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PCPs Often Misestimate Stroke and Bleeding Risk in AFPCPs Often Misestimate Stroke and Bleeding Risk in AF
A new study indicated that PCPs often under- or overestimate stroke and bleeding risk in patients with atrial fibrillation and that oral anticoagulant dosages are often suboptimal. Medscape Medical News
Source: Medscape Medical News Headlines - October 27, 2015 Category: Consumer Health News Tags: Internal Medicine News Source Type: news

Rivaroxaban in secondary cardiogenic stroke prevention: two-year single-center experience based on follow-up of 209 patients.
CONCLUSIONS: For patients with non-valvular atrial fibrillation and cerebrovascular events , the use of rivaroxaban in a real-world clinical setting results in a high efficacious treatment profile and acceptable safety. PMID: 26502939 [PubMed - as supplied by publisher]
Source: Polish Heart Journal - October 27, 2015 Category: Cardiology Authors: Lasek-Bal A, Urbanek T, Puz P, Piekarski M Tags: Kardiol Pol Source Type: research

Relationship of Time in Therapeutic Range (Ttr) with Bleeding and Stroke Incidences of Warfarinised Patients with Pulmonary Embolism in a Tertiary Hospital in Malaysia
This study aims to compare time in therapeutic range (TTR) of warfarin in patients with pulmonary embolism with bleeding and stroke and determine reasons of INR falling out of range.
Source: Value in Health - October 23, 2015 Category: Global & Universal Authors: N Sudirman, S Shaharuddin, CM Long, R Hashim, HH Zulkifly, SS Kasim, CW Lim Source Type: research

The Risk Stratification and Stroke Prevention Therapy Care Gap in Canadian Atrial Fibrillation Patients
Conclusions In a large Canadian AF population, primary care physicians did not provide a stroke or bleeding risk in a substantial proportion of their AF patients. When estimates were provided, they were on the basis of a predictive stroke and bleeding risk index in less than half of the patients. Furthermore, there was under- and overestimation of stroke and bleeding risk in a substantial proportion of patients. As many as 1 in 3 patients receiving warfarin have their TTR < 60%. These findings suggest an opportunity to enhance knowledge translation to primary care physicians.
Source: Canadian Journal of Cardiology - October 23, 2015 Category: Cardiology Source Type: research

Acute ischemic stroke and abnormal blood hemoglobin concentration
ConclusionsOur results suggest that an elevated HGB on the initial admission is associated with more severe strokes, greater disability at discharge, and higher 30‐day mortality after AIS. A low HGB on admission is associated with longer stay in the acute care hospital.
Source: Acta Neurologica Scandinavica - October 21, 2015 Category: Neurology Authors: J. C. Furlan, J. Fang, F. L. Silver Tags: Original Article Source Type: research

The zebra sign
A 65 year old female was transferred to the Hyperacute Stroke Unit after a routine L5/S1 laminectomy. She suffered a small dural tear. 3 hours post procedure, her GCS dropped to 3. CT scan showed a bi-cerebellar haemorrhage and MRI brain the next day revealed a convexity subarachoid haemorrhage. Imaging was reviewed with neuroradiologists and neurosurgeons. They recognised this as a typical case of post-dural puncture remote cerebellar haemorrhage. In surgical literature there are many cases reported since 1981 of "the Zebra sign". Patients can become obtunded up to 72 hours after the injury. The mechanism of the haemorrha...
Source: Journal of Neurology, Neurosurgery and Psychiatry - October 14, 2015 Category: Neurosurgery Authors: Patel, B., Nagendran, A., Khan, U. Tags: Brain stem / cerebellum, Stroke, Radiology, Radiology (diagnostics) Thur 21, Parallel session 5: Therapeutics Source Type: research

Prevalence, main determinants, and early outcome of patients with atrial fibrillation hospitalized with ischemic stroke: evaluation of the value of risk assessment scores for predicting risk of stroke or major bleeding following anticoagulation therapy.
CONCLUSION: The patients with atrial fibrillation hospitalized with ischemic stroke showed an important absolute risk of further stroke and early mortality. Despite substantiated advantages of warfarin prophylaxis, its limited application is still very common. PMID: 26422431 [PubMed - in process]
Source: Acta Bio-Medica : Atenei Parmensis - October 4, 2015 Category: Journals (General) Authors: Sadeghi R, Parsa Mahjoob M, Asadollahi M, Abbasi Z Tags: Acta Biomed Source Type: research

