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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

Stroke severity in patients with preceding direct oral anticoagulant therapy as compared to vitamin K antagonists
AbstractBackgroundAlthough direct oral anticoagulants (DOAC) have proven at least equally effective in the prevention of acute ischemic stroke (AIS) in patients with atrial fibrillation as compared to the vitamin K antagonists (VKA), no reliable data on the severity of AIS of DOAC patients as compared to VKA is available.MethodsUsing a prospectively collected cohort of AIS patients, we performed univariate and multivariate (displayed as adjusted Odds Ratios, OR and 95% confidence intervals, 95% CI) analyses regarding the severity of AIS in patients with preceding DOAC (N = 210) versus VKA (N = 173) therapy. Additio...
Source: Journal of Neurology - June 3, 2019 Category: Neurology Source Type: research

Neuroimaging and clinical outcomes of oral anticoagulant –associated intracerebral hemorrhage
ObjectiveWhether intracerebral hemorrhage (ICH) associated with non –vitamin K antagonist oral anticoagulants (NOAC‐ICH) has a better outcome compared to ICH associated with vitamin K antagonists (VKA‐ICH) is uncertain.MethodsWe performed a systematic review and individual patient data meta ‐analysis of cohort studies comparing clinical and radiological outcomes between NOAC‐ICH and VKA‐ICH patients. The primary outcome measure was 30‐day all‐cause mortality. All outcomes were assessed in multivariate regression analyses adjusted for age, sex, ICH location, and intraventricul ar hemorrhage extension.Results...
Source: Annals of Neurology - October 25, 2018 Category: Neurology Authors: Georgios Tsivgoulis, Duncan Wilson, Aristeidis H. Katsanos, Jo ão Sargento‐Freitas, Cláudia Marques‐Matos, Elsa Azevedo, Tomohide Adachi, Christian Brelie, Yoshifusa Aizawa, Hiroshi Abe, Hirofumi Tomita, Ken Okumura, Joji Hagii, David J Tags: Research Article Source Type: research

Non-Vitamin K Oral Anticoagulants (NOACs) and Their Reversal
AbstractPurpose of ReviewAn 80-year-old man presents with an acute right hemiparesis and National Institutes of Health Stroke Scale (NIHSS) of 25, 14  h after taking dabigatran. Activated partial thromboplastin time (aPTT) is 42.8 s. Arteriogram demonstrates left internal carotid artery thrombosis. What is the appropriate management of this patient with acute ischemic stroke while on a NOAC?Recent FindingsIdarucizumab is a reversal agent approved for dabigatran, and two more reversal agents, andexanet alfa and aripazine, are currently in development for NOACs.SummaryIn this article, we review currently available NOACs, t...
Source: Current Neurology and Neuroscience Reports - July 22, 2017 Category: Neuroscience Source Type: research

Questionable reversal of anticoagulation in the therapeutic management of cerebral haemorrhage associated with vitamin K antagonists.
Abstract Reversal of anticoagulation is recommended to correct the international normalised ratio (INR) for patients with intracranial haemorrhage (ICH) associated with vitamin K antagonists (VKA). However, the validity of such treatment is debated. We sought to identify, prospectively, the prognostic effect of VKA-ICH treatment in a cohort of patients (n=71; median age 78 years, range 20-89; 57% males). Data collated were: baseline characteristics, treatments, baseline and post-treatment INR, haematoma volume, and haematoma enlargement. Treatment effects and prognostic factor assessment were in relation to mortal...
Source: Thrombosis and Haemostasis - September 12, 2013 Category: Hematology Authors: Alonso de Leciñana M, Huertas N, Egido JA, Muriel A, García A, Ruiz-Ares G, Díez-Tejedor E, Fuentes B Tags: Thromb Haemost Source Type: research

CO33 Methodological Challenges and Considerations for Decision Makers When Assessing within-Class Comparative Effectiveness and Cost-Effectiveness: The Case of Non-Vitamin K Antagonist Oral Anticoagulants
The United Kingdom National Institute of Health Care Excellence (NICE) published a draft clinical guideline for consultation on anticoagulation therapy for stroke prevention in individuals with atrial fibrillation in September 2020 that addressed which non-vitamin K antagonist oral anticoagulant (NOAC) therapy (apixaban, dabigatran, rivaroxaban, edoxaban) is most clinically and cost-effective. We aimed to elucidate methodological considerations and challenges involved in evaluating the comparative effectiveness and cost-effectiveness of within-class treatments for the  purpose of decision making by a reimbursement authority.
Source: Value in Health - June 26, 2022 Category: International Medicine & Public Health Authors: A Briggs, A Howarth, S Davies, J Schneider, G Spentzouris, F Mughal, A Fuat, M Fay Source Type: research