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Which drug should we use for stroke prevention in atrial fibrillation?
This article reviews the latest evidence and development of new oral anticoagulants for the prevention of ischaemic stroke, as well as bleeding risk assessment, mitigation and management. Recent findingsDecision-making for stroke prevention has evolved towards the initial identification of ‘low-risk’ patients who do not need any antithrombotic therapy. Subsequent to this step, patients with at least 1 stroke risk factor can be offered effective stroke prevention, which is OAC. There is increased morbidity and mortality amongst warfarin users, if time in therapeutic range is poor. New oral anticoagulants (such as dabiga...
Source: Current Opinion in Cardiology - June 6, 2014 Category: Cardiology Tags: CLINICAL TRIALS: Edited by Harvey D. White Source Type: research

Systematic review and network meta-analysis of stroke prevention treatments in patients with atrial fibrillation.
CONCLUSION: All oral anticoagulants reduce the risk of stroke in AF patients. Some novel oral anticoagulants are associated with a lower stroke and/or major bleeding risk than warfarin. In addition to the safety and effectiveness of drug therapy, as reported in this study, individual treatment recommendations should also consider the patient's underlying stroke and bleeding risk profile. PMID: 27570467 [PubMed]
Source: Clinical Pharmacology: Advances and Applications - August 31, 2016 Category: Allergy & Immunology Tags: Clin Pharmacol Source Type: research

Oral antiplatelet and anticoagulant agents in the prevention and management of ischemic stroke.
Abstract Despite numerous advances over the last 50 years, stroke continues to be a leading cause of death and disability worldwide. The treatment and prevention of stroke has undergone extensive study, and significant advances in medical management have occurred within the past decade principally with the development of new classes of orally active anticoagulant drugs. Here we review these recent breakthroughs and the varying roles of anticoagulants and antiplatelet agents in the prevention and management of different ischemic stroke subtypes, as well as describe the benefits and ongoing challenges to incorporati...
Source: Current Pharmaceutical Design - December 20, 2016 Category: Drugs & Pharmacology Authors: Shrestha S, Coy S, Bekelis K Tags: Curr Pharm Des Source Type: research

Anticoagulation in acute ischemic stroke: A systematic search
Conclusion: The ideal time for initiating anticoagulation remains undefined, requiring further investigation. Early anticoagulation for ischemic stroke is not recommended, with few exceptions, such as that of argatroban.Resumo Introdu ção: O acidente vascular cerebral (AVC) é uma das doenças mais importantes no mundo. Vários cenários clínicos exigem dose completa de anticoagulantes para tratar a etiologia primária do AVC ou para o tratamento de uma comorbidade. Contudo, existem inúmeras controvérsias em relação ao tra tamento com anticoagulação no AVC, como tempo para o início, eficácia de acordo com a etio...
Source: Revista da Associacao Medica Brasileira - February 21, 2017 Category: Journals (General) Source Type: research

Impact of pre-admission treatment with non-vitamin K oral anticoagulants on stroke severity in patients with acute ischemic stroke
ConclusionsWe report a positive impact of pre-admission NOAC on ischemic stroke severity, which is particularly remarkable in light of the increased prevalence of prior stroke and lower rates of thrombolysis in this patient population.
Source: Journal of Thrombosis and Thrombolysis - February 23, 2018 Category: Hematology Source Type: research

Risk of stroke and bleeding in relation to hypertension in anticoagulated patients with atrial fibrillation: a meta-analysis of randomised controlled trials
CONCLUSIONS: Adequate blood pressure management is vital to optimally reduce the risk of stroke in patients with atrial fibrillation. The benefits of NOACs over VKAs, also apply to patients with elevated blood pressure.PMID:33685380 | DOI:10.1080/00015385.2021.1882111
Source: Acta Cardiologica - March 9, 2021 Category: Cardiology Authors: Ralf E Harskamp Wim A M Lucassen Renato D Lopes Jelle C L Himmelreich Gianfranco Parati Henk C P M van Weert Source Type: research

Medical Costs of Oral Anticoagulants vs Warfarin for Atrial Fibrillation Patients with Different Stroke Risks
Conclusions Medical cost differences associated with OACs vs. warfarin vary according to stroke risk. Of the three OACs, apixaban demonstrated consistent medical cost reductions vs. warfarin for NVAF patients with moderate and high stroke risks.
Source: Cardiology and Therapy - December 1, 2013 Category: Cardiology Source Type: research

Comparison of All-Cause, Stroke, and Bleed-Specific Healthcare Resource Utilization among Patients with Non-Valvular Atrial Fibrillation (NVAF) and Newly Treated with Dabigatran or Warfarin.
CONCLUSION: Among newly diagnosed newly treated NVAF patients, dabigatran users had significantly lower all-cause, stroke- and bleed-specific HCRU, lower risk of hospitalization for stroke or bleed events, lower 30-day readmissions, and higher persistence than warfarin users. PMID: 28649894 [PubMed - as supplied by publisher]
Source: Expert Review of Pharmacoeconomics and Outcomes Research - June 28, 2017 Category: Health Management Tags: Expert Rev Pharmacoecon Outcomes Res Source Type: research

Idarucizumab in Dabigatran-Treated Patients with Acute Ischemic Stroke Receiving Alteplase: A Systematic Review of the Available Evidence
ConclusionExperience with idarucizumab administration prior to tissue plasminogen activator treatment in acute ischemic stroke is limited. Initial clinical experience in less severe stroke syndromes and short time windows seems favorable. Larger cohorts are required to confirm safety, including bleeding complications and the risk of thrombosis.
Source: CNS Drugs - August 14, 2017 Category: Neurology Source Type: research

New Standards of Care in Ischemic Stroke
Conclusions: Endovascular therapy is now standard of care for eligible patients with anterior large vessel occlusions. Prolonged cardiac monitoring is recommended for patients with cryptogenic stroke. The novel anticoagulants are an alternative to warfarin in patients with AF.
Source: Journal of Neuro-Ophthalmology - August 17, 2017 Category: Opthalmology Tags: State-of-the-Art Review Source Type: research

Direct oral anticoagulants for stroke prevention in atrial fibrillation: treatment outcomes and dosing in special populations.
CONCLUSIONS: Overall, results of secondary analyses indicate that the recommended dosing strategy for each of the DOACs produces a consistent anticoagulant effect across a diverse patient population, including those at increased risk of stroke or bleeding. PMID: 30081727 [PubMed - in process]
Source: Adv Data - August 9, 2018 Category: Epidemiology Authors: Stacy ZA, Richter SK Tags: Ther Adv Cardiovasc Dis Source Type: research

Embolic stroke of undetermined source: Gateway to a new stroke entity?
Embolic stroke of unknown source is currently thought to represent a subpopulation of cryptogenic strokes defined by its embolic stroke pattern on imaging and if after a carefully performed diagnostic evaluation, a specific, well recognized cause of stroke has not been identified. The concept was primarily established to justify and enable the conduct of the Embolic Stroke of Unknown Source (ESUS)-trials, such as RESPECT-ESUS (Randomized, Double-Blind, Evaluation in Secondary Stroke Prevention Comparing the Efficacy and Safety of the Oral Thrombin Inhibitor Dabigatran Etexilate versus Acetylsalicylic Acid in Patients with ...
Source: The American Journal of Medicine - April 1, 2020 Category: General Medicine Authors: Wolf-R üdiger Schäbitz, Martin Köhrmann, Peter D. Schellinger, Jens Minnerup, Marc Fisher Tags: Review Source Type: research