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Summary of evidence-based guideline update: Prevention of stroke in nonvalvular atrial fibrillation: Report of the Guideline Development Subcommittee of the American Academy of Neurology
Objective: To update the 1998 American Academy of Neurology practice parameter on stroke prevention in nonvalvular atrial fibrillation (NVAF). How often do various technologies identify previously undetected NVAF? Which therapies reduce ischemic stroke risk with the least risk of hemorrhage, including intracranial hemorrhage? The complete guideline on which this summary is based is available as an online data supplement to this article. Methods: Systematic literature review; modified Delphi process recommendation formulation. Major conclusions: In patients with recent cryptogenic stroke, cardiac rhythm monitoring probabl...
Source: Neurology - February 24, 2014 Category: Neurology Authors: Culebras, A., Messe, S. R., Chaturvedi, S., Kase, C. S., Gronseth, G. Tags: All Cerebrovascular disease/Stroke SPECIAL ARTICLE Source Type: research

Stroke Prevention in Symptomatic Large Artery Intracranial Atherosclerosis Practice Advisory: Report of the AAN Guideline Subcommittee
Neurology. 2022 Mar 22;98(12):486-498. doi: 10.1212/WNL.0000000000200030.ABSTRACTBACKGROUND AND OBJECTIVES: To review treatments for reducing the risk of recurrent stroke or death in patients with symptomatic intracranial atherosclerotic arterial stenosis (sICAS).METHODS: The development of this practice advisory followed the process outlined in the American Academy of Neurology Clinical Practice Guideline Process Manual, 2011 Edition, as amended. The systematic review included studies through November 2020. Recommendations were based on evidence, related evidence, principles of care, and inferences.MAJOR RECOMMENDATIONS: ...
Source: Atherosclerosis - March 22, 2022 Category: Cardiology Authors: Tanya N Turan Osama O Zaidat Gary S Gronseth Marc I Chimowitz Antonio Culebras Anthony J Furlan Larry B Goldstein Nestor R Gonzalez Julius G Latorre Steven R Mess é Thanh N Nguyen Rajbeer S Sangha Michael J Schneck Aneesh B Singhal Lawrence R Wechsler Al Source Type: research

Aspirin and clopidogrel resistance in Indian patients with ischemic stroke and its associations with gene polymorphisms: A pilot study
Conclusion: Unlike aspirin, a high proportion of nonresponders to clopidogrel was identified. In an interim analysis on 65 Indian patients, a significant association was found between CYP2C19*2 and clopidogrel nonresponsiveness.
Source: Annals of Indian Academy of Neurology - April 8, 2019 Category: Neurology Authors: Samir Patel Vandana Arya Amrita Saraf Manorama Bhargava CS Agrawal Source Type: research

Summary of evidence-based guideline: Periprocedural management of antithrombotic medications in patients with ischemic cerebrovascular disease: Report of the Guideline Development Subcommittee of the American Academy of Neurology
Objective: To assess evidence regarding periprocedural management of antithrombotic drugs in patients with ischemic cerebrovascular disease. The complete guideline on which this summary is based is available as an online data supplement to this article. Methods: Systematic literature review with practice recommendations. Results and recommendations: Clinicians managing antithrombotic medications periprocedurally must weigh bleeding risks from drug continuation against thromboembolic risks from discontinuation. Stroke patients undergoing dental procedures should routinely continue aspirin (Level A). Stroke patients underg...
Source: Neurology - May 27, 2013 Category: Neurology Authors: Armstrong, M. J., Gronseth, G., Anderson, D. C., Biller, J., Cucchiara, B., Dafer, R., Goldstein, L. B., Schneck, M., Messe, S. R. Tags: Ultrasound, All Medical/Systemic disease, All Neuro-ophthalmology, All Cerebrovascular disease/Stroke, All Trauma SPECIAL ARTICLE Source Type: research

Development of apixaban: a novel anticoagulant for prevention of stroke in patients with atrial fibrillation
The factor Xa inhibitor apixaban is one of the novel anticoagulants to emerge as alternatives to long‐standing standards of care that include low‐molecular‐weight heparin and warfarin. The development of apixaban reflects a strategy to optimize the clinical pharmacology profile, dosing posology, trial designs, and statistical analyses across multiple indications, and to seek alignment with global health authorities. The primary objective of dose selection was to maintain balance between efficacy and bleeding risk. Twice‐daily dosing of apixaban, rather than once daily, was chosen to lower peak concentrations and re...
Source: Annals of the New York Academy of Sciences - November 5, 2014 Category: Science Authors: Michael S. Hanna, Puneet Mohan, Robert Knabb, Elora Gupta, Charles Frost, John H. Lawrence Tags: Original Article Source Type: research

