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The Reply
Dr. Jolobe, in his comments on our case study,1 is quite right in highlighting 2 pertinent examples of the potentially severe iatrogenic patient harm that may result from erroneous treatment of pauci-symptomatic acute type A aortic dissection masquerading and possibly misdiagnosed as an acute vascular event, be it ischemic stroke, acute myocardial infarction, or pulmonary thromboembolism.
Source: The American Journal of Medicine - August 1, 2021 Category: General Medicine Authors: Ami Schattner Tags: Letter Source Type: research

A comprehensive cardiovascular-renal-metabolic risk reduction approach to patients with Type 2 Diabetes Mellitus
Cardiovascular disease remains the leading cause of morbidity and mortality among patients with type 2 diabetes mellitus, despite decades of research into risk reduction strategies (1,2). While myocardial infarction and ischemic stroke are the most recognized drivers of mortality in this population, less well-appreciated forms of cardiovascular disease, including heart failure and peripheral arterial disease, also contribute significantly to this risk (3-5). Further, the development of renal disease among patients with type 2 diabetes mellitus is common (6), and it drastically increases the risk of cardiovascular disease a...
Source: The American Journal of Medicine - May 21, 2021 Category: General Medicine Authors: Neha J. Pagidipati, Dr. Prakash Deedwania Tags: Review Source Type: research

Oral Anticoagulation Use in High-Risk Patients Is Improved by Elimination of False-Positive and Inactive Atrial Fibrillation Cases
Multiple registries have reported that>40% of high-risk atrial fibrillation patients are not taking oral anticoagulants. The purpose of our study was to determine the presence or absence of active atrial fibrillation and CHA2DS2-VASc (Congestive heart failure, Hypertension, Age ≥75 y, Diabetes mellitus, prior Stroke [or transient ischemic attack or thromboembolism], Vascular disease, Age 65-74 y, Sex category) risk factors to accurately identify high-risk atrial fibrillation (CHA2DS2-VASc ≥2) patients requiring oral anticoagulants and the magnitude of the anticoagulant treatment gap.
Source: The American Journal of Medicine - December 23, 2020 Category: General Medicine Authors: Gerald V. Naccarelli, Mohammed Ruzieh, Deborah L. Wolbrette, Mauricio Sendra-Ferrer, John van Harskamp, Barbara Bentz, Gregory Caputo, Nathan McConkey, Kevin Mills, Stephen Wasemiller, Jovan Plamenac, Douglas Leslie, Frendy D. Glasser, Thomas W. Abendroth Tags: Clinical Research Study Source Type: research

High Fluctuation Between Anticoagulants, Frequent Off-Label Dosing, and No Difference Concerning Outcomes: Results of a Real-Life Cohort Study
Recently published studies indicated a high proportion of patients taking direct oral anticoagulants (DOACs) are off-label under- or overdosed. The present study aimed at investigating whether off-label dosages are corrected over time and whether off-label doses are associated with differences in bleeding rates, ischemic stroke, or venous thromboembolism.
Source: The American Journal of Medicine - October 24, 2020 Category: General Medicine Authors: Corinne M. Eschler, Ana Antelo, Georg-Christian Funk, Aristomenis K. Exadaktylos, Gregor Lindner Tags: Clinical Research Study Source Type: research

LDL Cholesterol and Ischemic Stroke in Patients with Nonvalvular Atrial Fibrillation
We examined the association between LDL-C levels and incident stroke in patients with atrial fibrillation treated with direct oral anticoagulants (DOACs).
Source: The American Journal of Medicine - September 28, 2020 Category: General Medicine Authors: Alexander Omelchenko, Tzipi Hornik-Lurie, Hagit Gabay, Saar Minha, Abid Assali, David Pereg Tags: Clinical Research Study Source Type: research

LDL-cholesterol and ischemic stroke in patients with non-valvular atrial fibrillation
We examined the association between LDL-C levels and incident stroke in patients with atrial fibrillation treated with direct oral anticoagulants (DOACs).
Source: The American Journal of Medicine - September 27, 2020 Category: General Medicine Authors: Alexander Omelchenko, Tzipi Hornik-Lurie, Hagit Gabay, Saar Minha, Abid Assali, David Pereg Source Type: research

Q Fever, CNS Vasculitis, and Stroke: A Case Report
A 43-year-old male pet shop owner on leflunomide for seronegative rheumatoid arthritis presented locally with strange behavior and aphasia, preceded by flu-like symptoms and high fevers. Initial workup revealed cerebrospinal fluid lymphocytic pleocytosis (22 cells, 74% lymphocytes), for which he was started on empiric antimicrobial therapy. Magnetic resonance imaging of the brain revealed extensive, bilateral ischemic strokes (Figure). A transesophageal echocardiogram was negative. He was then transferred to our institution for further evaluation.
Source: The American Journal of Medicine - May 27, 2020 Category: General Medicine Authors: Jason Maljaars, Santiago Ortega-Gutierrez, Tracey Cho, Amir Shaban Tags: Clinical Communication to the Editor Source Type: research

A Case of Acute Ischemic Stroke and CNS vasculitis in a Patient with Q Fever
A 43-year-old male pet shop owner on leflunomide for seronegative rheumatoid arthritis presented locally with strange behavior and aphasia, preceded by flu-like symptoms and high fevers. Initial workup revealed cerebrospinal fluid lymphocytic pleocytosis (22 cells, 74% lymphocytes), for which he was started on empiric antimicrobial therapy. A brain MRI revealed extensive, bilateral ischemic strokes (Figure 1). A transesophageal echocardiogram (TEE) was negative. He was then transferred to our institution for further evaluation.
Source: The American Journal of Medicine - May 27, 2020 Category: General Medicine Authors: Jason Maljaars, Santiago Ortega-Gutierrez, Tracey Cho, Amir Shaban Tags: Clinical Communication to the Editor Source Type: research

