Efficacy and safety of rivaroxaban for secondary prevention in non-valvular atrial fibrillation after cardioembolic stroke complicated by hemorrhagic transformation: a case report with a 3-year follow-up

2020 ◽  
Vol 179 (7-8) ◽  
Author(s):  
Simona Giubilato ◽  
Guido Giordano ◽  
Marilena Scarabelli ◽  
Francesco Amico
Keyword(s):  
Atrial Fibrillation ◽  
Case Report ◽  
Secondary Prevention ◽  
Hemorrhagic Transformation ◽  
Cardioembolic Stroke ◽  
Efficacy And Safety

scholarly journals Recurrent Hemorrhagic Transformation of Cardioembolic Stroke in an Elderly Patient: A Case Report and Literature Review

2021 ◽  
Vol 8 (05) ◽  
pp. 01-07
Author(s):  
Wengui Yu
Keyword(s):  
Atrial Fibrillation ◽  
Case Report ◽  
Antiplatelet Therapy ◽  
Stroke Prevention ◽  
Anticoagulation Therapy ◽  
Hemorrhagic Transformation ◽  
Cardioembolic Stroke ◽  
Current Evidence ◽  
Amyloid Angiopathy ◽  
Secondary Stroke Prevention

Proper therapy for secondary stroke prevention is crucial in the management of cardioembolic stroke. Although oral anticoagulants were the superior strategy for patients with atrial fibrillation and stroke per current evidence, many patients with cardioembolic stroke were prescribed with antiplatelet therapy due to concern for the risk of bleeding from anticoagulation therapy. We presented a case of an 84-years-old male patient who had sudden-onset left hemiparesis from cardioembolic stroke. Past medical history was significant for paroxysmal atrial fibrillation, hypertension and uncontrolled diabetes. Severe white matter hyperintensity (WMH) was identified with the brain imaging. The local hospital initiated antiplatelet therapy with Aspirin 100 mg daily for secondary stroke prevention. Subsequently he was found to have recurrent asymptomatic hemorrhagic transformation involving each of the infarctions. The case report highlighted that severe WMH and possible cerebral amyloid angiopathy could be a risk factor of hemorrhagic transformation and antiplatelet therapy should be used prudently in such condition.

Abstract 3681: Early Anticoagulation Is Not Associated With Hemorrhagic Transformation Of Ischemic Stroke In Patients With Atrial Fibrillation

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
H. B Brouwers ◽  
Svetlana Lorenzano ◽  
Lyndsey H Starks ◽  
David M Greer ◽  
Steven K Feske ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Clinical Data ◽  
Infarct Volume ◽  
Hemorrhagic Transformation ◽  
P Value ◽  
Long Term Outcome ◽  
Nihss Score

Purpose: Hemorrhagic transformation (HT) is a common and potentially devastating complication of ischemic stroke, however its prevalence, predictors, and outcome remain unclear. Early anticoagulation is thought to be a risk factor for HT which raises the clinical question when to (re)start anticoagulation in ischemic stroke patients who have a compelling indication, such as atrial fibrillation. We conducted a prospective cohort study to address this question and to identify association of hemorrhagic transformation with outcome measures in patients with atrial fibrillation in the setting of acute ischemic stroke. Materials and Methods: We performed a prospective study which enrolled consecutive patients admitted with acute ischemic stroke presenting to a single center over a three-year period. As part of the observational study, baseline clinical data and stroke characteristics as well as 3 month functional outcome were collected. For this sub-study, we restricted the analysis to subjects diagnosed with atrial fibrillation. CT and MRI scans were reviewed by experienced readers, blinded to clinical data, to assess for hemorrhagic transformation (using ECASS 2 criteria), microbleeds and infarct volumes in both admission and follow-up scans. Clinical and outcome data were analyzed for association with hemorrhagic transformation. Results: Of 94 patients, 63 had a history of atrial fibrillation (67.0%) and 31 had newly discovered atrial fibrillation (33.0%). We identified HT in 3 of 94 baseline scans (3.2%) and 22 of 48 follow-up scans (45.8%) obtained a median of 3 days post-stroke. In-hospital initiation of either anti-platelet (n = 36; OR 0.34 [95% CI 0.10-1.16], p-value = 0.09) or anticoagulation with unfractionated intravenous heparin or low molecular weight heparin (n = 72; OR 0.25 [95% CI 0.06-1.15], p-value = 0.08) was not associated with HT. Initial NIH Stroke Scale (NIHSS) score (median 13.0 [IQR 15.0] vs. 7.0 [IQR 10.0], p-value = 0.029) and baseline infarct volume (median 17 [IQR 42.03] vs. 5 [IQR 10.95], p-value = 0.011) were significantly higher in patients with HT compared to those without. Hemorrhagic transformation was associated with a significantly higher 48-hour median NIHSS score (20 [IQR 3.0] vs. 2 [IQR 3.25], p-value = 0.007) and larger final infarct volume (81.40 [IQR 82.75] vs. 9.95 [IQR 19.73], p-value < 0.001). Finally, we found a trend towards poorer 3-month modified Rankin Scale scores in subjects with HT (OR 11.25 [95% CI 0.97-130.22], p-value = 0.05). Conclusion: In patients with atrial fibrillation, initial NIHSS score and baseline infarct volume are associated with hemorrhagic transformation in acute ischemic stroke. Early initiation of antithrombotic therapy was not associated with hemorrhagic transformation. Patients with hemorrhagic transformation were found to have a poorer short and long term outcome and larger final infarct volumes.

