Stroke

STILL JUST NOTES, UNDER CONSTRUCTION

Stroke
t-PA contraindications
[ ] intracranial/intraspinal surgery, serious head trauma, or stroke in 3 months
[ ] h/o ICH
[ ] active internal bleed
[ ] intracranial malignancy, aneurysm, or AV malformation
[ ] on Warfarin w/INR > 1.7
[ ] heparin w/in 48 hours, platelet count < 100K

“two

major studies suggest that many…strokes of unknown origin — up to a third
— may stem from atrial fibrillation.” These “findings are likely to
encourage” physicians “to look more aggressively for signs of atrial
fibrillation in patients who suffer strokes of unknown cause.”
MedPage Today (6/26, Neale, 205K) reports that researchers found “in
the CRYSTAL AF trial, an insertable cardiac monitor detected atrial
fibrillation in 8.9% of patients and standard follow-up found it in 1.4%
within 6 months (HR 6.4, 95% CI 1.9-21.7).” Meanwhile, “in the EMBRACE
trial,” researchers found that “extended monitoring with an external 30-day
event-triggered recorder detected more cases of atrial fibrillation within
90 days than did a conventional 24-hour Holter monitor (16.1% versus 3.2%,
P<0.001).” The studies were published in the New England Journal of
Medicine.
Medscape (6/26, Hughes, 192K) reports that “in an editorial
accompanying publication of the EMBRACE and CRYSTAL-AF studies, Hooman
Kamel, MD, Weill Cornell Medical College, New York, says that ‘[T]he weight
of current evidence suggests that subclinical atrial fibrillation is a
modifiable risk factor for stroke recurrence, and its presence should be
thoroughly ruled out in this high-risk population. Therefore, most patients
with cryptogenic stroke or transient ischemic attack should undergo at least
several weeks of rhythm monitoring.’” HealthDay (6/26, Thompson, 5K) also
covers the story.

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