antiplatelet vs anticoagulant stroke
Intracranial hemorrhages (OR = 1.98; 95% CI, 1.20 to 3.28) were increased by oral anticoagulant therapy. On examination, his pulse is irregular. Antiplatelet vs Anticoagulant • Antiplatelet drugs block platelet plug formation while anticoagulants interfere with the extrinsic and intrinsic pathways. Cervical Artery Dissection in Stroke Study Trial Investigators(1). 9(May 1, 2008)
Henault LE, Copyright © 2008 by the American Academy of Family Physicians. In a recent cohort study of 472 patients older than 65 years and with newly diagnosed atrial fibrillation, 7.2 percent had major hemorrhage during their first year on warfarin, and 2.5 percent had intracranial hemorrhage.7 A subset of patients 80 years and older had a 13.1 percent incidence of major hemorrhage. At 3 months’ follow-up, 3 of the126 patients who received antiplatelets and 1 of the 124 patients who received anticoagulants suffered ipsilateral stroke recurrence. Anticoagulation therapy for stroke prevention in atrial fibrillation: how well do randomized trials translate into clinical practice? CADISS trial investigators, Markus HS, Hayter E, Levi C, Feldman A, Venables G, Norris J. Lancet Neurol. All disabling or fatal strokes (OR = 0.71; 95% CI, 0.59 to 1.04) and myocardial infarction (OR = 0.69; 95% CI, 0.47 to 1.01) were substantially, but not significantly, reduced by oral anticoagulants. Cardioembolic stroke afflicts 60,000 Americans annually and is most often caused by atrial fibrillation,2 which affects 5 percent of adults older than 65 years and 10 percent older than 80 years.1 Patients with atrial fibrillation who receive antiplatelet therapy alone have a 4 percent annual risk of stroke, although the more recent AnTicoagulation and Risk factors In Atrial fibrillation (ATRIA) study puts the estimate closer to 2.5 percent.1,3 Since the Stroke Prevention in Atrial Fibrillation (SPAF) trials were launched in 1987, more than a dozen studies have looked at anticoagulation in atrial fibrillation. New oral anticoagulants were not used, noted the researchers. Oral anticoagulation, although highly effective for stroke prevention in AF patients, is underutilised in the elderly and there is a relatively high rate of discontinuation of the anticoagulant therapy . Hylek EM, Two of the eight trials had populations with poorly controlled international normalized ratios. 2003;(3):CD000255. How, then, is the family physician to decide who will receive the most benefit from anticoagulation? A. Antiplatelet therapy vs. anticoagulation in cervical artery dissection: rationale and design of the Cervical Artery Dissection in Stroke Study (CADISS). The Cochrane Abstract is a summary of a review from the Cochrane Library. Lancet Neurol 2018 Dec A prespecified subgroup analysis of a randomized trial showed no significant difference between the drug categories in secondary stroke prevention in patients with patent foramen ovale. Answer C is incorrect because prasugrel is contraindicated in patients over 75 years. Neutrophil to Lymphocyte Ratio Predicts Outcome of Stroke by Cervicocranial Arterial Dissection. Rydén LE, Mean (SD) time to randomization was 3.65 (1.91) days. For patients with nonvalvular atrial fibrillation and no history of stroke or transient ischemic attack (TIA), how effective at preventing stroke is oral anticoagulation therapy compared with antiplatelet therapy? Reprints are not available from the authors. Antiplatelets are preferred over anticoagulants for this indication because of their association with lower rates of intracranial hemorrhage and slightly lower overall mortality rates. Background: Nonvalvular atrial fibrillation carries an increased risk of stroke mediated by embolism of stasis-precipitated thrombi originating in the left atrial appendage. Bethesda, MD 20894, Copyright Hylek EM, 2-5 Single antiplatelet therapy is generally preferred over dual antiplatelet therapy (DAPT) because DAPT results in increased bleeding, which outweighs any benefit. Immediate, unlimited access to all AFP content. Electrocardiography (ECG) confirms atrial fibrillation. afpserv@aafp.org for copyright questions and/or permission requests. 1. Antiplatelet vs Anticoagulation Therapy for Stroke Prevention Randomized trials have investigated the role of antiplatelet and anticoagulation therapies for primary and secondary prevention of thromboembolic events in patients with atrial fibrillation, as summarized in Table 2 . Pearce LA. Compared with antiplatelet therapy, oral anticoagulation significantly reduces stroke at an average follow-up of one to three years, but does not reduce mortality.