In this large cohort of patients with acute headache, a number of clinical variables could predict SAH with 100% sensitivity (contained in 1 of 3 different algorithms), including: age>40, neck pain/stiffness, witnessed loss of consciousness, headache onset with exertion, arrival by ambulance, vomiting, SBP>160 or DBP>100. If any of these are present, evaluation for SAH is warranted. In this cohort, the use of these predictors could have reduced the need for SAH evaluation (CT and LP) by about 10-20% (abstract)
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).
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 […]
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).