Nutrition: Vitamin K
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Uninterrupted anticoagulation during catheter ablation for atrial fibrillation: no difference in major bleeding and stroke between direct oral anticoagulants and vitamin K antagonists in an updated meta-analysis of randomised controlled trials.
Conclusion: Our meta-analysis suggests that uninterrupted DOAC is not superior to VKA in patients undergoing catheter ablation of AF with comparable rates of major bleeding and stroke. PMID: 32056498 [PubMed - as supplied by publisher]
Source: Acta Cardiologica - February 16, 2020 Category: Cardiology Tags: Acta Cardiol Source Type: research
Acute Ischemic Stroke Outcome and Preceding Anticoagulation: Direct Oral Anticoagulants Versus Vitamin K Antagonists
Oral anticoagulation is recommended for primary and secondary prevention of cardioembolic acute ischemic stroke (AIS). In nonvalvular atrial fibrillation (AF), direct oral anticoagulants (DOAC) efficacy and safety have been largely proven and are recommended over vitamin K antagonists (VKA) by international guidelines.1-3 AIS in the setting of AF is more often disabling and leads to increased mortality compared with stroke in patients without AF.4
Source: Journal of Stroke and Cerebrovascular Diseases - February 14, 2020 Category: Neurology Authors: Sofia Fel ício Tavares, Inês Ferreira, Vanessa Chaves, Luis Flores, Cristina Correia, Jorge Almeida, Luísa Fonseca, Paulo Castro Chaves Source Type: research
Pattern and Impact of Off-label Underdosing of Non-Vitamin K Antagonist Oral Anticoagulants in Patients with Atrial Fibrillation Who Are Indicated for Standard Dosing
With safety concerns about increasing bleeding, off-label underdosing of non-vitamin K antagonist anticoagulants (NOACs) is common in East Asian patients with atrial fibrillation (AF). We tried to investigate the pattern of NOAC underdosing and associated clinical outcomes in patients with AF who are indicated for standard dosing. Using the Korean National Health Insurance Service database, we evaluated 16568 patients with a new prescription of NOAC who are indicated for standard NOAC dosing and compared 4536 patients with warfarin with respect to thromboembolic events (ischemic stroke or systemic embolization), all-cause ...
Source: The American Journal of Cardiology - February 7, 2020 Category: Cardiology Authors: Min Soo Cho, Ji Eun Yun, Ji Jeong Park, Yun Jung Kim, Jessie Lee, Hyungmin Kim, Duk-Woo Park, Gi-Byoung Nam Source Type: research
Abbott Wins Approval for CATALYST Trial for At-Risk Stroke Patients
This study is an extremely important step in assessing the Amplatzer Amulet as an effective non-prescription drug alternative for patients with AFib who are at an increased risk for ischemic stroke." In an email sent to MD+DI, Abbott wrote, âWe already have an Amulet IDE trial underway that is intended to support our submission for approval in the U.S. for Amplatzer Amulet. The newly announced CATALYST trial will support our submission for an expanded indication for Amulet as a safe and effective alternative to NOAC drugs for patients with atrial fibrillation and at risk of stroke.â Abbo...
Source: MDDI - February 3, 2020 Category: Medical Devices Authors: Omar Ford Tags: Cardiovascular Regulatory and Compliance Source Type: news
Abbott Announces First-of-Its-Kind Trial to Assess New Therapy Option for People at Risk of Stroke
- The CATALYST trial will examine Abbott's Amplatzer ™ Amulet™ device compared to non-vitamin K oral anticoagulants, the current standard in attempting to lower stroke and bleeding risks for patients with atrial fibrillation
Source: Abbott.com - February 3, 2020 Category: Pharmaceuticals Source Type: news
Oral Anticoagulation in the Elderly and Frail.
In conclusion, elderly and frail patients requiring anticoagulation for AF or VTE are at higher risk of adverse outcomes, but also have a higher absolute benefit from OAC. Important practical aspects to improve efficacy and safety in this challenging population are summarized in this overview. PMID: 32000266 [PubMed - as supplied by publisher]
Source: Hamostaseologie - January 30, 2020 Category: Hematology Authors: Bauersachs RM, Herold J Tags: Hamostaseologie Source Type: research
Non-vitamin K Antagonist Oral Anticoagulants Beyond AF Non-vitamin K Antagonist Oral Anticoagulants Beyond AF
Several new studies are investigating the use of NOACs in other medical conditions beyond stroke prevention in AF and the prevention or treatment of VTE.European Heart Journal
Source: Medscape Today Headlines - January 29, 2020 Category: Consumer Health News Tags: Cardiology Journal Article Source Type: news
Non-vitamin K antagonist oral anticoagulation agents in patients with atrial fibrillation: Insights from Italian monitoring registries
ConclusionsThis study is the largest European real-world study ever published on NOACs. It includes all Italian patients treated with NOACs since 2013 accounting for about 1/3 of subjects with AF. The enrolled population consisted of very elderly patients, at high risk of ischemic adverse events. The AIFA registries are consolidated tools that guarantee the appropriateness of prescription and provide important information for the governance of National Health System by collecting real-world data.