scholarly journals Problems of Cardioembolic Stroke Primary and Secondary Prevention in the Latvian Population / Kardioemboliska Cerebrāla Infarkta Primārās un Sekundārās Profilakses Problēmas Latvijā

2015 ◽  
Vol 69 (5) ◽  
pp. 199-204
Author(s):  
Kristaps Jurjāns ◽  
Santa Sabeļnikova ◽  
Evija Miglāne ◽  
Baiba Luriņa ◽  
Oskars Kalējs ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Secondary Prevention ◽  
Patient Group ◽  
Oral Anticoagulants ◽  
Antiplatelet Agents ◽  
Cardioembolic Stroke ◽  
University Hospital ◽  
Primary And Secondary Prevention ◽  
Stroke Patients ◽  
Very High

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.

scholarly journals The role of the accessory pathway radiofrequency catheter ablation in the secondary prevention of the malignant tachyarrhythmias in patients with Wolff-Parkinson-White syndrome

2010 ◽  
Vol 67 (1) ◽  
pp. 48-54 ◽  
Author(s):  
Nebojsa Mujovic ◽  
Miodrag Grujic ◽  
Stevan Mrdja ◽  
Aleksandar Kocijancic ◽  
Tatjana Potpara ◽  
...  
Keyword(s):  
Physical Activity ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Secondary Prevention ◽  
Emotional Stress ◽  
Drug Administration ◽  
Clinical Manifestation ◽  
Accessory Pathway

Background/Aim. The occurrence of atrial fibrillation (AF) in the presence of an accessory pathway (AP) that conducts rapidly is potentially lethal because the rapid ventricular response may lead to ventricular fibrillation (VF). The aim of the study was to determine long-term efficacy of AP catheter-ablation using radiofrequency (RF) current in secondary prevention of VF in WPW patients. Methods. Study included a total of 192 symptomatic WPW patients who underwent RF catheter-ablation of AP in our institution from 1994 to 2007 and were available for clinical follow-up for more than 3 months after procedure. Results. Before ablation, VF was recorded in total of 27 patients (14.1%). In 14 of patients (51.9%) VF was the first clinical manifestation of WPW syndrome. A total of 35 VF episodes were identified in 27 patients. The occurrence of VF was preceded by physical activity or emotional stress in 17.1% of cases, by alcohol abuse in 2.9% and by inappropriate intravenous drug administration in 28.6%. In addition, no clear precipitating factor was identified in 40% of VF cases, while informations about activities preceding 11.4% of VF episodes were not available. The follow-up of 5.7 ? 3.3 years was obtained in all of 27 VF patients. Of the 20 patients who underwent successful AP ablation, all were alive, without syncope or ventricular tachyarrhythmias during long-term follow-up. In 4 of 7 unsuccessfully treated patients, recurrence of supraventricular tachycardia and/or preexcited atrial fibrillation were recorded; one of these patients suddenly died of VF, 6 years after procedure. Conclusion. In significant proportion of WPW patients, VF was the first clinical manifestation of WPW syndrome, often precipitated by physical activity, emotional stress or inappropriate drug administration. Successful elimination of AP by percutaneous RF catheter-ablation is highly effective in secondary prevention of life-threatening tachyarrhythmias in patients with ventricular preexcitation.

