Novel Oral Anticoagulant and Efficacy on Atrial Fibrillation Patients
Department of Biotechnology, Majhighariani Institute of Technology and Science, Odisha, India
- *Corresponding Author:
- Neha Anand
Institute of Technology and
E-mail: [email protected]
Received date: 02/08/2016; Accepted date: 05/08/2016; Published date: 11/08/2016
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Atrial fibrillation is the most common Cardiac arrhythmia and the third major cause of death in elderly. Atrial fibrillation is considered as a major cause for stroke in UK and England. Atrial fibrillation (AF) is associated with stroke due to thromboembolism. Atrial fibrillation is affecting more than 600,000 people all over world. Warfarin is the first anticoagulant which was used for atrial fibrillation patient. There is need for proper patient care and safety regulation while using warfarin, since there is risk of blood clotting in more for patients using warfarin. Novel Oral Anticoagulants (NOACs) which are new class of anticoagulant drugs and used instead of warfarin due to less risk of blood clotting in patients. Apixaban, Dabigatran and Rivaroxaban are most commonly used NOACs drugs. This review article gives complete description about efficacy and comparative use of Anti-coagulants and Novel Oral Anticoagulants in Atrial fibrillation patients having risk of stroke. It mainly focuses on use of NOACs in place of warfarin which is safe to use.
Oral Anticoagulant, Warafrin,
Anticoagulants are used for the patients suffering from atrial fibrillation related stroke. Warfarin is the most
commonly used anticoagulant, which prevents thrombosis and thromboembolism. In other words we can say it is
useful in reducing the risk of stroke in patients with AF by inhibiting formation of future blood clots especially in
veins and artery [1-9]. Warfarin is also used in antiphospholipid syndrome. Warfarin should not be used for patients
having bleeding disorders or high blood pressure because warfarin increases the risk of bleeding in patients which
can be fatal. Warfarin can cause bleeding easily in patients suffering from cancer, people more than 65 years old,
kidney or liver disease patients etc. [10-19].
Warfarin is prescribed for patients who had a condition of stroke, heart attack, deep vein thrombosis or
pulmonary embolism [20-27].
There are many limitation associated with the use of warfarin. Adjustment of dose and routine monitoring is
very important in use of warfarin for a patient's international normalized ratio (INR) and careful adjustment of the
dose of particular patient. Warfarin levels can be affected by diet of patients, alcohol use or any other drug use [28-36]. For example:
• There is higher risk of blood clotting or increases risk of stomach bleeding associated with the patients if
they are using any other medicine for pain, fever, swelling etc.
• Patient should avoid food which contains higher amount of Vitamin K such as leafy vegetables, vegetables
• Patient should not drink some particular juices like grapefruit, pomegranate, cranberry which leads to
some major side effects while using warfarin.
Some major points to remember while using warfarin:
• Patient should use warfarin as prescribed by doctor.
• It should be taken in time everyday.
• Patients should stop taking warfarin before 5-7 days of any surgery.
• It should be stored at room temperature.
Novel Oral Anticoagulants (NOACs)
NOACs (Novel Oral Anticoagulants) are also known as Directly Acting Oral anticoagulants (DOACs). It is a new class of anticoagulant drugs which are used in prevention of blood clotting to reduce the risk of stroke in patient with atrial fibrillation [37-41].
NOACs are direct inhibitors of thrombin and Xa (Xa-INHS) due to which these are used in place of warfarin. NOACs, interrupts the formation of blood clots due to which it takes more time for blood clotting and hence it reduces the risk of stroke. NOACs half-life is in the range of 8-14 hours. Blood concentration in NOACs is constant and peak. Thrombin generated in constant period of NOACs is small and plays a significant role [42-49].
Some commonly used NOACs are: Apixaban, Dabigatran and Rivaroxaban.
