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acute ischemic stroke in AF

Peter Appelros, Maria Háls Berglund, Jakob O Ström
BACKGROUND: In the absence of active management, the stroke risk after a transient ischemic attack (TIA) may be high. Almost 10 years ago, the results of the EXPRESS and SOS-TIA studies called for a more rapid management of TIA patients. The purpose of this study was to investigate the other stroke risks in the longer term, after the implementation of a more active approach to TIA. We also wanted to assess the predictive value of the ABCD2 score in this context. METHODS: Riksstroke is the national stroke registry in Sweden...
October 18, 2016: Cerebrovascular Diseases
Fadar Oliver Otite, Priyank Khandelwal, Seemant Chaturvedi, Jose G Romano, Ralph L Sacco, Amer M Malik
OBJECTIVE: To evaluate trends in atrial fibrillation (AF) prevalence in acute ischemic stroke (AIS) and TIA in the United States. METHODS: We used the Nationwide Inpatient Sample to retrospectively compute weighted prevalence of AF in AIS (n = 4,355,140) and TIA (n = 1,816,459) patients admitted to US hospitals from 2004 to 2013. Multivariate-adjusted models were used to evaluate the association of AF with clinical factors, mortality, length of stay, and cost. RESULTS: From 2004 to 2013, AF prevalence increased by 22% in AIS (20%-24%) and by 38% in TIA (12%-17%)...
October 12, 2016: Neurology
Liesl Zühlke, Ganesan Karthikeyan, Mark E Engel, Sumathy Rangarajan, Pam Mackie, Blanche Cupido, Katya Mauff, Shofiqul Islam, Rezeen Daniels, Veronica Francis, Stephen Ogendo, Bernard Gitura, Charles Mondo, Emmy Okello, Peter Lwabi, Mohammed M Al-Kebsi, Christopher Hugo-Hamman, Sahar S Sheta, Abraham Haileamlak, Wandimu Daniel, Dejuma Yadeta Goshu, Senbeta G Abdissa, Araya G Desta, Bekele A Shasho, Dufera M Begna, Ahmed ElSayed, Ahmed S Ibrahim, John Musuku, Fidelia Bode-Thomas, Christopher C Yilgwan, Ganiyu A Amusa, Olukemi Ige, Basil Okeahialam, Christopher Sutton, Rajeev Misra, Azza Abul Fadl, Neil Kennedy, Albertino Damasceno, Mahmoud U Sani, Okechukwu S Ogah, Taiwo Olunuga, Huda ElHassan, Ana Olga Mocumbi, Abiodun M Adeoye, Pindile S Mntla, Dike B Ojji, Joseph Mucumbitsi, Koon Teo, Salim Yusuf, Bongani M Mayosi
BACKGROUND: -There are few contemporary data on the mortality and morbidity associated with rheumatic heart disease (RHD) or information on their predictors. We report the two year follow-up of individuals with RHD from 14 low and middle income countries in Africa and Asia. METHODS: -Between January 2010 and November 2012, we enrolled 3343 patients from 25 centers in 14 countries and followed them for two years to assess mortality, congestive heart failure (CHF), stroke or transient ischemic attack (TIA), recurrent acute rheumatic fever (ARF), and infective endocarditis (IE)...
October 4, 2016: Circulation
Olaf M Dekkers, Erzsébet Erzsébet Horváth-Puhó, Suzanne C Cannegieter, Jan Vandenbroucke, Henrik Toft Sørensen, Jens Otto L Jorgensen
Objective Several studies have shown an increased risk for cardiovascular disease (CVD) in hyperthyroidism, but most studies have been too small to address the effect of hyperthyroidism on individual cardiovascular endpoints. Our main was to assess the association between hyperthyroidism, acute cardiovascular events, and mortality. Design Nationwide population based cohort study. Data were obtained from the Danish Civil Registration System and the Danish National Patient Registry, which covers all Danish hospitals...
