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Non-vitamin K oral anticoagulants as first-line regimen for acute ischemic stroke with non-valvular atrial fibrillation
There are various patterns in determining the choice of the first-line antithrombotic agent for acute stroke with non-valvular atrial fibrillation. We investigated the efficacy and safety of non-vitamin K oral anticoagulants as first-line antithrombotics for patients with acute stroke and non-valvular atrial fibrillation.
Source: Journal of Stroke and Cerebrovascular Diseases - August 15, 2020 Category: Neurology Authors: Chan Wook Park, Hyo Suk Nam, Ji Hoe Heo, Hyung Jong Park, Jin Kyo Choi, Hye Sun Lee, Han Kyu Na, Young Dae Kim Source Type: research

Racial Disparity in the Prescription of Anticoagulants and Risk of Stroke and Bleeding in Atrial Fibrillation Patients
Background: Oral anticoagulant (OAC) therapy is proven to be effective at reducing risk of stroke in patients with atrial fibrillation (AF). However, racial minorities with AF are less likely to be prescribed vitamin K anticoagulants (VKA). There is little information on the racial disparity in the prescription of the non-vitamin K oral anticoagulants (NOACs) and the associated risks of stroke and bleeding. Methods: We used data from the Northwestern Medicine Enterprise Data Warehouse – a joint initiative across 11 Northwestern Medicine affiliated healthcare centers within metropolitan Chicago, Illinois.
Source: Journal of Stroke and Cerebrovascular Diseases - February 27, 2020 Category: Neurology Authors: Yacob G. Tedla, Sarah M. Schwartz, Philip Silberman, Philip Greenland, Rod S. Passman 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 13, 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

Serum Retinoic Acid Level and The Risk of Poststroke Cognitive Impairment in Ischemic Stroke Patients
This study aimed to detect the association between RA level and PSCI among patients with first-ever acute ischemic stroke. Methods: Two hundred and 61 consecutive patients were prospectively recruited during March 2018 and March 2019.
Source: Journal of Stroke and Cerebrovascular Diseases - September 5, 2019 Category: Neurology Authors: Le Hou, Caixia Ding, Zhao Chen, Yuanyue Liu, Haishan Shi, Cong Zou, Hui Zhang, Zhiwei Lu, Dong Zheng 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 4, 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 27, 2019 Category: Neurology Authors: Alvin S. Das, Robert W. Regenhardt, Steven K. Feske, Mahmut Edip Gurol Tags: Review Article Source Type: research

Differences in dietary recall and subjective physical functioning status in stroke survivors with self-reported cognitive impairment.
CONCLUSION: A lower intake of polyunsaturated fat and vitamin B6 may be associated with cognitive function, ultimately affecting physical functioning, post-stroke. It is possible that differing stroke severity and difficulty recalling dietary habits could have affected the present findings. Therefore, further research is needed to determine if interventions designed to modify polyunsaturated fat and vitamin B6 intakes are able to influence cognitive and physical function in stroke survivors with varying degrees of functional and cognitive deficits. PMID: 30907282 [PubMed - as supplied by publisher]
Source: Topics in Stroke Rehabilitation - March 23, 2019 Category: Neurology Authors: Kelleher JL, Rodriguez AD, McGregor KM, Serra MC Tags: Top Stroke Rehabil Source Type: research

Platelet Surface CD62p and Serum Vitamin D Levels are Associated with Clopidogrel Resistance in Chinese Patients with Ischemic Stroke
Background: To explore the association of platelet activation markers, vitamin D, and antiplatelet drugs resistance in ischemic stroke patients. Methods: A total of 230 patients with ischemic stroke were enrolled in this study. Platelet aggregation, platelet activation marker (CD62p), and vitamin D were measured after 7-14 days of dual antiplatelet treatment (aspirin  + clopidogrel). All individuals were divided into a drug resistance group and a drug sensitive group according to the platelet maximum aggregation rate induced by antagonist adenosine diphosphate or arachidonic acid.
Source: Journal of Stroke and Cerebrovascular Diseases - February 20, 2019 Category: Neurology Authors: Bi-Chao Lu, Xiao-Jie Shi, Lin Liang, Na Dong, Zhi-Zhong Liu 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

