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Atrial fibrillation detection after cryptogenic stroke
Source: Internal and Emergency Medicine - October 1, 2014 Category: Emergency Medicine Source Type: research

Italian guidelines on thrombolysis indications in ischemic stroke have been revised after the IST-3 trial and Cochrane review
Source: Internal and Emergency Medicine - October 1, 2014 Category: Emergency Medicine Source Type: research

Safety and efficacy even after 90 years of age should prompt removal of upper age limits in systemic thrombolysis for stroke
Source: Internal and Emergency Medicine - October 1, 2014 Category: Emergency Medicine Source Type: research

Medication prescription and adherence disparities in non valvular atrial fibrillation patients: an Italian portrait from the ARAPACIS study
Abstract Non-valvular atrial fibrillation (NVAF) represents a major health-care problem, needing an extensive and strict thrombosis prevention for stroke and cardiovascular (CV) disease risks. NVAF management guidelines recommend adequate antithrombotic and anti-atherosclerotic therapies. Medication adherence has been recognized as a pivotal element in health quality promotion and in the achievement of better clinical outcomes. We conducted a post-hoc analysis of the “Atrial fibrillation Registry for Ankle-brachial index Prevalence Assessment-Collaborative Italian Study (ARAPACIS)” with the aim of discern...
Source: Internal and Emergency Medicine - November 23, 2014 Category: Emergency Medicine Source Type: research

Aortic dissection and stroke in a 37-year-old woman: discovering an emerging heritable connective tissue disorder
Source: Internal and Emergency Medicine - January 15, 2015 Category: Emergency Medicine Source Type: research

Direct oral anticoagulants in atrial fibrillation: can data from randomized clinical trials be safely transferred to the general population? Yes
Abstract Atrial fibrillation is the most common arrhythmia and is associated with significant morbidity and mortality. The current therapeutic options for patients at high thromboembolic risk include the vitamin K antagonists and the direct oral anticoagulants. These novel agents have been evaluated in more than 40,000 patients enrolled in four large randomized controlled trials for stroke prevention in non-valvular atrial fibrillation. When these results were pooled together, a greater efficacy profile, as well as a consistent reduction in life-threatening bleeding was shown in comparison to vitamin K antagonists...
Source: Internal and Emergency Medicine - July 7, 2015 Category: Emergency Medicine Source Type: research

Cardiovascular disease and hypertension in sub-Saharan Africa: burden, risk and interventions
Abstract Cardiovascular disease, including stroke, heart failure and kidney disease, has been common in sub-Saharan Africa for many years, and rapid urbanization is causing an upsurge of ischaemic heart disease and metabolic disorders. At least two-thirds of cardiovascular deaths now occur in low- and middle-income countries, bringing a double burden of disease to poor and developing world economies. High blood pressure (or hypertension) is by far the commonest underlying risk factor for cardiovascular disease. Its prevention, detection, treatment and control in sub-Saharan Africa are haphazard and suboptimal. Thi...
Source: Internal and Emergency Medicine - March 21, 2016 Category: Emergency Medicine Source Type: research

Systematic review: antihypertensive drug therapy in patients of African and South Asian ethnicity
In conclusion, in patients of African ethnicity, treatment initiated with ACE inhibitor or angiotensin II receptor blocker monotherapy was associated with adverse cardiovascular outcomes. We found no evidence of different efficacy of antihypertensive drugs in South Asians, but there is a need for trials with morbidity and mortality outcomes. Screening for cardiovascular risk at a younger age, treating hypertension at lower thresholds, and new delivery models to find, treat and follow hypertensives in the community may help reduce the excess cardiovascular mortality in these high-risk groups.
Source: Internal and Emergency Medicine - March 29, 2016 Category: Emergency Medicine Source Type: research

Survival protection by bodyweight in isolated scleroderma-related pulmonary artery hypertension
Abstract In chronic heart failure (CHF) due to systemic cardiovascular disease, obese patients have better survival. Bodyweight versus survival was analyzed post hoc in subjects with limited scleroderma (SSc) and isolated pulmonary artery hypertension (PAH), i.e. with CHF due to pulmonary vascular disease. Rheumatologists referred scleroderma subjects for evaluation, and PAH was ascertained by right heart catheterization (RHC). Forty-nine SSc-PAH subjects were stratified by body mass index (BMI): obese 7 (14.3 %), overweight 11 (22.4 %), normal weight 21 (42.9 %), and underweight 10 (20.4 %) for 24-month follo...
Source: Internal and Emergency Medicine - April 5, 2016 Category: Emergency Medicine Source Type: research

Oral anticoagulants for stroke prevention in patients with atrial fibrillation and previous intracranial hemorrhage
Source: Internal and Emergency Medicine - November 3, 2016 Category: Emergency Medicine Source Type: research

Real-world evidence with apixaban for stroke prevention in patients with nonvalvular atrial fibrillation in Germany: a retrospective study (REASSESS)
Source: Internal and Emergency Medicine - February 12, 2017 Category: Emergency Medicine Source Type: research

Italian intersociety consensus on DOAC use in internal medicine
AbstractThe direct oral anticoagulants (DOACs) are drugs used in clinical practice since 2009 for the prevention of stroke or systemic embolism in non-valvular atrial fibrillation, and for the treatment and secondary prevention of venous thromboembolism. The four DOACs, including the three factor Xa inhibitors (rivaroxaban, apixaban and edoxaban) and one direct thrombin inhibitor (dabigatran) provide oral anticoagulation therapy alternatives to Vitamin K antagonists (VKAs). Despite their clear advantages, the DOACs require on the part of the internist a thorough knowledge of their pharmacokinetic and pharmacodynamic charac...
Source: Internal and Emergency Medicine - February 12, 2017 Category: Emergency Medicine Source Type: research

Dabigatran etexilate: appropriate use in patients with chronic kidney disease and in the elderly patients
AbstractDabigatran etexilate (DE) is a direct thrombin inhibitor, which has been approved for the treatment of non-valvular atrial fibrillation (AF), and for the prevention and treatment of venous thromboembolism (VTE). Despite large randomized clinical trials and independent observational studies providing robust data concerning DE safety and efficacy, some physicians still perceive mild-to-moderate renal impairment and old age as a relative contraindication to its use. In this article, we review the available scientific evidence supporting the use of DE in these clinical situations. Patients with AF and chronic kidney di...
Source: Internal and Emergency Medicine - April 24, 2017 Category: Emergency Medicine Source Type: research

Is it reasonable to use a lower DOAC dose in some patients with VTE? NO
AbstractThe international guidelines recommend the use of direct oral anticoagulants (DOACs) over vitamin K antagonists for anticoagulation long-term therapy in patients diagnosed with venous thromboembolism (VTE), and for stroke prevention in patients with non-valvular atrial fibrillation (AF). Efficacy and safety of DOACS have been extensively evaluated in large phase III trials. According to the product label, dose reductions of DOACs are recommended for patients with AF and renal impairment, low body weight and concomitant use of interfering medications. Except for Edoxaban, dose reductions of DOACs are not recommended...
Source: Internal and Emergency Medicine - June 27, 2017 Category: Emergency Medicine Source Type: research

Acute kidney injury and stroke: unresolved issues
Source: Internal and Emergency Medicine - September 1, 2017 Category: Emergency Medicine Source Type: research

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