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Anticoagulants for acute ischaemic stroke.
CONCLUSIONS: Since the last version of the review, no new relevant studies have been published and so there is no additional information to change the conclusions. Early anticoagulant therapy is not associated with net short- or long-term benefit in people with acute ischaemic stroke. Treatment with anticoagulants reduced recurrent stroke, deep vein thrombosis and pulmonary embolism, but increased bleeding risk. The data do not support the routine use of any of the currently available anticoagulants in acute ischaemic stroke. PMID: 25764172 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - March 12, 2015 Category: Journals (General) Authors: Sandercock PA, Counsell C, Kane EJ Tags: Cochrane Database Syst Rev Source Type: research
Cilostazol research in Asia: can it be applied to European and American patients?
Cilostazol is an antiplatelet drug often used in Asian countries like Korea, Japan, and China. However, it is rarely used in the west. Cilostazol inhibits phosphodiesterase, increases cyclic AMP concentrations, and consequently inhibits platelet aggregation. Interestingly, it also has vasodilatory activity, inhibits vascular smooth muscle proliferation, and protects the endothelium. Studies in Asia have shown that cilostazol is effective in the secondary prevention of stroke. Moreover, it is significantly less likely to cause bleeding complications than aspirin. Additional trials have shown that cilostazol is effective in ...
Source: International Journal of Stroke - March 4, 2015 Category: Neurology Authors: Jong S. Kim, Sun U. Kwon, Shinichiro Uchiyama Tags: Leading Opinion (Invited) Source Type: research
Safety of intravenous thrombolysis for acute ischaemic stroke including concomitant neoplastic disease sufferers – experience from Poland
ConclusionIntravenous thrombolysis performed in Caucasian stroke patients with past or current neoplastic diseases, but not in the course of chemo‐ and radiotherapy, can be a safe and effective method of treatment. In making decision on the thrombolytic treatment, the risk of bleeding complications and the life expectancy should be assessed.
Source: International Journal of Clinical Practice - February 27, 2015 Category: Internal Medicine Authors: P. Sobolewski, W. Brola, W. Szczuchniak, M. Fudala, A. Sobota Tags: Original Paper Source Type: research
Effect of Decompressive Craniectomy on Outcome Following Subarachnoid Hemorrhage in Mice Basic Sciences
Conclusions— Performing DC to reduce ICP either during or acutely after SAH resulted in more severe bleeding, a higher incidence of rebleeding, and poorer outcome. Thus, elevated post-hemorrhagic ICP plays an important role in controlling bleeding after SAH and should therefore not be reduced acutely. If DC is considered for treating a patient with SAH, the timing of decompression should take these effects into consideration.
Source: Stroke - February 23, 2015 Category: Neurology Authors: Buhler, D., Azghandi, S., Schuller, K., Plesnila, N. Tags: Animal models of human disease, Cerebral Aneurysm, AVM, & Subarachnoid hemorrhage, Other Stroke Treatment - Surgical Basic Sciences Source Type: research
Warfarin use, mortality, bleeding and stroke in haemodialysis patients with atrial fibrillation
Conclusions In our population of HD patients with AF, the mortality is very high. OAT is not associated with increased mortality, while antiplatelet drugs are. OAT seems, on the contrary, associated with a better survival; however, it does not decrease the incidence of ischaemic stroke, whereas it increases the incidence of bleeding. Bleeding risk is lower in subjects in whom the INR is kept within the therapeutic range.
Source: Nephrology Dialysis Transplantation - February 23, 2015 Category: Urology & Nephrology Authors: Genovesi, S., Rossi, E., Gallieni, M., Stella, A., Badiali, F., Conte, F., Pasquali, S., Bertoli, S., Ondei, P., Bonforte, G., Pozzi, C., Rebora, P., Valsecchi, M. G., Santoro, A. Tags: Intra- and Extracorporeal Treatments of Kidney Failure Source Type: research
Bleeding risk, physical functioning and non-use of anticoagulation among patients with stroke and atrial fibrillation
Conclusion: It appears that in this sample, post-stroke anticoagulation decisions appear to be made based on clinical factors associated with bleed risk and motor deficits or physical functioning. However, opportunities may exist for improving clinician documentation of specific reasoning for non-anticoagulation prescription.
