Even Subclinical AF Is Associated with Stroke
Cardiology Summary and Comment
In patients with pacemakers, asymptomatic AF is common and warrants increased vigilance.
By Mark S. Link, MD
January 18, 2012
Covering:
Healey JS et al., N Engl J Med 2012 Jan 12; 366:120
Lamas G., N Engl J Med 2012 Jan 12; 366:178
TIA Clinics Might Be More Cost-Effective Than Hospitalization
Emergency Medicine Summary and Comment
However, developing such clinics for patients with transient ischemic attacks might not be feasible.
Complications from Rebleeding in Aneurysmal Subarachnoid Hemorrhage
Neurology Summary and Comment
After SAH, rebleeding increases mortality and the risk for cerebral and systemic complications but does not change the course or severity of delayed cerebral ischemia.
By Alejandro A. Rabinstein, MD
January 10, 2012
Covering:
Lord AS et al., Neurology 2012 Jan 3; 78:31
DWI-FLAIR Mismatch to Identify Acute Ischemic Stroke: Promising Data
Neurology Summary and Comment
A multicenter study suggests that the presence of mismatch between diffusion-weighted and fluid-attenuated inversion-recovery images may be a useful surrogate marker for ischemic stroke presentation within the time window for treatment with intravenous thrombolysis.
By Chelsea S. Kidwell, MD
January 10, 2012
Covering:
Thomalla G et al., Lancet Neurol 2011 Nov; 10:978
Early Seizures After Stroke Are Common
General Medicine Summary and Comment
Frequencies were about 4% and 15% within 7 days after ischemic and hemorrhagic strokes, respectively.
By Allan S. Brett, MD
January 5, 2012
Covering:
Beghi E et al., Neurology 2011 Nov 15; 77:1785
De Herdt V et al., Neurology 2011 Nov 15; 77:1794
Revised Guidelines: Secondary Prevention and Risk Reduction in Patients with Atherosclerotic Disease
Cardiology Clinical Practice Guideline Watch
Free
New recommendations for cardiac rehabilitation and risk reduction are welcome, but updated guidance is lacking on lipid and blood pressure management.
By JoAnne M. Foody, MD
January 4, 2012
Covering:
Smith SC Jr et al., Circulation 2011 Nov 29; 124:2458
How Often Must INR Be Checked in Patients Taking Warfarin in Stable Doses?
Cardiology Summary and Comment
A randomized trial demonstrates no significant difference in time in therapeutic range between patients monitored every 4 weeks and those monitored every 12 weeks.
By Joel M. Gore, MD
January 4, 2012
Covering:
Schulman S et al., Ann Intern Med 2011 Nov 15; 155:653
Effective Psychiatric Treatments in Neuropsychiatric Disorders
Psychiatry Year in Review
Researchers begin to answer the question of what works for psychiatric problems in neurology patients.
Even with Anticoagulation Therapy, Higher CHADS2 Scores Predict Worse Outcomes
Cardiology Summary and Comment
In a RE-LY substudy, the correlation was present and similar in all treatment arms.
By Joel M. Gore, MD
December 21, 2011
Covering:
Oldgren J et al., Ann Intern Med 2011 Nov 15; 155:660
Beyth RJ and Landefeld CS., Ann Intern Med 2011 Nov 15; 155:714
Poststroke Blood Pressure Affects Risk for Recurrent Stroke
General Medicine Summary and Comment
Risk was elevated with low and high systolic BP.
New-Onset Atrial Fibrillation During Severe Sepsis Is Associated with Stroke, Mortality
General Medicine Summary and Comment
AF occurred in 6% of such patients.
By Patricia Kritek, MD
December 20, 2011
Covering:
Walkey AJ et al., JAMA 2011 Nov 23/30; 306:2248
Goss CH and Carson SS., JAMA 2011 Nov 23/30; 306:2264
Prothrombin Complex Concentrate Reverses the Effects of Rivaroxaban but Not Dabigatran
Cardiology Summary and Comment
In healthy volunteers, coagulation test results rapidly normalized with a PCC after factor Xa — but not direct thrombin — inhibition.
By Mark S. Link, MD
December 14, 2011
Covering:
Eerenberg ES et al., Circulation 2011 Oct 4; 124:1573
Battinelli EM., Circulation 2011 Oct 4; 124:1508
Sodium Excretion of >7 g or <3 g Daily Is Associated with Elevated Cardiovascular Morbidity
General Medicine Summary and Comment
By comparison, higher potassium excretion was associated with lower stroke risk.
