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On Hoofs and Zebras – Struma Ovarii
A 75-year-old mother of ten suffering from a urinary tract infection developed macrohematuria and therefore an abdominal ultrasound was performed, followed by a CT scan when an unexpected large pelvic mass was discovered. Past history included hypertension, paroxysmal atrial fibrillation, and remote history of minor stroke (on candesartan, dabigatran, bisoprolol); bilateral chronic lymphedema; and hysterectomy due to prolapse at the age of 40. Imaging revealed nephrolithiasis and a prominent left adnexal mass suspected as ovarian cancer.
Source: The American Journal of Medicine - July 20, 2023 Category: General Medicine Authors: Ami Schattner, Ina Dubin, Livnat Uliel, Daniela Dick-Necula Tags: Clinical Communication to the Editor Source Type: research

Anticoagulant-related intracranial haemorrhage: time to anticoagulant reversal improving but still slower than thrombolysis for ischaemic stroke.
CONCLUSION: Door-to-any-reversal-agent and scan-to-PCC times have improved over time, but they remain significantly longer than IS thrombolysis times. Monitoring of reversal is inadequate, particularly for WRICH receiving PCC. PMID: 33582709 [PubMed - in process]
Source: New Zealand Medical Journal - February 17, 2021 Category: General Medicine Tags: N Z Med J Source Type: research

Dabigatran Reversal with Idarucizumab Preceding Thrombolysis in an Octogenarian Patient with Chronic Kidney Disease and Acute Stroke: a Case Report.
CONCLUSION: Our case showed the effectiveness and safety of giving Idarucizumab followed by thrombolysis in Dabigatran-treated atrial fibrillation with ischemic stroke. Based on this case, the procedure can be performed in an elderly population with chronic kidney disease when administered close to the limit of threshold for thrombolysis. PMID: 32778345 [PubMed - as supplied by publisher]
Source: Clinical Therapeutics - August 6, 2020 Category: Drugs & Pharmacology Authors: Laxamana LC, Co COC, Yu JRT, Mojica CV, Iboleon-Dy MAM, Domingo AMC, Ilano KCS, Macrohon-Valdez MCZ Tags: Clin Ther Source Type: research

The management of patients with acute ischemic stroke while on direct oral anticoagulants (DOACs): data from an Italian cohort and a proposed algorithm
This study aimed at investigating whether there is any relationship between DOAC plasma levels and the stroke occurrence, on the basis of the phenotypic classification and pathophysiology of the stroke, in a cohort of DOAC-treated patients admitted to our hospital for AIS o ver 1-year period. A total of 28 patients had DOAC plasma levels determined in emergency and were included in the study, nine patients receiving dabigatran, 11 rivaroxaban and 8 apixaban. The DOAC levels were low in 8/28 patients (28.6% of the sample), intermediate in 4 (14.3%) and high in 16 (57.1% ). The most prevalent stroke subtype was the small ves...
Source: Journal of Thrombosis and Thrombolysis - April 16, 2020 Category: Hematology Source Type: research

Non-vitamin K oral anticoagulants in nonvalvular atrial fibrillation: A network meta-analysis.
CONCLUSIONS: This study adds an attempt for treatment ranking of both efficacy and safety outcomes. Future trials comparing directly NOACs are needed in order to provide conclusive proofs for these results and not only circumstantial evidence offered by a network meta-analysis. PMID: 30896311 [PubMed - as supplied by publisher]
Source: Scandinavian Cardiovascular Journal - March 23, 2019 Category: Cardiology Tags: Scand Cardiovasc J Source Type: research

Timing of anticoagulation after recent ischaemic stroke in patients with atrial fibrillation
Publication date: Available online 8 November 2018Source: The Lancet NeurologyAuthor(s): David J Seiffge, David J Werring, Maurizio Paciaroni, Jesse Dawson, Steven Warach, Truman J Milling, Stefan T Engelter, Urs Fischer, Bo NorrvingSummaryBackgroundAbout 13–26% of all acute ischaemic strokes are related to non-valvular atrial fibrillation, the most common cardiac arrhythmia globally. Deciding when to initiate oral anticoagulation in patients with non-valvular atrial fibrillation is a longstanding, common, and unresolved clinical challenge. Although the risk of early recurrent ischaemic stroke is high in this population,...
Source: The Lancet Neurology - November 9, 2018 Category: Neurology Source Type: research

The role of delayed head CT in evaluation of elderly blunt head trauma victims taking antithrombotic therapy
ConclusionsD-CTH in elderly trauma patients taking antithrombotic agents shows no statistically significant or clinical benefit for diagnosing delayed intracranial hemorrhage after minor head injury. In those with delayed imaging showing new ICH, management was not significantly altered. Not enough data were available to predict which patients would develop D-ICH, even if asymptomatic.
Source: European Journal of Trauma and Emergency Surgery - April 24, 2017 Category: Emergency Medicine Source Type: research

