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Clinical Stroke prevention in atrial fibrillation.
Authors: Voukalis C, Shantsila E, Lip GY Abstract Oral anticoagulation therapy has reduced the risk of ischaemic stroke and improved the outcomes for patients with atrial fibrillation considerably. The emergence of the non-vitamin K oral anticoagulants as alternatives to vitamin K antagonists has significantly changed the practice of stroke prevention in atrial fibrillation. As the main complication with antithrombotic therapy is bleeding, physicians should always balance the risk of ischaemic stroke against intracranial haemorrhage and intervene where appropriate to reduce both risks. Individual approach is often ...
Source: Journal of the Royal College of Physicians of Edinburgh - June 3, 2017 Category: General Medicine Tags: J R Coll Physicians Edinb Source Type: research
Real-Time Distal, Multifocal, Repeated Lenticulostriate Bleeding Points during Thrombectomy in a Patient with Acute Variable M1 Occlusion: A Case Report and a Literature Review
We present a case of real-time incident detected on digital subtraction angiography (DSA) during thrombectomy in a patient with acute variable M1 occlusion.
Source: Journal of Stroke and Cerebrovascular Diseases - June 1, 2017 Category: Neurology Authors: Simone Peschillo, Francesco Diana, Claudio Colonnese, Vittorio Mellina, Francesco Marzetti, Italia La Rosa, Paolo Missori Source Type: research
Anti-embolic effect of Taorenchengqi Tang in rats with embolic stroke induced by occluding middle cerebral artery.
CONCLUSION: Either TRCQT alone or TRCQT plus aspirin exhibits potent neuroprotective effect by reducing infarct volume without changing the status of SAH, ICH and gastric bleeding possibly via inhibiting the platelet activation and increasing bleeding time. PMID: 31682375 [PubMed]
Source: Journal of Traditional Chinese Medicine - June 1, 2017 Category: Complementary Medicine Authors: Li J, Chang T, Chang N, Li J, Thanasekaran J, Chang CC Tags: J Tradit Chin Med Source Type: research
Relationship of Hypertension and Systolic Blood Pressure With the Risk of Stroke or Bleeding in Patients With Atrial Fibrillation: The Fushimi AF Registry.
CONCLUSION: The incidences of stroke/SE and bleeding were higher in AF and hypertension patients with elevated SBP. UMIN Clinical Trials Registry: UMIN000005834. PMID: 28575205 [PubMed - as supplied by publisher]
Source: American Journal of Hypertension - May 30, 2017 Category: Cardiology Authors: Ishii M, Ogawa H, Unoki T, An Y, Iguchi M, Masunaga N, Esato M, Chun YH, Tsuji H, Wada H, Hasegawa K, Abe M, Akao M Tags: Am J Hypertens Source Type: research
Antithrombotic treatment after stroke due to intracerebral haemorrhage.
CONCLUSIONS: There is insufficient evidence from RCTs to support or discourage the use of antithrombotic treatment after ICH. RCTs comparing starting versus avoiding antiplatelet or anticoagulant drugs after ICH appear justified and are needed in clinical practice. PMID: 28540976 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - May 25, 2017 Category: General Medicine Authors: Perry LA, Berge E, Bowditch J, Forfang E, Rønning OM, Hankey GJ, Villanueva E, Al-Shahi Salman R Tags: Cochrane Database Syst Rev Source Type: research
Real ‐world stroke prevention strategies in nonvalvular atrial fibrillation in patients with renal impairment
ConclusionRAMSES study showed that one‐third of the patients with NVAF had RI in the real‐world setting. Although it is mandatory in most of the patients with concomitant NVAF and RI, nearly one‐third of these patients did not receive any anticoagulant therapy.
Source: European Journal of Clinical Investigation - May 16, 2017 Category: General Medicine Authors: Kadir U. Mert, Gurbet Ö. Mert, Özcan Başaran, Osman Beton, Volkan Dogan, Mehmet Tekinalp, Ahmet Ç. Aykan, Ezgi Kalaycıoğlu, Ismail Bolat, Onur Taşar, Özgen Şafak, Macit Kalçık, Mehmet Yaman, Cevat Kırma, Murat Biteker, Tags: Original Article Source Type: research
Dealing With the Left Atrial Appendage for Stroke Prevention: Devices and Decision-Making
Left atrial appendage (LAA) device occlusion represents a major evolution in stroke prevention for atrial fibrillation (AF). Left atrial appendage device occlusion is now a proven strategy which provides long-term thromboembolic stroke prevention for patients with non-rheumatic AF. Evidence supports its benefit as an alternative to long-term anticoagulation while mitigating long-term bleeding risks and improving cardiovascular mortality. The therapy offers expanded options to physicians and patients negotiating stroke prevention (both primary and secondary prevention), but a good understanding of the risks and benefits is ...
