Neurology

Clopidogrel + ASA for minor stroke or TIA

In this large multicenter trial, patients with minor stroke or TIA were randomized to clopidogrel+ASA or ASA alone; 90-day stroke occurred in 8% vs 12% respectively, and rates of hemorrhage or hemorrhagic stroke were the same (abstract).

Guidelines for peri-procedural use of antithrombotics in ischemic cerebrovascular disease

These guidelines provide an evidence based for the use of periprocedural antithrombotics in patients with cerebrovascular disease. They recommend continuing ASA-warfarin for dental procedures, and most other minor procedures. There is little evidence to support the use of procedural bridging with heparin, and it does increase the risk of bleeding. Cessation of therapy for 7 or more days does significantly increase the risk of stroke (guidelines).

Thrombolytics in stroke; the faster the better

A large analysis from a stroke registry found better outcomes with earlier thrombolytics for acute ischemic stroke; every 15 minutes earlier was associated with an odds ratio of 0.96 for in-hospital death or intracranial hemorrhage, and an odds ratio of 1.03 for being discharged home and 1.04 for walking independently at discharge (abstract).

Intensive BP lowering in ICH

This large trial of patients with acute intracranial hemorrhage randomized them to usual BP care (target SBP <180) or intensive BP care (target SBP <140). Outcomes did not differ between the groups (death or major disability at 90 days), and there was no difference in serious adverse events, but the intensive group did have better overall Rankin scores. Intensive SBP lowering in acute ICH may be advantageous for functional outcomes (abstract).

No steroids for acute spinal cord injury

New consensus guidelines do not recommend steroids for acute spinal cord injury, citing studies that they do more harm than good (including higher rates of infections, complications, ICU LOS, and death) (abstract).
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