Source: IJC Heart and Vasculature - January 24, 2020 Category: Cardiology Source Type: research
Mortality in patients with intracerebral hemorrhage associated with antiplatelet agents, oral anticoagulants or no antithrombotic therapy.
In conclusion, preceding treatment with antithrombotic is associated with the severity of ICH. Age, previous stroke and clinical severity at presentation were independent predictors of in-hospital death in patients with ICH. PMID: 31955918 [PubMed - as supplied by publisher]
Source: European Journal of Internal Medicine - January 16, 2020 Category: Internal Medicine Authors: Franco L, Paciaroni M, Enrico ML, Scoditti U, Guideri F, Chiti A, De Vito A, Terruso V, Consoli D, Vanni S, Giossi A, Manina G, Nitti C, Re R, Sacco S, Cappelli R, Beyer-Westendorf J, Pomero F, Agnelli G, Becattini C Tags: Eur J Intern Med Source Type: research
How Effective and Safe Is Factor XI Inhibition in Preventing Venous Thrombosis?
The introduction of the direct oral anticoagulants for stroke prevention in atrial fibrillation and the management of thromboembolism has transformed the care of patients with these disorders. These drugs, which selectively and reversibly inhibit factor Xa or thrombin in the common pathway of the coagulation cascade, have a wide therapeutic window; this allows for simplified dosing regimens without laboratory monitoring of most adult patients as contrasted to vitamin K antagonists. This class of drug is also associated with a lower bleeding risk than vitamin K antagonists, which has been most clearly demonstrated by a 50% ...
Source: JAMA - January 14, 2020 Category: General Medicine Source Type: research
Influence of oral anticoagulation on stroke severity and outcomes: A propensity score matching case-control study
Oral anticoagulants (OAC) such as vitamin K antagonists (VKA) and direct-acting OACs (DOAC) remain the mainstay for prevention of cardioembolic stroke. The influence of previous OAC treatment on stroke severity and outcomes is not well stablished. We compared patients with incident cardioembolic strokes according to pre-stroke treatment.
Source: Journal of the Neurological Sciences - January 14, 2020 Category: Neurology Authors: A. Plaza Herr áiz, L. Lobato-Pérez, M. Ramírez-Torres, I. De Lorenzo, M. Alonso de Leciñana, E. Díez-Tejedor, B. Fuentes, J. Rodríguez-Pardo Source Type: research
Cost-effectiveness of dabigatran compared with rivaroxaban for prevention of stroke and systemic embolism in patients with atrial fibrillation in China.
Abstract PURPOSE: In China, dabigatran and rivaroxaban are the only approved non-vitamin K antagonist oral anticoagulants for the treatment of atrial fibrillation (AF). The goal of this article was to assess the cost-effectiveness of dabigatran versus rivaroxaban for the prevention of stroke and systemic embolism in Chinese patients with AF from the perspective of the Chinese health care system. METHODS: A Markov model was constructed to estimate the cost-effectiveness of dabigatran versus rivaroxaban. Clinical events were modeled for a lifetime horizon, based on clinical efficacy data from indirect treatment...
Source: Clinical Therapeutics - January 10, 2020 Category: Drugs & Pharmacology Authors: Dong SJ, Wu B, Zhai SD, Zhang YJ, Chu YB, Gupta P, Li YH Tags: Clin Ther Source Type: research
Direct oral anticoagulants and warfarin in patients with cirrhosis: a comparison of outcomes
In conclusion DOACs appear to be a safe alternative to warfarin in patients with mild to moderate cirrhosis. Further studies are warranted to confirm these findings.
Source: Journal of Thrombosis and Thrombolysis - January 8, 2020 Category: Hematology Source Type: research
Edoxaban versus warfarin in vitamin K antagonist experienced and na ïve patients from the edoxaban versus warfarin in subjects undergoing cardioversion of atrial fibrillation (ENSURE-AF) randomised trial
ConclusionsEdoxaban had comparable efficacy and safety to optimized anticoagulation with enox –warf. The primary efficacy and safety endpoint outcomes were broadly similar between VKA experienced or naïve patients.
Source: Clinical Research in Cardiology - January 8, 2020 Category: Cardiology Source Type: research
Vitamin K Antagonist Use and Risk for Intracranial Carotid Artery Calcification in Patients With Intracerebral Hemorrhage
Conclusions: Our findings do not support VKA use as an independent risk factor for higher ICAC degree in patients with ICH. We could not confirm the concerns about VKA use and intracranial carotid vascular calcification. We suggest further research in other cohorts with VKA users such as patients with ischemic stroke and atrial fibrillation.
