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Source: Journal of the American College of Cardiology
Condition: Ischemic Stroke
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Total 78 results found since Jan 2013.
Thromboembolic, Bleeding, and Mortality Risks of Rivaroxaban and Dabigatran in Asians With Nonvalvular Atrial Fibrillation
BackgroundIt is unclear whether the non –vitamin K antagonist oral anticoagulant agents rivaroxaban and dabigatran are superior to warfarin for efficacy and safety outcomes in Asians with nonvalvular atrial fibrillation (NVAF).ObjectivesThe aim of this study was to compare the risk for thromboembolic events, bleeding, and mortality associated with rivaroxaban and dabigatran versus warfarin in Asians with NVAF.MethodsA nationwide retrospective cohort study was conducted of consecutive patients with NVAF taking rivaroxaban (n = 3,916), dabigatran (n = 5,921), or warfarin (n = 5,251) using data collected from the Taiwan...
Source: Journal of the American College of Cardiology - September 20, 2016 Category: Cardiology Source Type: research
Effect of New Cerebral Ischemic Lesions on the Delirium Occurrence After Transcatheter Aortic Valve Replacement
Although only 2% to 5% of patients develop symptomatic stroke following transcatheter aortic valve replacement (TAVR), new cerebral lesions have been detected among the majority of these patients using diffusion weighted magnetic resonance imaging (DWI-MRI), irrespective of access site strategy(1). According to the published reports, new cerebral DWI lesions have been associated with future neurological and cognitive decline; however, the relationship between these lesions and post-operative delirium (POD) following TAVR remains unknown. By means of this study, we aimed to assess the impact of new cerebral DWI lesions on t...
Source: Journal of the American College of Cardiology - September 20, 2016 Category: Cardiology Source Type: research
Thrombotic and Embolic Complications Associated With Atrial Arrhythmia After Fontan Operation Role of Prophylactic Therapy
This study sought to determine the risk of TEC in this population and the role of anticoagulation therapy in TEC prevention.MethodsThis was a retrospective review of adults with atrial arrhythmia after Fontan operation who were evaluated at the Mayo Clinic between 1994 to 2014. TEC was classified into 2 groups: systemic TEC, defined as intracardiac thrombus, ischemic stroke, or systemic arterial embolus; and nonsystemic TEC, defined as Fontan conduit/right atrial thrombus or pulmonary embolus. Patients were divided into 3 groups: anticoagulation, antiplatelet, and no therapy cohorts.ResultsWe followed 278 patients, mean ag...
Source: Journal of the American College of Cardiology - September 13, 2016 Category: Cardiology Source Type: research
Cerebral Embolism A Silent Iatrogenic Complication of TAVR That Needs Voiced Consideration ∗
Transcatheter aortic valve replacement (TAVR) has rapidly and definitely changed the way patients with aortic stenosis are treated. Both the number of procedures and the indications have increased worldwide, allowing the inoperable patient to be treated, the high risk patient to be treated less invasively, and the intermediate risk patient to have the choice of an alternative to surgery (1–4). Clinical stroke or transient ischemic attack is not uncommon after aortic stenosis treatment, ranging in the randomized studies from 5% to 6% at 30 days to 8% to 10% at 1 year —one-half of them being major/disabling strokes (Tabl...
Source: Journal of the American College of Cardiology - August 2, 2016 Category: Cardiology Source Type: research
Stroke Prediction in Atrial Fibrillation Is it Black and White? ∗
Atrial fibrillation (AF) is a common arrhythmia that predisposes patients to risk of stroke (1) that can be prevented with anticoagulation (2) . However, a minority of patients with AF and risk of stroke are treated with anticoagulants (3) , with undertreatment being due to a variety of factors. Optimizing treatment depends, in part, on the ability to understand risks, benefits, and personal preferences of individual patients. The CHADS 2 (congestive heart failure, hypertension, age ≥75 years, diabetes, and 2 points for prior stroke or transient ischemic attack) scoring system has been useful for stratifying risk of ...
Source: Journal of the American College of Cardiology - July 26, 2016 Category: Cardiology Source Type: research
Aspirin Instead of Oral Anticoagulant Prescription in Atrial Fibrillation Patients at Risk for Stroke
ConclusionsIn a large, real-world cardiac outpatient population of AF patients with a moderate to high risk of stroke, more than 1 in 3 were treated with aspirin alone without OAC. Specific patient characteristics predicted prescription of aspirin therapy over OAC.
Source: Journal of the American College of Cardiology - June 21, 2016 Category: Cardiology Source Type: research
Aspirin in Atrial Fibrillation The Clot Thickens ∗
Aspirin is the original “wonder drug,” used in various forms for thousands of years for its analgesic, antipyretic, and anti-inflammatory properties (1), and more recently, for its ability to inhibit platelet aggregation, reducing the risk for occlusive vascular events associated with acute coronary syndromes, transient cerebral ischemic attacks and stroke, and peripheral vascular disease (2).
