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Cerebrovascular prevention in cardiac failure

Cerebrovascular prevention in cardiac failure. George Ntaios University of Thessaly, Larissa, Greece. Lausanne 6/09/2012. Stroke risk in cardiac failure. J Card Fail 2006; 12:39-46. Stroke risk increases with ↓ejection fraction [ SAVE trial ]. N Engl J Med 1997; 336:251-7.

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Cerebrovascular prevention in cardiac failure

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  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

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