(This post introduces my latest column on TheHeart.org | Medscape Cardiology. It’s about stroke in young people.) *** We define stroke as the death of brain cells. The typical cause is a blocked blood vessel in the brain. Stroke usually occurs in older people who have established blood vessel disease. Stroke is bad; it may […]
New Data Increase Caution on Left Atrial Appendage Occlusion
I remain concerned about the irrational exuberance among some of my colleagues toward left atrial appendage occlusion devices for the prevention of stroke in patients with atrial fibrillation. In short, these devices are plugs that doctors place into the left atrial appendage. The idea is to stop clots from forming or escaping from the left […]
How important are short AF episodes?
A study presented at the recent Heart Rhythm Society meeting in Chicago has added more uncertainty about the significance of short-duration AF episodes. Before I tell you about the study, I need to clarify what I mean by short-duration AF episodes, sometimes called subclinical AF (SCAF). SCAF is AF on a monitor that is often […]
Less is more in atrial fibrillation stroke prevention — please, drop the aspirin
A recent study in the Journal of the American College of Cardiology shed more light on the commonly used drug combination of aspirin and a vitamin-K antagonist (such as warfarin). It was a small registry study from one region of France but I believe it offered confirmatory evidence against this dangerous practice. Investigators followed patients […]
Is it safe to take aspirin and warfarin together?
The ultimate goal in medicine: protect the patient from stroke. Even a heart doctor has to admit the dominance of the human brain. Always think about preventing stroke. It’s one of the worst outcomes that can happen to a person. Life as a ‘normal’ human requires a healthy brain. A stroke irreversibly kills off part […]
Apixaban (Eliquis) gets FDA approval
Yesterday afternoon, the FDA finally approved apixaban (Eliquis) for the prevention of stroke in patients with non-valvular atrial fibrillation. I use the words ‘finally approved’ because the markedly positive ARISTOTLE trial was published 15 months ago in the New England Journal of Medicine. The long delay was mysterious. On paper, apixaban looks to be the […]
New Trials and Fibrillations post up: Thoughts on left atrial appendage occlusion to prevent stroke in AF
There was a lively debate on this topic at ESC 2012. One of the strategies proposed to reduce stroke in AF involves occlusion of the sack-like structure called the left atrial appendage. Two devices are being evaluated and nearing consideration for approval. There is a great deal of debate on these devices. Here is my […]
What’s the best blood thinner for AF ablation?
Let’s get off cell biology and back to something I really know. Atrial fibrillation, AF ablation and blood thinners. There was an important study published today in the Journal of the American College of Cardiology concerning the use of the new blood thinner, dabigatran (Pradaxa), around the time of AF ablation. A very concise overview, […]
Female gender and stroke risk in atrial fibrillation: Know your CHA2DS2-VASc Score
When it comes to the risk of stroke in atrial fibrillation, it pays to be a boy. Sorry, ladies. An important question came up on my recent post on AF and stroke. Why does being female give you an automatic point on CHADS2-VASc? I keep seeing it, but I don’t see why that is. It […]
The new blood thinners and personal accountability
I recently came across a very important blog post on the use of the novel new blood-thinner, dabigatran (Pradaxa). Fellow Kentucky cardiologist, and frequent TheHeart.org contributor, Dr. Melissa Walton-Shirley wrote this very detailed case presentation involving a cantankerous non-compliant rural patient with AF (atrial fibrillation) that sustained a stroke while “taking” dabigatran. Dr. Walton-Shirley details […]
Rivaroxaban: The next non-warfarin oral blood thinner
The unrelenting epidemic of inactivity and excessive eating wreaks havoc on more than just the heart and blood vessels. Lugging around extra weight also breaks down the joints and back. For evidence, look no further than the waiting room of any orthopedist; the people waiting for joint replacements look the same as those waiting to […]
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