Source: QJM - February 23, 2015 Category: Internal Medicine Authors: Schmid, A. A., Ofner, S., Shorr, R. I., Williams, L. S., Bravata, D. M. Tags: Original papers Source Type: research
Innovative thrombolytic strategy using a heterodimer diabody against TAFI and PAI-1 in mouse models of thrombosis and stroke
In conclusion, administration of a bispecific inhibitor against TAFI and PAI-1 results in a prominent profibrinolytic effect in mice without increased bleeding.
Source: Blood - February 19, 2015 Category: Hematology Authors: Wyseure, T., Rubio, M., Denorme, F., Martinez de Lizarrondo, S., Peeters, M., Gils, A., De Meyer, S. F., Vivien, D., Declerck, P. J. Tags: Thrombosis and Hemostasis Source Type: research
Low Body Weight Is Associated With the Incidence of Stroke in Atrial Fibrillation Patients.
Conclusions:Patients in the LBW group had high risk profiles and showed a higher incidence of stroke/SE, but the incidence of major bleeding was not particularly high. PMID: 25740669 [PubMed - as supplied by publisher]
Source: Circulation Journal - February 13, 2015 Category: Cardiology Authors: Hamatani Y, Ogawa H, Uozumi R, Iguchi M, Yamashita Y, Esato M, Chun YH, Tsuji H, Wada H, Hasegawa K, Abe M, Morita S, Akao M Tags: Circ J Source Type: research
Selection of Warfarin or One of the New Oral Antithrombotic Agents for Long-Term Prevention of Stroke among Persons with Atrial Fibrillation
Opinion statement Atrial fibrillation (AF) is the most common sustained cardiac rhythm disorder, which can potentially increases the risk of stroke by five-fold, thus, resulting in high public healthcare burden. Stroke prevention is vital in the management of AF patients. Vitamin K antagonists (VKA, eg, warfarin) have been the mainstay treatment to prevent ischemic stroke and systemic thromboembolism in AF patients for several decades. Despite the efficacy of warfarin, its limitations have recently driven the advent of some new antithrombotic agents, the non-VKA oral anticoagulant (NOACs, including dabigatran, ri...
Source: Current Treatment Options in Neurology - February 11, 2015 Category: Neurology Source Type: research
Anticoagulation therapy: Balancing the risks of stroke and bleeding in CKD
Nature Reviews Nephrology 11, 200 (2015). doi:10.1038/nrneph.2015.14 Authors: Arman Qamar & Deepak L. Bhatt Whether anticoagulation with warfarin is safe and reduces risk of stroke in patients with atrial fibrillation and chronic kidney disease is unclear. A recent observational study shows a net clinical benefit of warfarin—without increased risk of bleeding—in this population, including in patients on dialysis.
Source: Nature Reviews Nephrology - February 10, 2015 Category: Urology & Nephrology Authors: Arman QamarDeepak L. Bhatt Tags: News and Views Source Type: research
Brain Imaging in Acute Ischemic Stroke—MRI or CT?
Abstract In acute stroke, imaging provides different technologies to demonstrate stroke subtype, tissue perfusion and vessel patency. In this review, we highlight recent clinical studies that are likely to guide therapeutic decisions. Clot length in computed tomography (CT) and clot burden in MR, imaging of leptomeningeal collaterals and indicators for active bleeding are illustrated. Imaging-based concepts for treatment of stroke at awakening and pre-hospital treatment in specialized ambulances offer new potentials to improve patient outcome.
Source: Current Neurology and Neuroscience Reports - February 10, 2015 Category: Neuroscience Source Type: research
Development of a computerised decision aid for thrombolysis in acute stroke care
Conclusions: Our structured development process led to the development of a gamma prototype computerised decision aid. Initial evaluation has demonstrated reasonable acceptability of COMPASS amongst patients, relatives and clinicians. The impact of COMPASS on clinical outcomes requires wider prospective evaluation in clinical settings.