Source: Frontiers in Neurology - December 20, 2019 Category: Neurology Source Type: research
Rivaroxaban Reduces Arterial Thrombosis by Inhibition of FXa Driven Platelet Activation Via Protease Activated Receptor-1.
Conclusions: Here we identified FXa as potent platelet agonist that acts through PAR1. Therefore, RIVA exerts an antiplatelet effect that together with its well-known potent anticoagulatory capacity might lead to reduced frequency of atherothrombotic events and improved outcome in patients. PMID: 31859592 [PubMed - as supplied by publisher]
Source: Circulation Research - December 20, 2019 Category: Cardiology Authors: Petzold T, Thienel M, Dannenberg LK, Mourikis P, Helten C, Ayhan A, M'Pembele R, Achilles A, Trojovsky K, Konsek D, Zang Z, Regenauer R, Pircher J, Ehrlich A, Lüsebrink E, Nicolai L, Stocker T, Brandl R, Röschentaler F, Strecker J, Saleh I, Spannagl M, Tags: Circ Res Source Type: research
Non-vitamin K antagonist oral anticoagulants (NOACs) post-percutaneous coronary intervention: a network meta-analysis.
CONCLUSIONS: Very low- to moderate-certainty evidence suggests no meaningful difference in efficacy outcomes between non-vitamin K antagonist oral anticoagulants (NOAC) and vitamin K antagonists following percutaneous coronary interventions (PCI) in people with non-valvular atrial fibrillation. NOACs probably reduce the risk of recurrent hospitalisation for adverse events compared with vitamin K antagonists. Low- to moderate-certainty evidence suggests that dabigatran may reduce the rates of major and non-major bleeding, and apixaban and rivaroxaban probably reduce the rates of non-major bleeding compared with vitamin K an...
Source: Cochrane Database of Systematic Reviews - December 19, 2019 Category: General Medicine Authors: Al Said S, Alabed S, Kaier K, Tan AR, Bode C, Meerpohl JJ, Duerschmied D Tags: Cochrane Database Syst Rev Source Type: research
Optimization of risk stratification for anticoagulation-associated intracerebral hemorrhage: net risk estimation
ConclusionsIn this anticoagulation-associated ICH cohort, baseline hemorrhagic risk exceeded ischemic risk in approximately 50%, highlighting the importance of careful consideration of risk/benefit ratio prior to anticoagulation decisions. The remaining 50% suffered an ICH despite excess baseline ischemic risk, stressing the need for biomarkers to allow more precise estimation of hemorrhagic complication risk.
Source: Journal of Neurology - December 17, 2019 Category: Neurology Source Type: research
Is there a role for low-dose DOACs as prophylaxis?
Authors: Cohen AT, Hunt BJ Abstract The direct oral anticoagulants (DOACs) have transformed the management of thrombotic disorders. Large clinical trials have demonstrated that DOACs can replace vitamin K antagonists (VKAs) in the 2 existing major indications for anticoagulation: the prevention of stroke in atrial fibrillation and the acute treatment and secondary prevention of venous thromboembolism (VTE); this literature is widely known. In this article, we will concentrate on the less well-discussed benefits of the use of DOACs-using low doses as primary and secondary prophylaxis in both venous and arterial thro...
Source: Hematology ASH Education Program - December 7, 2019 Category: Hematology Tags: Hematology Am Soc Hematol Educ Program Source Type: research
Antiphosholipid syndrome and the risk of myocardial infarction: current evidence and uncertainties.
Abstract Antiphospholipid syndrome (APS) encompasses a wide spectrum of disease manifestations that may prevail in the form of venous or arterial thrombosis or lead to pregnancy complications in the presence of persisting antiphospholipid (aPL) antibodies. Unlike in the case of congenital thrombophilias where venous thromboses are more likely to occur as compared to arterial events, aPL antibodies may cause thrombosis in both types of vascular system, often including the coronary or cerebral arteries leading to myocardial infarction (MI) or stroke. In this review we summarize the complex pathomechanisms leading to...
Source: Polish Heart Journal - December 6, 2019 Category: Cardiology Authors: Lóczi L, Kappelmayer J, Tarr T, Bagoly Z Tags: Kardiol Pol Source Type: research
Comparing the Effectiveness and Safety of Non-Vitamin K Antagonist Oral Anticoagulants and Warfarin in the Elderly Asian Patients with Atrial Fibrillation: A Nationwide Cohort Study.
