Abstract P659: Pre-Stroke Chads 2 Scores Should Be Associated With Onset Severity and Functional Outcome in Acute Stroke Patients With Atrial Fibrillation During Oral Anticoagulants: A Sub-Analysis of PASTA Registry Study

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Kenichiro Sakai ◽  
Satoshi Suda ◽  
Masayuki Ueda ◽  
Yasuyuki Iguchi ◽  
Yoshiki Yagita ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Oral Anticoagulants ◽  
Multivariate Logistic Regression Analysis ◽  
Cardioembolic Stroke ◽  
Nihss Score ◽  
Excellent Outcome ◽  
Outcome Group ◽  
Group 2 ◽  
Ischemic Attack ◽  
The Impact

Background and Purpose: The impact of CHADS 2 score on neurological severity in patients with stroke during oral anticoagulant (OAC) has not yet been elucidated. We investigated the association between pre-stroke CHADS 2 score and severity on admission and functional outcome in acute cardioembolic stroke due to AF during OAC. Methods: We conducted an investigator-initiated, multicenter, prospective, observational cohort study, PASTA registry. One thousand forty-three patients with transient ischemic attack, ischemic stroke, and ICH who were taking OACs were prospectively enrolled in 25 medical institutions throughout Japan. We compared the clinical characteristics including severity onset and discharge outcome between low CHADS 2 score group (<2), and high CHADS 2 score group (≥2) in patients with cardioembolic stroke due to AF. Result: A total of 548 patients (237 women; median age 80 [quartiles 74-85] years) were enrolled. Of these, there were 76 patients (14%) in low CHADS 2 group and 472 (86%) in high CHADS 2 score group (Fig A). Along with increase of pre-stroke CHADS 2 score, NIHSS score was gradually increased (Fig B). Low CHADS 2 score group was associate with good outcome than high CHADS 2 group (p<0.001, Fig C). Age (p<0.001), male (p<0.001), pre-stroke CHADS 2 score (p<0.001), and initial NIHSS score (p<0.001) were significantly higher in non-excellent outcome (mRS≥2) group than excellent outcome group (mRS<2). In contrast, creatinine clearance and body weight were higher in excellent outcome group (Both p<0.001). Multivariate logistic regression analysis indicated that high pre-stroke CHADS 2 score independently associated with higher NIHSS score (NIHSS score≥6; OR 1.55, 95%CI 1.02-2.36, p=0.041) and non-excellent outcome (OR 1.94, 95%CI 1.01-3.80, p=0.047). Conclusion: The present study suggests that the pre-stroke CHADS 2 score should be useful for the prediction of clinical outcomes in patients with cardioembolic stroke due to AF even taking OAC.

Abstract T P53: Implementation and Outcome of Intravenous Recombinant Tissue Plasminogen Activator Administered 3-4.5 hour after Stroke in Korea

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Tai Hwan Park ◽  
Keun-Sik Hong ◽  
Sang-Soon Park ◽  
Youngchai Ko ◽  
Soo Joo Lee ◽  
...  
Keyword(s):  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Time Window ◽  
Recombinant Tissue Plasminogen Activator ◽  
Nihss Score ◽  
Excellent Outcome ◽  
Tissue Plasminogen ◽  
The Difference ◽  
Ischemic Attack ◽  
Iv Tpa

