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Racial and Ethnic Disparities in Stroke Prevention for Atrial Fibrillation
Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting around 2% of the population (1,2) and increasing the risk of stroke by 4 to 5 times (3). Anticoagulation with Vitamin K antagonists (VKAs) such as Warfarin (4) or the newer Direct Oral Anticoagulants (DOACs) (4,5) reduces this risk by up to 60%. AF-related strokes also tend to be more severe and disabling (6).
Source: The American Journal of Medicine - December 7, 2022 Category: General Medicine Authors: Peter Calvert, Kamala Tamirisa, Amin Al-Ahmad, Gregory Y H Lip, Dhiraj Gupta Tags: Review Source Type: research

Oral Anticoagulant Use for Patients with Atrial Fibrillation with Concomitant Anemia and/or Thrombocytopenia
Atrial fibrillation is the most common sustained cardiac arrhythmia in clinical practice, which is associated with an increased risk of thromboembolism, heart failure and mortality.1 Previous studies in atrial fibrillation patients have reported that abnormal hemoglobin and platelet counts may be associated with adverse events. However, these studies that specifically examined the associations between hemoglobin and platelet levels and adverse outcomes reported conflicting data.2-5 Although warfarin effectively reduces the risk of ischemic stroke by 64% compared to placebo/control,6 and non-vitamin K antagonist oral antico...
Source: The American Journal of Medicine - April 2, 2022 Category: General Medicine Authors: Yung-Hsin Yeh, Yi-Hsin Chan, Shao-Wei Chen, Shang-Hung Chang, Chun-Li Wang, Chi-Tai Kuo, Gregory Y.H. Li, Shih-Ann Chen, Tze-Fan Chao Tags: Clinical Research Study Source Type: research

Non-Vitamin K Antagonists versus Warfarin in Patients with Atrial Fibrillation and Bioprosthetic Valves: a Systematic Review and Meta-Analysis
Patients with bioprosthetic heart valves and valve repair with concomitant atrial fibrillation are at an increased risk of thromboembolic events.1-5 Until recently, there was a paucity of randomized data to guide the optimal anticoagulation strategy in this patient population. In a prior meta-analysis of 4 randomized studies in patients with atrial fibrillation and valvular heart disease, excluding significant mitral stenosis and mechanical valves, there was a significant reduction in the risk of stroke or systemic embolism with non-vitamin K antagonist oral anticoagulants (NOACs) vs.
Source: The American Journal of Medicine - October 7, 2021 Category: General Medicine Authors: Rhanderson Cardoso, Caique M.P. Ternes, Gustavo B. Justino, Amanda Fernandes, Ana Vitoria Rocha, Leonardo Knijnik, Andre d'Avila, Renato D. Lopes Tags: Clinical Research Study Source Type: research

Regular bleeding risk assessment associated with reduction in bleeding outcomes: The mAFA II randomised trial
Oral anticoagulants (OAC) are highly effective for the prevention of stroke in patients with atrial fibrillation.1,2 However, bleeding events are a detrimental side effect of OAC use, even despite the reduced risk of intracranial haemorrahge with the use of non –vitamin K antagonist oral anticoagulants (NOACs) with major bleeding rates at 2% to 4% and any bleeding of 11%-18% per year.3 Some of these bleeding events are non-clinically relevant bleeding, and overall there is a positive net clinical benefit for using OACs for stroke prevention for the major ity of atrial fibrillation patients.
Source: The American Journal of Medicine - April 11, 2020 Category: General Medicine Authors: Yutao Guo, Deirdre A. Lane, Yundai Chen, Gregory Y.H. Lip, mAF-App II Trial investigators Source Type: research

Oral anticoagulation in emergency department patients: high rates of off-label doses,no difference in bleeding rates
Patients with oral anticoagulation constitute an increasing proportion in the present medical routine.1 The approval of the first direct oral anticoagulant (DOAC) dabigatran by the U.S. food and drug administration in 2010 for the purpose of stroke prevention in patients with non-valvular atrial fibrillation revolutionized the therapy strategies of this entity since the Vitamin-K antagonists (VKA) warfarin, phenprocoumon and acenocoumarol had been the only available oral anticoagulants for decades.
Source: The American Journal of Medicine - October 23, 2019 Category: General Medicine Authors: Corinne M. Eschler, Bertram K. Woitok, Georg-Christian Funk, Philipp Walter, Volker Maier, Aristomenis K. Exadaktylos, Gregor Lindner Tags: Clinical Research Study Source Type: research

Etiological research using observational data, and net clinical benefit. Simplicity and practicality matter
Atrial fibrillation in an elderly patient requires oral anticoagulant (OAC) treatment, and contemporary international guidelines recommend treatment for atrial fibrillation patients at 75years or older.1,2 Substantial evidence (mostly in favour) of non-vitamin K antagonist oral anticoagulants (NOACs), in comparison with warfarin, has emerged over the past decade. In particular, the benefits from a lower risk of intracranial bleeding and the non-requirement for monitoring of anticoagulant effects have driven the uptake of NOACs as the preferred choice for stroke prevention in atrial fibrillation, although some regional differences are evident.
Source: The American Journal of Medicine - March 4, 2019 Category: General Medicine Authors: Peter Br ønnum Nielsen, Iain Buchan, Gregory Y.H. Lip Tags: Editorial Source Type: research