Source: Epidemiologic Perspectives and Innovations - February 7, 2015 Category: Epidemiology Authors: Darren FlynnDaniel J NesbittGary A FordPeter McMeekinHelen RodgersChristopher PriceChristian KrayRichard G Thomson Source Type: research
Paramedics may be best first line of defense in treating stroke patients
This study involved an unprecedented cooperative effort of paramedics in the field and emergency physicians serving as investigators,” said Dr. Sidney Starkman, co-principal investigator and co-director of the UCLA Stroke Center. “Through this study we were able to instill permanently in everyone’s mind the idea that ‘time is brain.’ We believe this represents a paradigm shift in the treatment of stroke and potentially numerous other neurological conditions,” said Starkman, who also is professor of emergency medicine and neurology at the Geffen School. “We demonstrated that paramedics not only are eager to pr...
Source: UCLA Newsroom: Health Sciences - February 5, 2015 Category: Universities & Medical Training Source Type: news
Letter by Weinrauch and Barkoudah Regarding Article, "Lack of Concordance Between Empirical Scores and Physician Assessments of Stroke and Bleeding Risk in Atrial Fibrillation. Results From the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) Registry".
PMID: 25645616 [PubMed - in process]
Source: Circulation - February 3, 2015 Category: Cardiology Authors: Weinrauch LA, Barkoudah E Tags: Circulation Source Type: research
Higher risk of death and stroke in patients with persistent vs. paroxysmal atrial fibrillation: results from the ROCKET-AF Trial
Conclusion In patients with AF at moderate-to-high risk of stroke receiving anticoagulation, those with persistent AF have a higher risk of thrombo-embolic events and worse survival compared with paroxysmal AF.
Source: European Heart Journal - February 2, 2015 Category: Cardiology Authors: Steinberg, B. A., Hellkamp, A. S., Lokhnygina, Y., Patel, M. R., Breithardt, G., Hankey, G. J., Becker, R. C., Singer, D. E., Halperin, J. L., Hacke, W., Nessel, C. C., Berkowitz, S. D., Mahaffey, K. W., Fox, K. A. A., Califf, R. M., Piccini, J. P., on be Tags: Atrial fibrillation Source Type: research
Balancing stroke and bleeding risks in patients with atrial fibrillation and renal failure: the Swedish Atrial Fibrillation Cohort study
Conclusions Patients with both AF and renal failure will probably benefit most from having the same treatment as is recommended for other patients with AF, without setting a higher or lower threshold for treatment. Adding additional points for renal failure to the CHADS2 and CHA2DS2-VASc scores did not improve their predictive value.
Source: European Heart Journal - February 2, 2015 Category: Cardiology Authors: Friberg, L., Benson, L., Lip, G. Y. H. Tags: Atrial fibrillation Source Type: research
Pharmacological treatment and prevention of cerebral small vessel disease: a review of potential interventions
Small vessel disease encompasses lacunar stroke, white matter hyperintensities, lacunes and microbleeds. It causes a quarter of all ischemic strokes, is the commonest cause of vascular dementia, and the cause is incompletely understood. Vascular prophylaxis, as appropriate for large artery disease and cardioembolism, includes antithrombotics, and blood pressure and lipid lowering; however, these strategies may not be effective for small vessel disease, or are already used routinely so precluding further detailed study. Further, intensive antiplatelet therapy is known to be hazardous in small vessel disease through enhanced...
Source: International Journal of Stroke - February 1, 2015 Category: Neurology Authors: Philip M. Bath, Joanna M. Wardlaw Tags: Review Source Type: research
Left atrial appendage occlusion for stroke prevention in atrial fibrillation: multicentre experience with the AMPLATZER Cardiac Plug.
Conclusions: In this multicentre study, LAAO with the ACP showed high procedural success and a favourable outcome for the prevention of AF-related thromboembolism. Modification in antithrombotic therapy after LAAO may result in reduction of bleeding events. PMID: 25604089 [PubMed - as supplied by publisher]
Source: EuroIntervention - January 26, 2015 Category: Cardiovascular & Thoracic Surgery Tags: EuroIntervention Source Type: research
Reasons Underlying Non-Adherence to and Discontinuation of Anticoagulation in Secondary Stroke Prevention among Patients with Atrial Fibrillation
Conclusion: Nonadherence to OAC in stroke patients results from fear of potential complications or inconvenience and physicians' concerns regarding functional status. OAC should be initiated wherever possible during the in-hospital stay.Eur Neurol 2015;73:184-191
Source: European Neurology - January 24, 2015 Category: Neurology Source Type: research
Over one in 10 patients taking aspirin 'inappropriately' increasing stroke risk
A study by Baylor College of Medicine found that 11 per cent of those taking the drugs in the US were doing so 'inappropriately', putting them at risk of thinning of the blood, which can cause excessive bleeding or stroke.
