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Total 442 results found since Jan 2013.
Mechanical thrombectomy for stroke patients anticoagulated with direct oral anticoagulants versus warfarin
BackgroundOutcomes after mechanical thrombectomy (MT) for large vessel occlusion (LVO) were compared between stroke patients anticoagulated with direct oral anticoagulants (DOACs) and those anticoagulated with warfarin.
Source: Journal of the Neurological Sciences - June 16, 2021 Category: Neurology Authors: Junpei Koge, Kanta Tanaka, Hiroshi Yamagami, Takeshi Yoshimoto, Kazutaka Uchida, Takeshi Morimoto, Kazunori Toyoda, Nobuyuki Sakai, Shinichi Yoshimura Source Type: research
Atrial Fibrillation and Ischemic Stroke: A Clinical Review
Semin Neurol DOI: 10.1055/s-0041-1726332Atrial fibrillation (AF) is an important risk factor for ischemic stroke resulting in a fivefold increased stroke risk and a twofold increased mortality. Our understanding of stroke mechanisms in AF has evolved since the concept of atrial cardiopathy was introduced as an underlying pathological change, with both AF and thromboembolism being common manifestations and outcomes. Despite the strong association with stroke, there is no evidence that screening for AF in asymptomatic patients improves clinical outcomes; however, there is strong evidence that patients with embolic stroke of ...
Source: Seminars in Neurology - April 13, 2021 Category: Neurology Authors: Migdady, Ibrahim Russman, Andrew Buletko, Andrew B. Tags: Review Article Source Type: research
Prevalence, Mechanisms, and Management of Ischemic Stroke in Heart Failure Patients
Semin Neurol DOI: 10.1055/s-0041-1726329Heart failure (HF) and stroke, two of the major causes of death worldwide, are closely associated. Although atrial fibrillation (AF), which occurs in more than half of patients with HF, is a major risk factor for stroke, there is a great deal of evidence that HF itself increases the risk of stroke independent of AF. The main mechanism of stroke appears to be thromboembolism. However, previous studies have failed to demonstrate the benefit of warfarin in patients with HF without AF, as the benefit of stroke prevention was counteracted by the increased incidence of major bleeding. Rece...
Source: Seminars in Neurology - April 13, 2021 Category: Neurology Authors: Seol, Hyeyoung Kim, Jong S. Tags: Review Article Source Type: research
Stroke Care during the COVID-19 Pandemic: International Expert Panel Review
This study, prepared by a large international panel of stroke experts, assesses the rapidly growing research and personal experience with COVID-19 stroke and offers recommendations for stroke management in this challenging new setting: modifications needed for prehospital emergency rescue and hyperacute care; inpatient intensive or stroke units; posthospitalization rehabilitation; follow-up including at-risk family and community; and multispecialty departmental developments in the allied professions.Summary: The severe acute respiratory syndrome coronavirus 2 uses spike proteins binding to tissue angiotensin-converting enz...
Source: Cerebrovascular Diseases - March 23, 2021 Category: Neurology Source Type: research
Risk of Stroke Outcomes in Atrial Fibrillation Patients Treated with Rivaroxaban and Warfarin
In a previous real-world study, rivaroxaban reduced the risk of stroke overall and severe stroke compared with warfarin in patients with nonvalvular atrial fibrillation (NVAF). The aim of this study was to assess the reproducibility in a different database of our previously observed results (Alberts M, et al. Stroke. 2020;51:549-555) on the risk of severe stroke among NVAF patients in a different population treated with rivaroxaban or warfarin.
