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Stroke anticoagulation

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https://www.readbyqxmd.com/read/28345154/outcomes-in-post-myocardial-infarction-patients-similar-to-those-of-the-pegasus-timi-54-trial-a-cohort-study-in-the-french-national-claims-database
#1
Patrick Blin, Caroline Dureau-Pournin, Régis Lassalle, Jérémy Jové, Florence Thomas-Delecourt, Cécile Droz-Perroteau, Nicolas Danchin, Nicholas Moore
AIMS: The present study aims to describe real-life outcomes in stable post-myocardial infarction (MI) patients similar to those in the PEGASUS-TIMI 54 trial (PEGASUS), which found long-term benefits of ticagrelor in patients with a history of MI. METHODS: One-year event-free post-MI patients were identified in the French claims database representative 1/97 sample (2005-2010) and followed up to 3 years. A PEGASUS-like (PL) population included patients with age ≥ 65 years, or age ≥50 and diabetes, renal dysfunction or prior MI, without stroke, end-stage renal failure or oral anticoagulation...
March 26, 2017: British Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/28343849/oral-anticoagulant-therapy-for-older-patients-with-atrial-fibrillation-a-review-of-current-evidence
#2
REVIEW
Mario Bo, Enrica Grisoglio, Enrico Brunetti, Yolanda Falcone, Niccolò Marchionni
Atrial fibrillation is more frequent in older patients, who have a higher risk of cardioembolic stroke and thromboembolism. Oral anticoagulant therapy is the standard of treatment for stroke prevention; however, under-prescription is still very common in older patients. The reasons underlying this phenomenon have not been systematically investigated, and true contraindications only partially account for it. An intimate skepticism on the real benefit-risk balance of oral anticoagulant therapy in the oldest patients seems to derive from the fact that most studies supporting it were conducted decades ago and included younger patients, with overall better functional and clinical status...
March 24, 2017: European Journal of Internal Medicine
https://www.readbyqxmd.com/read/28343220/hemorrhagic-transformations-after-thrombectomy-risk-factors-and-clinical-relevance
#3
Johannes Kaesmacher, Mirjam Kaesmacher, Christian Maegerlein, Claus Zimmer, Alexandra S Gersing, Silke Wunderlich, Benjamin Friedrich, Tobias Boeckh-Behrens, Justus F Kleine
BACKGROUND: Hemorrhagic transformation (HT) is a major complication of acute ischemic stroke, potentially associated with clinical deterioration. We attempted to identify risk factors and evaluated clinical relevance of minor and major HTs following endovascular thrombectomy (ET) in isolated middle cerebral artery (MCA) occlusions. METHODS: This is a retrospective single-center analysis of 409 patients with isolated MCA occlusion treated with ET. Patients' and procedural characteristics, severity of HT according to the European Cooperative Acute Stroke Study criteria, and clinical outcomes were analyzed...
March 25, 2017: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/28339885/alcohol-related-hospitalization-is-associated-with-increased-risk-of-ischaemic-stroke-among-low-risk-patients-with-atrial-fibrillation
#4
Faris Al-Khalili, Lina Benson, Leif Friberg
Aims: Patients with atrial fibrillation (AF) under the age of 65 and CHA2DS2-VASc risk score of 0 in men or 1 in women are considered to be at low risk for ischaemic stroke, and therefore without benefit of oral anticoagulation therapy. The objective of this study is to assess the incidence and predictors of ischaemic stroke among low-risk patients with AF identified from a National Patient Register. Methods and results: A retrospective study of 25 252 low-risk AF patients (age 18-64) out of total 345 123 AF patients identified from the Swedish Nationwide Patient Register for the period 1 January 2006 to 31 December 2012...
February 23, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/28339794/short-term-dabigatran-interruption-before-cardiac-rhythm-device-implantation-multi-centre-experience-from-the-re-ly-trial
#5
Vidal Essebag, Riccardo Proietti, David H Birnie, Jia Wang, James Douketis, Benoit Coutu, Ratika Parkash, Gregory Y H Lip, Stefan H Hohnloser, Andrew Moriarty, Jonas Oldgren, Stuart J Connolly, Michael Ezekowitz, Jeff S Healey
Aims: Cardiac implantable electronic device (CIED) surgery is commonly performed in patients with atrial fibrillation (AF). The current analysis was undertaken to compare peri-operative anticoagulation management, bleeding, and thrombotic events in AF patients treated with dabigatran vs. warfarin. Methods and results: This study included 611 patients treated with dabigatran vs. warfarin who underwent CIED surgery during the RE-LY trial. Among 201 warfarin-treated patients, warfarin was interrupted a median of 144 (inter-quartile range, IQR: 120-216) h, and 37 (18...
