Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-19T12:36:17.030Z Has data issue: false hasContentIssue false

Chapter 18 - Drugs, Devices, and Procedural Therapies to Prevent Recurrent Cardiogenic Embolic Stroke

from Part V - Prevention

Published online by Cambridge University Press:  15 December 2020

By
Graeme J. Hankey
Edited by
Jeffrey L. Saver  and
Graeme J. Hankey
Jeffrey L. Saver
Affiliation:
David Geffen School of Medicine, University of Ca
Graeme J. Hankey
Affiliation:
University of Western Australia, Perth
Get access

Summary

Cardiogenic embolism is a common cause of recurrent ischaemic stroke. The cardiac source of embolism is usually the left atrial appendage and atrium due to atrial fibrillation (AF). Other sources include the left ventricle, heart valves and venous system or right atrium, via a patent foramen ovale.The most effective thromboprophylactic is oral anticoagulation, which reduces the risk of recurrent stroke by about two thirds, compared to no anticoagulation. Four target-specific, direct-acting non-vitamin K antagonist oral anticoagulants (NOACs) – the direct thrombin inhibitor dabigatran etexilate, and the factor Xa inhibitors rivaroxaban, apixaban and edoxaban – are at least as efficacious and safe as warfarin, and apixaban is superior to, and as safe as, aspirin, for preventing stroke among patients with AF. Other potential stroke prevention strategies include left atrial appendage occlusion for patients with AF in whom anticoagulation is contraindicated, anticoagulation for left ventricular thrombus and prosthetic heart valves, antibiotics +/– valve surgery for infective endocarditis, and transcatheter device closure of a symptomatic patent foramen ovale.

Keywords

Cardiogenic embolismatrial fibrillationcardiomyopathyanticoagulationwarfarinNOACsatrial appendage occlusionpatent foramen ovalepreventiontreatment
Type
Chapter
Information
Stroke Prevention and Treatment
An Evidence-based Approach
 , pp. 337 - 383
Publisher: Cambridge University Press
Print publication year: 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

ACTIVE Investigators. (2009). Effect of clopidogrel added to aspirin in patients with atrial fibrillation. N Engl J Med, 360, 2066–78.Google Scholar
Albertsen, IE, Rasmussen, LH, Overvad, TF, Graungaard, T, Larsen, TB, Lip, GY. (2013). Risk of stroke or systemic embolism in atrial fibrillation patients treated with warfarin: a systematic review and meta-analysis. Stroke, 44, 1329–36.CrossRefGoogle ScholarPubMed
Alli, OO, Holmes, DR Jr. (2015). Left atrial appendage occlusion for stroke prevention. Curr Probl Cardiol, 40, 429–76.Google Scholar
Almekhlafi, MA, Wilton, SB, Rabi, DM, Ghali, WA, Lorenzetti, DL, Hill, MD. (2009). Recurrent cerebral ischemia in medically treated patent foramen ovale: a meta-analysis. Neurology, 73, 89–97.CrossRefGoogle ScholarPubMed
Ansell, JE, Bakhru, SH, Laulicht, BE, Steiner, SS, Grosso, M, Brown, K, et al. (2014). Use of PER977 to reverse the anticoagulant effect of edoxaban. N Engl J Med, 371, 2141–2Google Scholar
Baddour, LM, Wilson, WR, Bayer, AS, Fowler, VG Jr, Tleyjeh, IM, Rybak, MJ, et al. (2015) Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association. Circulation, 132, 1435–86.Google Scholar
Bala, MM, Paszek, E, Lesniak, W, Wloch-Kopec, D, Jasinska, K, Undas, A. (2018) Antiplatelet and anticoagulant agents for primary prevention of thrombosis in individuals with antiphospholipid antibodies. Cochrane Database Syst Rev, 7, CD012534.Google ScholarPubMed
Beyer-Westendorf, J, Forster, K, Pannach, S, Ebertz, F, Gelbricht, V, Thieme, C, et al. (2014). Rates, management, and outcome of rivaroxaban bleeding in daily care: results from the Dresden NOAC registry. Blood, 124, 955–962.CrossRefGoogle ScholarPubMed
Borre, ED, Goode, A, Raitz, G, Shah, B, Lowenstern, A, Chatterjee, R, et al. (2018). Predicting thromboembolic and bleeding event risk in patients with non-valvular atrial fibrillation: a systematic review. Thromb Haemost, 118, 2171–87.Google ScholarPubMed
