In this trial of 114 elderly patients (>age 65) undergoing spinal anesthesia for hip fracture repair, they were randomized to heavy or light sedation (with propofol). They found those in the light sedation group were significantly less likely to experience post-operative delirium (19% vs 40%) (abstract). This is a feasible way (if working closely with the surgeon and anesthesiologist) to reduce the risk of post-op delirium in high risk elders.
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).