scholarly journals Modern algorithms for the diagnosis and treatment of transient ischaemic attacks

2021 ◽  
Vol 99 (2) ◽  
pp. 85-90
Author(s):  
E. A. Shirokov ◽  
V. L. Glatko ◽  
O. A. Sapronenkova
Keyword(s):  
Diagnostic Criteria ◽  
Antithrombotic Therapy ◽  
Diagnosis And Treatment ◽  
Clinical Recommendations ◽  
Transient Ischaemic Attacks ◽  
Risk Of Bleeding ◽  
Methods Of Treatment

The article analyzes the current tendencies in the diagnosis and treatment of transient ischaemic attacks (TIA). The prevalence of TIA in the population has not been established due to the uncertainty of the diagnostic criteria. The authors discuss the problem of a qualitative diagnosis of TIA in detail. Based on the current clinical recommendations, modern and promising methods of treatment are discussed. The authors pay special attention to the assessment of the risk of bleeding during aggressive antithrombotic therapy.

Complex antithrombotic therapy and bleeding risk in patients with peripheral arterial disease

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Tseng ◽  
S Bhatt ◽  
M Girardo ◽  
D Liedl ◽  
P Wennberg ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Triple Therapy ◽  
Major Bleeding ◽  
Antithrombotic Therapy ◽  
Oral Anticoagulants ◽  
Bleeding Risk ◽  
Arterial Disease ◽  
Risk Of Bleeding ◽  
Increased Risk ◽  
Peripheral Arterial

Abstract Introduction Antiplatelet therapy is the cornerstone of treatment for many atherosclerotic vascular pathologies including peripheral arterial disease (PAD). Patients with PAD often have comorbid conditions that require complex antithrombotic therapy, i.e. combined antiplatelet and anticoagulation. Methods All adult patients undergoing ankle brachial index (ABI) measurements were included in the study. ABI values between 1.00 and 1.40 were considered normal, and values below 1.00 or above 1.40 were considered PAD. Demographic, comorbidity and outcome data were obtained using diagnostic codes from the electronic health record. Three medication classes were analyzed: aspirin, non-aspirin oral antiplatelets (e.g. P2Y12 inhibitors) and oral anticoagulants (warfarin and the direct oral anticoagulants). Medication use was determined for patients who had been on a medication for at least one year. Cox proportional hazard analysis for the time to first bleeding event was analyzed. Bleeding was defined as any bleeding requiring medical evaluation (including clinically-relevant non-major bleeding and major bleeding). Results In all, 40,144 patients were included in the analysis (mean age 66±15, 43% female). Patients with PAD were more likely to be on double therapy (one antiplatelet with anticoagulation) (28% vs 19%) and triple therapy (dual antiplatelet with anticoagulation) (10% vs 4%). Unadjusted hazard ratios for bleeding risk showed increased risk of bleeding for patients with PAD (1.18, 95% confidence interval [CI]: 1.08–1.29), though the association is no longer present after adjustment for antithrombotic therapy. Adjusting for age, sex and PAD class, compared to no antithrombotic therapy, there was increased risk of bleeding for monotherapy (1.91, 95% CI: 1.61–2.26), double therapy (3.40, 95% CI: 2.89–4.00) and triple therapy (5.00, 95% CI: 4.21–5.96). Among medications, aspirin and anticoagulant use was independently associated with the greatest increase in risk of bleeding. Conclusion Patients in PAD are at increased risk of bleeding secondary to antithrombotic therapy. Complex antithrombotic therapy with double or triple therapy confer additional bleeding risk, particularly regimens containing aspirin and oral anticoagulants. Funding Acknowledgement Type of funding source: None

Abstract 14763: Patients With a Perceived High-bleeding Risk in a Randomized Controlled Trial of Alert-based Computerized Decision Support for Stroke Prevention in Atrial Fibrillation: An Af-Alert Substudy

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Gregory Piazza ◽  
Shelley Hurwitz ◽  
Brett Carroll ◽  
Samuel Z Goldhaber
Keyword(s):  
Atrial Fibrillation ◽  
High Risk ◽  
Stroke Prevention ◽  
Antithrombotic Therapy ◽  
Controlled Trial ◽  
Bleeding Risk ◽  
Computerized Decision Support ◽  
Risk Of Bleeding ◽  
Randomized Controlled ◽  
Risk For Bleeding

