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Early Versus Late Anticoagulation for Acute Ischemic Stroke in Atrial Fibrillation: A Systematic Review and Meta-Analysis of 17,380 Patients.

BACKGROUND/OBJECTIVES: The optimal timing for initiating oral anticoagulants (OACs) after acute ischemic stroke (AIS) in patients with atrial fibrillation (AF) remains uncertain due to potential risks of recurrent stroke and bleeding. This meta-analysis compares early versus late OAC initiation for recurrent ischemic stroke, major bleeding, intracranial hemorrhage (ICH), systemic embolism, and all-cause mortality. METHODS: We conducted a meta-analysis of randomized controlled trials (RCTs), prospective, and retrospective observational studies. Data were pooled using random-effects models, and

Low-dose rescue tirofiban in mechanical thrombectomy for acute cerebral large-artery occlusion.

BACKGROUND AND PURPOSE: Tirofiban administration during mechanical thrombectomy (MT) remains controversial. The aim was to evaluate the safety and efficacy of a low-dose rescue tirofiban regimen during MT for Chinese acute ischaemic stroke (AIS) patients. METHODS: Patients from the ANGEL study, a multicentric, prospective registry study that included AIS patients who underwent MT owing to proximal large-artery occlusion from June 2015 to December 2017, were collected. The patients were dichotomized into tirofiban and non-tirofiban groups according to whether rescue tirofiban was performed dur

Rivaroxaban for stroke prevention in East Asian patients from the ROCKET AF trial.

BACKGROUND AND PURPOSE: In Rivaroxaban Once Daily Oral Direct Factor Xa Inhibitor Compared With Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) trial, rivaroxaban was noninferior to dose-adjusted warfarin in preventing stroke or systemic embolism among patients with nonvalvular atrial fibrillation at moderate to high stroke risk. Because of differences in patient demographics, epidemiology, and stroke risk management in East Asia, outcomes and relative effects of rivaroxaban versus warfarin were assessed to determine consistency among East As

Catheter-Based Left Atrial Appendage Closure vs Oral Anticoagulation in Patients With Atrial Fibrillation: A Systematic Review and Meta-Analysis.

IMPORTANCE: In patients with atrial fibrillation (AF), oral anticoagulation (OAC) is the gold standard for preventing ischemic stroke, at the expense of a higher risk of bleeding. Catheter-based left atrial appendage closure (LAAC) has been proposed as an alternative strategy to prevent stroke, but the efficacy and safety compared to OAC are uncertain. OBJECTIVE: To evaluate the efficacy and safety of catheter-based LAAC compared to OAC in patients with AF at high risk of stroke. DATA SOURCES: PubMed, Cochrane Central, and Web of Science were screened up to March 2026. The websites of leadin

A case of limb ischemia secondary to paradoxical embolism.

Paradoxical embolism is rarely considered a cause for acute limb ischemia. Although patent foramen ovales (PFOs) are often seen in young patients with stroke, clinicians may not consider evaluation for PFOs in young patients with acute peripheral ischemia. We present a 47-year-old patient presenting with lower extremity ischemia secondary to paradoxical embolism. This case highlights the importance of evaluating for paradoxical embolism in otherwise-unexplained cases of acute limb ischemia.

Advances and Ongoing Controversies in Patent Foramen Ovale Closure and Cryptogenic Stroke.

Up to a third of strokes are cryptogenic. The prevalence of patent foramen ovale (PFO) in patients with cryptogenic stroke is higher than in individuals with stroke of known origin. It has been proposed that some cryptogenic strokes can be caused by paradoxic embolism across a PFO. The treatment of PFO includes medical treatment with antithrombotic agents and percutaneous PFO closure. There is limited evidence to support PFO closure in unselected cases of cryptogenic stroke. However, large randomized clinical trials confirmed the superiority of transcatheter PFO closure compared with medical t

Navigating the Uncertainties of Antithrombotic Therapy After Transcatheter Patent Foramen Ovale Closure: A Comprehensive Review.

The patent foramen ovale (PFO), present in 25% of the population, can cause paradoxical embolism and stroke. Transcatheter PFO closure is the gold standard for recurrent embolism with significant inter-atrial shunting, with recent trials confirming its superiority in reducing ischemic stroke recurrence over medical therapy. However, device-related thrombosis remains a concern, posing risks of systemic embolism and neurological events. Optimal post-closure antithrombotic management, including the choice and duration of therapy, remains unclear. Recommendations suggest transient dual antiplatele

Переходный двусторонний тромби в пациенте с множественным склерозом и массовым лёгким эмболизмом: доклад по делу и обзор литературы.

