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Total 173 results found since Jan 2013.

Will unpredictable side effects dim the promise of new Alzheimer ’s drugs?
A sea change is underway in the treatment of Alzheimer’s disease, where for the first time a drug that targets the disease’s pathology and clearly slows cognitive decline has hit the U.S. market. A related therapy will likely be approved in the coming months. As many neurologists, patients, and brain scientists celebrate, they’re also nervously eyeing complications from treatment: brain swelling and bleeding, which in clinical trials affected up to about one-third of patients and ranged from asymptomatic to fatal. The side effect—amyloid-related imaging abnormalities, or ARIA—remains mysterious. “We don’...
Source: Science of Aging Knowledge Environment - August 2, 2023 Category: Geriatrics Source Type: research

Dabigatran - the First Approved DTI for SPAF.
Authors: Trailokya A, Hiremath JS Abstract Atrial fibrillation (AF) is commonly occurring arrhythmia in clinical practice. AF is easy to recognize but difficult to treat. Stroke is the most devastating complication of AF and is associated with a huge disease burden on the society. Effective stroke prevention is a priority for patients with AF. Two-thirds of strokes due to AF are preventable with suitable anticoagulant therapy. VKA like warfarin, acenocoumarol remains the gold standard for stroke prevention in AF (SPAF). However, it is associated with numerous limitations such as a high risk of drug-drug, drug-food ...
Source: Journal of the Association of Physicians of India - October 25, 2018 Category: General Medicine Tags: J Assoc Physicians India Source Type: research

Systematic review of efficacy of direct oral anticoagulants and vitamin K antagonists in left ventricular thrombus
ConclusionsCompared with VKAs, DOACs significantly reduce the risk of bleeding events and stroke in LVT patients, but mortality was similar in both groups. The advantages are apparent not only in patients belonging to the predominantly white residential areas such as North American and European regions but also in patients with LVT due to IHD. DOACs show promising effects in treating LVT compared with VKAs.
Source: ESC Heart Failure - July 27, 2022 Category: Cardiology Authors: Lei Huang, Yuan Tan, Yilong Pan Tags: Original Article Source Type: research

WITHDRAWN: Pharmacological cardioversion for atrial fibrillation and flutter.
CONCLUSIONS: There is no evidence that pharmacological cardioversion of atrial fibrillation to sinus rhythm is superior to rate control. Rhythm control is associated with more adverse effects and increased hospitalisation. It does not reduce the risk of stroke. The conclusions cannot be generalised to all people with atrial fibrillation. Most of the patients included in these studies were relatively older (>60 years) with significant cardiovascular risk factors. PMID: 29140557 [PubMed - as supplied by publisher]
Source: Cochrane Database of Systematic Reviews - November 15, 2017 Category: General Medicine Authors: Cordina J, Mead GE Tags: Cochrane Database Syst Rev Source Type: research

Trends in the Utilization of Left Atrial Appendage Exclusion in the United States
Stroke prevention remains a cornerstone in the management of patients with non-valvular atrial fibrillation (NVAF)1. Oral anticoagulation (OAC) is the main method of stroke prevention in NVAF worldwide. However,>50% of high-risk NVAF patients are not maintained on OAC due to comorbidities, frailty, bleeding complications, or non-compliance2. In 1996, Blackshear proposed Left atrial appendage exclusion (LAAE) as an alternative stroke prevention strategy in NVAF3. Because no randomized data were available to support the routine use of LAAE, its utilization remained initially limited to selected patients undergoing a concomitant cardiac surgery.
Source: The American Journal of Cardiology - April 6, 2020 Category: Cardiology Authors: Safi U. Khan, Muhammad Zia Khan, Mohamad Alkhouli Source Type: research

Reader's Comments: Trends in the Utilization of Left Atrial Appendage Exclusion in the United States
Stroke prevention remains a cornerstone in the management of patients with nonvalvular atrial fibrillation (NVAF).1 Oral anticoagulation is the main method of stroke prevention in NVAF worldwide. However,>50% of high-risk NVAF patients are not maintained on oral anticoagulation due to comorbidities, frailty, bleeding complications, or noncompliance.2 In 1996, Blackshear proposed left atrial appendage exclusion (LAAE) as an alternative stroke prevention strategy in NVAF.3 Because no randomized data were available to support the routine use of LAAE, its utilization remained initially limited to selected patients undergoing a...
Source: The American Journal of Cardiology - April 6, 2020 Category: Cardiology Authors: Safi U. Khan, Muhammad Zia Khan, Mohamad Alkhouli Source Type: research

