Article
Clinical Neurology
Daehoon Kim, Pil-Sung Yang, Jung-Hoon Sung, Eunsun Jang, Hee Tae Yu, Tae-Hoon Kim, Jae-Sun Uhm, Jong-Youn Kim, Hui-Nam Pak, Moon-Hyoung Lee, Gregory Y. H. Lip, Boyoung Joung
Summary: In frail patients with atrial fibrillation, oral anticoagulant treatment is associated with positive clinical outcomes. Direct oral anticoagulants have lower incidences of stroke, bleeding, and mortality compared to warfarin.
Article
Cardiac & Cardiovascular Systems
Jose Miguel Calderon, Fernando Martinez, Javier Diaz, Antonio Fernandez, Inmaculada Sauri, Ruth Uso, Jose Luis Trillo, Sara Vela, Carlos Bea, Josep Redon, Maria Jose Forner
Summary: The study found that in the real world, the use of anticoagulant treatments differs significantly from guideline recommendations and shows variability in their use. NOACs offer better protection compared to other treatment groups.
FRONTIERS IN CARDIOVASCULAR MEDICINE
(2022)
Article
Hematology
Elham Rahme, Richard Godin, Hacene Nedjar, Kaberi Dasgupta, Vicky Tagalakis
Summary: Standard-dose DOACs have similar stroke risks, better persistence, and mortality profiles compared to warfarin. Only standard-dose apixaban and dabigatran show better bleeding profiles than warfarin. Low-dose rivaroxaban demonstrates worse persistence, stroke, and bleeding profiles than warfarin, while low-dose apixaban and dabigatran have similar stroke risks and better bleeding profiles. Real-world use of DOACs may explain some differences observed in Canadian routine care compared to phase III clinical trials.
THROMBOSIS RESEARCH
(2021)
Article
Cardiac & Cardiovascular Systems
Andrew Kei-Yan Ng, Pauline Yeung Ng, April Ip, Raymond Chi-Yan Fung, Shing-Fung Chui, Chung-Wah Siu, Bryan P. Yan
Summary: This cohort study compared the efficacy of left atrial appendage occlusion (LAAO) and switch to direct oral anticoagulant (DOAC). The study found that LAAO had a similar risk of composite outcome of all-cause mortality, ischemic stroke, and major bleeding compared to DOAC switch. The LAAO group had a lower risk of all-cause mortality and cardiovascular mortality.
JOURNAL OF THE AMERICAN HEART ASSOCIATION
(2023)
Review
Cardiac & Cardiovascular Systems
Hizir Ozdemir, Dimitrios Sagris, Gregory Y. H. Lip, Azmil H. Abdul-Rahim
Summary: The purpose of this review is to summarize the association between atrial fibrillation and ischemic stroke, and provide insights on the pathophysiological mechanisms and clinical management of patients with atrial fibrillation in order to reduce the burden of ischemic stroke.
CURRENT CARDIOLOGY REPORTS
(2023)
Article
Medicine, General & Internal
Beatrice Dal Zotto, Lucia Barbieri, Gabriele Tumminello, Massimo Saviano, Domitilla Gentile, Stefano Lucreziotti, Loredana Frattini, Diego Tarricone, Stefano Carugo
Summary: This study aims to evaluate the mortality and clinical outcome of new-onset atrial fibrillation (AF) patients during ST-segment elevation myocardial infarction (STEMI). The study found that age and ejection fraction were important predictors of short- and long-term mortality.
Article
Clinical Neurology
Edward V. Kogan, Christopher T. Sciria, Christopher F. Liu, S. Chiu Wong, Geoffrey Bergman, James E. Ip, George Thomas, Steven M. Markowitz, Bruce B. Lerman, Luke K. Kim, Jim W. Cheung
Summary: This study analyzed the rates and predictors of early stroke and mortality following left atrial appendage occlusion (LAAO). The results showed low rates of early stroke and mortality, with majority of events occurring within 45 days of LAAO.
Article
Medicine, General & Internal
Adane Teshome Kefale, Woldesellassie M. Bezabhe, Gregory M. Peterson
Summary: This study investigated the prescription rate of oral anticoagulants (OACs) in low-risk atrial fibrillation (AF) patients and identified associated factors. It also described incident bleeding events in these patients. The results showed that 25.1% of low-risk AF patients received OACs within 60 days of diagnosis. Older age and the period following the widespread availability of direct-acting OACs were associated with a higher likelihood of OAC prescription. However, using OACs did not increase the rate of bleeding compared to non-users.
