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- Perspective and Pathogenesis
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1. Expanding frontiers of cerebrovascular disease
- Prof. Vladimir Hachinski
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2. Basic anatomy, physiology and pathophysiology of the cerebral circulation for the physician
- Prof. Jean-Claude Baron
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3. Pathophysiology of cerebral ischemia
- Prof. Wolf-Dieter Heiss
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4. Intracerebral hemorrhages: causes and clinical findings
- Prof. Louis Caplan
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5. Subarachnoid hemorrhage (SAH)
- Prof. R. Loch Macdonald
- Diagnosis
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6. Clinical diagnosis of stroke and subtypes
- Prof. Louis Caplan
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7. The investigation of stroke
- Dr. Bart Demaerschalk
- Treatment
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8. Acute therapy of stroke and reperfusion treatments
- Prof. Brian Silver
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9. Subarachnoid hemorrhage diagnosis and management
- Prof. Gary K. Steinberg
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10. Stroke-induced heart injury
- Dr. Luciano A. Sposato
- Rehabilitation
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11. Stroke rehabilitation: principles of stroke
- Prof. Robert Teasell
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12. Stroke rehabilitation: therapies and treatments
- Prof. Robert Teasell
- Prevention
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13. Lifestyle and nutrition in stroke prevention
- Prof. J. David Spence
- Special Topics
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15. Pediatric stroke: cerebrovascular injury in the developing brain
- Prof. Adam Kirton
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16. Stroke in women: epidemiology, risk and prevention
- Prof. Cheryl Bushnell
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17. Transient ischemic attack and cognition
- Dr. Jennifer Mandzia
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18. Vascular cognitive impairment
- Prof. Eric E. Smith
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19. Atrial fibrillation, anticoagulation and vitamins for homocysteine
- Prof. J. David Spence
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20. Stroke in the young adult
- Prof. Jeffrey Saver
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21. Stroke in the young
- Dr. Gyan Kumar
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22. Convergence and joint prevention of stroke and dementia
- Prof. Vladimir Hachinski
- Archived Lectures *These may not cover the latest advances in the field
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23. Vascular cognitive impairment
- Dr. John Bowler
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24. Pediatric stroke
- Dr. Gabrielle deVeber
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25. The deteriorating stroke
- Prof. Werner Hacke
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26. General management
- Prof. Bo Norrving
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27. The treatment of stroke: specific management - thrombolysis plus
- Prof. Nils Wahlgren
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28. Rehabilitation: the chronic phase
- Prof. Lalit Kalra
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29. Prevention: management of risk and protective factors
- Prof. Graeme Hankey
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30. Medical therapy for secondary prevention of ischemic stroke
- Prof. Larry Goldstein
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31. Subarachnoid haemorrhage
- Prof. Jan van Gijn
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32. Controversies in stroke
- Prof. Stephen Davies
- Prof. Geoffrey Donnan
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33. Medical and surgical stroke
- Prof. Carlos Kase
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34. The urgency of stroke prevention after TIA
- Prof. S. Claiborne Johnston
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35. Carotid endarterectomy, angioplasty and stenting
- Prof. Martin Brown
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36. The clinical diagnosis of stroke and stroke subtypes
- Prof. Louis Caplan
Printable Handouts
Navigable Slide Index
- Introduction
- Stroke series
- Disclosures
- Stroke and aging population
- Atrial fibrillation and age
- Projected number of adults with AF: 1995-2050
- Diagnosing cardioembolic stroke
- Baseline carotid plaque area as a predictor
- Cryptogenic stroke
- Ischemic stroke subtypes are changing (1)
- Ischemic stroke subtypes are changing (2)
- Treat early on clinical grounds
- AF, aging and under-anticoagulation
