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Primary prevention is a lot less effective than secondary prevention (as judged by the number needed to treat to prevent one stroke per year).Recent guidelines detail the evidence for primary prevention in stroke. Because stroke may indicate underlying atherosclerosis, it is important to determine the patient's risk for other cardiovascular diseases such as coronary heart disease. Conversely, aspirin prevents against first stroke in patients who have suffered a myocardial infarction.
rehab guidelines or physiotherapy accounts) highlighting the special circumstances and challenges sourrounding this group of patients. There is a lot of literature about secondary prevention of stroke but nothing about the special needs (physio, special hoists, chairs, oversize rhabilitation kit,etc.) and complications around rehabilitation of large patients.
Another possiblity (though less likely perhaps given your multiple stroke risk factors) is could this be MS rather than stroke? Visual loss could have been optic neuritis and the "stroke" in cerebellum could be a plaque. Certainly don't mean to alarm you, just let you know that there may be other possibolities. There are special types of MRI that can easily distinguish between a stroke an dMS.
Is the Aspirin really helpful for the prevention of stroke? What can you advise me to take in order to prevent the fate of the other members of my family.
Whereas the ADA used to recommend low-dose aspirin for every diabetic patient over the age of 40, their new guidelines suggest aspirin as a prevention strategy only in those with diabetes whose cardiovascular risk is above average. This includes men over age 50 or women over age 60 with at least one additional major risk factor. In other words, according to the ADA, younger diabetic patients without associated cardiovascular risk factors appear not to benefit from taking aspirin.
The ACC guideline recommend using aspirin (81 mg or more) in that group of patients, but the same guideline disclose that In patients younger than 60 y with lone Afib the risk of stroke or embolism is low without treatment and the effectiveness of aspirin for primary prevention of stroke relative to the risk of bleeding has not been established.
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Other observational studies support the risk of recurrent events associated with an atrial septal aneurysm. That said, the data for primary prevention is debated. Guidelines do support the use of Aspirin when an ASA and PFO coexist despite the lack of randomized data to support the therapy.
2. Can it be safely assumed that the TTE's results are accurate in regards to the PFO?
The causes of stroke are multiple and could include embolism from the heart or other areas (such as the aorta or other parts of the body), bleeds, atherosclerosis of the blood vessels, vasculitis (or inflammatory processes affecting the blood vessels of the brain), and others. The prevention of stroke typically depends on what are the risk factors a patient has. These may include aspirin, certain blood thinners, or cholesterol-lowering medications.
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//www.everydayhealth.com/health-report/atrial-fibrillation-and-stroke/diet-tips-for-afib.aspx?
Now according to revised guidelines by the american heart association for prevention of infective endocarditis, the antibiotic prophylaxis is not routinely recommended for all dental procedures. For patients with underlying cardiac conditions, prophylaxis is reasonable for all dental procedures that involve manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa. So, if the procedure involves the above manipulations, you may need prophylaxis.
Has your husband's protime and INR been tested? This is a simple finger stick blood test which measures coagulation speed. Normal INR is 1.0, atrial fib sufferers should have an INR of between 2.0 and 3.0. I would suggest strongly that your cardiologist be made aware of your concerns. At the same time, I also suggest that you request a protime and INR test.
For that population the ACC guidelines recommend aspirin of 81 mg or more to prevent stroke. As the rate of stroke is very low in the "lone" atrial fibrillation population , 81 mg is usual prescribed dose.
In patient without a known bleeding disorder, 81 mg of aspirin may increase the risk of bleeding in case of an injury, but usually the benefits outweigh the risks.
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