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Prevalence of Cardio-Embolic Brain Complications in Permanent and Paroxysmal Atrial Fibrillation Patients. Healthcare (Basel) 2023; 11:healthcare11020175. [PMID: 36673543 PMCID: PMC9858915 DOI: 10.3390/healthcare11020175] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/30/2022] [Accepted: 01/02/2023] [Indexed: 01/09/2023] Open
Abstract
Background: Atrial fibrillation (AF) is the most frequent of all cardiac arrhythmias, with an increasing prevalence in the last 20 years. Cardio-embolic brain complications (CEBC) related to AF often occur or recur, even following appropriate treatment. Method: We conducted a retrospective study and analyzed the presence of stroke, dementia, and Parkinson’s disease (PD) in both paroxysmal and permanent AF patients. The records of 1111 consecutive admitted patients with primary diagnosis of AF at the Municipal Emergency University Hospital, Timisoara, between 2015 and 2016 were examined. Statistical analysis was performed on the patients included in the study based on the inclusion and exclusion criteria. Results: A significant statistical difference was noted among the permanent AF group for stroke (48.75% vs. 26.74%, p < 0.001) and dementia (10.25% vs. 3.86%, p < 0.001) compared to paroxysmal AF patients. Permanent AF patients presented a higher risk of developing stroke, dementia, and PD compared to patients with paroxysmal AF. Meanwhile, male gender and an increase in age showed an increase in the odds of having cardio-embolic brain complications in patients with paroxysmal AF. Conclusion: Based on the results obtained, it can be concluded that the risk of cardio-cerebral embolic complications is greater in permanent AF patients compared to paroxysmal AF cases. Ischemic stroke and dementia are more frequent in the permanent AF group, but analyzing the data regarding the age of onset paroxysmal AF is critical due to the fact that it involves a younger population. Prompt diagnosis and treatment can help significantly in saving stroke patients.
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Kulesh AA, Demin DA. Issues of improving the management of patients with ischemic stroke on the background of atrial fibrillation. NEUROLOGY, NEUROPSYCHIATRY, PSYCHOSOMATICS 2022. [DOI: 10.14412/2074-2711-2022-6-115-121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- A. A. Kulesh
- Department of neurology and medical genetics, Acad. E.A. Vagner Perm State Medical University, Ministry of Health of Russia
| | - D. A. Demin
- Federal Center for Cardiovascular Surgery, Ministry of Health of Russia
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Sucker C, Dörner T. Aktuelle Aspekte und Strategien zum Einsatz oraler Antikoagulantien
und Plättchenfunktionshemmer in der Praxis. AKTUEL RHEUMATOL 2022. [DOI: 10.1055/a-1857-5295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
ZusammenfassungAufgrund erhöhter venöser und arterieller Risiken und
Begleiterkrankungen bei entzündlich-rheumatischen Erkrankungen sind die
Grundprinzipien der adäquaten medikamentösen Behandlung auch von
Bedeutung in der rheumatologischen Praxis. Bei der oralen Antikoagulation haben
die innovativen Nicht-Vitamin K-abhängigen oralen Antikoagulanzien
(NOAK) die „klassischen“ Antikoagulanzien, die Vitamin
K-Antagonisten (VKA), in vielen Indikationen weitgehend verdrängt;
allerdings finden sich weiterhin Gründe, Patienten anstelle von NOAK mit
VKA zu antikoagulieren. Bei der medikamentösen Hemmung der
Plättchenfunktion werden neben ASS die Thienopyridine Clopidogrel und
Prasugrel sowie Ticagrelor eingesetzt; von besonderer Bedeutung ist eine duale
Plättchenfunktionshemmung (DAPT) mit Kombination verschiedener
Plättchenhemmer. In dieser Übersichtsarbeit wird auf wichtige
Aspekte der oralen Antikoagulation und der oralen
Plättchenfunktionshemmung eingegangen.