Comparison between Warfarin and NOACs
NOACs function will be more effective and rapid in comparison with warfarin due to fast onset action and short half-life. Anticoagulation effect of NOACs is reducing quickly by drugs. Adjustment of dose and routine
monitoring of NOACs is not that much important as it is important in warfarin due to its superior expected anticoagulation activity. NOACs have less influence of diet and medication in comparison with warfarin. NOACs are more costly than warfarin (Table 1).
|Onset of action
|Routine Laboratory Monitoring
|Duration of blood-thinning effect
Table 1: Comparison between mechanism of warfarin and NOACs.
NOAC in non-valvular atrial fibrillation
NOACs are available in Ireland first in 2008 for thromboprophylaxis post orthopedic surgery. Dabigatran exexilate is a direct thrombin inhibitor and it was licensed in 2011 for stroke prevention in NVAF . In NVAF the
factor Xa inhibitor and apixaban was licensed in 2013 for stroke prevention. NOACs are all licensed for thromboprophylaxis post elective hip and knee replacement surgery. Some patient factors (age, renal function, weight), varying dose options, specific administration considerations are required by NOACs therapy [51-57].
List of non-inferiority randomized controlled Clinical trials in non valvular atrial fibrillation for stroke prevention:
• Apixaban: ARISTOTLE (vs. wafarin), AVERROES (vs. aspirin).
• Dabigatran: RE-LY (vs. warfarin).
• Rivaroxaban: ROCKET-AF (vs. warfarin).
In these trials ARISTOTLE and RE-LY were based on intention to treat population and ROCKET-AF used the per protocol population. In these NOACs Dabigatran is direct thrombin inhibitor and apixaban and rivaroxaban are
Apixaban is a direct oral factor Xa inhibitor which has rapid absorption. It has 12 hour half-life, and 25%
renal excretion. ARISTOTLE randomized clinical trial which was carried out to test apixaban for reducing stroke in atrial fibrillation. Age of ≥ 80 years is included in these criteria for lower dose selection in patients. Apixaban have greater effect on hemorrhagic stroke, major bleeding and clinically relevant non major bleeding than warfarin [58-66].
There are various differences were observed in studies of apixaban and warfarin use. While using apixaban there is less risk of gastrointestinal bleeding and other bleeding rates across age groups. ARISTOTLE was the first study in
which it is found that Apixaban is more suitable than warfarin in preventing stroke causing less bleeding, and resulting in lower mortality [67-71].
Here are some outcomes of study in relation with warfarin and apixaban
a. Primary outcome for apixaban group was 1.27% per year and for wafarin group it is 1.6%.
b. Rate of major bleeding for apixaban group was 2.13% per year and for warfarin it is 3.09%.
c. Death from any cause for apixabn group is 3.52% per year and for warfarin group it is 3.94%.
d. Rate of haemorrhagic stroke for apixban group is 0.24% per year and for warfarin group it is 0.47%.
e. Rate of ischemic stroke for apixaban group is 0.97%per year and for warfarin group it is 1.05%.
f. Intracranial haemorrhage for apixaban group is 0.33% per year and for warfarin group it is 0.80%.
Below provided is the apixaban trial data for different age groups (Table 2).
||< 80 Years
Table 2: Apixaban trial data for different age groups.
It is a direct thrombin inhibitor. RE-LY (Randomized Evaluation of Long-Term Anticoagulation Therapy) Trials is a randomized trial which is carried out to compare two different doses of dabigatran. Two doses are: 110 mg for < 75 years and 150 mg for higher risks of patients with ≥ 75 years. For this trail patient over 80 years are
approximately 16.5% [72-81]. Reduction in hemoglobin is at least 2.0 g/dl for major bleeding is defined by RE-LY.
Dabigatran 150 mg is the only NOAC in comparison with warfarin which has lower rates of ischaemic stroke and it is best for patient with atrial fibrillation. Some major criteria for reducing dose of dabigtran are age, renal
impairment and bleeding issue. Myocardial infarction (MI) [82-90] rate is more for both doses of Dabigatran in
comparison with warfarin. Along with this if there is high dose of dabigatran there is risk for gastrointestinal bleeding due to which a low gastric pH is required to increase the absorption of dabigatran [91-97].