Coma during a febrile illness – Respiratory Syncytial Virus-triggered ischemic stroke
An active 79-year-old woman was admitted in early December in coma.
Source: The American Journal of Medicine - May 18, 2020 Category: General Medicine Authors: Ami Schattner, Yair Glick, Ina Dubin Tags: CCE Source Type: research

Albuminuria and Risk of Cardiovascular Events and Mortality in a General Population of Patients with Type 2 Diabetes without Cardiovascular Disease: A Danish Cohort Study
Albuminuria level is associated with cardiovascular events and mortality in patients with diabetes. However, little is known about the association between albuminuria level in diabetes patients without overt cardiovascular disease. We aimed to examine the association between albuminuria level and the risk of ischemic stroke, myocardial infarction, and all-cause mortality in patients with type 2 diabetes without overt cardiovascular disease.
Source: The American Journal of Medicine - March 19, 2020 Category: General Medicine Authors: Mia Vicki Fangel, Peter Br ønnum Nielsen, Jette Kolding Kristensen, Torben Bjerregaard Larsen, Thure Filskov Overvad, Gregory YH Lip, Martin Bach Jensen Tags: Clinical Research Study Source Type: research

Cardiovascular and cerebrovascular safety of testosterone replacement therapy among aging men with low testosterone levels: a cohort study
We assessed the risk of ischemic stroke, transient ischemic attack, and myocardial infarction associated with testosterone replacement therapy (TRT) among aging men with low testosterone levels.
Source: The American Journal of Medicine - April 2, 2019 Category: General Medicine Authors: Simone Y. Loo, Laurent Azoulay, Rui Nie, Sophie Dell'Aniello, Oriana Hoi Yun Yu, Christel Renoux Tags: Clinical Research Study Source Type: research

Management of Acute Ischemic Stroke
The treatment of acute ischemic stroke has undergone a revolution recently with the publication of five positive thrombectomy trials in the early time window, 0-6 hours from stroke onset in 2015 and the more recent publication of two positive late window trials that included carefully selected patients up to 24 hours from stroke onset.1-3 The treatment efficacy of thrombectomy was highly robust in both time windows and the benefits can likely be expanded to less strictly selected patients. The treatment of acute ischemic stroke with thrombectomy built upon the more modest benefits observed previously with i.v.
Source: The American Journal of Medicine - October 25, 2018 Category: General Medicine Authors: Yunyun Xiong, Bharti Manwani, Marc Fisher Tags: Review Source Type: research

Concomitant use of direct oral anticoagulants with antiplatelet agents and the risk of major bleeding in patients with non-valvular atrial fibrillation
Direct oral anticoagulants (DOACs) are increasingly being used for ischemic stroke prevention among patients with non-valvular atrial fibrillation,1,2 partly because of their favorable efficacy and safety compared with vitamin K antagonists (VKAs).3 However, the safety of DOACs in patients with non-valvular atrial fibrillation requiring additional use of antiplatelet agents remains uncertain. This is important, as up to 30% of patients with non-valvular atrial fibrillation may receive concomitant treatments of oral anticoagulants with antiplatelets due to comorbid cardiovascular conditions.
Source: The American Journal of Medicine - October 25, 2018 Category: General Medicine Authors: Antonios Douros, Christel Renoux, Hui Yin, Kristian B. Filion, Samy Suissa, Laurent Azoulay Tags: Clinical Research Study Source Type: research

Arterial Ischemic Events Are a Major Complication in Cancer Patients with Venous Thromboembolism
A number of studies revealed that patients with venous thromboembolism are at increased risk of developing subsequent arterial ischemic events, such as myocardial infarction or stroke.1 –8 Prevention of such arterial ischemic events in addition to treating venous thromboembolismmay warrant combination therapy with antiplatelets and anticoagulants. Recent studies suggested an increased risk of arterial ischemic events in cancer patients.9,10 Accurate identification of patients at increased risk for arterial ischemic events during the course of anticoagulation for venous thromboembolismmay help to select those who would po...
Source: The American Journal of Medicine - May 26, 2018 Category: General Medicine Authors: Benjamin Brenner, Behnood Bikdeli, Inna Tzoran, Olga Madridano, Raquel L ópez-Reyes, José María Suriñach, Ángeles Blanco-Molina, Antonella Tufano, Juan José López Núñez, Javier Trujillo-Santos, Manuel Monreal, for the RIETE Investigators Tags: Clinical Research Study Source Type: research

Impact of Atrial Fibrillation on Cognitive Function, Psychological Distress, Quality of Life, and Impulsiveness
Atrial fibrillation is the most common cardiac arrhythmia and a known risk factor for cerebrovascular stroke. Atrial fibrillation and longstanding hypertension may produce ischemic lesions leading to progressive cognitive impairment. The impact of atrial fibrillation alone on cognitive impairment has not been evaluated. Our objective was to compare cognitive function, quality of life, psychological distress, and impulsiveness in people with atrial fibrillation and a matched control group.
Source: The American Journal of Medicine - February 4, 2018 Category: General Medicine Authors: Rokas Serpytis, Aurelija Navickaite, Emilija Serpytiene, Jurate Barysiene, Germanas Marinskis, Dalius Jatuzis, Zaneta Petrulioniene, Aleksandras Laucevicius, Pranas Serpytis Tags: Clinical Research Study Source Type: research

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