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Frequency of Hemorrhage on Follow Up Imaging in Stroke Patients Treated With rt-PA Depending on Clinical Course
Conclusions: Frequency of hemorrhagic transformation in Routine follow-up brain imaging and consecutive changes in therapeutic management were different depending on clinical course measured by NHISS score. Introduction Brain imaging 24–36 h after systemic thrombolysis for acute ischemic stroke is recommended in American Stroke Association and European Stroke Organization guidelines (1, 2). Brain imaging is performed to detect secondary bleeding or hemorrhagic transformation in order to adapt medical stroke prevention if necessary. Guideline recommendations are based on the results of the first study on rt-PA...
Source: Frontiers in Neurology - April 15, 2019 Category: Neurology Source Type: research

Asymptomatic Carotid Stenosis Is Associated With Circadian and Other Variability in Embolus Detection
Conclusions: Embolism associated with asymptomatic carotid stenosis shows circadian variation with highest rates 4–6 h before midday. This corresponds with peak circadian incidence of stroke and other vascular complications. These and ASED Study results show that monitoring frequency, duration, and time of day are important in ES detection. Introduction Transcranial Doppler (TCD) detected microembolism in the ipsilateral middle cerebral artery (MCA) may help stratify the risk of stroke and other arterial disease complications in persons with advanced (≥60%) asymptomatic carotid stenosis. If so, this t...
Source: Frontiers in Neurology - April 15, 2019 Category: Neurology Source Type: research

Angiographical Identification of Intracranial, Atherosclerosis-Related, Large Vessel Occlusion in Endovascular Treatment
Conclusions Among only a few identification methods, the ICAS-LVO can be feasibly identified by angiographical findings. The identification of ICAS-LVO based on based on occlusion type, is a reliable and practical identification method for ICAS-LVO. Procedural details by occlusion type and its predictability to endovascular results were reported. Furthermore, occlusion type can be determined before or in the early stages of the procedure, which may be most helpful in setting up an optimal endovascular treatment strategy. Author Contributions J-HB established the study idea, designed the manuscript structure, acquired an...
Source: Frontiers in Neurology - April 15, 2019 Category: Neurology Source Type: research

The Paradoxical Protective Effect of Liver Steatosis on Severity and Functional Outcome of Ischemic Stroke
Conclusions: Our study shows that a higher burden of liver steatosis seems to be associated with less severe stroke and better functional outcome after ischemic stroke or TIA. Introduction Non-alcoholic fatty liver disease (NAFLD) is a spectrum of diseases from simple steatosis to steatohepatitis with varying degree of fibrosis, and liver cirrhosis (1, 2). NAFLD is becoming the most common chronic liver disease worldwide including Korea, affecting approximately 25% of the general population (3, 4). NAFLD is closely associated with obesity, insulin resistance, and type 2 diabetes mellitus, and is even recognized as ...
Source: Frontiers in Neurology - April 11, 2019 Category: Neurology Source Type: research

Platelet Count Predicts Adverse Clinical Outcomes After Ischemic Stroke or TIA: Subgroup Analysis of CNSR II
Conclusion: In ischemic stroke or TIA patients with platelet count within normal range, platelet count may be a qualified predictor for long-term recurrent stroke, mortality, and poor functional outcome. Introduction Platelets exert a critical role in the pathogenesis of atherosclerotic complications of cardio-cerebrovascular disease, contributing to thrombus formation, and embolism (1, 2). Previous literature reported that platelets of various size and density are produced by megakaryocytes of different size and stages of maturation in different clinical conditions, suggesting various platelet patterns in differen...
Source: Frontiers in Neurology - April 11, 2019 Category: Neurology Source Type: research

Stenosis Length and Degree Interact With the Risk of Cerebrovascular Events Related to Internal Carotid Artery Stenosis
Conclusion: We found a statistically insignificant tendency for the ultrasound-measured length of sICAS<70% to be longer than that of sICAS≥70%. Moreover, the ultrasound-measured length of sICAS<90% was significantly longer than that of sICAS 90%. Among patients with sICAS≥70%, the degree and length of stenosis were inversely correlated. Larger studies are needed before a clinical implication can be drawn from these results. Introduction Internal carotid artery stenosis (ICAS) causes around one-fifth of ischemic cerebrovascular stroke and has the highest risk of early stroke recurrence...
Source: Frontiers in Neurology - April 8, 2019 Category: Neurology Source Type: research

Stroke Risk Stratification: CHA2DS2-VA or CHA2DS2-VASc?
It is with interest that we note the letter by Drs Overvad and colleagues in which concern is expressed regarding a newly proposed strategy in the recently published Australian Guidelines for Atrial Fibrillation (AF) [1]. Specifically we recommend that female sex category be dropped from the CHA2DS2-VASc score; therefore recommending a CHA2DS2-VA score.
Source: Heart, Lung and Circulation - March 30, 2019 Category: Cardiology Authors: David Brieger, Cia Connell, Ben Freedman Tags: Letter to the Editor Source Type: research

Adherence to antithrombotic therapy guidelines and atrial fibrillation in a rural hospital: a clinical audit.
CONCLUSIONS: This study confirms that the guidelines are routinely followed in clinical practice in this rural population. PMID: 30889960 [PubMed - in process]
Source: Rural and Remote Health - March 21, 2019 Category: Rural Health Tags: Rural Remote Health Source Type: research