Platelet-derived VWF is not essential for normal thrombosis and hemostasis but fosters ischemic stroke injury in mice
Von Willebrand factor (VWF) is a key hemostatic protein synthesized in both endothelial cells and megakaryocytes. Megakaryocyte-derived VWF is stored in α-granules of platelets and is enriched in hyperactive "ultra-large" VWF multimers. To elucidate the specific contribution of platelet VWF in hemostasis and thrombosis, we performed crossed bone marrow transplantations between C57BL/6J and Vwf–/– mice to generate chimeric mice. Chimeric mice specifically lacking platelet VWF showed normal tail bleeding and carotid artery thrombosis, similar to wild-type mice. Chimeric mice with VWF present only in platele...
Source: Blood - October 1, 2015 Category: Hematology Authors: Verhenne, S., Denorme, F., Libbrecht, S., Vandenbulcke, A., Pareyn, I., Deckmyn, H., Lambrecht, A., Nieswandt, B., Kleinschnitz, C., Vanhoorelbeke, K., De Meyer, S. F. Tags: Platelets and Thrombopoiesis, Thrombosis and Hemostasis Source Type: research

Cost-Effectiveness of Proton Pump Inhibitor Co-Therapy in Patients Taking Aspirin for Secondary Prevention of Ischemic Stroke
Conclusions Co-therapy with ASA plus PPI appears to be cost-effective compared with ASA monotherapy. The addition of PPI also appeared to prolong the duration of ASA therapy, thereby reducing the risk of ischemic stroke.
Source: PharmacoEconomics - October 1, 2015 Category: Health Management Source Type: research

Dual antiplatelet therapy in stroke and ICAS: Subgroup analysis of CHANCE
Conclusions: The results indicated higher rate of recurrent stroke in minor stroke or high-risk TIA patients with ICAS than in those without. However, there was no significant difference in the response to the 2 antiplatelet therapies between patients with and without ICAS in the CHANCE trial. Classification of evidence: This study provides Class II evidence that for patients with acute minor stroke or TIA with and without ICAS identified by MRA, clopidogrel plus aspirin is not significantly different than aspirin alone in preventing recurrent stroke.
Source: Neurology - September 28, 2015 Category: Neurology Authors: Liu, L., Wong, K. S. L., Leng, X., Pu, Y., Wang, Y., Jing, J., Zou, X., Pan, Y., Wang, A., Meng, X., Wang, C., Zhao, X., Soo, Y., Johnston, S. C., Wang, Y., For the CHANCE Investigators Tags: ARTICLE Source Type: research

Role of Endovascular Closure of the Left Atrial Appendage in Stroke Prevention for Atrial Fibrillation
Abstract The pathophysiologic mechanism of thromboembolic stroke in the setting of non-valvular atrial fibrillation (AF) resides in the left atrial appendage (LAA). In this setting, approximately 90 % of all strokes originate from this structure. Percutaneous left atrial appendage occlusion (LAAO) therapy has recently emerged as an important strategy for prevention of stroke and systemic embolism in patients with non-valvular AF. Systemic anticoagulation therapy in this AF population, while effective, is associated with a significant bleeding risk, drug compliance issues, and limited reversal strategies. In this...
Source: Current Atherosclerosis Reports - September 26, 2015 Category: Cardiology Source Type: research

NSAIDs increase bleeding risk in patients with atrial fibrillation on antithrombotic therapy
This study determined the risk...
Source: Evidence-Based Medicine - September 24, 2015 Category: Internal Medicine Authors: McGrath, E. R. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Ischaemic heart disease, Drugs: musculoskeletal and joint diseases, Arrhythmias Aetiology/Harm Source Type: research

Dual antiplatelet therapy with clopidogrel and aspirin after ischemic stroke: A review of the evidence.
CONCLUSION: Currently available evidence does not substantiate the widespread use of long-term aspirin with clopidogrel for the secondary prevention of ischemic stroke or TIA. PMID: 26386103 [PubMed - in process]
Source: American Journal of Health-System Pharmacy : AJHP - September 21, 2015 Category: Drugs & Pharmacology Authors: Davis KA, Miyares MA, Dietrich E Tags: Am J Health Syst Pharm Source Type: research

