TY  - JOUR
A1  - Schnabel, Renate B.
A1  - Camen, Stephan
A1  - Knebel, Fabian
A1  - Hagendorff, Andreas
A1  - Bavendiek, Udo
A1  - Böhm, Michael
A1  - Doehner, Wolfram
A1  - Endres, Matthias
A1  - Gröschel, Klaus
A1  - Goette, Andreas
A1  - Huttner, Hagen B.
A1  - Jensen, Christoph
A1  - Kirchhof, Paulus
A1  - Korosoglou, Grigorius
A1  - Laufs, Ulrich
A1  - Liman, Jan
A1  - Morbach, Caroline
A1  - Navabi, Darius Günther
A1  - Neumann-Haefelin, Tobias
A1  - Pfeilschifter, Waltraut
A1  - Poli, Sven
A1  - Rizos, Timolaos
A1  - Rolf, Andreas
A1  - Röther, Joachim
A1  - Schäbitz, Wolf Rüdiger
A1  - Steiner, Thorsten
A1  - Thomalla, Götz
A1  - Wachter, Rolf
A1  - Haeusler, Karl Georg
T1  - Expert opinion paper on cardiac imaging after ischemic stroke
JF  - Clinical Research in Cardiology
N2  - This expert opinion paper on cardiac imaging after acute ischemic stroke or transient ischemic attack (TIA) includes a statement of the "Heart and Brain" consortium of the German Cardiac Society and the German Stroke Society. The Stroke Unit-Commission of the German Stroke Society and the German Atrial Fibrillation NETwork (AFNET) endorsed this paper. Cardiac imaging is a key component of etiological work-up after stroke. Enhanced echocardiographic tools, constantly improving cardiac computer tomography (CT) as well as cardiac magnetic resonance imaging (MRI) offer comprehensive non- or less-invasive cardiac evaluation at the expense of increased costs and/or radiation exposure. Certain imaging findings usually lead to a change in medical secondary stroke prevention or may influence medical treatment. However, there is no proof from a randomized controlled trial (RCT) that the choice of the imaging method influences the prognosis of stroke patients. Summarizing present knowledge, the German Heart and Brain consortium proposes an interdisciplinary, staged standard diagnostic scheme for the detection of risk factors of cardio-embolic stroke. This expert opinion paper aims to give practical advice to physicians who are involved in stroke care. In line with the nature of an expert opinion paper, labeling of classes of recommendations is not provided, since many statements are based on expert opinion, reported case series, and clinical experience.
KW  - cardiac imaging
KW  - echocardiography
KW  - ischemic stroke
KW  - transient ischemic attack
KW  - expert opinion
KW  - magnetic resonance imaging
KW  - computed tomography
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-266662
SN  - 1861-0692
VL  - 110
IS  - 7
ER  - 
TY  - JOUR
A1  - Tütüncü, Serdar
A1  - Olma, Manuel
A1  - Kunze, Claudia
A1  - Dietzel, Joanna
A1  - Schurig, Johannes
A1  - Fiessler, Cornelia
A1  - Malsch, Carolin
A1  - Haas, Tobias Eberhard
A1  - Dimitrijeski, Boris
A1  - Doehner, Wolfram
A1  - Hagemann, Georg
A1  - Hamilton, Frank
A1  - Honermann, Martin
A1  - Jungehulsing, Gerhard Jan
A1  - Kauert, Andreas
A1  - Koennecke, Hans-Christian
A1  - Mackert, Bruno-Marcel
A1  - Nabavi, Darius
A1  - Nolte, Christian H.
A1  - Reis, Joschua Mirko
A1  - Schmehl, Ingo
A1  - Sparenberg, Paul
A1  - Stingele, Robert
A1  - Völzke, Enrico
A1  - Waldschmidt, Carolin
A1  - Zeise-Wehry, Daniel
A1  - Heuschmann, Peter U.
A1  - Endress, Matthias
A1  - Haeusler, Karl Georg
T1  - Off-label-dosing of non-vitamin K-dependent oral antagonists in AF patients before and after stroke: results of the prospective multicenter Berlin Atrial Fibrillation Registry
JF  - Journal of Neurology
N2  - Aims
We aimed to analyze prevalence and predictors of NOAC off-label under-dosing in AF patients before and after the index stroke.
Methods
The post hoc analysis included 1080 patients of the investigator-initiated, multicenter prospective Berlin Atrial Fibrillation Registry, designed to analyze medical stroke prevention in AF patients after acute ischemic stroke.
Results
At stroke onset, an off-label daily dose was prescribed in 61 (25.5%) of 239 NOAC patients with known AF and CHA2DS2-VASc score ≥ 1, of which 52 (21.8%) patients were under-dosed. Under-dosing was associated with age ≥ 80 years in patients on rivaroxaban [OR 2.90, 95% CI 1.05-7.9, P = 0.04; n = 29] or apixaban [OR 3.24, 95% CI 1.04-10.1, P = 0.04; n = 22]. At hospital discharge after the index stroke, NOAC off-label dose on admission was continued in 30 (49.2%) of 61 patients. Overall, 79 (13.7%) of 708 patients prescribed a NOAC at hospital discharge received an off-label dose, of whom 75 (10.6%) patients were under-dosed. Rivaroxaban under-dosing at discharge was associated with age ≥ 80 years [OR 3.49, 95% CI 1.24-9.84, P = 0.02; n = 19]; apixaban under-dosing with body weight ≤ 60 kg [OR 0.06, 95% CI 0.01-0.47, P < 0.01; n = 56], CHA2DS2-VASc score [OR per point 1.47, 95% CI 1.08-2.00, P = 0.01], and HAS-BLED score [OR per point 1.91, 95% CI 1.28-2.84, P < 0.01].
Conclusion
At stroke onset, off-label dosing was present in one out of four, and under-dosing in one out of five NOAC patients. Under-dosing of rivaroxaban or apixaban was related to old age. In-hospital treatment after stroke reduced off-label NOAC dosing, but one out of ten NOAC patients was under-dosed at discharge.
KW  - NOAC
KW  - ischemic stroke
KW  - atrial fibrillation
KW  - under-dosing
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-266969
SN  - 1432-1459
VL  - 269
IS  - 1
ER  -