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Rare causes of stroke-a frequent stroke etiology.
Abstract
As a whole, rare stroke causes represent a frequent stroke etiology. Since rare stroke causes affect primarily young patients, early diagnosis and treatment are of high socioeconomic relevance. In our everyday clinical practice, cervical artery dissection, which is the most common stroke etiology among patients < 45 years, and vasculitis are particularly important. In the case of vasculitis, devastating disease courses and potentially harmful treatment options complicate clinical decision-making. Non-vasculitic vasculopathies, infections, hematological disorders, coagulation disorders, metabolic disord...
Source: Der Nervenarzt - August 29, 2019 Category: Neurology Authors: Schmidt-Pogoda A, Minnerup J Tags: Nervenarzt Source Type: research
Warfarin Use, Stroke, and Bleeding Risk among Pre-Existing Atrial Fibrillation US Veterans Transitioning to Dialysis
In this study, we validated risk scores for stroke and bleeding in this population and assessed risk of stroke and bleeding among warfarin users compared to nonusers.Methods: We utilized a cohort of 28,620 pre-dialysis US veterans transitioning to hemodialysis between October 2007 and March 2015. Incident rates for the risks of stroke and bleeding were ascertained based upon CHA2DS2-VASc or HAS-BLED scores, respectively. A propensity score-based competing risk analysis was used to assess risk of stroke and bleeding.Findings: The mean age of our cohort was 77 ± 9 years, and the median CHA2DS2-VASc and HAS-BLED scores were ...
Source: Nephron - February 4, 2022 Category: Urology & Nephrology Source Type: research
Navigating Antiplatelet Treatment Options for Stroke: Evidence-Based and Pragmatic Strategies
AbstractPurpose of ReviewThe benefit of using antiplatelet monotherapy in acute ischemic stroke and secondary stroke prevention is well established. In the last few years, several large randomized trials showed that the use of short-term dual antiplatelet therapy in particular stroke subtypes may reduce the risk of recurrent ischemic events. The aim of this article is to provide a critical analysis of the current evidence and recommendations for the use of antiplatelet agents for stroke prevention.Recent FindingsLong-term therapy with aspirin, clopidogrel, or aspirin plus extended-release dipyridamole is recommended for se...
Source: Current Neurology and Neuroscience Reports - October 13, 2022 Category: Neuroscience Source Type: research
Stroke prevention of thoracoscopic left atrial appendage clipping in patients with non-valvular atrial fibrillation at high risk of stroke and bleeding: study protocol for a non-randomised controlled clinical trial
Introduction
Non-valvular atrial fibrillation (NVAF) is a high-risk factor for ischaemic stroke. The 2016 European Society of Cardiology Atrial Fibrillation Management guidelines recommend oral anticoagulants (OACs) to prevent stroke in men with CHA2DS2-VASc scores ≥2 and women ≥3. However, in patients with a high risk of stroke and a high risk of bleeding (HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly (> 65 years), Drugs/alcohol concomitantly) score≥3), OAC had a higher risk of bleeding. Left atrial appendage cl...
Source: BMJ Open - October 28, 2022 Category: General Medicine Authors: Ye, C., Han, X., Chen, Y., Liu, F., Ma, H., Yang, Y., Liu, Y., Hu, Q., Yao, Q., Xie, W., Xu, D. Tags: Open access, Surgery Source Type: research
Comparison of Prasugrel and Clopidogrel in Thrombotic Stroke Patients with Risk Factors for Ischemic Stroke Recurrence: An Integrated Analysis of PRASTRO-I, PRASTRO-II, and PRASTRO-III
Conclusions: This integrated analysis supports the findings of PRASTRO-III. Prasugrel is a promising treatment that results in a numerical reduction in the composite incidence of ischemic stroke, MI, and death from other vascular causes in patients with ischemic stroke who are at a high risk of stroke recurrence. No major safety issues were observed for prasugrel.Cerebrovasc Dis
Source: Cerebrovascular Diseases - April 3, 2023 Category: Neurology Source Type: research
Arterial Dissection and Stroke: Treatment and Recurrence (P03.191)
CONCLUSIONS: In patients with stroke or TIA secondary to dissection, half were treated with anticoagulation and most of the remainder with antiplatelets or a combination of both. The one year recurrence rate for stroke or TIA in this study was 7%. While treatment carries a risk of bleeding, this is lower than that for recurrent ischemia (7% vs. 2%). Patients who received no treatment had a higher risk of recurrent ischemic events, bleeding complication or death.Disclosure: Dr. Spevick has nothing to disclose. Dr. Jaigobin has nothing to disclose. Dr. Kapral has nothing to disclose.