Bruins Slot, KM, Berge, E. (2018). Factor Xa inhibitors versus vitamin K antagonists for preventing cerebral or systemic embolism in patients with atrial fibrillation. Cochrane Database Syst Rev, 3, CD008980. doi:10.1002/14651858.CD008980.pub3.Google Scholar
Cannon, CP, Bhatt, DL, Oldgren, J, Lip, GYH, Ellis, SG, Kimura, T, et al.; RE-DUAL PCI Steering Committee and Investigators. (2017). Dual antithrombotic therapy with dabigatran after PCI in atrial fibrillation. N Engl J Med, 377, 1513–24.Google Scholar
Chandrashekhar, Y, Westaby, S, Narula, J. (2009) Mitral stenosis. Lancet, 374, 1271–83.CrossRefGoogle ScholarPubMed
Chen, LY, Norby, FL, Chamberlain, AM, MacLehose, RF, Bengtson, LG, Lutsey, PL, et al. (2019). CHA2DS2-VASc score and stroke prediction in atrial fibrillation in whites, blacks and Hispanics. Stroke, 50, 28–33.Google Scholar
Chi, G, Kerneis, M, Kalayci, A, Liu, Y, Mehran, R, Bode, C, et al (2018). Safety and efficacy of non-vitamin K oral anticoagulant for atrial fibrillation patients after percutaneous coronary intervention: A bivariate analysis of the PIONEER AF-PCI and RE-DUAL PCI trial. Am Heart J, 203,17–24.CrossRefGoogle ScholarPubMed
Connolly, SJ, Pogue, J, Eikelboom, J, Flaker, G, Commerford, P, Franzosi, MG, et al. (2008). Benefit of oral anticoagulant over antiplatelet therapy in atrial fibrillation depends on the quality of international normalized ratio control achieved by centers and countries as measured by time in therapeutic range. Circulation, 118, 2029–37.CrossRefGoogle ScholarPubMed
Connolly, SJ, Ezekowitz, MD, Yusuf, S, Eikelboom, J, Oldgren, J, Parekh, A, et al., for the RE-LY Steering Committee and Investigators. (2009). Dabigatran versus warfarin in patients with atrial fibrillation. N Engl J Med, 361, 1139–51.Google Scholar
Connolly, SJ, Ezekowitz, MD, Yusuf, S, Reilly, PA, Wallentin, L, for the Randomized Evaluation of Long-Term Anticoagulation Therapy Investigators. (2010). Newly identified events in the RE-LY trial (letter to the editor). N Engl J Med, 363, 1875–6.Google Scholar
Connolly, SJ, Eikelboom, JW, Ng, J, Hirsh, J, Yusuf, S, Pogue, J, et al., and the ACTIVE (Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events) Steering Committee and Investigators. (2011a). Net clinical benefit of adding clopidogrel to aspirin therapy in patients with atrial fibrillation for whom vitamin K antagonists are unsuitable. Ann Intern Med, 155, 579–86.Google Scholar
Connolly, SJ, Eikelboom, J, Joyner, C, Diener, HC, Hart, R, Golitsyn, S, et al., and the AVERROES Steering Committee and Investigators. (2011b). Apixaban in patients with atrial fibrillation. N Engl J Med, 364, 806–17.Google Scholar
Connolly, SJ, Milling, TJ, Eikelboom, JW, Gibson, CM, Curnutte, JT, Gold, A, et al., ANNEXA-4 Investigators. (2016). Andexanet Alfa for acute major bleeding associated with factor Xa inhibitors. N Engl J Med, 375, 1131–41.CrossRefGoogle ScholarPubMed
Connolly, SJ, Crowther, M, Eikelboom, JW, Gibson, CM, Curnutte, JT, Lawrence, JH, et al; ANNEXA-4 Investigators. (2019). Full study report of Andexanet Alfa for bleeding associated with factor Xa inhibitors. N Engl J Med, 380, 1326–35.Google Scholar
Das, A, Liu, D. (2015). Novel antidotes for target specific oral anticoagulants. Exp Hematol Oncol, 4, 25.Google Scholar
DeWilde, WJ, Oirbans, T, Verheugt, FW, Kelder, JC, De Smet, JP, Adriaenssens, T, et al.; WOEST Study Investigators. (2013). Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomized, controlled trial. Lancet, 381, 1107–15.Google Scholar
Di Biase, L, Santangeli, P, Anselmino, M, Mohanty, P, Salvetti, I, Gili, S, et al. (2012). Does the left atrial appendage morphology correlate with the risk of stroke in patients with atrial fibrillation? Results from a multicenter study. J Am Coll Cardiol, 60, 531–8.Google Scholar