By Thomas L. Schwenk, MD
December 13, 2011
Covering:
O'Donnell MJ et al., JAMA 2011 Nov 23/30; 306:2229
Whelton PK., JAMA 2011 Nov 23/30; 306:2262
Antiplatelet Therapy for Atrial Fibrillation: One Drug or Two?
Cardiology Summary and Comment
In an ACTIVE substudy, the net clinical benefit of adding clopidogrel to aspirin in patients who were not candidates for warfarin was small and statistically nonsignificant.
By Joel M. Gore, MD
December 7, 2011
Covering:
Connolly SJ et al., Ann Intern Med 2011 Nov 1; 155:579
When Is Dabigatran More Cost-Effective Than Warfarin?
Cardiology Summary and Comment
For patients with nonvalvular atrial fibrillation who are not well-controlled on warfarin, the 150-mg dose of dabigatran can be a cost-effective choice for stroke prevention.
By Mark S. Link, MD
December 7, 2011
Covering:
Pink J et al., BMJ 2011 Oct 31; 343:d6333
Gage BF., BMJ 2011 Oct 31; 343:d6980
The Demise of EC-IC Bypass Surgery
Neurology Summary and Comment
Free
Extracranial-intracranial bypass plus medical therapy for symptomatic carotid occlusion was no more effective than medical therapy alone at preventing stroke and early mortality in a randomized trial.
By Seemant Chaturvedi, MD, FAHA, FAAN
December 6, 2011
Covering:
Powers WJ et al., JAMA 2011 Nov 9; 306:1983
Statins After Stroke or TIA: More Evidence of Benefits
Neurology Summary and Comment
A substudy of the SPARCL trial indicates that patients with stroke or transient ischemic attack benefit from statin therapy regardless of baseline diabetes.
By Hooman Kamel, MD
November 22, 2011
Covering:
Callahan A et al., Arch Neurol 2011 Oct; 68:1245
Patients with Brain AVMs Face Treatment Options and Uncertainty
Neurology Summary and Comment
Free
A systematic review and meta-analysis provides a useful summary of treatments for brain arteriovenous malformations but also highlights how little we know about optimal management.
By Hooman Kamel, MD
November 22, 2011
Covering:
van Beijnum Jet al., JAMA 2011 Nov 9; 306:2011
Patients with Diabetes and Prior Stroke Benefit from Thrombolytic Therapy for Treatment of Acute Stroke
Emergency Medicine Summary and Comment
Free
This finding will expand eligibility for thrombolysis in the U.S.
Stroke Thrombolytic Researchers Have Strong Ties to Pharma
Emergency Medicine Summary and Comment
Eighty-five percent of the most-cited papers on thrombolysis for stroke reported pharmaceutical company financial disclosures.
FDA Alert: FDA Approves Rivaroxaban to Prevent Strokes in Afib Patients
Neurology News in Context
This is the second alternative to warfarin to be approved in just over a year.
Missing Components in Discharge Summaries to Subacute Care Centers
Hospital Medicine Summary and Comment
Delayed discharge summary creation and lack of training are associated with omissions.
Ischemia Reduction vs. Bleeding After Acute Coronary Syndromes: Minimizing the Trade-Off
Cardiology Summary and Comment
Free
In ATLAS ACS 2–TIMI 51, adding low-dose rivaroxaban to secondary prevention regimens slightly but significantly improved outcomes in low-risk patients.
By Beat J. Meyer, MD
November 13, 2011
Covering:
Mega JL et al. for the ATLAS ACS 2–TIMI 51 Investigators., N Engl J Med 2011 Nov 13
Roe MT and Ohman EM., N Engl J Med 2011 Nov 13
Ischemic-Event Reduction After Acute Coronary Syndromes: Another Drug Strikes Out
Cardiology Summary and Comment
The thrombin-receptor antagonist vorapaxar increased risk for major bleeding without reducing ischemic events in patients with non–ST-segment-elevation ACS.
By Beat J. Meyer, MD
November 13, 2011
Covering:
Tricoci P et al for the TRACER Investigators., N Engl J Med 2011 Nov 13
Circulatory Arrest or Cerebral Perfusion During Pulmonary Endarterectomy?
Cardiology Summary and Comment
Surprisingly, cognitive function was similar after both procedures, suggesting no benefit of cerebral perfusion.
By Beat J. Meyer, MD
November 9, 2011
Covering:
Vuylsteke A et al., Lancet 2011 Oct 15; 378:1379
Jamieson S., Lancet 2011 Oct 15; 378:1359
