Warfarin underused by patients at risk for stroke

This study comes as no surprise to anyone who has worked in an anticoagulation clinic. There are far too many people in the community not being properly managed on their warfarin, or aren't taking it when they should be.

From Reuters:
New research indicates that most patients with atrial fibrillation -- the most common type of heart arrhythmia -- who suffered a stroke and were eligible for anticoagulation treatment, were not taking any warfarin or were not taking enough.

"These are missed opportunities for stroke prevention," lead author Dr. David J. Gladstone, from the University of Toronto, said in a statement. "Sadly, we frequently see patients admitted to a hospital with a devastating stroke who are known to have atrial fibrillation, yet were either not taking warfarin or were taking a dose that is not therapeutic."

Warfarin, also known by the trade name Coumadin, can reduce the risk of stroke by preventing the formation of blood clots, which often occur in patients with atrial fibrillation. The clot may detach from the wall of the blood vessel and become lodged in the brain, blocking the flow of blood and causing a stroke. Atrial fibrillation doesn't always cause symptoms, but the condition can be quite dangerous.

As they reported in the current online issue of Stroke, the researchers analyzed data for 597 patients with known atrial fibrillation and potentially preventable strokes who were entered in the Registry of the Canadian Stroke Network from 2003 to 2007....more

In-hospital stroke patients more likely to die: study

From the Ottawa Citizen:
One of the worst places to be if you have a stroke is in a hospital, new Canadian research suggests.

A study based on thousands of Ontario residents found patients who have a stroke while they're already in hospital wait twice as long for a brain scan and twice as long for a clot-busting drug as people who come to an emergency room with a stroke. They are also more likely to die.

"You would think, naively, that if someone has a stroke while in hospital -- given that we keep emphasizing the concept that 'time is brain' and the sooner you get to treatment, the better -- you would anticipate that they would have the best treatment," says Dr. Frank Silver, co-principal investigator of the Registry of the Canadian Stroke Network and medical professor at the University of Toronto. ...more

Stroke therapy fights cell death

From the Globe and Mail:
In recent years, huge advances have been made in the treatment of the most common type of stroke in which a clot blocks the flow of blood to part of the brain.

If a patient gets to a hospital within three hours of the onset of symptoms, doctors can administer a clot-busting drug that quickly restores blood flow and reduces the chances of long-term disability.

But there is a catch: A lot of patients don't make it to an emergency room in time to receive this brain-preserving therapy.

A new study suggests there may be another option for the latecomers. People treated with the antibiotic minocycline within six to 24 hours of the stroke suffered far fewer long-term disabilities than patients who didn't get the medication. ...more