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Source: JAMA
Condition: Thrombosis
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Total 17 results found since Jan 2013.
COVID-19 vs Influenza for Risk of Thrombotic Events in Hospitalized Patients —Reply
In Reply We appreciate the interest in our recent study and the opportunity to share our responses to the comments by Dr Yii and colleagues. We sought to assess whether the risk of arterial and venous thromboembolism among patients hospitalized with COVID-19 differed from those hospitalized with another respiratory viral infection. Patients with influenza in 2018-2019 were selected as the comparator because this pathogen also causes pandemics, results in hospitalization when severe, and is associated with increased risk of acute myocardial infarction, ischemic stroke, and venous thromboembolism. Evaluating outcomes of COVI...
Source: JAMA - December 27, 2022 Category: General Medicine Source Type: research
Remote Ischemic Conditioning —Feasible and Potentially Beneficial for Ischemic Stroke
Stroke is the second leading cause of death and disability in the world. In 1996, tissue plasminogen activator (tPA) was approved by the US Food and Drug Administration and remains the only approved pharmacologic agent for treatment of ischemic stroke in the US. In 2015, mechanical thrombectomy was shown to be beneficial for large vessel occlusion ischemic stroke, although 50% of patients treated with mechanical thrombectomy remain disabled at 3 months. Due to short time windows for thrombolytic therapy administration and the stroke system infrastructure needed for mechanical thrombectomy, these reperfusion therapies are a...
Source: JAMA - August 16, 2022 Category: General Medicine Source Type: research
Intra-arterial Thrombolysis to Target Occlusions in Distal Arteries and the Microcirculation
Acute ischemic stroke remains a leading cause of disability in the United States and worldwide despite substantially improved treatments for the most severe strokes over the last 5 years. Treatment of severe ischemic strokes, specifically those due to occlusion of large intracranial arteries, has been transformed by endovascular removal of the thrombus using stent retrievers or aspiration catheters. Treatment with mechanical thrombectomy is associated with a 20% to 27% absolute increase in the rate of functional independence compared with patients not treated with thrombectomy. Despite highly efficacious treatment, approxi...
Source: JAMA - March 1, 2022 Category: General Medicine Source Type: research
Intravenous Thrombolytic Therapy for Treatment of Acute Ischemic Stroke in Patients Taking NOACs
Intravenous thrombolytic therapy with recombinant tissue plasminogen activator (alteplase) is the cornerstone of acute ischemic stroke reperfusion therapy and is associated with significant improvements in outcomes. Historically, a number of exclusion criteria for use of alteplase had been in place, but over the past 20 years, some of these have been eliminated (eg, age>80 years, seizures at stroke onset) or have become less stringent (eg, exclusion criteria may not strictly apply to recent vitamin K antagonist treatment if the patient has an international normalized ratio<1.7, and treatment may be administered in an...
Source: JAMA - February 22, 2022 Category: General Medicine Source Type: research
Preliminary Investigation of In situ Thrombus Within Patent Foramen Ovale in Patients With and Without Stroke
This study uses high-resolution optical coherence tomography to investigate whether patent foramen ovale could be the site of thrombus formation in patients with or without stroke.
Source: JAMA - May 25, 2021 Category: General Medicine Source Type: research
Intravenous Thrombolysis Before Endovascular Thrombectomy for Acute Ischemic Stroke
The 2 reperfusion therapies of proven benefit for acute ischemic stroke, mechanical endovascular thrombectomy (EVT) and pharmacologic intravenous thrombolysis (IVT), have complementary advantages. EVT, which involves mechanical debulking, works well for accessible sizeable thrombi that occlude large cerebral vessels and are resistant to rapid thrombolytic dissolution. IVT, which involves chemical dissolution, works well for smaller thrombi that occlude medium and small cerebral vessels inaccessible or poorly accessible to endovascular technology. An open, important question has been whether the modest efficacy of IVT for l...
Source: JAMA - January 19, 2021 Category: General Medicine Source Type: research
Net Adverse Clinical Events With Antiplatelet Therapy in Acute Coronary Syndromes
Clopidogrel, prasugrel, and ticagrelor are oral platelet P2Y12 receptor inhibitors that decrease the risk of platelet-mediated coronary artery thrombosis. Clinical guidelines have recommended ticagrelor or prasugrel over clopidogrel in combination with aspirin as dual antiplatelet therapy (DAPT) for 1 year after acute coronary syndrome (ACS), whether or not percutaneous coronary intervention (PCI) is performed. The ticagrelor recommendation was based on the Study of Platelet Inhibition and Patient Outcomes (PLATO) trial, which enrolled 18 624 patients with ACS and randomized them to receive DAPT with either clopidogrel ...
