Deans' stroke musings

Changing stroke rehab and research worldwide now.Time is Brain!Just think of all the trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 493 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It's quite disgusting that this information is not available from every stroke association and doctors group.
My back ground story is here:http://oc1dean.blogspot.com/2010/11/my-background-story_8.html

Thursday, May 17, 2018

NOAC Not Better Against Cryptogenic Stroke Recurrence

What is your doctor keeping you on after your stroke to prevent the next one?
https://www.medpagetoday.com/cardiology/strokes/72909?

Rivaroxaban had no advantage over aspirin, and increased bleeding risk in trial

  • by Senior Associate Editor, MedPage Today
  • This article is a collaboration between MedPage Today® and:
    Medpage Today
Rivaroxaban (Xarelto) was not better than aspirin for preventing recurrence of ischemic strokes without a known source of the emboli, but it did increase bleeding risk, the NAVIGATE ESUS trial found.
For the primary endpoint, the non-vitamin K antagonist oral anticoagulant (NOAC) had an annualized rate of first recurrence of ischemic or hemorrhagic stroke or systemic embolism of 5.1% compared with 4.8% for aspirin (HR 1.07; 95% CI 0.87-1.33, P=0.52).
Recurrent ischemic stroke occurred at an identical 4.7% per year in both groups, Robert Hart, MD, of the Population Health Research Institute in Hamilton, Ontario, and colleagues reported online in the New England Journal of Medicine in a study published simultaneously with presentation at the European Stroke Organisation Conference in Gothenburg, Sweden.
Rivaroxaban substantially increased major bleeding, though, at an annualized rate of 1.8% compared with 0.7% on aspirin (HR 2.72, 95% CI 1.68-4.39, P<0.001). Life-threatening or fatal bleeding (HR 2.34), symptomatic intracranial hemorrhage (HR 4.02), and clinically relevant nonmajor bleeding (HR 1.51) were also significantly worse with rivaroxaban.
The trial included 7,213 patients ages 50 and older with "embolic stroke of undetermined source" -- i.e., not associated with proximal arterial stenosis or a recognized cardioembolic source, such as atrial fibrillation or left ventricular thrombus, and that are not lacunar -- who were randomized to 15-mg immediate-release rivaroxaban or 100-mg aspirin enteric coated tablets along with placebo given both groups to maintain blinding.
All participants had at least 20 total hours of cardiac rhythm monitoring to rule out atrial fibrillation lasting 6 minutes or longer.
"Rivaroxaban, including the 15-mg daily dose that was used in the current trial, has been effective for the prevention of recurrent stroke in patients with atrial fibrillation," the researchers noted, "and the absence of an observed lower rate of recurrent ischemic stroke with rivaroxaban than with aspirin in the current trial suggests that undetected paroxysmal atrial fibrillation was not a major cause of recurrent stroke."
While 7% of the included patients had a patent foramen ovale, the outcome influence of including these patients "is uncertain," according to the researchers, noting that the trials showing a benefit to closure in cryptogenic stroke came out just when recruitment stopped in NAVIGATE ESUS.
The trial was stopped early for excess bleeding risk without an offsetting chance of stroke prevention efficacy after patients had been followed for a median 11 months and 74% of the planned efficacy events had occurred.
Using a 20 mg rather than 15 mg dose of rivaroxaban wouldn't likely have made any difference in the findings, Hart's group suggested. But they noted that ongoing randomized trials are comparing other NOACs with aspirin in secondary prevention after cryptogenic stroke, such as RE-SPECT ESUS with dabigatran (Pradaxa) and ATTICUS with apixaban (Eliquis).
The trial was funded by Bayer and Janssen Research and Development.
Hart reported grants and personal fees from Bayer, outside of the NAVIGATE ESUS study.

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