Source: Neurology - February 14, 2013 Category: Neurology Authors: Spevick, J., Jaigobin, C., Kapral, M. Tags: P03 Cerebrovascular Disease III Source Type: research
Advances in Stroke Prevention in Atrial Fibrillation: Enhanced Risk Stratification Combined With the Newer Oral Anticoagulants
Abstract
Patients with atrial fibrillation (AF) have an increased stroke risk compared with those in sinus rhythm, although the absolute risk for individual patients is modulated by the presence of various additional risk factors. Patient selection for oral anticoagulation for stroke prevention is based on risks of stroke and bleeding. Although CHADS2 (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or transient ischemic attack) is the most widely used scheme for evaluating stroke risk in patients with AF, several other stroke risk factors are not included; therefore, many patients' strok...
Source: Clinical Cardiology - April 1, 2013 Category: Cardiology Authors: Freek W. A. Verheugt Tags: Review Source Type: research
Risks and Benefits of Anticoagulation in Atrial Fibrillation: Insights From the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF) Registry Original Articles
Conclusions—
In community-based outpatients with AF, use of OAC was high and driven by not only predominantly stroke but also bleeding risk. Stroke risk significantly affects OAC use among those with low bleeding risk, whereas those with high bleeding risk demonstrate consistently lower use of OAC regardless of stroke risk.
Source: Circulation: Cardiovascular Quality and Outcomes - July 16, 2013 Category: Cardiology Authors: Cullen, M. W., Kim, S., Piccini, J. P., Ansell, J. E., Fonarow, G. C., Hylek, E. M., Singer, D. E., Mahaffey, K. W., Kowey, P. R., Thomas, L., Go, A. S., Lopes, R. D., Chang, P., Peterson, E. D., Gersh, B. J., on behalf of the ORBIT-AF Investigators Tags: Coumarins, Arrhythmias, clinical electrophysiology, drugs, Embolic stroke, Risk Factors for Stroke, Anticoagulants Original Articles Source Type: research
Efficacy and safety of edoxaban in comparison with dabigatran, rivaroxaban and apixaban for stroke prevention in atrial fibrillation. An indirect comparison analysis.
Abstract
Large Phase 3 clinical trials for stroke prevention in atrial fibrillation (AF) have compared non-vitamin K antagonist oral anticoagulants (NOACs) against warfarin, with the edoxaban trial only recently reported. In the absence of head to head trials directly comparing these NOACs against each other, we compared the efficacy and safety of edoxaban to other agents by an indirect comparison analysis. We performed an indirect comparison analysis of edoxaban (2 dose strategies) against apixaban (1 dose), dabigatran etexilate (2 doses) and rivaroxaban (1 dose), for their relative efficacy and safety against ea...
Source: Thrombosis and Haemostasis - February 28, 2014 Category: Hematology Authors: Skjøth F, Larsen TB, Rasmussen LH, Lip GY Tags: Thromb Haemost Source Type: research
Warfarin Use and Risk of Stroke in Patients With Atrial Fibrillation Undergoing Hemodialysis: A Meta-Analysis
Abstract: In spite of the substantial burden of atrial fibrillation and associated elevated ischemic stroke risk in patients undergoing hemodialysis, the role of warfarin in these high-risk patients remains uncertain. Our objective was to clarify the association between warfarin use and risk of stroke for patients with atrial fibrillation undergoing dialysis.