Background: Although the benefit of intravenous recombinant tissue plasminogen activator (IV-TPA) has been proved in patients with 3-4.5 hour after stroke from a randomized trial and observational studies, in which most subjects were Western population. We aimed to determined the safety and efficacy of IV-TPA within the 3- to 4.5-hour window in Korean population. Methods: Using a prospective, web-based registry of consecutive patients with acute stroke or transient ischemic attack (TIA) admitted to 12 academic hospitals in Korea, we enrolled 616 patients receiving IV-TPA therapy within 3 hours and 107 within 3-4.5 hours after stroke onset for this study. Functional outcome measured by modified Rankin scale (mRS) at 3 months after stroke was compared between the two time window cohorts. Symptomatic intracranial hemorrhage (SICH) defined as any apparently extravascular blood in the brain or within the cranium associated with 4 points or more increase in the National Institutes of Health Stroke Scale (NIHSS) score or leading to death was evaluated for safety. Odds ratios (OR) and 95% confidence intervals (CI) was calculated to present the probability of achieving each outcome for patients treated within 3-4.5 hours compared to those treated within 3 hours. Results: The excellent outcome (mRS 0-1) was less often achieved in the 3-4.5 hours cohort than in the within 3 hours cohort (39.3% vs 42.9%), but the difference was not statistically significant after adjusting for age, sex, baseline NIHSS score, weight, glucose, center (adjusted OR [95% CI], 1.26 [0.60-2.65]). The proportion of mRS 0-2 at 3 months (48.6% vs55.7%) was not also different between two groups (adjusted OR [95% CI], 0.80 [0.41-1.54]). The rate of SICH was higher in the 3-4.5 hours cohort than in the within 3 hours cohort (4.7% vs 3.1%), but the difference was not statistically significant (adjusted OR [95% CI], 0.81 [0.20-3.35]). Conclusion: This study shows that IV-TPA therapy within the 3- to 4.5-hour window after ischemic stroke is safe and effective in Korean patients.

Abstract WP5: Outcomes Are Not Different Between Patients With Intermediate and High Dwi-aspects After Stent-retriever Thrombectomy

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Woong Yoon ◽  
Seul Kee Kim ◽  
Tae Wook Heo ◽  
Byung Hyun Baek ◽  
Jaechan Park
Keyword(s):  
Functional Outcome ◽  
Time Window ◽  
Multivariate Logistic Regression Analysis ◽  
Area Under The Curve ◽  
Stent Retriever ◽  
Operating Characteristics ◽  
Anterior Circulation ◽  
Good Outcome ◽  
Characteristics Analysis ◽  
The Impact

Introduction: Few studies have investigated the association between pretreatment DWI-ASPECTS and functional outcome after stent-retriever thrombectomy in patients with acute anterior circulation stroke. Hypothesis: Patients with acute stroke and DWI-ASPECTS <7 might have a similar chance of a good outcome compared to those with a higher DWI-ASPECTS, if they are treated with a stent-retriever thrombectomy in a short time window. However, this hypothesis has not been tested. Thus, this study aimed to investigate the impact of DWI-ASPECTS on functional outcome in patients with acute anterior circulation stroke who received a stent-retriever thrombectomy. Methods: We retrospectively analyzed the clinical and DWI data from 171 patients with acute anterior circulation stroke who were treated with stent-retriever thrombectomy within 6 hours of symptom onset. The DWI-ASPECTS was assessed by two readers. A good outcome was defined as a modified Rankin Scale score of 0-2 at 3 months. Results: The median DWI-ASPECTS was 7 (interquartile range, 6-8). Receiver operating characteristics analysis revealed an ASPECTS ≥ 7 was the optimal cut-off to predict a good outcome at 3 months (area under the curve=0.57; sensitivity, 75.3%; specificity, 34.4%). The rates of good outcome, symptomatic hemorrhage, and mortality were not different between high DWI-ASPECTS (scores of 7-10) and intermediate (scores of 4-6) groups. In patients with an intermediate DWI-ASPECTS, good outcome was achieved in 46.5% (20/43) of patients with successful revascularization (modified TICI 2b or 3), whereas no patients without successful revascularization had a good outcome ( P =0.016). In multivariate logistic regression analysis, independent predictors of good outcome were age and successful revascularization. Conclusions: Our study suggested that treatment outcomes were not different between patients with a high DWI-ASPECTS and those with an intermediate DWI-ASPECTS who underwent stent-retriever thrombectomy for acute anterior circulation stroke. Thus, patients with an intermediate DWI-ASPECTS otherwise eligible for endovascular therapy should not be excluded for stent-retriever thrombectomy or stroke trials.

scholarly journals Monocyte/High-Density Lipoprotein Ratio Predicts the Prognosis of Large Artery Atherosclerosis Ischemic Stroke

2021 ◽  
Vol 12 ◽  
Author(s):  
Youyu Li ◽  
Daqing Chen ◽  
Laifang Sun ◽  
Zhibo Chen ◽  
Weiwei Quan
Keyword(s):  
Ischemic Stroke ◽  
High Density Lipoprotein ◽  
Functional Outcome ◽  
Multivariate Logistic Regression Analysis ◽  
Density Lipoprotein ◽  
High Density ◽  
Large Artery ◽  
Poor Functional Outcome ◽  
Outcome Group ◽  
Increased Risk

