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acute ischemic stroke in AF

Ravi R Pradhan, Ashish Jha, Gaurav Nepal, Manju Sharma
Valvular heart disease is one of the more common diseases in low- and middle-income countries, when associated with atrial fibrillation (AF), carries a risk of multisystemic embolizations. We report a case of 37-year-old man with multiple systemic emboli consisting of acute ischemic stroke, acute myocardial infarction, and acute limb ischemia. This is a rare occurrence in a single subject. The patient had a background of rheumatic heart disease (RHD) involving severe mitral stenosis (MS) with AF, who was not compliant with his medications...
July 11, 2018: Curēus
Elyar Sadeghi-Hokmabadi, Mohammad Yazdchi, Mehdi Farhoudi, Homayoun Sadeghi, Aliakbar Taheraghdam, Reza Rikhtegar, Hannaneh Aliyar, Sahar Mohammadi-Fallah, Rogayyeh Asadi, Elham Mehdizadeh-Far, Neda Ghaemian
Background: Tissue plasminogen activator (tPA) has been long approved as an efficacious treatment in patients with acute ischemic stroke (AIS); however, due to some serious complications, particularly intracranial hemorrhage (ICH), many physicians are still reluctant to use it liberally. This study sought to find potential prognostic factors in patients with AIS treated with tPA. Methods: A retrospective, hospital-bases observational study was conducted. Consecutively, a total of 132 patients with AIS treated with intravenous tPA, form June 2011 to July 2015 were enrolled...
January 5, 2018: Iranian Journal of Neurology
Nobuo Kutsuna, Kotaro Makita, Kosei Goto, Koki Hirayama, Goro Kido, Yukihide Kagawa
Cerebral infarction (CI) caused by middle cerebral artery occlusion exhibits a very high mortality rate. To reduce this rate, a decompressive hemicraniectomy (DHC) is performed clinically based on several randomized trials. In ischemic stroke, a state of malnutrition leads to poor outcomes. However, little evidence is available on nutrition state in the acute phase after DHC. This preliminary study focuses on serum markers, especially dynamic or static nutrition-associated markers including prealbumin, transferrin, retinol binding protein (RBP) and serum albumin under tube feeding with Peptamen®AF (Nestlé Health Science Japan)...
2018: Advances in Experimental Medicine and Biology
Chih-Chung Shiao, Wei-Chih Kan, Jian-Jhong Wang, Yu-Feng Lin, Likwang Chen, Eric Chueh, Ya-Ting Huang, Wen-Po Chiang, Li-Jung Tseng, Chih-Hsien Wang, Vin-Cent Wu
The influence of acute kidney injury (AKI) on subsequent incident atrial fibrillation (AF) has not yet been fully addressed. This retrospective nationwide cohort study was conducted using Taiwan's National Health Insurance Research Database from 1 January 2000 to 31 December 2010. A total of 41,463 patients without a previous AF, mitral valve disease, and hyperthyroidism who developed de novo dialysis-requiring AKI (AKI-D) during their index hospitalization were enrolled. After propensity score matching, "non-recovery group" ( n = 2895), "AKI-recovery group" ( n = 2895) and "non-AKI group" (control group, n = 5790) were categorized...
August 29, 2018: Journal of Clinical Medicine
Gustavo Zapata-Wainberg, Jaime Masjuan, Sonia Quintas, Álvaro Ximénez-Carrillo, Andrés García Pastor, Maite Martínez Zabaleta, Pere Cardona, María Del Mar Freijo Guerrero, Laura Llull, Lorena Benavente Fernández, Mar Castellanos Rodrigo, José Egido, Joaquín Serena, José Vivancos
BACKGROUND/PURPOSE: To describe the clinical and epidemiological characteristics of acute ischemic stroke (AIS) in patients with atrial fibrillation (AF) previously treated with oral anticoagulants (OACs) according to the type of OAC prescribed. To analyze the outcomes of the patients and the therapeutic approach adopted by the neurologist in the acute phase and for secondary prevention. METHODS: We performed a multicenter, observational study based on prospective registries...
August 28, 2018: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Ahmet Guner, Alev Kılıcgedik, Macit Kalçık, Mehmet Ozkan
Coronary embolism (CE) is the underlying cause of 3% of acute coronary syndromes but is frequently overlooked in the differential diagnoses of acute coronary syndromes. The CE may be direct (left sided from the native or prosthetic heart valve, the left atrium, left atrial appendage or pulmonary venous bed), paradoxical (from the venous circulation through a patent foramen ovale, atrial septal defect, ventricular septal defects, cyanotic congenital heart defects or pulmonary arteriovenous malformations), or iatrogenic (following cardiac interventions...
