Tag: stroke
Warfarin Nonadherence: What Factors Lead Patients with Afib to Discontinue?
Patients with atrial fibrillation (AF) frequently discontinue their warfarin therapy, and a recently-published study offers insight into factors that may contribute to nonadherence. The report, released in JAMA Cardiology,... read more
Intubation in Special Patient Populations: Intracranial Hemorrhage
Lidocaine has weak evidence to support its ICP blunting effects. Fentanyl may be a better choice. Ketamine is a reasonable alternative to etomidate during induction. No differnce in mortality exists between usage of succinylcholine... read more
The Fluid Debate: Balanced or Unbalanced
Consider using balanced fluids in your ED unless you are treating a patient at risk for cerebral edema, or a patient with a chloride responsive metabolic alkalosis, e.g. from gastric losses. Although the superiority of balanced... read more
Efficacy of Combined Intravenous Thrombolysis and Thrombectomy
Mechanical thrombectomy (MT) improves clinical outcomes in patients with acute ischemic stroke (AIS) caused by a large vessel occlusion. However, it is not known whether intravenous thrombolysis (IVT) is of added benefit... read more
Combined Intravenous Thrombolysis and Thrombectomy vs Thrombectomy Alone for Acute Ischemic Stroke
The results indicate that treatment of patients experiencing AIS due to a large vessel occlusion with IVT before MT does not appear to provide a clinical benefit over MT alone. A randomized clinical trial seems warranted.... read more
General Anesthesia a Viable Sedation Strategy for Thrombectomy in Stroke
An analysis of a New York registry with 1174 patients who underwent thrombectomy showed a correlation between general anesthesia and death. Several other studies that only compared embolectomies done with and without general... read more
Association of ICH Among Patients Taking Non–Vitamin K Antagonist vs Vitamin K Antagonist Oral Anticoagulants With In-Hospital Mortality
Among patients with ICH, prior use of NOACs or warfarin was associated with higher in-hospital mortality compared with no OACs. Prior use of NOACs, compared with prior use of warfarin, was associated with lower risk of in-hospital... read more
Rivaroxaban Lowers Cardiovascular Risk But Increases Bleeding Risk
In 27,395 patients with stable atherosclerotic disease, the addition of 2.5 mg rivaroxaban twice daily to aspirin therapy reduced the rates of cardiovascular death, stroke, or nonfatal MI, at the cost of increased major bleeding... read more
Development and Validation of an Empiric Tool to Predict Favorable Neurologic Outcomes Among PICU Patients
This proposed prediction tool encompasses 20 risk factors into one probability to predict favorable neurologic outcome during ICU stay among children with critical illness. Future studies should seek external validation and... read more
PCI Strategies in Patients with Acute Myocardial Infarction and Cardiogenic Shock
In patients who have acute myocardial infarction with cardiogenic shock, early revascularization of the culprit artery by means of percutaneous coronary intervention (PCI) improves outcomes. However, the majority of patients... read more
Effects of Physical Activity on Poststroke Cognitive Function
Despite the social, health, and economic burdens associated with cognitive impairment poststroke, there is considerable uncertainty about the types of interventions that might preserve or restore cognitive abilities. The... read more
Catheter ablation lowers long-term risk of recurrent stroke in atrial fibrillation patients
Atrial fibrillation patients with a prior history of stroke who undergo catheter ablation to treat the abnormal heart rhythm lower their long-term risk of a recurrent stroke by 50 percent. The Intermountain study compared... read more
Detecting Undiagnosed Atrial Fibrillation with Cardiac Monitors
A group of researchers led by James A. Reiffel, M.D., did a study to determine the incidence of previously undiagnosed atrial fibrillation in high-risk patients with the use of insertable cardiac monitors (ICM). The results... read more
A multifaceted intervention to improve treatment with oral anticoagulants in atrial fibrillation
Oral anticoagulation is underused in patients with atrial fibrillation. We assessed the impact of a multifaceted educational intervention, versus usual care, on oral anticoagulant use in patients with atrial fibrillation.... read more
Thrombolytics for Stroke: The Evidence
Thrombolytics for stroke: undoubtedly the biggest controversy in emergency medicine. Also, the topic of this week’s Emergency Medicine Cases Journal Jam podcast. Rory Spiegel, Anton Helman, and I take a deep dive into the... read more
Cluster-Randomized, Crossover Trial of Head Positioning in Acute Stroke
The role of supine positioning after acute stroke in improving cerebral blood flow and the countervailing risk of aspiration pneumonia have led to variation in head positioning in clinical practice. Disability outcomes after... read more
Accuracy of Medical Claims for Identifying Cardiovascular and Bleeding Events After Myocardial Infarction
In this secondary analysis of a clinical trial of 12 365 patients with acute myocardial infarction, the cumulative 1-year event rates for myocardial infarction, stroke, and bleeding were lower when medical claims were used... read more