Source: Heart, Lung and Circulation - May 16, 2017 Category: Cardiology Authors: Karen P. Phillips, Vince Paul Source Type: research
Boston Scientific touts 1-year stroke reduction results in Watchman non-valvular AF trial
Boston Scientific (NYSE:BSX) today released 1-year results from the Ewolution registry study of its Watchman left atrial appendage closure device, touting a high implant success rate and stroke reduction in patients with non-valvular atrial fibrillation patients. Data was presented today at the Heart Rhythm Society’s 39th Annual Scientific Sessions in Chicago. “We are pleased to see that these ‘real-world’ results reinforce the positive outcomes observed in our clinical trial program, despite the registry patients being older and sicker than those enrolled in our previous trials,” rhythm man...
Source: Mass Device - May 12, 2017 Category: Medical Devices Authors: Fink Densford Tags: Cardiac Implants Cardiovascular Clinical Trials Boston Scientific Source Type: news
Renal function considerations for stroke prevention in atrial fibrillation
Renal impairment increases risk of stroke and systemic embolic events and bleeding in patients with atrial fibrillation. Direct oral anticoagulants have varied dependence on renal elimination, magnifying the importance of appropriate patient selection, dosing, and periodic kidney function monitoring. In randomized controlled trials of nonvalvular atrial fibrillation, direct oral anticoagulants were at least as effective and associated with less bleeding compared with warfarin. Each direct oral anticoagulant was associated with reduced risk of stroke and systemic embolic events and major bleeding compared with warfarin in n...
Source: The American Journal of Medicine - May 11, 2017 Category: General Medicine Authors: John Fanikos, Allison E. Burnett, Charles E. Mahan, Paul P. Dobesh Tags: Review Source Type: research
Non-Vitamin K Oral Anticoagulants for Stroke Prevention in Special Populations with Atrial Fibrillation
AbstractAtrial fibrillation (AF) is associated with an increased risk of ischemic stroke or systemic embolism compared with normal sinus rhythm. These strokes may efficiently be prevented in patients with risk factors using oral anticoagulant therapy, with either vitamin K antagonists (VKAs) or non-vitamin K antagonist oral anticoagulants (NOACs) (i.e., direct thrombin inhibitors or direct factor Xa inhibitors). Owing to their specific risk profiles, some AF populations may have increased risks of both thromboembolic and bleeding events. These AF patients may be denied oral anticoagulants, whilst evidence shows that the ab...
Source: Advances in Therapy - May 10, 2017 Category: Drugs & Pharmacology Source Type: research
Recent Trends in Neuro-endovascular Treatment for Acute Ischemic Stroke, Cerebral Aneurysms, Carotid Stenosis, and Brain Arteriovenous Malformations.
Authors: Matsumaru Y, Ishikawa E, Yamamoto T, Matsumura A Abstract The efficacy of mechanical thrombectomy with stent retrievers for emergent large vessel occlusion has been proved by randomized trials. Mechanical thrombectomy is increasingly being adopted in Japan since stent retrievers were first approved in 2014. An urgent clinical task is to offer structured systems of care to provide this treatment in a timely fashion to all patients with emergent large vessel occlusion. Treatment with flow-diverting stents is currently a preferred treatment option worldwide for large and giant unruptured aneurysms. Initial st...
Source: Neurologia Medico-Chirurgica - May 3, 2017 Category: Neurosurgery Tags: Neurol Med Chir (Tokyo) Source Type: research
Stroke in patients with chronic kidney disease & #8230;: How do we approach and manage it ?
This article is a review of stroke in patients with CKD and approach to managing it.
Source: Indian Journal of Nephrology - May 3, 2017 Category: Urology & Nephrology Authors: S Nayak-Rao MP Shenoy Source Type: research
Outcomes of Endovascular Thrombectomy with and without Thrombolysis for Acute Large Artery Ischaemic Stroke at a Tertiary Stroke Centre
Conclusion: Our study highlights the relatively large proportion of patients suitable for EVT who have a contraindication to alteplase and raises the hypothesis that adding alteplase to successful EVT may not be necessary to optimize functional outcome. The results are consistent with observational data from other endovascular centres and support a randomised controlled trial of EVT versus EVT with bridging alteplase.Cerebrovasc Dis Extra 2017;7:95 –102
Source: Cerebrovascular Diseases Extra - May 2, 2017 Category: Neurology Source Type: research
Are the results of intravenous thrombolysis trials reproduced in clinical practice? Comparison of observed and expected outcomes with the stroke-thrombolytic predictive instrument (STPI).
