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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EAt this year\u0027s International Stroke Conference, leaders in the field of stroke met to review some of the important updates to stroke-related guidelines. Included are some of the important revisions to the Guidelines for the Early Management of Patients With Acute Ischemic Stroke [Jauch EC et al. \u003Cem\u003EStroke\u003C\/em\u003E 2013]; 2012 Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage; an overview and recommendations for the use of the warfarin, dabigatran, apixaban, and rivaroxaban; and a discussion of the relationship between stroke and cardiovascular disease.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EIschemia\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EThrombotic Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EArrhythmias Guidelines\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPrevention \u0026amp; Screening\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ENeurology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EIschemia\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EThrombotic Disorders\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EArrhythmias\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENeurology Guidelines\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EPrevention \u0026amp; Screening\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EAt this year\u0027s International Stroke Conference, leaders in the field of stroke met to review some of the important updates to stroke-related guidelines.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EEdward C. Jauch, MD, MS, Medical University of South Carolina, Charleston, South Carolina, USA, discussed some of the important revisions to the Guidelines for the Early Management of Patients With Acute Ischemic Stroke [Jauch EC et al. \u003Cem\u003EStroke\u003C\/em\u003E 2013].\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EKey areas of focus include the importance of stroke systems of care, streamlining processes to minimize time, the importance of reperfusion (intravenous [IV] and intra-arterial), and expanded eligibility for reperfusion. The revised guidelines state that \u201cpatients should be transported rapidly to the closest available certified primary stroke center or comprehensive stroke center\u2026\u201d and they stress the importance of emergency medical services in prehospital notification. There are revised guidelines on emergency evaluation and diagnosis of stroke, particularly with respect to testing prior to initiation of IV tissue plasminogen activator (tPA) and the use optimal use of imaging. Revised recommendations for IV fibrinolysis now call for a door-to-needle time that is within 60 minutes from hospital arrival. There are several revised recommendations concerning eligibility criteria for the use of tPA, and there are new recommendations addressing endovascular interventions.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EAlejandro Rabinstein, MD, Mayo Clinic, Rochester, Minnesota, USA, reviewed the highlights from the 2012 Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage (aSAH) [Connolly ES et al. \u003Cem\u003EStroke\u003C\/em\u003E 2012] in the following areas:\u003C\/p\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ERisk Factors and Prevention\u003C\/h2\u003E\n         \u003Cp\u003E\n            \u003C\/p\u003E\u003Cul class=\u0022list-simple \u0022 id=\u0022list-1\u0022\u003E\u003Cli id=\u0022list-item-1\u0022\u003E\n                  \u003Cp id=\u0022p-7\u0022\u003E\u25aa Improved guidance for the treatment of hypertension (HTN).\u003C\/p\u003E\n               \u003C\/li\u003E\u003C\/ul\u003E\u003Cp\u003E\n         \u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ENatural History and Outcome\u003C\/h2\u003E\n         \u003Cp\u003E\n            \u003C\/p\u003E\u003Cul class=\u0022list-simple \u0022 id=\u0022list-2\u0022\u003E\u003Cli id=\u0022list-item-2\u0022\u003E\n                  \u003Cp id=\u0022p-9\u0022\u003E\u25aa Determine severity early using Hunt-Hess or World Federation Neurosurgeons Scale.\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-3\u0022\u003E\n                  \u003Cp id=\u0022p-10\u0022\u003E\u25aa Evaluate and treat suspected aSAH as soon as possible to reduce the risk of rebleeding.\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-4\u0022\u003E\n                  \u003Cp id=\u0022p-11\u0022\u003E\u25aa Introduce multidisciplinary and comprehensive follow-up.\u003C\/p\u003E\n               \u003C\/li\u003E\u003C\/ul\u003E\u003Cp\u003E\n         \u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EDiagnosis and Clinical Presentation\u003C\/h2\u003E\n         \u003Cp\u003E\n            \u003C\/p\u003E\u003Cul class=\u0022list-simple \u0022 id=\u0022list-3\u0022\u003E\u003Cli id=\u0022list-item-5\u0022\u003E\n                  \u003Cp id=\u0022p-13\u0022\u003E\u25aa Computed tomography angiography may be considered, but, if inconclusive, use digital subtraction angiography (DSA).