2. How do you manage and prevent stroke in a patient with atrial fibrillation, who has a very high CHA2DS2-VASc score of 5 with a high HAS-BLED score of 9 and in whom new oral anticoagulants are contraindicated?
2. CHA2DS2-VASc 수치가 5로서 매우 높으며 HAS-BLED 수치가 9로서 높아 새로운 경구용 항 응고제를 사용할 수 없는 심방 세동 환자의 뇌졸증은 어떻게 관리하고 예방하고 있습니까?
2. Làm thế nào để bạn kiểm soát và ngăn chặn đột quỵ ở bệnh nhân rung nhĩ có điểm CHA2DS2-VASc rất cao với điểm HAS-BLED là 9 và ở bệnh nhân bị chống chỉ định với thuốc kháng đông dạng uống mới?
2. Bagaimana Anda mengatasi dan mencegah stroke pada pasien dengan atrial fibrilasi, yang memiliki nilai CHA2DS-VASc sangat tinggi di angka 5 dengan nilai HAS-BLED tinggi di angka 9 dan dimana antikoagulan oral baru terkontraindikasi?
Department of Neurology, Asan Medical Center,
University of Ulsan, Republic of Korea
Professor Kwon is Professor of the Department of Neurology, Asan
Medical Center, at the University of Ulsan.
He graduated from Seoul National University, Seoul with a degree
in medicine and received his PhD from Chungbuk National University.
From 1989 to 1997, he did his internship and residency at Seoul
National University Hospital and received his board certification in
neurology in 1997. Since then, he held a fellowship in the Department
of Neurology, Asan Medical Center at the University of Ulsan. Professor
Kwon has also lectured in several international conferences.
Professor has an active involvement in leading clinical trials. He is the principal investigator
for five clinical trials: trial of cilostazol in symptomatic intracranial arterial stenosis II (TOSS 2),
overcome biochemical aspirin resistance through cilostazol combination (ARCC), prevention of
cardiovascular events in ischemic stroke patients with high risk of cerebral hemorrhage (PICASSO),
strategy for adequate blood pressure lowering in the patients with intracranial atherosclerosis
(Stable-ICAS) and acute stroke with xarelto to reduce hemorrhage, ischemic stroke
and hospital stay (triple AXEL). Professor Kwon has an extensive range of publications which
include more than 130 international publications and 35 articles in Korean journals; as well as
guidebooks and practical guidelines.
Professor Kwon has presented at a number of forums, including the International Stroke Conference,
European Stroke Conference, International Symposium on Atherosclerosis and World Congress
of Neurology.
The Zena and Michael A. Wiener Cardiovascular
Institute, Icahn School of Medicine at Mount Sinai, USA
Jonathan Halperin is the Robert and Harriet Heibrunn Professor of
Medicine at The Mount Sinai School of Medicine, New York University
and Director of Clinical Cardiology in the Zena and Michael A. Wierner
Cardiovascular Institute at The Mount Sinai Medical Center.
Professor Halperin was awarded an MD from Boston University in
1975. He has previously served in various federal appointments which
included the Cardiovascular and Renal Drugs Advisory Committee of
the U.S. Food and Drug Administration and the National Institutes of
Health where he was in the Data Safety Monitoring board for the clinical trial of aspirin and
simvastatin in pulmonary arterial hypertension and in the clinical trial coordinating centre of
the National Institutes of Health. He was the principal cardiologist who spearheaded the SPAF
(Stroke Prevention in Atrial Fibrillation clinical trials). The trials were conducted in multiple
centres where 3,600 patients and more than 100 investigators were involved. Currently, he is
involved in several clinical trials with the objective of developing more effective drugs for the
prevention of ischemia in a range of cardiovascular disease conditions.
Professor Halperin has authored a wide range of materials including over 100 peer-reviewed
reports, books, chapters, guidelines and position statements, invited articles and reviews, clinical
case reports, and abstracts. His numerous awards and honours include the Champion of Heart
and Stroke, Master of the Society for Vascular Medicine, The Heart of New York Award, The
Heart of New York Presidential Salute, Howard B. Sprague Research Fellowship Award, Samuel
Bronfman Department of Medicine Teaching Excellence, Samuel Bronfman Department of
Medicine Grand Rounds Award, Cardiology Fellows Society of Greater New York, The Simon
Dack Award, The Jacobi Medallion, The Solomon R. Berson Memorial Award, John R. Murray
Award, The University Hospital Chair and the Roland Jackson Memorial Medical Scholarship.
Dr. Raymond Wong is Honorary Clinical Associate Professor and Head of the Division of Haematology at the Department of Medicine & Therapeutics of the Chinese University of Hong Kong. He is also Consultant in the Department of Medicine and Therapeutics at the Prince of Wales Hospital, Hong Kong.
Dr. Wong received his medical degree from the Chinese University of Hong Kong and completed his training at Prince of Wales Hospital, Hong Kong in Haematology and Haematological Oncology, Internal Medicine and Clinical Pharmacology and Therapeutics. Dr. Wong undertook his Blood and Marrow Transplantation Fellowship training at the MD Anderson Cancer Center, Texas, USA and gained a Doctor of Medicine at the Chinese University of Hong Kong.
