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Hemorrhagic transformation and AF

Jaime Masjuan, Alicia DeFelipe
Patients with atrial fibrillation and prior stroke or transient ischemic attack exhibit a very high risk of recurrence. Secondary prevention with oral anticoagulants is mandatory. Overall, clinical guidelines recommend the use of target-specific oral anticoagulants over vitamin K antagonists for secondary prevention of stroke in patients with atrial fibrillation. However, many patients with atrial fibrillation and previous stroke are not receiving the appropriate antithrombotic treatment, perhaps due to the perceived risks of anticoagulation including the risk of hemorrhagic transformation of an ischemic stroke...
September 20, 2016: International Journal of Neuroscience
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
Junfeng Liu, Deren Wang, Yao Xiong, Bian Liu, Chenchen Wei, Zhenxing Ma, Bo Wu, Ruozhen Yuan, Hehan Tang, Ming Liu
Calcium is an essential element for life and has cerebroprotective property in stroke patients. Low serum calcium levels were found to be related to large hematoma volumes in intracerebral hemorrhagic patients and hemorrhagic transformation in ischemic stroke patients after thrombolysis. However, their impact on hemorrhage-prone small vessel disease represented by cerebral microbleeds (CMBs) is uncertain. We aim to investigate whether low serum calcium levels are associated with presence and location of CMBs...
June 2016: Medicine (Baltimore)
Eiichi Nomura, Tomohiko Ohshita, Eiji Imamura, Shinichi Wakabayashi, Hiroshi Kajikawa, Naohisa Hosomi, Masayasu Matsumoto
BACKGROUND: This study evaluated the rates of new lesions on diffusion-weighted images (DWIs) of magnetic resonance imaging (MRI) and hemorrhagic transformation (HT) during 2 weeks after acute ischemic stroke (AIS) in patients with atrial fibrillation (Af) who were given one of the non-vitamin K antagonist oral anticoagulants (NOACs); this was then compared with those who were given warfarin. METHODS AND RESULTS: Consecutive AIS patients with Af were enrolled between January 2008 and June 2013, and those selected were patients who had a MRI that included DWIs both on admission and after 2 weeks, and those given only wafrarin (warfarin group) or only one of the NOACs (NOAC group) within 2 weeks of admission...
2015: Circulation Journal: Official Journal of the Japanese Circulation Society
Yi-ping Lou, Shen-qiang Yan, Sheng Zhang, Zhi-cai Chen, Jin-ping Wan, Min Lou
OBJECTIVE: To investigate the impact of atrial fibrillation (AF) on clinical outcomes in patients with acute ischemic stroke undergoing thrombolytic therapy. METHODS: The clinical data of 330 patients with acute ischemic stroke who received intravenous recombinant tissue plasminogen activator (rt-PA) therapy in the Second Affiliated Hospital, Zhejiang University School of Medicine between June 2009 and August 2013 were reviewed. Clinical outcomes in AF and non-AF groups were evaluated by univariate and multivariate analysis...
January 2014: Zhejiang da Xue Xue Bao. Yi Xue Ban, Journal of Zhejiang University. Medical Sciences
Visnja Padjen, Marie Bodenant, Dejana R Jovanovic, Nelly Ponchelle-Dequatre, Novak Novakovic, Charlotte Cordonnier, Ljiljana Beslac-Bumbasirevic, Didier Leys
The question of whether i.v. rt-PA is beneficial in patients with ischaemic stroke and atrial fibrillation (AF) remains unresolved. Our objective was to evaluate the outcome of patients with AF who received i.v. rt-PA for stroke in the registries of Lille (France) and Belgrade (Serbia). End-points were poor outcome [modified Rankin Scale (mRS) 3-6], and symptomatic haemorrhagic transformation (sHT) according to ECASS3. Of 734 consecutive patients, 155 (21.2 %) had AF. The unadjusted comparison found patients with AF to be 12 years older, more likely to be women, to have hypertension, and baseline INR > 1...
December 2013: Journal of Neurology
Jung-Gon Lee, Kyung Bok Lee, Il-Mi Jang, Hakjae Roh, Moo-Young Ahn, Hee-Yeon Woo, Hye-Won Hwang
BACKGROUND: Decreased glomerular filtration rate (GFR) can increase the risk of bleeding tendency and hemorrhagic stroke. However, the relationship between the levels of GFR and hemorrhagic transformation (HT) after acute ischemic stroke is largely unknown. The aim of this study was to assess whether GFR level is associated with HT in acute ischemic stroke. METHODS: We reviewed 770 consecutive patients with acute ischemic stroke within 7 days from September 2007 to February 2012 in a prospective stroke registry database...
2013: Cerebrovascular Diseases
Pablo Alonso-Coello, Qi Zhou, Gordon Guyatt
Oral anticoagulation with vitamin k antagonists (VKAs) requires regular testing and dose adjustment. Home-monitoring (self-testing or self-management) is more effective than usual management. Dabigatran, does not require dose-adjustment and appears to be more effective at reducing the risk of stroke with similar risks of bleeding in patients with atrial fibrillation (AF). Dabigatran, however, has not been compared to the home-monitoring. It was the objective to evaluate the efficacy of dabigatran compared with home-monitoring of oral anticoagulation with VKAs...