CONCLUSION: In clinical practice, the rate of good outcomes is slightly lower than expected, according to the s-TPI, except for the most severe cases, whereas the rate of catastrophic outcomes is roughly similar. However, the rate of good outcomes is higher than predicted without treatment. This finding suggests that rt-PA is effective for improving outcomes in clinical practice. PMID: 28454980 [PubMed - as supplied by publisher]
Source: Revue Neurologique - May 1, 2017 Category: Neurology Tags: Rev Neurol (Paris) Source Type: research
Stroke prophylaxis in atrial fibrillation : When, how and for whom?
This article provides a review of the indications and contraindications of modern stroke prophylaxis and discusses the approach to frequent clinical scenarios, such as treatment of patients with an acute coronary syndrome, coronary stent intervention or catheter ablation of AF. PMID: 28439617 [PubMed - as supplied by publisher]
Source: Herz - April 26, 2017 Category: Cardiology Tags: Herz Source Type: research
Recent Advances in Stroke Prevention in Patients with Atrial Fibrillation and End-Stage Renal Disease
Background: Chronic kidney disease (CKD) is associated with a high prevalence of atrial fibrillation (AF), but in this population the risk/benefit ratio of anticoagulant therapy with vitamin K antagonists (VKA) for thromboprophylaxis is uncertain.Summary: In end-stage renal disease (ESRD) patients undergoing hemodialysis, VKA seem less effective in stroke prevention than in the general population, with an increased risk of major bleeding. Recently, novel oral anticoagulant agents (NOACs) have proven to be effective for stroke prevention in AF and have demonstrated an improved safety profile compared to VKA. Limited data fr...
Source: Cardiorenal Medicine - April 26, 2017 Category: Urology & Nephrology Source Type: research
Factors associated with non –vitamin K antagonist oral anticoagulants for stroke prevention in patients with new-onset atrial fibrillation: Results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II (ORBIT-AF II)
Conclusions In contemporary clinical practice, up to three-fourths of patients with new-onset AF are now initially treated with a NOAC for stroke prevention. Those selected for NOAC treatment had lower stroke and bleeding risk profiles, were more likely treated by cardiologists, and had higher socioeconomic status. Trial registration clinicaltrials.gov Identifier: NCT01701817
Source: American Heart Journal - April 25, 2017 Category: Cardiology Source Type: research
Safety of OnabotulinumtoxinA Treatment With Concomitant Antithrombotic Therapy in Patients With Post-stroke Spasticity: A Pooled Analysis of Randomized, Double-Blind Studies (S56.008)
Conclusions:There is no apparent increased risk of bleeding complications in patients on antithrombotics following IM onabotA treatment; nonetheless, careful observation of the injection site and patient education of the potential for bleeding complications remain warranted.Study Supported by: Allergan plc, Dublin, IrelandDisclosure: Dr. Dimitrova has received personal compensation for activities with Allergan as an employee. Dr. Dimitrova holds stock and/or stock options in Allergan. Dr. James has received personal compensation for activities with Allergan and Chase Pharmaceuticals as an employee. Dr. Liu has received per...
Source: Neurology - April 17, 2017 Category: Neurology Authors: Dimitrova, R., James, L., Liu, C., Orejudos, A., Yushmanova, I., Brin, M. Tags: Movement Disorders: Huntington ' s Disease and Drug-Induced Dyskinesias Source Type: research
Aspirin use is associated with decreased initial stroke severity in patients with acute ischemic stroke: Pilot study (P6.293)
Conclusions:Aspirin appears to decrease the severity of AIS in a dose response fashion. We were unable to observe the effect of aspirin in the acetylation of albumin. Acetylation of additional proteins will be studied in an attempt to identify patients who respond best to aspirin.Disclosure: Dr. Jensen has nothing to disclose. Dr. Leonard has nothing to disclose. Dr. Bar-Or has nothing to disclose. Dr. Rael has nothing to disclose. Dr. Bartt has nothing to disclose. Dr. Wagner has received personal compensation for activities with Genentech as a speaker. Dr. Bar-Or has nothing to disclose.
Source: Neurology - April 17, 2017 Category: Neurology Authors: Jensen, J., Leonard, J., Bar-Or, R., Rael, L., Bartt, R., Wagner, J., Bar-Or, D. Tags: Prevention of Cerebrovascular Disease Source Type: research
Outcomes of Endovascular Thrombectomy with and without thrombolysis for acute large artery ischaemic stroke at a Tertiary Stroke Centre (P5.259)
Conclusions:Our study supports the use of direct EVT for patients in whom alteplase is contraindicated. We observed no additional benefit of adding intravenous thrombolysis to EVT but the estimates are imprecise due to small numbers. Nevertheless, the results are consistent with observational data from other centres, and support a randomised controlled trial of EVT vs. EVT with bridging alteplase.Disclosure: Dr. Wee has nothing to disclose. Dr. Hankey has received personal compensation for activities with Bayer Pharmaceuticals and theheart.org (Medscape) as a speaker.
