2023
Left ventricular hypertrophy and left atrial size are associated with ischemic strokes among non-vitamin K antagonist oral anticoagulant users
Das A, Gökçal E, Fouks A, Horn M, Regenhardt R, Viswanathan A, Singhal A, Schwamm L, Greenberg S, Gurol M. Left ventricular hypertrophy and left atrial size are associated with ischemic strokes among non-vitamin K antagonist oral anticoagulant users. Journal Of Neurology 2023, 270: 5578-5588. PMID: 37548681, PMCID: PMC11111216, DOI: 10.1007/s00415-023-11916-7.Peer-Reviewed Original ResearchPrior cerebrovascular eventsAtrial volume indexVentricular hypertrophyCerebrovascular eventsNOAC usersAtrial sizeIS recurrenceSevere white matter hyperintensitiesVolume indexCerebral small vessel diseaseOral anticoagulant usersChronic renal failureRisk of strokeCox regression analysisQuaternary care centerSmall vessel diseaseAge-matched controlsWhite matter hyperintensitiesMultivariable regression modelsAnticoagulant usersApixaban useDabigatran useResults112 patientsMultivariable adjustmentOral anticoagulants
2022
Clinical and neuroimaging risk factors associated with the development of intracerebral hemorrhage while taking direct oral anticoagulants
Das A, Gökçal E, Regenhardt R, Warren A, Biffi A, Goldstein J, Kimberly W, Viswanathan A, Schwamm L, Rosand J, Greenberg S, Gurol M. Clinical and neuroimaging risk factors associated with the development of intracerebral hemorrhage while taking direct oral anticoagulants. Journal Of Neurology 2022, 269: 6589-6596. PMID: 35997817, PMCID: PMC10947801, DOI: 10.1007/s00415-022-11333-2.Peer-Reviewed Original ResearchConceptsCortical superficial siderosisPrior ischemic strokeDOAC usersCerebral microbleedsWhite matter hyperintensitiesIschemic strokeSevere white matter hyperintensitiesOral anticoagulant usageDirect oral anticoagulantsSingle referral centerHigh hemorrhagic riskCoronary artery diseaseAge-matched controlsMultivariable regression modelsDOAC therapyICH cohortPrior strokeOral anticoagulantsSuperficial siderosisBaseline demographicsReferral centerSmoking historyArtery diseaseConclusionsRisk factorsHemorrhage riskAssociation of Recent Use of Non–Vitamin K Antagonist Oral Anticoagulants With Intracranial Hemorrhage Among Patients With Acute Ischemic Stroke Treated With Alteplase
Kam W, Holmes D, Hernandez A, Saver J, Fonarow G, Smith E, Bhatt D, Schwamm L, Reeves M, Matsouaka R, Khan Y, Unverdorben M, Birmingham M, Lyden P, Asimos A, Altschul D, Schoonover T, Jumaa M, Nomura J, Suri M, Moore S, Lafranchise E, Olson D, Peterson E, Xian Y. Association of Recent Use of Non–Vitamin K Antagonist Oral Anticoagulants With Intracranial Hemorrhage Among Patients With Acute Ischemic Stroke Treated With Alteplase. JAMA 2022, 327: 760-771. PMID: 35143601, PMCID: PMC8832308, DOI: 10.1001/jama.2022.0948.Peer-Reviewed Original ResearchConceptsAcute ischemic strokeSymptomatic intracranial hemorrhageSecondary functional outcomesSecondary safety outcomesProportion of patientsIntravenous alteplaseIntracranial hemorrhageIschemic strokeFunctional outcomeOral anticoagulantsInpatient mortalitySafety outcomesNon-Vitamin K Antagonist Oral AnticoagulantsK Antagonist Oral AnticoagulantsBaseline clinical factorsGuidelines-Stroke programIntravenous alteplase administrationLong-term anticoagulantsUse of NOACsRetrospective cohort studyUse of anticoagulantsSignificant differencesAlteplase administrationCardiovascular comorbiditiesNOAC group
2021
Antithrombotic Therapy for Stroke Prevention in Patients With Ischemic Stroke With Aspirin Treatment Failure
