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Specialty: Emergency Medicine
Condition: Bleeding
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Total 109 results found since Jan 2013.
Direct oral anticoagulants in the secondary prevention of stroke and transient ischemic attack in patients with atrial fibrillation
Abstract
In patients with non-valvular atrial fibrillation (NVAF) and history of transient ischemic attack (TIA) or stroke, the rate of vascular events is higher in comparison to patients without history of stroke or TIA. A meta-analysis of direct oral anticoagulants (DOACs) studies, including only patients with history of stroke or TIA, report a significant reduction of 15 % in the rates of composite of stroke and systemic embolism in patients treated with DOACs, compared to those treated with warfarin. Furthermore, a reduction of 14 % for major bleeding, as well as a 56 % reduction for hemorrhagic stroke over...
Source: Internal and Emergency Medicine - April 11, 2015 Category: Emergency Medicine Source Type: research
Using Tenecteplase for Acute Ischemic Stroke: What Is the Hold Up?
Alteplase is the only Food and Drug Administration-approved intravenous (IV) thrombolytic medication for acute ischemic stroke. However, multiple recent studies comparing tenecteplase and alteplase suggest that tenecteplase is at least as efficacious as alteplase with regards to neurologic improvement. When given at 0.25 milligrams per kilogram (mg/kg), tenecteplase may have less bleeding complications than alteplase as well. This narrative review evaluates the literature and addresses the practical issues with regards to the use of tenecteplase versus alteplase for acute ischemic stroke, and it recommends that physicians ...
Source: Western Journal of Emergency Medicine - February 24, 2020 Category: Emergency Medicine Source Type: research
Stroke Prevention for Patients with Atrial Fibrillation: Values and Preferences of Canadian Emergency Medicine Trainees
Atrial Fibrillation (AF) is the most common serious cardiac arrhythmia and it is associated with a five-fold increase in the risk of ischemic stroke[1–3]. This risk can be reduced by up to 64% with oral anticoagulation (OAC)[4]. Many patients are first diagnosed with atrial fibrillation (AF) in the context of visit to the emergency department (ED) and AF can account for 1% or more of ED visits[5–7]. Clinical risk stratification for stroke and bleeding and subsequent prescription of OAC are the cornerstones of management of AF.
Source: The American Journal of Emergency Medicine - May 12, 2016 Category: Emergency Medicine Authors: William F. McIntyre, Zardasht Oqab, Payam Yazdan-Ashoori, Kieran L. Quinn, Erik M. van Oosten, Wilma M. Hopman, Adrian Baranchuk Tags: Correspondence Source Type: research
Stroke prevention for patients with atrial fibrillation: values and preferences of Canadian emergency medicine trainees
Atrial fibrillation (AF) is the most common serious cardiac arrhythmia, and it is associated with a 5-fold increase in the risk of ischemic stroke
[1 –3]
. This risk can be reduced by up to 64% with oral anticoagulation (OAC)
[4]
. Many patients are first diagnosed with AF in the context of visit to the emergency department (ED), and AF can account for 1% or more of ED visits
[5–7]
. Clinical risk stratification for stroke and bleeding and subsequent prescription of OAC are the cornerstones of management of AF.
Source: The American Journal of Emergency Medicine - May 12, 2016 Category: Emergency Medicine Authors: William F. McIntyre, Zardasht Oqab, Payam Yazdan-Ashoori, Kieran L. Quinn, Erik M. van Oosten, Wilma M. Hopman, Adrian Baranchuk Tags: Correspondence Source Type: research
Idarucizumab for Intravenous Thrombolysis and Endovascular Thrombectomy in Acute Stroke: A Case Report
Non –vitamin K antagonist oral anticoagulants (NOACs), such as dabigatran, are widely used to prevent ischemic stroke in patients with nonvalvular atrial fibrillation. Nonetheless, stroke occurs in 1–2% of patients, and the use of NOACs may increase the bleeding risk for patients who are receiving a cute treatment of intravenous thrombolysis (IVT) or endovascular thrombectomy (EVT). Idarucizumab, a monoclonal antibody developed to bind dabigatran, has been proven safe and effective for patients with uncontrolled bleeding or for patients planning to receive emergent procedures.
Source: The Journal of Emergency Medicine - November 15, 2019 Category: Emergency Medicine Authors: Yu-Ting Lin, Yen-Jun Lai, Tzu-Hsien Lai Tags: Selected Topics: Neurological Emergencies Source Type: research
A Noninvasive Stroke Volume Monitoring for Early Detection of Minimal Blood Loss: A Pilot Study
Conclusion:
Continuous noninvasive monitoring of SV may be superior to conventional indices (e.g., heart rate, blood pressure, or shock index) for early identification of acute blood loss. As an operator-independent and point-of-care technology, the SV whole body bio-impedance measurement may assist in accurate monitoring of potentially bleeding patients and early identification of hemorrhage.
Source: Shock - January 16, 2021 Category: Emergency Medicine Tags: Clinical Science Aspects Source Type: research
Thoracic aortic aneurysm and atrial fibrillation: clinical associations with the risk of stroke from a global federated health network analysis
ConclusionThis retrospective analysis reports a clinical concomitance of the two medical conditions, and shows in a PSM analysis an increased risk of ischemic events in patients affected by TAA and AF compared to AF alone.