CONCLUSIONS: Compared to warfarin, NOACs were associated with a significantly lower risk of adverse events, with heterogeneity in treatment effects among different age strata. Overall, the clear safety signal in favor of NOACs over warfarin was evident irrespective of age strata, being most marked in the most elderly. PMID: 31809694 [PubMed - as supplied by publisher]
Source: Chest - December 3, 2019 Category: Respiratory Medicine Authors: Chao TF, Chiang CE, Liao JN, Chen TJ, Lip GYH, Chen SA Tags: Chest Source Type: research
Non-vitamin K antagonist oral anticoagulants in patients with hypertrophic cardiomyopathy and atrial fibrillation: a systematic review and meta-analysis
AbstractSeveral studies have explored the use of NOACs compared with vitamin K antagonists (VKAs) in patients with hypertrophic cardiomyopathy (HCM) and atrial fibrillation (AF); and therefore, we aimed to compare the efficacy and safety outcomes of NOACs with VKAs in this population. We systematically searched the PubMed and Embase databases until August 5, 2019 for studies that compared the effect of NOACs with VKAs in patients with HCM and AF. The risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. A total of four observational studies were included in this meta-analysis. Over...
Source: Journal of Thrombosis and Thrombolysis - December 2, 2019 Category: Hematology Source Type: research
Should We Judge Stroke Risk by Static or Dynamic Risk Scores? A Focus on the Dynamic Nature of Stroke and Bleeding Risks in Patients With Atrial Fibrillation
Abstract: Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia and a major risk factor for stroke. The number of patients with AF is predicted to increase in the next few decades. AF has also negative impact on quality of life as well as it significantly increases the risk of cardiovascular disease and overall mortality. Because the stroke is a pivotal outcome of AF, its prevention with the use of anticoagulation therapy constitutes an important component of AF management. The decision on oral anticoagulants' prescription should be based on appropriate risk stratification to allow for comprehensive assessmen...
Source: Journal of Cardiovascular Pharmacology - December 1, 2019 Category: Cardiology Tags: Invited Review Article Source Type: research
Efficacy and Safety of Nonvitamin K Oral Anticoagulants in Patients with Atrial Fibrillation and Cancer: A Study-Level Meta-Analysis.
CONCLUSION: In AF patients with malignancy, NOACs appear at least as effective as VKAs in preventing thrombotic events and reduce intracranial bleeding. NOACs may represent a valid and more practical alternative to VKAs in this setting of high-risk patients. PMID: 31785599 [PubMed - as supplied by publisher]
Source: Thrombosis and Haemostasis - November 30, 2019 Category: Hematology Authors: Cavallari I, Verolino G, Romano S, Patti G Tags: Thromb Haemost Source Type: research
Searching for Atrial Fibrillation Poststroke: A White Paper of the AF-SCREEN International Collaboration.
H, Kirchhof P, Korompoki E, Krieger DW, Lip GYH, Løchen ML, Mairesse GH, Montaner J, Neubeck L, Ntaios G, Piccini JP, Potpara TS, Quinn TJ, Reiffel JA, Ribeiro ALP, Rienstra M, Rosenqvist M, Sakis T, Sinner MF, Svendsen JH, Van Gelder IC, Wachter R, Wijeratne T, Yan B Abstract Cardiac thromboembolism attributed to atrial fibrillation (AF) is responsible for up to one-third of ischemic strokes. Stroke may be the first manifestation of previously undetected AF. Given the efficacy of oral anticoagulants in preventing AF-related ischemic strokes, strategies of searching for AF after a stroke using ECG monitoring fol...
Source: Circulation - November 26, 2019 Category: Cardiology Authors: Schnabel RB, Haeusler KG, Healey JS, Freedman B, Boriani G, Brachmann J, Brandes A, Bustamante A, Casadei B, Crijns HJGM, Doehner W, Engström G, Fauchier L, Friberg L, Gladstone DJ, Glotzer TV, Goto S, Hankey GJ, Harbison JA, Hobbs FDR, Johnson LSB, Kame Tags: Circulation Source Type: research
Management and outcomes of real-world use of non-vitamin-K oral anticoagulants (NOACs) in patients with atrial fibrillation: experience of a dedicated NOAC clinic.
CONCLUSIONS: We observed low rates of bleeding and adverse drug reactions. However, rates of mortality and discontinuation were relatively high. These results could possibly be explained by the real-world nature of the data including higher-risk patients. PMID: 31773474 [PubMed - as supplied by publisher]
Source: Netherlands Heart Journal - November 26, 2019 Category: Cardiology Authors: de Veer AJWM, Bennaghmouch N, Wijffels MCEF, Ten Berg JM Tags: Neth Heart J Source Type: research
Idarucizumab for Intravenous Thrombolysis and Endovascular Thrombectomy in Acute Stroke: A Case Report
Non –vitamin K antagonist oral anticoagulants (NOACs), such as dabigatran, are widely used to prevent ischemic stroke in patients with nonvalvular atrial fibrillation. Nonetheless, stroke occurs in 1–2% of patients, and the use of NOACs may increase the bleeding risk for patients who are receiving a cute treatment of intravenous thrombolysis (IVT) or endovascular thrombectomy (EVT). Idarucizumab, a monoclonal antibody developed to bind dabigatran, has been proven safe and effective for patients with uncontrolled bleeding or for patients planning to receive emergent procedures.