Comparative Effectiveness and Safety of Rivaroxaban and Warfarin Among Nonvalvular Atrial Fibrillation (NVAF) Patients with Obesity and Polypharmacy in the United States (US)
ConclusionsThese results suggest that rivaroxaban is an effective and safe treatment option among NVAF patients with obesity and polypharmacy in a commercially-insured US population.
Source: Advances in Therapy - May 25, 2021 Category: Drugs & Pharmacology Source Type: research

Oral anticoagulant underutilization among elderly patients with atrial fibrillation: insights from the United States Medicare database
ConclusionsAlthough OAC therapy prescription is the standard of care for stroke prevention in AF patients, its overall utilization is still low among Medicare patients  ≥ 65 years old, with specific patient characteristics that predict underutilization.
Source: Journal of Interventional Cardiac Electrophysiology - July 9, 2022 Category: Cardiology Source Type: research

Lessons Learned from Managing Antithrombotic Therapy in Children Supported with Pediatric Ventricular Assist Devices
Stroke, thromboembolism, and bleeding are the most recognized complications associated with pediatric ventricular assist devices (VADs) and the leading cause of death and disability on VAD support. Recently, newer antithrombotic strategies like bivalirudin have emerged that appear to be associated with a reduction in the neurologic event rates, especially for smaller pediatric-specific VADs like the Berlin Heart and PediMag/CentriMag systems where the risk of stroke is the highest. While contemporary antithrombotic therapies have likely contributed to lowering adverse event rates, we speculate that clotting and bleeding ad...
Source: ASAIO Journal - November 1, 2022 Category: Medical Devices Tags: Review Source Type: research

Atrial Fibrillation Decision Support Tool: Population Perspective
Conclusions Availability of DOACs increases the proportion of patients for whom oral anticoagulation therapy is recommended in a real-world cohort of AF patients and increased projected QALYs by more than 1500 when all patients are receiving thromboprophylaxis as recommended by the AFDST compared with current treatment.
Source: American Heart Journal - August 23, 2017 Category: Cardiology Source Type: research

Carotid artery stenting without using any embolic protective device A single Centre experience.
CONCLUSION: Revascularisation interventions to be able to prevent the development of stroke are evaluated as important treatment options in patients with symptomatic or severe carotid stenosis. With careful patient selection in experienced centres and a multi-disciplinary approach both before and after the procedure, pleasing results can be obtained without the use of embolic protective devices. KEY WORDS: Carotid artery stenting, Embolic protective device, Stroke. PMID: 30665216 [PubMed - in process]
Source: Annali Italiani di Chirurgia - January 23, 2019 Category: Surgery Tags: Ann Ital Chir Source Type: research

Management of Chronic Hypertension Following Intracerebral Hemorrhage
Acute blood pressure control after a cerebrovascular event is integral in the immediate care of these patients to preserve perfusion to ischemic areas and prevent intracerebral bleeding. The majority of patients with ischemic stroke or intracerebral hemorrhage (ICH) present with preexisting hypertension and therefore require a treatment plan after the acute phase. The presence of chronic hypertension after ICH has often been discussed as a modifiable risk factor for recurrent events. Clinical evidence is relatively lacking for clinicians to understand the extent of blood pressure lowering and the optimal agents to use in t...
Source: Critical Care Nursing Quarterly - March 4, 2019 Category: Nursing Tags: Original Articles Source Type: research

Acute Myocardial Infarction in Severe Mental Health Illness: prevalence, clinical outcomes and process of care in United States hospitalizations.
ConclusionSchizophrenia and ‘other non-organic psychoses’ are the only SMI subtypes associated with adverse clinical outcomes after AMI. However, all patients with SMI were less likely to receive invasive management for AMI, with women and schizophrenia diagnosis being the strongest predictors of conservative management. A multidisciplinary approach between psychiatrists and cardiologists could improve outcomes of this high-risk population.
Source: Canadian Journal of Cardiology - May 3, 2019 Category: Cardiology Source Type: research

Antithrombotic therapy for chronic coronary syndrome and atrial fibrillation: less might be more
AbstractThe best strategy in atrial fibrillation (AF) after  >  12 months after an acute coronary syndrome or in patients with chronic coronary syndrome without an indication for interventional revascularization remains unclear. European guidelines generally recommend therapy with oral anticoagulation (OAC) alone, whereas North American guidelines advise com bination therapy consisting of OAC plus antiplatelet therapy in some patients. We performed a meta-analysis of available trials comparing these treatment strategies. The primary endpoint was major adverse cardiac events (MACE), secondary endpoints included maj...
Source: Journal of Thrombosis and Thrombolysis - December 2, 2019 Category: Hematology Source Type: research