Lusk J, Xu H, Peterson E, Bhatt D, Fonarow G, Smith E, Matsouaka R, Schwamm L, Xian Y. Antithrombotic Therapy for Stroke Prevention in Patients With Ischemic Stroke With Aspirin Treatment Failure. Stroke 2021, 52: e777-e781. PMID: 34702067, PMCID: PMC8608737, DOI: 10.1161/strokeaha.121.034622.Peer-Reviewed Original ResearchConceptsAspirin treatment failureDual antiplatelet therapyIschemic strokeAspirin monotherapyClopidogrel monotherapyAntiplatelet therapyAntithrombotic therapyTreatment failureAntithrombotic treatment patternsAspirin/dipyridamoleGuidelines-Stroke registryIschemic stroke survivorsAcute ischemic strokeHalf of patientsAmerican Heart AssociationComplex clinical scenariosNonvitamin KOral anticoagulantsStroke preventionStroke RegistryOlder patientsPreventive therapyTreatment patternsHeart AssociationStroke survivorsClinical Characteristics and Outcomes Associated With Oral Anticoagulant Use Among Patients Hospitalized With Intracerebral Hemorrhage
Xian Y, Zhang S, Inohara T, Grau-Sepulveda M, Matsouaka RA, Peterson ED, Piccini JP, Smith EE, Sheth KN, Bhatt DL, Fonarow GC, Schwamm LH. Clinical Characteristics and Outcomes Associated With Oral Anticoagulant Use Among Patients Hospitalized With Intracerebral Hemorrhage. JAMA Network Open 2021, 4: e2037438. PMID: 33591368, PMCID: PMC7887660, DOI: 10.1001/jamanetworkopen.2020.37438.Peer-Reviewed Original ResearchMeSH KeywordsAgedAged, 80 and overAnticoagulantsCase-Control StudiesCerebral HemorrhageCohort StudiesDependent AmbulationDrug Therapy, CombinationDual Anti-Platelet TherapyFactor Xa InhibitorsFemaleFunctional StatusHospicesHospital MortalityHumansMaleMiddle AgedOdds RatioPatient DischargePlatelet Aggregation InhibitorsRegistriesRisk FactorsWarfarinConceptsOral anticoagulant useOral anticoagulantsFXa inhibitorsHospital mortalityAnticoagulant useCohort studyIndependent ambulationMRS scoreIntracerebral hemorrhageGuidelines-Stroke registryCardiovascular risk factorsHospital mortality riskFactor Xa inhibitorsConcomitant warfarinOral anticoagulationAnticoagulation therapyAntiplatelet therapyHospital outcomesClinical characteristicsRankin ScaleSecondary outcomesPrimary outcomeRisk factorsWorse outcomesHigh prevalence
2019
Clinical Effectiveness of Direct Oral Anticoagulants vs Warfarin in Older Patients With Atrial Fibrillation and Ischemic Stroke
Xian Y, Xu H, O’Brien E, Shah S, Thomas L, Pencina M, Fonarow G, Olson D, Schwamm L, Bhatt D, Smith E, Hannah D, Maisch L, Lytle B, Peterson E, Hernandez A. Clinical Effectiveness of Direct Oral Anticoagulants vs Warfarin in Older Patients With Atrial Fibrillation and Ischemic Stroke. JAMA Neurology 2019, 76: 1192-1202. PMID: 31329212, PMCID: PMC6647003, DOI: 10.1001/jamaneurol.2019.2099.Peer-Reviewed Original ResearchDirect oral anticoagulantsAcute ischemic strokeMajor adverse cardiovascular eventsAdverse cardiovascular eventsIschemic strokeLong-term outcomesAtrial fibrillationCardiovascular eventsOral anticoagulantsClinical effectivenessHigh riskHealth Stroke Scale scoreBetter long-term outcomesFirst year postdischargeStroke Scale scorePatient-centered outcomesPatient-centered measuresDOAC useGuidelines-StrokeCardiovascular readmissionCause readmissionGastrointestinal bleedingStroke preventionWarfarin prescriptionBaseline characteristics
2018
Intravenous tPA (Tissue-Type Plasminogen Activator) in Patients With Acute Ischemic Stroke Taking Non–Vitamin K Antagonist Oral Anticoagulants Preceding Stroke
Jin C, Huang R, Peterson E, Laskowitz D, Hernandez A, Federspiel J, Schwamm L, Bhatt D, Smith E, Fonarow G, Xian Y. Intravenous tPA (Tissue-Type Plasminogen Activator) in Patients With Acute Ischemic Stroke Taking Non–Vitamin K Antagonist Oral Anticoagulants Preceding Stroke. Stroke 2018, 49: 2237-2240. PMID: 30354981, PMCID: PMC6706353, DOI: 10.1161/strokeaha.118.022128.Peer-Reviewed Original ResearchMeSH KeywordsAdministration, IntravenousAdministration, OralAntibodies, Monoclonal, HumanizedAnticoagulantsAntidotesAntithrombinsBrain IschemiaDabigatranFactor Xa InhibitorsFibrinolytic AgentsHumansIntracranial HemorrhagesOdds RatioPractice Guidelines as TopicPyrazolesPyridonesRivaroxabanStrokeTissue Plasminogen ActivatorConceptsSymptomatic intracranial hemorrhageAcute ischemic strokeIntravenous tPAIntracranial hemorrhageFavorable outcomeIschemic strokeThrombin timeAnti-Xa assaySensitive laboratory testsNOAC patientsOral anticoagulantsTPA administrationProhibitive riskSymptom onsetPatient characteristicsMedian timeMedication intakeCurrent guidelinesAnticoagulant effectLarge cohortClinical carePatientsOverall observed rateNOACsHemorrhageAssociation of Intracerebral Hemorrhage Among Patients Taking Non–Vitamin K Antagonist vs Vitamin K Antagonist Oral Anticoagulants With In-Hospital Mortality
