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acute ischemic stroke in AF

Masahiro Yasaka, Kazuo Minematsu, Kazunori Toyoda, Etsuro Mori, Teruyuki Hirano, Toshimitsu Hamasaki, Hiroshi Yamagami, Takehiko Nagao, Shinichi Yoshimura, Shinichiro Uchiyama
The efficacy of early anticoagulation in acute stroke with nonvalvular atrial fibrillation (NVAF) remains unclear. We performed a study to evaluate the risk of recurrent ischemic stroke (IS) and major bleeding in acute IS patients with NVAF who started rivaroxaban. This observational study evaluated patients with NVAF and acute IS/transient ischemic attack (TIA) in the middle cerebral arterial territory who started rivaroxaban within 30 days after the index IS/TIA. The primary endpoints were recurrent IS and major bleeding within 90 days after the index IS/TIA...
2019: PloS One
Alexander Wutzler, Christos Krogias, Anna Grau, Roland Veltkamp, Peter U Heuschmann, Karl Georg Haeusler
BACKGROUND: Atrial fibrillation (AF) is present in 15-20% of patients with acute ischemic stroke. Oral anticoagulation reduces the risk of AF-related recurrent stroke but clinical guideline recommendations are rather vague regarding its use in the acute phase of stroke. We aimed to assess the current clinical practice of medical stroke prevention in AF patients during the acute phase of ischemic stroke. METHODS: In April 2017, a standardized anonymous questionnaire was sent to clinical leads of all 298 certified stroke units in Germany...
February 12, 2019: BMC Neurology
Antonio Baule, Federico Cabigiosu, Bastianina Zanda, Alessandra Sanna, Claudia Mongili, Antonio Manca
Introduction: Dabigatran is one of the nonvitamin K antagonist oral anticoagulants. Thrombolytic treatment with intravenous recombinant tissue plasminogen activator is contraindicated in patients taking a DOAC. Idarucizumab was recently approved for dabigatran-activity reversing in severe bleeding, emergency surgery, or urgent procedures, but many attempts have been made to use idarucizumab in patients presenting with acute ischemic stroke in order to be eligible for thrombolysis. Case: Our patient was an 89-year-old woman with severe aphasia who was treated with dabigatran for nonvalvular atrial fibrillation...
November 2018: Journal of Vascular and Interventional Neurology
Ana Goico, Timothy Mikesell
Artery of Percheron (AOP) occlusion is a rare cause of ischemic stroke characterized by bilateral para-median thalamic infarcts. It usually presents with altered mental status, hyper-somnolence and ocular movement disorders. Here, we report a case of cardio-embolic AOP infarction in a 72-year-old man with sepsis and new-onset atrial fibrillation. Early diagnosis is challenging, but diffuse-weighted magnetic resonance imaging demonstrates the lesion in the acute setting. Anticoagulation therapy was started and patient's mental status gradually improved...
July 2018: Oxford Medical Case Reports
Anthony S Kim, J Donald Easton
Stroke symptoms can be unsettling, even when symptoms resolve, but focusing on stroke prevention can be empowering provided that effective interventions for appropriate patient populations are available. Current options include interventions for symptomatic carotid artery stenosis, anticoagulation for atrial fibrillation, high-dose statins, new oral anticoagulants, new developments in atrial fibrillation detection, and new therapeutics are in development. For antiplatelet therapy, aspirin monotherapy is effective but dual antiplatelet therapy with the combination of aspirin and clopidogrel increases hemorrhage risks over the long term that outweigh potential benefits...
February 6, 2019: International Journal of Stroke: Official Journal of the International Stroke Society
O A Baturina, D A Andreev, N A Ananicheva, M Yu Gilyarov, D A Sychev, A L Syrkin, D Yu Shchekochihin
PURPOSE: To assess the prevalence of atrial fibrillation (AF) and use of antithrombotic agents in adult patients with acute coronary syndrome (ACS). MATERIALS AND METHODS: We consecutively enrolled all ACS patients (n=1155) who were hospitalized in two Moscowbased percutaneous coronary intervention centers (each center performs over 500 PCIs a year) between October 2017 and February 2018. AF was diagnosed in 204 patients (17.7%). The risk of thromboembolic complications was assessed using the CHA2DS2-VASc Score...
January 27, 2019: Kardiologiia
Ashley Core, Nathan Pinner, Brittany Bethea, Jessica A Starr
BACKGROUND: Anticoagulation is the mainstay of secondary stroke prevention in patients with atrial fibrillation; however, few studies have assessed the optimal timing for initiation of anticoagulation post cardioembolic stroke. In the 2 weeks following an acute cardioembolic stroke, the risk of recurrent stroke is as high as 8%, but this risk must be balanced against the risk of hemorrhagic transformation with early initiation of anticoagulation. PURPOSE: This study described the time to initiation of anticoagulation and evaluated the in-hospital incidence of hemorrhagic and ischemic complications in 106 patients with atrial fibrillation post an acute cardioembolic stroke...
