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Stroke Etiologic Classification —Moving From Prediction to Precision
It is a truism of vascular neurology that secondary prevention depends on the cause of an ischemic stroke. We revascularize those with extracranial carotid stenosis, we anticoagulate those with cardioembolic infarcts due to atrial fibrillation, and we treat with antibiotics those with infective endocarditis. Determining the etiologic subtype, or cause, of stroke is therefore rightly considered the main objective of the evaluation of the patient with stroke. Despite the central role of this evaluation, it is surprising that our ability to determine the cause of stroke in many cases is quite limited, and that the process of ...
Source: JAMA Neurology - February 27, 2017 Category: Neurology Source Type: research

Broadening Our SCOPE of Understanding Patent Foramen Ovale High-risk Features and Stroke
Paradoxical embolization of a blood clot of presumed venous origin through a patent foramen ovale (PFO) is increasingly recognized as a legitimate cause of otherwise cryptogenic ischemic stroke (CIS). The term PFO-associated stroke has been proposed, as has where and how to classify this entity in the nomenclature of various ischemic stroke subtyping systems. PFOs are common, with prevalence as high as 25% in the general population. The prevalence of PFO is further increased in patients with CIS (overall 2.9 times higher), and especially so in the subset of younger patients (<55 years, 5.1 times higher). One estimate of...
Source: JAMA Neurology - October 10, 2022 Category: Neurology Source Type: research

Stroke Severity in Atrial Fibrillation Screening
This post hoc analysis of the Atrial Fibrillation Detected by Continuous Electrocardiogram Monitoring Using Implantable Loop Recorder to Prevent Stroke in High-Risk Individuals (LOOP) randomized clinical trial investigates if implantable loop recorder screening for atrial fibrillation can reduce the risk of severe stroke in individuals with risk factors or prior stroke history.
Source: JAMA Neurology - August 29, 2022 Category: Neurology Source Type: research

Predictors of Atrial Fibrillation in Patients With Stroke Attributed to Large- or Small-Vessel Disease
This prespecified analysis of the Stroke of Known Cause and Underlying Atrial Fibrillation (STROKE AF) randomized clinical trial investigates the association of commonly assessed risk factors with undiagnosed atrial fibrillation in patients with ischemic stroke from large- or small-vessel disease.
Source: JAMA Neurology - November 14, 2022 Category: Neurology Source Type: research

Anticoagulation Timing for Atrial Fibrillation in Acute Ischemic Stroke
Most stroke physicians will have been asked the best time to start anticoagulation for a patient with atrial fibrillation (AF) and acute ischemic stroke. There is no question that long-term anticoagulation with a direct oral anticoagulant or warfarin sodium reduces the risk of strokes in patients with AF, but the right time to start anticoagulation is uncertain.
Source: JAMA Neurology - September 11, 2017 Category: Neurology Source Type: research

Rivaroxaban vs Warfarin Sodium Early After AF-Related Mild Ischemic Stroke
This randomized clinical trial examines whether rivaroxaban or warfarin sodium is safer and more effective for preventing early recurrent stroke in patients with atrial fibrillation –related acute ischemic stroke.
Source: JAMA Neurology - September 11, 2017 Category: Neurology Source Type: research

Recurrent Stroke With Rivaroxaban Compared With Aspirin
This secondary analysis of a randomized clinical trial investigates whether rivaroxaban is associated with a reduction in recurrent stroke among patients with embolic stroke of undetermined source who have an increased risk of atrial fibrillation.
Source: JAMA Neurology - April 8, 2019 Category: Neurology Source Type: research

Evaluating Rates of Recurrent Ischemic Stroke Among Young Adults With Embolic Stroke of Undetermined Source
This cohort study evaluates rates of and factors associated with recurrent ischemic stroke and death as well as new-onset atrial fibrillation among younger adults.
Source: JAMA Neurology - March 14, 2022 Category: Neurology Source Type: research

