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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

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

Non-vitamin-K oral anticoagulants reduce mortality, stroke and intracranial haemorrhage when compared with warfarin in randomised trials of patients with non-valvular atrial fibrillation
Commentary on: Ruff CT, Giugliano RP, Braunwald E, et al.. Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet 2014;383:955–62. Context Historically, the standard medication for stroke prevention in atrial fibrillation (AF) has been a vitamin-K antagonist (warfarin). However, several non-vitamin-K oral anticoagulants (NOACs) have been developed and shown to be at least as effective as dose-adjusted warfarin in their respective phase-3 clinical trials.1–4 These include the direct thrombin inhibitor dabig...
Source: Evidence-Based Medicine - September 15, 2014 Category: Internal Medicine Authors: Steinberg, B. A. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Ischaemic heart disease, Connective tissue disease, Musculoskeletal syndromes, Diabetes, Arrhythmias Therapeutics Source Type: research

Effect of Variation in Published Stroke Rates on the Net Clinical Benefit of Anticoagulation for Atrial Fibrillation.
Conclusion: Variation in published AF stroke rates for patients not receiving anticoagulant therapy results in multifold variation in the net clinical benefit of anticoagulation. Guidelines should better reflect the uncertainty in current thresholds of stroke risk score for recommending anticoagulation. Primary Funding Source: None. PMID: 30264130 [PubMed - as supplied by publisher]
Source: Annals of Internal Medicine - September 25, 2018 Category: Internal Medicine Authors: Shah SJ, Eckman MH, Aspberg S, Go AS, Singer DE Tags: Ann Intern Med Source Type: research

Adherence to oral anticoagulation in ischemic stroke patients with atrial fibrillation
CONCLUSIONS: Adherence was poor in half of AF patients who survived an ischaemic stroke. Independent patient-related factors, rather than composite scores, were associated with poor adherence in these patients.KEY MESSAGESAdherence was poor in half of the atrial fibrillation patients who survived an ischaemic stroke.Independent patient-related factors rather than composite scores were associated with poor adherence.The findings support the importance of recognising adherence support as a crucial part of holistic patient care recommended by recent AF guideline.PMID:34498537 | DOI:10.1080/07853890.2021.1968031
Source: Annals of Medicine - September 9, 2021 Category: Internal Medicine Authors: Paula Tiili Ioannis Leventis Janne Kinnunen Ida Svedjeb äck Mika Lehto Efstathia Karagkiozi Dimitrios Sagris George Ntaios Jukka Putaala Source Type: research

Patients with atrial fibrillation and low risk of stroke - do they really need anticoagulation?
Authors: Trusz-Gluza M, Filipecki A, Urbańczyk-Świć D Abstract Atrial fibrillation (AF) significantly increases risk of thromboembolic events, in particular the risk of stroke. Anticoagulation therapy reduces this risk and the treatment should be lifelong. However, the risk in patients with non-valvular AF is not equally distributed. There are patients at low risk. Assessment of the thromboembolic risk according to guidelines is mandatory, most frequently CHA2DS2-VASc scheme is used. In the large group with the CHA2DS2-VASc-0 (females 1) the annual risk of stroke was 0.49%, ischemic stroke 0.43%, on the other si...
Source: Polskie Archiwum Medycyny Wewnetrznej - August 28, 2015 Category: Internal Medicine Tags: Pol Arch Med Wewn Source Type: research

Practical use of dabigatran etexilate for stroke prevention in atrial fibrillation
Summary Atrial fibrillation (AF) is associated with an increased risk of thromboembolism, and is the most prevalent factor for cardioembolic stroke. Vitamin K antagonists (VKAs) have been the standard of care for stroke prevention in patients with AF since the early 1990s. They are very effective for the prevention of cardioembolic stroke, but are limited by factors such as drug–drug interactions, food interactions, slow onset and offset of action, haemorrhage and need for routine anticoagulation monitoring to maintain a therapeutic international normalised ratio (INR). Multiple new oral anticoagulants have been develope...
Source: International Journal of Clinical Practice - April 5, 2013 Category: Internal Medicine Authors: K. Huber, S. J. Connolly, A. Kher, F. Christory, G.‐A. Dan, R. Hatala, R. G. Kiss, B. Meier, B. Merkely, B. Pieske, T. Potpara, J. Stępińska, N. Vene Klun, D. Vinereanu, P. Widimský Tags: Consensus Source Type: research