Inohara T, Xian Y, Liang L, Matsouaka R, Saver J, Smith E, Schwamm L, Reeves M, Hernandez A, Bhatt D, Peterson E, Fonarow G. Association of Intracerebral Hemorrhage Among Patients Taking Non–Vitamin K Antagonist vs Vitamin K Antagonist Oral Anticoagulants With In-Hospital Mortality. JAMA 2018, 319: 463-473. PMID: 29372247, PMCID: PMC5839299, DOI: 10.1001/jama.2017.21917.Peer-Reviewed Original ResearchConceptsHospital mortalityDual antiplatelet agentsIntracerebral hemorrhagePrior useOral anticoagulantsAntiplatelet agentsLower riskVitamin K Antagonist Oral AnticoagulantsK Antagonist Oral AnticoagulantsNon-vitamin K antagonistsGuidelines-Stroke hospitalsPrior antiplatelet therapyHospital mortality rateOral anticoagulant useRetrospective cohort studyWarfarin-treated patientsUse of OACInteraction p valuePrior strokeAnticoagulation therapyAntiplatelet therapyK antagonistsAnticoagulant useCohort studyHospital arrival
2017
Use of Intravenous Recombinant Tissue Plasminogen Activator in Patients With Acute Ischemic Stroke Who Take Non–Vitamin K Antagonist Oral Anticoagulants Before Stroke
Xian Y, Federspiel J, Hernandez A, Laskowitz D, Schwamm L, Bhatt D, Smith E, Fonarow G, Peterson E. Use of Intravenous Recombinant Tissue Plasminogen Activator in Patients With Acute Ischemic Stroke Who Take Non–Vitamin K Antagonist Oral Anticoagulants Before Stroke. Circulation 2017, 135: 1024-1035. PMID: 28119380, DOI: 10.1161/circulationaha.116.023940.Peer-Reviewed Original ResearchMeSH KeywordsAdministration, IntravenousAgedAged, 80 and overAnticoagulantsDabigatranFemaleFibrinolytic AgentsHemorrhageHospital MortalityHumansInternational Normalized RatioMalePyrazolesPyridonesRecombinant ProteinsRegistriesRetrospective StudiesRisk FactorsRivaroxabanStrokeTime FactorsTissue Plasminogen ActivatorTreatment OutcomeWarfarinConceptsIntravenous rt-PASymptomatic intracranial hemorrhageIschemic strokeRt-PAIntracranial hemorrhageOdds ratioNon-Vitamin K Antagonist Oral AnticoagulantsIntravenous recombinant tissue plasminogen activatorK Antagonist Oral AnticoagulantsRecombinant tissue plasminogen activatorGuidelines-Stroke registrySerious systemic hemorrhageAcute ischemic strokeAdjusted odds ratioAmerican Heart AssociationTissue plasminogen activatorOutcomes of useHospital mortalityRegistry hospitalsOral anticoagulantsSevere strokeAdverse eventsProhibitive riskRankin ScaleThrombolytic therapy
2016
Acute management of stroke patients taking non–vitamin K antagonist oral anticoagulants Addressing Real-world Anticoagulant Management Issues in Stroke (ARAMIS) Registry: Design and rationale
Xian Y, Hernandez A, Harding T, Fonarow G, Bhatt D, Suter R, Khan Y, Schwamm L, Peterson E. Acute management of stroke patients taking non–vitamin K antagonist oral anticoagulants Addressing Real-world Anticoagulant Management Issues in Stroke (ARAMIS) Registry: Design and rationale. American Heart Journal 2016, 182: 28-35. PMID: 27914497, DOI: 10.1016/j.ahj.2016.07.023.Peer-Reviewed Original ResearchMeSH KeywordsAdministration, OralAdultAnticoagulantsAntithrombinsAtrial FibrillationCohort StudiesDabigatranEmergency TreatmentFemaleHumansMaleMedication Therapy ManagementOutcome and Process Assessment, Health CarePyrazolesPyridinesPyridonesQuality ImprovementRegistriesRivaroxabanStrokeThiazolesUnited StatesWarfarinConceptsAcute ischemic strokeAnticoagulation-related intracerebral hemorrhageIntracerebral hemorrhageIschemic strokeStroke patientsOral anticoagulantsAcute ischemic stroke patientsCurrent treatment patternsLongitudinal medication useMulticenter cohort studyAcute stroke patientsIschemic stroke patientsReal-world clinical decisionsChronic anticoagulation therapyPatient-reported outcomesCritical unmet needChronic anticoagulationGuidelines-StrokeStroke prophylaxisAnticoagulation therapyIndex hospitalizationStroke RegistryCohort studyAcute managementMedication use
