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Fibrin Clot Permeability as a Predictor of Stroke and Bleeding in Anticoagulated Patients With Atrial Fibrillation Clinical Sciences
Background and Purpose—Formation of denser fiber networks has been reported in atrial fibrillation and ischemic stroke. In this longitudinal cohort study, we evaluated whether fibrin clot density may predict thromboembolic and bleeding risk in patients with atrial fibrillation on vitamin K antagonists.Methods—In 236 patients with atrial fibrillation receiving vitamin K antagonists treatment, we measured ex vivo plasma clot permeability (Ks), a measure of the pore size in fibrin networks.Results—During a median follow-up of 4.3 (interquartile range, 3.7–4.8) years, annual rates of ischemic stroke or transient ischem...
Source: Stroke - September 25, 2017 Category: Neurology Authors: Leszek Drabik, Paweł Wołkow, Anetta Undas Tags: Atrial Fibrillation, Ischemic Stroke, Thrombosis Original Contributions Source Type: research

Special MRI scan could identify stroke risk in people with atrial fibrillation
Atrial fibrillation is a heart rhythm disorder that affects millions of people. It can make you feel lousy. Even worse, it can cause potentially disabling or deadly strokes. A special MRI scan may — I stress the “may” — help identify people with atrial fibrillation who are at high risk of having a stroke. This could help many people with this condition to avoid taking warfarin or other clot-preventing medications for life. A normal heartbeat starts in a cluster of cells called the pacemaker. It sits in the heart’s upper right chamber (the right atrium). These cells generate a pulse of electricity that...
Source: New Harvard Health Information - April 28, 2015 Category: Consumer Health News Authors: Howard LeWine, M.D. Tags: Heart Health atrial fibrillation MRI prevention special MRI scan Stroke Stroke Risk Source Type: news

Early Recurrence and Cerebral Bleeding in Patients With Acute Ischemic Stroke and Atrial Fibrillation: Effect of Anticoagulation and Its Timing: The RAF Study Clinical Sciences
Conclusions— Acute stroke in atrial fibrillation patients is associated with high rates of ischemic recurrence and major bleeding at 90 days. This study has observed that high CHA2DS2-VASc score, high National Institutes of Health Stroke Scale, large ischemic lesions, and type of anticoagulant administered each independently led to a greater risk of recurrence and bleedings. Also, data showed that the best time for initiating anticoagulation treatment for secondary stroke prevention is 4 to 14 days from stroke onset. Moreover, patients treated with oral anticoagulants alone had better outcomes compared with patients ...
Source: Stroke - July 27, 2015 Category: Neurology Authors: Paciaroni, M., Agnelli, G., Falocci, N., Caso, V., Becattini, C., Marcheselli, S., Rueckert, C., Pezzini, A., Poli, L., Padovani, A., Csiba, L., Szabo, L., Sohn, S.-I., Tassinari, T., Abdul-Rahim, A. H., Michel, P., Cordier, M., Vanacker, P., Remillard, S Tags: Coumarins Clinical Sciences Source Type: research

Feasibility, safety and cost of outpatient management of acute minor ischaemic stroke: a population-based study
Conclusion Outpatient management of clinic-referred minor stroke is feasible and may be as safe as inpatient care. Rates of early hospital admission and recurrent stroke were low and uptake and maintenance of secondary prevention was high.
Source: Journal of Neurology, Neurosurgery and Psychiatry - February 15, 2013 Category: Neurosurgery Authors: Paul, N. L. M., Koton, S., Simoni, M., Geraghty, O. C., Luengo-Fernandez, R., Rothwell, P. M. Tags: Stroke Cerebrovascular disease Source Type: research

Abstract 12: Evaluation of Medical Costs Associated with Use of Novel Oral Anticoagulants Compared with Warfarin Among Nonvalvular Atrial Fibrillation Patients with Moderate and High Stroke Risk Concurrent I Session B: Oral Abstract Presentations on Stroke Topics
Conclusions: Of the three NOACs, apixaban demonstrated greater medical cost reductions relative to warfarin among NVAF patients at moderate and high stroke risk. The medical cost reduction associated with apixaban use instead of warfarin was greater for NVAF patients at higher stroke risk vs. those at moderate stroke risk and was driven primarily by higher absolute reductions in clinical event rates for major bleeding, stroke and systemic embolism.
Source: Circulation: Cardiovascular Quality and Outcomes - May 15, 2013 Category: Cardiology Authors: Deitelzweig, S., Amin, A., Jing, Y., Makenbaeva, D., Wiederkehr, D., Lin, J., Graham, J. Tags: Concurrent I Session B: Oral Abstract Presentations on Stroke Topics Source Type: research

