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Endovascular treatment for ischaemic stroke patients with and without atrial fibrillation, and the effects of adjunctive pharmacotherapy: a narrative review
Expert Opin Pharmacother. 2022 Dec 21. doi: 10.1080/14656566.2022.2161362. Online ahead of print.ABSTRACTINTRODUCTION: Endovascular thrombectomy (EVT) is associated with good clinical outcomes in anterior circulation ischaemic stroke. The impact of EVT on clinical outcomes in patients with ischaemic stroke with and without atrial fibrillation, and the effect of adjunctive pharmacological therapies with EVT, remains unclear.AREAS COVERED: The goal of this narrative review aims to provide an overview of studies which have examined: 1) associations between EVT and outcomes for patients following ischaemic stroke, 2) associati...
Source: Expert Opinion on Pharmacotherapy - December 21, 2022 Category: Drugs & Pharmacology Authors: Muath Alobaida Gregory Y H Lip Deirdre A Lane Dimitrios Sagris Andrew Hill Stephanie L Harrison Source Type: research

Recent Use of NOACs and Intracranial Hemorrhage in Patients With Stroke Treated With Alteplase
This retrospective cohort study uses data from hospitals participating in the Get With The Guidelines –Stroke registry on patients with acute ischemic stroke and compares the safety and functional outcomes of intravenous alteplase among patients who were taking non–vitamin K antagonist oral anticoagulants (NOACs) prior to stroke vs patients who were not taking long-term anticoagulants.
Source: JAMA - February 22, 2022 Category: General Medicine Source Type: research

Analysis of Influencing Factors of Compliance with Non-Vitamin K Antagonist Oral Anticoagulant in Patients with Nonvalvular Atrial Fibrillation and Correlation with the Severity of Ischemic Stroke
In this study, a total of 156 patients with NVAF who received NOAC anticoagulation therapy in our hospital from January 2018 to January 2019 were retrospectively analyzed. The results showed that education background, place of residence, number of complications, CHA2DS2-VASc score, and HAS-BLED score were independent influencing factors for NOACS compliance of NVAF patients. Also, the Pearson correlation analysis showed that there was a negative correlation (r = -0.465, P < 0.001) between NOAC compliance and severity of ischemic stroke in patients with NVAF. Therefore, clinical supervision and management of patients wit...
Source: Evidence-based Complementary and Alternative Medicine - October 29, 2021 Category: Complementary Medicine Authors: Li Zhu Xiaodan Zhang Jing Yang Source Type: research

Reducing delays to administration of prothrombin complex concentrate in patients with vitamin K antagonist-related intracerebral haemorrhage.
Abstract BACKGROUND/AIMS: Four-factor prothrombin complex concentrate is the first-line treatment in vitamin K antagonist-related intracerebral haemorrhage. Early administration is associated with improved patient outcomes. A quality improvement project investigated delays in prothrombin complex concentrate administration in vitamin K antagonist-related intracerebral haemorrhage in order to reduce the time from computed tomography scan confirming intracerebral haemorrhage to prothrombin complex concentrate administration (scan-to-needle time). METHOD: Twenty patients were identified by retrospective audit ove...
Source: British Journal of Hospital Medicine - February 1, 2020 Category: Internal Medicine Authors: Marrinan E, Chen L, Werring D, Turner D Tags: Br J Hosp Med (Lond) Source Type: research

Management of oral anticoagulation in very old patients with non valvular atrial fibrillation related acute ischemic stroke
AbstractThe optimal management of oral anticoagulation (OAC) in the acute phase of non valvular atrial fibrillation (NVAF)-related acute ischemic stroke (AIS) remains controversial, especially in very old patients. Therefore, the aim of our study was to evaluate the practical management of OAC in this context. We conducted an observational retrospective study on patients 85-years old and older admitted to two Italian hospitals for NVAF-related AIS. For each patient, clinical and brain computed tomography data were recorded. Type of OAC (vitamin K antagonists, VKAs or Direct Oral Anticoagulants, DOACs), dosage and starting ...
Source: Journal of Thrombosis and Thrombolysis - October 16, 2019 Category: Hematology Source Type: research

