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Atrial Appendage Thrombosis Risk Is Lower for Atrial Flutter Compared with Atrial Fibrillation
The risk of stroke and thromboembolism in atrial fibrillation is established. However, the evidence surrounding the risk of thromboembolism in patients with atrial flutter is not as clear. We hypothesized that atrial flutter would have indicators of less risk for thromboembolism compared with atrial fibrillation on transesophageal echocardiography, thereby possibly leading to a lower stroke risk.
Source: The American Journal of Medicine - November 8, 2017 Category: General Medicine Authors: Jennifer J. Huang, Sridhar Reddy, Tam H. Truong, Prakash Suryanarayana, Joseph S. Alpert Tags: Clinical Research Study Source Type: research

Atrial Flutter Has Less Left Atrial Spontaneous Contrast and Higher Left Atrial Appendage Emptying Velocity Compared with Atrial Fibrillation
The risk of stroke and thromboembolism in atrial fibrillation is established. There are clear guidelines in anticoagulation management of patient's with atrial fibrillation, however, the evidence surrounding the risk of thromboembolism in patients with atrial flutter is not as clear. We hypothesized that atrial flutter would have indicators of less risk for thromboembolism compared with atrial fibrillation on transesophageal echocardiography (TEE); thereby possibly leading to a lower stroke risk.
Source: The American Journal of Medicine - November 8, 2017 Category: General Medicine Authors: Jennifer J. Huang, Sridhar Reddy, Tam H. Truong, Prakash Suryanarayana, Joseph S. Alpert Tags: Clinical Research Study Source Type: research

Edoxaban: How Does the Newest Agent Fit into the DOAC Landscape?
Edoxaban is the most recently approved factor Xa inhibitor within the class of direct oral anticoagulants (DOACs). Like other DOACs, edoxaban was approved by the US Food and Drug Administration for treatment of venous thromboembolism and prevention of stroke in patients with nonvalvular atrial fibrillation. Similar to other DOACs, edoxaban has fewer drug –drug interactions than warfarin and does not require routine laboratory monitoring. Unlike other DOACs, edoxaban has yet to be approved for secondary or postoperative venous thromboembolism thromboprophylaxis.
Source: The American Journal of Medicine - April 5, 2017 Category: General Medicine Authors: Caitlin M. Gibson, Shannon W. Finks Tags: Review Source Type: research

Edoxaban: Defining place in therapy for the newest direct acting oral anticoagulant
Edoxaban is the most recently approved factor Xa inhibitor within the class of direct oral anticoagulants (DOACs). Like other DOACs, edoxaban was approved by the FDA for treatment of venous thromboembolism and prevention of stroke in patients with non-valvular atrial fibrillation. Similar to other DOACs, edoxaban has fewer drug-drug interactions than warfarin and does not require routine laboratory monitoring. Unlike other DOACs, edoxaban has yet to be approved for secondary or postoperative venous thromboembolism thromboprophylaxis.
Source: The American Journal of Medicine - April 5, 2017 Category: Journals (General) Authors: Caitlin M. Gibson, Shannon W. Finks Tags: Review Source Type: research

Preclinical and Clinical Data for Factor Xa and “Universal” Reversal Agents
Oral Factor Xa (FXa) inhibitors, a growing class of direct-acting anticoagulants, are frequently used to prevent stroke and systemic embolism in patients with atrial fibrillation and to prevent and treat venous thromboembolism. These drugs reduce the risk of clotting at the expense of increasing the risk of bleeding, and currently they have no specific reversal agent. However, andexanet  alfa, a recombinant modified FXa decoy molecule, is in a late-phase clinical trial in bleeding patients, and ciraparantag, a small molecule that appears to reverse many anticoagulants including the FXa inhibitors, is in development.
Source: The American Journal of Medicine - August 26, 2016 Category: Journals (General) Authors: Truman J. Milling, Scott Kaatz Tags: Review Source Type: research