\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-6\u0022\u003E\n                  \u003Cp id=\u0022p-14\u0022\u003E\u25aa Magnetic resonance imaging can be considered for emergency diagnosis if CT is nondiagnostic, but it does not obviate the need for a lumbar puncture.\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-7\u0022\u003E\n                  \u003Cp id=\u0022p-15\u0022\u003E\u25aa DSA with 3D rotational images is indicated before deciding on a treatment approach.\u003C\/p\u003E\n               \u003C\/li\u003E\u003C\/ul\u003E\u003Cp\u003E\n         \u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-4\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EMedical Measures to Prevent Rebleeding\u003C\/h2\u003E\n         \u003Cp\u003E\n            \u003C\/p\u003E\u003Cul class=\u0022list-simple \u0022 id=\u0022list-4\u0022\u003E\u003Cli id=\u0022list-item-8\u0022\u003E\n                  \u003Cp id=\u0022p-17\u0022\u003E\u25aa Control HTN with a titratable agent (decreasing systolic blood pressure to \u0026lt;160 mm Hg is reasonable).\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-9\u0022\u003E\n                  \u003Cp id=\u0022p-18\u0022\u003E\u25aa If treatment is delayed and there are no compelling contraindications, short-term (\u0026lt;72 hours) treatment with tranexamic acid or aminocaprioic acid is reasonable.\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-10\u0022\u003E\n                  \u003Cp id=\u0022p-19\u0022\u003E\u25aa Coiling should be considered for aneurysms that are amenable to both coiling and clipping.\u003C\/p\u003E\n               \u003C\/li\u003E\u003C\/ul\u003E\u003Cp\u003E\n         \u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-5\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EVasospasm\u003C\/h2\u003E\n         \u003Cp\u003E\n            \u003C\/p\u003E\u003Cul class=\u0022list-simple \u0022 id=\u0022list-5\u0022\u003E\u003Cli id=\u0022list-item-11\u0022\u003E\n                  \u003Cp id=\u0022p-21\u0022\u003E\u25aa Oral nimodipine is recommended.\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-12\u0022\u003E\n                  \u003Cp id=\u0022p-22\u0022\u003E\u25aa Maintain euvolemia and normal circulating volume to prevent delayed cerebral ischemia (DCI).\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-13\u0022\u003E\n                  \u003Cp id=\u0022p-23\u0022\u003E\u25aa Perfusion imaging can be useful.\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-14\u0022\u003E\n                  \u003Cp id=\u0022p-24\u0022\u003E\u25aa Induced HTN is recommended when DCI occurs unless precluded by cardiac status.\u003C\/p\u003E\n               \u003C\/li\u003E\u003C\/ul\u003E\u003Cp\u003E\n         \u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-6\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ESeizures\u003C\/h2\u003E\n         \u003Cp\u003E\n            \u003C\/p\u003E\u003Cul class=\u0022list-simple \u0022 id=\u0022list-6\u0022\u003E\u003Cli id=\u0022list-item-15\u0022\u003E\n                  \u003Cp id=\u0022p-26\u0022\u003E\u25aa Prophylactic antiepileptic drugs (AEDs) in the immediate posthemorrhagic period may be considered.\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-16\u0022\u003E\n                  \u003Cp id=\u0022p-27\u0022\u003E\u25aa Routine use of AEDs is not recommended but may be considered for patients with risk of delayed seizure disorder.\u003C\/p\u003E\n               \u003C\/li\u003E\u003C\/ul\u003E\u003Cp\u003E\n         \u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-7\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EMedical Complications\u003C\/h2\u003E\n         \u003Cp\u003E\n            \u003C\/p\u003E\u003Cul class=\u0022list-simple \u0022 id=\u0022list-7\u0022\u003E\u003Cli id=\u0022list-item-17\u0022\u003E\n                  \u003Cp id=\u0022p-29\u0022\u003E\u25aa Avoid hypotonic fluids and intravascular volume contraction.\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-18\u0022\u003E\n                  \u003Cp id=\u0022p-30\u0022\u003E\u25aa Monitor volume status in certain patients by central venous pressure and\/or pulmonary wedge and\/or fluid balance and treat volume contraction with crystalloids or colloids.\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-19\u0022\u003E\n                  \u003Cp id=\u0022p-31\u0022\u003E\u25aa Maintain normothermia.\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-20\u0022\u003E\n                  \u003Cp id=\u0022p-32\u0022\u003E\u25aa Consider careful glucose management with strict avoidance of hypoglycemia.\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-21\u0022\u003E\n                  \u003Cp id=\u0022p-33\u0022\u003E\u25aa Red blood cell transfusions to treat anemia may be reasonable (optimal hemoglobin goal is unknown).