scholarly journals Efficacy and Safety of Direct Oral Anticoagulants for Atrial Fibrillation Across Body Mass Index Categories

2020 ◽  
Vol 9 (24) ◽  
Author(s):  
Rachel M. Kaplan ◽  
Yoshihiro Tanaka ◽  
Rod S. Passman ◽  
Michelle Fine ◽  
Laura J. Rasmussen‐Torvik ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Body Mass Index ◽  
Body Mass ◽  
Intracranial Hemorrhage ◽  
Oral Anticoagulants ◽  
Efficacy And Safety ◽  
Class 1 ◽  
Direct Acting ◽  
Direct Acting Oral Anticoagulants

Background Direct‐acting oral anticoagulants are now the preferred method of anticoagulation in patients with atrial fibrillation. Limited data on efficacy and safety of these fixed‐dose regimens are available in severe obesity where drug pharmacokinetics and pharmacodynamics may be altered. The objectives of this study were to evaluate efficacy and safety in patients with atrial fibrillation taking direct‐acting oral anticoagulants across body mass index (BMI) categories in a contemporary, real‐world population. Methods and Results We performed a retrospective study of patients with atrial fibrillation at an integrated multisite healthcare system. Patients receiving a direct‐acting oral anticoagulant prescription and ≥12 months of follow‐up between 2010 and 2017 were included. The primary efficacy and safety outcomes were ischemic stroke or systemic embolism and intracranial hemorrhage. We performed Cox proportional hazards modeling to compute hazard ratios (HRs) adjusted for CHA 2 DS 2 ‐VASc score to examine differences by excess BMI categories relative to normal BMI. Of 7642 patients, mean±SD age was 69±12 years with a median (interquartile range) follow‐up of 3.8 (2.2–6.0) years. Approximately 22% had class 1 obesity and 19% had class 2 or 3 obesity. Stroke risks were similar in patients with and without obesity (HR, 1.2; 95% CI, 0.5–2.9; and HR, 0.68; 95% CI, 0.23–2.0 for class 1 and class 2 or 3 obesity compared with normal BMI, respectively). Risk of intracranial hemorrhage was also similar in class 1 and class 2 or 3 obesity compared with normal BMI (HR, 0.64; 95% CI, 0.35–1.2; and HR, 0.66; 95% CI, 0.35–1.2, respectively). Conclusions Direct‐acting oral anticoagulants demonstrated similar efficacy and safety across all BMI categories, even at high weight values.

P1440Left atrial appendage closure for stroke prevention in nonvalvular atrial fibrillation with Watchman device versus Amplatzer Cardiac Plug. Results of the multicenter Russian trial

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
K V Davtyan ◽  
G Simonyan ◽  
A A Kalemberg ◽  
A H Topchyan ◽  
D S Lebedev ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Survival Rate ◽  
Stroke Prevention ◽  
Atrial Appendage ◽  
Efficacy And Safety ◽  
Nonvalvular Atrial Fibrillation ◽  
Significant Difference ◽  
Watchman Device ◽  
Complications Rate

Abstract Background The data are limited on comparative efficacy and safety of the left atrial appendage occlusion (LAAO) using the Watchman device (WD) and Amplatzer Cardiac Plug (ACP) for stroke prevention in nonvalvular atrial fibrillation (AF) patients. Objective To assess the safety and efficacy of the WD compared with ACP for stroke prevention and adverse events in patients with AF. Methods 200 consecutive patients (median age 67.5yrs, 94 female, median CHA2DS2VASc score - 4, median HASBLED score 3) with nonvalvular AF and contraindications to oral anticoagulation therapy from 5 medical centers in Russia, who undergone LAAO implantation using WD (n = 108; WD group) and ACP (n = 92; ACP group) were enrolled into this study. The coprimary end point was the composite of TIA/stroke and procedure-related complications during follow up.  Secondary end points included successful LAA occluder implantation rate and incidence rates of significant leakage. Patients were followed at 45 days, 3, 6 and 12 months after enrollment. At each follow-up visit the data regarding clinical events and healthcare utilization were collected. Results During the follow-up TIA/stroke has occurred in 6.2% of patients in the WD group with no such events in ACP group (6.2% vs 0%, p = 0.012). The composite safety-efficacy survival rate in WD group was 91.7% versus 92.4% in ACP group (p = 0.85). The periprocedural major complications rate (pulmonary trunk perforation with fatal haemotamponade, nonfatal haemotamponade with pericardiocentesis, device embolisation) was significantly higher in ACP group compared with WD group (5.4% vs 0%, p = 0.005). There was no significant difference in overall events rate between groups (3.7% vs 7.6%, p = 0.2). Successful LAA occluder implantation was performed in all 92 (100%) patients with ACP and in 105 (97,2%) with WD (p = 0.053). The significant leakage (≥5mm) was 3.03% in WD group with no such events in ACP group (3.03% vs 0%, p = 0.059). Conclusion LAAO using ACP was associated with higher major procedure-related complications rate. Despite a higher TIA/stroke rate in WD group, the composite efficacy and safety survival rate of LAAO using the WD and ACP was comparable during 12 month follow up.

