Mueang Nakhon Pathom District

Atrial fibrillation AF is a major cause of heart-related illness and death, especially among Asian patients who face higher risks of serious bleeding such as brain hemorrhage compared to non-Asians. This research, called the COhort of antithrOmbotic use and cLinical outcomes in patients with Atrial Fibrillation COOL-AF Phase 2, aims to study how antithrombotic medication use changes over time and how these changes affect health outcomes in people with AF. The study is observational and conducted across multiple centers in Thailand. Participants in this study have known or newly diagnosed non-valvular AF and are followed without any intervention or treatment assigned by the study. The study plans to enroll about 3680 patients over two years from 33 centers. Participants will be monitored every 6 months for up to 3 years to observe patterns of medication use, particularly warfarin and non-vitamin K antagonist oral anticoagulants NOACs, and clinical events including stroke, systemic embolism, bleeding, heart attacks, and heart failure. Throughout the study, patients will have regular check-ins every six months to track their medication usage and health status. Researchers will collect data on important outcomes such as rates of stroke, bleeding events, and quality of life. The studys primary focus is on long-term safety and effectiveness of antithrombotic treatments in this population. The total participation duration can be up to 3 years, ensuring thorough observation of clinical outcomes and treatment patterns.

Researchers are investigating the effects of transcranial electrical stimulation tES, which includes transcranial direct current stimulation tDCS and transcranial alternating current stimulation tACS, combined with conventional physical therapy and cognitive-motor dual-task gait training in individuals who have experienced a stroke. The study focuses on those in the sub-acute phase at least 2 weeks after stroke onset up to chronic phase within 5 years post-stroke. The goal is to understand how these treatments affect brain activity, spinal motoneuron excitability, cognition, and motor performance, potentially improving rehabilitation approaches for stroke survivors. Participants will be randomly assigned to one of three groups active tDCS, active tACS, or sham stimulation, each followed by conventional physical therapy and cognitive-motor dual-task gait training. Each session includes 20 minutes of the assigned brain stimulation, 1 hour of physical therapy, and 30 minutes of gait training, with a total of 12 sessions over 4 weeks 3 sessions per week. Electrodes are placed over the affected side of the brains motor cortex, and stimulation parameters differ between tDCS and tACS to target neural plasticity and brain wave activity. Throughout the study, participants will undergo assessments at baseline, immediately post-intervention, and at 1- and 3-month follow-ups. These evaluations include brain activity measured by EEG, spinal motoneuron excitability via H-reflex tests, cognitive tests like the Montreal Cognitive Assessment and Stroop test, and motor function tests such as the Fugl-Meyer assessment and Timed Up and Go test. Researchers will also monitor walking performance under dual-task conditions to assess cognitive-motor interference, gathering a comprehensive picture of treatment effects and safety over time.