Given the growing use of direct oral anticoagulants, particularly in the elderly population, it is important as an emergency physician to be well versed on the methods of emergent reversal of these agents in the bleeding patient.
Stroke prevention is complex because of the varied stroke etiologies and the multifactorial approach necessary for optimal stroke prevention and risk factor management. Inevitably, primary care providers will be part of every aspect of stroke care and, with a thorough understanding of key aspects, can greatly assist in the management of these patients.
Following ischemic stroke in patients with non-valvular atrial fibrillation, the timing to restart anticoagulation treatment is uncertain and controversial. In addition, there is little data available regarding timing to restart anticoagulation following reperfusion therapy with either systemic thrombolysis and/or mechanical thrombectomy.
Imaging-defined leaflet thrombosis was common and similar between transcatheter aortic valve replacement and surgical aortic valve replacement bioprosthetic valves. These findings showed no apparent relationship to valve hemodynamics or to clinical outcomes, including stroke.
In a retrospective study involving 449 patients with severe COVID-19 requiring intensive care unit admission, those patients with a positive sepsis coagulation score or D-dimer greater than 3.0 mcg/mL who received prophylactic doses of low molecular weight heparin exhibited lower 28-day mortality.
In a randomized trial of patients already on anticoagulation undergoing transcatheter aortic valve replacement, adding clopidogrel to oral anticoagulation increased the incidence of serious bleeding vs. oral anticoagulation alone, but did not improve cardiovascular outcomes.
In a retrospective analysis of electronic health record data matched with remote pacemaker and implantable cardioverter-defibrillator recordings of atrial fibrillation episodes, a threshold daily arrhythmia burden portending higher stroke risk was determined over a range of CHA2DS2-VASc scores.
In this randomized trial of post-transcatheter aortic valve replacement patients without a separate indication for anticoagulation, a rivaroxaban-based approach was associated with a higher risk of death and thromboembolic complications compared with dual antiplatelet therapy.
Falls in patients older than 65 years of age are an increasingly common presentation in U.S. emergency departments, and intricate knowledge and confidence in the evaluation and management of these patients is vital.
In older patients with risk factors for stroke drawn from the general population, previously undiagnosed and asymptomatic episodes of atrial fibrillation are detected frequently via implantable loop recorder monitoring, allowing for early initiation of anticoagulation therapy.