It is a factor Xa inhibitor. ROCKET AF trial was a randomized trial for Rivaroxaban in which 14,264 patients with moderate or high risk for stroke were randomized. For this trail patient over 80 years were approximately 18.3%. In which it is found that Rivaroxaban is also useful like warfarin in stroke prevention and it also reduces the
risk of bleeding in and around the brain. Patient age is not considered as criteria for reduced dose with rivaroxaban. Fatal bleeding is less frequent in the rivaroxaban group due to lower rates of hemorrhagic stroke. Along with this gastrointestinal bleeding was more frequent in the rivaroxaban group [98-100].
Disadvantages Of Noacs
• Dabigatran dose can result in stomach upset.
• There is no antidote for NOACs patients.
• There is lack of monitoring ability in NOACs.
• It is cost effective.
• There is risk of bleeding in taking NOACs.
Guidelines For Use Of Noac
Some of guidelines which are to be used while using NOAC:
• Practical start up and follow up scheme for patients on new oral anticoagulants.
• In emergency situation there may be need of quantitative assessment of drug exposure and anticoagulant effect.
• Physicians should have to consider pharmacokinetic effect of pilot drugs and of co morbidities when prescribing NOACs.
• When physicians are using different anticoagulant therapy there is need to screen the continuation of anticoagulant therapy while minimizing the risk of bleeding.
• Physicians should develop different ways to optimize the actions with new oral anticoagulant intake.
• Physicians and patients should be aware from the dose errors and how to overcome the errors.
• NOAC should be used properly with chronic disease patients.
• Physicians should take care of bleeding complications.
• Patient’s characteristic and surgical factors should be observed properly while using NOAC.
• While using emergency intervention NOAC should be stopped.
Looking and analyzing through use of anticoagulants and novel oral anticoagulants in atrial fibrillation patients it is found that we can use both for patient’s but there is need for careful monitoring and more risk of blood clotting in patients using warfarin while patients using novel oral anticoagulants there is no need for regular patient monitoring and there is less risk of blood clotting which reduced risk of stroke in patients. Pros (i.e., Anticoagulation effect of NOACs is reducing quickly by drugs, it has short half-life period, no routine monitoring requirement, onset of faction is fast, there is no effect of food on patients using NOACs, etc.) and cons (i.e., There is no antidote for NOACs patients. it is cost effective, risk of bleeding in patients, etc.). Based on the trials carried out, NOACs have been proven more efficient.
- Ibrahim H, et al. Extreme coumadin resistance in a patient with atrial fibrillation and end stage renal disease. J Cardiovasc Res. 2015;4:6.
- Samadoulougou AK, et al. Cardio embolic stroke: data from 145 cases at the teaching hospital of yalgadoouedraogo, ouagadougou, burkinafaso. Int J Cardiovasc Res. 2015;4:1.
- Hansson A, et al. Self-treatment techniques in patients with paroxysmal atrial fibrillation and the probable influence of the autonomic nervous system. Int J Cardiovasc Res. 2013;2:2.
- Tsai WC and Lin YJ. The frequency analysis and the atrial fibrillation.J Biocatal Biotransformation.2012; 1:2.
- Salim I, et al. Systematic review of atrial fibrillation in patients with chronic kidney disease: prevalence, incidence, morbidity and mortality. Int J Cardiovasc Res. 2012;1:3.
- Shiga T. Persistence of oral anticoagulants in japanese patients with atrial fibrillation: non-vitamin k antagonist oral anticoagulant versus warfarin. Arrhythm Open Access. 2016;1:e102.
- Bhatia S, et al. Safety and efficacy of new oral anticoagulants in patients with atrial fibrillation: A literature review. J Diabetic Complications Med. 2015;1:101.
- Carnes EB, et al. Role of novel oral anticoagulants in primary and secondary thromboprophylaxis in cancer. J HematolThrombo Dis. 2015;3:222.
