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Adrià Arboix - One of the best experts on this subject based on the ideXlab platform.
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Antithrombotic medication for Cardioembolic Stroke prevention.
Stroke research and treatment, 2011Co-Authors: M. Angels Font, Jerzy Krupinski, Adrià ArboixAbstract:Embolism of cardiac origin accounts for about 20% of ischemic Strokes. Nonvalvular atrial fibrillation is the most frequent cause of Cardioembolic Stroke. Approximately 1% of population is affected by atrial fibrillation, and its prevalence is growing with ageing in the modern world. Strokes due to cardioembolism are in general severe and prone to early recurrence and have a higher long-term risk of recurrence and mortality. Despite its enormous preventive potential, continuous oral anticoagulation is prescribed for less than half of patients with atrial fibrillation who have risk factors for cardioembolism and no contraindications for anticoagulation. Available evidence does not support routine immediate anticoagulation of acute Cardioembolic Stroke. Anticoagulation therapy's associated risk of hemorrhage and monitoring requirements have encouraged the investigation of alternative therapies for individuals with atrial fibrillation. New anticoagulants being tested for prevention of Stroke are low-molecular-weight heparins (LMWH), unfractionated heparin, factor Xa inhibitors, or direct thrombin inhibitors like dabigatran etexilate and rivaroxaban. The later exhibit stable pharmacokinetics obviating the need for coagulation monitoring or dose titration, and they lack clinically significant food or drug interaction. Moreover, they offer another potential that includes fixed dosing, oral administration, and rapid onset of action. There are several concerns regarding potential harm, including an increased risk for hepatotoxicity, clinically significant bleeding, and acute coronary events. Therefore, additional trials and postmarketing surveillance will be needed.
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Cardioembolic Stroke: Clinical Features, Specific Cardiac Disorders and Prognosis
Current cardiology reviews, 2010Co-Authors: Adrià Arboix, Josefina AlióAbstract:This article provides the reader with an overview and up-date of clinical features, specific cardiac disorders and prognosis of Cardioembolic Stroke. Cardioembolic Stroke accounts for 14-30% of ischemic Strokes and, in general, is a severe condition; patients with Cardioembolic infarction are prone to early and long-term Stroke recurrence, although recurrences may be preventable by appropriate treatment during the acute phase and strict control at follow-up. Certain clinical features are suggestive of Cardioembolic infarction, including sudden onset to maximal deficit, decreased level of consciousness at onset, Wernicke’s aphasia or global aphasia without hemiparesis, a Valsalva manoeuvre at the time of Stroke onset, and co-occurrence of cerebral and systemic emboli. Lacunar clinical presentations, a lacunar infarct and especially multiple lacunar infarcts, make Cardioembolic origin unlikely. The more common high risk Cardioembolic conditions are atrial fibrillation, recent myocardial infarction, mechanical prosthetic valve, dilated myocardiopathy, and mitral rheumatic stenosis. Transthoracic and transesophageal echocardiogram can disclose structural heart diseases. Paroxysmal atrial dysrhyhtmia can be detected by Holter monitoring. In-hospital mortality in Cardioembolic Stroke (27.3%, in our series) is the highest as compared with other subtypes of cerebral infarction. In our experience, in-hospital mortality in patients with early embolic recurrence (within the first 7 days) was 77%. Patients with alcohol abuse, hypertension, valvular heart disease, nausea and vomiting, and previous cerebral infarction are at increased risk of early recurrent systemic embolization. Secondary prevention with anticoagulants should be started immediately if possible in patients at high risk for recurrent Cardioembolic Stroke in which contraindications, such as falls, poor compliance, uncontrolled epilepsy or gastrointestinal bleeding are absent.
