Cardioembolic stroke: everything has changed.

Stroke and Vascular Neurology
J David Spence

Abstract

Historically, because of the difficulty of using warfarin safely and effectively, many patients with cardioembolic stroke who should have been anticoagulated were instead given ineffective antiplatelet therapy (or no antithrombotic therapy). With the arrival of new oral anticoagulants that are not significantly more likely than aspirin to cause severe haemorrhage, everything has changed. Because antiplatelet agents are much less effective in preventing cardioembolic stroke, it is now more prudent to anticoagulate patients in whom cardioembolic stroke is strongly suspected. Recent advances include the recognition that intermittent atrial fibrillation is better detected with more prolonged monitoring of the cardiac rhythm, and that percutaneous closure of patent foramen ovale (PFO) may reduce the risk of stroke. However, because in most patients with stroke and PFO the PFO is incidental, this should be reserved for patients in whom paradoxical embolism is likely. A high shunt grade on transcranial Doppler saline studies, and clinical clues to paradoxical embolism, can help in appropriate selection of patients for percutaneous closure. For patients with atrial fibrillation who cannot be anticoagulated, ablation of the left atrial ...Continue Reading

References

Aug 1, 1991·Stroke; a Journal of Cerebral Circulation·P A WolfW B Kannel
May 28, 1987·The New England Journal of Medicine·S GlagovG J Kolettis
Apr 28, 1999·Archives of Internal Medicine·M Man-Son-HingA Laupacis
Aug 25, 1999·Clinical Pharmacology and Therapeutics·J J LiljaP J Neuvonen
Dec 7, 2002·Stroke; a Journal of Cerebral Circulation·J David SpenceTara Lohmann
Jan 24, 2004·Stroke; a Journal of Cerebral Circulation·Francesco IemoloJ David Spence
Apr 17, 2004·Stroke; a Journal of Cerebral Circulation·Gian Paolo Anzola
Jul 29, 2006·Stroke; a Journal of Cerebral Circulation·J David Spence
Aug 2, 2007·Journal of Thrombosis and Haemostasis : JTH·E K RomboutsF J M Van Der Meer
Mar 7, 2008·The New England Journal of Medicine·Ute I SchwarzC Michael Stein
Sep 2, 2008·Stroke; a Journal of Cerebral Circulation·David J GladstoneMoira K Kapral
Sep 30, 2008·Journal of the Neurological Sciences·A Ozcan OzdemirJ David Spence
Sep 1, 2009·The New England Journal of Medicine·Albert Schömig
Oct 12, 2010·Stroke; a Journal of Cerebral Circulation·David M Kent, David E Thaler
Feb 12, 2011·The New England Journal of Medicine·Stuart J ConnollyUNKNOWN AVERROES Steering Committee and Investigators
Jun 16, 2011·Circulation Journal : Official Journal of the Japanese Circulation Society·Hirotsugu Atarashi
Nov 2, 2011·Annals of Internal Medicine·Stuart J ConnollyUNKNOWN ACTIVE (Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events) Steering Committee and Inve
Nov 28, 2012·CMAJ : Canadian Medical Association Journal = Journal De L'Association Medicale Canadienne·Tara GomesDavid N Juurlink
Mar 22, 2014·Lancet Neurology·Robert G HartUNKNOWN Cryptogenic Stroke/ESUS International Working Group
Jun 26, 2014·The New England Journal of Medicine·David J GladstoneUNKNOWN EMBRACE Investigators and Coordinators
Sep 13, 2014·Stroke; a Journal of Cerebral Circulation·Chrysi BogiatziJ David Spence
Feb 24, 2015·Stroke; a Journal of Cerebral Circulation·David J GladstoneUNKNOWN EMBRACE Steering Committee and Investigators
Sep 22, 2015·JAMA Neurology·Catherine YangJ David Spence
Feb 27, 2016·Journal of the American College of Cardiology·David M KentDavid E Thaler
Apr 21, 2016·The New England Journal of Medicine·Pierre AmarencoUNKNOWN TIAregistry.org Investigators
Mar 21, 2017·The New England Journal of Medicine·Jeffrey I WeitzUNKNOWN EINSTEIN CHOICE Investigators
Aug 18, 2017·Lancet Neurology·J David SpenceGraeme J Hankey
Aug 29, 2017·The New England Journal of Medicine·John W EikelboomUNKNOWN COMPASS Investigators
Sep 14, 2017·The New England Journal of Medicine·Lars SøndergaardUNKNOWN Gore REDUCE Clinical Study Investigators
Sep 14, 2017·The New England Journal of Medicine·Jeffrey L SaverUNKNOWN RESPECT Investigators
Sep 14, 2017·The New England Journal of Medicine·Jean-Louis MasUNKNOWN CLOSE Investigators
Nov 11, 2017·JACC. Cardiovascular Interventions·Mohammad Khalid MojadidiBernhard Meier

❮ Previous
Next ❯

Citations

Jan 16, 2019·International Journal of Stroke : Official Journal of the International Stroke Society·J David Spence
Jun 26, 2020·Clinical and Applied Thrombosis/hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis·Jae C Chang
May 7, 2020·Blood Coagulation & Fibrinolysis : an International Journal in Haemostasis and Thrombosis·Naifang YeWenman Wu
Jun 28, 2019·International Journal of Molecular Sciences·Marta SikoraHieronim Jakubowski
Aug 31, 2020·F1000Research·J David Spence
Apr 23, 2019·Stroke; a Journal of Cerebral Circulation·Xiao-Meng YangYong-Jun Wang
Sep 22, 2019·Medicina·Kristaps JurjansAndrejs Millers
Apr 9, 2020·Current Pharmaceutical Design·Christos-Konstantinos AntoniouDimitrios Tousoulis
Aug 17, 2021·Cellular and Molecular Life Sciences : CMLS·Rentang BiBo Hu
Feb 5, 2022·Current Medical Research and Opinion·Kaili ZhangXiaoyuan Niu

❮ Previous
Next ❯

Methods Mentioned

BETA
acetylation
dissection
sedation
genotyping

Related Concepts

Related Feeds

Atrial Filbrillation

Atrial fibrillation refers to the abnormal heart rhythm characterized by rapid and irregular beating of the atria. Here is the latest research.

Atrial Fibrillation

Atrial fibrillation is a common arrhythmia that is associated with substantial morbidity and mortality, particularly due to stroke and thromboembolism. Here is the latest research.

Arrhythmia

Arrhythmias are abnormalities in heart rhythms, which can be either too fast or too slow. They can result from abnormalities of the initiation of an impulse or impulse conduction or a combination of both. Here is the latest research on arrhythmias.

Related Papers

Journal of Translational Internal Medicine
J David Spence
Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
Ravinay Bhindi
The American Journal of Cardiology
Mohammad K MojadidiB Meier
© 2022 Meta ULC. All rights reserved