Stroke, Major Bleeding and Mortality Outcomes in Warfarin Users with Atrial Fibrillation and Chronic Kidney Disease: A Meta-analysis of Observational Studies.
Conclusions: Based on this meta-analysis, the use of warfarin for AF may have an unfavorable risk/benefit ratio in patients with end-stage CKD but not in those with non-end stage CKD. PMID: 26378611 [PubMed - as supplied by publisher]
Source: Chest - September 17, 2015 Category: Respiratory Medicine Authors: Dahal K, Kunwar S, Rijal J, Schulman P, Lee J Tags: Chest Source Type: research

An aspirin a day helps prevent heart attack, stroke and colon cancer
A daily aspirin should be given to 50-year-olds at risk of suffering a heart attack or stroke in the next decade as long as they are not at risk of bleeding, the US Preventive Services Task Force said.
Source: the Mail online | Health - September 15, 2015 Category: Consumer Health News Source Type: news

Age, Ethnicity, and Stroke Risk in Patients With Atrial Fibrillation Another Stitch in the Patchwork ∗
The frequency with which clinicians encounter patients with nonvalvular atrial fibrillation (AF) and its association with ischemic stroke make estimation of the risk borne by individuals a daily issue in contemporary cardiology practice across the globe. In the balance lies the decision to employ long-term anticoagulation therapy with its attendant risk of severe bleeding. A variety of clinical risk scores are available to guide this decision, most prominently the CHA2DS2-VASc score, which cumulates the widely accepted, if unequally validated, clinical risk factors: heart failure (or impaired left ventricular function), hy...
Source: Journal of the American College of Cardiology - September 14, 2015 Category: Cardiology Source Type: research

Direct Oral Anticoagulants for the Prevention of Stroke in Patients with Nonvalvular Atrial Fibrillation: Understanding Differences and Similarities
Abstract The presence of atrial fibrillation (AF), the most common sustained cardiac arrhythmia, significantly increases the risk for stroke. Current guidelines recommend that the vitamin K antagonist warfarin or direct oral anticoagulants (DOACs), such as the approved direct thrombin inhibitor dabigatran and the approved direct factor Xa inhibitors apixaban, rivaroxaban, and edoxaban, should be used for thromboprophylaxis in patients with nonvalvular AF at risk for stroke or systemic embolic events (SEE). Warfarin, the mainstay of stroke prevention in AF, increases the risk of major bleeding. Furthermore, warfari...
Source: Drugs - September 14, 2015 Category: Drugs & Pharmacology Source Type: research

Stroke Risk Factors Beyond the CHADS-VASc Score: Can We Improve Our Identification of “High Stroke Risk” Patients With Atrial Fibrillation?
The prevention of stroke and other thromboembolic events plays a crucial role in the management of patients with atrial fibrillation. Not all patients with atrial fibrillation are equal in terms of thromboembolic risk; therefore, not all will benefit from oral anticoagulation treatment. The general principle is that the expected benefit of anticoagulation in reduction of thromboembolic risk must exceed the expected harm caused by possible bleeding. Some guidelines have focused on a categorical approach to stroke prevention, with a focus on identifying patients at high risk for oral anticoagulation.
Source: The American Journal of Cardiology - September 11, 2015 Category: Cardiology Authors: Filip M. Szymanski, Gregory Y.H. Lip, Krzysztof J. Filipiak, Anna E. Platek, Anna Hrynkiewicz-Szymanska, Grzegorz Opolski Tags: Review Source Type: research

Stroke Risk Factors Beyond the CHADS-VASc Score: Can We Improve our Identification of ‘High Stroke Risk’ Patients with Atrial Fibrillation?
The prevention of stroke and other thromboembolic events plays a crucial role in the management of atrial fibrillation (AF) patients. Not all AF patients are equal in terms of thromboembolic risk, therefore not all will benefit from oral anticoagulation treatment. The general principle is that the expected benefit of anticoagulation in reduction of thromboembolic risk must exceed the expected harm caused by possible bleeding. Some guidelines have focused on a categorical approach to stroke prevention, with a focus on identifying high risk patients for oral anticoagulation (OAC).
Source: The American Journal of Cardiology - September 11, 2015 Category: Cardiology Authors: Filip M. Szymanski, Gregory Y.H. Lip, Krzysztof J. Filipiak, Anna E. Platek, Anna Hrynkiewicz-Szymanska, Grzegorz Opolski Source Type: research

