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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Strokes are responsible for significant morbidity and mortality. Persons who have chronic atrial fibrillation are at higher risk of having a stroke. Previously, anticoagulation with warfarin was instituted only in persons with atrial fibrillation associated with valvular problems. More recently, five studies have shown a clear benefit to using warfarin in persons with atrial fibrillation related to nonvalvular conditions, such as hypertension, coronary artery disease, and heart failure. Patients who were given warfarin in therapeutic dosages, as measured by prothrombin time ratios and International Normalized Ratios (INRs), had a significant reduction in stroke risk ranging from 37 to 79% in the five studies. The outcomes of these five studies have changed the way persons with chronic, nonvalvular atrial fibrillation are managed. Health care providers play a key role in the counseling of patients who are considering the use of warfarin, the patient education regarding potential complications and drug interactions, and the ongoing monitoring and laboratory testing needed for dosage adjustments.
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PMID:Reducing the risk of stroke in patients with chronic, nonvalvular atrial fibrillation. 818 82

Many clinical trials have demonstrated the effectiveness of oral anticoagulation for the primary and secondary prevention of venous thromboembolism, myocardial infarction, systemic embolism and stroke. However, the relationship between potency and/or changes in anticoagulation therapy and frequency of complications is not clear. This study retrospectively investigated 157 patients (valvular heart disease 37, artificial valve replacement 19, atrial fibrillation 11, ischemic heart disease 55, post coronary artery bypass grafting 25, others 10: mean age 55 +/- 12 years) who received oral anticoagulation therapy for 4.9 +/- 3.2 years to investigate the development of complications. The thrombotest and prothrombin time were measured at follow-up examinations every month (mean interval 31 days). Target range of anticoagulation was 2.5 to 3.5 (international normalized ratio: INR). During the 770 patient-years of follow-up, seven major bleedings (cerebral, renal, gastrointestinal, etc.), 111 minor bleedings (subcutaneal, nasal, gum, etc. bleeding), 16 major thromboembolisms (cerebral, renal, etc. infarction) and 4 minor thromboembolisms (transient ischemic attack) were observed. INR at the onset of the complications was 2.93 +/- 0.41 in patients with bleeding and 1.81 +/- 0.46 in those with thromboembolism. INR was greater than 2.75 in all patients with major hemorrhage and less than 2.75 in those with major thromboembolism. Seventy-five percent of bleeding complications developed at the increasing phase of INR and 70% of thromboembolism at the decreasing phase. Cumulative rates free from bleeding complications with a mean INR of < or = 2.0, 2.0-2.5 and > 2.5 were 76.8, 62.8 and 45.5%, respectively, at 5 years.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Long-term follow-up in patients receiving anticoagulation therapy: potency of therapy and complications]. 820 35

A highly sensitive automated method, fluorogenic prothrombin time (FPT) method, was developed by a combination of a fluorogenic peptide substrate for thrombin and a centrifugal autoanalyzer (Cobas Bio). Using plasmas from stroke patients, we showed that the second reagent containing fluorogenic peptide substrate should be mixed after the first reagent containing tissue factor and plasma were mixed, that is, two steps method, in order to detect hypercoagulable state. When the first and the second reagent were mixed with plasma at the same time, that is, one step method, FPT was not sensitive to hypercoagulable state. We also showed that patient plasmas should be stored at -80 degrees C and subjected to FPT analysis immediately after thawing, not leaving at 4 degrees C or room temperature. Good correlation was observed on FPT of stroke patients using human tissue factor and bovine tissue factor. Another fluorogenic method was developed by the same principle for the evaluation of factors X and VII concentrations in plasma using deficient plasma of factor X or factor VII. Good correlation was observed on factors X and VII concentrations of stroke patients using human tissue factor and bovine tissue factor.
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PMID:[A basic study on a highly sensitive automated method for hypercoagulable state in plasma, fluorogenic prothrombin time (FPT) method]. 825 61