Diener, HC, Eikelboom, J, Connolly, SJ, Joyner, CD, Hart, RG, Lip, GY, et al.; AVERROES Steering Committee and Investigators. (2012). Apixaban versus aspirin in patients with atrial fibrillation and previous stroke or transient ischaemic attack: a predefined subgroup analysis from AVERROES, a randomized trial. Lancet Neurol, 11, 225–31.CrossRefGoogle ScholarPubMed
Douketis, JD, Spyropoulos, AC, Kaatz, S, Becker, RC, Caprini, JA, Dunn, AS, et al.; BRIDGE Investigators. (2015). Perioperative bridging anticoagulation in patients with atrial fibrillation. N Engl J Med, 373, 823–33.Google Scholar
Eikelboom, JW, Connolly, SJ, Brueckmann, M, Granger, CB, Kappetein, AP, Mack, MJ, et al.; RE-ALIGN Investigators. (2013). Dabigatran versus warfarin in patients with mechanical heart valves. N Engl J Med, 369, 1206–14.CrossRefGoogle ScholarPubMed
Eikelboom, JW, Quinlan, DJ, van Ryn, J, Weitz, JI. (2015). Idarucizumab: the antidote for reversal of dabigatran. Circulation, 132, 2412–22.Google Scholar
European Atrial Fibrillation Trial Study Group. (1993). Secondary prevention in non-rheumatic atrial fibrillation after transient ischemic attack or minor stroke. Lancet, 342, 1255–62.Google Scholar
Freudenberger, RS, Hellkamp, AS, Halperin, JL, Poole, J, Anderson, J, Johnson, G, et al. (2007). Risk of thromboembolism in heart failure: an analysis from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT). Circulation, 115, 2637–41.Google Scholar
Friberg, L, Rosenqvist, M, Lip, GY. (2012). Evaluation of risk stratification schemes for ischaemic stroke and bleeding in 182678 patients with atrial fibrillation: the Swedish Atrial Fibrillation cohort study. Eur Heart J, 33, 1500–10.Google Scholar
Gibson, CM, Mehran, R, Bode, C, Halperin, J, Verheugt, FW, Wildgoose, P, et al. (2016). Prevention of bleeding in patients with atrial fibrillation undergoing PCI. N Engl J Med, 375, 2423–34.Google Scholar
Giugliano, RP, Ruff, CT, Braunwald, E, Murphy, SA, Wiviott, SD, Halperin, JL, et al.; ENGAGE AF-TIMI 48 Investigators. (2013). Edoxaban versus warfarin in patients with atrial fibrillation. N Engl J Med, 369, 2093–104.Google Scholar
Giugliano, RP, Ruff, CT, Rost, NS, Silverman, S, Wiviott, SD, Lowe, C, et al.; ENGAGE AF-TIMI 48 Investigators. (2014). Cerebrovascular events in 21 105 patients with atrial fibrillation randomized to edoxaban versus warfarin: Effective Anticoagulation with Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis in Myocardial Infarction 48. Stroke, 45, 2372–8.Google Scholar
Gladstone, DJ, Spring, M, Dorian, P, for the EMBRACE Investigators and Coordinators. (2014). Atrial fibrillation in patients with cryptogenic stroke. N Engl J Med, 370, 2467–77.Google Scholar
Glund, S, Stangier, J, Schmohl, M, Gansser, D, Norris, S, van Ryn, J, et al. (2015). Safety, tolerability, and efficacy of idarucizumab for the reversal of the anticoagulant effect of dabigatran in healthy male volunteers: a randomised, placebo-controlled, double-blind phase 1 trial. Lancet, 386, 680–90.CrossRefGoogle ScholarPubMed
Goldberger, JJ, Arora, R, Green, D, Greenland, P, Lee, DC, Lloyd-Jones, DM, et al. (2015). Evaluating the atrial myopathy underlying atrial fibrillation: identifying the arrhythmogenic and thrombogenic substrate. Circulation, 132, 278–91.Google Scholar
Goldstein, JN, Refaai, MA, Milling, TJ Jr, Lewis, B, Goldberg-Alberts, R, Hug, BA, et al. (2015). Four-factor prothrombin complex concentrate versus plasma for rapid vitamin K antagonist reversal in patients needing urgent surgical or invasive interventions: a phase 3b, open-label, non-inferiority, randomised trial. Lancet, 385, 2077–87.Google Scholar
Gosselin, RC, Adcock, DM, Bates, SM, Douxfils, J, Favaloro, EJ, Gouin-Thibault, I, et al., International Council for Standardization in Haematology (ICSH). (2018). Recommendations for laboratory measurement of direct oral anticoagulants. Thromb Haemost, 118, 437–50.Google Scholar
Granger, CB, Alexander, JH, McMurray, JJV, Lopes, RD, Hylek, EM, Hanna, M, et al., for the ARISTOTLE Committees and Investigators. (2011). Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med, 365, 981–92.Google Scholar
