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A Thrombotic Stroke Model Based On Transient Cerebral Hypoxia-ischemia
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What's new in stroke? The top 10 studies of 2009-2011: part II

Robert G Hart1, Wiesław J Oczkowski

  • 1Vascular Neurology, Department of Neurology, University of Texas Health Science Center, San Antonio, United States. hartr@uthscsa.edu

Polskie Archiwum Medycyny Wewnetrznej
|June 23, 2011
PubMed

Insights

Novel anticoagulants like dabigatran and apixaban show promise for preventing strokes in atrial fibrillation (AF) patients. Carotid stenting risks vary by age compared to endarterectomy, requiring further long-term outcome analysis.

Area of Science:

  • Cardiology
  • Neurology
  • Vascular Surgery

Background:

  • Atrial fibrillation (AF) and cervical carotid artery stenosis are significant risk factors for stroke.
  • Optimizing stroke prevention strategies is crucial for patient outcomes.

Purpose of the Study:

  • To review recent evidence on stroke prevention in patients with AF and cervical carotid artery stenosis.
  • To evaluate the efficacy and safety of novel oral anticoagulants and antiplatelet therapies for AF stroke prevention.
  • To compare the risks of carotid artery stenting versus endarterectomy.

Main Methods:

  • Review of five key studies published between 2009 and 2011.
  • Analysis of two large phase III randomized trials (RE-LY, AVERROES) on novel oral anticoagulants in AF.
  • Evaluation of one trial (ACTIVE A) on dual antiplatelet therapy in AF.
  • Assessment of two large randomized trials (CREST, ICSS) comparing carotid stenting and endarterectomy.

Main Results:

  • Dabigatran was superior to warfarin for stroke prevention in AF; apixaban was superior to aspirin in warfarin-ineligible patients. Major bleeding rates were similar for novel anticoagulants.
  • Dual antiplatelet therapy (clopidogrel plus aspirin) improved stroke prevention in AF but increased major bleeding.
  • Carotid stenting showed higher periprocedural stroke rates than endarterectomy, particularly in patients over 70.

Conclusions:

  • Novel oral anticoagulants offer effective stroke prevention for AF patients with acceptable bleeding risk.
  • Dual antiplatelet therapy may be considered for select AF patients but carries increased bleeding risks.
  • Carotid stenting and endarterectomy have comparable short-term risks in younger patients, but long-term data are needed for definitive comparison, especially for older individuals.

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