Stroke

Stroke Prevention Medical interventions for everyday practice

Stroke Prevention Medical interventions for everyday practice

Paroxysmal or permanent atrial fibrillation associated with a CHA2DS2-VASc score of one or more for men, and two or more for women should prompt consideration of anticoagulation to reduce stroke risk. High-risk patients with atrial fibrillation remain significantly undertreated. Older patients, despite having a high risk of falls, are nevertheless likely to benefit from anticoagulation. Perioperative bridging anticoagulation for patients with atrial fibrillation is not routinely recommended. Direct oral anticoagulant drugs should be ceased 24 to 48 hours before procedures. Asymptomatic carotid atherosclerotic disease should be treated medically. Antiplatelet medication for secondary prevention has most benefit when given early after stroke or transient ischaemic attack.

Modern Medicine – Aug/Sept 2018

September 26, 2018 by Anticoagulants Cardiology Stroke

Study Reaffirms Low AF Stroke and Bleeding Rates

Study Reaffirms Low AF Stroke and Bleeding Rates – MM1701

Data from XAPASS – a prospective observational postauthorisation study, which enrolled more than 11 000 patients in Japan – confirmed low rates of both stroke and major bleeding in patients with non-valvular AF newly-initiated on rivaroxaban in routine clinical practice. These results were generally consistent with the Phase III J-ROCKET AF randomised clinical trial.

Modern Medicine – January 2017

January 27, 2017 by Anticoagulants Stroke

Cardioembolic Stroke – A Clinical Approach

Cardioembolic Stroke – A Clinical Approach – MM1609

Stroke is a major cause of death, most commonly by infarct (in approximately 85% of cases). Cardioembolism accounts for 15-40% of all ischemic strokes and importantly, three year mortality from a cardioembolic stroke may be as high as 50%. The initial mortality may be related to the stroke but after six months the cause of death is often related to underlying cardiovascular disease. Identifying cardiembolic stroke is important and should be followed by a systematic workup to identify the source of cardioembolism, as it can prevent further events by treating the underlying cardiac abnormality.

Modern Medicine – September 2016

October 6, 2016 by Cardiology Stroke

TIAs and Stroke Prevention | Rapid Assessment, Urgent Treatment

TIAs and Stroke Prevention | Rapid Assessment, Urgent Treatment – MM1607

A transient ischaemic attack (TIA) is a transient neurovascular event that resolves within 24 hours without acute infarction on MRI. Urgent investigations for TIA or stroke should include: imaging of the brain; imaging of the carotid and vertebral arteries; 12-channel ECG and Holter monitoring; transthoracic echocardiography; blood pressure, fasting lipids and glucose measurements. The American Heart Association (AHA)/American Stroke Association (ASA) have updated their guidelines on primary and secondary stroke prevention, focusing on lifestyle changes and management of hypertension, hyperlipidaemia and diabetes. The targets for primary prevention are less strict than for secondary prevention but the same principles for treatment and lifestyle changes apply.

Modern Medicine – July 2016

July 22, 2016 by Anticoagulants Cardiology Stroke

Transient Neurological Troubles in Patients with Type 2 Diabetes

Transient Neurological Troubles in Patients with Type 2 Diabetes – MM1305

Transient neurological attacks, early warning signs of cerebrovascular disease, are usually differentiated by their history. As type 2 diabetes is an important risk factor for a transient ischaemic attack (TIA) and subsequent stroke,
this article focuses on the acute, usually urgent management of this focal transient neurological problem and its prevention.

Modern Medicine – May 2013

May 14, 2013 by Cardiology Diabetes Neurology Stroke

Stroke in the Elderly: Predictable, Preventable and Treatable

Stroke in the Elderly – Predictable Preventable and Treatable – MM1302

Stroke is the second most common cause of death worldwide, with
most of the disease burden falling to the elderly and the very elderly.
Effective treatments are available for acute management and for
primary and secondary prevention of stroke. GPs are particularly
well placed for identifying at-risk patients and for initiating ‘triple
therapy’ of aspirin, a high-dose statin and blood pressure lowering
therapy.

Modern Medicine – February 2013

February 14, 2013 by Gerontology Stroke

Catheter Ablation for Atrial Fibrillation

Catheter Ablation for Atrial Fibrillation – MM1301

Regardless of whether a rate or rhythm-control based management
strategy is employed in the treatment of atrial fibrillation (AF), preservation
of the brain, in the prevention of stroke with appropriate
thromboprophylaxis, remains critical. Catheter-based isolation of
the pulmonary veins is an accepted intervention for patients with
symptomatic AF, especially when symptoms are severe, paroxysmal
or ‘lone’ AF is present, and when anti-arrhythmic drugs have failed.
The prospect of symptom relief should be the driver for AF ablation
in most patients.

Modern Medicine – January 2013

January 18, 2013 by Cardiology Stroke
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