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Anticoagulant therapy is recommended for the secondary prevention of stroke in patients with atrial fibrillation (AF). T he identification of patients at high risk for early recurrence, which are potential candidates to prompt anticoagulation, is crucial to justify the risk of bleeding associated with early anticoagulant treatment. The aim of this study was to evaluate in patients with acute ischemic stroke and AF the association between findings at trans-thoracic echocardiography (TTE) and 90 days recurrence. In consecutive patients with acute ischemic stroke and AF, TTE was performed within 7 days from hospital admission. Study outcomes were recurrent ischemic cerebrovascular events (stroke or TIA) and systemic embolism. 854 patients (mean age 76.3 ± 9.5 years) underwent a TTE evaluation; 63 patients (7.4 %) had at least a study outcome event. Left atrial thrombosis was present in 11 patients (1.3 %) among whom 1 had recurrent ischemic event. Left atrial enlargement was present in 548 patients (64.2 %) among whom 51 (9.3 %) had recurrent ischemic events. The recurrence rate in the 197 patients with severe left atrial enlargement was 11.7 %. On multivariate analysis, the presence of atrial enlargement (OR 2.13; 95 % CI 1.06-4.29, p = 0.033) and CHA2DS2-VASc score (OR 1.22; 95 % CI 1.04-1.45, p = 0.018, for each point increase) were correlated with ischemic recurrences. In patients with AF-associated acute stroke, left atrial enlargement is an independent marker of recurrent stroke and systemic embolism. The risk of recurrence is accounted for by severe atrial enlargement. TTE-detected left atrial thrombosis is relatively uncommon.

Paciaroni et AL JON 2015

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Starting on 29 May 2013 with many Oral Sessions fresh updates on Stroke Large clinical trials (RCTs)
at 11:25-12:30 Room: Auditorium INTERACT2, STICH II, CHIMES, IST-3, SPS3, next day PC-Trial, RESPECT, ALIAS, PHANTOM-S, ICSS, EVA-3S, STICH II.
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Cardioembolic Stroke as one of the  leading cause of global  disability deserves much more attention from health care authorities, the world stroke organization promotes the suscription of the “world stroke charter”

a signature may save lives

……We call on national governments, policy makers, payers and healthcare providers to take action to improve the lives of those with AF and drastically reduce the risks and costs of AF-related stroke.

How can we monitor Dabigatran effects ?

Dabigatran, like argatroban, does prolong the prothrombin time (PT) and partial thromboplastin time (PTT). It also prolongs the thrombin time (TT), which means it  generates a false decrease in fibrinogen assay results, given that the fibrinogen assay is based on the TT. Dabigatran’s plasma concentration peaks about two hours after the drug is taken, and its half-life is 12 to 17 hours, so the PT, PTT, and fibrinogen assays should be made at least 24 hours after discontinuing dabigatran. Biophen’s Hemoclot Thrombin Inhibitor allows exploration of all the direct anti-thrombin inhibitors (DTI), targeted to human thrombin.

and the winner is…. I extrapolated 220.000 € to Spanish projects while                                100.000 to Italy, Romania, Belg…

Paris, France and Ingelheim, Germany, 29th August 2011 – Last night at an award ceremony in Paris, the 32 winning projects of the global disease awareness initiative 1 Mission 1 Million – Getting to the Heart of Stroke were announced. The projects were chosen by the public and a panel of experts. They will be awarded a share of the €1 million donation to fulfil the overall mission of preventing as many as one million atrial fibrillation (AF)-related strokes through awareness campaigns. 1 Mission 1 Million is supported by over 45 third-party organisations around the world and is sponsored by Boehringer Ingelheim.

The 1 mission 1 million site report that soon the on line voting will be open ….

Sorry, the deadline for application was 31st december 2010. All submitted projects are now being reviewed by our expert panel.
Vote online for your favourite ideas from mid-February 2011
Tell friends and family to visit the campaign website

From Louisiana a new survey on dabigatran published on circulation in january : Dabigatran is a reasonable alternative to warfarin in patients requiring cardioversion.

On 31 december close the chance to’ submit applications for the BI sponsored initiative

Current Issue Volume 9, Issue 12 (December, 2010) Issue Contents: (Pages 1139-1232)

Because of the necessary trade-off between stroke prevention and bleeding with both doses of dabigatran, consultation with patients regarding their preferences for treatment dose will be even more important to ascertain their threshold for stroke prevention over increased bleeding risk or vice versa.

GermanyBayer has announced preliminary results of the ROCKET AF study, showed how thet the new oral factor Xa inhibitor rivaroxaban (Xarelto (R) ) met its primary efficacy end point of noninferiority to dose-adjusted warfarin on all-cause stroke and non-CNS embolism. The rates of the composite of major and nonmajor clinically relevant bleeding were comparable (the primary safety end point). The overall feeling in the field is not completely satisfactory, but is better to wait the full paper.