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Rivaroxaban Monotherapy is Preferable to Combination Therapy with Antiplatelets with Regards to Total Cardiovascular and Bleeding Events in Patients with AF and Stable CAD
In this study conducted across 294 centers, 2,215 patients were randomly assigned to rivaroxaban monotherapy, or therapy with rivaroxaban in combination with aspirin or a P2Y12 inhibitor. All patients were diagnosed with AF with a CHADS2 score greater than one, as well as confirmed CAD without percutaneous coronary intervention (PCI) or coronary artery bypass grafting within 12 months. Primary endpoints were the total number of first and subsequent bleeding and thrombotic events over a 24-month follow-up period. Thrombotic events included ischemic stroke, systemic embolism, myocardial infarction, and unstable angina requir...
Source: The Hospitalist - January 3, 2023 Category: Hospital Management Authors: Ronda Whitaker Tags: CAD & Atherosclerosis Cardiology In the Literature Source Type: research

DES reduce the risk of ISR in patients with ICAS compared to BMS
Dr. Snipe Clinical question: In patients with symptomatic high-grade intracranial atherosclerotic stenosis (ICAS), does the use of a drug-eluting stent (DES) reduce the incidence of in-stent restenosis (ISR) and stroke recurrence compared to using a bare-metal stent (BMS)? Background: ICAS is a common cause of stroke in North America (accounting for 8-10% of strokes) and is even more common in Asia (accounting for 30-50% of strokes). In previous trials, aggressive medical management was found to be the superior first-line treatment, but intracranial stenting is growing in popularity and safety. DES is known to reduce ISR ...
Source: The Hospitalist - August 1, 2022 Category: Hospital Management Authors: Ronda Whitaker Tags: CAD & Atherosclerosis Critical Care In the Literature Source Type: research

What Medications Prevent Delirium in Elderly Medical Inpatients?
This study demonstrated lower rates of delirium in the melatonin arm, with an impressive number needed to treat (NNT) below six patients; mortality and length of hospital stay were unaffected.3 A delirium-prevention effect of melatonin has not been reproduced in other studies, notably Jaiswal et al, which randomized patients to a placebo or 3 mg of melatonin and found no difference in rates of delirium prevention.7  The melatonin receptor agonist ramelteon also has small but favorable evidence for preventing non-ICU hospitalized delirium. This comes from a study of 67 patients aged 65 years or older who were randomized to...
Source: The Hospitalist - May 2, 2022 Category: Hospital Management Authors: Ronda Whitaker Tags: Drug Therapy Geriatrics Key Clinical Questions Medication Source Type: research

Can I use DOAC in a patient with renal disease?
Case A 76-year-old man is diagnosed with non-valvular atrial fibrillation. His comorbid conditions are hypertension, diabetes complicated by neuropathy, and chronic kidney disease stage 3. His current medications include metformin, lisinopril, gabapentin, and aspirin. His most recent laboratories showed a creatinine 1.8, creatinine clearance (CrCl) 35 mL/min, hemoglobin 11g/dL, and international normalized ratio 1.0. His congestive heart failure, hypertension, age, diabetes, stroke, vascular disease, and sex (CHADSVASc) score is 4. Which medication should we use to prevent stroke in this patient?  Brief overview of the is...
Source: The Hospitalist - February 3, 2022 Category: Hospital Management Authors: Ronda Whitaker Tags: Renal & Genitourinary Source Type: research

Benefits of early endovascular thrombectomy outlined in five trials
For patients with large-vessel ischemic stroke, endovascular thrombectomy produces better functional outcomes at 90 days than does optimal medical therapy, as long as the procedure is started within...
Source: Hospitalist News - September 27, 2016 Category: Hospital Management Source Type: research

Clot retrieval devices approved for initial ischemic stroke treatment
Two Trevo clot retrieval devices can now be marketed as an initial therapy to reduce paralysis from strokes that are caused by blood clots, according to a press release from the Food and Drug...
Source: Hospitalist News - September 6, 2016 Category: Hospital Management Source Type: research

