Article
Cardiac & Cardiovascular Systems
Zhiying Chen, Yuchuan Ding, Xunming Ji, Xiaoping Yin, Ran Meng
Summary: In recent years, with the increasing elderly population and widespread use of antithrombotic agents, along with the emergence of new magnetic resonance imaging sequences, the detection rate of cerebral microbleeds (CMB) has been gradually rising. CMB mainly reflects the severity of deep small vessel lesions, predicting hemorrhagic transformation. For patients with both CMB and significant antithrombotic indications, treatment becomes a dilemma.
JOURNAL OF THROMBOSIS AND THROMBOLYSIS
(2021)
Article
Medicine, General & Internal
Jordi Kuhne Escola, Simon Nagel, Verena Panitz, Tilman Reiff, Alexander Gutschalk, Christoph Gumbinger, Jan Christoph Purrucker
Summary: Managing acute ischemic stroke (AIS) in patients on oral anticoagulation treatment is challenging for stroke telemedicine, with NOAC intake being a significant barrier to administering intravenous thrombolysis (IVT) in these patients.
JOURNAL OF CLINICAL MEDICINE
(2021)
Article
Clinical Neurology
Benjamin Wagner, Lisa Hert, Alexandros A. Polymeris, Sabine Schaedelin, Johanna M. Lieb, David J. Seiffge, Christopher Traenka, Sebastian Thilemann, Joachim Fladt, Valerian L. Altersberger, Annaelle Zietz, Tolga D. Dittrich, Urs Fisch, Henrik Gensicke, Gian Marco De Marchis, Leo H. Bonati, Philippe A. Lyrer, Stefan T. Engelter, Nils Peters
Summary: In this observational study on AF-stroke patients treated with OAC, the presence of CMBs was associated with unfavorable clinical outcomes for both VKAs and DOACs, with a higher risk for recurrent IS than for ICH. Strokes were numerically higher under VKAs and increased in the presence of CMBs.
FRONTIERS IN NEUROLOGY
(2022)
Review
Cardiac & Cardiovascular Systems
Antonio Greco, Giovanni Occhipinti, Daniele Giacoppo, Federica Agnello, Claudio Laudani, Marco Spagnolo, Maria Sara Mauro, Carla Rochira, Simone Finocchiaro, Placido Maria Mazzone, Denise Cristiana Faro, Davide Landolina, Nicola Ammirabile, Antonino Imbesi, Carmelo Raffo, Davide Capodanno
Summary: This review provides a comprehensive summary of the latest evidence on antithrombotic therapy for ischemic stroke and offers an updated therapeutic algorithm for physicians to tailor the treatment strategy to individual patients.
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
(2023)
Article
Clinical Neurology
Alvin S. S. Das, Elif Goekcal, Avia Abramovitz Fouks, Mitchell J. J. Horn, Robert W. W. Regenhardt, Anand Viswanathan, Aneesh B. B. Singhal, Lee H. H. Schwamm, Steven M. M. Greenberg, M. Edip Gurol
Summary: The frequency of ischemic strokes (IS) in patients taking non-vitamin K antagonist oral anticoagulants (NOACs) is increasing. This study identified clinical, echocardiographic, and neuroimaging markers associated with IS in patients using NOACs for atrial fibrillation. Risk factors for developing IS among NOAC users included prior cerebrovascular events, diabetes, left ventricular hypertrophy, and increased left atrial size.
JOURNAL OF NEUROLOGY
(2023)
Review
Neurosciences
Dylan Ryan, Tarun Girotra, Wuwei Feng
Summary: Stroke is a complex vascular disease that causes disability and is a significant problem in the United States. It can be caused by ischemia or hemorrhage, and determining the cause and implementing prevention strategies are crucial for preserving brain function and preventing recurrent strokes. This review provides an overview of the available medical evidence regarding treatment options for ischemic, hemorrhagic, or venous stroke patients, including the use of left atrial appendage closure.
CNS & NEUROLOGICAL DISORDERS-DRUG TARGETS
(2023)
Article
Clinical Neurology
Mukul Sharma, Eric E. Smith, Lesly A. Pearce, Kanjana S. Perera, Scott E. Kasner, Byung-Woo Yoon, Sebastian F. Ameriso, Josep Puig, Dorte Damgaard, Jochen B. Fiebach, Keith W. Muir, Roland C. Veltkamp, Danilo S. Toni, Nikolay Shamalov, Rubens J. Gagliardi, Robert Mikulik, Stefan T. Engelter, Daniel Bereczki, Martin J. O'Donnell, Feryal Saad, Ashkan Shoamanesh, Scott D. Berkowitz, Hardi Mundl, Robert G. Hart
Summary: Covert brain infarcts occurred twice as often as clinical ischemic strokes in ESUS patients. Treatment with rivaroxaban did not significantly reduce the incidence of covert brain infarcts or increase microbleeds compared to aspirin, but the confidence intervals for treatment effects were wide.