Relationship Between Dietary Vitamin D and Deaths From Stroke and Coronary Heart Disease Brief Report
Background and Purpose—There is growing evidence about the importance of vitamin D for cardiovascular health. Therefore, we examined the relationship between dietary vitamin D intake and risk of mortality from stroke and coronary heart disease in Japanese population.Methods—A prospective study encompassing 58 646 healthy Japanese adults (23 099 men and 35 547 women) aged of 40 to 79 years in whom dietary vitamin D intake was determined via a self-administered food frequency questionnaire. The median follow-up period was 19.3 years (1989–2009). The hazard ratios and 95% confidence intervals of mortality were calcu...
Source: Stroke - January 22, 2018 Category: Neurology Authors: Haytham A. Sheerah, Ehab S. Eshak, Renzhe Cui, Hironori Imano, Hiroyasu Iso, Akiko Tamakoshi Tags: Cardiovascular Disease, Diet and Nutrition, Epidemiology, Risk Factors, Cerebrovascular Disease/Stroke Brief Reports Source Type: research

Sodium Valproate, a Histone Deacetylase Inhibitor, Is Associated With Reduced Stroke Risk After Previous Ischemic Stroke or Transient Ischemic Attack Clinical Sciences
Conclusions—These results suggest that exposure to SVA, an inhibitor of HDAC, may be associated with a lower recurrent stroke risk although we cannot exclude residual confounding in this study design. This supports the hypothesis that HDAC9 is important in the ischemic stroke pathogenesis and that its inhibition, by SVA or a more specific HDAC9 inhibitor, is worthy of evaluation as a treatment to prevent recurrent ischemic stroke.
Source: Stroke - December 22, 2017 Category: Neurology Authors: Rebecca L. Brookes, Siobhan Crichton, Charles D.A. Wolfe, Qilong Yi, Linxin Li, Graeme J. Hankey, Peter M. Rothwell, Hugh S. Markus Tags: Secondary Prevention, Genetics, Ischemic Stroke, Atherosclerosis Original Contributions 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

Intravenous Thrombolysis in Acute Ischemic Stroke Patients Pretreated With Non-Vitamin K Antagonist Oral Anticoagulants Emerging Therapy Critique
Source: Stroke - June 26, 2017 Category: Neurology Authors: Georgios Tsivgoulis, Apostolos Safouris Tags: Ischemic Stroke Emerging Therapy Critiques Source Type: research

Genetic Drivers of von Willebrand Factor Levels in an Ischemic Stroke Population and Association With Risk for Recurrent Stroke Clinical Sciences
Background and Purpose—von Willebrand factor (vWF) plays an important role in thrombus formation during cerebrovascular damage. We sought to investigate the potential role of circulating vWF in recurrent cerebrovascular events and identify genetic contributors to variation in vWF level in an ischemic stroke population.Methods—We analyzed the effect of circulating vWF on risk of recurrent stroke using survival models in the VISP trial (Vitamin Intervention for Stroke Prevention) and the use of vWF in reclassification over traditional factors. We conducted a genome-wide association study) with imputation, based on 1000 G...
Source: Stroke - May 22, 2017 Category: Neurology Authors: Stephen R. Williams, Fang–Chi Hsu, Keith L. Keene, Wei–Min Chen, Godfrey Dzhivhuho, Joe L. Rowles III, Andrew M. Southerland, Karen L. Furie, Stephen S. Rich, Bradford B. Worrall, Michele M. Sale Tags: Biomarkers, Cerebrovascular Disease/Stroke, Ischemic Stroke Original Contributions Source Type: research

