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.
In this double-blind, randomized controlled trial, etonogestrel implant users with prolonged or frequent menses who took 10 mg of tamoxifen twice daily for seven days as needed for irregular bleeding had an average of 9.8 (95% confidence interval, 4.6-15.0) more consecutive days of amenorrhea over a 90-day period compared to those who took a placebo.
Acute care providers will frequently encounter an adolescent with a new diagnosis of pregnancy or a known pregnancy (complicated or uncomplicated). The unique features of teenage pregnancy are critical to be familiar with, so as not to miss the diagnosis of pregnancy or identify a complication and initiate timely, appropriate management.
The Acute Stroke or Transient Ischemic Attack Treated with Ticagrelor and ASA for Prevention of Stroke and Death (THALES) study was designed to test the hypothesis that 30-day treatment with ticagrelor and aspirin would be superior to aspirin alone in reducing the risk of subsequent stroke or death in patients who had a non-cardioembolic ischemic stroke or transient ischemic attack.
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.
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.