Cryptogenic Strokes and Patent Foramen Ovales: What's the Right Treatment?
More than 25% of all ischemic strokes per year are cryptogenic, that is, their cause is not determined after an appropriate evaluation. In 1988, it was reported that the incidence of a patent foramen ovale was 30 to 40% in young patients with a cryptogenic stroke compared with 25% in the general population. This led to the suspicion that cryptogenic strokes were due to paradoxical embolism, that is, a venous thrombus crossing a patent foramen ovale to enter the left atrium and then the arterial circulation.
Source: The American Journal of Medicine - August 22, 2016 Category: Journals (General) Authors: James E. Dalen, Joseph S. Alpert Tags: Review Source Type: research

Cryptogenic Strokes and Patent Foramen Ovales: What ’s The Right Treatment?
More than 25% of all ischemic strokes per year are cryptogenic; that is their cause is not determined after an appropriate evaluation.In 1988 it was reported that the incidence of a patent foramen ovale (PFO) was 30 to 40% in young patients with a cryptogenic stroke compared to 25% in the general population. This led to the suspicion that cryptogenic strokes were due to paradoxical embolism; that is a venous thrombus crossing a patent foramen ovale to enter the left atrium and then the arterial circulation.
Source: The American Journal of Medicine - August 22, 2016 Category: Journals (General) Authors: James E. Dalen, Joseph S. Alpert Tags: Review Source Type: research

Unmasking a Hidden Cause of Persistent Facial Ulceration: The Relevancy of a Neurologic Examination
A 49-year-old woman presented to the Emergency Department of a tertiary medical center for evaluation of chronic facial ulceration. Her past medical history was significant for type II diabetes mellitus, hypothyroidism, antiphospholipid antibody syndrome, venous thromboembolism, and stroke. The patient noted progressive ulceration around the left nasal ala with extension to the left eyebrow and eyelid for 2 years. She had been evaluated for this problem numerous times at outside medical facilities.
Source: The American Journal of Medicine - May 19, 2016 Category: Journals (General) Authors: Kyle W. Mahoney, Jules B. Lipoff, Bennett W. Clark Tags: Diagnostic dilemma Source Type: research

Unmasking a Hidden Cause of Persistent Facial Ulceration The Relevancy of a Neurologic Examination
A 49-year-old woman presented to the emergency room of a tertiary medical center for evaluation of chronic facial ulceration. Her past medical history was significant for type II diabetes mellitus, hypothyroidism, antiphospholipid antibody syndrome, venous thromboembolism, and stroke. The patient noted progressive ulceration around the left nasal ala with extension to the left eyebrow and eyelid for 2 years. She had been evaluated for this problem numerous times at outside medical facilities. Previous treatments included three 6-week courses of intravenous vancomycin, one 6-week course of daptomycin, and one 2-week course of oral acyclovir.
Source: The American Journal of Medicine - May 19, 2016 Category: Journals (General) Authors: Kyle W. Mahoney, Jules B. Lipoff, Bennett W. Clark Tags: Diagnostic Dilemma Source Type: research

Unmasking a Hidden Cause of Persistent Facial Ulceration: The Relevancy of a Neurologic Examination
A 49-year-old woman presented to the Emergency Department of a tertiary medical center for evaluation of chronic facial ulceration. Her past medical history was significant for type II diabetes mellitus, hypothyroidism, antiphospholipid antibody syndrome, venous thromboembolism, and stroke. The patient noted progressive ulceration around the left nasal ala with extension to the left eyebrow and eyelid for 2 years. She had been evaluated for this problem numerous times at outside medical facilities.
Source: The American Journal of Medicine - May 19, 2016 Category: Journals (General) Authors: Kyle W. Mahoney, Jules B. Lipoff, Bennett W. Clark Tags: Diagnostic dilemma Source Type: research