Source: The Journal of Emergency Medicine - November 16, 2019 Category: Emergency Medicine Authors: Yu-Ting Lin, Yen-Jun Lai, Tzu-Hsien Lai Tags: Selected Topics: Neurological Emergencies Source Type: research
Four-year trends in oral anticoagulant use and declining rates of ischemic stroke among 194,030 atrial fibrillation patients drawn from a sample of 12 million people
ConclusionThere was a slight increase in the prevalence of AF between 2012 and 2015, while the overall use of antiplatelet agents decreased and that of OAC, particularly DOACs, increased. Over the same period, 1 year hospitalizations for ischemic stroke declined substantially, with a declining rate of hemorrhagic strokes.
Source: American Heart Journal - November 10, 2019 Category: Cardiology Source Type: research
Management of oral anticoagulation in very old patients with non valvular atrial fibrillation related acute ischemic stroke
AbstractThe optimal management of oral anticoagulation (OAC) in the acute phase of non valvular atrial fibrillation (NVAF)-related acute ischemic stroke (AIS) remains controversial, especially in very old patients. Therefore, the aim of our study was to evaluate the practical management of OAC in this context. We conducted an observational retrospective study on patients 85-years old and older admitted to two Italian hospitals for NVAF-related AIS. For each patient, clinical and brain computed tomography data were recorded. Type of OAC (vitamin K antagonists, VKAs or Direct Oral Anticoagulants, DOACs), dosage and starting ...
Source: Journal of Thrombosis and Thrombolysis - October 17, 2019 Category: Hematology Source Type: research
Role of Biological Markers for Cerebral Bleeding Risk STRATification in Patients with Atrial Fibrillation on Oral Anticoagulants for Primary or Secondary Prevention of Ischemic Stroke (Strat-AF Study): Study Design and Methodology.
Conclusions: The Strat-AF study may be an essential step towards the exploration of the role of a combined clinical biomarker or multiple biomarker models in predicting stroke risk in AF, and might sustain the incorporation of such new markers in the existing stroke prediction schemes by the demonstration of a greater incremental value in predicting stroke risk and improvement in clinical outcomes in a cost-effective fashion. PMID: 31548494 [PubMed - in process]
Source: Medicina (Kaunas) - September 23, 2019 Category: Universities & Medical Training Authors: Poggesi A, Barbato C, Galmozzi F, Camilleri E, Cesari F, Chiti S, Diciotti S, Galora S, Giusti B, Gori AM, Marzi C, Melone A, Mistri D, Pescini F, Pracucci G, Rinnoci V, Sarti C, Fainardi E, Marcucci R, Salvadori E Tags: Medicina (Kaunas) Source Type: research
Effectiveness, safety and costs of stroke prevention in non-valvular auricular fibrillation. Study of cohorts matched by Propensity score.
CONCLUSIONS: Most patients initiated VKA. We found no differences between VKA and dabigatran in the risk of stroke, haemorrhages or mortality. PMID: 31551166 [PubMed - as supplied by publisher]
Source: Atencion Primaria - September 21, 2019 Category: Primary Care Authors: Giner-Soriano M, Casajuana M, Roso-Llorach A, Vedia C, Morros R Tags: Aten Primaria Source Type: research
Reducing Stroke Risk in Atrial Fibrillation: Adherence to Guidelines Has Improved, but Patient Persistence with Anticoagulant Therapy Remains Suboptimal.
Authors: Lowres N, Giskes K, Hespe C, Freedman B Abstract Atrial fibrillation (AF) is a significant risk factor for avoidable stroke. Among high-risk patients with AF, stroke risk can be mitigated using oral anticoagulants (OACs), however reduction is largely contingent on physician prescription and patient persistence with OAC therapy. Over the past decade significant advances have occurred, with revisions to clinical practice guidelines relating to management of stroke risk in AF in several countries, and the introduction of non-vitamin K antagonist OACs (NOACs). This paper summarises the evolving body of researc...