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Affiliation(s)
- Christoph Sucker
- Transfusion Medicine and Hemostasis, COAGUMED Gerinnungszentrum Berlin,
Berlin, Germany
- Internal Medicine and Hemostasis, Medizinische Hochschule Brandenburg,
Brandenburg an der Havel, Germany
| | - Thomas Dörner
- Klinische Hämostaseologie, Med. Klinik mS Rheumatologie und
Klinische Immunologie, Charité Universitätsmedizin Berlin,
Germany
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Rajendram P, Fox K, Sivanandan B, Selchen D, Kassardjian CD, Saposnik G. Identifying gaps in the management of atrial fibrillation with anticoagulation for stroke prevention (GIANTS): a quality improvement initiative. J Neurol 2022; 269:5047-5051. [PMID: 35536407 DOI: 10.1007/s00415-022-11159-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 04/22/2022] [Accepted: 04/23/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Direct oral anticoagulants (DOACs) are indicated for preventing ischemic stroke in 95% of patients with atrial fibrillation (AF). However, DOACs are largely underutilized or inappropriately dosed. This study aimed to explore the rates of appropriate DOAC use between repatriated and non-repatriated patients with AF who presented with an acute ischemic stroke not deemed candidates for revascularization therapies. MATERIALS AND METHODS Data were collected via electronic medical records and patients were contacted via telephone to obtain medication information and other missing clinical information. Multivariate logistic regression analyses were conducted to determine associations between appropriate use of a DOAC and repatriation status adjusting for age, sex, and comorbidities. RESULTS A total of 49 patients were included in the study with a mean follow-up of 31.5 (± 11.9) months. Eleven patients (22.4%) died, and 4 (8.2%) patients were lost to follow-up. Overall, 9 (26.5%) patients (3 non-repatriated and 6 repatriated) were found to be on suboptimal or inappropriate anticoagulation. Repatriation was associated with over six fold (OR 6.53; 95% CI 1.20-35.7) likelihood of suboptimal or inappropriate anticoagulation. CONCLUSIONS Awareness of this finding is critical to overcome therapeutic inertia in the use of DOACs for ischemic stroke patients with AF. With stroke care becoming increasingly nuanced, peripheral centers may lack the ability to guide anticoagulation in a timely and effective manner. Creation of tertiary short-term follow-up stroke clinics with cardiology follow-up may be an effective strategy to ensure standard of care. Research into systems contributors affecting the appropriate use of DOACs should be elucidated.
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Affiliation(s)
- Phavalan Rajendram
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada.,Stroke Outcomes and Decision Neuroscience Research Unit, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Neurology Quality and Innovation Lab, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 55 Queen St. E., Toronto, ON, M5C 1R6, Canada
| | - Krystal Fox
- Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Brindan Sivanandan
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada.,Stroke Outcomes and Decision Neuroscience Research Unit, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Neurology Quality and Innovation Lab, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 55 Queen St. E., Toronto, ON, M5C 1R6, Canada
| | - Daniel Selchen
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada
| | - Charles D Kassardjian
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada.,Neurology Quality and Innovation Lab, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 55 Queen St. E., Toronto, ON, M5C 1R6, Canada
| | - Gustavo Saposnik
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada. .,Stroke Outcomes and Decision Neuroscience Research Unit, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada. .,Neurology Quality and Innovation Lab, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 55 Queen St. E., Toronto, ON, M5C 1R6, Canada.