Source: the Mail online | Health - January 13, 2015 Category: Consumer Health News Source Type: news
Meta-analysis of Net Long-term Benefit of Different Therapeutic Strategies in Patients with Cryptogenic Stroke and Patent Foramen Ovale
We pooled available data on follow-up events in patients with patent foramen ovale and cryptogenic stroke to evaluate the net clinical benefit of different therapeutic strategies (percutaneous closure vs antiplatelet vs anticoagulant therapy). MEDLINE/Pubmed and Cochrane databases and reviewed cited references to identify relevant studies were used; 3,311 patients from 21 clinical studies, both observational and randomized, with follow-up ≥12 months were overall included. Net clinical benefit was evaluated considering the cumulative incidence of both stroke/transient ischemic attack and major bleeding events.
Source: The American Journal of Cardiology - January 5, 2015 Category: Cardiology Authors: Giuseppe Patti, Francesco Pelliccia, Carlo Gaudio, Cesare Greco Source Type: research
Ischemic stroke in greyhounds
Stroke can be the result of ischemic or hemorrhagic events that cause decreased perfusion to the entire brain or to a specific region of the brain. Ischemic stroke is the result of vascular occlusion secondary to a thrombus or embolus. Hemorrhagic stroke is the result of bleeding.
Source: Advances in Small Animal Medicine and Surgery - January 1, 2015 Category: Veterinary Research Tags: Neurology Source Type: research
Response to letter regarding article, "warfarin use and the risk for stroke and bleeding in patients with atrial fibrillation undergoing dialysis".
PMID: 25539527 [PubMed - in process]
Source: Circulation - December 23, 2014 Category: Cardiology Authors: Shah M, Avgil Tsadok M, Jackevicius CA, Essebag V, Eisenberg MJ, Rahme E, Humphries KH, Tu JV, Behlouli H, Guo H, Pilote L Tags: Circulation Source Type: research
Letter by qureshi et Al regarding article, "warfarin use and the risk for stroke and bleeding in patients with atrial fibrillation undergoing dialysis".
PMID: 25539526 [PubMed - in process]
Source: Circulation - December 23, 2014 Category: Cardiology Authors: Qureshi W, Alirhayim Z, Khalid F Tags: Circulation Source Type: research
Stroke and Systemic Embolism Prevention in Patients with Atrial Fibrillation in Belgium: Comparative Cost Effectiveness of New Oral Anticoagulants and Warfarin
Conclusions Amongst NOACs, apixaban may be the most economically efficient alternative to warfarin in NVAF patients who are suitable for VKA treatment and eligible for stroke prevention in Belgium.
Source: Clinical Drug Investigation - December 16, 2014 Category: Drugs & Pharmacology Source Type: research
Memory gaps in graduates a 'stroke warning sign'
Conclusion This study showed that highly educated people who notice memory complaints in themselves may be more likely to develop stroke than those who don’t, over an average of 12 years. The study had a number of strengths, such as its population-based prospective design and availability of data on more than 9,000 participants at baseline with a long follow-up. However, there were also a number of limitations that weaken the strength of the conclusions. It was not clear whether the memory complaints were assessed just once at the start of the study or an ongoing basis. Some people may report memory complaints that are o...
Source: NHS News Feed - December 12, 2014 Category: Consumer Health News Tags: Neurology Mental health Older people Source Type: news
Time trends of aspirin and warfarin use on stroke and bleeding events in Chinese patients with new-onset atrial fibrillation.