Objective: Monocyte to high-density lipoprotein ratio is considered as a new inflammatory marker and has been used to predict the severity of coronary heart disease and the incidence of adverse cardiovascular events (ACEs). However, there is a lack of data relative to large artery atherosclerosis (LAA) ischemic stroke. We investigated whether the monocyte to high-density lipoprotein (HDL) ratio (MHR) is related to the 3-month functional prognosis of LAA ischemic stroke.Materials and Methods: A retrospective analysis was conducted on 316 LAA ischemic stroke patients. The 3-month functional outcome was divided into good and poor according to the modified Rankin Scale (mRS) score. Multivariate logistic regression analysis was performed to evaluate the correlation between MHR and prognosis of ischemic stroke.Results: The MHR level of poor functional outcome group was higher than that of the good functional outcome group [0.44 (0.3, 0.55) vs. 0.38 (0.27, 0.5), P = 0.025]. Logistic stepwise multiple regression revealed that MHR [odds ratio (OR) 9.464, 95%CI 2.257–39.678, P = 0.002] was an independent risk factor for the 3-month poor outcome of LAA ischemic stroke. Compared to the lower MHR tertile, the upper MHR tertile had a 3.03-fold increase (95% CI 1.475–6.225, P = 0.003) in the odds of poor functional outcome after adjustment for potential confounders. Moreover, a multivariable-adjusted restricted cubic spline (RCS) showed a positive close to a linear pattern of this association.Conclusion: Elevated MHR was independently associated with an increased risk of poor 3-month functional outcome of patients with LAA ischemic stroke.

Successful reperfusion, rather than number of passes, predicts clinical outcome after mechanical thrombectomy

2019 ◽  
Vol 12 (6) ◽  
pp. 548-551 ◽  
Author(s):  
Daniel A Tonetti ◽  
Shashvat M Desai ◽  
Stephanie Casillo ◽  
Jeremy Stone ◽  
Merritt Brown ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Mechanical Thrombectomy ◽  
Multivariate Logistic Regression Analysis ◽  
Functional Independence ◽  
Study Cohort ◽  
Vessel Occlusion ◽  
Nihss Score ◽  
Group 3 ◽  
Group 2 ◽  
Number Of Passes

IntroductionFor patients undergoing mechanical thrombectomy, numerous (>3) thrombectomy passes may be harmful. However, non-recanalization leads to poor outcomes. For patients requiring multiple thrombectomy passes to achieve reperfusion, it remains unclear if the risk/benefit ratio favors recanalization.ObjectiveTo test the hypothesis that the benefits afforded by successful reperfusion outweigh the risk conveyed by the numerous passes required.MethodsWe retrospectively reviewed prospectively collected data for patients presenting to a comprehensive stroke center with anterior circulation large vessel occlusion (ACLVO) and undergoing thrombectomy requiring more than one pass over 24 months. We stratified patients into three groups: group 1 (successful reperfusion in 2–3 passes), group 2 (successful reperfusion in ≥4 passes), and group 3 (unsuccessful reperfusion).Results250 patients with ACLVO constituted the study cohort. Despite similar demographics, group 2 patients had better clinical outcomes than those in group 3 at 24 hours (National Institutes of Health Stroke Scale (NIHSS) score 13.5 vs 19.1, p<0.001) and at 90 days (modified Rankin Scale score 0–2 rates of 31.1% vs 0.0%, p=0.006) On multivariate logistic regression analysis, age (p=0.034), Alberta Stroke Program Early CT Score (p<0.01), NIHSS score (p=0.02), and parenchymal hematoma type 2 (p=0.015) were significant predictors of functional independence among those who achieved successful reperfusion, but the number of passes required did not predict outcome for these patients (p=0.74).ConclusionPatients who achieve successful reperfusion after many passes have better clinical outcomes than those who do not, despite the number of passes and procedural time required. The number of passes required to achieve successful reperfusion beyond the first pass is not a predictor of functional independence.