JOURNAL OF CLINICAL MEDICINE
(2023)
Article
Cardiac & Cardiovascular Systems
Jin-Yi Hsu, Peter Pin-Sung Liu, Luciano A. Sposato, Huei-Kai Huang, An-Bang Liu, Edward Chia-Cheng Lai, Swu-Jane Lin, Cheng-Yang Hsieh, Ching-Hui Loh
Summary: This study evaluated the association between oral anticoagulant (OAC) use and the risk of recurrent ischemic stroke in atrial fibrillation detected after stroke (ADAF) patients in a real-world setting. The results showed that OAC use in ADAF patients was associated with a reduced risk of recurrent ischemic stroke, without an increased risk of intracranial hemorrhage (ICH).
FRONTIERS IN CARDIOVASCULAR MEDICINE
(2022)
Article
Pharmacology & Pharmacy
Sijie Chang, Wenlin Xu, Shuyi Wu, Lien Desteghe, Feilong Zhang, Jinhua Zhang
Summary: This study translated the Jessa Atrial fibrillation Knowledge Questionnaire (JAKQ) into Chinese and evaluated its reliability and validity. The results showed that the Chinese version of JAKQ has good reliability and validity and can be used to guide educational activities to improve the effectiveness and safety of atrial fibrillation oral anticoagulation (OAC) treatment. Chinese patients with atrial fibrillation have insufficient knowledge about atrial fibrillation and OAC. Lower JAKQ scores are associated with bleeding, indicating the need for targeted education.
FRONTIERS IN PHARMACOLOGY
(2023)
Article
Cardiac & Cardiovascular Systems
Joris J. Komen, Tomas Forslund, Aukje K. Mantel-Teeuwisse, Olaf H. Klungel, Mia von Euler, Frieder Braunschweig, Hakan Wallen, Paul Hjemdahl
Summary: This study analyzed 90-day mortality in atrial fibrillation (AF) patients after a stroke or a severe bleed, and found that NOAC treatment was associated with lower mortality rates, while warfarin may lead to higher mortality rates after intracranial hemorrhage.
EUROPEAN HEART JOURNAL-CARDIOVASCULAR PHARMACOTHERAPY
(2021)
Article
Cardiac & Cardiovascular Systems
Dong Lin, Yequn Chen, Jian Yong, Shiwan Wu, Yan Zhou, Weiping Li, Xuerui Tan, Ruisheng Liu
Summary: This study found that the use of low-dose rivaroxaban and low-intensity warfarin in Asian patients with atrial fibrillation can provide survival benefits, although the effects are smaller than those observed with recommended optimal anticoagulation.
FRONTIERS IN CARDIOVASCULAR MEDICINE
(2021)
Article
Cardiac & Cardiovascular Systems
Jing-Rong Wang, Xin Du, Jian-Zeng Dong, San-Shuai Chang, Chao Jiang, Cai-Hua Sang, De-Yong Long, Ri-Bo Tang, Hai-Bin Zhang, Jin-Cheng Guo, Yu-Mei Wen, Liu He, Chang-Sheng Ma
Summary: In China, the proportion of NVAF patients who initiated OAC therapy since new-onset AIS was still low. More efforts are needed on improving patients' adherence to anticoagulant therapy.
CLINICAL CARDIOLOGY
(2022)
Article
Public, Environmental & Occupational Health
Fausto Biancari, Konsta Teppo, Jussi Jaakkola, Olli Halminen, Miika Linna, Jari Haukka, Jukka Putaala, Pirjo Mustonen, Janne Kinnunen, Juha Hartikainen, Aapo Aro, Juhani Airaksinen, Mika Lehto
Summary: The personal income is associated with outcomes in patients with atrial fibrillation (AF), with low income being linked to higher incidence of cardiovascular events and mortality, especially among younger patients. Intervention strategies are needed to improve outcomes in AF patients.
JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH
(2022)
Article
Pharmacology & Pharmacy
Cormac Kennedy, Ahmed Gabr, Joan McCormack, Ronan Collins, Michael Barry, Joe Harbison
Summary: With the increasing utilization of oral anticoagulants, there has not been a significant change in the national ischemic stroke rates. The percentage of AF-related strokes has shown a decrease, while the percentage of patients experiencing stroke while on anticoagulant treatment has increased. The real-world effectiveness of DOACs requires further investigation.
