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https://www.readbyqxmd.com/read/28650086/systemic-thrombolysis-catheter-directed-thrombolysis-and-anticoagulation-for-intermediate-risk-pulmonary-embolism-a-simulation-modeling-analysis
#1
Christopher Kabrhel, Ayman Ali, Jin Choi, Chin Hur
OBJECTIVES: Decision-making around the use of thrombolysis for patients with intermediate-risk (submassive) PE remains challenging. Studies indicate favorable clinical outcomes with systemic thrombolytics (IV tPA), but the risk of major bleeding and hemorrhagic stroke is a deterrent. Catheter-directed thrombolysis (CDT) may be a preferable strategy, as it has been shown to have a lower risk of bleeding than systemic thrombolysis. However, a three-arm randomized control study comparing IV tPA, CDT, and anticoagulation alone, with long-term follow up, would be costly and is unlikely to be performed...
June 26, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28649478/cerebral-air-embolism-as-possible-cause-of-stroke-during-therapeutic-endobronchial-application-of-argon-plasma-coagulation
#2
Venkatkiran Kanchustambham, Manasa Reddy, Swetha Saladi, Setu Patolia
A 68-year-old male was admitted for evaluation of an endobronchial mass obstructing the right middle lobe (RML) and right lower lobe (RLL) of the lung. Flexible bronchoscopy revealed a notable endobronchial lesion in the bronchus intermedius that completely obstructed the RML and the RLL. Argon plasma coagulation (APC) at 30 watts and gas flow at 0.8 liters/minute to 1 liter/minute were applied to the tumor. In the recovery room, the patient was discovered to have a left-sided facial droop and left-sided weakness...
May 17, 2017: Curēus
https://www.readbyqxmd.com/read/28648320/cost-effectiveness-of-edoxaban-vs-warfarin-in-patients-with-atrial-fibrillation-based-on-results-of-the-engage-af-timi-48-trial-taiwanese-perspective
#3
Katherine A Vilain, Ming Chin Yang, Elise Chia Hui Tan, Kaijun Wang, Haiyan Li, Wan Hsuan Hsu, Robert P Giugliano, David J Cohen, Elizabeth A Magnuson
BACKGROUND: Novel anticoagulants, such as factor Xa inhibitors, have entered clinical practice as alternatives to warfarin for the prevention of stroke and systemic embolic event (SEE) in patients with atrial fibrillation (AF). It is not known whether edoxaban, the fourth-to-market factor Xa inhibitor approved for this indication, will be cost-effective in Taiwan, where the cost of warfarin monitoring is prohibitive. METHODS: A Markov model projecting lifetime results of edoxaban 60 mg/30 mg dose-reduced versus warfarin in patients with nonvalvular AF, based on the ENGAGE AF - TIMI 48 trial, found edoxaban to be of high value relative to warfarin, from the perspective of the US health care system...
May 2017: Value in Health Regional Issues
https://www.readbyqxmd.com/read/28647641/impact-of-left-subclavian-artery-revascularization-prior-to-thoracic-endovascular-aortic-repair-on-post-operative-cerebrovascular-hemodynamics
#4
Arnoud V Kamman, Jonathan L Eliason, David M Williams, Bo Yang, Frans L Moll, Santi Trimarchi, Kim A Eagle, Himanshu J Patel
OBJECTIVES: The impact of left subclavian artery (LSA) revascularization prior to thoracic endovascular aortic repair (TEVAR) on cerebrovascular flow is not well described. We studied bilateral vertebral and carotid artery flow characteristics before and after TEVAR, to evaluate the hemodynamic effects of LSA revascularization. METHODS: Seventy-four patients with mixed etiologies (mean age 70.9±10.5 years) underwent LSA revascularization and TEVAR (2006-2016) and had available pre- and post-operative carotid Duplex study available...
June 21, 2017: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/28645934/repeated-measurements-of-cardiac-biomarkers-in-atrial-fibrillation-and-validation-of-the-abc-stroke-score-over-time
#5
Ziad Hijazi, Bertil Lindahl, Jonas Oldgren, Ulrika Andersson, Johan Lindbäck, Christopher B Granger, John H Alexander, Bernard J Gersh, Michael Hanna, Veli-Pekka Harjola, Elaine M Hylek, Renato D Lopes, Agneta Siegbahn, Lars Wallentin
BACKGROUND: Cardiac biomarkers are independent risk markers in atrial fibrillation, and the novel biomarker-based ABC stroke score (age, biomarkers, and clinical history of prior stroke) was recently shown to improve the prediction of stroke risk in patients with atrial fibrillation. Our aim was to investigate the short-term variability of the cardiac biomarkers and evaluate whether the ABC stroke risk score provides a stable short-term risk estimate. METHODS AND RESULTS: According to the study protocol, samples were obtained at entry and also at 2 months in 4796 patients with atrial fibrillation followed for a median of 1...
