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Oral anticoagulation in atrial fibrillation.
Authors: Ansari JG, Garcha GS, Lakkis N Abstract Atrial fibrillation affects approximately 5 million patients in the United States. The rate of stroke in adults with atrial fibrillation depending on their risk factors varies between 1-20% annually. Anticoagulation with vitamin K antagonists such as warfarin has been the mainstay therapy but it is cumbersome and requires close follow-up. Since 2010, three new oral anticoagulants have received Food and Drug Administration approval for stroke prevention in atrial fibrillation. This review summarizes data from three landmark trials: RE-LY, ROCKET-AF, and ARISTOTLE. In ...
Source: Cardiovascular and Hematological Agents in Medicinal Chemistry - December 5, 2014 Category: Cardiology Tags: Cardiovasc Hematol Agents Med Chem Source Type: research

State-of-the-Art Endovascular Treatment of Acute Ischemic Stroke.
Authors: Raphaeli G, Mazighi M, Pereira VM, Turjman F, Striefler J Abstract Stroke is the third leading cause of death in the USA. An estimated 795,000 new or recurrent stroke events occur annually, mostly ischemic in nature. Arterial recanalization and subsequent reperfusion performed shortly after symptom onset can help to restore brain function in acute ischemic stroke (AIS). The only treatment currently approved by the United States Food and Drug Administration is intravenous tissue plasminogen activator, administered within 4.5 h of symptom onset. However, this short window often precludes effective interventi...
Source: Advances and Technical Standards in Neurosurgery - December 1, 2014 Category: Neurosurgery Tags: Adv Tech Stand Neurosurg Source Type: research

Oral Anticoagulation in Atrial Fibrillation.
Authors: Ansari JG, Garcha GS, Lakkis N Abstract Atrial fibrillation affects approximately 5 million patients in the United States. The rate of stroke in adults with atrial fibrillation depending on their risk factors varies between 1-20% annually. Anticoagulation with vitamin K antagonists such as warfarin has been the mainstay therapy but it is cumbersome and requires close follow-up. Since 2010, three new oral anticoagulants have received Food and Drug Administration approval for stroke prevention in atrial fibrillation. This review summarizes data from three landmark trials: RE-LY, ROCKET-AF, and ARISTOTLE. In ...
Source: Cardiovascular and Hematological Agents in Medicinal Chemistry - November 23, 2014 Category: Cardiology Tags: Cardiovasc Hematol Agents Med Chem Source Type: research

The Efficacy of Rivaroxaban in Patients With Atrial Fibrillation
Atrial fibrillation (AF), the most common form of cardiac arrhythmia, is a major risk factor for cardioembolic stroke. Dose-adjusted warfarin has been the gold standard for stroke prophylaxis in moderate- to high-risk patients with AF. However, the use of warfarin therapy is greatly limited by its narrow therapeutic window, numerous dietary restrictions, and drug–drug interactions, and an increased risk of hemorrhage. As a result, great emphasis has been placed on developing a new anticoagulant agent with fewer risks and limitations. Current data suggest that the oral direct factor Xa inhibitor rivaroxaban is a safe and ...
Source: American Journal of Therapeutics - September 1, 2014 Category: Drugs & Pharmacology Tags: Therapeutic Review Source Type: research

Early Ischemic Blood Brain Barrier Damage: A Potential Indicator for Hemorrhagic Transformation Following Tissue Plasminogen Activator (tPA) Thrombolysis?
Abstract Tissue plasminogen activator (tPA) thrombolysis, remains the only United States Food and Drug Administration(FDA) approvedtreatmentfor acute ischemia stroke. However, the use of tPA has been profoundly constraineddue to its narrow therapeutic time window and the increased risk of potentially deadly hemorrhagic complications. TPA-associated hemorrhagic transformation (HT) often occurs as a result of catastrophic failure of theblood brain barrier (BBB), wherein the affected cerebral capillaries can no longer hold blood constituents.Due to its direct contribution to edema and HT, reperfusion-associated BBB d...
Source: Current Neurovascular Research - May 30, 2014 Category: Neurology Authors: Jin X, Liu J, Liu W Tags: Curr Neurovasc Res Source Type: research