August 13, 2018: Echocardiography
Michael J Quon, Hassan Behlouli, Louise Pilote
OBJECTIVES: The purpose of this study was to determine if anticoagulation of patients with new onset secondary atrial fibrillation (AF) occurring with acute coronary syndromes (ACS), acute pulmonary disease, or sepsis is associated with a reduction in ischemic stroke or an increase in bleeding risk. BACKGROUND: Studies evaluating the benefits and risks of anticoagulation in secondary AF are infrequent, and the optimal management of these patients is not well understood...
March 2018: JACC. Clinical Electrophysiology
E O Vershinina, A N Repin
OBJECTIVE: to analyze long-term outcomes and to develop a model for determining the risk of long-term adverse сardiovascular events after elective percutaneous coronary interventions (PCI). MATERIALS AND METHODS: We included in this study 148 patients, sent from 2009 to 2011 for routine endovascular intervention for chronic ischemic heart disease on the background of stenotic coronary artery atherosclerosis. Outcomes of interventions were assessed over 6 years after the index PCI by analyzing medical records and telephone interviews...
July 2018: Kardiologiia
Mariana Alves, Marco Ribeiro Narciso, João Cruz, Marina Rocha, Teresa Fonseca
INTRODUCTION: The detection of paroxysmal atrial fibrillation (PAF) is crucial in the etiological study of an acute ischemic stroke (AIS), although this type of arrhythmia is often under-diagnosed. This prospective study aims to (1) evaluate the new-onset PAF detection rate among elderly patients with AIS in an acute setting, and (2) to assess the applicability of the STAF score (Score for the Targeting of Atrial Fibrillation) for such patients. METHODOLOGY: An observational and prospective study was performed over a period of 11 months...
July 27, 2018: Aging Clinical and Experimental Research
Shinji Ito, Koichi Kikuchi, Akihiro Ueda, Ryunosuke Nagao, Toshiki Maeda, Kenichiro Murate, Sayuri Shima, Yasuaki Mizutani, Yoshiki Niimi, Tatsuro Mutoh
Background: The development of acute multiple embolic infarctions (AMEI) resulting from cancer is known as Trousseau's syndrome (TS). At present, however, there is no good marker for predicting the prognosis of TS patients. In the present study, we evaluated the use of serial D-dimer levels as a prognostic marker for TS. Methods: This retrospective cohort study included 1,409 consecutive acute ischemic stroke patients. We selected a group of patients with TS showing AMEI ( n = 38; TS group) and a group of patients with atrial fibrillation (Af) and AMEI ( n = 35; Af group) as controls...
2018: Frontiers in Neurology
Ming-Su Liu, Yan Liao, Guang-Qin Li
Background: Whether there is a relationship between glomerular filtration rate (GFR) and hemorrhagic transformation (HT) after acute ischemic stroke (AIS) is still under debate. The aim of our study was to determine whether the GFR level is a predictor of HT in AIS patients without thrombolytic therapy (TT). Methods: Consecutive AIS patients without TT were included in this prospective study from January 2014 to December 2016 in the First Affiliated Hospital of Chongqing Medical University...
July 20, 2018: Chinese Medical Journal
Chao-Lun Lai, Ho-Min Chen, Min-Tsun Liao, Ting-Tse Lin
OBJECTIVES: To compare the effectiveness and safety of reduced-dose dabigatran, reduced-dose rivaroxaban, and warfarin in individuals aged 85 and older with atrial fibrillation (AF). DESIGN: Retrospective cohort study. SETTING: Taiwan National Health Insurance claims database, 2011∼2015. PARTICIPANTS: Individuals with AF aged 85 and older (mean 88.6) with incident use of oral anticoagulants between June 1, 2012 and May 31, 2015 (N=4,722; dabigatran 110 mg, n=1,489; rivaroxaban 15 mg/10 mg, n=1,736; warfarin, n=1,497)...
July 4, 2018: Journal of the American Geriatrics Society
Rogerio Ferreira Sampaio, Isabel Cristina Gomes, Eduardo Back Sternick
BACKGROUND: Long-term monitoring has been advocated to enhance the detection of atrial fibrillation (AF) in patients with stroke. OBJECTIVE: To evaluate the performance of a new ambulatory monitoring system with mobile data transmission (PoIP) compared with 24-hour Holter. We also aimed to evaluate the incidence of arrhythmias in patients with and without stroke or transient ischemic attack. METHODS: Consecutive patients with and without stroke or TIA, without AF, were matched by propensity score...