Source: Neurology - April 17, 2017 Category: Neurology Authors: Wee, C. K., Hankey, G. Tags: Acute Cerebrovascular Interventional Therapies Source Type: research
Decreased thromboembolic stroke but not atherosclerosis or vascular remodelling in mice with ROCK2-deficient platelets
ConclusionThese findings indicate that platelet ROCK2 plays important role in platelet function and thrombosis, but does not contribute to the pathogenesis of atherosclerosis and vascular remodeling.
Source: Cardiovascular Research - April 14, 2017 Category: Cardiology Source Type: research
Sex-Specific Comparative Effectiveness of Oral Anticoagulants in Elderly Patients With Newly Diagnosed Atrial Fibrillation Original Articles
Conclusions— The reduced risk of ischemic stroke in patients taking rivaroxaban, compared with dabigatran and warfarin, seems to be limited to men, whereas the higher risk of bleeding seems to be limited to women.
Source: Circulation: Cardiovascular Quality and Outcomes - April 13, 2017 Category: Cardiology Authors: Palamaner Subash Shantha, G., Bhave, P. D., Girotra, S., Hodgson-Zingman, D., Mazur, A., Giudici, M., Chrischilles, E., Vaughan Sarrazin, M. S. Tags: Anticoagulants, Cerebrovascular Disease/Stroke Original Articles Source Type: research
Real World Stroke Prevention Strategies in Nonvalvular Atrial Fibrillation in Patients with Renal Impairment
ConclusionRAMSES study showed that one‐third of the patients with NVAF had RI in the real‐world setting. Although it is mandatory in most of the patients with concomitant NVAF and RI, nearly one‐third of these patients did not receive any anticoagulant therapy.This article is protected by copyright. All rights reserved.
Source: European Journal of Clinical Investigation - April 13, 2017 Category: Journals (General) Authors: , Kadir U ğur Mert, Gurbet Özge Mert, Özcan Başaran, Osman Beton, Volkan Dogan, Mehmet Tekinalp, Ahmet Çağrı Aykan, Ezgi Kalaycıoğlu, Ismail Bolat, Onur Taşar, Özgen Şafak, Macit Kalçık, Mehmet Yaman, Cevat Kırma, Murat Biteker Tags: Original Article Source Type: research
A randomized clinical trial of oral hygiene care programmes during stroke rehabilitation
Conclusions Although both oral hygiene care programmes were effective in terms of plaque and gingival bleeding control, the AOHCP was more effective than the COHCP in reducing dental plaque and gingival bleeding. Clinical Significance This study highlighted the value of oral hygiene programmes within stroke outpatient rehabilitation and provides evidence to advocate for the inclusion of oral hygiene care programmes within stroke outpatient rehabilitation for patients with normal cognitive abilities.
Source: Journal of Dentistry - April 11, 2017 Category: Dentistry Source Type: research
Here today, gone tomorrow: The laa and stroke
Stroke prevention in the setting of non-valvular atrial fibrillation continues to attract great clinical interest,[1,2] the result of several known issues including: 1) the high morbidity and mortality associated with stroke which is the number one cause of death and disability, 2) the frequency of non-valvular atrial fibrillation (NVAF) and its association with an increased incidence of stroke – greater than 20% of strokes particularly in elderly patients are related to the NVAF, 3) the findings that approximately 90% of strokes in this setting are related to thrombus in the left atrial appendage (LAA), 4) anticoagul...
Source: Trends in Cardiovascular Medicine - April 11, 2017 Category: Cardiology Authors: Paul Friedman, David R. Holmes Source Type: research
Editorial commentary: Here today, gone tomorrow: The LAA and stroke
Stroke prevention in the setting of non-valvular atrial fibrillation (NVAF) continues to attract great clinical interest [1,2], the result of several known issues including (1) the high morbidity and mortality associated with stroke, which is the number one cause of death and disability, (2) the frequency of non-valvular atrial fibrillation and its association with an increased incidence of stroke —greater than 20% of strokes particularly in elderly patients are related to the NVAF, (3) the findings that approximately 90% of strokes in this setting are related to thrombus in the left atrial appendage (LAA) , (4) antic...