Recalibration of the HAS-BLED score - should haemorrhagic stroke account for 1 or 2 points?
Abstract Following a haemorrhagic stroke, it is uncertain whether this event scores 1 point (either for Stroke or Bleeding) or 2 points (1 point each for Stroke and Bleeding) on the HAS-BLED score. We investigated the value of a recalibration of the HAS-BLED score to account for 2 points from a haemorrhagic stroke. We analysed data from the Danish nationwide cohort of incident atrial fibrillation (AF) patients from January 1999 to December 2013. The primary outcome in this observational study was major bleeding. The original- and the recalibrated HAS-BLED scores were assessed and event rates of major bleeding...
Source: Chest - September 10, 2015 Category: Respiratory Medicine Authors: Nielsen PB, Larsen TB, Lip GY Tags: Chest Source Type: research

Cortical Superficial Siderosis and Risk of Bleeding after Thrombolysis for Ischemic Stroke
Conclusions: The prevalence of CSS in a clinical cohort of stroke patients that received IVT was low and thus does not appear to pose a substantial risk for symptomatic ICH although this may occur in individual patients. However, such analysis also needs to be extended to the very old stroke patients in whom IVT is increasingly used.Cerebrovasc Dis 2015;40:191-197
Source: Cerebrovascular Diseases - September 9, 2015 Category: Neurology Source Type: research

Closure versus medical therapy for preventing recurrent stroke in patients with patent foramen ovale and a history of cryptogenic stroke or transient ischemic attack.
CONCLUSIONS: The combined data from recent RCTs have shown no statistically significant differences between TDC and medical therapy in the prevention of recurrent ischemic stroke. TDC closure was associated with an increased risk of atrial fibrillation but not with serious adverse events. PMID: 26346232 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - September 8, 2015 Category: Journals (General) Authors: Li J, Liu J, Liu M, Zhang S, Hao Z, Zhang J, Zhang C Tags: Cochrane Database Syst Rev Source Type: research

The Efficacy and Safety of Vorapaxar With and Without a Thienopyridine for Secondary Prevention in Patients with Prior Myocardial Infarction and no History of Stroke or TIA: Results from TRA 2°P-TIMI 50.
CONCLUSIONS: -Vorapaxar reduced cardiovascular death, MI, or stroke in stable patients with a history of prior MI, whether treated concomitantly with a thienopyridine or not. The relative risk of moderate or severe bleeding was similarly increased irrespective of thienopyridine use. Clinical Trial Registration Information-http://www.clinicaltrials.gov. Identifier: NCT00526474. PMID: 26338971 [PubMed - as supplied by publisher]
Source: Circulation - September 3, 2015 Category: Cardiology Authors: Bohula EA, Aylward PE, Bonaca MP, Corbalan RL, Kiss RG, Murphy SA, Scirica BM, White H, Braunwald E, Morrow DA Tags: Circulation Source Type: research

Efficacy and safety of percutaneous left atrial appendage closure to prevent thromboembolic events in atrial fibrillation patients with high stroke and bleeding risk
Conclusion Left atrial appendage closure in patients with non-valvular atrial fibrillation and high risk for stroke and bleeding events effectively prevented stroke and reduced cerebral ischemic events compared to expected stroke rate according to CHA2DS2-VASc Score. Dual antiplatelet therapy for 3 months reduced the rate of bleeding events compared to 6 months therapy with no increase of thrombotic events.
Source: Clinical Research in Cardiology - August 29, 2015 Category: Cardiology Source Type: research

Patients with atrial fibrillation and low risk of stroke - do they really need anticoagulation?
Authors: Trusz-Gluza M, Filipecki A, Urbańczyk-Świć D Abstract Atrial fibrillation (AF) significantly increases risk of thromboembolic events, in particular the risk of stroke. Anticoagulation therapy reduces this risk and the treatment should be lifelong. However, the risk in patients with non-valvular AF is not equally distributed. There are patients at low risk. Assessment of the thromboembolic risk according to guidelines is mandatory, most frequently CHA2DS2-VASc scheme is used. In the large group with the CHA2DS2-VASc-0 (females 1) the annual risk of stroke was 0.49%, ischemic stroke 0.43%, on the other si...
Source: Polskie Archiwum Medycyny Wewnetrznej - August 28, 2015 Category: Internal Medicine Tags: Pol Arch Med Wewn Source Type: research