- Antiplatelet agents are not anticoagulants
- Activated platelets
- Retinal embolus of platelet aggregates
- White thrombus vs. red thrombus
- Antiplatelet agents don’t work in atrial fibrillation
- Adjusted dose warfarin vs. low-dose plus aspirin
- ASA vs. warfarin in elderly: BAFTA study
- ASA less effective than warfarin
- Poor INR control increases risk of stroke
- Warfarin will continue to be used
- Narrow therapeutic range
- Genetics of warfarin response
- Receptor polymorphism
- Metabolism polymorphism
- Aspirin vs. apixaban in AF: AVERROES trial
- Aspirin vs. apixaban in AF
- Apixaban vs. ASA in TIA/stroke
- CCS Guidelines
- It is a mistake to use antiplatelet agents for AF
- Controlling the INR matters
- Warfarin is impossible to use well
- Drug interactions with warfarin
- Real-world warfarin bleeding is higher and early
- Under-anticoagulation doesn’t work
- Seek AF, and ye shall find it
- EMBRACE study Intervention
- EMBRACE trial
- CRYSTAL AF study
- CCS guidelines: CHADS2 scores
- Recommendations - antithrombotic for AF
- Most thrombi in left atrial appendage
- Other approaches
- Protect - AF trial
- PLAATO device
- European PLAATO study
- New era in anticoagulation
- Novel oral anticoagulants
- Dabigatran vs. warfarin in atrial fibrillation
- Dabigatran plasma concentration and outcomes
- Therapeutic range for dabigatran
- Total drug exposure with declining renal function
- Need for blood levels of dabigatran
- Rivaroxaban vs. warfarin in AF
- Apixaban vs. warfarin in AF
- ICH in ROCKET
- New oral anticoagulants vs. warfarin in AF
- Reversal of Xa inhibitor with PCC
- Reversal with perosphere
- Homocysteine: alive again
- Homocysteine: steep dose-response curve
- Biological plausibility is overwhelming
- Homocysteine and venous thrombosis
- Homocysteine and atrial fibrillation
- Homocysteine increases risk in atrial fibrillation
- Vitamin B12 deficiency
- Baseline tHcy by serum B13
- Threshold B12 level for MMA and tHcy
- Metabolic B12 deficiency in the stroke prevention
- Proportion of patients with various B12 levels
- Metabolic B12 deficiency in vascular patients
- tHcy>14 micro-mol/L by age
- VISP efficacy analysis
- HOPE-2 trial
- Reduction of stroke in SuFolOM3 trial
- VITATOPS
- VITATOPS stratified by GFR
- B-vitamin treatment and diabetic nephropathy
- Vitamin therapy - stroke, MI, death
- Possible harmful effects of folic acid
- Cyanide from B12
- Interesting lessons
- What’s the secret?
- Find the cause, and treat it
- Contact details
Topics Covered
- Stroke, atrial fibrillation and aging population
- Ischemic stroke subtypes
- Role of anticoagulants and anti-platelets: data from clinical trials
- New era in anticoagulation
- Homocysteine and the risk for a cardiovascular event
- Vitamin B12 deficiency and the risk for stroke: data from clinical trials
Links
Series:
Categories:
Therapeutic Areas:
Talk Citation
Spence, J.D. (2015, March 18). Atrial fibrillation, anticoagulation and vitamins for homocysteine [Video file]. In The Biomedical & Life Sciences Collection, Henry Stewart Talks. Retrieved December 5, 2024, from https://doi.org/10.69645/DISW8162.Export Citation (RIS)
Publication History
Financial Disclosures
- Prof. J. David Spence has not informed HSTalks of any commercial/financial relationship that it is appropriate to disclose.
A selection of talks on Clinical Practice
Transcript
Please wait while the transcript is being prepared...
0:00
Hello,
I'm David Spence.
I'm from the Robarts
Research Institute
at Western University
in London, Canada,
and I'll be talking about
some new evidence and insights
regarding atrial
fibrillation, anticoagulants,
and vitamins for homocysteine.
0:17
This slide shows a list of all
the talks in the stroke series,
and they're all available online.
0:25
My disclosures are
listed on this slide.
And there are no disclosures
that are relevant to this talk,
except in the second
line, I have received
honoraria from Bayer and
Boehringer-Ingelheim and Pfizer.
0:40
So why is atrial fibrillation
increasingly important now?
It's because the
population is aging,
especially in developed countries.
The top section of this slide shows
the change in age distribution
in the Canadian population with
a huge increase in elderly people
because of the arrival of
the pig and the python,
the big boom and the baby boomers.
And stroke goes up
very steeply with age,
more so than myocardial infarction.
It's also commoner in women
than myocardial infarction,
partly because women live longer.
1:12
So in the Framingham Study, at
age 50, only 1.5% of stroke
was attributable to
atrial fibrillation,
but by age 80 to 89,
it was 23.5%.
And we now recognize that it's
really a higher proportion
because a lot of intermittent
atrial fibrillation
was missed in the past.
1:32
So here's a projection
of the expected number
of adults with atrial
fibrillation in the United States,
going from 1995 to 2050.
And it's more than a doubling
expected in atrial fibrillation.