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specific cardiac disorders in 402 consecutive patients with ischaemic Cardioembolic Stroke
International Journal of Cardiology, 2004Co-Authors: Ramon Pujadas Capmany, Adrià Arboix, Roser Casanasmunoz, Nuria AngueraferrandoAbstract:Abstract Background : To determine the cardiological substrate in acute Stroke patients presenting with a Cardioembolic Stroke subtype. Methods : Data of 402 consecutive patients with Cardioembolic Stroke (cerebral infarction, n =347; transient ischaemic attack, n =55) were collected from a prospective hospital-based Stroke registry in which data on 2000 Stroke patients over a 10-year period were included. In all patients, specific cardiac disorders were identified by physical examination and results of electrocardiography and transthoracic echocardiography. Holter monitoring and more sensitive techniques of cardiac imaging were used in selected cases. Results : Cardioembolic cerebral ischaemia accounted for 20% of all acute Strokes (25% of ischaemic cerebrovascular events). Cardiac sources of embolism included the following: (a) structural cardiac disorders associated with arrhythmia ( n =232), the most frequent being left ventricular hypertrophic hypertensive disease ( n =120) and rheumatic mitral valve disease ( n =49); (b) structural cardiac disease with sustained sinus rhythm ( n =81), the most frequent being systolic left ventricular dysfunction of both ischaemic ( n =35) or non-ischaemic ( n =24) aetiology; and (c) isolated atrial dysrhythmia (atrial fibrillation, n =88 and atrial flutter, n =1). Conclusions : Hypertrophic hypertensive cardiac disease complicated with atrial fibrillation was the most frequent cardiac source of emboli in Cardioembolic Stroke. Other important cardiac sources were isolated atrial fibrillation, rheumatic mitral valve disease, and systolic left ventricular dysfunction of ischaemic and non-ischaemic cause. The incidence of traditional emboligenous-prone cardiac disorders, such as mitral valve prolapse and mitral annular calcification was low.
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Clinical Predictors of Early Embolic Recurrence in Presumed Cardioembolic Stroke
Cerebrovascular diseases (Basel Switzerland), 1998Co-Authors: Adrià Arboix, Luis García-eroles, Montserrat Oliveres, J. Massons, Cecilia TargaAbstract:Background: We determined clinical predictive factors of in-hospital embolic recurrence in presumed Cardioembolic Stroke patients by means of multivariate analysis based on clinical
Maria I. Aguilar - One of the best experts on this subject based on the ideXlab platform.
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Secondary Prevention After Cardioembolic Stroke
Ischemic Stroke Therapeutics, 2016Co-Authors: Mark N. Rubin, W. David Freeman, Maria I. AguilarAbstract:Cardiac causes of ischemic Stroke usually lead to severe neurological deficits from large intracranial artery occlusion compared to small vessel ischemic Stroke. The most common cause of Cardioembolic Stroke is nonvalvular atrial fibrillation (AF), which has an increasing incidence with age. Other less common causes of Cardioembolic Stroke include myocardial infarction, left ventricular thrombus, reduced left ventricular ejection fraction, valvular abnormalities, and endocarditis. Patent foramen ovale (PFO) is a common finding on echocardiograms in patients with and without Stroke (up to 20 % of the population), and a controversial source of cryptogenic Stroke. AF Stroke trials demonstrate that anticoagulation is superior to antiplatelet therapy in terms of ischemic Stroke and systemic embolism prevention. Recently, warfarin has been compared with a number of drugs with different mechanisms of anticoagulation, namely direct thrombin (Factor II) inhibitors and Factor Xa inhibitors, which are collectively referred to as the novel or new oral anticoagulants (NOAC). Overall, the NOACs were found to be at least equally effective in reducing ischemic Stroke with less intracranial bleeding risk. NOACs are attractive because of warfarin’s narrow therapeutic index, requirement for frequent blood monitoring, multiple drug interactions, and a higher rate of intracranial bleeding as compared to NOACs in randomized trials. The best way to prevent Cardioembolic Stroke remains early detection and treatment of AF in eligible patients, and treating the underlying Stroke mechanism.
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Prevention of Cardioembolic Stroke
Neurotherapeutics, 2011Co-Authors: William David Freeman, Maria I. AguilarAbstract:Cardiac causes of ischemic Stroke lead to severe neurological deficits from large intracranial artery occlusion compared to small vessel ischemic Stroke. The most common cause of Cardioembolic Stroke is atrial fibrillation (AF), which has an increasing incidence with age. AF Stroke trials demonstrate that anti-coagulation is superior to anti-platelet therapy in terms of ischemic Stroke prevention. Recently, warfarin was compared with dabigatran, an oral, direct thrombin inhibitor, and was found to be at least equally effective in reducing ischemic Stroke with less intracranial bleeding risk. Future research is investigating other direct thrombin inhibitors as potential alternatives to warfarin, which has a narrow therapeutic index, requires frequent blood monitoring, has multiple drug interactions, and a higher rate of intracranial bleeding. Other causes of Cardioembolic Stroke include myocardial infarction, left ventricular thrombus, reduced ejection fraction, valvular abnormalities, and endocarditis. Patent foramen ovale is a common finding on echocardiograms in patients with and without Stroke (up to 20% of the population), and it is a controversial source of cryptogenic Stroke. The best way to prevent Cardioembolic Stroke remains early detection and treatment of AF, and treating the underlying Stroke mechanism. Cardiac magnetic resonance imaging is an emerging technology and reveals some sources of cardiac embolism missed by echocardiography, and might provide an additional diagnostic tool in investigating Cardioembolic Stroke.