2015
Real world effectiveness of warfarin among ischemic stroke patients with atrial fibrillation: observational analysis from Patient-Centered Research into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) study
Xian Y, Wu J, O'Brien E, Fonarow G, Olson D, Schwamm L, Bhatt D, Smith E, Suter R, Hannah D, Lindholm B, Maisch L, Greiner M, Lytle B, Pencina M, Peterson E, Hernandez A. Real world effectiveness of warfarin among ischemic stroke patients with atrial fibrillation: observational analysis from Patient-Centered Research into Outcomes Stroke Patients Prefer and Effectiveness Research (PROSPER) study. The BMJ 2015, 351: h3786. PMID: 26232340, PMCID: PMC4521370, DOI: 10.1136/bmj.h3786.Peer-Reviewed Original ResearchConceptsMajor adverse cardiovascular eventsIschemic stroke patientsCoronary artery diseaseIschemic strokeWarfarin treatmentAtrial fibrillationArtery diseaseStroke patientsRisk of MACEImproved long-term clinical outcomesPrevious coronary artery diseaseLong-term clinical outcomesMore daysAdverse cardiovascular eventsHealth Stroke ScaleRecurrent ischemic strokeTerm clinical outcomesAtrial fibrillation patientsSurvivors of strokeLongitudinal outcomesReal-world effectivenessPatient prefersCardiovascular eventsOral anticoagulantsStroke ProgramNovel Oral Anticoagulant Use Among Patients With Atrial Fibrillation Hospitalized With Ischemic Stroke or Transient Ischemic Attack
Patel P, Zhao X, Fonarow G, Lytle B, Smith E, Xian Y, Bhatt D, Peterson E, Schwamm L, Hernandez A. Novel Oral Anticoagulant Use Among Patients With Atrial Fibrillation Hospitalized With Ischemic Stroke or Transient Ischemic Attack. Circulation Cardiovascular Quality And Outcomes 2015, 8: 383-392. PMID: 26058721, PMCID: PMC4512906, DOI: 10.1161/circoutcomes.114.000907.Peer-Reviewed Original ResearchConceptsNovel oral anticoagulantsTransient ischemic attackAtrial fibrillation patientsIschemic attackIschemic strokeFibrillation patientsEligible patientsWarfarin therapyAtrial fibrillationNovel oral anticoagulant useCHA2DS2-VASc scoreRate of anticoagulationOral anticoagulant useLower stroke riskMultivariable logistic regressionAnticoagulation ratesGuidelines-StrokeNOAC useAnticoagulant useOral anticoagulantsStroke riskRisk factorsStudy populationPatterns of usePatientsPatient-Centered Research into Outcomes Stroke Patients Prefer and Effectiveness Research: Implementing the patient-driven research paradigm to aid decision making in stroke care
Xian Y, O’Brien E, Fonarow G, Olson D, Schwamm L, Hannah D, Lindholm B, Maisch L, Lytle B, Greiner M, Wu J, Peterson E, Pencina M, Hernandez A. Patient-Centered Research into Outcomes Stroke Patients Prefer and Effectiveness Research: Implementing the patient-driven research paradigm to aid decision making in stroke care. American Heart Journal 2015, 170: 36-45.e11. PMID: 26093862, DOI: 10.1016/j.ahj.2015.04.008.Peer-Reviewed Original ResearchMeSH KeywordsActivities of Daily LivingAgedAged, 80 and overAnticoagulantsAntidepressive AgentsCohort StudiesDecision MakingDepressionFemaleHumansHydroxymethylglutaryl-CoA Reductase InhibitorsMaleMiddle AgedPatient Care PlanningPatient Outcome AssessmentPatient PreferencePatient SatisfactionProspective StudiesQuality of LifeRetrospective StudiesSecondary PreventionStrokeTreatment OutcomeConceptsComparative effectiveness researchPatient prefersStroke careStroke patientsTreatment optionsEffectiveness researchMajor adverse cardiovascular eventsAdverse cardiovascular eventsIndividual patient preferencesHealth care providersOutcomes Research InstitutePatient-centered comparative effectiveness researchOutcomes research studiesHealth care communityGuidelines-StrokeCardiovascular eventsOral anticoagulantsPatient-centered outcomes research studiesStatin therapyPatient characteristicsPrimary outcomeClinical effectivenessComparative safetyPatient preferencesClinical trials