Легкая эмболия (ПЭ) может иметь сложные и нетипичные особенности, которые ставят под сомнение диагностику и управление, особенно в тех случаях, когда она сосуществует с внутрикардиозными тромби и неврологическими симптомами. Мы сообщаем о случае 67-летней женщины с множественным склерозом (MS), которая подала двусторонний физкультуру, двусудебный тромби и последующий эмболический инсульт. Несмотря на первоначальную съемку, подтверждающую возможное нарушение септальной системы (ASD) как путь к парадоксальной эмболии, как трансхиракическая эхокардиография, так и сердечная магнитная резонансная с

Совпадение в аннотации оригинала
Pulmonary embolism (PE) can present with complex and atypical features that challenge diagnosis and management, particularly when coexisting with intracardiac thrombi and neurological symptoms. We report a case of a 67-year-old woman with multiple sclerosis (MS) who presented with bilateral PE, bi-atrial thrombi, and a subsequent embolic stroke. Despite init…

External and extreme capsular stroke: clinical, topographical and etiological patterns.

BACKGROUND AND PURPOSE: To characterize clinically acute external (EcC) and extreme capsular (ExC) strokes in 9 patients with first-ever acute stroke. METHODS: Nine patients with a lesion limited to the EcC-ExC region proven by diffusion-weighted imaging included in our registry, corresponding to 0.3% of 3,600 patients with ischemic stroke, were studied. RESULTS: We found three main groups of clinical manifestations: (1) motor deficits in all patients (4 with faciobrachial, 2 with faciobrachiocrural, and 1 with brachiocrural, crural and facial paresis each); (2) hypesthesia in 3 patients wit

Stroke in young patients: a diagnostic challenge in the emergency room.

Stroke in young adults has been related to mechanisms different to those found in older individuals. Cardiogenic embolism, arteritis, atherosclerosis, fibromuscular dysplasia, pregnancy-related angiopathy, migrainous stroke, anaemia, antiphospholipid syndrome, arterial dissection, the consumption of toxic substances and head trauma have been described. We present a young man with a case history of tobacco and cocaine abuse who suffered a mild head trauma, with normal neurological examination, and a computed tomography scan image of a right anterior cerebral infarction. Serum biochemistry showe

Clinical characteristics and outcomes of Japanese atrial fibrillation patients with poor medication adherence: A sub-analysis of the GENERAL study.

BACKGROUND: Oral anticoagulation therapy is essential for preventing stroke in patients with atrial fibrillation (AF). However, poor anticoagulant adherence may hamper medication safety and effective prevention of stroke. METHODS: GENERAL is a prospective cohort study of AF patients taking rivaroxaban prescribed by general practitioners in Japan. In this study, anticoagulant adherence was calculated as the proportion of days covered (PDC), and patients were retrospectively divided into two groups: good adherence (PDC ≥80 %) and poor adherence (<80 %). RESULTS: Of 5680 patients in the GENERAL

Stroke in congenital heart disease and patent foramen ovale.

Congenital heart disease is usually regarded as an esoteric field of medicine, dealt with primarily by dedicated specialists. However, over the last two decades, increased attention has been given by the medical profession, the media and the general public to the possible association between a minor and common congenital heart defect, namely patent foramen ovale, and stroke. In recent months, unusual and unfortunate circumstances have made this topic one of the most fiercely debated medical issues in Israel. It is the belief of the authors of this paper that the association of PFO and stroke c

Cardioembolic infarction in the Sagrat Cor-Alianza Hospital of Barcelona Stroke Registry.

OBJECTIVES: To describe the clinical features of cardioembolic infarcts. MATERIAL & METHODS: Cardioembolic infarct was diagnosed in 231 (15.4%) of 1500 consecutive stroke patients included in a prospective stroke registry over an 8-year period. RESULTS: Cardiac sources of emboli included isolated atrial dysrhythmia (57.1%), valvular heart disease (20.3%), and coronary artery disease (18.2%). Patients with cardioembolic stroke showed a significantly higher (P < 0.00001) frequency of sudden onset of neurological deficit (79.7%) and altered consciousness (31.2%) than patients with lacunar infar…

Weighing the risks and benefits of anticoagulation in atrial fibrillation: a case report of left atrial appendage absence in a patient referred for procedural occlusion.

