1-07-14 Timing of anticoagulation as a secondary prevention in the cardioembolic stroke according to the Argentinean Neurological Society's cerebrovascular diseases' working team protocol. Efficacy and complications

Abstract Atrial fibrillation is one of major risk factors of cerebral infarction. The use of oral anticoagulants is the only evidence-based method of reducing the risk of cardioembolic accidents. The guidelines of oral anticoagulant admission and usage have been available since 2012. The results of this study show that of 550 stroke patients that were admitted to Pauls Stradiņš Clinical University Hospital, Rīga, Latvia, from 1 January 2014 until 1 July 2014, atrial fibrillation was diagnosed in 247 (45%) cases, and of these patients, only 8.5% used oral anticoagulants before the onset of stroke. Six months after discharge of 111 (44.9%) stroke survivors, five (4.5%) used no secondary prevention medication, 27 (24.3%) used antiplatelet agents, 54 (48.6%) warfarin, and 25 (22.5%) used target specific oral anticoagulants (TSOACs). The mortality rate was significantly higher in the patient group that used no secondary prevention medication or antiplatelet agents compared to the patient group that used oral anticoagulants. The use of oral anticoagulants for primary stroke prevention in Latvia is insufficient. The mortality of cardioembolic stroke in 180 days is very high - 40.4%. Secondary prevention is essential to prevent recurrent cardioembolic accidents.

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Secondary Prevention of Cardioembolic Stroke

Stroke ◽

10.1016/b978-0-323-69424-7.00064-8 ◽

2022 ◽

pp. 932-943.e4

Author(s):

Karen L. Furie ◽

Shadi Yaghi ◽

Muhib Khan

Keyword(s):

Secondary Prevention ◽

Cardioembolic Stroke

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Assessment of quality of neurosurgical care rendering in secondary prevention of cerebrovascular diseases in Ukraine

Ukrainian Neurosurgical Journal ◽

10.25305/unj.60850 ◽

2012 ◽

Vol 0 (3) ◽

pp. 57-63

Author(s):

Nikolay Sapon ◽

Andriy Huk ◽

Vasyl Kirichenko ◽

Galina Chitaeva ◽

Anna Nikiforova ◽

...

Keyword(s):

Secondary Prevention ◽

Cerebrovascular Diseases

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Is Anticoagulation Necessary for Severely Disabled Cardioembolic Stroke Survivors?

Medicina ◽

10.3390/medicina55090586 ◽

2019 ◽

Vol 55 (9) ◽

pp. 586

Author(s):

Kristaps Jurjans ◽

Baiba Vikmane ◽

Janis Vetra ◽

Evija Miglane ◽

Oskars Kalejs ◽

...

Keyword(s):

Atrial Fibrillation ◽

Secondary Prevention ◽

Vitamin K Antagonists ◽

Oral Anticoagulants ◽

Cardioembolic Stroke ◽

University Hospital ◽

Stroke Survivors ◽

Long Term Outcome ◽

Preventive Medication ◽

One Year

Background and Objectives: Oral anticoagulants are the hallmark of cardioembolic stroke prevention, but they are frequently underused, especially in elderly patients and patients with paroxysmal atrial fibrillation. In our paper, we analyzed the long-term outcome of severely disabled cardioembolic stroke survivors depending on the prescribed antithrombotic secondary prevention medication. Materials and Methods: In our study, we retrospectively collected data for ischemic stroke (IS) patients treated in P. Stradins Clinical University hospital, Riga, Latvia, from 2014 until 2017. Patients’ clinical data were collected using local stroke registry, including patients’ demographic data, vascular risk factors, clinical findings, and laboratory results. Severely disabled stroke survivors were followed up by phone at 30/90/180/365 days after discharge. Patients’ functional outcomes were assessed using the adapted version of The Rankin Focused Assessment–Ambulation. The collected data were compared in 4 groups according to prescribed secondary prevention medication. Results: A total of 682 (91.42%) patients were followed up and included in data analysis. The median age of patients was 80 (IQR = 75–85) years. Of these patients, 231 (31%) were males and 515 (69%) were females. One-year probability of survival of patients not taking any preventive medication was 53% (IQR = 29–76), while in patients taking antiplatelet agents it was 57% (IQR = 37–78), 78% (IQR = 68–88) of patients on Vitamin K antagonists (VKA) and 81% (IQR = 72–90) in patients on direct oral anticoagulants (DOACs). One year after discharge 73 (31%) had mRS 0–2, 50 (20.9%), 29 (12.1%) were still severely disabled, and 87 (36.4%) had died. Conclusions: Anticoagulant use in secondary prevention predicts better functional outcome and higher survival rate in patients with severe cardioembolic stroke due to non-valvular atrial fibrillation (NVAF), therefore severe neurological deficit must not be a reason of restriction of anticoagulation.

