1 / 25

Stroke Prevention in Cardiac Failure: Insights and Recommendations

Learn about the role of antithrombotic therapies in preventing strokes in patients with cardiac failure, focusing on risk factors, pathophysiology, and treatment options. Explore key studies and outcomes to make informed clinical decisions.

rowa
Download Presentation

Stroke Prevention in Cardiac Failure: Insights and Recommendations

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Cerebrovascular prevention in cardiac failure George Ntaios University of Thessaly, Larissa, Greece Lausanne 6/09/2012

  2. Stroke risk in cardiac failure J Card Fail 2006; 12:39-46

  3. Stroke risk increases with ↓ejection fraction [ SAVE trial ] N Engl J Med 1997; 336:251-7

  4. Pathophysiology of thrombus • - Virchow’s triad • Abnormalities of Blood Flow • Abnormalities of Blood Constituents • - Atrial fibrillation • Low cardiac output • Poor contractility • Aberrant flow in dilated chambers • Fibrinogen, vWf, thrombin, fibrin, • d-dimers, platelet volume, • β-thromboglobulin, p-selectin, etc. • Abnormalities of Vessel Wall • Nitric oxide, prostacyclin, endothelin, vWf levels, thromboxane A2, etc. J ThrombHaemost 2007; 5: 224–31 J Am Coll Cardiol 1999; 33;1424-26

  5. Atrialfibrillation Sinus rhythm

  6. Stroke prevention in patients with cardiac failure & atrial fibrillation

  7. Sinus rhythm

  8. The Warfarin/Aspirin Study in Heart Failure (WASH) Am Heart J 2004; 148:157–64

  9. The Warfarin/Aspirin Study in Heart Failure (WASH) Am Heart J 2004; 148:157–64

  10. The Warfarin/Aspirin Study in Heart Failure (WASH) • Composite event: • Death • Non-fatal stroke • Non-fatal MI Am Heart J 2004; 148:157–64

  11. The Heart failure Long-term Antithrombotic Study (HELAS) Eur J Heart Failure 2006; 8:428–32

  12. The Heart failure Long-term Antithrombotic Study (HELAS) Eur J Heart Failure 2006; 8:428–32

  13. Warfarin vs. placebo: All-cause deaths Cochrane Database of Systematic Reviews 2012; 6: CD003336

  14. Warfarin vs. placebo: Cardiovascular events Cochrane Database of Systematic Reviews 2012; 6: CD003336

  15. Warfarin vs. placebo: Major hemorrhages Cochrane Database of Systematic Reviews 2012; 6: CD003336

  16. Warfarin & Antiplatelet Therapy in Chronic Heart Failure (WATCH) Circulation. 2009; 119:1616-24

  17. Warfarin & Antiplatelet Therapy in Chronic Heart Failure (WATCH) Circulation. 2009; 119:1616-24

  18. Warfarin & Antiplatelet Therapy in Chronic Heart Failure (WATCH) • Composite event: • Death • Non-fatal stroke • Non-fatal MI Circulation. 2009; 119:1616-24

  19. Warfarin & Antiplatelet Therapy in Chronic Heart Failure (WATCH) Mortality Circulation. 2009; 119:1616-24

  20. Warfarin & Aspirin with Heart Failure & Sinus Rhythm (WARCEF) N Engl J Med. 2012; 366(20):1859-69

  21. Warfarin & Aspirin with Heart Failure & Sinus Rhythm (WARCEF) N Engl J Med. 2012; 366(20):1859-69

  22. Warfarin & Aspirin with Heart Failure & Sinus Rhythm (WARCEF) • Composite end-point • Ischemic stroke • Intracerebral hemorrhage • Death N Engl J Med. 2012; 366(20):1859-69

  23. Warfarin & Aspirin with Heart Failure & Sinus Rhythm (WARCEF) N Engl J Med. 2012; 366(20):1859-69

  24. Stroke prevention in patients with cardiac failure & sinus rhythm - Warfarin or aspirin are not better than placebo - Warfarin is not better than aspirin or clopidogrel

  25. Clinical practice Eur J Heart Fail. 2012;14(7):681-95

More Related