Cardiovascular Diseases Commons^™

We Have No Real Evidence Related To Anticoagulation Plus Aspirin For Stroke Prevention In Atrial Fibrillation, Yuxiang Wang

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Flaker GC, Gruber M, Connolly SJ, et al. Risks and benefits of combining aspirin with anticoagulant therapy in patients with atrial fibrillation: an exploratory analysis of stroke prevention using an oral thrombin inhibitor in atrial fibrillation (SPORTIF) trials. Am Heart J. 2006;152:967-973. doi: 10.1016/j.ahj.2006.06.024

Aspirin Resistance Predicts Adverse Cardiovascular Events In Patients With Symptomatic Peripheral Artery Disease, Tilak Pasala, Jennifer Soo Hoo, Mary Kate Lockhart, Rehan Waheed, Prasanna Sengodan, Jeffrey Alexander, Sanjay Gandhi

The Texas Heart Institute Journal

Antiplatelet therapy reduces the risk of myocardial infarction, stroke, and vascular death in patients who have symptomatic peripheral artery disease. However, a subset of patients who take aspirin continues to have recurrent cardiovascular events. There are few data on cardiovascular outcomes in patients with peripheral artery disease who manifest aspirin resistance.

Patients with peripheral artery disease on long-term aspirin therapy (≥4 wk) were tested for aspirin responsiveness by means of the VerifyNow Aspirin Assay. The mean follow-up duration was 22.6 ± 8.3 months. The primary endpoint was a composite of death, myocardial infarction, or ischemic stroke. Secondary endpoints were the …

Atrial Fibrillation And Stroke In Elderly Patients, Geetanjali Dang, Imaan Jahangir, Jasbir Sra, A. Jamil Tajik, Arshad Jahangir

Journal of Patient-Centered Research and Reviews

The increasing prevalence of stroke, with an estimated annual cost of $71.5 billion, has made it a major health problem that increases disability and death, particularly in patients with atrial fibrillation. Although advanced age and atrial fibrillation are recognized as strong risk factors for stroke, the basis for this susceptibility are not well defined. Aging or associated diseases are accompanied by changes in rheostatic, humoral, metabolic and hemodynamic factors that may contribute more to stroke predisposition than rhythm abnormality alone. Several thromboembolism-predisposing clinical characteristics and serum biomarkers with prognostic significance have been identified in patients with atrial fibrillation. Although anticoagulation …

Cost-Effectiveness Of Genomic-Based Warfarin Therapy, John Weissert, Kourosh Ravvaz

Journal of Patient-Centered Research and Reviews

Background: With over 40 years of demonstrated clinical efficacy, warfarin remains the world’s most used pharmaceutical to prevent ischemic stroke in patients with atrial fibrillation (AF). However, warfarin has many challenges. Thus, despite known effectiveness, warfarin is a leading cause to drug-induced morbidity and mortality. Over 50 different warfarin therapy protocols, including a number of pharmacogenomic-based (PG) protocols, with as many as 14 independent variables, have been developed to improve safety and efficacy, thereby reducing ischemic strokes and intracranial hemorrhages (ICH).

Purpose: To conduct a preliminary cost-effectiveness study to determine the price point at which using warfarin PG dosing to …

Underuse Of Oral Anticoagulants For Nonvalvular Atrial Fibrillation: Past, Present, And Future, Ramsey M Wehbe, Ajay Yadlapati

The Texas Heart Institute Journal

No abstract provided.

Efficacy Of Oral Anticoagulation In Stroke Prevention Among Sinus-Rhythm Patients Who Lack Left Atrial Mechanical Contraction After Cryoablation, José Martínez-Comendador, Javier Gualis, José Miguel Marcos-Vidal, Jonnatan Buber, Carlos Esteban Martín, Jesús Gomez-Plana, Miguel Angel Rodríguez, Ignacio Iglesias-Garriz, David Alonso, Carlos Soria, Eva Higuera Miguélez, Mario Castaño

The Texas Heart Institute Journal

The customary recommendation is that oral anticoagulation be withdrawn a few months after cryoablation for atrial fibrillation, independently of left atrial mechanical contraction in patients in sinus rhythm. Recently, a 5-fold increase in stroke has been described in sinus-rhythm patients who lack atrial mechanical contraction. One aim of this study was to evaluate the efficacy of oral anticoagulation in preventing postoperative stroke in such patients.

This prospective study divided 154 sinus-rhythm patients into 2 groups, depending on the presence (108 patients) or absence (46 patients) of left atrial mechanical contraction at 6 months after surgery, and monitored them annually for …

Is Apixaban Effective For The Prevention Of Stroke In Patients With Non-Valvular Atrial Fibrillation?, Amira Moore

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this EBM review is to determine whether or not Apixaban is effective for the prevention of stroke in patients with non-valvular atrial fibrillation.

STUDY DESIGN: Review of three English language primary studies published all published in 2011.

DATA SOUCRES: Three double-blind randomized control trials found using the Cochrane Database and PubMed.

