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52 in 52 – #38: Thrombolysis Guided by Perfusion Imaging up to 9 Hours after Onset of Stroke

EMDocs

This week we cover the EXTEND trial looking at thrombolysis up to 9 hours after stroke onset. and 9 hours after onset of symptoms, with non-infarcted brain tissue, does the administration of alteplase improve functional outcome at 90 days? Intervention: Alteplase 0.9 in alteplase group versus 0.9% to 53.54, p=0.053).

Stroke 98
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REBEL Cast Ep123: Reduced-Dose Systemic Peripheral Alteplase in Massive PE?

RebelEM

in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 to 4.0mg/hr typically given in EKOS therapy (See Below).

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SGEM Xtra: No Retreat, No Surrender – Thrombolysis for Acute Ischemic Stroke

The Skeptics' Guide to EM

This has been through various peer reviewed publications, doing Emergency Medicine Abstracts (EMA) audio program […] The post SGEM Xtra: No Retreat, No Surrender – Thrombolysis for Acute Ischemic Stroke first appeared on The Skeptics Guide to Emergency Medicine. It appears his concerns may have come true. Six trials showed no benefit.

Stroke 52
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Rethinking the Role of TXA: Are We Asking Too Much?

RebelEM

PMID: 37314244 Clinical Question: In advanced trauma systems, does prehospital administration of TXA increase the rate of survival with a favorable neurologic outcome in patients at risk for trauma-induced coagulopathy? 1.00 (0.9 – 1.12) Secondary Outcome Mortality 24h 9.7% Prehospital Tranexamic Acid for Severe Trauma.

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SGEM#182: Platelet Transfusions for Intracerebral Hemorrhage (PATCH) – Don’t Do It.

The Skeptics' Guide to EM

Platelet transfusion versus standard care after acute stroke due to spontaneous cerebral haemorrhage associated with antiplatelet therapy (PATCH): a randomised, open-label, phase 3 trial. Non-contrast head CT shows a hemorrhagic stroke. [display_podcast] Date: June 5th, 2017 Reference: Baharoglu et al. Lancet 2016. Lancet 2016.

Stroke 52
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Almost the AI Article I Want

Sensible Medicine

The only problem is that all these people were smokers, and they were not being followed for major adverse cardiovascular events (cardiovascular death, nonfatal MI, nonfatal stroke, or hospitalization for unstable angina -- MACE) which is what we use ASCVD to predict.

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SGEM#293: CRASH in the US, CRASH in the US, CRASH-2 in the USA

The Skeptics' Guide to EM

The evidence for TXA providing a patient-oriented outcome (POO) has been mixed. It seems to work for epistaxis ( SGEM#53 and SGEM#210 ), failed to demonstrate a decrease in all-cause mortality in post-partum hemorrhage ( SGEM#214 ), and did not result in an improved neurologic outcome in hemorrhagic strokes ( SGEM#236 ).