Restarting Anticoagulant Therapy After Intracranial Hemorrhage Clinical Sciences
Background and Purpose—The safety and efficacy of restarting anticoagulation therapy after intracranial hemorrhage (ICH) remain unclear. We performed a systematic review and meta-analysis to summarize the associations of anticoagulation resumption with the subsequent risk of ICH recurrence and thromboembolism.Methods—We searched published medical literature to identify cohort studies involving adults with anticoagulation-associated ICH. Our predictor variable was resumption of anticoagulation. Outcome measures were thromboembolic events (stroke and myocardial infarction) and recurrence of ICH. After assessing study het...
Source: Stroke - May 22, 2017 Category: Neurology Authors: Santosh B. Murthy, Ajay Gupta, Alexander E. Merkler, Babak B. Navi, Pitchaiah Mandava, Costantino Iadecola, Kevin N. Sheth, Daniel F. Hanley, Wendy C. Ziai, Hooman Kamel Tags: Catheter Ablation and Implantable Cardioverter-Defibrillator, Myocardial Infarction, Intracranial Hemorrhage, Ischemic Stroke Original Contributions Source Type: research

Risk of Ischemic Stroke Associated With Calcium Supplements With or Without Vitamin D: A Nested Case-Control Study Stroke
BackgroundThere is controversy surrounding the risk of ischemic stroke associated with the use of calcium supplements either in monotherapy or in combination with vitamin D.Methods and ResultsA nested case‐control study was performed with patients aged 40 to 89 years old, among whom a total of 2690 patients had a first episode of nonfatal ischemic stroke and for which 19 538 controls were randomly selected from the source population and frequency‐matched with cases for age, sex, and calendar year. Logistic regression provided the odds ratios while adjusting for confounding factors. A sensitivity analysis was performe...
Source: JAHA:Journal of the American Heart Association - May 18, 2017 Category: Cardiology Authors: de Abaȷo, F. J., Rodriguez-Martin, S., Rodriguez-Miguel, A., Gil, M. J. Tags: Cerebrovascular Disease/Stroke, Ischemic Stroke Original Research Source Type: research

Meta-analysis of folic acid efficacy trials in stroke prevention: Insight into effect modifiers
Conclusions: Folic acid supplementation could reduce the stroke risk in regions without folic acid fortification, particularly in trials using a relatively low dosage of folic acid and with low vitamin B12 levels.
Source: Neurology - May 8, 2017 Category: Neurology Authors: Zhao, M., Wu, G., Li, Y., Wang, X., Hou, F. F., Xu, X., Qin, X., Cai, Y. Tags: Stroke prevention, All Cerebrovascular disease/Stroke, Clinical trials Randomized controlled (CONSORT agreement), All epidemiology ARTICLE Source Type: research

A recurrent stroke stabilization after using novel Oral Anti-Coagulant
We report a patient who suffered from recurrent posterior circulation strokes occurring eight times in 4 months even under adequate antiplatelet medication. Changing the medication from antiplatelet agents to NOAC stopped the stroke recurrence.
Source: Journal of Stroke and Cerebrovascular Diseases - March 18, 2017 Category: Neurology Authors: Jeong Ho Han, Doo Eung Kim, Seung Min Kim, Sang Woo Han, Sang Won Ha Source Type: research

Recurrent stroke in a patient with vitamin B12 deficiency and MTHFR mutation
We report an unusual case of recurrent stroke in a patient with vitamin B12 deficiency who was also homozygous for the methylene tetrahydrofolate reductase (MTHFR) gene mutation. The patient was a 35-year-old male vegetarian with no known medical history who initially presented with global aphasia, slurred speech, right facial weakness, and right-sided hemiplegia and was found to have a stroke (NIH Stroke Scale score of 25). At that time a CT scan of the head ruled out intracranial hemorrhage and a CT angiogram of the head and neck was done. The patient was found to have occlusion of the M1 segment of the left middle cereb...
Source: Neurology Clinical Practice - February 12, 2017 Category: Neurology Authors: Zacharia, G., Shani, D., Ortiz, R. A. Tags: Stroke in young adults, Stroke prevention, Hematologic, All Cerebrovascular disease/Stroke Case Source Type: research