Cavernous Sinus Thrombosis in Children: Imaging Characteristics and Clinical Outcomes Brief Reports
Conclusions— CAN and infarcts were common in this modest cohort of children with CST. Despite the high incidence of CAN and infarction, outcomes were often favorable. Although this is the largest cohort of childhood CST reported to date, large multicenter cohorts are needed to confirm our findings and determine the preferred therapeutic strategies for childhood CST.
Source: Stroke - August 24, 2015 Category: Neurology Authors: Press, C. A., Lindsay, A., Stence, N. V., Fenton, L. Z., Bernard, T. J., Mirsky, D. M. Tags: Computerized tomography and Magnetic Resonance Imaging, Anticoagulants, Antiplatelets Brief Reports Source Type: research

Resident Physicians Choices of Anticoagulation for Stroke Prevention in Patients with Nonvalvular Atrial Fibrillation
This study revealed that, across a wide sampling of disciplines and centers, resident physician choices of anticoagulation in nonvalvular AF differ significantly from contemporary CCS guidelines. Teaser The mainstay of atrial fibrillation (AF) management is stroke prevention using oral anticoagulants. We surveyed 1014 resident physicians from family medicine, emergency medicine, internal medicine and adult cardiology specialties. We found that resident physicians provide care to large number of AF patients and their choices of anticoagulation for stroke prevention are not congruent with the Canadian Cardiovascular Society...
Source: Canadian Journal of Cardiology - August 15, 2015 Category: Cardiology Source Type: research

Discontinuation of oral anticoagulation preceding acute ischemic stroke - prevalence and outcomes: Comprehensive chart review.
CONCLUSION: About 2.6% or 1 in every 38 of all ischemic stokes occurred after OAC discontinuation. Strokes occurring after OAC discontinuation also have higher mortality and morbidity. Our data suggest that any planned discontinuation of OAC, however brief, should be carefully considered. PMID: 26239873 [PubMed - as supplied by publisher]
Source: Postgraduate Medicine - August 6, 2015 Category: Internal Medicine Tags: Postgrad Med Source Type: research

Underuse of anticoagulation in stroke patients with atrial fibrillation – the FibStroke Study
ConclusionsUnderuse of anticoagulation is a common contributor to ischaemic strokes and TIA episodes in patients with AF. Infrequent AF episodes, previous bleeds, patient preference and alcohol abuse were the most common reasons for not using OAC.
Source: European Journal of Neurology - August 1, 2015 Category: Neurology Authors: A. Palomäki, P. Mustonen, J. E. K. Hartikainen, I. Nuotio, T. Kiviniemi, A. Ylitalo, P. Hartikainen, K. E. J. Airaksinen Tags: Original Article Source Type: research

Underutilization of warfarin for stroke prophylaxis in patients with atrial fibrillation or atrial flutter in Korea.
CONCLUSIONS: A high portion of AF/AFL patients with CHADS2 score ≥2 were undertreated with warfarin. As ischemic stroke is one of the leading causes of death in Korea, a more aggressive approach to prevent stroke in patients with AF/AFL is required. PMID: 26242197 [PubMed - as supplied by publisher]
Source: Journal of Cardiology - August 1, 2015 Category: Cardiology Authors: Lee IH, Kim H, Je NK Tags: J Cardiol Source Type: research

Recanalization Therapies in Acute Ischemic Stroke Patients: Impact of Prior Treatment with Novel Oral Anticoagulants on Bleeding Complications and Outcome - A Pilot Study.
CONCLUSIONS: -IVT/IAT in selected patients with ischemic stroke under NOAC treatment has a safety profile similar to both, IVT/IAT in patients on subtherapeutic VKA-treatment or in those without prior anticoagulation. However, further prospective studies are needed, including the impact of specific coagulation tests. PMID: 26232277 [PubMed - as supplied by publisher]
Source: Circulation - July 31, 2015 Category: Cardiology Authors: Seiffge DJ, Van Hooff RJ, Nolte CH, Béjot Y, Turc G, Ikenberg B, Berge E, Persike M, Dequatre-Ponchelle N, Strbian D, Pfeilschifter W, Zini A, Tveiten A, Næss H, Michel P, Sztajzel R, Luft A, Gensicke H, Traenka C, Hert L, Scheitz JF, De Marchis G, Bona Tags: Circulation Source Type: research

