Search results for "Stroke"
Adding antiplatelet or anticoagulant to thrombolysis didn't improve stroke outcomes
Ischemic stroke patients who were randomized to IV argatroban or eptifibatide within 75 minutes of initiation of thrombolysis had higher mortality and lower Rankin scale scores at 90 days than patients given a placebo, a trial found.
https://acphospitalist.acponline.org/archives/2024/09/11/adding-antiplatelet-or-anticoagulant-to-thrombolysis-didnt-improve-stroke-outcomes.htm
11 Sep 2024
Stroke outcomes better when physicians travel to patients for mechanical thrombectomy
Transferring physicians instead of patients was associated with shorter time from onset of acute ischemic stroke symptoms to recanalization and better chance of functional independence at 90 days, a systematic review and meta-analysis found.
https://acphospitalist.acponline.org/archives/2024/06/26/stroke-outcomes-better-when-physicians-travel-to-patients-for-mechanical-thrombectomy.htm
26 Jun 2024
Thrombectomy improved outcomes even in stroke patients with a large infarct, trial finds
Stroke patients with a large infarct who underwent endovascular thrombectomy had a median modified Rankin scale score of four and a mortality rate of 36.1% at 90 days, compared to a score of six and a rate of 55.5% with medical therapy alone, a French trial found.
https://acphospitalist.acponline.org/archives/2024/05/15/thrombectomy-improved-outcomes-even-in-stroke-patients-with-a-large-infarct-trial-finds.htm
15 May 2024
Current tools insufficient to guide anticoagulation decisions for new-onset AF in sepsis
The most commonly used stroke risk calculator does not predict postsepsis stroke and should not be used to guide decisions about anticoagulation among patients with new-onset atrial fibrillation (AF) and sepsis, a new study concluded.
https://acphospitalist.acponline.org/archives/2024/04/17/current-tools-insufficient-to-guide-anticoagulation-decisions-for-new-onset-af-in-sepsis.htm
17 Apr 2024
Early minimally invasive surgery may improve outcomes for certain intracerebral hemorrhages
An industry-sponsored trial found that functional outcomes at 180 days were better with minimally invasive hematoma evacuation plus guideline-based medical management than medical management alone, if surgery could be done within 24 hours.
https://acphospitalist.acponline.org/archives/2024/04/17/early-minimally-invasive-surgery-may-improve-outcomes-for-certain-intracerebral-hemorrhages.htm
17 Apr 2024
Timing of stroke treatment, preventive therapies presented at stroke meeting
Mostly disappointing results on transfers for thrombectomy, delayed use of thrombolysis plus thrombectomy or tenecteplase, and anticoagulation for secondary prevention after cryptogenic stroke were reported at the International Stroke Conference.
https://acphospitalist.acponline.org/archives/2024/02/14/timing-of-stroke-treatment-preventive-therapies-presented-at-stroke-meeting.htm
14 Feb 2024
Short-term dual antiplatelet therapy underused after mild stroke, study finds
While prescriptions of dual antiplatelet therapy after mild noncardioembolic stroke increased from 25.7% in 2010 to 52.8% in 2022 in 168 Florida hospitals, underuse remained common, especially in women and non-Hispanic Black patients.
https://acphospitalist.acponline.org/archives/2023/09/13/short-term-dual-antiplatelet-therapy-underused-after-mild-stroke-study-finds.htm
13 Sep 2023
Analysis shows good adherence to stroke guidelines in stroke registry hospitals
The Get With The Guidelines study did identify some areas of potential improvement in inpatient stroke care, including more dysphagia screening and use of high-intensity statin therapy.
https://acphospitalist.acponline.org/archives/2022/07/27/analysis-shows-good-adherence-to-stroke-guidelines-in-stroke-registry-hospitals.htm
27 Jul 2022
AHA/ASA guideline addresses management of patients with spontaneous intracerebral hemorrhage
The American Heart Association/American Stroke Association (AHA/ASA) guideline updated the previous 2015 guideline and provided recommendations for reversing anticoagulation, lowering blood pressure, handling decisions to end life-sustaining treatment, and more.
https://acphospitalist.acponline.org/archives/2022/05/25/AHA-ASA-guideline-addresses-management-of-patients-with-spontaneous-intracerebral-hemorrhage.htm
25 May 2022
Flying thrombectomy teams faster than transferring stroke patients
The median time from the decision to pursue endovascular thrombectomy to the start of the procedure was 58 minutes in patients who received thrombectomy from interventionists deployed to them by helicopter and 148 minutes in patients transferred to the hospital, a German study found.