Stroke Prevention, Evaluation of Bleeding Risk and Anticoagulant Treatment Management in Atrial Fibrillation Contemporary International Guidelines
Publication date: Available online 21 February 2019Source: Canadian Journal of CardiologyAuthor(s): Marco Proietti, Deirdre A. Lane, Giuseppe Boriani, Gregory Y.H. LipAbstractIn recent years the management of AF patients has progressively and substantially changed due to the introduction of new treatments and the availability of new data regarding the epidemiology and clinical management of these patients. In the last two years alone, there have been seven new guidelines or guideline updates that have been published, introducing new recommendations and significantly revising previously published ones. Two updates for Canad...
Source: Canadian Journal of Cardiology - February 22, 2019 Category: Cardiology Source Type: research

Factors affecting general practitioners ’ decisions to adopt new prescription drugs – cohort analyses using Australian longitudinal physician survey data
We investigate factors affecting Australian general practitioners ’ decisions to adopt novel oral anticoagulants (NOACs) for the prevention of stroke/systemic embolism among patients with atrial fibrillation. A...
Source: BMC Health Services Research - February 7, 2019 Category: General Medicine Authors: Yuting Zhang, Susan J. M éndez and Anthony Scott Tags: Research article Source Type: research

Factors affecting general practitioners' decisions to adopt new prescription drugs - cohort analyses using Australian longitudinal physician survey data.
CONCLUSIONS: Our paper is one of the first to study the relationship between GPs' risk preferences, personality and their decisions to adopt new prescription drugs. Because NOACs are commonly prescribed and considered more cost-effective than their older counterpart, understanding factors affecting physicians' decisions to adopt NOACs has direct policy implications. Our results also highlight that even with universal coverage for prescription drugs, access to new drugs is different among patients, partially because who their doctors are and where they practice. PMID: 30728010 [PubMed - in process]
Source: Australian Family Physician - February 7, 2019 Category: Primary Care Authors: Zhang Y, Méndez SJ, Scott A Tags: BMC Health Serv Res Source Type: research

Real World Experience of Direct Oral Anticoagulants with Comparison of Safety Outcomes to the Warfarin Era of Venous Thromboembolism Treatment
Conclusion:This retrospective audit shows that our local safety outcomes are comparable to clinical trials. Low dose anticoagulation and high falls risk (a surrogate marker of frailty) were significant risk factors for both clinically significant bleeding and thrombotic stroke in the DOAC population. These patients are likely frailer with greater co-morbidities and have shared risk factors for bleeding and stroke, suggesting that for these high risk patients, low dose anticoagulation does not negate their risk of complications and careful prescribing and close monitoring remain essential.The sub-comparison between VTE pati...
Source: Blood - November 21, 2018 Category: Hematology Authors: Brook, R., Aswapanyawongse, N., Lim, H. Y., Ho, P. Tags: 331. Pathophysiology of Thrombosis: Poster II Source Type: research

Pioneering Australia ’s First Atrial Fibrillation Guidelines
Atrial fibrillation (AF) is the most common arrhythmia seen in clinical practice, and has a major impact on morbidity and mortality; linked to one in 12 deaths in Australia [2]. Though appropriate rhythm management and stroke prevention are essential, arguably, prevention is likely to achieve the greatest impact on these outcomes. These Australian-first guidelines [1], developed by the Heart Foundation and the Cardiac Society of Australia and New Zealand, incorporate the latest contemporary evidence in AF prevention by recommending a holistic approach.
Source: Heart, Lung and Circulation - November 1, 2018 Category: Cardiology Authors: Cia Connell, Garry L.R. Jennings Tags: Editorial Source Type: research

National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the diagnosis and management of atrial fibrillation 2018.
Authors: Brieger D, Amerena J, Attia JR, Bajorek B, Chan KH, Connell C, Freedman B, Ferguson C, Hall T, Haqqani HM, Hendriks J, Hespe CM, Hung J, Kalman JM, Sanders P, Worthington J, Yan T, Zwar NA Abstract INTRODUCTION: Atrial fibrillation (AF) is increasing in prevalence and is associated with significant morbidity and mortality. The optimal diagnostic and treatment strategies for AF are continually evolving and care for patients requires confidence in integrating these new developments into practice. These clinical practice guidelines will assist Australian practitioners in the diagnosis and management of adult ...
Source: Medical Journal of Australia - August 3, 2018 Category: General Medicine Tags: Med J Aust Source Type: research

NOACs Now Mainstream for the Use of Anticoagulation in Non-Valvular Atrial Fibrillation in Australia.
The management of stroke risk in patients with non-valvular atrial fibrillation has changed over the past few years. This change has occurred due to the introduction of novel oral anticoagulants (NOACs) such as apixaban, rivaroxaban and dabigatran for the management of non-valvular atrial fibrillation. These agents have shown comparable stroke risk reduction to warfarin in large international multicentre trials [1 –3]. This has changed the clinical practice of many treating physicians since their introduction from 2011 to 2013.
Source: Heart, Lung and Circulation - March 22, 2018 Category: Cardiology Authors: Derk Pol, Claire Curtis, Satish Ramukumar, Logan Bittinger Tags: Brief Communication Source Type: research

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