Antithrombotic Treatment Following Intracerebral Hemorrhage in Patients With and Without Atrial Fibrillation Clinical Sciences
Conclusions— In majority of patients who receive antithrombotic agents, treatment is initiated within 6 months of ICH. Still, many patients with compelling indications for antithrombotic treatment are not prescribed antithrombotic agents. Factors other than high risk of embolic stroke by CHA2DS2-VASc in ICH survivors with concurrent AF are used to guide the anticoagulant treatment decision in Swedish clinical practice.
Source: Stroke - July 27, 2015 Category: Neurology Authors: Pennlert, J., Asplund, K., Carlberg, B., Wiklund, P.-G., Wisten, A., Asberg, S., Eriksson, M. Tags: Acute Cerebral Hemorrhage, Anticoagulants, Antiplatelets, Epidemiology Clinical Sciences Source Type: research

White Matter Lesions Double the Risk of Post-Thrombolytic Intracerebral Hemorrhage Clinical Sciences
Conclusions— WMLs visible on computed tomography are associated with a more than doubled risk of sICH in patients treated with intravenous thrombolysis for acute ischemic stroke.
Source: Stroke - July 27, 2015 Category: Neurology Authors: Curtze, S., Haapaniemi, E., Melkas, S., Mustanoja, S., Putaala, J., Sairanen, T., Sibolt, G., Tiainen, M., Tatlisumak, T., Strbian, D. Tags: Computerized tomography and Magnetic Resonance Imaging, Thrombolysis Clinical Sciences Source Type: research

O-001 groin complications in endovascular mechanical thrombectomy for acute ischemic stroke: a 10-year single center experience
ConclusionsIn our series, the low groin complication rate (0.4%-0.8%) in thrombectomy suggests that concerns for vascular complications should not preclude the use of BGCs in the endovascular treatment of ischemic stroke.DisclosuresV. Shah: None. C. Martin: None. A. Hawkins: None. W. Holloway: None. S. Junna: None. N. Akhtar: None.
Source: Journal of NeuroInterventional Surgery - July 26, 2015 Category: Neurosurgery Authors: Shah, V., Martin, C., Hawkins, A., Holloway, W., Junna, S., Akhtar, N. Tags: SNIS 12th Annual Meeting Oral Abstracts Source Type: research

Warfarin use and the risks of stroke and bleeding in hemodialysis patients with atrial fibrillation: A systematic review and a meta-analysis
Conclusion This meta-analysis suggested that warfarin should not be recommended for the routine treatment of HD patients with AF.
Source: Nutrition, Metabolism and Cardiovascular Diseases - July 20, 2015 Category: Nutrition Source Type: research

Stroke and Bleeding Risk Associated With Antithrombotic Therapy for Patients With Nonvalvular Atrial Fibrillation in Clinical Practice Health Services and Outcomes Research
Conclusions Continuation of antithrombotic therapy as well as maintaining an adequate level of TTR is beneficial to prevent strokes while minimizing bleeding events.
Source: JAHA:Journal of the American Heart Association - July 17, 2015 Category: Cardiology Authors: An, J., Niu, F., Lang, D. T., Jazdzewski, K. P., Le, P. T., Rashid, N., Meissner, B., Mendes, R., Dills, D. G., Aranda, G., Bruno, A. Tags: Health Services and Outcomes Research Source Type: research

Influence of Genetic Polymorphisms on Clopidogrel Response and Clinical Outcomes in Patients with Acute Ischemic Stroke CYP2C19 Genotype on Clopidogrel Response.
CONCLUSIONS: CYP2C19*2 and CYP2C19*3 had a significant impact on clopidogrel response, but was not associated with ischemic events during 1 year of follow-up in patients with acute ischemic stroke. HPR was an independent risk factor for ischemic events, and the VerifyNow P2Y12 test may be available to guide individualized antiplatelet therapies in stroke patients in China. PMID: 26177117 [PubMed - as supplied by publisher]
Source: CNS Neuroscience and Therapeutics - July 15, 2015 Category: Neuroscience Authors: Han Y, Lv HH, Liu X, Dong Q, Yang XL, Li SX, Wu S, Jiang JM, Luo Z, Zhu DS, Zhang Y, Zheng Y, Guan YT, Xu JF Tags: CNS Neurosci Ther Source Type: research