INTERNATIONAL JOURNAL OF STROKE
(2022)
Article
Cardiac & Cardiovascular Systems
James Freeman, Angela Y. Higgins, Yongfei Wang, Chengan Du, Daniel J. Friedman, Usama A. Daimee, Karl E. Minges, Lucy Pereira, Andrew M. Goldsweig, Matthew J. Price, Vivek Y. Reddy, Douglas Gibson, Shephal K. Doshi, Paul D. Varosy, Frederick A. Masoudi, Jeptha P. Curtis
Summary: This study evaluated the postprocedure care patterns and compared the risk of adverse events for different discharge antithrombotic strategies after left atrial appendage occlusion (LAAO) with the Watchman device. The study found that practitioners rarely followed the recommended postprocedure treatment protocols and that discharge on warfarin or direct oral anticoagulants (DOACs) without aspirin was associated with a lower risk of adverse outcomes.
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
(2022)
Article
Clinical Neurology
Renjie Liu, Xin Shi, Jiahui Feng, Jianmin Piao, Zhongxi Yang, Yuhao Zhao, Haoyuan Yin, Xuan Chen
Summary: This study used a two-sample bidirectional Mendelian randomization analysis to evaluate the causal association between ischemic stroke (IS) and cerebral microbleeds (CMBs). The results showed that IS and small-vessel occlusion stroke (SVS) were significantly associated with CMBs, but there was no significant causal effect of CMBs on IS and its subtypes.
NEUROLOGY AND THERAPY
(2023)
Review
Medicine, General & Internal
Gauruv Bose, Justin Graveline, Vignan Yogendrakumar, Risa Shorr, Dean A. Fergusson, Gregoire Le Gal, Jonathan Coutinho, Marcelo Mendonca, Miguel Viana-Baptista, Simon Nagel, Dar Dowlatshahi
Summary: The systematic review of DOAC therapy in CVT found sufficient safety and efficacy despite variability in timing and dose of treatment. Further rigorous trials are needed to validate these findings and to determine optimal treatment regimens for CVT.
Article
Cardiac & Cardiovascular Systems
Alexander P. Benz, Stefan H. Hohnloser, John W. Eikelboom, Anthony P. Carnicelli, Robert P. Giugliano, Christopher B. Granger, Josephine Harrington, Ziad Hijazi, David A. Morrow, Manesh R. Patel, David J. Seiffge, Ashkan Shoamanesh, Lars Wallentin, Qilong Yi, Stuart J. Connolly
Summary: This study aimed to investigate the prognosis of patients with atrial fibrillation (AF) and ischemic stroke while on oral anticoagulation. The results showed that among the 1163 patients who had a post-randomization ischemic stroke while on study medication, 7.0% had a recurrent ischemic stroke within 1 year, and the all-cause mortality rate within 3 months was 12.4%.
EUROPEAN HEART JOURNAL
(2023)
Article
Clinical Neurology
Chong-xi Xu, Hui Xu, Tong Yi, Xing-yang Yi, Jun-peng Ma
Summary: The study found that age and hypertension are highly correlated with cerebral microbleeds, and in acute ischemic stroke patients, the number of cerebral microbleeds increases the incidence of intracranial hemorrhage. Cerebral microbleeds >= 10 are independent predictors of ICH.
FRONTIERS IN NEUROLOGY
(2021)
Article
Medicine, General & Internal
Paula Tiili, Ioannis Leventis, Janne Kinnunen, Ida Svedjeback, Mika Lehto, Efstathia Karagkiozi, Dimitrios Sagris, George Ntaios, Jukka Putaala
Summary: Adherence to oral anticoagulation therapy was poor in half of the atrial fibrillation patients who survived an ischaemic stroke. Independent patient-related factors were associated with poor adherence quality, highlighting the importance of recognizing adherence support as a crucial part of patient care.
ANNALS OF MEDICINE
(2021)
Article
Medicine, General & Internal
Roman Freixa-Pamias, Pedro Blanch Gracia, Maria Lluisa Rodriguez Latre, Luca Basile, Pilar Sanchez Chamero, Manuel Gomez-Choco, Pedro Armario, Antoni Martinez-Rubio, Josep Lupon
Summary: The annual incidence of IS remained stable while the annual incidence of AF-related IS decreased from 2013 to 2019. The prescription of oral anticoagulants, particularly direct oral anticoagulants, increased during this period, possibly contributing to the reduction in AF-related IS.
CURRENT MEDICAL RESEARCH AND OPINION
(2021)
Article
Clinical Neurology
David X. Zhao, Emma Gootee, Michelle C. Johansen
Summary: The study found an association between atrial cardiopathy and the presence of cerebral microbleeds in ischemic stroke patients, but not with the number of microbleeds.
FRONTIERS IN NEUROLOGY
(2022)