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Apixaban is recommended by the National Institute for Health and Clinical Excellence for the prevention of stroke and systemic embolism in people with non-valvular atrial fibrillation and at least one of the following risk factors: prior stroke or transient ischemic attack, age 75 years or older, diabetes, or symptomatic heart failure.
They are effective in the arterial circulation where classical Vitamin K antagonist anticoagulants have minimal effect. [2] Antiplatelet drugs are widely used in primary and secondary prevention of thrombotic disease, especially myocardial infarction and ischemic stroke. [1]
The incidence of post-stroke depression peaks at 3–6 months and usually resolves within 1–2 years after the stroke, although a minority of patients can go on to develop chronic depression. The diagnosis of post-stroke depression is complicated by other consequences of stroke such as fatigue and psychomotor retardation – which do not ...
[28] [29] This is consistent with a recent decision analysis model showing how the 'tipping point' on the decision to anticoagulate has changed with the availability of the 'safer' DOAC drugs, where the threshold for offering stroke prevention (i.e. oral anticoagulation) is a stroke rate of approximately 1%/year. [20] [30]
A cerebroprotectant (formerly known as a neuroprotectant) is a drug that is intended to protect the brain after the onset of acute ischemic stroke. [1] As stroke is the second largest cause of death worldwide and a leading cause of adult disability, over 150 drugs have been tested in clinical trials to provide cerebroprotection.
Anticoagulants such as heparin and warfarin have shown no benefit over aspirin with regards to five-year survival. [4] Patients who have lacunar strokes have a greater chance of surviving beyond thirty days (96%) than those with other types of stroke (85%), and better survival beyond a year (87% versus 65-70%).
The study found that dabigatran had comparable rates of ischemic stroke or systemic embolism, intracerebral haemorrhage, and all-cause mortality when compared to other anticoagulants like apixaban, edoxaban, and rivaroxaban. Notably, apixaban was associated with a lower risk of gastrointestinal bleeding than dabigatran and the others.
Hemorrhagic transformation is a process which involves the bleeding of brain tissue that has been affected by the stroke and can take two forms: petechial hemorrhage and parenchymal hemorrhage. [1] HT can lead to further damage to the brain tissue and worsen the outcome of the initial stroke.
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