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Jumah A, Fu S, Albanna AJ, Agarwal U, Fana M, Choudhury O, Idris A, Elfaham A, Iqbal Z, Schultz L, Latack K, Brady M, Scozzari D, Ramadan AR. Early vs late anticoagulation in acute ischemic stroke with indications outside atrial fibrillation. J Stroke Cerebrovasc Dis 2024; 33:107757. [PMID: 38705498 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/07/2024] [Accepted: 05/01/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Current literature lacks guidance on the safety of administering anticoagulation in acute ischemic stroke with emergent indications that require anticoagulation other than atrial fibrillation. Therefore, we tend to rely on studies investigating acute ischemic stroke in atrial fibrillation for anticoagulation recommendations. METHODS We retrospectively reviewed data for patients with acute ischemic stroke who had a non-atrial fibrillation emergent indication for anticoagulation (e.g., intra-arterial thrombus, intracardiac thrombus, acute coronary syndrome, acute limb ischemia, deep vein thrombosis and pulmonary embolism) diagnosed within 3 days of acute ischemic stroke. Patients who received anticoagulation ≤ 3 days of stroke onset (Group A) were compared to those who either received it afterwards or did not receive it at all (Group B). RESULTS Out of the 558 patients, only 88 patients met our inclusion criteria. Of the total cohort, 55.7 % patients were males, and basic demographics were similar in both groups except for milder strokes in Group A (national institute of health stroke scale 6 vs. 12.5, p = 0.03). Only 2 patients in Group A and 1 patient in Group B developed intracranial hemorrhage, which was not statistically significant. Group A patients had a lower incidence of both new diagnosis (2 % vs. 34.2 % %, p < 0.001) and propagation of an established venous thromboembolism. They also had a lower rate of any thromboembolic complication (2 % vs. 42 %, p < 0.001). CONCLUSION Early anticoagulation (i.e., ≤ 3 days) in non-atrial fibrillation ischemic stroke patients with an emergent indication may be safe and carry a lower risk of thromboembolic complications than later anticoagulation.
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Affiliation(s)
- Ammar Jumah
- Department of Neurology, Henry Ford Health, Detroit, MI, USA.
| | - Siyuan Fu
- Department of Neurology, Henry Ford Health, Detroit, MI, USA
| | | | - Utkarsh Agarwal
- Department of Neurology, Henry Ford Health, Detroit, MI, USA
| | - Michael Fana
- Department of Neurology, Henry Ford Health, Detroit, MI, USA
| | - Omar Choudhury
- Department of Neurology, Henry Ford Health, Detroit, MI, USA
| | - Anas Idris
- Department of Neurology, Henry Ford Health, Detroit, MI, USA
| | | | - Zahid Iqbal
- Department of Neurology, Henry Ford Health, Detroit, MI, USA
| | - Lonni Schultz
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI, USA
| | - Katie Latack
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI, USA
| | - Megan Brady
- Department of Neurology, Henry Ford Health, Detroit, MI, USA
| | - Dawn Scozzari
- Department of Neurology, Henry Ford Health, Detroit, MI, USA
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Jumah A, Albanna AJ, Qureshi M, Malik S. Reversible Cerebral Vasoconstriction Syndrome Secondary to Loperamide Ingestion: A Case Report. Neurohospitalist 2024; 14:186-188. [PMID: 38666269 PMCID: PMC11040623 DOI: 10.1177/19418744231209803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
Reversible cerebral vasoconstriction syndrome (RCVS) is a cerebrovascular disorder highlighted by diffuse and multifocal vasoconstriction of the cerebral circulation. This syndrome has been reported to be associated with provoking vasoactive agents, and the identification of such offenders is quite challenging. In our case, the patient's RCVS was caused by the ingestion of loperamide. Although being reported in the cardiac literature, cerebral vasoconstriction due to loperamide has not been reported yet.
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Affiliation(s)
- Ammar Jumah
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
| | | | - Momina Qureshi
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
| | - Shaneela Malik
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
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Albanna AJ, Jumah A, Agarwal U, Fana M, Kareem SA, Miller D. Anticoagulation Therapy in a Patient who had two Consecutive Strokes After Antibiotic Therapy for Infective Endocarditis: A Case Report. Neurohospitalist 2024; 14:204-207. [PMID: 38666280 PMCID: PMC11040627 DOI: 10.1177/19418744231224061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
A 77-year-old male presented with altered mentation and was diagnosed with infective endocarditis. Echocardiography revealed aortic valve vegetations. While receiving inpatient antibiotic therapy, the patient experienced an acute ischemic stroke. Magnetic resonance imaging of the brain showed punctate embolic-appearing infarcts in the right cerebellum and in the left occipital, frontal, and parietal lobes. Anticoagulation was not initiated due to a high risk of hemorrhagic transformation. He was readmitted after being discharged due to another episode of altered mentation. Repeat echocardiography indicated increased size of aortic valve vegetations. The patient was then transferred to our hospital for surgical intervention of enlarging vegetations, however was deemed unsuitable for surgery. During hospitalization, he suffered another embolic stroke in the right frontal lobe. By this time, the patient had completed a full course of antibiotics for infective endocarditis, and additional antibiotics were deemed unnecessary by our infectious disease specialists. Literature review highlighted that residual vegetations carry a higher risk for stroke, but no clear guidelines were found on how to intervene or assess the risk of hemorrhage with anticoagulation in this population. Consequently, a decision was made to initiate anticoagulation, Follow-up imaging revealed no evidence of hemorrhagic transformation. Subsequently, the patient remained stable and was discharged to a rehabilitation center, where he did not experience any further events.
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Affiliation(s)
| | - Ammar Jumah
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
| | - Utkarsh Agarwal
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
| | - Michael Fana
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
| | | | - Daniel Miller
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
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