BACKGROUND: The absence of the left atrial appendage is an exceedingly rare structural variant that could have important implications for anticoagulation regimens in patients with atrial fibrillation. CASE SUMMARY: We report the case of a 63-year-old Puerto Rican female with a history of hypertension, cerebral artery aneurysms, and type 2 diabetes mellitus who suffered multiple haemorrhagic strokes. The patient had never received anticoagulation therapy. During the indicated stroke work-up, the patient was found to have paroxysmal atrial fibrillation. Given the patients high risk for thromboe

Outcomes of Valvular Endocarditis in Patients With and Without Pericardial Effusion: A National Inpatient Sample Study.

Over the last decade, hospitalizations for infective endocarditis (IE) have been steadily increasing, leading to a significant healthcare bu … vs 7.3%, P < 0.001). The rates of heart failure, heart block, renal failure, cardiogenic shock, and embolic stroke were higher on PCE group. We found that presence of PCE is associated with higher inhospital mortality, longer length of stay, and greater utilization of cardiac surgery, as well as presence of heart failure, heart block, cardiogenic shock, and embo …

Cardiac papillary fibroelastomas: A 10-year single-center surgical experience and long-term echocardiographic follow-up study.

AIMS: Limited contemporary data are available on the clinical and echocardiographic outcomes after surgery for cardiac papillary fibroelastoma (CPF). The aim of this study was to review the clinical manifestations, pathological characteristics, surgical management, and prognoses of patients with histologically verified CPF, who underwent surgery at our cardiac surgery center from 2008 to 2018. METHODS AND RESULTS: Twelve patients of median age 62 years (28 to 77 years) were treated. Embolic stroke or transient ischemic attack (five patients, 42%) were the only CPF clinical manifestations. Ele…

Long-term outcomes of percutaneous coronary interventions within coronary artery bypass grafts.

INTRODUCTION: The long-term outcomes of percutaneous coronary interventions (PCIs) within coronary artery bypasses are still poor as compared to those within native coronary arteries. Thus, we aimed to assess predictors of long-term clinical outcomes after PCIs of coronary bypasses. MATERIAL AND METHODS: We enrolled 194 patients after PCIs of coronary artery bypasses at the mean age of 69.5 ±8.3 years (73.2% male). The primary study endpoint was a combination of target-vessel revascularization (TVR), target-lesion revascularization (TLR), myocardial infarction (MI), stroke, coronary artery by

[Multiple small subcortical infarction required to distinguish from lacunar infarction: evaluation by use of diffusion-weighted imaging].

Lacunar infarctions are small lesions caused by occlusion of the deep and penetrating vessels. Occlusion of such vessels are resulted from thrombosis based on atherosclerotic change. However, we occasionally encounter a patient with lacunar infarction seemed to be caused by embolic mechanism, as who has had previous experience of TIA or presented with clinical symptoms suddenly. Diffusion-weighted imaging (DWI) has high accuracy for depicting small ischemic lesions and discrimination of recent infarctions from old ones. We studied frequency, risk factors and stroke mechanism in the territory o

Direct Oral Anticoagulants Compared With Warfarin in Patients With Atrial Fibrillation and Valvular Heart Disease Without Mechanical Valves.

BACKGROUND: Despite proven efficacy and safety of direct oral anticoagulants (DOACs) over warfarin in patients with atrial fibrillation (AF), data on patients with AF and valvular heart disease remain scarce. We aimed to evaluate the DOACs compared with warfarin among patients with AF and valvular heart disease. METHODS AND RESULTS: We conducted a retrospective cohort study of patients ≥18 years of age, who had AF and valvular heart disease, and were new users of DOACs or warfarin. The primary effectiveness outcomes were ischemic stroke or systemic embolism, and bleeding for safety. We used C

Posterior cerebral artery territory infarcts in the New England Medical Center Posterior Circulation Registry.

BACKGROUND: Infarcts in the territory of the posterior cerebral arteries (PCAs) are common. Although associated clinical symptoms and signs are known, the mechanisms of stroke and the anatomical distribution of PCA territory lesions caused by the various stroke mechanisms are less well defined. Published reports have selected only special subgroups of patients. PATIENTS AND METHODS: We studied stroke mechanisms, infarct distribution, and clinical findings among 79 patients in the New England Medical Center Posterior Circulation Registry in whom brain imaging scans showed infarcts that involve