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Secondary Prevention of Cardioembolic Stroke
Stroke, 2011Co-Authors: Maria I. Aguilar, Oscar R. BenaventeAbstract:Cardioembolic Stroke is an important Stroke subtype, accounting for approximately one fifth of all ischemic Strokes. 1 Advances in imaging techniques have led to easier recognition of cardiac disorders potentially responsible for embolic Stroke. Because the underlying cardiac condition is often evident before Stroke occurs and antithrombotic therapies are notably effective, cardiogenic emboli to the brain are among the most preventable causes of Stroke.
Joan Montaner - One of the best experts on this subject based on the ideXlab platform.
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Cardioembolic Stroke diagnosis using blood biomarkers.
Current cardiology reviews, 2013Co-Authors: Victor Llombart, Teresa García-berrocoso, Alejandro Bustamante, Israel Fernandez-cadenas, Joan MontanerAbstract:Stroke is one of the main causes of death and disability in the world. Cardioembolic etiology accounts for approximately one fifth of all ischemic Strokes whereas 25-30% remains undetermined even after an advanced diagnostic workup. Despite there is not any biomarker currently approved to distinguish Cardioembolic Stroke among other etiologies in clinical practice the use of biomarkers represents a promising valuable complement to determine Stroke etiology reducing the number of cryptogenic Strokes and aiding in the prescription of the most appropriated primary and secondary treatments in order to minimize therapeutic risks and to avoid recurrences. In this review we present an update about specific Cardioembolic Stroke-related biomarkers at a protein, transcriptomic and genetic level. Finally, we also focused on reported biomarkers associated with atrial fibrillation (a cardiac illness strongly related with Cardioembolic Stroke subtype) thus with a potential to become biomarkers to detect Cardioembolic Stroke in the future.
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Blood Biomarkers in Cardioembolic Stroke
Current cardiology reviews, 2010Co-Authors: Teresa García-berrocoso, Israel Fernandez-cadenas, Pilar Delgado, Anna Rosell, Joan MontanerAbstract:One promising field in neurovascular diseases investigation is the use of biomarkers to guide Stroke etiology diagnosis and classification. Since treatment differs among etiologic subtypes and nowadays many patients receive a diagnosis of undetermined Stroke, biomarkers might become an important additional diagnostic tool. In this review we update current knowledge about biomarkers related with Cardioembolic Stroke etiology (such as BNP and D-dimer proteins, or PITX2 and ZFHX3 genes), that in the future, might allow rapidly guiding other diagnostic tests and accelerating the onset of an optimal secondary prevention.
Takenori Yamaguchi - One of the best experts on this subject based on the ideXlab platform.
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Effects of anticoagulation on infarct size and clinical outcome in acute Cardioembolic Stroke
Angiology, 2002Co-Authors: Masayuki Wakita, Masahiro Yasaka, Kazuo Minematsu, Takenori YamaguchiAbstract:Effects of anticoagulation on infarct size and outcome have not been fully elucidated in patients with acute Cardioembolic Stroke, although the anticoagulation therapy reduces both occurrence and r...
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Pathophysiology and treatment of Cardioembolic Stroke
Nihon Ronen Igakkai zasshi. Japanese journal of geriatrics, 1998Co-Authors: Masahiro Yasaka, Chiaki Yokota, Kazuo Minematsu, Takenori YamaguchiAbstract:To elucidate the pathophysiologic mechanism of Cardioembolic Stroke in elderly people and to devise therapeutic strategies for it, was analyzed 120 consecutive patients (77 men and 43 women aged 65 +/- 13 years) with acute Cardioembolic Stroke who were admitted within 7 days of the Stroke onset. We compared underlying heart diseases. NIH Stroke scale on admission, lesion size on computed tomography (CT), the relation between anticoagulant therapy and recurrence, complications during admission. ADL at discharge, recurrence, and death during the follow up period in three groups: patients aged less than 65 years (the young group), those aged from 65 to 74 years (the "non-old" group), and those aged more than 75 years (the "old old" group). In the "old old" group, non valvular atrial fibrillation (75.8%) was the most common underlying heart disease and so was rheumatic heart disease (33.3%) in the "non-old" group. NIH Stroke scale score (median, 11) and the proportion of patients with a large lesion (> 3 cm) of CT were higher in the "old old" group than in the other two groups. Immediate anticoagulation (A/C) within 14 days of onset was performed in more than 70% of the "non-old" and the "young old" groups but in only 57.6% of the "old old" group. Stroke recurred more often in 34 patients who did not receive immediate A/C than in the 86 who did (11.8% v.s. 2.3%. Chi square test, p = 0.053). Hemorrhage during immediate A/C and other complications (infection and pulmonary embolism) were seen in 2 and 14 patients, respectively, in both the "young old" groups, but not in the "non-old" group. Good outcomes (able to walk with or without cane) were more common in the "non-old" group (78.9%) than the other groups (57.1%, Chi square test, p < (0.01). A/C after the acute stage was done in more than 80% of those in the "non-old" and the "young old" groups, but in less than 30% of those in the "old old" group (Chi square test, p = 0.0514). Survival without recurrence during the observation period (605 +/- 550 days) was significantly lower in the "old old" group than in the other two groups (log-rank test, p = 0.0091). Cardioembolic Stroke in the elderly may be characterized as follows: (1) non valvular atrial fibrillation is the most common, (2) severe neurologic deficits on admission and large lesions on CT are noted, (3) complications (infection and pulmonary embolism) often occur, (4) A/C in both acute and chronic stages are done infrequently. Therefore, the indication and intensity of A/C for primary and secondary prevention and prevention of complications are important in management of Cardioembolic Stroke in the elderly.