June 23, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28645902/the-cause-of-the-stroke-a-diagnostic-uncertainty
#6
Abhishek Dattani, Ava Jackson
A 39-year-old man with a history of sickle cell disease (SCD) presented with left leg weakness. He had a normal CT head and CT angiogram, but MRI head showed multiple acute bilateral cortical infarcts including in the right precentral gyrus. The MRI findings were more in keeping with an embolic source rather than stroke related to SCD, although it could not be ruled out. He also had an echocardiogram which revealed a patent foramen ovale. He was treated with antiplatelet therapy and also had red blood cell exchange transfusion...
June 23, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28645780/salvia-miltiorrhiza-bunge-danshen-extract-attenuates-permanent-cerebral-ischemia-through-inhibiting-platelet-activation-in-rats
#7
Yu-Xiang Fei, Si-Qi Wang, Li-Jian Yang, Yan-Ying Qiu, Yi-Ze Li, Wen-Yuan Liu, Tao Xi, Wei-Rong Fang, Yun-Man Li
ETHNOPHARMACOLOGICAL RELEVANCE: Danshen is a crude herbal drug isolated from dried roots of Salvia miltiorrhiza Bunge. This plant is widely used in oriental medicine for the treatment of cardiovascular and cerebrovascular diseases. The supercritical CO2 extract from Danshen (SCED) (57.85%, 5.67% and 4.55% for tanshinone IIA, tanshinone I and cryptotanshinone respectively) was studied in this article, whose potential molecular mechanism remains unclear, especially in anti-thrombosis. AIM OF THE STUDY: The present study was designed to observe the protective effect of SCED on ischemic stroke in rats and to explore the underlying anti-thrombosis mechanism...
June 20, 2017: Journal of Ethnopharmacology
https://www.readbyqxmd.com/read/28645473/efficacy-and-safety-of-rivaroxaban-versus-warfarin-in-patients-taking-nondihydropyridine-calcium-channel-blockers-for-atrial-fibrillation-from-the-rocket-af-trial
#8
Jeffrey B Washam, Anne S Hellkamp, Yuliya Lokhnygina, Jonathan P Piccini, Scott D Berkowitz, Christopher C Nessel, Richard C Becker, Günter Breithardt, Keith A A Fox, Jonathan L Halperin, Graeme J Hankey, Kenneth W Mahaffey, Daniel E Singer, Manesh R Patel
Non-dihydropyridine calcium channel blockers (non-DHP CCBs) possess combined P-glycoprotein and moderate CYP3A4 inhibition, which may lead to increased exposure of medications that are substrates for these metabolic pathways, such as rivaroxaban. We evaluated the use and outcomes of non-DHP CCBs in patients with atrial fibrillation (AF) in Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF)...
May 29, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28645443/once-or-twice-daily-non-vitamin-k-antagonist-oral-anticoagulants-in-asian-patients-with-atrial-fibrillation-a%C3%A2-meta-analysis-of-randomized-controlled-trials
#9
Kang-Ling Wang, Chun-Chih Chiu, Doreen Su-Yin Tan, Chun-Yi Lin, En-Yu Lai, Shinya Goto, Robert P Giugliano, Chern-En Chiang
BACKGROUND/PURPOSE: Non-vitamin K antagonist oral anticoagulants (NOACs) have a half-life of around 12 h. We aimed to clarify if there was any effect modification by dosing (once- or twice-daily) regimens in Asian patients. METHODS: Phase III randomized controlled trials of NOACs compared with warfarin in Asian patients with atrial fibrillation (AF) were identified and extracted from PubMed, CENTRAL, and CINAHL databases through November 2016. Outcomes were pooled by dosing regimens with the Mantel-Haenszel fixed-effects model...
June 20, 2017: Journal of the Formosan Medical Association, Taiwan Yi Zhi
https://www.readbyqxmd.com/read/28644260/intravenous-alteplase-for-acute-stroke-and-pulmonary-embolism-in-a-patient-with-recent-abdominoplasty
#10
Michael E Christiansen, Gyanendra Kumar, Raman C Mahabir, Richard A Helmers, Bernard R Bendok, Cumara B O'Carroll
INTRODUCTION: Major surgery in the past 14 days is a relative contraindication to treatment of acute stroke with intravenous (IV) alteplase. The 2016 American Heart Association/American Stroke Association scientific statement discussing inclusion and exclusion criteria for alteplase in acute stroke allows for provider judgment citing a lack of evidence to support surgery as an absolute contraindication. CASE REPORT: A 59-year-old woman presented with acute left hemiparesis, dysarthria, and acute respiratory failure...