Gurol, ME. (2018). Nonpharmacological management of atrial fibrillation in patients at high intracranial hemorrhage risk. Stroke, 49, 247–254.Google Scholar
Hankey, GJ, Patel, MR, Stevens, SR, Becker, RC, Breithardt, G, Carolei, A, et al.; ROCKET AF Steering Committee Investigators. (2012). Rivaroxaban compared with warfarin in patients with atrial fibrillation and previous stroke or transient ischaemic attack: a subgroup analysis of ROCKET AF. Lancet Neurol, 11, 315-22.Google Scholar
Hankey, GJ, McQuillan, BM. (2018). Patent foramen ovale closure: the pendulum swings. Circulation, 137, 1991–3.Google Scholar
Hankey, GJ, Stevens, SR, Piccini, JP, Lokhnygina, Y, Mahaffey, KW, Halperin, JL, et al.; ROCKET AF Steering Committee and Investigators. (2014). Intracranial hemorrhage among patients with atrial fibrillation anticoagulated with warfarin or rivaroxaban: the rivaroxaban once daily, oral, direct factor XA inhibition compared with vitamin K antagonism for prevention of stroke and embolism trial in atrial fibrillation. Stroke, 45, 1304–12.Google Scholar
Hanif, H, Belley-Cote, EP, Alotaibi, A, Dvirnik, N, Neupane, B, Beyene, J, et al. (2018). Left atrial appendage occlusion for stroke prevention in patients with atrial fibrillation: a systematic review and network meta-analysis of randomized controlled trials. J Cardiovasc Surg (Torino), 59, 128–39.Google Scholar
Hart, RG, Diener, HC, Yang, S, Connolly, SJ, Wallentin, L, Reilly, PA, et al. (2012). Intracranial hemorrhage in atrial fibrillation patients during anticoagulation with warfarin or dabigatran: the RE-LY trial. Stroke, 43, 1511–17.Google Scholar
Hart, RG, Pearce, LA, Aguilar, MI. (2007). Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med, 146, 857–67.CrossRefGoogle ScholarPubMed
Healey, JS, Eikelboom, J, Douketis, J, Wallentin, L, Oldgren, J, Yang, S, et al. (2012). Periprocedural bleeding and thromboembolic events with dabigatran compared with warfarin: results from the Randomized Evaluation of Long- Term Anticoagulation Therapy (RE-LY) randomized trial. Circulation, 126, 343–8.Google Scholar
Healey, JS, Hart, RG, Pogue, J, Pfeffer, MA, Hohnloser, SH, De Caterina, R, et al. (2008). Risks and benefits of oral anticoagulation compared with clopidogrel plus aspirin in patients with atrial fibrillation according to stroke risk: the atrial fibrillation clopidogrel trial with irbesartan for prevention of vascular events (ACTIVE-W). Stroke, 39, 1482–6.Google Scholar
Heidbuchel, H, Verhamme, P, Alings, M, Antz, M, Hacke, W, Oldgren, J, et al.; European Heart Rhythm Association. (2013). European Heart Rhythm Association Practical Guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation. Europace, 15, 625–51.CrossRefGoogle ScholarPubMed
Heidbuchel, H, Verhamme, P, Alings, M, Antz, M, Diener, HC, Hacke, W, et al.; ESC Scientific Document Group. (2017) Updated European Heart Rhythm Association practical guide on the use of non-vitamin-K antagonist anticoagulants in patients with non-valvular atrial fibrillation: executive summary. Eur Heart J, 38, 2137–49.Google Scholar
Heo, YA. (2018). Andexanet alfa: first global approval. Drugs, 78, 1049–55.Google Scholar
Hijazi, Z, Lindbäck, J, Alexander, JH, Hanna, M, Held, C, Hylek, EM, et al., for the ARISTOTLE and STABILITY Investigators. (2016a). The ABC (age, biomarkers, clinical history) stroke risk score: a biomarker-based risk score for predicting stroke in atrial fibrillation. Eur Heart J, 37, 1582–90.Google Scholar
Hijazi, Z, Oldgren, J, Lindbäck, J, Alexander, JH, Connolly, SJ, Eikelboom, JW, et al., for the ARISTOTLE and RE-LY Investigators. (2016b). The novel biomarker-based ABC (age, biomarkers, clinical history)-bleeding risk score for patients with atrial fibrillation: a derivation and validation study. Lancet, 387, 2302–11.Google Scholar