January 31, 2019: Journal of Pharmacy Practice
Shinya Sonobe, Masahiro Yoshida, Kuniyasu Niizuma, Teiji Tominaga
Pulmonary vein thrombosis is a rare disease but can cause severe complications. However, pathophysiology of this entity is not fully understood. We report a case of mechanical thrombectomy for acute ischemic stroke arising from thrombus of the left superior pulmonary vein stump after left pneumonectomy. A 67-year-old male without atrial fibrillation presented with middle cerebral artery occlusion 11 days after left pneumonectomy. Contrast-enhanced computed tomography showed thrombus in the left superior pulmonary vein stump...
January 2019: NMC Case Report Journal
Michelle C Johansen, Michelle Lin, Saman Nazarian, Rebecca F Gottesman
OBJECTIVE: To determine the associations between transthoracic echocardiogram (TTE) cardiac structure/function measures and cardioembolic stroke (CES) and new-onset atrial fibrillation (AF) in patients without known AF. METHODS: Inpatients at a single institution (2013-2015) with imaging-confirmed ischemic stroke, no AF, and TTE within the 1st week were included. TTE structure/function variables were abstracted. Stroke subtype (CES vs other) was defined according to Trial of Org 10172 in Acute Stroke Treatment, blinded to TTE results...
January 23, 2019: Neurology
Ying Huang, Xiangping Liao, Zitan Song, Linghong Wang, Minghui Xiao, Shanquan Zhong
BACKGROUND Worldwide, stroke results in healthcare costs and economic costs, particularly in patients aged <45 years. This study aimed to evaluate the factors influencing the economic burden of ischemic stroke in younger patients in China based on the Trial of Org 10172 in Acute Stroke Treatment (TOAST) etiological classification. MATERIAL AND METHODS Retrospective review of the medical records of 961 patients aged between 18-45 years, diagnosed with acute ischemic stroke, was performed to identify healthcare costs for one year...
January 22, 2019: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
Jarosław Wajda, Maciej Świat, Aleksander J Owczarek, Michał Holecki, Jan Duława, Aniceta Brzozowska, Magdalena Olszanecka-Glinianowicz, Jerzy Chudek
BACKGROUND: Elevated circulating osteoprotegerin (OPG) level is associated with an increased risk of hospitalization for ischemic stroke and coronary artery disease. The aim of the present study was to analyze whether OPG assessment may improve the prediction of mortality in patients with stroke. PATIENTS AND METHODS: Serum OPG, fetuin A, 25-OH-D3 , intact parathyroid hormone levels were assessed in serum samples which were left over after routine tests in a hospital laboratory...
January 15, 2019: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Li Gong, Xiaoran Zheng, Lijin Feng, Xiang Zhang, Qiong Dong, Xiaoyu Zhou, Haichao Wang, Xiaojun Zhang, Zhongwen Shu, Yanxin Zhao, Xueyuan Liu
Mechanical thrombectomy (MT) is effective in managing patients with acute ischemic stroke (AIS) caused by large-vessel occlusions and allows for valuable histological analysis of thrombi. However, whether bridging therapy (pretreatment with intravenous thrombolysis before MT) provides additional benefits in patients with middle cerebral artery (MCA) occlusion remains unclear. Therefore, this study aimed to compare the effects of direct MT and bridging therapy, and to elucidate the correlation between thrombus composition and stroke subtypes...
January 18, 2019: Cell Transplantation
Brice Blum, Leah Wormack, Mason Holtel, Alexandria Penwell, Shyyon Lari, Brittany Walker, Thomas I Nathaniel
BACKGROUND: When untreated, dyslipidemia is a higher risk factor for stroke and stroke-related mortality in men than in women. However, when dyslipidemia is treated the risk reduction is the same, but men benefited from mortality reduction more than women. Whether there is a gender difference in exclusion criteria for the use of recombinant tissue plasminogen activator (rtPA) or thrombolysis therapy in an acute ischemic stroke subpopulation with dyslipidemia is yet to be investigated...