July 2017: Neurologist
https://www.readbyqxmd.com/read/28643004/effectiveness-and-safety-of-apixaban-therapy-in-daily-care-patients-with-atrial-fibrillation-results-from-the-dresden-noac-registry
#11
Sindy Helmert, Sandra Marten, Heike Mizera, Antje Reitter, Kurtulus Sahin, Luise Tittl, Jan Beyer-Westendorf
The effectiveness and safety of apixaban for stroke prevention in atrial fibrillation (SPAF) demonstrated in ARISTOTLE needs to be confirmed in daily care. To evaluate effectiveness and safety of apixaban therapy in SPAF patients in daily care, we used data from an ongoing, prospective, non-interventional registry of more than 3000 patients on novel oral anticoagulants in daily care. Between 1 December 2012 and 31 August 2015, 514 patients receiving apixaban were enrolled. During a mean follow-up of 803.5 ± 228...
June 22, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28642352/management-of-brain-arteriovenous-malformations-a-scientific-statement-for-healthcare-professionals-from-the-american-heart-association-american-stroke-association
#12
REVIEW
Colin P Derdeyn, Gregory J Zipfel, Felipe C Albuquerque, Daniel L Cooke, Edward Feldmann, Jason P Sheehan, James C Torner
PURPOSE: The aim of this statement is to review the current data and to make suggestions for the diagnosis and management of both ruptured and unruptured brain arteriovenous malformations. METHODS: The writing group met in person and by teleconference to establish search terms and to discuss narrative text and suggestions. Authors performed their own literature searches of PubMed, Medline, or Embase, specific to their allocated section, through the end of January 2015...
June 22, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28641848/the-use-of-embolic-protection-devices-is-associated-with-a-lower-stroke-and-death-rate-after-carotid-stenting
#13
Christoph Knappich, Andreas Kuehnl, Pavlos Tsantilas, Sofie Schmid, Thorben Breitkreuz, Michael Kallmayer, Alexander Zimmermann, Hans-Henning Eckstein
OBJECTIVES: The aim of this study was to analyze the association between intraprocedural and periprocedural variables and in-hospital stroke or death rate after carotid artery stenting. BACKGROUND: In Germany, all open surgical and endovascular procedures on the extracranial carotid artery must be documented in a statutory nationwide quality assurance database. METHODS: A total of 13,086 carotid artery stenting procedures for asymptomatic (63...
June 26, 2017: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28638293/septic-embolic-stroke-resulting-from-staphylococcus-lugdunensis-endocarditis
#14
Htoo Kyaw, Atif Z Shaikh, Gokul Yaratha, Misra Deepika
BACKGROUND: Staphylococcus lugdunensis, a member of the coagulase-negative staphylococci (CoNS), has been recognized as a causal organism for infective endocarditis since the 1980s. Although most CoNS have an insidious and chronic nature, they are involved in a variety of systemic infections. S lugdunensis infective endocarditis is a rare entity but is as catastrophic as Staphylococcus aureus infective endocarditis and requires aggressive antibiotic therapy and, typically, valve replacement...
2017: Ochsner Journal
https://www.readbyqxmd.com/read/28637732/outpatient-percutaneous-native-renal-biopsy-safety-profile-in-a-large-monocentric-cohort
#15
Dario Roccatello, Savino Sciascia, Daniela Rossi, Carla Naretto, Mario Bazzan, Laura Solfietti, Simone Baldovino, Elisa Menegatti
OBJECTIVES: We aim to evaluate the safety of performing percutaneous native kidney biopsy (PKB) as an outpatient procedure (implying an observation period of 6 hours) compared with the traditional inpatient policy. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: Group I, in whom PKB was performed in the outpatient department (2012-2016) and followed by 6 hours' observation period and then by regular outpatient visits and group II, in whom PKB was performed and followed by at least 1 day hospital admission...
