Stroke Archive

Q. I've been taking dabigatran (Pradaxa) for atrial fibrillation for a few years and haven't had any problems. But I've seen ads on television suggesting that this drug and others like it aren't safe. What's your advice?

A. Known as novel oral anticoagulants, these drugs make the blood less likely to clot, which helps prevent strokes. Others in the class include rivaroxaban (Xarelto), apixaban (Eliquis), and edoxaban (Savaysa). They work as well as the older anti-clotting drug warfarin (Coumadin) but don't require frequent testing for clotting function and are less likely to interact with food and other drugs.

By Anne Fabiny, M.D., Editor in Chief

Every so often, medical professional organizations issue new guidelines for treating diseases, based on an accumulation of new evidence. In 2013 the American College of Cardiology and American Heart Association issued a guideline on treating blood cholesterol to reduce atherosclerotic cardiovascular disease (ASCVD) risk, using a new risk calculator (online at health.harvard.edu/heartrisk) to estimate a person's risk of developing ASCVD over the next 10 years. The guideline created a controversy because using the new risk calculator gives everyone over 75 a risk score of at least 7.5%—the threshold for prescribing statins to prevent heart disease in younger people. By that measure, everyone over the age of 75 should be on a statin!

Q. I experienced a minute of blurred vision during a headache today. Is that cause for concern?

A. While temporary blurred vision usually does not indicate a serious underlying health problem, on occasion it can. In people over age 60, I am more concerned about that symptom, because it can be sign of a transient ischemic attack (TIA), also called a ministroke. The fact that your vision problem accompanied a headache could well indicate that you are suffering from a common type of headache—migraine. Migraines don't threaten permanent damage to your brain, whereas a TIA is a sign that a person is at risk for an impending stroke. Strokes can cause permanent brain damage. If you are younger than 60, if you have had headaches accompanied by visual problems multiple times in the past, or if you have been diagnosed as having migraine headaches, I'd feel even more confident that your symptoms are caused by this condition.

Daily aspirin use has increased among U.S. adults, according to a survey published May 2015 in the American Journal of Preventive Medicine. The survey asked more than 2,500 people ages 45 to 75 about their current aspirin use. The overall use was 52%, up from 41% in a similar survey in 2004. The most common reasons for taking daily aspirin were prevention of heart attack and stroke. Eighteen percent of aspirin users cited cancer prevention as their reason for taking aspirin. And while most users said they'd talked to their doctor before starting aspirin therapy, 25% of the respondents had not. That finding is troubling, since aspirin is a blood thinner. "Aspirin can increase the risk of bleeding in the brain or elsewhere in the body. This risk might be justified if there is a good reason for aspirin use, but might be entirely unjustifiable if not. That is why I always recommend discussing any medication or supplement use with one's primary care provider," says Dr. Natalia Rost, associate professor of neurology at Harvard Medical School. 

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As we reported in March, sleep apnea and other sleep breathing problems are associated with the development of dementia. Now a study published online April 15, 2015, by Neurology finds that sleep breathing problems are associated with an earlier onset of the decline in thinking skills.

Researchers analyzed the medical histories of about 2,500 people ages 55 to 90 and found that people with sleep breathing problems were diagnosed with mild cognitive impairment (a decline in thinking skills) an average of 10 years earlier than people who didn't have those problems. The encouraging news: people who treated their sleep breathing problems with a continuous positive airway pressure (CPAP) machine were diagnosed with mild cognitive impairment about 10 years later than people whose problems were not treated. The study doesn't prove a cause-and-effect relationship, but it does offer hope. "CPAP improves the quality of sleep in people with sleep-disordered breathing. Healthy sleep is an important time for our brains to accomplish critical 'housekeeping' tasks. One of these tasks is clearing beta-amyloid, one of the main proteins associated with Alzheimer's disease," says Dr. Scott McGinnis, an instructor in neurology at Harvard Medical School.

I had shingles in 2005 and haven?t had a shingles shot. I haven?t been able to find any studies that indicate whether a shot is feasible for people who have already had shingles. What do you recommend?

One in six people worldwide will have a stroke in his or her lifetime. Learn to recognize a "brain attack."

Heart attacks often make themselves known with a hard-to-ignore, obvious symptom like chest pain. That's not the case for strokes, which can cause a wide range of symptoms that may affect your ability to speak, see, move, or feel. A stroke interrupts blood flow to the brain, depriving brain cells of oxygen and nutrients. Prompt treatment can prevent a potentially devastating disability or death—which is why everyone should know the top warning signs of stroke.

People with high blood pressure could benefit from a B vitamin known as folate if they are not getting enough from their diets, according to a study in The Journal of the American Medical Association (JAMA).

The study included more than 20,000 adults in China with high blood pressure who had never had a stroke or heart attack. Participants who took folate supplements along with a blood pressure medication had fewer strokes over the four-and-one-half-year trial than those who only took the medication.

Many different medications can potentially harm the liver, so doctors sometimes do liver function tests to ensure safety. The worst-case scenario is liver failure, but when this happens, the cause is usually not prescription medications, but rather the over-the-counter painkiller acetaminophen (Tylenol) or herbal supplements, according to a study in Gastroenterology.

Researchers scrutinized 5.4 million records of patients in the Kaiser Permanente Northern California system from 2004 to 2010. They identified only 62 cases of liver failure, 32 of which were linked to medications. This may not precisely reflect national rates, but it does suggest that liver failure from medications is relatively uncommon.

A fainting spell can be inconsequential, or it can signal a serious health issue. It's important to learn why you faint.