Stroke

Does NOAC Use Preclude tPA for Acute Stroke?

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There was no significant difference in intracranial hemorrhage, serious systemic hemorrhage, or inpatient mortality for patients who used non-vitamin K oral anticoagulants in the seven days prior to receiving alteplase for acute ischemic stroke.

Source
Association of Recent Use of Non-Vitamin K Antagonist Oral Anticoagulants With Intracranial Hemorrhage Among Patients With Acute Ischemic Stroke Treated With Alteplase. JAMA. 2022 Feb 22;327(8):760-771. doi: 10.1001/jama.2022.0948.

CHOICE RCT – Post-Thrombectomy tPA for Stroke

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Among patients with acute ischemic stroke with large vessel occlusion that have been successfully reperfused with thrombectomy, the use of post-thrombectomy adjunctive intra-arterial alteplase results in greater likelihood of excellent neurologic outcome at 90 days – modified-Rankin score 0 or 1 – when compared with placebo.

Source
Effect of Intra-arterial Alteplase vs Placebo Following Successful Thrombectomy on Functional Outcomes in Patients With Large Vessel Occlusion Acute Ischemic Stroke: The CHOICE Randomized Clinical Trial. JAMA. 2022 Feb 10;e221645. doi: 10.1001/jama.2022.1645. Online ahead of print.

Early Endovascular Therapy for Basilar Artery Occlusion

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Time from symptom onset of a basilar artery occlusion (BAO) to endovascular therapy (EVT) of less than 6 hours compared to greater than 6 hours (up to 24 hours) was associated with lower odds of in-hospital mortality, disability, symptomatic intracranial hemorrhage, and higher odds of ambulation at discharge, discharge home and reperfusion.

Source
Association Between Endovascular Therapy Time to Treatment and Outcomes in Patients with Basilar Artery Occlusion. Circulation. 2022 Jan 20. doi: 10.1161/CIRCULATIONAHA.121.056554. Online ahead of print.

Rant – More HINTS We Have a Problem

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HINTS was misapplied 97% of the time by emergency physicians in patients with dizziness. Five patients that clinicians thought had central vertigo by HINTS all did not. Four of six patients who had proven central vertigo all had intermittent symptoms that sounded more like benign positional vertigo. I give up…

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