Summary of evidence-based guideline update: Prevention of stroke in nonvalvular atrial fibrillation: Report of the Guideline Development Subcommittee of the American Academy of Neurology
Objective: To update the 1998 American Academy of Neurology practice parameter on stroke prevention in nonvalvular atrial fibrillation (NVAF). How often do various technologies identify previously undetected NVAF? Which therapies reduce ischemic stroke risk with the least risk of hemorrhage, including intracranial hemorrhage? The complete guideline on which this summary is based is available as an online data supplement to this article. Methods: Systematic literature review; modified Delphi process recommendation formulation. Major conclusions: In patients with recent cryptogenic stroke, cardiac rhythm monitoring probabl...
Source: Neurology - February 24, 2014 Category: Neurology Authors: Culebras, A., Messe, S. R., Chaturvedi, S., Kase, C. S., Gronseth, G. Tags: All Cerebrovascular disease/Stroke SPECIAL ARTICLE Source Type: research

Impact of Prestroke Selective Serotonin Reuptake Inhibitor Treatment on Stroke Severity and Mortality Brief Reports
Conclusions— Prestroke SSRI use is associated with increased stroke severity and mortality in patients with hemorrhagic stroke. Although prestroke depression in itself may increase stroke severity and mortality, this was not found in SSRI users with ischemic stroke.
Source: Stroke - June 23, 2014 Category: Neurology Authors: Mortensen, J. K., Larsson, H., Johnsen, S. P., Andersen, G. Tags: Platelet function inhibitors, Acute Cerebral Hemorrhage, Acute Cerebral Infarction, Neuroprotectors Brief Reports Source Type: research

Blood Pressure Control and Risk of Stroke or Systemic Embolism in Patients With Atrial Fibrillation: Results From the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) Trial Stroke
Conclusions High BP measurement at any point during the trial was independently associated with a substantially higher risk of stroke or systemic embolism. These results strongly support efforts to treat elevated BP as an important strategy to optimally lower risk of stroke in patients with AF. Clinical Trial Registration URL: https://ClinicalTrials.gov/. Unique identifier: NCT00412984.
Source: JAHA:Journal of the American Heart Association - December 1, 2015 Category: Cardiology Authors: Rao, M. P., Halvorsen, S., Wojdyla, D., Thomas, L., Alexander, J. H., Hylek, E. M., Hanna, M., Bahit, M. C., Lopes, R. D., De Caterina, R., Erol, C., Goto, S., Lanas, F., Lewis, B. S., Husted, S., Gersh, B. J., Wallentin, L., Granger, C. B., the Apixaban Tags: Stroke Source Type: research

Risks and benefits of clopidogrel-aspirin in minor stroke or TIA: Time course analysis of CHANCE
Conclusions: Clopidogrel–aspirin treatment may have a benefit of reducing stroke risk outweighing the potential risk of increased bleeding especially within the first 2 weeks compared with aspirin alone in patients with minor stroke or TIA. Clinicaltrials.gov identifier: NCT00979589. Classification of evidence: This study provides Class II evidence that for patients with minor stroke or TIA, the reduction of stroke risk from clopidogrel plus aspirin within the first 2 weeks outweighs the risk of bleeding compared with aspirin alone.
Source: Neurology - May 15, 2017 Category: Neurology Authors: Pan, Y., Jing, J., Chen, W., Meng, X., Li, H., Zhao, X., Liu, L., Wang, D., Johnston, S. C., Wang, Y., Wang, Y., On behalf of the CHANCE investigators Tags: All Cerebrovascular disease/Stroke, Clinical trials Randomized controlled (CONSORT agreement) ARTICLE Source Type: research

The efficacy and safety of cilostazol in ischemic stroke patients with peripheral arterial disease (SPAD): protocol of a randomized, double‐blind, placebo‐controlled multicenter trial
ConclusionThe SPAD trial is the first study to evaluate the safety and efficacy of dual antiplatelet agents, aspirin plus cilostazol, in comparison with aspirin alone in patients with both ischemic stroke or TIA and PAD. Results from this trial will provide important information on the merit of adding cilostazol to aspirin for slowing down progression of atherosclerosis in patients with ischemic stroke and PAD.
Source: International Journal of Stroke - November 14, 2014 Category: Neurology Authors: Jiann‐Shing Jeng, Yu Sun, Jiunn‐Tay Lee, Ruey‐Tay Lin, Chih‐Hung Chen, Helen L. Po, Huey‐Juan Lin, Chung‐Hsiang Liu, Ming‐Hui Sun, Mu‐Chien Sun, Chang‐Ming Chern, Li‐Ming Lien, Hou‐Chang Chiu, Han‐Hwa Hu, Hung‐Yi Chiou, Sien‐Ts Tags: Protocols Source Type: research