October 3, 2016: European Journal of Endocrinology
Laurent Fauchier, Nicolas Clementy, Arnaud Bisson, Karim Stamboul, Fabrice Ivanes, Denis Angoulvant, Dominique Babuty, Gregory Y H Lip
BACKGROUND: Atrial fibrillation (AF) may be related to acute and temporary causes, whether cardiovascular or non-cardiovascular. It remains unclear whether the risk of ischemic stroke is different in this setting, and whether antithrombotic management should be different in these patients. The objective of the study was to describe and compare the risk of stroke in AF patients with and with no such temporary precipitating cause. METHODS: Among 8962 patients with AF seen between 2000 and 2010, we focused our analysis on 4587 patients with non-permanent AF, of whom 740 (16 %) had at least one possible temporary cause of AF...
September 30, 2016: Clinical Research in Cardiology: Official Journal of the German Cardiac Society
Charlotte H So, Mark H Eckman
The combined use of aspirin and oral anticoagulant therapy in patients with atrial fibrillation (AF) and stable coronary artery disease (CAD) has been questioned due to an increased risk of major bleeding with little to no benefit in preventing ischemic events. (1) To better understand patterns and indications for combined antiplatelet and anticoagulant therapy and identify patients who might reasonably be treated with oral anticoagulant (OAC) therapy alone. (2) To perform an updated literature review regarding the use of combined antiplatelet and OAC therapy in patients with AF and stable CAD...
September 24, 2016: Journal of Thrombosis and Thrombolysis
Ian C Y Chang, Yusuf M Agamawi, Erin Austin, Wayne O Adkisson, Henri Roukoz, Lisa N von Wald, Scott Sakaguchi, David G Benditt, Lin Y Chen
Whether the risk factors for cardiovascular (CV) outcomes are different in primary versus secondary prevention implantable cardioverter-defibrillator (ICD) patients is unclear. We sought to identify predictors of CV outcomes in ICD recipients for primary (G1) versus secondary prevention (G2). Consecutive patients who had ICD implanted during August 2005 to December 2009 were included. The primary outcome was a composite of appropriate shock, acute coronary syndrome, ischemic stroke, coronary revascularization, heart failure exacerbation, CV hospitalization, or all-cause death...
August 23, 2016: American Journal of Cardiology
Athanasia Vlahou, Konstantinos Diplaris, Fotini Ampatzidou, Lampos Karagounnis, George Drossos
Objectives Atrial fibrillation (AF) is the most common complication after coronary artery bypass grafting (CABG). It is associated with prolonged hospital stay and increased cost. The aim of this study is to investigate the relationship between transfusion of blood derivatives and occurrence of postoperative paroxysmal AF. Materials and Methods From June 2012 to February 2014, 446 patients undergoing CABG with cardiopulmonary bypass (CPB) were prospectively evaluated for occurrence of postoperative AF. Patients and procedural variables were recorded and were associated with the development of new-onset AF with logistic regression analysis...
August 30, 2016: Thoracic and Cardiovascular Surgeon
Jiming Li, Weiliang Luo
BACKGROUND AND OBJECTIVE: Atrial fibrillation (AF) is a risk factor for acute ischemic stroke (AIS). In mainland China, little is known of the hospitalization expenses of AIS patients with AF compared to those with normal sinus rhythm (SR). This study compared the itemized expenses of AIS patients with or without AF in a hospital in Huizhou City. METHODS: Patients hospitalized for AIS from March 2014 to March 2015 were enrolled, including 73 with AF and 751 with normal SR...
