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The AcT Trial: Tenecteplase vs Alteplase for Acute Ischemic Stroke

RebelEM

Background : Alteplase, a class of medication that converts plasminogen to plasmin leading to fibrin degradation and subsequent clot lysis, has been the standard of care for acute ischemic stroke (AIS) patients that meet eligibility criteria. mg/kg non-inferior to alteplase in the treatment of acute ischemic stroke? vs Alteplase 34.8%

Stroke 134
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The Study of the Week Is a Beautiful Example of Science Done Well

Sensible Medicine

Neurologist Hooman Kamel from the Weil Cornell Medical Center in NY had an idea about atrial fibrillation and stroke. Stroke came when these clots moved northward to the brain. One of the big issues with this theory was that studies had failed to show a strong relationship in time between the stroke and the irregular rhythm.

Wellness 132
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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 of symptom onset; stroke symptoms that started during sleep were assumed to have started halfway between the actual last known well and the time of wake-up. Intervention: Alteplase 0.9 in alteplase group versus 0.9%

Stroke 98
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Seed Oils: Real Harm or Just Another Food Fear Fad?

Sensible Medicine

His research has led him to a pretty clear opinion about the role of seed oils in health and disease. As a physician, scientist, wellness/longevity podcaster, and Ironman Triathlete, I strongly support healthy life choices. He is also an Ironman Triathlete, and wellness/longevity/health podcaster and writer.

Wellness 111
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SGEM Xtra: Are tPA Stroke Trials Really Fragile?

The Skeptics' Guide to EM

Fragility Index Meta-Analysis of Randomized Controlled Trials Shows Highly Robust Evidential Strength for Benefit of The post SGEM Xtra: Are tPA Stroke Trials Really Fragile? I knew about Jeff from his multiple publications in the stroke literature. first appeared on The Skeptics Guide to Emergency Medicine. This is an SGEM Xtra.

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The Latest Research in Neurologic Emergencies

ACEP Now

This comes out of INTERACT-4, a trial testing the efficacy of blood pressure reduction in undifferentiated acute stroke syndromes. Without delving into too much detail, approximately half of the over 2,300 patients in the trial suffered ischemic stroke, and the remainder hemorrhagic stroke.

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AF Duration? Another Big Story from 2023

Stop and Think

For an older patient with stroke risk factors and 3 hours of AF on a cardiac device, pre-2023 thinking would have us leaning toward anticoagulation. Edoxaban reduced the primary endpoint of stroke, systemic embolism, and cardiovascular death by 19% (HR, 0.81; 95% CI, 0.60-1.08; hours) to edoxaban vs placebo. I don’t know.

Stroke 92