- Amin A, et al. Economic evaluations of medical cost differences: use of targeted-specific oral anticoagulants vs. warfarin among patients with nonvalvular atrial fibrillation and venous thromboembolism in the U.S. J HematolThrombo Dis. 2015;3:209.
- Positive Airway pressure therapy for sleep disordered breathing in congestive heart failure is associated with reduction in pulmonary artery systolic pressure. J Sleep Disor Treat Care. 5:2.
- Naibé DT, et al. Functional capacity assessment in patients with chronic heart failure through the sixminute walk test in the cardiology department of yalgadoouédraogo university hospital, burkinafaso. J Cardiovasc Res. 2015;4:6.
- Benetti F, et al. Surgical implantation of stem cells in heart failure patients due to idiophatic cardiomyopathy. Prensa Med Argent. 2015;101:5.
- Kamath C. A novel approach to detect congestive heart failure using dispersion entropy. J Cardiovasc Res. 2015;4:6.
- Vitulano N, et al. Should every patient with heart failure be investigated for sleep apnea syndrome? Int J Cardiovasc Res. 2015;4:1.
- Ogeng’o J, et al. Pattern of heart failure in an adult kenyan population. Int J Cardiovasc Res. 2014;3:6.
- Di Salvo G, et al. Echocardiography in selecting pediatric patients and congenital heart disease patients for resynchronization therapy. Int J Cardiovasc Res. 2014;3:5.
- Matulac MO, et al. Sildenafil improves exercise capacity in heart failure: A meta-analysis sic heart study. Int J Cardiovasc Res. 2014;3:3.
- AgnieszkaJableka, et al. Assessment of autonomic nervous system dysfunction in elderly women suffering from chronic heart failure with or without type 2 diabetes. J Womens Health Issues Care. 2014;3:2.
- Rostagno C and Gensini GF. Do gender related differences exist in patients with heart failure referred to a division of internal medicine? Int J Cardiovasc Res. 2013;2:6.
- Casazza F, et al. Fulminant pulmonary embolism successfully treated with thrombolysis. AnalgResusc: Curr Res. 2015;4:1.
- Patra S, et al. Chronic thromboembolic pulmonary hypertension in a case with multi-drug resistant pulmonary tuberculosis. Int J Cardiovasc Res. 2015;4:1.
- Patra S, et al. Acute pulmonary embolism in young: A prospective observational study on clinical implication of age on the presentation and management of patients with acute pulmonary embolism. Int J Cardiovasc Res. 2014;3:4.
- Mikkilineni S, et al. Acute Right ventricular failure and pulmonary hypertension secondary to acute on chronic pulmonary thromboembolic disease. Int J Cardiovasc Res. 2013;2:5.
- Yang T, et al. The impact of appropriate use of coronary cardiac computed tomography on downstream resource utilization and patient management. J Cardiovasc Res. 2015;4:6.
- Terada T, et al. Comparison of estimated continuous cardiac output and transoesophageal echocardiography cardiac output for noninvasively measuring cardiac output in paediatric patients undergoing kidney transplant surgery: A pilot study. J Cardiovasc Res. 2015;4:6.
- Hinton RB, et al. Left ventricular noncompaction in noonan syndrome. J Genet Disor Genet Rep. 2016;5:2.
- Nadjiri J, et al. T1-mapping in daily cardiac magnetic resonance imaging practice: combined use of native t1 and extracellular volume quantification. J Cardiovasc Res. 2016;5:3.
- Yiannakopoulou ECH. Pharmacovigilance for novel oral anticoagulants: why is it so crucial? J Pharmacovigilance. 2015;3:e135.
- Turiel M, et al. Practical guide to the new oral anticoagulants. J Gen Pract. 2015;3:194.
- Micco PD, et al. Baseline analysis on the outcome of patients with deep vein thrombosis dvt before the global impact of new oral anticoagulants in italy: data from riete registry. J Blood Lymph. 2014;4:129.