BRITISH JOURNAL OF CLINICAL PHARMACOLOGY
(2022)
Article
Neuroimaging
Nishita Singh, Jessalyn K. Holodinsky, Nima Kashani, Rosalie McDonough, Fouzi Bala, MacKenzie Horn, Jillian Stang, Andrew M. Demchuk, Michael D. Hill, Mohammed A. Almekhlafi
Summary: This study aimed to predict the 90 day home time in stroke patients with a low baseline ASPECTS using random forest regression modeling. The results showed that patients with low ASPECTS who underwent EVT achieved comparable outcomes when selected based on demographic and clinical profiles similar to higher ASPECTS patients.
JOURNAL OF NEUROINTERVENTIONAL SURGERY
(2023)
Article
Clinical Neurology
Jessalyn K. Holodinsky, Patrice Lindsay, Amy Y. X. Yu, Aravind Ganesh, Raed A. Joundi, Michael D. Hill
Summary: This study used administrative data to estimate the number of stroke events resulting in hospital or emergency department presentation across Canada in the 2017-18 fiscal year. The findings indicate that a stroke event resulting in hospital or emergency department presentation occurs every 5 minutes in Canada.
CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES
(2023)
Article
Clinical Neurology
Bruce C. V. Campbell, Michael D. Hill, Thanh N. Nguyen, Joseph P. Broderick
Article
Clinical Neurology
Johanna M. Ospel, Wolfgang G. Kunz, Rosalie McDonough, Wim van Zwam, Floor Pinckaers, Jeffrey L. Saver, Michael D. Hill, Andrew M. Demchuk, Tudor G. Jovin, Peter Mitchell, Bruce C. Campbell, Phil White, Keith Muir, Hamza Achit, Serge Bracard, Scott Brown, Mayank Goyal
Summary: This study aimed to investigate the clinical and economic benefit of endovascular treatment (EVT) in stroke patients with mild preexisting symptoms/disability. The results showed that EVT, in addition to best medical management, was a superior treatment strategy, resulting in cost savings and improved quality of life.
Article
Clinical Neurology
K. Zhu, F. Bala, J. Zhang, F. Benali, P. Cimflova, B. J. Kim, R. McDonough, N. Singh, M. D. Hill, M. Goyal, A. Demchuk, B. K. Menon, W. Qiu
Summary: This article aims to develop an automated approach to quantify thrombus on NCCT and CTA in patients with stroke. The deep learning model obtained reliable results in both internal and external datasets.
AMERICAN JOURNAL OF NEURORADIOLOGY
(2023)
Article
Clinical Neurology
Ubong Udoh, Brian Dewar, Stuart Nicholls, Mark Fedyk, Robert Fahed, Jeff Perry, Michael D. Hill, Bijoy Menon, Richard H. Swartz, Alexandre Y. Poppe, Sophia Gocan, Jamie Brehaut, Katie Dainty, Victoria Shepherd, Dar Dowlatshahi, Michel Shamy
Summary: Advance consent is a potential solution to the challenge of obtaining informed consent for acute stroke trials. Canadian stroke clinic physicians expressed comfort and willingness in obtaining advance consent, with minimal disruption to clinic workflow. These findings support further investigation of advance consent for acute stroke trials.
CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES
(2023)
Review
Clinical Neurology
Ayoola Ademola, Lehana Thabane, Joel Adekanye, Ayooluwanimi Okikiolu, Samuel Babatunde, Mohammed A. Almekhlafi, Bijoy K. Menon, Michael D. Hill, Kevin A. Hildebrand, Tolulope T. Sajobi
Summary: This study evaluated the credibility of subgroup analyses in stroke trials and found that the quality of subgroup analysis reporting remains poor, indicating a need for improved training and guidance.
INTERNATIONAL JOURNAL OF STROKE
(2023)
Letter
Clinical Neurology
Nishita Singh, Petra Cimflova, Johanna Maria Ospel, Nima Kashani, Martha Marko, Arnuv D. Mayank, Michael Hill
Article
Clinical Neurology
Tanaporn Jaroenngarmsamer, Faysal Benali, Joachim Fladt, Nishita Singh, Fouzi Bala, Michael Tymianski, Michael D. Hill, Mayank Goyal, Aravind Ganesh
Summary: This study compared the ability of NCCT and MR imaging to assess brain atrophy in patients with acute ischemic stroke. The results showed that NCCT had a weaker ability to assess cortical atrophy and a stronger ability to assess subcortical atrophy.