Source: Journal of Stroke and Cerebrovascular Diseases - March 17, 2021 Category: Neurology Authors: Dejan Milentijevic, Jennifer H. Lin, Nancy Connolly, Yen-Wen Chen, Emily Kogan, Shubham Shrivastava, Erik Sjoeland, Mark J. Alberts Source Type: research
Safety of Intravenous Thrombolysis for Acute Ischemic Stroke in Patients Taking Warfarin with Subtherapeutic INR
Current guidelines allow the administration of intravenous recombinant tissue plasminogen activator (IV r-tPA) to warfarin-treated patients with acute ischemic stroke (AIS) who have an international normalized ratio (INR) of ≤1.7. However, concerns remain about the safety of using IV r-tPA in this situation due to a conceivable risk of symptomatic intracranial hemorrhage (sICH), lack of dedicated randomized controlled trials and the conflicts in the available data. We aimed to determine the risk of sICH in warfarin-tr eated patients with subtherapeutic INR who received IV r-tPA for AIS in our large volume comprehensive center.
Source: Journal of Stroke and Cerebrovascular Diseases - February 25, 2021 Category: Neurology Authors: Ashkan Mowla, Aurangzeb Memon, Seyed-Mostafa Razavi, Navdeep S. Lail, Caila B. Vaughn, Pegah Mohammadi, Robert N. Sawyer, Peyman Shirani Source Type: research
Pre-treatment of Single and Double Antiplatelet and Anticoagulant With Intravenous Thrombolysis for Older Adults With Acute Ischemic Stroke: The TTT-AIS Experience
Conclusion: For older adults with higher baseline severity of acute ischemic stroke, DAPP may increase the risk of SICH and mortality post IVT. However, DAPP is still not an indication to withdraw IVT and to prescribe low-dose IVT for older adults.
Source: Frontiers in Neurology - February 22, 2021 Category: Neurology Source Type: research
Risk of intracranial hemorrhage with direct oral anticoagulants: a systematic review and meta-analysis of randomized controlled trials
ConclusionAll DOACs had a lower risk of ICH than VKAs. In terms of the risk of ICH, DOACs were overall as safe as LMWHs, and apixaban and dabigatran were as safe as aspirin, but rivaroxaban was not. For secondary prevention stroke, the risk of ICH with DOACs was overall lower than warfarin and similar to aspirin, but it should be noted that compared with aspirin, rivaroxaban may increase the risk of ICH. This is the first pair-wise meta-analysis that compares the risk of ICH between DOACs and other antithrombotic drugs in detail across all diseases, which may have certain significance for patients with high risk of ICH to ...
Source: Journal of Neurology - February 17, 2021 Category: Neurology Source Type: research
A 56-Year-Old Woman with Recurrent Strokes: A Clear Case with a Therapeutic Dilemma
A 56-year-old woman with a history of cerebral amyloid angiopathy (CAA) complicated by prior intracranial hemorrhage (ICH) was evaluated for an asymptomatic ischemic stroke discovered on screening brain MRI. On echocardiogram, she was found to have a mass on her mitral valve and strongly positive antiphospholipid antibodies. She was diagnosed with nonbacterial thrombotic (Libman-Sacks) endocarditis associated with the primary antiphospholipid syndrome (APS). The treatment decision was complicated by the history of CAA with ICH within the last year with very high risk for bleeding complications if on anticoagulation. A mult...
Source: Case Reports in Neurology - February 15, 2021 Category: Neurology Source Type: research
Time to Stable Therapeutic Range on Initiation of Warfarin as an Indicator of Control
Warfarin remains widely used with a time in therapeutic range (TiTR) above 65% recommended for best outcomes. Patients not achieving or maintaining this warfarin control may be better suited to alternate anticoagulants. Despite this, there is limited data defining a suitable trial time in patients initiating warfarin therapy, therefore the aim of this study was to determine the mean time to stable therapeutic range (TtSTR).
Source: Journal of Stroke and Cerebrovascular Diseases - January 22, 2021 Category: Neurology Authors: Narong Puttasung, Andrew K Davey, Tony Badrick, Shailendra Anoopkumar-Dukie, Nijole Bernaitis Source Type: research
Current Advances in Endovascular Treatment of Intracranial Atherosclerotic Disease and Future Prospective
Intracranial atherosclerotic disease (ICAD) is an important cause of large vessel disease leading to acute ischemic stroke (AIS). Currently, medical management such as risk factor control, antiplatelet therapy, and lifestyle changes are considered the first-line of treatment to prevent transient ischemic attack (TIA) or AIS.1 The results of the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial2 demonstrated that symptomatic ICAD is a high-risk cause of recurrent stroke and highlighted the need for better treatment strategies, leading to consideration for both better medical management and the possibility of a...