Source: JAMA - October 27, 2020 Category: General Medicine Source Type: research
Association Between Thrombolytic Door-to-Needle Times and Ischemic Stroke Outcomes
This cohort study estimates associations between intravenous tissue plasminogen activator (tPA) door-to-needle times of less than 4.5 hours for acute ischemic stroke and 1-year mortality or readmission among Medicare beneficiaries aged 65 years or older.
Source: JAMA - June 2, 2020 Category: General Medicine Source Type: research
Long-term Outcomes After Thrombolytic Therapy for Acute Ischemic Stroke
The role of intravenous thrombolytic therapy in the management of acute ischemic stroke is well established, and faster administration of intravenous tissue plasminogen activator (tPA) has been associated with better short-term outcomes in clinical practice.
Source: JAMA - June 2, 2020 Category: General Medicine Source Type: research
How Effective and Safe Is Factor XI Inhibition in Preventing Venous Thrombosis?
The introduction of the direct oral anticoagulants for stroke prevention in atrial fibrillation and the management of thromboembolism has transformed the care of patients with these disorders. These drugs, which selectively and reversibly inhibit factor Xa or thrombin in the common pathway of the coagulation cascade, have a wide therapeutic window; this allows for simplified dosing regimens without laboratory monitoring of most adult patients as contrasted to vitamin K antagonists. This class of drug is also associated with a lower bleeding risk than vitamin K antagonists, which has been most clearly demonstrated by a 50% ...
Source: JAMA - January 14, 2020 Category: General Medicine Source Type: research
Association Between Unrecognized OSA and Cardiovascular Events After Major Noncardiac Surgery
This cohort study assesses the association between unrecognized obstructive sleep apnea (OSA) and 30-day risk of cardiovascular complications (myocardial injury, cardiac death, heart failure, thromboembolism, atrial fibrillation, and stroke) among adults undergoing major noncardiac surgery.
Source: JAMA - May 14, 2019 Category: General Medicine Source Type: research
Clinical Considerations for Aspirin Use for Primary Prevention in 2019
Reducing platelet activity with aspirin and other antiplatelet agents is an important factor in the prevention and management of atherothrombotic vascular events. For this indication, aspirin has both beneficial and potentially harmful effects; it can diminish or reverse thrombus formation (eg, in the setting of acute myocardial infarction or stroke), but it also increases the risk of bleeding.
Source: JAMA - January 22, 2019 Category: General Medicine Source Type: research
Clinical and Imaging Characteristics Associated With Thrombus Recanalization in Ischemic Stroke
This cohort study examines baseline clinical and biochemical variables, intracranial thrombus characteristics, and stroke workflow interval times associated with clot recanalization among patients with ischemic stroke treated with intravenous alteplase.
Source: JAMA - September 11, 2018 Category: General Medicine Source Type: research
Left Atrial Appendage Occlusion for Prevention of Thromboembolic Events
More than 600 000 patients in the United States undergo cardiac operations each year, including coronary artery bypass graft operations, valve repair or replacement procedures, or other more complex operations. Patients with atrial fibrillation (AF) who undergo these procedures are at risk for postoperative th romboembolic complications, with the left atrial appendage being a common site of thrombus formation. Occlusion of the left atrial appendage may reduce the risk of thromboembolic stroke and can be performed intraoperatively at the time of cardiac operations. The most common surgical approaches to ac hieve left atr...
Source: JAMA - January 23, 2018 Category: General Medicine Source Type: research
Measuring and Improving Quality
To the Editor In the Viewpoint by Drs McGlynn and Kerr, they stated that “The Joint Commission focuses on 3 major types of admission: myocardial infarction, pneumonia, and heart failure,” leaving most other conditions “largely unmeasured.” In fact, the Joint Commission’s measure sets have also addressed surgical care, perinatal care (the most common reason for hospital admission in the United States), children’s asthma, psychiatric care, venous thromboembolism, stroke, immunization, and tobacco and substance use. The Joint Commission is currently developing new performance measures for blood management and tota...
Source: JAMA - June 28, 2016 Category: Journals (General) Source Type: research
