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Efficacy and safety of direct oral anticoagulants vs vitamin K antagonists in patients with atrial fibrillation and end-stage renal disease on hemodialysis: A systematic review and meta-analysis
CONCLUSIONS: Among AF patients with ESRD on chronic hemodialysis, the risk of ischemic stroke, ischemic stroke or systemic embolism, minor bleeding, major bleeding, and all-cause mortality is similar in patients treated with DOACs compared to VKAs. Given that the meta-analysis of RCTs on gastrointestinal bleeding did not confirm the results of the meta-analysis of the observational studies, it cannot be concluded that gastrointestinal bleeding is lower among DOAC-treated patients.PROTOCOL REGISTRATION: PROSPERO CRD42023391966.PMID:37648582 | DOI:10.1016/j.ejim.2023.08.020
Source: European Journal of Internal Medicine - August 30, 2023 Category: Internal Medicine Authors: Ioannis Kyriakoulis Anastasia Adamou Iliana Stamatiou David Dimitris Chlorogiannis Ioannis Kardoutsos Despoina Koukousaki George Ntaios Source Type: research

A new strategy for anticoagulation: The factor XI inhibitors
Eur J Intern Med. 2023 Aug 4:S0953-6205(23)00284-4. doi: 10.1016/j.ejim.2023.08.001. Online ahead of print.ABSTRACTDirect oral anticoagulants (DOACs) are currently the first-choice therapy for the prevention of cardioembolic events in patients with atrial fibrillation and for the treatment of venous thromboembolism (VTE) due to their more favorable efficacy to safety profile in comparison to vitamin K antagonists (VKA). DOACs did not show a clinical benefit when used for in stroke prevention in patients with mechanic or rheumatic valves or in those who underwent transcatheter aortic valve implantation (TAVI), in the treatm...
Source: European Journal of Internal Medicine - August 6, 2023 Category: Internal Medicine Authors: Maria Cristina Vedovati Cecilia Becattini Giancarlo Agnelli Source Type: research

DOACs or Vitamin K Antagonists for Patients ≥ 85 With AF and Recent Stroke? DOACs or Vitamin K Antagonists for Patients ≥ 85 With AF and Recent Stroke?
Until recently, clinicians had little evidence to guide their decisions about the most effective and safe treatment for the oldest patients with atrial fibrillation and recent stroke.Medscape Medical News
Source: Medscape Internal Medicine Headlines - January 3, 2023 Category: Internal Medicine Tags: Cardiology News Source Type: news

Warfarin-induced isolated spontaneous subarachnoid hemorrhage: Rare case report
CONCLUSION: Warfarin is rarely associated with isolated subarachnoid hemorrhage. This case highlights a young male patient with spontaneous SAH after warfarin therapy for acute ischemic stroke. Aneurysmal rupture and trauma should be excluded before a diagnosis of warfarin-induced SAH is made.PMID:36582886 | PMC:PMC9793204 | DOI:10.1016/j.amsu.2022.104946
Source: Annals of Medicine - December 30, 2022 Category: Internal Medicine Authors: Mohamed Sheikh Hassan Ahmet Bakir Bakar Ali Adam Nor Osman Sidow Abdiwahid Ahmed Ibrahim Ishak Ahmed Abdi Mohamud Mire Waberi Source Type: research

Delaying clinical events among patients with non-valvular atrial fibrillation treated with oral anticoagulants: Insights from the ARISTOPHANES study
CONCLUSIONS: Over 12 months after initiation, apixaban and dabigatran conferred progressive increases in event free time for stroke/SE and MB vs warfarin, whereas rivaroxaban conferred an increase in stroke/SE-free time but a loss in MB-free time vs warfarin.PMID:36456387 | DOI:10.1016/j.ejim.2022.10.021
Source: European Journal of Internal Medicine - December 1, 2022 Category: Internal Medicine Authors: Steven Deitelzweig Allison Keshishian Amiee Kang Aaron Jenkins Nipun Atreja Patricia Schuler Jenny Jiang Huseyin Yuce Xiaoxi Sun Gregory Y H Lip Source Type: research

The association between the serum vitamin D levels and the stroke lesion size, functional ability, and cognition in elderly Korean ischemic stroke patients
This study included Korean ischemic stroke patients aged 65 to 85 years. The size of the lesion was measured in brain images taken within 24 hours of hospitalization. The level of 25-(OH) Vitamin D (ng/mL), a metabolite of vitamin D, in the serum collected within 48 hours of hospitalization, and the modified Barthel index (MBI), gait performance, the muscle power of hip and knee extensors on the hemiplegic side, and mini-mental status examination (MMSE) were recorded within 1 week of the onset of the disease. Each factor was compared through correlation analysis, and the significance was confirmed using the Spearman correl...
Source: Medicine - September 2, 2022 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Bilateral ptosis caused by patent foramen ovale-associated stroke
A 39-year-old woman presented with sudden onset bilateral ptosis and binocular diplopia for 3 days. The double vision was horizontal and most prominent when she was looking to the left side. The severity of symptoms does not vary over the day. She denied vertigo, headache, ocular pain, limb weakness, paresthesia, alcohol usage and botulinum toxin injection. Past medical history and family history were unremarkable. Neurological examination revealed bilateral ptosis, limited adduction in the right eye and normal pupils (Figure  1A). Other cranial nerves, extremity strength, coordination and sensory tests were intact. Deep ...
Source: QJM - August 16, 2022 Category: Internal Medicine Source Type: research

Economic evaluation of direct oral anticoagulants (DOACs) versus vitamin K antagonists (VKAs) for stroke prevention in patients with atrial fibrillation: a systematic review and meta-analysis
Conclusions Our meta-analysis provides comprehensive economic evidence that allows policy makers to generalise cost-effectiveness data to their local context. All DOACs may be cost-effective compared with VKA in HICs with TPP perspective. The pooling results produced moderate to high heterogeneity particularly in UMICs. Further studies are required to inform UMICs with SP. PROSPERO registeration number CRD 42019146610.
Source: Evidence-Based Medicine - July 28, 2022 Category: Internal Medicine Authors: Noviyani, R., Youngkong, S., Nathisuwan, S., Bagepally, B. S., Chaikledkaew, U., Chaiyakunapruk, N., McKay, G., Sritara, P., Attia, J., Thakkinstian, A. Tags: Open access Evidence synthesis Source Type: research

Vitamin D: The silent rescuer from ischemic stroke
Ann Med Surg (Lond). 2022 May 11;78:103751. doi: 10.1016/j.amsu.2022.103751. eCollection 2022 Jun.NO ABSTRACTPMID:35620044 | PMC:PMC9127262 | DOI:10.1016/j.amsu.2022.103751
Source: Annals of Medicine - May 27, 2022 Category: Internal Medicine Authors: Safinaz Khan Md Moshiur Rahman A H M Ataullah Rubaya Rashid Source Type: research

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