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De Marchis GM, Seiffge DJ, Schaedelin S, Wilson D, Caso V, Acciarresi M, Tsivgoulis G, Koga M, Yoshimura S, Toyoda K, Cappellari M, Bonetti B, Macha K, Kallmünzer B, Cereda CW, Lyrer P, Bonati LH, Paciaroni M, Engelter ST, Werring DJ. Early versus late start of direct oral anticoagulants after acute ischaemic stroke linked to atrial fibrillation: an observational study and individual patient data pooled analysis. J Neurol Neurosurg Psychiatry 2022; 93:119-125. [PMID: 34635567 DOI: 10.1136/jnnp-2021-327236] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 09/27/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The optimal timing to start direct oral anticoagulants (DOACs) after an acute ischaemic stroke (AIS) related to atrial fibrillation (AF) remains unclear. We aimed to compare early (≤5 days of AIS) versus late (>5 days of AIS) DOAC-start. METHODS This is an individual patient data pooled analysis of eight prospective European and Japanese cohort studies. We included patients with AIS related to non-valvular AF where a DOAC was started within 30 days. Primary endpoints were 30-day rates of recurrent AIS and ICH. RESULTS A total of 2550 patients were included. DOACs were started early in 1362 (53%) patients, late in 1188 (47%). During 212 patient-years, 37 patients had a recurrent AIS (1.5%), 16 (43%) before a DOAC was started; 6 patients (0.2%) had an ICH, all after DOAC-start. In the early DOAC-start group, 23 patients (1.7%) suffered from a recurrent AIS, while 2 patients (0.1%) had an ICH. In the late DOAC-start group, 14 patients (1.2%) suffered from a recurrent AIS; 4 patients (0.3%) suffered from ICH. In the propensity score-adjusted comparison of late versus early DOAC-start groups, there was no statistically significant difference in the hazard of recurrent AIS (aHR=1.2, 95% CI 0.5 to 2.9, p=0.69), ICH (aHR=6.0, 95% CI 0.6 to 56.3, p=0.12) or any stroke. CONCLUSIONS Our results do not corroborate concerns that an early DOAC-start might excessively increase the risk of ICH. The sevenfold higher risk of recurrent AIS than ICH suggests that an early DOAC-start might be reasonable, supporting enrolment into randomised trials comparing an early versus late DOAC-start.
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Affiliation(s)
- Gian Marco De Marchis
- Neurology and Stroke Center, University Hospital Basel & University of Basel, Basel, Switzerland
| | - David J Seiffge
- Neurology and Stroke Center, University Hospital Basel & University of Basel, Basel, Switzerland.,Neurology and Stroke Center, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Sabine Schaedelin
- Clinical Trial Unit, University Hospital of Basel & University of Basel, Basel, Switzerland
| | - Duncan Wilson
- Stroke Research Center, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | - Valeria Caso
- Stroke Unit, Santa Maria Misericordia Hospital, Perugia, Italy
| | - Monica Acciarresi
- Department of Neurology, San Giovanni Battista Hospital of Foligno, Foligno, Umbria, Italy
| | - Georgios Tsivgoulis
- Second Department of Neurology, 'Attikon' Hospital, University of Athens, School of Medicine, Athens, Greece.,Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Sohei Yoshimura
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Manuel Cappellari
- Department of Neuroscience, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Bruno Bonetti
- Department of Neuroscience, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Kosmas Macha
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Bernd Kallmünzer
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Carlo W Cereda
- Neurocenter of Southern Switzerland, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Philippe Lyrer
- Neurology and Stroke Center, University Hospital Basel & University of Basel, Basel, Switzerland
| | - Leo H Bonati
- Neurology and Stroke Center, University Hospital Basel & University of Basel, Basel, Switzerland
| | - Maurizio Paciaroni
- Department of Neurology & Stroke Unit, San Giuseppe Hospital IRCSS Multimedica, Milano, Italy
| | - Stefan T Engelter
- Neurology and Stroke Center, University Hospital Basel & University of Basel, Basel, Switzerland.,Department of Neurology & Neurorehabilitation, University Center for Medicine of Aging and Rehabilitation Basel, Felix Platter Hospital, Basel, Switzerland
| | - David J Werring
- Stroke Research Center, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
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Kulesh AA. Difficult issues in the management of patients with atrial fibrillation: a neurologist's point of view. NEUROLOGY, NEUROPSYCHIATRY, PSYCHOSOMATICS 2021. [DOI: 10.14412/2074-2711-2021-5-4-13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The article evaluates recent perspectives about the role of oral anticoagulants in the secondary prevention of cardioembolic stroke. The timing of prescribing drugs for ischemic stroke and transient ischemic attack is discussed in accordance with current clinical guidelines and the results of clinical trials. The issues of prescribing oral anticoagulants in some problematic situations, such as the elderly and senile age, reperfusion therapy, presence of hemorrhagic transformation, combined atherosclerosis of major head and neck arteries, cerebral microangiopathy, history of intracerebral hemorrhage, cryptogenic stroke, and low patient compliance are considered. Finally, an anticoagulant therapy algorithm in the acute period of cardioembolic stroke is presented.
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Affiliation(s)
- A. A. Kulesh
- Acad. E.A. Vagner Perm State Medical University, Ministry of Health of Russia
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