PubMed and Embase from January 1966 to January 2015 were searched to identify relevant studies. Inclusion criteria were cohort studies, patients with atrial fibrillation undergoing hemodialysis, and reported quantitative estimates of the multivariate adjusted relativ...
Source: Medicine - February 1, 2016 Category: Internal Medicine Tags: Research Article: Meta-Analysis of Observ Studies in Epidemiology Source Type: research
Statins and poststroke intracerebral hemorrhage: Concern but increasing reassurance
Post hoc analyses of data from randomized controlled trials can generate useful hypotheses, but need to be considered exploratory. When conducted, such evaluations should adhere to specified criteria and test for a treatment by subgroup interaction for the trial's primary endpoint.1 The best way to proceed if unexpected but potentially important outcomes occur is less clear. Concern that treatment with HMG-CoA reductase inhibitors (i.e., statins) might increase the risk of poststroke intracerebral hemorrhage (ICH) arose from an unanticipated observation in the Stroke Prevention with Aggressive Reduction in Cholesterol Leve...
Source: Neurology - April 24, 2016 Category: Neurology Authors: Goldstein, L. B., Nederkoorn, P. J. Tags: All Cerebrovascular disease/Stroke, Intracerebral hemorrhage EDITORIALS Source Type: research
CHA2DS2-VASc Recalibration with an Additional Age Category (50-64 years) Enhances Stroke Risk Stratification in Chinese Atrial Fibrillation Patients
CONCLUSION Chinese patients with AF and low CHA2DS2-VASc score were at a disproportionally high risk of ischemic stroke. Chinese patients between 50-64 are at a high risk for stroke despite a low CHA2DS2-VASc score and have low bleeding risk. Only patients aged <50 years are truly low risk. Teaser Chinese atrial fibrillation (AF) patients with low CHA2DS2-VASc scores had a higher ischemic stroke risk than the Caucasians’ counterparts. In this study, we identified that even for Chinese AF patients aged 50-64 years, stroke risk is still markedly elevated. Only patients aged <50 belong to the truly low risk group.
Source: Canadian Journal of Cardiology - May 13, 2016 Category: Cardiology Source Type: research
Reasons for exclusion from intravenous thrombolysis in stroke patients admitted to the Stroke Unit
AbstractIntravenous (IV) thrombolysis is the treatment in ischemic stroke, but only the minority of patients receive this medication. The primary objective of this study was to explore the reasons associated with the decision not to offer IV thrombolysis to stroke patients admitted to the Stroke Unit (SU). We conducted a retrospective analysis based on data collected from 876 consecutive stroke patients admitted to the SU <12 h of symptoms onset, treated or not with IV thrombolysis at the discretion of the treating neurologist. Of the 876 patients, 449 were thrombolysed and 427 non-thrombolysed. Stroke onset >4....
Source: Journal of Thrombosis and Thrombolysis - August 5, 2016 Category: Hematology Source Type: research
Decision-Making in Clinical Practice: Oral Anticoagulant Therapy in Patients with Non-valvular Atrial Fibrillation and a Single Additional Stroke Risk Factor
AbstractApproximately 1 in 3 –4 patients presenting with an ischemic stroke will also have atrial fibrillation (AF), and AF-related strokes can be effectively prevented using oral anticoagulant therapy (OAC), either with well-controlled vitamin K antagonists (VKAs) or non-vitamin K antagonist oral anticoagulants (NOACs). In a ddition, OAC use (both VKAs and NOACs) is associated with a 26% reduction in all-cause mortality (VKAs) or an additional 10% mortality reduction with NOACs relative to VKAs. The decision to use OAC in individual AF patient is based on the estimated balance of the benefit from ischemic stroke reducti...
Source: Advances in Therapy - December 7, 2016 Category: Drugs & Pharmacology Source Type: research