scholarly journals Stroke Severity Modified the Effect of Chronic Atrial Fibrillation on the Outcome of Thrombolytic Therapy

2021 ◽  
Author(s):  
Rui Shao ◽  
Zengna Wang ◽  
Hongfeng Shi ◽  
Yan Li ◽  
Yingle Zhuang ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Thrombolytic Therapy ◽  
Treatment Strategies ◽  
Multivariate Logistic Regression Analysis ◽  
Chronic Atrial Fibrillation ◽  
Stroke Severity ◽  
Modified Rankin Scale ◽  
Roc Curve Analysis ◽  
Nihss Score ◽  
The Impact

Abstract Background There is conflicting information regarding the impact of chronic atrial fibrillation (AF) on the outcomes of thrombolyzed patients with stroke. This study was designed to identify high-risk patients with chronic AF who had undergone thrombolysis treatment and to explore whether the baseline National Institutes of Health Stroke Scale (NIHSS) could be used to distinguish poor clinical outcomes in thrombolyzed patients. Methods A total of 164 acute ischemic stroke patients with chronic AF were enrolled in this study. The patients were categorized as having poor or favorable outcomes. A favorable 90-day outcome was defined as a modified Rankin Scale (mRS) score ≤ 2. Results Our study showed that the baseline NIHSS score of patients with poor functional recovery (mRS > 2) was significantly higher than that of patients with favorable outcomes (median 16 vs 12). Receiver operating characteristic (ROC) curve analysis of modified Rankin Scale(mRS) scores showed that a baseline NIHSS score of 14 was the optimal threshold for predicting unfavorable outcomes in patients with chronic AF. Multivariate logistic regression analysis showed that baseline NIHSS score > 14 was independently associated with poor outcomes (odds ratio = 4.182, 95% confidence interval 2.092–8.361). Conclusions Our study showed that stroke severity modified the effect of chronic AF on the outcome of thrombolytic therapy. The approach of stratifying stroke severity may be used to evaluate treatment strategies for decision making in intravenous thrombolytic therapy for acute stroke with chronic AF.

scholarly journals A Combined Clinical and Serum Biomarker-Based Approach May Allow Early Differentiation Between Patients With Minor Stroke and Transient Ischemic Attack as Well as Mid-term Prognostication

2021 ◽  
Vol 12 ◽  
Author(s):  
Johann Otto Pelz ◽  
Katharina Kubitz ◽  
Manja Kamprad-Lachmann ◽  
Kristian Harms ◽  
Martin Federbusch ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Transient Ischemic Attack ◽  
Symptom Onset ◽  
Serum Biomarkers ◽  
Serum Biomarker ◽  
Minor Stroke ◽  
Cerebral Magnetic Resonance Imaging ◽  
Excellent Outcome ◽  
Early Differentiation ◽  
Ischemic Attack

Background: Early differentiation between transient ischemic attack (TIA) and minor ischemic stroke (MIS) impacts on the patient's individual diagnostic work-up and treatment. Furthermore, estimations regarding persisting impairments after MIS are essential to guide rehabilitation programs. This study evaluated a combined clinical- and serum biomarker-based approach for the differentiation between TIA and MIS as well as the mid-term prognostication of the functional outcome, which is applicable within the first 24 h after symptom onset.Methods: Prospectively collected data were used for a retrospective analysis including the neurological deficit at admission (National Institutes of Health Stroke Scale, NIHSS) and the following serum biomarkers covering different pathophysiological aspects of stroke: Coagulation (fibrinogen, antithrombin), inflammation (C reactive protein), neuronal damage in the cellular [neuron specific enolase], and the extracellular compartment [matrix metalloproteinase-9, hyaluronic acid]. Further, cerebral magnetic resonance imaging was performed at baseline and day 7, while functional outcome was evaluated with the modified Rankin Scale (mRS) after 3, 6, and 12 months.Results: Based on data from 96 patients (age 64 ± 14 years), 23 TIA patients (NIHSS 0.6 ± 1.1) were compared with 73 MIS patients (NIHSS 2.4 ± 2.0). In a binary logistic regression analysis, the combination of NIHSS and serum biomarkers differentiated MIS from TIA with a sensitivity of 91.8% and a specificity of 60.9% [area under the curve (AUC) 0.84]. In patients with NIHSS 0 at admission, this panel resulted in a still acceptable sensitivity of 81.3% (specificity 71.4%, AUC 0.69) for the differentiation between MIS (n = 16) and TIA (n = 14). By adding age, remarkable sensitivities of 98.4, 100, and 98.2% for the prediction of an excellent outcome (mRS 0 or 1) were achieved with respect to time points investigated within the 1-year follow-up. However, the specificity was moderate and decreased over time (83.3, 70, 58.3%; AUC 0.96, 0.92, 0.91).Conclusion: This pilot study provides evidence that the NIHSS combined with selected serum biomarkers covering pathophysiological aspects of stroke may represent a useful tool to differentiate between MIS and TIA within 24 h after symptom onset. Further, this approach may accurately predict the mid-term outcome in minor stroke patients, which might help to allocate rehabilitative resources.