August 2018: Arquivos Brasileiros de Cardiologia
Alessandro Adami, Carolina Gentile, Thomas Hepp, Giulio Molon, Gian Luigi Gigli, Mariarosaria Valente, Vincent Thijs
Patients at short-term risk of paroxysmal atrial fibrillation (PAF) often exhibit increased RR interval variability during sinus rhythm. We studied if RR dynamic analysis, applied in the first hours after stroke unit (SU) admission, identified acute ischemic stroke patients at higher risk for subsequent PAF episodes detected within the SU hospitalization. Acute ischemic stroke patients underwent continuous cardiac monitoring (CCM) using standard bedside monitors immediately after SU admission. The CCM tracks from the first 48 h were analyzed using a telemedicine service (SRA clinic, Apoplex Medical, Germany)...
July 3, 2018: Translational Stroke Research
Kyoung-Im Cho, Bong-Joon Kim, Sang-Hoon Cho, Jin-Hyung Lee, Meyung-Kug Kim, Bong-Goo Yoo
BACKGROUND: Increased epicardial fat is known to be associated with the presence and chronicity of atrial fibrillation (AF). Free fatty acids (FFAs) are major components of epicardial fat; however, their potential association with AF in ischemic stroke has not been investigated. We aimed to assess the performance of echocardiographic epicardial fat thickness (EFT) and plasma FFA level in identifying patients with ischemic stroke and AF. METHODS: We enrolled a total of 214 consecutive patients (mean age, 66...
June 2018: Journal of cardiovascular imaging
Antonio Culebras, Sanam Anwar
PURPOSE OF REVIEW: In this article, we review the cerebrovascular complications of sleep apnea (SA). SA is the major sleep disorder associated with stroke and vascular dementia. RECENT FINDINGS: Sleep apnea syndrome of moderate to severe intensity affects 17% of 50-70-year-old men and 9% of 50-70-year-old women, making SA a notorious and prevalent disorder. SA increases the risk of hypertension, stroke, myocardial infarction, and atrial fibrillation (AF) and is closely linked to vascular dementia...
June 25, 2018: Current Neurology and Neuroscience Reports
Renato D Lopes, Amit N Vora, Danny Liaw, Christopher B Granger, Harald Darius, Shaun G Goodman, Roxana Mehran, Stephan Windecker, John H Alexander
BACKGROUND: The optimal antithrombotic strategy for patients with atrial fibrillation (AF) who develop acute coronary syndrome (ACS) and/or the need for percutaneous coronary intervention (PCI) is uncertain. The risk of bleeding is a major concern when oral anticoagulation is required to prevent stroke, and concomitant therapy with antiplatelet agents is required to minimize recurrent ischemic events. DESIGN: AUGUSTUS is an international, multicenter randomized trial with a 2 × 2 factorial design to compare apixaban with vitamin K antagonists and aspirin with placebo in patients with AF who develop ACS and/or undergo PCI and are receiving a P2Y12 inhibitor...
June 2018: American Heart Journal
Mohamad Alkhouli, Fahad Alqahtani, Sami Aljohani, Muhammad Alvi, David R Holmes
OBJECTIVES: This study aimed to investigate whether the excess morbidity and mortality of atrial fibrillation (AF)-related stroke persists in the contemporary era. BACKGROUND: Acute ischemic stroke (AIS) in patients with AF is associated with worse outcomes than in patients without AF. Stroke prevention strategies in patients with AF have improved over the last decade and AIS-related mortality overall has also declined. METHODS: Patients ≥18 years of age who were admitted with AIS between 2003 and 2014 were identified in the National Inpatient Sample...
May 2018: JACC. Clinical Electrophysiology
Niklas Ekerstad, Thomas Karlsson, Sara Söderqvist, Björn W Karlson
Background and objective: Multiple chronic conditions and recurring acute illness are frequent among elderly people. One such condition is atrial fibrillation (AF), which increases the risk of stroke up to fivefold. The aim of this study was to investigate the prevalence of AF among hospitalized frail elderly patients, their use of anticoagulation and their 12-month outcomes. Patients and methods: This was a clinical observational study of acutely hospitalized frail patients over the age of 75 years...
2018: Clinical Interventions in Aging
José Miguel Rivera-Caravaca, Vanessa Roldán, Marta Romera, María Asunción Esteve-Pastor, Mariano Valdés, Gregory Y H Lip, Vicente Vicente, Francisco Marín
BACKGROUND: Soluble fibrin monomer complex (SFMC) is a biomarker of fibrin formation abnormally elevated in clinical situations of hypercoagulability. OBJECTIVE: We investigated the association and predictive performance of SFMC for stroke, adverse cardiovascular events, cardiovascular mortality and all-cause mortality in a cohort of patients with atrial fibrillation (AF) receiving vitamin K antagonist (VKA) anticoagulant therapy. DESIGN: During the second semester of 2007, we included 1226 AF outpatients stable on VKAs (INR 2...
June 2018: Journal of General Internal Medicine
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