Introduction: A perceived increased risk of bleeding is one of the most frequent reasons for failure to prescribe anticoagulation for stroke prevention in atrial fibrillation (AF). We previously conducted a randomized controlled trial of alert-based computerized decision support (CDS) to increase prescription of antithrombotic therapy in 458 high-risk hospitalized patients with AF who were not being anticoagulated. Hypothesis: We hypothesized that patients with a perceived high risk for bleeding would have a similar HAS-BLED score and rate of major and clinically-relevant non-major bleeding. Methods: To determine the clinical characteristics and outcomes of these patients determined to be high-risk for bleeding, we analyzed the 248 patients in the alert group. Results: A perceived high risk of bleeding was the most common reason (77%) for omitting antithrombotic therapy. Median HAS-BLED scores were similar in these patients compared with those who were not deemed to have an increased bleeding risk (3 vs. 3, p=0.44). Despite being categorized as too high-risk for bleeding to receive antithrombotic therapy for stroke prevention at the time of the alert, nearly 12% of these patients were ultimately prescribed anticoagulation over the ensuing 90 days. The frequency of major and clinically-relevant non-major bleeding was similar between the two groups. Conclusions: In conclusion, a perceived high risk of bleeding was the most common reason for failure to prescribe antithrombotic therapy after the CDS alert. History of a prior bleeding event or underlying bleeding disorder was not reflected in a higher HAS-BLED score. Implementation of an alert-based CDS with specific attention to assessment of bleeding risk and mitigation warrants further study to encourage adherence to evidence-based clinical practice guideline recommendations for stroke prevention in AF.

scholarly journals Changes in Antithrombotic Therapy of Atrial Fibrillation in the Hospital in 2011-2012 and 2016-2017 (Pharmacoepidemiological Analysis)

2020 ◽  
Vol 16 (5) ◽  
pp. 686-692
Author(s):  
O. V. Reshetko ◽  
A. V. Sokolov ◽  
N. V. Furman ◽  
V. V. Agapov
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
High Risk ◽  
Antithrombotic Therapy ◽  
Heart Defects ◽  
Oral Anticoagulants ◽  
Prosthetic Heart Valve ◽  
Saratov Region ◽  
Coronary Syndrome ◽  
Risk Of Bleeding

Aim. To study the changes that have occurred in the pharmacotherapy of atrial fibrillation (AF) in the Saratov Region for 5 years by analyzing the antithrombotic therapy of patients who were admitted in a specialized department of the multidisciplinary hospital in Saratov in 2011-2012 and in 2016-2017.Material and methods. A pharmacoepidemiological retrospective study was conducted. The object of the study was the medical records of inpatients (Form 003/y) with the diagnosis “Atrial fibrillation” (ICD-X code I48), that consecutively admitted to the cardiology department of the multidisciplinary hospital in Saratov from January 1, 2011 to December, 31, 2012 (n=211) and from January 1, 2016 to December, 31, 2017 (n=227). Criteria for inclusion in the study: patients over 18 years of age, established diagnosis of non-valvular AF of ischemic genesis. Exclusion criteria from the study: non-ischemic cardiomyopathy, thyrotoxicosis, congenital heart defects, rheumatic heart damage, acute coronary syndrome, endocarditis, myocarditis, pericarditis, pulmonary thromboembolism, the presence of prosthetic heart valve. Pharmacoepidemiological analysis was carried out for the drugs prescribed during hospitalization and given by doctors at discharge of patients from the hospital. The risk of ischemic stroke was assessed using the CHA2DS2-VASc score, and the risk of bleeding – according to the HAS-BLED score.Results. When analyzing the risk of ischemic stroke, it was found that 100% of patients in 2011-2012 years and 98.2% in 2016-2017 years had indications for the prescription of oral anticoagulants (OAСs). In 2011-2012 there were no patients with a low risk of stroke (CHA2DS2-VASc=0). High risk of bleeding (HAS-BLED≥3) occurred in 4.7% of patients in 2011-2012 and in 10.6% in 2016-2017, however, due to the high risk of stroke, the refusal to prescribe OAC in these patients was inappropriate in accordance with the recommendations for the treatment of AF. In the group of patients with CHA2DS2-VASc=0 in 2016-2017 antiplatelet therapy was prescribed in 100% at the hospital stage and at discharge, which contradicts the guidelines, according to which antithrombotic therapy is not recommended to patients with CHA2DS2-VASc=0. In patients with CHA2DS2-VASc=1, a low percentage of anticoagulants prescription was noted. In 2016-2017 OACs were prescribed only in 12.5% of patients at all stages of observation. In 2011-2012 OAC alone was prescribed only to 1 person (20%) at the hospital stage, which does not comply with modern guidelines for the treatment of patients with AF, according to which patients with a risk score CHA2DS2-VASc=1 are recommended to receive OACs in the absence of contraindications. OACs prescription in group CHA2DS2-VASc≥2 occurred only in 15% of patients in 2011-2012 and in a third of patients in 2016-2017 (p<0.05). The frequency of isolated use of OACs significantly increased in 2016-2017 compared to 2011-2012 mainly due to the increase in the spectrum of direct OACs (DOACs) (p<0.05).Conclusion. For 5 years there have been significant changes in the antithrombotic therapy of AF in the Saratov Region. The frequency of prescribing OACs according to indications has increased mainly due to the introduction of the DOACs into clinical practice. However, prevention of stroke remains insufficient.