Source: Korean Circulation Journal - September 20, 2019 Category: Cardiology Tags: Korean Circ J Source Type: research
A Narrative Review of Nonvitamin K Antagonist Oral Anticoagulant Use in Secondary Stroke Prevention
The prevalence of atrial fibrillation (AF), the most common cardiac arrhythmia, increases with age, predisposing elderly patients to an increased risk of embolic stroke. With an increasingly aged population the number of people who experience a stroke every year, overall global burden of stroke, and numbers of stroke survivors and related deaths continue to increase. Anticoagulation with vitamin K antagonists (VKAs) reduces the risk of ischemic stroke in patients with AF; however, increased bleeding risk is well documented, particularly in the elderly.
Source: Journal of Stroke and Cerebrovascular Diseases - July 5, 2019 Category: Neurology Authors: Valeria Caso, Florian Masuhr Tags: Review Article Source Type: research
Treatment Approaches to Lacunar Stroke
Lacunar strokes are appropriately named for their ability to cavitate and form ponds or “little lakes” (Latin: lacune -ae meaning pond or pit is a diminutive form of lacus meaning lake). They account for a substantial proportion of both symptomatic and asymptomatic ischemic strokes. In recent years, there have been several advances in the management of large vessel occlusions. New therapies such as non-vitamin K antagonist oral anticoagulants and left atrial appendage closure have recently been developed to improve stroke prevention in atrial fibrillation; however, the treatment of small vessel disease-related strokes ...
Source: Journal of Stroke and Cerebrovascular Diseases - May 28, 2019 Category: Neurology Authors: Alvin S. Das, Robert W. Regenhardt, Steven K. Feske, Mahmut Edip Gurol Tags: Review Article Source Type: research
Safety of Recanalization Therapy in Patients with Acute Ischemic Stroke Under Anticoagulation: A Systematic Review and Meta-Analysis
Intravenous thrombolysis treatment (IVT) and endovascular therapy (EVT) have been proved as fist-line beneficial option for eligible patients who have acute ischemic stroke (AIS) with major safety concern of symptomatic intracranial hemorrhage (sICH). Unfortunately, the emergency management of patients with AIS taking vitamin K antagonists and with international normalized ratio higher than 1.7 or taking new oral anticoagulants (NOACs) represents a great challenge. We aim to comprehensively determine the safety of EVT in patients under prior-stroke anticoagulants and IVT in patients under NOAC use.
Source: Journal of Stroke and Cerebrovascular Diseases - July 15, 2018 Category: Neurology Authors: Mingsu Liu, Yang Zheng, Guangqin Li Tags: Review Article Source Type: research
Continuation or Discontinuation of Anticoagulation in the Early Phase After Acute Ischemic Stroke Brief Report
Background and Purpose—There is no consensus on whether anticoagulation should be continued or temporarily stopped in patients suffering acute ischemic stroke while using anticoagulation. We assessed treatment variations and outcomes in these patients.Methods—Post hoc analysis of PASS (Preventive Antibiotics in Stroke Study). We included patients with acute ischemic stroke who used anticoagulation at admission. We compared clinical outcomes, thrombotic, and major bleeding events at 3 months.Results—Nine percent (192/2101) of the patients with acute ischemic stroke used anticoagulation at admission (186 vitamin K anta...
Source: Stroke - June 25, 2018 Category: Neurology Authors: Adrien E. Groot, Jan-Dirk M. Vermeij, Willeke F. Westendorp, Paul J. Nederkoorn, Diederik van de Beek, Jonathan M. Coutinho Tags: Secondary Prevention, Anticoagulants, Cerebrovascular Disease/Stroke, Ischemic Stroke Brief Reports Source Type: research
Outcome of Secondary Stroke Prevention in Patients Taking Non –Vitamin K Antagonist Oral Anticoagulants
In this study, to determine whether or not there is a difference in outcome in secondary stroke prevention between warfarin and NOACs, patients w ith embolic stroke with newly prescribed anticoagulants were prospectively analyzed.
Source: Journal of Stroke and Cerebrovascular Diseases - December 21, 2017 Category: Neurology Authors: Taizen Nakase, Junta Moroi, Tatsuya Ishikawa Source Type: research
Analysis of Recurrent Stroke Volume and Prognosis between Warfarin and Four Non –Vitamin K Antagonist Oral Anticoagulants' Administration for Secondary Prevention of Stroke
We investigated recurrent stroke volume with nonvalvular atrial fibrillation (NVAF) patients treated with non –vitamin K antagonist oral anticoagulants (NOACs) about clinical backgrounds and number of recurrent stroke.
