Refining Clinical Risk Stratification for Predicting Stroke and Thromboembolism in Atrial Fibrillation Using a Novel Risk Factor-Based Approach

Lip, Gregory Y.H.; Nieuwlaat, Robby; Pisters, Ron; Lane, Deirdre A.; Crijns, Harry J.G.M.

doi:10.1378/chest.09-1584

Cited by 5,662 publications

(4,163 citation statements)

References 32 publications

Supporting

Mentioning

3,943

Contrasting

Unclassified

142

Order By: Relevance

“…The history of ischemic stroke carries a strong risk for ischemic stroke recurrence and some studies showed the mortality of AIS patients with a history of ischemic stroke was higher as compared with those without prior ischemic stroke (Kubo et al., 2006; Lip, Nieuwlaat, Pisters, Lane, & Crijns, 2010). Kallikreins, an important component of kallikrein–kinin system which has been shown to have a protective effect on patients with ischemic stroke (Zhang, Tao, Liu, & Wang, 2012).…”

Section: Discussionmentioning

confidence: 99%

“…In animal studies, the inflammatory cell accumulation could be inhibited by kallikrein in the ischemic brain. Furthermore, after the stimulatory effect of kinin on neuronal cell proliferation, it has been confirmed that kallikrein enhanced angiogenesis and promoted neurogenesis after the stimulatory effect of kinin on neuronal cell (Lip et al., 2010). In clinical studies, researchers also found that HUK could improve favorable recovery in AIS patients with level 3 hypertension within 3 months through its property of selectively dilating arterioles in the ischemic area and promoting the formation of new blood vessels (Zhang et al., 2012).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Human Urinary Kallidinogenase decreases recurrence risk and promotes good recovery

Han

Chen

Li³

et al. 2018

Brain and Behavior

View full text Add to dashboard Cite

ObjectivesTo evaluate the efficacy of Human Urinary Kallidinogenase (HUK) for secondary stroke prevention in the treatment of acute ischemic stroke (AIS) patients.Materials and MethodsIn this retrospective study, from October 2016 to June 2017, 300 consecutive AIS patients were registered in our database. Among them, 145 patients received HUK treatment (HUK group), and 155 patients received basic treatment (control group). Basic treatment was administrated on all patients. 0.15 PNA unit of HUK injection plus 100 ml saline in intravenous infusion was performed in the HUK group, with once a day for 14 consecutive days. The rate of recurrent stroke and modified Rankin Scale (mRS) scores in two groups were analyzed 12 months after the treatment.ResultsNo difference was found in the age, gender, comorbidities, smoking history, and NIHSS scores between two groups before treatment (p > 0.05). 12 months after treatment, 10 patients in the HUK group (10.3%) and 26 patients in the control group (16.8%) got stroke recurrence at 12 months (p = 0.009). The mRS score of HUK group was significantly lower than that in the control group (2.3 ± 1.2 vs. 3.5 ± 1.4, p = 0.011).ConclusionHuman Urinary Kallidinogenase is able to reduce the risk of stroke recurrence and promote good recovery for AIS patients within 12 months.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Human Urinary Kallidinogenase decreases recurrence risk and promotes good recovery

Han

Chen

Li³

et al. 2018

Brain and Behavior

View full text Add to dashboard Cite

show abstract

“…The Patient Register (http://www.sos.se) was used to obtain information needed for calculation of individual risk scores for ischaemic stroke and bleeding according to CHA 2 DS 2 ‐VASc1 and HAS‐BLED 13. In the CHA 2 DS 2 ‐VASc scheme, 2 points are given for previous stroke/transient ischaemic attack/systemic embolism, and for age ≥ 75 years and 1 point each for heart failure, hypertension, diabetes, vascular disease, female sex, and age 65–74 years.…”