Homma, S, Sacco, RL, Di Tullio, MR, Sciacca, RR, Mohr, JP; PFO In Cryptogenic Stroke Study (PICSS) Investigators. (2002). Effect of medical treatment in stroke patients with patent foramen ovale: Patent foramen ovale In Cryptogenic Stroke Study. Circulation, 105, 2625–31.Google Scholar
Huang, WY, Singer, DE, Wu, YL, Chiang, CE, Weng, HH, Lee, M, et al. (2018). Association of intracranial haemorrhage risk with non-vitamin K antagonist oral anticoagulant use vs aspirin use. A systematic review and meta-analysis. JAMA Neurol, 75, 1511–18.Google Scholar
Idarucizumab (Praxbind) – an antidote for dabigatran. (2015). Med Lett Drugs Ther, 57, 157–8.Google Scholar
Iversen, K, Ihlemann, N, Gill, SU, Madsen, T, Elming, H, Jensen, KT, et al. (2019). Partial oral versus intravenous antibiotic treatment of endocarditis. N Engl J Med, 380, 415–24.Google Scholar
Jonas, DE, Kahwati, LC, Yun, JDY, Middleton, JC, Coker-Schwimmer, M, Asher, GN. (2018). Screening for atrial fibrillation with electrocardiography: evidence report and systematic review for the US Preventive Services Task Force. JAMA, 320, 485–98.Google Scholar
Kasner, SE, Swaminathan, B, Lavados, P, Sharma, M, Muir, K, Veltkamp, R, et al.; NAVIGATE ESUS Investigators. (2018). Rivaroxaban or aspirin for patent foramen ovale and embolic stroke of undetermined source: a prespecified subgroup analysis from the NAVIGATE ESUS trial. Lancet Neurol, 17, 1053–60.Google Scholar
Kernan, WN, Ovbiagele, B, Black, HR, Bravata, DM, Chimowitz, MI, Ezekowitz, MD, et al. (2014). Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 45, 2160–236.CrossRefGoogle ScholarPubMed
Kontny, F, Dale, J, Abildgaard, U, Pedersen, TR. (1997). Randomized trial of low molecular weight heparin (dalteparin) in prevention of left ventricular thrombus formation and arterial embolism after acute anterior myocardial infarction: the Fragmin in Acute Myocardial Infarction (FRAMI) Study. J Am Coll Cardiol, 30,962–9.Google Scholar
Kuijpers, T, Spencer, FA, Siemieniuk, RAC, Vandvik, PO, Otto, CM, Lytvyn, L, et al. (2018). Patent foramen ovale closure, antiplatelet therapy or anticoagulation therapy alone for management of cryptogenic stroke? A clinical practice guideline. BMJ, 362, k2515.Google Scholar
Leyden, JM, Kleinig, TJ, Newbury, J, Castle, S, Cranefield, J, Anderson, CS, et al. (2013). Adelaide Stroke Incidence Study: declining stroke rates but many preventable cardioembolic strokes. Stroke, 44, 1226–31.CrossRefGoogle ScholarPubMed
Lindahl, TL, Wallstedt, M, Gustafsson, KM, Persson, E, Hillarp, A. (2015). More efficient reversal of dabigatran inhibition of coagulation by activated prothrombin complex concentrate or recombinant factor VIIa than by four-factor prothrombin complex concentrate. Thromb Res, 135, 544–7.Google Scholar
Lip, GY, Nieuwlaat, R, Pisters, R, Lane, DA, Crijns, HJ. (2010). Refining clinical risk stratification for predicting stroke and thromboembolism in AF using a novel risk factor-based approach: the Euro Heart Survey on Atrial Fibrillation. Chest, 137, 263–72.Google Scholar
Lowenstern, A, Al-Khatib, SM, Sharan, L, Chatterjee, R, Allen LaPointe, NM, Shah, B, et al. (2018). Interventions for preventing thromboembolic events in people with atrial fibrillation. A systematic review. Ann Intern Med, 169, 774–87.Google Scholar
Lu, G, DeGuzman, FR, Hollenbach, SJ, Karbarz, MJ, Abe, K, Lee, G, et al. (2013). A specific antidote for reversal of anticoagulation by direct and indirect inhibitors of coagulation factor Xa. Nat Med, 19, 446–51.Google Scholar
Mahajan, N, Ganguly, J, Simegn, M, Bhattacharya, P, Shankar, L, Madhavan, R, et al. (2010). Predictors of stroke in patients with severe systolic dysfunction in sinus rhythm: role of echocardiography. Int J Cardiol, 145, 87–9.Google Scholar
Maheshwari, A, Norby, FL, Roetker, NS, Soliman, EZ, Koene, RJ, Rooney, MR, et al. (2019). Refining predictions of atrial fibrillation-related stroke using the P2- CHA2DS2-VASc score. ARIC and MESA. Circulation, 139,180–91.Google Scholar
Majeed, A, Agren, A, Holmstrom, M, Bruzelius, M, Chaireti, R, Odeberg, J, et al. (2017). Management of rivaroxaban- or apixaban-associated major bleeding with prothrombin complex concentrates: a cohort study. Blood, 130,1706–12Google Scholar