Conclusion: Aspirin use increased amongst newly diagnosed Chinese AF patients with no relationship to the patient's stroke or bleeding risk. Warfarin use was very low. Given the healthcare burden of AF and its complications, our study has major implications for healthcare systems in non-Western countries, given the global burden of this common arrhythmia. PMID: 25501045 [PubMed - as supplied by publisher]
Source: Chest - December 11, 2014 Category: Respiratory Medicine Authors: Guo Y, Wang H, Tian Y, Wang Y, Lip GY Tags: Chest Source Type: research
Clinical events after transitioning from apixaban versus warfarin to warfarin at the end of the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial
Conclusions The excess in thrombotic and bleeding events in the apixaban group after study drug discontinuation appears to be related to an increased risk associated with the initiation of a VKA rather than a direct effect of apixaban. Whether ≥2 days of apixaban bridging improves outcomes during VKA transition is unknown and deserves further evaluation.
Source: American Heart Journal - December 9, 2014 Category: Cardiology Source Type: research
Women: Don't Use Aspirin For Routine Prevention Of Heart Attacks, Stroke, And Cancer
Although once widely recommended, aspirin for the prevention of a first heart attack or stroke (primary prevention) has lost favor in recent years, as the large number of bleeding complications appeared to offset the reduction in cardiovascular events. But at the same time evidence has emerged demonstrating the long-term effect of aspirin in preventing colorectal cancer, leading some to think that the risk-to-benefit equation for aspirin should be reconsidered.
Source: Forbes.com Healthcare News - December 5, 2014 Category: Pharmaceuticals Authors: Larry Husten Source Type: news
Dual antiplatelet therapy after noncardioembolic ischemic stroke or transient ischemic attack: pros and cons.
Authors: Hong KS Abstract Dual antiplatelet therapy simultaneously blocks different platelet activation pathways and might thus be more potent at inhibiting platelet activation and more effective at reducing major ischemic vascular events compared to antiplatelet monotherapy. Aspirin plus clopidogrel dual therapy is now the standard therapy for patients with acute coronary syndrome and for those undergoing percutaneous coronary intervention. However, dual antiplatelet therapy carries an increased risk of bleeding. Patients with ischemic stroke or transient ischemic attack (TIA) are generally older and likely to hav...
Source: Journal of Clinical Neurology - December 2, 2014 Category: Neurology Tags: J Clin Neurol Source Type: research
Intravenous thrombolysis or endovascular therapy for acute ischemic stroke associated with cervical internal carotid artery occlusion: the ICARO-3 study
Abstract The aim of the ICARO-3 study was to evaluate whether intra-arterial treatment, compared to intravenous thrombolysis, increases the rate of favourable functional outcome at 3 months in acute ischemic stroke and extracranial ICA occlusion. ICARO-3 was a non-randomized therapeutic trial that performed a non-blind assessment of outcomes using retrospective data collected prospectively from 37 centres in 7 countries. Patients treated with endovascular treatment within 6 h from stroke onset (cases) were matched with patients treated with intravenous thrombolysis within 4.5 h from symptom onset (controls). Pa...
Source: Journal of Neurology - December 2, 2014 Category: Neurology Source Type: research
Vorapaxar, Combination Antiplatelet Therapy, and Stroke ∗
Drugs that inhibit platelet activation and aggregation reduce vascular events, notably myocardial infarction (MI) and ischemic stroke, and are generally associated with low rates of bleeding (1). Available agents inhibit platelets via distinct mechanisms (Table 1) (2), and combining antiplatelet drugs with different mechanisms of action should enhance net antithrombotic activity. For over a decade, the standard of care in patients with acute coronary syndromes, particularly those undergoing coronary stent implantation, has been dual antiplatelet therapy with aspirin plus an adenosine diphosphate receptor antagonist. When ...
Source: Journal of the American College of Cardiology - December 1, 2014 Category: Cardiology Source Type: research
Intracranial haemorrhage and subsequent ischemic stroke in patients with atrial fibrillation: A nationwide cohort study.
Conclusion:In this large-scale study of AF patients treated with warfarin, first-time ICH was associated with an increased rate of ischaemic stroke/SE/TIA and mortality compared to the non-ICH group. There was a decrease in the warfarin prescription purchase rate post-ICH period compared to pre-ICH, which may partly explain the excess risk. Background: The risk of ischemic stroke/thromboembolic events after an intracranial haemorrhage (ICH) in atrial fibrillation (AF) patients on warfarin treatment is poorly characterised. The aim of this study was to assess the association between the risk of ischaemic stroke/thrombo...