Source: Trends in Cardiovascular Medicine - April 11, 2017 Category: Cardiology Authors: Paul A. Friedman, David R. Holmes Source Type: research
Real ‐World Clinical Characteristics and Treatment Patterns of Individuals Aged 80 and Older with Nonvalvular Atrial Fibrillation: Results from the ReAl‐life Multicenter Survey Evaluating Stroke Study
ConclusionNearly one‐fifth of individuals with NVAF in this real‐world sample were aged 80 and older. Participants aged 80 and older were more likely to be female and have more comorbidities than those who were younger than 80. Those aged 80 and older with AF were less likely to receive anticoagulants than those who were younger than 80, but having more comorbidities and other individual‐level characteristics may explain this difference. When they were prescribed OACs, participants aged 80 and older had poorer quality of anticoagulation than those who were younger, suggesting opportunities for improvement.
Source: Journal of the American Geriatrics Society - April 10, 2017 Category: Geriatrics Authors: Murat Biteker, Özcan Başaran, Volkan Doğan, İbrahim Altun, Fatma Özpamuk Karadeniz, Ahmet İlker Tekkesin, Yasin Çakıllı, Ceyhan Türkkan, Mehmet Hamidi, Vahit Demir, Mustafa Ozan Gürsoy, Müjgan Tek Öztürk, Gökhan Aksan, Sabri Seyis, Mehmet B Tags: Clinical Investigation Source Type: research
Is endovenous thrombolysis safety and efficacy in ischemic stroke comparable between patients aged over and above 80 years? Experience from an Argentinean cohort.
CONCLUSIONS: Endovenous thrombolysis in patients aged above 80 years was safe, although its efficacy in assuring a better clinical outcome was not as pronounced as in patients below 80 years. PMID: 28368081 [PubMed - in process]
Source: Revista de Neurologia - April 5, 2017 Category: Neurology Authors: Colla-Machado PE, Pigretti SG, Luzzi AA, Balian NR, Cristiano E, Zurru-Ganen MC Tags: Rev Neurol Source Type: research
Factors Associated with Non-vitamin K Antagonist Oral Anticoagulants for Stroke Prevention in Patients with New-Onset Atrial Fibrillation: Results from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation II (ORBIT-AF II)
Conclusions In contemporary clinical practice up to three-fourths of patients with new-onset AF are now initially treated with a NOAC for stroke prevention. Those selected for NOAC treatment had lower stroke and bleeding risk profiles, were more likely treated by cardiologists and had higher socioeconomic status. Trial Registration clinicaltrials.gov Identifier: NCT01701817
Source: American Heart Journal - April 4, 2017 Category: Cardiology Source Type: research
Low-molecular-weight heparins or heparinoids versus standard unfractionated heparin for acute ischaemic stroke.
CONCLUSIONS: Treatment with a LMWH or heparinoid after acute ischaemic stroke appears to decrease the occurrence of DVT compared with standard UFH, but there are too few data to provide reliable information on their effects on other important outcomes, including functional outcome, death and intracranial haemorrhage. PMID: 28374884 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - April 4, 2017 Category: Journals (General) Authors: Sandercock PA, Leong TS Tags: Cochrane Database Syst Rev Source Type: research
First case of ischemic stroke which happened during continuous intravenous infusion of rt-PA
We present a patient with left lower limb ischemia, treated by CDT, in which symptoms of stroke, proved to have ischemic etiology, started during continuous intra-arterial infusion of rt-PA. As the patient presented with the history of atrial fibrillation, the most probable mechanism of stroke was related to detachment of possible intra-atrial thrombus. Ischemic stroke which happened during intra-arterial thrombolysis with rt-PA has never been mentioned in literature yet and the case stands for the statement that very effective causative treatment of ischemic stroke with rt-PA is not sufficient to “prevent” ischemic st...
Source: Polish Journal of Neurology and Neurosurgery - April 2, 2017 Category: Neurosurgery Source Type: research
Acute ischemic stroke after cardiac catheterization: the protamine low-dose recombinant tissue plasminogen activator pathway
We report three patients with acute ischemic stroke after cardiac catheterization. After reversing the anticoagulant effect of unfractionated heparin with protamine, all of the patients were successfully off-label thrombolyzed with reduced doses of intravenous recombinant tissue plasminogen activator (0.6 mg/kg). This dose was preferred to reduce the risk of symptomatic cerebral or systemic bleeding. The sequential pathway of protamine recombinant tissue plasminogen activator at reduced doses may be safer for reducing intracranial or systemic bleeding events, whereas remaining efficacious for the treatment of acute ische...