Abstract P450: Serum Arachidonic Acid Levels in Relation With Outcome of Acute Intracerebral Hemorrhage

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Junichiro Takahashi ◽  
Kenichiro Sakai ◽  
Tomomichi Kitagawa ◽  
Takeo Sato ◽  
Hiroki Takatsu ◽  
...  
Keyword(s):  
Arachidonic Acid ◽  
Intracerebral Hemorrhage ◽  
Multivariate Logistic Regression Analysis ◽  
Favorable Outcome ◽  
Nihss Score ◽  
Poor Outcome ◽  
Poor Outcome Group ◽  
Outcome Group ◽  
Dihomogammalinolenic Acid ◽  
Laboratory Examinations

Introduction: The correlation between serum polyunsaturated fatty acids (PUFAs) such as Eicosapentaenoic Acid (EPA), Docosahexaenoic Acid (DHA), Arachidonic Acid (AA) and Dihomogammalinolenic Acid (DHLA) levels and clinical outcomes of cardiovascular disease are previously reported. The aim was to investigate serum PUFAs including AA levels to clinical outcome in intracerebral hemorrhage (ICH) patients. Method: From Nov 2012 to Nov 2019, ICH patients within 24 hours from the onset were enrolled. All patients underwent radiological investigations and laboratory examinations including measurement of serum PUFAs levels on admission. We divided patients into two groups, favorable outcome group (mRS at 3 months 0-3) and poor outcome group (mRS at 3 months 4-6). We compared baseline variables including serum PUFAs levels between two groups. Result: We enrolled 142patients (87 male, median age 60 years old, median NIHSS score 8). Of them, 113 patients (80%) were favorable outcome group and 29 patients (20%) were poor outcome group. Higher NIHSS score and larger size of hematoma on admission were found in poor outcome group (median NIHSS score 6 of favorable outcome vs. 14 of poor outcome, p<0.001, and median hematoma size, 7.5ml vs. 13.5ml, p=0.048). In serum PUFAs levels, only serum AA levels was significantly lower in poor outcome group (median interval 213μg/ml vs. 179μg/ml, p=0.002) though there were no difference of DHLA, EPA and DHA levels between two groups. In multivariate logistic regression analysis, lower serum AA levels was independently associated with poor outcome (OR 0.987, 95%CI 0.978-0.996, p=0.007, Figure). Conclusion: Serum AA levels may play an important role in predicting the outcome in ICH.

Thromboembolism and Mortality in the Tasmanian Atrial Fibrillation Study

2018 ◽  
Vol 23 (4) ◽  
pp. 329-336
Author(s):  
Endalkachew Admassie ◽  
Leanne Chalmers ◽  
Luke R. Bereznicki
Keyword(s):  
Atrial Fibrillation ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Incidence Rates ◽  
Public Hospitals ◽  
All Cause Mortality ◽  
Mortality Incidence ◽  
Time Periods ◽  
Ischemic Attack ◽  
The Impact