Source: Chest - November 20, 2014 Category: Respiratory Medicine Authors: Nielsen PB, Larsen TB, Gorst-Rasmussen A, Skjøth F, Rasmussen LH, Lip GY Tags: Chest Source Type: research
The impact of associated diabetic retinopathy on stroke and severe bleeding risk in diabetic patients with atrial fibrillation: The Loire Valley Atrial Fibrillation Project.
ConclusionCrude rates of stroke/TE increased in a stepwise fashion when non-diabetic AF patients were compared to diabetics with no retinopathy and diabetics with retinopathy. However, we have shown for the first time that the presence of diabetic retinopathy did not emerge as an independent predictor for stroke/TE or severe bleeding on multivariate analysis. Background: Diabetes mellitus is recognized as a stroke risk factor in atrial fibrillation (AF). Diabetics with retinopathy have an increased risk of systemic cardiovascular complications, and also, severe diabetic retinopathy predisposes to ocular bleeds. We hyp...
Source: Chest - November 20, 2014 Category: Respiratory Medicine Authors: Lip GY, Clementy N, Pierre B, Boyer M, Fauchier L Tags: Chest Source Type: research
Cost Effectiveness of Rivaroxaban for Stroke Prevention in German Patients with Atrial Fibrillation
Conclusions Our results showed that the substantially higher medication costs of rivaroxaban were offset by mitigating the shortcomings of warfarin, most notably frequent dose regulation and bleeding risk. Future health economic studies on novel oral anticoagulants should evaluate the cost effectiveness for secondary stroke prevention and, as clinical data from direct head-to-head comparisons become available, new anticoagulation therapies should be compared against each other.
Source: PharmacoEconomics - November 18, 2014 Category: Health Management Source Type: research
Antithrombotic therapy for atrial fibrillation in patients with acute ischemic stroke or transient ischemic attack
Although warfarin is more effective than are antiplatelet drugs for preventing stroke in patients with atrial fibrillation (AF), it is usually underutilized after stroke for various reasons. A global AF registry study indicated that warfarin was prescribed even less frequently for stroke prevention in Asia than in the West . The major problem of using warfarin in Asian populations is the increased risk of intracranial bleeding. The purpose of this study was to evaluate the use of antithrombotic therapy at discharge in a consecutive cohort of patients with acute ischemic stroke or transient ischemic attack (TIA) and AF.
Source: International Journal of Cardiology - November 13, 2014 Category: Cardiology Authors: Poh-Shiow Yeh, Chun-Ming Yang, Sheng-Hsiang Lin, Wei-Ming Wang, Po-Sheng Chen, Huey-Juan Lin, Kao-Chang Lin, Chia-Yu Chang, Tain-Junn Cheng, Yi-Heng Li Tags: Letter to the editor Source Type: research
Left atrial appendage closure for stroke prevention in non-valvular atrial fibrillation: rationale, devices in clinical development and insights into implantation techniques.
CONCLUSIONS: Catheter-based LAA occlusion is now being developed further as an interventional approach for stroke prevention in patients with atrial fibrillation. Implantation techniques and devices are being improved, which will probably result in better procedural safety. Appropriate operator training is of major importance for this approach. PMID: 25138187 [PubMed - in process]
Source: EuroIntervention - November 12, 2014 Category: Cardiovascular & Thoracic Surgery Tags: EuroIntervention Source Type: research
Comment Intermittent pneumatic compression after stroke
Acute stroke often causes immobility, which predisposes to deep vein thrombosis and pulmonary embolism and these can be fatal or disabling. Low-dose subcutaneous anticoagulation with heparins and heparinoids reduces the risk of venous thromboembolism, but the benefit is offset by haemorrhagic complications. Even targeting anticoagulation to patients at high risk of venous thromboembolism and low risk of bleeding does not add value because patients at high risk of venous thromboembolism (eg, increased severity of stroke) are also at high risk of bleeding.