A Phase II, double‐blind, randomized, parallel group, dose‐finding study of the safety and tolerability of darexaban compared with warfarin in patients with non‐valvular atrial fibrillation: the oral factor Xa inhibitor for prophylaxis of stroke in atrial fibrillation study 2 (OPAL‐2)
ConclusionsIn this Phase II study in patients with NVAF, a lower bleeding rate was observed in the 120 mg daily darexaban group compared with warfarin with a reduction in plasma D‐dimer as marker for hemostasis. Further investigation of the optimal dose of darexaban for the prevention of stroke in patients with NVAF would need to be considered.
Source: Journal of Thrombosis and Haemostasis - July 15, 2015 Category: Hematology Authors: G. Y. H. Lip, J. L. Halperin, P. Petersen, G. M. Rodgers, D. Pall, R. W. Renfurm Tags: Original Article Source Type: research

Stroke prevention in atrial fibrillation: evidence from real-life studies
Atrial fibrillation (AF) is an increasing public health issue, especially owing to an accompanying five-fold increased risk of stroke. Anticoagulants are the cornerstone of therapy for stroke prevention in AF. The clinical benefits of vitamin K antagonists (VKAs; namely warfarin) shown in randomized controlled trials (RCTs) have been challenged when used in clinical practice by issues including the need for international normalized ratio (INR) monitoring, food and drug interactions, low time in the therapeutic range in substantial numbers of patients, and serious bleeding events. Combined, these have led to both an under-i...
Source: European Journal of Heart Failure Supplements - July 10, 2015 Category: Cardiology Authors: Akao, M., Beyer-Westendorf, J., Goto, S., Peterson, E. Tags: Articles Source Type: research

Endoaortic Clamping Does Not Increase the Risk of Stroke in Minimal Access Mitral Valve Surgery: A Multicenter Experience
Conclusions Once procedural proficiency is acquired, endoaortic balloon clamping in MIMVS is a safe and effective technique. Despite the fact that this patient cohort also includes combined and redo procedures, the observed mortality and stroke rate compared favorably with the existing literature on primary isolated mitral valve surgery irrespective of the approach.
Source: The Annals of Thoracic Surgery - July 7, 2015 Category: Cardiovascular & Thoracic Surgery Source Type: research

Oral Anticoagulant Therapy in Atrial Fibrillation Patients at High Stroke and Bleeding Risk
Atrial fibrillation (AF) is associated with a 5-fold greater risk of ischemic stroke or systemic embolism compared with normal sinus rhythm. Cardioembolic AF-related strokes are often more severe, fatal or associated with greater permanent disability and higher recurrence rates than strokes of other aetiologies. These strokes may be effectively prevented with oral anticoagulant (OAC) therapy, using either vitamin K antagonists (VKAs) or non-vitamin K antagonist oral OACs (NOACs) such as the direct thrombin inhibitor dabigatran or direct factor Xa inhibitors rivaroxaban, apixaban or edoxaban.
Source: Progress in Cardiovascular Diseases - July 7, 2015 Category: Cardiology Authors: Tatjana S. Potpara, Gregory Y.H. Lip Tags: Invited Review Source Type: research

Endoaortic Clamping Does Not Increase the Risk of Stroke in Minimal Access Mitral Valve Surgery: A Multicenter Experience.
CONCLUSIONS: Once procedural proficiency is acquired, endoaortic balloon clamping in MIMVS is a safe and effective technique. Despite the fact that this patient cohort also includes combined and redo procedures, the observed mortality and stroke rate compared favorably with the existing literature on primary isolated mitral valve surgery irrespective of the approach. PMID: 26163356 [PubMed - as supplied by publisher]
Source: The Annals of Thoracic Surgery - July 7, 2015 Category: Cardiovascular & Thoracic Surgery Authors: Casselman F, Aramendi J, Bentala M, Candolfi P, Coppoolse R, Gersak B, Greco E, Herijgers P, Hunter S, Krakor R, Rinaldi M, Van Praet F, Van Vaerenbergh G, Zacharias J Tags: Ann Thorac Surg Source Type: research

WATCHMAN device gives patients alternative to blood thinners and reduces stroke risk
(MedStar Washington Hospital Center) MedStar Heart & Vascular Institute at MedStar Washington Hospital Center was the first in the Washington metropolitan region to implant the newly approved WATCHMAN Device. The new device is designed to prevent stroke in high-risk patients with atrial fibrillation who are seeking an alternative to blood-thinning medication. Blood thinners are effective in stroke risk reductions for A-fib patients, but many cannot tolerate these drugs because of the risk of bleeding. Now, there's a new option.
Source: EurekAlert! - Medicine and Health - July 2, 2015 Category: Global & Universal Source Type: news