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Antithrombin III and Low-Dose Heparin in Acute Cardioembolic Stroke
Cerebrovascular Diseases, 1995Co-Authors: Masahiro Yasaka, Takenori Yamaguchi, Hideki Moriyasu, Jiro Oita, Tohru Sawada, Teruo OmaeAbstract:We retrospectively studied the incidence of recurrent embolization and hemorrhagic complications during a 2-week period after the onset of Cardioembolic Stroke according to the form of anticoagulation
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Clinical features of recurrent embolization in acute Cardioembolic Stroke.
Stroke, 1993Co-Authors: Masahiro Yasaka, Takenori Yamaguchi, Tohru Sawada, J Oita, M Shichiri, Tsuyoshi OmaeAbstract:Recurrent embolization is a serious problem in acute Cardioembolic Stroke. However, the clinical features and predisposing factors of recurrent embolization have not been fully elucidated.Subjects were 227 consecutive patients (128 men and 99 women, aged 68.6 +/- 13.2 years) with acute Cardioembolic Stroke who did not receive anticoagulant therapy during the first 14 days after Stroke onset. We assigned the subjects to two groups according to the occurrence or nonoccurrence of recurrent attacks within 14 days of the Stroke onset. We assessed their clinical features, coagulation study results, and underlying heart disease.Recurrent brain or systemic embolization during the first 14 days after onset was noted in 46 patients (20.3%, group A) but not in the other 181 (group B). Recurrent embolization was more frequently noted at an early phase than at a late phase during the initial 14 days. Mortality was higher in group A (19.6%) than in group B (8.8%). The mean plasma level of antithrombin III (77.8 +/- 19....
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Immediate anticoagulation for intracardiac thrombus in acute Cardioembolic Stroke.
Angiology, 1992Co-Authors: Masahiro Yasaka, Takenori YamaguchiAbstract:To assess the efficacy of immediate anticoagulation therapy on intracardiac thrombus formation in acute Cardioembolic Stroke, serial two-dimensional echocardiographic examinations were performed in 25 patients with acute Cardioembolic Stroke. Anticoagulation therapy was commenced within two days of onset in 7 patients (group A) but not in 18 patients (group B). Appearance or enlargement of intracardiac thrombi were not detected in group A but were noted in 7 patients (39%) of group B. Recurrence of systemic embolism was demonstrated in 3 patients (17%) of group B. There were no serious hemorrhagic complications in either group. Immediate anticoagulation could, therefore, be effective in preventing intracardiac thrombus formation and the consequent recurrence of systemic embolization in acute Cardioembolic Stroke. Because the study was preliminary and not randomized, further randomized study is desirable to establish the efficacy of immediate anticoagulation therapy.
Oscar R. Benavente - One of the best experts on this subject based on the ideXlab platform.
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Secondary Prevention of Cardioembolic Stroke
Stroke, 2011Co-Authors: Maria I. Aguilar, Oscar R. BenaventeAbstract:Cardioembolic Stroke is an important Stroke subtype, accounting for approximately one fifth of all ischemic Strokes. 1 Advances in imaging techniques have led to easier recognition of cardiac disorders potentially responsible for embolic Stroke. Because the underlying cardiac condition is often evident before Stroke occurs and antithrombotic therapies are notably effective, cardiogenic emboli to the brain are among the most preventable causes of Stroke.