scholarly journals Clinical Recommendations of the Russian Gastroenterological Association on Diagnosis and Treatment of Infectious Esophagitis

2020 ◽  
Vol 30 (5) ◽  
pp. 63-83
Author(s):  
V. T. Ivashkin ◽  
N. D. Yuschuk ◽  
I. V. Maev ◽  
A. S. Trukhmanov ◽  
O. A. Storonova ◽  
...  
Keyword(s):  
Infectious Agent ◽  
Pain Syndrome ◽  
Relevant Information ◽  
Care Quality ◽  
Diagnosis And Treatment ◽  
Ulcer Bleeding ◽  
Esophageal Disease ◽  
Outpatient Basis ◽  
Family Doctors ◽  
Clinical Recommendations

Aim. Current clinical recommendations aim to provide gastroenterologists, general practitioners (family doctors), endoscopists and infectionists with modern methods for diagnosis and treatment of infectious esophagitis.Key points. Infectious esophagitis is an esophageal disease of fungal, viral, bacterial or parasitic origin. Esophagus may be affected per se or conjointly in a common gastrointestinal infection. All patients suspected for infectious esophagitis, unless contraindicated, are advised an esophagogastroduodenoscopy with biopsy to confirm diagnosis. Selected incidents of infectious esophagitis require a histological, immunohistochemical examination or polymerase chain reaction-based diagnosis to verify the infectious agent. Uncomplicated infectious esophagitis requires a conservative therapy, mostly on an outpatient basis. However, cases of severe odynophagia, dysphagia, severe pain syndrome, high complication risks (e.g., esophageal ulcer bleeding in thrombocytopenia), severe immunodeficiency, generalised forms of disease and severe concomitant disorders are considered for hospital care. The clinical recommendations outline criteria for the medical care quality assessment and provide relevant information to the patient.Conclusion. Diagnosis of infectious esophagitis capitalises on the clinical picture (odynophagia, dysphagia), presence of immunosuppression, endoscopic and histological evidence. All patients with infectious esophagitis of verified origin are recommended a suitable etiotropic therapy.

scholarly journals Clinical recommendations of the Russian Association of Endocrinologists for the diagnosis and treatment of autoimmune thyroiditis in children

2003 ◽  
Vol 49 (6) ◽  
pp. 51
Author(s):  
E. P. Kasatkina ◽  
M. I. Martynova ◽  
V. A. Peterkova ◽  
L. N. Samsonova ◽  
L. V. Sapelkina ◽  
...  
Keyword(s):  
Autoimmune Thyroiditis ◽  
Diagnosis And Treatment ◽  
Clinical Recommendations ◽  
Russian Association

The article is devoted to the clinical recommendations of the Russian Association of Endocrinologists for the diagnosis and treatment of autoimmune thyroiditis in children

scholarly journals The role of membrane-destabilizing processes in the pathogenesis and clinical manifestations of perinatal encephalopathy in children

2001 ◽  
Vol 82 (2) ◽  
pp. 137-138
Author(s):  
E. V. Levitina ◽  
G. A. Ivanichev ◽  
M. M. Minnibaev
Keyword(s):  
Nervous System ◽  
Early Diagnosis ◽  
Clinical Manifestations ◽  
Perinatal Period ◽  
Diagnosis And Treatment ◽  
Definition Of ◽  
Methods Of Treatment ◽  
All Diseases ◽  
Made In

2/3 of all diseases of the nervous system in children begin to develop in the perinatal period. In recent decades, great strides have been made in perinatal neurology in the development of criteria for early diagnosis and treatment of diseases. Further study of the biochemical foundations of perinatal lesions of the nervous system with the definition of objective markers of the severity of the lesion will reveal new links in its pathogenesis and develop more effective methods of treatment.

scholarly journals Update on the Diagnosis and Treatment of Idiopathic Intracranial Hypertension

2019 ◽  
Vol 39 (06) ◽  
pp. 682-691
Author(s):  
Sarah R. Ahmad ◽  
Heather E. Moss
Keyword(s):  
Clinical Trials ◽  
Intracranial Hypertension ◽  
Diagnostic Criteria ◽  
Surgical Management ◽  
Idiopathic Intracranial Hypertension ◽  
Diagnosis And Treatment ◽  
Evidence Based ◽  
Diagnosis And Management

AbstractAdvances in ophthalmic diagnostics and results of interventional clinical trials are shifting diagnosis and management of idiopathic intracranial hypertension (IIH) to be more technology- and evidence-based. In this article, the evidence supporting current diagnostic criteria, evaluation, and medical and surgical management of IIH are reviewed.

scholarly journals Evaluation of radiologic diagnostic criteria and treatment options in skeletal muscle hydatid cysts

