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on 30 August 2010

Ingelheim, Germany – Report: The European Society of Cardiology (ESC) today issued a revised version of  guidelines for the management of atrial fibrillation (AF), including guidance on the role of thge new oral treatment, dabigatran etexilate, for the prevention of embolism in patients with atrial fibrillation (AF).

At the same time, Boehringer Ingelheim confirms that Food and Drug Administration (FDA) granted a priority review designation for Boehringer Ingelheim’s novel oral direct thrombin inhibitor (DTI) dabigatran etexilate for the prevention of stroke in AF. A priority review designation is given to new drugs that are expected to offer large advances in treatment, or provide a treatment where no adequate therapy exists. An FDA advisory committee will meet on Monday, September 20th, to review and discuss dabigatran etexilate data.

In addition to the US, the registration process for dabigatran etexilate is underway in EU, Japan and other countries. The company expects to receive a marketing authorization for dabigatran etexilate in first countries by end of 2010 or beginning of 2011. The drug availability was expected according to many opinions in fall winter 2010. Similar molecules are expected also by other companies. For people with AF, it is the first competitor to warfarin that is likely to be marketed for stroke prevention, although caution is still urged by reviewers. Stay tuned….

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The Italian online version of the Merck manual depict uncommon cerebrovascular syndromes (subclavian steal, drop attack). Seems not updated since long time.  Dipiridamole, according to the web page,  is considered not effective. The chapter ends with something that sounds like “…a an aggressive treatment for stroke is not recommended…”.

“… Il trattamento aggressivo non sempre è giustificato, specialmente quando i deficit neurologici sono gravi o quando vi siano comorbilità associate (v. Cap. 294)....”

QJM Advance Access originally published online on July 2, 2010

ABCD and ABCD2 scores of ≥3 may be clinically useful in identifying TIA outpatients at raised risk of stroke in the medium to long term.

QJM 2010 103(9):679-685

see for ABCD Rothwell PM, Giles MF, Flossman E, Lovelock CE, Redgrave JNE, Warlow CP, et al. A simple score (ABCD) to identify individuals at high early risk of stroke after transient ischemic attack. Lancet (2005) 366:29–36

or Sciolla R, Melis F, for the SINPAC Group. Rapid identification of high-risk transient ischemic attacks. Prospective validation of the ABCD Score. Stroke (2008) 39:297–302