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Clinical Updates on Antiplatelet Therapy for Secondary Prevention in Acute Ischemic Stroke
Acta Neurol Taiwan. 2023 Sep 30;32(3):138-144.ABSTRACTAntiplatelet therapy is the first-line management for noncardioembolic transient ischemic attack (TIA) and acute ischemic stroke (IS). Herein, we review the safety and efficacy of antiplatelet therapies in patients with IS and TIA, primarily focusing on the acute stage. We discuss current antiplatelet monotherapy and the factors influencing efficacy and continuation rate according to clinical trial data. Aspirin remains the most commonly used first-line antiplatelet agent for preventing noncardioembolic stroke recurrence, and clopidogrel, cilostazol, and ticagrelor are ...
Source: Acta Neurologica Taiwanica - September 7, 2023 Category: Neurology Authors: Tsung-Lin Lee Yu-Ming Chang Pi-Shan Sung Source Type: research

EP News Clinical
Kirchof and colleagues (N Engl J Med. 2003; epub Aug. 25: PMID: 37622677) conducted a, double-blind, double-dummy, randomized trial of patients> 65 years with device-detected atrial high-rate episodes (AHREs)> 6 minutes. Patients were randomized to edoxaban (E) or placebo (P). The primary efficacy outcome was a composite of cardiovascular death, stroke, or systemic embolism. The safety outcome was a composite of death from any cause or major bleeding. Overall, 2536 patients were randomized, including 1270 to E and 1266 to P.
Source: Heart Rhythm - September 7, 2023 Category: Cardiology Authors: N. A. Mark Estes Source Type: research

Role of artificial intelligence and machine learning in the diagnosis of cerebrovascular disease
ConclusionThe implementation of AI and ML algorithms to supplement clinical practice has conferred a high degree of accuracy, efficiency, and expedited detection in the clinical and radiographic evaluation and management of ischemic and hemorrhagic strokes, AVMs, and aneurysms. Such algorithms have been explored for further purposes of prognostication for these conditions, with promising preliminary results. Further studies should evaluate the longitudinal implementation of such techniques into hospital networks and residency programs to supplement clinical practice, and the extent to which these techniques improve patient...
Source: Frontiers in Human Neuroscience - September 7, 2023 Category: Neuroscience Source Type: research

EP News: Clinical
Kirchof et  al (N Engl J Med August 25, 2003; https://doi.org/10.1056/NEJMoa2303062, PMID 37622677) conducted a double-blind, double-dummy, randomized trial of patients 65 years and older with device-detected atrial high-rate episodes lasting for ≥6 minutes. Patients were randomized to edoxaban (E) or place bo (P). The primary efficacy outcome was a composite of cardiovascular death, stroke, or systemic embolism. The safety outcome was a composite of death from any cause or major bleeding. Overall, 2536 patients were randomized, including 1270 to E and 1266 to P.
Source: Heart Rhythm - September 7, 2023 Category: Cardiology Authors: N.A. Mark Estes Tags: EP NEWS Source Type: research

Direct Oral Anticoagulants: Patients Benefit When Prescribers Get the Message
Direct oral anticoagulants (DOACs) have demonstrated similar or better efficacy to warfarin in reducing stroke and systemic embolic events in large-scale prospective trials.1 –4 In addition, these trials demonstrated either noninferiority or superiority in reducing bleeding events compared with warfarin. To treat high-risk patients with atrial fibrillation (AF) and avoid bleeding in low-risk patients, current guidelines recommend oral anticoagulants in high-risk patien ts with AF with CHA2DS2VASc scores of ≥2 in men and ≥3 in women.
Source: The American Journal of Cardiology - September 5, 2023 Category: Cardiology Authors: Gerald V. Naccarelli Tags: Editorial Source Type: research

Efficacy of ablation therapy on clinical outcomes in patients with atrial fibrillation: a systematic review and meta-analysis
CONCLUSION: Ablation significantly reduces the risk of stroke, cardiovascular mortality, all-cause mortality, and HF in AF patients, compared with medical therapy alone, supporting its use in clinical practice.PMID:37663739 | PMC:PMC10473299 | DOI:10.1097/MS9.0000000000000985
Source: Annals of Medicine - September 4, 2023 Category: Internal Medicine Authors: Mohammad Munim Zahoor Saad Ehsan Ullah Harriet Mmaitsi Kidiavai Shahda A H Eltieb Anjuli Devi Muhammad Anis Asif Akshay Vaswani Ammar Hyder Muhammad Roshan Hoti Sayed Jawad Sana Arshid Abhirami Shankar Muhammad Salman Source Type: research

Neutrophil-to-lymphocyte ratio at admission is a risk factor for in-hospital gastrointestinal bleeding in acute ischemic stroke patients after dual antiplatelet therapy: A case control study
Gastrointestinal bleeding is a clinically important complication in acute ischemic stroke patients after dual antiplatelet therapy. The present study was to explore the association between neutrophil-to-lymphocyte ratio (NLR) and in-hospital gastrointestinal  bleeding in acute ischemic stroke (AIS) patients who had received dual antiplatelet therapy.
Source: Journal of Stroke and Cerebrovascular Diseases - September 1, 2023 Category: Neurology Authors: Jiaming Huang, Foqiang Liao, Yeting Luo, Xu Shu Source Type: research

Short-term antithrombotic strategies after left atrial appendage occlusion: a systematic review and network meta-analysis
Conclusion: No significant difference was found among patients receiving DAPT, DOACs, and VKA in terms of stroke, DRT, and major bleeding events after LAAO. The SUCRA indicated that DAPT was ranked the worst among all antithrombotic strategies due to the higher risk of stroke, DRT, and major bleeding events, while VKAs were ranked the preferred antithrombotic strategy. However, DOACs are worthy of consideration due to their advantage of convenience.
Source: Frontiers in Pharmacology - September 1, 2023 Category: Drugs & Pharmacology Source Type: research