Source: Journal of the American College of Cardiology - June 21, 2016 Category: Cardiology Source Type: research
Ticagrelor for Prevention of Ischemic Events After Myocardial Infarction in Patients With Peripheral Artery Disease
This study evaluated the efficacy and safety of ticagrelor on major cardiovascular (CV) events and major adverse limb events in patients with PAD and a prior MI.MethodsPEGASUS-TIMI 54 (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin—Thrombolysis In Myocardial Infarction 54) randomized 21,162 patients with prior MI (1 to 3 years) to ticagrelor 90 mg twice daily, ticagrelor 60 mg twice daily, or placebo, all on a background of low-dose aspirin. History of PAD was obtained at baseline. Occurrences of major adverse cardiovascular events (...
Source: Journal of the American College of Cardiology - June 7, 2016 Category: Cardiology Source Type: research
The Development of Therapeutics for Peripheral Artery Disease A Unique Cardiovascular Risk Population ∗
Peripheral artery disease (PAD) primarily manifests as occlusive atherosclerosis in the peripheral circulation to the lower extremities (1). Symptomatic patients have either a profound exercise limitation or develop critical limb ischemia, and all of these patients are at heightened risk for major cardiovascular and ischemic limb events (2). Despite a severe morbidity and mortality risk, historically, little attention has been paid to developing targeted therapies to reduce this risk in patients with PAD (3). However, there were early signals that PAD may be responsive to potent antiplatelet therapy in the CAPRIE (Clopidog...
Source: Journal of the American College of Cardiology - June 7, 2016 Category: Cardiology Source Type: research
Reduction in Ischemic Events With Ticagrelor in Diabetic Patients With Prior Myocardial Infarction in PEGASUS–TIMI 54
ConclusionsIn patients with diabetes with prior MI, adding ticagrelor to aspirin significantly reduces the risk of recurrent ischemic events, including cardiovascular and coronary heart disease death. (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin [PEGASUS]; NCT01225562)
Source: Journal of the American College of Cardiology - June 7, 2016 Category: Cardiology Source Type: research
Acute Ischemic Stroke Intervention
Acute ischemic stroke (AIS) is the leading cause of disability worldwide and among the leading causes of mortality. Although intravenous tissue plasminogen activator (IV-rtPA) was approved nearly 2 decades ago for treatment of AIS, only a minority of patients receive it due to a narrow time window for administration and several contraindications to its use. Endovascular approaches to recanalization in AIS developed in the 1980s, and recently, 5 major randomized trials showed an overwhelming superior benefit of combining endovascular mechanical thrombectomy with IV-rtPA over IV-rtPA alone. In this paper, we discuss the evol...
Source: Journal of the American College of Cardiology - May 30, 2016 Category: Cardiology Source Type: research
Recent Endovascular Stroke Trials and Their Impact on Stroke Systems of Care
Five recently published randomized trials of endovascular therapy versus medical management, including intravenous thrombolysis, demonstrated strong positive data in support of intra-arterial thrombectomy procedures. The American Heart Association/American Stroke Association released a focused update of the 2013 guidelines on the early management of acute ischemic strokes to specifically incorporate the findings of the 5 “positive” trials. In this review, we examine the key results of those trials and the principal changes in the updated guidelines. We discuss the ongoing and future changes in stroke systems of care, w...
Source: Journal of the American College of Cardiology - May 30, 2016 Category: Cardiology Source Type: research
Comparing the ATRIA, CHADS 2 , and CHA 2 DS 2 -VASc Scores for Stroke Prediction in Atrial Fibrillation
Van den Ham et al. (1) recently compared the ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation), CHADS2 (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack), and CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack, vascular disease, age 65 to 74 years, female) stroke risk scores in a primary care community cohort of patients with first-diagnosed atrial fibrillation (AF) not using oral anticoagulation (OAC) for undefined reasons. They concluded that improved risk ...
Source: Journal of the American College of Cardiology - May 10, 2016 Category: Cardiology Source Type: research
Reply Comparing the ATRIA, CHADS 2 , and CHA 2 DS 2 -VASc Scores for Stroke Prediction in Atrial Fibrillation
We tested the ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation), CHADS2 (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke), and CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, prior stroke or transient ischemic attack, vascular disease, age 65 to 74 years, female) stroke risk scores in the CPRD (Clinical Practice Research Datalink) cohort of incident atrial fibrillation (AF) patients not using oral anticoagulants (OAC) because these are the patients for whom physicians must make the OAC treatment decision (1). The mean patient follo...
Source: Journal of the American College of Cardiology - May 10, 2016 Category: Cardiology Source Type: research
Recent Diabetes and Atrial Fibrillation Report Diverges From Pre-Existing Evidence
We read with interest the study by Ashburner et al. (1), investigating associations between duration of diabetes, glycemic control, and risk of ischemic stroke in patients with atrial fibrillation (AF) in the ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) cohort.
Source: Journal of the American College of Cardiology - May 10, 2016 Category: Cardiology Source Type: research