Source: Journal of Stroke and Cerebrovascular Diseases - October 21, 2017 Category: Neurology Authors: Yukie Kanai, Hiroaki Oguro, Nao Tahara, Hanako Matsuda, Hiroyuki Takayoshi, Shingo Mitaki, Keiichi Onoda, Shuhei Yamaguchi Source Type: research
Fibrin Clot Permeability as a Predictor of Stroke and Bleeding in Anticoagulated Patients With Atrial Fibrillation Clinical Sciences
Background and Purpose—Formation of denser fiber networks has been reported in atrial fibrillation and ischemic stroke. In this longitudinal cohort study, we evaluated whether fibrin clot density may predict thromboembolic and bleeding risk in patients with atrial fibrillation on vitamin K antagonists.Methods—In 236 patients with atrial fibrillation receiving vitamin K antagonists treatment, we measured ex vivo plasma clot permeability (Ks), a measure of the pore size in fibrin networks.Results—During a median follow-up of 4.3 (interquartile range, 3.7–4.8) years, annual rates of ischemic stroke or transient ischem...
Source: Stroke - September 25, 2017 Category: Neurology Authors: Leszek Drabik, Paweł Wołkow, Anetta Undas Tags: Atrial Fibrillation, Ischemic Stroke, Thrombosis Original Contributions Source Type: research
Real-World Setting Comparison of Nonvitamin-K Antagonist Oral Anticoagulants Versus Vitamin-K Antagonists for Stroke Prevention in Atrial Fibrillation Clinical Sciences
Conclusions—This meta-analysis confirms the main findings of the randomized controlled trials of dabigatran, rivaroxaban, and apixaban in the real-world setting and, hence, strengthens their validity.
Source: Stroke - August 28, 2017 Category: Neurology Authors: George Ntaios, Vasileios Papavasileiou, Konstantinos Makaritsis, Konstantinos Vemmos, Patrik Michel, Gregory Y.H. Lip Tags: Arrhythmias, Secondary Prevention, Meta Analysis, Mortality/Survival, Ischemic Stroke Original Contributions Source Type: research
Effectiveness and Safety of Apixaban, Dabigatran, and Rivaroxaban Versus Warfarin in Patients With Nonvalvular Atrial Fibrillation and Previous Stroke or Transient Ischemic Attack Clinical Sciences
Conclusions—Results from our study of the 3 NOACs versus warfarin in nonvalvular atrial fibrillation patients with a previous history of stroke/transient ischemic attack are relatively consistent with their respective phase III trials and previous stroke/transient ischemic attack subgroup analyses. All NOACs seemed no worse than warfarin in respect to ischemic stroke, ICH, or major bleeding risk.
Source: Stroke - July 24, 2017 Category: Neurology Authors: Craig I. Coleman, W. Frank Peacock, Thomas J. Bunz, Mark J. Alberts Tags: Arrhythmias, Quality and Outcomes, Intracranial Hemorrhage, Ischemic Stroke Original Contributions Source Type: research
Safety of Endovascular Thrombectomy in Patients Receiving Non-Vitamin K Antagonist Oral Anticoagulants Brief Reports
Conclusions— Thrombectomy in non–vitamin K antagonist oral anticoagulant patients seems safe although a comparatively high rate of asymptomatic hemorrhagic transformation was noted. Confirmation in larger prospective controlled cohorts is necessary. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT01850797.
Source: Stroke - March 28, 2016 Category: Neurology Authors: Purrucker, J. C., Wolf, M., Haas, K., Rizos, T., Khan, S., Dziewas, R., Kleinschnitz, C., Binder, A., Groschel, K., Hennerici, M. G., Lobotesis, K., Poli, S., Seidel, G., Neumann-Haefelin, T., Ringleb, P. A., Heuschmann, P. U., Veltkamp, R. Tags: Angiography, Anticoagulants, Ischemic Stroke Brief Reports Source Type: research
Point-of-Care Testing of Coagulation in Patients Treated With Non-Vitamin K Antagonist Oral Anticoagulants Clinical Sciences
Conclusions— If anti-Xa test is not available, we propose the use of the CoaguChek POCT to guide thrombolysis decisions after individual risk assessment in rivaroxaban-treated patients having acute ischemic stroke. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT02371044.
Source: Stroke - September 28, 2015 Category: Neurology Authors: Ebner, M., Peter, A., Spencer, C., Hartig, F., Birschmann, I., Kuhn, J., Wolf, M., Winter, N., Russo, F., Zuern, C. S., Blumenstock, G., Ziemann, U., Poli, S. Tags: Coagulation, Other anticoagulants, Other diagnostic testing, Emergency treatment of Stroke, Anticoagulants, Thrombolysis, Coagulation and fibronolysis Clinical Sciences Source Type: research
Potential new uses of non-vitamin K antagonist oral anticoagulants to treat and prevent stroke
Conclusion: There may be a role for NOACs in stroke prevention and treatment beyond atrial fibrillation. Randomized controlled trials are needed to compare NOACs to current stroke prevention and treatment strategies in certain subgroups of patients with cerebrovascular disease.
