American journal of therapeutics
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The burden of ischemic stroke in the United States continues to increase each year. Patients with stroke with the most severe disability require a disproportionately large share of healthcare resources. ⋯ We review the rationale, current literature, and future directions of mechanical devices for stroke thrombolysis. We also review pertinent issues related to thrombolysis-related intracerebral hemorrhage and appropriate patient selection.
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Review
Newer anticoagulants as an alternate to warfarin in atrial fibrillation: a changing paradigm.
Atrial fibrillation is the most common cardiac arrhythmia responsible for one third of the hospitalizations because of cardiac rhythm disturbances. Atrial fibrillation leads to stroke, heart failure, and other causes of mortality. Warfarin, a vitamin K antagonist, is the first-line agent for the prophylaxis of stroke in patients with atrial fibrillation. ⋯ A direct thrombin inhibitor, dabigatran, has been evaluated in clinical studies for prophylaxis in atrial fibrillation. Factor Xa inhibitors, direct as well as indirect inhibitors, are in various stages of development for their antithrombotic effect. This article reviews the studies done on these novel anticoagulants and their prophylactic potential for the prevention of stroke in atrial fibrillation.
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The natural history and optimal treatment for unruptured cerebral aneurysm and arteriovenous malformations (AVMs) remains unknown. The prevalence of intracranial aneurysms is estimated to be between 1% and 5%. The annual risk of rupture for small aneurysms in the anterior circulation is low. ⋯ The annual risk of rupture of AVMs that did not present with hemorrhage is low at approximately 0.9% per year. Factors that increase the risk of rupture include hemorrhagic presentation, deep AVM location, or deep venous drainage associated with the AVM. The treatment options for AVM available include conservative management, microsurgery, endovascular treatment, radiosurgery, or a combination of methods.