Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række
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Tidsskr. Nor. Laegeforen. · Jan 2014
Review Case ReportsIschaemic stroke with patent foramen ovale.
There is no sound scientific documentation of current guidelines for the treatment of cerebral infarction assumed to be due to patent foramen ovale. In this article, we present a young patient with this condition. In addition, we provide a general overview of the prevalence, recommended assessment and indications for treatment of patent foramen ovale in ischaemic stroke patients. ⋯ For stroke patients with patent foramen ovale, the choice between lifelong antithrombotic therapy alone and transcatheter closure is a difficult one. Treatment with antiplatelet agents remains the first choice in most cases. Well-designed studies are needed to identify which patients will benefit most from closure.
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Tidsskr. Nor. Laegeforen. · Jan 2014
Warfarin therapy for atrial fibrillation in general practice--is bleeding risk underestimated?
Atrial fibrillation increases by fivefold the risk for thromboembolic stroke. Warfarin therapy reduces that risk by 64%, but increases the risk for major bleeding. We wanted to study the quality of the warfarin therapy given in a Norwegian general practice and to calculate which patients would have probable benefit of the treatment. ⋯ For patients with high thromboembolism risk, we calculated a convincing benefit of warfarin therapy. Where there was lower risk the net benefit in our patients depended on which study population the calculation was based on. The EHS population forms the basis for the European guidelines for anticoagulant therapy, but appears to differ from the patients in Norwegian general practice. This may lead to an underestimation of the bleeding risk.