TALOS: a multicenter, randomized, double‐blind, placebo‐controlled trial to test the effects of citalopram in patients with acute stroke
DiscussionSSRI treatment is well tolerated and overall beneficial in the wake of stroke; it may also be neuroprotective and prevent new vascular events.
Source: International Journal of Stroke - April 8, 2015 Category: Neurology Authors: Kristian Lundsgaard Kraglund, Janne Kaergaard Mortensen, Erik Lerkevang Grove, Søren Paaske Johnsen, Grethe Andersen Tags: Protocol Source Type: research

Antiplatelet Strategies and Outcomes in Patients with Noncardioembolic Ischemic Stroke from a Real-World Study with a Five-Year Follow-Up
In conclusion, clopidogrel is suggested for patients with an ESRS >  3 and aspirin for patients with an ESRS ≤ 3 for the secondary prevention of noncardioembolic ischemic stroke in Chinese patients.
Source: Translational Stroke Research - December 30, 2016 Category: Neurology Source Type: research

Bleeding Complications Associated with Warfarin Treatment in Ischemic Stroke Patients with Atrial Fibrillation: A Population-Based Cohort Study
Background: Bleeding events are the major obstacle to the widespread use of warfarin for secondary stroke prevention. Previous studies have not examined the use of risk stratification scores to estimate lifetime bleeding risk associated with warfarin treatment in a population-based setting. The purpose of this study is to determine the lifetime risk of bleeding events in ischemic stroke patients with atrial fibrillation (AF) undergoing warfarin treatment in a population-based cohort and to evaluate the use of bleeding risk scores to identify patients at high risk for lifetime bleeding events.Methods: The resources of the R...
Source: Journal of Stroke and Cerebrovascular Diseases - March 18, 2013 Category: Neurology Authors: Raymond C.S. Seet, Alejandro A. Rabinstein, Teresa J.H. Christianson, George W. Petty, Robert D. Brown Tags: Original Articles Source Type: research

Ischemic Stroke and Intracranial Hemorrhage With Aspirin, Dabigatran, and Warfarin: Impact of Quality of Anticoagulation Control Clinical Sciences
Conclusions— In Chinese patients with atrial fibrillation, the benefits of warfarin therapy for stroke prevention and ICH risk are closely dependent on the quality of anticoagulation, as reflected by TTR. Even at the top TTR quartile, warfarin was associated with a higher stroke and ICH risk than dabigatran.
Source: Stroke - December 22, 2014 Category: Neurology Authors: Ho, C.-W., Ho, M.-H., Chan, P.-H., Hai, J.-J., Cheung, E., Yeung, C.-Y., Lau, K.-K., Chan, K.-H., Lau, C.-P., Lip, G. Y. H., Leung, G. K.-K., Tse, H.-F., Siu, C.-W. Tags: Coumarins, Other anticoagulants, Anticoagulants Clinical Sciences Source Type: research

Vitamin K antagonist-experienced patients with a history of stroke/transient ischaemic attack who switched from warfarin to dabigatran increased their rate of recurrent stroke/transient ischaemic attack compared with those on warfarin
Commentary on: Larsen TB, Rasmussen LH, Gorst-Rasmussen A, et al. Dabigatran and warfarin for secondary prevention of stroke in atrial fibrillation patients: a nationwide cohort study. Am J Med 2014;127:1172–8 . Context Randomised trials have shown that patients with atrial fibrillation (AF) who are treated with a non-vitamin K antagonist oral anticoagulant (NOAC), compared with warfarin, have similar or lower rates of stroke and major bleeding, markedly reduced rates of intracranial bleeding and a consistent pattern of reduced mortality.1 Dabigatran 150 mg two times a day is the only NOAC that can significantly...
Source: Evidence-Based Medicine - May 22, 2015 Category: Internal Medicine Authors: Eikelboom, J. W., Bosch, J. Tags: Epidemiologic studies, Time-to-event methods, Drugs: cardiovascular system, Stroke, Arrhythmias Aetiology/Harm Source Type: research