Mas, JL, Arquizan, C, Lamy, C, Zuber, M, Cabanes, L, Derumeaux, G, et al., and the Patent Foramen Ovale and Atrial Septal Aneurysm Study Group. (2001). Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm, or both. N Engl J Med, 345, 1740–6.Google Scholar
Mas, JL, Derumeaux, G, Guillon, B, Massardier, E, Hosseini, H, Mechtouff, L, et al., CLOSE Investigators. (2017) Patent foramen ovale closure or anticoagulation vs. antiplatelets after stroke. N Engl J Med, 377, 1011–21.Google Scholar
Massel, DR, Little, SH. (2013). Antiplatelet and anticoagulation for patients with prosthetic heart valves. Cochrane Database Syst Rev, 7, CD003464. doi:10.1002/14651858.CD003464.pub2.Google Scholar
Mazzucco, S, Li, L, Binney, L, Rothwell, PM; Oxford Vascular Study Phenotyped Cohort. (2018). Prevalence of patent foramen ovale in cryptogenic transient ischaemic attack and non-disabling stroke at older ages: a population-based study, systematic review, and meta-analysis. Lancet Neurol; 17, 609–17.Google Scholar
McGrath, ER, Kapral, MK, Fang, J, Eikelboom, JW, o Conghaile, A, Canavan, M, et al., and the Investigators of the Registry of the Canadian Stroke Network. (2012). Which risk factors are more associated with ischemic stroke than intracerebral hemorrhage in patients with atrial fibrillation? Stroke, 43, 2048–54.Google Scholar
Merkler, AE, Gialdini, G, Yaghi, S, Okin, PM, Iadecola, C, Navi, BB, Kamel, H. (2017). Safety outcomes after percutaneous transcatheter closure of patent foramen ovale. Stroke, 48, 3073–7.Google Scholar
Mir, H, Siemieniuk, RAC, Ge, LC, Foroutan, F, Fralick, M, Syed, T, et al (2018). Patent foramen ovale closure, antiplatelet therapy or anticoagulation in patients with patent foramen ovale and cryptogenic stroke: a systematic review and network meta-analysis incorporating complementary external evidence. BMJ Open, 8, e023761.CrossRefGoogle ScholarPubMed
Nishimura, RA, Otto, CM, Bonow, RO, Carabello, BA, Erwin, JP 3rd, Guyton, RA, et al. (2014). 2014 AHA/ACC Guideline for the Management of Patients with Valvular Heart Disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, 129, 2440–92.Google Scholar
Ng, KKH, Whiteley, W. (2017). Anticoagulation timing for atrial fibrillation in acute ischemic stroke: time to reopen Pandora’s box? JAMA Neurol, 74, 1174–5.Google Scholar
Ntaios, G, Papavasileiou, V, Diener, HC, Makaritsis, K, Michel, P. (2017). Nonvitamin-K-antagonist oral anticoagulants versus warfarin in patients with atrial fibrillation and previous stroke or transient ischemic attack: an updated systematic review and meta-analysis of randomized controlled trials. Int J Stroke, 12, 589–96.CrossRefGoogle ScholarPubMed
Ntaios, G, Papavasileiou, V, Sagris, D, Makaritsis, K, Vemmos, K, Steiner, T, Michel, P. (2018). Closure of patent foramen ovale versus medical therapy in patients with cryptogenic stroke or transient ischemic attack: updated systematic review and meta-analysis. Stroke, 49, 412–18.Google Scholar
Oldgren, J, Alings, M, Darius, H, Diener, HC, Eikelboom, J, Ezekowitz, MD, et al., and the RE-LY Investigators. (2011). Risks for stroke, bleeding, and death in patients with atrial fibrillation receiving dabigatran or warfarin in relation to the CHADS2 score: a subgroup analysis of the RE-LY trial. Ann Intern Med, 155, 660–7.Google Scholar
Olesen, JB, Lip, GY, Hansen, ML, Tolstrup, JS, Lindhardsen, J, Selmer, C, et al. (2011). Validation of risk stratification schemes for predicting stroke and thromboembolism in patients with atrial fibrillation: a nationwide cohort study. BMJ, 342, d124.Google Scholar
Patel, MR, Mahaffey, KW, Garg, J, Pan, G, Singer, DE, Hacke, W, et al., for the ROCKET AF Investigators. (2011). Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med, 365, 883–91.Google Scholar