Real Life Efficacy and Safety of Dabigatran for Stroke Prevention in Atrial Fibrillation – First Results of the Prospective Noac Registry (NCT01588119)

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 502-502
Author(s):  
Vera Gelbricht ◽  
Sebastian Werth ◽  
Christina Koehler ◽  
Ulrike Haensel ◽  
Luise Tittl ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Major Bleeding ◽  
Cardiovascular Events ◽  
Safety Data ◽  
Real Life ◽  
Bleeding Complications ◽  
Efficacy And Safety ◽  
Daily Care ◽  
Short Period

Abstract Abstract 502 Background: In the RE-LY trial, dabigatran (DB) has been found to be at least as effective and safe as warfarin to prevent stroke in atrial fibrillation (AF), which lead to approval in many countries. However, patients in RCT‘s present a selected population treated under a strict protocol and followed for a short period of time. Consequently, efficacy and safety of new oral anticoagulants (NOAC) need to be confirmed in unselected patients in daily care. Objectives: To evaluate the efficacy, safety and management issues of dabigatran anticoagulation in AF in daily care. Patients and methods: In the district of Saxony, Germany, a network of 200 physicians from private practice and hospitals enrol patients in the prospective NOAC registry. Inclusion criteria are: 1) indication for NOAC anticoagulation >3 month; 2) age > 18 years; 3) written informed consent; 4) availability for follow-up. No Exclusion criteria apply. In the registry, up to 2000 patients will receive prospective follow up (FU) by phone visits at day 30 day and quarterly thereafter to collect efficacy and safety data. Results: Until July31th 2012, 938 patients were registered. Of these, 201 received DB for AF (table 1). The population in our registry is older than in RELY (74.2 vs. 71.5 years) and has a higher CHADS2-Score (2.7 vs. 2.1). Interestingly, 110 mg BID was the preferred dosage in DB patients (55.7%) despite the fact that these patients had higher CHADS2-scores than patients receiving 150 mg BID (2.3 vs. 2.9). Two third of patients were newly anticoagulated and one third was switched from Vitamin-K antagonists, mainly due to poor INR control or bleeding complications. Results of 30-day-, 3-month and 6-month FU are shown in table 2. Currently, FU data cumulate to 86.8 patient years. During FU, Three patients (1.5%) experienced major cardiovascular events (xyz) and another two patients (1.0%) minor cardiovascular events (syncope). Until now, no deaths occurred. Bleeding complications were frequent (14.9%) but major bleeding was rare (n=3; 1.5%) none of which was fatal. At 3 month, 93% of patients were still taking DB but switch to other anticoagulants increased between 3 and 6 month, mainly due to side effects or incompliance. Conclusion: In unselected patients in daily care, DB is effective and safe with low rates of cardiovascular or major bleeding events. However, within 6 month, about 20% of patients are switched to other anticoagulants. Long-term data will be reported. Disclosures: Werth: Bayer Healthcare: Honoraria. Beyer-Westendorf:Bayer Healthcare: Bayer provided a grant to support the NOAC registry in part Other, Honoraria; Boehringer Ingelheim: Boehringer provided a grant to support the NOAC registry in part, Boehringer provided a grant to support the NOAC registry in part Other, Honoraria; Bristol Myers Squibb: Honoraria; Pfizer: Honoraria.

scholarly journals Predictive markers of atrial fibrillation in patients after acute ST-elevated myocardial infarction (the results of observational program “FAKEL”)