Source: Lancet Neurology - November 11, 2014 Category: Neurology Authors: Graeme J Hankey Tags: Comment Source Type: research
Risks for stroke and bleeding with warfarin or aspirin treatment in patients with atrial fibrillation at different CHA 2 DS 2 VASc scores: experience from the Stockholm region
Conclusions The present observations confirm earlier findings of undertreatment with warfarin and half of the high-risk patients treated with aspirin were obvious candidates for anticoagulant treatment. However, the other half of the patients had complicating co-morbidities, high bleeding risk, and poor prognosis. This and possible overtreatment of low-risk patients should be taken into account when considering more aggressive use of anticoagulant treatment.
Source: European Journal of Clinical Pharmacology - November 11, 2014 Category: Drugs & Pharmacology Source Type: research
Gastrointestinal Bleeding in Acute Ischemic Stroke: Recent Trends from the Fukuoka Stroke Registry
Background: Gastrointestinal (GI) hemorrhage is a potentially serious complication of acute stroke, but its incidence appears to be decreasing. The aim of this study was to elucidate the etiology of GI bleeding and its impact on clinical outcomes in patients with acute ischemic stroke in recent years. Methods: Using the database of the Fukuoka Stroke Registry, 6,529 patients with acute ischemic stroke registered between June 2007 and December 2012 were included in this study. We recorded clinical data including any previous history of peptic ulcer, prestroke drug history including the use of antiplatelets, anticoagulants, ...
Source: Cerebrovascular Diseases Extra - November 7, 2014 Category: Neurology Source Type: research
Intravenous Tissue Plasminogen Activator for an Ischemic Stroke with Occult Double Primary Cancer
Discussion: Although systemic thrombolysis with tPA for ischemic stroke in patients with advanced-stage cancer may be performed relatively safely, optimal post-thrombolysis management is important to prevent the complications.Case Rep Neurol 2014;6:238-242
Source: Case Reports in Neurology - November 7, 2014 Category: Neurology Source Type: research
Intravenous thrombolysis in a patient with left atrial myxoma with acute ischemic stroke
In this report we describe our experience of IVT in atrial myxoma patient with ischemic stroke and review the relevant literature.
Source: Annals of Indian Academy of Neurology - November 5, 2014 Category: Neurology Authors: Girish Baburao KulkarniRavi YadavVeerendrakumar MustareSailesh Modi Source Type: research
Development of apixaban: a novel anticoagulant for prevention of stroke in patients with atrial fibrillation
The factor Xa inhibitor apixaban is one of the novel anticoagulants to emerge as alternatives to long‐standing standards of care that include low‐molecular‐weight heparin and warfarin. The development of apixaban reflects a strategy to optimize the clinical pharmacology profile, dosing posology, trial designs, and statistical analyses across multiple indications, and to seek alignment with global health authorities. The primary objective of dose selection was to maintain balance between efficacy and bleeding risk. Twice‐daily dosing of apixaban, rather than once daily, was chosen to lower peak concentrations and re...
Source: Annals of the New York Academy of Sciences - November 5, 2014 Category: Science Authors: Michael S. Hanna, Puneet Mohan, Robert Knabb, Elora Gupta, Charles Frost, John H. Lawrence Tags: Original Article Source Type: research
Stroke and Bleeding Risks in Patients with Atrial Fibrillation
Publication date: April 2014 Source:Interventional Cardiology Clinics, Volume 3, Issue 2 Author(s): Abhishek Maan , Jeremy N. Ruskin , E. Kevin HeistTeaser Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with a substantial risk of stroke and mortality. Strokes in patients with AF are associated with a greater disability and poorer outcomes than strokes in patients in sinus rhythm. Patients with AF are at increased risk of bleeding, especially if they use anticoagulant therapy. Recent research in the field of anticoagulation has led to development of new anticoagulants for stroke preventio...