- Kamali F. Are novel oral anticoagulants noacs as safe as they are said to be?AdvPharmacoepidemiol Drug Saf. 2014;3:e126.
- Sairaku A, et al. How to use novel oral anticoagulants during the periprocedural period of atrial fibrillation ablation.Pharm Anal Acta. 2014;5:294.
- Patel S, et al. Effectiveness of pharmacy run anticoagulation clinics compared to large clinical trials of new oral anticoagulants. J Pharma Care Health Sys. 2014.
- Cox JL. Practical management of stroke prevention in patients with atrial fibrillation and renal impairment receiving newer oral anticoagulants: focus on rivaroxaban. J Gen Pract. 2014;2:144.
- Auer C and Wurm G. Outcome after acute head trauma needing neurosurgical intervention in patients with oral anticoagulants or anti-thrombotic agents. J Trauma Treat. 2012 ;1:131.
- Messori A, et al. Prevention of venous thromboembolism in major orthopedic surgery: bayesian network meta-analysis of 21 randomized trials evaluating unfractionated heparins, low-molecular weight heparins, and new oral anticoagulants. J Cardiovasc Res. 2015;4:5.
- Davies SE, et al. Obstructive sleep apnea is associated with increased frequency of nocturnal cardiac arrhythmias. J Sleep Disor: Treat Care. 2015;4:2.
- Muderris T, et al. Lateral sinus, transverse sinus and jugular vein thrombosis as a rare complication of chronic mastoiditis. J OtolRhinol. 2014;3:4.
- Marafioti V, et al. Amiodarone-induced life-threatening ventricular arrhythmias in a patient with cerebrogenicqt interval prolongation. Clinical Implications.Int J Cardiovasc Res. 2014;3:1.
- Sitwala P, et al. Arrhythmogenic right ventricular cardiomyopathy: A case presentation with a review. J Cardiovasc Res. 2015;4:6.
- Gainotti G, et al. A comparison between anxious-depressive disorders of stroke and multiple sclerosis patients, evaluated with specific twin scales. J Trauma Stress Disor Treat. 2016;5:2.
- Singh J, et al. Perioperative stroke after endonasal pituitary tumor resection: A case report. J Spine Neurosurg. 2015;4:2.
- He HL, et al. risk factors of admission delay after ischemic stroke in an urban tertiary care setting in china. Prensa Med Argent. 2014;100:1.
- Janoschka A, et al. The effect of 25 m versus 50 m course length on backstroke performance-an analysis of national and international swimmers.J Athl Enhancement. 2014;3:1.
- Nikodelis T, et al. Pelvis-upper trunk coordination at butterfly stroke and underwater dolphin kick: application on an elite female butterfly swimmer. J Athl Enhancement. 2013;2:5.
- Auzin M and de Weerd SR. Stroke in pregnancy. J Womens Health, Issues Care. 2013;2:5.
- Ellis C, et al. Improving stroke outcomes: a roadmap of care. Int J Neurorehabilitation. 2016;3:215.
- Fu Y, et al. A summary of acupuncture and moxibustion therapy for the urinary tract infection after stroke. J Infect Dis Diagn. 2016;1:107.
- Huang CF, et al. Case report of an unusual stroke-like creutzfeldt- jakob disease with medulla oblongata motor nuclei lesion. Intern Med. 2016;6:218.
- Kaneko F, et al. Acute effect of visually induced kinesthetic illusion in patients with stroke: A preliminary report. Int J Neurorehabilitation 2016;3:212.
- Sunanda T, et al. Role of HbA1c at admission on severity and functional outcome of ischemic stroke in patients with diabetes mellitus. J Neurol Neurophysiol. 2016;7:377.
- Al-Eithan MH. Facing neglect after stroke: clinical challenges in developing countries. Brain DisordTher. 2016;5:214.
- Theofanidis D. Nursing interventions and rehabilitation activities for stroke patients. J Nurs Care. 2016; 5: e131.