OUTCOME(S) MEASURED: Outcomes measured were occurrence of stroke (TIA or CVA), systemic embolism, major bleeding or clinically relevant non-major bleeding, and incidence of death.

RESULTS: Apixaban 2.5mg and 5mg were both superior to Warfarin in the prevention of stroke or …

New Oral Anticoagulants Are Not Superior To Warfarin In Secondary Prevention Of Stroke Or Transient Ischemic Attacks, But Lower The Risk Of Intracranial Bleeding: Insights From A Meta-Analysis And Indirect Treatment Comparisons, Partha Sardar, Saurav Chatterjee, Wen-Chih Wu, Edgar Lichstein, Joydeep Ghosh, Shamik Aikat, Debabrata Mukherjee

Internal Medicine Faculty Publications

PURPOSE: Patients with Atrial Fibrillation (AF) and prior stroke are classified as high risk in all risk stratification schemes. A systematic review and meta-analysis was performed to compare the efficacy and safety of New Oral Anticoagulants (NOACs) to warfarin in patients with AF and previous stroke or transient ischemic attack (TIA).

METHODS: Three randomized controlled trials (RCTs), including total 14527 patients, comparing NOACs (apixaban, dabigatran and rivaroxaban) with warfarin were included in the analysis. Primary efficacy endpoint was ischemic stroke, and primary safety endpoint was intracranial bleeding. Random-effects models were used to pool efficacy and safety data across RCTs. RevMan …

Is Electrical Muscle Stimulation Effective In The Progression Of Oral Feeding, For Patients With Dysphagia, Caused By A Stroke?, Kristen Iaconelli

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not electrical muscle stimulation is effective in the progression of oral feeding, for patients with dysphagia, caused by a stroke.

STUDY DESIGN: Review of 3 randomized controlled trials, published between 2008-2009.

DATA SOURCES: All 3 randomized controlled trials were found using the Cochrane database.

OUTCOMES MEASURED: All 3 studies measured subjective swallowing function pre- and post-treatment, however, each trial differed in the way they measured this. Permsirivanich et al used a functional oral intake scale (FOIS), or a 7-point scale reflecting the patient’s report of …

What Evidence Is Available On Apixaban For The Primary Prevention Of Stroke In Patients With Atrial Fibrillation?, Justin Dang, Laura Tsu

Pharmacy Faculty Articles and Research

This drug information question and answer sheet discusses the use of apixaban (Eliquis) for the primary prevention of stroke in patients with atrial fibrillation.

Carotid Artery Stenting Versus Endarterectomy: A Systematic Review, Amir Gahremanpour, Emerson C Perin, Guilherme Silva

The Texas Heart Institute Journal

For about 2 decades, investigators have been comparing carotid endarterectomy with carotid artery stenting in regard to their effectiveness and safety in treating carotid artery stenosis. We conducted a systematic review to summarize and appraise the available evidence provided by randomized trials, meta-analyses, and registries comparing the clinical outcomes of the 2 procedures. We searched the MEDLINE, SciVerse Scopus, and Cochrane databases and the bibliographies of pertinent textbooks and articles to identify these studies.

The results of clinical trials and, consequently, the meta-analyses of those trials produced conflicting results regarding the comparative effectiveness and safety of carotid endarterectomy and carotid …

Does Admission Hyperglycemia Predict Intracranial And Extracranial Vasculopathy?, Ather Mohammed Taqui, Ayeesha Kamran Kamal, Saqib Ali Gowani, Bhojo A Khealani, Shafquat Rozi

Community Health Sciences

Objective: To study the association between admission hyperglycaemia and the presence and pattern of intracranial and extracranial vascular disease.
Methods: This retrospective study was conducted at a major tertiary care hospital in Karachi, Pakistan. Patients who had presented with acute stroke and had undergone a carotid ultrasound doppler of the carotids and/or Magnetic Resonance Angiography (MRA) of the brain were included in the study. A multiple logistic regression analysis of variables was done for an abnormal finding on each investigation.
Results: Out of the total of 216 patients, the age of majority of the patients (83.3%) was >50 years …

Ischemic Stroke Subtypes In Pakistan: The Aga Khan University Stroke Data Bank, N. A. Syed, B. A. Khealani, S. Ali, A. Hasan, H. Brohi, T. Mozaffar, N. Ahmed, A. Hameed, S. M. Baig, M. Wasay

Department of Medicine

Objective: Frequency of ischemic stroke subtypes is influenced by ethnic and geographic variables. Our objective was to identify various stroke subtypes and its determinants at a tertiary care hospital.

Methods: We prospectively collected data on ischemic stroke subtypes admitted to The Aga Khan University Hospital in Karachi.

Results: A total of 596 patients were enrolled in 22 months in the Aga Khan Universtiy Stroke Registry. These included 393 patients with Ischemic stroke, 126 patients with intracerebral hemorrhage, 50 patients with subarachnoid hemorrhage and others. The ischemic stroke group was classified according to the TOAST criteria and comprised of lacunar 168/393 …