Pisters, R, Lane, DA, Nieuwlaat, R, de Vos, CB, Crijns, HJ, Lip, GY. (2010). A novel user-friendly score (HAS-BLED) to assess one-year risk of major bleeding in AF patients: the Euro Heart Survey. Chest, 138, 1093–100.Google Scholar
Pollack, CV Jr, Reilly, PA, Eikelboom, J, Glund, S, Verhamme, P, Bernstein, RA, et al. (2015). Idarucizumab for Dabigatran Reversal. N Engl J Med. 373, 511–20.Google Scholar
Pollack, CV Jr, Reilly, PA, van Ryn, J, Eikelboom, JW, Glund, S, Bernstein, RA, et al. (2017). Idarucizumab for dabigatran reversal – full cohort analysis. N Engl J Med, 377, 431–41.Google Scholar
Powers, WJ. (2018) Additional factors in considering patent foramen ovale closure to prevent recurrent ischemic stroke. JAMA Neurol, 75, 895.Google Scholar
Reddy, VY, Sievert, H, Halperin, J, Doshi, SK, Buchbinder, M, Neuzil, P, et al., PROTECT AF Steering Committee and Investigators. (2014). Percutaneous left atrial appendage closure vs warfarin for atrial fibrillation: a randomized clinical trial. JAMA, 312, 1988–98.Google Scholar
Reddy, VY, Doshi, SK, Kar, S, Gibson, DN, Price, MJ, Huber, K, et al.; PREVAIL and PROTECT AF Investigators. (2017). 5-year outcomes after left atrial appendage closure: from the PREVAIL and PROTECT AF trials. J Am Coll Cardiol, 70, 2964–75.CrossRefGoogle ScholarPubMed
Reddy, VY, Akehurst, RL, Amorosi, SL, Gavaghan, MB, Hertz, DS, Holmes, DR Jr. (2018). Cost-effectiveness of left atrial appendage closure with the WATCHMAN device compared with warfarin or non-vitamin K antagonist oral anticoagulants for secondary prevention in nonvalvular atrial fibrillation. Stroke, 49, 1464–70.Google Scholar
Ruff, CT, Giugliano, RP, Braunwald, E, Hoffman, EB, Deenadayalu, N, Ezekowitz, MD, et al. (2014). Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. Lancet, 383, 955–62.Google Scholar
Ruff, CT, Giugliano, RP, Braunwald, E, Morrow, DA, Murphy, SA, Kuder, JF, et al. (2015). Association between edoxaban dose, concentration, anti-factor Xa activity, and outcomes: an analysis of data from the randomised, double-blind ENGAGE AF-TIMI 48 trial. Lancet, 385, 2288–95.Google Scholar
Sahay, S, Nombela-Franco, L, Rodes-Cabau, J, Jimenez-Quevedo, P, Salinas, P, Biagioni, C, et al. (2017). Efficacy and safety of left atrial appendage closure versus medical treatment in atrial fibrillation: a network meta-analysis from randomised trials. Heart, 103, 139–47.Google Scholar
Salazar, CA, del Aguila, D, Cordova, EG. (2014). Direct thrombin inhibitors versus vitamin K antagonists for preventing cerebral or systemic embolism in people with non-valvular atrial fibrillation. Cochrane Database Syst Rev, 3, CD009893. doi:10.1002/14651858.CD009893.pub2.Google Scholar
Sanna, T, Diener, HC, Passman, RS, Di Lazzaro, V, Bernstein, RA, Morillo, CA, et al., for the CRYSTAL AF Investigators. (2014). Cryptogenic stroke and underlying atrial fibrillation. N Engl J Med, 370, 2478–86.Google Scholar
Sarode, R, Milling, TJ Jr, Refaai, MA, Mangione, A, Schneider, A, Durn, BL, et al. (2013). Efficacy and safety of a 4-factor prothrombin complex concentrate in patients on vitamin K antagonists presenting with major bleeding: a randomized, plasma-controlled, phase IIIb study. Circulation, 128, 1234–43.Google Scholar
Sartori, M, Cosmi, B. (2018). Andexanet alfa to reverse the anticoagulant activity of factor Xa inhibitors: a review of design, development and potential place in therapy. J Thromb Thrombolysis, 45, 345–52.Google Scholar
Saver, JL, Mattle, HP, Thaler, D. (2018). Patent foramen ovale closure versus medical therapy for cryptogenic ischemic stroke: a topical review. Stroke, 49, 1541–8.Google Scholar
Saxena, R, Koudstaal, PJ. (2004a). Anticoagulants for preventing stroke in patients with nonrheumatic atrial fibrillation and a history of stroke or transient ischaemic attack. Cochrane Database Syst Rev, 2, CD000185.Google Scholar
Saxena, R, Koudstaal, PJ. (2004b). Anticoagulants versus antiplatelet therapy for preventing stroke in patients with nonrheumatic atrial fibrillation and a history of stroke or transient ischemic attack. Cochrane Database Syst Rev, 4, CD000187.Google Scholar