OC1. Abstract Title: In-hospital Mortality and Morbidity among Patients Presenting with Intracranial Hemorrhage: A Single Center's Experience with Vitamin K Antagonists and the Direct Oral Anticoagulants
Oral anticoagulants are the preferred therapy for the treatment of venous thromboembolism and for stroke prevention among patients with atrial fibrillation. Given their widespread use, clinicians must balance efficacy of anticoagulation with their associated bleeding risks. Specifically, intracranial hemorrhage (ICH) is the most feared complication as this form of bleeding has the highest mortality and morbidity. To date, clinical trials suggest a lower incidence of ICH and better safety profile among patients prescribed the direct oral anticoagulants (DOACs) compared with traditional vitamin k antagonists (VKAs).
Source: Thrombosis Research - September 30, 2019 Category: Hematology Authors: C. Cipkar, S. Srinathan, P. Chiang, L. Castellucci Tags: Oral Communications Source Type: research

Neuroimaging and clinical outcomes of oral anticoagulant –associated intracerebral hemorrhage
ObjectiveWhether intracerebral hemorrhage (ICH) associated with non –vitamin K antagonist oral anticoagulants (NOAC‐ICH) has a better outcome compared to ICH associated with vitamin K antagonists (VKA‐ICH) is uncertain.MethodsWe performed a systematic review and individual patient data meta ‐analysis of cohort studies comparing clinical and radiological outcomes between NOAC‐ICH and VKA‐ICH patients. The primary outcome measure was 30‐day all‐cause mortality. All outcomes were assessed in multivariate regression analyses adjusted for age, sex, ICH location, and intraventricul ar hemorrhage extension.Results...
Source: Annals of Neurology - October 25, 2018 Category: Neurology Authors: Georgios Tsivgoulis, Duncan Wilson, Aristeidis H. Katsanos, Jo ão Sargento‐Freitas, Cláudia Marques‐Matos, Elsa Azevedo, Tomohide Adachi, Christian Brelie, Yoshifusa Aizawa, Hiroshi Abe, Hirofumi Tomita, Ken Okumura, Joji Hagii, David J Tags: Research Article Source Type: research

Cerebral microbleeds and intracranial haemorrhage risk in patients anticoagulated for atrial fibrillation after acute ischaemic stroke or transient ischaemic attack (CROMIS-2): a multicentre observational cohort study
This study is registered with ClinicalTrials.gov, number NCT02513316.FindingsBetween Aug 4, 2011, and July 31, 2015, we recruited 1490 participants of whom follow-up data were available for 1447 (97%), over a mean period of 850 days (SD 373; 3366 patient-years). The symptomatic intracranial haemorrhage rate in patients with cerebral microbleeds was 9·8 per 1000 patient-years (95% CI 4·0–20·3) compared with 2·6 per 1000 patient-years (95% CI 1·1–5·4) in those without cerebral microbleeds (adjusted hazard ratio 3·67, 95% CI 1·27–10·60). Compared with the HAS-BLED score alone (C-index 0·41, 95% CI 0·29–0·5...
Source: The Lancet Neurology - July 10, 2018 Category: Neurology Source Type: research

In-hospital ischaemic stroke treated with intravenous thrombolysis or mechanical thrombectomy
The objective of this study is to compare outcomes in patients with IHS and community-onset strokes (COS) treated by recanalization therapy. We analysed data prospectively collected in consecutive patients treated by thrombolysis, thrombectomy, or both for cerebral ischemia at the Lille University Hospital. We compared four outcomes measures at 3  months in patients with IHS and COS: (1) modified Rankin scale (mRS) 0–1, (2) mRS 0–2, (3) death, and (4) symptomatic intracranial haemorrhage (ECASS 2 definition). Of 1209 patients, 64 (5.3%) had IHS, with an increasing proportion over time (p = 0.001). Their median onset...
Source: Journal of Neurology - July 15, 2017 Category: Neurology Source Type: research