October 2012: Thrombosis and Haemostasis
Elsa Melki, Jérôme Mawet, Mariana Sarov-Riviere, Marie-Germaine Bousser
Contrasting with the abundant literature dedicated to atrial fibrillation (AF) and to the use of new oral anticoagulants in this setting, very few recent studies have focused on patients with AF-associated stroke. From November 2010 to March 2011, we conducted a small prospective 4-month study in the stroke units of Lariboisière and Bicêtre hospitals. Fifty patients with FA and stroke were included (14% of all strokes), including 45 patients with cerebral infarcts (CI), 3 with transient ischemic attacks (TIA) and 2 with intracerebral hemorrhage (ICH)...
April 2011: Bulletin de L'Académie Nationale de Médecine
Sen Lin, Bo Wu, Zi-Long Hao, Fan-Yi Kong, Wen-Dan Tao, De-Ren Wang, Sha He, Ming Liu
BACKGROUND: There is scant information on characteristics, treatment, functional outcome and case fatality of ischemic stroke with atrial fibrillation (AF) in China. METHODS: For this study, first-ever ischemic stroke patients who were admitted within 1 month of stroke onset during the period of March 2002 through December 2008 were included. Data on ischemic stroke patients were collected which included: demographics, risk factors, treatment administered, stroke-related complications and 3-month, 6-month and 1-year death and disability...
2011: Cerebrovascular Diseases
Ju-Hun Lee, Kwang-Yeol Park, Joon-Hyun Shin, Jae-Kwan Cha, Hahn-Young Kim, Jee-Hyun Kwon, Hyung Geun Oh, Kyung Bok Lee, Dong-Eog Kim, Sang-Won Ha, Kyung-Hee Cho, Sung-Il Sohn, Mi-Sun Oh, Kyung-Ho Yu, Byung-Chul Lee, Sun U Kwon
BACKGROUND AND PURPOSE: Patients with acute cardioembolic stroke frequently show hemorrhagic transformation (HTr). We attempted to identify predictors of symptomatic HTr in acute ischemic stroke with atrial fibrillation (AF). METHODS: Of the consecutive acute ischemic stroke patients with AF at 12 hospitals in Korea, patients with posterior circulation stroke or thrombolytic therapy were excluded. Immediate anticoagulation was recommended to all patients, except those with: (1) large infarcts, 50% or more of the middle cerebral artery territory, (2) significant HTr on initial imaging, or (3) other safety concerns...
2010: European Neurology
Hans T H Tu, Bruce C V Campbell, Soren Christensen, Marnie Collins, Deidre A De Silva, Kenneth S Butcher, Mark W Parsons, Patricia M Desmond, P Alan Barber, Christopher R Levi, Christopher F Bladin, Geoffrey A Donnan, Stephen M Davis
BACKGROUND: The reasons for worse outcome following ischemic stroke in patients with atrial fibrillation (AF) remain unclear. We aimed to elucidate the pathophysiological determinants of poorer stroke outcome in patients with AF using systematic MRI data from the Echoplanar Imaging Thrombolytic Evaluation Trial (EPITHET). METHODS: Comparisons of infarct size, hypoperfusion volume, infarct growth, arterial occlusion, recanalization, reperfusion, hemorrhagic transformation and stroke severity were made between patients with and without AF enrolled in the EPITHET study...
2010: Cerebrovascular Diseases
Kazumi Kimura, Yasuyuki Iguchi, Kensaku Shibazaki, Junya Aoki, Yuka Terasawa
BACKGROUND AND PURPOSE: Symptomatic intracranial hemorrhages are typically clinically catastrophic and occur more frequently with tissue plasminogen activator (t-PA) therapy compared to without t-PA therapy. However, it has been unclear whether asymptomatic intracranial hemorrhage has clinical implications. METHODS: Consecutive anterior-circulation ischemic stroke patients treated with t-PA within 3 h of stroke onset were studied prospectively. Patients with symptomatic hemorrhages were excluded from the study...
September 15, 2008: Journal of the Neurological Sciences
H Yamanouchi
Novalvular (nonrheumatic) atrial fibrillation (NVAF) is the most common cardiac condition associated with presumed embolic stroke, accounting for approximately half of the cardiogenic embolic infarctions. Of autopsied stroke patients in the Tokyo Metropolitan Geriatric Hospital, cerebral infarction was found in 75%, intracranial hemorrhage in 19%, and coexisting cerebral hemorrhage and cerebral infarction in 6%. Twenty-eight percent of the cerebral infarctions were embolic infarctions of cardiac origin, 56% of which were caused by NVAF...
May 1993: Nihon Ronen Igakkai Zasshi. Japanese Journal of Geriatrics
J L Mas
About 20% of cerebral ischemic strokes are the consequence of embolism arising from the heart. Their secondary prevention is based on the treatment of the causal heart disease, which is most often associated with an anticoagulant treatment. In case of nonrheumatismal atrial fibrillation (AF), the most frequent cause of cerebral embolism of cardiac origin, the benefits of a long-standing anticoagulant treatment in comparison with a placebo or with aspirin for the prevention of recurrence is being investigated in a European multicenter trial...
1993: Journal des Maladies Vasculaires
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