AF and stroke may be temporally related
CHICAGO – One-third of a large cohort of patients with an implantable cardiac device in place at the time of an ischemic stroke had one or more episodes of atrial fibrillation within the prior 30...
Source: Hospitalist News - May 4, 2016 Category: Hospital Management Source Type: research

Lower the CT to check the heart for embolic sources in acute stroke
LOS ANGELES – Enlarge the field of CT angiography to include the heart in acute ischemic stroke patients; you’ll quickly identify sources of cardiogenic emboli and other problems that will otherwise...
Source: Hospitalist News - March 12, 2016 Category: Hospital Management Source Type: research

VIDEO: Ischemic-stroke thrombectomy use widens and refines
LOS ANGELES – The use of endovascular thrombectomy in the United States to treat appropriate patients with acute ischemic stroke mushroomed during the past year, following several early-2015 reports...
Source: Hospitalist News - March 9, 2016 Category: Hospital Management Source Type: research

ISC: Thrombectomy shown highly cost-effective for stroke
LOS ANGELES – Endovascular thrombectomy is not only clinically the best option for many patients with acute, ischemic strokes involving a proximal occlusion in a large cerebral artery; it’s also...
Source: Hospitalist News - February 29, 2016 Category: Hospital Management Source Type: research

ISC: Imaging supplants clocks for targeting stroke reperfusion
LOS ANGELES – Can brain imaging surpass the clock for identifying acute ischemic stroke patients who will benefit from thrombolytic or thrombectomy treatment? That’s what experts now envision, based...
Source: Hospitalist News - February 26, 2016 Category: Hospital Management Source Type: research

VIDEO: Octogenarians benefit from ischemic stroke thrombectomy
LOS ANGELES – Clot removal to recanalize the occluded intracerebral arteries of acute ischemic stroke patients was as effective for producing good outcomes in patients aged 80 years or older as it...
Source: Hospitalist News - February 19, 2016 Category: Hospital Management Source Type: research

VIDEO: Post-stroke pioglitazone modestly protective against secondary vascular events
LOS ANGELES – Nondiabetic, insulin-resistant patients who started pioglitazone within 6 months of an ischemic stroke or transient ischemic attack had almost a 3% absolute risk reduction in secondary...
Source: Hospitalist News - February 19, 2016 Category: Hospital Management Source Type: research

Stent-retriever Therapy Improves the Rate of Functional Independence for Acute Ischemic Patients
NEW YORK (Reuters Health) – Stent-retriever therapy for the treatment of acute ischemic stroke improves the rate of functional independence at 90 days, according to a systematic review and meta-analysis. Stent retrievers are deployed in an occluded vessel, temporarily expanded into the body of a thrombus, and then retracted along with the thrombus. Dr. Mark... [Read More]
Source: The Hospitalist - February 9, 2016 Category: Hospital Management Authors: Will Boggs MD Tags: Clinical Education Hospitalist Innovation acute ischemic patients stroke treatment Source Type: research

New-Onset Perioperative Atrial Fibrillation Associated With Increased Risk of Ischemic Stroke
Clinical question For patients undergoing any inpatient surgery, is the presence of new-onset perioperative atrial fibrillation associated with a greater long-term risk of ischemic stroke? Bottom line Perioperative atrial fibrillation (AF) is associated with an increased risk of ischemic stroke for patients who are hospitalized for surgery. (LOE = 2b) Reference Gialdini G, Nearing K,... [Read More] The post New-Onset Perioperative Atrial Fibrillation Associated With Increased Risk of Ischemic Stroke appeared first on The Hospitalist.
Source: The Hospitalist - November 10, 2014 Category: Hospital Management Authors: Nita Shrikant Kulkarni, MD Tags: Clinical Literature Reviews atrial fibrillation outcome risk stroke surgery Source Type: research