Choosing the right drug to fit the patient when selecting oral anticoagulation for stroke prevention in atrial fibrillation
This article is protected by copyright. All rights reserved.
Source: Journal of Internal Medicine - March 1, 2015 Category: Internal Medicine Authors: Adrian M. Shields, Gregory Y. H. Lip Tags: Review Article Source Type: research

Association Between Serum Levels of Vitamin D and the Risk of Post-Stroke Anxiety
Abstract: Low levels of serum vitamin D are common in patients with mood disorders and stroke. It has been shown that low levels of serum vitamin D indicate a risk of depression in post-stroke subjects. Our aim was to determine the relationship between vitamin D and post-stroke anxiety (PSA). A consecutive series of 226 first acute ischemic stroke patients were recruited and followed up for 1 month. Serum levels of vitamin D were measured within 24 hours of admission. Patients with significant clinical symptoms of anxiety and a Hamilton anxiety scale score>7 were diagnosed as having PSA. In addition, 100 healthy subject...
Source: Medicine - May 1, 2016 Category: Internal Medicine Tags: Research Article: Observational Study Source Type: research

Effect of Vitamin D and calcium supplementation on ischaemic stroke outcome: a randomised controlled open ‐label trial
ConclusionsThis is the first randomised controlled study assessing the effect of vitamin D and calcium supplementation on ischaemic stroke outcomes and points towards a potential benefit. Findings need to be validated by a larger trial.
Source: International Journal of Clinical Practice - July 31, 2016 Category: Internal Medicine Authors: Anu Gupta, Sudesh Prabhakar, Manish Modi, Sanjay K Bhadada, Mani Kalaivani, Vivek Lal, Dheeraj Khurana Tags: Original Paper 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

Potential impact of new oral anticoagulants on the management of atrial fibrillation‐related stroke in primary care
ConclusionThe clinical and economic benefits of the new oral anticoagulants, along with appropriate risk stratification, may enable a higher number of patients with AF to receive effective and convenient prophylaxis for stroke prevention.
Source: International Journal of Clinical Practice - April 28, 2013 Category: Internal Medicine Authors: K. Harris, J. Mant Tags: Review Article Source Type: research

Atrial Fibrillation had Less Impact on the Risk of Ischemic Stroke in Non-anticoagulated Patients Undergoing Hemodialysis: Insight from the RAKUEN study.
Conclusion A great impact on death, but not ischemic stroke, was observed in non-anticoagulated hemodialysis patients with AF in comparison to those without AF from the analysis of the RAKUEN study. PMID: 29607945 [PubMed - as supplied by publisher]
Source: Internal Medicine - April 4, 2018 Category: Internal Medicine Tags: Intern Med Source Type: research

Characteristics of Ischemic Versus Hemorrhagic Stroke in Patients Receiving Oral Anticoagulants: Results of the PASTA Study
Conclusion The presence of CMBs, a history of stroke, natriuretic peptide and D-dimer levels, and PT-INR may be useful for risk stratification of either IS/TIA or ICH development in patients with AF receiving OACs.PMID:34483213 | DOI:10.2169/internalmedicine.8113-21
Source: Internal Medicine - September 6, 2021 Category: Internal Medicine Authors: Satoshi Suda Arata Abe Yasuyuki Iguchi Yoshiki Yagita Takao Kanzawa Seiji Okubo Nobuyuki Ohara Takayuki Mizunari Mineo Yamazaki Nobuhito Nakajima Kimito Kondo Shigeru Fujimoto Takeshi Inoue Takeshi Iwanaga Yuka Terasawa Kensaku Shibazaki Yu Kono Makoto Na Source Type: research

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