New Watchman study reports positive data
New data from a study of Boston Scientific (NYSE:BSX)’s Watchman left atrial appendage closure device reports positive results in a study comparing it to warfarin, an anticoagulant drug treatment, in patients with nonvalvular atrial fibrillation. The 2,406-patient study, published in the Journal of the American College of Cardiology, reported a lower rate of hemorrhagic strokes, unexplained and cardiovascular death and non-procedural bleeding when compared to warfarin. “I think the fact that we now actually have some good scientific data in the field is terribly important, it has been lacking. But I think we...
Source: Mass Device - June 16, 2015 Category: Medical Equipment Authors: Fink Densford Tags: Cardiac Implants Cardiovascular Clinical Trials Boston Scientific Stroke Source Type: news

Left Atrial Appendage Closure as an Alternative to Warfarin for Stroke Prevention in Atrial Fibrillation A Patient-Level Meta-Analysis
ConclusionsIn patients with NVAF at increased risk for stroke or bleeding who are candidates for chronic anticoagulation, LAAC resulted in improved rates of hemorrhagic stroke, cardiovascular/unexplained death, and nonprocedural bleeding compared to warfarin.
Source: Journal of the American College of Cardiology - June 15, 2015 Category: Cardiology Source Type: research

A novel snake venom‐derived GPIb antagonist, anfibatide, protects mice from acute experimental ischaemic stroke and reperfusion injury
Conclusions and ImplicationsOur data indicate anfibatide is a safe GPIb antagonist that exerts a protective effect on cerebral ischaemia and reperfusion injury. Anfibatide is a promising candidate that could be beneficial for the treatment of ischaemic stroke.
Source: British Journal of Pharmacology - June 12, 2015 Category: Drugs & Pharmacology Authors: Ting‐Ting Li, Man‐Li Fan, Shi‐Xiang Hou, Xiao‐Yi Li, Devin M Barry, Hui Jin, Sheng‐Yong Luo, Feng Kong, Lit‐Fui Lau, Xiang‐Rong Dai, Guo‐Hui Zhang, Lan‐Lan Zhou Tags: RESEARCH PAPER Source Type: research

INR optimization based on stroke risk factors in patients with non-valvular atrial fibrillation
Conclusion The intensity of anticoagulation therapy for Korean patients with NVAF is optimal when INR is between 1.7 and 2.2.
Source: International Journal of Clinical Pharmacy - June 12, 2015 Category: Drugs & Pharmacology Source Type: research

Eicosapentaenoic Acid as long-term secondary prevention after ischemic stroke
Conclusion: Hemorrhagic stroke was not occurred in our observation of EPA prescribed patients. The clinical features of recurrent stroke patients were the existing complications of dyslipidemia and renal dysfunction.
Source: Clinical and Translational Medicine - June 11, 2015 Category: Internal Medicine Authors: Taizen NakaseMasahiro SasakiAkifumi Suzuki Source Type: research

Rivaroxaban in the Prevention of Stroke and Systemic Embolism in Patients with Non-Valvular Atrial Fibrillation: Clinical Implications of the ROCKET AF Trial and Its Subanalyses
Abstract Atrial fibrillation (AF) is an increasingly common cause of stroke and systemic embolism. While warfarin has been the mainstay of stroke prevention in patients with AF, newer novel oral anticoagulant medications are now available. Rivaroxaban, a direct factor Xa inhibitor with a rapid onset and offset after oral administration, offers potential advantages over warfarin, predominantly due to its predictable pharmacokinetics across wide patient populations. It requires no coagulation monitoring, and only two different doses are needed (20 mg daily for patients with normal renal function and 15 mg daily in...
Source: American Journal of Cardiovascular Drugs - June 11, 2015 Category: Cardiology Source Type: research

Left Atrial Appendage Occlusion For Stroke Prevention
Atrial fibrillation (AF) remains the most common arrhythmia encountered in clinical practice. One of its more common deleterious effects is the development of thromboembolism leading to stroke. The left atrial appendage (LAA) has been shown to the site of the majority of thrombus formation leading to stroke. Anticoagulation with warfarin has been the treatment of choice for prevention of embolic events. Newer anticoagulants have been developed but they still have the potential side effect of causing major bleeding.
Source: Current Problems in Cardiology - June 11, 2015 Category: Cardiology Authors: Oluseun O. Alli, David R. Holmes Source Type: research