Early start of DOAC after ischemic stroke: Risk of intracranial hemorrhage and recurrent events
Conclusions: Even if DOACs are often started early after an index event, the risk of ICH appears to be low. Among all patients receiving anticoagulation, the rate of recurrent events was 6 times higher than the rate of ICH.
Source: Neurology - October 30, 2016 Category: Neurology Authors: Seiffge, D. J., Traenka, C., Polymeris, A., Hert, L., Peters, N., Lyrer, P., Engelter, S. T., Bonati, L. H., De Marchis, G. M. Tags: Stroke prevention, Clinical trials Observational study (Cohort, Case control) ARTICLE Source Type: research

Oral Anticoagulant Use in Atrial Fibrillation-Associated Ischemic Stroke: A Retrospective, Multicenter Survey in Northwestern China
Anticoagulation therapy has been recommended by major guidelines to reduce the risk of recurrent stroke in patients with atrial fibrillation-associated ischemic stroke (AFAIS). However, in real-world clinical practice, oral anticoagulants with either vitamin K antagonists or nonvitamin K antagonists are often underused for these patients. Here, we sought to investigate the current status of oral anticoagulant use in patients with AFAIS in northwestern China.
Source: Journal of Stroke and Cerebrovascular Diseases - September 15, 2016 Category: Neurology Authors: Jing Zhang, Xi-ai Yang, Yi Zhang, Jing-ya Wei, Feng Yang, Hua Gao, Wen-wen Jiao, Xiao-long Sun, Qiong Gao, Wen Jiang Source Type: research

Early Initiation of Anticoagulation with Direct Oral Anticoagulants in Patients after Transient Ischemic Attack or Ischemic Stroke
Direct oral anticoagulants (DOACs) are increasingly used for secondary prevention of cardioembolic stroke. While DOACs are associated with a long-term reduced risk of intracranial hemorrhage compared to vitamin K antagonists, pivotal trials avoided the very early period after stroke and few data exist on early initiation of DOAC therapy post stroke.
Source: Journal of Stroke and Cerebrovascular Diseases - July 18, 2016 Category: Neurology Authors: Kosmas Macha, Bastian Volbers, Tobias Bobinger, Natalia Kurka, Lorenz Breuer, Hagen B. Huttner, Stefan Schwab, Martin Köhrmann Source Type: research

Comparative Effectiveness of Interventions for Stroke Prevention in Atrial Fibrillation: A Network Meta-Analysis Arrhythmia and Electrophysiology
Conclusions The entire spectrum of therapy to prevent thromboembolism in nonvalvular AF significantly reduced stroke/systemic embolism events and mortality.
Source: JAHA:Journal of the American Heart Association - May 19, 2016 Category: Cardiology Authors: Tereshchenko, L. G., Henrikson, C. A., Cigarroa, J., Steinberg, J. S. Tags: Atrial Fibrillation, Anticoagulants, Treatment, Meta Analysis, Cerebrovascular Disease/Stroke Arrhythmia and Electrophysiology 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 27, 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

Effect of Adherence to Oral Anticoagulants on Risk of Stroke and Major Bleeding Among Patients With Atrial Fibrillation Arrhythmia and Electrophysiology
Conclusions Adherence to anticoagulation is poor in practice and may be modestly improved with NOACs. Adherence to therapy appears to be most important in patients with CHA2DS2-VASc score ≥2, whereas the benefits of anticoagulation may not outweigh the harms in patients with CHA2DS2-VASc score 0 or 1.
Source: JAHA:Journal of the American Heart Association - February 23, 2016 Category: Cardiology Authors: Yao, X., Abraham, N. S., Alexander, G. C., Crown, W., Montori, V. M., Sangaralingham, L. R., Gersh, B. J., Shah, N. D., Noseworthy, P. A. Tags: Arrhythmias, Atrial Fibrillation, Secondary Prevention, Intracranial Hemorrhage, Ischemic Stroke Arrhythmia and Electrophysiology Source Type: research