Source: Interventional Cardiology Clinics - November 3, 2014 Category: Cardiology Source Type: research
Blunt traumatic injury of the innominate artery resulting in a stroke – A rare presentation
We present a case of traumatic injury of the innominate artery resulting in an ischemic stroke. Case presentation A 20-year-old gentleman ejected from a two wheeler and run over by a truck presented to us with multiple bleeding facial wounds and severe crush injury of his upper torso. Bedside chest X-ray revealed a widened mediastinum and multiple rib fractures with pneumothoraces bilaterally which were drained with intercostal tubes. An hour into his stay in the ED he developed left hemiparesis. CT brain showed infarcts in right temporo-parietal and occipital regions. CT angiogram of neck vessels revealed an avulsion inj...
Source: Apollo Medicine - October 23, 2014 Category: Journals (General) Source Type: research
The Rabbit Shunt Model of Subarachnoid Haemorrhage
Abstract Aneurysmal subarachnoid haemorrhage (SAH) is a disease with devastating complications that leads to stroke, permanent neurological deficits and death. Clinical and ex-perimental work has demonstrated the importance of the contribution of delayed cerebral vasospasm (DCVS) indepen-dent early events to mortality, morbidity and functional out-come after SAH. In order to elucidate processes involved in early brain injury (EBI), animal models that reflect acute events of aneurysmal bleeding, such as increase in intracranial pressure (ICP) and decrease in cerebral perfusion pressure, are needed. In the presented...
Source: Translational Stroke Research - October 19, 2014 Category: Neurology Source Type: research
Comparison of the Risk Factor Profile, Stroke Subtypes, and Outcomes Between Stroke Patients Aged 65 Years or Younger and Elderly Stroke Patients: A Hospital-based Study
Conclusion We conclude that, apart from risk factors and stroke subtypes, the functional outcomes observed in the two groups differed. Early identification of these differences with good management may help to improve the clinical outcomes in younger stroke patients.
Source: International Journal of Gerontology - October 12, 2014 Category: Geriatrics Source Type: research
Optimal Stroke Prevention in the Geriatric Patient with Atrial Fibrillation: Position Paper of an Interdisciplinary Expert Panel
Drug Res (Stuttg)DOI: 10.1055/s-0034-1389984The present position paper summarises the outcomes of an expert panel discussion held by hospital-based and office-based physicians with ample experience in the treatment of geriatric patients. The optimal approach to stroke prevention in geriatric patients with atrial fibrillation (AF) has not been adequately clarified. Despite their high risk of stroke and clear indication for anticoagulation according to established risk scores, in practice geriatric AF patients often are withheld treatment because of comorbidities and comedications, concerns about low treatment adherence or f...
Source: Drug Research - October 6, 2014 Category: Drugs & Pharmacology Authors: Bahrmann, P.Wehling, M.Ropers, D.Flohr, J.Leischker, A.Röther, J. Tags: Review Source Type: research
Effects of nasogastric catheterization in patients with stroke and dysphagia.
This study aimed to analyze the effects of gastric intubation in patients with stroke and dysphagia. A systematic literature review was performed in six databases, using the keywords stroke and intubation, gastrointestinal. One hundred and twenty studies were found, from which three clinical trials were selected. The results showed different outcomes, including: increased serum albumin level (gastrostomy), poor prognosis and risk of death (gastrostomy), increased treatment failures because of blocking, displacement and reinsertion need of the nasogastric tube, and increased incidence of gastrointestinal bleeding (nasogastr...
Source: Revista Brasileira de Enfermagem - October 1, 2014 Category: Nursing Authors: Cavalcante TF, Araújo TL, Oliveira AR Tags: Rev Bras Enferm Source Type: research
Hemorrhagic stroke and new oral anticoagulants.
Abstract The recent release of new oral anticoagulants (NOAC) raises the question of the management of intracranial hemorrhage occurring during treatment with these molecules. Dabigatran, rivaroxaban and apixaban have different pharmacological characteristics that physicians need to know to adjust their prescription to each patient. Studies of efficacy and safety prior to the marketing of these molecules showed a decreased risk of intracranial hemorrhage compared with vitamin K antagonists. However, no reliable data are available regarding the prognosis of these hemorrhages occurring during NOAC treatment. In addi...
Source: Annales Francaises d'Anesthesie et de Reanimation - October 1, 2014 Category: Anesthesiology Authors: Derlon V, Corbonnois G, Martin M, Toussaint-Hacquard M, Audibert G Tags: Ann Fr Anesth Reanim Source Type: research