Background: Although utilization of anticoagulation in patients with atrial fibrillation (AF) has increased in recent years, contemporary data regarding thromboembolism and mortality incidence rates are limited outside of clinical trials. This study aimed to investigate the impact of the direct oral anticoagulants (DOACs) on the clinical outcomes of patients with AF included in the Tasmanian Atrial Fibrillation Study. Methods: The medical records of all patients with a primary or secondary diagnosis of AF who presented to public hospitals in Tasmania, Australia, between 2011 and 2015, were retrospectively reviewed. We investigated overall thromboembolic events (TEs), ischemic stroke/transient ischemic attack (IS/TIA), and mortality incidence rates in patients admitted to the Royal Hobart Hospital, the main teaching hospital in the state. We compared outcomes in 2 time periods: prior to the availability of DOACs (pre-DOAC; 2011 to mid-2013) and following their general availability after government subsidization (post-DOAC; mid-2013 to 2015). Results: Of the 2390 patients with AF admitted during the overall study period, 942 patients newly prescribed an antithrombotic medication (465 and 477 from the pre-DOAC and post-DOAC time periods, respectively) were followed. We observed a significant decrease in the incidence rates of overall TE (3.2 vs 1.7 per 100 patient-years [PY]; P < .001) and IS/TIA (2.1 vs 1.3 per 100 PY; P = .022) in the post-DOAC compared to the pre-DOAC period. All-cause mortality was significantly lower in the post-DOAC period (2.9 vs 2.2 per 100 PY, P = .028). Increasing age, prior stroke, and admission in the pre-DOAC era were all risk factors for TE, IS/TIA, and mortality in this study population. The risk of IS/TIA was more than doubled (hazard ratio: 2.54; 95% confidence interval: 1.17-5.52) in current smokers compared to ex- and nonsmokers. Conclusion: Thromboembolic event and all-cause mortality rates were lower following the widespread availability of DOACs in this population.

scholarly journals Women and Stroke: Different, yet Similar

2021 ◽  
pp. 106-111
Author(s):  
Nandini Mitta ◽  
Sapna Erat Sreedharan ◽  
Sankara P. Sarma ◽  
Padmavathy N. Sylaja
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Functional Outcome ◽  
South India ◽  
Stroke Severity ◽  
Sree Chitra Tirunal Institute ◽  
Large Artery ◽  
Stroke Subtype ◽  
Excellent Outcome ◽  
The Impact

<b><i>Background:</i></b> The impact of gender on acute ischemic stroke, in terms of presentation, severity, etiology, and outcome, is increasingly getting recognized. Here, we analyzed the gender-related differences in etiology and outcome of ischemic stroke in South India. <b><i>Methods:</i></b> Patients with first ever ischemic stroke within 1 week of onset presenting to the Comprehensive Stroke Care Centre, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India, were included in our study. Clinical and risk factor profile was documented. The stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) at onset, and stroke subtype classification was done using Trial of Org 10172 in Acute Ischemic Stroke criteria. The 3-month functional outcome was assessed using the modified Rankin Scale (mRS) with excellent outcome defined as an mRS ≤2. <b><i>Results:</i></b> Of the 742 patients, 250 (33.7%) were females. The age, clinical profile, and rate of reperfusion therapies did not differ between the genders. Women suffered more severe strokes (mean NIHSS 9.5 vs. 8.4, <i>p</i> = 0.03). While large artery atherosclerosis was more common in men (21.3% vs. 14.8%, <i>p</i> = 0.03), cardioembolic strokes secondary to rheumatic heart disease were more common in women (27.2% vs. 19.7%, <i>p</i> = 0.02). Men had a better 3-month functional outcome compared to women (68.6% vs. 61.2%, <i>p</i> = 0.04), but was not statistically significant after adjusting for confounders. <b><i>Conclusion:</i></b> Our data, from a single comprehensive stroke unit from South India, suggest that stroke in women are different, yet similar in many ways to men. Guideline-based treatment can result in comparable short-term outcomes, irrespective of admission stroke severity.

scholarly journals Difficult issues in the management of patients with atrial fibrillation: a neurologist's point of view

2021 ◽  
Vol 13 (5) ◽  
pp. 4-13
Author(s):  
A. A. Kulesh
Keyword(s):  
Oral Anticoagulants ◽  
Cryptogenic Stroke ◽  
The Elderly ◽  
Reperfusion Therapy ◽  
Hemorrhagic Transformation ◽  
Point Of View ◽  
Cardioembolic Stroke ◽  
Therapy Algorithm ◽  
History Of ◽  
Ischemic Attack

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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