Shared genetic susceptibility of vascular-related biomarkers with ischemic and recurrent stroke
Conclusions: Our data identify a genetic contribution to inflammatory and hemostatic biomarkers in a stroke population. Additionally, our results suggest shared genetic contributions to circulating CRP levels measured poststroke and risk for incident and recurrent ischemic stroke. These data broaden our understanding of genetic contributors to biomarker variation and ischemic stroke risk, which should be useful in clinical risk evaluation.
Source: Neurology - January 25, 2016 Category: Neurology Authors: Williams, S. R., Hsu, F.-C., Keene, K. L., Chen, W.-M., Nelson, S., Southerland, A. M., Madden, E. B., Coull, B., Gogarten, S. M., Furie, K. L., Dzhivhuho, G., Rowles, J. L., Mehndiratta, P., Malik, R., Dupuis, J., Lin, H., Seshadri, S., Rich, S. S., Sale Tags: All Cerebrovascular disease/Stroke, Case control studies, Risk factors in epidemiology, All Genetics, Association studies in genetics ARTICLE Source Type: research

Association between 5,10-Methylenetetrahydrofolate Reductase C677T Gene Polymorphism and Risk of Ischemic Stroke: A Meta-analysis
Hyperhomocysteinemia, a condition that is strongly determined by dietary intake of B vitamins, has been suggested to be an independent risk factor for ischemic stroke (IS). To test this hypothesis, we performed a meta-analysis to investigate the associations between 5,10-methylenetetrahydrofolate reductase (MTHFR) C677T gene polymorphism, which plays a critical role in modulating plasma homocysteine concentrations, and IS risk.
Source: Journal of Stroke and Cerebrovascular Diseases - January 5, 2016 Category: Neurology Authors: Yanli Song, Bohong Li, Chunjuan Wang, Penglian Wang, Xiang Gao, Gaifen Liu Source Type: research

Endovascular Treatment for Acute Ischemic Stroke in the Setting of Anticoagulation Brief Reports
Conclusions— Intra-arterial therapy seems to be safe in patients taking OACs; however, our study showed a nonsignificant increase in hemorrhage and mortality with a nonsignificant decrease in good outcomes in comparison with non-OAC patients. Although these nominal differences may have been related to older age and more comorbidities in the OAC group, larger studies are needed to confirm our findings given our limited sample size.
Source: Stroke - November 23, 2015 Category: Neurology Authors: Rebello, L. C., Haussen, D. C., Belagaje, S., Anderson, A., Frankel, M., Nogueira, R. G. Tags: Anticoagulants, Cerebrovascular Disease/Stroke, 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

Clinical and Economic Implications of Apixaban Versus Aspirin in the Low-Risk Nonvalvular Atrial Fibrillation Patients Clinical Sciences
Conclusions— Anticoagulant treatment with apixaban versus aspirin in low-risk patients, as identified using CHADS2 or CHA2DS2–VASc, is projected to increase life expectancy and provide clinical benefits that are cost effective.
Source: Stroke - September 28, 2015 Category: Neurology Authors: Lip, G. Y. H., Lanitis, T., Mardekian, J., Kongnakorn, T., Phatak, H., Dorian, P. Tags: Primary prevention, Cerebrovascular disease/stroke, Anticoagulants, Antiplatelets 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