Source: Blood Coagulation and Fibrinolysis - April 1, 2017 Category: Hematology Tags: Case Reports Source Type: research
Abstract 223: Impact of Differences in Once- vs Twice-Daily Medications Adherence on the Risk of Bleed and Stroke in Non-Valvular Atrial Fibrillation: Analysis of Randomized Trials and Claims Data Sources Session Title: Poster Session II
Conclusion: Among NVAF patients, better adherence to QD dosing was associated with a significantly lower stroke risk of QD but similar risk of bleed.
Source: Circulation: Cardiovascular Quality and Outcomes - March 31, 2017 Category: Cardiology Authors: McHorney, C. A., Peterson, E. D., Durkin, M., Ashton, V., Laliberte, F., Crivera, C., Sheikh, N., Germain, G., Schein, J. R., Xiao, Y., Lefebvre, P. Tags: Session Title: Poster Session II Source Type: research
Abstract 160: Impact of Medication Adherence on Risk of Stroke, Major Bleeding and Other Outcomes in Atrial Fibrillation Patients Using Novel Oral Anticoagulants (Dabigatran and Rivaroxaban) Session Title: Poster Session II
Conclusion: In our sample, adherence to NOACs was associated with a reduction in stroke and DVTPE risk but did not substantially increase bleeding risk. Further studies with newer NOACs are warranted.
Source: Circulation: Cardiovascular Quality and Outcomes - March 31, 2017 Category: Cardiology Authors: Deshpande, C. G., Willey Temkin, C., Laforge, R., Kogut, S. Tags: Session Title: Poster Session II Source Type: research
Relation of Risk of Stroke in Patients With Atrial Fibrillation to Body Mass Index (From Patients Treated With Rivaroxaban and Warfarin in the ROCKET AF Trial)
We investigated stroke outcomes in normal weight (body mass index [BMI] 18.50-24.99 kg/m2), overweight (BMI 25.00-29.99 kg/m2), and obese (BMI ≥30 kg/m2) patients with AF treated with rivaroxaban and warfarin. We compared the incidence of stroke and systemic embolic events (SEE) as well as bleeding events in normal weight (n=3289), overweight (n=5535), and obese (n=5206) patients in a post-hoc analysis of the ROCKET AF trial. Stroke and SEE rates per 100 patient-years were 2.93 in the normal weight group (reference group), 2.28 in the overweight group (adjusted hazard ratio [HR] 0.81, 95% confidence interval [CI]: 0.66-0...
Source: The American Journal of Cardiology - March 28, 2017 Category: Cardiology Authors: Somasekhara R. Balla, Derek D. Cyr, Yuliya Lokhyngina, Richard C. Becker, Scott D. Berkowitz, G ünter Breithardt, Keith A.A. Fox, Werner Hacke, Jonathan L. Halperin, Graeme J. Hankey, Kenneth W. Mahaffey, Christopher C. Nessel, Jonathan P. Piccini, Danie Source Type: research
Is There an Obesity Paradox for Outcomes in Atrial Fibrillation? Clinical Sciences
Conclusions—There may be an obesity paradox in atrial fibrillation patients, particularly for all-cause and cardiovascular death outcomes. An obesity paradox was also evident for stroke/systemic embolic event outcome in NOAC trials, with a treatment effect favoring NOACs over warfarin for both efficacy and safety that was significant only for normal weight patients.
Source: Stroke - March 27, 2017 Category: Neurology Authors: Marco Proietti, Elisa Guiducci, Paola Cheli, Gregory Y.H. Lip Tags: Catheter Ablation and Implantable Cardioverter-Defibrillator, Obesity, Anticoagulants, Quality and Outcomes Original Contributions Source Type: research
Risk of major bleeding and stroke associated with the use of vitamin K antagonists, nonvitamin K antagonist oral anticoagulants and aspirin in patients with atrial fibrillation: a cohort study
ConclusionsNOACs were associated with a higher risk on gastrointestinal bleeding, particularly in women. The use of NOACs in patients who are vulnerable for this type of bleeding should be carefully considered. NOACs and VKAs are equally effective in preventing stroke. Aspirin was not effective in the prevention of stroke in AF.
Source: British Journal of Clinical Pharmacology - March 24, 2017 Category: Drugs & Pharmacology Authors: Emilie M. Gieling, Hendrika A. Ham, Hein Onzenoort, Jacqueline Bos, Cornelis Kramers, Anthonius Boer, Frank Vries, Andrea M. Burden Tags: PHARMACOEPIDEMIOLOGY Source Type: research
LAA occluder device for stroke prevention: Data on WATCHMAN and other LAA occluders
NOAC therapy has become the standard for stroke prevention in patients with atrial fibrillation. Yet some patients suffer extracranial bleeding events or have other reasons to seek non-pharmacologic stroke protection. LAA occlusion with the WATCHMAN device has been proven safe and effective for such patients and is now recommended in current guidelines for this patient group; other devices also seek approval.