Mechanical Thrombectomy for Acute Ischemic Stroke
Coutinho et al have performed a timely post hoc analysis consisting of a patient population from 2 large, prospective, core laboratory –adjudicated trials: Solitaire With the Intention for Thrombectomy (SWIFT) and Solitaire Flow Restoration Thrombectomy for Acute Revascularization (STAR), and their report appears in this issue ofJAMA Neurology. Given that 85% of the patients in mechanical thrombectomy (MT) trials received intravenous thrombolysis (IVT), they highlight an important group of patients in whom MT was successful without IVT. The recent IVT and MT trials have clearly established the new standard in therapy for...
Source: JAMA Neurology - January 9, 2017 Category: Neurology Source Type: research

Clinical Effectiveness of Direct Oral Anticoagulants vs Warfarin in Older Patients With Atrial Fibrillation and Ischemic Stroke
This cohort assesses the clinical effectiveness of direct oral anticoagulants vs warfarin for stroke prevention in patients with atrial fibrillation.
Source: JAMA Neurology - July 22, 2019 Category: Neurology Source Type: research

Building Evidence on Safety of Thrombolysis for Patients Receiving Direct Oral Anticoagulants
Nearly 20% of patients with acute ischemic stroke (AIS) are undergoing direct oral anticoagulant (DOAC) treatment at the time of their stroke. Common indications for DOACs among these patients include stroke prevention from atrial fibrillation, treatment of venous and pulmonary thrombosis, and coronary and peripheral atherosclerotic disease. Novel indications for DOAC use are expected to emerge and may increase the proportion of patients with AIS who are undergoing treatment with DOACs. Current US and European acute stroke treatment guidelines recommend withholding intravenous thrombolysis (thrombolysis), a morbidity- and ...
Source: JAMA Neurology - January 3, 2023 Category: Neurology Source Type: research

Left Atrial Enlargement Could Be Detected on Extended Computed Tomography Angiography —Reply
In Reply We agree with Popkirov that left atrial volume is a better marker of incident atrial fibrillation than atrial diameter; however, we did not have these data available at all of the sites participating in the New Approach Rivaroxaban Inhibition of Factor Xa in a Global Trial Versus ASA to Prevent Embolism in Embolic Stroke of Undetermined Source (NAVIGATE-ESUS) trial. Recently completed and ongoing studies will help determine if our observation has a clinical role and may provide additional data on left atrial size and function. Once all of these data are available, guidelines committees will likely make recommendat...
Source: JAMA Neurology - November 11, 2019 Category: Neurology Source Type: research

Cerebral Microbleeds and Antithrombotic Treatments —Stop Worrying About Bleeding
Cerebral microbleeds (CMBs) are found in up to one-third of patients with ischemic stroke. Because of their hemorrhagic histopathological substrate, they have been historically associated with a risk of intracerebral hemorrhage (ICH). This has led to concerns about the safety of anticoagulation use in patients with CMBs even in the context of high risk of recurrent ischemic stroke, such as in atrial fibrillation. However, growing evidence suggests that CMBs are not only markers of bleeding propensity but also markers of future ischemic events. To further evaluate both types of risks, an assessment of the number and anatomi...
Source: JAMA Neurology - October 19, 2020 Category: Neurology Source Type: research

Error in Text
The Original Investigation “Severity and Etiology of Incident Stroke in Patients Screened for Atrial Fibrillation vs Usual Care and the Impact of Prior Stroke: A Post Hoc Analysis of the LOOP Randomized Clinical Trial,” published online August 29, 2022, had an error in the Statistical Analysis section of the text. The cut off for statistical significance should read P< .05 rather than P> .05. This error has been corrected online.
Source: JAMA Neurology - October 17, 2022 Category: Neurology Source Type: research

Potential Association Between Atrial Fibrillation and Dementia
In Reply We thank Chen and colleagues for their interest in our work and are pleased that our report triggers debate about the optimal treatment of atrial fibrillation (AF) to prevent dementia, in addition to stroke and other thromboembolic complications of AF.
Source: JAMA Neurology - March 21, 2016 Category: Neurology Source Type: research

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