Schneider, B, Bauer, R. (2005). Is surgical closure of patent foramen ovale the gold standard for treating interatrial shunts? An echocardiographic follow-up study. J Am Soc Echocardiogr, 18, 1385–91.Google Scholar
Seiffge, DJ, Werring, DJ, Paciaroni, M, Dawson, J, Warach, S, Milling, TJ, et al. (2019). Timing of anticoagulation after recent ischaemic stroke in patients with atrial fibrillation. Lancet Neurol, 18, 117–26.Google Scholar
Siegal, DM, Curnutte, JT, Connolly, SJ, Lu, G, Conley, PB, Wiens, BL, et al. (2015). Andexanet alfa for the reversal of factor Xa inhibitor activity. N Engl J Med, 373, 2413–24.Google Scholar
Song, Y, Wang, Z, Perlstein, I, Wang, J, LaCreta, F, Frost, RJA, Frost, C. (2017). Reversal of apixaban anticoagulation by four-factor prothrombin complex concentrates in healthy subjects: a randomized three-period crossover study. J Thromb Haemost, 15, 2125–37.Google Scholar
SPIRIT Trial Investigators. (1997). A randomized trial of anticoagulants versus aspirin after cerebral ischemia of presumed arterial origin. The Stroke Prevention in Reversible Ischemia Trial (SPIRIT) Study Group. Ann Neurol, 43, 857–65.Google Scholar
Sposato, LA, Cipriano, LE, Saposnik, G, Ruíz Vargas, E, Riccio, PM, Hachinski, V. (2015). Diagnosis of atrial fibrillation after stroke and transient ischaemic attack: a systematic review and meta-analysis. Lancet Neurol, 14, 377–87.Google Scholar
Steffel, J, Verhamme, P, Potpara, TS, Albaladejo, P, Antz, M, Desteghe, L, et al.; ESC Scientific Document Group. (2018). The 2018 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Eur Heart J, 39, 1330–93.Google Scholar
Steiner, T, Poli, S, Griebe, M, Husing, J, Hajda, J, Freiberger, A, et al. (2016). Fresh frozen plasma versus prothrombin complex concentrate in patients with intracranial haemorrhage related to vitamin K antagonists (INCH): a randomised trial. Lancet Neurol, 15, 566–73.Google Scholar
Turc, G, Calvet, D, Guérin, P, Sroussi, M, Chatellier, G, Mas, JL; CLOSE Investigators. (2018). Closure, anticoagulation, or antiplatelet therapy for cryptogenic stroke with patent foramen ovale: systematic review of randomized trials, sequential meta-analysis, and new insights from the CLOSE Study. J Am Heart Assoc, 7, pii: e008356.Google Scholar
Uphaus, T, Weber-Kruger, M, Grond, M, Toenges, G, Jahn-Eimermacher, A, Jauss, M, et al. (2019). Development and validation of a score to detect paroxysmal atrial fibrillation. Neurology, 92, e115–e124.Google Scholar
US Preventive Services Task Force, Curry, SJ, Krist, AH, Owens, DK, Barry, MJ, Caughey, AB, Davidson, KW, et al. (2018). Screening for atrial fibrillation with electrocardiography: US Preventive Services Task Force Recommendation Statement. JAMA, 320, 478–84Google Scholar
Vaitkus, PT, Barnathan, ES. (1993). Embolic potential, prevention and management of mural thrombus complicating anterior myocardial infarction: a meta-analysis. J Am Coll Cardiol, 22, 1004–9.Google Scholar
Verheugt, FW, Granger, CB. (2015). Oral anticoagulants for stroke prevention in atrial fibrillation: current status, special situations, and unmet needs. Lancet, 386, 303–10.Google Scholar
Wang, A, Gaca, JG, Chu, VH. (2018). Management considerations in infective endocarditis: a review. JAMA, 320, 72–83.Google Scholar
Warkentin, TE, Margetts, P, Connolly, SJ, Lamy, A, Ricci, C, Eikelboom, JW. (2012). Recombinant factor VIIa (rFVIIa) and hemodialysis to manage massive dabigatran-associated postcardiac surgery bleeding. Blood, 119, 2172–4.Google Scholar
Wilson, D, Ambler, G, Shakeshaft, C, Brown, MM, Charidimou, A, Al-Shahi Salman, R, et al.; CROMIS-2 collaborators. (2018). Cerebral microbleeds and intracranial haemorrhage risk in patients anticoagulated for atrial fibrillation after acute ischaemic stroke or transient ischaemic attack (CROMIS-2): a multicentre observational cohort study. Lancet Neurol, 17, 539–47.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×