2018 ◽  
Vol 17 (5) ◽  
pp. 25-33 ◽  
Author(s):  
I. A. Zolotovskaya ◽  
I. I. Davydkin ◽  
D. V. Duplyakov ◽  
V. A. Kokorin
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Cystatin C ◽  
Coronary Intervention ◽  
Therapeutic Benefit ◽  
Predictive Markers ◽  
Cardioembolic Stroke ◽  
Primary Pci ◽  
Galectin 3

Aim. To assess probability of atrial fibrillation (AF) in patients after ST-elevated myocardial infarction (STEMI) with undergone primary percutaneous coronary intervention (PCI).Material and methods. Prospective study in the period from December 2015 to November 2017 was carried out with consecutive inclusion of 107 patients at outpatient follow-up stage after STEMI who have undergone primary PCI. The mean age of patients was 69,5+7,8 years (40 (37,4%) women). Follow-up period was 18 months and included three visits (V): V1 — when included in the study, V2 — after 12 months, and V3 — after 18 months. The endpoints of the study were cases of first diagnosed AF, cardioembolic stroke and death. At all visits predictive markers (Willebrand factor, Cystatin C, N-terminal prohormone of brain natriuretic peptide (NT-proBNP), galectin-3) in the blood plasma were determined.Results. After 18 months of follow-up period in 19 (17,8%) patients were diagnosed AF, 5 of them (4,7%) had cardioembolic stroke, and 3 patients died. Median time of AF development from the onset of STEMI was 308 days. Cox multivariate analysis showed that the risk factors for first diagnosed AF were NT-proBNP — relative risk (RR): 1,05; 95% confidence interval (CI): 0,99-1,10 (p=0,038), cystatin C — RR: 1,44; 95% CI: 0,98-2,12 (p=0,043), galectin-3 — RR: 1,20; 95% CI: 1,03-1,40 (p=0,022).Conclusion. There was a highly significant relationship between NT-proBNP of ≥400,0 pg/mL, cystatin С of ≥1,45 ng/mL and galectin-3 of ≥25 mg/mL in patients after STEMI who underwent primary PCI. These markers might serve as predictors of first diagnosed AF. Identification of these biomarkers may have potential therapeutic benefit in improving the prognosis of patients after STEMI who have undergone primary PCI and reduce mortality from cardioembolic stroke.

scholarly journals Efficacy and safety of anticoagulant therapy in real clinical practice in patients with persistent atrial fibrillation after interventional treatment

2021 ◽  
Vol 28 (3) ◽  
pp. 21-27
Author(s):  
O. R. Eshmatov ◽  
R. E. Batalov ◽  
M. A. Dragunova ◽  
E. A. Archakov ◽  
S. V. Popov
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Anticoagulant Therapy ◽  
Medical Center ◽  
Persistent Atrial Fibrillation ◽  
Interventional Treatment ◽  
Efficacy And Safety ◽  
Thromboembolic Complications ◽  
Cryo Ablation

Aim. To study the efficacy and safety of anticoagulant therapy in patients with persistent atrial fibrillation (AF) after interventional treatment during 36 months of follow-up.Material and methods. The study included 135 patients (78 men and 58 women) in the age from 31 to 80 years (mean age 61.0 [55; 66]) with persistent AF who underwent catheter treatment. All patients were treated in the arrhythmia department of the Research Institute of Cardiology (Tomsk National Research Medical Center from 01.01.2017 to 31.12.2017.Results. In patients with persistent AF, the effectiveness of catheter treatment was 60% after 12 months of follow-up (81 patients had no documented AF during this period) and 63.7 % (n=86) - after 24 and 36 months. No fatal outcomes, myocardial infarction, or ischemic stroke were observed within 12 months after catheter treatment in patients with an effective procedure. During 36 months of follow-up, the incidence of ischemic stroke on the background of receiving anticoagulant therapy and effective catheter treatment of persistent AF was significantly lower than in patients with unsuccessful ablation (1.16% and 10%, respectively), even though not all patients from the first group received prescribed medication.Conclusion. Successful radiofrequency procedure/cryo-ablation of AF persistent form significantly reduced the risk of ischemic stroke from 10% to 1.16% and almost eliminated the likelihood of other thromboembolic complications, while the invasive strategy did not increase the risk of large and small bleeding in this group of patients.

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