Dr. Wong has broad research interests with a special focus on the biological and therapeutic aspects of leukaemias, autoimmune haematological diseases, stem cell transplantation, bleeding and thrombosis. He served as the Chairman of the Hong Kong Association of Blood Transfusion and Haematology from 2004 to 2005. Dr. Wong is the author or co-author of over 100 peer-reviewed articles, published in international journals such as Blood, Circulation, JAMA and the New England Journal of Medicine.
Ganesananthan Shanmuganathan is currently Consultant Physician and Gastroenterologist at Pantai Hospital Kuala Lumpur, Bangsar, Kuala Lumpur.
Dr. Ganesananthan Shanmuganathan graduated from the National University of Malaysia (UKM) in 1989 with a degree in medicine. He obtained his postgraduate medical diploma; Membership of the Royal Colleges of Physicians (MRCP) in 1993 and was subsequently appointed Head of Medicine at the Teluk Intan Hospital from 1994 to 1995. He embarked on his Fellowship in Gastroenterology (Ministry of Health, Adelaide and Melbourne) from 1996 to 1998. In 2002, Dr. Ganesananthan Shanmuganathan was appointed as Head of Gastroenterology at Kuala Lumpur Hospital, the largest public hospital in Malaysia.
He is a senior trainer in the field of Gastroenterology and Gastrointestinal (GI) Endoscopy. He was the first Malaysian to receive the Takeda Science Foundation Award and has received numerous awards for his medical services. Dr. Ganes opted for early retirement from public service in 2009 and was subsequently appointed Consultant Gastroenterologist with Pantai Hospital Kuala Lumpur.
He performs a whole array of diagnostic (OGDS, Colonoscopy, Capsule Endoscopy, Clinical Manometry and ambulatory pH study) and therapeutic endoscopic procedures, including ERCP, PEG tube placement, enteroscopy, stenting for benign and malignant strictures, polypectectomy and mucosal resection. He has a keen interest in endoscopic management of GI bleeding and has an impressive list of peer-reviewed publications and presentations at both local and international meetings.
Dr. Ganesananthan Shanmuganathan is honorary lecturer at the National University of Malaysia (UKM) and member of the Malaysian Society of Gastroenterology and Hepatology (MSGH), American Gastroenterological Association (AGA) and American Society for Gastrointestinal Endoscopy (ASGE).
Kenneth Butcher is an Associate Professor of Neurology at the University of Alberta. He completed his PhD concurrently with his MD at the University of Western Ontario. His thesis was based on the autonomic effects of stroke. Following his Neurology residency at the University of Alberta, Dr. Butcher travelled to Australia where he completed a post-doctoral fellowship in magnetic resonance imaging (MRI) and advanced computed tomography (CT) imaging of acute stroke. In 2006, he returned to Alberta and took up his current faculty position. His major clinical and research interests are in acute stroke care. He recently designed and led a multicentre, randomised, trial of blood pressure reduction in acute intracerebral haemorrhage patients.
His active research projects include MRI studies and CT perfusion studies, aimed at extending the time window for stroke thrombolysis. He is also assessing the utility of using novel oral anticoagulants acutely after minor stroke and transient ischemic attack. Dr. Butcher has over 100 peer-reviewed publications. He has Personnel Awards and Grantsin-Aid funding from the Alberta Heritage Innovates Health Solutions, Canadian Institutes of Health Research and the Heart and Stroke Foundation of Canada. Dr. Butcher holds a Canada Research Chair in Cerebrovascular Disease and the Heart and Stroke Foundation of Alberta, Northwest Territories (NWT) and Nunavut Professorship in Stroke Medicine.
Department of Neurology, Asan Medical Center,
University of Ulsan, Republic of Korea
The Zena and Michael A. Wiener Cardiovascular
Institute, Icahn School of Medicine at Mount Sinai, USA
Dr. Raymond Wong is Honorary Clinical Associate Professor and Head of the Division of Haematology at the Department of Medicine & Therapeutics of the Chinese University of Hong Kong. He is also Consultant in the Department of Medicine and Therapeutics at the Prince of Wales Hospital, Hong Kong.
Ganesananthan Shanmuganathan is currently Consultant Physician and Gastroenterologist at Pantai Hospital Kuala Lumpur, Bangsar, Kuala Lumpur.
Kenneth Butcher is an Associate Professor of Neurology at the University of Alberta. He completed his PhD concurrently with his MD at the University of Western Ontario. His thesis was based on the autonomic effects of stroke. Following his Neurology residency at the University of Alberta, Dr. Butcher travelled to Australia where he completed a post-doctoral fellowship in magnetic resonance imaging (MRI) and advanced computed tomography (CT) imaging of acute stroke. In 2006, he returned to Alberta and took up his current faculty position. His major clinical and research interests are in acute stroke care. He recently designed and led a multicentre, randomised, trial of blood pressure reduction in acute intracerebral haemorrhage patients.