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Early Maladaptive Cardiovascular Responses are Associated with Mortality in a Porcine Model of Hemorrhagic Shock
Conclusions: Despite similar initial changes in variables, we found that low CO, DBP, SV, DO2, SvO2, and high lactate are predictive of death in this animal model. The results of this experimental study suggest that maladaptive responses across a range of cardiovascular parameters that begin early after hemorrhage may be predictive of impending death, particularly in situations where early resuscitative treatment may be delayed.
Source: Shock - March 13, 2020 Category: Emergency Medicine Tags: Basic Science Aspects 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

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

Complications After Transcatheter Aortic Valve Implantation: an Updated Umbrella Review
AbstractPurpose of ReviewWe conducted a comprehensive and updated overview on complications occurring after transcatheter aortic valve implantation (TAVI) for severe aortic stenosis.Recent FindingsDespite remarkable improvements in patient selection, devices, procedures, and ancillary management, complications may still occur in patients undergoing TAVI. On top of most commonly described adverse events such as death, myocardial infarction, stroke, bleeding, vascular complication, renal failure, pacemaker implantation and residual valve regurgitation, other less common but similarly severe complications may still occur. The...
Source: Current Emergency and Hospital Medicine Reports - September 13, 2019 Category: Emergency Medicine Source Type: research

Early whole-body CT for treatment guidance in patients with return of spontaneous circulation after cardiac arrest
ConclusionsAn early WBCT is feasible and provides added diagnostic value for patients with ROSC after non-traumatic CA.
Source: Emergency Radiology - August 28, 2019 Category: Emergency Medicine Source Type: research

The effect of management models on thromboembolic and bleeding rates in anticoagulated patients: an ecological study
AbstractThe primary  study objective is to compare the outcomes of patients taking oral anticoagulant medications in two distinct populations treated according to different management models (comprehensive vs. usual care). (Design: regional prospective cohort study; setting: hospital admission data from two regions). Eligible partecipants were patients taking oral anticoagulant drugs (vitamin K antagonist or direct oral anticoagulants), residents in the Vicenza and Cremona districts from February 1st, 2016 to June 30th, 2017. Patients were identified by accessing the administrative databases of patient drug prescripti...
Source: Internal and Emergency Medicine - July 14, 2019 Category: Emergency Medicine Source Type: research

Sex-related differences in prevalence, treatment and outcomes in patients with atrial fibrillation
AbstractTo analyze sex-related differences about AF prevalence, use of OAC and outcomes focusing on the older age classes. We used administrative data of the Lombardy Region, describing period prevalence, use of OAC and outcomes from 2002 to 2014 for all patients diagnosed with AF. AF prevalence over the 2002 –2014 period was higher in males than in females (2.7% vs. 2.1%,p <  0.001), increasing with age. From 2003 to 2014, not treated AF patients decreased mostly in males (from 40.3 to 33.7% with respect to 43.7–39.8% in females). Age-stratified adjusted logistic regression analysis found that females were more...
Source: Internal and Emergency Medicine - June 25, 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

Tranexamic acid for treatment of pulmonary hemorrhage after tissue plasminogen activator administration for intubated patient
The risk of tPA in the treatment of stroke, is that approximately 5% of patients may have significant intracranial bleeding, increasing mortality to 45%. Use of tPA can also cause other forms of life-threatening bleeding, most commonly gastrointestinal bleeding. In this case review, we discuss the presentation and management of a patient with post-tPA pulmonary hemorrhage and the use of tranexamic acid (TXA) for the cessation of bleeding.
Source: The American Journal of Emergency Medicine - May 13, 2019 Category: Emergency Medicine Authors: Snaha Sanghvi, Anna Van Tuyl, Josh Greenstein, Barry Hahn 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

Real-world 2-year outcome of atrial fibrillation treatment with dabigatran, apixaban, and rivaroxaban in patients with and without chronic kidney disease
AbstractPatients with non-valvular atrial fibrillation (NVAF) and chronic kidney disease (CKD) are at increased risk of stroke and bleeding. Although direct oral anticoagulant (DOAC) trials excluded patients with severe CKD, a growing portion of CKD patients have been starting DOACs and limited data from real-world outcome in this high-risk setting are available. The INSigHT registry included 632 consecutive NVAF patients that started apixaban (256 patients, 41%), dabigatran (245, 39%) and rivaroxaban (131, 20%) between 2012 and 2015. Based on creatinine clearance, two sub-cohorts were defined: (1) non-CKD group (CrCl 60 â...
Source: Internal and Emergency Medicine - May 8, 2019 Category: Emergency Medicine Source Type: research

Accidental Rivaroxaban Intoxication in a Boy: Some Lessons in Managing New Oral Anticoagulants in Children
We report a child who presented abnormal coagulation tests after unintended ingestion of 4 tablets of rivaroxaban. The patient was treated with fresh frozen plasma as well as admitted to intensive care and improved several hours later. We discuss his presentation and review of the literature on this topic.
Source: Pediatric Emergency Care - March 1, 2019 Category: Emergency Medicine Tags: Illustrative Cases Source Type: research

Beneficial Effects of Adrenal Androgen Supplement in Bleeding Cirrhotic Rats
In conclusion, androgen deficiency exists in bleeding cirrhotic rats. DHEA augments terlipressin-induced amelioration of shock without influencing splanchnic hemodynamics, possibly rendering it a feasible adjunct to vasoconstrictors in variceal hemorrhage.
Source: Shock - November 14, 2018 Category: Emergency Medicine Tags: Basic Science Aspects 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

The Canadian Community Utilization of Stroke Prevention Study in Atrial Fibrillation in the Emergency Department (C-CUSP ED)
ConclusionAn oral anticoagulation prescription tool was associated with an increase in new oral anticoagulation prescription in the ED, irrespective of whether an atrial fibrillation clinic follow-up was scheduled. The use of an atrial fibrillation clinic was associated with a trend to a higher rate of oral anticoagulation at 6-month follow-up.
Source: Annals of Emergency Medicine - October 27, 2018 Category: Emergency Medicine Source Type: research

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