Stroke
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Indications for Reduced-Dose Direct Oral Anticoagulants
A subgroup analysis of the ENGAGE-AF TIMI 48 study of edoxaban 60 mg/day vs. 30 mg/day compared to warfarin in patients with atrial fibrillation of the group 80 years of age or older has shown that 30 mg/day results in less major bleeding without a concomitant increase in stroke risk compared to 60 mg/day or warfarin.
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Are Women with Atrial Fibrillation Still at Higher Risk of Ischemic Stroke?
A Finnish national database study of newly diagnosed atrial fibrillation from 2007-2018 has shown that the independent association of ischemic stroke risk with female sex initially was high but trended downward to nonsignificant at the end of the study. This has implications for the risk stratification of atrial fibrillation patients regarding oral anticoagulation therapy.
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Searching for a Neuroprotective Agent in Celery Seed Oil
A Phase III double-blind, placebo-controlled, randomized, controlled trial suggests that early administration of DL-3-n-butylphthalide, when given adjunctively to thrombolysis or endovascular therapy, improves functional outcomes in patients with acute ischemic stroke. Statistically significant results of well-designed analyses are tantalizing, but confidence in the findings is tempered by a lack of generalizability, an unclear mechanism of action, and trial design irregularities.
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Timing of Anticoagulation Administration Following Atrial Fibrillation-Associated Stroke
A prospective, blinded, randomized study of early vs. later administration of oral anticoagulation after ischemic stroke in patients with atrial fibrillation calibrated by cerebral imaging showed no significant difference in 30-day outcomes.
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Lawsuits Allege Delays, Failure to Treat with Mechanical Thrombectomy
Malpractice claims involving intravenous thrombolytic therapy to treat acute ischemic stroke patients are more likely to allege failure to treat than to allege complications related to therapy. A group of researchers wanted to know if the same was true regarding mechanical thrombectomy.
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Delays in Acute Stroke Treatment Contribute to Malpractice Claims
Recent research findings underscore the importance of always considering stroke in the differential diagnosis of altered mental status, even when the patient does not arrive by EMS.
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American Heart Association Urges Improvement in Stroke Care
In a scientific statement, the group offered tactics to eliminate the racial and ethnic inequities that exist in stroke incidence, prevalence, treatment, and outcomes.
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Stroke and a Wide QRS
The ECG in the figure is from an older man who presented with an acute stroke. He denied chest pain. Why is there QRS widening? What might be the clinical implications?
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Emergency Department Evaluation of Vertigo and Dizziness
Vertigo can be a complicated complaint for emergency medicine physicians to manage. The differential for this is broad, ranging from benign processes, such as BPPV, to more devastating causes, such as posterior strokes.
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Does the Completeness of Coronary Revascularization Affect the Outcome of Transcatheter Aortic Valve Replacement?
In this study of data from the REVASC TAVI registry, completeness of myocardial revascularization did not significantly affect the risk of all-cause mortality or the combined endpoint of death, stroke, myocardial infarction, or heart failure hospitalization at two years.