January 16, 2019: BMC Women's Health
Brice Blum, Leanne Brechtel, Thomas Nathaniel
BACKGROUND: The benefits of a special stroke care unit (SSCU) over a non-specialized stroke care unit (NSSCU) is well documented in the literature. However, there are concerns that the benefits seen in the SSCU do not consider clinical risk factors that affect thrombolysis therapy. METHOD: Retrospective data were collected from a stroke registry between January 1, 2010-June 30, 2016. Univariate analysis determined differences in exclusion criteria between the SSCU and NSSCU, while multivariable binary logistic regression adjusted for confounding variables...
January 12, 2019: Archives of Medical Research
Fumi Kiyuna, Noriko Sato, Ryu Matsuo, Masahiro Kamouchi, Jun Hata, Yoshinobu Wakisaka, Junya Kuroda, Tetsuro Ago, Takanari Kitazono
Importance: It is unknown whether poststroke outcome varies between different potential causes in patients with cryptogenic stroke. Objective: To investigate whether functional outcome differs according to potential embolic sources after cryptogenic stroke. Design, Setting, and Participants: This multicenter, hospital-based, prospective stroke registry cohort study investigated potential embolic sources on admission and assessed 3-month outcome in patients with ischemic stroke hospitalized at 7 stroke centers in the Fukuoka Stroke Registry...
September 7, 2018: JAMA network open
Eyal Cohen, Erzsébet Horváth-Puhó, Joel G Ray, Lars Pedersen, Vera Ehrenstein, Nancy Adler, Simone Vigod, Arnold Milstein, Henrik Toft Sørensen
Importance: Having a child with a major birth defect can be a life-changing and stressful event that may be associated with higher cardiovascular disease (CVD) risk, yet the long-term burden of CVD for the child's mother is unknown. Objective: To assess whether mothers of an infant born with a major congenital anomaly are at higher risk of CVD compared with a comparison cohort. Design, Setting, and Participants: A population-based cohort study using individual-level linked registry data in Denmark included 42 943 women who gave birth to an infant with a major congenital anomaly between January 1, 1979, and December 31, 2013; and follow-up was conducted until 2015...
September 7, 2018: JAMA network open
Yen-Ju Lung, Wei-Chieh Weng, Chia-Lun Wu, Wen-Yi Huang
BACKGROUND: Aggressive lipid-lowering treatment reduces the risk of cardiovascular events, but remains controversial in stroke patients. We investigate the influence of total cholesterol level on 5-year outcomes of ischemic stroke patients with high-grade internal carotid artery (ICA) stenosis and poststroke functional dependence. METHODS: One-hundred and ninety-six acute ischemic stroke patients with high-grade ICA stenosis and modified Rankin Scale score ≥ 3 upon discharge were enrolled and prospectively observed for 5 years...
January 11, 2019: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
Hoang T Phan, Mathew J Reeves, Christopher L Blizzard, Amanda G Thrift, Dominique A Cadilhac, Jonathan Sturm, Petr Otahal, Peter Rothwell, Yannick Bejot, Norberto L Cabral, Peter Appelros, Janika Kõrv, Riina Vibo, Cesar Minelli, Seana L Gall
Background Women have worse outcomes after stroke than men, and this may be partly explained by stroke severity. We examined factors contributing to sex differences in severity of acute stroke assessed by the National Institutes of Health Stroke Scale. Methods and Results We pooled individual participant data with National Institutes of Health Stroke Scale assessment (N=6343) from 8 population-based stroke incidence studies (1996-2014), forming part of INSTRUCT (International Stroke Outcomes Study). Information on sociodemographics, stroke-related clinical factors, comorbidities, and pre-stroke function were obtained...
January 8, 2019: Journal of the American Heart Association
B Hebant, L Guyant-Marechal, D Maltête, R Lefaucheur
Transient ischemic attacks (TIAs) typically present with easily recognizable neurological focal deficits. Symptoms such as paroxysmal involuntary movements are not usually considered to be a manifestation of TIA. We report a case with video documentation of TIA due to permanent atrial flutter presenting as acute left hemichorea. To our knowledge, such a case has not yet been reported. The present case constitutes a crucial diagnostic challenge in neurological practice in order to prevent a high risk of subsequent ischemic stroke...
December 27, 2018: Journal of Postgraduate Medicine
Harsh V Gupta, Christopher W Finlay, Sajish Jacob, Sunil K Raina, Ricky W Lee, Archana Hinduja
OBJECTIVE: Our study aimed to determine the prognostic value of elevated Brain Natriuretic Peptide (BNP) among patients who received intravenous thrombolysis (IVT) in acute ischemic stroke (AIS). BACKGROUND: The elevation in BNP level is correlated with infarct size, poststroke mortality, and CHADS2 score. Currently, there is a lack of validated biomarker to predict the outcome in patients with acute ischemic stroke, and there is a complex interaction amongst multiple variables...
January 2019: Neurologist
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