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Spectrum of cerebral injuries from atrial fibrillation and atrial fibrillation management. (A) Large right middle cerebral artery territorial infarction on diffusion-weighted magnetic resonance imaging (MRI; arrow). (B) Ischemic infarction in multiple vascular territories on diffusion-weighted MRI. Left frontal lobe (blue arrow), right occipital lobe (red arrow), left occipital lobe (yellow arrow) are involved in this image on cerebral MRI (arrows). (C) Multiple microbleeds (white arrows) along with a larger right frontal subcortical hemorrhage (blue arrow) on brain MRI with susceptibility images. (D) Large high convexity right frontal hematoma with surrounding vasogenic edema on noncontrast computed tomography of the head (arrow).

Dementia and Atrial Fibrillation: Pathophysiological Mechanisms and Therapeutic Implications

Atrial fibrillation increases the risk of stroke by a factor of four- to fivefold, and dementia is a common consequence of stroke. However, atrial fibrillation has been associated with cognitive impairment and dementia, even in patients without prior overt stroke. Nonischemic mechanisms include cerebral hypoperfusion, vascular inflammation, brain atrophy, genetic factors, and shared risk factors […]

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Should Atrial Fibrillation Patients Take Oral Anticoagulants? (video)

A majority of atrial fibrillation patients who have not been treated oral anticoagulants (OAC) meet guideline indications for treatment. Untreated patients are at increased risk for adverse outcomes. In this video, AJM editor-in-chief Dr. Joseph S. Alpert discusses this new research in the April 2017 issue of the American Journal of Medicine. Read the Research: […]

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Silent Atrial Fibrillation and Cryptogenic Strokes

A new suspected cause of cryptic strokes is “silent atrial fibrillation.” Pacemakers and other implanted devices allow continuous recording of cardiac rhythm for months or years. They have discovered that short periods of atrial fibrillation lasting minutes or hours are frequent and usually are asymptomatic. A meta-analysis of 50 studies involving more than 10,000 patients […]

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The patient brought this smartphone photograph (submitted with her permission) to the clinic. It revealed well-demarcated anterior tongue discoloration that occurred with food intake. Her primary care provider thought that the changes were likely ischemic secondary to vasculitis and initiated treatment and a workup for giant cell arteritis.

A Picture’s Worth: Giant Cell Arteritis

The ubiquitous smartphone became a helpful diagnostic tool when a patient used one to snap a photograph of her tongue. Although her symptoms were vague and nonspecific, her photograph facilitated the diagnosis of a serious, potentially debilitating illness. A generally healthy 63-year-old woman presented with a 1-week history of sore throat and periodic burning tongue […]

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Antithrombotic strategy by CHA2DS2-VASc score. DAP = dual antithrombotic therapy with 2 antiplatelet agents; OAC + AA = dual antithrombotic therapy with an oral anticoagulant plus 1 antiplatelet agent; TT = triple antithrombotic therapy (oral anticoagulation plus dual antiplatelet therapy).

Triple vs Dual Antithrombotic Therapy in Patients with AF & CAD

Background The role of triple antithrombotic therapy vs dual antithrombotic therapy in patients with both atrial fibrillation and coronary artery disease remains unclear. This study explores the differences in treatment practices and outcomes between triple antithrombotic therapy and dual antithrombotic therapy in patients with atrial fibrillation and coronary artery disease. Methods Using the Outcomes Registry […]

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Quarterly visits for atrial fibrillation by anticoagulant type. DOAC = direct oral anticoagulant.

National Trends in Ambulatory Oral Anticoagulant Use

A nationally representative audit of outpatient office visits shows that direct oral anticoagulants, associated with increased use of oral anticoagulation for patients with atrial fibrillation, are being rapidly adopted. Background Four direct oral anticoagulants (DOACs) have been brought to market for the treatment of nonvalvular atrial fibrillation and venous thromboembolism. Many forces, including numerous positive […]

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