Combined use of anticoagulant and antiplatelet on outcome after stroke in patients with nonvalvular atrial fibrillation and systemic atherosclerosis

Heo, JoonNyung; Lee, Hyungwoo; Lee, Il Hyung; Lim, In Hwan; Hong, Soon-Ho; Shin, Joonggyeong; Nam, Hyo Suk; Kim, Young Dae

doi:10.1038/s41598-023-51013-3

Cited by 4 publications

(1 citation statement)

References 32 publications

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“…Oral anticoagulant plus an antiplatelet agent was associated with a decreased risk of all-cause mortality and myocardial infarction but an increased risk of ischemic stroke among this population. 13 So in patients with aortic plaques, particularly if mobile or with possible thrombotic component like the cases we presented, the decision on anticoagulant therapy should be considered on an individual basis after careful evaluation of the risk/benefit ratio.…”

Section: Atherosclerotic Plaque and Stroke In Patients With Afmentioning

confidence: 92%

3‐D transesophageal echocardiography aids in assessment of embolic stroke due to aortic atherosclerotic plaque: A case series

Wen,

Naqvi

2024

Echocardiography

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Atherosclerosis is the most common cause of heart disease and stroke. Plaque thickness ≥4 mm in the ascending aorta or aortic arch is strongly correlated with cerebral embolic events and ischemic stroke. However, despite imaging workup, the cause of embolic stroke remains unidentified in many patients. Transesophageal echocardiography (TEE) is the preferred echocardiographic method for the evaluation of cardiac source of emboli. 2D TEE imaging evaluates aortic root and aortic arch in a single plane or two planes with biplane imaging. However, 2D TEE often fails to detect mobile or complex components in the ascending aorta and aortic arch plaques. The routine availability of 3D TEE in current ultrasound systems may significantly improve the assessment of aortic plaques as a potential embolic source. In this case series, we present four consecutive patients with stroke who underwent TEE by a single cardiologist for possible cardioembolic source. Some of these patients may have been labelled as “cryptogenic stroke” or “embolic stroke of undetermined source” (ESUS) due to the presence of insignificant or nonmobile ascending aortic or aortic arch plaques on 2D TEE imaging. In our four consecutive patients with ESUS who underwent TEE by a single operator, 3D TEE showed complex aortic arch plaques with ulceration with mobile components and established these plaques as the likely source of embolic stroke.

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Section: Atherosclerotic Plaque and Stroke In Patients With Afmentioning

confidence: 92%

3‐D transesophageal echocardiography aids in assessment of embolic stroke due to aortic atherosclerotic plaque: A case series

Wen,

Naqvi

2024

Echocardiography

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Ischemic Stroke: Pathophysiology and Evolving Treatment Approaches

Majumder

2024

J Exp Neurosci

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Stroke remains a leading cause of mortality and disability, with ischemic stroke being the most common type. It occurs due to reduced cerebral blood flow, leading to a cascade of events initiated by oxygen and nutrient deprivation, triggering excitotoxicity, oxidative stress, and inflammation and finally culminating in neuronal injury and death. Key molecular players in ischemic stroke include glutamate receptors, acid-sensing ion channels, and purinergic receptors, exacerbating cellular damage through calcium influx, oxidative stress, and mitochondrial dysfunction. Understanding these mechanisms has shaped therapeutic strategies, such as neuroprotective agents and stem cell therapies. Current treatments such as tissue plasminogen activator (tPA) emphasize timely intervention, yet challenges persist in patient-specific variability and accessibility. This review provides an overview of ischemic stroke pathophysiology, emphasizing cellular responses to ischemia and current and future therapeutic approaches including stem cell therapies aimed at mitigating stroke-induced disabilities and improving long-term outcomes.

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Assessment of Coronary Artery Disease in Non-Valvular Atrial Fibrillation: Is This Light at the End of the Tunnel?

Batta,

Hatwal,

Sharma

2024

VHRM

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Non-valvular atrial fibrillation (NVAF) is the most common sustained arrhythmia worldwide, and is associated with significant morbidity and mortality. Increasing life expectancy, coupled with a surge in comorbidity burden, has resulted in a sharp increase in NVAF prevalence over the last three decades. Coronary artery disease (CAD) is an important and clinically relevant risk factor of AF. Concomitant CAD has significant implications for AF management and is a major determinant of the overall outcomes. Shared risk factors, a common pathophysiological basis, and heightened thrombogenesis culminating in cardiovascular adverse events, highlight the close association between the two. The clinical course of AF is worse when associated with CAD, resulting in poor heart rate control, increased propensity to develop stroke and myocardial infarction, increased likelihood of acute presentation with hemodynamic collapse and pulmonary edema, increased bleeding tendencies, and poor response to ablation therapies. Emerging research highlighting the significant role of underlying CAD as an independent predictor of thromboembolic risk has paved the way for the adoption of CAD beyond prior myocardial infarction into the symbol “V” of the CHA2DS2-VASc score. In our opinion, elderly patients aged >65 years with AF, with a history of one or more cardiovascular comorbidities, or evidence of atherosclerosis in other vascular beds should warrant a closer look and a dedicated effort to look for associated CAD. This would allow for a more holistic and comprehensive approach to patients with AF and ultimately help reduce the disease burden and improve the overall outcomes.

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Combined use of anticoagulant and antiplatelet on outcome after stroke in patients with nonvalvular atrial fibrillation and systemic atherosclerosis

Cited by 4 publications

References 32 publications

3‐D transesophageal echocardiography aids in assessment of embolic stroke due to aortic atherosclerotic plaque: A case series

3‐D transesophageal echocardiography aids in assessment of embolic stroke due to aortic atherosclerotic plaque: A case series

Ischemic Stroke: Pathophysiology and Evolving Treatment Approaches

Assessment of Coronary Artery Disease in Non-Valvular Atrial Fibrillation: Is This Light at the End of the Tunnel?

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