In order to evaluate the efficacy of warfarin for the secondary prevention of cardioembolic stroke due to nonvalvular atrial fibrillation (NVAF), we retrospectively investigated the frequencies of recurrent brain embolism and hemorrhagic complications in 68 subjects (62 +/- 9 years old, 54 men and 14 women), who had experienced at least one cardioembolic stroke prior to the study period. The follow-up period was 39 +/- 27 months. Paroxysmal and persistent atrial fibrillation were seen in 37 and 31 subjects, respectively. We assigned the subjects to three subgroups according to types of the events during the follow-up; recurrence group, hemorrhage group, and non-accident group. Prothrombin time (international normalized ratio, INR) was assessed as mean value during the follow-up period. The prothrombin time at the time of recurrence and hemorrhagic complication was also taken into consideration for data analysis. Recurrent brain embolism was observed in three patients (1.4%/yr). Major bleeding occurred in 12 patients (5.5%/yr) and three of them were fatal (subarachnoid hemorrhage, brain hemorrhage, and acute subdural hematoma). The mean value of INR in the hemorrhage group (3.0) was higher than that in the recurrence group (2.2) and in the non-accident group (2.3) (p < 0.001, vs. non-accident group). The lowest mean value of INR in the hemorrhage group was 2.5. The prothrombin time in the recurrence group did not differ from that in the non-accident group. The death rate in the hemorrhage group (4/12, 33.3%) was higher than those in the recurrence group (0) and in the non-accident group (4/53, 7.5%) (p < 0.01, vs. non-accident group).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Warfarin therapy for secondary prevention of cardioembolic stroke with nonvalvular atrial fibrillation--a retrospective study]. 826 96

"Silent" lacunar stroke, often found in the elderly, has been proposed as a predisposing condition for clinically overt stroke. However, the risk factors related to this condition have not been studied thoroughly. We conducted brain magnetic resonance imaging and measured the levels of fibrinogen, molecular markers of coagulation activation [prothrombin fragment 1 + 2 (F1 + 2)] and endothelial cell damage [von Willebrand factor (vWF) and thrombomodulin], and lipid profiles including lipoprotein (a) [Lp(a)] in 178 asymptomatic, high-risk, Japanese subjects aged 44 to 93 years. We also studied 32 symptomatic patients with lacunar stroke (symptomatic lacunar group). The prevalence of silent lacunar stroke increased with age up to 85 years but decreased with age in those 85 years old and older. Of the 160 elderly subjects ( > or = 60 years) 84 (53%) had > or = 1 lacunar infarcts (silent lacunar group) and the remaining 76 were considered as the nonlacunar group. Fibrinogen and F1 + 2 levels in the silent lacunar group were significantly higher than those in the nonlacunar group (P < .01). Mean Lp(a) levels and the prevalence of subjects with an Lp(a) level > 30 mg/dL were significantly higher in the symptomatic lacunar group than the nonlacunar group (P < .05), whereas these levels in the silent lacunar group were intermediate to those of the other two groups. When we further classified the silent lacunar group into three subgroups based on the number of lacunes (few lacunes, 1 or 2; moderate number of lacunes, 3 or 4; and numerous lacunes, > or = 5), levels of Lp(a), F1 + 2, vWF, and thrombomodulin were significantly higher and Lp(a) levels > 30 mg/dL more common in the numerous-lacune than in the few-lacune subgroup. We conclude that silent lacunar stroke is often found in asymptomatic, high-risk, elderly Japanese patients and that silent multiple lacunar stroke is associated with hypercoagulability, endothelial cell damage, and high Lp(a) levels.
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PMID:'Silent' cerebral infarction is associated with hypercoagulability, endothelial cell damage, and high Lp(a) levels in elderly Japanese. 864 Apr

We reviewed the results of 68 consecutive Fontan procedures from 1978 to 1993 to determine the frequency of late central neurologic complications of the Fontan procedure in patients living at a mean altitude of 4500 feet. Two surviving patients had transient neurologic symptoms or signs with no corresponding evidence of brain injury by magnetic resonance imaging (MRI), whereas six surviving patients had strokes defined by sustained neurologic symptoms or signs with areas of brain injury identified by MRI [8.8% (6.0-13.0%; 70% confidence limits)]. Collectively, patients with neurologic symptoms had normal hemoglobin values, platelet counts, partial thromboplastin times, and prothrombin times at the onset of clinical neurologic findings. Two patients were taking antiplatelet agents, and one patient was taking warfarin. One of the patients with transient neurologic findings and all of the stroke patients had residual right-to-left shunts. Thus strokes were not uncommon in our patients after the Fontan procedure. Brain injury may result from thromboembolic events associated with residual right-to-left shunts, but our total number of asymptomatic patients with a residual shunt or brain abnormalities by MRI is not known.
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PMID:Factors associated with stroke following the Fontan procedure. 865 12