\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-22\u0022\u003E\n                  \u003Cp id=\u0022p-34\u0022\u003E\u25aa Fludrocortisone and hypertonic saline are reasonable to prevent and treat hyponatremia.\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-23\u0022\u003E\n                  \u003Cp id=\u0022p-35\u0022\u003E\u25aa Early identification and targeted treatment of heparin-induced thrombocytopenia and deep vein thrombosis are recommended.\u003C\/p\u003E\n               \u003C\/li\u003E\u003C\/ul\u003E\u003Cp\u003E\n         \u003C\/p\u003E\n         \u003Cp id=\u0022p-36\u0022\u003EDr. Rabinstein said that most cases of aSAH are eminently treatable and the objective should be full functional recovery.\u003C\/p\u003E\n         \u003Cp id=\u0022p-37\u0022\u003EDaniel T. Lackland, DrPH, Medical University of South Carolina, Charleston, South Carolina, USA, provided evidence and recommendations for the inclusion of patients with stroke among those considered to be at high risk of cardiovascular disease (CVD) as well as part of the outcome cluster in risk prediction instruments for vascular disease [Lackland DT et al. \u003Cem\u003EStroke\u003C\/em\u003E 2012]. The evidence for the inclusion of stroke in the vascular outcome cluster is that many of the same risk factors and mechanisms that cause heart disease also cause stroke, and many treatments (antihypertensive treatment, statins) that reduce the risk of heart disease also reduce the risk of stroke. The inclusion of stroke as an outcome could lead to an increase in the absolute risks of vascular events by 5% to 10% and thus, detect additional patients eligible for more intensive preventive interventions. Inclusion of atherosclerotic stroke among the categories of risk equivalents is shown in \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E.\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/1\/8\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Stroke as a Risk Equivalent: Percentage of Participants With Levels of Risk by Age\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-566362526\u0022 data-figure-caption=\u0022Stroke as a Risk Equivalent: Percentage of Participants With Levels of Risk by Age\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/1\/8\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/1\/8\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/1\/8\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12934\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-38\u0022 class=\u0022first-child\u0022\u003EStroke as a Risk Equivalent: Percentage of Participants With Levels of Risk by Age\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003ECAD=coronary artery disease; NS=no stroke; S-OI=stroke otherwise identified; S-NI=stroke newly identified.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced from Lackland DT et al. Inclusion of Stroke in Cardiovascular Risk Prediction Instruments: A Statement for Healthcare Professionals From the American Heart Association\/American Stroke Association. \u003Cem\u003EStroke\u003C\/em\u003E Jul 2012;43(7):1998\u20132027. With permission from Lipincott Williams and Wilkins.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-39\u0022\u003EDr. Lackland suggests the following regarding stroke and risk assessment:\u003C\/p\u003E\n         \u003Cp\u003E\n            \u003C\/p\u003E\u003Col class=\u0022list-ord \u0022 id=\u0022list-8\u0022\u003E\u003Cli id=\u0022list-item-24\u0022\u003E\n                  \u003Cp id=\u0022p-41\u0022\u003ELarge vessel atherosclerotic ischemic stroke should be considered as coronary heart disease risk equivalent.\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-25\u0022\u003E\n                  \u003Cp id=\u0022p-42\u0022\u003EIschemic stroke can reasonably be considered a relevant outcome along with coronary heart disease (CHD) outcomes in CVD risk prediction instruments.\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-26\u0022\u003E\n                  \u003Cp id=\u0022p-43\u0022\u003EIschemic stroke subtypes other than large vessel atherosclerosis may reasonably be considered as CHD risk equivalents; future research is needed.\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-27\u0022\u003E\n                  \u003Cp id=\u0022p-44\u0022\u003EHemorrhagic strokes and strokes of undetermined subtypes may be included among outcomes in general CVD risk prediction instruments.\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-28\u0022\u003E\n                  \u003Cp id=\u0022p-45\u0022\u003EIschemic stroke can reasonably be considered a relevant outcome in clinical 10-year cardiovascular risk prediction instruments.\u003C\/p\u003E\n               \u003C\/li\u003E\u003Cli id=\u0022list-item-29\u0022\u003E\n                  \u003Cp id=\u0022p-46\u0022\u003EFurther clinical epidemiological studies are needed.