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Source: JAMA
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Total 276 results found since Jan 2013.
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Source: JAMA - June 14, 2022 Category: General Medicine Source Type: research
Use of Oral Anticoagulants and Intracranial Hemorrhage Among Patients With Acute Ischemic Stroke
To the Editor A recent article suggested that the use of non –vitamin K antagonist oral anticoagulants (NOACs) within 7 days of intravenous alteplase was not associated with an increased risk of intracranial hemorrhage. However, we are concerned that some readers may interpret these results as an endorsement of the use of alteplase in patients with acute st roke who were taking NOACs, irrespective of the time frame of last use. Based on dose-finding studies, the drug half-life is 12 hours for apixaban, 11 to 13 hours for rivaroxaban, 10 to 14 hours for edoxaban, and 12 to 17 hours for dabigatran in patients with normal k...
Source: JAMA - June 21, 2022 Category: General Medicine Source Type: research
The Concept of Transient Ischemic Attack
To the Editor A recent Viewpoint suggested that the concept of transient ischemic attack (TIA) should be retired. The authors proposed the term acute ischemic cerebrovascular syndrome in its place, stating that all focal ischemia in the brain can cause tissue damage. Although I appreciate the contributions of both authors for raising awareness of TIA being a medical emergency that warrants emergency evaluation due to the high risk of stroke in the early period after a TIA, I do not agree that the concept of TIA should be retired.
Source: JAMA - June 28, 2022 Category: General Medicine Source Type: research
Intra-arterial Alteplase vs Placebo After Successful Thrombectomy and Functional Outcomes in Patients With Large Vessel Occlusion Acute Ischemic Stroke —Reply
In Reply In response to the comments by Dr Mai and colleagues about the change in the primary outcome of the CHOICE trial, we would like to provide several clarifications. First, the definition of the primary outcome in the original protocol was submitted for publication on July 15, 2019. Second, the registered protocol (NCT03876119) was first posted on March 15, 2019, but the primary outcome definition was changed and posted on March 19, 2021. Third, the summary of the history of these protocol changes was included in Supplement 2 of the article. As required by Spanish law, these changes were also communicated to the Span...
Source: JAMA - June 28, 2022 Category: General Medicine Source Type: research
Echocardiographic Measures of Left Atrial Function and Size and Incident Dementia
To the Editor A recent study described a significant association between left atrial function and an increased risk of subsequent dementia, independent of the presence of atrial fibrillation. These findings are similar to our 2009 study, which examined subclinical left atrial dysfunction and risk of stroke in patients with patent foramen ovale (PFO). We found that impairment of reservoir, conduit, and contractile strain and impairment of emptying, passive emptying, and active emptying fraction was present in patients with multiple ischemic events, PFO, and atrial septal aneurysm compared with healthy individuals. After PFO...
Source: JAMA - July 19, 2022 Category: General Medicine Source Type: research
HIV, Subclinical Cardiovascular Disease, and Clinical Progression
People living with HIV have higher risks of cardiovascular disease (CVD) including myocardial infarction, heart failure, stroke, pulmonary hypertension, and sudden cardiac death than those without HIV. These excess CVD risks persist in the modern HIV treatment era and are not readily explained by demographic, environmental, or clinical confounding factors. Nor are these HIV-associated CVD risks explained by antiretroviral therapy (ART); the net cardiovascular and overall benefits of effective HIV treatment clearly outweigh the risks. Thus, refining HIV-specific contributors to CVD pathogenesis is critically important for i...
Source: JAMA - September 13, 2022 Category: General Medicine Source Type: research
Ischemic Stroke in Patients With Asymptomatic Severe Carotid Stenosis Without Surgical Intervention
To the Editor In a recent study, the authors reported 133 ipsilateral ischemic strokes among patients with medically treated asymptomatic severe carotid stenosis who did not undergo surgical intervention after a mean follow-up of 4.1 years. During this follow-up period, 55.6% of the 3737 patients died; however, cause of death was not reported in this study. Could some of these deaths have been caused by major strokes, and is it possible that these events were missed?
Source: JAMA - September 27, 2022 Category: General Medicine Source Type: research
Telmisartan and Walking Performance in Peripheral Artery Disease
Lower extremity peripheral artery disease (PAD) is a morbid manifestation of atherosclerosis that affects an estimated 230 million people worldwide. In the context of an aging population and the increasing rates of diabetes, the prevalence of PAD is expected to increase. Patients with PAD, by virtue of having atherosclerosis, have a heightened risk of myocardial infarction and stroke; thus reducing these risks has been the primary focus of most medical interventions. Although these efforts are warranted, recent evidence has broadened awareness that the dominant morbidity involves the limbs, including functional impairment ...
Source: JAMA - October 4, 2022 Category: General Medicine Source Type: research
Vitamin and Mineral Supplements for Primary Prevention of Cardiovascular Disease and Cancer
To the Editor A recent recommendation of the US Preventive Services Task Force (USPSTF) concluded that there is no convincing evidence that vitamin supplements are beneficial for primary prevention of cardiovascular disease or cancer. However, we would like to highlight an important exception: B vitamins used to lower homocysteine levels do prevent stroke.
Source: JAMA - October 18, 2022 Category: General Medicine Source Type: research
Stenting Plus Medical Therapy and Risk of Stroke and Death in Patients With Symptomatic Intracranial Stenosis
To the Editor We have some observations about the CASSISS trial, which did not demonstrate superiority of intracranial stenting added to optimal medical therapy. This finding was similar to the SAMMPRIS and VISSIT trials.
Source: JAMA - December 27, 2022 Category: General Medicine Source Type: research
Stenting Plus Medical Therapy and Risk of Stroke and Death in Patients With Symptomatic Intracranial Stenosis —Reply
In Reply We agree with the comments by Drs Zedde and Pascarella and Drs Alexander and Yu that patient selection in our study may have altered the effect on the outcomes of stenting and medical therapy for patients with intracranial stenosis.
Source: JAMA - December 27, 2022 Category: General Medicine Source Type: research
COVID-19 vs Influenza for Risk of Thrombotic Events in Hospitalized Patients —Reply
In Reply We appreciate the interest in our recent study and the opportunity to share our responses to the comments by Dr Yii and colleagues. We sought to assess whether the risk of arterial and venous thromboembolism among patients hospitalized with COVID-19 differed from those hospitalized with another respiratory viral infection. Patients with influenza in 2018-2019 were selected as the comparator because this pathogen also causes pandemics, results in hospitalization when severe, and is associated with increased risk of acute myocardial infarction, ischemic stroke, and venous thromboembolism. Evaluating outcomes of COVI...
Source: JAMA - December 27, 2022 Category: General Medicine Source Type: research
Gout Flare and Cardiovascular Events
In this study, more individuals with gout and cardiovascular events had a history of cardiovascular disease and high to very high cardiovascular risk than matched controls with gout who did not have cardiovascular events.
Source: JAMA - January 3, 2023 Category: General Medicine Source Type: research
Rate-Adaptive Atrial Pacing for Heart Failure With Preserved Ejection Fraction
To the Editor The recent RAPID-HF study explored the important concept of supporting heart rate in patients with heart failure and chronotropic insufficiency. Although the study reached a null conclusion, I believe it is important not to overextrapolate the findings. Cardiac output, by definition, is heart rate × stroke volume. Because these are not independent variables, the authors saw that when exercise heart rate was increased with atrial pacing, they could not measure an increase in cardiac output.
Source: JAMA - June 20, 2023 Category: General Medicine Source Type: research