Section: Methodsmentioning

confidence: 99%

Heart failure: a weak link in CHA₂DS₂‐VASc

Friberg

Lund

2018

ESC Heart Failure

View full text Add to dashboard Cite

AimsIn atrial fibrillation, stroke risk is assessed by the CHA2DS2‐VASc score. Heart failure is included in CHA2DS2‐VASc, but the rationale is uncertain. Our objective was to test if heart failure is a risk factor for stroke, independent of other risk factors in CHA2DS2‐VASc.Methods and resultsWe studied 300 839 patients with atrial fibrillation in the Swedish Patient Register 2005–11. Three definitions of heart failure were used in order to assess the robustness of the results. In the main analysis, heart failure was defined by a hospital discharge diagnosis of heart failure as first or second diagnosis and a filled prescription of a diuretic within 3 months before index + 30 days. The second definition counted first or second discharge diagnoses <1 year before index + 30 days and the third definition any heart failure diagnosis in open or hospital care before index + 30 days. Associations with outcomes were assessed with multivariable Cox analyses. Patients with heart failure were older (80.5 vs. 74.0 years, P < 0.001) and had higher CHA2DS2‐VASc score (4.4 vs. 2.7, P < 0.001). The 1 year incidence of ischaemic stroke without warfarin was 4.4% with heart failure and 3.1% without. Adjustment for the cofactors in CHA2DS2‐VASc eradicated the difference in stroke risk between patients with and without heart failure (hazard ratio 1.01 with 95% confidence interval 0.96–1.05). The area under the receiver operating characteristic curve for CHA2DS2‐VASc was not improved by points for heart failure.ConclusionsA clinical diagnosis of heart failure was not an independent risk factor for stroke in patients with atrial fibrillation, which may have implications for anticoagulation management.

show abstract

“…Concomitant baseline co‐morbidities such as hypertension, diabetes, vascular disease, and prior ischaemic stroke are well‐known prognostic factors of stroke and bleeding in other heart diseases 20, 21. Thus, we fitted the Cox models after adjusting for these clinical factors, including age and sex.…”

Section: Methodsmentioning

confidence: 99%

Risk of stroke and bleeding in patients with heart failure and chronic kidney disease: a nationwide cohort study

et al. 2018

Self Cite

View full text Add to dashboard Cite

AimsThe aim of this study was to assess the prognostic value of chronic kidney disease (CKD) in relation to ischaemic stroke, intracranial haemorrhage, major bleeding, and all‐cause death in heart failure patients without atrial fibrillation.Methods and resultsIn this observational cohort study, heart failure patients without atrial fibrillation were identified using Danish nationwide registries. Risk of stroke, major haemorrhage, and death were calculated after 1 and 5 years to compare patients with and without CKD, ±dialysis [dialysis: CKD with renal replacement therapy (CKD‐RRT); no dialysis: CKD‐no RRT]. A total of 43 199 heart failure patients were included, among which 0.8% had CKD‐RRT and 5.9% had CKD‐no RRT. When compared with heart failure patients without CKD, both CKD‐RRT and CKD‐no RRT were associated with a higher 5 year rate of major bleeding (CKD‐RRT: adjusted hazard ratio (aHR): 2.91, 95% confidence interval (CI): 2.29 to 3.70; CKD‐no RRT: aHR: 1.28, 95% CI: 1.13 to 1.45) and all‐cause death (CKD‐RRT: aHR: 2.40, 95% CI: 2.07 to 2.77; CKD‐no RRT: aHR: 1.63, 95% CI: 1.55 to 1.73). For the endpoints of ischaemic stroke and intracranial bleeding, only CKD‐no RRT was associated with significantly higher 5 year rates (ischaemic stroke: aHR: 1.31, 95% CI: 1.13 to 1.52; intracranial haemorrhage: aHR: 1.66, 95% CI: 1.04 to 2.65).ConclusionsCompared with patients without CKD, among incident heart failure patients without atrial fibrillation, CKD both with and without dialysis was associated with a higher rate of major bleeding and all‐cause death. Only CKD‐no RRT was associated with a higher rate of ischaemic stroke and intracranial bleeding.

show abstract

Refining Clinical Risk Stratification for Predicting Stroke and Thromboembolism in Atrial Fibrillation Using a Novel Risk Factor-Based Approach

Cited by 5,662 publications

References 32 publications

Human Urinary Kallidinogenase decreases recurrence risk and promotes good recovery

Human Urinary Kallidinogenase decreases recurrence risk and promotes good recovery

Heart failure: a weak link in CHA₂DS₂‐VASc

Risk of stroke and bleeding in patients with heart failure and chronic kidney disease: a nationwide cohort study

Contact Info

Product

Resources

About

Refining Clinical Risk Stratification for Predicting Stroke and Thromboembolism in Atrial Fibrillation Using a Novel Risk Factor-Based Approach

Cited by 5,662 publications

References 32 publications

Human Urinary Kallidinogenase decreases recurrence risk and promotes good recovery

Human Urinary Kallidinogenase decreases recurrence risk and promotes good recovery

Heart failure: a weak link in CHA2DS2‐VASc

Risk of stroke and bleeding in patients with heart failure and chronic kidney disease: a nationwide cohort study

Contact Info

Product

Resources

About

Heart failure: a weak link in CHA₂DS₂‐VASc