AMERICAN JOURNAL OF NEURORADIOLOGY
(2023)
Article
Clinical Neurology
Rena Seeger, Ubong Udoh, Brian Dewar, Stuart Nicholls, Mark Fedyk, Robert Fahed, Jeff Perry, Michael D. Hill, Bijoy Menon, Richard H. Swartz, Alexandre Y. Poppe, Sophia Gocan, Jamie Brehaut, Katie Dainty, Victoria Shepherd, Dar Dowlatshahi, Michel Shamy
Summary: This survey explores the acceptability of advance consent among Canadian Research Ethics Board (REB) chairs who review acute stroke trials. The majority of respondents expressed comfort approving studies that adopt advance consent, but no clear preference for advance consent over deferral of consent emerged. Concerns were raised about broad rather than trial-specific advance consent. These findings shed light on the acceptability of advance consent to Canadian ethics regulators.
CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES
(2023)
Article
Clinical Neurology
Miranda Wan, Patrice Lindsay, Amy Y. X. Yu, Michael D. Hill, Jessalyn K. Holodinsky
Summary: We provide an updated estimate of adult stroke event rates by age group, sex, and stroke type using Canadian administrative data. Overall, our findings show that there are similar stroke event rates between women and men, with slight differences in stroke event rate at various ages by sex and stroke type. These emerging patterns warrant attention in future studies. Our findings emphasize the importance of continuous surveillance to monitor the epidemiology of stroke in Canada.
CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES
(2023)
Article
Endocrinology & Metabolism
Alexander D. Rebchuk, Michael D. Hill, Mayank Goyal, Andrew Demchuk, Shelagh B. Coutts, Negar Asdaghi, Dar Dowlatshahi, Jessalyn K. Holodinsky, Enrico Fainardi, Jai Shankar, Mohamed Najm, Marta Rubiera, Alexander Khaw, Wu Qiu, Bijoy K. Menon, Thalia S. Field
Summary: Women, especially postmenopausal women, have worse outcomes after acute ischemic stroke. One possible reason for this is the decrease in the vasculoprotective effects of estrogen in older women. This study investigated the effects of sex and age on neuroradiological predictors of recanalization in acute ischemic stroke patients. The results showed that there was no association between sex and radiological predictors of recanalization.
JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM
(2023)
Article
Neuroimaging
Nathaniel Rex, Johanna M. Ospel, Scott B. Brown, Rosalie McDonough, Nima Kashani, Michael D. Hill, Diederik W. J. Dippel, Bruce Campbell, Keith W. Muir, Andrew M. Demchuk, Serge Bracard, Francis Guillemin, Tudor G. Jovin, Peter J. Mitchell, Phil White, Charles B. L. M. Majoie, Jeffrey L. Saver, Mayank Goyal
Summary: This study compared the functional outcomes of patients with acute ischemic stroke (AIS) with large vessel occlusion (LVO) who underwent endovascular treatment (EVT) with poor reperfusion, with those who received best medical management only. The results showed that patients with poor reperfusion after EVT had worse functional outcomes compared to those who only received medical management.
JOURNAL OF NEUROINTERVENTIONAL SURGERY
(2023)
Article
Clinical Neurology
Faysal Benali, Joachim Fladt, Tanaporn Jaroenngarmsamer, Fouzi Bala, Nishita Singh, Johanna Maria Ospel, Michael Tymianski, Michael D. Hill, Mayank Goyal, Aravind Ganesh
Summary: Brain atrophy, as assessed on acute noncontrast computed tomography imaging, was found to be associated with less favorable stroke recovery and worse 90-day functional outcomes after endovascular thrombectomy (EVT). This information may help physicians manage recovery expectations and plan post-EVT care for patients and their families.
Article
Clinical Neurology
Joseph P. Broderick, Gisele Sampaio Silva, Magdy Selim, Scott E. Kasner, Yasmin Aziz, Jocelyn Sutherland, Edward C. Jauch, Opeolu M. Adeoye, Michael D. Hill, Eva A. Mistry, Patrick D. Lyden, J. Mocco, Elaine M. Smith, Macarena Hernandez-Jimenez, Emir Deljkich, Hooman Kamel
Summary: The STAIR meeting discussed opportunities for improving enrollment in acute stroke trials, focusing on issues such as emergency consent, eligibility criteria, investigator availability, and trial execution.