Articles Tagged With: stroke
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Indications for Reduced-Dose Direct Oral Anticoagulants
A subgroup analysis of the ENGAGE-AF TIMI 48 study of edoxaban 60 mg/day vs. 30 mg/day compared to warfarin in patients with atrial fibrillation of the group 80 years of age or older has shown that 30 mg/day results in less major bleeding without a concomitant increase in stroke risk compared to 60 mg/day or warfarin.
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Can Large Vessel Strokes Be Treated with IV Thrombolysis in an Extended Time Window?
In this trial involving Chinese patients with ischemic stroke caused by large vessel occlusion, treatment with tenecteplase administered 4.5 to 24 hours after stroke onset resulted in less disability and similar survival compared to standard medical treatment.
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Incidental Cerebral Microinfarcts in Patients with Active Cancer
In this study of patients with active cancers, 3.6% had asymptomatic, incidental acute ischemic stroke lesions on magnetic resonance imaging and had three times the risk of having a subsequent clinical stroke in the next month.
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Are Women with Atrial Fibrillation Still at Higher Risk of Ischemic Stroke?
A Finnish national database study of newly diagnosed atrial fibrillation from 2007-2018 has shown that the independent association of ischemic stroke risk with female sex initially was high but trended downward to nonsignificant at the end of the study. This has implications for the risk stratification of atrial fibrillation patients regarding oral anticoagulation therapy.
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Better Outcomes for Acute Stroke Patients Who Arrive Rapidly at Endovascular-Capable Centers
The SELECT2 trial was structured to identify which patients with large ischemic strokes would benefit from endovascular thrombectomy and analyzed the effect of direct arrival at a thrombectomy-capable center compared to transfer from a primary stroke center.
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Intravenous Tenecteplase for Stroke After 4.5 Hours Does Not Improve Outcome
The TIMELESS study was developed to evaluate the effect of treatment with tenecteplase 4.5 to 24 hours after stroke onset in patients with large artery occlusion who subsequently would go on to endovascular thrombectomy.
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PFO Closure Review Shows High Proportion of Off-Label Use
In this retrospective cohort study using administrative data from a U.S. payor source, only 58.6% of patients undergoing patent foramen ovale closure had the procedure done for the approved indication of stroke or systemic embolism. A significant proportion of patients were outside the recommended age range.
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Informed Consent Practices for Acute Stroke Treatment Vary
Currently, the two cornerstones of acute ischemic stroke treatment are intravenous thrombolysis and, for patients with large vessel occlusions, endovascular thrombectomy. For treating clinicians, the question becomes: How do clinicians ensure that patients (or their surrogate decisionmakers) make an informed decision while avoiding treatment delays that can result in worse outcomes?
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Apixaban Dose in Atrial Fibrillation Patients with Chronic Kidney Disease
A large nationwide health systems database study comparing 5 mg apixaban vs. 2.5 mg twice daily in patients with stage 4/5 chronic kidney disease not on dialysis shows that the 5 mg dose increases the risk of bleeding compared to 2.5 mg without any improvement in the risk of stroke, systemic emboli, or death.
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Apixaban vs. Aspirin for Subclinical Atrial Fibrillation
A randomized controlled trial of apixaban vs. low-dose aspirin therapy for subclinical atrial fibrillation detected by implanted electrophysiologic devices showed that apixaban is associated with fewer strokes, but more major bleeding episodes compared to aspirin.