\u003C\/p\u003E\n               \u003C\/li\u003E\u003C\/ol\u003E\u003Cp\u003E\n         \u003C\/p\u003E\n         \u003Cp id=\u0022p-47\u0022\u003EIn a discussion of the current optimal therapy for stroke prevention in atrial fibrillation (AF), Karen L. Furie, MD, Brown University, Providence, Rhode Island, USA, provided an overview and recommendations for the use of the warfarin, dabigatran, apixaban, and rivaroxaban.\u003C\/p\u003E\n         \u003Cp id=\u0022p-48\u0022\u003EEvidence for the use of dabigatran, an oral pro-drug and competitive inhibitor of Factor II, comes from the RE-LY study [Connolly SJ et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2009], which showed that dabigatran 110 mg was similar to warfarin for stroke prevention, with lower rates of major hemorrhage, and 150 mg was superior to warfarin but had similar rates of major hemorrhage.\u003C\/p\u003E\n         \u003Cp id=\u0022p-49\u0022\u003ERivaroxaban is a direct factor Xa inhibitor that is noninferior to warfarin for the prevention of stroke, systemic embolism, or the risk of major bleeding. This was confirmed in both the ROCKET AF study [Patel MR et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2011] and the J-ROCKET study that also confirmed the safety and efficacy of rivaroxaban in patients with moderate renal impairment and preserved renal function [Hori M et al. \u003Cem\u003ECirc J\u003C\/em\u003E 2012].\u003C\/p\u003E\n         \u003Cp id=\u0022p-50\u0022\u003EIn the AVERROES trial, apixaban (another factor Xa inhibitor) reduced the risk of stroke and systemic embolism relative to aspirin without significantly increasing the risk of major bleeding or intracranial hemorrhage in patients with AF for whom vitamin K antagonist therapy was unsuitable [Connolly SJ et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2011]. Apixaban was also shown to be superior to warfarin for preventing hemorrhagic stroke and similar for preventing ischemic stroke in the ARISTOTLE trial. It caused less bleeding and lowered mortality [Granger CB et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2011].\u003C\/p\u003E\n         \u003Cp id=\u0022p-51\u0022\u003EA comparison overview of these new agents versus warfarin is shown in \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E.\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/12936\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/12936\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12936\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-52\u0022 class=\u0022first-child\u0022\u003EOverview of New Agents Versus Warfarin\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-54\u0022\u003EThe use of warfarin, dabigatran, apixaban, and rivaroxaban are all indicated for stroke prevention (Class I-IIa, Level of Evidence A-B). Although the safety and efficacy of combining dabigatran, rivaroxaban, or apixaban with an antiplatelet agent has been established at a Class IIb, Level of Evidence C, Dr. Furie feels that the use of these agents in combination with antiplatelet therapy should be considered with caution. When selecting optimal therapy for stroke prevention in AF, vascular neurologists should base their decision on risk factors, cost, tolerability, patient preference, drug interactions, and compliance. Patients should be educated about the need for careful transitions and potential risks.\u003C\/p\u003E\n         \u003Cdiv id=\u0022F2\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/1\/8\/F2.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022The editors would like to thank the many members of the American Stroke Association presenting faculty who generously gave their time to ensure the accuracy and quality of the articles in this publication.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-566362526\u0022 data-figure-caption=\u0022The editors would like to thank the many members of the American Stroke Association presenting faculty who generously gave their time to ensure the accuracy and quality of the articles in this publication.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure2\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/1\/8\/F2.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/1\/8\/F2.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure2\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/13\/1\/8\/F2.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12935\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\n               \u003Cp id=\u0022p-55\u0022 class=\u0022first-child\u0022\u003EThe editors would like to thank the many members of the American Stroke Association presenting faculty who generously gave their time to ensure the accuracy and quality of the articles in this publication.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2013 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/13\/1\/8.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzo2cp\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzo2cp\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzo2cp\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}