Source: Neurology - September 21, 2015 Category: Neurology Authors: Yaghi, S., Kamel, H., Elkind, M. S. V. Tags: Stroke prevention, All Cerebrovascular disease/Stroke, Infarction, Cerebral venous thrombosis VIEWS & amp;amp; REVIEWS Source Type: research
Non-Vitamin K Antagonist Oral Anticoagulants for Stroke Prevention in Asian Patients With Nonvalvular Atrial Fibrillation: Meta-Analysis Clinical Sciences
Conclusions— Our findings suggest that standard-dose NOACs were more effective and safer in Asians than in non-Asians, whereas low-dose NOACs performed similarly in both populations.
Source: Stroke - August 24, 2015 Category: Neurology Authors: Wang, K.-L., Lip, G. Y. H., Lin, S.-J., Chiang, C.-E. Tags: Other anticoagulants, Anticoagulants Clinical Sciences Source Type: research
Vitamin K antagonist-experienced patients with a history of stroke/transient ischaemic attack who switched from warfarin to dabigatran increased their rate of recurrent stroke/transient ischaemic attack compared with those on warfarin
Commentary on: Larsen TB, Rasmussen LH, Gorst-Rasmussen A, et al. Dabigatran and warfarin for secondary prevention of stroke in atrial fibrillation patients: a nationwide cohort study. Am J Med 2014;127:1172–8 . Context Randomised trials have shown that patients with atrial fibrillation (AF) who are treated with a non-vitamin K antagonist oral anticoagulant (NOAC), compared with warfarin, have similar or lower rates of stroke and major bleeding, markedly reduced rates of intracranial bleeding and a consistent pattern of reduced mortality.1 Dabigatran 150 mg two times a day is the only NOAC that can significantly...
Source: Evidence-Based Medicine - May 22, 2015 Category: Internal Medicine Authors: Eikelboom, J. W., Bosch, J. Tags: Epidemiologic studies, Time-to-event methods, Drugs: cardiovascular system, Stroke, Arrhythmias Aetiology/Harm Source Type: research
Severity and Functional Outcome of Patients with Cardioembolic Stroke Occurring during Non-vitamin K Antagonist Oral Anticoagulant Treatment
Severity and functional outcome of patients with cardioembolic stroke (CE) occurring during non-vitamin K antagonist oral anticoagulant (NOAC) treatment remain uncertain.
Source: Journal of Stroke and Cerebrovascular Diseases - April 2, 2015 Category: Neurology Authors: Hirofumi Tomita, Joji Hagii, Norifumi Metoki, Shin Saito, Hiroshi Shiroto, Hiroyasu Hitomi, Takaatsu Kamada, Satoshi Seino, Koki Takahashi, Satoko Sasaki, Minoru Yasujima, Ken Okumura Source Type: research
Non-vitamin-K oral anticoagulants reduce mortality, stroke and intracranial haemorrhage when compared with warfarin in randomised trials of patients with non-valvular atrial fibrillation
Commentary on: Ruff CT, Giugliano RP, Braunwald E, et al.. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet 2014;383:955–62. Context Historically, the standard medication for stroke prevention in atrial fibrillation (AF) has been a vitamin-K antagonist (warfarin). However, several non-vitamin-K oral anticoagulants (NOACs) have been developed and shown to be at least as effective as dose-adjusted warfarin in their respective phase-3 clinical trials.1–4 These include the direct thrombin inhibitor dabig...
Source: Evidence-Based Medicine - September 15, 2014 Category: Internal Medicine Authors: Steinberg, B. A. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Ischaemic heart disease, Connective tissue disease, Musculoskeletal syndromes, Diabetes, Arrhythmias Therapeutics Source Type: research
Intracranial Hemorrhage Among Patients With Atrial Fibrillation Anticoagulated With Warfarin or Rivaroxaban: The Rivaroxaban Once Daily, Oral, Direct Factor Xa Inhibition Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation Clinical Sciences
Conclusions— Among patients with atrial fibrillation treated with anticoagulation, the risk of ICH was higher among Asians, blacks, the elderly, and in those with previous stroke or transient ischemic attack, increased diastolic blood pressure, and reduced platelet count or serum albumin at baseline. The risk of ICH was significantly lower in patients with heart failure and in those who were randomized to rivaroxaban instead of warfarin. The external validity of these findings requires testing in other atrial fibrillation populations.
Source: Stroke - April 28, 2014 Category: Neurology Authors: Hankey, G. J., Stevens, S. R., Piccini, J. P., Lokhnygina, Y., Mahaffey, K. W., Halperin, J. L., Patel, M. R., Breithardt, G., Singer, D. E., Becker, R. C., Berkowitz, S. D., Paolini, J. F., Nessel, C. C., Hacke, W., Fox, K. A. A., Califf, R. M., on behal Tags: Acute Cerebral Hemorrhage, Anticoagulants Clinical Sciences Source Type: research