FDA Finds Pradaxa Linked to Lower Stroke, Brain Hemorrhage Risk
A Food and Drug Administration analysis found the blood thinner Pradaxa was better at avoiding strokes and brain hemorrhage, though it was linked to more stomach bleeding.
Source: WSJ.com: Health - May 14, 2014 Category: Pharmaceuticals Tags: PAID Source Type: news

Practical use of dabigatran etexilate for stroke prevention in atrial fibrillation
Summary Atrial fibrillation (AF) is associated with an increased risk of thromboembolism, and is the most prevalent factor for cardioembolic stroke. Vitamin K antagonists (VKAs) have been the standard of care for stroke prevention in patients with AF since the early 1990s. They are very effective for the prevention of cardioembolic stroke, but are limited by factors such as drug–drug interactions, food interactions, slow onset and offset of action, haemorrhage and need for routine anticoagulation monitoring to maintain a therapeutic international normalised ratio (INR). Multiple new oral anticoagulants have been develope...
Source: International Journal of Clinical Practice - April 5, 2013 Category: Internal Medicine Authors: K. Huber, S. J. Connolly, A. Kher, F. Christory, G.‐A. Dan, R. Hatala, R. G. Kiss, B. Meier, B. Merkely, B. Pieske, T. Potpara, J. Stępińska, N. Vene Klun, D. Vinereanu, P. Widimský Tags: Consensus Source Type: research

UCLA-led study finds devices no better than meds in recovery from clot-caused strokes
When someone has a stroke, time equals brain. The longer a stroke is left untreated, the more brain tissue is lost. Since the only proven treatment — a clot-busting drug — works in less than half of patients, stroke physicians had high hopes for a mechanical device that could travel through the blocked blood vessel to retrieve or break up the clot, restoring blood flow to the brain.   But in a recently completed multi-site trial in which UCLA served as the clinical coordinating center, researchers found there was no overall recovery benefit to patients treated with clot-removal (embolectomy) devices, compa...
Source: UCLA Newsroom: Health Sciences - March 13, 2013 Category: Universities & Medical Training Source Type: news

tPA and warfarin: Time to move forward
The appropriate use of IV tissue plasminogen activator (tPA) for patients with acute ischemic stroke remains an area of active discussion among health care professionals. Since its approval in the United States by the Food and Drug Administration in 1996, the medical community has continued to review and discuss the risks vs benefits of this important therapy. Two recent publications1,2 and accompanying editorials have refocused attention on the vexing issue of using IV tPA in patients taking warfarin. The Xian et al.1 study found a 1.1% absolute increase in the risk of intracranial hemorrhage (ICH) with warfarin use (5.7%...
Source: Neurology - February 4, 2013 Category: Neurology Authors: Alberts, M. J., Naidech, A. M. Tags: All Cerebrovascular disease/Stroke EDITORIALS Source Type: research

Dabigatran, a Cause of Hematologic Emergency.
Abstract ABSTRACT:: Dabigatran etexilate, a direct thrombin inhibitor, has become an alternative to warfarin for stroke prevention in patients with nonvalvular atrial fibrillation. There remains a concern about its overdose and life-threatening hemorrhage because of unavailability of appropriate coagulation tests to monitor and antidotes to reverse its effects. There are no clinical data about its safety in patients with fluctuating renal function. Multiple bleeding events reported with dabigatran have prompted the U.S. Food and Drug Administration to further investigate these reports. Four clinical cases with lif...
Source: The American Journal of the Medical Sciences - December 5, 2012 Category: Journals (General) Authors: Lal Y, Van Heukelom J Tags: Am J Med Sci Source Type: research

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