February 23, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/28337024/angiotensin-ii-promotes-the-anticoagulant-effects-of-rivaroxaban-via-angiotensin-type-2-receptor-signaling-in-mice
#6
Dan Yang, Junjie Shao, Ruifeng Hu, Haimei Chen, Ping Xie, Chang Liu
Rivaroxaban is an oral direct factor Xa inhibitor approved for the treatment of stroke and systemic thromboembolism in patients with non-valvular atrial fibrillation. Despite its efficacy, rivaroxaban therapy results in adverse effects and complications, such as bleeding. Angiotensin II (AngII) is implicated in many cardiovascular conditions, such as hypertension and heart failure. In this study, we investigate whether AngII influences anticoagulant effects of rivaroxaban by using an experimental mouse model with type 2 diabetes mellitus and advanced glycation end product (AGE)-exposed human umbilical vein endothelial cells (HUVECs)...
March 23, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28336387/the-word-heart-federation-roadmap-for-nonvalvular-atrial-fibrillation
#7
Adrianna Murphy, Amitava Banerjee, Günter Breithardt, A John Camm, Patrick Commerford, Ben Freedman, J Antonio Gonzalez-Hermosillo, Jonathan L Halperin, Chu-Pak Lau, Pablo Perel, Denis Xavier, David Wood, Xavier Jouven, Carlos A Morillo
BACKGROUND: The World Heart Federation has undertaken an initiative to develop a series of Roadmaps to promote development of national policies and health systems approaches, and to identify potential roadblocks on the road to effective prevention, detection, and management of cardiovascular disease in low-and middle-income countries (LMICs) and develop strategies for overcoming these. This Roadmap focuses on atrial fibrillation (AF). AF is the most common, clinically significant arrhythmia and, among other clinical outcomes, is associated with increased risk of stroke...
March 20, 2017: Global Heart
https://www.readbyqxmd.com/read/28335637/reversing-the-anticoagulation-effects-of-dabigatran
#8
William E Dager, Linda Banares
The standard of care for oral anticoagulation therapy has primarily been warfarin, which is limited by its indirect mechanism-of-action, variable kinetics, tolerability, and routine monitoring concerns. The direct-acting oral anticoagulants (DOACs) have predictable pharmacokinetics and pharmacodynamics, and improved safety and efficacy compared to warfarin for the prevention of stroke in patients with nonvalvular atrial fibrillation and prevention or management of venous thromboembolism. Consequential bleeding is a concern with all anticoagulants...
March 24, 2017: Hospital Practice (Minneapolis)
https://www.readbyqxmd.com/read/28331926/cessation-of-oral-anticoagulation-is-an-important-risk-factor-for-stroke-and-mortality-in-atrial-fibrillation-patients
#9
José Miguel Rivera-Caravaca, Vanessa Roldán, María Asunción Esteve-Pastor, Mariano Valdés, Vicente Vicente, Gregory Y H Lip, Francisco Marín
Oral anticoagulation (OAC) is highly effective preventing stroke and mortality in AF, but withdrawal is common in the elderly, when high bleeding risk and when are difficulties achieving an optimal time in therapeutic range (TTR). We analysed the rate of OAC cessation, predisposing factors to cessation and the relation to clinical outcomes in a large 'real world' cohort of AF patients over a long follow-up period. Consecutive non-valvular AF outpatients clinically stables for six months were recruited. Rates of cardiovascular events, major bleeding and mortality were recorded and related to OAC cessation...
March 23, 2017: Thrombosis and Haemostasis
https://www.readbyqxmd.com/read/28330690/subclinical-leaflet-thrombosis-in-surgical-and-transcatheter-bioprosthetic-aortic-valves-an-observational-study
#10
Tarun Chakravarty, Lars Søndergaard, John Friedman, Ole De Backer, Daniel Berman, Klaus F Kofoed, Hasan Jilaihawi, Takahiro Shiota, Yigal Abramowitz, Troels H Jørgensen, Tanya Rami, Sharjeel Israr, Gregory Fontana, Martina de Knegt, Andreas Fuchs, Patrick Lyden, Alfredo Trento, Deepak L Bhatt, Martin B Leon, Raj R Makkar
BACKGROUND: Subclinical leaflet thrombosis of bioprosthetic aortic valves after transcatheter valve replacement (TAVR) and surgical aortic valve replacement (SAVR) has been found with CT imaging. The objective of this study was to report the prevalence of subclinical leaflet thrombosis in surgical and transcatheter aortic valves and the effect of novel oral anticoagulants (NOACs) on the subclinical leaflet thrombosis and subsequent valve haemodynamics and clinical outcomes on the basis of two registries of patients who had CT imaging done after TAVR or SAVR...
