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Diener H.-C.,Universitatsklinik For Neurologie Und Schlaganfallzentrum | Weber R.,Universitatsklinik For Neurologie Und Schlaganfallzentrum | Weimar C.,Universitatsklinik For Neurologie Und Schlaganfallzentrum | Frank B.,Universitatsklinik For Neurologie Und Schlaganfallzentrum | Kirchhof P.,Universitatsklinikum Munster
Psychopharmakotherapie | Year: 2011

Atrial fibrillation (AF) is an important risk factor for stroke. Oral anticoagulation with vitamin-Kantagonists reduces stroke risk in patients with AF by about 64%. The risk of bleeding is only acceptable if the international normalized ratio (INR) is kept between 2.0 and 3.0. Oral direct thrombin antagonists such as dabigatran are given in a fixed daily dose irrespective of age, body weight or ethnicity. Dabigatran has no interaction with food and only minimal interactions with a few other drugs. The RE-LY study in 18,133 patients with atrial fibrillation showed that dabigatranetexilate 110 mg bid is as effective as warfarin in the prevention of stroke and systemic embolism and that dabigatranetexilate 150 mg bid is superior to warfarin. Both doses of dabigatranetexilate have a significantly lower incidence of cerebral hemorrhage or intracranial bleeds. Dabigatran offers a safe and effective alternative treatment to warfarin in patients with AF. Source


Diener H.C.,Universitatsklinik For Neurologie Und Schlaganfallzentrum | Frank B.,Universitatsklinik For Neurologie Und Schlaganfallzentrum | Hajjar K.,Universitatsklinik For Neurologie Und Schlaganfallzentrum | Weimar C.,Universitatsklinik For Neurologie Und Schlaganfallzentrum
Nervenarzt | Year: 2014

Systemic thrombolysis with recombinant tissue-type plasminogen activator (rt-PA) remains the only effective and approved medical treatment of acute ischemic stroke. Several studies have demonstrated the importance of rapid recanalization. The efficacy of thrombectomy has so far not been sufficiently shown in randomized clinical trials; therefore, inclusion of suitable patients in one of the currently ongoing randomized trials is of great importance. The early treatment with magnesium after acute ischemic stroke during the pre-hospital phase did not prove to be neuroprotective. Intermittent pneumatic compression of the lower extremities in immobilized stroke patients effectively prevents deep venous thrombosis and pulmonary embolism. In patients with lacunar stroke the combination of aspirin and clopidogrel is not superior to aspirin alone and causes more bleeding complications. The novel oral anticoagulants are superior to warfarin in secondary prevention and carry a lower risk of intracranial and systemic bleeding complications. New studies will investigate whether dabigatran or rivaroxaban are superior to aspirin in secondary prevention after cryptogenic stroke. © 2014 Springer-Verlag. Source

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