Stroke Patients Likely Safe To Continue Blood Thinners Before Minor Surgery
A new guideline from the American Academy of Neurology advises that it is likely safe for patients to continue taking blood thinners like aspirin or warfarin before minor procedures such as a cataract operation, minor dental surgery or dermatological procedure. Developed with financial support from the American Academy of Neurology, the guideline appears in the 28 May issue of Neurology, the Academy's official journal...
Source: Health News from Medical News Today - May 30, 2013 Category: Consumer Health News Tags: Stroke Source Type: news

Short-Term Clopidogrel Plus Aspirin Prevents Second Ischemic Stroke Better Than Aspirin Alone.
PMID: 31414775 [PubMed - in process]
Source: American Family Physician - August 14, 2019 Category: Primary Care Authors: Shaughnessy AF Tags: Am Fam Physician Source Type: research

Aspirin after Acute Ischemic Stroke.
PMID: 32866353 [PubMed - in process]
Source: American Family Physician - August 31, 2020 Category: Primary Care Authors: Conway J, Friedman BW Tags: Am Fam Physician Source Type: research

Stenosis Length and Degree Interact With the Risk of Cerebrovascular Events Related to Internal Carotid Artery Stenosis
Conclusion: We found a statistically insignificant tendency for the ultrasound-measured length of sICAS<70% to be longer than that of sICAS≥70%. Moreover, the ultrasound-measured length of sICAS<90% was significantly longer than that of sICAS 90%. Among patients with sICAS≥70%, the degree and length of stenosis were inversely correlated. Larger studies are needed before a clinical implication can be drawn from these results. Introduction Internal carotid artery stenosis (ICAS) causes around one-fifth of ischemic cerebrovascular stroke and has the highest risk of early stroke recurrence...
Source: Frontiers in Neurology - April 8, 2019 Category: Neurology Source Type: research

Asymptomatic Carotid Stenosis Is Associated With Circadian and Other Variability in Embolus Detection
Conclusions: Embolism associated with asymptomatic carotid stenosis shows circadian variation with highest rates 4–6 h before midday. This corresponds with peak circadian incidence of stroke and other vascular complications. These and ASED Study results show that monitoring frequency, duration, and time of day are important in ES detection. Introduction Transcranial Doppler (TCD) detected microembolism in the ipsilateral middle cerebral artery (MCA) may help stratify the risk of stroke and other arterial disease complications in persons with advanced (≥60%) asymptomatic carotid stenosis. If so, this t...
Source: Frontiers in Neurology - April 15, 2019 Category: Neurology Source Type: research

Clinical Performance Measures that Matter —Are You Ready?
Conclusion The future will belong to those who can prove value. The use of a clinical performance dashboard and comparisons to national data will help to ensure that when the payers come knocking on our doors looking for "proof" that what we do enhances patient care and improves patient outcome, we’ll have an answer! This is the first in a yearlong series of articles developed by the Academy of International Mobile Healthcare Integration (AIMHI).The AIMHI article series is developed in partnership with JEMS to help educate EMS agencies on the hallmarks and attributes of high-performance/high-value EMS system de...
Source: JEMS Special Topics - December 11, 2018 Category: Emergency Medicine Authors: Wayne C. Harbour, NRP Tags: Exclusive Articles Operations Administration and Leadership Source Type: news

AAN: Don't Stop Warfarin for Dental Visits (CME/CE)
(MedPage Today) -- Patients taking aspirin or warfarin (Coumadin) for prevention after a stroke don't need to stop the drug for dental procedures, the American Academy of Neurology recommended.
Source: MedPage Today Gastroenterology - May 28, 2013 Category: Gastroenterology Source Type: news

Arguments favoring low versus high dose aspirin in the prophylaxis of venous thromboembolism
The use of aspirin in the prevention of venous thromboembolism (VTE) is still controversial. In a profound review on the use of aspirin for primary and secondary prevention of venous thromboembolism and other cardiovascular disorders Cohen et al. [1] conclude that the benefits of aspirin are well documented for conditions like myocardial infarction, coronary heart disease, and stroke, but less clearly for prevention of VTE after orthopedic surgery. The latter indistinctness has been a matter of concern in many earlier reviews and meta-analyses, and has even led to non-uniform guidelines on VTE prevention from the American ...
Source: Thrombosis Research - January 27, 2016 Category: Hematology Authors: Piet Borgdorff, Geert Jan Tangelder Tags: Correspondence Source Type: research