In this longitudinal f/u of 323 nursing home residents with advanced dementia, over half had died by 18 months. Most suffered complications within the 18 month f/u, including eating problems (86%), fever (53%), and pneumonia (41%), and 41% of them underwent some intervention in the last 3 months of life (ED visit, hospitalization, IV therapy, or tube feeds). Those that had health care proxies that understood their prognosis were much less likely to undergo these interventions. This study highlights the grim prognosis, and high prevalence of complications and interventions, in nursing home patients with advanced dementia (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).