The gap between indicated and prescribed stroke prevention therapies in a high-risk geriatric population
ConclusionsThis data set suggests that 37% of eligible elderly LTC residents failed to receive recommended stroke prevention therapies.
Source: Journal of Interventional Cardiac Electrophysiology - January 15, 2017 Category: Cardiology Source Type: research

Reversing the effects of the new anti-clotting drugs
The oral anticoagulant warfarin (Coumadin) became available for prescription in 1954. This anti-clotting drug commanded national attention when President Dwight Eisenhower received the drug as part of his treatment following a heart attack. No other oral anticoagulant was successfully developed and marketed in the United States until 2010. Warfarin is a dangerous drug. Along with insulin, it is responsible for the most emergency hospitalizations due to adverse drug reactions. Whereas insulin causes low blood sugar, warfarin is notorious for the complication of major bleeding. Warfarin is plagued by hundreds of drug-drug an...
Source: New Harvard Health Information - December 9, 2015 Category: Consumer Health News Authors: Samuel Z. Goldhaber, MD Tags: Drugs and Supplements Health Heart Health Hypertension and Stroke anti-clotting coumadin deep-vein-thrombosis DVT Source Type: news

The Role of FEIBA in Reversing Novel Oral Anticoagulants in Intracerebral Hemorrhage
Conclusion In this small case series, reversal of NOAC with FEIBA was not associated with ICH expansion or any thrombotic or hemorrhagic complications.
Source: Neurocritical Care - November 6, 2015 Category: Neurology Source Type: research

A pulmonary vein thrombus in a patient with autonomic nervous dysfunction
Publication date: Available online 8 May 2015 Source:IJC Heart & Vasculature Author(s): Hidekazu Takeuchi Ischemic stroke is a serious clinical problem, and preventing ischemic stroke is an important clinical target. Left atrial thrombus is a known cause of ischemic stroke. In 2015, I reported that nearly all left atrial thrombi result from a pulmonary vein thrombus (PVT), indicating that PVT is associated with ischemic stroke. However, the relationship between PVT and autonomic nervous function is unknown. Although PVT is believed to be rare, since 2012, I have reported several cases of PVT in elderly patients w...
Source: IJC Heart and Vasculature - May 9, 2015 Category: Cardiology Source Type: research

Special MRI scan could identify stroke risk in people with atrial fibrillation
Atrial fibrillation is a heart rhythm disorder that affects millions of people. It can make you feel lousy. Even worse, it can cause potentially disabling or deadly strokes. A special MRI scan may — I stress the “may” — help identify people with atrial fibrillation who are at high risk of having a stroke. This could help many people with this condition to avoid taking warfarin or other clot-preventing medications for life. A normal heartbeat starts in a cluster of cells called the pacemaker. It sits in the heart’s upper right chamber (the right atrium). These cells generate a pulse of electricity that...
Source: New Harvard Health Information - April 28, 2015 Category: Consumer Health News Authors: Howard LeWine, M.D. Tags: Heart Health atrial fibrillation MRI prevention special MRI scan Stroke Stroke Risk Source Type: news

Abstract 161: Atrial Fibrillation in India: Insights from the PINNACLE India Outpatient Registry Session Title: Poster Session I
Conclusion: AF is tough to diagnose since it is often asymptomatic and clinicians need many tests to confirm diagnosis. Lack of documentation or detection of AF and its associated conditions is a concern. AF can lead to life threatening problems such as stroke and heart failure. The surveillance of AF in India is important in order to identify opportunities for intervention. Continued data collection through the use of a cardiovascular registry can improve the understanding of AF in India.
Source: Circulation: Cardiovascular Quality and Outcomes - June 2, 2014 Category: Cardiology Authors: Glusenkamp, N. T., Risch, S. A., Kerkar, P., Kumar, G., Oetgen, W. J. Tags: Session Title: Poster Session I Source Type: research

Dabigatran etexilate: management in acute ischemic stroke.
Abstract A 54-year-old man treated with dabigatran experienced new onset of a stroke with a score of 9 on the National Institutes of Health Stroke Scale. Administration of recombinant tissue plasminogen activator (rtPA) was not recommended because of the dabigatran therapy. Angiography showed occlusion of the left middle cerebral artery by an embolic thrombus. Suction thrombectomy achieved flow through the inferior division of the artery. Computed tomography of the head showed possible intracranial hemorrhage, and dabigatran reversal was attempted with prothrombin complex concentrate and recombinant factor VIIa. C...
Source: American Journal of Critical Care - March 1, 2013 Category: Nursing Authors: Javedani PP, Horowitz BZ, Clark WM, Lutsep HL Tags: Am J Crit Care Source Type: research