Comparative stroke, bleeding, and mortality risks in older Medicare patients treated with oral anticoagulants for nonvalvular atrial fibrillation
Non-vitamin K antagonist oral anticoagulants (NOACs) are alternatives to warfarin in patients with nonvalvular atrial fibrillation. Randomized trials compared NOACs to warfarin, but none have compared individual NOACs against each other for safety and effectiveness.
Source: The American Journal of Medicine - January 9, 2019 Category: General Medicine Authors: David J. Graham, Elande Baro, Rongmei Zhang, Jiemin Liao, Michael Wernecke, Marsha E. Reichman, Mao Hu, Onyekachukwu Illoh, Yuqin Wei, Margie R. Goulding, Yoganand Chillarige, Mary Ross Southworth, Thomas E. MaCurdy, Jeffrey A. Kelman Tags: Clinical Research Study 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

Intracranial Calcification Due to Hypoparathyroidism
A 70-year-old Japanese man with a history of idiopathic hypoparathyroidism presented to the Emergency Department of our hospital owing to weakness in his right leg. Although his primary care doctor had prescribed activated vitamin D analogues, his serum calcium level was slightly low at 8.0  mg/dL. Owing to suspicions of stroke, he underwent radiographic imaging of the head. Computed tomography revealed bilateral and symmetrical calcifications in the basal ganglia, cerebellum, and at the gray-white junction in the axial image and the sagittal image (Figure).
Source: The American Journal of Medicine - January 16, 2018 Category: General Medicine Authors: Ko Harada, Tatsuya Fujikawa Tags: Clinical Communication to the Editor Source Type: research

Non-Vitamin K Antagonist Oral Anticoagulants for Cardioversion in Atrial Fibrillation: An Updated Meta-analysis
Non-vitamin K oral anticoagulants are now proven alternatives to vitamin K antagonists for stroke prevention in atrial fibrillation. However, there are few data on the efficacy and safety of their use for cardioversion, in which the risk of thromboembolic events is heightened.
Source: The American Journal of Medicine - October 13, 2016 Category: Journals (General) Authors: Giulia Renda, Fabrizio Ricci, Raffaele De Caterina Tags: Clinical research study Source Type: research

Raised Intracranial Pressure Secondary to Vitamin Overdose
We report a patient for whom multi-vitamin ingestion was associated with neurological symptoms which mimicked acute stroke.
Source: The American Journal of Medicine - December 16, 2015 Category: Journals (General) Authors: Christopher Keith Oldroyd, Matthew Walters, Krishna Dani Tags: Clinical Communication to the Editor Source Type: research

Dabigatran and warfarin for secondary prevention of stroke in atrial fibrillation patients: A nationwide cohort study
This study revealed, that in clinical practice, vitamin K antagonist-experienced patients with a history of stroke or transient ischemic attack who switch to dabigatran therapy may have an increased rate of a recurrent stroke compared to patients persisting with vitamin K antagonist therapy.
Source: The American Journal of Medicine - September 1, 2014 Category: Journals (General) Authors: Torben Bjerregaard Larsen, Lars Hvilsted Rasmussen, Anders Gorst-Rasmussen, Flemming Skjøth, Deirdre A. Lane, Gregory Y.H. Lip Source Type: research

SAME-TTR score, time in therapeutic range and outcomes in anticoagulated patients with atrial fibrillation
Oral anticoagulation is highly effective preventing stroke and mortality in non-valvular atrial fibrillation patients. However, the efficacy and safety of vitamin K antagonists, the main oral anticoagulation drug used) strongly depends upon the quantity of anticoagulation control, as reflected by the average percentage of the time in therapeutic range of INR (International Normalised Ratio) 2.0-3.0. An easy, simple prediction of which atrial fibrillation patients are likely to do well on vitamin K antagonists (with good average time in therapeutic range) could guide decision-making between using vitamin K antagonists (eg.
Source: The American Journal of Medicine - May 22, 2014 Category: Journals (General) Authors: Pilar Gallego, Vanessa Roldán, Francisco Marin, José Gálvez, Mariano Valdés, Vicente Vicente, Gregory Y.H. Lip Source Type: research

SAMe-TTR Score, Time in Therapeutic Range, and Outcomes in Anticoagulated Patients with Atrial Fibrillation
Oral anticoagulation is highly effective in preventing stroke and mortality in nonvalvular atrial fibrillation patients. However, the efficacy and safety of vitamin K antagonists (the main oral anticoagulation drug used) strongly depends upon the quantity of anticoagulation control, as reflected by the average percentage of the time in therapeutic range of international normalized ratio 2.0-3.0. An easy, simple prediction of which atrial fibrillation patients are likely to do well on vitamin K antagonists (with good average time in therapeutic range) could guide decision-making between using vitamin K antagonists (eg, warf...
Source: The American Journal of Medicine - May 22, 2014 Category: Journals (General) Authors: Pilar Gallego, Vanessa Roldán, Francisco Marin, José Gálvez, Mariano Valdés, Vicente Vicente, Gregory Y.H. Lip Tags: Clinical research study Source Type: research

A ‘Posterior Circulation Stroke’ that Benefits from Vitamins
A 75-year-old woman was admitted for somnolence and confusion. She had been treated for hypertension and hyperlipidemia. One year before, she had been hospitalized for a mild right ataxic hemiparesis attributed to a lacunar stroke and received aspirin 100 mg/day. For the past 6 months, she regularly complained about gastric discomfort and bloating, which was attributed to the aspirin intake. As a consequence of her gastric problems and her decreasing appetite, her food intake was very limited. During a call, 24 hours before admission, she complained about nausea and vomiting for the past 2 days; she felt dizzy and staggere...
Source: The American Journal of Medicine - December 13, 2013 Category: Journals (General) Authors: Theodoros Karapanayiotides, Athanasia Anastasiou, Nikolaos Barmpas, Nikolaos Grigoriadis, Dimitrios Karacostas Tags: Clinical communications to the editor Source Type: research

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