North American Thrombosis Forum, AF Action Initiative Consensus Document
The North American Thrombosis Forum Atrial Fibrillation Action Initiative consensus document is a comprehensive yet practical briefing document focusing on stroke and bleeding risk assessment in patients with atrial fibrillation, as well as recommendations regarding anticoagulation options and management. Despite the breadth of clinical trial data and guideline recommendation updates, many clinicians continue to struggle to synthesize the disparate information available. This problem slows the uptake and utilization of updated risk prediction tools and adoption of new oral anticoagulants.
Source: The American Journal of Medicine - April 26, 2016 Category: Journals (General) Authors: Christian T. Ruff, Jack E. Ansell, Richard C. Becker, Emelia J. Benjamin, David J. Deicicchi, N.A. Mark Estes, Michael D. Ezekowitz, John Fanikos, Jawed Fareed, David Garcia, Robert P. Giugliano, Samuel Z. Goldhaber, Christopher Granger, Jeff S. Healey, R Source Type: research

Thrombolysis; a critical first-line therapy with an unfulfilled potential
A blood clot or thrombus triggers the onset of most vascular diseases, like stroke or heart attack. Thrombolysis is the only treatment that can restore blood flow rapidly and easily. Unfortunately, the standard thrombolytic, tissue plasminogen activator (tPA), has proven inadequate and is being replaced by invasive endovascular procedures, which are time-consuming and limited in their availability in relation to the scope of the problem. Historically, when tPA clinical trials began, it was insufficiently recognized that without the other natural plasminogen activator, prourokinase (proUK), thrombolysis by tPA was seriously compromised.
Source: The American Journal of Medicine - December 20, 2015 Category: Journals (General) Authors: Victor Gurewich Tags: Review Source Type: research

Thrombolysis: A Critical First-Line Therapy with an Unfulfilled Potential
A blood clot or thrombus triggers the onset of most vascular diseases, like stroke or heart attack. Thrombolysis is the only treatment that can restore blood flow rapidly and easily. Unfortunately, the standard thrombolytic, tissue plasminogen activator (tPA), has proven inadequate and is being replaced by invasive endovascular procedures, which are time consuming and limited in their availability in relation to the scope of the problem. Historically, when tPA clinical trials began, it was not recognized sufficiently that without the other natural plasminogen activator, prourokinase (proUK), thrombolysis by tPA was seriously compromised.
Source: The American Journal of Medicine - December 20, 2015 Category: Journals (General) Authors: Victor Gurewich Tags: Review Source Type: research

Antiphospholipid syndrome: an important differential diagnosis for culture-negative endocarditis
Sometimes the initial diagnosis proves secondary to an illness that is diagnosed later. This was the case when a 37-year-old woman presented to the hospital with sudden-onset persistent left-sided weakness. While she reported pain in the right maxilla, lethargy, and malaise in the month prior to presentation, she denied headache, sensory change, visual disturbances, fever, chills or weight loss. Hypertension was her only cardiovascular risk factor, but she took no regular medications. She had no history of stroke, ischemic heart disease, deep vein thrombosis, pulmonary embolism, or miscarriage, and she had no family histor...
Source: The American Journal of Medicine - November 26, 2014 Category: Journals (General) Authors: Louis W. Wang, Baptiste Noël, Elodie Descloux, David W. Baron Source Type: research

NSAID Use and Association with Cardiovascular Outcomes in Outpatients with Stable Atherothrombotic Disease
Abstract: Background: Nonsteroidal anti-inflammatory drugs (NSAIDs) other than aspirin have been linked to heart failure, salt retention, adverse ventricular remodeling, and thrombosis. We therefore sought to assess their impact on cardiovascular events in outpatients with stable atherothrombotic disease.Methods: We analyzed 44,095 patients in the REduction of Atherothrombosis for Continued Health (REACH) registry with information on NSAID use and 4-year follow-up. Cox proportional hazard models, including NSAID use as a time-dependent covariate, were constructed and adjusted for key baseline characteristics. End points of...
Source: The American Journal of Medicine - November 25, 2013 Category: Journals (General) Authors: Payal Kohli, Ph. Gabriel Steg, Christopher P. Cannon, Sidney C. Smith, Kim A. Eagle, E. Magnus Ohman, Mark J. Alberts, Elaine Hoffman, Jianping Guo, Tabassome Simon, Emmanuel Sorbets, Shinya Goto, Deepak L. Bhatt, REACH Registry Investigators Tags: Clinical research studies Source Type: research

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