August 25, 2016: Journal of Medical Economics
Masatoshi Koga, Sohei Yoshimura, Yasuhiro Hasegawa, Satoshi Shibuya, Yasuhiro Ito, Hideki Matsuoka, Kazuhiro Takamatsu, Kazutoshi Nishiyama, Kenichi Todo, Kazumi Kimura, Eisuke Furui, Tadashi Terasaki, Yoshiaki Shiokawa, Kenji Kamiyama, Shunya Takizawa, Satoshi Okuda, Yasushi Okada, Tomoaki Kameda, Yoshinari Nagakane, Yoshiki Yagita, Kazuomi Kario, Masayuki Shiozawa, Shoichiro Sato, Hiroshi Yamagami, Shoji Arihiro, Kazunori Toyoda
BACKGROUND AND PURPOSE: The discrimination between paroxysmal and sustained (persistent or permanent) atrial fibrillation (AF) has not been considered in the approach to secondary stroke prevention. We aimed to assess the differences in clinical outcomes between mostly anticoagulated patients with sustained and paroxysmal AF who had previous ischemic stroke or transient ischemic attack. METHODS: Using data from 1192 nonvalvular AF patients with acute ischemic stroke or transient ischemic attack who were registered in the SAMURAI-NVAF study (Stroke Management With Urgent Risk-Factor Assessment and Improvement-Nonvalvular AF; a prospective, multicenter, observational study), we divided patients into those with paroxysmal AF and those with sustained AF...
October 2016: Stroke; a Journal of Cerebral Circulation
Yerim Kim, Seung-Hoon Lee
BACKGROUND: Although atrial fibrillation (AF) is a leading cause of recurrent embolic stroke, secondary AF after stroke has been reported frequently. Because of the different treatment each uses, it is important to detect the exact stroke-etiology. OBJECTIVES: The aim of this study was to compare the embolic stroke in patients with known AF and after-admission AF (AAAF). METHODS: Between October 2002 and July 2009, those who were diagnosed with AF (n=354) were enrolled in our study out of a total of 2026 acute ischemic stroke (IS) patients...
November 1, 2016: International Journal of Cardiology
Larry R Jackson, Jonathan P Piccini, Derek D Cyr, Matthew T Roe, Megan L Neely, Felipe Martinez, Thomas F Lüscher, Renato D Lopes, Kenneth J Winters, Harvey D White, Paul W Armstrong, Keith A A Fox, Dorairaj Prabhakaran, Deepak L Bhatt, E Magnus Ohman, Ramón Corbalán
Associations between atrial fibrillation (AF), outcomes, and response to antiplatelet therapies in patients with acute coronary syndrome (ACS) managed medically without revascularization remain uncertain. We examined these associations for medically managed ACS patients randomized to dual antiplatelet therapy (DAPT) using patient data from the TRILOGY ACS trial. DAPT included aspirin plus clopidogrel 75 mg/d or prasugrel 10 mg/d (5 mg/d for those <60 kg or age ≥75 years). Patients receiving oral anticoagulants were excluded...
September 2016: Clinical Cardiology
Cheung-Ter Ong, Yi-Sin Wong, Chi-Shun Wu, Yu-Hsiang Su
BACKGROUND/PURPOSE: In-hospital mortality rate of acute ischemic stroke patients remains between 3% and 18%. For improving the quality of stroke care, we investigated the factors that contribute to the risk of in-hospital mortality in acute ischemic stroke patients. MATERIALS AND METHODS: Between January 1, 2007, and December 31, 2011, 2,556 acute ischemic stroke patients admitted to a stroke unit were included in this study. Factors such as demographic characteristics, clinical characteristics, comorbidities, and complications related to in-hospital mortality were assessed...
2016: Therapeutics and Clinical Risk Management
Yu-Chin Su, Siew-Na Lim, Fu-Yi Yang, Shinn-Kuang Lin
BACKGROUND/PURPOSE: Although cerebral emboli are a frequent cause of cardiogenic stroke, the possibility of a reduction in cerebral perfusion consequent to arrhythmia or impaired cardiac function should be considered in patients with atrial fibrillation (AF). METHODS: We reviewed sonographic studies and clinical features of patients with acute ischemic stroke. A total of 144 patients with AF and 144 age- and sex-matched patients with small vessel occlusion but without AF were included...