- Rey-Matias RR and Leochic CFD. Rehabilitation techniques in dysphagia management among stroke patients: A systematic review. Int J Phys Med Rehabil. 2016;4:340.
- Garipelli G, et al. Virtual reality based neurorehabilitation in acute stroke: A feasibility study. Int J Phys Med Rehabil. 2016;4:338.
- Cerrone P and Marini C. Endovascular treatment over standard medical therapy in acute ischemic stroke: A meta-analysis of randomized controlled trials. Cardiovasc Pharm Open Access. 2016;5:181.
- Heijnen RWH, et al. The experiences and opinions of dutch stroke patients regarding early hospital discharge and subsequent rehabilitation assessment and planning in a nursing home. J GerontolGeriatr Res. 2016;5:310.
- Balaney B and Bowman MAH. Acute ischemic stroke with elevated cardiac troponin: A case report and review of the literature. J Clin Case Rep. 2016;6:777.
- Gozum MALP and Rosales RL.Botulinum toxin a therapy in early post-stroke spasticity: providing a wider treatment avenue. Int J Neurorehabilitation. 2016;3:207.
- Ojike N, et al. Racial disparity in stroke awareness in the US: an analysis of the 2014 national health interview survey. J Neurol Neurophysiol. 2016;7:365.
- Shah IA, et al. Effect of fluoxetine on motor recovery after acute haemorrhagic stroke: A randomized trial. J Neurol Neurophysiol. 2016;7:364.
- Lygouris CG, et al. Effect of primary percutaneous coronary intervention on renal function in acute st elevation myocardial infarction. Int J Cardiovasc Res. 2015;4:1.
- Shah N, et al. Obstructive sleep apnea in the acute myocardial infarction setting - should i treat my patient? J Sleep Disor: Treat Care. 2013;2:1.
- Abdullahi A. Things to note in stroke rehabilitation. J Nurs Care. 2015;4:266.
- Hawamdeh Z, et al. Environment and the daily functioning of jordanian patients with stroke: An exploratory study. Int J Phys Med Rehabil. 2015;3:288.
- Pallesen H and Roenn-Smidt H. Body and self-identity in stroke rehabilitation. Int J Phys Med Rehabil. 2015;3:287.
- Pokharel BR, et al. stroke in young patients - A new trend in nepalese perspective? J Nutr Disorders Ther. 2015;S1:001.
- Sugi T, et al. Relationship between stroke volume variation and stroke volume during major abdominal surgery using arterial pulse contour analysis. J AnesthClin Res. 2016;7:609.
- Shirazi MHK and Hosseini SM. Optimized protocol is the key for clinical use of stem cell therapy in stroke. Adv Genet Eng 2016;5:145.
- Kumar C and Pathan N. Effectiveness of manual perturbation exercises in improving balance, function and mobility in stroke patients: A randomized controlled trial. J Nov Physiother. 2016;6:284.
- Ngo Nonga B, et al. Prevalence of significant carotid stenosis and other risk factors in patients with acute ischemic stroke in yaounde, cameroon. J Vasc Med Surg. 2016;4:257.
- Dossena M. Stroke and mesenchymal stromal cells: mechanisms of neuroprotection and future prospects. J Biomol Res Ther. 2016.5:e145.
- Carrasco L, et al. A typical presentation of a posterior inferior cerebellar artery stroke found by magnetic resonance imaging, on a woman without prior known comorbid on implantable contraception: A case report. J Neurol Disord. 2016;4:261.
- Altenburger PA, et al. Impact of Yoga on postural stability in stroke. Int j neurorehabilitation. 2016;3:195.
- Cutting S and Flaherty E. Stroke in a young patient: A sentinel presentation of neurosyphilis and human immunodeficiency virus HIV. J Neuroinfect Dis. 2016;7:197.
- Kikuchi K, et al. Potential benefit of uric acid for thrombolytic therapy in acute ischemic stroke. Biochem Anal Biochem. 2016;5:250.