2019 ◽  
Vol 27 (3) ◽  
pp. 230949901988121 ◽  
Author(s):  
Hasan U Oğur ◽  
Rana Kapukaya ◽  
Özgür Külahçı ◽  
Cengiz Yılmaz ◽  
Kemal Yüce ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Diagnostic Criteria ◽  
Diagnosis And Treatment ◽  
Alternative Methods ◽  
Muscular Tissue ◽  
Hydatid Cysts ◽  
Mri Findings ◽  
Cyst Excision ◽  
Soft Tissue Involvement ◽  
The Mean

Aim: To investigate the diagnosis and treatment methods of soft tissue involvement of hydatid cysts (HCs). Materials and Methods: Eleven patients who were diagnosed as having HC with muscular tissue (soft tissue) involvement between 2010 and 2016 were evaluated retrospectively. Seven patients had typical HC magnetic resonance imaging (MRI) and four patients had cysts with an unusual appearance. We evaluated how to diagnose the cysts using imaging methods, their characteristic radiologic images, and treatment alternatives against the disease. The patients were treated with antihelminthic chemotherapy preoperatively and postoperatively. Results: Of the 11 patients who underwent treatment, 7 were diagnosed using MRI and 4 were diagnosed with histopathologic examinations. The mean follow-up period was 16 (range, 6–24) months, and the mean age was 39.4 (range, 24–56) years. In seven patients, multivesicular appearance with specific MRI findings, T2-hypointense rim appearance, double-rim sign, membrane dissociation, and appearance of daughter cysts were identified as diagnostic criteria. Two patients underwent ultrasound assisted percutaneous aspiration–injection–reaspiration (PAIR) treatment. Seven patients underwent total pericystectomy, and two patients underwent subtotal pericystectomy with serum saline injection into the cyst. Two patients showed signs of mild anaphylaxis, one during the diagnosis and one during treatment. Conclusion: There may be difficulties in the diagnosis and treatment of HCs of the musculoskeletal system. It should be known that there are alternative methods in the treatment (cyst excision and PAIR treatment). Clinical, serologic, and radiologic findings should be used in the diagnosis. To avoid complications during the histopathologic diagnosis, MRI should be examined in detail. It is thought that atypical cysts can be diagnosed (double-layer appearance and peripheral rim sign) in addition to typical cysts (detached membrane and multivesicular appearance), and diagnosis and treatment can be planned without anaphylactic complications.

scholarly journals Hereditary Hemorrhagic Telangiectasia: Systemic Therapies, Guidelines, and an Evolving Standard of Care

Blood ◽  
2020 ◽  
Author(s):  
Hanny Al-Samkari
Keyword(s):  
Hereditary Hemorrhagic Telangiectasia ◽  
Standard Treatment ◽  
Treatment Options ◽  
Standard Of Care ◽  
Diagnosis And Treatment ◽  
International Guidelines ◽  
Clinical Recommendations ◽  
Antiangiogenic Therapies ◽  
Systemic Therapies ◽  
Second International

Hereditary hemorrhagic telangiectasia (HHT) management is evolving due to the emergence and development of antiangiogenic therapies to eliminate bleeding telangiectasias and achieve hemostasis. This is reflected in recent clinical recommendations published in the Second International Guidelines for the Diagnosis and Treatment of HHT, in which systemic therapies including antiangiogenics and antifibrinolytics are now recommended as standard treatment options for bleeding. This review highlights the new recommendations especially relevant to hematologists in managing bleeding, anticoagulation, and anemia in patients with HHT.

Defining and Diagnosing Involuntary Emotional Expression Disorder

CNS Spectrums ◽  
2006 ◽  
Vol 11 (S6) ◽  
pp. 1-11 ◽  
Author(s):  
Jeffrey L. Cummings ◽  
David B. Arciniegas ◽  
Benjamin R. Brooks ◽  
Robert M. Herndon ◽  
Edward C. Lauterbach ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Traumatic Brain Injury ◽  
Amyotrophic Lateral Sclerosis ◽  
Brain Injury ◽  
Diagnostic Criteria ◽  
Emotional Expression ◽  
Diagnosis And Treatment ◽  
Neurological Conditions ◽  
Lateral Sclerosis

AbstractUncontrollable episodes of emotional expression occur in a variety of neurological conditions. This emotional disinhibition syndrome is characterized by episodes of crying or laughing that are unrelated to or out of proportion to the eliciting stimulus. This syndrome is common among patients with amyotrophic lateral sclerosis, multiple sclerosis, stroke, and traumatic brain injury and a variety of terms and definitions have been used to describe it. The confusing nomenclature has been a barrier to understanding, diagnosis, and treatment of this disorder. The authors propose a unifying term, involuntary emotional expression disorder (IEED), and provide diagnostic criteria for this disorder.

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