The Clinical Relevance of Microbleeds in Stroke study (CROMIS‐2): rationale, design, and methods
Background and rationaleThe increasing use of oral anticoagulants, mostly to prevent ischemic stroke due to atrial fibrillation in an ageing population, has been associated with a fivefold increased incidence of oral anticoagulant‐associated intracerebral hemorrhage: a rare, serious, and unpredictable complication. We hypothesize that cerebral microbleeds and other markers of cerebral small vessel disease on magnetic resonance imaging, and genetic polymorphisms (e.g. influencing cerebral small vessel integrity or anticoagulation stability), are associated with an increased risk of oral anticoagulant‐associated intracer...
Source: International Journal of Stroke - August 2, 2015 Category: Neurology Authors: Andreas Charidimou, Duncan Wilson, Clare Shakeshaft, Gareth Ambler, Mark White, Hannah Cohen, Tarek Yousry, Rustam Al‐Shahi Salman, Gregory Lip, Henry Houlden, Hans R. Jäger, Martin M. Brown, David J. Werring Tags: Protocol Source Type: research

Clinical Relevance of , , , and Gene Polymorphisms and Serum Vitamin Profile among Malay Patients with Ischemic Stroke
The purpose of this study was threefold. First, it was to determine the relationship between serum vitamin profiles and ischemic stroke. The second purpose was to investigate the association of methylenetetrahydrofolate reductase (MTHFR), endothelial nitric oxide synthase (eNOS), angiotensin converting enzyme (ACE), and apolipoprotein-E (ApoE) gene polymorphisms with ischemic stroke and further correlate with serum vitamin profiles among ischemic stroke patients. The third purpose of the study was to highlight the interaction of MTHFR and eNOS haplotypes with serum vitamin profiles and ischemic stroke risks.
Source: Journal of Stroke and Cerebrovascular Diseases - July 14, 2015 Category: Neurology Authors: Loo Keat Wei, Anthony Au, Saras Menon, Siew Hua Gan, Lyn R. Griffiths Source Type: research

Protocol for Cerebral Microbleeds During the Non–Vitamin K Antagonist Oral Anticoagulants or Warfarin Therapy in Stroke Patients With Nonvalvular Atrial Fibrillation (CMB-NOW) Study: Multisite Pilot Trial
Anticoagulants are widely used to prevent recurrence of ischemic stroke in patients with nonvalvular atrial fibrillation, but in some patients, they also cause bleeding, particularly intracranial hemorrhage. One of the independent predictors of intracerebral hemorrhage is the presence of cerebral microbleeds (CMBs); a high incidence of intracerebral hemorrhage is reported in warfarin-treated patients with multiple CMBs. Longitudinal study suggested that the presence of CMBs at baseline is a predictor of new CMBs in warfarin-treated patients.
Source: Journal of Stroke and Cerebrovascular Diseases - July 4, 2015 Category: Neurology Authors: Shunya Takizawa, Fumiaki Tanaka, Kazutoshi Nishiyama, Yasuhiro Hasegawa, Eiichiro Nagata, Atsushi Mizuma, Sachiko Yutani, Taira Nakayama, Hiroyuki Kobayashi, Noriharu Yanagimachi, Takashi Okazaki, Kazuo Kitagawa, CMB-NOW Study Investigators Source Type: research

Low Serum Vitamin D Is Independently Associated with Larger Lesion Volumes after Ischemic Stroke
Despite its high prevalence, known association with vascular disease and stroke incidence and fatality, little is known about the contribution of vitamin D status to a worse outcome after ischemic stroke. Therefore, we sought to assess whether low serum 25-hydroxyvitamin D (25[OH]D), a marker of vitamin D status, is predictive of the ischemic infarct volume and whether it relates to a worse outcome.
Source: Journal of Stroke and Cerebrovascular Diseases - May 22, 2015 Category: Neurology Authors: Anya Turetsky, Richard P. Goddeau, Nils Henninger Source Type: research

Using the Watchman device to close the left atrial appendage reduces risk of stroke in atrial fibrillation, compared to using warfarin
Commentary to: Reddy VY, Sievert H, Halperin J, et al.; PROTECT AF Steering Committee and Investigators. Percutaneous left atrial appendage closure vs warfarin for atrial fibrillation: a randomized clinical trial. JAMA 2014;312:1988–98 . Context Atrial fibrillation (AF) is a common arrhythmia in clinical practice. The major complication of AF is thromboembolic stroke. Patients with AF have a fivefold higher risk of stroke and a twofold increase in mortality.1 As complete cure for AF is never certain, the aims of AF therapy are symptom relief and prevention of thromboembolic events. The latter can be managed by vitami...
Source: Evidence-Based Medicine - May 22, 2015 Category: Internal Medicine Authors: Swaans, M. J., Alipour, A., Boersma, L. V. Tags: Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Arrhythmias Therapeutics/Prevention 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