March 19, 2017: Lancet
https://www.readbyqxmd.com/read/28330631/clinical-features-and-prognosis-in-patients-with-atrial-fibrillation-and-prior-stroke-comparing-the-fushimi-and-darlington-af-registries
#11
Hisashi Ogawa, Keitaro Senoo, Yoshimori An, Alena Shantsila, Eduard Shantsila, Deirdre A Lane, Andreas Wolff, Masaharu Akao, Gregory Y H Lip
BACKGROUND: Ethnic differences in clinical characteristics, stroke risk profiles and outcomes among atrial fibrillation (AF) patients may exist. We therefore compared AF patients with previous stroke from Japan and the United Kingdom (UK). METHODS: We compared clinical characteristics, stroke risk and outcomes among AF patients from the Fushimi AF registry who had experienced a previous stroke (Japan; n=688; 19.7%) and the Darlington AF registry (UK; n=428; 19.0%)...
March 16, 2017: EBioMedicine
https://www.readbyqxmd.com/read/28329395/long-term-symptom-improvement-and-patient-satisfaction-following-catheter-ablation-of-supraventricular-tachycardia-insights-from-the-german-ablation-registry
#12
Johannes Brachmann, Thorsten Lewalter, Karl-Heinz Kuck, Dietrich Andresen, Stephan Willems, Stefan G Spitzer, Florian Straube, Burghard Schumacher, Lars Eckardt, Dejan Danilovic, Dierk Thomas, Matthias Hochadel, Jochen Senges
Aims: To analyse outcomes of supraventricular tachycardia (SVT) ablations performed within a prospective German Ablation Quality Registry. Methods and results: Data from 12 566 patients who underwent catheter ablation of SVT between January 2007 and January 2010 to treat atrial fibrillation (AFIB, 37.2% of procedures), atrial flutter (AFL, 29.9%), atrioventricular nodal re-entrant tachycardia (AVNRT, 23.2%), atrioventricular re-entrant tachycardia (6.3%), and focal atrial tachycardia (AT, 3...
March 17, 2017: European Heart Journal
https://www.readbyqxmd.com/read/28329215/triple-antithrombotic-therapy-in-patients-with-atrial-fibrillation-undergoing-percutaneous-coronary-intervention-a-viewpoint
#13
Jennifer C V Gwyn, Mark R Thomas, Paulus Kirchhof
Patients undergoing percutaneous coronary intervention (PCI) are treated with dual antiplatelet therapy to reduce the risk of subsequent myocardial infarction (MI) and stent thrombosis. Approximately 5-10% of patients undergoing PCI also have atrial fibrillation (AF). Patients with AF have an additional requirement for anticoagulation, as dual antiplatelet therapy alone is insufficient to adequately reduce the risk of stroke in patients with AF. However, it is now well established that combining anticoagulants with dual antiplatelet therapy also causes a significant increase in the risk of bleeding...
March 13, 2017: European Heart Journal. Cardiovascular Pharmacotherapy
https://www.readbyqxmd.com/read/28326589/risk-of-myocardial-infarction-in-patients-with-atrial-fibrillation-using-vitamin-k-antagonists-aspirin-or-direct-acting-oral-anticoagulants
#14
Leo M Stolk, Frank de Vries, Chiel Ebbelaar, Anthonius de Boer, Tom Schalekamp, Patrick Souverein, Arina Ten Cate-Hoek, Andrea M Burden
AIM: Direct-acting oral anticoagulants (DOACs) have become available for the prevention of stroke in patients with atrial fibrillation (AF). Conflicting results have been published on the risk of acute myocardial infarction (AMI) with the use of DOACs in comparison with vitamin K antagonists (VKAs). The objective of the present study was to evaluate the risk of AMI in patients with AF who are exposed to either VKAs, DOACs or low-dose (< 325 mg) aspirin. METHODS: We conducted a population-based cohort study using data from the Clinical Practice Research Datalink (2008-2014)...
March 22, 2017: British Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/28322423/uptake-of-non-vitamin-k-antagonist-oral-anti-coagulants-in-patients-with-atrial-fibrillation-a-prospective-cohort-study
#15
Matylda Zimny, Steffen Blum, Peter Ammann, Paul Erne, Giorgio Moschovitis, Marcello Di Valentino, Dipen Shah, Jürg Schläpfer, Cyrill Vogt, Alexandra Tabord, Michael Kühne, Christian Sticherling, Stefan Osswald, David Conen
AIMS: We aimed to assess the uptake of non-vitamin K antagonist oral anticoagulants (NOACs) among patients with atrial fibrillation between 2010 and 2015 in Switzerland. METHODS: We performed a prospective observational cohort study. At the baseline examination and during yearly follow-ups, we used questionnaires to obtain information about clinical characteristics and antithrombotic treatment. Stroke risk was assessed using the CHA2DS2-VASc score. RESULTS: 1545 patients were enrolled across seven centres in Switzerland...
