Embolic Stroke

Researchers have developed a new way of identifying patients at risk of an irregular heartbeat, known as 'atrial fibrillation'. While not life threatening, the condition increases people's risk of having a transient ischaemic attack (TIA) or stroke by up to five times. A new study reveals four specific factors that can predict which patients will have atrial fibrillation. These include older age, higher diastolic blood pressure and problems with both the coordination and function of the upper left chamber of the heart. The team went on to create an easy tool for doctors to use in practice to identify those at high risk. And they hope that this will help diagnose and treat more patients, reducing their risk of future strokes. Researchers at the University of East Anglia have developed a new way of identifying patients at risk of an irregular heartbeat, known as 'atrial fibrillation'. While not life threatening, the condition increases people's risk of having a transient ischaemic attack (TIA) or stroke by up to five times. A new study, published today, reveals four specific factors that can predict which patients will have atrial fibrillation. These include older age, higher diastolic blood pressure and problems with both the coordination and function of the upper left chamber of the heart. The team went on to create an easy tool for doctors to use in practice to identify those at high risk. And they hope that this will help diagnose and treat more patients, reducing their risk of future strokes. Lead researcher Prof Vassilios Vassiliou, from UEA's Norwich Medical School and Honorary Consultant Cardiologist at the Norfolk and Norwich University Hospital, said: "Identifying who is at high risk and more likely to develop atrial fibrillation is very important. "This is because it requires specific treatment with anticoagulants, commonly known as blood thinners, to reduce the risk of future strokes. "Patients who have had a stroke usually undergo multiple investigations to determine the cause of the stroke, as this can influence the treatment they receive long-term. "These investigations include prolonged monitoring of the heart rhythm with a small implantable device called a loop recorder, and an ultrasound of the heart, called an echocardiogram." The research team collected data from 323 patients across the East of England, treated at Cambridge University Hospitals NHS Foundation Trust, who had had a stroke with no cause identified- known as Embolic Stroke of Undetermined Source. They analysed medical records as well as data from prolonged heart rhythm monitoring. They also studied their echocardiograms. Prof Vassiliou said: "We determined how many of these patients were found to have atrial fibrillation up to three years following their stroke, and went on to perform a thorough assessment to identify if there are specific parameters that are connected with atrial fibrillation identification. "We identified four parameters that were linked with the development of atrial fibrillation, which were consistently present in patients that had this arrhythmia. We then developed a model that can be used to predict who will show atrial fibrillation in the next three years, and is therefore at increased risk of another stroke in the future." "This is a very easy tool that any doctor can use in clinical practice," he added. "And it can potentially help doctors provide more targeted and effective treatment to these patients, ultimately aiming to highlight the people at higher risk of this arrhythmia that can benefit from prolonged heart rhythm monitoring and earlier anticoagulation to prevent a future stroke." This research was led by the University of East Anglia in collaboration with Cambridge University Hospitals NHS Foundation Trust, West Suffolk Hospital NHS Foundation Trust, the University of Cambridge, the Norfolk and Norwich University Hospital and the University of Newcastle. 'Atrial Fibrillation in Embolic Stroke of Undetermined Source: Role of advanced imaging of left atrial function' is published in the European Journal of Preventive Cardiology and simultaneously presented at theEuropean Society of Cardiology in Amsterdam.

SAN FRANCISCO, April 4, 2023 /PRNewswire/ -- InsightRX – which provides cloud-based precision medicine software to optimize treatment decisions – presented research comparing model-informed precision dosing (MIPD) to a hospital dosing nomogram for therapeutic heparin dosing at the 17th National Conference on Anticoagulation Therapy held April 1-3 in San Francisco. The research, titled "Anti-Xa target attainment & dose selection: comparison of pharmacokinetic model-guided dosing versus institutional practice," was presented during a one-hour poster session on Saturday, April 1, at the San Francisco Marriott Marquis. Jonathan D. Faldasz, Pharm.D., BCPS, senior director of product and customer experience at InsightRX, was the presenter. MIPD has proven clinically beneficial in achieving therapeutic drug exposure and decreasing the need for dosing adjustment, yet there has been little research on the application of MIPD to the dosing of unfractionated heparin (UFH). An InsightRX team recently conducted a simulation from which it concluded that an initial therapeutic heparin dosing strategy using MIPD may enable more accurate dosing than would an average hospital dosing nomogram (a flow chart for calculating the correct dosage for a specific patient). Heparin is an anticoagulant used therapeutically to prevent or slow the development and growth of blood clots in people with certain medical conditions or patients undergoing high-risk medical procedures. Unfortunately, anticoagulants have been "consistently identified as the most common cause of adverse drug events (ADEs)" in healthcare settings. And despite advances in therapeutic heparin dosing and monitoring, determining the right dosage can be extremely challenging because each patient eliminates heparin at their own rate, based on variables such as their size, blood composition, and underlying disease state. This undermines the effectiveness of standardized dosing guidelines and introduces some risk to patients. Heparin levels below the target range for a patient can result in further and worsening clot formation, with potential for embolic organ failure, embolic stroke and death, while levels above the target range can trigger major bleeding, with serious consequences including hemorrhagic stroke, organ failure and death. It is essential, therefore, to closely monitor the effect that heparin is having on a patient. The two most common measures of heparins activity are the antifactory-Xa assay (anti-Xa) and activated partial thromboplastic time (aPTT). InsightRX researchers conducted a digital twin study in which they assembled real-world covariate weight distributions from a sample of 2,000 de-identified adult patients from the InsightRX database. The researchers then combined that data with synthesized data generated according to inter-patient variation as defined by a model describing the pharmacokinetic/pharmacodynamics of heparin developed by Delavenne et al. An initial dose was calculated according to a typical hospital nomogram (both low and high dose) and as predicted by two pharmacokinetic (PK) models (Delavenne et al and Brunet et al) to achieve steady-state anti-Xa concentration in the desired therapeutic range of 0.3-0.7 units/mL. Results of the simulation show that initial heparin dosing using MIPD is more likely to result in target dosage attainment than would a hospital nomogram. This is significant because more accurate initial heparin dosing will reduce the number of patients whose doses must be adjusted and will minimize the likelihood of an ADE that could be life-threatening or life-changing to a patient. "This is a promising development in improving the ability of hospitals to ensure patients receiving heparin injections are being administered safe and effective dosages," said Sirj Goswami, CEO and co-founder of InsightRX. "Our study shows that, used with the right dosing model, MIPD can potentially be used to drive better outcomes for patients being treated with heparin." About InsightRX InsightRX is a healthcare technology company that has developed cloud-based applications for precision medicine and clinical analytics designed to individualize treatment at the point of care. The platform leverages patient-specific data, pharmacology models, and machine learning to understand each patient's unique pharmacological profile and can be integrated seamlessly within a clinical workflow. Media Contact Megan Moriarty Amendola Communications for InsightRX 913.515.7530 [email protected] SOURCE InsightRX