Effect of warfarin versus aspirin on blood viscosity in cardioembolic stroke with atrial fibrillation: a prospective clinical trial

Lee, Chan-Hyuk; Jung, Keun‐Hwa; Cho, Daniel J.; Jeong, Seul-Ki

doi:10.1186/s12883-019-1315-5

Cited by 21 publications

(19 citation statements)

References 37 publications

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“…BV can be modified using drugs such as vasodilators, statins, or antithrombotics [2,16,17]. A few studies have examined the effect of antithrombotics on BV [17][18][19] and found that warfarin, heparin, and argatroban can decrease BV [17,20]. Varying results have been observed with antiplatelets, depending on the experimental protocol used in the study.…”

Section: Discussionmentioning

confidence: 99%

Prior antithrombotic use is significantly associated with decreased blood viscosity within 24 hours of symptom onset in patients with acute ischemic stroke

et al. 2019

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Background: Blood viscosity (BV) is the intrinsic resistance of blood to flow and is a measure of blood stickiness. Several clinical and epidemiologic studies have demonstrated an association between BV and the occurrence of major thromboembolic events. Although BV is significantly higher in cases of lacunar or cardioembolic strokes, its relationship with demographic and laboratory parameters during the acute stage of ischemic stroke is unknown. We investigated the relationship between baseline characteristics of acute ischemic stroke and BV within 24 hours of symptom onset in patients with acute ischemic stroke. Methods: We enrolled patients aged 40 years or older with documented histories of ischemic stroke or transient ischemic attack within 24 hours of symptom onset. A scanning capillary-tube viscometer was used to assess whole BV. Results: The mean age was 69.6±12.03 years and 44.4% of the patients were female. Of 189 patients, 68.3% had a history of hypertension; 27%, diabetes; 42.9%, hypercholesterolemia; 3.7%, coronary artery disease; and 18%, stroke. Additionally, 40.7% were current smokers. Sixty-one patients (32.3%) were regularly taking antithrombotics. Multiple linear regression analysis revealed that hematocrit was positively corelated with increased BV and prior antithrombotic use was corelated with decreased BV. Hematocrit-adjusted partial correlation demonstrated that prior antithrombotic use was significantly associated with decreased BV. Conclusion: Prior antithrombotic use is significantly associated with decreased BV within 24 hours of symptom onset in patients with acute ischemic stroke. Our findings indicate that antithrombotic medications may change the hemorheological profile in these patients.

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Section: Discussionmentioning

confidence: 99%

Prior antithrombotic use is significantly associated with decreased blood viscosity within 24 hours of symptom onset in patients with acute ischemic stroke

et al. 2019

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“…Corresponding to such variation in shear rate, the difference in WBV changes within 0.00175 Pa.s to 0.0055 Pa.s in average(0.5 ≤ ψ ≤ 1.5). On the other hand, in a prospective clinical trial, Lee et al 50 showed that Aspirin and Warfarin alter WBV by approximately 0.00042 Pa.s and 0.00024 Pa.s, for a shear-rate difference from 300 to 1000 s-1, respectively. Ma et al 51 found that Aspirin have noticeable effects on WBV at low shear rates (5 s-1) and negligible effects at medium and high shear rates (100 s-1, 200 s-1).…”

Section: Discussionmentioning

confidence: 99%

The hemodynamic complexities underlying transient ischemic attacks in early-stage Moyamoya disease: an exploratory CFD study