- Suppiej A, et al. Long-term neuropsychological outcome and quality of life in perinatal ischemic stroke. J PediatrNeurol Med. 2016;1:104.
- Creed JA, et al. Aerococcusurinae infective endocarditis-related stroke: a case report. J Cardiovasc Dis Diagn. 2016;4:232.
- Tang WK, et al. Default mode network in post-stroke depression. J Depress Anxiety. 2015;5:e110.
- Ahmed AB and Cirstea CM. Positive effect of impairment-oriented training on n-acetylaspartate levels of ipsilesional motor cortex in subcortical stroke:A case study. Int J Phys Med Rehabil. 2016;4:325.
- Yimenicioglu S, et al. Evaluatıon of pediatric stroke patients. J Clin Case Rep. 2015;5:677.
- Theofanidis D. Monitoring in post stroke management. J Nurs Care. 2016;5:e129.
- Tshikwela ML, et al. Clinical, biological and ct predictors of in-hospital mortality in ischemic stroke patients in central africa. J Trop Dis. 2015;4:186.
- Serra MC, et al. Reduced resting metabolic rate in adults with hemiparetic chronic stroke. J Neurol Neurophysiol. 2015;6:1000341.
- Hung SC, et al. Effects of pre-arrival hospital notification by emergency medicine service system on acute stroke patients: a new experience in kaohsiung city. Emerg Med Los Angel. 2015;5:284.
- Roever L and Resende ES. Diabetes and metabolic syndrome can contribute to recurrent vascular events in patients with lacunar stroke? J Neurol Disord. 2015;S1:e101.
- Lapchak PA. Neuronal dysregulation in stroke-associated pseudobulbar affect pba: diagnostic scales and current treatment options. J Neurol Neurophysiol. 2015;6:323.
- Medvedkova SA and Berezin AE. Vascular endothelial growth factor-1 level and functional neurologic recovery after ischemic hemispheric stroke.Neurochem Neuropharm Open Access. 2015;1:102.
- Subramaniam S and Bhatt T. Does a virtual reality-based dance training paradigm increase balance control in chronic stroke survivors? A Preliminary Study.Int J Neurorehabilitation. 2015;2:185.
- Waghavkar SN and Ganvir SS. Effectiveness of mirror therapy to improve hand functions in acute and subacute stroke patients. Int J Neurorehabilitation. 2015;2:184.
- Williams O, et al. Hip hop stroke: study protocol for a randomized controlled trial to address stroke literacy. J Clin Trials. 2015;5:242.
- Kumar C and Gupta N. A comparison between task oriented and client-centred task-oriented approaches to improve upper limb functioning in people with sub-acute stroke. J Nov Physiother. 2015;5:276.
- Ren X and Simpkins JW. Deciphering the blood-brain barrier damage in stroke: mitochondrial mechanism. J Neuroinfect Dis. 2015;S2:e002.
- Ali MH, et al. A comparative study between hold relax technique and static stretching to improve gait parameter of hemiplegic stroke patients. Int J Neurorehabilitation. 2015;2:180.
- Rongrong W and Tong Z. The motor function improvement of the affected hand after stroke induced by music-supported therapy: a randomized control clinical trail. Int J Neurorehabilitation. 2015;2:1000177.
- Ogeng’o J, et al. Ischemic cortical stroke in a kenyan referral hospital. J Mol Biomark Diagn. 2015;5:238.
- Nissar S, et al. MTHFR c677t polymorphism and risk of ischemic stroke in kashmiri population. Hereditary Genet. 2015;4:155.
- Lamola G, et al. Clinical assessments for predicting functional recovery after stroke. Int J Neurorehabilitation. 2015;2:174.
- Canuet L, et al. Neurorehabilitation in stroke: the role of functional connectivity. Int J Neurorehabilitation. 2015;2:172.
- Tadevosyan K, T et al. Variations in immediate-early genes encoding c-fos, c-jun and ier5 transcription factors are associated with ischemic stroke. Adv Genet Eng. 2015;4:127.