Fibroblast Growth Factor 23 and Risk of Incident Stroke in Community-Living Adults Clinical Sciences
Conclusions— Higher FGF23 concentrations were associated with higher risk of cardioembolic but not with other stroke subtypes in community-dwelling adults. Additional studies should delineate reasons for these findings.
Source: Stroke - January 26, 2015 Category: Neurology Authors: Panwar, B., Jenny, N. S., Howard, V. J., Wadley, V. G., Muntner, P., Kissela, B. M., Judd, S. E., Gutierrez, O. M. Tags: Acute Cerebral Infarction, Embolic stroke, Epidemiology Clinical Sciences Source Type: research

Stroke prevention: managing modifiable risk factors.
Authors: Di Legge S, Koch G, Diomedi M, Stanzione P, Sallustio F Abstract Prevention plays a crucial role in counteracting morbidity and mortality related to ischemic stroke. It has been estimated that 50% of stroke are preventable through control of modifiable risk factors and lifestyle changes. Antihypertensive treatment is recommended for both prevention of recurrent stroke and other vascular events. The use of antiplatelets and statins has been shown to reduce the risk of recurrent stroke and other vascular events. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are ...
Source: Stroke Research and Treatment - December 2, 2014 Category: Neurology Tags: Stroke Res Treat Source Type: research

Nontraditional Serum Lipid Variables and Recurrent Stroke Risk Clinical Sciences
Conclusions— Of various nontraditional lipid variables, elevated baseline triglycerides/HDL-C and total cholesterol/HDL-C ratios predict future vascular risk after a stroke, but only elevated triglycerides/HDL-C ratio is related to risk of recurrent stroke. Future studies should assess the role of triglycerides/HDL-C as a potential therapeutic target for global vascular risk reduction after stroke.
Source: Stroke - October 27, 2014 Category: Neurology Authors: Park, J.-H., Lee, J., Ovbiagele, B. Tags: Other Stroke Treatment - Medical Clinical Sciences Source Type: research

Rivaroxaban for Stroke Prevention in East Asian Patients From the ROCKET AF Trial Clinical Sciences
Conclusions— Observed relative efficacy and safety of rivaroxaban versus warfarin were similar among patients within and outside East Asia. Rivaroxaban, 20 mg once daily, is an alternative to warfarin for stroke prevention in East Asians with nonvalvular atrial fibrillation. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT00123456.
Source: Stroke - May 27, 2014 Category: Neurology Authors: Wong, K. S. L., Hu, D. Y., Oomman, A., Tan, R.-S., Patel, M. R., Singer, D. E., Breithardt, G., Mahaffey, K. W., Becker, R. C., Califf, R., Fox, K. A. A., Berkowitz, S. D., Hacke, W., Hankey, G. J., on behalf of The Executive Steering Committee and the RO Tags: Other anticoagulants, Embolic stroke, Anticoagulants Clinical Sciences Source Type: research

Consistency of Blood Pressure Control After Ischemic Stroke: Prevalence and Prognosis Clinical Sciences
Conclusions— In this rigorous clinical trial, fewer than one third of patients with stroke had BP controlled ≥75% of the time for 2 years. Furthermore, consistency of BP control among those with elevated baseline systolic BP was linked to reduction in risk of recurrent stroke and stroke, myocardial infarction, and vascular death.
Source: Stroke - April 28, 2014 Category: Neurology Authors: Towfighi, A., Markovic, D., Ovbiagele, B. Tags: Cerebrovascular disease/stroke Clinical Sciences Source Type: research