Source: Trends in Cardiovascular Medicine - March 24, 2017 Category: Cardiology Authors: Martin W. Bergmann Source Type: research
Cessation of oral anticoagulation is an important risk factor for stroke and mortality in atrial fibrillation patients.
In conclusion, in non-valvular AF patients, cessation of OAC was independently associated with the risk of stroke, adverse cardiovascular events and mortality. Bleeding events and some variables associated with higher bleeding risk are responsible for OAC cessation. PMID: 28331926 [PubMed - as supplied by publisher]
Source: Thrombosis and Haemostasis - March 23, 2017 Category: Hematology Authors: Rivera-Caravaca JM, Roldán V, Esteve-Pastor MA, Valdés M, Vicente V, Lip GY, Marín F Tags: Thromb Haemost Source Type: research
The unfinished issue of ischaemic stroke and embolic events during ablation for atrial fibrillation: the authors' reply
We thank Dr. Providenciaet al.1 for the concern and comments on our article.2 We agree with them that discontinuation of warfarin before catheter ablation for atrial fibrillation (AF) is likely associated with increased risk of periprocedural thrombo-embolic events. We cannot comment on the effects of different periprocedural anticoagulation strategy used in our cohort on thrombo-embolic events during AF ablation because of only a small minority of patients who were anti-coagulated with uninterrupted warfarin. Although several reports indicate that AF ablation can be performed safely with fewer stroke and bleeding complica...
Source: Europace - March 17, 2017 Category: Cardiology Source Type: research
Feasibility and safety of direct catheter-based thrombectomy in the treatment of acute ischemic stroke. Cooperation of cardiologists, neurologists and radiologists. Prospective registry PRAGUE-16.
CONCLUSIONS: Direct catheter-based thrombectomy may be considered in patients with contraindications for thrombolysis or in patients with very short CT - groin puncture times. A randomized trial is needed to better evaluate the role of direct catheter-based thrombectomy. Acute stroke interventions performed in close cooperation of cardiologists, neurologists and radiologists are feasible and safe. PMID: 28242586 [PubMed - as supplied by publisher]
Source: EuroIntervention - March 2, 2017 Category: Cardiovascular & Thoracic Surgery Tags: EuroIntervention Source Type: research
Clinical Features of Thalamic Stroke
Opinion statementThe thalamus plays an important role in different brain functions including memory, emotions, sleep-wake cycle, executive functions, mediating general cortical alerting responses, processing of sensory (including taste, somatosensory, visual, and auditory) information and relaying it to the cortex, and sensorimotor control. Thalamic stroke, both in isolation and in combination with infarcts involving other structures, are not rare. The functional complexity of the thalami nuclei and the not uncommon normal variations of arteries supply the thalamus induce wide variations in presentation of thalami infarcts...
Source: Current Treatment Options in Neurology - March 1, 2017 Category: Neurology Source Type: research
Quality of warfarin therapy and risk of stroke, bleeding, and mortality among patients with atrial fibrillation: results from the nationwide FinWAF Registry
ConclusionsThe quality of warfarin treatment was strongly associated with the risk of stroke and the prognosis of AF patients. Patient outcomes continued to improve with increasing TTR values up to a TTR ≥80%; therefore, the target for the TTR should exceed 80% instead of the traditional range of at least 60–70%. Copyright © 2017 John Wiley & Sons, Ltd.
Source: Pharmacoepidemiology and Drug Safety - March 1, 2017 Category: Drugs & Pharmacology Authors: Mika Lehto, Jussi Niiranen, Pasi Korhonen, Juha Meht älä, Houssem Khanfir, Fabian Hoti, Riitta Lassila, Pekka Raatikainen Tags: Original Report Source Type: research
Efficacy and safety of ticagrelor versus aspirin in acute stroke or transient ischaemic attack of atherosclerotic origin: a subgroup analysis of SOCRATES, a randomised, double-blind, controlled trial
Publication date: Available online 23 February 2017 Source:The Lancet Neurology Author(s): Pierre Amarenco, Gregory W Albers, Hans Denison, J Donald Easton, Scott R Evans, Peter Held, Michael D Hill, Jenny Jonasson, Scott E Kasner, Per Ladenvall, Kazuo Minematsu, Carlos A Molina, Yongjun Wang, K S Lawrence Wong, S Claiborne Johnston Background Ticagrelor is an effective antiplatelet therapy for patients with coronary atherosclerotic disease and might be more effective than aspirin in preventing recurrent stroke and cardiovascular events in patients with acute cerebral ischaemia of atherosclerotic origin. Our aim was to te...