Source: Journal of Stroke and Cerebrovascular Diseases - December 22, 2020 Category: Neurology Authors: Mostafa Jafari, Thanh N. Nguyen, Santiago Ortega-Gutierrez, Muhammad Shazam Hussain, Ameer E. Hassan, Asad Ikram, Javed Khader Eliyas, Gustavo J. Rodriguez, Afshin A. Divani Tags: Review Article Source Type: research
Inactivated Four-Factor Prothrombin Complex Concentrate Dosing Practices for Reversal of Warfarin-Related Intracranial Hemorrhage
ConclusionsMost patients received single doses of I4F-PCC, with adjunctive reversal agents and rounding doses to vial size. The time difference from baseline INR to factor product administration is a potential opportunity for process improvement in the management of warfarin-related ICH.
Source: Neurocritical Care - November 20, 2020 Category: Neurology Source Type: research
Clinical Trial Based Rationale for the Successful Use of DOAC in the Treatment of Cerebral Venous Sinus Thrombosis (CVST): A Case Report
In cerebral venous sinus thrombosis (CVST), venous sinus occlusion increases venous pressure and disrupts venous return, resulting in progression to venous infarction and venous hemorrhage, with poor neurologic outcome. Therefore, early recanalization of the major venous sinus is critical.Anticoagulant therapy with continuous intravenous infusion of heparin and subsequent oral anticoagulant administration is the recommended first line of treatment for CVST. Some large clinical trials for venous thromboembolism (VTE) have shown that direct oral anticoagulant (DOAC) is non-inferior to the standard therapy with heparin or war...
Source: Journal of Stroke and Cerebrovascular Diseases - September 3, 2020 Category: Neurology Authors: Toshiaki Bando, Yasushi Ueno, Daisuke Shimo, Takahiro Kuroyama, Kazuyuki Mikami, Shinya Hori, Osamu Hirai Tags: Case Report Source Type: research
Convexity Subarachnoid Hemorrhage Soon after Starting a Direct Oral Anticoagulant in 2 Patients with Acute Infarction
Convexity subarachnoid hemorrhage (cSAH) is typically due to head trauma, but various nontraumatic causes for cSAH are known also. Nontraumatic cSAH is most commonly associated with cerebral amyloid angiopathy (CAA) in the elderly or with reversible cerebral vasoconstriction syndrome in younger subjects,1 but cSAH rarely occurs subsequent to acute ischemic stroke.2 Direct oral anticoagulants (DOACs) are used to reduce the risk of ischemic stroke and systemic embolism in patients with non-valvular atrial fibrillation and have favorable bleeding profiles as compared with warfarin,3,4 but here we describe 2 cSAH patients who ...
Source: Journal of Stroke and Cerebrovascular Diseases - August 13, 2020 Category: Neurology Authors: Yoichiro Sugita, Yoichiro Nishida, Satoru Ishibashi, Takanori Yokota Tags: Case Report Source Type: research
Left Atrial Appendage Closure for Patients with Cerebral Amyloid Angiopathy and Atrial Fibrillation: the LAA-CAA Cohort
AbstractAnticoagulation increases the risk of intracerebral hemorrhage (ICH) in patients with cerebral amyloid angiopathy (CAA), so the management of stroke-risk in patients with both atrial fibrillation (AF) and CAA is controversial. Advances in left atrial appendage closure (LAAC) techniques provide a stroke-risk-reduction option which avoids long-term oral anticoagulation (OAC). We aimed to evaluate the safety of this intervention in patients with CAA. This is an observational cohort study of patients with severe CAA (with or without ICH) and AF who were treated with LAA closure. The Watchman ™ and Amulet® LAAC devic...
Source: Translational Stroke Research - August 6, 2020 Category: Neurology Source Type: research