Source: Internal and Emergency Medicine - January 14, 2023 Category: Emergency Medicine Source Type: research
The acute management of haemorrhage, surgery and overdose in patients receiving dabigatran
Dabigatran is an oral direct thrombin inhibitor (DTI) licensed for stroke prevention in atrial fibrillation and likely to be soon approved in Europe for treatment of venous thrombosis. Predictable pharmacokinetics and a reduced risk of intracranial haemorrhage do not negate the potential risk of haemorrhage. Unlike warfarin, there is no reversal agent and measurement of the anticoagulant effect is not ‘routine’. The prothrombin time/international normalised ratio response to dabigatran is inconsistent and should not be measured when assessing a patient who is bleeding or needs emergency surgery. The activated p...
Source: Emergency Medicine Journal - January 15, 2014 Category: Emergency Medicine Authors: Alikhan, R., Rayment, R., Keeling, D., Baglin, T., Benson, G., Green, L., Marshall, S., Patel, R., Pavord, S., Rose, P., Tait, C. Tags: Poisoning/Injestion, Open access, Drugs: cardiovascular system, Stroke, Poisoning Review Source Type: research
Initial results of the re-verse ad trial: idarucizumab reverses the anticoagulant effects of dabigatran in patients in an emergency setting of major bleeding, urgent surgery or interventions
Conclusion
Idarucizumab is a promising specific reversal agent that rapidly and safely reverses dabigatran's anticoagulant effects within minutes in emergency situations that reflect real world clinical practice.
Source: Emergency Medicine Journal - November 23, 2015 Category: Emergency Medicine Authors: Pollack, C., Eikelboom, J., Weitz, J., Reilly, P., Glund, S., Dubiel, R., Kreuzer, J., Stangier, J., Wang, B., Gagg, J., Verhamme, P., Bernstein, R., Huisman, M., Hylek, E., Kamphuisen, P., Levy, J., Selke, F., Steiner, T., Kam, C. Tags: Drugs: cardiovascular system, Stroke TOP SCORING NON TRAINEES Source Type: research
Time trends in intracranial bleeding and new oral anticoagulant prescription
Conclusion
We found an increasing number of patients treated for intracranial bleeding over time. Warfarin accounted for a disproportionate number of intracranial bleeds and the new oral anticoagulants, fewer than expected.
Source: Emergency Medicine Journal - November 23, 2015 Category: Emergency Medicine Authors: Hogg, K., Stiell, I., Bahl, B. Tags: Drugs: cardiovascular system, Stroke RCEM FREE PAPERS Source Type: research
Tenecteplase utility in acute ischemic stroke patients: A clinical review of current evidence
Acute ischemic stroke is leading cause of disability in the United States. Treatment is aimed at reducing impact of cerebral clot burden and life-long disability. Traditional fibrinolytic treatment with recombinant tissue plasminogen activator (tPA) has shown to be effective but at high risk of major bleeding. Multiple studies have evaluated tenecteplase as an alternative to tPA.
Source: The American Journal of Emergency Medicine - November 14, 2018 Category: Emergency Medicine Authors: Amelia Nelson, Gregory Kelly, Richard Byyny, Catherine Dionne, Candice Preslaski, Kevin Kaucher Source Type: research
Stroke Prophylaxis for Atrial Fibrillation? To Prescribe or Not to Prescribe—A Qualitative Study on the Decisionmaking Process of Emergency Department Providers
ConclusionThe decision to prescribe oral anticoagulation in the ED is complex. Improving guideline adherence will require a multifaceted approach inclusive of system-level improvements, physician education, and the development of ED-specific tools and guidelines.
Source: Annals of Emergency Medicine - May 11, 2019 Category: Emergency Medicine Source Type: research
Aspirin For Preventing A First Heart Attack Or Stroke.
This article is protected by copyright. All rights reserved.
PMID: 31125462 [PubMed - as supplied by publisher]
Source: Accident and Emergency Nursing - May 23, 2019 Category: Emergency Medicine Authors: Roach K, Ritchie M, Zehtabchi S Tags: Acad Emerg Med Source Type: research
Safety of antithrombotic therapy in East Asian patients
In conclusion, further investigations are necessary to clarify the specific conditions where the risk of serious bleeding events in East Asian patients differ substantially compared to the global. In addition, further understanding of the mechanisms causing the different bleeding response in specific conditions in East Asian is awaited.
Source: Internal and Emergency Medicine - March 8, 2021 Category: Emergency Medicine Source Type: research
CHA2DS2-VASc Scores and Major Bleeding in Patients With Nonvalvular Atrial Fibrillation Who Are Receiving Rivaroxaban
Conclusion Higher CHA2DS2-VASc scores are associated with increased incidence of major bleeding in nonvalvular atrial fibrillation patients receiving rivaroxaban.
Source: Annals of Emergency Medicine - April 23, 2017 Category: Emergency Medicine Source Type: research