Source: The Lancet Neurology - February 24, 2017 Category: Neurology Source Type: research
Edoxaban for stroke prevention in atrial fibrillation and treatment of venous thromboembolism: an expert position paper.
Abstract Edoxaban is the most recent available representative of the Non-Vitamin K antagonist oral anticoagulants (NOAC). The approval was based on the largest phase III trials of NOACs for stroke prevention in patients with non-valvular atrial fibrillation (AF, ENGAGE-AF), and for the treatment of venous thromboembolism (VTE, HOKUSAI-VTE). In both trials, edoxaban was associated with similar efficacy and a significant reduction in bleeding events with respect to the pre-defined primary safety endpoints, as compared to warfarin.Additionally, the once daily dosing of edoxaban, the clinically investigated strateg...
Source: Hamostaseologie - February 24, 2017 Category: Hematology Authors: Weiss TW, Rohla M, Dieplinger B, Domanovits H, Fries D, Vosko MR, Gary T, Ay C Tags: Wien Med Wochenschr Source Type: research
Alcohol-related hospitalization is associated with increased risk of ischaemic stroke among low-risk patients with atrial fibrillation
ConclusionThe presence of a previous hospitalization with an alcohol-related disease was associated with a small but significant increase in the risk of stroke among low-risk AF patients. More research about relation between alcohol use and ischaemic stroke in AF patients is warranted.
Source: Europace - February 23, 2017 Category: Cardiology Source Type: research
Evaluation of the role of susceptibility-weighted imaging in thrombolytic therapy for acute ischemic stroke
Publication date: Available online 20 February 2017 Source:Journal of Clinical Neuroscience Author(s): Guangjian Zhao, Ling Sun, Ziran Wang, Liquan Wang, Zhongrong Cheng, Hongyan Lei, Daiqun Yang, Yansen Cui, Shirui Zhang We inspected low-intensity venous signals and microbleeds in patients with acute ischemic stroke (AIS) using susceptibility-weighted imaging (SWI) before and after administration of within-thrombolytic-time-window thrombolytic therapies, and observed their prognosis and safety, in order to guide individualized thrombolytic therapies. Patients with AIS were divided into groups A or B according to the pres...
Source: Journal of Clinical Neuroscience - February 21, 2017 Category: Neuroscience Source Type: research
Warfarin and the risk of stroke and bleeding in patients with atrial fibrillation receiving dialysis: A systematic review and meta-analysis
Conclusion Observational studies suggest that warfarin was not associated with a clear benefit or harm among patients who have atrial fibrillation and are receiving dialysis. These estimates were limited by study heterogeneity including the inability to account for a number of important confounders such as the time in the therapeutic range. Given the high prevalence of atrial fibrillation, stroke, and bleeding complications in this population, well-designed clinical trials of warfarin and other anti-coagulants are urgently needed. Teaser Patients with atrial fibrillation receiving maintenance dialysis are at a high risk of...
Source: Canadian Journal of Cardiology - February 21, 2017 Category: Cardiology Source Type: research
Serum trace elements are associated with hemostasis, lipid spectrum and inflammatory markers in men suffering from acute ischemic stroke
AbstractThe primary objective of the study is investigation of the association between trace elements status and hemostasis, lipid spectrum and inflammatory markers in acute ischemic stroke (AIS). A total of 30 men suffering from AIS and 30 healthy controls were involved in the current survey. Blood count, serum lipid spectrum, complement components C4 and C3a, vascular endothelial growth factor (VEGF), S100B protein, NR2 antibodies (NR2Ab), and total antioxidant status (TAS), as well as plasma fibrinogen, and D-dimer levels and activated partial thromboplastin time (APTT) were assessed. Serum trace elements were analyzed ...
Source: Metabolic Brain Disease - February 20, 2017 Category: Neurology Source Type: research
Left atrial appendage occlusion for stroke prevention in patients with atrial fibrillation: a systematic review and network meta-analysis of randomized controlled trials.
CONCLUSIONS: LAA occlusion appears to preserve the benefits of oral anticoagulation therapy for stroke prevention in patients with AF, but the current evidence is of low quality. PMID: 28215062 [PubMed - as supplied by publisher]
Source: The Journal of Cardiovascular Surgery - February 17, 2017 Category: Cardiovascular & Thoracic Surgery Authors: Hanif H, Belley-Cote EP, Alotaibi A, Dvirnik N, Neupane B, Beyene J, Eikelboom JW, Holmes D, Whitlock RP Tags: J Cardiovasc Surg (Torino) Source Type: research