https://acphospitalist.acponline.org/archives/2022/05/11/flying-teams-to-perform-thrombectomy-faster-than-transferring-stroke-patients.htm
11 May 2022
About two-thirds of stroke survivors discharged to a SNF with low function died within a year
In a study of Medicare beneficiaries, the lowest-functioning stroke survivors who were discharged to a skilled nursing facility (SNF) had 64% mortality at one year, whereas those discharged to an inpatient rehabilitation facility had 29.6% mortality at one year.
https://acphospitalist.acponline.org/archives/2022/03/09/about-two-thirds-of-stroke-survivors-discharged-to-a-snf-with-low-function.htm
9 Mar 2022
AHA recommends five core elements to improve management of in-hospital stroke
A new scientific statement from the American Heart Association calls on hospitals to deliver stroke training to all staff, create rapid response teams, standardize evaluation, address treatment barriers, and conduct quality oversight.
https://acphospitalist.acponline.org/archives/2022/02/16/aha-recommends-five-core-elements-to-improve-management-of-in-hospital-stroke.htm
16 Feb 2022
Rule developed for starting DOACs after stroke in patients with atrial fibrillation
Using a “1-2-3-4-day rule” to choose when to start direct-acting oral anticoagulants (DOACs) based on stroke severity appeared to decrease risk for recurrent stroke or systemic embolism without increasing bleeding risk.
https://acphospitalist.acponline.org/archives/2022/02/09/rule-developed-for-starting-doacs-after-stroke-in-patients-with-atrial-fibrillation.htm
9 Feb 2022
Meta-analysis supports use of direct mechanical thrombectomy without IV thrombolysis
Patients who had an acute ischemic stroke had similar rates of functional independence and mortality three months afterward regardless of whether their mechanical thrombectomy was preceded by IV thrombolysis, but those who didn't get thrombolysis had lower odds of intracranial hemorrhage.
https://acphospitalist.acponline.org/weekly/archives/2021/11/24/4.htm
24 Nov 2021
Greater SBP reduction linked to better outcomes after thrombolysis for stroke
Analyses of the ENCHANTED trial found that in the day after stroke symptom onset, every 10-mm Hg drop in systolic blood pressure (SBP) (down to as low as 110 to 120 mm Hg) was associated with a 20% decrease in the odds of unfavorable functional status.
https://acphospitalist.acponline.org/weekly/archives/2021/11/03/3.htm
3 Nov 2021
Mobile stroke units led to better outcomes in patients eligible for tPA
A prospective, observational, multicenter study found that median time from stroke onset to administration of tissue plasminogen activator (tPA) was 72 minutes in patients treated by mobile stroke units and 108 minutes for those receiving standard emergency medical services.
https://acphospitalist.acponline.org/weekly/archives/2021/09/15/3.htm
15 Sep 2021
CT perfusion imaging not often available at hospitals treating acute ischemic stroke
In findings from a Texas Medicare cohort validated with national data, 3% of patients with acute ischemic stroke were evaluated with CT perfusion, and most cases were evaluated at hospitals that did not offer this test.
https://acphospitalist.acponline.org/weekly/archives/2021/03/31/4.htm
31 Mar 2021
Early anticoagulation appears safe after acute ischemic stroke in patients with afib
The AREST trial, which ended early due to changes in national guidelines, found statistically similar but numerically lower rates of the primary study outcome (fatal stroke, recurrent ischemic stroke, or transient ischemic attack) in those who received anticoagulation early with apixaban versus later with warfarin.
https://acphospitalist.acponline.org/weekly/archives/2021/03/03/5.htm
3 Mar 2021
Stroke transitional care model not effective in real-world practice
The primary outcome, functional status at 90 days, did not differ in acute stroke patients assigned to receive transitional care management and those assigned to usual care.
https://acphospitalist.acponline.org/weekly/archives/2020/06/10/5.htm
10 Jun 2020
tPA bolus within 48 hours of DOAC use not associated with increased risk for intracerebral hemorrhage vs. warfarin or no anticoagulation
A systematic review and meta-analysis compared the rate of symptomatic intracerebral hemorrhage in stroke patients pretreated with a direct oral anticoagulant (DOAC) versus those without prior anticoagulation and those on warfarin with an international normalized ratio below 1.7.
https://acphospitalist.acponline.org/weekly/archives/2020/01/08/3.htm
8 Jan 2020