March 21, 2017: Swiss Medical Weekly
https://www.readbyqxmd.com/read/28321414/medical-and-interventional-therapy-for-spontaneous-vertebral-artery-dissection-in-the-craniocervical-segment
#16
Guiyun Zhang, Zuoquan Chen
Background and Purpose. Spontaneous vertebral artery dissection (SVAD) is an important reason for posterior-circulation-ischemic stroke in the young and middle-aged population. Although some previous reports reveal a favorable outcome with conservative therapy, it is still controversial in the treatment of SVAD in some specific patients. Herein, we present our 10 years of clinical experience for SVAD at this location. Material and Methods. 20 patients with 20 SVADs in V2 and V3 segments were retrospectively studied...
2017: BioMed Research International
https://www.readbyqxmd.com/read/28320118/prothrombin-complex-concentrate-administration-for-bleeding-associated-with-non-vitamin-k-antagonist-oral-anticoagulants-the-samurai-nvaf-study
#17
Sohei Yoshimura, Shoichiro Sato, Kenichi Todo, Yasushi Okada, Eisuke Furui, Takayuki Matsuki, Hiroshi Yamagami, Masatoshi Koga, Jun C Takahashi, Kazuyuki Nagatsuka, Shoji Arihiro, Kazunori Toyoda
BACKGROUND: Antidotes appropriate for non-vitamin K antagonist (VKA) oral anticoagulants (NOACs) are not yet in widespread clinical use. Efficacy of prothrombin complex concentrate (PCC) in NOAC-associated bleeding remains unclarified. METHODS: Ten NOAC users (4 women, median 74years old) who developed major bleeding and received PCC were prospectively enrolled. Eight single-center NOAC users (0 women, median 74years old) with intracerebral hemorrhage, who over the same period did not receive PCC, were studied for comparison...
April 15, 2017: Journal of the Neurological Sciences
https://www.readbyqxmd.com/read/28319471/early-secondary-prevention-after-initially-ineffective-revascularization-treatments-for-acute-ischemic-stroke-due-to-tandem-occlusion
#18
Stefano Forlivesi, Elia Pancheri, Giuseppe Moretto, Paolo Bovi, Manuel Cappellari
The most effective treatment of patients with stroke due to tandem occlusion is still unclear. We report the case of a man with stroke due to tandem internal carotid artery/middle cerebral artery occlusion, who underwent initially ineffective intravenous thrombolysis (IVT) and endovascular treatment. Early anticoagulation with apixaban was started after 48 h of IVT, given a newly diagnosed nonvalvular atrial fibrillation. Spontaneous partial recanalization of the cervical internal carotid artery was noted, and carotid endarterectomy was performed 72 h after IVT and 8 h after the last dose of apixaban...
March 17, 2017: Blood Coagulation & Fibrinolysis: An International Journal in Haemostasis and Thrombosis
https://www.readbyqxmd.com/read/28317289/stroke-recurrence-in-patients-with-atrial-fibrillation-concomitant-carotid-artery-stenosis-doubles-the-risk
#19
H Lehtola, K E J Airaksinen, P Hartikainen, J E K Hartikainen, A Palomäki, I Nuotio, A Ylitalo, T Kiviniemi, P Mustonen
BACKGROUND AND PURPOSE: Atrial fibrillation (AF) and significant carotid artery stenosis (CAS) often coexist in patients with acute stroke but whether CAS affects the stroke recurrence rate in anticoagulated AF patients is largely unknown. The effect of concomitant CAS on both short- and long-term prognosis after stroke in patients with AF was evaluated. METHODS: The multicentre, retrospective FibStroke registry included AF patients with an ischaemic stroke or transient ischaemic attack (TIA) during 2003-2012...
March 20, 2017: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
https://www.readbyqxmd.com/read/28317274/quality-of-warfarin-therapy-and-risk-of-stroke-bleeding-and-mortality-among-patients-with-atrial-fibrillation-results-from-the-nationwide-finwaf-registry
#20
Mika Lehto, Jussi Niiranen, Pasi Korhonen, Juha Mehtälä, Houssem Khanfir, Fabian Hoti, Riitta Lassila, Pekka Raatikainen
PURPOSE: The most important management strategy in atrial fibrillation (AF) patients is preventing stroke with oral anticoagulants. Warfarin is still used as a first-line anticoagulant, although non-vitamin K antagonist oral anticoagulants are currently recommended to manage AF. Using a large, unselected national sample of AF patients, we evaluated the relationships between quality of warfarin therapy and the risks of thromboembolism, bleeding complications, and mortality. METHODS: The nationwide FinWAF study included 54 568 AF patients taking warfarin...
March 19, 2017: Pharmacoepidemiology and Drug Safety
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