0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Comment & Response |

New Oral Anticoagulants and the Risk for Intracranial Hemorrhage

Manolis S. Kallistratos, MD, PhD, FESC1; Leonidas E. Poulimenos, MD, FESC1; Athanasios J. Manolis, MD, FESC1
[+] Author Affiliations
1Department of Cardiology, Asklepeion General Hospital, Athens, Greece
JAMA Neurol. 2014;71(3):370-371. doi:10.1001/jamaneurol.2013.5963.
Text Size: A A A
Published online

Extract

To the Editor The excellent article by Chatterjee et al1 underlines the effectiveness and safety of novel oral anticoagulants over warfarin in terms of major bleeding (intracranial hemorrhage). Several recent studies, such as ROCKET-AF (Rivaroxaban Once-daily oral direct factor Xa inhibition Compared with vitamin K antagonism for prevention of stroke and Embolism Trial in Atrial Fibrillation), RE-LY (Randomized Evaluation of Long Term Anticoagulant Therapy with Dabigatran Etexilate), AVERROES (Apixaban Versus Acetylsalicylic Acid to Prevent Strokes), and ARISTOTLE (Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation), demonstrated the superiority (or noninferiority, depending on the dose) of newer anticoagulants vs vitamin K antagonists, in terms of risk reduction for stroke and major bleedings, using an easier and apparently safer drug regimen. However, all these studies, and the meta-analysis of Chatterjee et al, had a major limitation: blood pressure control during follow-up has not been assessed. The prevalence of arterial hypertension in the participants of these studies was extremely high; it ranged from 80% to 90%.2 It is well known that hypertension is associated with increased risk for stroke as well as with major bleeding. The presence of systolic blood pressures higher than 160 mm Hg is among the clinical characteristics of the HAS-BLED (hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol concomitantly) score, while in the CHA2DS2VASc (congestive heart failure, hypertension, 75 years of age and older, diabetes mellitus, previous stroke or transient ischemic attack, vascular disease, 65 to 74 years of age, female) score, hypertension represents a major risk factor. Thus, apart from the comparison of vitamin K antagonists with novel oral anticoagulants, blood pressure control also plays a significant role for the reduction of major bleeding. In terms of stroke incidence, in the combined SPORTIF (Stroke Prevention Using Oral Thrombin Inhibitor in Atrial Fibrillation) III and V cohort, the event rate for stroke/systemic embolic events increased markedly at mean systolic blood pressure rates of greater than 140 mm Hg.3,4

Topics

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

March 1, 2014
Claudia Stöllberger, MD; Josef Finsterer, MD, PhD
1Krankenanstalt Rudolfstiftung, Wien, Österreich
JAMA Neurol. 2014;71(3):369-370. doi:10.1001/jamaneurol.2013.5966.
March 1, 2014
Saurav Chatterjee, MD; Partha Sardar, MD; Giuseppe Biondi-Zoccai, MD; Dharam J. Kumbhani, MD, SM, MRCP
1Division of Cardiology, St Lukes-Roosevelt Hospital, Mount Sinai Health System, New York, New York
2Department of Medicine, New York Medical College–Metropolitan Hospital Center, New York, New York
3Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
4Division of Cardiology, University of Texas Southwestern, Dallas, Texas
JAMA Neurol. 2014;71(3):371-372. doi:10.1001/jamaneurol.2013.6003.
CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

719 Views
0 Citations
×

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Jobs
brightcove.createExperiences();