July 8, 2016: Journal of the Formosan Medical Association, Taiwan Yi Zhi
Essa Hariri, Ahmad Hachem, Georges Sarkis, Samer Nasr
Atrial fibrillation (AF) is the most common form of cardiac arrhythmias and an independent risk factor for stroke. Despite major advances in monitoring strategies, clinicians tend to miss the diagnoses of AF and especially paroxysmal AF due mainly to its asymptomatic presentation and the rather limited duration dedicated for monitoring for AF after a stroke, which is 24 hours as per the current recommended guidelines. Hence, determining the optimal duration of monitoring for paroxysmal atrial fibrillation after acute ischemic stroke remains a matter of debate...
2016: BioMed Research International
Tae-Won Kim, In-Uk Song, Sung-Woo Chung, Joong-Seok Kim, Jaseong Koo, Kwang-Soo Lee
Objective Left atrial enlargement (LAE) may predispose individuals to blood stasis in atrial fibrillation (AF), and thus play a crucial role in thrombogenesis. The D-dimer level is one of the surrogate markers for a hypercoagulable state and reflects thrombus formation in AF. Since the D-dimer level reflects hypercoagulability as well as thrombus and fibrin burdens, LAE could be associated with a D-dimer elevation. However, no studies have explored this association or which factors contribute to increases in the D-dimer levels in patients with AF...
2016: Internal Medicine
Nils Henninger, Richard P Goddeau, Ameeta Karmarkar, Johanna Helenius, David D McManus
BACKGROUND AND PURPOSE: Patients with a cardioembolic stroke (CES) have worse outcomes than stroke patients with other causes of stroke. Among patients with CES, atrial fibrillation (AF) is a common comorbidity. Mounting data indicate that AF may be related to stroke pathogenesis beyond acute cerebral thromboembolism. We sought to determine whether AF represents an independent risk factor for stroke severity and outcome among patients with CES. METHODS: We retrospectively analyzed patients with acute hemispheric CES included in an academic medical center's stroke registry...
June 2016: Stroke; a Journal of Cerebral Circulation
Hans-Christoph Diener, Christoph Kleinschnitz
Non-vitamin-K oral anticoagulants (NOACs) represent a major advance in the prevention of stroke in patients with atrial fibrillation (AF), offering a similar, if not superior, efficacy and safety profile and several practical advantages over oral vitamin K antagonists (VKAs). The rapid onset of action of the NOACs, their relatively short half-live, and the availability of specific reversal agents may be advantageous when managing acute ischemic strokes, and in the post-stroke, post-transient ischemic attack, and post-intracranial hemorrhage settings...
May 2016: Journal of Stroke
Sheng-Feng Sung, Cheng-Yang Hsieh, Huey-Juan Lin, Yu-Wei Chen, Yea-Huei Kao Yang, Chung-Yi Li
BACKGROUND: Stroke patients have a high risk for recurrence, which is positively correlated with the number of risk factors. The assessment of risk factors is essential in both stroke outcomes research and the surveillance of stroke burden. However, methods for assessment of risk factors using claims data are not well developed. METHODS: We enrolled 6469 patients with acute ischemic stroke, transient ischemic attack, or intracerebral hemorrhage from hospital-based stroke registries, which were linked with Taiwan's National Health Insurance (NHI) claims database...
July 15, 2016: International Journal of Cardiology
Jen-Chun Wang, Wu-Chien Chien, Chi-Hsiang Chung, Wen-I Liao, Shih-Hung Tsai
BACKGROUND: Bisphosphonates (BPs) are a class of medications used for the treatment of osteoporosis. Nitrogen-containing BPs (N-BPs) are more potent than non-nitrogenous BPs in terms of their effects on osteoporosis. We examined the effects of N-BPs on osteoporosis in patients included in a large population-based cohort study. METHODS: Based on the National Health Insurance Research Database of Taiwan, we identified 1258 patients with osteoporosis who had received N-BP treatment from 2005 through 2010...
July 15, 2016: International Journal of Cardiology
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