Rashad

Saqr

Fujimura

et al. 2020

Sci Rep

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Moyamoya disease (MMD) is a rare cerebro-occlusive disease with unknown etiology that can cause both ischemic and hemorrhagic stroke. MMD is characterized by progressive stenosis of the terminal internal carotid artery (ICA) and development of basal brain collaterals. Early-stage MMD is known to cause hemodynamic insufficiency despite mild or moderate stenosis of the intracranial arteries, but the exact mechanism underlying this pathophysiological condition is undetermined. We used highresolution Large eddy Simulations to investigate multiple complex hemodynamic phenomena that led to cerebral ischemia in five patients with early-stage MMD. The effects of transitional flow, coherent flow structures and blood shear-thinning properties through regions of tortuous and stenosed arteries were explored and linked to symptomatology. It is evidently shown that in some cases complex vortex structures, such as Rankine-type vortices, redirects blood flow away from some arteries causing significant reduction in blood flow. Moreover, partial blood hammer (PBH) phenomenon was detected in some cases and led to significant hemodynamic insufficiency. PBH events were attributed to the interaction between shear-thinning properties, transitional flow structures and loss of upstream pressure-velocity phase lag. We clearly show that the hemodynamic complexities in early-stage MMD could induce ischemia and explain the non-responsiveness to antiplatelet therapy.Moyamoya disease (MMD) is a rare cerebrovascular disease, characterized by bilateral occlusive changes at the internal carotid artery (ICA) terminus and an abnormal collaterals development at the base of the brain 1 . MMD is more prevalent in East Asian populations and can present as either ischemic or hemorrhagic stroke 2 . MMD can occur in pediatric or adult populations 2-4 and can present as bilateral or unilateral disease involvement 5 . The basic pathology of MMD, including its temporal profile, is clearly indicated by Suzuki's angiographic staging 1 , demonstrating the pathologic conversion of the cerebral vascular supply from internal carotid (IC) to the external carotid (EC) system 6 . Insufficiency of this 'IC-EC conversion system' could result in either ischemic or hemorrhage MMD presentations.Recent advance in high resolution magnetic resonance (HR-MR) vascular wall imaging enabled us to diagnose MMD even in its early stage, by demonstrating the characteristic vascular wall structure such as outer-diameter narrowing and the concentric stenosis of the affected intracranial arteries 7-9 . All of these characteristic findings by HR-MR vascular wall imaging are precisely reflected by vascular wall pathology of MMD including medial layer thinning and the waving of internal elastic lamina 10,11 . Accurate diagnosis of the early-stage MMD is clinically important because it could manifest as transient ischemic attacks (TIA) and/or cerebral infarction due to the significant hemodynamic compromise, despite its mild or moderate stenosis. Nonetheless, the mechanism

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“…Some studies 32,33 have indicated that antiplatelet therapy will change the viscosity of blood, which is a crucial parameter when performing CFD simulation. The non-Newtonian blood viscosity model predict lower threshold of WSS values and slightly severe gradients.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic effects of intracranial aneurysms from stent-induced straightening of parent vessels by stent-assisted coiling embolization

Leng

Wan

Li³

et al. 2021

Interv Neuroradiol

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Background Straightening of parent vessels happens for stent-assisted coiling embolization (SACE) treatment of intracranial aneurysms. This study aims to investigate aneurysmal hemodynamic modifications caused by stent-induced vessel straightening. Methods Stent and coil deployments of a SACE-treated distal bifurcation aneurysm by finite element method were performed first with the preoperative (not straightened, NS) and postoperative (straightened, S) vessel models respectively. Computational fluid dynamics were then performed for eight models, including (I) NS only model, (II) NS+stent model, (III) NS+coils model, (IV) NS+stent+coils model, (V) S only model, (VI) S+stent model, (VII) S+coils model, and (VIII) S+stent+coils model. Finally, changes in aneurysmal flow velocity, isovelocity surface and wall shear stress (WSS) were analyzed qualitatively and quantitatively. Results The flow was less in the S models than that in the corresponding NS models. Coils blocked most of the flow into the aneurysm sac in both NS models and S models and vessel straightening had more profound effect on the high aneurysmal flow volume reduction than coiling, while stenting generated adverse effect on flow reduction. Taking the NS only model as baseline (100%), the sac-averaged velocities of models II to VIII were 112%, 36%, 42%, 45%, 39%, 12%, 13%, and high flow volumes were 119%, 21%, 30%, 10%, 8%, 3%, 3%, while the sac-averaged WSSs were 106%, 37%, 44%, 41%, 35%, 17% and 24%, respectively. Conclusions Stent-induced vessel straightening combined coil embolization has the best performance in hemodynamic modifications and may reduce the recurrence rate, whereas stenting may generate adverse effect on hemodynamic alterations.

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Effect of warfarin versus aspirin on blood viscosity in cardioembolic stroke with atrial fibrillation: a prospective clinical trial

Cited by 21 publications

References 37 publications

Prior antithrombotic use is significantly associated with decreased blood viscosity within 24 hours of symptom onset in patients with acute ischemic stroke

Prior antithrombotic use is significantly associated with decreased blood viscosity within 24 hours of symptom onset in patients with acute ischemic stroke

The hemodynamic complexities underlying transient ischemic attacks in early-stage Moyamoya disease: an exploratory CFD study

Hemodynamic effects of intracranial aneurysms from stent-induced straightening of parent vessels by stent-assisted coiling embolization

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