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Cardioembolic Stroke: Mechanisms and Therapeutics

Seminars in Neurology ◽

10.1055/s-0037-1603465 ◽

2017 ◽

Vol 37 (03) ◽

pp. 326-338 ◽

Cited By ~ 4

Author(s):

Daniel Sacchetti ◽

Karen Furie ◽

Shadi Yaghi

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Secondary Prevention ◽

Aortic Arch ◽

Patent Foramen Ovale ◽

Systolic Heart Failure ◽

Treatment Strategies ◽

Daily Practice ◽

Cardioembolic Stroke ◽

Foramen Ovale

AbstractCardioembolic stroke accounts for nearly 30% of all known stroke mechanisms. This percentage may be underestimated, however, when considering the large proportion of cryptogenic strokes that likely have a covert cardiac source. Although it is well known that cardioembolic stroke can occur in the setting of atrial fibrillation, other mechanisms such as a systolic heart failure, patent foramen ovale, valvular dysfunction, and aortic arch atheroma are commonly encountered in daily practice. The authors provide an overview on the epidemiology, pathogenesis, diagnostic evaluation, and secondary prevention treatment strategies for cardioembolic stroke.

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Chinese Stroke Association guidelines for clinical management of cerebrovascular disorders: executive summary and 2019 update of clinical management of ischaemic cerebrovascular diseases

Stroke and Vascular Neurology ◽

10.1136/svn-2020-000378 ◽

2020 ◽

Vol 5 (2) ◽

pp. 159-176 ◽

Cited By ~ 2

Author(s):

Liping Liu ◽

Weiqi Chen ◽

Hongyu Zhou ◽

Wanying Duan ◽

Shujuan Li ◽

...

Keyword(s):

Secondary Prevention ◽

Clinical Management ◽

Cerebrovascular Disorders ◽

Intravenous Thrombolysis ◽

Cerebrovascular Diseases ◽

Evidence Based ◽

Level Of Evidence ◽

Executive Summary ◽

Writing Group ◽

Evidence Based Guideline

AimStroke is the leading cause of disability and death in China. Ischaemic stroke accounts for about 60%–80% of all strokes. It is of considerable significance to carry out multidimensional management of ischaemic cerebrovascular diseases. This evidence-based guideline aims to provide the latest detailed and comprehensive recommendations on the diagnosis, treatment and secondary prevention of ischaemic cerebrovascular diseases.MethodsWe had performed comprehensive searches of MEDLINE (via PubMed) (before 30 June 2019), and integrated the relevant information into charts and distributed to the writing group. Writing group members discussed and determined the recommendations through teleconference. We used the level of evidence grading algorithm of Chinese Stroke Association to grade each recommendation. The draft was reviewed by the Guideline Writing Committee of Chinese Stroke Association Stroke and finalised. This guideline is fully updated every 3 years.ResultsThis evidence-based guideline is based on the treatment, care and prevention of ischaemic cerebrovascular diseases, which emphasises on pathogenesis evaluation, intravenous thrombolysis, endovascular therapy, antiplatelet therapy, prevention and treatment of complications, and risk factor management.ConclusionsThis updated guideline presents a framework for the management of ischaemic cerebrovascular diseases. Timely first-aid measures, professional care in the acute stage, and proactive secondary prevention will be helpful to patients.

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