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BACKGROUND AND PURPOSE: More than a dozen schemes for stratifying stroke risk in patients with nonvalvular atrial fibrillation have been published. Differences among these schemes lead to inconsistent stroke risk estimates for many atrial fibrillation patients, resulting in confusion among clinicians and nonuniform use of anticoagulation. METHODS: Twelve published schemes stratifying stroke risk in patients with nonvalvular atrial fibrillation are analyzed, and observed stroke rates in independent test cohorts are compared with predicted risk status...
June 2008: Stroke; a Journal of Cerebral Circulation
Lars Wallentin, Renato D Lopes, Michael Hanna, Laine Thomas, Anne Hellkamp, Sunil Nepal, Elaine M Hylek, Sana M Al-Khatib, John H Alexander, Marco Alings, John Amerena, Jack Ansell, Philip Aylward, Jozef Bartunek, Patrick Commerford, Raffaele De Caterina, Cetin Erol, Veli-Pekka Harjola, Claes Held, John D Horowitz, Kurt Huber, Steen Husted, Matyas Keltai, Fernando Lanas, Liu Lisheng, John J V McMurray, Byung-Hee Oh, Mårten Rosenqvist, Witold Ruzyllo, Philippe Gabriel Steg, Dragos Vinereanu, Denis Xavier, Christopher B Granger
BACKGROUND: In the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial, apixaban compared with warfarin reduced stroke and systemic embolism, major bleeding, and mortality. We evaluated treatment effects in relation to 2 predictions of time in therapeutic range (TTR). METHODS AND RESULTS: The trial randomized 18 201 patients with atrial fibrillation to apixaban 5 mg twice daily or warfarin for at least 12 months...
June 4, 2013: Circulation
Stuart J Connolly, Michael D Ezekowitz, Salim Yusuf, John Eikelboom, Jonas Oldgren, Amit Parekh, Janice Pogue, Paul A Reilly, Ellison Themeles, Jeanne Varrone, Susan Wang, Marco Alings, Denis Xavier, Jun Zhu, Rafael Diaz, Basil S Lewis, Harald Darius, Hans-Christoph Diener, Campbell D Joyner, Lars Wallentin
BACKGROUND: Warfarin reduces the risk of stroke in patients with atrial fibrillation but increases the risk of hemorrhage and is difficult to use. Dabigatran is a new oral direct thrombin inhibitor. METHODS: In this noninferiority trial, we randomly assigned 18,113 patients who had atrial fibrillation and a risk of stroke to receive, in a blinded fashion, fixed doses of dabigatran--110 mg or 150 mg twice daily--or, in an unblinded fashion, adjusted-dose warfarin...
September 17, 2009: New England Journal of Medicine
Lauren E Odum, Kelly A Cochran, Daniel S Aistrope, Kathleen A Snella
The association of atrial fibrillation and resultant thromboembolic stroke is readily recognized in the published literature. However, the identification and weight of other risk factors that increase stroke risk are varied. To predict which patients are at greatest risk for thromboembolic stroke, numerous risk stratification schemas have been developed to guide thromboprophylactic treatment decisions. The well-known CHADS(2) scoring system incorporates risk factors such as congestive heart failure, hypertension, age 75 years or older, diabetes mellitus, and previous stroke or transient ischemic attack...
March 2012: Pharmacotherapy
Chatchawan Piyaskulkaew, Tejwant Singh, Susan Szpunar, Louis Saravolatz, Howard Rosman
The CHADS(2) score is widely used to assess the risk of stroke in patients with atrial fibrillation (AF). Patients with score of 0 and 1 are considered 'low risk' and are often treated with aspirin. In a Danish Study, the CHA(2)DS(2)--VASc score was shown to identify low and high-risk subgroups among patients with CHADS(2) score of 0 and 1, with annual risk ranging from 0.84 to 8.18%. This study seeks to assess whether using CHA(2)DS(2)--VASc score will identify high-risk subset of patients with low CHADS(2) scores in an American population...
May 2014: Journal of Thrombosis and Thrombolysis
F Palm, T Kleemann, M Dos Santos, C Urbanek, F Buggle, A Safer, M G Hennerici, H Becher, R Zahn, A J Grau
BACKGROUND AND PURPOSE: Atrial fibrillation (AF) is amongst the most important etiologies of ischaemic stroke. In a population-based stroke registry, we tested the hypothesis of low adherence to current guidelines as a main cause of high rates of AF-associated stroke. METHODS: Within the Ludwigshafen Stroke Study (LuSSt), a prospective ongoing population-based stroke register, we analyzed all patients with a first-ever ischaemic stroke (FEIS) owing to AF in 2006 and 2007...
January 2013: European Journal of Neurology
Hirad Yarmohammadi, Tristan Klosterman, Gaganpreet Grewal, M Chadi Alraies, Brandon C Varr, Bruce Lindsay, Andrew O Zurick, Kevin Shrestha, W H Wilson Tang, Mandeep Bhargava, Allan L Klein
The CHADS₂ scoring system was found to be a good predictor for risk stratification of stroke in patients with atrial fibrillation. The effectiveness of this scoring system in assessing thrombogenic milieu before direct-current cardioversion has not yet fully been established on a large scale. In this study, data from 2,369 consecutive patients in whom transesophageal echocardiography was performed for screening before direct-current cardioversion from 1999 to 2008 were analyzed. Left atrial (LA) or LA appendage (LAA) thrombogenic milieu (spontaneous echo contrast, sludge, and thrombus) was investigated...
September 1, 2013: American Journal of Cardiology
Richard L Verrier, Ana F G Silva, Rodolfo Bonatti, Julio A P Batatinha, Bruce D Nearing, Gongxin Liu, Sridharan Rajamani, Dewan Zeng, Luiz Belardinelli
INTRODUCTION: Ventricular rate during atrial fibrillation (AF) can be reduced by slowing atrioventricular (AV) node conduction and/or by decreasing dominant frequency of AF. We investigated whether combined administration of ivabradine and ranolazine reduces ventricular rate during AF. METHODS AND RESULTS: Ivabradine (maximum clinical dose, 0.25 mg/kg, and 0.10 mg/kg, i.v.) and ranolazine (2.4 mg/kg, i.v., bolus followed by 0.135 mg/kg/min) were studied in an anesthetized pig (N = 16) model of AF...
March 2015: Journal of Cardiovascular Electrophysiology
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