Heparin in Acute Embolic Stroke Trial, which enrolled patients with stroke and atrial fibrillati...
Source: Neurology - October 30, 2016 Category: Neurology Authors: Cucchiara, B. Tags: Stroke prevention, Clinical trials Observational study (Cohort, Case control) EDITORIALS Source Type: research

Rivaroxaban Versus Dabigatran or Warfarin in Real-World Studies of Stroke Prevention in Atrial Fibrillation Clinical Sciences
Conclusions—In this systematic review and meta-analysis, rivaroxaban was as effective as dabigatran, but was more effective than warfarin for the prevention of stroke/thromboembolism in atrial fibrillation patients. Major bleeding risk was significantly higher with rivaroxaban than with dabigatran, as was all-cause mortality and gastrointestinal bleeding. Rivaroxaban was comparable to warfarin for major bleeding, with an increased risk in gastrointestinal bleeding and decreased risk of intracranial hemorrhage.
Source: Stroke - March 27, 2017 Category: Neurology Authors: Ying Bai, Hai Deng, Alena Shantsila, Gregory Y.H. Lip Tags: Meta Analysis, Quality and Outcomes Original Contributions Source Type: research

Impact of Vascular Risk factors on Hemorrhagic Transformation Following rt-PA Administration for Acute Ischemic Stroke (P4.269)
Conclusions:No vascular risk factor was independently associated with HT, suggesting a confounding effect from stroke severity (NIHSS score).Disclosure: Dr. Shaban has nothing to disclose. Dr. Tasneem has nothing to disclose. Dr. Dandapat has nothing to disclose. Dr. Ahmed has nothing to disclose. Dr. Policeni has nothing to disclose. Dr. Olalde has nothing to disclose. Dr. Samaniego has nothing to disclose. Dr. Shim has nothing to disclose. Dr. Pieper has nothing to disclose. Dr. Leira has nothing to disclose. Dr. Ortega-Gutierrez has nothing to disclose. Dr. Adams has nothing to disclose. Dr. Nagaraja has nothing to disclose.
Source: Neurology - April 17, 2017 Category: Neurology Authors: Shaban, A., Tasneem, N., Dandapat, S., Ahmed, U., Policeni, B., Olalde, H., Samaniego, E., Shim, H., Pieper, C., Leira, E., Ortega-Gutierrez, S., Adams, H., Nagaraja, N. Tags: Thrombolysis and Acute Evaluation in Ischemic Stroke Source Type: research

Ischemic Stroke in Nonvalvular Atrial Fibrillation at Warfarin Initiation Clinical Sciences
Conclusions—Warfarin effect was qualitatively different in the first 30 days after initiation than subsequently. This is consistent with a modest increase in stroke risk occurring briefly after starting warfarin.
Source: Stroke - May 22, 2017 Category: Neurology Authors: Ping G. Tepper, Xianchen Liu, Melissa Hamilton, Jack Mardekian, William Petkun, Wilson Tan, Daniel E. Singer Tags: Epidemiology Original Contributions Source Type: research

Cardioembolic Ischemic Stroke Gene Expression Fingerprint in Blood: a Systematic Review and Verification Analysis
AbstractAn accurate etiological classification is key to optimize secondary prevention after ischemic stroke, but the cause remains undetermined in one third of patients. Several studies pointed out the usefulness of circulating gene expression markers to discriminate cardioembolic (CE) strokes, mainly due to atrial fibrillation (AF), while only exploring them in small cohorts. A systematic review of studies analyzing high-throughput gene expression in blood samples to discriminate CE strokes was performed. Significantly dysregulated genes were considered as candidates, and a selection of them was validated by RT-qPCR in 1...
Source: Translational Stroke Research - September 1, 2019 Category: Neurology Source Type: research

In-thrombus thrombin secretion: a new diagnostic marker of atrial fibrillation in cryptogenic stroke
Conclusions An assay measuring the change in thrombin in clots retrieved during acute stroke endovascular thrombectomy procedures may serve as a diagnostic marker of the origin of the clot. The suggested mechanism for these differences may be the clot location before its retrieval, with high blood flow causing thrombin washout in atherosclerotic clots, in contrast to atrium appendage low blood flow retaining high thrombin levels.
Source: Journal of NeuroInterventional Surgery - August 13, 2021 Category: Neurosurgery Authors: Itsekson Hayosh, Z., Abu Bandora, E., Shelestovich, N., Nulman, M., Bakon, M., Yaniv, G., Khaitovitch, B., Balan, S., Gerasimova, A., Drori, T., Mausbach, S., Schwammenthal, Y., Afek, A., Chapman, J., Shavit Stein, E., Orion, D. Tags: Ischemic stroke Source Type: research

Analysis of microRNA signatures in ischemic stroke thrombus
Conclusions The microRNA expression pattern can provide information regarding the mechanism of stroke by reflecting the underlying pathological status of the organ from which the thrombus was derived.
Source: Journal of NeuroInterventional Surgery - April 12, 2022 Category: Neurosurgery Authors: Kim, J.-M., Byun, J.-S., Kim, J., Park, M.-S., Hong, S. A., Nam, T.-K., Choi, H. H., Hong, S., Han, S.-H., Jeong, H.-B., Park, K.-Y., Kim, H. R. Tags: Ischemic stroke Source Type: research