Seasonal influence on mortality from cardiovascular and cerebrovascular diseases is well documented. Understanding the seasonal variations in cardiovascular risk factors can shed light on this phenomenon. Elevation of coagulation factors during cold weather may in part explain the higher mortality from myocardial infarction and stroke in winter. The Cardiovascular Disease Risk Factors Community Study (CVDFACTS) included subjects belonging to 2 cohorts located in northern and southern Taiwan. This study included 2877 subjects aged 18 and above whose blood levels were examined for various coagulating factors. Besides measuring conventional cardiovascular risk factors including: blood pressure, body mass index and total cholesterol, values for blood fibrinogen, factor VII activity, factor VIII activity, plasminogen, antithrombin III, prothrombin time and activated partial thromboplastin time were determined for all subjects. Of these hemostatic parameters, levels of all, except prothrombin time, were statistically different between days with mean temperature > 20 degrees C and days with temperature < or = 20 degrees C (P < 0.01). In cold weather, a greater tendency to clot in circulatory system was demonstrated in this study, indicating seasonal variations may be demonstrated in this subtropical region.
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PMID:Values of blood coagulating factors vary with ambient temperature: the Cardiovascular Disease Risk Factor Two-Township Study in Taiwan. 890 10

Atrial fibrillation is an independent risk factor for cerebral and systemic embolism. The risk increases with the patient's age and the presence of other risk factors: hypertension, diabetes, cardiac failure, prior transient ischemic attacks or embolic stroke. Risk stratification is of essential importance to allow the choice of the most suitable prophylaxis with antithrombotic drugs for the individual patient. On the basis of the results of controlled clinical trials, it is possible to suggest the following guidelines: a) in patients at low risk (< 65 years, with no other risk factor) the drug of first choice should be acetylsalicylic acid; b) in patients at high risk (> 65 years, with one or more risk factors) the drugs of first choice are oral anticoagulants, given at doses that prolong the prothrombin time to INR values of 2-3; c) in patients at high risk with contraindications to oral anticoagulants, acetylsalicylic acid or indobufen (shown to be as effective as oral anticoagulants in patients with prior transient ischemic attacks or stroke) should be considered.
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PMID:[Prevention of thromboembolism in atrial fibrillation of non-valvular etiology]. 900 15

Bone marrow necrosis (BMN) is a relatively rare entity and has been associated with a poor prognosis. It is most commonly found in patients with neoplastic disorders, severe infections and sickle cell anemia. An unusual case of antiphospholipid syndrome (APS) with extensive bone marrow necrosis is described in a 27 year old woman. The patient presented with severe pancytopenia, some cognitive impairment resulting from a previous cerebrovascular accident, fever, hypertension, dyspnoea, tachycardia, hepatosplenomegaly, and vaginal bleeding. Her laboratory findings included a strongly positive Coombs' test (anti-IgG and anti-C3d), a prothrombin time of 23 seconds and an activated partial thromboplastin time of 45 seconds. Anticardiolipin antibody tests were positive. Antinuclear and anti-DNA antibodies were negative but the anti-SM test was positive. A bone marrow biopsy specimen was reported as showing extensive necrosis. The patient was treated with steroids, transfusion, and plasma exchange with some clinical improvement but her pancytopenia did not respond and necessitated frequent transfusions. This case lends further support to the association between APS and BMN.
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PMID:Bone marrow necrosis in antiphospholipid syndrome. 915 83

The efficacy of conventional dose adjusted oral anticoagulation for stroke prevention in patients with non-valvular atrial fibrillation is well-documented but not considered ideal as primary antithrombotic treatment in elderly patients. The antithrombotic effect of fixed minidose warfarin 1.25 mg/day alone or in combination with aspirin 300 mg/day, of conventional dose adjusted warfarin (INR 2.0-3.0), and of aspirin 300 mg/day have been investigated in outpatients with chronic nonvalvular atrial fibrillation in the second Copenhagen Atrial Fibrillation, Aspirin and Anticoagulant Therapy Study (AFASAK 2). In order to investigate the effect on the coagulation system of the treatments, the International Normalized Ratio of the prothrombin time (INR) and prothrombin fragment 1 + 2 (F1 + 2) were monitored at baseline and after three months of treatment in 100 patients consecutively included in the trial. At baseline no differences in INR and F1 + 2 between the four treatment groups were present. After three months of therapy the level of INR increased significantly from baseline in patients receiving warfarin in any dose and the level of F1 + 2 decreased significantly by combined minidose warfarin-aspirin and by dose adjusted warfarin. When comparing the changes over time in F1 + 2 (three-month value minus baseline value) during therapy with fixed minidose warfarin, combined minidose warfarin-aspirin and aspirin alone no significant difference between the groups was found. In conclusion, INR was changed by all three warfarin regimens but only dose adjusted warfarin (INR 2.0-3.0) had a marked effect on F1 + 2.
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PMID:Effect of fixed minidose warfarin, conventional dose warfarin and aspirin on INR and prothrombin fragment 1 + 2 in patients with atrial fibrillation. 918 90


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