June 21, 2017: BMJ Open
https://www.readbyqxmd.com/read/28635338/risk-of-stroke-systemic-embolism-major-bleeding-and-associated-costs-in-non-valvular-atrial-fibrillation-patients-who-initiated-apixaban-dabigatran-or-rivaroxaban-compared-with-warfarin-in-the-united-states-medicare-population
#16
Alpesh Amin, Allison Keshishian, Jeffrey Trocio, Oluwaseyi Dina, Hannah Le, Lisa Rosenblatt, Xianchen Liu, Jack Mardekian, Qisu Zhang, Onur Baser, Lien Vo
OBJECTIVE: To compare the risk and cost of stroke/systemic embolism (SE) and major bleeding between each direct oral anticoagulant (DOAC) and warfarin among non-valvular atrial fibrillation (NVAF) patients. METHODS: Patients (≥65 years) initiating warfarin or DOACs (apixaban, rivaroxaban, and dabigatran) were selected from the Medicare database from 01/01/2013-12/31/2014. Patients initiating each DOAC were matched 1:1 to warfarin patients using propensity score matching to balance demographics and clinical characteristics...
June 21, 2017: Current Medical Research and Opinion
https://www.readbyqxmd.com/read/28629627/direct-oral-anticoagulants-in-patients-with-cervical-artery-dissection-and-cerebral-venous-thrombosis-a-case-series-and-review-of-the-literature
#17
Manuel Cappellari, Paolo Bovi
BACKGROUND: To date, very little is known about the effects of direct oral anticoagulants (DOA) use in patients with cervical artery dissection (CAD) and cerebral venous thrombosis (CVT). We present our initial experience with the use of DOA for CAD and CVT and an overview of the published literature. METHODS: From our database, we identified 4 patients who received DOA after CAD and 4 patients after CVT. Also, we analyzed the data reported for 45 patients who received DOA after CAD and 23 after CVT from review of the literature...
June 13, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28626055/ischemic-stroke-what-does-the-histological-composition-tell-us-about-the-origin-of-the-thrombus
#18
Peter B Sporns, Uta Hanning, Wolfram Schwindt, Aglaé Velasco, Jens Minnerup, Tarek Zoubi, Walter Heindel, Astrid Jeibmann, Thomas Ulrich Niederstadt
BACKGROUND AND PURPOSE: The introduction of stent retrievers allows for a complete extraction and histological analysis of human thrombi. Ischemic stroke is a major health issue, and differentiation of underlying causes is highly relevant to prevent recurrent stroke. Therefore, histopathologic analysis of the embolic clots after removal may provide valuable information about underlying pathologies. This study analyzes histological clot composition and aims to identify specific patterns that might help to distinguish causes of ischemic stroke...
June 16, 2017: Stroke; a Journal of Cerebral Circulation
https://www.readbyqxmd.com/read/28625637/a-randomized-phase-2-evaluation-of-the-chk1-inhibitor-ly2603618-administered-in-combination-with-pemetrexed-and-cisplatin-in-patients-with-advanced-nonsquamous-non-small-cell-lung-cancer
#19
Thomas Wehler, Michael Thomas, Christian Schumann, Joaquim Bosch-Barrera, Nuria Viñolas Segarra, Nicolas J Dickgreber, Klaus Dalhoff, Martin Sebastian, Jesus Corral Jaime, Miriam Alonso, Scott M Hynes, Ji Lin, Karla Hurt, Aimee Bence Lin, Emiliano Calvo, Luis Paz-Ares
This phase 2 portion of a phase 1/2 study examined the efficacy and safety of LY2603618, a selective checkpoint kinase 1 inhibitor, combined with pemetrexed and cisplatin (LY+Pem+Cis) in patients with advanced nonsquamous non-small cell lung cancer (NSCLC). This multicenter, randomized, controlled, open-label study (NCT01139775) enrolled patients with stage IV nonsquamous NSCLC and an Eastern Cooperative Oncology Group performance status ≤1. Patients were randomized (2:1) to LY+Pem+Cis or pemetrexed and cisplatin (Pem+Cis)...
June 2017: Lung Cancer: Journal of the International Association for the Study of Lung Cancer
https://www.readbyqxmd.com/read/28625383/the-assessment-of-the-watchman-device-in-patients-unsuitable-for-oral-anticoagulation-asap-too-trial
#20
David R Holmes, Vivek Y Reddy, Maurice Buchbinder, Kenneth Stein, Myriah Elletson, Martin W Bergmann, Boris Schmidt, Jacqueline Saw
BACKGROUND: Oral anticoagulants (OACs) reduce stroke risks with nonvalvular atrial fibrillation (AF); however, they are underused because of absolute or relative contraindications due to real or perceived risk of bleeding. Although left atrial appendage closure is increasingly performed in OAC-ineligible patients, this has not been studied in a randomized controlled trial. STUDY OBJECTIVES: The ASAP-TOO study is designed to establish the safety and effectiveness of the Watchman left atrial appendage closure device in patients with nonvalvular AF who are deemed ineligible for OAC...
July 2017: American Heart Journal
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